Indian Journal of Cancer
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Item Survival and prognostic factors of childhood Ewing sarcoma – Experience from a cancer center in South India(Medknow Publications, 2025-03) Rajeswari, Binitha; Prasanth, VR; Thankamony, Priyakumari; Nair, Manjusha; Sojamani, Guruprasad Chellappan; Sankar, Arun; Sugath, Bhaskar Subin; Krishna, K M Jagathnath; Kusumakumary, P; Jayasree, KBackground: Childhood Ewing sarcoma (ES) – both osseous and extraosseous – has good outcomes with aggressive treatment that includes chemotherapy, surgery, and radiation therapy (RT). In this paper, we report our experience on the survival and prognostic factors of ES. Materials and Methods: Seventy-four newly diagnosed patients with ES, less than 14 years of age, registered in Pediatric Oncology Department of our center, over a period of 5 years, from July 1, 2010 to June 30, 2015, were included. Results: Mean age at presentation was 8.93 years. Primary osseous sites were the extremity (n = 30), pelvis (n = 10), chest wall (n = 9), spine (n = 7), and skull (n = 5), and the extraosseous primary site was involved in 17.6% (n = 13). Metastatic disease was present in 17 patients (23%). Also, 52 patients received three-weekly vincristine/doxorubicin/ cyclophosphamide (VDC)/ifosfamide/etoposide (IE) and 21 patients received only VDC. There was no treatment-related mortality. Local control modalities were surgery alone (n = 12), definitive RT (n = 33), surgery and RT (n = 20), palliative RT (n = 4), or none (n = 4). At a median duration of follow-up of 64 months, the 5-year event-free survival (EFS) for the entire cohort was 50.4% (60.6% for localized and 17.6% for metastatic) and the 5-year overall survival (OS) was 54.6% (64.2% for localized and 23.5% for metastatic). Among the prognostic factors analyzed (age, gender, lactate dehydrogenase [LDH] levels, site, and metastases), presence of metastases was the only factor significantly associated with poorer EFS and OS. Conclusion: Localized ES has a favorable outcome even in resource-limited settings, and treatment intensification by interval-compressed chemotherapy may improve the outcomes further. Presence of metastasis at presentation confers a poor outcome.Item The effect of cognitive-behavioral therapy on distress management among head and neck cancer patients undergoing surgery at a tertiary care center in Eastern India(Medknow Publications, 2025-03) Mohanty, Debiprasad; Epari, Venkatarao; Singh, Aalapti; Mishra, Suvendu Narayan; Rout, Twinkle; Agrawala, SunilBackground: A diagnosis of cancer increases susceptibility to stress; thus, cancer patients are at high risk for a variety of emotional disorders, including anxiety, traumatic stress, and depression. Psychological distress may have multiple negative impacts on health outcomes. Surgical cancer patients are at an increased risk of cancer-related fatigue and psychological distress. Studies in the West have shown that there is a 40%–80% reduction in cancer-related distress if the patients are subjected to appropriate psycho-oncological interventions. Objectives: The aims of this study were to 1) screen head and neck cancer patients for distress by using a cancer-specific questionnaire, 2) to test the association of cancer-related distress with the sociodemographic characteristics of patients, and 3) to evaluate the effect of cognitive-behavioral therapy (CBT) on the distress level of head and neck cancer patients about to undergo surgery. Methods and Materials: A pre-tested, semi-structured, self-administered 23-item Questionnaire on Stress in Cancer patients (QSC-R23) were used to measure the level of distress. Three sessions of CBT of 1-hour duration on every alternate day were given to elicit the response. Categorical data were analyzed using the Chi-square test. Paired sample t test was applied to compare the pre and post scores. The correlation was done to compare continuous variables by using Pearson’s correlation test. Linear regression analysis was performed to elicit the effect of other associated variables. Results: The mean age of the 94 participants was 54.64 (±10.97) years. The mean pre-score was 60.06 (±20.42), and the mean post-score was 34.63 (±5.3). There was a significant improvement in the post-score (P = 0.0001), implying a reduction in stress among the study participants after the three sessions of CBT. Participants with middle/high monthly family income (P = 0.35, 95% CI = 0.639–17.418), with no past medical history (P = 0.35, 95% CI = 0.639–17.418) and no past psychiatric history (P = 0.005, 95% CI = 3.621–20.162) were more likely to benefit from the intervention. Conclusion: Owing to the lack of supportive literature from India, it is assumed that the prevalence rates of cancer-related distress in patients may be underestimated, resulting in a lack of availability of suitable intervention(s). However, thisstudy has successfully reported that CBT can reduce the distress levels among cancer patients. However, there is still a need to explore this research and produce more relevant evidence-based literature.Item High plasma prolactin is associated with PRL-R and predicts poor prognosis in Chinese postmenopausal women with breast cancer(Medknow Publications, 2025-03) He, Lifang; Jin, Xiaolong; Wu, Jundong; Wei, Xiaolong; Huang, Guangsheng; Hong, Yingsong; Li, Yaoquan; Liang, Peide; Huang, Wen-HeBackground: Prolactin (PRL) plays an important role in mammary epithelial cell development and lactation. Increased levels of PRL are observed in human breast cancer, but the underlying mechanism and prognostic significance of PRL are still controversial. In this study, we sought to determine the significance of PRL in Chinese postmenopausal women with breast cancer. Methods: Plasma PRL levels in 326 healthy individuals and 333 postmenopausal breast cancer patients were analyzed. Immunohistochemical staining of cytoplasmic prolactin receptor (PRL-R) was performed. Moreover, the relationships between plasma PRL and clinicopathological parameters as well as survival in breast cancer patients were evaluated. Results: We found that high plasma levels of PRL was more common in breast cancer patients than in healthy individuals. We also observed that high level of PRL was associated with adverse prognostic factors, such as larger tumor size, more lymph node metastasis, advanced tumor stage, negative estrogen receptor (ER) expression, and negative progesterone receptor (PR) expression of breast cancer. Kaplan–Meier analysis showed that high plasma level of PRL correlated with poor disease-free and overall survival, while Cox regression models demonstrated that high plasma level of PRL was an independent prognostic marker for disease-free survival. The rate of PRL-R positivity among those with high plasma PRL was significantly higher than that of patients with low PRL (P < 0.05). Conclusion: The plasma PRL level and PRL-R expression in tumor tissue may be prognostic for Chinese postmenopausal women with breast cancer. The inhibition of PRL and PRL-R signaling is a potential therapeutic approach for endocrine therapy in breast cancer.Item Peripheral monocyte count is associated with the risk of liver metastasis: A study of 7187 newly diagnosed patients with colorectal cancer(Medknow Publications, 2025-03) Yang, Yue; Song, Lijie; Cao, Jingyu; Zeng, Wanting; Liu, Jing; Shi, Xuetao; Zhao, LeiObjective: To evaluate the effect of the absolute peripheral blood monocyte count (AMC) on the risk of synchronous colorectal liver metastasis (synCRLM). Materials and Methods: AMC as well as other baseline clinical characteristics between the synCRLM+ group (with synCRLM) and the synCRLM ? group (without synCRLM) were measured. Taking AMC of 0.47 × 109/L as the cut-off value, the prevalence of synCRLM was compared between AMC?high level group (AMC ? 0.47 × 109/L) and AMC-low level group (AMC ? 0.47 × 109/L); significant predictors for synCRLM were analyzed by logistic regression analysis. Results: The AMC value of the synCRLM? group was significantly lower than that in the synCRLM+ group. The difference was statistically significant (Mann–Whitney U test, Z = –6.546, P = 0.001). There was no significant difference in age, the primary site of tumor, and tumor size between the two groups. The prevalence of synCRLM in the AMC-low group was lower than that in the AMC?high group, and the difference was statistically significant (?2 = 34.861, P = 0.001). At the same time, univariate and multivariate regression analyses showed that (elevated) AMC, eosinophil, basophil, triglyceride, alanine transaminase (ALT), alkaline phosphatase (ALP), carbohydrate antigen 19-9 (CA19-9), tumor stage, and distant metastasis status were risk factors of synCRLM, with AMC found to be an independent and the highest risk factor for synCRLM (hazard ratio [HR]: 1.455, [95% confidence interval {CI}: 1.012–2.093], P = 0.043). Conclusion: In conclusion, elevated AMC is highly associated with an increased risk of colorectal liver metastasis (CRLM).Item Haploidentical stem cell transplantation in newly diagnosed high-risk neuroblastoma: Results from a single-arm, prospective study from India(Medknow Publications, 2025-03) Swaminathan, Venkateswaran V.; Uppuluri, Ramya; Meena, Satish K.; Varla, Harika; Chandar, Rumesh; Raj, RevathiBackground: With increasing data on graft-versus-tumor (GVT) effect in neuroblastoma, we aimed to evaluate the possibility of haploidentical stem cell transplantation (HSCT) as a technique to induce GVT and thereby improve outcomes in high-risk neuroblastoma. Patients and Methods: We performed a prospective, single-arm study and included children from 18 months to 18 years of age diagnosed with high-risk neuroblastoma and who underwent a haploidentical HSCT from a parent donor. All children were started on induction chemotherapy as per the SIOP-Europa-Neuroblastoma (SIOPEN) protocol, followed by assessment and surgery when feasible. Conditioning in the unmanipulated graft included thiotepa/fludarabine/ busulfan. With a T-depleted graft, conditioning included rabbit anti-thymocyte globulin/fludarabine/thiotepa/melphalan. Results: Of the five children, one child received T-depleted and four children received T-replete stem cells with posttransplant cyclophosphamide, with 100% engraftment, no regimen-related toxicities, and documented remission. Grade I/II skin GVHD occurred in all children who responded to steroids. We administered involved-field radiotherapy in four children around D + 60–75 post-HSCT, followed by 13-cis retinoic acid. At 1 year post-HSCT, three had isolated central nervous system relapse; one child had isolated pelvic bone relapse. One child relapsed 2 months post-HSCT. Progression-free survival was 12 months in 4/5 children and 6 months in one child. All except one child succumbed to progressive disease post relapse. Conclusion: Children with high-risk neuroblastoma continued to relapse within a year post-HSCT in our cohort. Significant improvement in outcomes was not demonstrated with haploidentical HSCT. We urgently need new strategies including deeper remission induction with upfront metaiodobenzylguanidine (MIBG) therapy followed by HSCT to improve the outcomes.Item The prognostic role of omental, ovarian chemotherapy response score and CA125 in predicting survival in patients with tubo-ovarian high-grade serous carcinoma/primary peritoneal carcinoma receiving neoadjuvant chemotherapy(Medknow Publications, 2025-03) Ravi, Ramya D.; Kulkarni, Kiran A.; Acharya, Geeta; Siddharta, Premalatha; Ravikumar, Gayatri; Bidkar, Vishakha C.; Mohanapriya, DObjective: To assess the role of omental and ovarian chemotherapy response score (CRS) and CA125 as a predictor of prognosis in patients with tubo-ovarian high-grade serous carcinoma (HGSC)/primary peritoneal carcinoma (PPC) receiving neoadjuvant chemotherapy (NACT). In addition, to study the correlation of omental CRS with chemoresistance. Methods: A retrospective record review of patients with tubo-ovarian HGSC/PPC receiving NACT followed by interval debulking surgery (IDS) between January 2012 and May 2020 was done. The slides of the omentum and ovarian tissue of the patients were retrieved and reviewed by a trained pathologist. During analysis, CRS 1 and CRS 2 were merged together for comparison against CRS 3. Results: A total of 44 patients with a mean age of 54 years were included in the study. Among the patients, 29.5%, 38.6%, and 31.8% had a CRS of 1, 2, and 3, respectively, on the omental specimen and 31.8%, 43.2%, and 25% on the ovarian specimen. Median PFS and OS was significantly better with omental CRS 3 (P = < 0.0001 and P = < 0.00065). No significant difference in median OS of patients was noted with ovarian CRS 1, 2, or 3 (P = 0.057); however, the median PFS was significantly better in patients with CRS 3 on ovarian tissue (P = 0.036). Platinum resistance was significantly lower in patients with CRS 3 on omentum (P = 0.001). The value of CA125 post NACT had a significant association with PFS on both univariate and multivariate analyses. There was no statistically significant correlation between CA125 and omental CRS. Conclusion: Omental CRS has a prognostic significance for patients with tubo-ovarian HGSC/PPC receiving NACT and correlates significantly with PFS and OS. Ovarian CRS correlates significantly only with PFS. Post NACT CA125 value had a significant association with PFS.Item Case report of Ewing’s sarcoma of mandible – an unforeseen quandary(Medknow Publications, 2025-03) Ruparelia, Pritesh; Verma, Oshin; Gill, Navneet; Ruparelia, KoshaEwing’s sarcoma (ES) is a rare sarcoma of bone and soft tissue that uncommonly involves head and neck. Accurate diagnosis of ES family of tumors is crucial for appropriate clinical management of patients. The present case demonstrates the importance of advanced imaging technologies to aid in proper diagnosis of ES.Item Rare scenarios in germ cell tumors: A case series(Medknow Publications, 2025-03) Kamala, Lakshmi H.; Narayanan, Geetha; Vasudevan, Arun; Radhakrishnan, NeelimaGerm cell tumors are native to the testis, retroperitoneum, and mediastinum. Here, we report our experience on rare scenarios in this entity. The first patient presented with a primary mediastinal germ cell tumor with 2° hemophagocytosis. This dysregulated immune milieu portends a dismal outcome irrespective of treatment. Gastrointestinal involvement in germ cell tumor accounts for only 5% of cases. The Second case with duodenal involvement and hematemesis is believed to be due to contiguous infiltration of the retroperitoneal node. Another case with bleeding ileal intussusception was seen after high-dose chemotherapy in a relapsed non-gestational choriocarcinoma. Bone metastases are exceptional in seminomas and we report such a case as well. Our next patient had thrombotic cardiac involvement which is scarce in the literature. Last patient in this series is an 81-year-old man with sertoli leydig cell tumor. This rare disease in elderly should be differentiated from other entities as the management for each differs.Item Demystifying the conundrum of medullary thyroid cancers and providing a brief review of literature(Medknow Publications, 2025-03) Krishnamurthy, Arvind; Kothandaraman, Srikamakshi; Keerthi, MSS; Ramachandran, Krishna KumarBackground: The aim of this study was to evaluate the clinicopathological features, patterns of care, and the survival outcomes of patients with medullary thyroid cancers (MTCs) treated at our tertiary care center. Methods: We conducted a retrospective analysis of all patients with a histological diagnosis of MTC and who had been treated at our tertiary care center from August 1, 1986 through November 31, 2019. Results: MTC in 83 patients were managed in the said period and comprised 44 men and 39 women. The median age of the patient cohort was 45 years. Seventy-seven of 83 patients underwent upfront surgery that entailed a total thyroidectomy and a central compartment neck dissection and a lateral compartment neck dissection, as was deemed appropriate. The disease-free survival rates at 5, 10, and 20 years for the present study were 62%, 51%, and 46%, respectively, and the overall survival rates for the same periods were 85%, 80%, and 76%, respectively. A formal analysis of the various prognostic factors was made. In multivariate analysis, the factors that significantly influenced the disease-free survival included gender and lymph node ratio. Furthermore, on multivariate analysis, the factors that significantly influenced the overall survival included age and gender, with male patients and patients aged >55 years faring poorly. Conclusion: Our study has clearly demonstrated the favorable long-term survival outcomes of patients with MTCs. Furthermore, the analysis of various prognostic factors adds to our understanding of the biology of this rare form of thyroid cancer.Item Cytomegalovirus infection in non-Hodgkin lymphoma: A case series(Medknow Publications, 2025-03) Jobanputra, Kunal; Ravind, Rahul; Kashyap, Yashwant; Bonda, Avinash; Bagal, BhausahebCytomegalovirus, a common infection in immunocompromised hosts, can cause clinical manifestations ranging from asymptomatic or mild infection to severe end?organ involvement. Cytomegalovirus infection in hematologic malignancies is often reported in patients receiving allogeneic stem?cell transplant and less commonly in nontransplant settings. Disease?related impaired host immunity and drug?induced immunosuppression are important risk factors. We describe three cases of cytomegalovirus end?organ disease – one case of life?threatening encephalitis, possibly due to cytomegalovirus, and two cases of treated cytomegalovirus retinitis.Item CD3 negative T-ALL – A case study of three cases and review of the literature(Medknow Publications, 2025-03) Bansal, Shashi; Gilhotra, Simran; Sharma, Upendra; Purohit, AbhishekT-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) is a neoplasm of lymphoblasts that is usually TdT-positive and variably expresses CD1a, CD2, cytoplasmic CD3 (cytoCD3), CD4, CD5, CD7, and CD8. Acute undifferentiated leukemia (AUL) is a rare entity and is defined by the expression of not more than one membrane marker for any given lineage. Blasts express HLA-DR, CD34, and/or CD38 and may be positive for terminal deoxynucleotidyl transferase (TdT). Mixed-phenotype acute leukemia (MPAL) is a hematologic malignancy with immunophenotypic co-expression of markers from at least two cell lineages. In this case series of acute leukemia, we emphasize on key diagnostic or biological points of acute leukemia of ambiguous lineage versus T-ALL and provide a relevant literature review. A diagnosis of AUL can be debatable for our cases; however, the positivity of CD5 and CD7 (bright) ruled out AUL. Although cyCD3 is a T-cell lineage-specific marker of T-ALL, its negativity does not always rule out the diagnosis as several cases have been reported with a negative cyCD3, as reported in our cases.Item Renal epithelioid aggressive angiomyolipoma in a patient with tuberous sclerosis and past contralateral benign renal angiomyolipoma(Medknow Publications, 2025-03) Pecorella, Irene; Tornese, Andrea; Rullo, EmmaTwenty-five percent of all aggressive angiomyolipomas (AMLs) are related to tuberous sclerosis. Our patient was a 42-year-old man with tuberous sclerosis and a medical history of a benign AML in the left kidney. Presently, an epithelioid AML was detected in his right kidney and, despite our conducting extensive surgery, a large pulmonary metastasis with mediastinal lymph node involvement followed 20 months later. Close follow-up of the patient is advised when epithelioid cells are observed in angiomyolipoma. Immunohistochemistry for mismatch repair proteins showed that PMS2, MSH2, and MSH6 were absent in both the tumor and normal kidney. Microsatellite instability may contribute along with a mutation of TSC gene to the oncogenic events leading to AML.Item Carbimazole-induced acute myeloid leukemia: A very rare case report and review of the literature(Medknow Publications, 2025-03) Mittal, Lalchand; Jasuja, SandeepNeutropenia is a common side effect in hyperthyroid patients with long-term use of antithyroid drugs. Antithyroid drugs have been used for the management of hyperthyroidism and rarely may cause life-threatening side effects such as pancytopenia and very rarely may cause acute leukemia. The current case report is of a 34-year-old man diagnosed with hyperthyroidism who presented with pancytopenia after treatment with carbimazole for past 7 months; he initially improved with supportive treatment. The patient restarted treatment with carbimazole but with a reduced dose. He was readmitted for fever and high total leukocyte counts after 3 months of restarting carbimazole. The patient was thoroughly investigated, and bone marrow aspiration examination showed acute myeloid leukemia. This presentation of acute myeloid leukemia was likely attributed to the reexposure to carbimazole, although the association of acute myeloid leukemia with autoimmune thyroid disease cannot be denied.Item Rare complication of chylous ascites following surgery and radiotherapy in endometrial carcinoma managed by diet modification: Case report(Medknow Publications, 2025-03) Hantodkar, Rujuta N.; Patel, Bijal; Dave, Pariseema S.; Palkhiwala, NeilChylous ascites is an uncommon complication seen in gynecological malignancies. The incidence of postoperative chylous ascites in gynecological malignancies is 0.17%. It is the extravasation of milky chyle into the peritoneal cavity due to lymphatic obstruction or injury and is diagnosed by the detection of triglyceride levels greater than 200 mg/dl in ascitic fluid. The site of leakage can be determined by lymphangiography or lymphoscintigraphy. The majority of the cases of chylous ascites can be treated by conservative methods, such as a dietary modification to a low-fat high-protein diet, bowel rest, total parenteral nutrition, medications, and large-volume paracentesis. If these measures fail, surgical modalities such as laparotomy or peritoneovenous shunting are employed. In our case, the patient was successfully managed on dietary modification alone. This case report emphasizes the importance of conservative management for chylous ascites following surgery and radiotherapy in endometrial carcinoma.Item Delay in the diagnosis of oral cancer in India, time to focus toward capacity building of physicians: A prospective observational study(Medknow Publications, 2025-03) Sahu, Guru C.; Shankar, Ravi; Singhavi, Hitesh R.; Daga, Dipti; Rai, Dharmendra K.; Gupta, Monika; Mishra, AseemBackground: Delay in diagnosis of head and neck cancers is responsible for advanced presentation of the disease leading to increased morbidity and mortality. Methods: A questionnaire-based prospective observational study consisting of 150 patients was performed in a tertiary care center established in North India. The factors responsible for professional and patient delay including demographic details and the clinical examination findings, health-related behavior, socio-economic status based on modified Kuppuswamy’s scale, and the health care factors were also evaluated. Results: The mean age of the patients at the time of diagnosis was 48.32 years (S.D: 12.467 and range 27–80 years). Male patients showed predominance with a ratio of 11.5:1. Buccoalveolar cancers were the most common sites, whereas 55% had nodal metastasis and 70% were advanced stage cancers. Overall advanced stage patients (p < 0.02) and node positive patients (p < 0.04) were present significantly more in those with the physician’s delay (P1D). There was higher P1D in patients with no tobacco habits (76.9% vs 53.3%) (p < 0.05). Self-motivated individuals had significantly shorter patient delay (p < 0.00); however, physician delay was similar. Conclusion: Circumventing physicians delay by training and capacity building of the general physicians will lead to early diagnosis and timely treatment of the head and neck cancer patients.Item Psychosocial issues faced by children with cancer: Lessons learnt from a tertiary care center in South India(Medknow Publications, 2025-03) Shajan, Sheena; Srinivasan, Hema N.; Joseph, Leenu L.; Boddu, Deepthi; John, Rikki R.; Mathew, Leni G.; Totadri, SidharthBackground: Psychosocial issues adversely impact children with cancer but are seldom addressed. Materials and Methods: Children with cancer who were consecutively referred to the pediatric psycho-oncologist from June 2016 to September 2018 were included in a retrospective study. Psychosocial issues were categorized as disease related (DR), treatment related (TR), interpersonal related (IPR), and academic related (AR). The interventions provided were classified as counseling, prolonged psychotherapy, and referral to a child psychiatrist for pharmacologic therapy. Results: The mean age of the 212 children included in the study was 10.7 ± 4.2 years, and the male to female ratio was 1.8:1. Of the 212 children, AR, TR, DR, and IPR concerns were identified in 93 (44%), 61 (29%), 41 (19%), and three (1%) patients, respectively. Fourteen of the 212 (7%) patients had concerns spanning all four domains. Thirty-six (48%) of the 56 children aged ?7 years were identified to have TR issues. Of the 99 children aged ?13 years, 65 (61%) demonstrated AR issues. Conclusions: Children with cancer experience several psychosocial issues. They can be classified into specific clusters that differ across different age groups. The majority of patients with psychosocial concerns can be managed with psychotherapy.Item Distribution of genetic polymorphisms of nucleotide excision repair genes and risk of gastrointestinal cancer: Findings from a case-control study(Medknow Publications, 2025-03) Patil, Madhavi N.; Datkhile, Kailas DhondibhauBackground: Gastrointestinal cancer (GI) is one of the most common and deadly cancers worldwide. In the present study, we assessed the association between single nucleotide polymorphisms (SNPs) within nucleotide excision repair (NER) pathway genes (xeroderma pigmentosum complementation group C [XPC], xeroderma pigmentosum complementation group G [XPG], and xeroderma pigmentosum complementation group D [XPD]) and the GI cancer risk in the rural population of Maharashtra. Methods: The genotyping of XPC, XPD, and XPG genes was studied by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method using 200 clinically confirmed GI cancer cases and equal number of healthy controls. The association of polymorphisms was confirmed by odds ratio (OR) with 95% confidence interval (CI). Results: The frequency distribution of XPD gene (C22541A) polymorphism showed that variant A/A genotype increased four times (OR = 4.08; 95% CI = 2.14–7.77; P: < 0.0001) and G23591A polymorphism with heterozygous G/A genotype showed significant correlation (OR = 6.90; 95% CI = 4.28–11.11; P < 0.0001) with risk of GI cancer compared to variant A/A genotype (OR = 1.92; 95% CI = 1.00–3.69; P = 0.04). The results of genetic association analysis of XPC at codon 939 of exon 15 and XPG at codon 1104 of exon 15 showed no association with GI cancer risk in the studied population. Conclusion: Our results indicated that XPD Arg156Arg and Asp312Asn polymorphisms were significantly associated with GI cancer risk whereas XPC Lys939Gln and XPG His1104Asp polymorphisms were not statistically significant.Item Predicting pulmonary complications after esophagectomy: A retrospective cohort study(Medknow Publications, 2025-03) Ranganathan, Priya; Jiwnani, Sabita; Ashok, Apurva; Purwar, Pallavi; Karimundackal, George; Parab, Swapnil; Shetmahajan, Madhavi; Pramesh, Conjeevaram S.Background: Pulmonary complications are the main cause of postoperative mortality in patients undergoing esophagectomy. The aim of this study was to identify the risk factors associated with major pulmonary complications in these patients. Methods: This was a retrospective cohort study of patients who underwent esophagectomy between January 2004 and December 2014. We retrieved data on patient- and surgery-related variables and the postoperative complications from medical records, including age, gender, physical status as per the American Society of Anesthesiologists’ (ASA) classification, smoking status, hemoglobin, albumin, creatinine, forced expiratory volume in the first second (FEV1), neoadjuvant therapy, type of surgery (transthoracic vs. others), thoracic approach (minimally invasive vs. open), lymphadenectomy type (three field or abdominal vs. two field), intraoperative blood loss, operative time, and use of epidural analgesia. We classified pulmonary complications using the Clavien–Dindo system. Multivariable logistic regression analysis was used to derive the odds ratios (OR) with 95% confidence intervals (CI) to identify significant risk factors for major pulmonary complications (Clavien–Dindo grade 3 or more). Results: We obtained relevant data on 1189 patients operated during the study period. Increasing age (OR 1.03, 95% CI 1.01; 1.04; P < 0.01), FEV1% less than 70% (OR 1.71, 95% CI 1.03; 2.83; P = 0.04), three-field lymphadenectomy (OR 2.12, 95% CI 1.50; 3.01; P < 0.01), and use of analgesia techniques other than epidural (OR 1.51, 95% CI 1.07; 2.13; P = 0.02) were independent predictors of major pulmonary complications. Conclusions: The recognition of factors associated with increased risk of pulmonary complications in patients undergoing esophagectomy could help in risk stratification, preoperative optimization, and early detection of complications.Item Can preoperative 18F-fluorodeoxyglucose positron emission tomography parameters predict the molecular subtype of breast cancer?(Medknow Publications, 2025-03) Duymus, Mehmet Esat; Bulgurcu, Abdullah; Ogur, Umit; Ercan, Sirma; Kilincer, AbidinBackground: This study aims to evaluate the predictive value of metabolic parameters in detecting invasive breast cancer molecular subtypes. Methods: We enrolled 112 patients who had a preoperative 18F?fluorodeoxyglucose positron emission tomography computed tomography (18F?FDG PET?CT) scan and were operated on with a diagnosis of invasive breast cancer between January 2017 and August 2020. We evaluated associations among maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and clinicopathological findings by dividing the specimen into three tumor subtypes according to estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER?2) expressions. Results: There was a significant difference between the three groups in the SUVmax value of axillary lymph node metastasis (P = 0.014), but no significant difference was revealed for TLG and MTV (P = 0.858 and P = 0.083, respectively). There was a significant difference between groups in SUVmax and TLG (P < 0.001 and P = 0.001, respectively) for the primary tumor, but no significant difference was observed in MTV (P = 0.051). Conclusion: We suggest that primary tumor SUVmax can be used to differentiate triple?negative patients from other subgroups, and primary tumor TLG can be used to distinguish hormone receptor positive (HR+) patients from other subgroups.Item Streamlining the radiotherapy practice through multidisciplinary peer review rounds: An initial 4-year experience from an Indian radiotherapy department(Medknow Publications, 2025-03) Raveendran, Vysakh; Rajendran, Ganapathi Raman; Makuni, Dinesh; Puzhakkal, NiyasAim and Background: Multidisciplinary peer review is a proven and effective quality control method in radiotherapy. This study reports and analyzes the impact of the peer review rounds of a modern radiotherapy department during the first 4 years. Subjects and Methods: Prospectively documented data for 183 peer review sessions consisting of 3725 patients from June 2017 to May 2021 were obtained. The proportion of cases that required major (unacceptable and requires an immediate correction before delivery) and minor plan changes (not ideal, but still allowable for delivery) were analyzed on a site-specific basis. Pareto charts were plotted for each site to demonstrate the reasons for plan changes. Results: Among the cases reviewed, 197 plans (5.29%) required any plan modifications; among these, 111 (2.98%) were major changes, while 86 (2.31%) cases required minor changes. The major changes suggested had decreased from 5.84% to 1.58% over time. The reasons for plan changes were site dependent. Frequent reasons for major plan change were modification in clinical target volume (63.06%), followed by a change in dose or fractionation (24.32%). Minor plan changes were mainly due to changes in normal tissue contour or dose (32.56%), followed by field port or MLCs (23.26%). Conclusions: Adherence to peer review practices since the establishment of the department has led to a considerable reduction in plan modifications with time as a result of consistent improvement in the radiotherapy processes.