Regional Cancer Center Experience Research Articles

Assessment of breast cancer optimal care timeframes in a regional and rural real-world setting: A regional cancer centre experience in Australia.

e12614 Background: The Breast Cancer Optimal Care Pathway (Cancer Australia) is a national patient-centred guideline that seeks to standardise the management pathway for breast cancer patients and spans from early diagnosis through to survivorship. The guideline provides suggested optimal management-based timeframes including the time from general practitioner (GP) referral to specialist review (<2 weeks), time from specialist review to completion of investigations and multidisciplinary discussion (MDT) (<2 weeks), time to initiation of neoadjuvant therapy from MDT (<4 weeks) and time to surgery following completion of neoadjuvant therapy (<6 weeks). Methods: Retrospective data was obtained for patients undergoing neoadjuvant systemic therapy for newly diagnosed breast cancer between 2021 and 2023 at a regional tertiary cancer centre in Australia (Townsville University Hospital). Data included baseline patient demographics, tumour characteristics, staging, key optimal care pathway timepoints, treatment regimen and outcomes. Median and interquartile range were calculated for key timepoints. Results: Overall, 53 patients (100% female) were identified for inclusion. 10% of patients identified as Indigenous (n=5), 36% lived rurally (n=19) and 13% were treated using a tele-chemotherapy model (n=7). Receptor status was triple-negative in 20 patients (38%), hormone-positive in 17 patients (32%) and HER2-positive in 16 patients (30%). 15% of patients had stage I disease (n=8), 58% had stage II disease (n=31), 21% had stage III disease (n=11), while 6% of patients had oligometastatic stage IV disease at diagnosis (n=3). 24 patients (50%) were seen by a specialist within 2 weeks of GP referral (median: 15 days; IQR 9-19). 46 patients (87%) had a definitive management plan formulated at MDT within 2 weeks of specialist review (median: 5 days; IQR 4-9), with delays most commonly due to pending investigations (n=5; 9%). 48 patients (91%) proceeded with neoadjuvant therapy within 4 weeks of MDT (median: 14 days; IQR 11-22), with delays most commonly due to concurrent infections including COVID. 90% of patients (n=46) were ultimately commenced on neoadjuvant treatment within the 8-week optimal care timeframe from initial GP referral (median: 34 days; IQR 27-47). In comparison to patients living locally, patients residing in rural areas were less likely to achieve this target (79% v 97%, p=0.05). 83% of patients (n=43) underwent surgery within 6-weeks of completion of neoadjuvant treatment (median: 30 days; IQR 27-34). Conclusions: The neoadjuvant breast cancer optimal care timeframes were feasible to achieve in a regional and rural setting. However, further targeted research is needed to improve adherence to optimal care standards for patients from rural areas, such as the timeframe from initial referral to completion of investigations and MDT.

141 - Retrospective review of patients receiving thoracic palliative radiotherapy (TRT) for non-small-cell lung cancer (NSCLC) in Weston Park Cancer Centre (WPCC): a real world regional cancer centre experience

141 - Retrospective review of patients receiving thoracic palliative radiotherapy (TRT) for non-small-cell lung cancer (NSCLC) in Weston Park Cancer Centre (WPCC): a real world regional cancer centre experience

Single-Stage Free Flap Reconstruction Following Extremity Sarcoma Resection: a Regional Cancer Center Experience.

Surgery remains mainstay modality of treatment of STS of extremity. In majority of patients, primary closure is possible following surgical resection of the tumor. Primary closure of wound may not be feasible in tumors with large area of skin involvement and sometimes following a whoopsprocedure. We analyzed postoperative complications and oncological outcomes in patients who underwent free flap reconstruction. Thirty-seven patients who required a free flap for reconstruction of the defect following resection of the STS were included in the study. There were 26 men and 11 women with a mean age of 40years. Seventy-three percent tumors were in lower limb; 62% patients had undergone a whoops procedure elsewhere. Flaps were fasciocutaneous in 19, myocutaneous in 15, and free muscle transfers in 3 patients. Seventeen patients had early surgical site complications. Nine patients had early flap failures. Of the 9, 6 patients had total loss of flap and in 3 the flaps were salvaged. Two patients had partial loss (< 50% of total area) of flap. Four patients had edge necrosis and two had suture diastasis. Nine patients had late surgical site complications. Four had post-radiotherapy wound dehiscence. Late SSI was noted in two. Late joint contracture and chronic lymphedema was seen in one patient each. One died due to sepsis. Statistically significant association was not found between patient, tumor or treatment-related factors and complications or flap failures. Mean duration of surgery was 7.73h. Twenty-three patients required multiple surgeries due to complications. Mean time to initiate adjuvant therapy from the date of surgery was 47days. Mean OS of the group was 67 ± 7.3months. Mean RFS was 58 ± 7.8months. Single-stage free flap reconstruction following surgical resection of extremity sarcoma is a viable option of reconstruction while salvaging the limb. Though associated with high rate of early surgical site complications, they are manageable.

Role of Salvage Surgery in Gestational Trophoblastic Neoplasia: a Regional Cancer Centre Experience.

Gestational trophoblastic neoplasia (GTN) is a curable cancer with chemotherapy. However, some develop chemoresistance to standard chemotherapy and surgery can be a useful option in them. Our study aimed to assess the role of salvage surgery in GTN with chemoresistance. It is a retrospective hospital-based study from 2000 to 2021. Case sheets of women who underwent salvage surgery for chemoresistance were reviewed and clinical parameters like preoperative hCG, antecedent pregnancy, WHO risk score, multiple chemotherapy regimens prior surgery, presence of > 1 disease site, and presence of residual choriocarcinoma that predicted the effect of surgery on serological response were assessed using Fisher's exact test. A total of 19 patients with high-risk GTN developed chemoresistance and underwent salvage surgery. Eight underwent hysterectomy, 3 underwent hysterectomy plus adnexal tumour resection, six received fertility-sparing surgery, and two underwent segmental resection of the lung. Histopathological examination revealed viable tumour in7/19 patients, but significant fall in median hCG level from 161.5 mIU/ml (preoperatively) to 15.5 mIU/ml (postoperatively) was noted. Preoperative hCG < 100 mIU/ml (p = 0.019) was the most important determinant of complete response to surgery. All the patients who had disease confined to the uterus and/or lungs at the time of surgery achieved remission after completion of treatment. Our study concludes that in the case of chemoresistant high-risk GTN, carefully selected cases with low hCG levels and disease confined to the uterus and/or lungs get the most benefit of surgery. The use of postoperative chemotherapy after complete response is essential to maintain remission and prevent relapse.

Primary Tracheal Cancer

Background: Primary tracheal cancers (PTC) are uncommon, and the treatment methods vary considerably. Aim: The aim of the present study was to explore the clinical features, management, and prognosis of PTC in an Indian context. Methods: Nineteen patients of PTC were retrieved from the medical records over a period from January 2013 to December 2019. The clinical profile, histological features, and treatment details were recorded and outcomes are analyzed in terms of progression-free survival (PFS) and overall survival (OS). Results: Histological distribution for the cases were squamous cell carcinoma (SCC) (n = 12), adenoid cystic carcinoma (ACC) (n = 6) and small cell carcinoma (n = 1). All the patients were symptomatic. SCC was located more (7 out of 12 cases; 58.33%) in the lower third of the trachea than ACC (2 out of 6 cases; 33.33%). At initial diagnosis, five patients had metastatic disease and all the cases were of SCC histology (4 cases treated with palliative chemotherapy and 1 case received best supportive care). Among nonmetastatic cases (n = 14), 4 patients (SCC: 2; ACC: 2) were considered for primary surgery and the rest were considered unresectable and treated with other modalities except one case of ACC who did not come for treatment after diagnosis. The median PFS for ACC patients was higher than SCC (32 months vs. 10 months; P = 0.013). The median OS for ACC was higher than SCC cases (34.5 months vs. 11.2 months; P = 0.009). Conclusions: SCC followed by ACC are the most common histology types for PTC. ACC has a better prognosis compared to SCC.

915P Carboplatin in combination with three weekly paclitaxel as first line therapy in patients with recurrent/metastatic head and neck cancers: A regional cancer center experience

HNC are the sixth most common malignancy diagnosed worldwide and is the most common cancer of males in India and treatment in recurrent/metastatic setting is challenging. For patients with R/M HNSSC, the EXTREME regimen has been established as standard of care in the first-line treatment for more than 10 years. However, many patients are not eligible for this regimen due to various reasons also including patients’ choice and logistics. This retrospective study aimed to evaluate the efficacy and tolerability of carboplatin and paclitaxel as first line treatment in patients with R/M HNC.

Carboplatin in combination with 3-weekly paclitaxel as first-line therapy in patients with recurrent/metastatic head-and-neck cancers: A regional cancer center experience

Background: Head-and-neck cancers (HNCs) collectively are the sixth most common malignancy diagnosed worldwide and treatment in recurrent/metastatic setting is challenging. This retrospective study aimed to evaluate the efficacy and tolerability of carboplatin and paclitaxel as first-line treatment in patients with recurrent and/or metastatic (R/M HNCs). Materials and Methods: A total of 182 patients with recurrent and/or metastatic HNC who received carboplatin and paclitaxel combination 3 weekly as first-line therapy at medical oncology department of our tertiary care cancer institute in Bangalore between January 2018 and January 2020 were reviewed. The patients who progressed during chemotherapy were receiving oral metronomic chemotherapy or best supportive chemotherapy. The patients were followed up every 2 monthly. Results: At the completion of treatment, the overall response rate was 15.4%. The median progression-free survival was 4.3 months (95% confidence interval [CI]: 2.9–5.6), and the median overall survival was 8.2 months (95% CI: 6.8–9.7). The main toxicities in the present study were Grade 3–4 hematologic 19.8%, mucositis 1.6%, and diarrhea 2.7%, and the rate of febrile neutropenia was 6.6%. None of the patients died of treatment-related toxicity. Conclusion: The combination of carboplatin with 3-weekly paclitaxel is effective in R/M HNC patients.

Volume Modulated Arc Therapy in Head &amp; Neck Cancer: An A.H. Regional Cancer Centre Experience

Volume Modulated Arc Therapy in Head &amp; Neck Cancer: An A.H. Regional Cancer Centre Experience

A Hospital Based Case Control Study on Oral Cancer: K.M.I.O (Regional Cancer Center) Experience

A Hospital Based Case Control Study on Oral Cancer: K.M.I.O (Regional Cancer Center) Experience

An audit of brain tumor patients treated in 5 years at a single institute: Our regional cancer center experience.

Brain tumors constitute a small presentation of all cancers (1.4%) and cancer related deaths (2.5%). Most of the brain tumors are malignant and carry bad prognosis and even if those which are benign still can interfere with brain functions that are required for daily living. We did an audit of brain tumor patients treated in our center and see their prognosis in correlation with different histological types. We analyzed 497 patients treated at our center from June 2007 to June 2012 of different histological types. All the patients underwent complete central nervous system examination and thorough workup including hematological investigations, radiological investigations, and confirmation of histological type by biopsy. These patients were then treated with surgery followed by radiotherapy or upfront curative radiotherapy as per staging and then kept on regular follow-up as per institutional protocol. Majority of patients were astrocytomas (309 patients) followed by a pituitary adenoma (39 patients), oligodendroglioma (33 patients), medulloblastoma (22 patients), arteriovenous malformations (19 patients), craniopharyngioma (16 patients), and recurrent brain tumors (12 patients). There were few cases of central nervous lymphoma, meningioma, melanocytoma, ependymomas, schwannomas, hemangiopericytoma, gliosarcoma, and primitive neuroectodermal tumor. The histological types vary differently regarding presentation, treatment, and prognosis. Astrocytomas are the most common tumors in presentation (309 patients) in which the high-grade astrocytomas carried worse prognosis. Benign tumors such as pituitary adenomas, schwannomas, and craniopharyngiomas had the best prognosis with survival seen up to almost last follow-up.

English

English

Evaluation of adequacy of conventional radiotherapy fields based on bony landmarks in cervical cancer patients using contrast enhanced computed tomography scan- A regional cancer centre experience

Evaluation of adequacy of conventional radiotherapy fields based on bony landmarks in cervical cancer patients using contrast enhanced computed tomography scan- A regional cancer centre experience - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.068, Indian Journal o

Voice Rehabilitation After Laryngectomy: A Regional Cancer Centre Experience and Review of Literature.

Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.

Результаты лечения пациентов с гепатоцеллюлярным раком: опыт регионального онкологического центра Краснодарского края

Результаты лечения пациентов с гепатоцеллюлярным раком: опыт регионального онкологического центра Краснодарского края

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer - regional cancer center experience.

PurposeThe study is to evaluate the difference between outcomes of two high-dose-rate fractionation schedules in the treatment of intracavitary brachytherapy (ICBT) of cervical cancer.Material and methodsA retrospective analysis of 163 cervical cancer patients was completed. All patients received external beam radiotherapy (EBRT) to whole pelvis with concurrent weekly chemotherapy, followed by ICBT with either 7 Gy per fraction in three fractions (arm A) or 9 Gy per fraction in two fractions (arm B). Median follow-up was 19 months. The outcomes were compared in terms of 2-year actuarial local control, disease-free survival, overall survival, and late toxicity in the two treatment arms.ResultsThe 2-year actuarial local control rates in arm A and arm B were 88.5% and 91.5%, respectively. The actuarial 2-year disease-free survival rates in arm A and arm B were 85.9% and 82.6%, respectively. The actuarial 2-year overall survival in arm A and arm B were 95.7% and 100%, respectively (p = 0.06). There were 12.7% and 15.2% local failures in arm A and arm B, respectively. Distant metastases were seen in 8.5% and 7.6% in arm A and arm B, respectively. The 2-year actuarial risk of developing late rectal toxicity in arm A and arm B were 5.6% and 5.4%, respectively. The 2-year actuarial risk of developing late bladder toxicity in arm A and arm B were 2.8% and 2.2%, respectively.ConclusionsICBT treatment with 9 Gy in two fractions offers equivocal local control rates and survival rates in cancer cervix cases with many advantages of short overall treatment time, improved patient compliance, cost effectiveness, and reduced exposure to aesthetic agents. The toxicities observed were few, low grade, and easily manageable.

Genetic syndromes in childhood cancers – A regional cancer center experience

Genetic syndromes in childhood cancers – A regional cancer center experience

Primary Cytoreductive surgery (PS) and Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (NACT/IDS) in Advanced Epithelial Ovarian Cancer (EOC): Regional Cancer Centre Experience

Primary Cytoreductive surgery (PS) and Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (NACT/IDS) in Advanced Epithelial Ovarian Cancer (EOC): Regional Cancer Centre Experience

Paediatric rhabdomyosarcoma: a regional cancer centre experience.

Paediatric rhabdomyosarcoma: a regional cancer centre experience.

Metastatic thymic epithelial tumors: A regional cancer center experience.

Thymic epithelial tumors (TET) are the most common tumors of the anterior mediastinum. Patients with advanced/metastatic disease are usually treated with palliative chemotherapy (CT). Unfortunately, even though various palliative CT regimens have been used for long time, there is a real scarcity of published Indian data regarding the experience of palliative CT in metastatic TET (mTET). This is a retrospective analysis of mTET patients treated between January 2010 and September 2017. Patients who received at least three cycles of first-line palliative CT were included for analysis of response rates, toxicity, and survival and prognostic factors. Of the 49 mTET patients, 27 (55.1%) were males. The median age at diagnosis was 52 years (range: 25-65). Eighteen patients (36.7%) had Masaoka Stage IVa disease, and the rest of the patients had IVb disease. The most common site of metastasis was pleuropericardium (n = 18), followed by lungs (n = 16) and lymph nodes (n = 9). The median progression-free survival and overall survival (OS) were 11.2 months (95% confidence interval [CI], 8.7-13.6) and 20.2 months (95% CI, 17.1-22.8), respectively, for the whole cohort (n = 49). The median OS of patients with Stage IVa disease was significantly better than that of the patients with Stage IVb disease (log-rank P = 0.000). Moreover, the "responders" to first-line CT had a significantly better median OS than the "nonresponders" (log-rank P = 0.000). Various first-line palliative CT regimens were well tolerated in our patients. Adriamycin Cisplatin Vincristine Cyclophosphamide (ADOC), Cyclophosphamide Adriamycin Cisplatin, and paclitaxel + carboplatin all are viable first-line palliative CT options for mTET and showed a comparable survival in Indian patients. The present study suggested that "responders" to first-line CT and those with Stage IVa disease might have a better survival than "nonresponders" and those with Stage IVb disease, respectively.

361P - Results of patients of locally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy or upfront concurrent chemoradiotherapy: A regional cancer centre experience

361P - Results of patients of locally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy or upfront concurrent chemoradiotherapy: A regional cancer centre experience