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Results in Journal Asian Pacific Journal of Cancer Care: 272

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Derri Hafa Nurfajri, Sawkar Vijay Pramod, Ferry Safriadi, Betty Suryawathy Hernowo
Asian Pacific Journal of Cancer Care, Volume 7, pp 581-586; https://doi.org/10.31557/apjcc.2022.7.3.581-586

Abstract:
Background: Bladder tumors are the most common neoplasm of the lower urinary tract. Bladder carcinoma arising from a suprapubic cystostomy tract is a relatively rare. Some patients with bladder tumors have difficult urethral access for urinary retention due to inaccessible urethra. Most people think cystostomy in patient with bladder cancer can cause seeding and upstaging to suprapubic cystostomy tract. This study aim of suprapubic cystostomy can cause seeding and upstaging of bladder cancer. Methods: Literature obtained from the search results of Pubmed, Medscape, Science Direct, Scopus, Cochrane Library, and Google Scholar electronic databases with the keywords used are “suprapubic catheter and bladder cancer”, “suprapubic catheter and bladder tumor”, “suprapubic catheter and bladder carcinoma”, “suprapubic cystotomy and bladder carcinoma”, and “suprapubic catheter and bladder cancer upstaging” with no time limits. Results: Eighty two articles were obtained from the electronic database. Following all the inclusion and exclusion criteria, the final selection considered 5 literature with 16 patient eligible for this literature review. The five literature involved a total of 16 bladder cancer patients with a suprapubic catheter. The duration of suprapubic catheter insertion was between 1 to 3 months. As long as it is within the specified time and from the location of cancer, literature result there will be no seeding and upgrading in the suprapubic cystostomy tract. In our case report we have patient with duration suprapubic cystostomy 1 months wih no seeding and upgrading cancer. Conclusion: Although SPC is an effective, inexpensive, easy mode of access for bladder tumors with difficult urethral access for urinary retention due to inaccessible urethra, it also presents a risk of SPC tract bladder cancer, mostly SCC and TCC. It is important to be aware of any suspicious signs and symptoms, duration time of use suprapubic cystostomy and location of the cancer.
Vipul Mehta, Parul Gupta, Ravinder Singh Gothwal, Rohitashwa Dana, Narendra Gupta, Shivani Gupta
Asian Pacific Journal of Cancer Care, Volume 7, pp 509-514; https://doi.org/10.31557/apjcc.2022.7.3.509-514

Abstract:
Background: Present study compares two high-dose-rate intracavitary brachytherapy (ICBT) planning methods using two-dimensional orthogonal radiography and three-dimensional computed tomography (3D-CT) with regard to dose to target volume and organs at risk (OAR) in carcinoma cervix. Methodology: ICBT plans for 22-patients were compared using 2D planning and three-dimensional computed tomography (3D-CT) planning techniques. 2D treatment plans were generated using 2D-orthogonal images and dose was prescribed at Point A while 3D-CT plans were generated using 3D-CT images after contouring target volume and organs at risk. In 2D planning rectal and bladder doses were assessed as per ICRU-38 and in 3D planning, 0.1cc, 0.2cc, 0.5cc and 1cc doses of bladder and rectum were evaluated. Doses to target and organ at risks (rectum and bladder) were compared for each planning method. Results: Mean dose received by D90, D95 and D100 was 8.05±1.59Gy, 7.19±1.43Gy and 4.79±0.93Gy respectively. ICRU bladder and rectal point doses were 5.19±1.36Gy and 5.03±0.36Gy respectively. Mean dose received by bladder D0.1cc, D0.2cc, D1cc, D2cc and D5cc was 2.38±0.80, 2.22±.75, 1.85±0.64, 1.51±0.64 and 1.29±.49 times higher than ICRU bladder reference point dose. Similarly mean dose received by rectum D0.1cc, D0.2cc, D1cc, D2cc and D5cc was 1.49±0.27, 1.43±.25, 1.25±0.23, 1.09±0.21 and 0.93±.21 times higher than ICRU rectal reference point dose. Conclusion: This study demonstrates suboptimal target coverage and underestimation of dose to OAR by 2-dimensional radiography when actual dose estimation was done by 3-dimensional brachytherapy planning for the same brachytherapy session.
, Deivanayagam R, Valli S
Asian Pacific Journal of Cancer Care, Volume 7, pp 587-588; https://doi.org/10.31557/apjcc.2022.7.3.587-588

Abstract:
Clivus is a rare location for metastasis. We report a patient with lung cancer presented to us with diplopia and headache. He was found to have clival metastasis and treated with palliative radiation therapy to clivus. Metastasis is also a differential to be considered when patients present with clival lesion.
, Susi Susanah, Ponpon Idjradinata, Feti Karfiati
Asian Pacific Journal of Cancer Care, Volume 7, pp 573-576; https://doi.org/10.31557/apjcc.2022.7.3.573-576

Abstract:
Background: We aim to analyze which tumor location gives more favorable chemotherapy response in intraocular retinoblastoma grade B, C, and D as well as to report the first case series in Indonesia. Methods: Six boys with age ranging from 10 weeks to 47 months old were recruited into the study from April 2019 to January 2020 at National Eye Centre, Cicendo Eye Hospital, and Hasan Sadikin General Hospital, Bandung, West Java, Indonesia. Retinoblastoma (RB) patients underwent examination under anesthesia (EUA). Tumor size and location were evaluated by using RetCam pre and post 2 cycles of chemotherapy. The tumors were classified according to the International Intraocular Retinoblastoma Classification. Results: There were two patients with unilateral RB and four patients with bilateral RB. All patients had leukocoria and sought medical advice within 12 months of onset. There were one tumor in the macular zone, six tumors in the equatorial zone, and two tumors in the ora zone. Two cycles of intravenous vincristine, etoposide, and carboplatin (VEC) were administered and the tumor diameter was re-evaluated afterwards. The tumor size was decreased following 2 cycles of chemotherapy. Conclusions: Ora zone showed a more favorable chemotherapy response.
Khaleel Mohson, Mohammed Ali Jafaar
Asian Pacific Journal of Cancer Care, Volume 7, pp 481-484; https://doi.org/10.31557/apjcc.2022.7.3.481-484

Abstract:
Background: Palpable superficial mass (es) is a major complain making patients attending any surgical and otolarygeal clinic. Most of these lesions are related to thyroid, cervical lymph nodes or salivary glands Triple assessment technique using clinical examination, ultrasound and cytology are usually sufficient in reaching the final diagnosis especially in specialized surgical centers. Aims: The objective of this study was to assess how accurate ultrasound in guessing the diagnosis of the lesion and how accurate as a guide for fine needle aspiration cytology (FNAC). Methods: A prospective study included 50 patients who were presented with self-detected head or neck lump and attending the specialized surgical clinic in the Medical City Complex, Baghdad during the period from November 2019 to October 2020. Their age ranged from 10-63 years. Patients were underwent ultrasound examination after clinical examination and then subjected to ultrasound guided FNAC. Results: Twenty patients presented with palpable lump were included in this study. Their ages ranged between 10 to 63 years (mean age 37.8 years). Regarding the distribution of the anatomical locations the majority of the lesions were lymph nodes (7/20) six of them are cervical and one of them was inguinal, the 2nd common location was the parotid gland seen in four out of twenty, The provisional diagnosis provided by ultrasound for lococregional pathology was benign in majority of Lymph node group (5/7) and malignant in two, three out of four parotid lesions are benign and all thyroid cases are also benign, The FNAC results in correlation with ultrasound findings are in concordance regarding the lymph nodes and parotid aspirates in 100% while thyroid aspirate was in concordance in 100% after two passes due to bloody aspirate, the aspirate from the breast is 50% in line and no concordance seen in 50 %, the aspirate is compatible regarding the hip mediastinum and sternomastoid while is not conclusive in lung aspirate. The accuracy of ultrasound in guiding the needle for targeting the lesion is 100%, and overall accuracy of ultrasound in reaching the final diagnosis is 85% with 100 % sensitivity. Conclusion: Ultrasound guided FNAC represents a reliable interventional radiology modality for targeting the needle to any superficial or ultrasound reachable deep seated head and neck lesion and considered a recommended method for assessment of underlying cause responsible for palpable head and neck mass this is due to reliable focusing the mass lesion, avoiding nearby vital organ or vessel and direct real time visualization of the needle within the lesion and by that sampling cells by flickering the needle within the lesion.
Asian Pacific Journal of Cancer Care, Volume 7, pp 555-563; https://doi.org/10.31557/apjcc.2022.7.3.555-563

Abstract:
Objectives: Cervical dysplasia which is the precursor or premalignant form of cervical cancer is prolonged; hence its diagnosis is essential for the early detection and inhibiting the development of cervical cancer. This review briefs the extensive studies conducted globally to gain knowledge about the development of cervical dysplasia along with the risk factors associated, role of human papilloma virus (HPV), potential diagnostic biomarkers and association with various micronutrient levels. Materials and method: All these data were collected through extensive literature review. Result: Based on the review, it can be stated that HPV virus (HPV 16 most commonly) is the most important etiological agent for the process of cervical carcinogenesis. However, HPV infection solely does not cause cervical cancer. There are various factors which act synergistically to develop cervical dysplasia and cancer. Smoking was found to be an important independent risk factor. There are studies which showed conflicting results regarding oral contraceptive intake association with cervical dysplasia. There are quite a few biomarkers like HPV DNA, p16INK4a, telomerase, and microRNA expression which have been identified as effective in diagnosing cervical dysplasia. Chromosome 3q mutation has been reported to be present in early dysplastic lesions; hence, it can be used in screening early lesions. Various micronutrient studies highlighted the facts that high plasma concentrations of several carotenoids and Vitamin C are inversely proportional to the degree of cervical dysplasia. Low red cell folate levels n plasma increases the risk of cervical dysplasia association. Low dietary intake of Vitamin A is also associated with increased risk of cervical dysplasia. Conclusion: Finally, it can be stated that more extensive studies relating to nutritional and serum markers level need to be conducted with larger cohorts so that an appropriate nutrition plan can be implemented for these patients.
Thokozani Maseko, Samson Haumba, Xolisile Dlamini, Hlophe Lomalanga, Nonhlanhla Mahlalela, Mandzisi Mkhontfo, Zanele Nhlabatsi, Nomxolisi Mabuza, Debrah Vambe
Asian Pacific Journal of Cancer Care, Volume 7, pp 491-497; https://doi.org/10.31557/apjcc.2022.7.3.491-497

Abstract:
Background: Cancer is a major public health problem for both developed and developing countries, and more than 70% of cancer deaths occur in developing countries. In Eswatini, cancer is the third leading cause of morbidity and mortality among non-communicable diseases. Cancer is therefore a major health problem for the country that needs urgent attention. Amongst the major contributing factors is lack of knowledge about the disease, lack of awareness on need to screen, issues related to availability and access to screening, diagnosis and treatment services. Health workers have a direct contact with patients hence can pass information to them. This study assessed the knowledge, attitudes and associated factors of health workers towards cancer in Eswatini. Methods: A quantitatively designed cross-sectional study was conducted among health workers using a structured questionnaire. Health workers were enrolled from 12 health facilities countrywide which included hospitals, health centres and clinics. Data were analysed using quantitative methods and presented on tables. Results: A total of 748 health workers were enrolled in the study. Most of them (84.9%) had average knowledge about cancer. Their knowledge differed by age (p<0.001), marital status (p=0.006), employment position (p<0.001), professional qualification (p=0.001), level of education and years of employment (p<0.001). Almost all the HCWs (99.3%) had positive attitudes towards cancer. Conclusion: The HCWs had average knowledge and positive attitudes. There is a need for training programs for HCWs to improve their knowledge as they act a source of information for the population.
Nayi Zongo, Parateyandé Bonaventure Yameogo, Amélie Nare, Adeline R Djigemdé, Abdoul Halim Bagué, Nomwendé Lamoussa Marie Ouedraogo, Mamadou Windsouri, Ahmadou Dem
Asian Pacific Journal of Cancer Care, Volume 7, pp 485-489; https://doi.org/10.31557/apjcc.2022.7.3.485-489

Abstract:
Objective: To describe the indications, surgical techniques and results of breast oncoplasty. Patients and methods: Retrospective and descriptive study of oncoplastic breast surgery performed between January 2013 and March 2021. We were interested in the indications, techniques, and aesthetic and oncological results. Overall survival was assessed by the Kaplan Meier technique and survival comparisons by logRank. Aesthetic results and quality of life were assessed by the modified BREAST-Q questionnaire. Results: We report 64 cases of oncoplastic breast surgery in Ouagadougou, that is 6.9% of the 917 surgeries performed for breast cancers. We performed 14 Round Block for upper quadrant carcinomas. Eight external oncoplasties were performed for infiltrating ductal carcinomas of the external quadrants. The upper pedicle technique was performed in 19 cases and the Thorek amputation graft technique in 13 cases for lower quadrant carcinomas with macromastia and major ptosis. The supero-postero-internal pedicle technique help to avoid necrosis and amputation of the nipple in 8 cases. The 5-year overall survival was 90.5%. The patients were satisfied with the volume of the remaining breasts and their aesthetic appearance. Conclusion: Oncoplasty is increasingly performed in Burkina Faso. It should take its place with the recent advent of radiotherapy in our country. A larger cohort will better describe its results.
Ram Singh, Hari Krishna Raju Sagiraju, Sudarsan Krishnasamy, Prashant Sirohiya, Balbir Kumar, Brajesh Kumar Ratre, Sushma Bhatnagar
Asian Pacific Journal of Cancer Care, Volume 7, pp 515-517; https://doi.org/10.31557/apjcc.2022.7.3.515-517

Abstract:
Background: The development of acute kidney injury (AKI) in patients infected with COVID-19 has been observed to be associated with poor outcomes. Our study aimed to measure the outcomes of COVID-19 in cancer patients who developed AKI during hospitalization and the predictive baseline clinical and laboratory factors associated with the development of AKI. Materials and Methods: This retrospective cohort study was conducted at a COVID hospital that included only cancer patients with COVID-19 infection. Acute kidney injury (AKI) was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The demographic, clinical, laboratory and outcomes data were collected from the hospital electronic database and abstracted from the case files. Results: Thirteen (12.8%) of the total 102 cancer patients developed AKI during hospitalization. Out of 13, 11 (84.6%) patients presented with hypoxemia during admission and required oxygen support. Breathlessness [Odds Ratio (OR) (95% CI): 5.8 (1.1-31.3)] or hypoxemia [OR 22.6 (2.6-194.5)] at the time of presentation and requirement of oxygen support [OR 7.5 (1.4-40.5)] were significantly associated with AKI after adjusting for age, gender, vaccination status and comorbidities. Median baseline values of inflammatory markers were significantly higher among those who developed AKI. Out of 102, 27 (26.5%) patients had in-hospital mortality. Mortality was high among those who developed AKI compared to those who didn’t develop AKI (92.3% vs 16.1%, p-value: <0.001). Conclusions: The cancer patients infected by COVID-19 and who developed AKI were more vulnerable to poor outcomes in terms of in-hospital mortality. The patients with severe disease at presentation and higher levels of baseline inflammatory markers CRP, ferritin, and D-Dimer were more susceptible to the development of AKI and in turn, led to a higher risk of in-hospital mortality in these patients.
, Grace Shalmont, Umi Mangesti Tjiptoningsih
Asian Pacific Journal of Cancer Care, Volume 7, pp 593-596; https://doi.org/10.31557/apjcc.2022.7.3.593-596

Abstract:
Objective: Lymphoepithelial carcinoma (LEC) is rarely found as one type of salivary gland malignancy, especially the parotid gland. Based on data only covers 0.86% of all cases of salivary gland malignancies with an annual incidence rate of 0.01 cases per 100,000 population. Liver metastasis from this type of cancer is very uncommon. Methode: We reported a 64-year-old female patient who presented with a lump in the left neck which enlarged within four years. Total parotidectomy and modified radical neck dissection were done and the diagnosis of lymphoepithelial carcinoma of the parotid gland was establishes based on pathology examination. The patient was then given adjuvant radiotherapy. Five months after initial treatment, the patient shows no locoregional recurrence. However, the patient developed multifocal liver metastases which were deemed inoperable. Results: Liver metastases in the case of lymphoepithelial carcinoma have a worse prognosis than other types of cancer because it usually manifests in multiple and disseminated lesions rather than solitary.
Ativitch AsavachaIsuvikom, Ongart Somintara, Yotdanai Namuangchan, Chaiwat Aphivatanasiri, Anongporn Wongbuddha
Asian Pacific Journal of Cancer Care, Volume 7, pp 459-465; https://doi.org/10.31557/apjcc.2022.7.3.459-465

Abstract:
Objectives: The retrospective study evaluated the clinical outcome after treatment of patients diagnosed with ductal carcinoma in situ of breast and reanalyzed the prognostic factors related to recurrence rate and disease free survival(DFS) using long-term follow-up. Material & Methods: Between January 2008 and July 2021, 130 patients previously diagnosed ductal carcinoma in situ underwent surgery. We collected retrospective data characteristic data, radiology data, operative data, pathology data, clinical outcome and time to breast tumor recurrence. Median follow-up time was 51.5 months. Results: The 12-year cumulative incidence of tumor recurrence and re- excision in 130 patients were 6.92%(9 patients) and 12.31%(16 patients). Among 9 patients, 5 patients had locoregional recurrence, 3 patients had distant metastasis recurrence and 1 patient had both. Ki-67(OR, 1.06;95% CI 1.00 – 1.11); p-value = 0.045) was associated with an increase risk of recurrence tumor in multivariable analysis. Simple mastectomy(41.54%) and wide excision (38.46%) were the most surgery in this study. Conclusion: The retrospective study showed the 12-year cumulative incidence of recurrence tumor. Although Ki-67 increased risk of recurrence tumor.
Shivangi Agrawal, , Ravinder Singh Gothwal, Ramraj Meena, Abhinav Kakkar
Asian Pacific Journal of Cancer Care, Volume 7, pp 519-524; https://doi.org/10.31557/apjcc.2022.7.3.519-524

Abstract:
Purpose of study: To evaluate the efficacy and safety of oral pilocarpine concomitantly with radiation treatment for the prevention of radiation induced xerostomia in Head and Neck cancer patients. Material and methods: A prospective randomized study was carried out on 60 histopathological proven squamous cell cancer patients of Head and neck region. All patients received a total radiation dose of 66Gy /33 fraction/6.2 weeks (2Gy/fraction, 5 days/ week) on Telecobalt machine with or without concurrent chemotherapy. The concurrent chemotherapy eligible patients received, weekly chemotherapy courses using cisplatin 30 mg/m2. Patients in the study group received oral pilocarpine 5.0 mg three times a day starting 3 days prior to start of radiotherapy and continued for 3 months post radiotherapy. Patients were evaluated on subjective basis based on Zimmerman Questionnaire and EORTC QLQ HN 35. The statistical analysis was done by Paired sample T test. Results: The average Zimmerman Xerostomia score for all parameters combined was as follows: First assessment -100mm vs 100mm; Second assessment -50mm vs 45mm; Third assessment -59mm vs 52mm; Fourth assessment -64mm vs 57mm, Fifth assessment -71mm vs 68. As per QLQ-HN 35 questionnaire used for assessment of quality of life of patients in both groups, we observed that better scores were obtained in the pilocarpine group in comparison to control group. Conclusion: In the present study, the effectiveness of Pilocarpine given during and 3 months post radiotherapy was observed in terms of better compliance during radiation treatment. Most of the patients had less subjective symptoms with lesser grades of toxicities observed during various phases of assessment post RT.
, Rakesh Garg, Prashant Sirohyia, Brajesh Kumar Ratre, Ram Singh
Asian Pacific Journal of Cancer Care, Volume 7, pp 571-572; https://doi.org/10.31557/apjcc.2022.7.3.571-572

Abstract:
The COVID-19 pandemic has affected human life in all spheres. However, the medical and health practices seen changed a lot since the arrival of this pandemic. This article describes the positive and negative impact of covid in the medical field. The integration of telehealth needs to be emphasized and positive changes like hand hygiene, wearing a mask, and appropriate social distancing and online interactive learning may be useful in health care practices. Although, the negative effects of the pandemic like ignoring the patients with other comorbidity and deteriorating mental health of HCW must be kept in mind and should be properly addressed.
, Enaam Abdelrhman Abdelgader, Ebtihal Ahmed Babekir, Nour Mahmoud Abdelateif, Sadia Osman Abdelrahim, Osama Ali Altayeb, Eman Abbass Fadul, Hussam Ali Osman, Salem Ahmed Bamusa, Ibrahim Khider Ibrahim
Asian Pacific Journal of Cancer Care, Volume 7, pp 467-474; https://doi.org/10.31557/apjcc.2022.7.3.467-474

Abstract:
Objective: Our study aimed to characterize clinical, hematological and Immunophenotyping patterns in Sudanese patients with Chronic Lymphocytic Leukemia. Methods: A cross-sectional study was conducted in Khartoum state, Sudan, during the period from April 2017 to April 2018, involved 110 CLL patients. Physical examination, Complete Blood Count and Immunophenotyping were performed for all patients to confirm the diagnosis. Clinical staging such as Rai and Binet stages were applied. The statistical analysis was performed by using SPSS version 23.0. Results: In this study, 71.8% were males and 28.2% were females. Lymphadenopathy, splenomegaly, hepatomegaly, leukocytosis, thrombocytopenia, and anemia were seen in 71%, 49%, 13%, 60.9%, 39% and 34.5% of patients respectively. However, about 90% of patients displayed an advanced Rai risk stage and 70% were at Binet stage B or C. All CLL samples expressed CD45, CD19 and CD20. All the CLL cases were negative for the T-cell marker CD3.CD5 was expressed in 80% patients; CD23 was expressed in 92.7% patients. CD22, CD79b and FMC7 were negative in 91.8%, 77.3%, and 96.4% of patients respectively. Conclusions: CLL in Sudan is a disease of the elderly and more frequently in males than females. The incidence at young patients was higher than those reported by Western studies. Most of our patients presented advanced Rai and Binet stages. CD22 may be a highly specific marker for diagnosing CLL in Sudanese patients and should be included in all diagnostic panels used to differentiate CLL from other B cell lymphoproliferative disorders in Sudan.
Shubham Bidhuri, , Harshitha K, Sunita Malik, Akriti Gautam, Priyanka Pangtey, Rashmi Arora, Charanjeet Ahluwalia
Asian Pacific Journal of Cancer Care, Volume 7, pp 445-449; https://doi.org/10.31557/apjcc.2022.7.3.445-449

Abstract:
Objectives: To assess the predictive value of Swede score with VIA as the screening method and identify a cut-off score that predicts high grade CIN. Methods: Records of 324 women who were VIA positive and had acetowhite lesion on colposcopy graded according to Swede score followed by biopsy/excisional procedure were included in the analysis. Sensitivity, Specificity, PPV & NPV for each Swede score were calculated and area under the ROC curve (AUROC) for score predicting high grade histopathology (≥ CIN 2) was estimated. A p value less than 0.05 was considered statistically significant. Results: As the swede score increased from 0 to 10, the sensitivity decreased and specificity increased i.e. sensitivity of score < 6 was high whereas specificity of score > 6 was high. At a cut-off of Swede Score ≥6, it predicted high grade histology with a sensitivity of 51%, and a speci-ficity of 79%. The highest diagnostic accuracy was at swede score cut off >6 i.e. 64.6%. Conclusion: We recommend biopsy at a Swede score of 5 or less and treatment by excision at a Swede score of 6 or more.
, Raghavender Reddy T, Avdhesh K Rai, Partha S Roy, Asif Iqbal, Suhani Barbhuiyan, Nithin Raj, Sreya Mallik, Satya S Sarangi
Asian Pacific Journal of Cancer Care, Volume 7, pp 475-480; https://doi.org/10.31557/apjcc.2022.7.3.475-480

Abstract:
Background: Pediatric cancer patients are considered one of vulnerable group for Covid-19 infections and its associated complication. We assessed Covid-19 prevalence and implications in pediatric cancer patients of NorthEast India. Methods: Retrospective study was conducted between July 2020 to June 2021 at Dr B Borooah Cancer Institute (BBCI), Guwahati, Assam, India. Medical records of the childhood cancer patients were analyzed. All patients who were tested for SARS-CoV-2 were collected. All childhood cancer patients with age group between one to eighteen years were included. Results: Fifty two out of 701 (7%) cancer patients in children were found to be positive for SARS-CoV2 by RT-PCR testing. Among COVID-19 positive patients, the median age was six years. In COVID-19 positive group, thirty (57.6 %) were suffering from hematological malignancy and twenty two (42.4%) have solid malignancy. In COVID-19 positive group, Among the hematological malignancies; acute lymphoblastic leukemia (ALL) comprises 70% (21), acute myeloid leukemia (AML) 16.66% (5) and lymphoma accounting for 13.33%. Fever, cough and sore throat was presenting symptom in majority of patients. Survival outcome has shown statistically significant association (p=0.0001) between COVID-19 positive and negative pediatric cancer patients. Eight deaths occurred in COVID-19 positive patients but there was only one death in COVID-19 negative patients. Conclusion: Among COVID-19 positive childhood cancer patients risk of death was significantly higher compared to COVID-19 negative patients and majority of deaths occurred in hematological malignancies receiving intensive chemotherapy.
, Ozlem Saraydaroglu, Omer Afsin Ozmen
Asian Pacific Journal of Cancer Care, Volume 7, pp 589-592; https://doi.org/10.31557/apjcc.2022.7.3.589-592

Abstract:
Immunoglobulin G4–related disease is characterized by increased serum immunoglobulin G4 level, enlargement in the relevant organs and histopathologically intense storiform fibrosis, lymphoplasmacytic infiltration rich in immunoglobulin G4 positive plasma cells, and obliterative phlebitis. In this report, a patient who underwent a laryngeal biopsy with a pre-diagnosis of malignancy, but had findings consistent with immunoglobulin G4–related disease in the biopsy sample, is described. Immunoglobulin G4–related disease can be seen in very rare localizations. It should be kept in mind in differential diagnosis when tissues especially containing inflammation rich in plasma cells are encountered. Clinical, laboratory and pathological correlation is extremely important in the diagnosis of an immunoglobulin G4-related disease.
Dlamaini Xolisile, Hlophe Lomalanga, Maseko Thokozani, Mahlalela Nonhlanhla, Mkhontfo Mandzisi, Nhlabatsi Zanele, Mabuza Nomxolisi, Vambe Debrah, Haumba Samson
Asian Pacific Journal of Cancer Care, Volume 7, pp 499-507; https://doi.org/10.31557/apjcc.2022.7.3.499-507

Abstract:
Background: Cancer care in low-middle income countries is very poor. About 85% of preventable cancers such as cervical cancers are contributing factors to mortality rate which is 18 times higher in low middle-income countries. This is partly due to observed delays and underutilization of prevention, diagnosis, and treatment services in developing countries, and delays in seeking health care when symptoms start or inadequacy or lack of services. Similar trends in delays are observed in Eswatini, and this study was conducted to identify the causes of such delays in Eswatini. Methods: A qualitative phenomenological study was conducted among cancer survivors and health workers. Focused group discussions were conducted among the cancer survivors from all four regions in the country using a focus group discussion topic guide. The health workers were enrolled as key informants and face-to-face interviews were conducted using a key informant interview guide. The key informants were hospital managers such as Hospital Administrators, Hospital Matrons, and Hospital Senior Medical Officers from all major hospitals and health centres in the country. Results: The findings showed that causes of cancer delays were due to patient related delays which include fear of cancer diagnosis and denial that led to delay in seeking care; shock, disbelief, and fear at time of diagnosis which delayed use of treatment services. Part of the delays were due to health system related delays which include lack of knowledge by health care workers; inadequacy of infrastructure and skill for delivering cancer services in the health system; delays in being (properly) diagnosed and treated for cancer. Conclusion: Cancer care delays in Eswatini relate to both the patient and the health system. These findings should be using in developing strategies to improve cancer care in Eswatini and to replan cancer programs so that they meet the needs of cancer patients.
Tavseef Ahmad Tali, Fiza Amin, Nazir Ahmad Khan, Javaid Ahmad Dar, Arshad Manzoor Najmi, Mushtaq Ahmad Sofi, Shahid Rashid, Waseem Aijaz Kitab, Murtaza Shaf, Mansoora Akhter
Asian Pacific Journal of Cancer Care, Volume 7, pp 441-444; https://doi.org/10.31557/apjcc.2022.7.3.441-444

Abstract:
Background: Cancer of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease with no identified primary. CUP has been reported to comprise approximately 2% to 5% of all cancer cases. With the availability of sophisticated imaging techniques and targeted therapies in the treatment of cancer, the extent of workup in CUP remains a challenge and should be based on the clinical presentation, radiological imaging, tumour biomarkers, pathology with immunhistochemistry and the patient’s ability to tolerate therapy. Objectives: To study the incidence, clinical presentation, histology, treatment modalities used, survival and lacunae in not establishing the diagnosis of primary.Materials & Methods: This was a retroprospective study done between January 2014 to December 2018. 650 patients of cancer of unknown primary at presentation were enrolled in this study. After going through various investigations, primary of 387 patients were detected & hence, were excluded from this study. Primary could not be detected in 263 patients even after going through comprehensive work up and henceforth, these were taken up for this study. Demographics, imaging, pathology and treatment data were analyzed from the case records retrospectively between 1st January 2014 to June 2017. The data was collected prospectively between July 2017 to December 2018. Patients with histopathological evidence of metastatic lesion were included and patients whose primary were detected after comprehensive work-up were excluded from this study. Results: Incidence of unknown primary was 0.65 per 1 lakh population. Majority of the patients were from rural areas (77.9%) & most of the patients were in the age group of 61-80 years (47.1%). Male to female ratio was 1.45:1. Abdominal pain (29.7%) and bone pain (20.5%) were the most common clinical symptoms reported. Computed Tomography & PET-CT scans detected primary lesions in 156 out of 650 (24%) & 12 out of 33 (33.3%) patients respectively. Adenocarcinoma was the most common histology (58.6%). The most common treatment modality received by the patients was external beam radiotherapy (12.5%). The median survival of the studied patients was 6-12 months. Conclusion: Patients presenting with metastatic carcinoma with unknown primary have poor outcomes. These patients need a patientcentred, streamlined, rapid diagnostic pathway. The outcome of these patients with standard chemotherapy remains poor. Larger studies with other therapeutic and novel agents are warranted to improve the treatment outcomes.
Korosh Saber, , Farzan Madadizadeh
Asian Pacific Journal of Cancer Care, Volume 7, pp 451-458; https://doi.org/10.31557/apjcc.2022.7.3.451-458

Abstract:
Introduction: Studies have shown that anxiety caused by the COVID-19 epidemic affects the patient’s decision-making processes regarding treatment and may even force him to refuse to continue treatment or disrupt the function and efficiency of treatment. This study aimed to determine the anxiety caused by COVID-19 and related factors in cancer patients undergoing radiotherapy. Methods: This analytical cross-sectional study included 125 cancer patients which sampled through convenience sampling from patients who admitted to radiotherapy centre in Yazd, Iran, in 2021. Patients had different primary cancers such as Breast, Lung, Head and Neck, Prostate, Stomach, Cervix, Blood, Intestine, Brain, Skin, Lymphoma, Kidney and Oesophagus. The COVID-19 Disease Anxiety Scale (CDSA) questionnaire was used to collect data. The frequency, percentage, mean (standard deviation), median (interquartile range=IQR) were used to description and the Mann–Whitney U and Kruskal-Wallis tests were used for data analysis. All analyses were performed in SPSS software (version 24) with a significance level of 5%. Results: In total, 55.2% of patients (69 patients) were male, 85.6% (107 patients) were married, and the mean (SD) age of participants was 50.16 (13.93) years. Median (IQR) the scores of mental, physical and anxiety symptoms were 11 (13), 4 (8), and 16 (18), respectively, which were moderate in physical and psychological symptoms according to guidelines. In terms of total anxiety classification, total anxiety score in our study was in mild category. Median of the CDSA score was significantly different in levels of age, education, economic status, and type of job (p<0.001). Conclusion: COVID-19 anxiety in cancer patients was in the mild level. Young people and people with lower social, economic, and educational status are more anxious. However, in addition to targeted safety and prevention measures, training and counselling programs may also be useful in reducing anxiety level.
, Saloni Chawla, Achyut Koirala, Uddhav Dhakal, Ramanand Shah
Asian Pacific Journal of Cancer Care, Volume 7, pp 273-278; https://doi.org/10.31557/apjcc.2022.7.2.273-278

Abstract:
The majority of cancer patients will require radiotherapy at some time during their illness, either for curative or palliative purposes, making it an important part of a multidisciplinary cancer treatment approach. External beam radiotherapy and brachytherapy are two methods of administering radiation to the tumor location. Cobalt tele source, Linear accelerator, and Tomotherapy are examples of external beam radiotherapy equipment; similarly, after loading brachytherapy unit is an example of brachytherapy equipment. Because these units generate radiation, a specific site design is required to guarantee that radiation leakage is kept to a minimum. Linear accelerator and Brachytherapy devices are housed in specialized chambers known as “Bunkers.” The engineering of these bunkers is still a difficulty. The layout of the radiation department is designed in such a way that it will smooth the day-to-day operations and maximize the efficiency of the working crew. The general considerations, location, and layout of different rooms built for the LINAC and brachytherapy unit at CMC, Bharatpur, Nepal are discussed in this study.
, Palak Gandhi, Jagannathan Krishnan, Jay Ghetiya
Asian Pacific Journal of Cancer Care, Volume 7, pp 435-438; https://doi.org/10.31557/apjcc.2022.7.2.435-438

Abstract:
A case report of a very rare entity of persistent Müllerian duct syndrome with malignant transformation of Mullerian remnant is presented. A twenty-two-year-old phenotypically normal male presented with complain of hematuria and lower abdominal pain. On examination patient had bilateral cryptorchidism and on imaging bilateral duplication of pelvicalyceal system and ureters and left sided ureterocoele. There was a malignant mass lesion with metastatic lymphadenopathy in pelvis. The diagnosis of persistent Mullerian duct syndrome was suspected on MRI pelvis and confirmed by genetic and pathological testings. Risk of malignant transformation of undescended testis and Mullerian remnants increases with age and have impact on psychological health of patient, so early diagnosis becomes crucial.
Selvaluxmy Ganesarajah, Vasanth Cristopher Jayapaul, , Vengada Krishnan
Asian Pacific Journal of Cancer Care, Volume 7, pp 279-284; https://doi.org/10.31557/apjcc.2022.7.2.279-284

Abstract:
Background: The incidence of renal failure in carcinoma cervix ranges from 14% to 44·2%. The interventional strategies like ureteric stenting and percutaneous nephrostomy can be considered to improve renal function. The primary objective of our study is to analyze the impact of hydroureteronephrosis [HUN] in the outcome of cervical cancer patients treated with radical radiation. The secondary objective is to analyze the role of ureteric stenting to protect the renal function while proceeding with radical radiation. Methods: In this retrospective study, all patients with stage IIIB cervical cancer treated with radical radiation therapy at our institution from January 2010 to December 2019 were included. Results: Among the total 483 stage IIIB patients, 146 patients [30·22%] had hydronephrosis.Thirty eight [26·02%] out of 146 patients with HUN underwent ureteric stenting. The five year overall survival [OS] was 61·4 ± 0·04 % and on subset analysis, overallsurvival was 65·7 ± 0·05 % for patients without HUN and 50·6 ± 0·06 % for patientswith HUN. [P value 1·1 mg/dL have benefitted more from stenting. In this high risk subgroup, the one year overall survival was 65·2 ± 0·11 % and 42·4 ±0·13 % for patients with and without stenting. [p value 0·07]. No major stent related morbidity occurred. Conclusions: Hydronephrosis in cervical cancer patients indicates bad prognosis which results in decreased survival. The presence of hydronephrosis should be redesignated as a separate substage, IIIB2 in future FIGO updates, for better prognostication and treatment recommendations. The relief of obstructive uropathy should be sought out inpatients with serum creatinine levels > 1·1 mg/dL or bilateral hydronephrosis before theinitiation of oncological treatment.
Asian Pacific Journal of Cancer Care, Volume 7, pp 285-293; https://doi.org/10.31557/apjcc.2022.7.2.285-293

Abstract:
Introduction: Chemotherapy-induced severe neutropenia requires dose reduction, delay in treatment, or discontinuation, and induces neutropenic complications resulting in poor outcomes and increased healthcare costs. This study aims to identify the risk factors for chemotherapy-induced severe neutropenia and outcome in advanced-stage NSCLC. Method: From July 2014-January 2019, advanced-stage NSCLC who received chemotherapy were retrospectively analyzed. Demographic and risk factors data were collected from the electronic medical record system. Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe neutropenia. Survival curves were estimated using the Kaplan–Meier method. Results: Among 259 patients, 37 (14.28%) and 3 patients (1.2%) developed severe neutropenia and febrile neutropenia respectively. In multivariate analysis, restriction of protein diet (OR 9.54; 95%CI 2.44-37.24; P=0.001), concomitant use herbal medicine (OR 8.66; 95% CI 1.04-72.07; P=0.045), high BMI (OR3.1; 95% CI 1.07-8.99; P=0.04), renal disease (OR 3.9; 95% CI 1.7-8.91; P=0.001), number of cycle chemotherapy > 4 (OR 3.97; 95% CI 1.11-14.18; P=0.03) were significant predictors of Chemotherapy-induced severe neutropenia. No difference in response rate, progression-free survival and overall survival among groups (RR 18.9% vs 26.7%; median PFS; 9.6 vs 8.2 months, P=0.32 and median OS 13.8 vs 16.7 months, P=0.79 in severe and non-severe neutropenia respectively).Conclusions: The present study indicates that protein-restricted diet, concomitant use of herbal medicine, BMI ≥ 25 kg/m2, renal disease, and more than 4 cycles of chemotherapy are significant risk factors for chemotherapy-induced severe neutropenia. Therefore, patients with these risk factors should be more carefully monitored.
, Madhu Narayan, Krishnan Rajkumar, V Vasanthi
Asian Pacific Journal of Cancer Care, Volume 7, pp 357-362; https://doi.org/10.31557/apjcc.2022.7.2.357-362

Abstract:
Introduction: Intermediate filament and its prime role in the cytoskeleton involved in maintaining cell morphology, and is mainly observed in epithelial cells called as Cytokeratin. CKAE1/AE3 is a combination of two different clones of anti-CK monoclonal antibodies, a single reagent can be obtained with broad spectrum reactivity to high molecular weight and low molecular weight CK which can be used in different types of cancers or lesions. Aim: To compare the expression of the CK-AE1/AE3 in oral squamous cell carcinoma (OSCC) and potentially malignant oral disorders (PMOD) through immunohistochemical method through a systematic review process. Materials and Methods: Articles or original studies related to the use of IHC marker AE1/AE3 in OSCC, malignant tumors and PMODs were selected for systematic review process. PUBMED and GOOGLE SCHOLAR were the search engines used for collection of articles. Keywords used were PAN CK [AE1/AE3], SCC, OSCC, PMOD. Articles included based on PRISMA guidelines. Results: A total article based on search strategy identified 492 suitable abstracts; 474 did not meet the eligibility criteria. Full text articles were obtained for 18 articles. Six articles were excluded from the study for various reasons like case reports, reviews and letters to editors and any article published in languages other than English were also excluded. Finally, after considering all the inclusion and exclusion criteria, a total of 12 articles were included in the study. Considering all these articles, comparing the expression of pan-cytokeratin [ae1/ae3] in oral squamous cell carcinoma and potential malignant oral disorders.
, Mustafa Majeed Obaid, Bassam Francis Matti, Nareen Tawfeeq Abbas
Asian Pacific Journal of Cancer Care, Volume 7, pp 267-272; https://doi.org/10.31557/apjcc.2022.7.2.267-272

Abstract:
Background: Second line treatment of chronic myeloid leukemia (CML) is crucial after imatinib therapy failure. In Iraq, nilotinib is the only available second line tyrosine kinase inhibitors (TKIs), making management of CML patients with failure response to 1st generation TKIs as a great challenge to the health system. Objectives: Our study tries to evaluate nilotinib safety and efficacy among CML patients in Karbala province of Iraq as the only drug available as second line treatment for CML patients post imatinib failure. Materials & Methods: This research was carried out in Al-Hussein cancer center in Karbala province of Iraq between January 2012 & December 2020. Nilotinib was used as a second-line treatment for 30 CML patients and their response were assessed by the level of BCR-ABL1 transcription in peripheral blood at 3 months, 6 months and 12 months from starting treatments. Results: The median age was 42.5 years, included 16 males and 14 females with male to female ratio 1.14. According to Sokal score 15 patients were high risk, 11 patients were intermediate risk and 4 patients were low risk. More than 66% of our patients achieved major molecular response (MMR) after starting nilotinib as second line. The BCR- ABL transcription level had a significant reduction from baseline at 3 months, 6 months and 12 months respectively (P value <0.05). Male patients and those who received imatinib for ≥ 24 months were better survival. Conclusion: Nilotinib is effective and safe drugs as second line treatment among Iraqi patients.
Mansour Ansari, Shida Askarpour, , Mohammad Mohammadianpanah, Niloofar Ahmadloo, Shapoor Omidvari, Ahmad Mosalaei, Sayed Hasan Hamedi, Mohammad Zare-Bandamiri
Asian Pacific Journal of Cancer Care, Volume 7, pp 261-266; https://doi.org/10.31557/apjcc.2022.7.2.261-266

Abstract:
Introduction: Salivary gland tumors are rare tumors that account for 3 to 4% of head and neck neoplasms. These tumors may arise from 6 major and numerous minor salivary glands. This study was designed to investigate the factors affecting the prognosis of salivary gland tumors. Methods: This study is a retrospective descriptive study in which the records of patients with salivary gland tumors referred to the Radiotherapy and Oncology Center of Namazi Hospital from 2005 to 2015 were reviewed. Results: 158 patients were included in this study with a mean age of 55.37 years. 49% of the patients were men. Adenoid Cystic Carcinoma was the most common histological type (30.57%) and Adenocarcinoma with a prevalence of 1.91% had the lowest prevalence rate in this study. 65.19% of salivary gland neoplasms in this study had parotid gland involvement and sublingual gland involvement had the lowest prevalence (3.8%). The results of survival analysis clearly illustrated that surgery, pathology type and stage was statistically significant in survival. Discussion: Clinical, pathological and therapeutic factors in people with malignant salivary gland neoplasms have a significant relationship with their survival. controversies on treatment and outcome continues.
Perwasha Kerio, , Anusha Hassan, Aamera Shah, Ammara Manzoor
Asian Pacific Journal of Cancer Care, Volume 7, pp 253-259; https://doi.org/10.31557/apjcc.2022.7.2.253-259

Abstract:
Objective: To evaluate the treatment outcomes in patients with epithelial ovarian cancer following neoadjuvant chemotherapy presenting at a tertiary care hospital. Materials and methods: It was a longitudinal study conducted at the department of medical oncology, Jinnah postgraduate medical center, Karachi Pakistan from May 2018-Feb 2020. One twenty-five women of age 20-80 years with confirmed diagnosis of ovarian carcinoma (stage 1-4) who were referred from different medical institutes of Karachi were included in the study. Surgery and systematic chemotherapy were the primary treatment at the time of ovarian cancer diagnosis. Until death or last follow-up, treatment results were measured. Based on the treatments received from recurrence, systematic chemotherapy was further classified as 2nd line and 3rd line. Females who relapse after 6 months with platinum based treatment were underwent for re-treatment with carboplatin and cisplatin in combination or alone or those who recurred within 6 months and progress on 1st line were treated with non-platinum based systematic chemotherapy. SPSS version 23 was used to analyze data. Results: The mean age of the study sample was reported as 46.23 years. The cumulative survival proportion of complete remission after first line platinum based chemotherapy with respect to duration of 1st line therapy was estimated as 0.027 and the median survival time was reported as 135 (95% CI: 128.81-141.18) days. The cumulative survival proportion of complete remission after second line chemotherapy with respect to duration of 2nd line therapy platinum based was estimated as 0.82 and the median survival time was reported as 156 (95% CI: 144.18-167.81) days. Hence, statistically significant difference was observed between platinum and non-platinum based chemotherapy (p=0.008) in second line therapy. Whereas, no case of complete remission occurred after third line chemotherapy. Conclusion: The chemotherapy based on platinum (1st line) showed complete remission in most of the patients. After second line therapy, few patients showed disease progression and they underwent for third line therapy. The median time from 2nd line therapy to 3rd line therapy was reported as 123 days. In third line therapy, majority patients received non-platinum based chemotherapy where majority showed disease progression. The median survival time of 2 patients who died during third line therapy was reported as 8.75 months. The median survival time after 1st line therapy was 150 days. The median survival time after 2nd line therapy was 156 days.
Sherin James, , Vipin Gopinath, Sangeetha K Nayanar
Asian Pacific Journal of Cancer Care, Volume 7, pp 415-419; https://doi.org/10.31557/apjcc.2022.7.2.415-419

Abstract:
Introduction: Collision tumours (CT) of the thyroid refer to the coexistence of two or more independent, histologically distinct malignant tumours. Though the presence of multifocal differentiated thyroid carcinomas is common, it is extremely rare for the thyroid to harbour more than one type of malignancy simultaneously. Methods: An extensive literature search of PubMed databases identified very few cases indicating the tumour rarity. To the best of our knowledge, this is the first documentation of a case series including various combinations of CT in the thyroid. Our main aim is to explore the phenotypic characteristics of CT in the thyroid with an aim of revealing unique features associated with this rare entity. Results: Of a total of 138 thyroid cancers treated during the eight-year period, five (3.62%) were diagnosed as CT. All were females with a median age of 50 years. Papillary Thyroid Carcinoma (PTC) was the major component (80%) in collision with medullary (MC), follicular, and hurthle cell carcinomas. Both cases with papillary microcarcinoma showed vascular emboli and patients with a combination of MC and PTC had nodal metastasis. 80% of patients had a survival of more than 2.5 years and are alive without disease at present. Our study showed features like female predominance and PTC as the most common component with good overall survival. Metastatic and survival rates were consistent with matched singleton pathology. Conclusion: Insight into the genomic and proteomic pathways of this entity is the need of the hour.
, Rahul D. Lethika, Irappa V. Madabhavi
Asian Pacific Journal of Cancer Care, Volume 7, pp 213-217; https://doi.org/10.31557/apjcc.2022.7.2.213-217

Abstract:
Background: North Karnataka consisting of large rural population doesnot have any report on carcinoma cervix clinical profile and treatment outcomes. Objectives: analysing the clinicopathological profile and survival data from a tertiary cancer Centre in north Karnataka and comparing it with that of data published worldwide. Methods: We analysed carcinoma cervix patients from our centre between Oct 2014 to Oct 2016. The clinicopathological, treatment-related parameters, outcomes were analysed. Results: A total of 360/450 patients treated radically, 60% of the patients were between 40-60 years with the youngest being 22 years and the eldest 84 years. 33.3% of patients had Comorbidity, 85% patients had History of bleeding. 87%were from rural area, 44.8% were literate. 46.6% of patients had stage IIIB followed by II (27.8%), 3.8%had para-aortic node and 3.1% had pelvic nodes. 93.3% had SCC, 80% received chemoradiation, 13%received adjuvant Radiation/chemoradiation and 7% only surgery. Response data available for 320 patients (88.8%) among 320, 74.6% had complete response, Residual disease present in 14%, 3% patients had stable disease and progressive disease in 7%. At 18 months post-treatment, the survival data were available for only 244 (67.7%) patients, out of which 187 patients (67.7%) were alive. Overall 50% of the patients lost to follow up within 3 years of treatment completion. The 3-year survival for the patients who followed up until 3 years was 62.3% (111/178 patients). The stage-wise 3-year survival was 70.6% for stage I, 83.6% for II, 60% for IIIA, 49% for IIIB, 33.3% for IIIC2 (para-aortic nodal involvement) and 28.6% for stage IVA (P-0.001). Conclusion: Awareness about carcinoma cervix in the rural population is still lacking and they are presenting at an advanced stage, which largely effects on survival of the patients.
Kamonchanok Choosak, Thitirath Thantiprechapong
Asian Pacific Journal of Cancer Care, Volume 7, pp 201-205; https://doi.org/10.31557/apjcc.2022.7.2.201-205

Abstract:
Objective: Due to primary and secondary ovarian cancer have different management, preoperative assessment is important. We endeavor to identify the different preoperative clinical characteristics. Methods: We performed a retrospective case-control study that included 31 patients with secondary ovarian cancer (SOC) and 301 controls with primary ovarian cancer (POC) diagnosed between 2007 and 2018. The demographic parameters, signs, symptoms, preoperative tumor marker levels, and imaging findings were reviewed. Results: The incidence of SOC was 2.5% (66/2605) of all ovarian malignancies. The most common site of origin was the colon (58.1%). Thirty-five percent of the patients with SOC had a history of previous malignancy and 80.8% of them were multiparous. Abdominal mass and bladder symptoms were significantly higher in patients with POC than those with SOC (p < 0.001, p = 0.04, respectively). The preoperative imaging showed that SOC was more often bilateralism (p < 0.001) and more presence of ascites (p = 0.004). The consistency of SOC was cystic-solid (50%). From the multivariate analysis, the risk of SOC was significantly increased in patients who developed previous malignancy, CEA level (>5 ng/mL), and CA 125/CEA ratio (≤25) with the odds ratios (95%CI) of 5.07 (1.52, 16.96), 6.17 (1.68, 22.59) and 12.12 (3.91, 37.59), respectively. Conclusions: The preoperative distinction between POC and SOC is difficult. A history of malignancy, an elevated serum CEA, and CA 125/CEA ratio, can provide a useful clue for diagnosis and proper management in these patients.
, Muktanjalee Deka, Manisha Salvi, B K Das, B C Goswami
Asian Pacific Journal of Cancer Care, Volume 7, pp 247-251; https://doi.org/10.31557/apjcc.2022.7.2.247-251

Abstract:
Introduction: Frozen section is an intraoperative pathological technique which has very important role to play in diagnostics and also it plays important role in futher surgical management as specially in oncology setup. Most common indications for frozen section were confirmation of neoplasms, evaluation of margins status, evaluation of metastasis etc. Materials and Methods: This is a prospective study of 200 frozen section cases, where frozen sections were compared with permanent Haematoxylin and Eosin stained slides. Accuracy of frozen sections were analysed with various parameters like true positive, false positive, sensitivity, specificity, concordance rate etc. Results: Highest number cases were from gall bladder/ biliary tract (45) followed by breast tissue (43), lymph node (32) etc. Diagnostic accuracy of frozen section was 95.5% (191/200 cases) when compared with permanent section. Concordance rate was 191 (95.5%), sensitivity 89.5% with positive predictive value 96.7% and negative predictive value 94.9% respectively. Conclusion: Adequate and accurate sampling is recommended and also interpretation error should be minimized to help reducing the rate of discordant cases.
Rinki Sarma, , Rakesh Garg, Brajesh Kumar
Asian Pacific Journal of Cancer Care, Volume 7, pp 401-403; https://doi.org/10.31557/apjcc.2022.7.2.401-403

Abstract:
One-time reinfection with SARS-Cov-2 does not warranty of immunity against reinfection due to various possible reasons for this like waning immunity or high viral load or an immunocompromised state. Cases of reinfection have been reported from many countries in the world, here in this case series we are sharing the experience of three cases of reinfection from India. Two of them were old with multiple comorbidities and one is a young patient with no comorbidity. All three-patient got reinfected less than two months.
Geetha Muttath, Greeshma Keloth Erakkotan, Anjana Jayaraj, Suja Cheruliyil Ayyappan, Arun Kumar. E.S, Vinin Narayanan, Joneetha Jones, Arun. P. Narendran, Nabeel Yahiya, Akhil. P. Suresh, et al.
Asian Pacific Journal of Cancer Care, Volume 7, pp 207-211; https://doi.org/10.31557/apjcc.2022.7.2.207-211

Abstract:
Introduction: Lung is a major organ at risk during Post Mastectomy RadioTherapy (PMRT), because of the risk of Radiation Pneumonitis (RP). In countries like India 2D RT is widely used due to limited access to advanced technologies. We estimated the lung dose volumetrically in breast cancer patients treated with 2D tangential techniques, the incidence of acute RP and its association with lung dose. Methodology: Retrospective study of patients who underwent PMRT was done. The images with structure sets of cases planned using 2D technique were transferred to TPS and 3 D plans were generated. CLD, MLD, LL were measured from the 2D plan in the CT simulator. LDmean and V20 were measured from from DVH, in the TPS. Correlation between V20 and LDmean was done with CLD, MLD and LL. The incidence of radiation pneumonitis and its association with lung dose also was studied. Result: Total 50 patients were analyzed of which 3 patients had radiation pneumonitis. The mean CLD was 2.28 cm ± 0.54cm, MLD was 2.32 ± 0.6cm and LL was 12.52 ±2cm. V20 for two fields (MT+LT) was 17.04 ± 5.6 Gy and for three field (MT,LT and SCF) was 28.75 ± 8.6 Gy. Positive correlation was found between for V20 & LDmean and CLD, MLD & LL (p<0.05) 6% of patients developed Radiation pneumonitis but did not have association with V20 or MLD. Conclusion: Radiation pneumonitis is major concern after chest wall irradiation and the incidence is expected to be high with conventional technique where the volume is not accurately measured. It is still an option in countries like India with resource constraints by planning cautiously with the indicators of irradiated lung, like CLD and MLD within limits thus minimizing the incidence of radiation induced lung injury.
, Ashwin Thovarayi, Pritanjali Singh, Rakesh Ranjan, Rohit Saini, Arkaprava Sinha, Arijit Saha
Asian Pacific Journal of Cancer Care, Volume 7, pp 431-433; https://doi.org/10.31557/apjcc.2022.7.2.431-433

Abstract:
Globally, head and neck cancer is estimated to occur in more than 700,000 patients a year and cause 400,000 deaths and second most common cancer in India among both sexes and all ages. Even after optimal treatment for primary cancer, there are cases where second primary cancers develop around the previously treated areas. This occurrence is explained by the concept of field cancerization, which refers to a term where a carcinogen such as tobacco when chewed, exposes the mucosa to the carcinogen starting from the oral cavity to the upper aerodigestive tract. Combinations of two primary malignancies are seen in around 3% to 5% of patients, combinations of three cancers in about 0.5%, and combinations of four malignant tumors in about 0.3% of patients with a previous history of cancer. Early diagnosis and detection of these cancers are necessary for optimal treatment as with each occurrence the tolerability and the response rates gets poorer.
Ymty Wijeratne, Hdkc Hapuachchige, S Kannangara
Asian Pacific Journal of Cancer Care, Volume 7, pp 409-413; https://doi.org/10.31557/apjcc.2022.7.2.409-413

Abstract:
Vaginal melanomas are extremely rare gynaecological malignancy with aggressive behavior resulting in poor outcome. The aetiology is not well understood so far. There is no standardized treatment owing to the extreme rarity of the disease, however surgical excision with adjuvant radiotherapy has been the widely practiced treatment. The role of lymphadenectomy is controversial. The six cases reported between November 2015 to November 2021 at the National cancer institute Sri Lanka were treated primarily by surgical excision including hysterocolpectomy, colpectomy, and wide local excision. Pelvic lymphadenectomy was not done in most cases. Only one patient has received adjuvant radiotherapy. Only one patient died during the follow-up and 2 had recurrences.
, Fadekemi O. Gabriel-Raji, Salimat A. Yusuf-Awesu, Rukayat O. Salawu-Giwa, Oluwaseun E. Familusi
Asian Pacific Journal of Cancer Care, Volume 7, pp 219-230; https://doi.org/10.31557/apjcc.2022.7.2.219-230

Abstract:
Background: The burden of HPV infection and its diseases is very high in Sub-Saharan Africa and unfortunately many vulnerable women in this region have little or no knowledge about the infection and its diseases. Bearing in mind the vital role knowledge plays in disease prevention and control, our study aimed to assess women’s knowledge about relevant aspects of human papillomavirus (HPV) infection & its related diseases and to predict the factors that influence their knowledge. Material and methods: A cross-sectional study conducted among 500 women attending a tertiary health institution in Nigeria using a self-administered structured questionnaire to assess knowledge about HPV infection, its related diseases and associated risk factors. Knowledge scores were derived, participants were categorized into having either good or poor knowledge and factors associated with good knowledge were assessed. Data was analyzed was using Statistical Package for Social Sciences version 23.0. Results: The knowledge of HPV infection & its diseases was poor with only 26.3% (123/468) of participants having good level of knowledge. Worse still, only 21.4% believed that they were at risk of acquiring the infection. Tertiary education (AOR=2.40, CI=1.30-4.44, P=0.005), low parity (AOR=4.22, CI=1.40-12.66, P=0.011), and having electronic media (AOR=6.06, CI=2.86-12.9, P<0.001), print media (AOR=4.00, CI=1.21-13.16, P=0.023), healthcare professionals (HCP) (AOR=6.30, CI=3.56-11.11, P<0.001) and organized program (AOR=13.16, CI=5.08-34.48, P<0.001) as primary sources of information significantly predicted good knowledge of HPV infection & its related diseases. Conclusion: Knowledge of HPV infection and its related diseases is very low among Nigerian women in our study. Tertiary education, low parity and having electronic media, print media, HCP and organized health programs as primary sources of information significantly predicted of good knowledge. Health education through these information channels may help to bridge the gap in knowledge and improve public knowledge about HPV and its related diseases.
Sharathbabu N Manjunath, , Malay S. Sarkar, Satinder S. Kaushal
Asian Pacific Journal of Cancer Care, Volume 7, pp 239-246; https://doi.org/10.31557/apjcc.2022.7.2.239-246

Abstract:
Background: Primary lung cancers in India were reported to be rare in earlier studies. But the trend is changing and there is increased incidence of lung cancers. Aims and Objectives: This present descriptive observational study was conducted to report the risk factor profile of the lung cancer patients from the Himalayan state of the Indian population. Materials and Methods: This descriptive epidemiological study was conducted from a single centre, in a prospective observational design, among the patients who were diagnosed as carcinoma lung histologically or cytologically over a period of one year in a tertiary care referral centre in the Himalayan state of the Northern India. The patients data was collected in detailed manner pertaining to age, sex, residence and occupation, questionnaires regarding risk factors like smoking history, Environmental tobacco smoke exposure, Indoor pollution, Alcohol history, HIV infection, Structural lung disease, Religion and Geography. Results: One hundred and one consecutive patients of primary lung cancer were recruited in the study which was confirmed either cytologically or histopathologically. Out of 101 patients, 79 (78.2%) were males and 22 (21.8%) were females, mean age was 62.65 years, 97 (96%) patients had rural background and 4 (4%) patients had urban background, 96 (95.04%) patients were active smokers, 3 (2.9%) were passive smokers and non smokers were 2 (1.9%), 25 (24.8%) were vegetarians and 76 (75.2%) were non vegetarians. 36 patients (35.6%) were from altitude of 0-1000 meters, 41 patients (40.6%) were from altitude of 1001-2000 meters, 21.8% were from altitude of 2001-3000 meters and 2% were from altitude of 3001-4000 meters. Adenocarcinoma was the most common type at all altitudes. Conclusions: Awareness about carcinoma lung in the Himalayan state especially in rural population is still lacking and are presenting at an advanced stage, which largely impact on survival of the patients. This study provides the data pertaining to risk factor profile of the lung cancer patients from the Himalayan state and can be utilised for future comparison with other Indian studies, to educate the community and to spread the awareness of the prevailing lung cancer risk factors.
, Mel Valerie Cruz-Ordinario, Vivian Butalid, Marie Belle Francia
Asian Pacific Journal of Cancer Care, Volume 7, pp 405-408; https://doi.org/10.31557/apjcc.2022.7.2.405-408

Abstract:
Background: Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL) at the present time. However, it rarely presents in the intranasal cavity as the primary site. There is scarcity of local data on this disease, and the outcomes to the standard treatment are still unclear. Objective: In this case series, we presented 2 patients with primary intranasal DLBCL that were treated with chemotherapy ± anti-CD20 antibody and radiotherapy. Results: Both cases were in the early stage of disease. One patient was given systemic chemotherapy (CHOP) plus anti-CD20 antibody (Rituximab), and the other patient was only given chemotherapy (CHOP) due to financial constraints. The systemic treatment was followed by Involved-Field Radiotherapy (IFRT). Both patients demonstrated with an objective radiologic and clinical response to the treatment. The patients had no evidence of disease recurrence at 36 months. Conclusion: The cases presented showed that primary intranasal DLBCL appears to have an objective and durable response to the treatment for DLBCL as prescribed by the guidelines. The findings in this study can be added to the pool of data to expand our comprehension of this disease process.
, Niharika Bisht, Arti Sarin, Amul Kapoor, Deepak Mulajker, Samir Gupta, Richa Joshi, Nishant Lohia, Sirshendu Ghosh, Virendra Suhag
Asian Pacific Journal of Cancer Care, Volume 7, pp 231-237; https://doi.org/10.31557/apjcc.2022.7.2.231-237

Abstract:
Introduction: Chemoradiotherapy (CRT) with concurrent cisplatin-based chemotherapy is the treatment of choice of locally advanced head and neck cancers (LAHNC), but the optimal regimen of cisplatin remains contentious. Though 3-weekly cisplatin is the recommended schedule, it is associated with severe adverse reactions. A lower dose weekly schedule is generally accepted to be more tolerable and is widely used in our country. Methodology: Our study retrospectively compares the 3-weekly and the weekly concurrent cisplatin schedules in patients of LAHNC treated with CRT. Patients were selected for either schedule based on the treating physician’s preference. The two schedules were compared for treatment-related toxicities, radiotherapy interruptions, cumulative cisplatin doses delivered and overall survival (OS) as well as disease-free survival (DFS) at 2 years. Results: In our study, 43 patients received the 3-weekly schedule while 40 received the weekly schedule. Age, gender, disease stage or site did not affect selection for either regimen, except cancers of the nasopharynx and salivary glands, who almost exclusively received the 3-weekly schedule (90.1%). Patients who received adjuvant CRT after radical surgery were more likely to receive the weekly schedule (66.7%) while patients treated with up-front CRT were more often given the 3-weekly schedule (57.6%). Overall, the 3-weekly arm was associated with more toxicities and treatment breaks, but was more successful in delivering an adequate cumulative dose of cisplatin and had a better OS and DFS at 2 years follow up compared to the weekly arm. It also appeared that treating physicians were more likely to withhold one or more of the weekly cycles to manage treatment toxicity which lead to inadequate cumulative dosing in a high (45%) percentage of patients. Conclusion: Our study reiterates that the 3-weekly cisplatin arm has a better outcome profile than the weekly cisplatin arm at the price of increased toxicity. Weekly schedules have lower toxicities but may not achieve outcomes equivalent to 3-weekly unless adequate cumulative doses are achieved. As our study is retrospective and non-randomized, selection bias may have affected our results.
Saori Murata, , Kai Sugihara, Tetsuya Sakai, Kota Ishioka, Saeko Takahashi, Shinji Sasada, Hiroyuki Yasuda, Koichi Fukunaga
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 191-196; https://doi.org/10.31557/apjcc.2022.7.1.191-196

Abstract:
Background: The neutrophil-to-lymphocyte ratio (NLR) is recognized as a predictive and prognostic biomarker in various malignancies. We investigated the utility of the NLR in patients with advanced non-small cell lung cancer (NSCLC) in the early phase of nivolumab monotherapy. Methods: Thirty-one patients with advanced NSCLC were treated with nivolumab monotherapy from January 2016 to August 2017. They underwent the first response evaluation 8.3±3.3 weeks (mean±SD) after 3.8±1.8 times of administration. The NLR values at baseline (NLR/base) and at the first response evaluation (NLR/1st) were analyzed to evaluate for the association between NLR and the following parameters: treatment response, progression-free survival (PFS) and overall survival (OS). Results: The median follow-up period was 467 days (range: 38-1903 days). NLR/1st in the disease control (DC) group (n=21, median: 4.36, range: 0.82-11.3) was significantly lower than that in the progression disease (PD) group (n=10, median: 11.91, range 2.04-31.00) (p<0.01). The median PFS and OS for all patients were 184 and 540 days, respectively. A higher NLR/1st resulted in a worse DC rate (OR 0.78, p<0.05), and was associated with shorter PFS (HR 1.11, p<0.005) and OS (HR 1.12, p<0.0005). A greater increase in NLR, from NLR/base to NLR/1st was associated with shorter PFS (HR 2.04, p<0.01) and OS (HR 1.66, p<0.05). Conclusions: In NSCLC patients receiving nivolumab monotherapy, elevated NLR at the first response evaluation and its inclined change from baseline could be significantly stronger markers of poor response and predictors of worse prognosis than NLR at baseline.
, Yogesh Verma, Rahat Hadi, Fareha Khatoon, Mashkoor Ahmed
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 47-54; https://doi.org/10.31557/apjcc.2022.7.1.47-54

Abstract:
Introduction: Cervical cancer is the fourth most commonly occurring lethal cancer among women worldwide. The primary curative treatment option for women suffering from locally advanced cervical cancer includes external beam radiotherapy (EBRT) with concurrent weekly platinum-based radiosensitizing chemotherapy and brachytherapy (BT) to obtain finest treatment outcomes. Aim: The purpose of this study is to assess tumor response following HDRBT preceded by EBRT and to identify optimum radiation fractionation schedule for better response with tolerable radiation toxicity. Material and methods: 91 patients diagnosed with carcinoma of uterine cervix were screened for inclusion in the study. Patients were categorized according to FIGO Staging system The patient was put in lithotomy position and given anesthesia and fletcher suit applicator was applied to the patient push the bladder and rectum and finally shifted to the HDR treatment unit. All the associations were tested by using chi square test. Results: In our study it was found that majority (44%) of the cases were aged 51-60 years. Vaginal bleeding and squamous cell carcinoma was found in most of the cases. The acute radiation toxicities were more in elderly age group and the association was found to be statistically significant (p<0.05) except Genitourinary – cystitis. Age group 51-60 years was significantly associated with response (p=0.034) with lower risk of partial response (OR=0.31 (0.10-0.95), while the symptom Backache/Pain in abdomen had significantly higher risk of partial response (p=0.002, OR=16.24 (1.7-154.8). Conclusion: When compared to traditional techniques, HDR can achieve very high rates of local control while lowering morbidity.
, Eastpal Singh, Manjit Kaur Rana, Pardeep Sharma, Sheetal Sachdeva
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 3-8; https://doi.org/10.31557/apjcc.2022.7.1.3-8

Abstract:
Aim: The present study was carried out to analyse the incidence of non-adherence to the radiotherapy treatment and study the factors associated with non- adherence.Patient and methods: The retrospective study was conducted at a tertiary cancer care institute, Punjab. All the patients treated during one year with curative intent with conventional fractionation were included. Incidence of non-adherence was driven and the various parameters like age, gender, site of tumor, stage of disease, intent of treatment, distance from the treating institute, financial constraints were analysed. Results: A total of 660 patients were taken. 6 out of 660 did not come for treatment initiation, hence 654 patients were eligible to be studied. The cumulative incidence of non -adherence was 12.8% (84 out of 654). The majority of patients were of head and neck 31 (36.9%), Elderly >60 years 27 (32.1%), Stage IV 42 (50 %), patients residing in more than 50 km from the institute 47 (55.9%), concurrent chemotherapy 71 (84%), the a major proportion of patient had more than 1 week gap 54 (64%) with 25 (29%) having more than 2 weeks gap. The factors found to be associated with non- adherence was elderly age (p value 0.06), advanced stage (p value 0.003), use of concurrent chemotherapy (p value 0.001), distance from the institute (p value 0.03), treatment with radical intent (p value < 0.001), patients utilizing various government schemes (p value 0.004). No significant association was found between the gender and site of the tumor (p value 0.17 and 0.14 respectively) with the non -adherence. Conclusions: The factors associated were stage of disease, elderly, concurrent chemotherapy, more distance travelled to reach the institute. Non adherence needs to be addressed by proper counselling of patients at the first visit to hospital itself. After the 3 week of radiotherapy treatment patient needs to be seen and followed more frequently when chances skipping treatment are high.
, Joneetha Jones, Aswanth .K.Anil, Akhil. P.Suresh, Satheesh Babu. T.V, Geetha Muttath, Arun Kumar. E.S
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 65-69; https://doi.org/10.31557/apjcc.2022.7.1.65-69

Abstract:
Background: Different other imaging modalities help in accurate gross tumor volume delineation. Studies have shown conflicting results for intermodality GTV comparison. Since in our institute we routinely take planning CT and planning MRI for laryngeal and pharyngeal tumors treated with definitive radiotherapy, with this study we intent to compare the gross tumor volume (GTV) with these modalities in these tumors. Materials & Methods: Study population included pharyngeal and laryngeal carcinoma patients treated. Planning CT and planning MRI images of these patients were retrieved. Gross tumor volume (GTV) was delineated by a Radiation Oncologist in both these image sets and GTVs were documented. Results: Out of 87 patients analysed, the overall median GTV with planning CT and planning MRI were 20.4 cc & 18.2 cc respectively. Median GTV with planning CT & MRI for different sites like Nasopharynx, Oropharynx, Larynx and Hypopharynx were 32.85 & 27.75 cc, 22.1 & 20.9 cc, 8.25 & 10.35cc and 20.55 & 20.6 cc respectively with no statistically significant difference. Median GTVs with CT & MRI for different primary tumor stages like T2, T3, T4a, T4b were 14.3 & 14.3 cc, 20.45 & 19 cc, 16.55 & 27.45 cc and 50.75 & 52.4 cc respectively. Analysis showed 94.6 % correlation between GTVs with CT & MRI. Conclusion: This study showed comparable median GTVs with planning CT & MRI for pharyngeal and laryngeal carcinomas. Subset analysis did not show any significant difference in GTVs with two modalities for different primary tumor site. As expected there was good correlation between GTVs of two modalities. Even though the results does not show significant intermodality variation for GTV delineation. With the results of this study we cannot question the use of multiple modalities for GTV delineation as subtle variation in GTV can result in differences in target volumes resulting in differences in toxicity profile.
Jamila Ali Alsanabani, Butheinah Ali Al-Sharafi, Afif Ahmed Al-Nabhi
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 15-20; https://doi.org/10.31557/apjcc.2022.7.1.15-20

Abstract:
Background: Oncoplastic breast conserving surgery is limited in treatment of Yemeni breast cancer. The aim of this study is to evaluate the reliability and safety of oncoplastic breast surgery in Yemeni patients with early breast cancer. Material & Methods: Patients with early breast cancer who underwent oncoplastic breast conserving surgery from July 2014 to July 2020 were included in this retrospective study. Data on the patient’s demographic, tumor characteristics, the type of oncoplastic technique performed, surgical margin involved, re-excision rate, complications, satisfaction, follow up and local recurrence rate were included to evaluate the results. Results: A total of 50 breast cancer patients underwent oncoplastic surgery by using different techniques. Volume displacement technique was the commonest technique used in 92% of the patients (local glandular flap in 64%, reduction mammoplasty in 22%, Grissoti flap in 4% and bat-wing in 2%) While the volume replacement (Latissmus dorsi flap) technique was used in 8 % of the patients with small breasts. 70% of the patients were less than 40 years old. The mean tumor size was 3.4cm. Most of the tumors (84%) was invasive ductal carcinoma. The overall postoperative complication was 14% [wound infection (4%), wound dehiscence (8%) and fat necrosis (2%)]. Re excision rate was 12% and complete mastectomy was performed for 2 patients. Patient satisfaction was 96%. Local recurrence rate was 4% with mean follow up of 23.1 (SD:16) months.Conclusion: The oncoplastic breast conserving surgery is reliable and safe with good oncological and aesthetic outcomes for treatment of early breast cancer in Yemeni patients.
, M. Yanina Pepino, Anna Arthur, Karen Chapman-Novakofski
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 117-124; https://doi.org/10.31557/apjcc.2022.7.1.117-124

Abstract:
Background: Most head and neck cancer (HNC) patients undergoing aggressive treatments with chemoradiotherapy and surgical resection of tumors suffer from symptoms long after treatment is completed that hinder adequate oral food intake, collectively known as Nutrition Impact Symptoms (NIS). Our aim was to examine the correlations between NIS and HNC survivors’ vegetable intake and use of seasoning. Methods: We conducted a 29-item telephone administrated survey to collect vegetable intake and seasoning habits among HNC survivors (n=22, age 61.4 ± 9.8 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment identified through the cancer registry at Carle Foundation Hospital. Treatment-related side-effects (11 items) including difficulty swallowing, dry mouth, and mouth sores reflected NIS. A mean composite score was created for all the symptoms where higher scores indicated greater NIS. Spearman correlations examined the relationships between NIS, vegetable intake, and seasoning. Results: Half (50%) of the participants reported no change in their vegetable intake since diagnosis of cancer, and on average, ate 1 cup/day of total vegetables. Higher NIS scores associated with higher pumpkin and sweet potatoes intake (r (20) = .43, p<0.05), and there was a trend for higher scores of difficulties swallowing to be associated with lower corn and peas intake (r (20) =-.37, p=0.08). Participants with higher scores of problems with teeth and gums were less likely to use seasoning (r (20) = -.42, p<0.05). Conclusion: The findings support that HNC treatment can affect vegetable intake long after completion of radiotherapy. However, it would be premature for any recommendations to be derived from the present study for health professionals. A larger, observational study with a longer follow-up is therefore needed to examine these correlations.
Taruna Singh, Yogesh Verma, Meena Tiwari, Rahat Hadi, Mukti Nath Singh
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 79-84; https://doi.org/10.31557/apjcc.2022.7.1.79-84

Abstract:
Introduction: The effectiveness of adjuvant radiation therapy (RT) in the treatment of GBC has not yet been established. The effectiveness of adjuvant radiation therapy (RT) in the treatment of GBC has not yet been established. Following surgical resection, postoperative external beam RT can diminish local relapse; though effect on global survival has not been confirmed due to lack of good quality clinical trials. Thus the aim of the study was to assess the efficacy of the multivariate modality of therapy in Gallbladder malignancies. Materials and method: The present prospective comparative study of multivariate modality of therapy in Gallbladder malignancies was carried out in a low resource North Indian cancer center from. Only those patients were selected who were histologically confirmed of adenocarconima of gall bladder, squamous cell carcinoma and oat cell carcinoma. Staging was done according to TNM classification no concurrent medical illness, Karnofsky performances status of patient >70. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). A value of p<0.05 was considered statistically significant. Result: Majority (29.3%) of the cases were aged 61-70 years just followed by the age group 41-50 years, females were in majority (73.2%). Higher stage had significantly higher risk of partial or no response (p<0.001). An increasing trend of toxicities was observed with increasing dose. Significant association was found between toxicities and treatment response at dose 2000 cGy (p<0.001) and 4500 cGy (p<0.001). The Cox regression analysis showed higher hazard ratio for stage IV (HR=2.33 95% CI : 0.31-17.66) followed by stage II/III (HR=1.67 95% CI : 0.17-16.02). Conclusion: Healthcare professionals should discuss the indeterminate benefit and possible risks of adjuvant therapy when counseling their patients and reassure enrollment in clinical trials of novel regimens. The curative potential of current adjuvant therapy in gallbladder cancer is questionable, justifying placebo-controlled investigation of novel chemotherapy combinations or alternative approaches. To confirm the efficacy of adjuvant therapy, a major randomized controlled trial is required with large sample size. The improvement in radiation delivery with intensity modulated radiotherapy (IMRT), image guided radiotherapy has further paved the way for exploration of adjuvant radiation for GBC.
Rahul Sud, Vr Mujeeb
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 91-100; https://doi.org/10.31557/apjcc.2022.7.1.91-100

Abstract:
Background and objective: Tumor mutational burden (TMB) and microsatellite instability (MSI) are predictive clinical markers of responses to immunotherapy in a wide range of advanced cancers, including colorectal cancers. The data about TMB and MSI in Indian patients is scarce. Hence, assessed the incidence of MSI, TMB, and actionable alterations in genes of patients with metastatic colorectal carcinoma. Methods: A single centre, observational, prospective study in newly diagnosed patients (n=60) with colorectal carcinoma were assessed for MSI incidence, mutational burden, and actionable alterations in genes. Results: The TMB ranged between 5.08 and 2391 mutations per megabase, and 12 (20%) had low TMB, 12 (20%) intermediate TMB and 36 (60%) high TMB. The TMB was high in right-sided than left-sided cancer (100% vs. 47%). Three or more two, and one genomic alteration were observed in 26 (44%), 20 (33%), and (20%) patients, respectively. Gene fusion was absent in all 60 patients. Gene mutations were predominant in the left-sided than right-sided but statistically insignificant (p=0.7). APC, TP53, and BRCA2 gene mutations were evident in 46, 28, and 22 patients, respectively. Wild KRAS/NRAS gene alterations were evident in all metastatic cancers (n=22) presented at baseline. There was no significant correlation between the genomic alterations and age, sex, histology, or tumor differentiation. Conclusion: This study highlights the importance of detecting genomic mutations at the earliest. Genomic mutations should form the basis for customizing and exploring newer targeted therapy against the most common genomic alteration like APC, TP53, and RAS mutations to improve outcomes.
Saroj Dhaka, Anil Rajani, Rakesh Sihag, Rajesh Kumar, Shankar Lal Jakhar
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 9-13; https://doi.org/10.31557/apjcc.2022.7.1.9-13

Abstract:
Background: Brain metastases is a major health care problem and is the most common intracranial cancer in adults. These patients may benefit from intensive treatments including neurosurgery and radiosurgery but many patients cannot receive such treatment, and whole brain radiotherapy (WBRT) alone is the only option. The most common WBRT schedule is 30 Grays (Gy) in 10 fractions (fr). However there is need to develop fractionation schedules, but total dose still remain dilemma.The Purpose of this study to assess the potential benefit of dose escalation beyond 30 Gy. Patients and methods: Total 120 patients with multiple brain metastases, previously untreated with WBRT were randomly assigned into two arms. All patients have favorable survival prognosis. Seventy patients received a total 30Gy in 10fr, 3Gy/fr administered daily 5days/week in arm A and 50 patients received 39Gy in 13fr, with same schedule in arm B. Both arms were compared for local control (LC) and overall survival (OS). Results: The LC rate at 18 months was 11% after 30 Gy and 24% after 39 Gy (p value=0.068). The survival rate at18 months was 21% after 30 Gy and 38% after 39Gy (OS 21% vs. 38%, hazard ratio 0.593; 95% CI: .395-.891; p value=0.047). On subgroup analysis of primary tumor, the 18 months LC rate was 16% vs 53% in Breast (p value=0.020) and10% vs 11% in Lung cancer (p value=0.809) in arm A and B respectively; the 18 months OS rate was 14% vs26% in Lung (P value=0.160) and 37% vs 73% in Brest cancer (p value=0.034) in arm A and B respectively. Conclusion: Escalation of the WBRT dose beyond 30 Gy resulted in better outcomes, particularly for patients with primary breast cancer.
Geetha Muttath, Greeshma Keloth Erakkotan, Vinin Narayanan, Joneetha Jones, Arun. P. Narendran, Nabeel Yahiya, Akhil. P. Suresh, Muhammed Minhaj, Muhammed Riyas
Published: 11 February 2022
Asian Pacific Journal of Cancer Care, Volume 7, pp 55-59; https://doi.org/10.31557/apjcc.2022.7.1.55-59

Abstract:
Background: Chemoradiation plays an important role in cervical cancer treatment but dose to organs at risk (OAR) is the limitation while escalating dose to target. With conformal techniques dose escalation is made possible without increase in toxicities. Though node positive cervical cancers have poorer prognosis delivering higher dose to the involved nodes have shown benefit. We aim to determine the patterns of failure in node positive cervical cancer patients treated with chemoradiation and to determine the grade III and IV toxicities associated with it.Methods and Materials: In this retrospective study node positive cervical cancer patients treated with conformal radiotherapy were analysed. 45 Gy -50.4 Gy was given to the pelvis and 55 Gy to positive nodes with sequential or simultaneous integrated boost (SIB) in 25 -28 fractions with weekly cisplatin 40mg/m2 followed by brachy therapy. Extended fields were used to treat patients with positive para aortic lymph nodes. Treatment toxicities were recorded as per CTCAE version 4.3. Results: Of the 62 patients 87.1% had squamous cell carcinoma and majority were in stage II (38.7%). At a median follow up of 33 months two (3.2%) patients had local recurrence, eight (12.9 %) had distant failure and one (1.6%) had loco regional recurrence. Lung was the most common site of metastasis followed by the supraclavicular region. The 3 year overall and disease free survival were 91.4 % and 77.2 % respectively. Stage of the disease (p=0.001) and residue at the end of therapy (p-0.010) showed significant association with DFS but not with OS. 21 (33%) had Grade III –IV toxicities, nine (13%) having acute toxicities and 12 (19.4%) had late toxicities. Conclusion: Though node positive cervical cancers have poor prognosis our study showed that aggressive management improves the outcome without increase in toxicities.
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