Tertiary Care Cancer Center Research Articles

Real World Outcomes with Treatment Free Remission in Chronic Myeloid Leukemia-Experience from a Tertiary Care Cancer Centre.

Chronic myeloid leukaemia (CML) is caused by balanced translocation t(9::22)(q34;q11) resulting in formation of pathogenic BCR-ABL fusion gene. Tyrosine kinase inhibitors (TKI) have revolutionised the treatment of CML. Ongoing treatment with TKI leads to side effects and has financial impact. Teratogenic potential of TKI and growth disturbance also represent an important challenge. Thus, TKI discontinuation in form of treatment free remission (TFR) has emerged as a new and important therapeutic goal. In this retrospective study, we reviewed CML patients who were kept on TFR. Inclusion criteria was patient age ≥ 18years diagnosed with CML in chronic phase who met the criteria for TFR and opted for same and who were in DMR but stopped TKI for any reason. We analysed the data for baseline characteristics, molecular relapse (MR), survival without molecular relapse (SWMR), TFR duration and factors affecting MR. We included 38 patients in this analysis. Thirty five (92%) patients were treated with imatinib at diagnosis. Median duration of TKI treatment was 135months. 37 patients (97.5%) achieved DMR on TKI and median time from TKI initiation to DMR was 96months. Median duration of DMR prior to TKI discontinuation was 41months. TKI was discontinued after counselling for TFR in 26 patients (68%) while it was discontinued due to intolerance in 10 patients (29%). At median molecular follow up of 25months, nine patients (23.7%) had molecular relapse. Median SWMR was not reached and 2year estimated SWMR was 65.2% (95%CI,47.2- 83.2). Of all relapses, 5/9 (55.5%) occurred in the first six months of TFR. On univariate analysis, duration of TKI and duration of DMR were predictive of molecular relapse. On multivariate analysis, none of these factors were found to be significant. This retrospective study suggests that for CML CP patients achieving deep molecular response, discontinuing TKI therapy in real-world settings may be feasible while potentially achieving comparable outcomes.

Breast lymphomas: Clinical and pathological insights from a tertiary cancer care center in India.

Breast lymphomas are a rare group of malignancies that are further subdivided into primary and secondary. AIMS: To study the pathological and clinical course of breast lymphomas. This is a retrospective analysis of patients treated at our institute over a period of 4.5 years from September 2018 to February 2023. The details of all the patients diagnosed with breast lymphoma were reviewed and analysed for the histomorphological, immunohistochemical, clinical, and treatment details. Appropriate statistical analysis including Kaplan-Meier methods was used. Out of 11 cases of breast lymphoma, five were primary and six were secondary. It was seen predominantly in females (82%) and the age range was 31 to 73 years. Diffuse large B cell lymphoma (DLBCL) was the predominant morphology (73%), along with single rare cases of ALK-negative anaplastic large cell lymphoma, Burkitt lymphoma, and small lymphocytic lymphoma. The treatment details were analyzed for 7 patients. The median follow-up was 28 months. Rituximab along with CHOP regimen or its variants was commonly used as first-line treatment with initial response rates of 71%. The median progression-free survival was 5 months. The median overall survival was 15 months. Lymphomas of the breast are rare but it is crucial to differentiate them from the commoner breast carcinomas as the treatment and prognosis vary vastly.

Clinical Profile of Pediatric Oncology Patients Treated by Radiotherapy: A Retrospective Audit from a Tertiary Cancer Care Center in South India

Introduction With the increase in the number of pediatric cancers in India, there is a need for a multimodal approach involving various disciplines of therapy in which radiotherapy is one of the important areas of treatment. As there is a paucity of studies in South India about the profile of pediatric cancer patients who have undergone radiotherapy the present study was undertaken. Methods A record-based retrospective study was conducted at the department of pediatric hematology-oncology and radiotherapy at a tertiary care hospital in South India using a data abstraction form which consisted of sociodemographic details of study participants, primary diagnosis, confirmed diagnosis, site of radiotherapy, current status of the patient, etc. Chi-square test or Fisher's exact test was used to find out significant association between current status of study participants and various determinants influencing it. Results Highest proportion, n = 35 (30.4%), of cases were in the age group of 10 to 14 years. Among them, 48 children were primarily diagnosed to have hematolymphoid malignancy while 67(%) had solid tumor. Majority of the patients, n = 110 (95.6%), were treated on curative intent. Conclusion Radiotherapy remains an important modality of cancer-directed therapy in children with cancer. Radiotherapy still forms an integral part of cancer-directed treatment in children with cancer as demonstrated in our population.

Abstract PO2-04-12: From Clinical Trials to Clinical Practice; Real World Clinical Outcomes of Patients Treated with Ribociclib in Combination with Aromatase Inhibitors or Fulvestrant for HR-Positive, HER2- Negative Metastatic Breast Cancer

Abstract Background: Cyclin-dependent kinase (CDK) 4/6 inhibitors have revolutionized the treatment landscape of hormone receptor-positive (HR+), human epidermal growth factor receptor-2 (HER2)-negative metastatic breast cancer (MBC), with an impressive efficacy and safety profile. Here we report real-world clinical outcomes and toxicity data in patients treated at a tertiary care cancer center. Methods: The study is a retrospective analysis of individual patients’ data. All consecutive patients with HR+ and HER2-negative MBC, treated at our institution with ribociclib plus aromatase inhibitors (AI) or fulvestrant, between June 2017 and May 2020 were reviewed. Data were collected from patients’ electronic medical records. Progression free survival (PFS) was defined as the time from treatment initiation with CDK4/6i until the first documented progression, death from any cause or last follow-up, whichever occurred first. The Overall survival (OS) was defined as the time from treatment initiation with CDK4/6i until the date of death from any cause, or last follow-up. Results: A total of 305 patients, median age 49 (22-87) years were enrolled. Although bone metastasis was reported in 241 (79.0%) patients, bone-only metastasis was identified in 64 (20.9%). Visceral metastasis in the liver and lungs were reported in 22.0% and 25.9 % of patients, respectively. CDK4/6i combined with AI were used in first-line setting in 195 (63.9%) patients and with fulvestrant as a second line (20.7%) or beyond (15.4%). Dose reduction was required in 44 (14.14%) patients, mostly because of neutropenia (n=38, 12.5%) and abnormal liver enzymes (n=12, 3.9%), while 11 (3.6%) discontinued treatment, mostly due cardiac toxicities. Nevertheless, there were no deaths due to toxicity. Patients were followed up for a median of 31.1 months. Overall response rate (ORR) was 51.4% and median PFS, irrespective of the line of therapy, was 19.3 (17.6-23.3) months. PFS was longer in first-line setting; 23.1 (19.7-NR) months compared to 13.9 (10.2-17.6) months in second-line or beyond, p< 0 .0001, and when combined with AI compared to fulvestrant; 28.6 (17.8-23.1) months versus 9.1 (4.4-NR) months, p=0.0001, and in those with bone-only metastasis; 23.1 (19.5-NR) months versus 17.3 (12.2-18.9) months for patients with visceral metastasis, p=0.0008. The median OS was not reached. Conclusions: Despite enrolling sicker patients, and outside the stringent clinical trials settings, our treatment outcomes, in real world settings, are comparable to those reported in major clinical trials, including MONALEESA-2, MONALEESA-3 and MONALEESA-7. Citation Format: Baha' Sharaf, Faris Tamimi, Sarah Edaily, Osama Salama, Hazem Abdulelah, Anas Zayed, Mahmoud Abunasser, Hala Abu-Fares, Hikmat Abdel-Razeq. From Clinical Trials to Clinical Practice; Real World Clinical Outcomes of Patients Treated with Ribociclib in Combination with Aromatase Inhibitors or Fulvestrant for HR-Positive, HER2- Negative Metastatic Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-04-12.

Abstract PO4-01-03: Dual anti-HER2 Therapy with Pertuzumab and Trastuzumab versus Trastuzumab Alone in Addition to Anthracycline and Taxane-Based Neoadjuvant Therapy in Patients with HER2-Positive Early-Stage Breast Cancer; Real-World Data

Abstract Background: When use in the neoadjuvant setting, anti-HER2 targeted therapy had improved pathologic complete response rate (pCR) in patients with HER2-positive early-stage breast cancer (EBC). Here we present real-world data on the use trastuzumab with or without pertuzumab on the backbone of anthracycline and taxanes-based NSAPB-B27 chemotherapy regimen. Methods: We retrospectively reviewed records of patients with HER2-positive EBC who received neoadjuvant therapy using the National Surgical Adjuvant Breast and Bowel Project (NSABP)-B27 protocol (4 cycles of adriamycin and cyclophosphamide, followed by 4 more cycles of docetaxel; all given every 3 weeks) with anti-HER2 therapy from Jan 2014 to September 2021, treated at a tertiary care cancer center. The clinicopathological features, treatment received, and outcome were collected from patients’ electronic medical records. We estimated 3-year disease-free survival (DFS), a validated endpoint in HER2-positive EBC, using Kaplan-Meier with recurrence and/or death as events. Outcomes were reported in subgroups based on known prognostic factors. Results: The study comprised 528 patients with a median follow-up of 36 months. Median age was 48 (21-80) years. Hormone receptors (HR) were positive in 379 (71.8%), lymph node-involvement prior to neoadjuvant therapy was reported in 402 (76.1%) patients and 319 (60,4%) had grade-3 disease. Majority (n= 482, 91.3%) were labeled HER2-positive based on immunohistochemistry staining (IHC+3) and the rest were based on IHC+2 with positive FISH/ISH. Dual anti-HER2 therapy (trastuzumab and pertuzumab) was used in 316 (59.8%) patients, single agent trastuzumab in 173 (32.8 %) patients, while 39 (7.4%) others did not receive any anti-HER2 therapy. Except for 9 (1.7%) patients who progressed while on treatment, all patients underwent surgery. Among the whole group, 225 (43.4%) achieved pCR; significantly higher (n=80, 53.7%) in HR-negative compared to 38.3% among those with HR-positive disease, p=0.002. Additionally, pCR was higher in patients who received dual anti-HER2 (46.2%) compared to 39.3% for those treated with trastuzumab and 28.2% for those who did not receive anti-HER2 therapy. Following surgery, 463 (89.4%) of the patients received adjuvant trastuzumab, however, none of them received pertuzumab or TDM1 in adjuvant sitting. Estimated 3-year DFS was 86.1% with dual anti-HER2 and 83.0% with trastuzumab alone, p=0.19. However, DFS was better among those with node-negative disease; 96.5% compared to 80.9% in node-positive disease, p= < 0.001. Patients who achieved pCR had significantly better 3-year DFS; 89.3% compared to 80.2% in patients with residual disease, p= 0.006. Conclusions: Even with the wide use of pertuzumab in the neoadjuvant setting, the DFS was not improved compared to trastuzumab alone, and this highlights the importance of switching trastuzumab to TDM1, or to continue with pertuzumab in the adjuvant setting in patient with residual disease. Citation Format: Baha' Sharaf, Faris Tamimi, Osama Salama, Anas Zayed, Osama El Khatib, Suhaib Khater, Malek Horani, Suhaib Al-Sawajneh, Yosra AL-Masri, Hikmat Abdel-Razeq. Dual anti-HER2 Therapy with Pertuzumab and Trastuzumab versus Trastuzumab Alone in Addition to Anthracycline and Taxane-Based Neoadjuvant Therapy in Patients with HER2-Positive Early-Stage Breast Cancer; Real-World Data [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-01-03.

672: Catastrophic health expenditure (CHE): Experience from a tertiary cancer care centre in India

672: Catastrophic health expenditure (CHE): Experience from a tertiary cancer care centre in India

Evaluation of quality indicators in microbiology and infectious disease serology laboratory: A study from a tertiary cancer care centre in Gujarat, India

Introduction: Quality indicators (QIs) are important for the monitoring and evaluation of laboratory performance at pre-analytical, analytical, and post-analytical phases. Errors in the laboratory arise more frequently before and after the analysis of samples. The total testing process (TTP) therefore needs to be evaluated for good laboratory performance. A good quality indicator should give information about the performance of a process, thereby governing the quality of services.Objective: To analyse TTP and QIs for a period of six years of screening of laboratory performance.Methods: This retrospective analysis was conducted for the period 2017 to 2022. QIs at pre-analytical (12), analytical (04) and post-analytical (03) phases were defined and analysed on a monthly basis. The laboratory followed the guidelines of the International Organization for Standardization (ISO) 15189:2012 to identify errors in all sections.Results: A total of 259,694 samples were received during the study period. A total of 628,817 tests were performed. The overall error rate was 1.25/1000 tests. Error in the pre-analytic phase was 0.96/1000 tests, the commonest being haemolysed samples. Error in the analytical phase was 0.33/1000 tests. The error of postanalytical phase was 0.48/1000 tests with turn round time (TAT) outliers being the commonest.Conclusion: Amongst all phases of QIs, errors were minimum in the analytical phase. Continuous monitoring and analysis of QIs helps in identification of common errors in the laboratory. Corrective measures will help to improve quality of the laboratory services, and hence the patient outcome. Regular training, evaluation of technical staff, regular preventive maintenance and calibration of all analytical instruments helps in reducing the errors.

Cavernous Sinus Metastasis in Patients of Head & Neck Squamous Cell Carcinoma: A Series of Five Rare Instances and Review of Literature.

Head and neck squamous cell carcinoma (HNSCC) exhibits a higher degree of local aggressiveness as compared to a tendency for distant metastasis. Cavernous sinus metastasis from HNSCC is exceptionally rare, with only a handful of cases reported worldwide. This case series presents five instances showcasing an unusual metastatic pattern of HNSCC to the cavernous sinus, documented over one year in a single tertiary cancer care centre in Northeast India. Typically, the treatment of cavernous sinus metastasis involves radiotherapy and chemotherapy with a palliative intent. Unfortunately, the prognosis for this entity is grim, with survival typically measured in months. Notably, all five patients were diagnosed with cavernous sinus metastasis manifested within 6 to 18 weeks post-completion of their definitive treatment. Among these five patients, four patients developed left-sided cavernous sinus metastasis and had the primary disease on the left side with nodal positivity and extranodal extension. Given the rarity of metastasis in this region, maintaining a vigilant follow-up is imperative for the early identification and treatment of these patients, especially in patients with left-sided primary with nodal positivity and extracapsular extension.

Reconstructive Head and Neck Microsurgery in a High-Volume Cancer Center—Long-Term Impact of an Early Experience

Objectives The aim of this study was to evaluate a 16-year-long outcome of an evolving practical approach to reconstructive microsurgery in a high volume, resource-constrained, head and neck cancer care setting. Patients and Methods Seventy-three consecutive cases of free flap reconstruction done by the Head and Neck Surgical Oncology team of Regional Cancer Centre, Thiruvananthapuram, from October 2004 to May 2020 were prospectively studied for flap viability, cosmesis, morbidity, and oncologic safety. The cases were selected based on their “emphatic” superiority to the conventional alternative as determined by two or more surgeons of the head and neck team or the recommendations of the head and neck tumor board. Results With the long-term results, this article discusses and validates our strategy for controlled patient recruitment for reconstructive microsurgery to ensure the best resource utilization in a tertiary cancer care center. Conclusions Adequate training and optimal application are the key factors determining success in microvascular reconstructive surgery in resource-constrained, high-volume cancer care facilities.

Molecular Profiling of High-Grade B-Cell Non-Hodgkin Lymphomas and Its Clinicopathologic Correlation in an Indian Tertiary Cancer Care Center

Abstract Introduction Double-expressor and double-hit lymphomas (DHL) are known to be more aggressive and have poor outcomes with standard chemotherapy regimens. Objectives To assess the incidence of DHL and triple-hit lymphomas (THL) and correlate them with clinicopathologic parameters. Materials and Methods Patients who were diagnosed with high-grade lymphomas from April 2021 to September 2022 were prospectively followed up, and details comprising clinical and pathological parameters, including the immunohistochemistry expression status and gene rearrangements of MYC, BCL2, and BCL6, were recorded. Results The incidence of DHL and THL in our study was 16.43%. The separate incidence of the DHL-BCL2, DHL-BCL6, and THL groups was 16.43, 13.69, and 2.73%, respectively. The germinal center B cell subtype of histology was predominantly seen in DHLs. MYC, BCL2, and BCL6 expressions do not correlate well with translocations of these genes. Conclusion Double protein expression cannot be used for screening to decide which patients should undergo fluorescence in situ hybridization, as this would result in missing 4.5% of DHLs.

Evaluating Peer Review of Palliative Radiation Plans at a Canadian Tertiary Care Cancer Center.

Peer review (PR) of palliative-intent radiation plans is an importantbut understudied component of quality assurance. This retrospective review aims to improve our understanding of palliative PR by examining the characteristics of reviewed plans and peer feedback along with the associated time burden of two different types of PR processes. This single-institution, quality assurance project assessed palliative PR between 2018 and 2020. Initially, the PR involved a multi-disciplinary team PR. Subsequently, it transitioned to independent PR by a single physician. Characteristics of reviewed plans and feedback on PR were captured and abstracted. Time requirements of PR were based on self-reported estimates and attendance records. A total of 1942 cases were reviewed, representing 85.7% (1942/2266) of all palliative-intent plans between 2018 and 2020. A total of41.1% (n=799) were simple (2D/3D) radiation plans while 56.0% (n=1087) were complex (volumetric modulated arc therapy (VMAT) or tomotherapy) plans. Approximately one-third (30.4%, n=590) of all plans were stereotactic treatments. The rate of any peer feedback was 2.3% (n=45), while the rate of a specific recommended or implemented change was 1.2% (n=24) and 0.9% (n=18), respectively. PR before the start of treatment was associated with more frequent recommended (p=0.005) and implemented changes (p=0.008). Most other factors, including plan complexity and use of stereotactic radiation, were not predictive in this analysis. Comparing the independent versus team PR approach, there was no significant difference in recommended or implemented changes. The mean±standard deviation (SD) staff time required per plan reviewed was 36±6 and 37±6 minutes, including 21±6 and 10±6 minutes of physician time, for team and independent PR, respectively. This work highlights the high frequency of complex and stereotactic radiation in the palliative setting, along with the importance of timely PR and the potential benefit of reviewing even simple, 2D/3D radiation plans. Additionally, from a process perspective, our work showed that independent PR may require less dedicated physician time.

IJCM_150A: A profile of Head and Neck Cancer patients attending a tertiary cancer care centre in Southern Karnataka

Background: Overall, 57.5% of head and neck cancers (HNC) globally are from Asia. In India, HNC accounted for 30% of all cancers in males and 11 to 16% in females, of all sites of cancer. HNC in the low- and middle-income countries differ from those in the Western part of the globe in terms of age, site of disease, etiology, and molecular biology. Poverty, illiteracy, advanced stage at presentation, lack of access to affordable treatment facilities pose a major challenge in management of these cancers. Objective: To identify the socio-demographic and epidemiological factors influencing the cause of Head and neck cancer Methodology: A cross sectional study was conducted between February 2023 till November 2023, in Manipal Comprehensive Cancer Care Centre, Kasturba Hospital, Manipal. All the newly diagnosed Head and Neck cancer (HNC) patients aged above 18 years, from December 2022 were included in the study. The participants were interviewed with the structured questionnaire. Details of the socio-demographic characteristics, various risk factors of HNC, presenting symptoms, co-morbid conditions, anthropometric details, dietary habits, level of physical activity when they were healthy, tobacco, alcohol and betel quid use were taken. Institutional Ethics Committee Approval and informed consent from the participants were taken before the initiation of the study Results: The study found that 84% of the head and neck cancer patients were males. 78% of the cases had education only up to or less than 10th std. The middle class and lower class (according to BG prasad scale) constituted 62% of the cases. 70% reported the site of cancer as oral cavity. Conclusion: The study found that consumption of tobacco, alcohol andNon-vegetarian diet are more commonly seen in HNC cases. Also, males, age group of 51-70 years, belonging to middle-class SES, are more affected.

Radical Oophorectomy for Advanced Ovarian Cancer: A Feasibility Study from Tertiary Care Cancer Centre in Eastern India.

Radical oophorectomy was first performed by Hudson in order to remove an "intact ovarian tumour lodged in the pelvis, with the entire peritoneum remaining attached". We report 16 cases of radical oophorectomy done at our institute in the past 3years and have analysed the perioperative morbidity as well as feasibility of performing the surgery without much of perioperative complication. Twenty-three patients with advanced ovarian cancer who underwent modified en bloc pelvic resection at our institute, between November 2018 and October 2021, were initially enrolled. Patients below 70years, resectable disease on CT scan and no significant comorbidities were included. Exclusion criteria were extra-abdominal metastasis, secondary cancers or complete intestinal obstruction. Initially, 23 patients were enrolled out of which seven patients were excluded. Hence, a total of 16 patients with ovarian cancer extensively infiltrating into nearby pelvic organs and peritoneum were included. In Type 1 radical oophorectomy, retrograde modified radical hysterectomy alongwith in toto removal of the bilateral adnexae, pelvic cul-de-sac and affected pelvic peritoneum is done. Type 2 radical oophorectomy includes total parietal and visceral pelvic peritonectomy as well as an en bloc resection of the rectosigmoid colon below the peritoneal reflection. Radical oophorectomy is feasible with acceptable complication rate. In our study, only one patient had burst abdomen that too due to the poor nutritional status of the patient. There was no surgery-related deaths, but one patient succumbed to pulmonary embolism 5 days after the operation. Hence, radical oophorectomy proves to be an effective, feasible and secure surgical technique in cases of advanced ovarian malignancies with extensive involvement of peritoneum, pelvis and visceras.

Prevalence and Characteristics of Pathological Fractures in Patients Referred to Specialist Palliative Care: A Retrospective Study From India.

Background: Prevalence of pathological fractures in palliative care is less studied. This study aimed to determine the annual prevalence of pathological fractures and describe the characteristics and treatments in patients with pathological fractures referred to a specialist palliative care clinic in a tertiary care cancer center in India. Methods: Data of adult cancer patients newly referred to the specialist palliative care clinic over 1year with a clinico-radiological diagnosis of pathological fracture was included. Key outcomes of interest were annual prevalence, clinical characteristics, symptoms and treatments offered. Results: 75 out of 5800 (1.29%) patients newly referred to the clinic over 1year had pathological fractures. Lung cancer was the most common primary diagnosis (n = 23).Dorsal spine (n = 25) was the most common site of fracture. Pain was the predominant symptom. Mean pain score was 7.04(SD = 1.75) and 42 patients (56%) required strong opioids for analgesia. Only 11 (16%) patients underwent surgical fixation. Median duration from diagnosis of cancer to occurrence of fracture was found to be 329days. Treatment goals changed to best supportive care in 33 patients (44%) post fracture. Patients with bone and soft tissue neoplasms and those who received only chemotherapy previously had a higher risk of occurrence of fractures. Conclusion: Annual prevalence of pathological fractures in patients referred to the specialist palliative care clinic was 1.29%. It was associated with significant symptom burden and affected oncological treatments. Close monitoring of patients with bone metastases is crucial and proactive implementation of prophylactic measures to prevent such skeletal related events is warranted.

Demographic characteristics and short-term outcomes of laparoscopic colon cancer surgeries at a newly developed cancer center in Peshawar, Pakistan.

In Pakistan, colon cancer ranks fourth in incidence, exhibiting survival rates of 90% to 14%, contingent on TNM staging and early detection. This research focuses on the demographic involvement and short-term outcomes of elective colon cancer resections at a newly established tertiary care cancer center utilizing laparoscopic procedures. A retrospective analysis of elective laparoscopic colorectal resections at Shaukat Khanum Memorial Cancer Institute and Research Centre, Peshawar, from April 2021 to February 2022 was conducted. Out of 157 cases, 79 had colon cancer. Criteria included patients >18 years old with positive biopsies; consent non-providers were excluded. Statistical analysis employed descriptive statistics and cross-tabulations using SPSS-22. The study encompassed biopsy-confirmed colon cancers in patients >18 years. 157 colorectal cases were performed, including 79 colon cancers. The sample comprised 61 males (77.2%) and 18 females (22.7%), mean age 42 years. Most patients (33%) were in the 36-45 age group. Majority were from KPK (69.6%), followed by Afghanistan (24%). Tumors were predominantly in the ascending colon (30.3%). Most were moderately differentiated (70.8%). Mean lymph node yield was 19.0, with 1.2% requiring open laparotomy. Post-discharge, one readmission occurred within 30 days. Mortality within 90 days was 2%, attributed to aspiration pneumonia and chemotherapy-related effects. Elective laparoscopic colonic surgery exhibits safety and efficacy in treating colon cancer. The study provides evidence of minimal morbidity and mortality, low readmission rates, and absence of anastomotic leaks. Hence, elective laparoscopic colonic surgery should be favored due to fewer post-operative complications and superior short-term outcomes. Larger studies on colon cancer are imperative for enhanced healthcare delivery.

Mortality Audit of Cancer Patients in the Department of Medical Oncology at a Tertiary Cancer Care Centre in South India.

Considerable advances in the diagnosis and treatment of cancer have made a huge impact on morbidity and mortality from neoplastic diseases. However, cancer remains the leading cause of death across the world. This is a retrospective study carried out at a tertiary cancer care centre (Kidwai Memorial Institute of Oncology, Bangalore) in South India. Case records of all cancer patients who died while receiving inpatient treatment between January 2022 and December 2022 under the Department of Medical Oncology were reviewed and studied. There was a total of 240 deaths. Out of these, the majority of deaths 147 (61.25%) were patients with haematological malignancies while the remaining 93 (38.75%) were patients with solid tumours. In patients with solid tumours, the majority 49 (52.7%) were in the age group of 40 to 60 years while only 18 (19.35%) patients were less than 40 years. The majority of patients weremale sex i.e. 55(59.1%) and undergoing treatment with palliative intent 81 (87%). The most common organ was the lung in 21 patients (22.6%) followed by the breast while the most common system involved was the gastrointestinal tract in 28 (30.1%) patients. The most frequent cause of death was progressive disease in 72 (77.4%) while sepsis (11 patients; 11.8%) was the second most frequent cause of death in solid tumours. In haematological malignancies, also a significant number of 57 (38.8%) patients were in the age group of 40 to 60 years. Fifty-two (35.3%) patients were in the age group of 22 to 40 years. The majority weremale sex (79 patients; 53.7%). About the phase of treatment, the majority of deaths 45 (30.6%) were during induction and under evaluation. Those with relapse/refractorydisease were 38 (25.9%). A substantial number of patients had acute myeloid leukaemia47 (32%) and five (3.4%) deaths were acute promyelocytic leukaemiapatients. Twenty-three patients (15.6%) hadacute lymphoblastic leukaemia. The most common cause of death was sepsis in 76 patients (51.7%) whileintracranial bleeding was in 34 patients (23.1%). In some patients, there were multiple causes leading to death. Mortality audits are important to evaluate the services being provided at any centre. One can appreciate the lacunae in handling a particular disease or flaws in a treatment protocol or the staff delivering the treatment. Sepsis is the leading cause of death in patients with haematological malignancy; even in solid malignancy sepsis accounts for a substantial proportion of deaths and should be handled aggressively to save lives.

Exploring Malnutrition Risk in Cancer Chemotherapy Patients: An Assessment of Associated Factors in a Tertiary Care Cancer Center

Objectives: This study aimed to assess the risk of malnutrition in cancer chemotherapy patients and identify the associated factors. Materials and Methods: It is a cross-sectional study. Purposive sampling was used to collect data from a tertiary care cancer centre. The study collected data from 101 participants and used a malnutrition screening tool (MST) to assess the risk of malnutrition. Results: The majority of participants in the study were female (61.4%) and in the 3rd or 4th stage of cancer (57.4% and 41.6%, respectively). Of the participants, 63.4% experienced weight loss without trying chemotherapy, and 60.4% were at risk for malnutrition. Cancer stage was associated with malnutrition risk, but other clinical variables were not. Conclusion: Malnutrition is a significant issue among cancer chemotherapy patients in the study’s population. The findings of this study can be used to develop interventions to prevent and manage malnutrition in patients with cancer and improve the effectiveness of cancer treatment in the Indian population.

Frequency of Programmed Death Receptor Ligand 1 Expression and Clinicopathological Factors Associated With Metastatic Triple-Negative Breast Cancer at a Tertiary Cancer Care Centre in South India.

Purpose Triple-negative breast cancer (TNBC) has a poor outcome compared to other subtypes. Immune checkpoint inhibitors (ICIs) have changed the treatment paradigm in metastatic diseases as well as in neoadjuvant setting. The response to these agents is affected by programmed death ligand 1 (PDL1) receptor expression which are reported objectively as a score. PDL1 is a prognostic marker also. Here, we present clinicopathological characteristics of metastatic TNBCs, report the proportion of PDL1 expression and its association with clinicopathological factors as well as survival. Methods This is a prospective study carried out at a tertiary cancer care centre in South India. Case records of all breast cancer patients treated in two years between August 2021 and July 2023 were reviewed, patients with metastatic TNBC were selected. Patient's characteristics, histological features, molecular profile, and treatment were analyzed. PDL1 testing was carried out on pretreatment tumor tissue sections with immunohistochemistry (IHC) (Dako 22C3). PDL1 staining was interpreted as negative or positive based on combined positive score (CPS), with an expression less than 10 considered negative. Results A total of 118 patients were analyzed. With a median age of 46 years (36-65 years), 52.5% (62/118) were premenopausal. Family history of Ca Breast was seen in 22% (26/118) patients. A majority of patients had left-sided tumor 55.9% (66/118). Visceral metastasis was more common 96.6% (82/118) than skeletal. Radical intent of treatment was adopted in 10% as patients had oligometastatic disease at presentation. As front-line treatment, anthracycline-based chemotherapy was administered to the majority 54.2% (64/118). The PDL1 expression with CPS more or equal to 10 was seen in 32.2% (38/118) patients. Survival was associated with menopausal status (p value=0.000) and family history (p value=0.028) but notwith PDL1 nor sidedness in our study. Estimated survival at 12 months in PDL1 negative case is 10 ± 0.29 months, while in PDL1 positive case it is slightly more at 10± 0.75 months, but difference was not found to be statistically significant (p value=0.15). Conclusion TNBCs are highly aggressive subtype with limited treatment options and poorer outcomes. Our study shows PDL1 expression in 31.66% of the cases similar to other literature from India. Survival is associated with menopausal status and family history. No association was found between survival and PDL1 as well sidedness in our study.

52 Functional outcome after Locally Advanced Tongue cancer resections by Pull-through approach: Study from a tertiary cancer care center.

52 Functional outcome after Locally Advanced Tongue cancer resections by Pull-through approach: Study from a tertiary cancer care center.

Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients.

Multiple myeloma (MM) represents the second most common hematologic malignancy (15%). Induction with bortezomib, cyclophosphamide, and dexamthasone VCd (d: low dose dexamthasone) regimen is widely used due to its high effectiveness, low toxicity and good tolerability, particularly with renal impairment. Real-world data on the use of VCD in clinical practice is lacking. Evaluate the real-world experience of the VCD regimen. Retrospective. Tumor registry database of tertiary cancer care center. newly diagnosed MM patients who received VCD induction and underwent autologous stem cell transplant (ASCT) from July 2007 to July 2020. response evaluation, progression-free survival (PFS) and overall survival (OS). 87 patients. Of 102 patients who started induction with VCd, 87 patients experienced a partial response or more overall response rate of 85%). The median age of these 87 patients at diagnosis was 52 years, of which 29.9% presented with renal impairment and 60.3% of patients had stage 2 by the Revised International Staging System (R-ISS). Patients with a standard cytogenetic risk achieved a better response compared to those with a poor cytogenetic risk (P=.044). The post-induction response rates were 6.9% stringent complete remission (sCR), 35% complete remission (CR); 41.4% very good partial response (VGPR), and 16.1% partial response (PR), respectively; the response rates became greater for sCR and CR post-transplantation at day 100 with 16.1% sCR, 35.6% CR, 32.2% VGPR and 16.1% PR, respectively. The median PFS was 49 months and 5 years OS was 84%. PFS was better in patients who achieved sCR vs PR (83 vs 35 months, P=.037). High LDH, high-risk cytogenetic and stage 3 R-ISS showed a worse median PFS and OS. VCD induction in newly diagnosed MM is highly effective, convenient, tolerable and affordable regimen, especially in low and middle-income countries with limited resources, also with favorable outcomes and survival. while those who did not respond successfully shifted to VRD or VTD. The usual limitations of a retrospective analysis using registry-level data, no data on quality of life.