Tertiary Cancer Center In India Research Articles

Empty pelvis syndrome: a retrospective audit from a tertiary cancer center.

Empty pelvis syndrome (EPS) has been defined as a complications arising as a sequel of empty space created after extensive pelvic surgery involving perineal resection. However this definition has been heterogenous throughout the limited literature available. Hence, EPS is a significant yet under recognized complication vexing both patients and surgeons. Even till date, prevention and management of EPS remain a challenge. Various preventive strategies have been employed each with its own complications. Few small studies mentioned incidence of this dreaded complication in between 20 and 40%. But most of these studies quote vague evidence and especially only after TPE surgeries. To the best of our knowledge, incidence after APR and PE has never been mentioned in literature. To assess the clinical burden of empty pelvis syndrome in patients undergoing abdominoperineal resection (APR), posterior exenteration (PE), or total pelvic exenteration (TPE) for low rectal cancers. This is a retrospective audit from a high-volume tertiary cancer center in India. Patients who underwent APR, PE, or TPE between the years 2013 to 2021 were screened and analyzed for incidence, presentation, and management of empty pelvic syndrome (EPS). A total of 1224 patients' electronic medical records were screened for complications related to empty pelvis. The overall incidence of EPS was 95/1224 (7%) with 55/1024 (5%) in APR, 8/39 (20.5%) in PE, and 32/143 (21.9%) in TPE. The most common clinical presentation was small bowel obstruction 43/95 (45.2%) and most presented late, 56/95 (60%), i.e., after 30days of surgery. Most of the patients who had EPS were managed conservatively 55/95 (57%). EPS is a significant clinical problem that can lead to major morbidity, especially after exenterative surgeries warranting effective preventive strategies.

Telangiectatic Osteosarcoma—A Single-Center Experience

Telangiectatic osteosarcoma is an uncommon subtype of osteosarcoma accounting for less than 4% of all cases of osteosarcoma. It is characterized by distinctive radiographic, pathologic features, and prognostic implications. Radiologically and microscopically, it mimics aneurysmal bone cyst. The objective of this study was to study the clinical profile and treatment outcome of patients with telangiectatic osteosarcoma. Thirteen patients were diagnosed with telangiectatic osteosarcoma in the department of medical oncology at a tertiary cancer center in India during a 12-year period. All patients were above 15 years of age. The median age at presentation was 20 years, males were predominant, and the commonest sites of involvement were lower end of femur and upper end of humerus. Ten patients underwent treatment that consisted of neoadjuvant and/or adjuvant chemotherapy with ifosfamide, doxorubicin, cisplatin regimen and limb sparing surgery or amputation. Currently, eight out of ten patients are alive in remission at a median follow-up of 50 months with survival ranging from 18 to 138 months.

Does granulocyte transfusion help pediatric cancer patients with sepsis?

Sepsis-related mortality continues to be a major concern while treating pediatric cancer patients, more so with the rise in the incidence of multidrug-resistant organisms (MDRO). In this retrospective study conducted between January 2021 and December 2022 at a tertiary cancer center in India, granulocyte transfusion was offered in addition to standard antimicrobial therapy to 64 children with hematolymphoid malignancy who developed 75 episodes of severe sepsis following intensive chemotherapy. Forty-four (83%) of 53 blood culture proven sepsis was caused by MDROs. Thirty-seven (70%) patients with blood culture proven sepsis cleared the organism after granulocyte transfusion. Thirty-day mortality was 25% for the entire study cohort and 32% for patients with MDRO sepsis.

Assessing the feasibility of recording smartphone-based patient-reported outcomes in patients with cancer: A pilot study.

e13528 Background: We conducted this study to evaluate the feasibility of completing patient-reported outcomes (PROs) using a mobile-based secure system at home, as opposed to the traditional method of completing them in crowded outpatient oncology clinics during hospital visits, which may not be ideal in resource-limited settings. Methods: The study included patients aged over 18 years who were newly diagnosed with solid-organ cancer between July 2021 and July 2022 at a tertiary cancer center in India. Patients who were able to use a smartphone were invited to complete a mobile-based Edmonton Symptom Assessment Scale (ESAS) questionnaire, which was accessed via a secure link sent to their phone as a chat. The ESAS questionnaire included physical (six domains: pain, tiredness, drowsiness, shortness of breath, nausea, loss of appetite), psychological (anxiety and depression), and overall well-being (one domain) questions, each rated on a scale of 0-10, with a higher number indicating greater symptom burden. Symptoms were classified as mild (1-3), and moderate to severe (4-10). The primary objective was to determine the completion rate of the questionnaire, while the secondary objectives were to determine the incidence of moderate to severe symptoms, both physical and psychological, at cancer diagnosis. Multivariate logistic regression analysis was used to identify factors associated with moderate to severe symptoms. Results: We reached out to 707 consecutive patients who had recently been diagnosed with solid-organ cancer and used smart phone. The median age of participants was 53 years (with an interquartile range of 43-62 years), and 52.3% were female. Breast cancer (30.6%) was the most common diagnosis, followed by lung cancer (28.8%). Approximately, one-third of all patients had metastatic disease at diagnosis, while others were similarly distributed in stage I-III. Overall, 650 patients (91.9%) patients completed the mobile-based questionnaire; 38.9% of patients had moderate to severe physical symptoms and 30.9% had moderate to severe psychological symptoms. Pain (57.7%) and tiredness (58.7%) were the most commonly reported physical symptoms in moderate to severe category, while nausea (18.1%) and drowsiness (20.3%) were reported least frequently as moderate to severe. Anxiety (35.1%) was more prevalent than depression (26.1%). The total symptom score was mild in 76.5% of patients and moderate to severe in 18.8%. On multivariate logistic regression, patients with advancing age, female sex, and metastatic disease at diagnosis were more likely to report moderate to severe symptoms. Conclusions: Using smartphone-based PROs can be an efficient way to record symptoms in cancer patients, and their high completion rates make them suitable for routine use in oncology clinics, especially considering the increasing number of smartphone subscribers globally.

P-371 Docetaxel-based perioperative chemotherapy in gastric and gastroesophageal (GEJ) adenocarcinomas – a real world experience from a tertiary cancer centre in India

P-371 Docetaxel-based perioperative chemotherapy in gastric and gastroesophageal (GEJ) adenocarcinomas – a real world experience from a tertiary cancer centre in India

Outcome and prognostic variables in childhood rhabdomyosarcoma (RMS) with emphasis on impact of FOXO1 fusions in non-metastatic RMS: experience from a tertiary cancer centre in India.

While factors influencing outcomes of rhabdomyosarcoma (RMS) in developed countries have evolved from clinical characteristics to molecular profiles, similar data from developing countries are scarce. This is a single-centre analysis of outcomes in treated cases of RMS, with emphasis on prevalence, risk-migration and prognostic impact of Forkhead Box O1 (FOXO1) in non-metastatic RMS. All children with histopathologically proven RMS, treated between January 2013 and December 2018 were included. Intergroup Rhabdomyosarcoma Study-4 risk stratification was used, with treatment based on a multimodality-regimen with chemotherapy (Vincristine/Ifosfamide/Etoposide and Vincristine/Actinomycin-D/Cyclophosphamide) and appropriate local therapy. Formalin-fixed paraffin-embedded tissues were tested using Reverse Transcriptase-Polymerase Chain Reaction for FOXO1-fusions (PAX3(P3F); PAX7(P7F)). A total of 221 children (Cohort-1) were included, of which 182 patients had non-metastatic disease (Cohort-2). Thirty-six (16%), 146 (66%), 39 (18%) patients were low-risk (LR), intermediate-risk (IR) and high-risk, respectively. FOXO1-fusion status was available in 140 patients with localised RMS (Cohort 3). P3F and P7F were detected in 25/49 (51%) and 14/85 (16.5%) of alveolar and embryonal variants, respectively. The 5-year-event-free survival (EFS)/overall survival (OS) of Cohorts 1, 2 and 3 was 48.5%/55.5%, 54.6%/62.6% and 55.1%/63.7%, respectively. Amongst the localised RMS, presence of nodal metastases and primary tumour size > 10 cms were adverse prognostic factorvs (p < 0.05). On incorporating fusion-status in risk-stratification, 6/29 (21%) patients migrated from LR (A/B) to IR. All patients who re-categorised as LR (FOXO1 negative) had a 5-year EFS/OS of 80.81%/90.91%. FOXO1-negative tumours had a better 5-year relapse-free survival (58.92% versus 44.63%; p = 0.296) with a near-significant correlation in favourable-site tumours (75.10% versus 45.83%; p = 0.063). While FOXO1-fusions have superior prognostic utility compared to histology alone in localised, favourable-site RMS, traditional prognostic factors (tumour size and nodal metastases) impacted outcome the most in this subset. Strengthening of early referral systems in community and timely local intervention can help in improving outcome in resource-constrained countries.

Treatment Outcome of Burkitt's Lymphoma in Adolescents and Adults: A Retrospective Study

Abstract Introduction Burkitt's lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma (NHL) having three distinct subtypes: endemic, sporadic, and immunodeficiency-associated BL. Sporadic BL accounts for only 1 to 2% of adult NHL. Objectives The objective of this article was to study the clinical profile and treatment outcome of patients with BL. Materials and Methods This was a retrospective study of 60 patients with BL conducted in the department of medical oncology at a tertiary cancer center in India during a 10-year period. Patients with BL/leukemia above 14 years of age diagnosed during the study period were included and their clinical presentation, treatment details, and outcome were studied. Results Among 60 cases with BL, there were 41 males and 19 females. The median age at presentation was 42 years (range: 14–81 years). The main symptoms were lymphadenopathy, abdominal pain, and abdominal distension. Two patients each had paraparesis, breast lump, and jaw swelling and one patient had involvement of the cervix. Thirteen patients had features of tumor lysis at presentation. The Ann Arbor stage was I in 17, II in 16, III in 5, and IV in 22. Fifty-five patients received combination chemotherapy that included hyper-cyclophosphamide, vincristine, adriamycin, dexamethasone ± rituximab (hyper-CVAD ± R; 35), cyclophosphamide, adriamycin, vincristine, prednisolone/ cyclophosphamide, vincristine, prednisolone ± rituximab CHOP ± R (13), Berlin-Frankfurt-Munich protocol (4), and others (3). Thirty-four patients attained remission, 13 patients had progressive disease, and 8 patients died during chemotherapy. At a median follow-up of 113 months, 58% patients were alive. Conclusions BL accounts for 1.57% of NHL above the age of 14 years with male preponderance. Intensive, short-duration chemotherapy is the standard treatment. Treatment with hyper-CVAD ± R gives 8-year progression-free survival and overall survival (OS) of 60%. Treatment with CHOP ± R is an alternative option in elderly frail patients with an 8-year OS of 46%.

Ewing's sarcoma in adolescents and adults - 10-year experience from a tertiary cancer center in India.

Ewing's sarcoma (EWS) is an aggressive small round cell tumor, affecting bone and soft tissues and is mostly seen in childhood and second decade of life. EWS accounts for 10-12% of bone tumors in more than 15 years age group and is even rarer after 40 years of age. This retrospective analysis was conducted among patients aged more than 15 years with histologically proven EWS. Among 240 cases of EWS treated at our center during 2001-2010, 130 (54%) were more than 15 years of age. The median age was 20 years with a male: female ratio of 2.4:1. Ninety percent had skeletal EWS, 10% had extra skeletal EWS, and 37% patients were metastatic at presentation. Eighty-two received curative treatment with chemotherapy (vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide (VAC/IE)) along with local treatment, radiotherapy (RT) in 61, surgery alone in seven, and RT plus surgery in 14. Two- and 5-year overall survival (OS) was 43.3% and 25.5%, respectively, for the entire series. The OS for the non-metastatic group was 63.2% at 2 years and 36.5% at 5 years, and the progression free survival was 53.7% at 2 years and 37.8% at 5 years. High lactate dehydrogenase was found to be a significant poor prognostic factor (P = 0.001). Median OS for localized central EWS was 49.2 months and that for peripheral EWS was 24 months. Patients more than 20 years of age with non-metastatic disease had better OS compared to those with 15-20 years of age. Treatment of EWS requires a multidisciplinary approach with radical surgery and/or radiation to control local disease and multiagent chemotherapy to control systemic disease. Long-term follow-up is essential because of disease relapse and treatment-related complications.

Impact of minimal residual disease on relapse in childhood acute lymphoblastic leukemia: Lessons learnt from a tertiary cancer center in India

Prognostic predictive value of end of induction minimal residual disease (EOI-MRD) is well established in acute lymphoblastic leukemia (ALL). We evaluated the factors likely to affect EOI-MRD positivity (>0.01%) by flow cytometry and relapse in different BFM-95 (Berlin–Frankfurt–Munich) risk groups among children and adolescents. In this retrospective study, data of 223 newly diagnosed patients with ALL was analyzed. Association between demographic and pretreatment characteristics with EOI-MRD was assessed. Risk factors for relapse were analyzed using univariate and multivariate Cox regression. Proportion of the SR (standard risk), MR (moderate risk), and HR (high risk) patients was 18.8%, 60.9%, 20.3%, respectively. Positive EOI-MRD among these risk groups was observed in 11.9%, 18.3%, and 55.5% patients respectively (p value <.01%). MRD positivity was more likely to be associated with older age (>10 years) and BFM-HR patients (p value .0008 and <.0001). Thirty-four (15.2%) patients relapsed in the whole cohort. On univariate analysis, statistically significant factors for RFS (relapse-free survival) included hyperleukocytosis, high-risk cytogenetics, NCI (National Cancer Institute) high risk, poor day-8 prednisolone response, BFM–HR and positive EOI-MRD status. Of all these only EOI-MRD retained its impact by multivariate analysis. Positive EOI-MRD significantly predicted relapse in BFM-MR with 5-year RFS of 88.0% and 68.4% (p value .02). Five-year RFS of EOI-MRD negative and positive groups were 86.4% and 65.5%, respectively (p value .004). EOI-MRD is a powerful tool to predict relapse in children and adolescent with ALL especially in BFM-MR. Application of MRD in HR patients needs to be redefined in conjunction with other variables.

Mini-plate versus Reconstruction Plate: A Comparative Analysis of Complications in Free Fibula Osteocutaneous Flaps for Oral Cancer

Background: Advanced Oral cancers require segmental mandibulectomy, which ideally requires fibula flap reconstruction. Mini-plates or reconstruction plates are used for fibula fixation as per the surgeon’s preference, but the complication rates of each have hardly been studied. The purpose of this study was to find the incidence of plate-related complications, the factors attributing to it, and the difference in complication rates between mini-plate and reconstruction plate for fibula flap fixation exclusively in oral cancer patients who underwent segmental mandibulectomy as part of ablative surgery. Materials and Methods: The study was a retrospective observational study of oral cancer patients who underwent free fibula osteocutaneous flap reconstruction for mandibulectomy defects from November 2010 to November 2020 at a tertiary cancer center in India. Statistical Methods: Chi-square test, Fisher’s exact test. Results: Thirty-nine patients were included in the study and the mean follow-up period was 31 months. Seventeen of them had mini-plate fixation, 16 had reconstruction plate fixation and in two patients, both were used. About 25.64% of patients had complications. In the mini-plate group, 11.7% of patients had complications whereas 44.4% had complications in the recon plate group. 9/32 patients who took adjuvant treatment had complications, and in this subset of patients, there was a significant difference in the incidence of complications between the mini and recon plate groups (P = 0.03). Conclusion: Mini-plates are associated with less complications while used for fixation in microvascular fibula osteocutaneous flaps in oral cavity malignancy who are potential candidates for adjuvant treatment.

Combination of image-guided IMRT and IGBT in locally advanced carcinoma cervix: Prospective evaluation of toxicities and clinical outcomes from a tertiary cancer center in India.

We aimed to assess the toxicity profile and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with a combination of image-guided intensity-modulated radiation therapy (IG-IMRT) and image-guided brachytherapy (IGBT). 25 LACC patients were recruited in this single-arm prospective study. Whole pelvis IG-IMRT was delivered (45 Gy with simultaneously integrated nodal boost of 55 Gy in 25 fractions), with concurrent weekly cisplatin (40 mg/m2). Patients received IGBT of 7 Gy each in 4 fractions to high-risk clinical target volume (HR-CTV). First fraction was done under MRI, and subsequent fractions were performed under CT guidance. Primary endpoint was acute toxicity, and secondary endpoints were 2-year loco-regional control and late toxicity. The median age was 52 years, and FIGO 2018 stage distribution was IIA2, IIB, IIIB, and IIIC1 in 12%, 40%, 20%, and 28% patients, respectively. All patients received concurrent chemotherapy with median number of 5 cycles (range, 4-5 cycles). Grade 1 and 2 diarrhea, and grade 1 cystitis was reported in 4 (16%), 3 (12%), and 2 (8%) patients, respectively. Grade 1 and 2 anemia, and grade 1 and 2 dermatitis were observed in 3 (12%) and 2 (8%), and 3 (12%) and 3 (12%) patients, respectively. No patient reported grade 3-4 acute toxicity. At median follow-up of 29.5 months (range, 25-37 months), late grade 1 bladder toxicity was observed in 1 (4%) patient. Loco-regional control at 1 and 2 years were 96% and 92%, respectively. The combination of IG-IMRT and IGBT yielded excellent outcomes in terms of acute toxicity and loco-regional control.

Trans-rectal ultrasound-guided hybrid intra-cavitary and interstitial brachytherapy in carcinoma cervix: A feasibility study from a tertiary cancer center in India.

To report the feasibility of performing hybrid intra-cavitary and interstitial (IC/IS) brachytherapy in patients with carcinoma cervix under trans-rectal ultrasound (TRUS) guidance. All patients who received an external beam radiotherapy (EBRT) dose of 50 Gy in 25 fractions with weekly chemotherapy, followed by a brachytherapy boost (21 Gy in 3 fractions) were prospectively included for analysis. IC/IS brachytherapy was performed using Fletcher style tandem and ovoid applicator with interstitial component under TRUS guidance. Parameters of implant quality analyzed included ability to insert tandem, ratio of needles loaded to the number of needles inserted, and incidence of uterine or organ at risk (OARs) perforation. Dosimetric parameters evaluated were dose to point A*, TRAK, D90 high-risk clinical target volume (HR-CTV), and D2cc to OARs (bladder, rectum, and sigmoid). Width and thickness of the target was compared between TRUS (TRUSw and TRUSt) and MRI (MRIw and MRIt). Twenty carcinoma cervix patients treated with IC/IS brachytherapy were included for analysis. The mean HR-CTV volume was 36 cc. The median number of needles used were 6 (range, 2-10 needles). None of the patients had uterine perforation. Two patients had bowel and bladder perforation. The mean D90 HR-CTV and D98 HR-CTV were 87.3 Gy and 82 Gy EQD2, respectively. The mean D2cc to the bladder, rectum, and sigmoid were 80 Gy, 70 Gy, and 64 Gy EQD2, respectively. The mean dose to point A* was 70.4 Gy EQD2. The mean TRAK was 0.40. The mean TRUSw (±SD) and MRIw (±SD) were 4.58 cm (±0.44) and 4.49 cm (±0.50), respectively. The mean TRUSt (±SD) and MRIt (±SD) were 2.7 cm (±0.59) and 2.62 cm (±0.59), respectively. On statistical analysis, there was a significant correlation between TRUSw and MRIw (r = 0.93), and TRUSt and MRIt (r = 0.98). TRUS-guided IC/IS brachytherapy is feasible and provides adequate coverage of the target, with acceptable doses to OARs.

Predictors of poor response to chemotherapy in pediatric Hodgkin lymphoma - A retrospective analysis from tertiary cancer center in India

Predictors of poor response to chemotherapy in pediatric Hodgkin lymphoma - A retrospective analysis from tertiary cancer center in India

Real World Experience with Osteosarcoma from a Tertiary Cancer Centre in India

Background: Osteosarcoma represents the commonest category of bone tumors in the children and young adults and stability in its incidence rates have been observed throughout the world. The present study evaluated the varied profile of Indian patients with osteosarcoma with a special emphasis on the survival patterns in a tertiary cancer care centre in India.

Parents’ experiences with prognosis communication in advanced pediatric cancers

Prognostic information in advanced cancers is distressing. We surveyed 30 parents of children with advanced cancer from a tertiary cancer center in India to understand parental preferences for prognostic information. We found that 17/20 (85%) parents desired as much information about prognosis as possible and wanted it expressed numerically. All parents found information about the prognosis to be upsetting but still wanted additional information about the prognosis, except, 2/20 (10%). Parents who found information ‘somewhat’ or ‘extremely’ upsetting 8/20 (40%) were no less likely to say that knowing prognosis was important, or that it helped in decision-making. Thus, although many parents find prognostic information about their children with cancer upsetting, parents who are upset by prognostic information are no less likely to want it. The upsetting nature of prognostic information does not diminish parents’ desire for such information or their sense of hope.

An Analysis of the Survival of Gall Bladder Patients in a Tertiary Cancer Center in India using Accelerated Failure Time Models

Objective: Accelerated Failure Time (AFT) models are an useful alternative of Cox- PH model to determine the significant predictors affecting the survival of the patients. This article aims to determine the significant prognostic factors of hospitalized Gall Bladder Cancer patients in Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India by applying AFT Models. To the best of our knowledge, this is the first study to be carried out in India identifying the factors of Gall bladder patients using AFTM.&#x0D; Materials and Methods: The data are taken from original proformae of 652 hospital admitted Gall Bladder patients from a tertiary care hospital from Delhi from the period January 2012 to December 2016. These models take the logarithm of survival time, S(t) as dependent variable and prognostic factors as independent variables. Thereby, effect of these prognostic factors is multiplicative and therefore these models can be easily interpreted. AFTM demonstrates the predictor’s effect in terms of time ratio (TR). Analysis was implemented on R software version 3.5.1.&#x0D; Results and Conclusions: In the Gall Bladder data considered in this article, shape of hazard function, H(t) and the exploratory data analysis falls in line with the Lognormal AFT model. AFT models give an estimate of Time Ratio which helps doctors, clinicians, epidemiologists etc. to determine the effect of treatment in terms of an increasing/decreasing survival time.

Pediatric cancer-associated thrombosis: Analysis from a tertiary care cancer center in India.

Thrombotic events (TEs) have been extensively studied in adult cancer patients, but data in children are limited. We prospectively analyzed pediatric cancer-associated thrombosis (PCAT) in children with malignancies. Children below 15years of age with confirmed malignancies, treated at a large tertiary cancer center in India from July 2015 to March 2020 developing any TE were eligible. A standardized approach for detection and management was followed. Data were collected after informed consent. Of 6132 eligible children, 150 (2.44%) had 152 TEs, with median age 8.5years and male:female of 1.83:1. Most TEs occurred on chemotherapy: 111 (74.0%). The most common site was central nervous system (CNS) 59 (39.3%), followed by upper-limb venous system 37 (24.7%). Hemato-lymphoid (HL) malignancies were more prone to PCAT than solid tumors (ST) (incidence 3.23% vs. 1.58%; odds ratio [OR]=2.06, 95% confidence interval [CI] [1.36-2.88]; p<.001). Malignancies associated with PCAT were acute lymphoblastic leukemia (ALL) 2.94%, acute myeloid leukemia (AML) 6.66%, and non-Hodgkin lymphomas 5.35%. Response imaging done in 106 (70.7%) children showed complete to partial resolution in almost 90% children. Death was attributable to TE in seven (4.66%) children. Age above 10years (OR 2.33, 95% CI [1.59-3.41]; p<.001), AML (OR 4.62, 95% CI [1.98-10.74]; p=.0062), and non-Hodgkin lymphoma (OR 4.01, 95% CI [1.15-14.04]; p=.029) were significantly associated with TEs. In ALL, age more than 10years (OR 1.86, 95% CI [1.06-3.24]; p<.03), T-ALL (OR 3.32, 95% CI [1.69-6.54]; p=.001), and intermediate-risk group (OR 4.97, 95% CI [1.12-22.02]; p=.035) were significantly associated with thrombosis. The 2-year event-free survival (EFS) for HL malignancies with PCAT was 55.3% versus 72.1% in those without PCAT (p=.05), overall survival (OS) being 84.6% versus 80.0% (p=.32). Incidence of PCAT was 2.4%, and occurred predominantly in older children with hematolymphoid malignancies early in treatment. Most resolved completely with low molecular weight heparin (LMWH) and mortality was low. In hematolymphoid malignancies, PCAT reduce EFS, highlighting the need for prevention.

Outcomes of organ preservation treatment in advanced laryngeal carcinoma: A retrospective analysis from a single institution.

Chemoradiation is the standard treatment for patients with locally advanced laryngeal carcinoma with intact cartilage and functional larynx. The aim of this retrospective study was to assess overall survival (OS) and disease-free survival (DFS) of patients with locally advanced (stage III and stage IV) squamous cell carcinoma of the larynx who have been treated with definitive radical radiotherapy (RT) with or without chemotherapy in a tertiary cancer center in India between January 1, 2006 and December 31, 2015. Data were collected using structured proforma. The patients were treated with RT alone, induction chemotherapy (IC) followed by RT, concurrent chemoradiation therapy (CCRT) or IC followed by CCRT. Response assessment was conducted at 3-4 months post-treatment. Patient-, tumor- and treatment-related factors were documented and were associated with DFS and OS. Survival curves were generated using the Kaplan-Meier method and the statistical significance of survival curves was assessed using the log-rank test. Prognostic factors were assessed using the Cox proportional hazards regression model. A total of 630 patients were included in the present study. The most common age group at presentation was 50-70 years (n=477; 75.7%) and 95.4% (n=601) patients were male. The most common stage at presentation was stage III (n=367, 58.1%). The median follow-up period for the entire group of was 59 months (range, 2-175 months). A complete response after treatment was seen in 549 patients (87.1%). Salvage surgery was performed for 11 patients with residual disease. A total of 134 patients (21.3%) had developed locoregional and distant relapses, and salvage surgery was performed for 31 out of 102 patients with locoregional relapse. The 5-year OS was 48.7% and the 5-year DFS was 45.7%. The stage-wise OS rates were 58.9, 34.9 and 30.4% (P=0.001) and the stage-wise DFS rates were 56.3, 32.0 and 21.7 (P=0.001) for stage III, IVa and IVb, respectively. Results from the present study demonstrated the feasibility of delivery of chemoradiation protocols with good results in a developing country.

Nodular lymphocyte-predominant Hodgkin lymphoma and clinical impact of its variant histology: a clinicopathologic study from tertiary cancer centre in India

Nodular lymphocyte-predominant Hodgkin lymphoma and clinical impact of its variant histology: a clinicopathologic study from tertiary cancer centre in India

Metaplastic carcinoma of the breast: real-world outcome from a tertiary cancer centre in India.

Metaplastic carcinoma (MPC) is a rare subgroup of breast tumours accounting for <5% of all invasive breast cancers. Histologically confirmed 40 MPC from January 2001 to December 2018 were identified from our electronic database: stage I 2.5% (n = 1), stage II 40% (n = 16), stage III 45% (n = 18) and stage IV 12.5% (n = 5). The mean tumour size was 6 cm, node-negative in 60%, and hormone receptor-negative in 75%. Among the 35 non-metastatic patients, 17 (48.6%) received initial neoadjuvant treatment (NAT), followed by surgery, and only 1 had a complete pathological response. At a median follow-up of 60 months, 17% (n = 6) had a recurrence. All six of them had lung metastasis. The 5-year overall survival (OS) and disease-free survival were 64.4% and 66.3%, respectively. Age more than 46 years (p = 0.027), tumour size more than 5 cm (p = 0.037), and nodal positivity (p = 0.001) were predictors of OS. In node-positive patients, the 5-year OS in those who underwent initial surgery was 80% and after NAT was 21.4% (p = 0.069). In node-negative patients, the 5-year OS after initial surgery was 83.3% and after NAT was 90% (p = 0.380). A statistical significance could not be demonstrated due to the small number of patients. Due to chemoresistance, the concept of initial NAT in MPC of the breast is a subject to be studied in the future. Upfront surgery should be considered for operable diseases (including stage III), followed by a decision on adjuvant therapy. Optimal treatment and effective systemic therapy regimens are yet to be defined.