PALLIATIVE CHEMORADIOTHERAPY VERSUS RADIOTHERAPY ALONE FOR MANAGEMENT OF LOCALLY ADVANCED HEAD & NECK CARCINOMA PATIENTS WITH POOR PERFORMANCE STATUS
Introduction: Palliative external beam radiotherapy (EBRT) and chemotherapy is commonly practiced for management of locally advanced head & neck carcinoma (LAHNC) patients with poor performance status. This study compares EBRT alone and EBRT along with low dose Gemcitabine. Method: Study was conducted in Department of Radiotherapy, PGIMS Rohtak, in 2008-09; on histopathologically proven, untreated 60 cases of LAHNC, having KPS 60-70. Patients were randomly assigned either control group (n=30), given EBRT alone as 20Gy/5Fr/5days or study group (n=30), given EBRT as 20Gy/ 5Fr/ 5days and Gemcitabine 200 mg/m2 i.v. 2 hour prior to radiotherapy on day 1. Mean age was 53 years (26-84 years). Male:female ratio was 5:1. Most common primary site was base of tongue followed by larynx. Major symptoms were pain, difficulty in swallowing and altered voice. Patients were staged as per AJCC 2002; 2/3rd were stage IVA and 1/3rd were IVB. Despite randomization, there was no significant difference between two groups in age, sex, primary site, stage, and performance status. The side effects were graded as per RTOG criteria. Results: Objective response, 3 months post-treatment, in the chemoradiotherapy and radiotherapy alone group respectively was: CR 7% vs 0%; PR 30% vs 33%; stable disease 56% vs 46% and progressive disease 7% vs 20%. Subjective response, similarly was better in study group through out; even significantly better in dysphagia at 3 months follow up. Acute skin reactions were: Grade I- 73% vs 47% at 2 weeks and 60% vs 40% at 1 month respectively. Acute mucosal reactions were: Grade I- 30% vs 17%, Grade II- 43% vs 17% respectively. No hematological and grade III/IV skin or mucosal reactions observed. Differences in reactions were not statistically significant. Conclusion: In management of LAHNC patients with poor performance status, addition of low dose Gemcitabine to palliative radiotherapy gives better disease control and symptomatic relief without unmanageable side...
Cancer cells have a multitude of mechanisms to avoid and suppress immunity. Normal cells when exposed to chemical carcinogens, irradiation and certain viruses get transformed to cancer cells which can grow indefinitely. These cells have decreased requirements for growth factors; do not undergo apoptosis resulting in malignancy. The tumor cells have various antigens which are responsible for the generation of immune responses towards that particular tumor. There are two types of tumor antigens; tumors specific transplantation antigens (TSTAs) and tumor associated transplantation antigens (TATAs). The TSTAs are specific to tumor, result from mutations which alter the cellular proteins while TATAs may be proteins present in or during some stages of fetal development but not expressed or expressed at low levels in normal adult cells. Adoptive T-cell therapy involves the ex vivo cultivation of T cells with activity against a specific target cancer antigen to increase the frequency of these T cells to achieve therapeutic levels and then infuse them back into the patient. Oncolytic viruses selectively infect, replicate in, and kill tumor cells with no or limited impact on normal tissues which means that tumor cells have surface receptors to bind the virus. Monoclonal antibodies (mAbs) are immunoglobulins derived from a single clone of B cells, act by targeting an antigen which acts a ligand of receptor involved in signal transduction within the...
ABSTRACT Aim of the Study: To review and suggest treatment approach for rare diseases Leiomyosarcoma of testis. Material and Method: Here, we have reviewed management of Primary Leiomyosarcoma of the testis by search of case reports in PubMed Central, Embase, Cochrane, and Web of Science Central database. We have classified the obtained information as per Oxford Centre for Evidence Based Medicine (OCEBM) level of evidence, and National Comprehensive Cancer Network (NCCN) Categories of Evidence and Consensus. Here, current treatment scenario for sarcoma and its outcome will be discussed for a new case of low grade primary leiomyosarcoma of testis that was confirmed with Immuno-histochemistry after high inguinal orchidectomy, for painless testicular mass. Systematic review, line listing of old reported cases and treatment evidences were analysed by reviewing various international databases. Results: Leiomyosarcoma is a very rare disease, and only few cases have been reported on online databases. It is usually reported among elderly men following irradiation or long-term anabolic steroid use. Intensive search reveals lack of definitive guidelines for management of leiomyosarcoma because available evidence is level V as per OCEBM and level C as per NCCN. Conclusion: Even though early diagnosis and treatment by high inguinal orchidectomy improves survival and decreases risk of recurrence of leiomyosarcoma, there is need of research and definitive chemotherapy guidelines, similar to sarcoma of other site of the...
UNVEILING THE MYSTERIOUS WORLD OF SALIVARY DUCT CARCINOMA OF THE PAROTID GLAND- A RARE CASE REPORT AND REVIEW OF THE LITERATURE.
Among many variants of salivary gland tumors, salivary duct carcinoma (SDC) of the parotid gland is a highly aggressive and rare malignant tumor which ranks among those with the worst prognosis and a significant mortality. These tumors got their name based on its microscopic resemblance and being analogous to similar schemes in the ductal carcinoma of the breast. The characteristic microscopic features of salivary duct carcinoma are composed of comedo necrosis, a cribriform and papillary pattern of intraductal growth and aggressive infiltration to adjacent structures. Majority of cases are typically treated with radical parotidectomy with or without neck dissection followed by adjuvant radiotherapy. We present a case of a 60 year old male patient who presented with progressive facial paralysis and right parotid swelling. FNAC was positive for malignancy. PET-CT showed a lesion in right superficial lobe of parotid with bilateral neck nodes. Patient underwent right total parotidectomy with right radical neck dissection and left modified neck dissection. Facial nerve was preserved. Microscopic examination reported it as a salivary duct carcinoma, positive for Her2/neu antibody with lymph node metastasis (22/23). Patient received adjuvant radiotherapy and 12 cycles of Transtuzumab. There were no recurrences or metastases within 12 months of...
Gestational trophoblastic diseases include hydatidiform moles and gestational trophoblastic neoplasia i.e. invasive mole, choriocarcinoma, placental site trophoblastic tumor and epitheloid trophoblastic tumor. Incidence from India has been reported up to 2.4/ 1000 pregnancies, 2.5/ 1000 deliveries and 2.6/ 1000 live births. The standard protocols for management exist and are evolving fast. Though all gestational trophoblastic diseases are not malignant, still these need to be managed intensively, because of their potentially life threatening complications and common occurrence in fertility age group females. The better aspect is that; if timely and standard interventions are made; these are highly curable conditions, even with preservation of reproductive...
Desmoid tumor is a slow growing neoplasm with aggressive infiltration of adjacent tissue with very rare metastatic potential. We report a 35 years old female patient with desmoid tumor of the anterior abdominal wall who underwent primary resection followed by mesh pasty. Patient had a past history of abdominal surgery in form of caesarean section, and after 5 years of surgery, she presented with a lump over right hypochondrium since last one year. Patient was assessed before surgery by clinical evaluation, abdominal ultrasound, computerized axial tomography scanning (CT scan), magnetic resonance imaging (MRI), and histopathology and immunohistochemistry report.Patient was operated with wide local excision of rectus abdominis muscle mass with meshplasty under general anaesthesia. After all, histology in this case revealed a desmoid tumor with negative β-Catenin report of operated tissue. In view of the negative surgical margins, patient has been put on regular follow...
IMPACT OF CHRONOMODULATED RADIOTHERAPY ON ACUTE SKIN TOXICITY IN CHEST WALL IRRADIATED BREAST CANCER PATIENTS – A SINGLE INSTITUTION ANALYSIS.
Abstract: We explored the possible association between the timing of delivery of radiation and the grade of skin reaction that develops in breast cancer patients receiving chest wall irradiation as adjuvant treatment after modified radical mastectomy. Invasive breast cancer patients, registered during the period of January 2013 – December 2014, who had undergone modified radical mastectomy followed by chest wall irradiation, were eligible for inclusion to the study. All the patients received chest wall external beam radiotherapy (EBRT) to a dose of 50 Gy in 25 fractions, one fraction a day, five days a week, delivered as tangential opposed pair, from a Cobalt 60 teletherapy source. Patients were stratified based on whether they received EBRT in the morning (between 8 am – 11 am) or in the evening between (5 pm – 8 pm). The clinicopathological characteristics of patients in both the arms were relatively well balanced. The incidence of higher grade of skin reaction (grade 3 or 4) was 22.5 % compared to 35.7 % in the morning and evening arms respectively, which was statistically significant (p = 0.039). The time to development of Grade 3 or 4 toxicity was 4.44 weeks compared to 4.11 weeks in the morning and evening arms respectively, suggesting that higher toxicity developed earlier in the patients receiving EBRT in the evening, though not statistically significant (p =...
Primary Non-Hodgkin lymphoma (NHL) of liver is a very rare malignancy. Here, we report a case of 26 years old man who presented with right upper abdomen pain and lump, reduced appetite and progressive weakness of 4 month’s duration. Liver functions were deranged but serology was negative for viral markers and α Fetoprotein was within normal range. Ultrasonography and Computed Tomography scan of the abdomen revealed large nodule in right lobe of the liver. USG guided biopsy of liver mass and fluorescence in situ hybridization for CD markers established diagnosis of primary NHL of liver. Extensive investigations including X-ray of chest, whole-body positron-emission tomography scan and bone marrow biopsy showed no involvement of mediastinum, spleen, bone marrow or any other organ or lymph nodes significantly. Having B symptoms disease was staged IVB, the patient has been treated with 6 cycles of R-CHOP regimen (Rituximab/Cyclophosphamide–Doxorubicin–Vincristine–Prednisolone) followed by 2 courses of CHOP every three weekly. Response has been excellent and patient is asymptomatic as of now. This case highlights that primary hepatic lymphoma should be considered in the differential diagnosis of space-occupying liver lesions in presence of normal levels of...
Our objective is to review the current articles pertaining to multimodality treatment that surround the management of retromolar trigone (RMT) cancer patients. RMT tumors constitute a small minority of all oral cancers. Majority of these patients present with locally advanced stage and its treatment is challenging. Good oncologic outcomes can be achieved by advocating an aggressive surgical approach in combination with post operative radiation therapy. In this literature review we intend to discuss locally advanced trigone cancer and its outcome after the completion of the multimodality...
Primary involvement of vulva or breast by non-hodgkin lymphoma (NHL) is known to occur uncommonly. Only 24 cases of NHL vulva and around 250 cases of NHL breast alone have been reported, so far; but none with simultaneous involvement of the two sites together. We report the first case having both sites involved in a 35 year old Indian female.