Tertiary Care Oncology Center Research Articles

Outcomes of Palliative Colonic Stent Placement in Malignant Colonic Obstruction: Experience from a Tertiary Care Oncology Center in India

Abstract Introduction Colonic self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analyzed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology center in Western India. Methods Retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 and September 2021. Demographic details, intent of stent placement, site of obstruction, length of stricture, technical success of stenting, clinical success, and complications (both immediate and long term) were noted. Results Sixty-one patients underwent colonic SEMS placement during the study period (mean age 53.6 years, 50.7% men). Obstruction was due to primary colonic malignancy in 43 (70.5%) patients and extracolonic malignancies in 18 (29.5%) patients. Most common extracolonic malignancy was gallbladder cancer in 8 (44.4%) patients. Most common site of obstruction was sigmoid colon in 18 (29.5%) patients. Proximal colonic obstruction was seen in 17 (27.9%) patients. Peritoneal metastases were seen in 26 (42.6%) patients. Colonoscopy revealed an impassable stenosis in 58 (95.1%) patients. Median length of stricture was 5 cm (range 2–9 cm). Technical success was achieved in 98.3% (60/61). Clinical success was achieved in 51 (86.4%) patients. Perforation during colonic SEMS placement was seen in 2 (3.4%) patients. Stent migration was seen in 3 (5.9%) patients, needing surgery for retrieval in all 3 patients. Over a median follow-up of 9 months (0–21 months), stent block was seen in 7 (13.7%) patients. Stent block developed after a median period of 6 months. Of these patients, three patients underwent SEMS placement within the SEMS and the other four patients underwent surgery. Conclusion Colonic SEMS placement achieves good palliation of malignant colonic obstruction in approximately 87% patients. Long-term complications like obstruction occur in a few patients after a median duration of 6 months.

A clinicoepidemiological and management profile of metastatic carcinoma gallbladder in the northeast part of Indian patients in a tertiary care center.

Metastatic gallbladder cancer (GBC) is a highly fatal malignancy and it is difficult to treat the advanced stage of GBC. In India, northern and northeastern states are the worst affected by this disease. We, hereby, report the clinicoepidemiological and management profile of 242 patients of metastatic carcinoma of GB. In this study, a total of 242 cases of metastatic GBC (detected either on the first presentation or during follow-up) were managed at the Department of Medical Oncology tertiary care oncology center in the northeast part of India from May 2018 to September 2019. On presentation, all patients were subjected to detailed history and clinical examination, followed by requisite investigations and were treated as per the existent guidelines. One-hundred and forty-two patients were female, while 100 patients were male out of 242 patients. Female patients with metastatic GBC presented with the mean age of 54, while for males, 51.4 years. The most common presentation was pain abdomen (81.8%), while the second most common was anorexia (77.2%), followed by weight loss (62.8%) and mass per abdomen (60.7%). The most common site of metastasis recorded in our study was the liver (79.7%), followed by nonregional abdominal lymph node (69.4%) and ascites (64.4%). Out of the 242 patients, 24 patients had presented in poor Eastern Cooperative Oncology Group Performance Status (≥3) hence were deemed unfit for any oncological interventions. About 136 (56.1%) patients had presented with features of obstructive jaundice, however only 108 patients were subjected to biliary drainage procedure. After the biliary drainage procedures, only one-third (38 out of 136; 35.1%) of patients were finally able to receive chemotherapy. In India, unfortunately, many patients present very late during the course of their illness. There is a need for the development of effective chemotherapy or targeted therapy and also there is an unmet need for patients' education. There has been an increase in the incidence of this malignancy, especially in the Northeast part of India; hence, it is the need of the hour to study various epidemiological and causative factors of the disease. Furthermore, the development of therapies for the effective management of this malignancy is really required.

Retrospective Study of Treatment Free Remission in Patients with Chronic Myeloid Leukaemia(CML) Treated at Tertiary Care Oncology Centre from India

Background Tyrosine kinase inhibitors (TKI) have dramatically improved outcomes in Chronic Myeloid Leukemia(CML) patients, but lifelong TKI therapy can negatively impact patients' quality of life due to chronic adverse events. Treatment free remission(TFR) is now the new goal of CML therapy. Studies have shown this is feasible in developed countries. Literature on discontinuation of TKI therapy in resource limited countries such as India is scarce. The purpose of this study was to investigate whether some chronic myeloid leukemia patients with excellent and sustained molecular responses to tyrosine kinase inhibitor treatment can gradually de-escalate TKI therapy and stop therapy in Indian setting. Methods We included all patients above the age of 18years with diagnosis of CML in first Chronic Phase (CP) on TKI therapy of minimum 3 years duration with major molecular response (MMR i.e., <0.1% BCR-ABL1 transcript) of minimum of 2 years duration, enrolled for treatment free remission between January 2018 to December 2021. Starting dose of imatinib was 400mg once daily, dasatinib 100mg once daily and nilotinib 300mg twice a day. In this study the dose of these drugs was reduced by 25% every 6 months . This dose reduction was done with 2 monthly outpatient clinic visits and 2 monthly BCR-ABL1 quantitative PCR monitoring. Patients who maintained MMR during 6 months of dose de-escalation qualified for next level of dose de-escalation. Eventually treatment was stopped completely and monitoring continued. This was retrospective medical record based study done at a tertiary care centre in North India. Results Between Jan 2018 to Dec 2021, 29 patients were enrolled for dose de-escalation and treatment cessation. Among these 29 patients, 19 were on imatinib, 2 on dasatinib and 8 patients on nilotinib. Median age was 39 years( range 21 years to 67 years). Twelve patients were male and 17 female. Median duration of TKI therapy prior to de-escalation was 8 years (range 4years-14 years). Median duration of major molecular response prior to dose reduction was 6 years( range 3years-12 years). In our study 17 of 29 patients had an outcome, while 12 patients are still on de-escalation phase with maintained MMR and are not included in the outcome analysis. Eight patient had loss of MMR(47.05%), 6 while on dose de-escalation and 2 after cessation of TKI. All eight patients achieved MMR after re-initiation of the prior dose, out of these 6 patients had sustained MMR(>6months) at reduced TKI dosing compared to conventional dose. Nine patients (52.9%) have successfully stopped TKI for median duration of 11months (range 6 to 19 months). Conclusion TKI de-escalation was safe for most patients with excellent prior response to TKI therapy. This way of dose reduction , ensured motivation and commitment of patients by doing regular OPD follow ups and BCR-ABL1 PCR testing. In our study 52.9% patient could successfully maintain TFR at a median follow up of 11 months of stopping the drug. We also identified that a subgroup of patients(35.29%) who were unsuccessful in complete cessation of therapy but maintained their molecular response at reduce dose of TKI . These findings show that lower TKI doses might maintain molecular responses in these patients, implying that such patients could be overtreated with routine dosing. More studies of dose de-escalation are warranted.

NIMG-77. MAGNETIC RESONANCE IMAGING AND AMINO ACID POSITRON EMISSION TOMOGRAPHY IN DIFFERENTIATING TUMOR RECURRENCE FROM RADIATION NECROSIS IN HIGH GRADE GLIOMAS

Abstract BACKGROUND AND PURPOSE Differentiating tumor recurrence (TR) from radiation necrosis (RN) in high grade glioma (HGG) following radiotherapy can be challenging. The ability of conventional magnetic resonance imaging (MRI) to differentiate TR from post-therapeutic effects is often limited. Multiparametric advanced MRI (perfusion) and positron emission tomography (PET) with amino acid tracers, specifically 18F-Fluoroethyl-Tyrosine (FET) can provide relevant additional information on tumor metabolism, which allows for a more accurate diagnosis to differentiate tumor recurrence from radiation necrosis in high grade gliomas. MATERIALS AND METHODS Prospective analysis of 62 lesions in 62 patients with HGG who underwent both MRI and FET-PET imaging within three weeks intervals was done independently by a neuroradiologist and nuclear medicine physician. The study was conducted in a tertiary care oncology center between July 2018 and August 2021. Manually segmented regions of interest were placed over the areas of maximum enhancement/suspicion on MRI and FET uptake, which were used to calculate the relative cerebral volume (rCBV) and tumor to background ratios, respectively. Definitive diagnosis (TR versus RN) was made on clinico-radiological follow-up or histopathological report (wherever available). RESULTS Out of the 62 lesions that were studied, 46 and 16 had TR and RN, respectively. The sensitivity and specificity for determination of TR in HGG with conventional MRI were 98% and 62.5% respectively, while with FET-PET it was 91% and 87.5% respectively. The PPV , NPV and accuracy for MRI were 88%, 91% , 89% , while for FET-PET it was 95%, 78% and 90% respectively. A combination of MRI and PET parameters (mean target-to-background ratio), demonstrated an increase in diagnostic accuracy to 97%. CONCLUSION Cumulative imaging with MRI and FET-PET offers a multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value.

Pedicled flaps for reconstruction after surgeries of lower limb malignant tumors - A feasible tool in the arsenal of a surgeon? – A review of 24 cases operated in a tertiary care oncology centre in north eastern part of India

With the advent of free flaps, pedicled flaps have taken somewhat of a backseat in reconstruction of post-surgical defects of the lower limb. However neither are all candidates suitable for free flaps nor is the procedure an easy one to perform in all centres provided the constrains of available facilities and operation theatre dates. In this retrospective and prospective study carried out in a tertiary care oncology centre in the north eastern part of india we review the outcome and feasibility of pedicled flaps for reconstruction after surgeries of lower limb malignant tumors.

CML-428 Real World Data of Treatment Free Remission (TFR) in Patients With Chronic Myeloid Leukemia (CML) Treated at a Tertiary Care Oncology Center in India

TFR has emerged as a new treatment goal in treatment of CML. To describe the outcomes of CML patients undergoing treatment free remission (TFR) in clinical practice. Retrospective analysis of CML patients treated from January 2018 to December 2021 who underwent TFR. Tertiary care cancer center Patients: 38 patients who opted for TFR after counselling or tyrosine kinase inhibitor (TKI) stopped due to various reasons in deep molecular response (DMR) were included. 92% were treated with imatinib at diagnosis. Median duration of TKI treatment was 135 months (6-242). 97.5% achieved DMR on TKI and median time from TKI initiation to DMR was 96 months (12-228). Median duration of DMR prior to TKI discontinuation was 41 months (0-67). TKI was discontinued after counselling for TFR in 26 patients (68%) while it was discontinued due to intolerance in 10 patients (29%). Data was analyzed for molecular relapse (MR), survival without molecular relapse (SWMR), TFR duration, and factors affecting MR. At median follow up of 25 months, nine patients (23.7%) had molecular relapse and three patients died. Median SWMR was not reached, and 2-year estimated SWMR was 65.2% (95%CI,47.2-83.2). After censoring for the competing events of death, 2-year cumulative molecular relapse was 26.8% (95%CI, 10.5-43). Median time to MR was 4 months. Of all relapses, 55.5% occurred in the first six months of TFR. Nine patients (23.7%) were restarted on TKI. Two patients with MR were not restarted on TKI as one patient died immediately after MR and another patient was not keen on restarting TKI despite repeated counselling. Median TFR duration was not reached, and 2-year estimated TFR was 73.4% (95%CI, 58.3-88.5). After restart of TKI, median duration to achieve MMR was 6 months (range, 1-17) in patients with molecular relapse. At the time of analysis, molecular disease statuses were DMR, MMR and less than MMR in 23, 10 and 2 patients respectively. TKI can be safely discontinued in real life practice in chronic phase CML patients in DMR and comparable TFR outcomes can be achieved. Grant acknowledgement: None.

Comparison of Three Methods for Enumeration of Residual White Blood Cells in Single Donor Apheresis Platelets

Background and Objectives: The aim of this study was to compare three platforms side-by-side: Nageotte hemocytometer, flow cytometry (FC), and standard hematology analyzer for enumeration of residual white blood cells (rWBCs) in single donor platelets (SDPs) apheresis. Materials and Methods: This was a prospective observational study conducted in a tertiary care oncology center by evaluating 36 units of SDP that were collected and tested in parallel by three different methods for the enumeration of rWBCs. All tests were performed within 24 h of collection according to the manufacturers' recommended methods. Counting by the Nageotte hemocytometer was done by: rWBC/μl = (cells counted × dilution/gridded area volume [50 μl]) and FC calculation was performed by: rWBC/μl = (total beads × total number of leukocyte events/total beads acquired × total sample volume). Results: The number of rWBCs detected by FC was between 1 white blood cell (WBC)/μl and 8 WBCs/μl; whereas, those detected by Nageotte chamber were between 3 WBC/μl and 6 WBCs/μl. The range of rWBC detected by hematology analyzer was 100 WBC/μl to 270 WBCs/μl. There was no correlation observed between the results obtained in standard hematology analyzer with any of the other two methods. The concordance correlation coefficient was measured by kappa analysis and found to be 0.71 between hemocytometry and FC. Linear regression analysis also showed a moderate correlation (R 2 = 0.42) between the two methods. However, the coefficient of variation was found to be 49.32% in Nageotte method compared to the 17.55% in FC (P &lt; 0.001). Conclusion: FC followed by Nageotte chamber counting is a better method compared to the standard hematology analyzer for the enumeration of rWBCs. To overcome the cost of FC it is high time to explore the scope and feasibility of a centralized quality monitoring system in India for all leukoreduced blood components.

22P A comparison of new ESGO-ESTRO-ESP endometrial risk classification with previous classification in predicting outcome

BackgroundThe new ESGO-ESTRO-ESP 2020 risk classification system (molecular classification unknown) has allocated fewer patients to the high-risk group compared to the previous risk stratification system in 2016. The study aims to clinically validate the new system in predicting the outcome compared to the previous one.MethodsWe retrospectively analyzed the data of 684 patients treated between 2009 and 2013 for carcinoma endometrium in a tertiary care oncology center. The three years overall survival (OS) and disease-free survival (DFS) estimates were generated independently using the Kaplan Meier method for the new and previous classification system. Akaike information criterion and concordance index was calculated between both staging systems to identify better predictive model.ResultsTable: 22PESGO 2016 and ESGO-2020 cross-tabulationESGO-2020TotalLowIntermediateHigh- IntermediateHighAdvancedESGO 2016Low2160000216Intermediate08100081High-Intermediate05440058High011241580283Advanced00024446Total21613612816044684 Open table in a new tab ConclusionsThe new 2020 risk stratification appears better predictive of survival events.Legal entity responsible for the studyInstitutional Review Board, Regional Cancer Centre, Thiruvananthapuram.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest. BackgroundThe new ESGO-ESTRO-ESP 2020 risk classification system (molecular classification unknown) has allocated fewer patients to the high-risk group compared to the previous risk stratification system in 2016. The study aims to clinically validate the new system in predicting the outcome compared to the previous one. The new ESGO-ESTRO-ESP 2020 risk classification system (molecular classification unknown) has allocated fewer patients to the high-risk group compared to the previous risk stratification system in 2016. The study aims to clinically validate the new system in predicting the outcome compared to the previous one. MethodsWe retrospectively analyzed the data of 684 patients treated between 2009 and 2013 for carcinoma endometrium in a tertiary care oncology center. The three years overall survival (OS) and disease-free survival (DFS) estimates were generated independently using the Kaplan Meier method for the new and previous classification system. Akaike information criterion and concordance index was calculated between both staging systems to identify better predictive model. We retrospectively analyzed the data of 684 patients treated between 2009 and 2013 for carcinoma endometrium in a tertiary care oncology center. The three years overall survival (OS) and disease-free survival (DFS) estimates were generated independently using the Kaplan Meier method for the new and previous classification system. Akaike information criterion and concordance index was calculated between both staging systems to identify better predictive model. ResultsTable: 22PESGO 2016 and ESGO-2020 cross-tabulationESGO-2020TotalLowIntermediateHigh- IntermediateHighAdvancedESGO 2016Low2160000216Intermediate08100081High-Intermediate05440058High011241580283Advanced00024446Total21613612816044684 Open table in a new tab ConclusionsThe new 2020 risk stratification appears better predictive of survival events. The new 2020 risk stratification appears better predictive of survival events.

Are we missing reverse TRALI? – A real world experience from a tertiary care oncology centre in India

Transfusion related acute lung injury (TRALI) is a rare but potentially fatal pulmonary complication of transfusion that presents as acute hypoxemia and non-cardiogenic pulmonary oedema, developing during or within six hours of transfusion. Majority of the cases reported are due to transfusion of plasma rich blood components containing antibodies to human leukocyte antigen (anti-HLA) or human neutrophil antigen (anti-HNA). Rarely, anti-HLA or anti-HNA in recipients against transfused donor leukocyte antigens, cause TRALI by a reverse mechanism. Herein, we report three cases of suspected TRALI following transfusions of buffy coat derived granulocytes and peripheral blood stem cells. Three patients with hematological malignancies developed pulmonary symptoms after transfusions of leukocyte rich blood components. All cases showed findings of bilateral pulmonary infiltrates at chest radiography and patients were managed accordingly; however, all three expired within seven days of transfusion due to progressive respiratory deterioration. The patients were transfusion dependent for a long time and had received multiple non-leukoreduced blood components in the past. Clinical findings in all three cases indicate the possibility of reverse TRALI. Although, patients’ anti-HLA or anti-HNA antibodies concordance with donors’ cognate antigens (HLA and HNA) was not confirmed; yet these three cases suggest that reverse pathogenesis of TRALI is not as infrequent as reported in the literature. However, reverse TRALI has not been confirmed as the presence and nature of antibodies in the transfused recipient were not investigated due to the non availability of immunodiagnostic tests in India.

The determinants of donor safety and product quality in optimization of apheresis granulocyte harvest: An experience from a tertiary care oncology centre in India

Allogeneic granulocyte transfusions play a substantial role in treatment of lifethreatening neutropenia-associated infections in patients undergoing intensive chemotherapy and hematopoietic stem cell transplant. Granulocyte harvest by apheresis is considered a safe and effective method to obtain adequate therapeutic granulocyte dosage for clinical effectiveness. This study described the experiences associated with apheresis granulocyte harvest procedures in our tertiary care haemato-oncology centre. We have analysed the incidence of adverse events (AEs) with associated potential risk factors contributing to donor safety and improvement in product quality. Retrospective data of 131 healthy allogeneic donors who underwent granulocyte harvest from May 2016 to July 2020 were analyzed. AEs were observed in overall 29 procedures (22.13%), including 14.50% citrate reactions, 7.6% venous access-related reactions, and 1.52% vasovagal reactions. Older age (p = 0.012) and higher body mass index (p = 0.015) in donors were significant variables found associated with a higher incidence of AEs. There was no significant impact of AEs on granulocyte product yield (p = 0.41) with a median collection yield of 1.73 × 10 10 cells/ unit. In multivariate analysis, post-mobilization parameters like total leukocyte counts (p = 0.036), absolute neutrophil counts (p = 0.042), and platelet counts (p = 0.006) showed a positive correlation with higher product yield. All the donors successfully donated and tolerated granulocyte colony stimulating factor plus dexamethasone mobilization and granulocyte apheresis harvest without any serious AEs. Our study shows that optimal technical and procedural modifications during apheresis granulocyte harvest procedures can overcome the associated potential risks by providing donor safety and improving product quality.

Plateletpheresis donation through donor awareness, motivation, and recruitment drives: A unique concept and experience from a tertiary care oncology centre in India.

The majority of blood donor motivational and awareness activities are directed toward whole blood donation and not much emphasis is given to the plateletpheresis. The study was designed to analyze the effectiveness of the unique concept of platelet drives (PD) to increase voluntary plateletpheresis donations. The study was a retrospective study conducted at a tertiary care oncology hospital-based blood transfusion services (BTS). A total of 13 PDs were conducted from January 2016 to December 2020. A total of 559 potential donors came for the donor registration and 125 donors got deferred on medical history. A total of 434 donors gave their samples for the testing of plateletpheresis. The median age of potential male and female donors was 32 and 30 years respectively. A total of 58 males and two females have donated single donor platelets (14.3% vs. 7.4%, P=0.319). The median age of male and female donors was 36 and 42 years, respectively. In male donors, 48 had donated once, seven donated twice, two donated thrice and one donor donated four times. Out of two female donors, one donor donated twice and the other donor donated four times. The female donors were more committed to repeat donations (P=0.004). Since the start of PDs, the number of voluntary donations has increased considerably over the years. PDs have helped in increasing the number of voluntary plateletpheresis donors. All the BTS must have the standard operating procedures in place for these kinds of awareness and motivational drives.

Clinicoepidemiological profile of adenoid cystic carcinoma: Experience from a tertiary care oncology center in Kashmir, India

Background: Adenoid cystic carcinoma (ACC) is a relatively rare tumor mostly involving head and neck region of the body. Due to lack of high-quality evidence, optimal treatment is still controversial and continues to evolve over time. Aim and Objectives: To analyze the clinicoepidemiological profile of ACC in Kashmir. Materials and Methods: Data of 30 patients, who were treated in the Regional Cancer Center at She-i-Kashmir Institute of Medical Sciences (Deemed University, Srinagar) between January 2015 and December 2019, were reviewed with respect to their demographic and clinical profile. Results: The study included 30 patients with ACC. The mean age at presentation was 55 ± 12.15 years. There were 10 (33.3%) males and 20 (66.6%) females. Among salivary gland ACC s, sublingual gland (06/30, 20%) was the most common site followed by parotid gland (05/30, 16.7%). Nonhead and neck primary ACC cases were reported from lung (6.7%) and breast (6.7%). Majority of the patients presented in stage-III (43.3). Only 5 patients presented with distant metastasis. All patients were subjected to surgery. Adjuvant radiotherapy was given in 18 patients (60%). Three patients received all three modalities (surgery, radiotherapy, and chemotherapy). The overall one year survival was 96%. However, the mean & median survivals reported were 24 & 18 months respectively. Surgery with negative surgical margin is the first choice of treatment for the patients with ACC. Our findings show that the prognosis of patients with ACC in our center is comparable to other parts of country. Conclusion: ACC has locally aggressive behavior. Adjuvant radiotherapy improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.

Cytomorphological Categorization of Thyroid Lesions according to The Bethesda System for Reporting Thyroid Cytology and Correlation with their Histological Outcome: An Indian Oncology Centre Experience.

Objective:The objective of this study was to report the experience of an Indian premiere tertiary care oncology center in reporting fine needle aspiration cytology of thyroid lesions according to the Bethesda system of reporting thyroid cytopathology (TBSRTC) given by National Cancer Institute (NCI). These were then correlated with their histopathological outcome, analyzing the level of specificity and sensitivity of the procedure.Material and Methods:Aspiration cytology of thyroid lesions, presented during a 5.5-year duration, was reported retrospectively and prospectively, according TBSRTC, and correlated with their histopathologic diagnosis.Results:A total of 431 patients were evaluated comprising 289 females and 142 males, with a median age of 52 years. Among the cytological categories 80 (18.6%) were non-diagnostic (ND), 131 (30.2%) benign, 45 (10.4%) follicular lesion of undetermined significance (FLUS), 27 (6.3%) follicular neoplasm, 33 (7.9%) suspicious for malignancy (SM), and 115 (26.7%) malignant. Histopathology reports were available in 142 of these cases. Final malignant diagnosis was reported in 11 of 14 ND (78.6%), 5 of 18 benign cases (27.7%); 9 of 17 FLUS (52.9%), 7 of 13 FLUS (53.89%), 19 of 20 SM (95%), and 58 of 60 malignant cases (96.7%). The procedure had sensitivity of 94.4%, specificity of 61.9%, positive predictive value of 90.3% and negative predictive value of 72.22%.Conclusion:TBSRTC provides uniform categorization of thyroid cytology, which also helps in further management. This valid system has helped to streamline the reporting terminologies as well as the clinical management.

Serial monitoring of ionised calcium levels in plateletpheresis donors: A study from tertiary care oncology centre in India

BackgroundPlateletpheresis is a safe procedure, and the most common reaction is hypocalcemia which is transient and self-limiting, but it can have an impact on donor experience and donor return rate. AimTo serially monitor the ionized calcium levels of the plateletpheresis donors and to correlate with symptoms of hypocalcemia if any. MethodsIt was a prospective observational study in 126 healthy voluntary donors eligible for plateletpheresis as per the Departmental SOP and after taking written informed consent. Procedures were conducted on continuous flow centrifugation (CFC) and intermittent flow centrifugation (IFC) cell separators. Donor blood samples were collected in pre-heparinized syringes at different intervals to measure ionized calcium levels (iCa++) by venous blood gas analysis (Cobas 221). ResultsThere was a continuous and gradual decrease in iCa++ from start to 30–45 minutes during the procedure; while the levels showed a gradual increase at end of the procedure and reached near the baseline values after 15−30 min of completion of the procedure. The change in iCa++ was statistically significant at 30 min and 45 min (p < 0.05), which was correlated with symptoms of hypocalcemia observed in 32.5 % (41/126) of the donors. Females experienced more symptoms of hypocalcemia as compared to males (p < 0.01). Donors who underwent plateletpheresis on the IFC machine experienced more symptoms of hypocalcemia as compared to the CFC machine (p < 0.05). ConclusionFor donors with persistent symptoms of hypocalcemia which are unrelieved by procedural modifications (reducing blood return rate, citrate infusion rate, etc.) measurement of iCa++ and administration of oral calcium tablets may be considered.

Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India.

BACKGROUNDSurgical resection is a treatment of choice for gallbladder cancer (GBC) patients but only 10% of patients have a resectable disease at presentation. Even after surgical resection, overall survival (OS) has been poor due to high rates of recurrence. Combination of surgery and systemic therapy can improve outcomes in this aggressive disease.AIMTo summarize our single-center experience with multimodality management of resectable GBC patients.METHODSData of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database. Information extracted included demographics, operative and perioperative details, histopathology, neoadjuvant/adjuvant therapy, follow-up, and recurrence. To know the factors associated with recurrence and OS, univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables, respectively. Multivariate analysis was done using multiple regression analysis.RESULTSOf 274 patients with GBC taken up for surgical resection, 172 (62.7%) were female and the median age was 56 years. On exploration, 102 patients were found to have a metastatic or unresectable disease (distant metastasis in 66 and locally unresectable in 34). Of 172 patients who finally underwent surgery, 93 (54%) underwent wedge resection followed by anatomical segment IVb/V resection in 66 (38.4%) and modified extended right hepatectomy in 12 (7%) patients. The postoperative mortality at 90 d was 4.6%. During a median follow-up period of 20 mo, 71 (41.2%) patients developed recurrence. Estimated 1-, 3-, and 5-years OS rates were 86.5%, 56%, and 43.5%, respectively. Estimated 1- and 3-year disease free survival (DFS) rates were 75% and 49.2%, respectively. On multivariate analysis, inferior OS was seen with pT3/T4 tumor (P = 0.0001), perineural invasion (P = 0.0096), and R+ resection (P = 0.0125). However, only pT3/T4 tumors were associated with a poor DFS (P < 0.0001).CONCLUSIONMultimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%. R+ resection, higher T stage, and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes. Multimodality treatment of GBC has potential to improve the survival of GBC patients.

A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India

AbstractIntroduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children.Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India.Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis.Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant.Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.

Serous endometrial intraepithelial carcinoma: A clinico-pathological study of 48 cases and its association with endometrial polyps – A tertiary care oncology centre experience

BackgroundEndometrial serous carcinoma (ESC) is an aggressive neoplasm wherein the recent studies have shown that it arises from its putative precursor namely the serous endometrial intraepithelial carcinoma (SEIC). SEIC usually arises in inactive/ atrophic endometrium but surprisingly is frequently associated endometrial polyps (EPs). The aim of this study was to assess the incidence of SEIC with or without invasion, its clinical behaviour and association with endometrial polyp. Materials and MethodsAfter Institutional review board approval, a total of 205 samples (belonging to 120 patients); diagnosed as ESC from January 2009 to December 2015 were retrieved and reviewed for presence of in situ carcinoma and also for associated endometrial polyp. ResultsThe mean age at diagnosis was 62.40 years with postmenopausal bleeding being the most common presenting symptom. The incidence of SEIC with or without invasive tumor was 40% (48/120). Of these 48 cases; 25 cases were associated with in-situ carcinoma arising in the EPs which amounted to 52% of the total cases. The overall three year survival and disease free survival in SEIC with or without invasion were 1.9% and 0.25%, indicating the aggressive nature of the disease. ConclusionSEIC is a difficult histopathological diagnosis and one should carefully look for these lesion, especially in the EPs which are frequently associated with them. Extensive sampling of the EP will be helpful to pick up in-situ carcinoma arising in EP. SEIC is an aggressive disease on its own with a propensity to develop distant metastasis even in the absence of myometrial invasion and hence should be treated with optimum surgical staging and if indicated aggressive adjuvant treatment protocols.

Ossifying Fibromas of the Head and Neck Region: A Clinicopathological Study of 45 Cases.

Ossifying fibromas of the head and neck region are classified as cemento-ossifying fibroma (COF) (odontogenic origin), and two types of juvenile ossifying fibromas: juvenile trabecular ossifying fibroma (JTOF), and juvenile psammomatous ossifying fibroma (JPOF). The potential for recurrence in JTOF and JPOF and the discovery of newer molecular signatures necessitates accurate histological classification. Over 12years (2005-2017), a total of 45 patients with 51 tumours were retrieved and reviewed for clinic-pathological features from the archives of a tertiary care oncology centre. Of 45 cases, COF, JTOF and JPOF comprised 13 (28.9%), 11 (24.4%) and 18 (40%) cases respectively. Three cases were unclassifiable. M: F ratio was 1:3.3, 1.1:1, 2:1 for COF, JTOF and JPOF respectively with an age range of 6-66years (mean: 24.6, median; 18.1years). The most common site for COF was mandible, for JTOF was maxilla, and for JPOF was ethmoid sinus. One case of mixed JTOF and JPOF histology was seen. Aneurysmal bone cyst-like areas were seen in 26.6% of cases, most commonly in JPOF. Follow up was available in 23 cases, and ranged from 4 to 207months. Three cases of JPOF had a recurrence and one patient with JTOF had residual disease after surgery. One case of COF demonstrated increased parathyroid hormone levels. COF, JTOF, and JPOF are clinically, radiologically and histologically distinct entities. Surgical resection is the mainstay of treatment. JPOF has a higher incidence of recurrence as compared to JTOF and COF and hence needs a more aggressive follow-up.

Two-piece oral facial prothesis retained with magnets for a complex maxillary facial defect: A clinical report

Total flap failure is a devastating complication in head and neck reconstruction. This clinical report describes the rehabilitation of an extensive maxillectomy defect communicating with the midface by using a 2-piece magnet-retained orofacial prosthesis fabricated in heat-processed acrylic resin. The innovative design and choice of material allowed early rehabilitation of a patient receiving palliative care at a resource-constrained tertiary care oncology center. Prosthetic treatment served to reduce the period of hospitalization and helped the patient to resocialize.

Moving Next-Generation Sequencing into the Clinic

AbstractWith an advancement in the field of molecular diagnostics, there has been a profound evolution in the testing modalities, especially in the field of oncology. In the past decade, sequencing technology has evolved drastically with the advent of high-throughput next-generation sequencing (NGS). Subsequently, the single-gene tests have been replaced by multigene panel-based assays, deep sequencing, massively parallel whole genome, whole-exome sequencing, and so on. NGS has provided molecular diagnostics professionals a wonderful tool to explore and unearth the genetic alterations, underpinning the pathophysiology of the disease. However, this development has posed new challenges which consist of the following; understanding the technology, types of platforms available, various sequencing strategies, bioinformatics and data analysis algorithm, reporting of various variants, and validation of assays and overall for developing NGS assay for clinical utility. The challenges involved sometimes impede development of these high-end assays in laboratories. The present article provides a broad overview of our journey in setting up the NGS assay in a molecular pathology laboratory at a tertiary care oncology center. We hereby describe various important points and steps to be followed while working on the NGS setup, right from its inception to final drafting of the reports, with inclusion of various validation steps. We aim at providing a beginner’s guide to set up NGS assays in the laboratory using recommended best practices and various international guidelines.