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 =...
A RETROSPECTIVE ANALYSIS OF PALLIATIVE SURGICAL PROCEDURES FOR ADVANCED MALIGNANCIES IN A PRIVATE TERTIARY CANCER CARE CENTER.
Palliative surgery is an important, yet understudied aspect of palliative care. The present article emphasizes the diversity of palliative surgical procedures performed at a private tertiary cancer care center in India and the need of the multidisciplinary approach towards it. Though the overall morbidity and mortality is high, a significant number of cancer patients are alleviated from their symptoms and have a better quality of life, even in those with an anticipated short...
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...
Depression is a major psychiatric disorder producing non-pathological sadness and stress. Depression has a major negative impact on patients and their family member’s also. Overlapping of depressive symptoms with physical symptoms makes the diagnosis even more challenging. In biological mechanism, damage-associated molecular patterns (DAMPs) on damaged tissue bind to pattern recognition receptors (PRRs) on leukocytes, causing expression of transcription factor nuclear factor-κ-β (NFκβ) and production of numerous pro-inflammatory cytokines, including interleukin-1 (IL-1), interferon-α (INF-α), IL-6 and tumor necrosis factor (TNF). Some studies have reported delayed stress, addressing the need of mental health counseling throughout a continuum of care. Psychotherapy, in combination with antidepressant medications, and communication skills can act as a central component of patient care on the basic principle of physical, psychological, social and spiritual palliative...
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...
MIXED GERM CELL TUMOR OF OVARY AND MAYER ROKITANSKY KUSTNER HAUSER SYNDROME: AN UNUSUAL COMBINATION!
Germ cell tumor of ovary in young female is most common ovarian neoplasm but represent less than three percent of all ovarian malignancies in females. Mixed germ cell tumor is a variant of germ cell tumors and its presentation with Mayer Rokitansky Kustner Hauser Syndrome, which represents the most common type of utero-vaginal agenesis, is very unusual. However, for patients with primary amenorrhea, Mayer Rokitansky Kustner Hauser syndrome is the second common cause. We describe an interesting, uncommon and unexpected case in a young Indian female patient with primary amenorrhea due to this syndrome coexisting with mixed germ cell...
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.
Background & Objective Lung Cancer is a major health problem worldwide with high fatality rate. Smoking is a known to be the most important risk factor, though all smokers do not develop lung cancer. This is because individuals differ in metabolism of pro-carcinogens present in cigarette smoke by cytochrome P450 (CYP 450) enzymes. Variable forms of CYP450 enzymes are produced due to presence of multiple alleles or polymorphs of CYP 450 gene. CYP 1A1 polymorphisms were the first CYP genes to be associated with lung cancer. Several single nucleotide polymorphisms (SNPs) have been identified in CYP1A1 gene, some of which are suspected to be linked with lung cancer. This study has been done to find association of CYP1A1 genes- m1, m2, and m4 polymorphism with lung cancer in heavy smokers. Methods & Results This is an observational analytical study on heavy smoker eighty males, of which forty were with lung cancer (Group I) and remaining forty were with non-lung cancer (Group II). CYP1A1 gene m1, m2 and m4 polymorphism was detected by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) techniques. Steps involved in these techniques are DNA isolation, polymerase chain reaction, DNA electrophoresis and restriction fragment length polymorphism. CYP1A1 m1 Gene polymorphism was found in 3 out of 22 (13.6%) cases of squamous cell lung cancer and only 1 case (4.5%) had both the m1 and m2 gene polymorphisms. None of these polymorphisms was seen in non-lung cancer smokers and in patients with non-squamous cell lung cancer. Interpretation & Conclusion CYP1A1 gene related m1 and m2 polymorphisms may have some contributory role for lung squamous cell carcinoma development and m4 polymorphism has no role in development of lung cancer in Indian population of eastern part of Gujarat. All lung carcinoma cases may not have gene polymorphism of CYP1A1...
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...
Background- Astroblastoma is partially understood, poorly reported and rare in occurrence tumor with significant dilemma regarding cellular origin, diagnostic criteria, clinical behavior, and management protocol. Material and method– Thorough search of published English scientific literature was made with search word Astroblastoma through Google Search, PubMed, Research Gate and Cochrane Library till June 2018. The reports thus collected were examined for data regarding age, gender, location and laterality of disease, pathological grade, treatment received, and outcome of treatment. Results– Data of 161 patients was retrieved from 72 publications. Median age at presentation was 18 years. Females were affected much more frequently than males. Most common site of involvement was the frontal lobe. Laterality data was inconsistent and sparingly reported. Most common presenting complaint was headache followed by history of seizure. Surgery was performed in majority of patients-79.6% of the patients underwent a gross total resection, 45% (44 out of 98 reported) had a high-grade tumor. Sixty patients received adjuvant radiation with a median dose of 54 Gy (Range 20-72), mostly for high grade, residual or recurrent disease. Adjuvant chemotherapy was used in 25 patients. Median follow-up was 43 months (range 1-238). Median overall survival was 138 months. Patients with a higher-grade tumor had significantly worse overall survival. Conclusion- Astroblastoma is rare but known to have two distinct grades, with higher-grade tumors bearing significantly poor survival. Maximal safe surgery is the standard. Though there is lack of consensus, adjuvant radiotherapy with or without Temozolamide should be considered in view of high rates of local...