Tertiary Oncology Research Articles

Good outcomes after aggressive treatment of immune checkpoint inhibitor related myasthenia gravis: a case series

IntroductionMyasthenia gravis (MG) is a rare but potentially life-threatening complication of immune- checkpoint inhibitor (ICI) therapy and often co-presents with myositis and myocarditis. We present a series of six patients from a tertiary oncology center.MethodsWe reviewed The Christie Hospital database of immunotherapy-related toxicity from 2017–2020. Symptom severity was assessed using the MGFA classification.ResultsSix patients with ICI-related MG were identified. The median number of preceding immunotherapy doses was 2. Common initial presenting complaints were ptosis (100%) and diplopia (50%) with 2/6 patients showing severe (MGFA > II) symptoms. Five patients had concomitant myositis and myocarditis. AChR or MuSK autoantibodies were positive in three patients. Two patients required advanced respiratory support.All patients received urgent treatment with intravenous methylprednisolone and mycophenolate. Five also received intravenous immunoglobulin and a single patient was treated additionally with abatacept and rituximab. No patient died from MG-related complications. All were successfully discharged following the acute episode.DiscussionPrevious case series of ICI-related MG have reported high mortality rates, particularly in those with overlapping myositis/myocarditis. In our cohort we demonstrate good outcomes associated with early aggressive treatment with IVIG, IVMP, and mycophenolate. An agreed national treatment protocol or clinical discussion forum would be beneficial.jamweaver75@gmail.com17

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.

Management of immune-related hepatitis in patients being treated with checkpoint inhibitors for metastatic melanoma, a review and case series.

Immune-related hepatitis is an adverse effect following treatment with immune-checkpoint inhibitors, such as ipilimumab, nivolumab and pembrolizumab. International guidelines advise on the use of corticosteroids as first-line treatment, although guidance on how to treat cases resistant to corticosteroids is limited. We aimed to evaluate the presentation and management of patients with grade 3-4 immune-related hepatitis, following treatment with immune-checkpoint inhibitors for stage 4 or unresectable or stage 3 melanoma, with a particular focus on steroid-refractory cases. A retrospective observational review of patients developing immune-related hepatitis whilst undergoing treatment with immune checkpoint inhibitors for advanced melanoma from July 2014 to February 2020 at a tertiary oncology centre. Forty-one patients developed immune-related hepatitis, of which 83% had been treated with the combination of ipilimumab and nivolumab. The median time to onset of IR-hepatitis was 47 days (range: 4-476), and the median time to peak alanine aminotransferase was 71 days (range: 4-478). Four patients had resolution of grade 3 immune-related hepatitis without the introduction of corticosteroids. A total of 37 patients were treated with corticosteroids. A total of 12 required oral treatment only and 13 were successfully managed as outpatients. Six patients had steroid-refractory immune-related hepatitis; and all received tacrolimus, with one also receiving mycophenolate mofetil and infliximab. This study describes the largest UK series of immune-related hepatitis patients in the literature. We present two important deviations from current guidelines. Firstly, there is some evidence that withholding steroids is possible in grade 3-4 immune-related hepatitis. Secondly, tacrolimus can be used successfully to manage patients resistant to corticosteroids, with the early introduction most beneficial to reduce time on steroids.

Minimally invasive treatment of conn's adenoma: real world cases in tertiary oncology center

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Video consulting during the COVID-19 pandemic- Improving or worsening access to care?

Introduction: The use of telemedicine in breast surgery occurred almost overnight to maintain outpatient service provision during the COVID-19 pandemic. There is concern that remote consultations could lead to a widening of health inequalities. To evaluate this issue further, the present study looked to explore patient attitudes and access towards video consultations (VCs) in a tertiary referral breast oncology centre.Methods: Research approval was granted from the Local NHS Quality Improvement Office. Prospective questionnaires were distributed to outpatients at the Nottingham Breast Institute from July to September 2021. Along with patient demographics, information regarding access to VC hardware and general attitudes towards VCs were collected. The data was tabulated and explored both quantitatively and qualitatively.Results: 519 questionnaires were analysed. The average age was 47.3 years (range 14-88 years). 92% of respondents had access to a video-enabled device, with 90% having access to a video-enabled smartphone. For each additional increase in decade of age over 40 years there was a decrease in access to a video-enabled device. Digital literacy also varied with age, with 61% of under 40s being happy to use VC technology independently compared to 39% of over 50s. Interestingly, 58% of respondents preferred telephone consultations and 80% face to face consultations when compared to VCs.Conclusion: This study illustrates that most patients only have access to a mobile phone for VCs and prefer traditional face to face consultations. Older patients were more likely to have poorer access to VCs and considerations are required to minimize inequalities in this group. Introduction: The use of telemedicine in breast surgery occurred almost overnight to maintain outpatient service provision during the COVID-19 pandemic. There is concern that remote consultations could lead to a widening of health inequalities. To evaluate this issue further, the present study looked to explore patient attitudes and access towards video consultations (VCs) in a tertiary referral breast oncology centre. Methods: Research approval was granted from the Local NHS Quality Improvement Office. Prospective questionnaires were distributed to outpatients at the Nottingham Breast Institute from July to September 2021. Along with patient demographics, information regarding access to VC hardware and general attitudes towards VCs were collected. The data was tabulated and explored both quantitatively and qualitatively. Results: 519 questionnaires were analysed. The average age was 47.3 years (range 14-88 years). 92% of respondents had access to a video-enabled device, with 90% having access to a video-enabled smartphone. For each additional increase in decade of age over 40 years there was a decrease in access to a video-enabled device. Digital literacy also varied with age, with 61% of under 40s being happy to use VC technology independently compared to 39% of over 50s. Interestingly, 58% of respondents preferred telephone consultations and 80% face to face consultations when compared to VCs. Conclusion: This study illustrates that most patients only have access to a mobile phone for VCs and prefer traditional face to face consultations. Older patients were more likely to have poorer access to VCs and considerations are required to minimize inequalities in this group.

Utility of surgical instruments in tertiary breast oncology centre

Introduction: Optimising surgical trays and reducing the number of instruments requiring sterilisation, has both financial and environmental benefits. For every 10 instruments there is an estimated £5.32 increase in cost, with the associated energy and transport usage having implications on the environment. The time/ergonomics of having fewer surgical instruments also has additional benefits to the surgical team and patient. In 2019, we performed around 1600 breast surgeries at our tertiary referral centre. This study looks at the utility of our surgical trays at the Nottingham Breast Institute (NBI).

Patient needs in evacuation of a tertiary oncology center.

To inform ongoing contingency planning, hospital staff conducted a cross-sectional survey of patients' needs in the event of a full-facility evacuation of a tertiary oncology center. Both outpatients and inpatients were included. Of the total of 269 patients, 76.6 percent were able to evacuate by walking out of the hospital and be transported sitting. Only 30 patients needed evacuation by an ambulance. Assessment of the lowest acceptable level of care after evacuation revealed that 66.5 percent of the patients could be discharged to their own home, including 40.8 percent of all inpatients. Due to the need to continue specialized cancer treatment, fewer patients could be transferred to other hospitals than found in previous studies of general acute care hospitals.

Patient reported experience in a radiation oncology department

Understanding patient experience is essential to providing high quality, person-centered care. A real-time baseline cross-sectional study was completed to identify gaps in patient experience that can be targeted for quality improvement (QI). This study is part of PROSE (Person-centered Radiation Oncology Service Enhancement), a QI initiative developed to improve patient experience at a tertiary cancer centre Radiation Oncology (RO) Department. Data was collected using the Your Voice Matters (YVM) questionnaire. The YVM captures information on the patient’s last visit, and questions are organized based on dimensions of person-centered care. Recruitment occurred between May and August 2019 in the radiation department. Consecutive patients during the study period were approached to complete the YVM either in reference to their initial consultation or previous treatment appointment. Percent positive scores were calculated for quantitative data and a content analysis was completed for open-text data. Of 512 patients approached, a total of 400 patients participated across tumors groups. Overall, patients highly endorsed positive experiences with feeling respected by their healthcare provider. Contacting the clinic, emotional support and wait times were rated as the least positive components of experience across appointment types and tumors groups. The Lung tumour group demonstrated worse experiences across all domains during treatments compared to all other tumour groups. Gaps and differences in patient experience were demonstrated across appointment types and tumour groups. This study provides direction to effectively develop and implement QI work aimed at improving patient experience. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

External Validation of O-RADS US Risk Stratification and Management System

Background The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system (O-RADS US) was designed to improve risk assessment and management of ovarian and adnexal lesions. Validation studies including both surgical and nonsurgical treatment as the reference standard remain lacking. Purpose To externally validate O-RADS US in women who underwent either surgical or nonsurgical treatment and to determine if incorporating acoustic shadowing as a benign finding improves diagnostic performance. Materials and Methods This retrospective study included consecutive women who underwent pelvic US between August 2015 and April 2017 at a tertiary referral oncology center. Two independent readers blinded to clinical and histologic outcome assigned an O-RADS risk category and an International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model risk of malignancy score to assessable lesions. Reference standards were surgical histopathology or 2-year imaging follow-up. Receiver operating characteristic (ROC) curve analysis was used to evaluate performance of the O-RADS US, ADNEX, and modified O-RADS models incorporating acoustic shadowing. Results In total, 227 women (mean age, 52 years ± 16 [SD]) with 262 ovarian or adnexal lesions were evaluated. Of these lesions, 187 (71%) were benign and 75 (29%) were malignant. The proportion of malignancy was 0% (0 of 100) for O-RADS 2, 3% (one of 32) for O-RADS 3, 35% (22 of 63) for O-RADS 4, and 78% (52 of 67) for O-RADS 5. The area under the ROC curve (AUC) for O-RADS and ADNEX was 0.91 (95% CI: 0.88, 0.94) and 0.95 (95% CI: 0.92, 0.97; P = .01), respectively. The addition of acoustic shadowing as a benign finding improved O-RADS AUC to 0.94 (95% CI: 0.91, 0.96; P = .01). Use of O-RADS 4 as a threshold yielded a sensitivity of 99% (74 of 75; 95% CI: 96, 100) and a specificity of 70% (131 of 187; 95% CI: 64, 77). Conclusion In a tertiary referral oncology center, the Ovarian-Adnexal Reporting and Data System US risk stratification and management system enabled accurate distinction of benign from malignant ovarian and adnexal lesions. Adding acoustic shadowing as a benign finding improved its diagnostic performance. © RSNA, 2022 See also the editorial by Levine in this issue.

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.

The length of time taken from gastrostomy tube insertion to removal and the factors influencing this following curative head and neck cancer treatment: a service evaluation at a single tertiary oncology centre.

Patients with head and neck cancer experience side effects following surgery, radiotherapy and chemotherapy which can significantly impact on their ability to take adequate oral diet. Some common side effects include dysphagia, taste changes, nausea, mucositis and altered saliva. In our local centre patients are offered a prophylactic gastrostomy feeding tube allowing timely enteral feeding if they are unable to meet their nutritional requirements orally. The primary aim of this service evaluation was to determine the average length of time from gastrostomy tube insertion to removal.

Clinical Profile and Outcomes of Primary Immunodeficiency and Malignancy in Childhood at a Tertiary Oncology Center in Developing Country

Primary immune deficiencies are a group of heterogenous genetic disorders characterized by frequent infections, autoimmunity and malignancy. In this study, we aimed to evaluate clinical characteristics, outcomes of children with malignancy developed on background of primary immunodeficiency and compare survival rates of patients between malignant lymphoma with primary immunodeficiency and without immunodeficiency from tertiary oncology center in a developing country. A total 23 patients with primary immunodeficiency and malignancy were evaluated retrospectively. A total of 26 malignancies (first or second) in 23 patients were determined. The median age at the time of the first malignancy was 8 years (ranges 2–18 years) with increased male ratio (M/F:14/9). Non-Hodgkin lymphoma (n = 17; 65%) was the most common malignancy, followed by Hodgkin lymphoma (n = 5), anaplastic ependymoma (n = 1), spinal glioblastoma multiforme (n = 1), retinoblastoma (n = 1) and intracranial hemangiopericytoma (n = 1). The median follow-up time of patients was 25 months (ranges between 1 and 189 months). The 5-year overall survival rate of patients with malignant lymphoma associated with primary immunodeficiency (41%) were lower than immunocompetent patients with malignant lymphoma (80%) (p = 0.000). The 5-year overall survival of patients was diagnosed between 2021 and 2013 years (62%) was higher than previous years (22%) (p = 0.03). In conclusion, non-Hodgkin lymphomas were the most common histopathologic type in patients with malignancy associated with primary immunodeficiency in the present study. The survival of patients with malignant lymphoma associated with primary immunodeficiency has improved in recent years, yet it is still lower than immunocompetent patients with lymphoma and new targeted drugs are required for better survival rates.

Abstract P1-18-33: Real-world outcomes with palbociclib, abemaciclib and ribociclib; experience of a tertiary oncology centre in the United Kingdom

Abstract Background 3 CDK4/6 inhibitors (CDKi) were approved 2015-7 and are standard of care for metastatic hormone-positive breast cancer, in first line with letrozole or second with fulvestrant. The Phase III randomised controlled trials (RCTs) show similar hazard ratios (HR) for progression-free survival (PFS) of 0.46-0.58. We compared them head-to-head and examined subgroups for differential response. Methods We retrospectively reviewed all patients who received CDKi up to March 2020 at our Oncology centre and the 4 local hospitals we serve. Kaplan-Meier method was used to generate time-to-event curves and Log-rank test was used to compare differences. Results 208 patients had median age 61 and follow-up 20 months. Palbociclib was most frequently used (128 patients) followed by abemaciclib (60) and ribociclib (20). Overall, median PFS was 20.8 months (95% confidence interval, CI, 17.2-28.0) and median OS was not reached. On the Kaplan-Meier curve there is a visible benefit with ribociclib, but due to the small group size, this did not reach statistical significance (p = 0.143). Patients received CDKi with aromatase inhibitor (176) or fulvestrant (32). Median PFS was 22.8 and 9.5 months respectively; HR 0.32 (95% CI 0.17-0.59). Median OS was not reached in either group; HR 0.22 (95% CI 0.09-0.56). Out of the ER strongly-positive patients (160), those with PR 7-8 did better than those with PR 0-4, with median PFS 28.7 and 14.0 months respectively; HR 0.40 (95% CI 0.22-0.72). Median OS was not reached for PR 7-8, and 31.8 months for PR 0-4. 115 patients received 1 (20%), 2 (13%) or more (12%) subsequent therapies. Patients who received everolimus at any point had better outcomes. Median OS was not reached in the everolimus group, and 28.5 months in the rest; HR 0.22 (95% CI 0.11-0.44). As patients suitable for everolimus may represent a distinct population, a comparison of baseline characteristics is presented [Table 1]. Patients with invasive ductal cancer (IDC) or lobular (ILC) had median PFS 17.1 and 24.2 months respectively; HR 0.69 (95% CI 0.43-1.09). Median OS was not reached in either group; HR 0.54 (95% CI 0.26-1.10). Median number of cycles was 17. Treatment was ongoing in 42% of patients at data cut-off. Dose was reduced in 43% and delayed in 74%. Mean dose intensity was 85%. Reasons for stopping treatment were progressive disease (70%), toxicity (20%) or unrecorded (10%). 60% experienced toxicities of grade 3 or above, or which resulted in dose adjustment. The commonest were neutropenia (38%), diarrhoea (11%) and lethargy (10%). Less frequent were mucositis, nausea, vomiting and anorexia (2% each). Of 68 patients with accessible documentation of radiological response, 41 had partial and 27 had complete response. Conclusions Our outcomes are comparable to those achieved in RCTs, despite poorer baseline characteristics [Table 2]. Our data suggest OS benefit with ribociclib. Predictors of good outcome include subsequent everolimus, strong PR+, strong ER+ and ILC. The prognostic benefit of lobular histology has not been definitively shown elsewhere. Table 1.comparing baseline characteristics between the everolimus subgroup and the restSubsequent therapy included everolimus n=35Subsequent therapy excluded everolimus n=61DemographicsMedian age (range)62 (30-83)58 (34-90)PS 0-1 (%)34 (97%)51 (84%)PS 2-3 (%)1 (3%)8 (13%)Tumour characteristicsLeft-sided breast cancer (%)20 (57%)27 (44%)Right-sided breast cancer (%)10 (29%)25 (41%)Bilateral (%)0 (0%)2 (3%)Data missing (%)5 (14%)7 (11%)Grade 1 (%)1 (3%)1 (2%)Grade 2 (%)17 (49%)24 (39%)Grade 3 (%)10 (29%)24 (39%)Data missing (%)7 (20%)12 (20%)Ductal (%)22 (63%)43 (70%)Lobular (%)8 (23%)7 (11%)Data missing (%)5 (14%)11 (18%)PR 7-817 (49%)18 (30%)ER 7-828 (80%)46 (75%)Visceral disease13 (37%)30 (49%)Metastatic at diagnosis (%)5 (14%)10 (16%)Median metastasis-free interval (range)9.5 years (0-37.7 years)4.6 years (0-36.0 years)Subsequent lines of therapy19 (26%)34 (56%)213 (37%)15 (25%)3 or more13 (37%)12 (20%) Table 2.comparing baseline characteristics between the current study and the key RCTsAuditRCTsMedian age (range)6160PS 0-188%99%PS 2-316%1%Ductal62%38%Lobular16%7%Histology missing22%55%PR 0-418%PR- 12% in 1L, 23% in 2LPR 7-848%PR+ 54% in 1L, 74% in 2LVisceral disease40%49%Bone-only18%23%Metastatic at diagnosis21%34%Not metastatic at diagnosis79%66%Median metastasis-free interval6.9 years51% >12m, 9% <=12m Citation Format: Lei Wang, Muhammad Ibrahim, Anthony Neal. Real-world outcomes with palbociclib, abemaciclib and ribociclib; experience of a tertiary oncology centre in the United Kingdom [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-33.

Fertility preservation in gynaecology oncology patients: Experience from an Australian tertiary oncology centre.

Management for gynaecological cancers often includes removal of the reproductive organs and/or the use of gonadotoxic therapies resulting in sub-fertility. Oncofertility and discussion of fertility preservation in these patients is critical. To determine the rate of fertility preservation discussion among a cohort of patients with a gynaecological cancer and what determinants impact likelihood of a discussion. A seven-year quantitative retrospective study was conducted at a single oncology centre, including 15-45year old patients with a gynaecological cancer. The primary outcome was if a fertility preservation discussion occurred during a consultation. Secondary outcomes included if a referral was made and what fertility preservation services were undertaken. Determinants that impacted the likelihood of a fertility preservation discussion were analysed. One hundred and twenty-one patients were analysed. There were 84 (69%) patients who had a documented fertility preservation discussion, and 46% were referred to a fertility specialist for consultation. Age was a significant determinant, with patients aged 30-39years of age more commonly having a fertility preservation discussion. Patients with a high-grade cancer compared to patients with a lower-grade cancer (grade one or two) were only a third as likely to have a discussion surrounding their fertility (odds ratio: 0.33, 95% CI: 0.13-0.86; P=0.02). We conclude that rates of discussion around fertility options for patients with cancer are lower than the recommended guidelines. Oncofertility is an important discipline which we believe needs to be emphasised within the gynaecology oncology community and management of patients should include a multi-disciplinary team.

Outcomes in Clinically Node Positive Bladder Cancer Patients at a Tertiary Cancer Centre in the UK

Purpose: Poor prognosis TxN+M0 bladder cancer has limited evidence-based guidelines defining optimum management. We evaluated real-world outcomes and treatment approaches for patients at a tertiary oncology centre.

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.

Outcomes of cataract surgery in patients previously treated with orbital radiotherapy.

To quantify the risks for cataract surgery in patients who have previously undergone external beam radiotherapy (EBRT). Tertiary ophthalmology and oncology hospital. Retrospective case series. Patients treated with orbital EBRT at the Beatson West of Scotland Cancer Centre between 2001 and 2019 were identified, and clinical records were reviewed to identify those who had subsequently undergone cataract surgery. Preoperative and postoperative case records, and operation records, were reviewed to identify demographic data and data regarding complications and surgical outcomes. 46 eyes (of 33 patients) were included. The indications for EBRT included thyroid eye disease, lymphoma, choroidal metastases, and other orbital malignancies. Mean corrected preoperative Snellen visual acuity was 20/100 (range 20/30 to 20/2000) improving to 20/25 (20/12 to 20/160, 1-way analysis of variance P < .01). Mean visual gain was 0.5 logMAR (-0.9 to 1.9). There was 1 case of posterior capsule (PC) rupture with vitreous loss (2%). Dense PC plaque was noted intraoperatively in 19.5% (n = 9). 13% (n = 6) required Nd:YAG laser posterior capsulotomy. There were 6 cases (13%) of cystoid macular edema (CME). Visual outcomes after cataract surgery in this cohort of patients were similar to those obtained in a nationwide cohort. EBRT seemed to be associated with an increased incidence of intraoperative PC plaque, postoperative CME (which in most cases settled with treatment), and need for posterior capsulotomy.

Pulmonary Oncology—Scope of the Pulmonologist

AbstractThe International Agency for Research on Cancer GLOBOCAN project has predicted that India's cancer burden will nearly double in the next 20 years, from slightly more than a million new cases in 2012 to more than 1·7 million by 2035. In India, chronic respiratory diseases have emerged as a leading health care burden with chronic obstructive pulmonary disease (COPD) being the second leading cause of deaths and disability-adjusted life years. Patients with COPD are 6.35 times more likely to develop lung cancer. The deadly dual epidemic of “chronic respiratory diseases and cancer” warrants not only prevention but also creating an increased awareness among oncologists as well as pulmonologists to enable early diagnosis and treatment. It would be incorrect to assume that the scope of a pulmonologist in oncology is just diagnosing and treating lung cancer or prescribing chemotherapy for lung cancer. There is a larger world full of opportunities beyond that, and we look at the pulmonologist as a member of a multidisciplinary oncology team working together with the surgical, radiation, and medical oncologist and ancillary specialties to address all the issues highlighted earlier that are faced in oncology practice. The current exposure to pulmonary oncology and related complications during postgraduate training for respiratory medicine in India is limited. It is necessary not only to educate the pulmonologist on their role in an oncology setup but also to increase the awareness across all oncology specialties regarding the pulmonologist's contribution in management of the cancer patient. In this review, written based on our experience gained in our pulmonology service in our tertiary oncology center, we have tried to portray the wide role of the pulmonologist in oncology. We have realized that what is lacking is the basic awareness regarding the above potential, both among pulmonologists and oncologists. Our mission is to take this message across specialists in India, highlighting how we can work synergistically in the fight against cancer.

Primary bone tumors and tumor-like lesions of the wrist: a single-center experience

Aim: The incidence of primary bone tumors of the wrist is increasing. The aim of this study was to examine the characteristics, treatment protocols, complication rates, and functional outcomes of bone tumors of the wrist treated in a tertiary orthopedic oncology center.&#x0D; Material and Method: We retrospectively analyzed 93 patients with bone tumors located in the wrist (63 distal radius, 23 distal ulna, 7 carpal bone) who were operated on between 2005 and 2020. Demographic information was recorded. Functional outcomes were evaluated with the Musculoskeletal Tumor Society System (MSTS) scoring system.&#x0D; Results: There were 57 male and 36 female patients. The average follow-up period was 32 months (range 16-163). There were 82 benign and 11 malignant lesions. Distal radius was the most common site of involvement. The most common type of benign tumor in the distal radius and distal ulna was the giant cell tumor (GCT; 26 and 10 patients, respectively). Among the malignant tumors in the distal radius, 5 were Ewing sarcoma, and 2 were osteosarcoma. All patients with malignant lesions underwent wide surgical resection and free vascularized fibular graft (FVFG) reconstruction. Of the malignant tumors in the distal ulna, 3 were Ewing sarcoma, and 1 was osteosarcoma. These were treated with wide resection and FVFG reconstruction (n=3) and wide resection and fibular strut graft (n=1). The rarest site for tumors in the wrist was the carpal bones. Carpal bone lesions included scaphoid (n=5) and lunate (n=2) tumors. In all of these patients, pathological examination indicated intraosseous ganglion cysts. The average MSTS score of all patients was 27 (range 24-30). Of the 36 patients with GCT, 4 (11%) developed local recurrence. One patient with Ewing sarcoma developed local recurrence and underwent secondary amputation. Distant lung metastasis was observed in 5 of 8 patients with Ewing sarcoma. &#x0D; Conclusion: Our study confirmed that bone tumors in the wrist are rare. Most benign tumors can be treated with curettage and cement augmentation. For malignant tumors, it is possible to restore function with FVFG.

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.