Journal of Cancer Research and Therapeutics
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Item 125I brachytherapy seeds implantation for an inoperable large retroperitoneal leiomyosarcoma(Wolters Kluwer India Pvt. Ltd., 2020-05) Di, Xuemin; Liang, Yansong; Yu, Huimin; Zhao, Jinxin; Wang, Zeyang; Zhao, Jing; Sui, Aixia; Zhang, Hongtao; Wang, JuanRetroperitoneal leiomyosarcoma is relatively uncommon. Leiomyosarcoma has accounted for about 5%-10% of soft-tissue sarcoma, and 1/2–2/3 of the primary lesions were retroperitoneal, with a cumulative 5-year survival rate of only 35%.Leiomyosarcoma is one kind of soft-tissue sarcoma with the lowest survival rates due to the invasive growth, difficult treatment, and poor prognosis.The present study reported a case of a 78-year-old male diagnosed as left retroperitoneal leiomyosarcoma, who had received three operations. Computed tomography (CT) demonstrated a mass of approximately 12.9 cm × 6.9 cm × 6.6 cm in his retroperitoneal region. The Eastern cooperative oncology group and numerical rating scale scores of pain were 1 and 5, respectively. Multiple treatment strategies were administered, including the application of drainage and125I seed implantation. A total of 90125I seeds were implanted into the tumor through repetitious operations, with 30 seeds each time. Treatment planning system was involved to calculate the source distribution.125I seeds with the activity of 0.5 mCi were implanted under the guidance of CT, and dosimetric verification was performed after the operation. D90 (90% minimum prescription dose received by target volume) was 40 Gy. Follow-up was performed after 6 months, and complete response was achieved in the local lesions. However, there was no evidence-based treatment currently and the majority of our knowledge was based on results from case reports, thus further studies would be requiredItem 125I implantation under computed tomography guidance to treat patients with recurrent pelvic tumors: Retrospective analysis of clinical results(Wolters Kluwer India Pvt. Ltd., 2020-01) Li, Chuang; Wang, Ruoyu; Wang, Zhe; Zhao, Guangsheng; Zhou, JunObjective: The objective of the study was to evaluate computed tomography (CT)-guided 125I implantation for the treatment of recurrent and malignant pelvic tumors. Materials and Methods: Fifteen cases of pelvic malignant tumors were studied. Tumor length/diameter was 4–10 cm (average: 6.8 ± 2.3 cm). In patients with pelvic recurrence or metastasis of malignant tumors, comprehensive treatment, including surgery, chemotherapy, or radiotherapy, was performed alongside CT-guided 125I implantation. The follow-up clinical benefit rate, rate of pain relief, quality of life score, and status of any complications were analyzed. Results: The patients were followed up for 6 months after the operation, and evaluation of lesions revealed complete response (CR) in 3/15 cases, partial response (PR) in 8/15 cases, stable disease in 3/15 cases, and progressive disease in 1/15 cases. The total effective rate (CR + PR) was 73.3% (11/15), and the pain relief rate was 86.6% (13/15). No bleeding, pelvic abscesses, intestinal fistulas, intestinal perforations, or other complications were reported. Conclusions: When using CT-guided 125I implantation, patients with malignant abdominal tumors undergo a convenient operation, sustain little trauma, and have an improved quality of lifeItem 4 lines to 4 dimensions: the challenges ahead.(2006-04-14) Datta, Niloy RItem Aberrant signal transduction in Indian triple-negative breast cancer patients(Wolters Kluwer India Pvt. Ltd., 2019-10) Bhaskara, Vasantha Kumar; Jayaram, Chaitra; Priyanga, M; Nayaka, N H Thilak; Shivakumara, A; Amaresh, Nagarathna; Mysorekar, Vijaya VAim of Study: The aim of this study is to correlate the prominin-1 or CD133 association with functional pathway markers of cancer stemness in Indian triple-negative breast cancer (TNBC) patient samples. Materials and Methods: TNBC samples were confirmed for the absence of hormone receptors (estrogen receptor–ER/progesterone receptor) and human epidermal growth factor receptor-2 or proto-oncogene neu or erbB2 or CD340 by immunohistochemical analysis. Formalin-fixed paraffin-embedded samples of patients were used to collect the total RNA. Then, one-step reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the cancer stemness-related transcript levels in the different samples. The RT-PCR products were analyzed semi-quantitatively on agarose gels. The band intensities of respective samples for different transcripts were analyzed by densitometry. Results: TNBC-confirmed samples had shown increased levels of CD133 transcript than control tissues. Further, elevated CD133 transcripts are correlated with higher transcript levels of NOTCH1/FZD7/transforming growth factor-beta receptor Type III R/patched-1 pathway mediators. Conclusions: This work has clearly indicated that there is a correlation between CD133 and functional pathways that control cancer stem cells in TNBC. These observations may indicate the possible association between cancer stemness and TNBC malignancyItem Accelerated partial breast irradiation with high dose rate brachytherapy for early breast cancer.(2005-07-14) Rath, G K; Sharma, D NItem Accelerated partial breast irradiation: an advanced form of hypofractionation.(2008-01-18) Budrukkar, AshwiniAltered fractionation schedules are being increasingly investigated in the treatment of breast cancer. Two such schedules that are frequently compared are hypofractionated external beam radiation therapy (HERT) and accelerated partial breast irradiation (APBI). Though these two modalities are considered separately, APBI is an actually an advanced form of hypofractionation, where acceleration of the treatment is possible due to the smaller volume being irradiated. HERT as well as APBI are investigational at present and are being tested in randomized trials. This article looks at the advantages of APBI as a hypofractionation schedule.Item Accessory breast tissue in axilla masquerading as breast cancer recurrence.(2008-04-09) Goyal, Shikha; Puri, Tarun; Gupta, Ruchika; Julka, Pramod K; Rath, Goura KEctopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.Item Acinic cell carcinoma of the posterior buccal mucosa: A rare case report(Wolters Kluwer India Pvt. Ltd., 2020-07) Babu, Sharlene Sara; S, Sunil; Prathap, Akhilesh; Mathew, Anuna LailaAcinic cell carcinoma (ACC) is a low-grade malignant salivary gland neoplasm that comprises approximately 17% of primary salivary gland malignancies or about 6% of all salivary gland neoplasms. The most common intraoral sites are the buccal mucosa, lips, and palate. The diagnosis of ACC frequently presents difficulties, owing to its great radiological and cytological similarity with benign tumors and with normal acinar component of the salivary gland, respectively. The management of ACC consists of complete surgical excision. Here, we report a case of ACC on the left retromolar trigone, a rare location in a 44-year-old femaleItem Acute treatment-related toxicity in elderly patients with good performance status compared to young patients in locally advanced esophageal carcinoma treated by definitive chemoradiation: A retrospective comparative study(Wolters Kluwer India Pvt. Ltd., 2020-04) Mohata, Shweta; Kumar, HS; Sharma, Neeti; Jhakhar, Shankar Lal; Beniwal, Surendra; Harsh, Kamlesh KumarIntroduction: The benefit of definitive chemoradiotherapy (CRT) in elderly patients with locally advanced esophageal cancer is not well established. We perform a single institutional retrospective study of CRT in terms of toxicity in elderly patients (age more than 60 years) as compared with young cohort (age <60 years) in locally advanced nonmetastatic esophageal cancer. Patients and Methods: A total 145 of patients, 79 in young age (Group A) and 66 patients of elder age (Group B) with Stage II and III squamous cell carcinoma of the esophagus with ECOG PS of 0–1, who had undergone definitive CRT at our institute from January 2015 to November 2018 were selected for this analysis. Chemotherapy was cisplatin (40 mg/m2) given concurrently on weekly basis with radiotherapy (RT). Total prescribed dose of RT was 50.4 Gy at the rate of 1.8 Gy per fraction. Median age was 40 years (25–60 years) and 65 years (60–75 years) in young and elderly group, respectively. Follow-up is done at median of 28 months (1–48 months) after treatment. Results: Acute Grade 2–3 esophagitis was seen in 48.10% in young cohort, while it was 60.6% in older group. Grade 2–3 nausea and vomiting was seen in 32.91% in young age patients, while it was 45.5% in elder patients. No statistically significant difference is seen in acute treatment-related toxicity in young and elderly group. Conclusion: Our conclusion is that patients with adequate functional status should not be excluded from curative CRT based on age aloneItem Adaptive intensity-modulated radiotherapy in head-and-neck cancer: A volumetric and dosimetric study(Wolters Kluwer India Pvt. Ltd., 2019-05) Burela, Nagarjuna; Tej, Prakash Soni; Patni, Nidhi; Natarajan, ThiruIntroduction and Objective: Anatomic and volumetric changes occur in head-and-neck cancer during fractionated radiotherapy (RT), and the actual dose received by patient is considerably different from the original plan. The purpose of this study is to evaluate volumetric and dosimetric changes occurring during radiation therapy. Patients and Methods: Ten patients of locally advanced head-and-neck cancer, 6 oropharynx, 3 larynx, and 1 hypopharynx underwent computed tomography (CT) simulation before treatment and after 4 weeks during RT treatment. Original plan (OPLAN) was generated based on initial CT scan for the entire course of treatment. The initial plan is implemented on the second planning CT scan, and the dose distribution is recalculated. Beam configuration of OPLAN was applied onto the second CT scan and then hybrid plan (HPLAN30) was generated. RPLAN30 is the intensity-modulated RT replan generated on the second CT scan for the remaining 30 Gy. Dose and volume parameters between OPLAN30 (based on the first CT scan for the remaining 30 Gy), HPLAN30, and RPLAN30 were compared. Results: The volume reduction of planning target volume (PTV), ipsilateral and contralateral parotid after 4 weeks of RT, was statistically significant (P < 0.05). D2% and V > 107% of PTV were higher in HPLAN than that of RPLAN (P < 0.05). Hybrid plans showed increase in delivered dose to spinal cord. Mid treatment replanning reduced doses to spinal cord (Dmax and D1%), which is statistically significant (P < 0.05). Mean doses to ipsilateral and contralateral parotid of RPLAN (21.4 Gy and 16.74 Gy, respectively) were reduced when compared to that of HPLAN (22.99 Gy and 22 Gy, respectively). Conclusion: Interim CT scanning and replanning (adaptive) improves target volume coverage and normal tissue sparingItem Adding bit of esthetics with science modification of batwing mastopexy for breast conservation in a young patient with giant fibroadenoma breast(Wolters Kluwer India Pvt. Ltd., 2019-10) Kumar, H Harish; Rahman, N K Faslu; Ramesh, Rakesh S; Raghunandan, GCA 19-year-old girl presented with a lump in her right breast and with a history of surgery for the similar complaint 3 years back. Ultrasound was suggestive of benign solitary lesion of size 16 cm × 10 cm. Core biopsy was suggestive of phyllodes tumor, and the histopathology report of previous surgery was also suggestive of phyllodes tumor. Wide excision of the tumor and reconstruction was done with batwing mastopexy and with a slight modification of the described technique so that to avoid contralateral reduction mammoplasty in a young unmarried girl. Postoperative histopathology was suggestive of fibroadenoma measuring 15 cm × 8 cm with all margins free of tumor, and it is probably one of the biggest fibroadenomas reported so far. On follow-up, no significant disparity noted between the appearances of both breastsItem Adenocarcinoma in a tailgut cyst: A rare case report(Wolters Kluwer India Pvt. Ltd., 2019-01) Valecha, Jyoti; Ojha, Sandeep S; Sharma, Abhishek; Nilkanthe, RamraoTailgut cysts (TGCs) are rare congenital lesions derived from the remnants of primitive hindgut and are usually lined by squamous, transitional, or glandular epithelium. Malignant transformation in TGC may occur which is still rarer. Most common malignancies that arise from these cysts are adenocarcinomas. Preoperative diagnosis is difficult as high degree of suspicion is required for the diagnosis. We report here a case of adenocarcinoma arising in a tale gut cyst diagnosed preoperatively and till date very few cases have been reported in literatureItem Adjuvant radiation therapy in gall bladder cancers: 10 years experience at Tata Memorial Hospital.(2006-04-14) Mahantshetty, Umesh M; Palled, S R; Engineer, R; Homkar, G; Shrivastava, S K; Shukla, P JINTRODUCTION AND PURPOSE: In gall bladder cancers, even after curative surgery, survivals are dismal and loco-regional failure accounts for 40-86%. Although these are considered radio-resistant, adjuvant radiation, with or without chemotherapy, has been tried to improve loco-regional control and overall survival rates. With an aim to evaluate the natural history of gall bladder cancers, role of radiation therapy (RT) and prognostication, a retrospective analysis was undertaken. MATERIALS AND METHODS: Between 1991-2000, 60 patients with gall bladder cancer, treated with radical intent, were evaluated. Patients details including history, physical examination, liver function tests, ultrasonography of the abdomen and chest X-ray; and CT scan Abdomen if done, were noted. In patients who underwent surgery, surgical details, histopathology and pathological staging, were recorded. The details of post-operative adjuvant treatment, including radiation therapy details, as well as chemotherapeutic agents, number of cycles and type of infusion [bolus/infusion], were noted. RESULTS: Sixty patients underwent surgery. On histopathological staging, 28 patients (46.5%) had stage II, 19 (32%) had stage III, 12 (20%) had stage-I and 1 patient had stage IV disease. Thirteen (21%) patents did not receive any adjuvant treatment, 32 (53%) patients received adjuvant RT alone, 8(14%) received post-operative CT+RT and 7 (12%) patients received CT alone. With a median follow-up of 18 months (12-124 months), 27 (45%) patients were disease free, 11 (19%) had local failures, 7 (11%) had loco-regional, 7 (11%) loco-regional+distant, 4 (7%) distant and 4 (7%) patients had local+distant failures. The Overall Disease Free Survival (DFS) and overall survival was 30% and 25%, at 5 years, respectively. Stage grouping ('P' = 0.007), Pathological T ('P' = 0.01) had significant impact on DFS on univariate analysis, where as histological grade ('P' = 0.06) showed trend towards significance. CONCLUSION: Gall bladder cancers are aggressive and lethal. Early diagnosis and curative surgery, followed by appropriate adjuvant radiation therapy, may improve survivals, with no established consensus till date. Following curative surgery, pathological T stage and stage grouping, are the significant prognostic factors for outcome.Item Adjuvant radiotherapy for uterine carcinosarcoma: A retrospective assessment of treatment outcomes(Wolters Kluwer India Pvt. Ltd., 2019-12) Yilmaz, Ugur; Alanyali, Senem; Aras, Arif Bulent; Ozsaran, ZeynepObjectives: The objective of the study is to understand the impact of adjuvant radiotherapy (RT) and prognostic factors for patients diagnosed with uterine carcinosarcoma. Materials and Methods: The records of 31 patients receiving adjuvant RT between the dates of September 2003–January 2013 in our clinic were evaluated retrospectively. Surgery was performed in 27 (87%) patients as staging laparotomy, for 4 patients as total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pelvic external beam radiotherapy (EBRT) was 4500–5040 cGy in 25–28 fractions. In addition, 23 patients received brachytherapy following EBRT, 12 patients received adjuvant, and 1 patient received neoadjuvant chemotherapy (CT). Results: The median age was 63 (between 30 and 78). The stage distribution of the patients was as follows: Stage I, 20 (64%); Stage II, 7 (23%), and Stage III, 4 (13%) patients. Five-year locoregional control (LRC) rate was 100%, disease-free survival (DFS) and overall survival (OS) rates were 65.5% and 66.2%, respectively. Stage I or II patients have a tendency for better 5-year OS and DFS rates than Stage III patients (73.1% vs. 42.9% and 72.7% vs. 42.9%; P = 0.065 and 0.051). Regarding lymph node dissection was performed or not, 5-year OS (64.7% vs. 75.0%) was not statistically different between groups (P = 0.77). Five-year OS and DFS rates were 69.2% and 61.5% for patients receiving CT (adjuvant or neoadjuvant) versus 63.7% and 68.8% for patients not receiving CT; P = 0.63 and P = 0.89, respectively. Based on the analysis of peritoneal washings, 5-year OS was 0% for patients with malignant or suspicious cytology whereas 89% for patients with benign cytology (P = 0.000). A negative correlation was observed between mitotic count of sarcomatous component and DFS time (rs = −0.812 and P = 0.05). Conclusions: Surgery and adjuvant RT seem beneficial for excellent LRC rate. However, survival rates are low due to distant metastases. Thus, there is a great need for better systemic therapiesItem Adjuvant radiotherapy in carcinoma buccal mucosa; more conformal the best: Is it so?(Wolters Kluwer India Pvt. Ltd., 2019-05) Koushik, A S Kirthi; Sebastian, M G John; MG, Janaki; S, SathishIntroduction: Since 1980s, computerization has made improvements in radiation therapy delivery from conventional two-dimensional to three-dimensional conformal radiotherapy (2DCRT to 3DCRT) to intensity-modulated radiotherapy (IMRT) and its newer versions. This small study is aimed to compare the existing techniques for planning target volume (PTV) and organ at risk (OAR) dose distribution parameters in postoperative buccal mucosa cases. Materials and Methods: Ten post operative cases of early stage carcinoma buccal mucosa in whom only post operative bed irradiation was indicated was enrolled and was planned with conventional, 3DCRT and IMRT techniques to get 95% PTV coverage and dose received by organs at risk were recorded and evaluated. Results: Mean and standard deviation values for PTV 95% for IMRT, 3DCRT, and conventional plans were 96.4 ± 1.8, 95.1 ± 1.9, and 91 ± 2.7, respectively. Dose received by OARs was high in conventional technique when compared to the other two. Maximum dose received by 1 cc of brain (46.2 ± 7.9 and 60.8 ± 3.8) (priority was given for PTV coverage) and mean dose received by the same eye (13.6 ± 1.4 and 22 ± 2.4) were less in IMRT when compared to 3DCRT. However, maximum dose received by 1 cc of brainstem (29.7 ± 7.6 and 14.1 ± 9.5), optic chiasma (29.2 ± 4.2 and 12 ± 2.1), spinal cord (31.8 ± 3 and 20.9 ± 4.2), and the same-side optic nerve (22 ± 6.9 and 11.7 ± 9.4) and mean dose received by opposite-side parotid (8.7 ± 1.1 and 1.7 ± 0.4) and submandibular gland (18.6 ± 1.7 and 3.2 ± 0.9) were more with IMRT when compared to 3DCRT. Conclusion: In postoperative cases of early-stage carcinoma buccal mucosa, it is good enough to treat with 3DCRT technique. Here, the target area will be well lateralized, and 3DCRT technique can give good target coverage and less dose to OARs, especially the only remaining major salivary glands.Item The administration of peroxisome proliferator-activated receptors α/γ agonist TZD18 inhibits cell growth and induces apoptosis in human gastric cancer cell lines(Wolters Kluwer India Pvt. Ltd., 2019-01) Ma, Yuhong; Wang, Bin; Li, Ling; Wang, Fang; Xia, XichaoAim of Study: This study is to investigate the effects of a novel peroxisome proliferator-activated receptor (PPAR) α/γ dual agonist TZD18 on cell growth, apoptosis, caspase activity, mitochondrial membrane potential, cytochrome c release, and apoptotic-related protein expression in MKN-45 cells. Materials and Methods: 3-(4, 5-dimethylthiazolyl)-2,5-diphenyltetrazolium bromide assay against various human cancer cell lines was performed to investigate the whether TZD18 could in reduce the proliferation rates of cancer cells. The percentages of apoptotic cells and mitochondrial membrane potential level were determined by flow cytometry. The subcellular localization of cytochrome c was examined by immunofluorescence microscopy. Western blotting assay was performed to reveal the expression of apoptosis-related proteins. Results: The results showed that the administration of TZD18 could inhibit the growth of MKN-45 cells in a dose- and time-dependent manner. In addition, the apoptotic ratio increased sharply along with a significant increase of caspase activities, mitochondrial membrane potential, and cytochrome c release following TZD18 exposure. The expression of Bax and p27kip1 increased significantly, whereas the expression level of Bcl-2 protein was downregulated. Conclusion: These results indicated that the administration of PPAR α/γ agonist TZD18 may inhibit cell growth by inducing the apoptotic process in MKN-45 cellsItem Adult paratesticular malignant fibrous histiocytoma treated with surgery, systemic chemotherapy and postoperative adjuvant radiotherapy.(2006-10-14) Padula, Gilbert D A; Schmitz, MatthewParatesticular malignant fibrous histiocytoma is an extremely rare malignancy of the scrotum. This malignancy has rarely been described in the literature and scant information exists on the optimal management of this cancer. We present here a case of a 57-year-old man with a diagnosis of high-grade malignant fibrous histiocytoma of the left intrascrotal region who underwent radical orchiectomy, systemic chemotherapy and postoperative radiotherapy.Item Advances in radiation oncology: time to move ahead.(2006-10-14) Rath, G K; Sharma, D N; Bahl, AmitItem Advantages of multiple algorithm support in treatment planning system for external beam dose calculations.(2005-01-14) ,The complexity of interactions and the nature of the approximations made in the formulation of the algorithm require that the user be familiar with the limitations of various models. As computer power keeps growing, calculation algorithms are tending more towards physically based models. The nature and quantity of the data required varies according to the model which may be either measurement based models or physical based models. Multiple dose calculation algorithm support found in XiO Treatment Planning System can be used to advantage when choice is to be made between speed and accuracy. Thus XiO allows end users generate plans accurately and quickly to optimize the delivery of radiation therapy.Item An advisory by the association of radiation oncologists of India for radiation therapy patients and staff among COVID 19 pandemic(Wolters Kluwer India Pvt. Ltd., 2020-07) Talapatra, Kaustav; Gupta, Manoj; Singh, Kishore; Giri, GV; Vashistha, RajeshCovid19 has become a major public health problem in India and the rest of the world. The dramatic rise in the incidence of COVID 19 cases has severely challenged our healthcare system and forced us to work with limited infrastructure, resources, and workforce. However, even in this time of adversity, we as oncologists cannot neglect the seriousness of cancer care and the utmost attention it requires for the timely management of our patients. Hence, the Association of Radiation Oncologists of India has come up with an advisory for radiation therapy keeping in mind such aspects.