A Retrospective Comparative Study of Concomitant Chemoradiotherapy followed by Adjuvant Temozolomide Versus Radiotherapy Alone In Newly Diagnosed Glioblastoma Multiforme – An Experience at Radium Institute, Patna Medical College and Hospital, India

S. Raj, P.N. Pandit, K. Kishor

Radium Institute, Patna Medical College and Hospital, India

Abstract

Introduction: Glioblastoma Multiforme (WHO grade IV glioma) still remains a dreadful diagnosis in oncology with the median survival ranging between 12 to 17 months, despite the recent advances in its management(11,12) It is the most common malignant primary tumour in adults(13). The standard of care is Maximal Safe Resection followed by Concomitant ChemoRadiotherapy.

Methods: During the period 2006 to 2010 at Radium Institute, Patna Medical College and Hospital (PMCH) in India, a study was conducted on 37 newly diagnosed GBM cases in which the control-arm (c-arm) received Conventional Radiotherapy (60Gy/30#) only whereas the study arm (s-arm) received Concomitant Chemoradiotherapy followed by Adjuvant Temozolomide.

Results: The median survival was 15.4 months in the s-arm as compared to 12.4 months in the c-arm. The OS showed a significant improvement with p-value of 0.05 and PFS also showed a benefit with a p-value of 0.005.

Conclusion: The results were encouraging with improvement in OS as well as PFS in the s-arm and were at par with the other similar studies conducted in different parts of the world.  

Keywords: Concomitant Chemoradiotherapy, Temozolomide, Adjuvant, Glioblastoma Multiforme, GBM, WHO grade IV Glioma

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12-19

EGFR and HER-2/neu Expression in Gallbladder Carcinoma: An Institutional Experience

R. Hadi, M.C. Pant, N. Husain, A. Singhal, R. Khurana, G.R. Agarwal, S. Masood, N.P. Awasthi
Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow-226010, Uttar Pradesh, India 

Abstract

Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary tract in India. Despite the recent advancement in the understanding of the cancer biology, the disease still remains a therapeutic challenge with poor prognosis and low survival. Surgery is the primary modality of treatment and rest of the modalities are basically adjuvant in nature. This study was performed to evaluate the epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor-2 (HER-2/neu) expression in GBC.

Methods: The present study was prospective and done in tertiary super-specialty institute of northern India. This was a pilot study, and at the time of completion, 29 samples were found suitable which were later submitted for EGFR and HER-2/neu evaluation. The sample includes both cases of GBC (n=18) and cholecystitis (n=11) as control. (Table 1) After performing necessary processing, slides were incubated with primary antibody (EGFR) ready to use (RTU) BioGenex, India and HER-2/neu dilution 1:600, Dakopatts (Denmark). Then slides were incubated with secondary antibody (Real Envision Detection Kit, Dakopatts, Denmark). Finally in mounted slides, cell membrane staining was used to assess positivity for EGFR and HER-2/neu.

Results: EGFR was positive in 21/29 (72.41%) overall, out of which 14/18 (77.78%) positive in cases and 7/11 (63.64%) positive in control. (Table 1, 3)(Figure 2). For HER-2/neu, it was positive in 21/29 (72.41%) overall, just like in EGFR mentioned above, but positive 12/18 (66.67%) in cases and 9/11 (81.82%) in control respectively. (Table 1, 3)(Figure 3)

Conclusion: Despite the efforts by many investigators, GBC continues to represent a major challenge in oncology. Surgical resection remains the only curative treatment for this disease. The roles of radiation, chemoradiation, and chemotherapy in neoadjuvant and adjuvant settings remained to be defined in prospective studies. With further studies based on molecular understanding and developing new targeted therapies, we will be in better position to manage GBC and increase the survival rate. .

Keywords: EGFR, HER-2/neu, GBC, Targeted therapy, chemotherapy, Immunohistochemistry

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20-24

Potential Co-Relation Between Chronic Periodontitis And Cancer – An Emerging Concept 

T.G. Shrihari, V. Vasudevan, V. Manjunath, D. Devaraju Department of Oral Medicine and Radiology, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India

Abstract

Periodontal disease caused chiefly by bacteria is characterized by inflammation, bacteremia, and a strong immune response. It is based on evidence that a continuous long–term exposure to oral bacteremia and bacterial toxins induces inflammatory immune response after immune evasion releases growth factors such as FGF, EGF, TGF-Beta, free radicals such as ROS and NOS, cytokines such as TNFAlfa, IL-1 Beta, IL-6; and matrix metalloproteinase such as MMP-9. Immature myeloid cells such as macrophages, dendritic cells and granulocytes involved in chronic inflammation and tumor progression through immunosuppressive activity against innate and adaptive immunity by factors such as iNOS, Arginase1 and ROS, activate major transcriptional factors such as NF-KB and STAT3 that could contribute to genetic instability, uncontrolled cell proliferation, angiogenesis, resistance to apoptosis, epithelial to mesenchymal transition, immunosuppression, invasion and metastasis. This study is a product of research and analysis on the role of chronic inflammatory mediators of chronic periodontitis in progression to cancer.

Keywords: Myeloid-derived suppressor cells, LPSlipopolysaccharide, TLR- Toll like receptor, MMPMatrix, metalloproteinase.

25-29

Primary Parotid Lymphoma From A Regional Cancer Center in South India 

B.K. Govind¹, K.C. Lakshmaiah¹, D. Lokanatha¹, B.Suresh¹, C.S. Premalata², C.R. Rao², L.J. Abraham¹, K.N. Lokesh¹, L,K. Rajeev¹, V. Arroju¹, V. Sathyanarayanan^1
1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India. ²Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, India

Abstract

Primary parotid lymphoma (PPL) is an unusual entity and there is limited data in Indian population. Hence we undertook this retrospective observational study of primary parotid lymphoma at our Center in Southern India. This study includes 7 consecutive cases diagnosed as PPL by tissue biopsy/superficial/deep parotidectomy confirmed by immunohistochemistry between January 2007 and December 2012.

Results: Median age was 54 years (range 29- 78 years), and it was more common in males. According to Ann Arbor stage, Advanced stage (stage III and IV) was seen in 2 (28.57%). According to the International Prognostic Index (IPI), most (6) were low risk (85.7%). Overall survival ranged from 1-45 months with median OS of 18 months. To conclude, PPL presents more often in early stage and low IPI score. Surgery +/- chemoimmunotherapy with radiotherapy to the parotid is the standard treatment at present. 

Keywords: extra nodal, parotid, lymphoma, India

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30-37

Honey on oral mucositis: A Randomized controlled trial 

J. L. Jayalekshmi, R. Lakshmi, A. Mukerji
College of Nursing, JIPMER and Regional Cancer Center, JIPMER, Puducherry, India

Abstract

Background and objective: The main stream of management of head and neck cancer is by radiotherapy and surgery. During radiation therapy in head and neck cancers, oral cavity is directly exposed to high dose radiation which leads to several side effects - oral mucositis being the most distressing one. This study was intended to assess the effects of applying honey on oral mucositis during radiation therapy.

Material and Methods: The research design used in this study was Randomized Control Trial with single blinding method in the Radiotherapy Unit of Regional Cancer Centre (RCC), at JIPMER. The study population included a total of 28 patients. Participants in experimental group were given 15ml natural honey for applying on oral mucosa and in control group 15ml plain water were given. Assessment of oral mucosa was done after every 5 doses of radiation therapy using RTOG scale and severity of oral mucositis was assessed.

Results: There was a statistically significant difference in degree of oral mucositis between the experimental and control group in week 4, 5 and 6 (p<0.01). During the whole course of study, 9 (64.28%) participants in control group developed grade III oral mucositis while only one participant (7.14%) in experimental group developed grade III oral mucositis.

Conclusion: The study concluded that applying natural honey on oral mucositis was effective among head and neck cancers patients receiving external beam radiation therapy.

Keywords: honey on oral mucositis, oral mucositis, honey 

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38-44

Clinical Characteristics and prognostic analysis of Triple-negative Breast Cancer: Single institute experience 

V.V. Maka, H. Panchal, S.N. Shukla, S.S. Talati, P.M. Shah, K.M. Patel, A.S. Anand, S.A. Shah, A.A. Patel, S. Parikh
Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Abstract

Background: Triple-negative breast cancer (TNBC) is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy.

Materials and Methods: A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival.

Results: In our study, patients were young (median age at presentation, 47yrs), premenopausal (54%), tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma (90%), histological grade higher than two (90%). Relapses were early and preferential visceral (32%) and CNS metastasises (11.7%). 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens (43%), sequential anthracycline and taxane-based regimen (24%) and other regimes like CMF (13%) were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up.

Conclusions: Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed.

Keywords: Triple negative breast cancer, clinicopathological profile and prognostic factors

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45-50

Histopathological pattern of thyroid diseases among patients in Hadhramout-Yemen

F.O. Aram¹, A.A. Bahannan¹*, S.S. Bafakeer^2
1Department of General Surgery and Surgical Specialties,
²Department of Basic Medical Sciences, College of Medicine and Health Science, Hadhramout University, Hadhramout Province, Mukalla, Yemen

Abstract

Objective: To determine the histopathological pattern of thyroid diseases among patients in Hadhramout Province, Yemen

Methods: A descriptive retrospective study was conducted at Ibn Sina Central Teaching Hospital, in Mukalla city, Hadhramout, Yemen between January 2007 and December 2012. Eight hundred and seventeen patients with thyropathy were included in this study diagnosed histologically by experienced pathologists using fine needle aspiration cytology. This was followed-up by postoperative pathological thyroid specimen study. The patients in the study were treated medically and surgically by authors.

Results: 817 patients with thyropathy were included in the study. There were 716 (87.6%) females and 101 (12.4%) males, with a female to male ratio of 7:1. The age of the patients ranged from 5 to 80 years, with a mean age of 37.7±12.2 years. Median age was 35. More than half of the patients aged between 21-40 years. The majority of the thyroid lesions were non neoplastic = 703 (86%). The most common lesion was simple colloid goiter = 578 (82%) followed by thyroid Hashimoto = 75 (10.7%). The minority were granulomatous (subacute) thyroiditis, hyperplastic nodule and thyroglossal cyst, 5 (0.7%), 6 (0.9%), 8 (1.1%) respectively. 114 (14%) patients have neoplastic lesions. 61 (7.5%) patients have benign adenoma, 2 (1.75%) patients have Hurthel cell adenoma. 43 (5.3%) patients have papillary carcinoma while 3 (2.63%) patients have anaplastic carcinoma. The less common malignant neoplastic thyroid lesions were primary lymphoma, follicular and medullary carcinoma, and mucoepidermoid carcinoma, 2 (1.75%), 1 (0.9%), 1 (0.9%), and 1 (0.9%) respectively.

Conclusion: The most common non-neoplastic thyroid disorder reported in this study is a simple colloid goiter. Adenoma was found to be the most common benign tumor while papillary carcinoma was found to be the most common malignant one. Most cancerous lesions were found within the age groups in the third and the fourth decade, mostly females.

Keywords: Simple colloid goiter, Hashimoto thyroiditis, papillary carcinoma

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51-63

Exploring the Clinicopathological Parameters Affecting the Outcome in Egyptian Patients with Multiple Myeloma

Y. A. Sallam, M.A. Samra, A. A. Gaber
Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt

Abstract

Background: Multiple myeloma (MM) is a plasma-cell neoplasm in which the interplay of several clinical, pathological and genetic parameters affects the patient’s prognosis and response to treatment and survival.

Aim: The aim of this study was to evaluate the different clinicopathological parameters of MM patients in correlation with response to therapy, progressionfree survival (PFS) and overall survival (OS).

Methods: This retrospective study was performed on 60 MM patients diagnosed at NCI, Cairo University from January 2005 to December 2008. The patients were evaluated for different clinicopathological parameters which were correlated to their response to treatment, OS and PFS.

Results: Sixty patients were followed up for a median period of 21 months wherein about 90% received 1st line treatment: 34 VAD, 17 MP and 3 dexamethasone. Six patients (10%) were referred for BSC. CR was achieved by 15%, 11.7% achieved good PR, 6.7% achieved PR, 22.1% have stable disease, 35% experienced disease progression. ECOG PS-I patients have 39 months median survival compared to 12 months for patients with PS ECOG-II (P 0.005). Patients with multiple skeletal lesions (≥3) have median OS of 19 months (P 0.03). Patients who presented with plasmacytoma have better OS than those without (38 months versus 14 months) (P<0.05). Patients <60 years old have a better median OS compared to patients >60 years (37 months versus 12 months) (P 0.001). OS was 39 months in female patients versus 14 months in male patients (P0.025). Median OS was 9 months for patients with comorbidities versus 27 months for those without (P0.01), 39 months for patients with non-detected paraproteinuria versus 18 months for those with paraproteinuria (P 0.045), 18 months for stage II disease versus 12 months for stage III disease (P0.001), 12 months for patients with elevated serum LDH versus 39 months for those with normal levels (P 0.001), 27 months for patients with normal serum creatinine level versus 13 months for those with elevated levels (> 1.4 mg/dl) (P 0.005), 27 months for patients with normal serum calcium levels versus 10 months for those with hypercalcemia (P 0.03).

Conclusion: Besides FISH-guided molecular cytogenetic classification of myeloma abnormality, a specific risk-stratification model based upon the patient’s age, sex, performance status, lytic bone lesions, plasma cells labeling index, serum creatinine, calcium, LDH, B2M and paraproteins in serum and urine, can depict the response to treatment, OS and PFS of patients with MM.

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64-70

Multidetector CT (MDCT) Findings Of Primary Hepatic Lymphoma

A. El-Badrawy¹, A. M. Tawfik¹, W. Mahmoud¹, E. Abdel-Salam¹, M.M. Taalab², O. Farouk³, Y. Zakaria⁴, A.M. Shebl⁵, H. El-Hadaad^6
1Radiology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
²Clinical Hematology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
³Surgical Oncology Department, Oncology Center- Mansoura University, Egypt .
⁴Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura, Egypt .
⁵Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
⁶Clinical Oncology & Nuclear Medicine Department, Mansoura Faculty of Medicine, Mansoura, Egypt

Abstract

Objective: The aim of this study was to describe the triphasic multidetector CT (MDCT) finding of primary hepatic lymphoma (PHL).

Materials and Methods: This retrospective study included eighteen patients. Each patient presented with primary hepatobiliary lymphoma without associated lymphadenopathy or other visceral involvement. Triphasic CT scanning was performed on one of two systems (64 MD CT) in 12 patients and (6 MDCT) in 6 patients. All eighteen patients underwent ultrasound percutaneous trucut liver biopsy using 18-gauge biopsy needle. Pathology was confirmed on all cases.

Results: Four of eighteen patients presented with a single focal lesion. Thirteen of eighteen patients presented with multiple well defined focal lesions. One patient presented with a diffuse hepatic involvement. On triphasic CT, three patients showed gradual progressive contrast enhancement. Lesions remained isodense to the liver on the arterial phase with mild enhancement in the portal phase and showed washout on the delayed phase in two patients. The remaining thirteen patients showed multiple hypodense non-enhancing lesions.

Conclusions: PHL presents a wide spectrum of imaging findings on triphasic MDCT with no characteristic imaging pattern. MDCT can be used for detection of the lesion and biopsy is used for diagnosis. PHL should always be considered in the differential diagnosis of a liver focal lesion either single or multiple.

Keywords: Fine needle aspiration cytology, lymph node, malignancy

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71-78

Mobile Phone Use and the Risk of Parotid Gland Tumors: A Retrospective Case-Control Study 

K. AL-Qahtani
Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, KSA 

Abstract

Background: Mobile phones are integral part of the modern lifestyle. As they emit radio frequency electromagnetic field, their role in carcinogenesis needs to be ascertained. The goal of this study was to investigate the association between the use of cellular phones and the risk for parotid gland tumors.

Materials and Methods: A total of 26 patients diagnosed with parotid gland tumors and 61 healthy controls were enrolled through a hospital-based retrospective case-control study. The patients were referred and admitted to a tertiary hospital from January 1996 to March 2013.

Results: The Odds of exposure were 3.47 times higher among patients compared to their controls. 95% CI suggested that the true Odds Ratio (OR) at the population level could be somewhere between 1.3 and 9.23 and so the observed OR was statistically significant at 5% level of significance.

Conclusions: Overall, an association between the exposure of cellular phone use for more than 1 hour daily and parotid tumor was observed. This association should be interpreted with caution because of the relatively small sample size. 

Key words: parotid gland tumor, mobile phone, non-ionizing radiation, risk factor, radiofrequency electromagnetic field

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79-85

Clinicopathological Spectrum Of Gall Bladder Cancer In Kashmir - An Institutional Study 

R. Makhdoomi¹, N. Bashir², N. Bhat³, S.bashir¹, F. Mustafa¹, A. Aiman¹, A. Charak¹, S. Hussain¹, S. Shafi¹, S. Bhat³, N. Bashir¹, Z. Zahir¹, P. Shah^1
1Department of Pathology, ²Department of Hematology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir.
³Department of Pathology, Govt Medical College, Srinagar, Kashmir

Abstract

Gallbladder cancer is a highly aggressive malignancy that usually presents at an advanced incurable stage. It is the fifth most common gastro-intestinal tumor and leads to approximately 2800 deaths in United States annually. This was a retrospective study carried out in the Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, a 650-bed super speciality hospital in Kashmir valley. We reviewed the histopathological records of all the patients who were diagnosed as carcinoma gallbladder from Dec 2009-Dec 2013. Gross findings and histopathological findings were noted from the departmental archival material and clinical records of the patients including the clinical presentation, laboratory investigations, radiological investigations, pre-operative diagnosis and intra-operative findings, were retrieved from the hospital records. We analyzed 57 cases of carcinoma gallbladder for their clinicopathological features It included 19 males and 37 females. In our study, adenocarcinomas accounted for 87.5% of total carcinomas. Incidentally, all but one patient where gall stones were found, adenocarcinomas were seen. We have 4 patients of squamous cell carcinoma. In our series we have a single case of small cell carcinoma which was positive for neuroendocrine markers. In our study, gall stones were seen only in 8 cases (14%) of the total cases. 

Keywords: Gallbladder, Gallbladder cancer, Adenocarcinoma, Squamous cell carcinoma, small cell carcinoma, Gallstone

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86-93

Chronic Inflammation and Cancer: Paradigm on Tumor Progression, Metastasis and Therapeutic Intervention 

S. Khan¹, M. Jain², V. Mathur³, SMA Feroz^4
1Dept. of Oral and Maxillofacial Pathology, College of Dentistry; Jazan University, Jazan, KSA.
²Dept. of Oral Pathology and Microbiology, People’s Dental Academy, Bhopal, MP, India.
³Dept. of Oral Pathology and Microbiology, People’s College of Dental Sciences & Research Centre, Bhopal, MP, India.
⁴Dept. of Prosthodontics, College of Dentistry; Jazan University, Jazan, KSA

Abstract

As early as the 19th century, inflammation has been perceived to have a link with cancer but this perception has waned through the passing of time. In recent years however a renewed interest on inflammation and cancer connection stemming from different lines of work has been evolved that leads to a generally-accepted paradigm. In the tumor microenvironment, smouldering inflammation contributes to the proliferation and survival of malignant cells, angiogenesis, metastasis, subversion of adaptive immunity, reduced response to hormones and chemotherapeutic agents. Thus, this review will try to unravel and explain molecular events, mediators and regulators linking inflammation to cancer.

Keywords: Chronic inflammation, Invasion, Metastasis, Chemokines, Cytokines

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