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Year : 2015  |  Volume : 11  |  Issue : 7  |  Page : 88-92

Lung and Thorax

Date of Web Publication24-Nov-2015

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How to cite this article:
. Lung and Thorax. J Can Res Ther 2015;11, Suppl S3:88-92

How to cite this URL:
. Lung and Thorax. J Can Res Ther [serial online] 2015 [cited 2019 Nov 13];11:88-92. Available from: http://www.cancerjournal.net/text.asp?2015/11/7/88/170052

Abstract: 030

Squamous cell carcinoma of lung associated with rare cutaneous paraneoplastic syndrome: Systemic lupus erythromatosus

D. S. Nihantya , S. R. Pallad, K. P. R. Pramod, T. Naveen, S. Poojar, I. Khaleel

Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India, E-mail: nihanthyds@gmail.com

Background: Lung cancer is the leading cause of cancer death worldwide. Lung cancer is associated with various cutaneous para-neoplastic manifestations like Tylosis, Dermatomyositis and polymyositis, Vasculitis, SLE, are few to name. SLE is a chronic, multi system and an autoimmune disease, rarely seen in lung cancers. In some cases it may precede diagnosis of malignancy while in other cases it may occur late in the course of disease or can be precipitated by exposure to immunosuppressive drugs or smoking. Compared with the general population, overall there is a slight increase (10-15%) in the incidence of cancer in patients diagnosed with SLE. Aim: To report a case of lung cancer co-existing with SLE. Materials and Methods: A 71 year old male, simultaneously presented with respiratory and cutaneous symptoms, on further evaluation with FDG PET, biopsy of the lung and skin lesions, radiologically and histopathologically the diagnosis of Carcinoma Lung co-existent with SLE was established. Treatment: Planned on Palliative Chemo radiation, received 3 cycles of weekly parenteral Nabpaclitaxel 100 mg with parenteral Carboplatin 450 mg once in 4 weeks, post 3 cycles of chemotherapy, Radiation was planned. Patient received a Biological equivalent dose of 60 Gy to the gross tumor, on Linac by IMRT technique. Concurrently was treated with steroids, for the cutaneous lesions. Currently is on palliative chemotherapy. Results: Patient improved symptomatically with complete resolution of cutaneous manifestations and is symptom free, local response to be assessed after completion of 8 cycles of palliative chemotherapy. Conclusion: There are very few reported cases of SLE coexisting with Lung cancer. The pathogenesis that associates SLE and lung cancer remains undetermined, various hypotheses have been established like the genetic susceptibility that could predispose to the development of both SLE and lung cancer, fibrotic Lung disease due to chronic inflammation could induce DNA damage that may lead to lung cancer and the drugs used to treat SLE, might serve as a risk factor for malignancy by the cytotoxic effect exhibited by the drug but the role of immunosuppressive therapy is yet to be established. Lung cancers can severely affect the organ function and quality of life, thus treating the underlying cancer is the first step. This is hereby a rare case of SLE with lung cancer treated at our Institution.

Abstract: 038

A prospective study comparing induction chemotherapy followed by chemoradiation versus chemoradiation alone in stage III NSCLC

R. Bhattacharjee , S. Roy, S. Basu

Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India, E-mail: rajib17cmc2gmail.com

Background: Locally advanced non small cell lung carcinoma (stage III) has usually been treated by surgery or radiotherapy. The new approaches to combined modality treatment of loco-regionally advanced inoperable NSCLC are sequential chemoradiotherapy (induction chemotherapy followed by standard radiation therapy) and concurrent chemoradiotherapy. An alternate approach may be the use of induction chemotherapy before concurrent chemoradiation. Aim: The study aims to compare the response rate and toxicity pattern in two arms between induction chemotherapy followed by chemoradiotherapy versus concurrent chemoradiotherapy in locally advanced non small cell lung cancer. Materials and Methods: The study was conducted from January 2013 to August 2014. Eligible patients were histopathologically proven cases of NSCLC stage III within the age group of 18-70 years, ECOG performance status of 0-2 and without any serious co-morbidity. Eligible patients (n = 53) were randomized into two arms. In arm A (n = 28), patients received weekly paclitaxel (50 mg/m2) and carboplatin (AUC 2) IV concurrently with XRT to 66 Gy at 2 Gy/# for 7 weeks. In arm B (n = 25), two cycles of induction chemotherapy with paclitaxel (200 mg/m 2 ) and carboplatin (AUC 6) IV every 21 days. Following the completion of induction chemotherapy, concurrent chemoradiotherapy began on day 43 and continued as outlined for patients on arm A. Mean period of follow up was 8 months. Primary end points were treatment response and toxicity response and secondary end points were DFS and PFS. Results: Out of the 53 patients randomized, 48 were finally analyzed. Overall response rate (CR + PR) 4-6 weeks after completion of treatment was higher in arm B (56% v 69.55%; p = 0.759). Acute hematogenous and acute skin toxicity was higher in arm A (60% v 47.82%; p = 0.496 and 24% v 17.39%; p = 0.598 respectively) and acute pulmonary and aero-digestive tract toxicity were higher in arm B (56% v 69.56; p = 0.524 and 64 v 82.59; p = 0.44 respectively), but none of these differences were statistically significant. There were hardly any difference in DFS and PFS in arm A & B (9.5 vs 10 months and 10.4 v 11.8 months respectively; CI 95%). Conclusion: No significant difference in terms of efficacy and toxicity could be unearthed between induction chemotherapy followed by chemoradiotherapy and chemoradiotherapy alone in the present study population. Further studies with larger sample size and longer duration of follow up are necessary.

Abstract: 049

Randomized controlled trial of yoga among non small cell lung cancer patients: Effects on pulmonary function

I. Khan , S. Sinha, A. Manna

Medical College, Kolkata West Bengal, India, E-mail: indranilkhan@live.com

Background: Since time immemorial, yoga is being practiced in India as a complete wellness schedule integrating the body and mind. The importance of yoga is being highlighted in recent times through World Yoga Day celebrated on June 21 across the world. While there are claims that yoga can help patients cope with cancer, there is little scientific research material to establish this. Herein it became imperative to study the effects of yoga on different types of cancer. As a first of its kind, through this randomized controlled trial, the effects of yoga on pulmonary function is being studied in non small cell lung cancer patients receiving radiotherapy. Aim: This study demonstrates the impact of yoga, including physical poses, breathing and meditation exercises on pulmonary function among non small cell lung cancer patients receiving radiotherapy. Materials and Methods: From March 1, 2015 to June 20, 2015, 60 patients attending Radiotherapy department of a tertiary cancer centre in India with locally advanced non small cell lung cancer (Stage IIIA and IIIB) were randomly assigned (1:1 ratio) to a test group receiving concomitant yoga schedule along with radiotherapy and a control group receiving only radiotherapy. Pulmonary function testing was done 2 weeks before commencement and 6 weeks after completion of radiotherapy in both the groups; predictors of adherence were also assessed. Results: Regression analyses pointed out that the intervention group experienced more improvement in FEV1 (p = 0.03) compared to the control group. Conclusion: The above data suggests yoga as a beneficial adjunct tool to improve pulmonary function in non small cell lung cancer patients receiving radiotherapy.

Abstract: 114

A dosimetric analytical comparison between 3DCRT Vs VMAT in locally advanced lung cancer

C. Prakash , S. Barik, S. Misra 1 , A. Srivastava, M. Rastogi

Ram Manohar Lohia Institute of Medical Sciences, 1 Sanjay Gandhi Postgraduate Institute Of Medical Sciences, Lucknow, Uttar Pradesh, India, E-mail: dr.chandra.onco@gmail.com

Background: There have been recent advances in external beam radiotherapy moving from conventional to conformal therapy. Currently VMAT has increasing interest due to shorter treatment time and less number of mus. There is several evidence which are in favour of VMAT especially in lung, prostate, anal cancer etc. Introduction: VMAT simultaneously deals with changing gantry position, dose rate and multileaf-collimator (MLC) position. It allows escalating dose to tumour volume and minimises to oars in shorter treatment duration when compared with IMRT. Objective: To analyse dosimetric differences between 3DCRT and VMAT techniques in planning for locally advanced lung cancer. Materials and Methods: 8 patients were retrospectively studied. In each patient parameters were analysed based on dose volume histogram of 3DCRT and VMAT. Parameters included were PTV, Total Lung-PTV and other organs at risk. Results: The mean doses to PTV, 95% isodose line conformity and homogeneity was equal in both the arms [ (96.076% Vs 98.68%) (p = 0.231) ]. The mean value of achieved constraint of the oars were also equal excepting mean dose to brachial plexus, (29.53 Gy Vs 48.87 Gy) and total lung-PTV (12.32 Gy Vs 14.32 Gy), (p = 0.21) which were better in VMAT arm but not statistically significant. Conclusion: Single arc VMAT is a valid option in achieving highly conformal dose distribution and considerable dose reduction in organs at risk.

Abstract: 151

Assessment of chemoradiotherapy response in lung cancer with computed tomography

H. Tripathi , M. Saini, H. Bhatia, M. Gupta 1 , S. Raghuvanshi

SRHU University, 1 Cancer Research Institute, Dehradun, Uttarakhand, India, E-mail: harshitatripathi160789@gmail.com

Aim: The purpose of our study is to evaluate the Computed Tomography based radiological response of patients with lung cancer who have undergone chemoradiotherapy. Materials and Methods: Thirty patients suffering from carcinoma lung who received chemoradiotherapy but no surgery were studied. Responses were evaluated using Computed Tomography which were obtained before chemoradiotherapy and after 6 weeks of completion of treatment. Contrast enhanced CT scan of chest with slice acquisition thickness of 8mm and reconstruction interval of 8mm from the level of 2 cm superior to lung apices upto the diaphragm including adrenals were taken. Results: The median thoracic Radiotherapy dose was 60 Gy and all patients had a Karnofsky performance status ≥60. Median 3 cycles of cisplatin based chemotherapy was given in all patients. All patients (100%) had pulmonary mass at presentation with mediastinal lymphadenopathy in 26 (86.7%), pleural effusion 12 (40%) and chest wall invasion 4 (13.3%) patients. Post radiotherapy new pulmonary collapse/consolidation was seen in 2 (6.6%), cavity 1 (3.3%) and 3 (10%) patients had new sign of mediastinal Lymphadenopathy. Ground glass opacity 9 (30%), air bronchogram 6 (20%), calcification 8 (26.6%) and fibrotic band was seen in 15 (50%) patients 1 month post radiotherapy. More than one finding was seen in same patient. The maximal responses on CT images were complete response in 8 (26.6%) patients, partial response in 17 (56.6%) patients, stable disease in one (3.3%) patient and progressive disease in four patients (13.3%). Thus, the overall response rate (combined complete response and partial response) was 83.3% (25 of 30). Conclusion: Multidetector Computed Tomography is important imaging tools for a non-invasive assessment of tumour response and provides precise characterization of size, contour, extent and tissue composition of the suspicious lesion. In clinical practice this will be of importance for non-invasive characterization of pulmonary nodules and response assessment in lung cancer.

Abstract: 152

First Indian experience of single fraction lung SBRT treatment on linear accelerator

R. Panchal , I. Kaur, L. Chaudhari, S. Chanda, P. Mathew, P. Shah,

V. Naik, N. Asarawala

M S Patel Cancer Centre, Karamsad, Anand, India, E-mail: rusp2582@yahoo.co.in

Background: SBRT is potential to control oligometastasis to lung from various primary sites. Response rate totally depends upon the prescribed dose to the target and its volume. Our past clinical experience and outcomes of the delivered total dose prescriptions ranging from 48 Gy/8#, 40 Gy/5#, 50 Gy/5#, 55 Gy/5#, 48 Gy/4#, 50 Gy/4#, 37.5 Gy/3#, 45 Gy/3# to 54 Gy/3#. This is the first clinical case, where we delivered total dose 34 Gy/1# at our center. Aim: We hereby report our clinical experience of the response and acute toxicity of extreme hypo-fractionation treatment. Materials and Methods: One patient aged 74 years, with oligometastasis to lung (total 3 lesions, one on right side and two on left side confirmed by PET-CT scan and primary under control) from Adenocarcinoma of rectum primary was selected for SBRT treatment. Two lesions, one on right central (3.01cc) and another on left peripheral (20.57cc) were planned with 55 Gy/5# @ 11 Gy/# and treated on alternate days. The left side lesion (1.7cc) away from ribs and all normal structures was planned with 34 Gy/1# and treated at last. Patient simulated with the help of vacuum cushion. The 4DCT scans were performed on GE Optima 128 Slice CT scanner. For patient breathing pattern recording Varian Real-Time Positioning Management System (RPM) were used. The respiratory co-related CT scans were further used for internal target volume (ITV) extraction. The ITV (respiratory corrected GTV) was extracted by creating MIP (Maximum intensity projection) on Focal 4D contouring workstation using 10 phase datasets. For all lesions, the PTV was created with 3mm symmetrical margin to ITV. The mid ventilation scan was used for the generation of treatment plans with CMS Monaco treatment planning system. The on couch treatment position verification and real time target motion were analyzed with the help of 4D CBCT (Symmetry) image guidance. The setup errors were corrected by the use of 6DOF Hexapod Couch. Results: We found nil acute toxicity of radiation therapy during treatment and post treatment follow up at 3 months. The CT scan after 3 months shows complete resolution of all three lesions. Conclusion: The PTV margin reduction, real time tumor position verification and accurate setup error corrections help to deliver extreme hypo-fractionated treatments in clinic. Long term follow up is required for late toxicity evaluation and local control analysis.

Abstract: 155

Squamous cell carcinoma of lung with skull metastasis: A case report

S. Mandal

Saroj Gupta Cancer Centre and Institute, Kolkata, West Bengal, India, E-mail: dr.sanchayan2012@gmail.com

Background: Squamous cell carcinoma lung presents about 30 percent of all non small cell lung carcinoma. It almost always associated with smoking and usually spreads to brain, bones, liver, adrenal glands and small intestine. But, spreading to skull bones is a rare event. Case Presentation: We here present a case of a 43 year old smoker with squamous cell carcinoma of lung where patient admitted with huge skull lesion invading through both inner and outer table and brain also. Previously, patient underwent lobectomy and three cycles of chemotherapy. This time, patient received palliative radiation to skull at our institute. Conclusion: There is only single case report worldwide similar to this case and proved the unusual presentation of this rare occurrence. It also raises questions about the appropriate management of patients with intracranial metastasis with invasion of skull.

Abstract: 163

Mucoepidermoid carcinoma lung: A rare case presentation

S. Halder , A. G. Dastidar, R. Ghosh, S. Roy, S. Roychowdhury,

T. Bapari, D. Singh

Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India, E-mail: sh6675@gmail.com

Background: Mucoepidermoid Carcinoma (MEC) lung are extremely rare, slow growing, low grade malignant neoplasm which are derived from the sub mucosal glands of the tracheo-bronchial tree and bear structural homology with exocrine salivary gland. Aim: MECs account for approximately 0.1-0.2% of thoracic malignancies. Here we report a case of young female diagnosed as MEC lung and treated with primary surgery and adjuvant chemotherapy. Materials and Methods: A 13 years old female presented with cough and hemoptysis for 2 months. Bronchoscopy revealed growth in right main bronchus completely occluding the lumen and slightly projecting into trachea. Biopsy from the growth was inconclusive. She then underwent right upper lobectomy. Histopathology report showed well circumscribed tumour composed of nests of cells with round or oval nuclei and abundant clear cytoplasm. Tubules lined by mucin secreting epithelium present. Surgical cut margin free. Tumour cells were immune positive for cytokeratin, and epithelial membrane antigen (EMA) and immune negative for P63 and thyroid transcription factor-1 (TTF1) indicating a diagnosis of MEC. She received 4 cycles of adjuvant chemotherapy. Results: After completion of chemotherapy she was in regular follow up since last six months. On follow up she was asymptomatic. Work up revealed there was complete remission (CR). Conclusion : MEC treated with surgery along with adjuvant chemotherapy improves overall response but more prospective studies are necessary to optimize definite treatment guidelines.

Abstract: 208

Continuous hyperfractionated accelerated radiation therapy week-end less versus conventional radiotherapy in combination with neo-adjuvant chemotherapy in locally advanced non small cell lung cancer

R. Kumar , A. Hemalatha, H. S. Kumar, R. Purohit, P. Murali

Acharya Tulasi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India, E-mail: drrsinwer@gmail.com

Background: The unresectable stage III lung cancer is usually treated concurrently with radiotherapy & chemotherapy both. The locoregional control & increased overall survival obtained by CHART was more than the calculated by meta-analysis trials of chemo-radiotherapy. In an effort to dose escalation and to make CHART more feasible it was modified to a CHART weekend-less regimen, called CHARTWEL. In the recent past some trials have indicated therapeutic advantage with CHARTWEL combined with induction chemotherapy. In the present study we compared the results of induction CT followed by CHARTWEL vs chemo radiation in the form of conventional radiation therapy. Aim: The primary outcome was to see whether the therapeutic advantage can be retained in form of locoregional control while reducing the hospital stay of the patients & to assess toxicities. Materials and Methods: Total 50 consecutive patients with unresectable stage III non-small-cell lung cancer were first given four cycles of neoadjuvant chemotherapy in form of paclitaxel & cisplatin three weekly. After three weeks of completion of the fourth cycle, radiotherapy was planned. 25 patients received two dimensional radiotherapy using three daily fractions 1.5 Gy in 5 days/week to a total dose of 58.5 Gy at cobalt-60 machine while 25 received 66 Gy/33fr with conventional fractionation. Disease response was evaluated by RECIST criteria. Results: Overall, 28% of patients in study arm and 20% in control arm had complete response. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients (p value > 0.05). There was no statistical difference in grades of toxicities except oesophagitis grade III seen in two patients of study arm (p value < 0.05). Conclusion: This study suggests that CHARTWEL can be used in combination with neoadjuvant chemotherapy to treat patients with stage III lung cancer. The advantage of CHARTWEL as smaller dose & shorter duration comparative to conventional radiotherapy. Further CHARTWEL is economical feasible for poor patients with shorter duration of stay in the hospital and hence the treatment. Although, large multivariate studies still needed to ascertain the need and benefits of CHARTWEL with neoadjuvant chemotherapy.

Abstract: 211

Role of geftinib in advanced non small cell lung carcinoma:

A retrospective study

A. K. Arya , I. Yadav, T. Samani, L. Pandey

Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, E-mail: akarya_agra@yahoo.com

Background: Lung cancer is the leading cause of cancer among men in India. Gefitinib, represents a new treatment option for patients with advanced non-small-cell lung cancer (nsclc). We analysed patients receiving oral gefitinib for advanced nsclc in our institution to understand the clinical response. Materials and Methods: The study included all patients with histology-proven NSCLC, who had failed previous chemotherapy regimens, or those chemotherapy-naive patients who were either not willing or unfit for conventional chemotherapy and radiotherapy. Gefitinib was administered 250 mg/day until disease progression, unacceptable toxicity, or death occurred. Patients who were diagnosed from january 2012 to december2014 were included. Data were collected on demographics, smoking status, type of tumour, previous local tt. previous detailed information about chemotherapy status and response, time of starting gefitinib from the time of diagnosis, duration of gefitinib treatment. Time to progression, symptom improvement and outcome after gefitinib. Patient's initial evaluation of response was performed after the first month of tt. By chest x-ray. Symptomatic improvement as evaluated according to the clinical judgment and kps scoring by the treating physician. Overall survival was defined as the period between the date of diagnosis and the date of last follow-up or date of death. Time to progression was defined as the period between initiation of gefitinib treatment and the date of progression or date of last follow-up. Results: 16 patients with NSCLC, were included in this study. The mean age of patients was 59.6 years (range 40-68 year). There were 11 (68%) men and 5 (32%) women. 3 (30%) of the patients were non smoker. In smokers (mainly bidi smoker) mean year of smoking 23 yr, out of 13 smokers 9 were occasional alcoholic. Majority of the patients had advanced disease. The most common histopathology type was squamous cell carcinoma (scc; 61%), followed by (39%) adenocarcinoma. The mean duration of gefitinib treatment was 177 days (range 90-270 days). Out of 16 patient, 9 receive prior chemotherapy and 7 did not mean os is 315 days (range 118-452 days). Mean pfs 192 days (range 122-252 days). 13 out of 16 pt. Were symptomatically better for a mean duration of 112 days (82-200 days). Conclusion: In case of advanced NSCLC patients, treatment with gefitinib is still a viable option. Gefitinib therapy of 250 mg/day has a tolerable toxicity profile and is well tolerated.

Abstract: 264

Analysis of never smoker Indian females with primary lung cancer

S. Khan , K. Kamble, A. Diwan, V. Mahobia

GMCH, Nagpur, Maharashtra, India, E-mail: Subeera.k@gmail.com

Background: Lung cancer has been the most common cancer in the world for several decades. There are estimated to be 1.8 million new cases in 2012 (12.9% of the total), 58% of which occurred in the less developed regions. In India as per NCRP's Population Based Cancer Registries AAR's for lung cancer in females are highest in Aizawal (44.6%) district. In Maharashtra, Mumbai has the highest incidence (4.2%), followed by Nagpur (3.9%) aim analysis of clinic - pathological characteristics of lung cancer in never smoker females Materials and Methods: Retrospective study 149 female lung cancer patients registered from january 2010 to december 2014, clinical records of 121 were available Results: Out of the total 511 patients of lung cancer, 362 (70.84%) males and 149 (29.16%) females. M:F ratio 2.42:1. Median age in males 60 years, females 55 years. 99 (27.45%) males and 60 (40%) of females were in the age group of <50 years. 117 (96.7%) females were never smokers, 4 (3.3%) smoked tobacco. Smokeless tobacco was consumed by 30 (24.79%). Exposure to passive tobacco smoke was present only in 15 (18.75%). Asbestos exposure was present in 6 (4.96%). 11 (9.09%) patients were erroneously diagnosed as pulmonary TB, leading to delay in diagnosis of malignancy. Cough was the most common presenting symptom 92 (77.3%), followed by breathlessness 66 (54.55%), chest pain 64 (52.89%), haemoptysis14 (11.57%), hoarseness of voice10 (8.26%). SVC syndrome was present in 5 (4.13%), presentation was in stage IV in 84 (69.42%) & locally advanced disease was present in 20 (16.53%). Amongst stage IV, malignant pleural effusion was seen in 31 (36.9%), whereas the brain 17 (20.23%) & liver 17 (20.23%) were most common sites of distant metastases. SCLC was present in 5 (4.1%) & majority 92 (76.03%) patients had NSCLC, most common histology was adenocarcinoma 66 (54.54%), followed by squamous cell 20 (16.5%). Palliative chemotherapy was received by 74 (61.16%). Radiation was received by 29 (23.96%) patients (27 palliative, 2 radical). Survival rate was 47.1% at 6 months, 19.84% at 1 yr, 3.31% at 2 yrs. Conclusion: Our study is consistent with prior studies, with females having advanced stage at presentation, a lower median age at diagnosis as compared to males, and adenocarcinoma as subtype. However median age at presentation in never smoker females was lower as compared to Western studies probably suggesting risk factors unrelated to tobacco smoking maybe at work in Indian setting. case-control studies are needed to establish whether smokeless tobacco consumption can be an associated contributory risk factor.

Abstract: 304

Pleuropulmonary blastoma in an adult patient: A case report

V. Raturi , M. L. B. Bhatt, R. Kumar, J. Gaur, D. Kishan, R. Singh,

M. Saha, P. Katepogu

King George's Medical University, Lucknow, Uttar Pradesh, India, E-mail: vijaycric@gmail.com

Introduction: Pleuropulmonary blastoma (PPB) is a malignant tumor of lung affecting children. PPB is a rare entity having an incidence between 0.25-0.5% of all primary lung malignancies. PPB occurs exclusively in children younger than 12 years. In this case report, we present a 21 year-old male who was admitted with chest pain, haemoptysis, dyspnea, weight loss and on biopsy was diagnosed as PPB. Case Report: A 21 years old male was admitted in our hospital with chest pain, haemoptysis, dyspnea, generalized weakness and loss of weight. At the time of presentation skiagram of chest PA view was suggestive of well defined round to oval homogeneous radioopacity noted in upper lobe of left lung. Computed tomography examination of thorax revealed a large well defined rounded inhomogenously enhancing soft tissue space-occupying lesion in left hilar & suprahilar region with extensions and mass effect. On physical examination was pulse rate of 78/minute, regular, respiration rate of 22/minute, blood pressure 124/82 mm of Hg, temperature 36.2΀C (97.2΀F). Lung auscultation revealed decreased breath sounds on the left side of hemithorax. Laboratory investigations showed a leucocyte count 6800/mm3, hemoglobin 10.1 g/dl, platelet count of 1.5 lac cells/mm3, serum AFP - 2.79 ng/ml, serum LDH - 547.3 IU/L, serum beta- HCG - <1.0 IU/ml. Biopsy was taken from intrathoracic mass which was histopathologically suggestive of PPB. Immnunohistochemistry revealved cytokeratin positive. Metastatic workup was negative for distant spread of the disease. Organ function evaluation of liver, kidney, lung and cardiac was undertaken and was found with in normal limits. Due to extensive disease, patient was started with Ifosfamide and Adriamycin (IE) based chemotherapy & was given 4 cycles of this combination chemotherapy, followed by left upper lobectomy & now patient is on adjuvant chemotherapy comprising Ifosfamide & Adriamycin combination. Conclusion: we submit that PPB is a disease of early childhood. We have reported here a case of PPB in a young adult patient. This is intended at highlighting the fact, that PPB may occur in adult individuals as well, though not a very common occurrence. Thus, high index of suspicion with typically well-defined radiological image may help in clinching diagnosis, though histopathological examination with immunohistochemical evaluation may establish the diagnosis at an early stage which may be crucial in successful management of such cases.

Abstract: 356

Retrospective analysis of limited stage small cell carcinoma of lung treated curatively with chemo-radiotherapy from 2010-2014 in Tata Memorial Hospital, Mumbai

G. Panda , J. P. Agarwal, S. G. Laskar, K. Prabash, V. Noronha, G. Karimundackal, C. S. Pramesh

Tata Memorial Hospital, Mumbai, Maharashtra, India, E-mail: goutam_guntu@yahoo.com

Purpose: To analyze outcome of curative intent treatment in patients with small cell lung cancer [SCLC] limited disease [LD] and factors affecting the outcome. Materials and Methods: Thirty patients suffering from SCLC LD were treated with curative intent chemoradiotherapy followed by Prophylactic Cranial Irradiation [PCI] from 2010 to 2014 at TMH, Mumbai. Available medical records were reviewed to analyze the outcome. Results: Radiotherapy dose to primary disease ranged from 48 Gy to 60 Gy using conventional fractionation. Cisplatin or carboplatin, etoposide were the chemotherapeutic drugs used. All but two patients received early PCI. Two patients who didn't receive PCI, were those who died during the course of treatment. One patient died of heat stroke and other one died of cardiac cause. PCI dose ranged from 24.75 Gy/11 fractions to 25 Gy/10 fractions. Thus twenty-eight patients completed treatment. None of the patients developed any acute toxicity of Grade III or more as per RTOG grading. Out of Thirty patients, six are lost to follow up. The median overall survival[OS] is 44 months. Three patients died from non-cancerous causes including the patients who died during the course of treatment. Two patients developed brain metastasis even after receiving PCI. These patients received palliative whole brain radiotherapy [WBRT]. Doses of WBRT were 20 Gy/10fractions & 30 Gy/10fractions. On univariate analysis, favorable outcome is seen with younger age at presentation [less than or equal to 60 years of age, worse OS; p = 0.017], no co-morbidity[worse outcome with any co-morbidity; p = 0.005], good performance status at presentation[Karnofsky Performance Status 80 or more, associated with good outcome; p = 0.009]. Though statistically not significant, there is a trend of better outcome with female sex & lower value of LDH. On Cox regression multivariate analysis, age was the only factor significantly [p = 0.043] associated with outcome; performance status and comorbidity were not statistically significant. Conclusion: Patients of SCLC LD with younger age, good performance status without any co-morbidity at presentation completing the treatment have a good outcome.

Abstract: 363

Malignant acrospiroma of chest wall: An unusual clinical experience

M. Ravi Krishna, P. Das, B. Subramanian

Sri Venkateswara Institute of Medical Sciences, Cancer Center, Tirupati, Andra Pradesh, India, E-mail: santroravi@gmail.com

Background: Malignant acrospiroma occurs very rarely and is found more commonly over face and extremities. Involvement of chest wall is of an unusual phenomenon. The prognosis for survival in malignant acrospiroma is very poor. The local relapse rate has been reported to be as high as 50% inspite of adequate surgical excision. Distant Metastases have been reported in more than 60% of cases within the first two years and 5-year disease-free survival is less than 30%. We present a case of malignant acrospiroma of chest wall who was treated successfully at our center. Materials and Methods: A 51 year post menopausal woman presented with a painless swelling on her upper back over 1 month duration. On examination a solitary, mobile and firmly consistent nodular swelling of size 5 Χ 4 Χ 3 cm on right upper back just behind the posterior axillary fold in sub cutaneous plane with skin over the tumor adherent over 3 Χ 2 cm area. No axillary lymphadenopathy was detected. Wide local excision of the mass with more than 1 cm margin was attempted. Histopathologic report was favoring malignant acrospiroma/carcinomatous deposits and basal resected margin was positiside. Immunocytochemistry for CEA was negative and CK showing moderate to intense cytoplasmic positivity suggestive of malignant acrospiroma of eccrine sweat glands. The patient defaulted for two months after surgical excision for adjuvant treatment. On clinical examination of the scar on right posterior axillary fold a firm, mobile axillary lymphadenopathy of size 3 x 2 cm palpable on right sideaxillary region. FNAC revealed malignant deposits in the axillary lymph node. Patient was then undergone right axillary lymph node dissection which was positive for malignancy. The patient was then undergone adjuvant radiotherapy to the chest wall and right axillary region with 60 Gy in 30 fractions. Results: The patient after repeated surgical excision and adjuvant radiotherapy to chest wall and axillary region is now completely free of disease and local recurrence even two years after treatment. Conclusion: Although radiation therapy has no been proved to be beneficial and role of any chemo-therapeutic agent is questionable, still it has been proposed to be one possible modality to treat locally and locoregionally aggressive malignant sweat gland tumor of chest wall with regional lymphadenopathy following aggressive surgical excision.

Abstract: 426

Cyberknife SBRT: An effective tool for moving tumors in primary or metastatic lung cancer

A. Abhishek , T. Kataria, B. Gupta, T. Basu, S. Bisht, K. P. Karthick

Medanta - The Medicity, Gurgaon, Haryana, India, E-mail: ashuabhishek@gmail.com

Introduction: Stereotactic body radiotherapy (SBRT) is an effective ablative radiation technique for early stage lung cancer and limited lung metastases (oligometastases). Cyberknife, a novel robotic SBRT delivery system aided with real time image guidance and tumor tracking, is a promising treatment option for selected lung cases. Materials and Methods: We present consecutive 20 cases treated on Cyberknife for lung lesions from Jan 2013 till August 2014, with one year follow up and analyzed for various clinical and dosimetric parameters. Also, for 5 cases treated with Cyberknife X sight lung tracking, dummy IMRT plans (considering no motion management in free breathing) were prepared and compared dosimetrically with actual cyberknife 2 view plans. Results: Out of all 20 cases with primary (12 cases) or metastatic (8 cases) disease, tracking modality used was 2 view or X sight lung (11 cases), 1 view (3 cases) and 0 view (6 cases). For Cyberknife plans, Gross Tumor Volume (GTV), PTV, number of beams and nodes were recorded as 56 cc [range 4 cc - 326 cc], 97.6 cc [range 12.5cc - 523cc], 261 {range 159-531} and 84 {range 55-84}, respectively. Patients were planned for mean dose of 46.4 Gy [range 18 Gy-63Gy] delivered over 3-10 fractions. First assessment 6-8 weeks post completion of Cyberknife treatment revealed 43% [22%-90%] reduction in size of the primary tumor and 45% [23% - 80%] reduction in PET SUV values. Patients tolerated treatment well with no grade 3 toxicities. Till last available follow up, 5 cases (25%) had complete metabolic and morphological response (CR) locally, 12 cases (60%) had partial response (PR) and 3 cases (15%) had stable disease locally. None of the cases had local progression, however five cases had systemic progression 3-6 months post Cyberknife completion. On comparison of Cyberknife 2 view plans with dummy plans, ipsilateral lung V10 and V20 were 38% and 48% higher in dummy plans, respectively. Conclusion: Initial results of dosimetric and clinical response for our cases are very encouraging. With lesser overall treatment volumes aided by precise tumor targeting in Cyberknife, there is a greater scope of critical organ sparing than conventional modalities which have to account for target motion by adding extra safety margins. With possibility of treatment in free breathing, Cyberknife has better treatment compliance and promises greater precision SBRT dose delivery in selected cases.

Abstract: 428

Assessment of quality of life in patients with advanced lung cancer receiving chemotherapy

A. Das , G. N. Srivastav, D. Kumar, T. B. Singh, S. Pradhan

Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, E-mail: dravipsa_das@rediffmail.com

Background: Lung cancer, especially in our country, is mostly diagnosed in an advanced stage and patients require palliative treatment, predominantly with chemotherapy (CT). Quality of Life (QOL) is an important issue in these patients. Aim: Study QOL in patients with advanced stage lung cancer receiving CT. Materials and Methods: Thirty-three patients fulfilling the eligibility criteria were recruited for this prospective study carried out during the period April 2014 to June 2015. Following initial evaluation including history, BMI, Karnofsky Score and QOL assessment using EORTC QLQ-C30 version 3.0 and QLQ-LC13 questionnaire, patients were taken up for CT. Twenty-six patients completed at least 3 cycles, and 23 patients completed 6 cycles of CT. BMI, Karnofsky scores and QOL were evaluated before CT, after 3 weeks of third and sixth cycles of CT. The collected data was analyzed using SPSS version 16.0 software. Descriptive analysis was undertaken to characterize the sample and paired 't' test was used for comparative analysis of QLRH before and after chemotherapy. Results: Of the 33 patients initially taken up for the study, only 23 were available for final analysis. There was an increase in the median Karnofsky score by a value of 10 after 3 cycles, with score remaining static after completion of 6 cycles. There was decrease in the mean values of BMI both after 3 rd and 6 th cycle of CT. Following 3 cycles of CT, there was a significant improvement in General Health Status/QOL (p < 0.001). All functional scales showed improvement compared to pre-CT status. In the symptomatic scale, improvements in pain, dyspnoea and insomnia were highly significant. After 6 cycles of CT, there was a significant improvement in QOL and in physical, emotional, role and social functioning of patients, and in symptom scale there was marked improvements in pain, fatigue, insomnia, dyspnoea, appetite loss, but deterioration of diarrhea and financial difficulties In the lung cancer specific module, after 6 cycles of CT, there was significant improvement in dyspnoea, cough, haemoptysis, chest pain and other body part pain but worsening in symptoms of sore mouth, peripheral neuropathy and alopecia. Conclusion: CT has significant role in improving the functional state, alleviation of distressing symptoms, and improving the overall QOL of advanced stage lung cancer patients, though at cost of increase in adverse effects due to CT that are temporary and could be managed conservatively.


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