Tata Medical Center Research Articles

A real-world study on the clinicopathological profile, treatment outcomes and health-related quality of life, anxiety and depression among patients with desmoid tumor at two tertiary care centers in India.

The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce. This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023. 200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores. Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment.

Quality Assurance in Radiotherapy (RT)-Specific Trials: Indian Scenario

AimsThere is evidence that proper radiotherapy trial quality assurance (RTTQA) translates into improved outcomes for patients. However, the practice of RTTQA is heterogeneous and implemented in a diverse manner across trials. In this paper, we review the RTTQA report for randomised trials (RCT) conducted in India and present our experience with RTTQA for various clinical trials and highlight the key achievements and challenges. Materials and methodsSearch was performed using the keywords and the variations thereof for “radiotherapy” and author affiliations from India, its states and major metropolitan cities. Pubmed search filters were used to restrict results to RCT published in the past 5 years (2019–2024). Reporting of RTTQA procedures from publications and protocols was documented along with the protocol-specified dosimetric goals. We also evaluated a few clinical trials performed in the Department of Radiation Oncology at Tata Medical Center. The different RTTQA procedures and results for four representative clinical trials have been described. ResultsA formal RTTQA process was reported by only one out of 24 randomised controlled trials and formal dosimetric goals were pre-specified by 9 of 13 trials where IMRT was used as treatment. RTTQA requirements were tailored for each clinical trial at Tata Medical Center. For the HYPORT trial, the RTTQA process focused on ensuring the matchline doses were homogenous. HYPORT B trial commissioned the use of a simultaneous integrated boost technique which emphasised conformal avoidance of dose spillage to contralateral breast and lung. HYPORT Adjuvant and PROPARA trials are multicentre clinical trials. While HYPORT Adjuvant focussed on ensuring that the dose delivery met the predefined constraints, segmentation of the target volume was important for the PROPARA trial. ConclusionWe demonstrate different RTTQA procedures required for representative clinical trials and highlight key challenges encountered.

A Bayesian quantile joint modeling of multivariate longitudinal and time-to-event data.

Linear mixed models are traditionally used for jointly modeling (multivariate) longitudinal outcomes and event-time(s). However, when the outcomes are non-Gaussian a quantile regression model is more appropriate. In addition, in the presence of some time-varying covariates, it might be of interest to see how the effects of different covariates vary from one quantile level (of outcomes) to the other, and consequently how the event-time changes across different quantiles. For such analyses linear quantile mixed models can be used, and an efficient computational algorithm can be developed. We analyze a dataset from the Acute Lymphocytic Leukemia (ALL) maintenance study conducted by Tata Medical Center, Kolkata. In this study, the patients suffering from ALL were treated with two standard drugs (6MP and MTx) for the first two years, and three biomarkers (e.g. lymphocyte count, neutrophil count and platelet count) were longitudinally measured. After treatment the patients were followed nearly for the next three years, and the relapse-time (if any) for each patient was recorded. For this dataset we develop a Bayesian quantile joint model for the three longitudinal biomarkers and time-to-relapse. We consider an Asymmetric Laplace Distribution (ALD) for each outcome, and exploit the mixture representation of the ALD for developing a Gibbs sampler algorithm to estimate the regression coefficients. Our proposed model allows different quantile levels for different biomarkers, but still simultaneously estimates the regression coefficients corresponding to a particular quantile combination. We infer that a higher lymphocyte count accelerates the chance of a relapse while a higher neutrophil count and a higher platelet count (jointly) reduce it. Also, we infer that across (almost) all quantiles 6MP reduces the lymphocyte count, while MTx increases the neutrophil count. Simulation studies are performed to assess the effectiveness of the proposed approach.

A Descriptive Study to Identify the Problem Faced by New Joinee Staff Nurses and To Develop and Validate a Module on “Know You’re Bengali” Based On Identified Problem On Effective Communication With Only Bengali Speaking Patients, At Tata Medical Center, Kolkata

A Descriptive Study to Identify the Problem Faced by New Joinee Staff Nurses and To Develop and Validate a Module on “Know You’re Bengali” Based On Identified Problem On Effective Communication With Only Bengali Speaking Patients, At Tata Medical Center, Kolkata

Characteristics and outcomes of gallbladder cancer patients at the Tata Medical Center, Kolkata 2017-2019.

The north and north-eastern regions of India have among the highest incidence of gallbladder cancer (GBC) in the world. WereporttheclinicopathologicalcharateristicsandoutcomeofGBCpatientsinIndia. Electronic medical records of patients diagnosed with GBC atTataMedicalCenter,Kolkatabetween 2017 and 2019 were analyzed. There were 698 cases of confirmed GBC with a median age of 58 (IQR: 50-65) years and female:male ratio of 1.96. At presentation, 91% (496/544) had stage III/IV disease and 30% (189/640) had incidental GBC. The 2-year overall survival (OS) was 100% (95% CI: 100-100); 61% (95% CI: 45-83); 30% (95% CI: 21-43); and 9% (95% CI: 6-13) for stages I-IV, respectively (p= <0.0001). For all patients, the 2-year OS in patients who had a radical cholecystectomy followed by adjuvant therapy (N= 36) was 50% (95% CI: 39-64), compared to 29% (95% CI: 22-38) for those who had a simple cholecystectomy and/or chemotherapy (N= 265) and 9% (95% CI: 6-14) in patients who were palliated (N= 107) (p= <0.0001). The combined surgical/chemotherapy approach for patients with stage II GBC showed the best outcomes. Early detection of GBC remains problematic with the majority of patients presenting with stage III-IV and who have a median survival of 9.1months. Our data suggests that the tumor is chemoresponsive and multi-center collaborative clinical trials to identify alternative therapies are urgently required.

P-294 Colon carcinoma in adolescents and young adults, not so rare: Experience from an Indian cancer center

The rise of colorectal carcinoma in adolescents and young adults (AYA) is a growing global concern. Limited studies are available which have focused on colon cancer in this population. We aimed to assess clinicopathologic features and outcomes of colon carcinoma in this population. We conducted a retrospective study including patients with colon carcinoma aged 13 to 30 years who presented to Tata Medical Center between 1 Jan 2012 and 31 Dec 2020. Information extracted from electronic medical records (EMR) included demographics, risk factors, stage at presentation, pathologic information, treatment, and follow-up details. Rectal primaries were excluded. Overall survival (OS) was estimated with the Kaplan-Meier method and Cox proportional hazard model was used to identify factors associated with survival. 2845 patients with colon cancer were registered in the hospital during this period. A total of 148 (5.8%) patients belonged to the age group of AYA, with the majority being males (58%). A family history of cancer was present in 36% of cases. Hereditary cancer syndrome was present in 26 (17.6%) patients (Lynch syndrome 10.1%, familial adenomatous polyposis 5.4%, and others 2%). The most common presenting features were bleeding (45.9%) and altered bowel (41.2%). The most common site was sigmoid colon in 76(51.4%) cases, while tumors arising from descending, transverse, and ascending colon were 12.2%, 16.9%, and 19.6%, respectively. The majority of them had signet ring morphology (58%). Sixty-two (49.1%) patients initially presented with metastatic disease. The distribution of patients in stages I, II, III were 4.1%, 16.2%, and 37.8%, respectively. At a median follow-up of 44 (95% confidence interval [CI] 33.8- 61.5) months, 5-year OS was 37.2% (95% CI 31.8-42.8) in the entire cohort. Five-year OS for stages I, II, III, and IV were 100%, 53%, 26%, and 16%. Adverse histology (p=0.001) and higher stage at presentation (p < 0.001) were associated with poorer survival. The proportion of AYA patients with colon carcinoma was more than expected, and they presented with advanced stages and poorer histology. Most patients had sporadic cancers. Five-year OS for stages II-IV was worse than those reported in older patients.

Early experience with blinatumomab in B-cell precursor (BCP) acute lymphoblastic leukaemia (ALL) at the Tata Medical Center (TMC), Kolkata

Early experience with blinatumomab in B-cell precursor (BCP) acute lymphoblastic leukaemia (ALL) at the Tata Medical Center (TMC), Kolkata

Molecular Epidemiology of SARS-CoV-2 in Healthcare Workers and Identification of Viral Genomic Correlates of Transmissibility and Vaccine Break Through Infection: A Retrospective Observational Study From a Cancer Hospital in Eastern India

Background: Despite COVID vaccination with COVISHIELD vaccine (ChAdOx1 ncov-19) large number of healthcare workers (HCWs) was getting infected in wave-2 of the pandemic in a cancer hospital in eastern part of India.Methods: Retrospective observational study of HCWs. Whole genome sequencing of SARS CoV-2 using Illumina NovaSeq was done. Mutations from both waves were compared to identify genomic correlates of transmissibility and vaccine breakthrough infections.Findings: Vaccine breakthrough infections were seen in 127 HCWs out of 1,806 fully vaccinated staff (7.03%). Median number of HCWs infected per day in wave-1 was 0.92 versus 3.25 in wave-2. Majority of wave-1 samples belonged to B.1 and B.1.1 lineage. Variant of concern- Delta variant (90%), and variant of interest- Kappa variant (10%), was seen in only wave-2 samples. Total mutation observed in wave-2 samples (median = 44) was 1.8 times than wave-1 sample (median=24). Same trend was observed in coding mutation count. Spike protein in wave-2 samples contain 13 non-synonymous mutation as compared to 8 seen in wave-1 samples. E484Q- vaccine escape mutant was detected in five samples of wave-2; T478K – highly infectious mutation was seen in 31 samples of wave-2. We identified a novelcoding disruptive in-frame deletion (c.467_472delAGTTCA, p.Glu156_Arg158delinsGly) in the Spike protein. This mutation was seen only in wave-2 (78%, n=39) samples. The mutation overlaps the spike protein NTD domain and is present in the supersite b-hairpin.Interpretation: We noted that vaccine breakthrough infections (although mostly mild) were not uncommon and occurred despite two doses of COVISHIELD vaccine. The potential causes of vaccine breakthrough infections, and the most optimal schedule for HCWs need to be investigated.Funding Information: Study was funded by the institutional research fund of Tata Medical Center, Kolkata, India.Declaration of Interests: None to declare. Ethics Approval Statement: The TMC-IRB approved the study on 10th October 2020. The memo number was 2020/Govt/33/IRB46.

Symptomatology of Advanced Gastrointestinal and Hepatobiliary Cancers in Palliative Care: Single Center Tertiary Care Experience from Eastern India

The spectrum of symptoms for an oncologist or oncosurgeon about gastrointestinal (GI) and hepatobiliary (HB) cancers varies from the spectrum of symptoms that a palliative care physician ascertains. There is a paucity of data regarding GI and HB cancer symptomatology in a palliative care outset. Hence, we conducted this study to understand the same and identify the most common symptom clusters among these cancers. The present study was retrospective observational study conducted on patients referred to palliative care department of Tata medical center, Kolkata, India. A total of 495 patient’s case records were reviewed with GI and HB cancers. Age, gender, co-morbidities, Eastern Cooperative Oncology Group (ECOG) status, symptomatology, physical examination findings, and histopathological diagnosis were reviewed from the case records and documented. Symptomatology included pain, nausea, vomiting, anxiety, depression, constipation, anorexia, early satiety and loose stools. The mean age of the patients was 57.73 ± 12.50 years with male: female ratio of 1.60. The most common organ system involved was gall bladder (22.63%) followed by pancreas (16.97%). The most common symptom was abdominal pain (63.64%) followed by anorexia (28.08%) and constipation (21.62%) and the least common ones were loose stools (3.84%) and neuropsychiatric symptoms (4.85%). Nausea-vomiting cluster (38.10%) and abdominal pain-nausea/vomiting (28.38%) cluster were most common among stomach carcinomas. Abdominal pain-constipation cluster (23.21%) was more common among gall bladder carcinomas. Future studies directing to identify these symptoms and clusters over the quality of life of advanced cancer patients are warranted.

170P Predictors for cancer-related fatigue among patients with advanced lung cancer attending palliative care department: A prospective observational study

Background: Cancer-related fatigue (CRF) among patients with lung cancer (LC) is present before and after treatment and present in about three fourth of cases. CRF is often a common unmet need affecting the quality of life of patients with LC. We conducted this study to understand the predictors for CRF among patients with LC attending the palliative care department in our center. Methods: A prospective observational study was conducted among patients having LC. The study was conducted on patients referred to the palliative care department of Tata Medical Center, Kolkata from January 2019 to June 2019. Those patients whose Karnofsky status is less than 40, with a history of diabetes, heart disease, psychiatric disease, and psychotropic drugs were excluded from the study. Edmonton Symptom Scale was used to assess the various symptoms like pain, fatigue, nausea, depression, anxiety, appetite, well-being, cough, and shortness of breath. History of any surgery, chemotherapy, or radiotherapy along with blood investigations like serum albumin, hemoglobin, and white blood cell count was documented. Results: Eighty-four patients with LC with a mean age of 61.5 years were included in the present study. The prevalence of CRF was 48.80%. Univariate analysis revealed that the presence of cough (p < 0.001), breathlessness (p < 0.001), hemoglobin levels (p = 0.012), and radiotherapy treatment (p = 0.038) to be associated with fatigue. After multiple logistic regression analysis with fatigue as outcome variable, revealed that presence of cough [OR = 3.80; 95% CI = 1.13 to 12.80;(p = 0.031)] and breathlessness [OR = 3.57; 95% CI = 1.19 to 10.73; (p = 0.023)] as significant predictors affecting fatigue among lung cancer patients. Conclusions: Half of our patients with LC had CRF. The presence of cough and breathlessness were significant factors that affected the CRF in the present study after the confounding factors were adjusted. Further studies on this associated symptom cluster of fatigue, breathlessness, and cough have to be conducted. While managing the patients with fatigue it is important that these associated symptoms like cough and breathlessness have to be handled. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Clinicopathological features and outcomes of choriocarcinoma: A retrospective analysis from an Indian tertiary cancer center

Background: Choriocarcinoma is the most common form of gestational trophoblastic neoplasia seen by medical oncologists. It is a rare condition and data related to its long-term outcomes from the Indian subcontinent are sparse. Objectives: The primary objective of this study was to assess the clinicopathological characteristics and clinical outcomes of patients with of choriocarcinoma; the secondary objective was to assess the correlation of outcomes with risk stratification. Materials and Methods: This single-center retrospective study was conducted at the Tata Medical Center, a tertiary cancer center in West Bengal, India. We identified all the cases of choriocarcinoma treated at our hospital from the electronic medical records and noted their baseline characteristics, treatment details, and clinical outcomes. Descriptive statistics were used for baseline characteristics, and the Kaplan–Meier method was used for the survival analysis. Results: A total of 24 patients were included in the study. The median age of the patients was 29 years (interquartile range, 25.9–39.5). The median time interval from the last pregnancy was 5 months (range, 0 months to 11 years). The World Health Organization risk score was low in 8 (33.3%) and high in 16 (66.7%) patients. There were 6 (25%) patients who received single-agent chemotherapy, 14 (66.7%) received the EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen, and 1 (4.7%) received the VIP (etoposide, ifosfamide, and cisplatin) regimen, with the latter 2 being given only to high-risk patients. The median follow-up was 10.9 months (95% confidence interval [CI], 4.2–28.5). The median progression-free survival was not reached (NR) (95% CI, 7.2–NR). Similarly, the median overall survival was NR (95% CI, 10.56–NR). Conclusion: Our study provides real-world data for this rare malignancy and reinforces the fact that choriocarcinoma is a highly curable disease. Despite the clinicopathological variations in the different parts of the country, the long-term outcomes are favorable.

Covid-19 and Cancer: A Scientometric Assessment of India's Publications During 2020–21

The article examines and evaluates India's research output on the theme ‘Covid-19 and Cancer’ using bibliometric methods. A total of 520 India's publications were identified on the topic of ‘Covid-19 and Cancer’ in Scopus database, that were cited 2713 times with an average of 5.22 citations per paper. About 12.11% of these publications received external funding support and registered 8.25 citations per paper. The largest number of India's publictaions (88.46%) were published in Medicine journals and adults constitutes the largest population age group (15.38%) studied among India's total publications. Lung cancer research constitutes the largest publications share (9.42%) among different types of cancers and surgery reported the largest publication share among treatment methods studies in India's total publications on this topic. The maximum number of publications emerged from USA, Italy and U.K. (2641, 1357 and 1153 publications), and publications from China (24.56, Spain (14.52) and Italy (13.12) received the highest citation per paper. The organisations that produced the highest number of publications were Tata Memorial Hospital, Mumbai (75 papers), All India Institute of Medical Sciences, New Delhi (63 papers), Homi Bhabha National Institute, Mumbai (59 papers) and Postgraduate Institute of Medical Education & Research, Chandigarh (35 papers). The organisations with highest citation impact per paper and relative citation index were Tata Medical Center, Kolkata (13.0 and 2.49), BHU-Varanasi (12.70 and 2.43), VMMC and Safdarjang Hospital, New Delhi (5.0 and 0.96) and Tata Memorial Hospital, Mumbai (4.73 and 0.91). The authors that produced the highest number of publications were B. Biswas (12 papers), S. Bhatnagar (11 papers) and A. Batra (9 papers). The authors who had the highest citation impact per paper and relative citation index were P. Chaturvedi (13.25 and 2.54), C.S. Pramesh (12.29 and 2.35) and S. Gupta (4.0 and 0.77). The journals that produced the highest number of publications were Indian Journal of Medical and Paediatric Oncology (with 28 papers), Indian Journal of Surgical Oncology (19 papers) and Journal of Surgical Oncology (18 papers) and the most impactful journals were Clinical Oncology (19.17), JCO Global Oncology (19.09) and Indian Pediatrics (17.80). The most studied subfields as reflected in keyword frequency were Covid-19, Pandemic (332), Neoplasms (175), Cancer Patients (112), Malignant Neoplasm (100), Cancer Surgery (79) and Cancer Chemotherapy (66).

Germline predisposition in pediatric brain tumors: Experience from tata medical center, Kolkata

Germline predisposition in pediatric brain tumors: Experience from tata medical center, Kolkata

Genomic profile at diagnosis by targeted high throughput sequencing, and real-world clinical outcomes in patients diagnosed with acute myeloid leukemia at a tertiary care cancer center.

e19515 Background: Acute Myeloid Leukemia (AML) is a highly heterogeneous disease. High throughput sequencing (HTS) has led to the discovery of a number of recurrently mutated genes in AML &amp; has provided a detailed molecular landscape of the disease. This information is now extensively utilised &amp; interpreted in AML. Methods: Retrospective analysis of 47 patients with newly diagnosed AML for those who had both cytogenetic and targeted HTS information at diagnosis, [median age: 44y (12-80y); 24 females] &amp; treated at Tata Medical Center, India between 2013-2019. HTS was performed using Illumina Trusight myeloid panel and/or Thermo Fisher Scientific Oncomine Myeloid panel, and mutation data from the common 28 genes were used. Patients were stratified by European Leukemia Net (ELN) 2010 and 2017 guidelines. Standard of care clinical outcome data was available for all patients. Results: 45 of 47 patients had mutations. The most frequently mutated gene was FLT3 (n = 13, 28.9%), followed by NPM1 (n = 8, 17.8%), and others [ IDH1, IDH2, TET2, CEBPA, and NRAS; n = 7, 15.6%). ELN-2010 classified 6 patients as Favourable (12.8%), 10 as Intermediate-I (21.3%), 25 as Intermediate-II (53.2%) and 6 as Adverse (12.8%) risk groups. One patient migrated to the adverse group from Intermediate-II when ELN-2017 was applied. ELN 2017 re-classification: Favorable (n = 6, 12.8%), intermediate (n = 34, 72.3%), and adverse risk groups (n = 7, 14.9%). Co-occurrence of driver gene mutations was found in NPM1 and FLT3 (8.2%) frequently. Patients with mutations in epigenetic modifiers ( ASXL1, IDH1, IDH2, DNMT3A) had high Variant Allele Frequency (VAF, 40-50%) while those with signaling pathway gene mutations ( NRAS, KRAS) had low VAF (9-25%). At a median follow up of 3.25 years, median overall survival in the three risk groups (favorable, intermediate, adverse) were 11.25 mons, 7 mons and 8 mons respectively, and relapse rates were 16%, 29% and 42% respectively. Conclusions: Early experience from a middle-income real-world setting suggests feasibility of integration of HTS information in practise, as additional prognostic/ predictive information. The pattern of a high VAF in epigenetic modifier gene mutations, potentially as a result of early acquisition during clonal development, needs further evaluation. This data set has helped us initiate a prospective multimodal omics study at our institution.

Evaluation of CA-125 as an Indicator of Imaging During Follow-up of Carcinoma Ovary: Original Research.

Women with response to primary treatment for advanced ovarian cancer are said to have progression if CA125 increases more than double the upper normal limit (70IU/L) on follow-up. It was, however, noted that large section of women with CA125 > 35IU/L had disease on imaging. To compare values of CA125 rise at which radiological recurrence can be detected. This is a retrospective observational study where women with advanced epithelial ovarian cancer who underwent interval debulking surgery and completed treatment at Tata Medical Center, Kolkata, India, from 2012 to 2016, and were followed up with Ca125. If CA125 doubled or exceeded 35IU/L or increased to ≥ 70IU/L, women were subjected to imaging. Among 142 women who underwent treatment, 64 women with response to primary treatment had recurrence. Recurrence was noted in two (3%) patients with doubling of Ca125 but ≤ 35IU/, 18 (24%) patients with CA125 > 35IU/L and 41 (64%) patients when CA125 was ≥ 70IU/L. Three patients (5%) with normal CA125 had recurrence. Among the recurrence group, 45 women had R0 during surgery of which 27 (60%) had CA125 ≥ 70IU/L and 14 (31%) had CA125 > 35IU/L during recurrence. Sensitivity and specificity of value > 35IU/L were 30.51% and 33.33%, respectively, with accuracy of 32.03%, while sensitivity and specificity at > 70IU/L were 69.49% and 66.67%, respectively, with accuracy of 67.97%. CA125 value of ≥ 70IU/L is a better predictor of recurrence; however, imaging done when value rises > 35IU/L would be able to detect significant recurrences early thus allowing early treatment.

When you hear hoof beats, it may also be a Zebra: a case report in a malignancy glottis

&lt;p&gt;Laryngeal cancer is one of the leading causes of death in Indian males. Papillary thyroid carcinoma is the most common subtype of thyroid cancer in 80% of cases and has a tendency to metastasize to lymph nodes. Patients with laryngeal cancers undergoing laryngectomy might have other occult primaries including thyroid carcinoma especially in patients with recurrent laryngeal carcinomas. We report a case of recurrent laryngeal carcinoma with incidental carcinomas. This study was conducted at TATA medical center, Kolkata.&lt;/p&gt;

Postoperative pulmonary complications in robot-assisted uro-oncological surgeries: Our experience in a tertiary cancer care centre.

Postoperative pulmonary complications in robot-assisted uro-oncological surgeries: Our experience in a tertiary cancer care centre.

Colistin Susceptibility Testing of Gram-Negative Bacilli: Better Performance of Vitek2 System than E-Test Compared to Broth Microdilution Method as the Gold Standard Test

AbstractIntroduction: Unavailability of optimal susceptibility testing (ST) challenges the clinical use of colistin. Broth microdilution (BMD), which is the reference for colistin ST, is inconvenient for diagnostics. Vitek2 and E-test although technically easier, are no longer recommended. Materials and Methods: For the evaluation of Vitek2 and E-test in reference with BMD, a total of 138 Gram-negative bacilli (GNB) especially carbapenem-resistant isolates from Tata Medical Center, Kolkata, India, were included during 2017–2018. The evaluation was performed only for Enterobacteriaceae (n = 102), but not for non-fermentative GNB (n = 36) due to lack of colistin-resistant (COLR) isolates. Results and Conclusion: Of 138 isolates, meropenem, colistin and dual resistance were detected in 110 (79.7%), 31 (22.5%) and 21 (15.2%) of isolates, respectively. Using the European Committee on Antimicrobial Susceptibility Testing guidelines (susceptible, ≤2 μg/ml), Vitek2 performed better than E-test (essential agreement, 92.2% vs. 63.7%; categorical agreement, 94.1% vs. 93.1%; very major error [VME], 10% vs. 23.3%). However, Vitek2 overcalled resistance than E-test (major error, 4.2% vs. 0%). Considering Chew et al. proposed breakpoints (susceptible, ≤1 μg/ml), VMEs declined for both test (6.7% vs. 10%), but still remained unacceptable. Of eight colistin-heteroresistant isolates, two VME were categorised by Vitek2, one VME was by E-test, and two were uninterpretable. Both Vitek2 and E-test are unreliable. Further studies correlating minimum inhibitory concentrations with clinical outcome are needed to determine the accurate breakpoints for better patient management.

Cachexia at Diagnosis adversely predicts outcomes in patients with Aggressive B-Cell NHL receiving standard of care treatment: A Prospective Observational Study from India

Background and Objectives:Cancer associated malnutrition and cachexia is an important determinant of the patient's short and long term outcomes. This prospective study was conducted to determine the association between cachexia at diagnosis and overall survival of patients with aggressive B-cell non-Hodgkin's Lymphoma (ABNHL) Methods:This investigator initiated single centre prospective observational study was conducted at the Tata Medical Center, Kolkata, India between Jan 2015 and Mar 2019 after IRB approval. Patients diagnosed with ABNHL receiving standard of care chemo-immunotherapy were eligible. This study was supported by an educational research grant from Baxter to our institution. All patients who consented to participate were screened for cachexia at entry using a modified Subjective Global Assessment (SGA) tool (1). Baseline clinical factors of prognostic importance including stage, IPI score, etc. were recorded. All statistical analysis was carried out using EpiInfo-ver.7 software. Results:239 patients diagnosed with high grade B-NHL were recruited. The study group included 89 women and 150 men, and 77 (32.1%) were older than 65 years. 130 (54.3%) patients received private care. 88(36.8%) had IPI stage high-intermediate plus high grade; 136 (56.9%) had Ann Arbor stage III plus IV disease; 40 (16.7%) had extra-nodal NHL; 96 (40.1%) had weight loss and 107(44.7%) had reduced food intake. Cachexia scores estimated by the modified SGA tool was SGA-A in 101, SGA-B in 120 and SGA-C in 18 patients. Only 37 (15.4%) had been subjected to screening for malnutrition prior to cancer treatment. 44 (20.5%) patients experienced neutropenic sepsis during treatment. At a median follow up of 457 days, 69% achieved complete remission at the end of initial therapy, 50 (20.9%) patients died during the study period. In univariate analysis, SGA, IPI, Stage and age groups were statistically significant prognostic markers. The 2-year actuarial survival of all patients adjusted for SGA, IPI and Stage was 72%. The two-year actuarial survival in the SGA-A, SGA-B, and SGA-C groups were respectively 80%, 68% and 45% (p&lt;0.001). In a multivariate analysis using cox proportional hazards method the hazard ratio for SGA B was 1.67 (0.94-2.97), and SGA-C was 3.65, after adjusting for IPI and stage groups (p=0.0137).The follow up is continuing and final multivariate analysis will be done when sufficient events have occurred. Conclusions:Cachexia at diagnosis is an important independent prognostic biomarker in patients with ABNHL. The role of routine screening for cachexia before initiating treatments and providing individualized medical nutrition therapy along with physical therapy during chemotherapy to prevent worsening of cachexia and improve survival needs evaluation.

School re-entry after treatment for pediatric brain tumors at tata medical center, kolkata

School re-entry after treatment for pediatric brain tumors at tata medical center, kolkata