Peripheral neuropathy is a structural or functional abnormality of peripheral nerves giving rise to neuropathic symptoms. Neuropathic symptoms can be motor, sensory and autonomic or varied combination of these major categories. Chemotherapeutic agents frequently cause various neuropathic symptoms and signs depending upon culprit agent, its dose and duration. Chemotherapy-Induced Peripheral Neurotoxicity is a common, disabling and dose-limiting side-effect of cancer treatment and its assessment is difficult. Some patients complain of tingling, numbness and pain in distal extremities while others may also develop motor and autonomic symptoms. Some patients remain symptomatic even after discontinuation of offending drugs. Patients with chemotherapy induced neuropathy bear higher healthcare cost than cancer patients without neuropathy. As new chemotherapeutic agents are being developed it is important to measure chemotherapy induced peripheral neuropathy accurately so that it can be recognized at an earlier stage, the treatment can be modified appropriately and disease progression can be monitored. An added advantage would be a possibility of reliable comparison between neuropathic side effect of newer and older chemotherapeutic...
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...
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 =...
CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. CoQ10 has a role in carcinoma breast, cervix, lung, prostate, melanoma, cancer chemotherapy and cancer related fatigue. Future trends involving CoQ10 in many cancers needs more clinical trials for better understanding of CoQ10 efficacy.. Oral CoQ10 administration can correct CoQ10 deficiency since it increases CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. CoQ10 has a role in carcinoma breast, cervix, lung, prostate, melanoma, cancer chemotherapy and cancer related fatigue. Future trends involving CoQ10 in many cancers needs more clinical trials for better understanding of CoQ10...
Anaplastic large cell lymphoma (ALCL) represents 2 to 3% of non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase negative (ALK-) subtype accounts for 15-50% of all ALCL. Primary bone involvement in lymphoma is uncommon and constitutes less than 1% of all lymphomas and 4-5% of all extranodal NHL. Hence extra-nodal primary bone involvement in ALCL is even rarer. We report the 14th case of primary ALCL in a 38 year old Indian female. Other than the uncommon site, there is no reason not to keep NHL as differential diagnosis, as the condition responds too well to standard...
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...
Primary renal Non-hodgkin lymphoma is rare. Most of the cases are unilateral though bilateral cases have been reported. Extrarenal involvement is to be excluded by imaging/ staging laprotomy for definitive diagnosis. We are presenting a case of 40-year-old Indian female who was attended with history of right flank pain for 3 years, found to have right renal mass on CT scan, underwent right radical nephrectomy and six courses of chemotherapy with CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) regimen subsequent to histo-pathological confirmation. Patient is asymptomatic on follow up of 18...
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...
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...
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...