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Year : 2017  |  Volume : 13  |  Issue : 7  |  Page : 1-453


Date of Web Publication10-Nov-2017

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How to cite this article:
. Abstract. J Can Res Ther 2017;13, Suppl S1:1-453

How to cite this URL:
. Abstract. J Can Res Ther [serial online] 2017 [cited 2019 Feb 20];13:1-453. Available from: http://www.cancerjournal.net/text.asp?2017/13/7/1/218087

 > Abstract Id: YUGP0205 Top

Nupharidines Enriched Leaf Extract Of Nuphar Lutea Reduces Experimental Melanoma Metastasis And Modulates Erk And Nf-?B Pathways

Presenter- *Prof. Jacob Gopas

Co-author - Janet Ozer PhD, Dimitry Fishman MD, Avi Golan-Goldhirsh

Nuphar lutea L. SM., leaf and rhizome extracts (NUP), contain nupharidines as active ingredients. Nupharidines belong to the sesquiterpene lactones class of a naturally occurring plant terpenoids. This family of compounds has gained considerable interest for treating infection, inflammation and cancer. NF-?B is a central, downstream regulator of inflammation, cell proliferation and apoptosis. In our previous work we demonstrated strong inhibition of NF-?B activity and induction of apoptosis by NUP. In addition, NUP exhibited anti-inflammatory properties and partial protection from LPS-induced septic shock by modulating ERK pathway and cytokine secretion in macrophages. In the present study, we examined the effect of NUP in a B16 melanoma experimental murine lung metastasis model and its ability to affect the ERK and NF-?B pathways in variety of cell lines. We showed that NUP and cisplatin combined treatment was synergistic and reduced the lung metastatic load. In addition NUP treatment inhibited TNF?-induced I?B? degradation and NF- ?B nuclear translocation. We also observed that NUP induced ERK activation. Furthermore, ERK inhibition prevented NF-?B inactivation by NUP. Interestingly, NUP treatment induced ERK activation in a human melanoma cell line, expressing BRAF mutation. Overall, our work implies that co-administration of NF-?B inhibitors with standard anticancer drugs or radiotherapy, may act as “sensitizers†or as inhibitors of multidrug resistance.

 > Abstract Id: YUGP0211 Top

Comparative Study Of Work Load Using Calculation Of Time Analysis & Its Management


Co-author - Gurvinder Singh Wadhawan, Dr Munish, DR G Yadav

COMPARATIVE STUDY OF WORK LOAD USING CALCULATION OF TIME ANALYSIS & ITS MANAGEMENT Rajiv Gandhi Cancer Institute & Research Centre, Delhi,India Description Radiation oncology department is a major part of cancer centre where exclusively this dreaded disease is being treated. We RTT(Radiation Therapy Technologist)the members of a multidisciplinary team comprising of radiation oncologist , medical physicist always struggle with complicated time taking treatment set-ups and huge patients load on daily basis ( approx.180-250 patients per day )on all Teletherapy units. Purpose The aim of this study is to drive a radiotherapy work load using patient data related to treatment information on teletherapy treatment units at our institute. The patient care quality and quantity should be balanced in radiation oncology .We deliver treatment/radiation doses to about 1500-2000 RT NO.cases per year using five LINACs. Material & Methods Clinac-ix/ RAPID ARC, TRUE BEAM, Synergy , Primus ,Artiste Result All data collected on daily basis during the study. The fraction duration was calculated as the time when the patient enters the room until the time patient left the room. We collected data for the month of November-December--January 2017 on each teletherapy/Simulator unit as per annexure. Mixed beam takes on average 14 minutes for delivering radiation doses through four setup fields/single beam 9.6 minutes through three setup fields/single beam takes on average 20.5 minutes through more than four setup fields in IMRT cases/single beam takes on average 24.2 minutes through more than four setup fields in IGRT cases/ single beam on average 17 minutes for Technique Rapid-Arc, IGRT/IMRT 22 minutes for delivering radiation doses through more than four setup fields. Conclusion Management of Patient set-up and positioning errors, Quality of site specific target delineation during imaging and analysis of planned and delivered fraction are the major challenges faced by RTT using IGRT technique for consistency of iso-centricity and image fusion by KVCBCT/MVCBCT for periodic monitoring of target verification.

 > Abstract Id: YUGP0301 Top

Head And Neck Squamous Cell Carcinoma:Factors Related To Lymph Node Metastases

Presenter- *Dr. Ramkishan Gonuguntla

Co-author - Dr. Sanjay M Desai, Dr. Deepak Agrawal, Pradeep

Background: Head and Neck squamous cell carcinoma (HNSCC) are among the top 3 cancers in India and accounts for 30 % of the country’s cancer burden. In this study, we will focus on the lymph nodal metastasis from Head and Neck cancers regarding facts, such as incidence; stage, histopathology and grade of primary tumor. Study design: All patients of head and cancer who were operated in a period of four years in the department of surgical oncology, Sri Aurobindo Medical College & Hospital, Madhya Pradesh, were included in the study. Data is gathered from in patient files, operative records and Histopathology records. Results: Buccal mucosa is the most common site of cancer (42.6%). Incidence is common in male population and male to female ratio is 1.2:1.Most patients presented in middle age and stage IV is the most common presentation. 86.4% of tumors are low grade. High grade tumors presented with advanced stage and more number of metastatic lymph nodes. There is direct correlation between lymphovascular invasion and lymph node metastases. Conclusion: Location of primary tumor pattern of invasion, histologic grade, disease stage, will influence the lymph node metastasis, and prognosis in HNSCC. Assessments of mentioned parameters are beneficial in selecting patients who need more aggressive treatment modalities.

 > Abstract Id: YUGP0319 Top

Secondary Peritoneal Malignancy Presenting Clinically With Signs Of Malignant Bowel Obstruction Without Overt Radiological Signs €” Defining A Novel Gastro Intestinal Syndrome €” A Case Report

Presenter- *Dr. Rahul Arora

Co-author - Rahul D. Arora, ,

Gastrointestinal Malignancies: Non Colorectal Cancer Secondary Peritoneal Malignancy presenting clinically with signs of Malignant Bowel Obstruction without overt Radiological signs — Defining a Novel Gastro intestinal Syndrome — A Case Report Author - Rahul D. Arora Research done during tenure as Junior Resident (Academic), Dept. of Palliative Medicine, Tata Memorial Centre, Tata Memorial Hospital. Background - Malignant Bowel obstruction can occur as a result of Primary Gastrointestinal cancer (Intraluminal) or Secondary peritoneal metastasis (extrinsic compression) and usually portends a poor prognosis. Case details - A 45 year male patient presented with signs of Intractable Hiccoughs since the past 3 months, reduced oral intake since the past 3 months, Abdominal distension since the past 2 months, Postprandial vomiting since the past 2 months which had become bilious since the past 1 month ,Constipation since the past 1 month and Obstipation since the past 2 days. He had been diagnosed as a case of Signet Ring Cell Carcinoma of the Stomach and had been taken up for an operative procedure where suboptimal debulking and Palliative Gastrojejunostomy was done in view of extensive secondary peritoneal metastasis. He had also received two cycles of Adjuvant Chemotherapy. A Nasojejunal tube had been inserted after considering a diagnosis of Gastric outlet obstruction following which a Nasogastric tube was inserted in view of intractable vomiting. A Clinical examination was suggestive of multiple nodular abdominal swellings, reduced to absent Bowel sounds along with dullness in both the flanks. An Abdominal Radiograph done subsequently was not suggestive of multiple air fluid levels. Fecal impaction was unlikely in the absence of clinical evidence and prescription of multiple prokinetic agents. He was started on Pharmacological management of Malignant Bowel obstruction following which there was an improvement in symptoms. A CT done subsequently was suggestive of massive subhepatic fluid collection with normal Bowel loops. 1100 ml of Haemmorhagic fluid was removed followed by 3 units of Fresh frozen plasma Infusion. Intravenous Albumin infusion was considered in view of Bilateral pitting edema , anasarca in the setting of hypoalbuminemia. Discussion - The choice of anti emetic in this setting needs to be scrutinised since the patient had been started on Inj Ondansetron along with Inj Octreotide which was subsequently changed to Inj Metoclopramide which was continued till a return of bowel sounds was noticed. Did the Gastrojejunostomy procedure mask the symptoms of Bowel obstruction. Are multiple air fluid levels seen in Bowel obstruction due to extrinsic compression. Is TPN indicated in the setting of starvation in advanced cancer as a respite measure. What is the incidence of Starvation ketoacidosis in advanced cancer and has it been shown to adversely affect prognosis. Conclusion - Pharmacological management of Malignant Bowel Obstruction may have to be instituted in the absence of Radiological signs. The dosage, duration and efficacy of Prokinetic agents and their predisposition to Perforation in the setting of MBO needs to be evaluated further. Keywords Bowel obstruction Secondary peritoneal metastasis absence of radiological signs.

 > Abstract Id: YUGP0321 Top

Characterisation And Prognostication Of Pain €” A Single Centre, Observational Trial In Advanced Cancer

Presenter- *Dr. Rahul Arora

Co-author - Rahul D. Arora, ,

Title Characterisation and Prognostication of Pain — A Single centre, Observational Trial in Advanced Cancer Author - Rahul D. Arora Research done during tenure as Junior Resident (Academic), Dept. of Palliative Medicine, Tata Memorial Centre, Tata Memorial Hospital. Background Pain has been shown to have a prevalence ranging between 39 to 66 percent in various phases of the trajectory of Cancer. The Edmonton Classification System for Cancer Pain (ECS-CP) which has been developed for the characterization of Pain has five sub-domains which are essential in describing the Patient’s pain. Prognostication which has been measured as the number of days to achieve stable pain control traditionally needs to be re-defined with an added emphasis on the science of survival. Haematological indices have been proposed as a means of correlating Pain with survival. Methodology Baseline Pain was characterised at initial visit by ECS-CP. Acute exacerbation of Pain was characterized on the Alberta Breakthrough Pain Assessment Tool (Original version). Pain Education Booklet was issued for recording the Maximum Pain Intensity, Episodes of Exacerbation of Pain and symptoms of Opioid induced Adverse effects daily. Results 85 out of 96 Patients who underwent screening over a period of six months met the Inclusion Criteria of Moderate Pain and estimated survival of more than 6 weeks. Haematological Indices were available in 56, Opioid related Adverse Effects in 45 and Morphine Equivalent Daily Dosage in 42 patients at first visit. The median Morphine Equivalent Daily Dose was 45 mg. A significant weak Positive correlation was documented between Palliative Prognostic Index (PPI) and Age, PPI and Pain Intensity at first visit, Number of Positive factors for Poor Prognostication of Pain on ECS- CP and MEDD, Number of Days the Patient was on Opioids and Fatigue. There was a weak positive correlation between NLR, PLR and Pain Intensity. Lack of recruitment, Gatekeeping and Attrition were recognized as Key Challenges. Conclusion A Composite Tool which includes markers of Chronic Inflammation along with Biochemical Parameters needs to be formulated. ABPAT can be used successfully in the clinical (outpatient) setting. The utility of WHO Step iv for multimodality management of Pain needs to be recognized, discussed and debated further. Comparibility of Data gathered in a multitude of settings (Hospital, Home and Hospice) along with reliability of information collected Telephonically needs to be discussed in the unique setting of advanced Cancer. Potential answers to the Complex Ethical and Logistical Dilemmas relevant to Research in advanced Cancer include - Detailed Informed Consent Form , Recognition of Patient and Caregiver willingness to participate in Research (overcome Gatekeeping), Recruitment in a multiplicity of settings (increase accrual), Novel Trial Designs (N of 1, Fast track), Statistical Methods (Imputational Analysis, Bootstrapping) along with a Structured Patient oriented Community Outreach Program (prevent attrition) . CLINICAL TRIAL IDENTIFICATION CTRI ID REF /2015/12/010267

 > Abstract Id: YUGP0467 Top

Compliance To Head And Neck Radiotherapy In Our Patient Population At Tertiary Care Centre, Rims, Ranchi

Presenter- *Dr. Anup Kumar


Background: The treatment of head and neck cancer is complex, costly, toxic and challenging particularly in this part of the world where majority of the patients are from rural background and lower socioeconomic status. Persistent patient compliance is crucial, unplanned treatment interruptions reduce cure rates. Treatmentprolongation reduces local control and overall survivalrates, making adherence to treatment a key factorin optimal outcome.The present study estimates the compliance rate in patients who underwentradiotherapy for head and neck cancer. Materials and Methods: A retrospective study comprising of 64 patients of head and neck cancer registered or referred to the tertiary care centre, RIMS, Ranchi during Jan ’14 to December ’16 were taken. The clinical and demographic data were fetched from ODRI: institutional oncology database. Results: A total of 64 patients were included in the study. The mean age of presentation was 50 years. 73 % of patients were males and 27 % were females. Mostly patients were nontribal (85.4 %)compared to 14.6 % of tribal patients. 90.6% of the patients were married and only 9.4% were unmarried. 20 (32.25 %) of study patients did not miss any treatment; 32 (50 %) patients missed 1 to 6 treatments; 4 (6.25 %)patients missed 7 to 14 treatments, and 3 (4.68 %) patients missed more than 14 treatments. 3 (4.68 %) patients did not completed the treatment, while 2 (3.12%) patients didnot started the treatment. Reasons for missed treatments were hospitalization and toxicity. Conclusion: Approximately 81% of the patients were compliant to cancer-directed therapy. Efforts are ongoing to further improve adherence in our population.

 > Abstract Id: YUGP0475 Top

Association Of Cancer Stem Cell Marker Cd133 With Grade ,Stage And Smoking Index In Lung Carcinoma .

Presenter- *Dr. Neema Tiwari

Co-author - A.N Srivastava*,, Shailendra Yadav, Manoj Jain

Association of cancer stem cell marker CD133 with grade ,stage and smoking index in lung carcinoma . Neema Tiwari*, A.N Srivastava*, Shailendra Yadav**, Manoj Jain***, Suryakant**, Nishi Tandon* *Department of Pathology, Eras Lucknow Medical College and Hospital **Deapartment of CTVS and Department of Pulmonary medicine,KGMU ***Department of Pathology, SGPGI INTRODUCTION Lung cancer is a very serious problem of the Indian subcontinent, especially in the lower socioeconomic subgroups. As per the ICMR [Indian Council Of Medical Research] registry of 2002 lung cancer is the 5th most common tumor overall and 2nd most common tumor in the males in India. It accounts for 6.9% of new cancer cases detected each year. CD133 is one of the best-characterized markers of CSCs in colorectal and pancreatic cancers however; its role in lung cancer needs further study. The tumorigenic cells in SCLC and NSCLC were first characterized as a rare population of undifferentiated cells expressing CD133, a marker of normal and CSCs of the hematopoietic, neural, endothelial and epithelial lineages. [18] AIM- To study the association of cancer stem cell marker CD133 with tumor grade and stage as well as smoking index, in lung carcinoma patients. MATERIAL AND METHODS-Biopsies from 55 fresh previously untreated lung cancer patients visiting the Pulmonary Medicine Department of Era’s Lucknow Medical College and Hospital Lucknow [ELMC&H] & King George’s Medical College and Hospital [KGMU], Lucknow were taken, after taking proper informed consent from them. Ethical clearance was taken from the institute. Complete history including the smoking index as well as the radiological profile was recorded. The biopsies were processed in Dept. of Pathology, into paraffin blocks, and stained by Haematoxylin and Eosin [Sigma] staining for histopathological diagnosis .Immunohistochemistry was done for detection of CSC marker CD 133[Daco]. CONCLUSION-On studying the association of the markers with the staging of the tumor we saw that the expression of CD133 was observed in 62.5% of Stage I, 90% of Stage II, 94.1% of Stage III and 100% of Stage IV cases. Statistically, there was a significant association between CD133 expression and stage of disease (p

 > Abstract Id: YUGP0485 Top

Isolated Bony Metastasis To Upper Limb From Carcinoma Esophagus : Report Of Three Cases

Presenter- *Dr. Joydeep Purkayastha

Co-author - Taposhi Roy Sarkar, Pallabika Mondal, Niju Pegu

Introduction: Carcinoma esophagus is one of the dreaded diseases occurring in the human population. The malignant process of esophageal cancer commonly involves the loco-regional areas. Distant metastasis occurs in approximately one third of cases specifically to lung, liver, bone and brain. Hematogenous metastasis to the upper limb bones is a very rare event. Case Reports: Case No.1 A 65 year old lady with carcinoma esophagus presented with a painful swelling in the right ring finger for a duration of 1 month. She was diagnosed as carcinoma of the upper thoracic esophagus for which she was treated with chemo-radiation therapy 2 years ago. On clinical examination, there was a firm, tender swelling involving the region of the terminal phalanx of the right ring finger. The overlying skin of the ring finger was intact. X-ray examination revealed destruction of the terminal phalanx of the right ring finger with surrounding soft tissue swelling that were suggestive of bone metastasis. On endoscopy and CT scan there was no loco-regional or any other systemic disease. In view of the isolated metastatic disease amputation of the right ring finger was done through the head of the middle phalanx. Histophathological examination of the amputed finger revealed features of metastatic squamous cell carcinoma consistent with esophageal primary. There was complete destruction of the terminal phalanx while the overlying skin was intact. The patient is under regular follow up and is doing well at 24 months. Case No.2 A 72 year old follow up female patient of carcinoma esophagus presented with a painless swelling of the left elbow, one year after completion of chemo-radiation. FNAC from the elbow swelling detected features of metastatic squamous cell carcinoma. X-ray of the left elbow revealed soft tissue swelling around elbow with lytic area in olecranon process suggestive of metastasis. There was no evidence of any recurrent disease elsewhere on radiological investigation and endoscopy. She was taken up for Radiation therapy and received a total dose of 30 Gray in 10 daily doses. At 3 weeks post radiation the tumour in the elbow subsided completely. X-ray of the elbow showed resolution of the soft tissue swelling with healing of the lytic area in the bone. The patient has been kept under follow up and is keeping well at 18 months. Case No.3 A 70 year old patient had squamous cell carcinoma of esophagus at 25 cms for which she received radiation therapy to a total dose of 60 Gy. After a period of 3 months following completion of radiation she developed a swelling of the left index finger. The overlying skin was intact. X-ray examination revealed complete destruction of the distal phalanx of the left index finger with soft tissue swelling. There was no disease recurrence elsewhere on endoscopic and radiological examination. She underwent amputation of the distal finger. Histopathological examination revealed features of squamous cell carcinoma. She is doing well at a follow up period of 4 months. Discussion: Esophageal cancer is considered to be one of the dreaded diseases because of its adverse effects on swallowing and therefore the quality of life. In general, the prognosis is poor as most patient present with advanced disease. The 5 year survival rate with localised disease is about 38 % while with regional spread it is around 20 %. Patients with distant metastasis have less than 3 % five year survival. The disease spreads by local extension to adjacent organs and to lymph nodes in the mediastinum, neck or abdomen depending upon the location of the primary tumour. Distant metastasis has been found to occur in lung, liver, bone and brain. Metastasis to the upper limb bone is very unusual. There are a few case reports of metastasis to the phalanx from carcinoma of esophagus. The mode of spread is by the haematogenous route. It presents as a localised swelling and is at times misinterpreted as infective or inflammatory lesion. Palliative chemotherapy is the preferred treatment for metastatic carcinoma esophagus. Radiation therapy may be considered for control of isolated localised metastatic disease. Palliative amputation is a good option for metastasis to phalanx for relief of pain and discomfort. In our patients the primary disease in the esophagus was controlled by chemoradiation. They developed isolated metastasis to the upper limb bones after remaining disease free for a certain period. Moreover, there was no evidence of any local recurrence or any metastasis elsewhere. Hence, they were taken up for palliative treatment of the isolated localised disease. In the 2 patients with metastasis to the distal phalanx there was complete destruction of the bone that warranted minor amputation. Hence they were taken up for palliative surgery without FNAC or biopsy. In the patient with metastatic disease in the elbow, surgery would have required major limb amputation. Hence she was offered radiation therapy, after tissue diagnosis, to which she responded very well. Systemic therapy was not considered in view of the isolated recurrence, old age and compromised general condition and they were kept on close follow up. We conclude that if any patient with carcinoma esophagus presents with localised swelling of the limb, the possibility of metastaic disease should considered and such patients could be managed with local treatment including radiation therapy or amputation.

 > Abstract Id: YUGP0488 Top

€Œectopic Undescended Parathyroid Adenoma: A Case Reportâ€



Review of literature: Ectopic parathyroid glands occur in 5% of people, occasionally located high in the neck under the jaw (called an un-descended parathyroid gland). These are often overlooked by inexperienced Radiologists and Surgeons, especially when these occur in uncommon or rare positions. Introduction: We Report here a case of Left Ectopic Undescended parathyroid adenoma located high in the neck, at the angle of jaw which was diagnosed primarily on ultrasound at our institution, followed by Sestamibi and CT-SPECT and Surgery. Clinical History: Patient is a middle aged female planned for hysterectomy. Her Preoperative investigations showed raised Serum Calcium (13.0mg/dL) Serum PTH 914.6 pg/mL & 25— OH Vitamin D 8.0 g/Ml. Ultrasound Neck showed a well-defined ovoid hypoechoic nodule measuring 34x15x12 mm, volume 3.0 cc, with characteristic eccentric vascularity, located just inferior and adjacent to the left submandibular gland suggestive of ectopic undescended left superior parathyroid nodule Sestamibi (Technetium MIBI) ssuggested Left ectopic undescended parathyroid adenoma (below the pole of left submandibular gland), confirmed further on CT - SPECT Surgical Findings The patient was operated and a 30x23x10mm sized parathyroid adenoma was removed and confirmed on histopathology Conclusion High resolution colour Doppler ultrasound by a dedicated Radiologist has a great potential to detect and localise the parathyroid nodules in cases of hyperparathyroidism. Ultrasound also gives precise anatomical landmarks for surgery and characterises the nodule. Ultrasound diagnoses nodules in proven Sestamibi negative cases of hyperparathyroidism. KEY WORDS: Parathyroid adenoma, Hyperparathyroidism, Ectopic undescended, Ultrasound neck with colour Doppler.

 > Abstract Id: YUGP0490 Top

Modulation Of The Sirt-1/P53 Axis By Butyrate Inhibits The Hepatitis B Virus Replication

Presenter- *Mr. Kishor Pant

Co-author - Saman man Pradhan, Senthil K, Venugopal,

Hepatitis B Virus is a ds-DNA Virus, responsible for hepatocellular carcinoma (HCC), liver cirrhosis, fibrosis and a large number of mortality worldwide. HBV modulates many cellular factors for its replication and survival in host cell. Reactive oxygen species (ROS) theatre produced in the host cells during HBV infection was considered to inhibit the cellular antioxidants and Sirt-1 expression. However, the exact molecular mechanisms involved in the ROS-induced HBV replication has been not known. HepG2.2.15 cells (Hep G2 cells expressing HBV genome stably) werewere treated with the NAC (20Âμm) and Sirt-1 inhibitor Butyrate (5mM) overnight. Western blotting was performed for the proteins Sirt-1, HBx, p-akt, akt, pmTOR, mTOR, Beclin-1, LC-3, ATG5, and ?-actin using specific primary antibodies, followed by secondary antibodies and subsequent detection using ECL reagent. Analysis of ROS was performed using the H2-DCFDA in fluoresce microscopy. Autophagy assay was done using the Cyto-ID autophagy detection kit. Determination of the HBsAg was performed by ELISA and HBV-DNA was analysed using the Real-Time PCR method. HBV infection increased the ROS production and formation of autophagic bodies were observed in the cells. Addition of the NAC (antioxidant) inhabited both the autophagy and ROS production in HepG2.2.1.5 cells via modulation of the Beclin-1, LC-3 and ATG-5 expression. HBV transfection also induced the Sirt-1 expression which was inhibited by the addition of the butyrate and sirt-1 Si-RNA. Inhibition of the Sirt-1 expression by butyrate or Si-RNA inhibited the viral replication and HBV-induced autophagy. Furthermore, inhibition of Sirt-1 also lead to over-expression of the Actylated-P53, which in turn inhibited the cell proliferation in HBV-infected cells. In this present study we have shown that HBV infection Leads to the over-expression of Sirt-1, which was be inhibited by butyrate treatment. These data may provide a possibility for the use of butyrate in therapeutic applications.

 > Abstract Id: YUGP0492 Top

Reactive Oxygen Species Produced By Hbv Help In Replication And Autophagy In Host Cells

Presenter- *Mr. Kishor Pant

Co-author - Amit K. Mishra, PhD, MSc.

Background: Hepatitis B Virus (HBV) is responsible for liver cirrhosis, fibrosis and hepatocellular carcinoma (HCC) worldwide. HBV modulates many cellular and molecular factors in host cells for its replication and survival including, ROS is considered to inhibit the cellular antioxidants and SIRT-1 expression. However, the exact molecular mechanisms involved in the ROS-induced autophagy and HBV replication has been not known. Methods: HepG2.2.15 cells (Hep G2 cells expressing HBV genome stably) were treated with the NAC (20Âμm) overnight. Western blotting was performed for the proteins Sirt-1, HBx, p-akt, akt, p-mTOR, mTOR, Beclin-1, LC-3, ATG5, and ?-actin using specific primary antibodies, followed by secondary antibodies and subsequent detection using ECL reagent. Analysis of ROS was performed using the H2-DCFDA in fluoresce microscopy. Autophagy assay was done using the Cyto-ID autophagy detection kit. Determination of the HBsAg was performed by ELISA and HBV-DNA was analysed using the Real-Time PCR method. Results: HBV infection increased the ROS production and formation of autophagic bodies were observed in the cells. Addition of the NAC (antioxidant) inhabited both the autophagy and ROS production in HepG2.2.1.5 cells via modulation of the Beclin-1, LC-3 and ATG-5 expression. HBV transfection also induced the SIRT-1 expression which was inhibited by the addition of the NAC and sirt-1 Si-RNA. Inhibition of the SIRT-1 expression by NAC or Si-RNA inhibited the viral replication and HBV-induced autophagy. Conclusion: In this present study we have shown that HBV infection Leads to the over-expression of SIRT-1, responsible for Autophagy and viral replication in host cells, which was be inhibited by NAC treatment. These data may provide a possibility of ROS inhibition and its therapeutic applications for HBV therapy.

 > Abstract Id: YUGP0494 Top

Reflecting At Palliative Care Through A Students Eye

Presenter- *Dr. Faaiza Rehman

Co-author - Faaiza Rehman, MBBS MD, MBBS MD

Introduction: As a medical student, one may have had several encounters with terminally ill patients. However my very first encounter in my first year of medical school, was of an 8-year old family member, who was diagnosed with leukemia. Being in the healthcare field, I thought, it would help me face the situation better. However, I promptly felt the inadequacies to address these situations at my level. I spent my visiting hours quietly by the side of the grieving family. The helplessness I felt in those moments could probably be explained by my closeness to the patient and also my lack of being prepared. Hoping to get better prepared as my education advances, I continued to move forward. However, I felt no better prepared as the newly diagnosed breast cancer lady in the hospital bed was shocked. Another encounter with a close family member with advanced metastatic breast cancer, I continued to feel inadequately prepared to deal with these difficult situations. Methods: As a reflection on my ongoing medical education journey, a questionnaire for medical students was formulated- to rate their understanding of palliative care and to deal with conversations revolving around difficult situations. Participants were 50 medical students consisting of numeric rating scales of the questionnaires of (0-10). Results: The participants rated their knowledge of palliative care as low (average: 4.3) and most of the participants were concerned about the palliative care education given in the medical school (average: 3.05). The above data also correlated with their ability to deal confidently with a terminally ill patient with an average score of 4.85 out of 10. Most of the participants agreed on the inclusion of palliative care education in the medical curriculum (average: 8.1). Conclusion: Effective undergraduate education is required to enable graduating doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for international medical students is not well documented. The reflection highlights the importance of incorporating palliative care education in an era where the population is aging at a fast pace with increasing incidence of cancer. Inclusion of palliative care education in the medical curriculum at the undergraduate level may benefit the students to be better care providers in the generations to come.

 > Abstract Id: YUGP0496 Top

Rationale Of Using Dynamic Imaging For Characterization Of Suspicious Lung Masses On Contrast Enhanced Multi Detector Computed Tomography With Their Histopathological Correlation

Presenter- *Dr. Saurav Bhagat

Co-author - Sachin Khanduri, ,

OBJECTIVES:To assess the utility of dynamic imaging viz. wash-in and wash-out characteristics via Multi detector CECT in differentiating benign and malignant pulmonary masses. MATERIALS AND METHODS: 73 patients who were suspected to have malignant pulmonary mass on the basis of clinical symptoms and chest radiograph were included in the study after ethical committe approval. All the patients underwent MDCT scanning and three series of images were obtained for each patient- non-contrast, early enhanced and 15 minutes delayed enhanced scans. CT findings were assessed in terms of wash-in, absolute and relative percentage washout of contrast. Biopsy of the mass was done and sent for histopathological evaluation. Sensitivity, specificity and area under curve for diagnosing malignancy in the lung masses were calculated by considering both the wash-in and washout characteristics at dynamic CT and plotting the Receiver operating curve after the final diagnosis which was obtained by histopathological evaluation. RESULTS: Receiver operating curve analysis was used to calculate the sensitivity, specificity and diagnostic accuracy of wash-in and wash-out(both absolute and relative percentage wash-out) values via dynamic contrast enhanced computed tomography. Threshold net enhancement (wash-in) value of >22.5 HU had sensitivity, specificity and diagnostic accuracy of 88.5% and 57.1% and 82% respectively in predicting malignancy. Threshold relative percentage wash-out of

 > Abstract Id: YUGP0500 Top

Can Locally Advanced Primary Or Recurrent Breast Cacner Be Controlled With Re-Irradition And Thermographically Monitored Wira-Hyperthermia?

Presenter- *Dr. Markus Notter

Co-author - Notter, ,

Introduction: Locally recurrent breast cancer after previous radiotherapy is a challenging clinical situation since initial RT considerably limits the level of re-irradiation (re-RT). Under these conditions, the combination with superficial hyperthermia offers the possibility of achieving local control even with lower RT doses as recently shown by Notter et al. (IHJ, 2016). Methods: We report now of 102 patients with large-area, locally recurrent breast cancer (57 patients with lymphangiosis included), which were treated in this retrospective study from9/2009 to 2/2017 with combined hypo-fractionated, low-dose re-RT (4 Gy 1x/week up to a total dose of 20 Gy), delivered 1-4 min after thermography-controlled water-filtered infrared A hyperthermia (wIRA-HT). 24 patients had tissue transfer, 18 patients presented with microscopic disease. Results: Overall response was: CR: 63/102 (62%), PR: 35/102 (34%), NC: 3/102 (3%), PD: 1/102 (1%). Response rates in patients with macroscopic disease were: CR: 45/84 (54%), PR: 35/84 (42%), NC: 3 /84 (3%), PD: 1/84 (1%). Local control throughout life time after CR: for macroscopic disease (all): 62%, for macroscopic disease with lymphangiosis: 36%, for macroscopic disease wtihout lymphangiosis: 95%, for microscopic disease: 100%. Out of 17 patients with re-recurrences, 30 manifestations were observed: 5 infield (17%), 13 at the border (43%) and 12 outside (40%). In summary local control of heavily pretreated, large-area breast cancer recurrences is maintained in 73% of patients throughout life time. Most of the re-recurrences are observed at the border of or outside former treatment fields. Irradiances up to 150-200 mW/cm2 were applied without generation of heat pain and thus limited patient compliance. Conclusions: The clinical wIRA/HT-setting used offers a series of advantages over other techniques currently used in clinical oncology. These include: contact-free heating (e.g., of ulcerated, bleeding tumors) and treatment of irregularly shaped, widespread lesions. No patchwork technique is required for larger sizes (diameter of treatment field is 23-26 cm per applicator with approx. 7% inhomogeneity of irradiance, circular field area = 420-530 cm2). Adaptation to larger areas can be achieved by a twin-applicator system. wIRA is independent of individual body contours. While thermal dosimetry for HT is generally performed with fiberoptic probes that sample only a small number at set locations, in the system applied real-time thermography is used which assesses large surface temperature distributions allowing for the observation of dynamic developments during HT sessions. Thermography also enables the instant and easily achievable protection of heat-sensitive tissue structures (e.g., scars) and can thus avoid hot spots and grade 2-4 skin toxicities. Because of low toxicity with this treatment schedule, wIRA-RT can be used for re-reRT-settings (e.g., in 17 patients in our study). Limitations for wIRA-HT: tumor lesions with depth extensions >20 mm. Outlook: Based on these experiences wIRA-HT/re-RT is not only an efficient treatment option for recurrent breast cancer, but could be evaluated in locally advanced primary breast cancer, e.g,. cancer en cuirasse, as well as in other superficial cancer entities as e.g., angiosarcoma, malignant melanoma, vulva carcinoma, skin metastasis of different primary tumours. Reference: Notter et al. (2016), Int. J. Hyperthermia DOI: 10.1080/02656736.2016.123573

 > Abstract Id: YUGP0507 Top

Evidence On Role Of Chemotherapy In Head And Neck Osteosarcoma (Hnos): Adjuvant Chemotherapy Improves Overall Survival.

Presenter- *Dr. Sandhya Gokavarapu

Co-author - Yiming Chen, Prof Tong Ji,

Osteosarcoma is an aggressive bone malignancy rarely presenting in head and neck sites, the trials for extremity osteosarcoma show improved survival by chemotherapy. The head and neck osteosarcomas(HNOs) were excluded in these trials because of atypical presentation and disease course. Further, sufficient numbers were not possible for a trial. We present a largest retrospective study from single institute investigating the role of chemotherapy in the management of HNOs. Patients and methods The retrospective cohort of HNOs treated from 2007 to 2015 of a tertiary hospital were charted. The therapeutic and prognostic factors were analyzed for overall survival (OS), disease free survival (DFS), local control (LC) and metastasis (MT) in univariate and multivariate analysis. The minimum and median period of follow up was 12 months and 4.67 years. Results There was a total of 157 patients definitively treated with surgery in the time period. 7 The multivariate cox regression showed significance of tumor site(p=0.034), margin status(p=0.006), chemotherapy(p=0.025), histological subtype(p=0.012) as predictors of overall survival. The margin status(p=0.002), Radiotherapy(p=0.005) were significant predictors for local recurrence. patients had positive margins and all were maxillary or skull base tumors. The age and histology subtype(p=0.058) were borderline significant predictors of metastasis(p=0.065). The KM method for OS of different chemotherapy groups(p=0.013), and survival with and without chemotherapy (p=0.007) was significant. The OS was significantly better with adjuvant chemotherapy among various treatment plans(p=0.034). Conclusion Chemotherapy improves OS of HNOs. a random multi institute trial is needed to achieve better results.

 > Abstract Id: YUGP0521 Top

Surgical Treatment Of Re-Recurrent Dermatofibrosarcomaprotuberans (Dfsp) Of Anterior Chest Wall And Reconstruction Using Pectoralis Major Myocutaneous Flap: A Case Report

Presenter- *Dr. Nikhil Garg

Co-author - dr nikhil garg, ,

Dermatofibrosarcoma protuberans is a rare, soft tissue tumor with high rate of recurrence. It is locally aggressive, with a low rate of metastasis. We describe the case of a 30-year-old female who presented with a re-recurrent, large tumor situated on the anterior chest wall in the sternal region. We did a wide local excision and covered the resulting defect by using pectoralis major myocutaneous flap. Histopathology and immunohistochemical staining findings were consistent with the diagnosis of Dermatofibrosarcoma Protuberance. All the margin were free of tumor. Post operatively the patient was treated with radiotherapy. The patient was disease free at 36-month follow up.

 > Abstract Id: YUGP0523 Top

Role Of Post Mastectomy Radiotherapy In T1,T2 Lesions With 1-3 Positive Axillary Lymph Nodes - A Retrospective Study Of 101 Cases.

Presenter- *Dr. Nikhil Garg

Co-author - Dr. Makarand B Bhole, ,

Title: ROLE OF POST MASTECTOMY RADIOTHERAPY IN T1,T2 LESIONS WITH 1-3 POSITIVE AXILLARY LYMPH NODES - A Retrospective study of 101 Cases. Name : Dr Nikhil Garg Gujarat Cancer and Research Institute , Ahmedabad, India Introduction: Post mastectomy radiotherapy (PMRT) reduces loco-regional recurrence (LRR) and improves overall survival , There is international consensus to recommend PMRT for patients with tumour size more than 5 cm (T3), tumour invasion of the skin, pectoral muscle or chest wall (T4) and patients with > 4 positive lymph nodes (LN) . However, the role of PMRT for patients with T1 , T2 disease with 1—3 positive LN is still controversial. The side effects of radiotherapy and its associated morbidity have to be considered in the risk benefit ratio , thus difficult to arrive at consensus in early breast cancer.In a developing country like India, factors such as patient education, level of awareness, financial aspect, long term follow up, limitation of resources have to be balanced and tailored according to the indication and need of the patient. Objectives 1.Empirically explore whether it is advisable to carry out radiation when there are 1-3 nodes 2..Whether Perinodal extention in this subgroup is an important parameter to consider for radiotherapy. Material and Methods: We collected data after approval from our institutional board review committee and analysed case files of patients who presented and were treated at our governmental tertiary referral centre from a period between 2012-2015.Of the 691 patients who underwent mastectomy, we short listed 101 cases for our study who fulfilled our basic inclusion criteria of T1,2 N1 on final histopathology. The inclusion criteria for this analysis were: (1) Female patients with unilateral breast cancer and no distant metastasis at initial diagnosis who underwent mastectomy and axillary lymph node dissection; (2) postoperative pathology indicated T1—2 and 1—3 positive axillary lymph nodes (T1—2N1M0) disease, at least 10 lymph nodes removed by axillary dissection; (3) complete surgical resection of the tumor and negative margins; (4) complete estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor family 2 (Her2) status; (5) No neoadjuvant chemotherapy was administered before surgery and endocrine therapy was performed based on the hormone receptor status. In order to study the research questions, we formulated hypotheses as follows,1. Radiotherapy does not have any impact on recurrence post mastectomy.2. There is no influence of Peri nodal extention on recurrence. The above hypotheses were tested using chi-square test. Results: On applying chi square test we found out the observed and the expected value Radiotherapy was given in 60 patients and 41 were not given .Recurrences were obtained in 9 amongst radiotherapy and without radiotherapy in 16.When chi square was appliedwith 1 degree of freedom , the value was highly significant at 0.006 with 99% CI.Hence our hypothesis was rejected. Also in case of PNE with recurrence and radiotherapy,8 had PNE with radiotherapy and recurrence and 27 had no recurrence,on computation degree of freedom was 3 and p value was 0.013% hence highly significant. Conclusions:Radiotherapy should be strongly considered in patients with 1-3 nodes post mastectomy as it decreases the chances of recurrence and also if PNE is present chances of recurrence are increased , hence radiotherapy be considered.

 > Abstract Id: YUGP0527 Top

Identification Of Molecular Alterations In Breast Cancer Patients Of Indian Origin Using Next Generation Sequencing: A Case Series Study

Presenter- *Ms. Ankita Sharma

Co-author - Dr. Sangeeta Choudhury, Dr. Rakesh Koul, NA

Women with early onset breast cancers, triple negative breast cancers, bilateral breast cancers or family history have a likelihood of Hereditary Breast & Ovarian Cancer Syndrome (HBOC) majorly having germline mutations in BRCA1 and BRCA2. Individuals with BRCA1 or BRCA2 pathogenic variant have a lifetime risk of developing breast cancer (40%-80%) and ovarian cancer (11%-40%). Thus, our study attempted to assess the genetic/familial high risk group by determining the germline mutations/variants and its frequency in BRCA1, BRCA2 and TP53 genes using Next Generation Sequencing (NGS) technology. 11 Breast cancer patient’s saliva samples, pathologically and clinically confirmed/proven (based on NCCN guidelines) were processed. The coding regions of all transcripts of BRCA-TP53 panel consisted of 21177kb including 217,120-mer probes, targeting 70 regions were subjected to NGS (Illumina-MiSeq platform). Three out of 11 were positive (27.3%) for HBOC Syndrome. 2 amongst 3 were positive for “likely pathogenic†variant in BRCA2 wherein one of the case study (age, 35yrs; pT1NoMo) presented with a heterozygous deletion (c.3226delG) resulting in frameshift and consequently premature termination of p.Val1076Terfs. The second case (age, 35yrs; pT2N2Mo) was found to have heterozygous deletion at c.3846_3847delTGfs (2codon deletion) resulting into frameshift truncating the protein (p.Val1283LysfsTer2) to a length of 1283 amino acid (aa) as opposed to 3418aa. Additionally, a delirious TP53 Gln216Ser mutation resulted in truncated protein of 216aa size (shorter by 168aa). The third case study (age, 44yrs; pT3N1Mo) identified a heterozygous duplication in BRCA1 (c.2214dupT) leading to a mutational termination of lysine at 739codon (378aa truncated protein Vs 1863aa). Interestingly, this patient had a family history of breast and larynx cancer. Considering the majority of breast cancers are sporadic in Indian population; the present study justifies the need to evaluate on basis of genetic screening of BRCA1, BRCA2 and additional screening of TP53 which may enhance prognostic value. For the first time, a novel variant (likely pathogenic/ likely disease causing) was identified that had neither been previously reported in literature nor identified in Indian population. Acknowledgement: Dr Jyoti Bajpai Dikshit, Dr. Jaya Singh, Dr Parul Manek from Strand Life Sciences, Bangaluru.

 > Abstract Id: YUGP0529 Top

Title: Identification Of Vulnerable Groups And Methods Of Nutritional Intervention In Radiotherapy By Simple Measure Of Weight Change

Presenter- *Dr. Hemant Sant

Co-author - Dr Hemant Anant Sant, Dr Rahul Misra DNB MD,

Title: Identification of vulnerable groups and methods of Nutritional intervention in Radiotherapy by simple measure of weight change Sant H.S ,Misra R.(1) Consultant ,Preventive Oncology HCG Cancer Center Vadodara, (1)Consultant Oncologist-Radiotherapy HCG Cancer Center Vadodara India 390012 Abstract BACKGROUND : Radiotherapy is used as weapon to treat cancers before during and after Chemotherapy and Surgery.Most patients who take modern Radiotherapy Treatment have fewer side effects now.Most get all the side effects that prevents Oral feeding and Normal appetite-Mucositis Ulcers Nausea and Weight Loss.The aim of present study was to simply find and use ‘Net weight change’ after completion of Radiotherapy as gross Indicator of proper Nutritional Support. METHODS:All 65 patients who walked in with any cancer any location any stage were initially included in the study(1 Sept-Nov30 2016).Later 22 were excluded as they did not complete minimum 15 days treatment (15)or were advanced cancers lost to followup (7).Weights were taken serially from day 1 till treatment (upto12 weeks) ended.Individualized Nutritional support was given by Nutritionists and support staff guided and monitored by us. RESULTS: 28/50 patients had weight loss.12/50 had history of Chemotherapy.20/50 were Oral &Head-Neck Cancers.All Head & Neck patients lost weight during Radiotherapy while weight gain group were from Non Head & Neck cancers and 3DRT groups.We could identify which groups were vulnerable to weight loss and when and how should we intervene to minimize weight loss by timely Individualized Nutritional support in this small batch. CONCLUSION: We found that simple net indicator of Nutritional support and its effect on a patient during Radiotherapy was weight loss prevention or a gain.Lesser the side effects,Lesser was weight loss and better the quality of life and vice versa.We have marked groups which are more vulnerable and need more aggressive Nutritional therapy to add a tangible benefit in quality of life.It also encouraged Patients to complete the entire treatment and may be translate into better outcomes.Hence a larger study is needed to ponder upon the role of timely Nutritional intervention in Radiotherapy. KEY WORDS: Cancer,radiotherapy,weight loss Date 18th April 2017 .@Mobile 9825038201 E Mail: drhemantsant61@gmail.com

 > Abstract Id: YUGP0558 Top

Impact Of Histological Subtypes On Treatment Outcomes In Post Nactrt Locally Advanced Rectal Adenocarcinoma.

Presenter- *Dr. RAJESH SHINDE

Co-author - Devayani Niyogi, Dr Avanish Saklani, Rahul Bhamre

Aims: Treatment Outcomes of locally advanced rectal cancer differ in different histologic types. But there is lack of robust evidence to support this assumption. In the era of NACTRT as a standard of care, we intended to look for the impact of different histologic subtypes on treatment outcomes of locally advanced rectal cancer patients. Methods: Our study is a prospective analysis of a retrospectively maintained rectal cancer database from 1st January 2013 to 31st December 2014. 205 consecutive patients of locally advanced rectal cancer patients, who had received Long course NACTRT, were grouped into 3 groups (Grp A-Signet, Grp B-Mucinous, Grp C-Non signet-non mucinous). All the 3 groups were analyzed with respect to demographic characteristics, Post NACTRT response, Margin status, recurrence pattern, DFS & OS. Results: Total no of pts included in this study was 205. Grp A included 31; Grp B-35 & Grp C included 139 pts (15.1%, 17.1% & 67.8% respectively). Overall complete response rate in entire cohort was 18.5%. Amongst the different groups, CR rates were 22.6%, 28.6% & 15.1% in Grp A, B & C respectively. Disease progression during NACTRT was seen in 22.6%, 2.9% & 6.4% in Grp A, B & C respectively. Additional systemic therapy (NACTRT f/b NACT) was required in Grp A-35.5%, Grp B- 20 % & Grp C- 17.2% patients. Recurrence rates were 19.35%, 28.5% & 23.7% in Grp A, B & C respectively. DFS was 21.7 mths in Grp A, 29.7 mths in Grp B & 34.5 mths in Grp C respectively (p-0.001). There was no significant difference in DFS between Grp B & Grp C. But there is Significant difference when Grp A is compared to Grp B /C separately. Similarly there was no significant difference in OS between Grp B & Grp C. But there is Significant difference when Grp A is compared to Grp B /C separately (Grp A- 25.4, Grp B- 37.6 & Grp C- 39.7 mths respectively, p-0.00). Conclusions: Outcomes with signet ring histology are poorer as compared to mucinous/ non signet-non-mucinous adenocarcinoma. Although post NACTRT, CR rates are higher in Signet histology, this does not translate into survival benefit of these patients. Also signet ring histology cohort requires additional systemic therapy more often than the other histological subtypes. This may suggest a need of additional/ alternative treatment options (e.g. SCRT f/b NACT) for these patients.

 > Abstract Id: YUGP0560 Top

Does Histological Subtype Affects The Long-Term Outcomes In Patients With Complete Pathological Response To Nactrt In Locally Advanced Ca Rectum? €” A Retrospective Analysis.

Presenter- *Dr. RAJESH SHINDE

Co-author - Rahul Bhamre, Devayani Niyogi, Dr Avanish Saklani

Abstract: Complete pathological response (pCR) is a independent prognostic factor of favorable outcomes in locally advanced rectal cancers treated with neoadjuvant chemoradiotherapy (NACTRT). Various studies have reported pCR rates of approximately 15—25%. Various predictive factors of pCR are described & these include tumor size, histological subtype, clinical stage at presentation, absence of circumferential involvement, different neoadjuvant regimens and interval between NACTRT and surgery. We intended to asses the impact of histological subtype on long-term outcomes in patients with pCR. Methods: 73 consecutive patients of locally advanced rectal cancer, who had complete pathological response after long course NACTRT during 2013 to 2015 were included in the analysis. Study population was grouped into 3 histological groups (Signet, Mucinous & Non signet-non mucinous). These 3 groups were compared with respect to recurrence rate, recurrence pattern, DFS & OS. Results: Study cohort was divided into 3 groups-signet (16.4%), mucinous (24.6%) & non signet-non-mucinous adenocarcinoma (59%). Median age was 43 yrs & mean pre-treatment CEA level was 9.1 ng/ml. With median follow up time was 35 months, 3 yr overall survival (OS) & disease free survival (DFS) was found to be 92.5% &75.3% respectively. There was no difference in DFS/OS amongst the 3 groups. Conclusion: Histological subtype doesn’t appear to affect the long-term outcomes in patients with pathological complete response to NACTRT.

 > Abstract Id: YUGP0591 Top

Urinary Toxicity In High Risk Prostate Cancer Patients Treated With Whole Pelvis Intensity Modulated Radiotherapy (Wp-Imrt) With Cone Beam Ct (Cbct) For Image Guidance

Presenter- *Dr. Simon Pavamani

Co-author - Ms. Aruna Muthukumar, Dr. Deepa Madathil, Dr.Antonisamy

Aim: In India, the incidence of prostate cancer is low and patients are usually diagnosed in an advanced stage of the disease. Patients with localized high risk prostate cancer usually undergo androgen deprivation therapy (ADT) and whole pelvic radiation. This study aimed to assess the impact of radiation on urinary toxicity in Indian men with prostate cancer undergoing WP-IMRT utilizing CBCT image guidance. Materials and methods: In 2010, our centre acquired a linear accelerator with CBCT. The cohort consisted of 44 patients with localized high risk prostate cancer, treated with ADT and WP-IMRT between 2010 and 2016. WP-IMRT (4680 cGy) was followed by an IMRT boost (2520 to 3200cGy) or moderate Hypofractionation (6625 cGy) based on the tolerance of organs at risk. Image guidance was done by daily CBCT prior to radiation. Urinary symptoms of the patients were assessed by recording the International Prostate Symptom Score (IPSS) prior to starting radiation (baseline) and during each follow up. The initial scores were analyzed and compared with the scores on follow up. The IPSS scores were categorized into three groups namely mild (0-7), moderate (8-19) and severe (>19). Results: The median follow up was 18.5 months (range 4-66 months) and median total RT dose was 7560cGy (range 6625-7880cGy). Initially, the Pre-treatment IPSS score of 40.9% of the patients was mild, 47.7% of the patients was moderate and 11.4% of the patients was severe. But after 24 months, the IPSS score of 64.3% of the patients was mild, 35.7% of patients was moderate and none were severe. Conclusion: Patients undergoing WP-IMRT experience urinary toxicity. However, this resolves within within 6 to 24 months and majority of patients do not experience any significant long term urinary toxicity. This indicates that radiation dose escalation with WP-IMRT is well tolerated by high risk prostate cancer patients.

 > Abstract Id: YUGP0637 Top

Study Design And Early Result Of Phase I Study To Evaluate Feasibility Of Stereotactic Ablative Radiotherapy For Early Stage Glottic Cancer

Presenter- *Dr. Chan Woo Wee

Co-author - Tosol Yu, Noorie Choi, Hong-Gyun Wu

Background: Reducing overall treatment time in radiotherapy (RT) for early glottic cancer has advantages of improved patient convenience and local control. Recently, avoidance of organs at risk has become possible with advances in high-precision image-guided and volumetric-modulated arc therapy (VMAT) techniques. The purpose of this study was to evaluate the feasibility of stereotactic ablative RT for early glottic cancer. This report is a preliminary result analyzing participants of the first dose level. Methods/Design: Eligible patients were provided with informed consent received hypofrationated RT to the larynx with a simultaneous integrated boost to the gross tumor. The fraction size was to be increased stepwisely from 3.5 Gy (total dose 59.4Gy) to 9 Gy (total dose 45Gy). The protocol-specified dose-limiting toxicities were defined as grade 3 or higher toxicities. The voice outcome and quality of life (QoL) was assessed with electroglottography (EGG) and Head and Neck Cancer Inventory (HNCI), respectively, at post-RT 1 month and 6 months. Results: Seven patients received 59.5 Gy with 3.5-Gy per fraction as the first dose level. None of the patients developed grade 2 or higher toxicity throughout a median follow-up of 16.8 months. All 7 patients were disease-free at both locoregional and distant sites. Both 6-month and 1-year local control rates were 100%. Voice assessment by EGG didn’t change significantly at 6 months after RT compared to those at pre-treatment. The overall HNCI score difference between pre-treatment and post-treatment was not significant (p = 0.69). Conclusion: This study showed acceptable toxicity, good voice outcome and QoL in patients treated with hypofractionated VMAT of 3.5-Gy per fraction for early glottic cancer. This phase I study is currently ongoing with 55 Gy in 11 fractions and will be followed by 45 Gy in 5 fractions.

 > Abstract Id: YUGP0643 Top

Studies On Hereditary Colorectal Cancers: Experience From A Rural Cancer Center- Kalish Cancer Hospital & Research Center In Western India

Presenter- *Dr. Rakshit Shah

Co-author - Yogesh Mistry, Jisha elias, Coral Karunakaran

Background: Colorectal cancer (CRC) is the fourth most common cancer in men and third most common cancer in women worldwide, with higher incidence reported in western countries. Over the last decade a remarkable 2-4 fold increase in CRC incidence has been observed in Asian countries like India. Lower prevalence of sporadic CRC cases in India have been linked to lifestyle, with an emphasis on a vegetarian diet. However, the incidence of hereditary CRCs in India have not been well documented. In the west hereditary CRCs i.e. Familial adenomatous polyposis (FAP) and Lynch syndrome or the Hereditary Nonpolyposis Colon Cancer (HNPCC) are common and account for 1% and 2-5% of the CRCs reported, respectively. We report a similar trend at a rural cancer center in western India (KCHRC, Goraj, Gujarat), where 70-75 CRC patients are seen annually. Methods: We have identified three families, one diagnosed with FAP and two with HNPCC. In order to identify the underlying germline mutation in each family, we sequenced the genomes of 3 families, one with FAP and two with reported HNPCC. Results: In The FAP family, we identified a novel heterozygous mutation in the APC (pSerPhefster6) gene in 3 affected members, all aged above 45 years. The mutation was also found in younger unaffected members of this family who have been appropriately counselled. Both HNPCC families had unique mutations in the MLH1 gene, a frequently mutated gene in HNPCC with a role in DNA mismatch repair. Conclusions: Thus far we have identified mutations in genes frequently reported in the west in both FAP and HNPCC. In FAP the region of mutation is APC but the mutation is unique. Further larger number of patients require to evaluate and compare to western countries.

 > Abstract Id: YUGP0653 Top

Comparison Of 3Dcrt,F-Imrt And I-Imrt In Early Breast Carcinoma

Presenter- *Dr. Sasikala Prabaharan

Co-author - dr kumaraswamy, dr sanjiv sharma, SRIRAM

Comparison of 3DCRT,FORWARD- IMRT,INVERSE-IMRT in whole breast irradiation ABSTRACT Objective To analyse the advantage of F-IMRT compared to 3DCRT and I-IMRT in whole breast irradiation. Materials/methods 30 patients CT simulation scans were taken and all the three plans were generated for each patient in prowess panther TPS with 50Gy/25# to the whole breast. For 3DCRT 2 opposing tangential wedge field, for F-IMRT 2 opposing tangential fields without wedge but with multiple beamlets manually created and for I-IMRT multiple ipsilateral tangential fields were used. In all the plans 95% PTV was receiving 100% of the dose.V110%,V105%,conformity and homogeneity index, monitor units, heart, lung and opposite breast dose were analysed by D Mann Whitney U test Results The mean Monitor units for 3DCRT,F-IMRT and I-IMRT is 384mu,263mu,298 mu respectively in which F-IMRT is better than I-IMRT and 3DCRT (p < 0.001).The mean homogeneity index for 3DCRT, F-IMRT and I-IMRT is 0.19, 0.15, 0.22 respectively in which F-IMRT is better than I-IMRT (p < 0.026) and3DCRT (P < 0.0001).The mean D5 heart dose with 3DCRT,F-IMRT and I-IMRT is 2605cGy, 2070cGy, 2419cGy respectively in which F-IMRT is better than I-IMRT (P=0.231) and 3DCRT (P=0.329). Mean V20 ipsilateral lung dose for 3DCRT,F-IMRT and I-IMRT is 21%,20.6%,22.7% respectively in which F-IMRT is better than I-IMRT P=0.102 and 3DCRT (P=.525). Mean opposite breast dose for 3DCRT,F-IMRT and I-IMRT is 87cGy 93cGy, 155cGy respectively in which 3DCRT is better than F-IMRT( P=0.600) and I-IMRT P< 0.001) Conclusion Forward IMRT provided significantly less monitor units, better homogeneity index, less cardiac, and lung dose as compared to 3DCRT and Inverse IMRT for the same tumor coverage.However clinical implication of Forward IMRT and long term follow up for breast cosmesis and normal tissue toxicity are required to substantiate the current study. Key words-3DCRT,F-IMRT,I-IMRT,Breast carcinoma

 > Abstract Id: YUGP0655 Top

The Plasma Cell-Free Nuclear Dna Concentration Is An Indicative Marker For Breast Cancer Progression: Epidemiologic Evidence Of Dietary Flaxseed Factors Protection Against Her-2-Positive Breast Cancer.

Presenter- *Ms. Vanita Shrikant Bhat

Co-author - Vanita Shrikant Bhat, Dr Basavaraj Madhusudhan,

Earlier studies investigating the relation of dietary flaxseed consumption to prevent breast cancer have produced conflicting results. We hypothesized that dietary flaxseed factors associated with breast cancer risk might differentially influence the HER-2 status of the breast cancer. It is evident from screening study that the increased levels of plasma cell-free nuclear DNA concentration of cancer patients has frequently shown HER-2 as indicative marker for breast cancer progression. The possibility of using plasma DNA level as the indicator of tumor stage in breast cancer was investigated in plasma samples obtained from 100 breast cancer patients and 100 healthy women who were included as controls. Four dietary patterns had been identified previously by dietary flaxseed factors analysis: (1) high consumption of cooked vegetables and regular cereals with flaxseed, (2). high consumption of cooked vegetables and regular cereals without flaxseed, (3). prudent consumption of cooked vegetables, poultry, fish, meat, eggs, with flaxseed, and (4). prudent consumption of cooked vegetables, poultry, fish, meat, eggs, without flaxseed. In the study, relative risks (RRs) of developing HER-2-positive and HER-2-negative breast cancers by consumption dietary flaxseed factor scores were assessed by multinomial logistic regression. Circulatory plasma free DNA was extracted from plasma samples and quantified by fluorimeter and Nano drop. The median concentration of plasma DNA in the plasma samples from breast cancer patients classified by TNM staging system as stage I, II, III, IV and breast surgical patients were showed increasing trend as 1.0, 323, 531, 1,344 and 1.0 ng/ml , respectively for the occurrence of breast cancer and which was measured using Nano-drop. The level of plasma DNA in the stage II- IV group was significantly higher in breast cancer patients than those in the surgical group with breast cancer and control group (P value \ 0.001). The plasma DNA concentration in stage II, III and IV of breast cancer were significantly higher in breast cancer patients in comparison with healthy women group. The tumor size, TNM stage and metastasis were significantly correlated with plasma DNA breast cancer patients in comparison with healthy women group. From results, high consumption of cooked vegetables and regular cereals with flaxseed dietary pattern had a protective effect against HER-2-positive cancers for the highest tertile and much stronger than for HER-2-negative breast cancer. This important finding that the cooked vegetables and regular cereals with flaxseed dietary pattern protects mainly against a specific breast cancer subtype indicates that future studies on flaxseed dietary risk factors such as polyphenolics should explicitly take account of the heterogeneity of breast cancer phenotypes. Multinomial logistic regression analysis was used to develop statistical model and to obtain estimates of the relative risk of breast cancer and relative risk of death according to the plasma DNA concentration. A cut-off point of anything between 80 and120 ng/ml with increasing the number of biopsies results in the increased detection of localized breast cancer that warranted the early screening and treatment follow up breast cancer will be discussed. Key words: breast cancer; plasma DNA; flaxseed, dietary pattern; HER-2; Cut point Screening

 > Abstract Id: YUGP0661 Top

The Possible Role Of Diabetes In The Etiology Of Laryngeal Cancer

Presenter- *Prof. Roberto Menicagli

Co-author - bolla gianni, menicagli laura, esseridou anastassia

Background: Laryngeal cancer and oral cancer are not always correlated with genetic mutations, HPV infection, smoking, and alcohol abuse. In the absence of these risk factors, there is an increase on these cancers with a parallel increase of diabetes. The aim of this study is to verify if diabetes could be a risk factor for the laryngeal cancer. Methods: A questionnaire was given to a group of ninety laryngectomees to verify if these patients have presented diabetes and xerostomia before surgery. In two groups, diabetics and healthy persons, the values of the salivary mucins and the pH were evaluated. The results were statistically analysed using Fisher Exact Test and Chi square Test Results: Diabetes is a risk factor: p= 0.0445 for laryngectomees male vs control group. Xerostomia in laryngectomees male is a risk factor: p= 0.050. The values of mucins and pH in diabetic group show significant difference: p=0.05 vs control group Discussion: In all autoimmune diseases, a decrease in the value of pH and salivary flow consequently decreases the value of spinnbarkeit which measures the capacity of the mucous layer to adhere to the epithelium and alter the protective oral mucin layer. We find that diabetes is epidemiologically correlated with laryngeal cancer. In fact, only diabetes increases the concentration of salivary mucins with a formation of mucin layer even more reduced, and so completely ineffective in protecting the mucosa. Conclusions: The increase of mucin secretion in diabetes alters much the protective layer allowing the risk factors to promote cancer growth.

 > Abstract Id: YUGP0671 Top

Safety, Efficacy, And Survival Rate Comparison Of Apcedenâ® Dendritic Cell Immunotherapy With Best Supportive Care In Patients With Refractory Solid Malignancies

Presenter- *Mr. Chaitanya Kumar

Co-author - , ,

Background.APCEDEN® is an autologous (self) monocyte derived Dendritic Cell immunotherapy which activates the immune system against cancerous cells in the body. DC Immunotherapy(APCEDEN®) is safe and can induce antitumor immunity even in patients with advanced disease as evident from the trial reports. A retrospective survival benefit analysis of APCEDEN for management of refractory solid malignancies, was performed in comparison with appropriate control group subjects on the advice of Indian Council of Medical Research (ICMR) and Central Drug Standard Control Organisation (CDSCO). Methods.Subjects (Retrospective data) selected for the analysis matched with the treatment group on parameters like survival data, geographical region, age, gender, ECOG performance status, and stage of the disease.APCEDEN®treatment survival data were adapted from the study by Bapsyet al. Survival benefit was assessed using Kaplan Meier analysis for survival rate, median survival days, and hazard ratio estimation. The APCEDEN®treatment group was divided into two cohorts based on the first evaluation response of the subjects. Results. The investigation suggests a substantial survival benefit of 199 days for the APCEDEN®administered groupover the control population (356 days versus 157 days). The event free survival time of APCEDEN®therapy was 439 days in patients who demonstrated an objective response at first evaluation as per the immune related Response Criteria (irRC). The hazard ratio of APCEDEN®treatment was estimated to be 0.35. Conclusions.APCEDEN®demonstrated highly conclusive survival benefits in comparison to analogous control group patients with advanced solid malignancies receiving no active systemic treatment. Furthermore, the safety and efficacy profile of APCEDEN®therapy was favourable, validating earlier published data.

 > Abstract Id: YUGP0673 Top

Nanomedicines Mediated Targeting Of Cancer Stem Cells

Presenter- *Ms. Deepika Singh

Co-author - , ,

Nanomedicines mediated targeting of Cancer Stem Cells Deepika Singh* and Sanjeeb Kumar Sahoo Institute of Life Sciences, Bhubaneswar, India (deepika89singh@yahoo.com) Various studies have delineated subpopulations of cells within tumors that differ in terms of their self-renewal capacity, long-term proliferation potential, capacity to seed new tumors when implanted in an appropriate host, and cancer recurrence potential; such cells are known as Cancer Stem Cells (CSCs). With advances in new technologies, several features of CSCs have been revealed, including their recurrence, metastasis, multidrug resistance, dormancy, and survival under hypoxic conditions. As a result of their tumor-initiating ability and resistance to conventional chemotherapy and radiotherapy, CSCs have emerged as targets for cancer therapy in recent years. Conventional treatment with chemotherapy and radiotherapy can kill bulk tumor cells but fail to result in long-lasting clinical outcomes, because they are ineffective against CSCs. Thus, following conventional treatment, the presence of CSCs leads to tumor relapse. Studies have revealed that CSCs display plasticity via their reversible transition between the stem and non-stem cell states. Therefore, depletion of CSCs alone might not be sufficient for complete tumor regression because it is likely that the differentiated tumor cells are capable of becoming CSCs and, thus, sustaining tumor growth. Hence, approaches targeting both CSCs and non-CSCs are crucial. It is found that the Epithelial-to-Mesenchymal Transition (EMT) and Mesenchymal-to-Epithelial Transition (MET) are crucial events for CSCs metastasis. EMT is a phenomenon whereby epithelial cells acquire fibroblast-like properties, lose their cell—cell adhesion, and increase their motility, facilitating the escape of tumor cells from primary tumors. Thus, the EMT is relevant to the maintenance and acquisition of stem cell-like characteristics and is sufficient to endow stem cell properties to differentiated normal and cancer cells. At the site of metastasis, the disseminated mesenchymal tumor cells undergo the reverse transition, the MET. This link between EMT, MET, and CSCs presents attractive opportunities for drug development via agents targeting specifically more mesenchymal carcinoma cells, rather than their epithelial counterparts, to eliminate CSCs. In recent years, the nanotechnology-based delivery of different therapeutics (i.e., nanomedicines) has shown potential for the treatment of CSCs by overcoming some of the limitations of the conventional therapeutics, such as poor water solubility, poor pharmacokinetics, and non-specific toxicity; these improvements enhance the penetration of the drugs into the CSC niche, leading to reduced chances of tumor relapse. Over the past few years, researchers have focused on designing nanoformulation that carries dual drugs (one specific against CSCs and the other one against bulk tumor cells) for delivery to the target site via active or passive targeting. Here, we highlight the use of nanomedicine-mediated dual drug delivery to target CSCs and bulk cancer cells simultaneously where one drug is specific for inducing forced differentiation and another conventional drug for targeting bulk tumor cells.

 > Abstract Id: YUGP0690 Top

Omission Of Postoperative Radiotherapy Following Breast Conserving Surgery For Ductal Carcinoma In Situ Of The Breast: A Multicenter, Retrospective Study In Korea (Krog 16-02)

Presenter- *Prof. Kyung Hwan Shin

Co-author - Kyubo Kim, So-Youn Jung, Won Park

Background: To evaluate the loco-regional recurrence (LRR) rate after breast conserving surgery without postoperative radiotherapy (RT) for ductal carcinoma in situ (DCIS) of the breast. Materials and Methods: Between 2000 and 2010, 311 DCIS patients from 9 institutions were analyzed retrospectively. The median age was 47 (range, 20-82). The median tumor size was 7mm (range, 0.01-76). Margin width was 50 yrs and any margin width status (n=64), (2) 1.2% in age ?50 yrs and margin width ?1cm (n=93), (3) 13.1% in age ?50 yrs and margin width <1cm.

 > Abstract Id: YUGP0694 Top

Complications And Outcomes Of Groin Dissections Using Modified Skin Bridge Technique: Experience From A Tertiary Care Cancer Centre In North India

Presenter- *Dr. Ashish Jakhetiya

Co-author - Ashutosh Mishra, Pankaj Kumar Garg, MD Ray

Introduction Historically groin dissections are associated with high morbidity and various modifications have been described in the literature with contradictory outcomes. Here we report initial long-term outcomes of 105 groin dissections performed by modified skin bridge technique. Methods A retrospective analysis of the computerized cancer database was performed to retrieve details of all the cancer patients who had undergone groin dissections during January 2012 to September 2016. Data pertaining to clinical profile including demographics, clinical and histopathological details, treatment profile, procedure related morbidity and relapse patterns were extracted and analyzed Results A total of 75 patients included in the present study with 105 groin dissections. Mean age was 49.62 (SD 13.72) years with male: female ratio of 53:22. Out of 105, only inguinal dissection (ILND) was performed in 43 and total 62 ilio-inguinal dissections (IILND) were performed. In 19 (25%) patients underwent prophylactic groin dissection and in 56 (75%) therapeutic elective groin dissection was performed. Mean duration of surgery was 101 (SD 31.70) minutes. Mean duration of hospital stay after surgery was 5.72 (SD 2.96) days. The most common diagnosis was carcinoma penis (25%) followed by malignant melanoma (14.6%) and squamous cell carcinoma (13.33%) of lower extremities. Overall most common complications were seroma (14.28%) and skin edge necrosis (7.61%) followed by surgical site infection (4.76%). After a median follow-up of 7.7 months (IQR 0.5- 49.5), a total of 17 patients (22.67%) developed recurrence. Most common site of recurrence was systemic 13 (17.34%) patients and isolated regional recurrence was observed in only 3 (4%) patients. Conclusion Groin dissection still remains an important diagnostic as well as therapeutic procedure justifying its potential of morbidity. Modified skin bridge technique is very effective method to minimize all postoperative complications with optimal oncological outcomes.

 > Abstract Id: YUGP0696 Top

Barriers In Enrolment In Lung Cancer Study

Presenter- *Dr. SUCHETA MORE


Objective - To find out the barriers in enrolment for clinical trial. Introduction- The success of a clinical trial is the recruitment and retention of a study population of an adequate sample size. In all clinical trials, the process starts with a screening period. The screening period starts with the signing of the informed consent. During the screening period, inclusion/exclusion criteria for the study participation is checked. Subjects who meet all inclusion criteria and exclusion criterion are eligible to be randomized . Significant proportion of patient do not participate in clinical trial in spite of meeting exclusion and inclusion criteria. It is important to find out the reasons for not participating in clinical trials. This will help in developing strategies to overcome it. Materials & Methods- We retrospectively analyzed a prospectively maintained database during 2015. We have entered the reason for not participating for a specific study of targeted therapy in lung cancer. We have done descriptive analysis of data. Results- Information concerning 92 patients with EGFR mutation positive in non small cell lung cancer who were treatment naive and ECOG 0-2 were included in this analysis. In the year 2015 out of 92 patients, 61 patient were randomized (66%) with met protocol eligibility criteria for a particular study and agreed to participate in clinical trial .So, 31 (33%) patient were screen failure. The reason for screen failure were16 of 31 patients were ECOG 3 (17%); 9 of 31patient were already started treatment (9%) in the OPD because they did not want to wait for the report; 5 of 31patient did not want to participate as they preferred oral targeted therapy(5%).1 of 31 had financially constraint(1%) Conclusion- Barriers to cancer clinical trial accrual can be prospectively identified. This will help us in addressing these barriers for futures studies.

 > Abstract Id: YUGP0706 Top

To Compare And Determine The Diagnostic Accuracy Of Fdg Pet Scan In Predicting Pathological Response In Operated Carcinoma Esophagus Patients After Initial Neoadjuvant Chemoradiation And Neoadjuvant Chemotherapy

Presenter- *Dr. Neelam Sharma

Co-author - Abhishek Purkyastha, Dr S Vishwanath, Dr Pradeep Jaiswal

Purpose: The objective of this study was to determine whether [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan could predict the pathological response in esophageal carcinoma after surgery in patients receiving neoadjuvant chemoradiation (NACCRT) and neoadjuvant chemotherapy (NACT). Methods This randomized prospective study has been carried out in 30 consecutive patients; 15 in each arm including both males and females of carcinoma esophagus middle and lower 1/3rdof both histologically proven squamous and adenocarcinoma from March 2014 to October 2016 at Department of Radiation Oncology of our institute after obtaining a written informed consent from the patients. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The sample size was calculated keeping in view at the most 5% risk, with minimum 80% power and 5% significance level (significant at 95% confidence level).However, consideration of the past data, which gives idea of variation in the variables, played an important role in calculating the sample size.The sample size estimation was done by calculating intake of locally advanced esophageal cancer, satisfying all inclusion criteria at our center from previous year’s hospital records. Eligibility Criteria: For the patients included in the study, the length and width of the tumor was not exceeded 8 cm and 5 cm, respectively. Only patients with tumors of clinical stage T1N1 or T2-3N0-1 with no clinical evidence of metastatic spread (M0), according to the International Union against Cancer (UICC) tumor—node—metastasis (TNM) classification, were enrolled. Eligible patients were 18 to 75 years of age, had a World Health Organization (WHO) performance status score of 2 or lower (on a scale of 0 to 5, with 0 indicating fully active, 1 unable to carry out heavy physical work, and 2 up and about more than half the day but unable to work), and had lost 10% or less of body weight. Patients also had to have adequate hematologic, renal, hepatic, and pulmonary function, as well as no history of other cancer or previous radiotherapy or chemotherapy. Randomization and treatment: Patients were randomized into two groups using a piece of paper method. The terms NACCRT NACT were written separately on each piece of paper and patients were asked to pick up a random piece of paper at the registration counter in the presence of a blind observer. Patients were assigned to a particular group according to the respective piece of paper picked up by them. In both the groups patients were evaluated with [18F] FDG-PET CT scan in addition to upper gastrointestinal endoscopy (UGIE) and biopsy. After initial work up patients in NACCRT arm received five cycles of weekly chemo-radiotherapy intravenous inj carboplatin targeted at an area under the curve of 2 mg/ml/min (AUC 2) and inj paclitaxel 50 mg/m2 of body-surface area (BSA) for 23 days with concurrent radiotherapy 41â€Â¢4 Gy, given in 23 fractions of 1â€Â¢8 Gy on 5 days per week followed by surgery. In NACT arm, the patients received two cycles of 3 weekly chemotherapy with inj paclitaxel 175 mg/m2 and inj carboplatin targeted at an area under the curve of 5 mg/ml/min (AUC 5). Post neoadjuvant therapy evaluation: In both the groups a repeat work up involving UGIE and FDG PET-CT was performed to assess the response to NAT after 5 weeks of NACCRT and NACT before patients were taken up for surgery. Whole body FDG PET-CT scan spanning base of skull to mid-thigh was done 45 minutes after intravenous injection of 370 MBq (Millibequerel) of 18-Fluoro-deoxy Glucose (18-FDG) using a whole body full ring dedicated LSO PET-CT scanner. Computed tomography images were obtained using 130 KV and 90mAs (mean) without administration of IV or Oral contrast. Standardized uptake values (SUV) were determined with a small fixed-dimension region of interest (ROI), 8 mm in diameter; and the value was determined using the highest activity inside this area. SUV values were calculated after correction of radioactive decay according to the following formula: SUV = ROI activity (MBq/ml)/injected dose (MBq/body weight g). ROIs were drawn at every level where tumor tissue was detectable, and maximal SUV was the highest detectable value inside the tumor. SUV of the primary tumor was determined at baseline and after therapy. Maximal SUV of the pretreatment scan was labeled as SUV1, and the post-treatment scan SUV2. Change percentage (SUV?%) was expressed as [(SUV1-SUV2)/SUV1]x100. Surgery and histological analysis: Patients in both NACCRT and NACT arms underwent surgery preferably within 5-6 weeks of neoadjuvant treatment. A video assisted thoracoscopicsurgical (VATS) esophagectomy approach was adopted for tumors involving middle and lower 1/3rd. For tumors involving the lower 1/3 rd where VATS was not possible a transhiatal resection was performed.As per histology the specimens were separated into two groups as per Mandard classification with or without regressive changes, while the regressive changes included the stromal changes and cytological alterations.[11] Basing on these changes the tumor regression was classified into five histological TRGs,based on vital tumor tissue at the ratio of fibrosis: TRG 1 was defined as complete regression fibrosis without detectable tissue of tumor; TRG 2 as fibrosis with scattered tumor cells; TRG 3 was fibrosis and tumor cells with preponderance of fibrosis; TRG 4 was fibrosis and tumor cells with preponderance of tumor cells; TRG 5 was tissue of tumor without changes of regression.Patient with TRG 1-2 were considered responders while 3-5 were considered non responders. Statistical analysis All analysis was performed with SPSS version 17.0. All quantitative data were expressed as medians (ranges).The diagnostic accuracy of [18F]-FDG-PET-CT was calculated by the Receiver operating characteristics curve (ROC) test. The area under the ROC curve (AUC) provides a measure for the accuracy of a diagnostic test. It ranges from 0.5 to 1.0.The optimum cut off value for differentiation of responding and non-responding tumors was defined by the point of ROC curve with minimum distance from the 0% false positive rate and 100% true positive rate. The correlation between the SUV% and TRG was compared between NACCRT and NACT group using a paired T-test. Results The median age was 58 years, there was a male preponderance. 27/30 (90%) patients had Squamous histopathology with involvement of middle 1/3rd of esophagus. Most patients had stage III disease. Change in SUV values post neoadjuvant treatment in responders and nonresponders: In 33.3% responders in NACCRT group the SUV fell from 12.58±1.68 to 2.36±0.52 respectively (P value < 0.0001).In 20% responders in NACT group SUV fell from 9.7±0.85 to 2.0±0.43 respectively (P value < 0.001) .Though there was a statistically significant reduction in SUV value in both the groups after neoadjuvant treatment but a comparison between the NACCRT and NACT arm lead to a mean SUV value of 57.80 ±22.40 and 45.92±19.23 with a nonsignificant P value of 0.13. This leads to a conclusion that both the treatments result in a significant metabolic response however one does not outperforms the other in a statistically significant manner. TRG 1-2 versus TRG 3-5in NACCRT and NACT group: In NACCRT group of the 15 patients 7(46.6%) had achieved a complete or near complete response (TRG 1-2) while 8 of 15 patients (53.4%) had less or no response (TRG 3-5). While in NACT group 6 out of 15 (40%) patients had TRG 1-2 while 9/15 (60%) patients had TRG 3-5. In NACCRT group TRG had a mean value of 2.53±1.25 while in NACT group TRG had a mean value of 2.93±1.28 with a non significant P value of 0.393.This lead to a conclusion that there is no statistically significant difference between the NACCRT and NACT groups as far as TRG grade is concerned. Correlation between SUV% reduction and TRG: In our study we found a significant correlation between the [%?SUV max] reduction and TRG after analyzing the data of all 30 patients in both NACCRT and NACT group with a significance value of 0.002 where correlation is significant at a value of 0.01 level ( 2-tailed) ROC Curve Analysis: ROC curve analysis for an AUC of 0.693 (Figure-7) and sensitivity and specificity of 18FFDG PET scan of 80% and 46.7% respectively. Conclusion In our study we found that though there was a statistically significant reduction in SUV value in both the groups after NAT but a comparison between the NACCRT and NACT arm lead to a mean SUV value of 57.80 ±22.40 and 45.92±19.23 with a non significant P value of 0.13.This leads to a conclusion that both the treatments result in a significant metabolic response however one does not outperforms the other in a statistically significant manner.An early marker of response offers the greatest potential clinical advantage, particularly if those not benefiting from treatment could be identified and offered alternative approaches, and this was the hypothesis evaluated in this study.However the major drawback of this study was a small sample size. Despite that we could conclude by this study that [18 F]-FDG-PET CT is a good diagnostic modality for response assessment after NAT in locally advanced carcinoma esophagus patients and helps in differentiating between responders and non-responders significantly. TABLE SHOWING (SUV?%) AND TRG IN BOTH GROUPS SERIAL NO SUV(Max) UPTAKE BEFORE NACCRT SUV(Max) UPTAKE AFTER NACCRT (SUV?%) TUMOR REGRESSION GRADE (Mandard) 1. 12.4 2.1 83.06% 3 2. 19.5 12.4 57.25% 3 3. 16.3 9.3 42.94% 2 4. 17.6 10.6 39.72% 3 5. 21.5 14.2 33.95% 4 6. 16.2 9.8 39.50% 4 7. 11.4 1.8 98.2% 1 8. 14.5 9.1 37.24% 4 9. 16.5 10.3 37.57% 3 10. 15.2 8.6 43.42% 2 11. 10.8 2.3 91.8% 1 12. 14.3 7.2 49.65% 1 13. 17.6 8.3 52.84% 3 14. 15.1 2.4 84.10% 2 15. 13.2 3.2 75.75% 1 SERIAL NO SUV(Max) UPTAKE BEFORE NACT SUV (Max)UPTAKE AFTER NACT (SUV?%) TUMOR REGRESSION GRADE (Mandard) 1. 10.5 2.2 79.04% 2 2. 8.8 1.5 82.95% 1 3. 9.8 2.3 76.53% 3 4. 17.5 11.1 36.57% 4 5. 18.6 12.8 31.18% 3 6. 16.8 10.5 37.5% 2 7. 19.1 13.6 28.79% 5 8. 12.5 6.4 48.8% 3 9. 16.5 10.8 52.77% 2 10. 17.5 9.8 44.00% 1 11. 15.3 12.1 20.91% 2 12. 12.4 8.6 30.64% 3 13. 11.5 7.5 34.78% 4 14. 16.8 10.4 38.09% 4 15. 17.5 9.4 46.28% 4

 > Abstract Id: YUGP0718 Top




TITLE To establish the Role and Accuracy of Ultrasound measurements of parathyroid nodules, in operated cases of Hyperparathyroidism, as correlated with surgical findings: Retrospective Study done at a single Institution in India AUTHORS ALKA ASHMITA SINGHAL, S S Baijal, Ambrish Mithal, Sunil K Mishra, Deepak Sarin, Sowrabh Arora, Radiology and Nuclear Medicine, Endocrinology, Head and Neck Surgery, Medanta the Medicity Gurgaon Haryana India INSTITUTE AND HOSPITAL Medanta the Medicity Hospital Gurgaon Haryana New Delhi NCR India PRINCIPAL AUTHOR CV Dr Alka Ashmita Singhal Senior Consultant —Radiology at Medanta Division of Radiology and Nuclear Medicine for the past 5 years. She has a previous work experience from Sydney, Australia of 10 years and Toronto, Canada for 2 years. She is dedicated to quality, accuracy and patient satisfaction. She did Medical Ultrasound from ASUM, Sydney and Doppler and MSK USG Certification from ARDMS USA. ABSTRACT AIMS: To establish the Role and Accuracy of Ultrasound measurements of parathyroid nodules, to help guide the surgeon at the time of surgery and to set up standards of diagnostic ultrasound of neck in cases of hyperparathyroidism. METHODS: This was a retrospective study conducted at a single institution in India. Patients diagnosed with Hyperparathyroidism and Operated from year 2013 to 2017 were included. Biochemical and radiological parameters were evaluated and analyzed. Biochemical (Serum Calcium, PTH, and Vit D Phosphates) and radiological parameters (MIBI, USG, and Methionine PET) were evaluated to establish clinical and Radiological diagnosis. SAMPLE SIZE: A total of 200 Patients operated for parathyroid nodules were studied retrospectively. ULTRASOUND EQUIPMENT AND TECHNIQUE: High resolution linear USG on Siemens 2000 AND Siemens X700. Identification of a parathyroid nodule was done as per ultrasound criteria. After precise localization of the parathyroid nodule, three dimensions of the nodule were measured on a split screen format as length x width x transverse measurement. (Example 18 mm x 9 mm x 6 mm, volume = 0.4 cc) The volume measurement was calculated by the software of USG machine. POST OPERATIVE SURGICAL NODULE DIMENSIONS: The FROZEN SPECIMEN GROSS REPORT was obtained from the Histopathology. Three Measurements in three orthogonal planes and the specimen weight were compared with pre-operative parathyroid nodule measurements. The weight of the Gross Specimen was compared with the volume of the nodule obtained at ultrasound. Data was then analysed for correlation and accuracy. SCIENTIFIC VALUE The study helps in guiding the surgeon by better planning and saving operating time and patient morbidity. Also retrospectively it helps in establishing diagnostic standards of ultrasound examination and measurements. RESULTS: USG SIZE VERSUS SURGICAL SIZE: Among them â€Â¢ 170 patients (85%) had the sizes of the ultrasound nodules lying between 90-110 % of the size of nodules as measured at surgery. â€Â¢ And 15 patients (7.5 %) had nodules sizes between 85- 115 % range of the surgically measured nodules. â€Â¢ 6 patients (3%) had nodule size between 80-120 % of the surgical measurements. â€Â¢ And 3 Patients (4.5 %) had additional nodules at surgery. (Bilobed parathyroid) ANALYSIS: The size correlation between good ultrasound measurements and surgical measurements was as follows (Accurate and Good Correlation) In 85 % cases, the range was only minus 10% to plus 10% In 7.5% cases, the range was minus 15% to plus 15% In 3 % cases, the range was minus 20% to plus 20% In remaining 4.5 % cases there were additional nodules (bilobed and others) CONCLUSION 1 Precise measurements of a well localized parathyroid nodule gives confidence and reassurance to the operating surgeon at the time of removal. It can obviate the need for further exploration. 2 The surgeon at the time of surgery correlating all the three dimensions of the removed nodule with the corresponding sizes mentioned in the diagnostic ultrasound report. (Intraoperative PTH Drop is however utilized for further confirmation). 3 Overall, the study showed 95.5 % of operated parathyroid nodules within plus or minus 20 % of the sizes measured at diagnostic ultrasound. 4 It helps in pre-operative surgical planning, counselling and management of the patient. 5 Retrospective analysis helps in setting up diagnostic ultrasound standards. ADDITIONAL BENEFITS: Apart from Accurate size of the nodule (s) USG gives precise localization of nodule and its depth level and anatomical relationship with the important landmarks in the neck. Helps in localization of superior versus inferior parathyroid nodule in equivocal cases at mid thyroid level. (Important as to avoid injury to recurrent laryngeal nerve) Ultrasound finds parathyroid nodules in Sestamibi negative or equivocal cases of hyperparathyroidism. Ultrasound finds additional nodules in cases where sestamibi showed only one nodule. USG evaluates the localized nodules for their cystic and solid component, and for any suspicious features if any. USG localizes Ectopic parathyroid nodules in the neck. USG evaluates the parathyroid nodules which do not take up radioactive tracer even at surgery. Ultrasound evaluates the thyroid for any nodules or associated pathology Neck is evaluated for associated lymphadenopathy and its characterization KEYWORDS: Hyperparathyroidism, Sestamibi, Ultrasound neck for parathyroid nodules, Parathyroid adenoma, Parathyroid nodule size and measurements, Parathyroid surgery, Head and Neck surgery.

 > Abstract Id: YUGP0720 Top

Primary Leiomyosarcoma Of Cervix: Now It Counts!

Presenter- *Dr. Sulbha Mittal

Co-author - Yashpal Verma, Tarun Kumar, Manish Bansal

Aim of the Study: To review and suggest treatment approach for Primary Leiomyosarcoma of cervix. Material and Method: We have reviewed literature to find out optimum management of Primary Leiomyosarcoma of the cervix by search in PubMed Central, Embase, Cochrane, and Web of Science Central database. We have classified the obtained information as per Oxford Centre for Evidence Based Medicine (OCEBM) level of evidence, and National Comprehensive Cancer Network (NCCN) Categories of Evidence and Consensus. Current treatment scenario for sarcoma and its outcome will be discussed for treatment naive case of primary leiomyosarcoma of cervix based on systematic review, line listing of old reported cases and treatment evidence. Results: Leiomyosarcoma is a rare disease, and only few cases have been reported on online databases. It generally occurs in the perimenopausal and postmenopausal population in their 4th—6th decades of life. Diagnosis is confirmed by histopathology and immunohistochemistry. Combined modality of treatment including surgery, radiotherapy and chemotherapy need to be used in these patients to achieve better survival. Intensive literature search reveals lack of definitive guidelines for management of leiomyosarcoma of cervix, the only available evidence is level V as per OCEBM and level C as per NCCN. Conclusion: Though present data suggests that combined modality of treatment including surgery, radiotherapy and chemotherapy should be used in these patients to achieve better survival, in view of increasing number of cases there is need to frame definitive management guidelines, similar to sarcoma of other site of the body.

 > Abstract Id: YUGP0726 Top

Primary Vaginal Papillary Adenocarcinoma Of Vagina: A Rare Malignancy

Presenter- *Dr. Nancy Lal

Co-author - Dr. V. YOGI, Dr. O. P. SINGH, NANCY LAL

Background- Primary carcinoma of the vagina is rare malignancy of female genital tract which constitutes 2% of all gynecological malignancies. The peak incidence is in the sixth and seventh decades of life. Approximately 50% of vaginal cancers arises on the posterior wall of the upper one third of the vagina. The majority of primary vaginal malignancies are squamous cell carcinoma constitutes 80 to 90 % and the remaining are adenocarcinoma about 5 to 10 %. Histological patterns of adenocarcinoma include clear cell carcinoma, adenosquamous, papillary & undifferentiated. Other types are melanomas, sarcomas and unspecified types. Case report-We report a case of primary vaginal papillary adenocarcinoma in a 60 years old woman presented to our department with symptoms of persistent and profuse clear vaginal discharge since 7 months, vaginal bleeding since 2 months and pain in lower abdominal region since 1 month and USG showed ill defined soft tissue mass seen in upper vagina. CT scan suggestive of large ill defined mass approximately 3.3X1.8 cm seen in upper vagina and few subcentrimetric pericaecal and mesenteric lymph nodes seen largest measuring 9mm in short axis, hepatomegaly with grade I fatty changes and multiple cholelethiasis. Immunohistochemistry showed CK20, DUPAN 2 positive and CA 125, CK7, serum CEA negative. Conclusion- This case reported here for its rare presentation in all gynecological malignancies. Keywords- Primary vaginal carcinoma, Papillary adenocarcinoma

 > Abstract Id: YUGP0734 Top

Long Term Hypocalcemia €” Prediction (Lthp) In Thyroidectomy

Presenter- *Dr. Nebu George

Co-author - deepak janardhanan, ,

INTRODUCTION Hypocalcaemia is a common sequelae of total thyroidectomy and is usually transient (30%).Only few develop permanent hypoparathyroidism. Till date, no effective risk stratification score is available to predict post-operative hypocalcaemia . Development of such a score would help to initiate calcium supplementation as early as possible and thus avoid prolonged hospital stay and unwarranted prolonged calcium supplementation in some patients who might not need it . AIM â€Â¢ To predict long term hypocalcaemia in patients undergoing thyroidectomy based on preoperative and 6hrs post-operative parathormone value. â€Â¢ To device a weighted score to predict long term hypocalcaemia, after analyzing various clinical and intraoperative variables. MATERIALS &METHODS All patients who underwent total or completion thyroidectomy from April 2015 to May 2016 at our institution for malignancy with preoperative parathormone value within the normal range were included in the study after ethical committee clearance. Patients with abnormal serum albumin and serum calcium values preoperatively were excluded from the study . Biochemical value less than 7.5 on first or second post operative day or presence of signs or symptoms were considered as positive for hypocalcaemia. Post thyroidectomy Long term hypocalcaemia was defined as, when calcium supplementation had to be continued for more than three months after thyroidectomy. Post op 6th hour PTH level fall was noted in all patients and cut off point for prediction of long-term hypocalcaemia was determined statistically using paired t test . Factors like PTH level fall, Calcium level fall, histology, central compartment neck dissection, age of patient, Intra operative parathyroid identification, intraoperative extra capsular spread/extra thyroidal spread, pre op calcium level and extent of surgery were analysed for statistical significance in predicting hypocalcaemia.these clinncal and biochemical parameters were also used to devise a weighted score to predict patients who might go in for long term hypocalcemia RESULTS A total of 105 patients were included in the study of which 77 were females 19 patients were less than 20yrs of age, t. . Post operatively, calcium supplementation was initiated for 52%. In the majority the calcium supplementation could be tapered and stopped by 2nd month following surgery. 5.7% had normal calcium in the 1st post-operative day but developed hypocalcaemia after 4th post-operative day requiring re-hospitalization. All these patients who developed delayed hypocalcaemia with initial normal calcium levels had fall in parathormone to more than 45% of initial value. A PTH fall of 45% or more was found to be significant in predicting hypocalcaemia that required calcium supplementation for upto 2 months(p-value < 0.001 using Chi-square test). Patients in the less than 20 yr age group were more prone to develop hypocalcaemia with 66% developing hypocalcaemia in the post-operative period. In individuals below 20 years, a PTH fall of 56% or more ,was attributed to calcium supplementation with a sensitivity of 83.3% In 7.6 % of patients, calcium supplementation couldn’t be tapered even after 3 months and all of these patients had fall in parathormone to more than 80% of preoperative value.

 > Abstract Id: YUGP0740 Top

The Occupational Stress And Mental Health In Cardiac And Non Cardiac Patients


Co-author - Dr.Ramachandran Narayanan, ,

Introduction: Much of research studies in global level have shown that occupational stress is one of the strong determent factors of coronary heart diseases among people in general and causes ischemic heart diseases in particular. However, exploring the extent to which the type or nature of ailments and its subsequent risk factors have an effect on the onset of mental health will help evolve suitable preventive measures. The present study attempts to explore the status of mental health and occupational stress with respect to two categories of patients: Those who are suffering from cardiac problems and those suffering from non cardiac health problems. Means and Methodology adopted: The occupational stress Questionnaire and Mental Health Questionnaire were administered to both cardiac and non cardiac patients. The cardiac group consisted of 40 patients who were being treated at the cardiology department of a reputed government hospital, and non cardiac group 40 patients consisted of our patients of the same hospital being treated for non cardiac problems like knee pain, headache, etc. Responses to these self-reported questionnaires were subjected to statistical analysis to find out the difference between cardiac and non-cardiac groups. Results: The results revealed that cardiac patients tend to have lower levels of mental health than no cardiac patients. Similarly, cardiac patients were reported to have higher levels of stress due to role ambiguity, powerlessness, intrinsic impoverishment and unprofitability. Conclusions: The implications of the study were implementation of interventions to improve the internal strength of cardiac patients to overcome various aspects of occupational stress.

 > Abstract Id: YUGP0750 Top

High Dose Rate Endobronchial Brachytherapy: Our Institutional Experience As An Effective Palliative Treatment Modality In Bronchial Carcinoma

Presenter- *Dr. Jigna Bhattacharya

Co-author - Dr R K Vyas, Dr Saheli Saha,

Background: Treatment of inoperable carcinoma lung poses a challenge both due to the magnitude and local symptoms with resultant worsening of performance status of the patients. Endobronchial brachytherapy is an established modality for palliation of symptoms, namely dyspnoea, haemoptysis and cough that result from disease infiltration of the airways. This study was aimed at evaluating the role of HDR endobronchial brachytherapy with external radiotherapy for symptomatic improvement and compliance for such patients at our institution. Method: 50 patients of inoperable Ca Lung with significant bronchial component, including non-small cell and small cell, were assessed. Patients were evaluated with fibre optic bronchoscopy regarding degree of bronchial obstruction. They were randomized in to two treatment arms, Arm A: External beam Radiotherapy followed by endobronchial brachytherapy (EBBT). Arm B: Endobronchial brachytherapy followed by External RT. Endobronchial Brachytherapy was delivered using remote afterloading HDR brachytherapy with Ir192 source. Dose for external RT was 30Gy/10#, on Linear Accelerator or Co-60 teletherapy unit. Endobronchial brachytherapy dose range was 6.5Gy -10Gy in single or two fractions, one week apart. Bronchoscopic assessment was done after one week of each fraction of endobronchial brachytherapy as well as after completion of treatment at every 1 month for 3 months. In some patients with good response, follow up bronchoscopy was performed after 6 months. Response to the therapy was also assessed with the Speiser scoring criteria. Results: Total 50 patients were randomised into two arms according to presenting symptoms and Bronchoscopic feasibility for the catheter insertion. There were 20 patients in arm A and 30 patients in arm B. In short follow up, complete response for haemoptysis was achieved in 98% of patients (n=14), 80% patients showed complete response to dyspnoea (n=46). Symptoms like chest pain and cough showed less improvement after endobronchial brachytherapy. Re-expansion of atelectasis was seen in 100% patients (n=29). Values in both the arms were compared using t-test. The pre- and post-treatment symptomatic differences were comparable in both the arms and statistically significant for dyspnoea, chest pain, cough, haemoptysis while it was found to be insignificant in patients with change of voice. Conclusion: Endobronchial brachytherapy, as documented, is an important palliative modality to relieve the obstructive symptoms like dyspnoea and hemoptysis, in patients with intrabronchial malignant mass. Contact : Mobile: 9426024694 Email: jignabhattacharya@gmail.com

 > Abstract Id: YUGP0756 Top

Assessing Enamel Mineralization During X-Ray Photon Radiotherapy For Head And Neck Cancers.

Presenter- *Mr. Jagadish Kudkuli

Co-author - Riaz Abdulla, Manzoor AP, Sneha Dhar

Background: Radiotherapy is an important treatment modality for combating malignant tumors especially in cases of head and neck cancers. Radiation-induced caries occurs as a synonymous clinical condition due to side effects of radiotherapy along with trismus, severe dentition breakdown, xerostomia, associated loss of masticatory function etc. Several interventional studies have shown a direct effect of radiation on tribology, ultrastructure and chemical composition of teeth. Linear accelerator (LINAC) based X-ray photon radiotherapy is routinely incorporated into Treatment Planning System (TPS) to improve Tumour Control Probability (TCP) and to curb Normal tissue complicating probability (NTCP) to a maximum extent possible. As of yet, there are no studies focussing on microhardness of teeth under x-ray photon radiation intervention. Purpose: To evaluate the percentage mineral content in teeth enamel exposed to LINAC X-ray irradiation, using microhardness technique Materials and Methods: The study was approved by Institutional Ethics Committee, Yenepoya University, India (YUEC/2015/259). A total of 23 human permanent teeth samples were collected from extractions done during the surgical procedure in Department of Oral Surgery, Yenepoya Dental College, Mangalore. Bucco-lingual sections were prepared using a diamond plated dental micro motor. Buccal enamel surfaces were exposed to different treatment doses of x-ray photon ionizing radiation viz. 20 Gy, 40 Gy, 60 Gy and 80 Gy. Before and after radiation, Indents were made using Vickers diamond micro-indenter at the rate of 100 gf for 15 seconds. Hardness numbers and percentage mineral content of buccal enamel slices were calculated using Vickers and Knoop microhardness inter-conversion indices and the difference obtained in pre and post-irradiated samples were expressed as percentage mineral loss of buccal enamel surface. Results: Gradual decrease in mineral percentage was observed in radiation exposed samples from 20-80 Gray. While there was not much difference with 20 Gray samples compared to controls, greater loss of percentage mineralization was noted with an increase in radiation dose from 40 to 80 Gray. Results indicate a clear impact of LINAC X-ray photon radiation on teeth enamel surface. Conclusion: Decrease in mineral percentage values of buccal enamel surface indicates loss of mineralization under radiation intervention. Several ultrastructural and elemental characterization studies have suggested tampering of the crystal lattice; hydroxyapatite, which forms a major part of enamel ultrastructure. X-ray powder diffraction (XRD), Fourier Transform Infra-Red (FTIR) spectroscopy and Scanning Electron Microscopy (SEM) data from previous studies support our observation that radiation exposure could induce teeth enamel demineralisation. Loss of enamel and teeth structure might be major contributing factors for incidence of radiation caries in head and patients prescribed to radiotherapy. In conclusion, a dose above 40 Gy from linear accelerator X-ray source can cause serious loss in mineral density of teeth.

 > Abstract Id: YUGP0758 Top

Evaluation Of Distress And Exploring Emotional Issues In Patients Undergoing Pelvic Radiation Therapy: A Subjective Report On Psychosocial Well Being Of Indian Cancer Patients.

Presenter- *Mr. Irfan Lone

Co-author - Dr Swarupa Mitra, ,

Introduction Radiation therapy is one of the important motilities of cancer treatment yielding promising clinical outcomes. However it also poses many challenges on emotional and physical parameters and many patients experience emotional distress prior to the initiation of radiotherapy, during the course of treatment and even its completion, thus resulting in detrimental implications on their quality of life. Objective The current study explores the psychosocial issues and along with the level of distress among cancer patients receiving pelvic Radiation Therapy. Methodology Using Distress thermometer by NCCN, the level of distress was assessed and an in-depth semi structured interview schedule was constructed to explore psychosocial concerns of the patients. Statistical analysis was done using SPSS 21. Results: Fifty nine patients receiving External Beam Radiation Therapy for pelvic area were included, and 35.5% of them were in fourth decade of life, followed by 29% and 25% in fifth and sixth decades respectively. Almost all of them had not received any previous radiation therapy and majority (81%) came from middle social economic families. Almost half of them were aware of their diagnosis and only 12% had awareness of the prognosis. Conclusion: Majority of Indian patients experience extreme level of distress before, during and after radiation therapy, with women experiencing it more than their male counterparts. Irrespective of gender, moderate to extreme level of distress is experienced before and during RT by majority of patients, and moderate level of distress still persists in most of the patients after 3 to 5 weeks of completing RT. Also associated with it are many psychosocial concerns that are of significant relevance, while they receive Radiation Therapy. Future research should explore more physical and psychological parameters associated with radiation therapy so that appropriate psychological therapies and intervention are designed help patients cope with treatment. Also irrespective of the awareness of their disease diagnosis and prognosis, patients should be counseled about treatment motilities, their expected side effects and ways to cope, which can lead to their better Quality of Life.

 > Abstract Id: YUGP0764 Top

Factors Influencing Survival In Advanced Stage Gastric Cancer


Co-author - Dr.Kalaichelvi Kannan, Dr. Sureshkumar S, Dr. Raja Gopal

Background As per GLOBOCAN 2012 Gastric cancer is one of the most common cancers worldwide and third most common cause for cancer related mortality. The prognosis remains poor for this cancer inspite of multimodality approach. Objective To analyze the relationship between survival and covariates and find the factors influencing the survival in locally advanced and advanced stages in tertiary care centre in South India. Methodology A retrospective study was done using data of patients treated from the period of January 2012 to November 2016. 518 patients with an advanced disease were found. Age, personal habits, stage of the disease, site of metastasis, histology and the treatment given were analyzed. Statistical analysis was done to find out the relationship between survival and the mentioned covariates using Kaplan-Meier and Cox regression. Results 343 patients received chemotherapy or surgery or both. 175 patients did not receive any treatment except palliative bypass procedures. Median survival in those who underwent definitive surgery with chemotherapy is 29 versus 8 months in those who underwent palliative bypass procedures. Also significant survival difference was seen with those received <2 versus ?2 cycles of chemotherapy (20months versus 10months).Stage IIIA and IIIB showed significant survival benefit compared to Stage IV (29,13 Vs 9 months respectively). Cox regression multivariate analysis showed significant hazard results for surgery, ?2 cycles of chemotherapy and stage of the disease. Conclusions In advanced gastric cancer survival is influenced by factors like surgery, ?2 cycles of chemotherapy and stage of the disease but factors like age, smoking, alcohol, site of metastasis and histology do not influence it. KEY WORDS: Gastric cancer, survival, surgery, chemotherapy, stage

 > Abstract Id: YUGP0766 Top

Detection And Classification Of Tumor In Mammograms Using Discrete Wavelet Transform And Support Vector Machine

Presenter- *Mr. Abhishek Sehrawat

Co-author - Abhishek Sehrawat, Deepthi Sehrawat,

The breast cancer is common causes among women. It is detectable. The detection of the tumor method follows pre-processing, feature extraction, and classification. In pre-processing the noises is removed by Gaussian filters from the original images and elaborate the image. The wavelet features are used for the classification to get the tumor classification. The support vector machine is used for classification. Pre-processing - The pre-processing is used to identify the tumor. It is significantly increasing the reliability, robustness of the image. It is used to remove the noise and elaborate the image using Gaussian filter. To reduce the work area only to the relevant region that exactly contains the breast. It acquires the image from the database as the input image. Gaussian Filter - The noise is removed from the image by Gaussian filter and its impulse response is Gaussian function. It is a class of linear smoothening filters with the weight chosen according to the shape of Gaussian function. For smoothening purpose Gaussian kernel is mainly used. It is used to remove noise from the normal distribution. The filter window is symmetric in center so it makes Gaussian filter as unrealized. But it is not limitation for application if the bandwidth is much larger than the signal. Five properties make Gaussian functions useful. These properties of Gaussian filter smoothing filters are effective low-pass filters from the view of both the spatial and frequency domains are efficient. Segmentation - The next step is segmentation after image acquisition. Segmentation is the process of classifying the image into several regions [30]. The proposed segmentation of intensity images such as mammograms is based on thresholding technique (Ostu method).involves the separation of background from the breast tissues in the thresholding in mammogram images. Based on the threshold value the pixels that are less than the threshold are considered as background and the remaining pixels are considered as breast. Classification - Support vector machine (SVM)is used to classify the tumor as normal, benign; malignant it helps to predict the feature of the extracted image will be input to the classification system. Classification process is dividing into training phase and testing phase. In the training phase known data are given and the classifier is trained, and in the testing phase unknown data are given and the classification is performed by using trained classifier. According to the pattern presented in the form of a feature vector. Support Vector Machine The Support Vector Machine (SVM) is a supervised device with associated learning algorithm that analyzes data and recognize pattern. It searches for a separating hyper plane to separates positive and negative from each other with maximum margin. So, the distance between the decisions surface. SVM classifier is designed to solve a binary classification problem finding the class boundary, the hyper plane maximizing the margin in the given training. RESULTS AND DISCUSSION The proposed method is tested by using the mini-MIAS database of mammograms. All images are digitized at the resolution of 1024 × 1024 pixels and 8- bit accuracy (gray level). The proposed algorithm was implemented in a MATLAB environment. Simulation results show that the proposed algorithms yield significantly superior image quality when it is compared to the Global thresholding method and window based adaptive thresholding method. CONCLUSION Here, wavelet based adaptive windowing method is presented for the segmentation of bright targets in an image. To propose Coarse segmentation the wavelet based histogram thresholding is used where, the threshold value is chosen by performing 1-D wavelet based analysis of PDFs of wavelet transformed images at different channels. Window wing method is used to obtained Final segmented result. And by choosing threshold the simulation results show that the proposed method is effective to segment the tumors in mammograms and it can also be used in other segmentation applications. Simulation results show that the proposed algorithms yield significantly superior image quality when it is compared to the Global thresholding method and window based adaptive thresholding method.

 > Abstract Id: YUGP0768 Top

Activated Salivary Mmp-2 In Diagnosis And Prognosis Of Breast Cancer

Presenter- *Prof. Amitava Chatterjee

Co-author - Dr Md Nasim ali, Dr Ramanuj Mukherjee, R G Kar Med Col, Dr Anjan Adhikari, R G Kar Med Col

Title-Activated Salivary MMP-2-In Diagnosis and Prognosis of Breast Cancer Suvajit Mondal*, Md Nasim Ali***, Ramanuj Mukherjee**, Anjan Adhikari** and Amitava Chatterjee*, Ramakrishna Mission Vivekananda University, Narendrapur, R G Kar Medical College**, Kolkata and BCKV, Nadia***. Correspondance : Amitava Chatterjee at amitavachatterjee24@gmail.com Introduction- Matrixmetalloproteinase-2 (MMP-2) has been reported to be involved in the pathogenesis of cancer. The over expression of MMP-2 is associated with the progression of malignancy of several types of carcinoma. Human saliva is a biological fluid with several advantages for non-invasive diagnosis and prognosis of diseases. The aim of this study was to detect expression and activity of MMP-2 in biological fluids (saliva, urine etc) derived from breast cancer patients using non invasive method before and after surgery of the same breast cancer patients. Methods- Substrate gel electrophoresis (Zymography) was done to study the activity of MMPs at stages of breast cancer. ELISA was done to study the presence and difference of MMP-2, TIMP-2 and VEGF before and after surgery of the same breast cancer patients. Immuno Blot and immunoprecipation of salivary proteins was performed to confirm the presence of activated MMP-2. Results- Comparative zymography shows the increase in MMP-2 activity along with the increase in stages of the disease. ELISA shows the presence and difference of MMP-2, TIMP-2 and VEGF in saliva of same patients before and after surgery. The comparative zymogram shows the MMP activity of the same breast cancer patients at different time point after surgery (follow up). Conclusion- Our results showed that the activity of MMP-2 was higher at the time before surgery than the after in saliva collected from the same patients. The comparative zymogram at different time point after surgery of the same patient strongly indicate the use of MMP activity in prognosis. Therefore we suggested active form of salivary MMP-2 could be used as a novel potential biomarker for diagnosis and prognosis of breast cancer using non invasive method.

 > Abstract Id: YUGP0776 Top

Children With Acute Lymphoblastic Leukemia And Families: Focus Group Study Of Their Unmet Needs

Presenter- *Ms. Tanuja Kaushal

Co-author - Dr. Sujata Satapathy, Prof. Rakesh Chadda, Prof. Sameer Bakhshi

Background: The impact of pediatric oncology is psychosocially and physically profound. Children and their families have problems coping with the stresses of treatment, surgery, chemotherapy, and radiation. However, qualitative research incorporating the phenomenological experiences of children and their caregivers and professionals dealing with such cases in explaining the fabrics of trauma they handle especially in Indian socio-cultural set up is needed.Purpose: To study the needs and challenges faced by children with cancer and their families and professionals using Focused Group discussions (FGD) approach.Methods: A total of 64 participants participated across eight FGDs: 4 FGDs with parents of children with ALL (n=31); 1 FGD with professionals working in the field of cancer (n=10) and 3 FGDs with children with ALL (n= 23). Results:Three major categories of information emerged during analyses: (1) Needs and challenges faced by the participants; (2) Factors moderating influence of challenges; (3) Technical suggestions by experts highlighting ways to address challenges. 5 Domains of challenges emerged namely: Lack of awareness, Cognitive problems, psychosocial issues, physical problems and socio emotional & behavioral problems.Discussion on the emerged themes and sub-themes has been done in the light of global literature, existing theoretical frameworks, and cultural scenario of India.Conclusion:No longer considered an inevitably fatal disease, childhood cancer nonetheless presents many challenges for children and families.An effective and culturally sensitive psychosocial support for patients and their families during and post treatment, in addition to medical therapy, is strongly recommended. Key Words: childhood cancer, families, professionals, focused group discussion, challenges Conflict of interest: Nil Copyright of the abstract: ICC-2017

 > Abstract Id: YUGP0781 Top

Analysis On The Pattern Of Care And Survival Of Patient With Nasopharyngeal Cancer In Saint Luke’S Medical Center Global City

Presenter- *Dr. Poly BUNPA

Co-author - Dr. Angela P. Camacho, ,

Objective/Purpose Nasopharyngeal cancer is one of the most common cancers in Asia. The high incidence might relate to South East Asian diet rich in salted vegetable, meat and fish. The overall survival of locally advanced Nasopharyngeal cancer was improved from 47% to 78% with additional of concurrent chemotherapy to radiotherapy. The purpose of this study is to report on loco-regional and survival rate of patients treated at our institution. Methods and patient Characteristic From January 2014 to December 2016, there were 37 patients, diagnosed with nasopharyngeal cancer stage I to stage IV, treated in Saint Luke’s Medical Center Global City. Of 37, four were excluded from the analysis due to the following reasons: two patients did not start radiation therapy, one patient has no available data and one patient has no follow up. This rendered only 33 patients eligibly to be in the study. The age range of population was from 26 to 72 years of age, with a mean age of 46 among the subjects. Twenty-three were male and ten were Female. Sixteen patients had histology WHO type 2 and seventeen had WHO type III. Fourteen patients received concurrent weekly low dose cisplatine and 13 patients received high dose chemotherapy. Mean treatment duration time was 50.9 days. Results After completion of radiotherapy, twenty-six patients had complete response, 4 patients had partial response and 2 patients had stable disease of the nasopharyngeal mass, four patients had stable disease for the neck nodes and one patient had nodal progression after the treatment. The median follow up for overall survival was 18 months. A total of four patients were dead. One patient had both local and distance failure, one had local and nodal recurrence, one had distance failure and one had local failure only. The distance recurrence sites are lung, liver, bone and intra abdominal lymph nodes. The 3 years overall survival and progression free survival were both 87.8%. There were no severe late complications observed in the study. Conclusion Our finding demonstrates high disease free survival and overall survival rate in nasopharyngeal cancer treated in our center, however, longer follow up is needed.

 > Abstract Id: YUGP0789 Top

Prednisolone Therapy As An Intervention In Terminal Cancer Patients, A Prospective Randomized Double Blind Cross Over Study

Presenter- *Dr. Vishnu Harilal


PREDNISOLONE THERAPY AS AN INTERVENTION IN TERMINAL CANCER PATIENTS, A PROSPECTIVE RANDOMIZED DOUBLE BLIND CROSS OVER STUDY ABSTRACT OF THE STUDY OBJECTIVES This study was designed to assess the efficacy of prednisolone therapy in relation to improving the quality of life in terminal cancer patients. MATERIALS AND METHODS A randomized, prospective, double-blind, cross-over, placebo-controlled, clinical trial where patients were randomized to receive prednisolone 40mg or matching placebo for 14 consecutive days. Study medication was provided in blinded packages which contained packets of either placebo or prednisolone as specified by a computer-generated randomization scheme. After the 14-day, double-blind phase was completed, all patients were given prednisolone for 20 days. The end points of the study were pain, psychiatric status, appetite, nutritional status, daily activity, and performance and were evaluated using FACT-G , FAACT , FACIT F , BECKS depression questionnaire and VAS. RESULTS On completion of double blind phase it was observed that There was significant improvement in overall quality of life of the study group compared to controls (F=3077.5) ;p

 > Abstract Id: YUGP0793 Top

Prospective Study Of Comparison Of Clinical [ Bed Side ] Examination Versus Examination Under Anesthesia In Staging Of Carcinoma Cervix At Vims,Bellary

Presenter- *Dr. SHIVA KUMAR

Co-author - Chandrashekhar K, ,

OBJECTIVE 1. To compare the bedside staging method and EUA staging methods for staging cervical cancer. 2. To identify factors that may limit bedside staging method for cervical cancer. METHODOLOGY The patients suspected of cervical cancer and scheduled for EUA, biopsy and staging on the theatre list were subjected to bedside staging method on the ward on day 1, On day 2 same patient subjected for EUA staging method. Clinicians performing the staging as EUA were blinded from the results of the bedside staging method. Findings of bedside are compared with EUA. STUDY PERIOD : 1st February 2016 to 31st October 2017 RESULTS The study will find the correlation for the speculum, bimanual and per rectal examination assessment processes respectively during bedside method as compared to the EUA. The sensitivity and accuracy of the speculum examination during bedside staging will be found. Sensitivity and accuracy of bimanual examination will be found for bed side and EUA examination.The bedside staging method to assign the accurate stage of the cervical cancer and its correlation with EUA will be done. CONCLUSION At end of study it will be recommend to abandoning theEUA staging method for bedside staging method or not.

 > Abstract Id: YUGP0797 Top

The Improvement Of Relative And Relative Conditional Survival In Head And Neck Squamous Cell Carcinoma: A Population-Based Analysis Using The Seer Program (1973€”2014)

Presenter- *Dr. Yijun Kim

Co-author - Jin Ho Kim, ,

PURPOSE: to evaluate the changes of relative survival (RS) and relative conditional survival (RCS) in patients with head and neck squamous cell carcinoma (HNSCC) between two periods of 1973—1998 and 1999—2014. PATIENTS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) program data, a total of 87,923 patients of HNSCC were enrolled and dichotomized into group 1(1973—1998) and group 2(1999—2014) according to time period of diagnosis. The RS and 5-year RCS (RCS5) according to tumor extent, age, and subsites were also compared. Z test was performed to compare the RS and 95% confidential intervals using log-log transformation were calculated for the RS and RCS. RESULTS: The RC and RCS5 between two time periods increased significantly. The 10-year RS improved from 38% to 52% (z=32.401, p65 years. In tongue and tonsil cancer, 10-year RS increased more than 20% (z=29.226, p90% of RCS5 at 5 years after diagnosis in the group 2, while larynx revealed only 3% improvements of the RS (z=2.191, p=0.029). CONCLUSION: The RS and RCS5 in HNSCC increased over time. The improvements of the RS and RCS5 were dominant in the regional and distant diseases. However, the RCS5 in regional and distant diseases did not reach plateaus until 10 years after diagnosis and several subsites including larynx showed minimal improvements of the RS and RCS, suggesting that further development of more effective treatments in advanced HNSCC is necessary.

 > Abstract Id: YUGP0801 Top

Primitive Neuroectodermal Tumor (Pnet) Of Thyroid : A Rare Presentation

Presenter- *Dr. Shravan Shetty

Co-author - Dr.Dhairyasheel Savant, Dr. Akanksha Chichra,

Extraskeletal Ewing's sarcoma (EES) is rare.EES commonly arises in the soft tissues of trunk or extremities.EES is rare in the head and neck region;most of those have been documented in nasal cavity, paranasal sinuses and neck. Head and neck PNETs have an intermediate prognosis.We report the case of a 12 year old boy who presented with primitive neuroectodermal tumor of the thyroid and was treated with multimodal treatment including surgery,chemotherapy and radiotherapy.The patient is alive and fit with a functional larynx.Major drug regimens use vincristine,doxorubicin,ifosfamide or cyclophosphamide,dactinomycin and/or etoposide.Complete surgical excision is undertaken whenever possible to improve long-term survival.However,the relative radiosensitivity of tumors of the Ewing family,suggest multimodal treatment including adjuvant conformal radiotherapy in case of positive margins or poor response to chemotherapy rather than resection with 2-3 cm margins,which would imply laryngeal sacrifice for thyroid tumors

 > Abstract Id: YUGP0807 Top

The Initial Experience With 68Gallium-Dota-Exendin-4 Pet/Ct Scan For Localisation Of Insulinoma

Presenter- *Dr. Pallavi U N

Co-author - Dr Ishita B Sen, Dr Vineet Pant, Dr Sugandha Dureja

Introduction: Insulinoma is the most common cause of endogenous hyperinsulinemic hypoglycaemia. The management of Insulinoma is challenging and requires several investigations for identification and exact localization of the tumor. In this retrospective study, we present our initial experience with 68Gallium-DOTA-exendin-4 PET/CT scan in detection and localisation of insulinoma. Methods: 68Gallium-DOTA-exendin-4 PET/CT scan was performed in eight patients with endogenous hyperinsulinemic hypoglycaemia. The scan findings were compared with histopathological findings in the patients. Results: Out of 8 patients, 3 patients showed intense 68Gallium-DOTA-exendin-4 uptake with peak and mean SUVs in positive lesions to be 22 ± 3 and 25 ± 1 respectively. Three patients with positive 68Gallium-DOTA-exendin-4 PET/CT scan and two patients symptomatic but negative 68Gallium-DOTA-exendin-4 PET/CT scan underwent surgery .The histopathological examination confirmed the diagnosis of insulinoma in all the three patients with positive scan and in one patient with negative scan. The histhology of other patient with negative 68Gallium-DOTA-exendin-4 PET/CT scan proved nesidioblatosis. The rest of the three patients did not undergo surgery. Hypoglycaemic episodes in three of them were subsequently diagnosed to be due to a prediabetic condition, antibodies to insulin and non-insulinoma pancreatogenous hypoglycaemia syndrome respectively. The sensitivity and specificity of 68Gallium-DOTA-exendin-4 PET/CT scan in localizing and detecting insulinoma was found to be 75% and 100% respectively. Conclusion: The initial experience with 68Gallium-DOTA-Exendin-4 PET/CT scan suggests that it is highly sensitive and specific for identification and exact localization of insulinoma, which can be guide for better surgical exploration.

 > Abstract Id: YUGP0809 Top

Emotional Health Care Of Cancer Survivors- Challenges And Opportunities

Presenter- *Prof. SRINIVASA MURTHY

Co-author - , ,

Cancer becomes a life changing experiences for all people diagnosed with cancer and their families. In India, cancer care is focused on the ‘medical’( surgery, chemotherapy and radiotherapy). Most of the care is cross-sectional and the availability of life long support and care is mostly missing from the treating centres. Emotional health care as an integral part of cancer care is in the initial stages of development. Research in India relating to mental health/ emotional health has focused on identifying the psychiatric syndromes and quality of life. Interventional studies to evaluate the impact and effectiveness of psychosocial interventions is limited. As the persons with a diagnosis of cancer reach the treatment facilities early in the illness, the treatments get better, there will be greater numbers of persons who are cancer survivors. Cancer survivors experience a number of psycho-social challenges. The most prominent is the ‘fear of recurrence’. Other needs are the need to reorganize their personal, family, professional and social lives. A growing recognition in this survivor status is for spiritual support. There is growing evidence of positive benefits of emotional health care on the quality of life, decrease in distress and better clinical outcomes. However, at present, the medical facilities are not geared to provide these needs in a longitudinal manner. The challenges are the lack of knowledge about survivorship in the Indian context( among differing social and economic groups); the limited numbers of mental health professionals, and the stigma attached to seeking emotional support. There is an opportunity to fill this ‘gap’ by self-care measures. The proven measures to promote mental health of survivors like physical activity, listening to music, writing narratives, sharing of feelings, problem-solving, yoga, meditation, spiritual practices etc are eminently suitable for empowerment of survivors. The availability of mobile phones and internet makes reaching these skills practicable. There is an urgent need to implement ‘self-care’emotional mental health care programmes and evaluate their impact.

 > Abstract Id: YUGP0811 Top

Treatment And Cosmetic Results In Indonesian Woman With T1-2N0 Breast Cancer Treated With Breast-Conserving Treatment

Presenter- *Mr. Rafiq Sulistyo Nugroho

Co-author - Ratnawati Soediro, Nurjati Chairani Siregar, Zubairi Djoerban

Background: To obtain the breast conserving treatment (BCT) outcomes compare to mastectomy for Indonesian women with T1-2N0 breast cancer and evaluate its cosmetic result. Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), disease-free survival (DFS) and cosmetic outcome according to harvard Score. Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 — 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 — 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 — 0.80) and DFS (HR 0.38; 95% CI 0.19 — 0.78). Among a hundred and three patients who had performed cosmetic evaluation, 59 (57.3%) patients had excellent — good, 9 (8.7%) patients had fair and 35 (34%) patients had poor cosmetic outcome. Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS. Almost 60 percents of patients treated with BCT had favorable cosmetic result. Keywords: Breast-conserving treatment, mastectomy, cosmetic, result

 > Abstract Id: YUGP0818 Top

The Spectrum Of Lymph Node Involvement After Extended Cholecystectomy And Its Correlation With Pt Stage In Carcinoma Gall Bladder Patients.

Presenter- *Dr. B MADHU NARAYANA


AIM: - To determine the spectrum of lymph node involvement after extended cholecystectomy and its correlation with pT Stage in carcinoma gall bladder patients. METHODS: - A total of 57 patients who were suspected/diagnosed to have Carcinoma gall bladder were studied prospectively. They had undergone extended cholecystectomy with systematic lymphadenectomy over a period of January 2014 to December 2015 in Dept. of General Surgery, PGIMER, Chandigarh. If Aortocaval lymph node frozen was reported as negative then extended cholecystectomy along with cystic, pericholedochal, peripancreactic ,periportal , coeliac artery, Common Hepatic Artery, Left Hepatic Artery, Right Hepatic Artery, Hepato-duodenal lymph nodes were sent separately for evaluation. RESULTS: - Out of 57 patients, 8 were excluded (5 were reported as xanthogranulomatous cholecystitis, 2 as chronic cholecystitis, 1 as IgG4 related disease).In remaining 49 patients, 6 were incidental carcinoma gall bladder. A total of 555 lymph nodes were examined in 49 patients with range of 0 to 26 and median of 11. 79 lymph nodes were positive in 19 patients (38.7%).Overall most common lymph nodes involved were peripancreatic (n=9/49; 18.4%), common hepatic artery (n=7/49;14.3%), periportal (n=7/49;14.3%), hepato-duodenal 5/49;10.2%), pericholedochal (n=4/49;8.2%), cystic (n=3/49;6.1%), coeliac (n=2/49;4.1%), LHA nodes (1/49;2%) and RHA lymph nodes (1/49;2%). pT1 stage (n=5/49; 10.2%) had periportal lymph nodes involved (n=1/5;20%).pT2 stage tumors (n=12/49;24.5%) had involved pericholedochal (n=3/12;25%), cystic (n=2/12;16.6%), peripancreatic (n=2/12;16.6%), Common HepaticArterynodes n=1/12;8.3%), periportal (n=1/12;8.3)hepato-duodenal nodes (n=1/12;8.3) .pT3 stage tumors (n=32/49;65.3%) had involved peri-pancreatic (n=7/32;21.9%), Common Hepatic Artery (n=6/32;18.7%), periportal (n=5/32;15.6%), hepato-duodenal (n=4/32;12.5%) , celiac (n= 2/32 ;6.25%) , pericholdecochal (n=1/32;3.1%), LHA nodes (n=1/32;3.1%), RHA nodes (n=1/32;3.1%), cystic lymph nodes (n=1/32;3.1%) with p>0.05. CONCLUSION: -Peripancreatic lymph nodes were the most common involved irrespective of ‘pT’stage. Extended cholecystectomy with lymphadenectomy plays critical role for R0 resection irrespective of ‘pT’stage.

 > Abstract Id: YUGP0834 Top

Estimate The Impact Of Chemotherapy In The Patients With Osteosarcoma The Existence Of Chromosomal Instability For Prognosis And Variability Of Response.

Presenter- *Dr. Iqboljon Shermatov

Co-author - D.Sh.Polatova, M.S.Geldiva, Kh.G. Abdikarimov

Most of the bone sarcomas characterized with extremely malignancy and high resistance to chemotherapy and radiationtherapy. This tumor process could be accompanied with deep violations and defense mechanisms of organism. Growing the tumor may bring to forming endogenic toxic substances, which cause mutagenic effect in lymphocyte of peripheral blood. In this way, registration level of chromosomal aberration of lymphocyte in peripheral blood of patients with osteosarcoma can help to estimate the effectiveness of treatment. The study was held with the aim of estimate the effect of chemotherapy in the patients of osteosarcoma with the existence of chromosomal instability for prognosis and variability of response. Studying the index of survival was held by the method of Kaplan-Mayer (1958), comparing the gradation between the signs of osteosarcoma used the method of Student-Fisher (p2 0,05) Received analysis of cytogenetic changes of lymphocytes in peripheral blood of patients with osteosarcoma till the clinical examination and treatment showed that cytogenetic characteristics of lymphocytes of peripheral blood could be one of the criteria to estimate the treatment and prognosis of this disease. Received results of analysis showed that general survival 3 and 5 yearly patients with osteosarcoma in chromosomal aberration higher discrimination (more then 5%) consisted of 82.4±0.9% and 5.9±0.5% and in lower rate of 5% 92.5±0.2% and 36.2±3.1%. In chromosomal aberration higher discrimination level (5%) 3 and 5 yearly without metastatic survival consisted of 18 and 6%/. In the level of chromosomal aberration lower 5% survival was 60 and 40%. Cumulative survival in lower rate chromosomal aberration consisted of 60 and 40%. Without recurrent 3 and 5 yearly survival consisted of 18 and 4% in higher rate chromosomal aberration, and in lower rate 60-36%. In such situation, the analysis showed that lack of the treatment effect in patients with chromosomal aberration higher than in healthy people with clinical effects. Consequently, identifying the level of chromosomal aberration of lymphocyte in peripheral blood of patients with osteosarcoma till the beginning of treatment, can give us the chance to predict the effect of treatment.

 > Abstract Id: YUGP0846 Top

The Prevalence Of Chronic Kidney Disease Among Patients Diagnosed With Solid Malignancies At Teaching Hospital Anuradhapura And The Impact On Treatment Decisions

Presenter- *Dr. Rasitha Mahilal Atapattu Wijekoon

Co-author - R M A Wijekoon, N A M Perera, H M S P K Herath

Aim: This study was conducted to assess the prevalence of clinical and sub clinical renal impairment in patients with non-haematological cancers of Teaching Hospital — Anuradhapura and the impact of renal function on Oncological decisions. The Anuradhapura Teaching Hospital was selected as the North Central Province (NCP), where hospital is located is affected by a chronic kidney disease of unproven aetiology. Materials & methods: Two hundred and two patients registered in the oncology unit B of Teaching Hospital Anuradhapura, between 1st April 2016 and 31st October 2016 were included in the study. Patient demographic data, cancer sub site, renal function, proposed first intervention and the treatment modifications based on renal impairment were recorded. Results: Serum creatinine level was available for 80% of patients with a trimmed mean and median of 94.5 mmol% and 86.5 mmol% respectively. Fifty one patients (31%) had elevated creatinine level above the lab reference level. In male patients, 41% had raised creatinine level compared to 21% in females. The mean calculated estimated Glomerular Filtration Rate (eGFR) was 54ml/min and over 65% of patients had eGFR of less than 60ml/min. Patients with Breast cancer had highest mean eGFR of 76 ml/min and lowest means were recorded for upper GI, Genito-urinary and Head & Neck cancers with values of 37 ml/min, 38 ml/min and 43 ml/min. Out of all patients 21% had their treatment modified due to inadequate renal function and 51% of Head & Neck cancer patients and 33% of lung cancer patients received modified treatment. Conclusion: The study demonstrated that higher proportion of cancer patients of North Central Province are having clinically relevant renal impairment. Proportion of patients with low eGFR was much higher than the proportion with raised measured serum creatinine level. This renal impairment is severe enough to modify treatment decision of high proportion of patients, especially patients diagnosed with Head and Neck cancer. Key words: Renal impairment, North Central Province, Head and Neck cancer, Estimated Glomerular Filtration Rate, Serum creatinine level

 > Abstract Id: YUGP0850 Top

Incidence Of Prostate Cancer At A Single Tertiary Care Center In North Karnataka

Presenter- *Mr. Shridhar Ghagane

Co-author - Shridhar C. Ghagane, R. B. Nerli, M. B. Hiremath

CONTEXT: Prostate cancer (PC) remains one of the most common cancers affecting men today. Thus, understanding the prevalence, disease characteristics, and changing demographics of Indian PC patients has emerged as an important aspect of study. AIMS: We aimed to present the case series of PC patients from single tertiary care center in North Karnataka. SETTINGS AND DESIGN: The study designed over a period of 8 years from 2007 to 2015 was conducted in the Department of Urology, KLES Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. MATERIALS AND METHODS: A total of 471 newly diagnosed patients with PC from 2007 to 2015 were included in the study. Sociodemographic, clinical characteristics, radiological and histopathological findings of all patients were collected and analyzed for the risk of PC. STATISTICAL ANALYSIS USED: The statistical analysis used in this study was IBM SPSS Statistics software Inc., version 20.0. RESULTS: A total of 471 patients were diagnosed with PC, the mean age at presentation was 70 years, and mean prostate?specific antigen (PSA) level was 37.71 ng/mL. Digital rectal examination (DRE) was abnormal in 87.5% of 471 cases. Significant correlation was observed between PSA level and DRE (P = 0.0005), correlation of PSA and Gleason’s score was P = 0.0006, and histopathological results showed high risk in patients (P = 0.0001). CONCLUSIONS: This is the first hospital?based study of PC incidence with clinical and histopathological features. PC remains an important public health problem with increasing incidence and significant burden on health?care resources in India.

 > Abstract Id: YUGP0854 Top

A Retrospective Study Of 94 Cases Of Ovarian Malignancies Below 20 Years Of Age Presenting At A Tertiary Cancer Hospital In Kolkata From 1996 To 2015

Presenter- *Dr. NIDHU MONDAL


Aims and Objectives Retrospective Observational study of childhood and adolescent ovarian malignancies. Materials and Methods Data from software and bed head tickets of patients in the hospital between 01 January 1996 to 31 December 2015 were analysed. Results 94 cases of ovarian malignancies were analysed from bed head tickets. Fifty three percent cases already had major surgery before registration. Majority of the patients had dyspeptic symptoms and presented with a pelvi-abdominal mass with or without ascitis. Almost 50% cases were histopathologically diagnosed as Dysgerminoma . Most of the patients were treated with adjuvant chemotherapy. Majority of patients were lost to follow-up. Discussion Childhood and adolescent ovarian malignancies are different biologically, pathologically and clinically from the adult counterpart. Psychological factor for the parents must be taken into consideration. Because of late diagnosis, the overall prognosis was poor. Conclusion Early diagnosis and vigilant follow up is needed to determine the long term prognosis and overall survival.

 > Abstract Id: YUGP0856 Top

Dosimetric Comparison Between Impt And Photon-Based Imrt Or Vmat As A Boost In Carcinoma Of Cervix

Presenter- *Dr. Manoj Sharma

Co-author - Dr Eugene Hug, Manindra Bhushan, Dennis Mah

Purpose: Brachytherapy is essential for local treatment in carcinoma cervix, but some patients are not suitable for it. Now a day, in these patients, we normally prefer boost by Intensity Modulated Radiotherapy (IMRT). We are evaluating dosimetric comparison of proton vs IMRT and Volumetric Modulated Arc Therapy (VMAT) as a boost to know whether protons can replace photons. Methods and Materials: Five patients were taken who received external beam radiotherapy to pelvis by IMRT. Three different plans were made for Intensity Modulated Proton Therapy (IMPT), IMRT and VMAT. The prescription to Planning Target Volume (PTV) was 20 Gy in 4 fractions. Dose to 95% PTV (D95%), Conformity Index (CI) and Homogeneity Index (HI) was evaluated for PTV as well as Dmax, D2cc, Dmean were evaluated for OARs along with Integral Dose (ID) of normal tissue and OARs. Results: PTV coverage was optimal and homogeneous with modulated protons as well as photons. For IMPT, coverage D95% was 20.01 ± 0.02 Gy (IMRT: 20.08 ± 0.06 Gy and VMAT: 20.1 ± 0.04 Gy). With regard to the organs at risk, Dmax of bladder for IMPT was 21.05 ± 0.05 Gy (IMRT: 20.8 ± 0.21 Gy and VMAT: 21.65 ± 0.41 Gy) while for rectum, Dmax for IMPT was 21.04 ± 0.03 Gy (IMRT: 20.81 ± 0.12 Gy and VMAT: 21.66 ± 0.38 Gy). Integral dose (ID) to normal tissue in IMPT was 14.17 ± 2.65 Gy (IMRT: 25.29 ± 6.35 Gy and VMAT: 25.24 ± 6.24 Gy). Conclusions: Our results indicate that modulated protons when compared with photons, provides comparable conformal plans. However, IMPT reduces the integral dose to critical structures significantly, compared to IMRT and VMAT. Although IMPT is better alternative for such cases, further research is required to substantiate such findings.

 > Abstract Id: YUGP0860 Top

Prospective Study To Compare Concurrent Chemo-Radiotherapy With Radiotherapy Alone In Management Of Oesophageal Carcinoma Pradeep Kn, A.K.Arya, Ashwini.L, K.C.Laxmaiah Sn Medical College,Agra

Presenter- *Dr. Pradeep Kumar K N

Co-author - Pradeep kumar k n, A. K. Arya, Ashwini L

PROSPECTIVE STUDY TO COMPARE CONCURRENT CHEMO-RADIOTHERAPY WITH RADIOTHERAPY ALONE IN MANAGEMENT OF OESOPHAGEAL CARCINOMA PRADEEP KN, A.K.Arya, Ashwini.L, K.C.Laxmaiah SN MEDICAL COLLEGE,AGRA ABSTRACT Background Carcinoma esophagus mostlypresents in advance stage. Surgery is considered to be prime modality of treatment, though radiation therapy is also an important therapeutic modality. Concurrentchemo radiation has been accepted as the standard of care in patients who are deemed unfit for surgery. , but the outcomes are controversial. Our goals were to compare the therapeutic effects of concurrent chemo radiotherapy and radiotherapy alone in locally advanced esophageal cancer using meta-analysis. Materials and methods The study carried out between December 2014 to July 2016. 31locally advanced esophagealcancer were evaluable.Following a written informed consent , patients with previously untreated ,documented as squamous cell carcinoma of esophagus were inducted into this study if they satisfied KPS>50,Hb>10,normal liver and kidney function . Endoscopic and radiological evaluation was done. Patients were randomized into two groups.Group B - control receivedonly radiotherapy. Group B — receivedconcurrent chemo-radiotherapy. Cisplatin35mg/m2(max-50mg) given weekly.The treatment outcome was assessed in terms of response, dysphagia free interval and toxicities. Result: Out of 31 pt, 19 were male. Male to female ratio was 3:2.The median age at diagnosis was 52 yr. and median follow up was 6.5 months. Majority patients (77.4%) got complete response at the end of treatment.18 pts. were enrolled in Arm A and 13 in Arm B. 2 local recurrence and 3 distant metastasis were reported in Arm A whereas it was zero in Arm B. Mean dysphagia free survival in Arm A and B (DyFS) were 2.5 and 6.5 months respectively. DFS were 1 and 7month whereas OS 9 and 15 months in Arm —A&B respectively. Acute toxicities were more in Arm —B. 24 patients alive, 5 patients died, 2patients were lost of follow up Conclusion Concurrent chemo radiotherapy significantly improve overall survival,Dysphagia free survival, reduced the risk of persistent and recurrencewith increase toxicity.

 > Abstract Id: YUGP0862 Top

Prognostic Factors And Survival Of Carcinoma Of Breast In Women Aged 35 Years Or Less €” A Tertiary Health Center Study

Presenter- *Dr. Ankitbhai Shah

Co-author - Prof. Dr. B. B. Pandey, Dr Preeti Jain,

Abstract Title — Prognostic factors and survival of carcinoma of breast in women aged 35 years or less — A tertiary health center study Authors — Dr. Ankitbhai A Shah1, Prof. Dr. B. B. Pandey2, Dr. Preeti Jain3 Author information — 1 - DNB trainee, Mahavir cancer sansthan, Phulwarisharif, Patna, Bihar. 2 — Professor and Head of department, Department of Surgical Oncology, Mahavir cancer sansthan, Phulwarisharif, Patna, Bihar. 3 — Consultant, Department of Surgical Oncology, Mahavir cancer sansthan, Phulwarisharif, Patna, Bihar. Author information: First Author Name — Dr Ankitbhai Atulbhai Shah Qualification — DNB Trainee in Surgical Oncology Institution — Mahavir Cancer Sansthan, Phulwarisharif, Patna, Bihar. Address — B/306, Vrajbhumi flates, near Lotus school, behind falgun tenement, jodhpur village road, satellite, Ahmedabad — 380015. E mail id — ankitdr86@gmail.com Abstract Body Abstract Title — Prognostic factors and survival of carcinoma of breast in women aged 35 years or less — A tertiary health center study Introduction Breast cancer is less common in younger women. Prognosis and survival of these patients, when compared with older patients, is still evolving. Material and Methods Women with age up to 35 years and diagnosed breast cancer primarily in our institute by core needle biopsy from January 2014 to June 2016 were included in the study (N=100). Disease Free Survival (DFS) and Overall Survival (OS) were the outcomes of interest in the prognosis analyses. Survival rates were estimated using the Kaplan-Meier product limit method. Differences between survival curves were tested using the log rank test. Statistical analyses were performed using statistical software. Results Majority of patients presented late with lump in the breast being the most common presentation (100%) and with higher tumour stage (70% in stage III). 37% of patients were presented with high grade. Axillary lymph node metastases were seen in 63% of patients. Lymphovascular invasion were seen in 34% and extra nodal extension were seen in 31%. Lower hormonal positivity (38%), higher HER2neu positivity (27%) and higher triple negative (39%) patients were observed. Sixteen month DFS and OS were 70% and 81% respectively. By using multivariate Cox-regression analysis, the independent predictors of lower disease free survival were extra nodal extension, HER2neu positive subset and Defaulter for adjuvant treatment whereas the independent predictor of lower overall survival was extra nodal extension only. Conclusion Breast carcinoma in the age group 35 years or below is a distinct identity and having different behaviour which needs special attention and approach for proper management and outcome.

 > Abstract Id: YUGP0866 Top

Deep Inspiration Breath Hold (Dibh) Treatment Benefits For Left-Sided Breast Cancer


Co-author -

Mohd Khairul Bin Mohd Zambri1 1 Bachelor of Medical Radiation Sciences (Radiation Therapy), Department of Radiotherapy and Nuclear Medicine, Sunway Medical Centre, Selangor, Malaysia. Email address: mkmz1@hotmail.com. Abstract: This presentation is aimed to create awareness among radiation therapist and radiation oncologist on the benefits of using Deep Inspiration Breath Hold (DIBH) technique for left-sided breast cancer patients. DIBH is a technique that is used for left-sided breast cancer patients undergoing radiotherapy. As the heart located behind and slightly left of the breastbone, it is possible it will receive some dose and potentially cause late side effects in the future. The volume of the heart that will receive the radiation dose depends on factors such as the shape of the lungs, positioning of the heart and the location of the primary tumor. This presentation also includes the cause, risk factors, and prevalence of breast cancer in Malaysia and evidence of the relationship between breast cancer treatment with lung and heart problems. Highlighted will be the importance of the DIBH technique for left-sided breast patients in reducing the complications to the heart and lung and will also explore the issues involved while using this technique and how to overcome them. It is proven that the benefits of DIBH treatment of early staged, left-sided breast cancer patients help in reducing and/or avoiding lung and heart issues in the long term side effects from a few studies. The issues in treating patients using DIBH include the inability to perform breath-hold for requested amount of time (20-30 seconds), patient compliance and treatment verification for DIBH techniques. However, this presentation will explore the advantages and disadvantages of reducing the radiation dose for the heart and lung. Lastly, there will be a slight introduction to the future developments of the DIBH treatment conjoined with surface guided radiation therapy.

 > Abstract Id: YUGP0880 Top

Spectral Analysis To Evaluate The Effect Of Treatment On Autonomic Nervous System In Pulmonary Metastasis

Presenter- *Ms. Reema Shukla

Co-author - Dr Yogender Aggarwal, ,

Power spectral density (PSD) analysis was obtained from tachogram (Kubios 2.0, Finland) of five minutes lead II Electrocardiogram (ECG) recording using Acknowledge 4.0 (Biopac Systems Inc., USA). 24 pulmonary metastasis and 30 control volunteers participated in this study. Power contents of low frequency (LF) (0.04 to 0.15Hz) and high frequency (HF) (0.15 to 0.4 Hz) were the frequency bands obtained from PSD and LF/HF ratio was calculated. The correlation of frequency bands with treatment given or without treatment and autonomic nervous system (ANS) was established to understand ANS dysfunction in pulmonary metastases. It was found that with the treatment (chemotherapy or radiotherapy), LF and LF/HF decreased and HF increased in eastern cooperative oncology group (ECOG) 4 stating parasympathetic dominance. Artificial neural network represents a classification accuracy of 68.66%. Thus, there exists sympathetic dominance with disease but after treatment parasympathetic dominance occurs.

 > Abstract Id: YUGP0882 Top

Evaluation Of In Vitro Antioxidant And Anticancer Activity Of Simarouba Glauca Leaf Extracts On T-24 Bladder Cancer Cell Line

Presenter- *Ms. Sridevi Puranik

Co-author - Sridevi Puranik, Murigendra B. Hiremath, Shridhar C. Ghagane

The use of medicinal plants have been practiced to treat cancer aliments across the world. We aim to evaluate in vitro antioxidant and in vitro anticancer activities of Simarouba glauca leaf extracts on T-24 Bladder cancer cell line. Herbal extraction was carried out by Soxhlet extraction method using chloroform, ethylacetate, methanol, ethanol, aqueous and hydroalcohol. Phytochemical analysis was done using biochemical tests. Total phenolic content was estimated by FCR method. Antioxidant potential of leaf extracts was analyzed by FRAP assay, PM assay and DPPH assay. In vitro anticancer activity on T-24 bladder cancer cell line was assessed by MTT assay. Phytochemical analysis revealed the presence of rich secondary metabolite present in all the solvent extracts. Hydroalcoholic extract showed highest presence of phenolic content (92.38±0.29 mg/g) GAE. Ethanol and methanol extract showed highest antioxidant capacity in DPPH, FRAP and PM assay as compared to the other extracts based on the test performed. The results confirmed that ethanol extract significantly (p

 > Abstract Id: YUGP0886 Top

Clinico Pathological Profile Of Male Breast Cancer Treated In A Regional Cancer Centre Of Eastern India


Co-author - Dr Niharika Panda, Dr Siba Sankar Mahapatra, Dr Sagarika Samantaray

ABSTRACT Male Breast Cancer is known to be an uncommon malignancy. Due to less number of cases available the research in the field is very few. The present study is aimed at finding the incidence, the age profile and the histological types and receptor status of male breast cancer cases treated in a Regional Cancer Centre in eastern India. Twenty seven cases of male breast cancer patients were registered in a regional cancer centre. The age wise incidence was observed. The clinicopathological profile like the histopathological pattern, the Tumour Node Metastasis (TNM) staging and the receptor status were analysed from case records. The median age of presentation in our study was found to be 61years. Out of the 27 cases 14 (51.85%) were found to be in advanced stage i.e stage III followed by 9(33.33%) cases in stage II. Apart from the common invasive duct carcinoma few uncommon variants like papillary, metaplastic, mucinous and invasive lobular were also found. In twelve numbers of cases (44.44%) the receptor status was ER +ve, PR +ve and HER-2 neu —ve followed by ER +ve, PR +ve and HER-2 neu +ve. Though maximum number of cases (45%) were found at age of 61-70 still a good number of cases (26%) are also registered at age of 51-60 and followed by 22% in 41-50 indicating that occurrence of male breast cancer is shifting towards younger age groups. Public awareness, early screening and detection shall be a must to have a better treatment response and quality of life. Keywords-male breast cancer, clinico pathological profile.

 > Abstract Id: YUGP0888 Top

Molecular Biomarker Microrna-296 May Prognosticate And Help Direct Future Therapies For Squamous Cell Carcinoma Oesophagus

Presenter- *Dr. Vinay Gaikwad

Co-author - Anuj Jain, Robin Thambudorai, Nalini Carlton

Introduction Squamous cell carcinoma (SCC) oesophagus is one of the most common and fatal cancers in India. The prognosis of affected patients remains unsatisfactory despite the advances in therapeutic options such as surgery, chemotherapy and radiation therapy. Consequently, there is a great need for molecular biomarkers to allow a tailored multimodal approach with increased efficacy. MicroRNAs are involved in biological and pathological processes. More specifically, microRNA-296 expression has been demonstrated in SCC oesophagus tissue samples and may be linked to the prognosis based on the level of expression. Materials and Methods Paraffin-embedded biopsy blocks of patients diagnosed with SCC oesophagus from 1st November 2008 to 31st October 2011 were procured from the department of pathology, Christian Medical College and Hospital, Ludhiana. Following appropriate sample processing, the miScript SYBR Green PCR kit (Qiagen) was used for the first strand synthesis with PCR primers. This was followed by microRNA expression profiling using a real-time PCR machine (Rotor-Gene Q, Qiagen). Two variants of microRNA- 296 expression were calculated: miR296-3p and miR296-5p. Results There were a total of 30 patients included in the study, out of which 29 were cases and one was control. Treatment modalities included surgery, chemoradiation, chemotherapy, and palliative care. The mean follow up period was 8.3 months. The majority of patients died within one year of diagnosis with a mean survival of 9.3 months. The patients with high expression of the miR296-5p marker experienced longer survival. In Stage IV disease, miR296-5p expression was low. On applying log rank test, the p value was 0.03, which was statistically significant. The results derived from the Kaplan-Meier survival curve of miR296-3p were not statistically significant. Conclusion MicroRNA-296 may be a useful biomarker to prognosticate patients with SCC oesophagus. It can be postulated that by its downregulation, microRNA-296 shows promise as a potential target for intervention in this malignancy.

 > Abstract Id: YUGP0889 Top

Radio-Guided And Endoscopic Assisted Organ Preservation Surgery For A Cirrhotic Patient With Multiple Duodenal Neuroendocrine Tumors

Presenter- *Dr. Vinay Gaikwad

Co-author - Jyoti Bhat, Noaline Sinha,

Introduction Major abdominal surgery in patients with cirrhosis carries a significant risk of hepatic decompensation. In relatively indolent conditions such as low-grade neuroendocrine tumors, organ preservation is often sufficient to afford cure. Intraoperative assistance using nuclear medicine and endoscopy can assure complete tumour removal while avoiding major debilitating surgery. We describe a case scenario where these techniques have been utilized effectively. Materials and Methods A 56-year-old lady with Child A cirrhosis presented with symptoms of acidity and flushing. An upper endoscopy reported multiple lesions from D1 till the distal D2 (around 15 lesions), which were confirmed on histopathology to be grade 1 neuroendocrine tumors. A 68Ga-PET did not reveal extraduodenal disease. She had a history of decompensation and the risk of a Whipple procedure was unacceptably high. Results We performed radio-guided surgery using a hand held gamma probe, which detected an additional pancreatic head deposit. Intraoperative endoscopy was used to mark the proximal and distal extend of the duodenal lesions. A duodenotomy was then performed and each lesion was excised and repaired. Regional lymphadenectomy was also performed. The patient recovered smoothly and is disease-free for 21 months. Conclusion Intraoperative techniques such as radio-guided and endoscopic localization can assist in organ preservation, while ensuring complete tumour removal in selected patients with suitable results.

 > Abstract Id: YUGP0892 Top

Safety And Antitumor Activity Of Arsenic Trioxide (Ato) Plus Infusional 5-Fu, Leucovorin And Irinotecan (Folfiri) As Second-Line Treatment For Refractory Metastatic Colorectal Cancer: Preliminary Results From A Pilot Study

Presenter- *Dr. Tamojit Chaudhuri

Co-author - K C Lakshmaiah, K Govind Babu, Lokanatha Dasappa

Background: After failing oxaliplatin-based first-line chemotherapy (CT), about 4-21% of patients with metastatic colorectal cancer (mCRC) respond to irinotecan-based second-line treatment. Prolonged exposure of colon cancer cells to 5-FU induces resistance, due to increased synthesis of thymidylate synthase (TS). Earlier studies have demonstrated that ATO can significantly re-sensitize resistant colon cancer cells to 5-FU by down regulating TS. Moreover, ATO can also act as a vascular disrupting agent and has synergistic effect with irinotecan on tumor growth delay. We hypothesized that a combination of ATO with FOLFIRI regimen in mCRC patients refractory to first-line FOLFOX, could further improve the outcome of second-line CT. Methods: The inclusion criteria were: age ?18 years; pathologically proven mCRC; ECOG PS ?2; refractory to first-line FOLFOX; not affording for biologic agents due to economic constraint; adequate organ functions and measurable disease according to RECIST 1.1. Major exclusion criteria were: ?2 lines of previous CT for metastatic disease; congestive cardiac failure and evidence of brain metastases. Patients were administered ATO 0.15 mg/kg/day on days 1 to 2, along with FOLFIRI regimen at standard doses every 2 weeks, until disease progression, unacceptable toxicity or patients’ refusal. Responses to CT were reported according to RECIST 1.1. Adverse events were classified based on CTCAE v 4.0. Results: Between October 2016 and May 2017, 13 patients with refractory mCRC were treated with this investigational combination. The median age was 47 years (range, 32-65); 10 males and 3 females; ECOG PS 0-1/2, 12/1; site of primary tumor rectum/colon, 8/5. Median baseline serum CEA was 78 ng/ml (range, 18-836). The most common site of metastases was liver (n=7) followed by peritoneum (n=5), lungs (n=3) and non-regional lymph-nodes (n=3); number of involved metastatic sites 1-2/?3, 8/5. After 6 cycles of CT, overall response rate and disease control rate was 23% and 84.6% respectively (CR=0, PR=3 pts, SD=8 pts); approximately 69% of patients experienced a ?50% decline in serum CEA level. At a median follow-up of 5.5 months (range, 4-8), 7 patients had disease progression and kept on best supportive care; 6 patients were still on study drugs; and all 13 patients were alive. Median progression-free survival was 4.5 months (95%CI 3.8-5.2), from the initiation of ATO plus FOLFIRI. The toxicities were as follows: Grade 1/2 toxicity: fatigue (4 pts.), constipation (1), nausea and vomiting (1). Grade 3 toxicity: fatigue (3), neutropenia (2), diarrhea (2), QTc prolongation (1). No patient experienced grade 4 toxicities. Conclusions: The addition of ATO 0.15 mg/kg/day on days 1 to 2, to standard FOLFIRI regimen as second-line CT in patients with refractory mCRC offers an encouraging anti-tumor effect at the cost of manageable toxicity. Key-words: Refractory metastatic colorectal cancer, thymidylate synthase, ATO, FOLFIRI regimen

 > Abstract Id: YUGP0904 Top

Parameter Dosimetric Analysis Of Breast Irradiation Between Conformal Techniques, Field-In-Field, And Simultaneous Integrated Boost

Presenter- *Dr. Suherman Hadisaputro

Co-author - Soehartati Gondhowiharjo, ,

Breast cancer is second most common cancer in the world in 2008. In Indonesia, breast cancer is the most common cancer. Radiotherapy has an important role in breast cancer therapy but gives significant toxicity mainly heart, lung and can lead secondary contralateral breast cancer. Many techniques are performed to reduce the toxicity. The techniques include 3D conformal technique, field-in-field, and simultaneous integrated boost. These techniques already available in Cipto Mangunkusumo Hospital but the dosimetric comparison among these techniques is not available yet. This study is an retrospective study aimed to compare the dosimetric parameters of conformal technique, field-in-field, and simultaneous integrated boost. The study was performed in RSUPN Cipto Mangunkusumo, Jakarta in three months (2010, November until 2011, January). Target population was early stage breast cancer patients (stage I-II) who already had CT planning. Total sample was 10 patients. We compare the dosimetric parameters of patient irradiation therapy using these three techniques. No difference in terms of dose coverage of PTV V95% tumor on the left breast among the three techniques (969.73 cc vs 944.84 vs 914.24 cc, p = 0953). There is a statistically significant difference in terms of Conformity Index (1.001 vs 1.006 vs 1.010, p

 > Abstract Id: YUGP0906 Top

Management Of Thyroid Nodules With Atypical Cytology On Fine-Needle Aspiration With Ultrasonogram

Presenter- *Dr. Ajit Kushwaha

Co-author - ajit kumar kushwaha, GSN raju, subhransu jena

ABSTRACT : Objective: Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) are indeterminate lesions with malignancy incidence of 5-15%. We evaluate the role of thyroid ultrasound in predicting malignancy in Bethesda type III nodules, and thus suggest management guidelines in these nodules. Method: patient with Bethesda type III nodules were subjected to high resolution ultrasonography of neck. The features analyzed while performing US examination are size, site, echogenicity (solid, cystic), margins (circumscribed, micro lobular, irregular), calcification (micro, macro or egg shell) and shape of the lesion. On the basis of ultrasound these nodules were categorized into probably benign or suspicious of malignancy. All these patient were subjected to surgery and final histopathological report were compared with ultrasonographic features. Results: The positive predictive value of ultrasonogram in predicting malignancy in Bethesda type-III nodules is 84.2%, while specificity of ultrasonogram is 90.9% and sensitivity in predicting malignancy is 80%. Conclusion : When the USG features are suggestive of benign lesion then a repeat USG guided FNAC may be considered and when the USG features are suggestive of malignant lesion then a repeat FNA is unnecessary and a definitive surgery should be considered.

 > Abstract Id: YUGP0910 Top

A Bioequivalence Study Of Proposed Bevacizumab Biosimilar Myl-1402O (A) Vs Eu-Avastin (B) And Us-Avastin (C)

Presenter- *Ms. Lisa Medlen

Co-author - Matthew Hummel, Tjerk Bosje, Andrew Shaw

Background: MYL-1402O is a proposed bevacizumab biosimilar. The similarity of MYL- 1402O to Avastin has been demonstrated in physicochemical analyses and nonclinical studies. Methods: This single-center, randomized, double-blind, 3-arm, parallel-group study was conducted in healthy adult male volunteers. The primary objective of this study was to establish pharmacokinetic (PK) similarity of MYL-1402O (A) to EU-Avastin (B) and US-Avastin (C), and B to C. Subjects were randomized to receive either A, B, or C 1 mg/kg over 90 minutes as an intravenous infusion. Dose was selected based on the lower dose in the linear range of PK and acceptable safety in healthy volunteers. Bioequivalence was to be concluded if the 90% CIs of the ratios (A/B, A/C, and B/C) of least squares means of the natural log-transformed AUC0-? were within 80% to 125%. AUC0-t, Cmax, tmax, kel, and t½ were assessed as secondary PK parameters. Results: A total of 111 subjects (37/treatment) were enrolled and 110 (37 [A], 36 [B], 37[C]) were included in the analysis. Bioequivalence was demonstrated between A and B, A and C, and between B and C. Least squares mean ratios of AUC0-? were close to 1, and 90% CIs were within 80% to 125% for all comparisons (A/B, 89.23%-98.98%; B/C, 98.20%-108.93%; A/C, 92.32%-102.33%). The secondary PK parameters were also comparable, with the 90% CIs for ratios of AUC0-t and Cmax within 80% to 125%. A total of 313 treatment-emergent adverse events (TEAEs) were reported, 116 by 33 (89%) subjects who received A, 99 by 29 (78%) subjects who received B, and 98 by 28 (76%) subjects who received C. Most TEAEs were consistent with the clinical data for bevacizumab (Avastin). No serious or unexpected TEAEs were reported. The TEAEs were grade 1 or 2 in severity. Percentage of subjects positive for antidrug antibodies at each time point (predose and days 15, 43, 71, and 99) was comparable across the 3 treatments. Conclusions: These results confirm bioequivalence of MYL-1402O vs EU-Avastin and US-Avastin. All treatments were well tolerated and no significant safety issues emerged. Clinical trial information: NCT02469987

 > Abstract Id: YUGP0918 Top

Induction Chemotherapy In Locally Advanced T4B And Technically Unresectable T4A Oral Cavity Squamous Cell Cancers: Does It Improve Treatment Outcomes?

Presenter- *Dr. Tamojit Chaudhuri

Co-author - K C Lakshmaiah, K Govind Babu, Lokanatha Dasappa

Background: Surgical excision is the mainstay of treatment for oral cavity squamous cell cancers (OSCCs). The median survival of locally advanced unresectable OSCCs (T4b and technically unresectable T4a) with various non-surgical treatment modalities is only 2—12 months. We hypothesized that induction chemotherapy (IC) in this subgroup of patients could improve the overall treatment outcome by reducing the tumor bulk and allowing definitive surgery. Methods: Patients diagnosed with locally advanced unresectable OSCCs (T4b and technically unresectable T4a) from January 2013 and May 2017 at our center, who received 2-3 cycles of IC and then assessed for resectability, were reviewed retrospectively. After IC, patients were reassessed clinico-radiologically and planned for either definitive surgery with adjuvant CTRT or non-surgical treatment including definitive CTRT, palliative RT or best supportive care (BSC). The inclusion criteria were: age ?18 years, pathologically proven OSCC, ECOG PS ?2; and adequate organ functions. Major exclusion criteria were: previous therapy for OSCC, congestive cardiac failure and evidence of metastatic disease. Patients received either TP (paclitaxel 175 mg/m2 on day 1, and cisplatin 75 mg/m2 on day 1) or TPF (paclitaxel 175 mg/m2 /docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and 5?FU 750 mg/m2/d on days 1 to 5) as IC, every 3 weeks along with primary G?CSF prophylaxis. Responses to IC were reported according to RECIST 1.1. Adverse events were classified based on CTCAE v 4.0. Statistical analyses were performed by SPSS version 17. Results: Total 206 patients received either TP (n=180) or TPF (n=26) as IC. The median age was 44 years (range, 35-62); 78.2% were males; ECOG PS 0?1/2, 100%/0%; site of primary tumor buccal mucosa/gingivo-buccal complex/oral tongue, 73.8%/21.4%/4.8%; primary tumor grade I/II/III, 53.4%/38.8%/7.8%. Responses to IC were as follows: partial response in 31 (15%) patients, stable disease in 140 (68%) patients and disease progression in 35 (17%) patients. All grade 3-4 toxicities were higher with TPF than TP regimen: neutropenia (30.8% vs. 12.2%), febrile neutropenia (19.2% vs. 4.4%), mucositis (15.4% vs. 6.1%) and diarrhea (11.5% vs. 2.8%). Post-IC, resectability was achieved in 35 (17%) patients (7 in TPF arm and 28 in TP arm); but 9 of them did not undergo surgery due to logistic reasons. The median survival of patients who underwent definitive surgery followed by adjuvant CTRT (n=26, 12.6%) was 19.4 months (95% CI: 16.4-22.3) and for those treated with non-surgical local therapy (n=180) was 7.6 months (95% CI: 6.2-8.8) (log-rank p = 0.000). Conclusions: This study suggests that IC is effective in converting locally advanced unresectable OSCCs to operable disease in a significant proportion of patients and has the potential to improve survival outcomes in that patient population, in comparison to non-surgical treatment. Key-words: Induction chemotherapy, oral cavity squamous cell cancers, resectability

 > Abstract Id: YUGP0920 Top

Tetanus From A Synovial Sarcoma Occuring With A Synchronous Malignancy- Extragonadal Germ Cell Tumor: A Case Report

Presenter- *Dr. Christian Cesar Esplana

Co-author - Graciex Fernando, ,

BACKGROUND: Tetanus in a cancer patient is uncommon. Primary Extragonadal teratoma and synovial sarcoma are uncommon malignancies and both occurring simultaneously is extremely rare. We report a case of tetanus in a patient with a synchronous double primary malignancy. CASE PRESENTATION: We report a 21-year old Filipino man presenting with trismus, opisthotonus, difficulty in breathing and seizures. On physical examination, a fungating mass on the 1st distal phalanx of his left foot and an enlarged left thigh mass was noted. Due to persistent desaturation, he was intubated, placed on mechanical ventilatory support and subsequently underwent tracheostomy, He was given tetanus immunoglobulin, tetanus toxoid, penicillin G, metronidazole and diazepam. He underwent ray amputation of left big toe with wide excision of the tumor and biopsy of the thigh mass which revealed synovial sarcoma and immature teratoma, respectively. CT Imaging of the chest, abdomen and bone scan was unremarkable. MRI of the left thigh showed a large thigh mass measuring 9.4x8.3x 5.5cm with aggressive features, unremarkable regional lymph nodes and osseous structures. Two weeks post biopsy, the thigh mass progressively enlarged, became necrotic associated with a foul smelling discharge and moderate to severe pain. He underwent wide excision of the thigh mass. Histopathology revealed an extragonadal immature teratoma with lymphovascular space invasion supported by immunohistochemistry. After nutritional up-building, the patient underwent and completed 4 cycles of chemotherapy with Etoposide-Cisplatin regimen. There was no recurrence of mass lesions. CONCLUSION: Tetanus in the setting of a malignancy is treatable with prompt medical, surgical and supportive management. In the setting of a known primary malignancy, a thorough and comprehensive history, physical examination and metastatic work-up should always be performed for the diagnosis of a synchronous malignancy. In the setting of a non-metastatic disease, treatment should be individualized for both malignancies with the aim of cure.

 > Abstract Id: YUGP0924 Top

Use Of Thought Diary, Imagery Technique And Thought Distraction To Reduce The Anxiety And Negative Automatic Thought In A Cancer Patient With Multiple Organ Problems.


Co-author - Dr. S. Ganapathy Ramanan, ,

Mr. P.S 47 year old male hailing from a middle class family of Thiruvullur district of Tamil Nadu, was apparently normal until 04th October, 2014 and was admitted to Kumaran Hospital, Chennai on 04th October, 2014 with chief complaints of breathlessness and general weakness. On 06th October, 2014 morning patient developed respiratory problems and shifted to ICU for further care and later a Tracheotomy was done to ease the breathing and to safe guard life of the patient. Later during the ICU stay, the ICU in-charge doctors and nurses found some changes in the behavior of the patient and the patient referred to Psychiatrist and Psycho-oncologist, psychiatrist diagnosed the problem as acute confusion stage with low Potassium and Sodium level. After two days of medical management psycho-oncologist met the patient and the patient reported high levels of anxiety and negative automatic thought associated with uncertainty in diagnosis, returning to normal speech and life, death anxiety, about family’s future. During this time level of anxiety on HADS was 19. At this stage psycho-oncologist started thought distraction and imagery in the beginning and a week later thought diary also started to deal with anxiety associated with uncertainty about the diagnosis of the disease and negative automatic thought. After 3 weeks of continues and vigorous training the patient reported that the intensity and rate of negative automatic thought was decreased significantly and the score (TOTAL SCORE = 12) in HADS showed that there is a significant reduction in the level of anxiety.

 > Abstract Id: YUGP0928 Top

Low Grade, Multiple, Ta Non-Muscle Invasive Bladder Tumors: Tumor Recurrence And Worsening Progression

Presenter- *Dr. Rajendra Nerli

Co-author - Rajendra Nerli, Shridhar C. Ghagane, Shankar K

Introduction: Nearly half of newly diagnosed cases of bladder cancer are low grade, noninvasive and papillary tumors. The standard treatment for non-muscle invasive bladder cancer (NMIBC) has been transurethral resection of the bladder tumor (TUR-BT) with or without adjuvant intravesical instillation (IVI) of chemotherapy or Bacillus Calmette-Guerin (BCG) therapy. NMIBC is known to be associated with high rates of recurrence and risk of progression. In this study we have retrospectively analyzed the clinical outcome of initially diagnosed multiple low grade Ta tumors, with a special focus on tumor recurrence and worsening progression (WP) pattern. Materials & Methods: We retrospectively reviewed 42 patients with primary, multiple, low grade Ta bladder cancer. We defined WP as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinico-pathological factors and tumor recurrence as well as WP pattern were analyzed. Results: Tumor recurrence and WP occurred in 23 (54.76%) and 8 (19.04%) patients during follow-up (median follow-up: 57.38 months), respectively. WP to high grade/stage was seen in 8 patients. Multivariate analysis demonstrated that use of tobacco (p < 0.0001) and absence of IVI (p < 0.0001) were significant risk factors for tumor recurrence. The 5- year recurrence free survival rate for non-tobacco users (74.0%) was significantly higher than that for tobacco users (42.5%, p = 0.0001), and also higher for patients receiving intravesical instillation (84.2% vs. 30.0% without IVI, p = 0.0001) Conclusions: Recurrence is common, in patients with low grade, Ta bladder cancer, especially in the setting of multiplicity. Recurrences occurred in 54.76% of patients and WP occurred in 19.04% of patients. Use of tobacco and non-use of IVI was strongly associated with high recurrence rate.

 > Abstract Id: YUGP0934 Top

The Use Of Human Epididymis Protein 4 And Risk Of Ovarian Malignancy Algorithm For Prediction Of Ovarian Carcinoma In Women With Ovarian Tumors

Presenter- *Dr. Kanwarneet Singh

Co-author - Prof G.Suryanarayana Raju, ,

Objective : The purpose of this study was to evaluate the diagnostic performance of human epididymis protein 4 (HE4), CA125 and the Risk of Ovarian Malignancy Algorithm (ROMA) for distinguishing between benign and malignant ovarian masses in women presenting with ovarian tumors. Material and Methods: This was a prospective study done at Nizam’s institute of Medical sciences from September 2015 to March 2017. 92 patients who had an ovarian mass on imaging and were scheduled to undergo surgery were included in the study. Serum CA125 and HE4 were measured on preoperative samples. ROMA was calculated for each sample. Results: A total of 92 women with an ovarian mass were evaluated, of which 30 had ovarian cancer, 5 had borderline tumors and 57 had benign tumors. Compared to CA125, HE4 had improved specificity (98.4% vs 63.1%) but similar sensitivity for differentiating between benign ovarian mass and ovarian carcinoma. ROMA had similar senstivity (91.4% vs 88.57%) as CA125, but showed improved specificity (82.4% vs 63.1%). ROMA accurately predicted 82.4% of benign cases as low risk, and 90% of all ovarian cancers as high risk . Median serum CA125 and HE4 levels were higher in patients with ovarian carcinoma compared to subjects with benign disease. HE4 was within the reference range in all 6 patients of endometriosis while CA125 was elevated in 5 of these patients. CA125 was raised in 37% of benign cases while HE4 was raised in 10% of benign cases. A normal HE4 level was strongly suggestive of benign disease regardless of the CA-125 result and ruled out ovarian Carcinoma in nearly 90% of premenopausal women with elevated CA125. Conclusions: HE4 and ROMA index is of help in the triage of ovarian masses into benign and malignant groups with performance better than CA125.

 > Abstract Id: YUGP0942 Top

Effects Of Laterality And Grade On Cognition In Patients With Glioma Prior To Surgery

Presenter- *Dr. Sandhya Cherkil

Co-author - Liza Mary Cherian, Dilip Panikar, Deepak Kuttikattu Soman

Background: Tumor site, laterality, and tumor grade are some of the tumor variables which determines the extent and severity of the cognitive deficits. This study aims to understand the effects of laterality and grade on cognitive functions in patients with glioma who are to undergo surgery for the tumor Methods: The study included 108 consecutively referred patients to the neuropsychologist. Mean age of the patient group was 47.1 years. There were 35 patients with low grade glioma and 73 patients with high grade tumor. Out of the sample, 58 of them had tumor on the left, 38 of them had right sided tumor and 12 of them had tumors in the deep structures of the brain. Each of the patient was assessed with the neurocognitive assessment tools. The cognitive functions assessed were visuospatial function, logical memory, auditory verbal memory, rate of learning, executive functions, information processing speed, auditory attention span and working memory. Chi Square was used to find the association between laterality and grade of the tumor with cognitive variables. Significance was assumed at p

 > Abstract Id: YUGP0944 Top

Laterality And Gender: Psychological Morbidities In Pre Op Patients With Glioma

Presenter- *Ms. Liza Cherian

Co-author - Sandhya Cherkil, Dilip Panikar, Deepak Kuttikattu Soman

Background: Brain tumors often have psychological co morbidities of anxiety and depression, caused by the tumor itself and the treatment regimens, as well as the financial and psychological demands made on the patient. The study examines the anxiety and depression levels in the patients diagnosed with glioma, who are to undergo surgery. Method: The study included 96 consecutively referred patients to the neuropsychologist. Mean age of the patient group was 47.1 years. There were 35 patients with low grade glioma and 73 patients with high grade tumor. Out of the 96 patients, 58 of them had tumor on the left, and 38 of them had right sided tumor. In depth assessment of the life stressors and personality of the patients were done in the intake interview. Anxiety and depression were assessed and scored using Hospital Anxiety and Depression Scale. Chi Square was used to find the association between laterality and gender of the tumor with anxiety and depression. Significance was assumed at p

 > Abstract Id: YUGP0948 Top

Postoperative Complications And Outcome In Patients Undergoing Minimal Invasive Esophagectomy For Esophageal Cancer.

Presenter- *Dr. Nikhil Dharmadhikari

Co-author - Dr Amit Patil, Dr Nikhil Gulavani, Dr Rajesh Mistry

Postoperative Complications and Outcome in Patients undergoing Minimal Invasive Esophagectomy For Esophageal Cancer. Presenter - Dr Nikhil Dharmadhikari Co-author — Dr Amit Patil, Dr Nikhil Gulavani, Dr Rajesh Mistry Centre for Cancer, Kokilaben Dhirubhai Ambani Hospital, Mumbai Aims and Objectives To confirm the perceived advantages of Minimal Invasive Surgery in terms of postoperative morbidity and morbidity. Materials and Methods All patients with biopsy proven esophageal carcinoma, either Squamous cell carcinoma or Adenocarcinoma, undergoing Minimal Invasive Esophagectomy will be recruited in the study. MIE will include all those patients undergoing MIE (thoracoscopy + laparoscopy) and Hybrid MIE (laparotomy with thoracoscopy or laparoscopy with thoracotomy). Patients with conversion to open surgery will be excluded from the study. All patients will undergo routine evaluation, including history and physical examination, chest radiography, esophagoduodenoscopy and CECT of the chest and abdomen and PET scan if indicated. Patients will be followed up during OPD visits. The categorical data will be summarised by frequency count and percentages of the categories. To prove the statistical significance , Chi-square / Fishers exact test test will be used at 5% level of significance. Results We studied 60 patients who underwent minimal invasive esophagectomy during the study period. The mean age of patients was 60.2 yrs with 63.33% males and 36.67% patients being females. Of the 60 patients 55% had lower esophageal and GE junction growth while 38.33% patients had middle third lesion and 6.67% were upper esophageal lesions. Twenty nine patients underwent NACT followed by surgery while 31 patients were taken up for primary surgery. Hybrid MIE- 3 field was done in 78.33% of patients, 10% underwent total MIE, 3.33% underwent Hybrid Ivorlewis and 8.33% underwent laparoscopic transhiatal esophagectomy. Pulmonary complications accounted for 16.67% and were the commonest to occur while CVS complications occurred in 15% of patients. Minor wound complication accounted for 6.67%. Cord paresis due to injury to the recurrent laryngeal nerve intraoperatively occured in 11.67% of patients while in 3.33% of patients developed leak postoperatively. Conduit related problems like tube dilatation, anastomotic stricture occurred in 6.66%. Postoperative mortality was 3.33%. Of the 60 patients, 58 were followed up (2 died postoperatively), 51 patients (85%) are disease free, 1 patient (1.67%) is alive with local recurrence, 3 patients (5%) are alive with distant metastases, 2 patients (3.33%) have died of disease while one patient (1.67%) died of other cause. Conclusion Several minimally invasive esophagectomy techniques have been described and represent safe alternatives for the surgical management of esophageal cancer. We have demonstrated that MIE is feasible and safe, with low mortality, acceptable morbidity. The data suggest that operative morbidity and mortality is not significantly different between open and MIE. The data however are severely limited in that the majority of the studies are either retrospective case series, or case control studies, or meta-analyses of retrospective case control studies—all limited by both selection and publication bias with only two randomised control trials in the literature, both reporting advantage of MIE over open esophagectomy. Further prospective, randomized studies are are needed to clarify the role of MIE in the surgical treatment of oesophageal cancer.

 > Abstract Id: YUGP0962 Top

A New Shield For Intraoperative Electron Radiotherapy In Early-Stage Breast Cancer

Presenter- *Dr. Mariko Kawamura

Co-author - Takeshi Kamomae, Yoshiyuki Itoh, Tohru Okada

Purpose: Intraoperative electron radiotherapy (IOERT) can be safely performed in patients with breast cancer by using a shield disk made of hard acrylic resin and copper. However, the shielding disk must be larger than the irradiated field, which leads to large scars with poor cosmetic outcomes. The purpose of our study was to design a new shield that can be inserted via smaller scars and inflated to the size of the irradiated field. Herein, we will report the basic assessment of our newly designed shield consisting of a breast tissue expander and contrast media. Materials and methods: The radiation shielding performance of the contrast media consisted of three different mixture ratios of iodine (240 mg/ml, 300 mg/ml, and 350 mg/ml) that were verified in contrast to water by experimental measurements using 9- and 12-MeV electron beams. The acrylic container filled with water or contrast media was placed at a depth of 90% of the percentage depth dose (PDD) curves in each beam, and the doses at the entrance and exit of the acrylic container were measured. Results: The 90% values of the PDD curve (R90) were 28 and 38 mm for 9- and 12-MeV beams, respectively. The measured doses at the entrances of the acrylic containers filled with water, 240 mg/ml, 300 mg/ml, and 350 mg/ml of contrast media were 94.2%, 96.3%, 100%, and 99.1%, respectively, for the 9-MeV electron beam, and 89.9%, 98.0%, 98.7%, and 99.0%, respectively, for the 12-MeV electron beam, showing larger back scatter with contrast media. The transmitted doses at the exits of the acrylic containers were 18.5%, 3.7%, 2.4%, and 2.2%, respectively, for 9-MeV electron beam and 47.2%, 25.7%, 19.5%, and 20.6%, respectively, for 12-MeV electron beam. The Monte Carlo simulation doses agreed within 2.0% of the experimental doses. The entrance dose of the breast tissue expander was 95% for the 12-MeV electron beam when filled with water, which was 5% greater than that for the acrylic container filled with water. Conclusion: The new shield consists of a breast tissue expander filled with contrast media that may reduce the transmitted dose by more than half in contrast to water while maintaining the uniform dose to the target, which may enable IOERT with smaller scars in patients with breast cancer. This new technique may improve the cosmetic outcomes of patients with breast cancer who undergo IOERT.

 > Abstract Id: YUGP0964 Top

Free Flap €” Are They A Boon? : A Quality Of Life Analysis

Presenter- *Dr. Shitanshu Sharma

Co-author - Shashank Nath Singh, Mohnish Grover, Nishi Sonkhiya

Background We always assess the treatment being administered to the cancer patients in terms of 5-year survival often ignoring the quality of life which the patient has. Life is not something to be quantified without making it better. It is not just about prolonging the duration of survival. This study is being carried out in our institution to emphasize on this aspect of patients’ life rather than just counting the years he lives after being diagnosed and treated for cancer. During this study all the University of Washington quality of life (UW-QOL) data collected in the institute since July 2014 of the patients who underwent free flap microvascular reconstruction after ablative oral cavity cancer surgery was analyzed. Methods This ongoing study comprises of 51 patients who underwent surgery for oral cavity squamous cell carcinoma followed by free flap reconstruction at SMS Medical College and Hospital since July 2014. The patients were asked to complete the UW-QOL questionnaire (validated Hindi version). The questionnaire represents the patient’s own perception of their level of QOL. Version 4 of the UW QOL, in use since 2000, has 12 domains, a question that asks patients to choose up to three domains of most importance to them and three global questions about their health-related and overall QOL. Overall QOL includes not only physical and mental health, but also many other factors, such as family, friends, spirituality or personal leisure activities that are important to the enjoyment of life. Results and discussion The cohort comprised 51 patients. Mean age was 56.6 years. 82.35% were men and 17.65% were women. T3/T4 advanced tumors were present for 35.29%. All the patients had free-flap surgery and 41 patients (80.4%) had adjuvant radiotherapy. The patients rated swallowing, speech and chewing as top 3 domains of concern. Overall, when asked what their HRQOL had been like during the previous 7 days, patients replied as: 2(3.92%) outstanding, 17(33.33%) very good, 20(39.21%) good, 9(17.64%) fair, 2(3.92%) poor and 1(1.96%) very poor. Overall, QOL not only includes physical and mental health but also many other important factors, and the patients rated their overall QOL in the previous 7 days as: 3.92% outstanding, 33.33% very good, 33.33% good, 23.53% fair, 3.92% poor and 1.96% very poor. Conclusion UW QOL provides an important tool to assess the quality of life a patient leads after he is cured of the disease. The study pins the importance to the patient’s aspect of the treatment outcome. Stage of the disease and radiotherapy were seen to affect domain scores. Studies have shown that patients reconstructed with free flap had a better appearance and better shoulder function as well as better role emotion when compared to those patients reconstructed with other loco-regional flaps. The composite score and overall QOL as assessed using the UW-QOL scale (version 4) were modestly high in our series of patients who had undergone free flap reconstruction.

 > Abstract Id: YUGP0968 Top

Retrospective Review Of Operable Carcinoma Esophagus €” Our Institutional Experience

Presenter- *Dr. ROHIT JHA


Aim:- To assess the outcomes of carcinoma esophagus operated in our institute and the possible lessons learnt. Materials and methods:- A retrospective analysis of 88 patients of carcinoma esophagus operated in the year 2013-14 in our institute was done. These patients were evaluated in terms of neo-adjuvant treatment given, surgery done, post surgical results and follow-up. All patients of carcinoma esophagus stage T2 or greater were considered. Advanced cases were excluded from our study. Results:- 65% of patients were between 40-60 years of age . Male and females were equally affected. 89% of cancers were in lower 1/3rd (32cm or lower). 70% were Squamous cell carcinoma and rest adeno carcinoma. 54% of patients were directly operated, 30% received NACT(neo-adjuvant chemotherapy) and 5% received NACT+ RT(neo-adjuvant chemo-radiation) and 1 patient was operated after palliative RT due to good response. 62% of patients were pathologically N0.Highest nodal positivity was among surgery group (44%) and NACTRT had the lowest rate (23%). Post-operative mortality rate was 11% and complication rate was 33% of which 62% were respiratory. NACT+RT group had maximum post operative morbidity. NACT group had the lowest recurrence and mortality rate (7.6% each) at 2 years, while surgery group had the highest recurrence rate (12.5%) and the NACTRT group had the highest mortality rate (23%). Discussion:- thus NACT has shown the best outcome in terms of survivorship. NACTRT has high morbidity and mortality rates in our study despite having better loco-regional response. Poor socio-economic status and poor general health of the patient could contribute to this as compared to western countries. CONCLUSION:- our study favours NACT followed by surgery to be the best treatment modality for carcinoma esophagus patients in the Indian scenario with the least recurrence and mortality rates.

 > Abstract Id: YUGP0970 Top

Comparitive Study Of Clinico-Radiological And Histopathological Staging In Oral Cancer Patients

Presenter- *Dr. ROHIT JHA


Aim:- to compare the accuracy of clinic-radiological staging of cancer patients in comparison with the final histo-pathological staging in patients of buccal mucosa cancer. Materials and methods:- a retrospective analysis of 260 patients of buccal mucosa cancer operated in our institute in the year 2015 was made. A comparative study was then done between the stage of the disease by clinic-radiological assessment and the final histo-pathological stage obtained. Also compared was the accuracy of the conventional C.T. scan in detecting bony involvement in these patients when compared to the histo-pathological data. Results and discussion:- it was seen that clinico-radiological staging had an accuracy of 82.6% in detecting T1 lesions, 51.54% in detecting T2 lesions, 41.6% in detecting T3 lesions and 77.5% in detecting T4 lesions. Accuracy of detecting bony involvement by CT scan was 77.3% with false positive of 7.3% and a false negative of 15.4%. Conclusion:- thus clinico-radiological accuracy was seen to be greater in T1 and T4 lesions as compared to T2 and T3 lesions. This could be due to the difficulty in accurately measuring the tumor dimensions, as well as due to a change in the tumour size post surgical resection. CT scan was shown to have a high false negative rate in detection of bony erosion as well as a significant false positive rate.

 > Abstract Id: YUGP0974 Top

Effect Of External Radiation To The Formation Of Micronucleus In Buccal Mucosa’S Epithelial Basal Cell In Head And Neck Cancer Patients

Presenter- *Dr. Arundito Widikusumo

Co-author - Rosita Anggraeni, A. Haris Budi Widodo, Schandra Purnamawati

ABSTRACT Introduction: External radiation for head and neck cancer may induce damage on healthy cell’s chromosome in buccal mucosa which is characterized by the formation of basal cell micronucleus Method: This study uses pretest protest control group design. As much as 17 head and neck patients in the Department of Radiotherapy, Prof. dr. Margono Soekarjo hospital were involved. Subject were divided into 2 groups, 10 patients underwent external radiation with 10 x 2 Gy dosage and 7 patient were control group who were untreated with external radiation. The sampling of buccal mucosa swab were conducted on day 0 and day 14. The swab were stained with Modified Fuelgen method. The number of micronucleus were analyzed using Paired T-test for each group and Independent T-test to compare between both group. Result: Means of micronucleus count per 1000 cells on day 0 and day 14 for treatment group were 7,83 ± 1,14 and 19,06 ± 1, 53, while in control group were 7,62 ± 1,14 and 8,43 ± 1,10. Escalation of micronucleus count for treatment group were 11,2 ± 1,74 (p0,05). Micronucleus count for treatment group was significantly higher compared to control group (p

 > Abstract Id: YUGP0976 Top

Role Of Biopsy Tract Excision During Surgery In Extremity Osteosarcoma After Neoadjuvant Chemotherapy

Presenter- *Dr. Sivakumar Mahalingam

Co-author - Anandraja, ,

Background: Biopsy for osteosarcoma is usually performed by a needle biopsy. Osteosarcoma being a chemo-sensitive malignancy, neoadjuvant chemotherapy can sterilize the biopsy tracts. Purpose: Our primary purpose was to see if disease is present in needle tract biopsy scars excised during surgery following neoadjuvant chemotherapy in extremity osteosarcoma and the need to remove the same. Methods: A retrospective study of 150 consecutive patients treated at our Institution. Inclusion criteria: Patients having extremity osteosarcoma with a needle biopsy performed at our Institution and having surgery after neoadjuvant chemotherapy. Histology on biopsy tracts were standard reporting format. Exclusion criteria: Extremity osteosarcoma undergoing straight surgery. Biopsy performed outside our Institution. All open biopsies. Results: 150 patients were included in the study. All patients received neoadjuvant chemotherapy. 80(53.33%) patients underwent surgery after 3 cycles of chemotherapy, 62(41.33%) underwent surgery after 4 cycles, 8 patients underwent surgery after 6 cycles of chemotherapy. The sites were distal femur(68%) followed by proximal tibia(29.33%) and the proximal humerus(2.66%). 139 patients (92.66%) patients underwent limb salvage surgery and the remaining underwent amputation (7.34%). On histopathology only two patients had residual tumour in the biopsy tract, on review of the records, both patients had progression on chemotherapy and underwent amputation. 13 patients had complete pathological response to neoadjuvant chemotherapy. 79 patients had response rate > 90%, 27 patients had response rate between 60-90% and the remaining had response less than 60%. 7 patients had local recurrence during follow-up. Conclusion: In patients who have a needle biopsy and later undergo surgery for extremity osteosarcoma following neoadjuvant chemotherapy, the role of excision of biopsy scars is questionable.

 > Abstract Id: YUGP0978 Top

A Retrospective And Prospective Study Of Clinical, Radiological And Pathological Parameters In Determining Neck Metastases In Early Stage Anterior 2/3Rd Carcinoma Tongue

Presenter- *Dr. GARIMA DAGA

Co-author - Sanjay Sharma, ,

Basis of study: To study clinical, radiological and pathologic predictive factors to determine cervical nodal metastasis in early stage carcinoma of anterior 2/3rd of the tongue in our Indian cohort. Material and methods: A retrospective and prospective study was conducted on fifty patients with early carcinoma tongue of anterior 2/3rd tongue from January 2011 to June 2015. All patients underwent primarily surgical treatment i.e. glossectomy and neck dissection. Data regarding clinical parameters including age, T stage (cT stage), growth pattern, radiological parameters including tumor size, radiological tumor thickness (RTT) and pathological parameters including pathological tumor size (pT stage), grade of differentiation, pathological tumor thickness (PTT), perineural and lymphovascular invasion (PNI and LVI) and margin status and pattern of invasion was collected and correlated with presence or absence of neck metastasis. Statistical performance of each categorical variable including cT, RTT, pT, PTT, PNI, and LVI was calculated terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) to predict cervical lymph node metastasis. Results: cT, RTT, pT and PTT were found to be the most significant predictors (p

 > Abstract Id: YUGP0981 Top

Solid Pseudopapillary Neoplasm Of Pancreas In Male: A Rare Entity

Presenter- *Dr. GARIMA DAGA

Co-author - Prashant Kerkar, ,

Introduction: Solid pseudopapillary neoplasm (SPN) is a rare pancreatic neoplasm with a reported incidence of 0.1% to 2.7% of all pancreatic tumors. It typically affects young women with female to male ratio of 10:1. It usually shows an indolent behavior and often detected incidentally on imaging. Pathological and/or cytological evaluation remains the gold standard in establishing a definitive diagnosis. SPN carries good prognosis without any need of adjuvant treatment in most cases, even in the presence of metastatic disease. We hereby present a case of SPT in a 34 year old male with its clinical, diagnostic and management details. Material and methods: A 34 year old male was incidentally detected to have a pancreatic lesion on routine health check up. Abdominal USG revealed a 4 x 3.5 cms solid hypoechoic lesion in pancreas without any calcifications and liquefaction. Pancreatic protocol computed tomography revealed a well circumscribed 4 x 4 cms heterogeneously enhancing mass in head neck region of pancreas. EUS FNA revealed solid and cystic pseudopaillary neoplasm of pancreas. Tumors markers were within normal limits. Pylorus preserving pancreaticoduodenectomy was performed. Post operative course was uneventful Results: Final histopathology revealed SPN of pancreas which was confirmed on immunohistochemistry which was positive for CD 10, CD 56 and PR. Patient is doing fine till 18 months of follow up. Conclusion: SPN of the pancreas should be considered in the differential diagnosis of any pancreatic mass in a young male despite of its rare incidence. SPN possesses a low malignant potential and complete surgical resection with clear margins is the treatment of choice and following R0 resection, SPN has an excellent prognosis

 > Abstract Id: YUGP0997 Top

Multi-Institutional Clinical Studies Of Chemoradiotherapy For Cervical Cancer Among Asian Countries Under The Framework Of Forum For Nuclear Cooperation In Asia (Fnca)

Presenter- *Prof. Masaru Wakatsuki

Co-author - Shingo Kato, Tatsuya Ohno, Yaowalak Chansilpa

The Forum for Nuclear Cooperation in Asia (FNCA) is a Japan-led cooperation framework for peaceful and safe use of nuclear science and technology in Asia. Under this framework, ten projects are currently underway, and radiation oncology project is one of them. This project was launched in 1993, and recently eleven countries has been participating in the project, including BGD, CHA, IDN, JPN, KAZ, KOR, MAL, MON, PHL, THA, VTN. The purposes of the project are to establish optimal treatment protocols of radiotherapy and chemotherapy for predominant cancers in Asia, and to improve the quality of radiotherapy in the FNCA member countries, and finally to improve treatment outcomes for predominant cancers in Asia. For these purposes, we have been conducting several activities, including international multi-institutional clinical studies of radiotherapy (RT) or chemoradiotherapy (CRT) for various cancers and physical quality assurance and quality control (QA/QC) of radiotherapy. Since the project started in 1995, we have conducted four multi-institutional clinical studies of RT or CRT for advanced cervical cancer among the FNCA member countries. In the first study (Cervix-I, 1996-2003), we standardized RT for cervical cancer, because various differences in RT techniques existed among the countries. We treated locally advanced cervical cancer patients according to the standardized protocol, and achieved favorable treatment outcomes. In the second study (Cervix-II, 1999-2006), we built a protocol of accelerated hyperfractionated RT to the pelvis and evaluated its toxicity and efficacy, because it was difficult to use CRT in some developing countries at that time due to technical and socio-economic constraints. In the third study (Cervix-III, 2003-2010), we conducted a phase II clinical study of CRT for locally advanced cervical cancer. We treated patients with locally advanced cervical cancer with concurrent RT and weekly cisplatin chemotherapy, and achieved favorable treatment outcomes with acceptable toxicities. In the fourth study (Cervix-IV, 2009-), we have been conducting a phase II clinical study of concurrent extended-field RT and weekly cisplatin chemotherapy for node positive locally advanced cervical cancer. When conducting the first clinical study, we experienced many problems and difficulties; 1) wide differences in the cultural and socio-economic status among countries, which may have resulted in large imbalance of patient enrollment, 2) wide differences in cancer imaging among institutions, which may have resulted in staging error, 3) poor compliance with the treatment protocol, and 4) poor follow-up rate. With the dedicated efforts of the physicians of the study group, these problems have been solved, and the quality of the recent Cervix-III and IV studies have been improved with the excellent compliance with the protocols and follow-up rates. Cervix-III protocol has become one of the standard treatment protocols of CRT for cervical cancer in the FNCA member countries. Radiation Oncologists and medical physicists in the FNCA member countries have been trained through conducting clinical studies. And the network established by the FNCA project has the potential to promote and strengthen further international cooperation in the field of radiation oncology in Asia. We will initiate a new clinical study of 3D image guided brachytherapy for cervical cancer this year.

 > Abstract Id: YUGP1004 Top

Incidence And Risk Factors Of Oral Candidiasis In Head And Neck Cancer (Hnc) Patients Receiving Radiotherapy (Rt) Or Concurrent Chemoradiotherapy (Ccrt)

Presenter- *Ms. Somying Wongsrita

Co-author - Imjai Chitapanarux, ,

Objectives: The purpose of this study was to estimate the incidence and determine risk factors of oral candidiasis in HNC patients receiving RT or CCRT. Methods: Sixty-five patients were examined weekly during RT to identify oral candidiasis. Swab cultures for fungi were obtained before RT (baseline), between the 15th -17th fraction of RT (mid) or immediately diagnosis of oral candidiasis, and immediately after complete RT (final). Results: The incidence of oral candidiasis in our study was 61.54% and the median occurrence of clinical oral candidiasis was 16th fraction (range 7th to 33rd fraction). The incidence of fungal colonization was 33.85%, 65.57%, and 54% at baseline, mid, and final, respectively. The dominant of fungal species were Candida albicans. After multivariate analysis, the significant factors for oral candidiasis were female (OR = 30.36 (95% CI: 2.99 to 308.63; P = 0.004)), increased age (OR = 1.10 (95% CI: 1.03 to 1.18; P = 0.007)) and lidocaine HCl viscous using (OR = 9.82 (95% CI: 1.19 to 80.37; P = 0.03)). While benzydamine HCl using (OR = 0.02 (95% CI: 0.005 to 0.59; P = 0.02)) associated with decreasing infection rate. Conclusions: There is quite high incidence of oral candidiasis in HNC patient receiving RT or CCRT in this study. The significant risk factors were female, increased age and lidocaine HCl viscous using.

 > Abstract Id: YUGP1016 Top

Young Onset Rectal Cancer- Live Fast, Die Young? Insights From A Tertiary Care Standalone Oncology And Research Institute

Presenter- *Dr. Ruparna Khurana

Co-author - Swarupa Mitra, Manoj Kumar Sharma, Inderjit Kaur Wahi

BACKGROUND: There has been a dramatic increase in the incidence of rectal cancer in patients younger than 50 years of age, over the last few decades. This alarming trend is marred with advanced stage at diagnosis, aggressive histological features like mucinous and signet ring cells and poor over all response to therapy. This study aims to review young rectal cancer patients in terms of clinico-pathological presentation, response to therapy and outcomes. AIM: To assess clinical characteristics, response to therapy and clinical outcome in young onset rectal cancer patients. MATERIALS AND METHODS: All rectal cancer patients referred to the Radiation Oncology department for preoperative chemoradiation between January 2010 and December 2015 were retrospectively reviewed from hospital data base and statistically analysed. Patients aged 50 years or less were categorised as young onset and were studied for clinical parameters, compliance to therapy, radiological and pathological response and sphincter preservation. Survival analysis using Kaplan-Meier plots was done to compute the disease free survival (DFS) and overall survival (OS). Univariate and multivariate analyses were done to identify predictive and prognostic factors for tumour down staging, DFS and OS. RESULTS: A total of 246 rectal cancer patients attended the Radiation Oncology OPD from January 2010 to December 2015. One hundred thirty (52.8%) patients were young onset and the mean age at diagnosis was 36.7 years. A definite male preponderance was noted with 63.8% males. Most tumours involved the distal rectum with mean distance from the anal verge being 5 cm. Adenocarcinoma accounted for 98% of all histologies with moderate to poor differentiation present in more than half cases (60%). Advanced stage at diagnosis was noted with 81% of patients belonging to stage 3 and above. A good compliance to treatment was noted with 97% patients undergoing preoperative chemoradiation and 71% patients undergoing surgery. Only 33.3% patients had down staging of tumours following preoperative chemo-radiation. Furthermore, radiological complete response rate was 19% and pathological complete response rate was 17%. The sphincter preservation rate was 40%. The mean follow up duration was 21.4 months (range, 0 to 86.86 months), median DFS was 54.46 months (95% CI, 41.65-67.26) and the median OS was 56.83 months (95% CI, 51.94-80.04), which is not significantly different from OS in the older patients. Stage at diagnosis, nodal status and pre-treatment CEA levels emerged as significant predictors of tumour down staging, DFS and OS on univariate and multivariate analysis. CONCLUSION: Young onset rectal cancer is an emerging clinico-pathological entity with increasing incidence. Further research is needed to understand unique genetic and molecular features that make it different from its conventional counterpart. Our review suggested that young age at diagnosis portends a poor prognosis. However young patients with an inherent advantage of better general health and compliance may do better if diagnosed earlier. Hence meticulous and well-structured screening programs, high index of suspicion for early diagnosis and initiation of therapy are warranted.

 > Abstract Id: YUGP1022 Top

Cancer Epidemiology Profile Based On Hospital Based Cancer Registry At Cipto Mangunkusumo National General Hospital Year 2008-2013

Presenter- *Dr. Ngakan Putu Daksa Ganapati

Co-author - Nadia Christina, Ericko Ekaputra, Adjie Kusumadjati

Introduction Cancer registration defined as a continous process in a systematic data collection on the incidence and characteristics of the neoplasm It can provide basic data for cancer research and help policymaker to determine hospital policy related to cancer. Materials and Methods This study was a cross sectional descriptive study of all registered cancer patients on Hospital Based Cancer Registry (HBCR) from January 2008-December 2013 in Cipto Mangunkusumo National General Hospital (RSCM). Results The result was as follows: the number of cancer cases in RSCM during 2008-2013 were 23,818 cancer cases. The number of male patients compared with female was 1:1.7. The majority of patients aged was 45-54. The most frequent job was housewive and most of patients came from outside of Jakarta, than from Jakarta. Cervical cancer, breast cancer, hematopoietic and reticuloendothelial systems malignancies, nasopharynx cancer and lymphnodes malignancies were the most common cancer type. For female, the most common cancer cases were : cervical, breast, ovarian, hematopoietic and reticuloendothelial systems and thyroid. For male, the most common cancer cases were nasopharynx, hematopoietic and reticuloendothelial systems, lymph nodes, liver and skin. The staging disease data in this study was very low due to inadequate medical report recording. Most common Histopathological type were: non keratinized squamous cell carcinoma (cervical), invasive ductal carcinoma (breast), non keratinized squamous cell carcinoma (nasopharynx), acute lymphoblastic leukemia (hematopoietic and reticuloendothelial systems), and lymphoma-non hodgkin (lymphnodes). Conclusion This study showed that overall cancer patients in Cipto Mangunkusumo National General Hospital year 2008-2013 were similar with patients profile in prior HBCR studies.

 > Abstract Id: YUGP1024 Top

Case Report: The Role Of Radiation Therapy In Emergency Management Of Choriocarcinoma With Excessive Vaginal Bleeding

Presenter- *Dr. Ngakan Putu Daksa Ganapati

Co-author - , ,

IIntroduction Choriocarcinoma is one form of Gestational Trophoblastic Neoplasia (GTN) with a rare event number. It is a malignancy that is indicated by anaplasia and abnormal tropoblastic hyperplasia, which invade directly into the myometrium and is often found to have spread mainly to the lungs (80%), vagina (30%), brain (10%), and liver (10%). Major management of PTG cases is chemotherapy. In curative purpose, the role of radiotherapy in the management of choriocarcinoma is not very significant. This case report describes the role of radiotherapy in the management of GTN for palliative purpose. Materials and Methods A 25-year-old woman, presented with a chief complaint of excessive vaginal bleeding which did not respond to conservative therapy. She came with anemia and grade I hypovolemic shock. Patient was diagnosed with Choriocarcinoma based on post-curettage’s pathology, maternal ultrasound and serum B-HCG levels. Results Patient underwent chemotherapy with MTX regimen for 8 cycles. The tumor was not respond to chemotherapy and there was also metastasis in the lung. Chemotherapy regimens were subsequently replaced by EMACO, and after chemotherapy completion she was scheduled for surgery. During the second cycle of EMACO chemotherapy, she had vaginal bleeding which could not be controlled with local and systemic hemostasis therapy. Patient was referred to Radiotherapy Department for hemostasis radiation. Patient was given AP-PA radiation with doses of 300 cGy per fraction using 10 MV linear accelerator. After 2nd fractions, bleeding was said reduce, and after 10th fractions there was no bleeding. Conclusion Radiotherapy can be one of the therapeutic modalities for treating excessive vaginal bleeding of primary site in GTN which did not response to conservative therapy. Adequate data and further research are needed to obtain effectiveness of radiotherapy in excessive bleeding control in GTN.

 > Abstract Id: YUGP1032 Top

Mr Mammography For Evaluation Of Residual Disease After Excisional Biopsy For Breast Cancer

Presenter- *Dr. Shubha Garg

Co-author - Dr Veda Padma Priya, Dr Rajeev Kumar,

BACKGROUND : Approximately 10% of patients with early breast cancer present to our institute after initial excisional biopsy performed at another hospital. The T stage and margin status are often not available. In this setting we sought to assess the utility of breast MRI in evaluating residual disease in patients after excisional biopsy on basis of morphology & kinetics. MATERIALS & METHODS: The medical records of 114 patients who underwent surgery for early breast cancer post lumpectomy status from September 2010 to December 2014 were reviewed retrospectively. 67 patients underwent contrast-enhanced MRI before surgery and subsequently underwent either re-excision lumpectomy or mastectomy with histopathological correlation. RESULTS: About 67 patients were found eligible for study. The mean age of onset was 44.97 years[Range 28-70]. The ratio of Left: Right were 30:37. 38 patients were positive for residual disease on MRI - 27 underwent MRM or mastectomy and 11 underwent BCS. 3 patients were found to have multifocal and multicentric disease on MRI and none had a contralateral disease. 29 patients who were negative for residual disease on MRI — 8 had residual disease on final histopathology report. The sensitivity and specificity of MRI for detecting residual disease were 77.14% and 65.62%. The positive predictive value of MRI was 71.05 and negative predictive value was 72.41. CONCLUSION: Although post surgical changes challenges assessment of residual disease, MR mammography is still useful in prediction of residual lesion after excisional biopsy for breast cancer. Hence, it should be considered in patients post excisional biopsy.

 > Abstract Id: YUGP1034 Top

Primary Mucosal Malignant Melanoma Of Ano-Rectal And Vulvo-Vagina: Epidemeology, Clinico-Pathological And Survival Characteristics With Proposal Of Reconciliation The Tumor Staging

Presenter- *Dr. Arun Pandey

Co-author - , ,

Background Primary malignant mucosal melanoma (PMMM) arises from the melanocytes located in mucosal membranes lining respiratory, gastrointestinal, and urinary tract. The common sites of PMMM are nasal cavity, oral cavity, ano-rectum, vulva, and vagina. Most mucosal melanomas tend to occur in occult sites, which together with the lack of early and specific signs contributes to the late diagnosis and thus poor prognosis. PMMM accounts for only 1.4% of all melanoma cases, and its incidence is reported in literature to have remained consistently stable over last many years. PMMMs arising in ano-rectum and vulvo-vagina carry poor prognosis in comparison to the conventional common histological types of cancers. Material and methods We analysed patients who presented at our institute with PMMs over the last decade, with the primary sites of ano-rectum and vulvo-vagina tract mucosa. We compared the PMMM of rectum and anal canal with aspect to epidemiology, clinical staging, treatment (surgical and non-surgical, including new targeted agents) and stage specific disease free and overall survival with adenocarcinoma of rectum and squamous cell carcinoma anal canal, respectively. PMMM vulvo-vagina compared with squamous cell carcinoma of vulva and vagina, respectively. Median follow up was 23 months (range 3-41 months) in all groups. Results At our institute, a tertiary cancer care centre, the proportion of PMMMs in comparison to cutaneous melanoma has increased over the last decade. We identified a total of 98 case of PMMM, which included anorectal primary in 51, vulva primary in 31 and vaginal mucosal primary in 16 cases. PMMMs of ano-rectum and vulvo-vagina presented with advance stage either with local infiltration or lymph node metastasis. Three-year overall survival (OS) of anal canal PMMM versus SCC in stage I to IV was 67% vs 89%, 41% vs 69%, 13% vs 52% and 9% vs 29%, respectively. Rectal PMMMs versus adenocarcinoma 3-year OS was 49% vs 92%, 42% vs 67%, 18% vs 47% and 4% vs 15% in stage I to IV, respectively. In PMMMs of vulva versus SCC vulva 3-yr OS, 41% vs 88%, 36% vs 67%, 20% vs 37% and 7% vs 23%, and in vaginal PMMMs, 39% vs 87%, 32% vs 59%, 17% vs 43% and 3% vs 19% in stage I,II,III, and IV, respectively. Conclusion PMMMs are rare and aggressive tumours with poor prognosis. Each anatomic site has peculiar approach to its treatment, in spite of the same tumour morphology and origin. PMMMs of ano-rectum and vulvo-vagina have poor prognosis in a comparison to common types of cancer in these regions when adjusted for stage-distribution (pathological AJCC staging). Thus, we recommend further discussion regarding the reassignment of the AJCC staging of anorectal and vulvo-vaginal PMMMs in reconciliation with the staging for other common histological cancer types in these regions.

 > Abstract Id: YUGP1036 Top

Assessment Of Risk Factors Predicting Central Compartment Nodal Metastases In Clinically Node Negative Papillary Carcinoma Thyroid - A Prospective Study

Presenter- *Dr. Arun Pandey

Co-author - , ,

Introduction Nodal metastases in papillary thyroid carcinoma (PTC) are associated with a higher rate of locoregional and distant recurrence. Need for a central compartment lymph node dissection (therapeutic CLND) in cN+ PTC is universally accepted; this however, is not true for cN0 PTC, where a consensus for performing prophylactic CLND (pCLND) remains lacking. Aim & Objectives To identify risk factors related to patient or tumor characteristics (age, sex, tumor size, focality, bilaterality, tumor extent, tumor location), to predict risk of CLNM in cN0 PTC. And thus, facilitating a risk based approach to selection of patients for prophylactic CLND. Material and methods Patients presenting with previously untreated PTC, found to have a cN0 disease based on findings of clinical examination and USG neck, were included in the study. All patients underwent total thyroidectomy with pCLND. Patients having pathologically reported CLNM were analysed with respect to presence or absence of previously identified risk factors. At the time of analysis, 43 patients had been included in the study (November, 2014 to June, 2016) and are analysed here. Results CLNM was found in 65.1% cases on pathological examination. Most of the patients had bilateral CLNM (63%). Tumor size (>4cm), and extrathyroidal extension were shown to be significantly associated with CLNM (p-0.024, and 0.04 respectively); while, multicentricty (p- 0.02), ipsilateral CLNM (p- 0.001), and extrathyroidal extension (p-0.016) were found to be significantly associated with contralateral CLNM. Risk of permanent hypoparathyroidism, and permanent RLN injury was not significantly different from that seen in patients who underwent total thyroidectomy at our institute during the same time period. Conclusion In this study, we present here our interim results, as the study is still continuing. According to the present study, at least an ipsilateral pCLND should be considered in patients with extrathyroidal extension, and tumor size >4cm; while consideration for bilateral pCLND should be given in cases with multicentricity and those with extrathyroidal extension.

 > Abstract Id: YUGP1038 Top

Anti Tumor Activity Of A Fraction Of Hydatid Cyst Fluid On Colon Cancer Growth Tumor In Animal Model

Presenter- *Dr. Shahla Rostamirad

Co-author - Prof.Yousofi, ,

Background: Hydatid cyst is the larval stage of the tape worm Echinococcus granulosus which is located in human and livestock viscera. Cancer is the main cause of death in developed countries. There are some scientific evidences indicating that parasitic infections induce antitumor activity against certain types of cancers. In this study, the effects of a fraction of hydatid cyst fluid on colon cancer tumor in BALB/c mice were investigated. Materials and methods: In this experimental work three groups of mice were challenged with mouse colon cancer cells. Two weeks later group one was injected with a fraction of hydatid cyst fluid absorbed on alum as adjuvant. The second group was injected with alum alone and the third group left intact. The tumor size in all mice were measured. Result: In mice injected with a fraction of hydatid cyst fluid tumor size was smaller than the two control groups and the difference was statistically significant. Conclusion: The results of this study showed that injection of a fraction of hydatid cyst fluid significantly inhibits the growth colon cancer growth.

 > Abstract Id: YUGP1046 Top

Unusal Intraoperative Complications During Minimally Invasive Surgery

Presenter- *Dr. Jagannath Dixit

Co-author - Dr Rajesh, Dr Ashok,, Dr Manish

Few of the unusual complications we experienced during the intial Laparoscopic and Robotic surgery in GI malignancy surgeries 1.Ontable pneumothorax during central line insertion 2 thoracic duct leak 3.Snapping of the IMA 4.Ureteric injury during stapling 5.Ileostomy twist causing obstruction and correction using Drain tube insertion 6.ureteric and rectal wall stappling causing diarrhoeal presentation all are managed without significant morbidity

 > Abstract Id: YUGP1048 Top

Cancer Profile In Jakarta Province Region 2008 - 2012: Based On Data At Ciptomangunkusumo Hospital As Controlling Center For Cancer Registration Of Jakarta Province

Presenter- *Mr. Wahyudi Nurhidayat

Co-author - Denny Handoyo, Dion Firli Bramantyo, Fathiya Juwita Hanum

Background: According to WHO (World Health Organization) data in 2012, cancer occupies the second cause of death in developed countries after cardiovascular disease and become the third leading cause of death in developing countries after cardiovascular and infectious diseases. Currently, data on cancer profiles obtained from cancer registration activitie s in Indonesia does not exist. Cancer profiles with good collecting and reporting methods are required for the establishment of Indonesia population-based cancer registry. The Minister of Health of Indonesia has designated Ciptomangunkusumo Hospital as a control center for cancer registration of Jakarta Province. This study aims to provide a description of cancer profile of Jakarta Province in 2008 to 2012 based on data from Ciptomangunkusumo Hospital as a control center for cancer registration of Jakarta Province. Methods: This was a cross sectional descriptive study by collecting data from cancer registry at Ciptomangunkusumo Hospital to establish cancer profile in Jakarta Province in 2008 to 2012. Results: 14,726 cancer patients were found, with male and female ratio of 1: 1.8. The majority of patients are between 45-54 years old. Most of patients came to the health care facility were in advanced stage, as many as 31.8%. The number of patient is highest from West Jakarta (27.5%) and followed by from East Jakarta (25.5%). The five most frequent cancer found in both sexes were breast cancer, cervical cancer, hematopoietic and reticuloendothelial system malignancy, lung and bronchial cancer, and nasopharyngeal cancer. The five most common cancers in male were lung cancer, nasopharyngeal cancer, hematopoietic and reticuloendothelial system malignancy, liver cancer, and lymph node cancer. The five most common cancers in female were breast cancer, cervical cancer, ovarian cancer, hematopoietic and reticuloendothelial system malignancy, and thyroid gland cancer. Conclusion: The results of this study are similar with GLOBOCAN 2012 results for Southeast Asia region, but the data coverage was still not optimal because not all health care facilities in Jakarta submitted cancer patients data. Suggestion: Further research is needed with broader coverage involving all health care facilities in the Province of Jakarta. Keywords: cancer, cancer profile, cancer registration, Jakarta Province

 > Abstract Id: YUGP1056 Top

Prostate Specific Antigen Nadir Within 12 Months As An Early Surrogate Marker Of Biochemical Failure And Distant Metastasis After Low-Dose-Rate Brachytherapy For Localized Prostate Cancer

Presenter- *Mr. Shuichi Nishimura

Co-author - Toshio Ohashi, Kaneda Tomoya, Sakayori Masanori

Purpose: Nadir prostate-speci?c antigen (nPSA) after definitive radiotherapy for prostate cancer has been investigated as a predictive factor for treatment outcomes. However, nPSA usually requires several years before determination in many patients, limiting the clinical utility of nPSA as a predictive factor. Earlier markers of recurrence risk after the completion of radiotherapy would be clinically useful. In this study, we investigated the significance of nPSA within 12 months (nPSA12) after low-dose-rate prostate brachytherapy (LDR-PB) on biochemical failure (BF) or distant metastasis (DM). Methods and Materials: Between 2006 and 2014, 474 consecutive patients with localized prostate cancer were treated with LDR-PB without androgen deprivation therapy. The minimum follow-up duration was 24 months. The median age at diagnosis was 70 years. The median pretreatment PSA was 6.5 ng/ml. By NCCN guideline’s risk group, 237 were low risk, 210 were intermediate risk, and 27 were high risk. BF was defined according to Phoenix de?nition. Kaplan-Meier method was used to estimate BF free survival rate (BFFS) and DM free survival rate (DMFS). Univariate and multivariate analyses were used to determine the significance of nPSA12 and other clinical factors on BF and DM. Results: The median follow-up duration was 61.4 months. Of the 474 patients, 19 experienced BF, and 11 experienced DM. The median nPSA12 was 0.7 ng/ml. When dividing patients according to low (?0.7) and high (>0.7) nPSA12, the 7-year BFFS rates for patients with nPSA12 ?0.7 and >0.7 ng/ml were 99.1% and 90.2%, respectively (p = 0.004), and the 7-year DMFS rates with nPSA12 ?0.7 and >0.7 ng/ml were 99.5% and 94.8%, respectively (p = 0.010). Multivariate analysis demonstrated that nPSA12 was an independent predictor of BF (p = 0.004) and DM (p = 0.020). Conclusions: The nPSA12 in prostate cancer patients treated with LDR-PB is signi?cantly associated with the risk of BF and DM. For patients achieving nPSA12 ?0.7 ng/mL, the risk of subsequent failure was

 > Abstract Id: YUGP1062 Top

Development Of Integrated Yoga Module For Carcinoma Cervix Undergoing Chemoradiation

Presenter- *Dr. GOVARDHAN HB

Co-author - Govardhan H B, Khaleel I A, Sridhar P

Background Cervical cancer is the second most common cancer in women worldwide, leading to severe debility and poor quality of life. Studies have reported the usefulness of yoga in managing the fatigue, stress and psychosocial outcomes in cervical carcinoma; however, a validated and structured yoga module is unavailable. The aim of this study is to develop and validate an integrated yoga module (IYM) for cervical carcinoma. Methodology After a thorough review of classical yoga texts and contemporary yoga literature an integrated yoga module was formulated. Five experienced yoga experts, who fulfilled the inclusion criteria, were selected for validating the content of the IYM. A total of 28 practices were included in the IYM, and each was rated as (i) not essential, (ii) useful but not essential, and (iii) essential; Lawshe’s formula, was used to calculate the content validity ratio (CVR) for the module. Results Data analysis revealed that of the 28 IYM practices, 22 exhibited significant content validity (cut-off value: 0.99, as calculated by applying Lawshe’s formula for the CVR). Conclusions The IYM received good content validity and thus is valid for cervical cancer. However, future studies need to be conducted to determine the feasibility and efficacy of the developed module. Acknowledgement- this project is completely sponsered by Ministry of AYUSH, Govt of INDIA.

 > Abstract Id: YUGP1064 Top

Feasibility Of Conducting Yoga Program In Carcinoma Cervix Patients Undergoing Chemoradiation.

Presenter- *Dr. GOVARDHAN HB

Co-author - Govardhan H B, Khaleel I A, Sridhar P

Aim: The aim of the study was to test the feasibility of comprehensive yoga program designed for cervical carcinoma. Settings and Design:A yoga program was chosen which included practices like loosening exercises (loosening exercises), Postures(asanas) , relaxation techniques, breathing exercises (Pranayama) and chanting meditation to be taught by a professional yoga instructor in a 4 week period daily with home practice for one month. Materials and Methods: The yoga therapy was pilot tested on 10 cervical carcinoma cases undergoing chemoradiation in KIDWAI Cancer Institute, Bangalore. Questionnaires namely: EORTC QLQ C-30 for quality of life, DASS 21 for depression, anxiety and stress, FACIT (version 4) for fatigue, FACT Cx for general wellbeing were recorded weekly once to assess the feasibility and acceptability of the practice. Results: Severity of depression, anxiety and stress substantially reduced at the end of 4 weeks and one month follow up post therapy. The over all quality of life showed better scores with a greater impact on the emotional wellbeing. Conclusion: A comprehensive yoga therapy is feasible in patients with cervical cancer and useful to alleviate the stress and anxiety which further better treatment outcomes. Acknowledgement- this project is completely sponsered by Ministry of AYUSH, Govt of INDIA.

 > Abstract Id: YUGP1066 Top

Completion Thyroidectomy For Differentiated Thyroid Cancers - Predicting Contralateral Disease



Background: Completion thyroidectomy is a neck re-exploration performed when the biopsy report of a hemi thyroidectomy is an unexpected malignancy or when an incomplete resection has been performed on the ipsilateral thyroid lobe. In spite of the various risk models available to decide upon the extent of surgery, we end up performing a good number of completion thyroidectomies. These surgeries are associated with an increased risk of hypoparathyroidism (9 — 15%) and also the danger of recurrent laryngeal nerve injury (up to 6%). Hence, this study was performed to determine the pathologic factors which would predict the occurrence of malignancy in the contralateral lobe. Materials and methods: A retrospective review of the case records of all patients who underwent completion thyroidectomies between January 2010 and December 2014 was done. A total of 90 patients underwent completion thyroidectomy during this period. The hisopathology reports of the original surgery were analysed with respect to the following variables: tumor type, tumor stage, presence of extra-thyroidal spread, presence of capsular invasion, perineural spread, lymphovascular invasion, nodal positivity and multifocality of the tumor. Statistical analysis was done using the chi-square test and odds ratio. Results: A total of 28 patients (31.1%) were detected to have malignancy in the contralateral lobe. All these were histologically well differentiated thyroid cancers with 25 being papillary carcinomas and 3 being follicular. The two factors which were statistically significant in predicting the occurrence of malignancy in the contralateral thyroid lobe were multifocality of the tumor (p

 > Abstract Id: YUGP1068 Top

Contextual Analysis Of Breast And Cervical Cancer Screening And Association Of Health Care Utilization And Health Insurance Coverage With Screening Uptake Among Adult Women In India

Presenter- *Dr. Sutapa Agrawal

Co-author - Awdhesh Yadav, Preet K Dhillon, Elizabeth A. Van Dyne

Background: Worldwide one in every five women with cervical cancer comes from India, and breast cancer is now the most commonly occurring cancer in India. Studies in breast and cervical cancer screening in high-income countries show that women with greater access to healthcare are more likely to have been screened and hence, have earlier stages at diagnosis and longer survival. Having a recent physician visit or a usual source of health care also is a predictive of screening adherence. India’s National Programme for Cardiovascular disease, Diabetes, Cancer and Stroke (NPCDCS), 2014 recommends breast and cervical cancer screening for 30-64 year old women, yet no empirical evidence exists about the prevalence and determinants of population-level cancer screening in India. Objective: We aim to describe the prevalence of pelvic examination and use of  Pap smear More Details test for cervical cancer screening and the prevalence of mammography for breast cancer screening among women aged 30-64 years in India and to estimate its association with health care utilization, health insurance status, current health conditions and other socio-economic determinants and lifestyle risk factors. Data and Methods: We used data from the national population-based multi-stage stratified nationally representative World Health Organisation’s Study on Global Ageing and Adult Health (WHO-SAGE), conducted in six large populous states in India namely Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal during 2007-2010. The sample consisted of 12,198 respondents (4717 men, 7481 women) aged 18 years and above. Our analysis focused on 4724 number of women aged 30-64 years of age in consistency with NPCDCS guidelines. The outcome was reporting of a pelvic examination, a PAP (Papanicolaou) smear test for cervical cancer screening and undergoing a mammography for breast cancer screening, ever. The main independent variables were health care utilization and the presence of health insurance. Multivariable logistic regression analysis was performed to assess the association of health care utilization, health insurance status and other selected characteristics with cancer screening uptake. Results: One out of ten women (12.3%;n=457) reported ever having a pelvic examination and two out of five among those (20.2%;n=98) reported having a PAP smear test, and 1.6% (n=77) reported ever having a mammography. Prevalence of pelvic examination and a PAP smear test was higher among women who reported inpatient hospital care, outpatient care, having health insurance coverage, among those who reported of suffering from arthritis, angina, chronic lung disease, or depression, those who rated their current health status as good, women with more than six years of education, in Hindu women, women residing in urban areas, and belonging to richest wealth quintile household. A similar pattern was found for mammography use. In multivariate logistic regression analysis, the likelihood of reporting a pelvic examination was higher among women who had inpatient hospital care (OR:2.23;95%CI:1.72-2.90), outpatient care (OR:1.58;95%CI:1.11-2.24), women reported of suffering from chronic lung disease (OR:1.84;95%CI:1.02-3.30), hypertension (OR:1.38;95%CI:1.09-1.76), or 40-49 years (OR:1.41;95%CI:1.03-1.92), educated women (OR ranges from 2.15 (95%CI:1.69-2.72) (for 1-5 yrs of education) to 1.54(1.15-2.05) (for 9+ years of education), women belonging to richest wealth quintile household (OR:1.49;95%CI:1.08-2.07); lower likelihood was among women aged 70+ (OR:0.42;95%CI:0.25-0.72), among Muslim women (OR:0.68;95%CI:0.50-0.92) and among rural women (OR:0.60;95%CI:0.49-0.73). Women reporting of a PAP smear test was also higher in inpatient and outpatient care, those reporting angina or diabetes, or depression, and rural residence. The likelihood of reporting a mammography were four times higher among women who had an inpatient care (OR:4.35;95%CI:2.57-7.37), more than six times higher among women who reported of angina (OR:6.47;95%CI:3.18-13.18), more than twice likely among women reporting of depression diagnosis (OR:2.91;95%CI:1.13-7.48), educated women (6-8 years of education OR:2.45;95%CI:1.09-5.49; 9+years of education OR:2.71;955CI:1.21-6.07). Conclusions: Cancer screening uptake remains very low among adult women aged 30-64 years in India. Access to health care and concurrent reporting of other common NCDs were the strongest factors associated with screening uptake while women’s education and household wealth were also associated with higher screening uptake. There is a need to improve accessibility and affordability of cervical and breast cancer screening in India to ensure effective prevention and management of cervical and breast cancer in this age group.

 > Abstract Id: YUGP1075 Top

A Generic Treatment Modality For Malignancy By Assisted Molecular Self-Repairing And Cell Ablation And, In Combination With Virtual Fencing And Modified Radiosurgery

Presenter- *Dr. Jayakar Johnson Joseph

Co-author - , ,

Introduction: In this treatment modality, we intent to use a set of IoT devices of Molecular Dynamics Synchronized Manipulator System of (MDSMS) Instrumentation to orchestrate the treatment for Malignancy. Adapted Postulates: Core of this Instrumentation is a specific Signal detector which is assigned to detect the signals of Wave-bundles in duel wavelengths, emitted from Bio-molecules. This detector is designed with a new postulate which describes an eigen-rotational wave mechanics, that provides attributes to simulate the intrinsic dynamics of the source molecules that is analysed by Wave Bundle Spectrometry for precision targeting and manipulation of the dynamics of the source in Virtual Reality. Experimentations to Calibrate the Instrumentation: To calibrate this instrumentation, we propose to conduct cell culture experimentations with Cancer Exosomes that perform Cell-Independent MicroRNA Biogenesis and promote Tumorigenesis. The variables on these experimentations are representational in a Fish Bone Diagram to express the Cause-Effect analysis for Reverse engineering the Transformation of Normal Cell into Cancer Cell. Thereby, we propose Wave Bundle Spectrometry Analysis of all Bio-molecules available from these Cell Culture Experimentation, so that we may able to deploy molecular profiling for all bio-molecules involved in the transformation of Normal cell into Malignant cell, with their Wave Bundle Spectral Signature Patterns by Machine Learning. These Wave Bundle Spectral Signatures are used to identify Specific Bio-markers and to proceed with real-time treatment by precision targeting and mater-energy delivery. Treatment Modes: Though the treatment modality is generic in nature, the sets of devices in this Instrumentation that orchestrate for the treatment differs depending on the location of the tumour and stage of manifestation of the disease. Moreover, some of the devices of MDSMS Instrumentation is also integrated with the Radiosurgery units for Precision targeting in radiosurgery. Thus, the treatment modes may be grouped as follows: For Pre-malignant transformations: â€Â¢ Only Assisted Molecular Self-repairing. â€Â¢ Assisted Molecular Self-repairing and Long-term Virtual Fencing and monitoring. For In-situ malignancy: â€Â¢ Cell Ablation with Assisted Molecular Self-repairing of the margins. â€Â¢ Cell Ablation with Assisted Molecular Self-repairing of the margins and, Long-term Virtual Fencing and monitoring. â€Â¢ Cell Ablation, followed by Wave Bundle Spectrometry Integrated Radiosurgery of the margins. For Established malignancy: â€Â¢ Wave Bundle Spectrometry Integrated Radiosurgery. â€Â¢ Massive Cell Ablation followed by Wave Bundle Spectrometry Integrated Radiosurgery of the periphery. â€Â¢ Surgical removal under Virtual Fencing to prevent Metastatic spread. â€Â¢ Surgical removal and Cell Ablation under Virtual Fencing to prevent Metastatic Spread. â€Â¢ Surgical removal under Virtual Fencing to prevent Metastatic spread, followed by Wave Bundle Spectrometry Integrated Radiosurgery of the margins. â€Â¢ Surgical removal and Cell Ablation under Virtual Fencing to prevent Metastatic Spread, followed by Wave Bundle Spectrometry Integrated Radiosurgery of the margins. For Metastases: â€Â¢ Cell Ablation. â€Â¢ Cell Ablation followed by Wave Bundle Spectrometry Integrated Radiosurgery. â€Â¢ Wave Bundle Spectrometry Integrated Massive Radiosurgery. Advantages: Targeted for Curative treatment with the exclusion of toxic Chemotherapy and very little use of high energy radiation.

 > Abstract Id: YUGP1076 Top

To Evaluate The Acute Toxicity Profile In Patients Undergoing Post Operative Chemoradiotherapy In Gastric Cancer

Presenter- *Dr. Deep Shankar Pruthi

Co-author - Dr Mushtaq Ahmad, Dr Meenu Gupta, Dr Vipul Nautiyal

BACKGROUND : The primary curative treatment of gastric carcinoma is surgical resection. However in view of high incidence of loco regional failure, it is recommended that patients with resected gastric cancer should receive adjuvant treatment. The median Overall Survival is significantly better in patients who were treated with adjuvant Chemoradiation. However, Chemoradiotherapy is associated with significantly increased toxicity, particularly hematologic and gastrointestinal. MATERIAL & METHODS: Between November 2013 and November 2014, 30 patients of Gastric Cancer underwent Adjuvant Postoperative Chemoradiotherapy. Chemoradiotherapy consisted of 4500cGy of radiation at 180cGy/day using 3DCRT technique, 5 days/week for 5 weeks, with fluorouracil (400mg/m2) and leucovorin (20mg/m2) administered on the first 4 days and the last 4 days of Radiotherapy. The primary endpoint was Acute Toxicity Profile of Chemoradiotherapy which was assessed as per the Common Terminology Criteria for Adverse Events v3.0 (CTCAE). RESULTS: The mean age was 54.5 years and male : female ratio was 4:1. The AJCC stage distribution included 3 patients (10%) with stage IB, 18 patients (60%) with Stage II and 9 patients (30%) with Stage III disease. Most common site was antrum and pylorus (15 patients — 50%). 29 out of 30 patients completed the treatment protocol. Among hematological toxicities, 9 patients (30%) developed Grade II anemia and 1 patient (3%) developed Grade III anemia. 12 patients (40%) developed Grade I-II Leucopenia while 2 patients (6%) developed Grade III-IV leukopenia. 5 patients (17%) developed Grade I-II thrombocytopenia while 3 patients (10%) developed Grade III-IV thrombocytopenia. In Gastrointestinal toxicities, nausea and vomiting was most commonly observed. 17 patients (57%) developed nausea and vomiting (Grade I & II) while 1 patient experienced Grade III nausea and vomiting. 5 patients (17%) experienced diarrhoea (Grade I & II) during EBRT. Radiotherapy interruption was seen in 4 patients, 3 patients with < 1 week duration and 1 patient with > 1 week duration. 7 patients required admission for supportive care during EBRT. 1 patient required Ryle Tube feeding while 7 patients required intravenous fluid administration. CONCLUSION: Chemoradiotherapy as Adjuvant therapy for Resected Gastric Cancer with Calcium Leucovorin and 5FU was well tolerated in terms of haematological and gastrointestinal toxicity. However a larger sample size is needed for significant results.

 > Abstract Id: YUGP1080 Top

Colorectal Carcinoma An Increase In Younger Age Presentation-A A Tertiary Cancer Hospital In Kurnool Study

Presenter- *Dr. Kumari Motepalli

Co-author - , ,

Author : M Pandu Ranga kumari MD(RT) Back ground: Colorectal cancer is relatively uncommon malignancy in India when compared with the western world. generally a disease affecting individuals 50 years of age and older and is much less common in persons under 40 years of age. It is also a very uncommon pediatric malignancy but now there is a increase in incidence in younger age Aims: To study the age, gender, site of primary tumor, histopathological type of colorectal cancer cases with specific reference to young adults. Settings and Design: Tertiary care hospital, Retrospective study. Materials and Methods: We conducted a retrospective study of all colorectal carcinomas (CRC) which were diagnosed during the past 6 years i.e., from January 2011 to December 2016. Patients were divided in to two groups - 40 years and younger, and older than 40 years. The records were analyzed in detail for age, gender, site of primary tumor, histopathological type.The results of the two groups were compared Results: Two hundred and twenty three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.5%(88) and those under age 20 comprised 2.69%(6). Among those under 40 years of age, majority were males (56.8%), most occurred in the rectum (75%). Most of them were adenocarinoma in that poorly differentiated, mucin-secreting,signet ring type adenocarcinomas are most frequent (35.2%) and presented at advanced stage (33%). This was similar to those reported in other literatures. Conclusions: CRC in our institution is more often seen in younger individuals too as reported in other studies. The reasons for this are not clear. Therefore, further studies are required to address the role of diet and personal habits with CRC in this region. Also, a high index of suspicion among young adults is necessary and futher consideration for screening in Indians too Key words : colorectal cancer,young age,increased incidence,poor prognosis,need for screening

 > Abstract Id: YUGP1084 Top

Cisplatin Versus Carboplatin In Patients Over 70 Years With Advanced Head And Neck Squamous Cell Carcinoma With Curative Intent Concurrent Chemo?Radiation. Predictors Of Oncological Outcomes

Presenter- *Dr. Vijay kumar Srinivasalu

Co-author - Narayana subramaniam, Narender kumar, Deepak balasubramaniam

Introduction : Addition of chemotherapy either cisplatin (CIS) or carboplatin (CARBO) increases the effect of radiation in patients (pts) with advanced head and neck squamous cell carcinoma (HNSCC) who received concurrent chemoradiation (CCRT). In the elderly due to multiple comorbidities and issues on tolerance of chemotherapy a choice on CIS versus CARBO is highly debatable, hence we conducted this study. Materials and methods : Retrospective analysis of stage III/IV HNSCC in pts > 70 years who received linac based radical CCRT with dose equivalent to 70Gy in conventional fractionation (n=57) with either CIS or CARBO between 2006 to 2014 were included. Results: Pts with stage III/IV (25.6%/75.4%) HNSCC (n=57) of oropharynx (n=15), larynx (n=18) or hypopharynx (n=24) underwent radical CCRT having mean age 75.18 yrs (range 70?86 years) and male to female ratio of 10.4:1. Pts on CCRT who got cisplatin (CIS) (n=35) and carboplatin (CARBO) (n=22) had mean weight loss of 3.53 (range 0?10) kgs. Total of 61.4% (CIS = 62.8%, CARBO = 59.1%) completed chemotherapy (defined as cumulative dose of 200mg/m2 of CIS and 5 weekly dose of CARBO at AUC 2) and 98.2% completed RT without any treatment related death. Higher grades of neutropenia(33.3%) and hyponatremia(17.5%) with CIS and hypercreatinemia(10.5%) with CARBO was noted. There was no significant difference in PFS and OS between the two groups. Factors predicting good PFS were ECOG (1 vs 2) HR=0.25 (95%CI:0.09?0.70), Completion of treatment without any breaks while on CCRT, HR=2.54 (95%CI:1.02?6.32, p=0.04), and age in 70?75 years, HR=1.09 (adjusted for alcohol and smoking) (95%CI: 1.01?1.20, p=0.08). Factors suggestive of poor PFS were hyponatremia , hypercreatinemia and weight loss > 3kgs from their baseline. PFS (80%) in pts with stage III and IV disease was 22 (95%CI: 12.4?87.2) months and 15.53 (95%CI: 8.6?20.6) months respectively. Conclusion: Curative intent CCRT should be considered as standard of care in elderly patients > 70 years with good ECOG status. Aggressive swallowing rehabilitation, abstinence from smoking and alcohol are likely to improve outcomes. Both cisplatin and carboplatin showed significant benefit in PFS with fewer side effects and either of them can be considered.

 > Abstract Id: YUGP1086 Top

Evaluation Of Outcomes And Prognostic Factors In Paediatric Extraskeletal Ewings Sarcoma : A Single Institution Experience

Presenter- *Dr. Vijay kumar Srinivasalu

Co-author - Harisankaran, Arun philip, Annu susan

BACKGROUND : Ewing's sarcoma (ES) represent the most frequent small and round cell bone tumors of childhood and adolescence. Data on extraskeletal ewings sarcoma (EES) with uniform chemotherapy protocol are very minimal. We aimed to assess this aspect in our patients and identify prognostic factors in patients with extraskeletal ewings sarcoma. MATERIALS AND METHODS : A retrospective analysis of data was done between January 2005 and January 2016. These paediatric EES patients who received chemotherapy with VAC-IE regimen were evaluated for their response, overall survival (OS) and Event free survival (EFS). The prognostic factors which influenced their overall survival was also analysed. RESULTS: 41 paediatric EES patients were diagnosed at our institute out of which 31 patients received treatment at our hospital. 25.8% (8) were metastatic at presentation. The mean age was 12.37 years (1-18 years) with a predominant female preponderance 54.8%. The commonest site at presentation was presacral mass (7) and mass in the brain parenchyma (8). Rare sites of presentation as a nasal mass and parotid mass was seen in one patients each. 78% received chemotherapy with VAC-IE regimen. The ORR was 71% (8 CR + 9 PR). Commonest hematological toxicity was grade III neutropenia in 5 (20.8%). 8 patients received local RT. The 3 year OS and EFS in the localized EES was 55% and 39% and in metastatic EES was 35% and 24% respectively. Low hemoglobin (P?=?0.05) and high LDH (P?=?0.01) predicted inferior OS for the entire EES cohort on multivariate analysis. CONCLUSION : High LDH and low hemoglobin is associated with poor OS for patients with EES ewings sarcoma. VAC-IE is a very effective and a safe chemotherapy regimen and should be considered in patients with extraskeletal ewings sarcoma.

 > Abstract Id: YUGP1088 Top

Validation Of Prostate Cancer Metastatis Through Low Cost Microfluidic Approach.

Presenter- *Dr. Deepika Sharma

Co-author - Assim Verma, Bhanu Prakash,

Cancer metastasis includes complex microenvironment with several ligands and factors promoting the spread of cancer from its primary sites to other vital organs like bones, liver, lungs and brain. To study the metastasis process effectively organ-on-chip with 3D cell culture system is vital. Microfluidics gives us ability to mimic the complex microenvironment on PDMS based chips. However conventional process for microfluidic chip fabrication is based on X-Ray lithography process which has several shortcomings like productivity, associated cost and time consumption. We have fabricated Organ-on-chip which mimics complex organ microenvironment by conventional photolithography techniques seem promising by precisely mimicking secondary organs in a chip surrounded by endothelial cell monolayer. We have validated prostate cancer metastasis using organ-on-chip fabricated by laser on PDMS. Also, the role of bone specific CXCL12 ligand in extravasation of prostate cancer to bone has been demonstrated as in-vivo studies have shown the CXCR4-CXCL12 axis to play the prominent role in metastasis. The cancer cells metastasize by breaching endothelial cells monolayer and further degrading 3D Extracellular Matrix (ECM) within the chip due to the presence of specific ligands mimicking the secondary organ for cancer metastasis. Apart from being ecofriendly and inexpensive, this novel approach also gives better room for more complex design improvisation than conventional photolithography techniques. Biggest advantage of our process is its cost effectiveness & rapid fabrication as we have estimated ?30/chip & can fabricate more than 10 chips/hour. Apparently high through-output study of cancer metastasis and its inhibition can be done by employing different microenvironment conditioning in the chip depending upon the type of cancer, drug, combination of drugs etc.

 > Abstract Id: YUGP1098 Top

Triple-Negative Breast Cancer In Young Women -Indian Scenario

Presenter- *Dr. Shubha Garg

Co-author - Dr Veda Padma Priya, ,

OBJECTIVE: To investigate the clinicopathological characteristics and prognosis in young patients with estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and Her-2-negative (triple-negative) breast cancer (TNBC) in young patients. METHODS: Young patients (< or = 40 years old) with TNBC treated at the Rajiv Gandhi Cancer Institute & research Centre between October 2010 to September 2016 were included in the study. The clinicopathological features and prognosis of those 85 patients were retrospectively analysed. SPSS 23 was used for statistical analyses and Kaplan Meir graph plotted. RESULTS Among 320 young (<=40) patients with breast cancer, 85 patients (26.56%) were triple-negative. The median age was 34.01 years. 85 patients (100%) were diagnosed with invasive ductal carcinoma. 62.35% of the patients were classified as T1 or T2. The TNM stages included: 9 patients in stage I (10.6%), 44 in stage II (51.7%), 32 in stage III (37.64%). The overall disease-free survival (DFS) was 88.2% and stage wise in Stage I-100%, Stage II 97.7% and Stage III was 71.9%. The corresponding overall survival (OS) rate was 98.8% and stagewise in Stage I and II 100%, Stage III 96.9% respectively. 10 patients developed recurrence or metastatic disease during the follow-up period. 9 developed recurrence or metastatic disease within 1 year of surgery while 1 patient developed recurrence 16 months following surgery. CONCLUSION BRCA positive cases in triple negative young (

 > Abstract Id: YUGP1106 Top

Low Rectal Cancers:Evolution From Apr To Sphincter Saving Procedures

Presenter- *Dr. Asif Mehraj

Co-author - Fazal Q Parray, Nisar A Chowdri, Rauf A Wani

Background : Distal rectal cancers present a challenging task for surgeons in terms of providing a Sphincter Saving Procedure (SSP) as compared to Abdomino Perineal Resection (APR) and maintaining oncological safety. APR used to be commonly performed surgery for distal rectal cancers, but because of better understanding of cancer biology, better surgical techniques, newer neoadjuvant therapies & advent of surgical staplers, SSP are being preferred by both surgeons & patients. OBJECTIVES: Our primary aim was to compare the trend of APR & SSP in distal rectal cancers at a high volume Colorectal surgery centre. Secondarily we aimed to compare the quality of life (QOL) between APR & SSP & also determine the incidence of diversion stoma following Low Anterior Resection (LAR). METHODS: This was a retrospective study of 3 years .Patients with cancers & precancerous lesions within 10cm from anal verge who underwent APR & other SSP were included. RESULTS: Overall incidence of APR as compared to SSP was 17.36. In lesions ?6cm & ?7.5cm APR constituted 26.4% & 22.7 % respectively. There was no significant difference in overall quality of life (QOL) between patients subjected to APR & LAR. However, urinary frequency (p=0.0001), abdominal pain (p=0.0001) & embarrassment (p=0.0001) were more in APR as compared to SSP group. Covering stoma was fashioned in 62.5% patients overall & in 91.8% & 83.3% in patients with lesions ?6 cm & ?7.5 cm respectively. CONCLUSION: As a result of improved surgical skills, better technology and high volume centre the trend is shifting more towards sphincter saving procedures. As a result of complications following LAR, QOL between APR & LAR does not differ much.Majority of patients with very low colorectal or coloanal anastomosis have a diversion stoma.

 > Abstract Id: YUGP1109 Top

Experience With Primary Retro-Peritoneal/Abdominal Germ Cell Tumor In Children.

Presenter- *Dr. Basant Kumar

Co-author - vijai d upadhyaya, manish k gupta, nijgal mutt

Background: Primary extra-gonadal germ cell tumors are rare and account for only 1 — 4% of all germ cell tumors. Prognosis is usually excellent after complete excision but perioperative management is a distinct challenge. Aim of this study is to present perioperative problems and morbidity associated with management of these tumors. Material and Method: We retrospectively evaluated the patients having non-renal retro-peritoneal/abdominal masses from July, 2012 to July, 2016 at our center from hospital records with diagnosis of germ cell tumor. Details of patients were reviewed including demography, clinical presentations, investigations, perioperative problems, pathology, management, final outcome and follow-up. Result: From July, 2012 to July, 2016, 11 patients with retro-peritoneal/abdominal germ cell tumor were managed. Diagnoses were yolk sac tumor (YST) in 3 patients and teratoma in 8 patients. 4 patients were female and age ranged from 2.5 months to 6 years (median age 14 months). 2 patients had respiratory problems while 3 had sub acute bowel obstructions at the time of presentation. Patients with YSTs and 2 patients with immature teratoma received chemotherapy. Almost complete excision performed in all patients. Perioperative problems include excessive bleeding (2), excision of part of adjacent organ (2), hypothermia and respiratory problems and chemo related toxicity (1). Adhesive bowel obstructions occurred in 5 patients with in 3 month of post surgery in which 4 required re-explorations and adhesiolysis. 2 patients were died while 2 were lost in follow-up. Rest patients are under follow-up without recurrence. Follow-up period ranged from 6 — 45 months. Conclusion: The management of retro-peritoneal/abdominal germ cell tumor (GCT) is challenge. Various surgical difficulties and morbidity associated with resection of these tumors depends on clinical presentation, size and site of tumor and age of patient. KEY-WORDS: Germ cell tumor; Yolk sac tumor; Teratoma; Retro-peritoneal; Management.

 > Abstract Id: YUGP1119 Top

Pretreatment Neutrophil: Lymphocyte Ratio As A Predictor Of Recurrence In Locally Advanced Cervical Cancer: Preliminary Study.

Presenter- *Dr. Henry Kodrat

Co-author - Lucky Taufika Yuhedi, Handoko, David Andi Wijaya

Introduction: One of the cancer characteristics in hallmark of cancer is tumor inflammation. Tumor inflammation has a big contribution in tumor progression. The neutrophil lymphocyte ratio (NLR) is an emerging biomarker of inflammation, which has a prognosis value in various cancers. Higher NLR is associated with more aggressive disease. This study was conducted to investigate the role of pretreatment NLR as a predictor of recurrence in locally advanced cervical cancer in our population. Methods We evaluated retrospectively our medical record for locally advanced cervical cancer patients, which underwent radiotherapy at our department between January and April 2015 and had follow-up more than 6 months. NLR was calculated before treatment. Pretreatment NLR was tested for association with recurrence status, pathologic prognostic factor and correlation with hemoglobin level. Results 15 patients were enrolled in this analysis. There was no difference in pretreatment NLR in recurrent compared with non-recurrent (median 4.14 compared with 3.79. p= 0.794). For pathologic prognostic factor: There was no difference on pathologic type; squamous cell carcinoma compared with adenocarcinoma (median 6.69 compared with 2.27. p=0.068); There was no difference in cell differentiation; well differentiation compared with moderate differentiation (median 3.33 compared with 6.69 P=0.41). There was no difference in LVSI (+) compared with LVSI (-) (median 2.25 compared with 6.03, p=0.18). There was negative-weak non-significant correlation between hemoglobin level and pre-treatment NLR (r=-0.352. p=0.198). Conclusions: Due to small sample size, there was no significant NLR difference between recurrent disease and not recurrent disease. We need to evaluate more data to make more accurate conclusion. Keywords: cervical cancer, lymphocyte, neutrophil, ratio.

 > Abstract Id: YUGP1127 Top

Design Of Biodegradable Spacers For Delivery Of Chemotherapeutic Drugs Synchronous With Radiation Therapy For Improved Efficacy

Presenter- *Prof. Dattatri Nagesha

Co-author - Ms. Rajasree P H, ,

Cancer Nanotechnology is a new paradigm in cancer therapy which involves the design of novel drug delivery and/or diagnostic system. Commercially successful products, Doxil® and Abraxane® are nanotechnology-enabled chemotherapeutic agents that are currently available in the market. The past decade has seen the emergence of nanotechnology-based concepts for enhancing radiation therapy. Gold nanoparticles have been delivered to tumor region and when external beam radiation is delivered to that area there has been a significant improvement in treatment outcome in animal models. In another approach, gold fiducials that are used for tumor delineation purposes have been coated with chemotherapeutic drugs for localized chemotherapy. However, the full potential of nanotechnology-enabled improvements to radiation therapy is yet to be explored. A new concept that our Lab is working is to suggest improvements to brachytherapy spacers that are used in permanent brachytherapy. The inert spacers that are used for spatial distribution of brachytherapy seeds are modified to deliver chemotherapeutic drugs locally within the tumor area and thereby improving the efficacy of radiation treatment. In this work, we have designed biodegradable polycaprolactone spacers that have been loaded with two chemotherapeutic agents — Doxorubicin and Curcumin. The choice of two drugs is to attack cancer by two different mechanisms and when this is synchronized with radiation, will result in a trifecta mode of kill and thereby improving the efficacy of radiation treatment. The results show that by optimizing the design parameters the drug release was tuned between 20 to 45 days. The novelty of this concept is there is no literature on the design of such biodegradable spacers for localized delivery of radiosensitizers synchronous with radiation. The versatility of this method is that the choice of drugs can be changed and the release kinetics altered to meet the specification of the treatment protocol recommended to the patient. The extension of this work in the future would be in personalized medicine wherein the design of these biodegradable spacers would be tailor-made for a specific person.

 > Abstract Id: YUGP1133 Top

Prognostic Significance Of Keratinization And Non Keratinization In Squamous Cell Cancer (Scc) Uterine Cervix

Presenter- *Dr. BIBIN FRANCIS

Co-author - Dr O.P Singh, Dr Veenita Yogi, Dr H.U Ghori

TITLE- Prognostic significance of keratinization and non keratinization in squamous cell cancer (SCC) uterine cervix. AIM- To determine the influence of keratinization on prognosis in squamous cell cancer (SCC) of uterine cervix. MATERIALS AND METHODS- A total of 105 patients with keratinized squamous cell carcinoma (KSCC) and non-keratinized squamous cell carcinoma (NKSCC) of cancer cervix that had started receiving treatment between 2012 and 2014 at dept. of radiotherapy GMC Bhopal were retrospectively studied and observed till date. Data were analyzed using Pearson Chi-square, Student’s T tests. Kaplan—Meier and Cox Regression Proportional Hazards survival analysis was conducted in SPSS. RESULTS- The NKSCC group had 62 and the KSCC had 43 patients with mean age being 50 years in both groups, respectively. In general, patients with KSCC were more likely to have advanced stage (FIGO III and IV) disease while patients with NKSCC were more likely to have poorly differentiated neoplasm. The prevalence of lymph node metastasis remained similar in both histology types. Overall, the 5-year survival (among 44 patients who have completed 5 years of follow-up) in NKSCC was 63.64% (n= 14) as compared to 68.18% (n= 15) in the KSCC group (p= 0.75045). A total of 15 NKSCC and 16 KSCC patients did not received or completed treatment. 61 patients had completed 3 year follow-up at present among which 66% (n= 40) were having NKSCC and 44% (n= 21) KSCC while 3 year survival in NKSCC was 82.5% (n= 33) and in KSCC it was 57.14% (n= 12) (p= 0.032425). CONCLUSION- This is an institutional based study reporting the prognostic importance of keratinization in SCC. KSCC may be less radiosensitive and associated with shorter overall survival. Also, in SCC cervix, keratinization signifies striking reduction in survival of patients receiving complete treatment. KEYWORDS- Cervical cancer, Keratinization, Survival â€Â¢

 > Abstract Id: YUGP1139 Top

Comparison Of Laparoscopic Total Esophagectomy Vs Robotic Total Esopagectomy

Presenter- *Dr. Jagannath Dixit

Co-author - Dr Rajesh, Dr Ashok, Dr Noor Mohammed

We compared 20 cases each of Laparoscopic versus Robotic Esophagectomies for carcinoma of the Esophagus On following comparisons were made 1.Duration of surgery 2.Blood Loss/Blood transfusions 3.Post operative pain 4.Lenghth of ICU stay 5 Lymphnode yield 6 Starting of orally and any anastomotic leak 7. Cost of treatment comparative study revealed Robotic esophagectomy has few added Advantages

 > Abstract Id: YUGP1141 Top

Tracheal Injury In The Neck During Mckewons 3-Stage Trans-Thoracic Esophago-Gastrectomy : Report Of A Case

Presenter- *Dr. Joydeep Purkayastha

Co-author - Niju Pegu, Taposhi Roy Sarkar, Dwipen Kalita

Introduction: Iatrogenic tracheal injuries are uncommon, but potentially lethal and associated with significant morbidity. Tracheal injury during esophageal surgery has been reported more commonly during trans-hiatal resection. Injury during trans- thoracic esophageal resection occurs less as the surgery is done under vision. We report a case of tracheal tear in the neck that occurred during trans-thoracic esophagectomy that was detected during the neck dissection and repaired successfully. Case Rerport: A 46 years old lady with carcinoma esophagus was taken up for treatment in our institute. The endoscopy detected a long segment growth in the mid esophagus while the computerised tomography scan revealed a large bulky disease with surrounding infiltration. As per our institutional protocol she underwent neo-adjuvant chemotherapy with a combination of Paclitaxel and cisplatin for a total of 3 cycles. The tumour responded very well and had a more than 50 % response. She was prepared and taken up for McKewon 3 stage trans-thoracic esophagectomy. Intubation was done initially by a double lumen endotracheal tube. Mobilization of the esophagus through right postero-lateral thoracotomy could be done without any difficulty. Thereafter the endotracheal tube was replaced with a single lumen one. Stomach was mobilized through a midline abdominal incision. Then the neck dissection and mobilization of the cervical esophagus was undertaken. While mobilizing the cervical esophagus, a longitudinal tear was detected in the posterior membranous part of the trachea, about 5 cms long. The tear was identified on seeing the cuff of the endotracheal tube that got visualized in the neck dissection field. Immediately, the cuff of the endotracheal tube was deflated and the tube was pushed further inside by the anaesthetist that prevented air leak. The tear in the trachea was successfully repaired by interrupted 4-0 polypropylene suture. The rest of the surgery was completed by division of the esophagus and stomach, pull-up of stomach tube followed by esophago-gastric anastomosis in the neck. The tracheal defect was further secured by buttressing part of the pulled up stomach around it. The patient was kept intubated and on ventilation overnight. She could be extubated the next day morning and did not have any respiratory difficulty. She recovered well and could be discharged on the 7th post-operative day. Discussion: Tracheal injury during esophagectomy is an uncommon but potentially fatal complication. Majority of the injuries occur during transhiatal esophagectomy. The membranous trachea is most vulnerable for such iatrogenic tear. However, tracheal injury during trans-thoracic esophagectomy is unusual. There are few reports of tracheal injury during thorascopic mobilization of esophagus which were successfully managed by conversion to thoracotomy and repair. Injury to the trachea in the neck during esophagectomy is very rare and we have not found any report of such an event. The best management of such injuries is early detection and primary repair of the trachea. Repair is usually done with interrupted 4-0 polypropylene suture along with reinforcement by buttressing the gastric conduit over the tear. Neoadjuvant radiation and chemotherapy alone or in combination may be a risk factor for intraoperative tracheal tear.

 > Abstract Id: YUGP1145 Top

Early Outcomes Of Immediate Breast Reconstructions Using Acellular Dermal Matrix After Mastectomy For Breast Cancer

Presenter- *Dr. Mihir Chandarana

Co-author - Mr. Mihir Chandarana, Mr. Soni Soumian, Mr. Sekhar Marla

Introduction About one-third of patients undergoing mastectomy in the United Kingdom have immediate breast reconstruction (IBR). The last decade has seen a paradigm shift from autologous reconstructive options to implant-based reconstructions using acellular dermal matrix (ADM). IBR is performed with either a subpectoral or a prepectoral implant placement along with ADM. We report short-term outcomes of IBR using implant and ADM after a mastectomy for breast cancer from our institution. Materials and methods A retrospective analysis of prospectively maintained data of all patients undergoing mastectomy with IBR from 1st January 2015 to 31st May 2017 was performed. Demographic details, pathological details, surgical techniques and perioperative outcomes were analyzed. Results Out of the total of 131 patients (155 reconstructions), 61 patients had prepectoral and 70 patients had subpectoral implant reconstructions. Median age was 51.2 years with a mean BMI of 26 kg/m2. About 20% of the reconstructions were bilateral. Median follow-up was 8.5 months. 19% patients had complications (Clavien-Dindo grade III or more). Overall explant rate was 5.4% in prepectoral group versus 11.6% in subpectoral group (p = 0.44). There was a statistically significant correlation between bilateral reconstructions and complication rate (p = 0.002) as well as explant rate (p = 0.027). Conclusion Implant-based IBR have acceptable outcomes following a skin sparing or nipple sparing mastectomy with comparable outcomes between subpectoral and prepectoral techniques. Bilateral reconstructions have a higher complication rate with a higher explant rate.

 > Abstract Id: YUGP1147 Top

Lateral Intercostal Artery Perforator Flap For Partial Breast Reconstruction In Breast Cancer

Presenter- *Dr. Mihir Chandarana

Co-author - Mr. Mihir Chandarana, Sankaran Narayanan, Mr. Sekhar Marla

Background About 60% of patients with breast cancer in the Western world are treated with Breast Conservation Surgery (BCS). Resection of more than 20% of breast volume requires oncoplastic techniques to restore breast shape and symmetry. Reconstructive options like therapeutic mammoplasty, mini LD flap and free flaps have significant morbidity, longer operating times and scars in remote areas. Recently, local perforator flaps have evolved as a new technique for partial breast reconstruction. We report a case series of Lateral intercostal artery perforator (LICAP) flaps from our institution. Materials and methods A retrospective analysis of prospectively collected data was performed. All patients treated with BCS and reconstruction with LICAP flap were included in the analysis. Breast surgeons trained in oncoplastic techniques performed the surgery. Criteria for patient selection and short-term outcomes were evaluated. Results Ten patients underwent BCS and reconstruction with LICAP flap from June 2016 to June 2017 were included. The mean age of the cohort was 60.5 years, with a mean BMI of 28.5 kg/m2. Average specimen volume excised was 150.4 cc. Largest tumor excised was 45 mm on pathology. None of the patients had any post-operative complications or short-term morbidity. Two patients had a positive margin on excision and re-excision was performed without difficulty. All patients received adjuvant radiotherapy. Conclusion LICAP flap is a feasible option for partial breast reconstruction for tumors located in outer aspect of breast. It spares the latissimus dorsi flap for possible future use. Added advantages are avoidance of a mastectomy, mammoplasty, symmetrisation surgery and mini LD flap. Microvascular surgical techniques are not necessary for the reconstruction.

 > Abstract Id: YUGP1149 Top

To Evaluate The Role Of Swastharakshak In Cancer.

Presenter- *Ms. Ankita Umrao

Co-author - , ,

ABSTRACT: Basis of the study: Cancer is a deadly disease with an estimate of 25% growth by 2020 in India. The multistep process of carcinogenesis involves three stages: initiation, promotion, and progression. Substantial evidences have been found in literature suggesting a key role of free radicals in all the three stages of cancer. Free radicals are also responsible for co lateral damage following chemotherapy. To prevent this free radical damage; antioxidants play a protective role against cancer by terminating the chain reaction before vital molecules are damaged. Food flavoring spices are known to possess active medicinal properties. A growing realization about spices exhibiting potent anti-carcinogenic properties has been supported by several experimental findings. A novel herbal formulation, Swastharakshak® contains well established antioxidants, pro-apoptotic, anti-proliferative, anti-inflammatory, immunomodulatory condiments. Oxidative stress results from increase in toxic reactive oxygen and nitrogen species (ROS/ RNO) which plays a crucial role in cancer development, including inflammation, angiogenesis and apoptosis. Antioxidants are important to decrease the oxidative stress in the body. Cancer chemo-prevention and chemo protection utilizes natural or synthetic chemical compounds to prevent, reverse or repress the development of cancer. According to World Health Organization, more than 80% of world’s population depends on traditional medicines. Several herbal formulations have been prepared but only a few have reached into the pipeline for cancer treatment. Herbal formulations lack substantial characterization of their active components and hence do not have the efficacy of purified molecules as observed in formulated standard chemotherapy drugs. Many a times, the efficacy of individual components in the formulation is dependent on other components in the formulation and poses a daunting task to delineate the efficacy of each component. An alternative approach to this problem is to procure a fingerprint by NMR spectroscopy, which enable positive identification of components in the formulations and thus standardization can be achieved. In the present preliminary study, the chemo-preventive and therapeutic potential of aqueous suspension of Swastharakshak® against Ehrlich Ascites cells induced breast tumor and peritoneal Ascites in Swiss albino mice has been evaluated with respect to tumor burden, mean survival time, percentage life span and hematological parameters. An NMR spectra for the same is procured to maintain a standard reference. Materials and methods: In vivo and In vitro studies: In-vitro effects of different doses of Swastharakshak® in HeLa and K562 cell lines were studied. MTT assay for viability, Acridine orange staining for apoptosis was performed. In -vivo studies were performed in Swiss albino male mice (7-8 weeks old) weighing 20-25g. The animals were kept in ventilated cages having air-conditioned animal facility with 12 h light / dark cycle and provided with standard mouse food and tap water ad libitum. The animals were broadly divided in two groups: Prophylactic and therapeutic. Each group was further divided into five groups of 6 animals each: Group I animals served ascontrol, were put on a normal diet and were given distilled water (vehicle) by oral gavage daily for entire study duration. Group II animals served as carcinogen control. Ehrlich Ascites cells (EAC) (1×106 cells) were injected intraperitoneally and cancer was developed for 10 days in carcinogenic group. Group III and IV included low dose (250mg.Kg) and high dose (500mg/Kg) of Swastharakshak® water extract oral treatment, respectively.Low and high dose of Swastharakshak® was obtained from acute toxicity (as per OECD guidelines 425). Group V was treated with standard 5-Flurouracil (20mg/Kg), injected intraperitoneally. In prophylactic model, Group III, IV and V were given respective treatment and dose before tumor induction for 15 days. In therapeutic models, treatment was started from day 11 for 20 days after tumor inductionwhereas in prophylactic models, experiment was terminated on day 11 after tumor induction in Group III, IV and V. Animals in all groups were observed for any apparent signs of toxicity and mortality during the entire period of study. To study the effects of Swastharakshak® water extract treatment on mice, experiments were terminated aftereuthanizing animals andblood was collected. Several parameters: hematological parameters, weight of animal, tumor size, Ascites volume, mean survival time and percentage life span were assessed in Group III, IV and V. Liver histology was done for animals of all the groups. Mean survival time and percentage life span was calculated as follows: Mean Survival Time (MST) = (day of 1st day + day of last death) 2 Percentage life span= [(mean survival of treated group/ Mean survival of control group)-1}100 The data was expressed as mean ± SE values. The statistical significance of the difference between control and experimental groups was determined by performing one-way analysis of variance (ANOVA). Results: Cells shrinkage, DNA fragmentation, apoptotic bodies were observed within 24Hr of Swastharakshak® treatment as compared to control HeLa and K562 cell lines. Table 1 represents the findings of the present study. Table 1: Chemo-preventive and therapeutic effects of Swastharakshak® on Ehrlich Ascites carcinoma models in Swiss albino mice. Breast site tumor Prophylactic model Therapeutic model Groups/ Parameters Normal control (I) EAC model (II) Low dose (III) High dose (IV) 5-FU (V) Normal control (I) EAC model (II) Low dose (III) High dose (IV) 5-FU (V) Tumor size (cm) --------- 1.69± 0.03### 1.21± 0.02*** 0.75± 0.01*** 0.45± 0.03*** ------- 2.42± 0.09### 1.75 ± 0.05*** 1.02± 0.05*** 0.78 ± 0.03*** Body weight (g) 24.58± 0.3 32.78± 0.26### 30.93± 0.22*** 28.74± 0.2*** 27.43± 0.22*** 25.5± 0.56 34.83± 0.24### 31.1 ± 0.27*** 27.48 ± 0.22** 27.48 ± 0.22** Mean survival time (MST) --------- 15.83±0.3### 20±0.44*** 23.16±0.3*** 25.66±0.49*** ------- 17.66±0.21### 22.83 ±0.3*** 26.16±0.3*** 28.66±0.21*** % increase in life span --------- -------- 26.34 46.3 62.09 ------- -------- 29.27 48.13 62.28 RBC count (cells/mL×106) 10.67 ± 0.11 4.11 ± 0.16### 5.23 ± 0.11*** 6.34 ± 0.2*** 7.84 ± 0.16*** 10.51 ± 0.2 3.94 ± 0.21### 5.44 ± 0.16*** 6.95 ± 0.08*** 7.83 ± 0.08*** Hb content (g/dL) 15.36 ± 0.19 7.1 ± 0.21### 8.91 ± 0.16*** 10.13 ± 0.13*** 12.08 ± 0.13*** 15.22 ± 0.17 7.25 ± 0.16### 9.22 ± 0.14*** 12.06 ± 0.26*** 12.98 ± 0.23*** Total WBC count (cells/mL×103) 9.69 ± 0.13 19.56 ± 0.26### 17.75 ± 0.11*** 15.44 ± 0.12*** 13.15 ± 0.09*** 9.32 ± 0.06 21.21 ± 0.24### 16.61 ± 0.24*** 14.34 ± 0.18*** 13.26 ± 0.27*** Ascites Carcinoma (peritoneal) model Prophylactic model Therapeutic model Group\ Parameters Normal control (I) EAC model (II) Low dose (III) High dose (IV) 5-FU (V) Normal control (I) EAC model (II) Low dose (III) High dose (IV) 5-FU (V) Tumor vol. (ml) --------- 18.12±0.09### 16.18±0.22*** 11.68±0.07*** 8.81±0.28*** --------- 17.5±0.11### 13.96±0.34*** 9.89±0.09*** 7.71±0.2*** Packed cell vol. (ml) --------- 11.95±0.12### 7.98±0.09*** 5.22±0.33*** 3.84±0.13*** --------- 11.46±0.26### 8.03±0.14*** 5.06±0.19*** 4.65±0.11*** RBC count (cells/mL×106) 10.46 ± 0.22 4.01 ± 0.12### 4.4 ± 0.18*** 5.98±0.09*** 7.21±0.13*** 10.51 ± 0.2 3.84 ± 0.06### 5.32 ± 0.08*** 7.08±0.31*** 8.45±0.12*** Hb content (g/dL) 15.13±0.18 7.31±0.19### 8.96±0.16*** 11.06±0.09*** 11.78±0.15*** 15.22 ± 0.17 7.09±0.1### 9.16±0.14*** 10.43±0.15*** 12.17±0.14*** Total WBC count (cells/mL×103) 9.59 ± 0.18 20.41± 0.41### 18.87± 0.21*** 16.27± 0.21*** 14.05± 0.13*** 9.32 ± 0.06 21.34± 0.47### 19.07± 0.14*** 7.08±0.31*** 7.08±0.31*** Values are expressed as Mean ± SEM, n=6, ***p

 > Abstract Id: YUGP1151 Top

Feasibility Of Lower Acquistion Time With Iq Spect In Myocardial Perfusion Imaging



IQ SPECT-CT Consists of Smartzoom Cardio Centric and 3D iterative SPECT Reconstruction and makes it possible to perform myocardial perfusion imaging scans in a short time Abstract: IQ SPECT-CT can reduce myocardial perfusion imaging the acquisition time to one fourth (14 seconds/view) that at standard SPECT procedure. Further reduction of the acquisition time to one eighth of the standard time(7seconds/view) was evaluated. Methods: 30 patients with suspected (or) diagnosed CAD underwent Rest and / or Stress study in Tc99m SestaMIBI myocardial perfusion imaging protocol. Two consecutive SPECT acquisitions 14 seconds and 7 seconds were performed. Electrocardiogram — Gated image were reconstructed with & without attenuation correction. Polar maps were generated and visually scored by two blinded NM physicians for image quality and perfusion defect in 17 segments. Results: Image Quality scored higher with the 14 seconds view acquisition both with and without AC. The 7 seconds image and the 14seconds image with Attenuation correction were comparable images. Where as Non Attenuated correction images are not comparable. Conclusion: Image Quality with 7seconds acquisition was found to be comparable in AC image to previously validated 14 seconds acquisition. Reduced acquisition time with comparable image quality is possible only with the use IQ SPECT with CT based attenuations. It Provide patient comfort and efficiency of the department. However needs more clinical evaluation needed.

 > Abstract Id: YUGP1161 Top

Video: Laparoscopic Nerve Sparing Radical Hysterectomy For Early Stage Cervical Cancer; The Endoscopic Magnification Facilitates Better Visualization.

Presenter- *Dr. Praveen Rathod

Co-author - Praveen Rathod, Chamraj, Manjula

Video Abstract: Surgical Technique Laparoscopic Nerve Sparing Radical Hysterectomy for Early Stage Cervical Cancer; the Endoscopic Magnification Facilitates Better Visualization. Authors: Praveen Rathod*, Chamraj, Manjula, Balasubbiah Y. Department of Gynaecology, RDT Hospital Kalyandurg, Anantpur district, AP. Correspondence*: rathodps2003@yahoo.com Abstract To avoid bowel, bladder, and sexual dysfunction, a nerve-sparing radical hysterectomy has been developed. The operation seems to be associated with prompt recovery of bladder function, minimal need for self-catheterization, and less bowel dysfunction. Introduction: From the superior hypogastric plexus located over the sacral promontory, two hypogastric nerves containing sympathetic fibers run into the small pelvis beneath the ureter and are responsible for such functions as bladder compliance, urinary continence, and small muscle contractions at orgasm. The hypogastric nerves fuse with parasympathetic fibers of the pelvic splanchnic nerves, coming from sacral roots 2, 3, and 4, to form the inferior hypogastric plexus, which is situated in the dorsal part of the parametrium and the dorsal vesicouterine ligament. The parasympathetic fibers are responsible for vaginal lubrication and genital swelling during sexual arousal, detrusor contractility, and various rectal functions. Method: This Laparoscopic surgery video demonstrates the identification of the hypogastric nerves fuse with parasympathetic fibers of the pelvic splanchnic nerves, coming from sacral roots 2, 3, and 4, to form the inferior hypogastric plexus (IHP), and sparing the nerve plexuses by dissection of the uterosacral ligament to lateralise the hypogastric nerves and sparing the inferior hypogastric plexus by dissection parametrium at the level of deep uterine vein. Conclusion: The inbuilt natural endoscopic magnification facilitates the better visualization of pelvic nerves and guides in fine dissection of hypogastric, splanchnic, and IHP at the level of uterosacral ligament and deep uterine vein. The preservation of nerves is important to prevent post-operative bowel, bladder and sexual dysfunctions in patients with early stage cervical cancers.

 > Abstract Id: YUGP1162 Top

Video: Diaphragm Stripping And Resection To Optimize Primary Cytoreduction In Advanced Epithelial Ovarian Cancer.

Presenter- *Dr. Praveen Rathod

Co-author - Praveen Rathod, Sravanti, Sneha

Video: Surgical technique Diaphragm Stripping and Resection to Optimize Primary Cytoreduction in Advanced Epithelial Ovarian Cancer. Authors: Praveen Rathod*, Sravanti N, Arpita A, Sneha R, Rajshekar K, Pallavi V R, U D Bafna. Department of Gynaecological Oncology, Kidwai Cancer Institute, Bengaluru *Correspondence: rathodps2003@yahoo.com Abstract Standard approach for medically stable advanced ovarian cancer patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. The objective optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. Therefore, we aim to present this video to explain the anatomy of diaphragm, steps of liver mobilization and the resection of affected peritoneum from the peripheral muscular part. “Diaphragmatic strippingâ€. The full thickness diaphragm resection toward the central tendinous area, where the diaphragm is reduced to a thin aponeurosis, often requiring a full thickness resection. Once the resection and stripping of the diaphragm have been completed. The defect is closed by a single layer continuous locking water tight sutures with prolene or PDS 1-0. The Intercostal drainage may not be needed once the closure is water tight. CONCLUSIONS: We conclude with our decades of experiences; the diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer contributes to the achievement of complete cytoreduction with low perioperative complication rate; full-thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.

 > Abstract Id: YUGP1165 Top

Role Of Main Pancreatic Duct Diameter And Remnant Pancreatic Volume In Predicting Pancreatic Fistula After Pancreato Duodenectomy (Pd)

Presenter- *Dr. Aditya Kulkarni

Co-author - V C Jha, G R Verma, Ajay Gulati

Background: Post PD mortality has declined in the recent past; however, the morbidity continues to remain high due to high incidence of POPF. A number of risk factors have been studied earlier. We studied the role of remnant pancreatic volume (RPV) and the main pancreatic duct diameter (MPDd) in predicting POPF. Methods: A total of 58 consecutive patients undergoing pancreatoduodenectomy were recruited .After the exclusion criteria, forty three patients were included in final analysis. The diameter of pancreatic duct at neck of pancreas (MPDd) on CECT scan and the presumed RPV from left border of SMV was calculated using Siemens CT Volumetric Software. Postoperative progress was monitored till the discharge Results: There was no significant difference in patient demographics, incidence of preoperative cholangitis, biliary stenting or CA 19.9 levels between patients with or without POPF except that fistula group of patients had significantly higher incidence of pruritis. (0.0187). The overall incidence of POPF was 46.5% (20/43). (Clavien- Dindo Grade1= 13 (65%), Grade2= 3 (15%), Grade3=4(20%).The (MPDd) varied from 1 mm to 12.5 mm. (mean 4.87 ± 2.86 mm) and the residual pancreatic volume from 12.95 cm3 to 78 cm3 (mean 39.17± 16.71 cm3). The incidence of POPF was significantly high, 72.7% (8/11) in patients with non dilated PD ( 35 cm3 had fistula rate of 56.5% compared to 35% in RPV 35 cm3 (objective risk factor) predicted the development of POPF in 83.3% cases. Conclusions: It may be concluded that patients with non dilated PD had significantly high incidence of POPF than dilated PD in patients undergoing pancreatoduodenectomy. There was no significant difference in the RPV of patients with or without POPF. Measuring RPV, an objective criteria is better than soft pancreas (subjective criteria) in predicting the development of POPF in patient with non dilated pancreatic duct.

 > Abstract Id: YUGP1167 Top

'Cytoreductive Surgery With Hipec ''As Primary Treatment Modality For Advanced Ovarian Malignancies- Our Experience

Presenter- *Dr. RAMYA Y

Co-author - Dr Somashekhar SP, Dr Shabber S Zaveri, Dr Vijay Ahuja

Aims & objectives: Cytoreductive surgery with HIPEC is a novel treatment for peritoneal surface malignancies. The role of HIPEC along with optimal cytoreduction in patients with Primary Stage IIIc ovarian malignancies with peritoneal metastasis is yet to be established. This study was conducted to see the efficacy of the same in Indian setup. Materials & methods: This is a prospective study, done between July 2013 to June 2017. Patients with Stage IIIc carcinoma ovary underwent optimal cytoreduction with HIPEC either as frontline or as interval setting were included. The perioperative data were analysed. Results: Total of 65 patients underwent the procedure: as frontline in 24.6% (n=16) and interval cytoreduction 75.3% (n=49). Mean peritoneal carcinomatosis index was 8.5 ± 7.45 (Range 2-30). All patients underwent total peritonectomy. 10% patients had multivisceral resection. Cisplatin was used as the agent for HIPEC in 86%. Average surgery duration was 9 ± 2.7 hours (Range 5.5 — 19). Average duration of hospital stay was 13days. Majority of patients had papillary serous carcinoma type (90%). Postoperative morbidity Grade III & IV morbidity was noted in 12-16% & 30days mortality was 4.6% .Patients with PCI score >15, multivisceral resection had higher postoperative morbidity. After a median follow-up of 20 months, 15.8% had recurrences and 5.3% patients succumbed to disease. Conclusion: Advanced ovarian malignancies with peritoneal metastasis are amenable for extensive cytoreduction and HIPEC with acceptable morbidity in Indian patients even in the primary setting. A dedicated team of surgeon, anesthetist, medical oncologist, and intensivist is mandatory for better outcome.

 > Abstract Id: YUGP1169 Top

'Endopredict Test”- In Our Practice: A Prospective Study

Presenter- *Dr. RAMYA Y

Co-author - Dr Somashekhar SP, Dr Shabber S Zaveri, Dr Ashwin KR

Aims & objectives: The EndoPredict test is a novel tool to predict the risk of metastases in patients with estrogen receptor positive, HER2 negative breast cancer treated with endocrine therapy alone. It integrates genomic and clinical information. In this study, we investigated the performance of this test in our clinical practice in Indian setup. Materials & methods: This study was performed between September 2016 to June 2017. Total of 32 eligible patients underwent EndoPredict assay & their data were analysed. Results: Mean age was 62 years. Beast conservation was done in 46.8%. 68% were T1-2N0 stage. Regarding the molecular EP class, samples from 13 patients (40.6%) had a low-risk, whereas 19 patients (59.4%) showed a high-risk gene profile. After integration of the clinicopathological factors the combined clinical and molecular score (EPclin) resulted in a low-risk group of 18 patients (56.25%), while 15(46.8%) had a high risk EPclin score. The EPclin-based estimated median 10-year-risk for metastases with endocrine therapy alone was 12% for the whole cohort. Majority of pT1N0 patients were in the low risk group (99%), whereas patients with positive lymph nodal involvement were in the high risk category (88%). Comparison of pre- and post-test therapy decisions showed a change of therapy in around 30% of patients. Conclusion: Our results show that the EndoPredict assay could be routinely performed and the results can change the treatment decisions. Long term follow up is needed for the validation in our clinical setting.

 > Abstract Id: YUGP1173 Top

Discordance Rate Of Er, Pr And Her-2 In Recurrent Breast Cancer : A Study From Tertiary Cancer Center In South India.

Presenter- *Dr. Abhishek Anand

Co-author - Linu Abraham Jacob, K C Lakshmaiah, K Govind Babu

Introduction A central component of the treatment of breast cancer is full knowledge of extent of the disease and the biological features. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status are clinically used to define breast cancer subtypes and are therapeutically as well as prognostically important in the management of breast carcinoma. The discordance of hormone receptor status (HR) and HER2 status between primary and the recurrent breast cancer specimen has been recognized in studies. In addition change in therapy based on the receptor status of recurrent disease has also been reported. Although biopsy of recurrent breast cancer has been recently recommended by international clinical guidelines, HR and HER2 status of primary tumors are still being used in making decisions for the systemic therapies of recurrent breast cancer . Moreover, fine needle aspiration cytology (FNAC) without the IHC is a common practice for the management of recurrent breast cancer in developing countries where resources are limited. Despite the ongoing studies looking into the discordance rate and its implications worldwide the data from India is limited. In the present study we analysed the discordance rate of ER, PR and HER2 status between primary and recurrent breast cancer at a single institute. Methods This was a prospective study carried out at the Department of Medical Oncology, Kidwai Cancer Institute, from September 2015 to February 2017. All breast cancer patients coming with a recurrence (locoregional or metastatic) were analyzed. Patients with metastatic cancer upfront and those who underwent breast conserving therapy for primary tumor were excluded from the study. The immunohistochemistry (IHC) report for ER, PR, and HER2 status of the primary tumor was required for inclusion in the study. Biopsy was done from the recurrent site and IHC study was performed on the specimen. Hormone positivity was taken as ?3+ on Allred scoring. Fluorescence in-situ hybridization (FISH) study was performed for patients with equivocal (2+) result of HER2 on IHC. The discordance of ER, PR and HER2 status between primary tumor and recurrent disease were analysed. Mc Nemar test on SPSS version 23.0 was used to see the statistical significance. Results A total of 78 patients satisfied our inclusion criteria and were analyzed. The clinical and pathological profile of patients have been described in Table 1.The discordance rate of ER was 13.7% (n=11). Among these 3.7% had ER changed from positive to negative whereas 10% had change from negative to positive. The discordance rate for PR was higher with 28.7% (n=23). Those who had receptor changed from positive to negative was 7.5% while 21.2% had change from negative to positive. The discordance of HER2 was seen in 21.2% (n=17) with 3.7% showing change from positive to negative and 17.5% showing change from negative to positive. The receptor status and discordance rate between primary and recurrent disease have been shown in Table 1. Table 1. Clinical and pathological profile and discordance rate of ER, PR, and HER2 n=78 % Median age of primary tumor 42 (25-65) Premenopausal 52 67 Postmenopausal 26 33 Stage at diagnosis I 0 0 II 32 41 III 46 59 Grade of primary tumor I 2 3 II 21 27 III 55 70 Histology of primary tumor Invasive ca NST 78 100 Recurrence Locoregional 35 45 Visceral 14 18 Locoregional+visceral 29 37 Site of biopsy for HPE & IHC Locoregional 46 59 Distant metastasis 32 41 Number of patients % ER discordance 11 13.7 p=.227 PL(+), RML(-) 3 3.7 PL(-), RML(+) 8 10 PR discordance 23 28.7 p=.017 PL(+), RML(-) 6 7.5 PL(-), RML(+) 17 21.2 HER2 discordance 17 21.2 p=.013 PL(+), RML(-) 3 3.7 PL(-), RML(+) 14 17.5 HPE- Histopathological examination, PL — Primary lesion, RML — Recurrent metastatic lesion Conclusion The discordance rate in our study was 13.7%, 28.7%, and 21.2% for ER, PR, and HER2 respectively. This is similar to that reported in the literature, although the discordance in ER was not statistically significant. On contrary to the reported literature, a higher number of patients had receptor negative in primary to receptor positive in the recurrent specimen than from converting from positive to negative. This was seen for ER (PL+, RML- =3.7% vs PL-, RML+=10%); PR (PL+, RML-=7.5% vs PL-, RML+=21.2%); as well as HER2 (PL+, RML- =3.7% vs PL-, RML+=17.5%). The exact cause of this discordance has not been confirmed. Possible explanations include: pre-analytic and analytic variability (eg. sampling errors, different techniques in processing and performing the tests) , intra-tumoral heterogeneity, clonal selection ,variable ER-lineage differentiation of a putative disseminated breast cancer stem cell during the course of the disease, selective effect of previous treatments (adjuvant endocrine, chemotherapy and trastuzumab therapy) and, switch in tumor biology (eg. dedifferentiation). This discordance of receptors have an important implications in the management as well as prognosis. Therefore, routine biopsy and analyses for ER,PR, and HER2 status in the recurrent setting should be done in all patients.

 > Abstract Id: YUGP1175 Top

Outcome Analysis Following Preoperative Two Drug Chemotherapy Regimen In Osteosarcoma- A 10 Year Study From A Single Tertiary Care Referral Centre:

Presenter- *Dr. Maheswaran Satishkumar

Co-author - prof S.Subbiah, prof G.Gopu, dr senthilkumar

Introduction: Osteosarcoma is the most common type of primary malignant bone tumour, with majority of them being high grade occurring commonly in the second decade. The prognosis of high grade osteosarcoma has improved dramatically , after the advent of multimodal therapy. With current use of combination chemotherapy the survival has increased from 10-20% in pre chemotherapy era to almost 70-80% in post chemotherapy era. Limb salvage is possible in more than 80% of these patients, which has improved the quality of life in these patients. There are very few trials which has evaluated the efficacy of different chemotherapy regimens. Weather combining three or four drugs has any added advantage at the cost of toxicity is an unanswered question.This study is a long term 10 years analytical study from a single institution, which is a tertiary care referral centre, done to study the outcomes using two drug regimen in osteosarcoma. Aims and objectives: To study the response, recurrence free and over all survival and limb salvage rates in these patients treated with two drug preoperative chemotherapy regimen for osteosarcoma. Materials and methods: The study included 63 cases of high grade osteosarcomas, treated with cisplatin and Adriamycin preoperative chemotherapy, between January2007 to March 2017. Results: 63 cases of high grade osteosarcoma, of which 49 were male and 14 were females. The average age was 13. Lower end of femur was commonest in our series followed by lower end Tibia. 2 cases were osteosarcoma of the mandible.11 patients presented with lung metastasis at presentation. All patients were treated with preoperative chemotherapy using two drugs- Cisplatin(100mg/m2)on day 1 and Adriamycin(25mg/m2)on days 1-3 .Good responders are those who had atleast 90% necrosis in post excision specimen while others are non responders. Pre surgical response evaluation was made after every cycle using subjective parameters like reduction of pain, increase in range of movements, subjective decrease in swelling and objective parameters like decrease in size of swelling, soft tissue disease, x ray features of increased calcifications, healing of pathological fractures and also CT was done after 3 cycles along with an MRI to look for disease response, (decrease in peri lesional edema, decrease in tumour vascularity), marrow involvement and neurovascular status. Statistical analysis was made using p value and Kaplan meier analysis. In our study 26 patients had good response(41.2%) and 34 patients had poor response(53.9%), while 2 patients discontinued treatment by defaulting .Only one patient who had lung metastasis at presentation had good response and metastasis disappeared after chemotherapy which was confirmed by imaging. Among the good responders, the recurrence free survival at 3 years were 85.26% and over all survival was 89.01%. While in non responders or poor responders, the 3 year recurrence free survival was 53.61% and over all survival at 3 years was 49.70%. Among the patients who presented with metastatic disease, out of the 11 patients, 3 patients had progressive disease and 7 patients had static disease and one had good response with complete remission of lung metastasis..Metastatectomy was done in 2 patients, who had static response. Out of the two cases of mandibular osteosarcoma, one patient had poor response and developed lung metastasis(multiple) post surgical excision at 9 months .None of the patients who had progressive disease and distant recurrence responded to chemotherapy with addition of ifosfomide, in our study.There were no grade 3 or 4 toxicities, and death related to chemotherapy in our study group. None of our patients discontinued treatment due to toxicity. Our limb salvage rate is 86%.Our analysis is in par with available literature and the acceptability of two drug regimen was much better and was also less toxic. Institutions using three drug regimen has reported good response of about 37- 44% and disease free survival of about 85% in good response category.However the grade 3 and 4 toxicities with high dose methotrexate, bone marrow suppression with ifosfomide are of concern. Conclusion: From our study , we have analysed that using two drug regimen which is well tolerated and acceptable, the response achieved is equal or even slightly better than that of three or four drug regimen. The use of preoperative chemotherapy has improved survival in good responders. However the rate of limb salvage or recurrence were independent of chemotherapy. Using two drug regimen the adherence to treatment and compliance is improved leading to better acceptability in patients.

 > Abstract Id: YUGP1177 Top

Prospective Study On Er,Pr,Her 2- Neu,Ki67 Expression And Discordance Pattern In Recurrent And/(Or) Metastatic Carcinoma Breast And Its Therapeutic Implications

Presenter- *Dr. Maheswaran Satishkumar


Introduction: The treatment of breast cancer is complex with many molecular subtypes and various prognostic factors which influence treatment response, disease progression and survival. There are few studies reported in literature which has analysed the molecular pattern, but only few amongst them has elucidated in detail , the implications for molecular typing in metastatic and recurrent setting breast cancer setting. There are not much studies, on KI67 discordance being analysed. In this prospective study we have, in depth analysed the pattern of discordance in each sites of metastasis and the response to systemic therapy and hence the prognosis. Aims And Objectives: 1.To determine ER,PR,HER 2 Neu, Ki67 from recurrent and/ or,metastatic , carcinoma breast ,to study the expression pattern and discordance. 2.To study the degree of discordance in relation to the site of metastasis and pattern of metastasis(synchronous vs metachronous). 3.To determine the correlation of expression/discordance pattern with the response to chemotherapy . Type Of Study- Prospective analytical study conducted at centre for oncology,government royapettah hospital for a period of three years. Duration - November 2014- January 2017 Materials And Data analysis: Data analysis was done using statistical p values, Kaplan meier estimator ,and calculating the 95% confidence intervals(CI). â€Â¢ Total No Of Patients Enrolled So Far In Study- 110 â€Â¢ Total No Of Patients Analysed — 110 â€Â¢ Total No Of Premenopausal Patients - 41(37.3%) â€Â¢ Total No Post Menopausal Patients- 69(62.7%) â€Â¢ Total No Er,Pr +Ve Cases: 72( Premenopausal — 19, Post Menopausal-53) â€Â¢ Er Negative, Pr Positive-1 â€Â¢ Total NO of Her 2 +ve cases- 18(premenopausal=5, post meno-13) â€Â¢ Luminal A- 22cases(ER+,PR+,HER2 -,KI67

 > Abstract Id: YUGP1181 Top

The Less Studied Synovial Sarcoma- An Institutional Experience

Presenter- *Dr. K Siva Prasad

Co-author - K Meher Lakshmi, , G Stalin Bala, M Lakshmi Srinivas, G Sadashivudu, G Stalin Bala

Introduction : Treating soft tissue sarcoma (STS) poses several challenges to the clinician due to varied presentation, heterogeneous biology, and unpredictable recurrences in the majority of cases. The data specifically regarding synovial sarcoma is very less as many clinical trials combine with other soft tissue sarcoma during reporting. Available data are mostly from the western countries and in the Indian subcontinent it is sparse. Hence we tried to study the clinical profile, tumor characteristics and treatment strategies used were analyzed. Materials and Methods: It is a retrospective, observational medical record based study. We retrieved medical records of sarcoma cases at our institution treated between 2010 and 2014( 5 years). Total 452 cases of sarcomas are registered and among them bone sarcomas were 250 and STS were 202 cases. We found 42 cases of synovial sarcoma and details were analyzed. Results: The mean age is 30.1 years (range 10-53 years), male to female ratio is 1.25 :1. Commonest site being lower limb region in 32 (76%) cases followed by upper limb in 6 (14%) and thorax in 4 (10%) cases.Mean tumor size is 12 cm( range 3-20 cms) with 6 (14%) having lymphnodes at the time of diagnosis. Among 42 cases, 9 were metastatic at the time of presentation. Thirty three resectable cases underwent local excision in 25 cases and 8 underwent amputation of local part with margins of R0 in 29 (88%), R1 in 2 (6%) and R2 in 2 (6%) cases.The commonest sites for metastasis are as follows : lung, bone and liver. Median TTP is 19 months (range 12-60 months ) and in metastatic cases the PFS is 10 months (range 1-19 months). Conclusion : Synovial sarcoma is one of the commonest type of STS in the community which requires multimodality management. Most of the recurrences occurs in first 2 years of therapy and lung is the most common metastatic site. Limitations of this study include: single institute study, selection bias, small sample size. Urgent need of new therapeutic options are required and boom of immunotherapy yet to hit in the field of STS.

 > Abstract Id: YUGP1189 Top

Prostate Specific Antigen Nadir Within 12 Months As An Early Surrogate Marker Of Biochemical Failure And Distant Metastasis After Low-Dose-Rate Brachytherapy For Localized Prostate Cancer

Presenter- *Mr. Shuichi Nishimura

Co-author - Toshio Ohashi, Kaneda Tomoya, Sakayori Masanori

Purpose: Nadir prostate-speci?c antigen (nPSA) after definitive radiotherapy for prostate cancer has been investigated as a predictive factor for treatment outcomes. However, nPSA usually requires several years before determination in many patients, limiting the clinical utility of nPSA as a predictive factor. Earlier markers of recurrence risk after the completion of radiotherapy would be clinically useful. In this study, we investigated the significance of nPSA within 12 months (nPSA12) after low-dose-rate prostate brachytherapy (LDR-PB) on biochemical failure (BF) or distant metastasis (DM). Methods and Materials: Between 2006 and 2014, 474 consecutive patients with localized prostate cancer were treated with LDR-PB without androgen deprivation therapy. The minimum follow-up duration was 24 months. The median age at diagnosis was 70 years. The median pretreatment PSA was 6.5 ng/ml. By NCCN guideline’s risk group, 237 were low risk, 210 were intermediate risk, and 27 were high risk. BF was defined according to Phoenix de?nition. Kaplan-Meier method was used to estimate BF free survival rate (BFFS) and DM free survival rate (DMFS). Univariate and multivariate analyses were used to determine the significance of nPSA12 and other clinical factors on BF and DM. Results: The median follow-up duration was 61.4 months. Of the 474 patients, 19 experienced BF, and 11 experienced DM. The median nPSA12 was 0.7 ng/ml. When dividing patients according to low (?0.7) and high (>0.7) nPSA12, the 7-year BFFS rates for patients with nPSA12 ?0.7 and >0.7 ng/ml were 99.1% and 90.2%, respectively (p = 0.004), and the 7-year DMFS rates with nPSA12 ?0.7 and >0.7 ng/ml were 99.5% and 94.8%, respectively (p = 0.010). Multivariate analysis demonstrated that nPSA12 was an independent predictor of BF (p = 0.004) and DM (p = 0.020). Conclusions: The nPSA12 in prostate cancer patients treated with LDR-PB is signi?cantly associated with the risk of BF and DM. For patients achieving nPSA12 ?0.7 ng/mL, the risk of subsequent failure was

 > Abstract Id: YUGP1202 Top

Interstitial Brachytherapy For Early Stage Tongue Cancer: Analysis Of The Long-Term Treatment Results For Survival And Complications.

Presenter- *Dr. Yuki Takeuchi

Co-author - Yuji Murakami, Nobuki Imano, Ippei Takahashi

The basis of this study: The basis of this study was to evaluate the long-term treatment results of?interstitial brachytherapy (IBT) in patients with early stage tongue cancer. Methods and materials: We analyzed 226 patients with early stage tongue cancer treated by IBT using Ir-192 sources and Au-198 seeds between 1994 and 2009. There were 78 females and 148 males. The median age was 59 years (22-93). Histology was squamous cell carcinoma in 224 patients, others in 2. There were Tis / T1 / T2 in 3 / 67 / 156 patients. The median thickness of tumor measured by sonography was 6mm (1-22). The growth type was infiltrative / superficial / unknown in 117 / 106 / 3 patients. IBT was performed using Ir-192 in 203 patients and Au-198 in 23 patients. Median irradiation doses of Ir-192 and Au-198 were 68 Gy (43-73) and 84 Gy (60-99), respectively. The prescribed point of brachytherapy was at the plane 5mm from the plane of the radioactive sources. External beam radiation therapy (EBRT) was performed before brachytherapy in 72 patients. Median dose of EBRT was 30Gy (15-46). Chemotherapy was combined with brachytherapy in 88 patients. Results: Median follow up time for survivors was 129 months (44-242). The 10-year overall survival (OS) and cause specific survival (CSS) rates was 71% and 87%, respectively. The 10-year local control and regional control rates were 85% and 67%, respectively. More than 80% of the regional metastasis was occurred within 1 year, and more than 90% was within 2 years. In the multivariate analysis, significant differences in OS were seen with age, tumor thickness and having double cancer. Also, significant differences in the regional metastasis were seen in the tumor thickness and sex. On the other hand, in the univariate and multivariate analysis, there was no significant difference in the local recurrence. According to the classification by Shibuya, grade 2 soft tissue complications were observed in 4 patients and grade 2 mandibular complications in 2 patients. There were no grade 3 late complications. Conclusion: Our 10-year treatment results of IBT for early stage tongue cancer showed favorable survival and low occurrence rate in patients with severe late complications.

 > Abstract Id: YUGP1203 Top

Only Methylene Blue In Sentinel Lymph Node Biopsy For Early Breast Cancer - A Prospective Study.

Presenter- *Dr. Rakesh Ramesh

Co-author - Dr Ramu D, Dr Suraj Manjunath, Dr Shivakumar K

Only methylene blue in sentinel lymph node biopsy for early breast cancer - a prospective study. Dr Rakesh S Ramesh , Dr D Ramu , Dr Suraj Manjunath , Dr Shivakumar K , Dr Rajaram B V , Dr Hemanth N , Dr Elvis , Dr Faslu Rahman . The Department Of Surgical Oncology ,St Johns Medical College Hospital , Bangalore. Background Sentinel lymph node biopsy is the standard technique for negative axilla in early breast cancer for staging and for planning the adjuvant treatment. Sentinel lymph node can be identified by Blue dye technique or radioisotope technique - most of the oncology centers will not have the nuclear medicine facilities to do the radioisotope technique . Studies have shown that only dye technique is equally effective compared to the combined dye and radioisotope technique. Since methylene blue is cheaper than isosulphane blue and easily available - this study is a effort to look for the efficacy of methylene blue in sentinel lymph node biopsy for early breast cancer patient in a teaching hospital. Methods And Materials From May 2015 to April 2016- Forty patients with early breast cancer had undergone treatment in the Department of Surgical Oncology ,St Johns Medical College Hospital. After ethical committee clearance , informed consent - 3ml of 1% Methylene Blue was injected in the periareolar area of the affected breast and looked for the sentinel lymph node in the ipsilateral axilla. Results The overall accuracy of identifying the sentinel lymph node was 94.7% ( 38 out of 40 patients ) with a false negative rate of 5.26% . The sensitivity of the study was 89% and specificity of 100% . The positive predictive value was 100% and negative predictive value of 93.3%. Conclusion This study using methylene blue for identifying sentinel node showed very high accuracy rate and low false negative rate . We propose that only methylene blue technique is an efficient method for sentinel lymph node identification . This can be confidently practiced in centers without nuclear medicine facility .

 > Abstract Id: YUGP1209 Top

Arsenic Induced Cancers : Dreadful Situations Ahead

Presenter- *Dr. PRABIR BIJOY KAR

Co-author - , ,

Presenter : Dr Prabir Bijoy Kar , MS , FAIS, Oncosurgeon Chief of Oncosurgery, Barasat Cancer Research and welfare Centre, W B Visiting consultant : AMRI cancer centre, Desun Hospital , Kolkata E mail : drpbkar@yahoo.co.in Mob : 09830039032 Address for communication: 114/1, Bosepukur Purbapara Rd. Kolkata - 700107 Arsenic has been known for centuries for its various uses in several industries and also for its deleterious effects on our body. Amongst the various bad effects chronic arsenic poisoning has been found to cause cancers of skin , lungs, kidneys, stomach , liver etc. This has been studied extensively in areas where the level of arsenic is higher than the safety levels as stipulated by WHO . This includes Norther Chile, Taiwan , parts of Southeast Asia including India, Bangladesh etc. In India most parts of West Bengal , parts of Bihar and Jharkhand are having high levels of Arsenic in groundwater resulting in chronic arsenic poisoning. The carcinogenic effects of arsenicosis has been well accepted by various research agencies and environment protection bodies like IARC USEPA. Major portion of West Bengal is not having arsenic free drinking water and a vast majority of population is exposed to arsenicosis . Several families are losing their members every year due to aesenic induced cancers. Most residents of villages and semi urban areas of north-eastern part of West Bengal are destined to have cancer deaths and hence need serious thought on this. This is a preliminary study report of such patients attending our hospitals mostly with various skin changes which are at large pre- malignant conditions and often reversible by appropriate treatment. This presentation is aimed to highlight the different modes of presentations, investigations for diagnosis and treatment in early and advanced stages. If appropriate measures are taken most of these cancers can be prevented and their lives can be saved. ………………………………………………………………………………………………………………. I hereby certify that There is no conflict of interest. Kindly try to keep it as a lecture of 15- 20 mts duration. Dr Prabir Bijoy Kar

 > Abstract Id: YUGP1211 Top

A Randomized Controlled Trial Comparing The Efficacy Of Methylene Blue Dye Versus Combination Of Methylene Blue Dye And Radioactive Sulphur Colloid In Sentinel Lymph Node Biopsy For Early Stage Breast Cancer Patients

Presenter- *Dr. Vikas Gupta

Co-author - Dr KVVN Raju, Dr T Subramanyeshwar Rao, Dr Satish pawar

AIMS AND OBJECTIVES : To study the efficacy of methylene blue dye alone versus combination of methylene blue dye and radioactive colloid in sentinel lymph node biopsy for early stage breast cancer patients INTRODUCTION: Sentinel lymph node biopsy ( SLNB) has become a standard of care for management of axilla in patient with early stage node negative breast cancer patients . However the technique of SLNB is still not well defined, with some studies favouring combination of blue dye and radioactive sulphur colloid whereas others showing equal outcomes with blue dye alone. Methylene blue dye is readily available for use in patients. Radiaoactive sulphur colloid on the other hand is available only in select centres with nuclear medicine facilitiesThe purpose of this study is to find out whether we can use Methylene blue dye alone for sentinel lymph node biopsy in early stage breast cancer patients instead of combination of methylene blue dye and radioactive sulphur colloid. This is more important in the Indian context where radioactive sulphur colloid and nuclear medicine facilities are not available everywhere. MATERIALS AND METHOD: Preoperatively, all patients were investigated in the same manner with routine blood investigations ,bilateral mammogram and Breast lump biopsy . Exclusion criteria included radiologically (Ultrasound ) non suspicious axillary lymph nodes OR suspicious lymph nodes negative on FNAC . Patients randomized into methylene blue arm ,were injected with 5 ml of methylene blue peritumorally in subcutaneous tissue about 10 mins prior to incision , and injection site was adequately massaged for 5 mins. Patients randomized into methylene blue and radioactive colloid arm , were first injected with 1 millicurie (mCi) of filtered technetium-99m sulphur colloid ([99mTc]TSC) in a total volume of 1 mL of normal saline periareolar , intradermally about 2 hrs prior to surgery and then 10 mins prior to incision patient was injected with methylene blue (5 ml) in the peritumoral area. An intraoperative gamma-detecting probe was used to help and guide the dissection. Histopathological analysis for sentinel LNs was performed by frozen section and permanent sections with H&E (haematoxylin and eosin), whereas the non SNs were evaluated by H&E alone. STASTICAL METHOD: Data was collected and analysed by the SPSS 12.0 program . Fisher's exact test and Student's t test were used to compare the two groups. P 0.05). Also pT stage (size of tumour) was comparable between the two subset of patients CONCLUSION: 1. Negative predictive value and false negative rate, which are the most important predictors of efficacy of the technique used for identification of sentinel lymph nodes is comparable, whether blue dye is used alone or a combination of blue dye and radioactive colloid is used. 2. Use of radioactive Tc -99 sulphur colloid, entails availability of nuclear medicine facilities and necessary expertise which may not be possible in all centers ,in which case blue dye may be used alone with equivalent outcomes. 3. Sentinel lymph node biopsy can be accomplished with acceptable yield of sentinel lymph nodes , irrespective of age and body mass index of patient.

 > Abstract Id: YUGP1223 Top

Comparison Of Icru 38 Rectal Reference Point Dose Estimates With Measured Dose In-Vivo In Cobalt-60 Hdr Brachytherapy For Cervical Cancer

Presenter- *Dr. Cesar Vincent III Villafuerte

Co-author - Edilberto Joaquin V. Fragante Jr., MD, Marivic Bacaling Candado, MMP,

The objective of this study was to compare the ICRU 38 calculated rectal dose with in-vivo dosimetry measured doses in Cobalt-60 HDR brachytherapy for cervical cancer. A total of 48 brachytherapy insertions done on 15 patients treated from January to March 2017 at our institution were included in this prospective cross sectional study. The results demonstrated no significant difference between the computed ICRU rectal point dose and in-vivo maximum measured rectal dose ((r) 0.6208, p

 > Abstract Id: YUGP1231 Top

Survival Analysis For Advanced Stage Maxillary Sinus Carcinoma Treated With Combined Modality Approaches Incorporating Radiotherapy



Introduction: Carcinoma maxilla is a rare disease and usually present in advanced stage. Survival is poor despite treatment approach using multimodality treatment concept. Aim: To study the clinical outcome and survival analysis of patients treated with combined modality approaches for advanced stage maxillary sinus carcinoma. Materials and Methods: The medical records of 25 patients of advanced stage maxillary sinus carcinoma treated with curative intent from 2011 to 2016 were analyzed retrospectively. All the patients underwent primary surgery followed by postoperative adjuvant radiotherapy. Survival analysis was done using Kaplan-Meier method. Results: All patients presented with advanced disease stage III or IV; nodal involvement was observed in five patients (20%). The three-year overall survival for all patients after surgery and postoperative radiotherapy with or without concurrent chemotherapy was 74%. Median survival was 17 months. The most common pattern of recurrence was at the primary site, which was observed in five patients(20%).pT4 lesion ,lymph node involvement ,surgical margins positive, depth of invasion>10mm, ,high grade, LVI/PNI were prognostic factors of importance. Conclusion: Primary surgical treatment of maxillary sinus carcinoma in advanced stage followed by post operative adjuvant radiotherapy is a good treatment option.

 > Abstract Id: YUGP1235 Top

Educational Short Film Vs Conventional Power Point Based Lectures In School Based Tobacco Awareness Programs €”Experiences From A Tertiary Cancer Center

Presenter- *Dr. Neethu Ambali Parambil


Background Tobacco use is the single biggest preventable cause of death in the world. 14.6% of students use tobacco in any form (GYTS 2009). Educational short films can be used in tobacco awareness to make teaching- learning process easier and interesting. Student engagement and knowledge acquisition becomes more efficient when the learners experience an event through multimedia simulation. Aim and objectives To study the effectiveness of 1) Educational short film as a tool for tobacco awareness. 2) Short film over power point lecture in delivering anti-tobacco awareness Materials and Methods The study was conducted in schools of Kannur , Kozhikode and Waynad districts and Puduchery after obtaining institutional consent.. Schools were randomly selected into group1 and 2. 6% difference with a power of 80% and 95% CI between two arms suggest a sample size of 961 each. A pre tested, structured questionnaire in local language, based on facts in the 1 hour film and power point was used. In group1, the anti-tobacco short film “U TURN†produced by MCC was screened. Awareness levels were checked pre and post screening using the questionnaire after assuring confidentiality of response. In group 2, a PowerPoint lecture on tobacco was conducted. Awareness levels were checked using the same questionnaire. Of the 11 questions, 1,2were on ever tobacco use,3 ,4 on passive smoking and the remaining based on tobacco contents, health hazards, second hand smoke, related laws and cessation were framed to assess awareness level. Inclusion criteria: Students of classes 8, 9, 10, 11and 12 Exclusion criteria: Students who have previously viewed the film or attended any tobacco awareness programs. Results Data was collected from the sample size of 961 students in each arm and under evaluation .Results are awaited. Conclusion If results prove the short film more effective, it will help in planning school based tobacco awareness programs, with little man power. It will provide a powerful tool for awareness creation and anti-tobacco message dissemination to larger part of schools in Kerala.

 > Abstract Id: YUGP1237 Top

Analysis Of Volumetric And Consequential Dosimetric Changes In Parotid Glands In Locally Advance Head And Neck Cancers During The Course Of Intensity Modulated Radiotherapy And Finding The Need Of Adaptive Radiotherapy For Parotid Gland Sparing

Presenter- *Dr. Dinesh Kumar Singh

Co-author - Dr. Rajesh Pasricha, Dr. Nidhi Patni, Dr Jaishree Goyal

Background: Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). Therefore the risks of parotid glands overdose and a xerostomia increase. The purposes of the study are: 1. To estimate the volumetric changes in parotid gland during the course of IMRT 2. Calculate the consequential dosimetric changes Methods: It is a prospective analysis, Fifteen patients received radical IMRT for LAHNC. Repeat CT scans were used to estimate the dose distributions delivered during the treatment at the end of 2nd week, 4th week and 6th week. Each repeat CT scan was registered with planning CT scan. Recontouring was done on each repeat CT scan and volume of parotids were calculated. Original IMRT treatment plan was then transferred onto each of repeat CT scans. DVH was recalculated for each repeat CT scans and compared for dosimetric end points (Dmean and D50%). Repeated measure ANOVA test was used to establish whether changes in the same variable, observed at different treatment weeks, were significant. Post hoc Bonferroni test was used for pairwise comparison between data from planning CT scan with data from first, second and third repeat CT scans, respectively. Results: Right Parotid gland On planning CT scan the mean volume of right parotid was 19cc which was decreased to 18.63cc, 17.25cc, and 16.14cc on first, second and third repeat CT scan respectively. These changes were statistically significant between planning and second repeat CT scan (p = 0.0001) and planning and third repeat CT scans (p

 > Abstract Id: YUGP1244 Top

Role Of Topical Aloe Vera Gel In Recovery Of Higher Grade Radiation Induced Dermatitis.

Presenter- *Dr. VEENITA YOGI

Co-author - Veenita Yogi, O.P.Singh, Varsha Mandloi

Radiation induced dermatitis is a common adverse effect of radiation therapy, in spite of skin sparing effect of megavoltage.Approximately 90% of the patients received radiation therapy may develop skin reaction of any grade during therapy, leading to therapy delays,diminution of patients health state and quality of life.In this study we have used topical aloe vera gel for treatment of higher grade radiation induced dermatitis. Material and Methods: This prospective study conducted on 85 carcinoma patients of head and neck ,breast and cervix during year 2015 and 2016.All the patients has received EBRT on cobalt-60,at least 46 Gy. According to the RTOG skin reaction grading,patients who have developed grade III and IV skin reaction were adviced to use aloe vera gel on irradiated site thrice daily with routine skin and nursing care. Results: In this study 67% female and 33% were male patients.Median age of the patients was 43.3 years (range 25-70 years).Head and neck patients were 42%,breast 23% and cervix 35%.The prescribed radiation doses were 46-70 Gy,2 Gy per fraction,for a treatment duration 32-52 days ,using a field size 80-380 cm2,according to treatment site.Out of 85 patients, 65 treated with concurrent chemotherapy.Grade III (22%) and grade IV(14%) dermatitis occurs in the 5th week of radiation which causes treatment delay ,ranges 2-10 days,according to severity and patient related factors.It was noticed that after application of aloe vera gel ,dermatitis completely recovers within 3-7 days. Conclusion: Radiation induced dermatitis has to happened due to rapid cell division in skin.In spite of skin sparing effect of megavoltage ,35-40% dose is received by skin and it increases in parallel opposing field.Till date no treatment is available which can prevent radiation induced dermatitis.In our observational study ,it was noticed that topical aloe vera gel was more effective in recovery of higher grade radiation induced dermatitis.

 > Abstract Id: YUGP1245 Top

Patterns Of Failure After Definitive Treatment Of Squamous Cell Carcinoma Of Oropharynx, Hypopharynx And Larynx Treated By Higher End Techniques: An Institutional Experience From Western India.



Introduction: As most of the centers in India is still cobalt based, limited clinical data is available in India about the effect of newer techniques like intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT),Rapid arc. Aim: To detect patterns of failure after definitive treatment of squamous cell carcinoma of oropharynx, hypopharynx and larynx treated by higher end techniques like IMRT,IGRT,Rapid arc. Material and Methods: Between May 2015 to 2017, fourty four patients treated by higher end techniques, 40 definitively and four postoperatively were analysed. Standard radical dose was 70G/35# in definitive setting while 60-66Gy/30-33# in adjuvant setting. Results: Median age was 58.5 years (range 30-82 years).Five patients had stage II,15 patients had stage III and 24 patients had stage IV disease.39 patients received concurrent chemotherapy either cisplatin or cetuximab and five patients did not receive any systemic therapy. Median follow up was 9.78 months (range 3-26 months).25 patients (56.81%) out of 44 patients had locoregionally controlled disease. Seven patients had residual disease,six patients had local recurrence,six patients had nodal recurrence,one patient had both local and nodal recurrence and one patient had distant metastasis recurrence only. The 2 year rate of locoregional controlled disease (LRC) was approx 60%. The rate of overall survival and distant metastasis free survival rate were 20.53 months and 16.38 months respectively. Among the 19 patients who failed 14 patients had oropharynx as primary, 2 had hypopharyngeal primary and 3 patients had laryngeal primary. Conclusion: Our study clearly supports the use of higher end techniques like IMRT,IGRT,Rapid arc in developing country like India to decrease the chance of locoregional failure.

 > Abstract Id: YUGP1247 Top

Sentinel Lymph Node Detection In Early Stage Cervical Cancer Patients Using Methylene Blue.

Presenter- *Dr. Vijaya Lakshmi

Co-author - Dr Narendra H, Dr Amit K Chouhan,

objective : the aim of this study is to investigate the feasibility of sentinel lymph node detection with methylene blue dye alone in early stage cervical cancer methods : in a prospective study between july 2016 and june 2017 ,15 patients with early cervical cancer (2 in stageIA1, 1 in stage IA2, 10 in stage IB1, 1 in stage IB2,1 in stage IIA) underwent radical hysterectomy and pelvic lymphadenectomy . Prior to surgery 1 ml 1% methylene blue was injected at 3, 6, 9, 12' 0 clock position peritumorally results : a mean of 3.13 sentinel nodes were detected per patient. the test has a sensitivity, specificity and negative predictive value of 97.5%,99.82%, 93.76% respectively . Most common location of detection was obturator group of lymph nodes conclusion : methylene blue is an effective tracer to detect sentinel lymph node in patients with early stage cervical cancer

 > Abstract Id: YUGP1249 Top

Research In Pediatric Solid Tumor In India: Need To Focus On Basic Research And Survivorship Issues

Presenter- *Dr. SUJITH KUMAR M

Co-author - , ,

Background: Pediatric oncology research especially in solid tumors is limited, in spite of significant number of children treated in our country. Aim: To identify the areas of pediatric solid tumor research in the country and to compare with international research Materials and Methods: Literature search was done in Pubmed regarding the published data on pediatric solid tumors (except neurological and osteosarcoma) from Indian researchers and from all over the world during last 3 years (March 2014 to March 2017). No other literature review sites were used. Comparisons were drawn and descriptive statistics used. The final analysis was limited to neuroblastoma, retinoblastoma, hepatoblastoma, germ cell tumor and wilms tumor. Results: A total of 738 published Pubmed indexed studies were identified (Indian: 84, International: 654, 11%). The majority of studies were related to Neuroblastoma (51%) followed by Wilms tumor (19%) and Retinoblastoma (14%).Among Indian studies, Neuroblastoma and Retinoblastoma were predominant (35%) followed by Wilm tumor (19%), Hepatoblastoma (5%). Total published papers (n=738) included (in descending order), preclinical/molecular lab studies (33%), case reports/series (19%), review/ guidelines (11%) etc and survivorship studies were minimum (2%). Treatment related papers were 14% (systemic chemotherapy-6% and local therapy including surgery/radiotherapy/interventional radiology-8%) ,diagnostic (imaging/pathology) studies were 9% and other clinical studies were 6%.Targeted therapy/Immunotherapy related papers constituted 5%, majority in Neuroblastoma. Indian papers included (in descending order), case series/reports (40%), review article (15%), preclinical/molecular (15%, majority in retinoblastoma) etc. No studies on survivorship issues/ targeted therapy were published. Conclusion: In this study, Indian studies on pediatric solid tumor research constituted about one tenth of international published studies with predominant type being case reports/series. In India, Preclinical/Molecular research is lacking when compared to international scenario. Globally, there is very low focus on pediatric solid tumor related survivorship issues and needs to be addressed by the pediatric oncology community urgently

 > Abstract Id: YUGP1251 Top

Comparative Study On Intra Operative Localization Of Sentinel Lymph Node In Breast Cancer Patients Using Tc 99M Sulfur Colloid And Blue Dye.

Presenter- *Dr. Vindhya Malasani

Co-author - Dr. Ishita B Sen, Dr. Vineet pant, Dr. Sugandha Dureja

Background: A sentinel lymph node (SLN) is considered to be the first lymph node which is draining the tumor site. Radioactive Tc-99m labeled sulfur colloid, vital blue dye such as isosulfan blue or methylene blue, or the combination of the both are generally used for sentinel lymph node localization. In this study, we compare the sensitivity of both the methods to establish an effective method for SLN localization. Methods: Fourty patients diagnosed with stage I and II breast cancer evidenced by fine-needle aspiration, core biopsy or lumpectomy without clinically palpable lymph nodes had undergone sentinel lymph node localization by both radiocolloid and dye. 300-400ÂμCi of 99mTc-labeled filtered sulfur colloid in 0.3—0.4 mL was administered intradermally in the periaerolar region in the tumor quadrant, 30 mins — 1 h prior to the surgery. For blue dye analysis, 1ml methylene blue dye, was administered in 4—6 sites, intraparenchymally, in the peritumor locations during the surgery. All lymph nodes with counts greater than 10 times that of the background counts, whether or not blue dye positive, and all blue dye-positive lymph nodes, whether or not radiocolloid positive were excised and labeled accordingly. Frozen sectioning and hematoxylin and eosin and immunohistologic (cytokeratin) staining inspection were conducted on all lymph nodes. Results: SLN localization was positive in 36 patients with radiocolloid and 34 patients with blue dye and 2 patients did not show either of the two. The sensitivity for colloid alone, blue dye alone and the combination of both the methods was 90%, 85% and 95% respectively. The concordance between blue dye and radiocolloid was 80%. Metastatic lymph node involvement was found in 13/38 (34.2 %) of patients. Conclusion: Both the radiocolloid and dye drain to the same node in most of the patients, however the sensitivity is highest with the combination of the two methods.

 > Abstract Id: YUGP1261 Top

Verrucous Carcinoma Of The Penis €” Our Experience

Presenter- *Dr. Rajendra Nerli

Co-author - Rajendra B. Nerli, Shridhar C. Ghagane, Vishal Kadeli

Introduction: Penile verrucous carcinoma is an extremely rare disease. The etiology, diagnosis and treatment of this carcinoma remain poorly understood. We report our series of pure penile verrucous carcinoma and discuss the clinical, pathological and outcome following surgical treatment. Materials & Methods: Hospital data was retrospectively retrieved in relation to patients admitted and treated for verrucous carcinoma of the penis at our center. Age at presentation, presenting clinical symptoms, biopsy techniques, histopathological reports, surgical procedure and outcome were noted and analyzed. Results: During the period, a total of 27 males with a mean age of 57.11±5.55 years were treated for verrucous carcinoma of the penis. All the 27 patients presented with exophytic lesions appearing like cauliflower, verrucous and papillary. An appropriate biopsy was performed in all and the biopsies confirmed the diagnosis of verrucous carcinoma. Twenty two (81.4%) patients partial penectomy and Five (18.51%) others underwent wide excision. All these patients were followed up and none of the patients exhibited recurrence. Conclusions: Penile verrucous carcinoma is rare with locally invasive characteristics and complete surgical excision is the management of choice. Close follow-up is of great importance due to a substantial risk of local recurrence of the disease.

 > Abstract Id: YUGP1267 Top

Influence Of Gantry Angle Increment On Head And Neck Volumetric Modulated Arc Therapy Planning And Delivery In Elekta Synergy┢ With Monaco Planning System.

Presenter- *Mr. MIDHUN KUMAR K M

Co-author - D. Manigandan, P. Mohandas, Narendra Bhalla

Aim: The objective of the study was to evaluate the influence of gantry angle increment (GAI) on planning and delivery of head and neck volumetric modulated arc (VMAT) plans. Methods/Materials: Three nasopharyngeal cancer patients treated with VMAT were chosen for this study. VMAT Dual arc (190°-340°) plans were generated for same targets with different GAIs (10°, 15°, 20°, 30° and 40°) (6000cGy/30Fractions, Only Phase-1 targets were considered for study). For consistency, all plans were generated by same planner using Monaco treatment planning system (Ver.5.11) for Elekta Synergy┢ linear accelerator for 6MV photon beam with 1cm leaf width at isocenter. Patient specific QA was performed for each plan using PTW OctaviousTM phantom and 2D Array729 detector and gamma pass rate (GPR) (3mm3%) were analyzed. For plan comparison, conformity index (CI) = Planning Target Volume (PTV) received by 95% of the Prescribed dose/volume of PTV, heterogeneity index (HI) = Dose Received by the 5% of the PTV/Dose received by the 95% of the PTV, were analyzed. In addition, mean doses to left, right parotids, Maximum dose to brainstem (DBrMax), spinal cord (DSpMax) and monitor units (MUs) required delivering a plan were studied. Results/Discussions: The average CI for PTV were 0.91±0.01, 0.96±0, 0.98±0, 0.99±0 and 0.96±0, for GAI of 10°, 15°, 20°, 30° and 40°. Similarly, HI was 1.13±0.02, 1.12±0.01, 1.10±0.01, 1.08±0.02, and 1.12±0.01. Mean doses to left, right parotids increased from 10° to 30° GAI and reduced at 40° GAI. DBrMax were 3687±253cGy, 4016±76cGy, 4020±92cGy and 3945±5 for increasing order of GAI. DSpMax were 4030±15cGy, 3994±21cGy, 4059±44cGy, 3956±58cGy, and 4036±21cGy for GAI of 10°, 15°, 20°, 30° and 40°. Use of higher GAI reduced the number of MU required (1069±101cGy, 966±233cGy, 921±172cGy, 893±227cGy, and 802±128cGy). Quality plans were found to be produced with the use of GAI 20°- 30° with reduction of MU and good dose coverage. Average GPR observed for all the plans was 97.5±0.5% and GAI was not affecting the deliverability of the plan. Conclusion: For nasopharyngeal cancers, quality VMAT plans can be achieved with GAI of 20° to 30° without compromising plan quality and deliverability.

 > Abstract Id: YUGP1275 Top

A Retrospective Study Comparing Pathological Complete Response After Neoadjuvant Chemotherapy Or Chemoradiotherapy Followed By Surgery For Carcinoma Esophagus

Presenter- *Dr. Amit Patil

Co-author - Dr. Tirathram Kaushik, Dr. Rajesh Mistry,

Aim: To study the pathological complete response rates among various histological subgroups of carcinoma esophagus treated with multimodality therapy in the form of neo-adjuvant chemotherapy or chemoradiotherapy followed by surgery. Materials & Methods : All patients with biopsy proven esophageal carcinoma (either Squamous cell carcinoma or adenocarcinoma) and who underwent multimodality treatment in the Centre for Cancer, Kokilaben Dhirubhai Ambani Hospital, Andheri (W), Mumbai, India from 1st January 2010 to 30th April 2016 were included in the study. Demographic, clinical and pathological data was collected from the hospital database and analysed. To prove the statistical significance, Chi-square / Fishers exact test was used with a p value less than 0.05 considered statistically significant. Results : A total of 111 patients underwent multimodality treatment for carcinoma esophagus and were included in the study. The mean age of patients was 57.8 yrs with 71.2% males and 28.8% patients being females. Twenty nine patients underwent neoadjuvant CTRT followed by surgery while 82 patients underwent neoadjuvant CT followed by surgery. The margin positivity and rate of R0 resection was similar in both the groups. The pCR rate was 7.3% in the neoadjuvant CT group and 24.1% in the neoadjuvant CTRT group and difference was statistically significant (p= 0.038). The pCR rate was independent of the tumour histology and location. The percentage of patients with TRG 1 was 12.2% in the CT group and 31% in the CTRT group and the difference between the two groups was statistically significant (p=0.041). Conclusion : Multimodality treatment is the standard of care for carcinoma esophagus. Our data suggests that neoadjuvant CTRT improves the pathological complete response rates and tumour regression grades as compared to neoadjuvant chemotherapy.

 > Abstract Id: YUGP1290 Top

Neoadjuvant Chemotherapy With Docetaxel,Carboplatin And Trastuzumab-Preliminary Analysis Of Clinical And Pathological Response Rates

Presenter- *Dr. Asoora Arunsha


Neoadjuvant chemotherapy with docetaxel,carboplatin and trastuzumab-preliminary analysis of clinical and pathological response rates Introduction and background Carcinoma of the Breast is rapidly becoming the most common malignancy in India .Neoadjuvant chemotherapy in carcinoma breast is a very important and rapidly evolving topic in Clinical Oncology. In the Indian scenario, this topic is especially important as a very high percentage of our patients present with locally advanced disease, unfit for primary surgery. The evolution of neoadjuvant chemotherapy from the early regimes like CMF to latest recommended schedules like TAC have been associated with higher clinical,pathological and correspondingly higher survival rates, but sadly they are associated with higher toxicities also.As pCR rates have been directly correlated with survival rates, the need of the hour is to establish chemotherapy regimens with higher pCR rates but lower toxicities.The safety and efficacy of the DCH regimen in Her2 +ve patients in the neoadjuvant setting has been tested in various International trials achieving pCR rates of >50 %.This study aims to replicate the results in an Indian setting while monitoring the toxicity profile . Materials and methods— This is a single arm prospective study which included locally advanced breast cancer patients from age 18 to 70.All patients were planned for treatment with neoadjuvant chemotherapy and surgery + adjuvant Radiotherapy.All patients were proven Her2+ve by IHC/FISH testing on trucut biopsy specimens. After obtaining cardiology fitness and written informed consent, all patients were given the DCH schedule () with prophylactic GCSF support. Clinical evaluation was done after every 3 cycles and after completion of 6 cycles of chemotherapy, patients underwent radical surgery and pathological evaluation. Results :10 patients who were included in the have completed the treatment out of which 6 patients have completed surgery and have apthology reposts for assessment.Among these 6 patients ,5 had complete pathological response and 1 had partial response(83% pCR).out of the remaining 4 who completed,3 had complete response clinically (by RECIST criteria) and 1 had a partial response(ORR 100%). All of the patients have completed the planned treatment and no dose reduction had to be done in any patient.Only one patient had a grade 1 neutropenia in one cycle .No mucositis or cardiotoxicity was reported. Conclusion :- the preliminary data from this study sugersts that the DCH schedule is a well tolerated schedule which gives higher pCR rates than conventional chemothaerapyschedues with reduced toxicity. Studies like this could be the herald of a paradigm shift in the neoadjuvant chemotherapy of carcinoma breast in that it not only foregoes the traditional Anthracycline and cyclophosphamide based schedules but also adds targeted agents along with Platinum,which is not an agent used in the radical treatment of carcinoma breast .

 > Abstract Id: YUGP1308 Top

Role Of 18F-Fdg Pet/Ct In Guiding Management Of Clinically Node Negative Neck (Cn0) In Carcinoma Oral Cavity

Presenter- *Dr. Anushree Vartak


BACKGROUND Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in early stage oral cavity carcinoma. The advantage of 18F-FDG PET/CT over conventional staging modalities is in its ability to identify lymph nodes without morphological changes yet harbouring occult metastases. We present findings of our study conducted to evaluate diagnostic accuracy of 18F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity at a tertiary health care centre. MATERIAL & METHODS In a single institution prospective study, 51 consecutive patients with histologically proven, T1/T2 oral cavity carcinoma and no evidence of lymph node metastases (cN0) by clinical examination or imaging (USG/CT/MRI) underwent 18F-FDG PET/CT before elective neck dissection of 58 neck sides. 18F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate sensitivity, specificity, positive & negative predictive values & diagnostic accuracy. RESULTS 18F-FDG PET/CT correctly characterized the occult lymph node metastasis status (TP +TN) in 51 of 58 neck sides, yielding an diagnostic accuracy of 87.93%.Sensitivity of 18F FDG PET/CT in detecting occult lymph node metastases was 90 % while specificity was 87.5 %. While a positive PET accurately predicted the disease in only 60% (PPV), a negative 18F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (NPV). If a decision regarding the need for neck dissection had been based solely on 18F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. CONCLUSION In early stage carcinoma oral cavity, 18F-FDG PET/CT is more accurate than conventional staging modalities in staging of neck. Based on the high negative predictive value of 18F-FDG PET/CT found in our study, incorporating 18F-FDG PET/CT in the preoperative staging paradigm of T1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.

 > Abstract Id: YUGP1314 Top

Institutional Experience Of Single Stage Dual Plane Implant Reconstruction -Post Modified Radical Mastectomy : Challenges And Outcomes

Presenter- *Dr. Anushree Vartak


Introduction: Breast Reconstruction results have continued to improve as we have seen an evolution in mastectomy techniques from radical, to modified radical. However, currently practiced techniques of implant-based reconstruction are far from perfect. Review of current literature shows that postoperative complications with direct-to-implant sub-pectoral reconstruction remain significant. At our institute we were able to lower the risk of complications including implant loss while providing patients with a safe and aesthetically pleasing result with modification of dual plane technique. Aims: This study analyzes results of our series of patients with carcinoma breast who underwent modified radical mastectomy followed by immediate reconstruction with dual plane implant. Material & Methods: All patients who underwent single-staged dual plane cohesive silicone gel filled implant-based breast reconstruction using a Modified Stewart’s /Orr’s mastectomy incision were included. Demographics, clinical data, operative details and postoperative complications were analyzed. Results: Fifteen patients (19 breasts) underwent single-staged dual plane implant based reconstruction over the period of 3.92 yrs. The average age of the patients was 36.88 years at the time of the operation. Mean follow-up time was 13.33 months (1—47 months). Postoperative complications occurred in 3 patients which were resolved with conservative management while no cases resulted in implant loss. Implant size varied depending upon the contra lateral breast volume. Most patients were early breast cancers except 2 LABC patients out of which one had local recurrence post BCS. Both received NACT followed by adjuvant chemotherapy and radiotherapy .Four patients had bilateral carcinoma breast out of which one had hereditary breast ovarian cancer syndrome (BRCA positive). Conclusions: The results of this study show that an immediate single-stage dual plane breast reconstruction with a cohesive silicone gel filled implant can be performed with excellent aesthetic outcomes and minimal complications.

 > Abstract Id: YUGP1328 Top

An Enigma Of Incidental Gallbladder Carcinoma: Single Institution Experience From A High Incidence Area

Presenter- *Dr. ANKUR VERMA

Co-author - Dr Vivek Kumar Malhotra, Dr Akash Agarwal,

Introduction Incidental gallbladder carcinoma (IGBC) is an incidental finding diagnosed on histopathological examination (HPE) of gallbladder specimen removed for benign gallbladder diseases. The incidence of IGBC ranges from 0.19 - 3.3%. However, many such tumors are probably missed on either pre-operative evaluation and/or during cholecystectomy. Objectives To find the proportion of patients of IGBC who had preoperative and/or intra-operative suspicious of GBC but were subjected to simple cholecystectomy. Materials and Methods An analysis of data collected from 56 consecutive IGBC patients who presented to our centre between April 2016- May 2017 was done.A review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect. Results In our study, preoperative ultrasonographies (USG) were suspicious in 39% (22/56) of patients. CECT scan was done in 13 suspicious patients based on preoperative USG and had suspicious findings in 10 patients. Majority of procedures were open cholecystectomy (39/56), one patient underwent conversion from laparoscopic to open cholecystectomy. Suspicion for malignancy (gallbladder mass, polyp, dense adhesion and enlarged lymph nodes) was documented in only 15 (26.7%) patients intra-operatively. Twenty two patients had pathological T2 lesion, eight patients had T3 and only two had T1b lesion. T stage was not known in 24 patients. 17/56(30.3 %) patients were referred within one month of primary surgery 35.7% (20/56) between in one to two months, 23.3% (13/56) between two and six months and 10.7% (6/56) after six months of primary surgery. 17 out of 56 (30.3%) were advised completion surgery. Of these, eight patients underwent completion surgery, nine did not undergo surgery. Locally advanced inoperable disease was present in seven patients. Seventeen patients presented with metastasis (17/56). Fifteen patients were lost to follow up. Conclusion In patients with GBC, a radical R0 resection is the only hope for cure. Radiologists and surgeons should keep a high index of suspicion of GBC in high incidence areas. Whenever, there is any suspicion, patients should be promptly referred to centres experienced and equipped in managing these patients. Even when detected incidentally, prompt referral is very important to maximise chances of curative resection. Surgeons in these high incidence areas should be educated about the harms of performing simple cholecystectomy in patients with suspicious lesion either on preoperative imaging and/or intraoperatively.

 > Abstract Id: YUGP1335 Top

Kdr Mutation: A High-Frequency Rare Mutation And Its Correlation With Other Somatic Mutations In Indian Colorectal Cancer Patients

Presenter- *Mr. Mayank Jauhri

Co-author - Vani Gupta, Yogender Shokeen, Sachin Minhas

Aim: This study aims to find out the frequency of KDR mutation in Colorectal cancer patients and if any correlation exists between KDR mutation and demographical features or with other common and uncommon gene mutations occurring in Colon cancer. Methods: FFPE samples of 112 patients were analyzed using Next Generation Sequencing. Results: KDR was found to be mutated most frequently among the uncommon gene mutations in patients (19.6%). 21/22 patients had the p.Q472H type of KDR mutation. It was significantly associated with PTEN (p=0.003), KRAS (p=0.026), APC (p=0.033), EGFR (p=0.036), NOTCH1 (p=0.029) and ERBB4 (p=0.008) mutations. More number of males (22.06%) harbored KDR mutations than the number of females (15.9%). A higher number of KDR mutations in Stage III (31%) as compared to other stages — I-II (19.23%) and IV (7.31%) was reported. KDR mutations were found to be in greater number in patients with lymph node metastasis (27.3%) as compared to liver metastasis (8%). However, a statistically significant association of any clinical parameter was not found. Conclusion: Our results suggest that although KDR is a rare somatic mutation in CRC, it plays a pivotal role in the development of colon cancer via angiogenesis pathway.

 > Abstract Id: YUGP1339 Top

Neoadjuvant Chemotherapy Plus Concurrent Chemoradiation Versus Concurrent Chemoradiation Followed By Adjuvant Chemotherapy For The Treatment Of Nasopharyngeal Carcinoma: A Retrospective Study

Presenter- *Ms. Panchalee Phakoetsuk

Co-author - Panithan Kongsupapsiri, Siriarrayapa Chachvarat, Imjai Chitapanarux

Objective: To determine whether neoadjuvant chemotherapy can improve survival rates compared to adjuvant chemotherapy in nasopharyngeal carcinoma patients. Materials and methods: A total of 152 patients with biopsy-proven nasopharyngeal carcinoma were assigned to receive neoadjuvant chemotherapy then CCRT or CCRT followed by adjuvant chemotherapy between January 2007 and December 2013 in Maharaj Nakorn Chiang Mai Hospital. The regimen of chemotherapy was platinum-based in both groups. Radiation technique was done by whether 2D or IMRT. The survival rates were assessed by Kaplan-Meier analysis, and survival curves were compared using log-rank-test. Multivariate analysis was conducted using the cox proportional-hazards regression. Results: With a median follow-up of 32.4 months, the median overall survival 14.9 months, the 3 years overall survival (OS) rate is 48.68%. The 3 years OS rates differed significantly between two groups. The 3 years overall survival rates in CCRT followed by adjuvant chemotherapy were 62.3 % versus neoadjuvant chemotherapy plus CCRT 38.46% (p = 0.01, HR 1.89, 95%CI 1.16-1.43). In multivariate analysis: age (

 > Abstract Id: YUGP1357 Top

Generalized Signal Transduction: Receptor Tyrosine Kinases In Cancer Development

Presenter- *Mr. Ziaul Faruque Joy

Co-author - Sourav Chakrabarty, S M Abu Sayem, n/a

One of the largest group of catalytic cell surface receptors found in human body are the receptor tyrosine kinases (RTKs) majority of which are involved in regulating signal transductions for cell growth, proliferation, differentiation, survival and apoptosis in particular. A series of RTKs mediated phosphorylation and SH2 domain containing proteins interaction with phosphotyrosines residues of RTK phosphorylated protein activate a G-protein named ras which is triggered to an action after substituting its bound GDP for GTP upon activation of a nucleotide exchange factor linked to catalytic cell surface receptors through a relay of signaling proteins. The tyrosine phosphorylation to activate RTKs and activation of ras are reversed by a tyrosine specific phosphatase and intrinsic GTPase activity of ras respectively. Short lasting phenomena which are inappropriate to act in proliferation and differentiation signaling convert into persistent signals before they disappear through a series of serine threonine phosphorylation mediated by three component of mitogen activated protein (MAP) kinase cascades where three kinases don’t act separately rather reported to relay signal downward being attached to a three component module within a scaffold. In a signaling relay where activation of MAP kinase kinase kinase by ras is followed by MAP Kinase Kinase Kinase mediated phosphorylation of MAP kinase kinase which then phosphorylates tyrosine and threonine residues of a MAP kinase for its activation. Resulting MAP kinase activation triggers the phosphorylation of many gene regulatory proteins which in turns activate many genes necessary for cell growth, differentiation, proliferation and survival. Abnormalities such as permanently switched on, absence of component, extra copy number in the cells etc. from any of this signaling component mediated by mutation or any other cellular changes result in uncontrolled excessive proliferation of the cells, designated as cancer and RTK pathways malfunctioning are reportedly increasing in various cancer development now a days. Key Words: Caner, Receptor Tyrosine Kinase (RTK), Mitogen Activated Protein (MAP) Kinase, Ras, Phosphorylation, Catalytic Cell Surface Receptors.

 > Abstract Id: YUGP1359 Top

Prospective Study Of Sequential Ultra?Low Then Standard Dose 18F?Fdg Pet/Ct Scans For Lung Lesion Detectability

Presenter- *Dr. Ivan Tham

Co-author - Joshua Schaefferkoetter, David Townsend, Maurizio Conti

Background Lung cancer screening with low?dose computed tomography ?CT? is better than chest X?rays but is nonspecific. Accuracy is improved with positron emission tomography ?PET?, at a cost of additional radiation. We had previously reported on simulated low?dose PET imaging and demonstrated that 10x106 net true counts is sufficient to generate images with acceptable diagnostic quality. We now hypothesize that we can maintain image quality with a 92% reduction of fluorodeoxyglucose ?FDG? tracer activity from 6 mCi to 0.5 mCi. Methods Nine patients have been scanned with two sequential PET/CT scans on the same day. The patient is first scanned with 0.5 mCi FDG and a low?dose CT protocol, followed by a routine PET/CT with 6 mCi FDG. PET data from the standard?dose scan were manipulated to emulate various noise ?dose? levels, corresponding to nine pre?defined true count levels. Data were matched to the level of the low?dose scan, to compare noise statistics to a ground truth and to directly validate our methods. The data were reconstructed, with many independent noise realizations, and the images were reviewed. Ten lesions, in seven patients, were identified as having the size and uptake consistent with those found in early disease. For a given count level, the corresponding images were determined to be acceptable if lesion detectability was comparable to that found in the full?statistic image set. Detection performance was determined automatically by machine learning, namely, convolution neural networks trained by 4 previous observer responses. Results Lesion detection accuracy was evaluated in 4458 total image sub-volumes. Regions containing both target lesions(2627 samples) and healthy lung background(1831 samples) were used to assess sensitivity and specificity at all noise levels. Results presented are stratified by true count/millions: 20. The mean sensitivities and specificities (%) across the 4 observer models were 0.35, 18.85, 62.35, 85.4, 95.73, 96.23, 96.42, and 6.64, 6.93, 20.43, 66.54, 93.55, 96.87, 98.25. Conclusion Low?dose PET can provide good performance for lesion detection within the true count range 5?10×106.

 > Abstract Id: YUGP1365 Top

Role Of Rhoc-Rock2 Signaling In Cervical Carcinoma Radiation Response

Presenter- *Dr. Sweta Srivastava

Co-author - Annapurna P, Pavana Thomas, Avinash Udayshankar

Radiation therapy plays an important role in the local and regional control of tumours. Attempts to enhance the efficacy of radiotherapy include use of conventional low dose chemotherapy as biological modifiers, for example use of cisplatin for cervical cancer. Despite best efforts there is a patient subpopulation that does not respond to therapy resulting in recurrence. Cervical cancer is the second most common cancer affecting women. We have investigated the role of RhoC, a small GTPase, and ROCK2, its effector kinase, as modifiers of radioresistance in cervical cancer. Our data suggests that overexpression of RhoC, in vitro, results in enhanced radioprotection in cervical carcinoma derived cell lines SiHa and CaSki. Analysis of gene transcripts suggests that RhoC overexpressing cells have increased expression of DNA repair machinery. These cells also exhibit enhanced stemness as evident from an increased expression of stemness genes such as Nanog, Notch1, Sox2 and Oct4. Importantly overexpression of RhoC results in enhanced ROCK2 expression which also modulates the radiation response by regulating the DNA repair machinery. In vitro inhibition of ROCK2, using antibodies, resulted in enhanced cell death both in cell lines and patient biopsy derived cells. Notably live sorting of ROCK2 overexpressing cells and transcript analysis indicates a similar pattern of expression of DNA repair proteins as studied in RhoC overexpressing cells. Additionally flowcytometricaly live sorted ROCK2 high cells exhibit a better cell survival as compared to ROCK2 low cells. These data collectively implicate RhoC-ROCK2 signaling pathway as a regulator of radiation response in cervical cancer. Our results thus suggest that ROCK2 can be developed as a prognostic biomarker.

 > Abstract Id: YUGP1367 Top

The 8Th Edition Of The Uicc/Ajcc Staging System For Nasopharyngeal Carcinoma Is Prognostically Useful For Patients Treated With Intensity-Modulated Radiotherapy

Presenter- *Prof. Junlin Yi

Co-author - Li Gao, Jingwei Luo, Xiaodong Huang

Purpose: To evaluate the 8th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC) in patients treated with intensity-modulated radiotherapy (IMRT). Methods and materials: A total of 520 patients with biopsy-proven, non-metastatic NPC treated with IMRT in our institution between January 2003 and January 2010, were retrospectively re-staged with the 8th edition staging system. The distribution and the impact of T stage, N stage and clinical stage on overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were analyzed. Results: The proportion of patients in Stage I, II, III and IVA were 3.5%, 18.1%, 46.0%, and 32.5%, respectively.The 5-year OS, DFS, LRFS, DMFS were 79.1%, 74.5%, 90.9%, and 83.4%, respectively. The 5-year LRFS rates for T1-4 patients were 97%, 94.5%, 93.7% and 73.9%, respectively. The differences between T1 and T2, T1 and T3, T2 and T3 were lack of significant statistically. The 5-year DMFS rates for N0-3 patients were 100%, 85.8%, 82.8% and 71.7%, respectively. The differences between N1 and N2 were lack of significant statistically. The 5-year disease-specific survival (DSS) rates for stage I-IV patients were 100%, 93.3%, 84.6% and 64.0%, respectively. The differences between I and II, I and III, II and IIIwere lack of significant statistically. Conclusions: The 8th edition of the staging system is acceptable with regard to the distribution of clinical stage and prediction of treatment outcomes.

 > Abstract Id: YUGP1369 Top

10 €Œkey†Steps During Laparoscopic (Robotic-Assisted) Radical Prostatectomy Needed To Optimise Continence Recovery Post-Surgery: Analysis And Outcomes.

Presenter- *Dr. Santosh Waigankar

Co-author - Tirathram Kaushik,, Abhinav Pednekar,, T.B. Yuvaraja.

Introduction & Objectives: Quest for maximum continence recovery after robotic radical prostatectomy (RRP) continues. As experience increases RRP procedural steps undergo modifications. We analyse the outcomes of using 10 “key steps†in laparoscopic (robotic-assisted) radical prostatectomy w.r.t urinary continence. Material and Methods: 200 consecutive RRPs performed by a single surgeon for localised prostate cancer were analysed. Two groups were formed: Group A (first consecutive 100 pts-Few key steps) & Group B (next consecutive 100 pts-All key steps) and compared. The 10 key steps [Seminal vesicle pedicle clipping, Endopelvic fascia incision, apical dissection, bladder neck dissection & reconstruction, athermal nerve sparing approach, athermal ligation of the DVC, urethral length, modified Rocco stitch, water tight vesicourethral anastomosis and dynamic lateral suspension of posterior reconstruction stitch†(DLSPRS)]. Patients were evaluated at 1m, 3m and 6months for continence using the Expanded Prostate Cancer Index (EPIC) urinary function scale and pad usage/day (continence defined as zero pads per day). All were taught Kegel exercises during postoperative period. Results: Patients' characteristics and perioperative outcomes were comparable. In Group A, the continence rates at 1, 3 and 6 months were 38%, 60% and 69% & in Group B it was 65%, 76% and 88% respectively. Group B had significantly higher continence at 1 and 3 months (p value 0.04). There were no complications related to these key steps. Conclusion: The “10 key steps†helps in improving early continence recovery. Further prospective non randomized study is underway in our institute.

 > Abstract Id: YUGP1371 Top

Robotic Partial Nephrectomy For T1B Renal Masses & Influence On The €Œpentafecta†Outcomes: Single Institute-Single Surgeon Retrospective Analysis.

Presenter- *Dr. Santosh Waigankar

Co-author - Tirathram Kaushik, Dr. Abhinav Pednekar, T.B. Yuvaraja

INTRODUCTION AND OBJECTIVES: The Pentafecta is a conglomerate of measure of effectiveness of robotic partial nephrectomy (RPN) in treating small renal masses. The applicability of Pentafecta for analyzing the outcomes of small renal masses 4cm and 7 cm). Tumor complexity was assigned according to R.E.N.A.L Nephrometry score. Tumors were further divided into low (4-6), intermediate (7-9) and high-risk (10-12) groups. Pentafecta included glomerular filtration rate (eGFR) decreased < 10% from baseline post-surgery, negative surgical margin, zero perioperative complications, warm ischemia time of 25 minutes and early return to work within a week. Factors predicting Pentafecta (tumor size, R.E.N.A.L Nephrometry score, experience with RPN, Charlson comorbidity score, preoperative GFR and body mass index) were analyzed. RESULTS: 120 patients met our inclusion criteria. Median age was 61 years (Range 35-69 yrs), median tumor Nephrometry score was 9 (82 low, 30 Intermediate & 8 High-risk groups), median warm ischemia time was 23 min with overall complication rate of 5% and zero positive margin rate. Pentafecta was achieved in 80% pts (96 patients). Multivariable analysis showed increasing cumulative RPN experience and increasing tumor complexity score as predictors of achieving Pentafecta. CONCLUSIONS: Robotic partial nephrectomy helps to achieve reasonable outcomes. Pentafecta rates is a good parameter to measure them. Renal Nephrometry score and surgeon’s experience with RPN are good predictors of achieving Pentafecta for T1b tumors. Pentafecta rates provide us with an immediate surrogate for surgical quality. More follow up data is required to validate utility of Pentafecta as a surrogate for long-term outcomes.

 > Abstract Id: YUGP1377 Top

Multi-Institutional Retrospective Analysis Of Carbon Ion Radiotherapy For Prostate Cancer; The Japan Carbon Ion Radiation Oncology Study Group (J-Cros) 1501

Presenter- *Dr. Hidemasa Kawamura

Co-author - Nobuteru Kubo, Takuma Nomiya, Hiroshi Tsuji

Basis; Carbon ion radiotherapy (CIRT) has been started in Japan in 1994 and favorable outcomes with low incidence of adverse effects reported. Multi-institutional analysis of the patients with prostate cancer who have received CIRT as the prospective study in each institute of the Japan Carbon ion Radiation Oncology Study Group (J-CROS) was carried out. Materials and methods; Data of patients enrolled in prospective clinical trials performed at National institute of radiological science, Gunma university heavy ion medical center and Ion beam therapy center, SAGA-HIMAT foundation were retrospectively analyzed. CIRT dose and fractionations were 66-63Gy(RBE)in 20 fractions, 57.6Gy(RBE) in 16 fractions or 51.6Gy(RBE) in 12fractions. All patient risks were reclassified according to the D'Amico risk classification. A short-term (about 6 months) androgen deprivation therapy (ADT) and a long-term (more than 2 years) ADT were combined with CIRT for the intermediate-risk group and the high-risk group, respectively. ADT was not combined in low-risk group. The biochemical failure was defined as a rise of >2.0 ng/mL above PSA nadir (Phoenix definition). Results; Between December 2003 and December 2014, the total number of enrolled patients from all three institutions was 2157. The number of patients in low-risk, intermediate-risk, and high-risk groups were 263, 679, and 1215, respectively. A total of 1754 patients (82%) received ADT. The median follow-up periods of surviving patients was 29 months. The five-year biochemical relapse-free survivals (bRFS) in low-risk, intermediate-risk, and high-risk patients were 92%, 89%, and 92%, respectively. The five-year local control rates (LCR) and cause-specific survivals (CSS) in low-risk, intermediate-risk, and high-risk patients were 98%, 96%, and 99% for LCR, respectively, and 100%, 100%, and 99% for CSS, respectively. The incidence of grade (G) 2 and G3 late toxicities were 4.5% and 0% for the bladder, and 0.5% and 0% for the rectum, respectively. Conclusions; The first multi-institutional data on CIRT for prostate cancer suggested that the treatment outcomes of CIRT were favorable with less toxicity, especially in high-risk group patients.

 > Abstract Id: YUGP1384 Top

Relationship Between Dose-Volume Histogram Parameters And Local Control In Ct-Based 3D Image Guided Adaptive Brachytherapy For Cervical Cancer.

Presenter- *Dr. Shohei Okazaki

Co-author - Shin-ei Noda, Yu Kumazaki, Ryuta Hirai

Purpose: To investigate the prognostic factors of local recurrence in cervical cancer patients treated with three-dimensional image guided adaptive brachytherapy (3D-IGABT). Materials and methods: We retrospectively analyzed the data of 104 cervical cancer patients who received definitive radiotherapy at our institute between June 2013 and October 2015. Radiotherapy consisted of external beam radiotherapy (EBRT) and brachytherapy (BT). EBRT was delivered to the pelvis with a total dose of 39.6-55 Gy (median 50 Gy). CT-based 3D-IGABT was weekly performed 3-5 session in total. At each brachytherapy session, 6 Gy or more was aimed to prescribe to the high risk clinical target volume (HR-CTV). The relationships between the prognostic factors, including stage, tumor size, histology, use of chemotherapy, total (EBRT + BT) D90 and D98 for HR-CTV, and D90 and D98 for HR-CTV at BT and local control probability were analyzed. Results: Median age was 64 years (range, 29-85 years). Eleven patients had Stage I, 51 had Stage II, and 42 had Stage III-IVa. Median initial tumor size was 5.0 cm (range, 1.0-11.0 cm). Histologically, 90 patients had squamous cell carcinomas. Seventy-eight patients received concurrent chemoradiotherapy. The 2-year overall survival rates and local control rates for Stage I/II/III-IVa patients were 100%/94%/82% and 100%/94%/85%, respectively. Eight patients developed local recurrences, and 5 of them had recurrences within HR-CTV at the first BT. Univariate analyses showed D90 and D98 for HR-CTV at BT were significant factors for local control. Local control rate was higher when HR-CTV D90 at BT was > 36 GyEQD2 (p 28 GyEQD2 (p 6.5 Gy (= 9 GyEQD2) or HR-CTV D98 > 5.5 Gy (= 7 GyEQD2) at every BT session may be needed to achieve high local control probability.

 > Abstract Id: YUGP1386 Top

A Reliable Nomogram Predicting Overall Survival In Triple Negative Breast Cancer

Presenter- *Prof. Nna Jing

Co-author - Ming-Wei Ma, Xian-Shu Gao2,

Purpose:Currently there is no reliable nomogram to predict overall survival (OS) for patients with triple negative breast cancer (TNBC). The purpose of this study is to examine our cohort of TNBC patients and to develop the above nomogram through the correlation of clinical characteristics and pathological parameters with OS. Methods: We analyzed 340 TNBC patients between April 2009 and April 2012 at our institution. Patients who had in situ carcinoma, special type of invasive breast carcinoma and who did not receive standard postoperative treatment were excluded from this analysis. Patients with no complete clinical data were also excluded. A total of 242 patients were eligible. Age, family history, menopause, operative type, tumor size, tumor histological grade, the number of axillary metastatic lymph node, postoperative pathological TNM stage, vascular invasion, perineural invasion, CK5/6 expression status, Ki67 index and E-cadherin expression status were analyzed. Predictors were used in multivariable logistic regression analysis based nomograms to estimate the probabilities of OS. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index(C-index) with calibration curve and ROC curve. Analyses were performed with SPSS and statistical software R (version 3.2.1). Results: Median follow up time was 70.73 months (range, 7.2-95.93 months). Median age was 51 years (range, 29-69 years). 32.6%, 42.6%, 24.8% of the patients were in stage I, II, III, respectively. The 3-year and 5-year OS for all patients were 86.5% (95% CI, 82.2%—90.8%) and 81.1% (95% CI, 76.2%—86.0%), respectively. Multivariate analyses demonstrated that age, tumor size, the number of axillary metastatic lymph node and E-cadherin expression were the independent risk factors for OS. These predictors were used in nomogram to estimate the 3-year and 5-year OS, respectively. Calibration curves for probabilities showed good agreement between prediction by nomogram and actual observation. The C-index was 0.821. Conclusion: Using clinical-pathological information, we produced nomograms which may accurately predict the 3-year and 5-year OS for patients with TNBC.

 > Abstract Id: YUGP1388 Top

The Global Incidence And Prevalence Of Hepatocellular Carcinoma Over The Next Ten Years (2017-2027)

Presenter- *Dr. Ruchika Sharma

Co-author - Nishant Kumar, Erin Mayo,

The Global Incidence and Prevalence of Hepatocellular Carcinoma over the Next Ten Years (2017-2027) Author: Ruchika Sharma, BDS, MPH, Decision Resources Group, Bangalore, India. Co-author 1: Nishant Kumar, BSc, MPH, Decision Resources Group, London, United Kingdom. Co-author 2: Erin Mayo, DVM, MPH, Decision Resources Group, Princeton, USA Aim: To estimate the global incidence and prevalence of Hepatocellular Carcinoma (HCC) by region using a multifactorial forecast model. Methods: Using a critically appraised set of country-specific cancer registries HCC incidence was estimated for 45 countries, representing approximately 90% of the world population in 2017. Key risk factors for HCC were identified including HBV, HCV, alcohol abuse, and obesity. These were quantified and an incidence model for HCC was developed that incorporates the effect of changes in exposure to each of these risk factors. For the developing countries under study, measures of economic development such as gross domestic product (GDP) were considered as key indicators for access to healthcare and the adoption of dietary patterns and lifestyles potentially predisposing to HCC. Observed correlations between GDP, HCC risk, and survival were used to trend HCC incidence over the next ten years. Prevalence was estimated as a cumulative incidence over preceding ten years with adjustments for disease-specific and competing-cause mortality for each year. Results: The incidence of HCC in 2017 ranges from 2 per 100,000 in Latin America to 27 per 100,000 in high income Asian Pacific countries. Over the next ten years, we expect approximately 30% increase in HCC cases in most regions of the world due to several factors. Conclusion: The incidence and prevalence of HCC is slated to increase considerably over the ten year period. Across most of the countries under study, declines in incidence attributable to improved control of HBV and HCV infection are countered by increases in incidence attributable to alcohol abuse, obesity, and an aging population due to the higher associated risk of hepatocellular carcinoma in these older age-groups.

 > Abstract Id: YUGP1390 Top

Discordance Rate Of Er, Pr And Her-2 In Recurrent Breast Cancer: A Study From Tertiary Cancer Center In South India.

Presenter- *Dr. Abhishek Anand

Co-author - Linu Abraham Jacob, K C Lakshmaiah, Govind Babu K

Introduction Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status are clinically used to define breast cancer subtypes and are therapeutically as well as prognostically important. The discordance of ER, PR, and HER2 between primary and the recurrent breast cancer has been recognized in studies with few reporting change in therapy as well. Despite the ongoing studies looking into the discordance rate and its implications worldwide, the data from Indian subcontinent is limited. Methods This was a prospective study carried out from September 2015 to February 2017. All recurrent (locoregional or metastatic) breast cancer patients were analyzed. Biopsy was done from the recurrent site and IHC study was performed. The discordance of ER, PR and HER2 status between primary tumor and recurrent disease were analyzed. Mc Nemar test on SPSS version 23.0 was used to see the statistical significance. Results A total of 78 patients were analyzed. Thirty five (45%) patients had only locoregional, 14 (18%) had only visceral and 29 (37%) had locoregional alongwith visceral metastasis at recurrence. The discordance rate for ER was 13.7% (n=11; p=.227). Among these, 3 (3.7%) had ER changed from positive to negative whereas 8 (10%) had change from negative to positive. The discordance rate for PR was higher with 28.7% (n=23; p=.017). Those who had receptor changed from positive to negative was 6 (7.5%) while 17 (21.2%) had change from negative to positive. The discordance of HER2 was seen in 21.2% (n=17; p=.013) with 3 (3.7%) showing change from positive to negative and 14 (17.5%) from negative to positive. Conclusion The discordance rate in our study was 13.7%, 28.7%, and 21.2% for ER, PR, and HER2 respectively. On contrary to the reported literature, a higher number of patients had receptor negative in primary to receptor positive in the recurrent specimen than converting from positive to negative. Therefore, routine biopsy and analyses for ER, PR, and HER2 status in the recurrent setting should be done in all patients, which have important implications in the management as well as prognosis.

 > Abstract Id: YUGP1394 Top

The Global Incidence And Prevalence Of Acute Myeloid Leukemia Over The Next Ten Years (2017-2027)

Presenter- *Dr. Atul Sharma

Co-author - Michael Hughes, ,

Objective: To estimate the global incidence and prevalence of Acute Myeloid Leukemia (AML) by region over the next ten years using a multi-factorial forecast model. Methods: Using a critically appraised set of country-specific cancer registries, AML incidence was estimated for 45 countries, representing approximately 90% of the world population in 2017. Observed correlations between GDP, AML risk, and survival were used to trend AML incidence over the next ten years. AML survival was trended using an attenuated function of historical trends and factoring in the anticipated uptake of newer, more efficacious treatment regimens in the future by incorporating data from two phase III clinical trials. Prevalence was estimated as a cumulative incidence over preceding twenty years with adjustments for disease-specific and competing-cause mortality for each year. To estimate incident and prevalent AML globally, aggregate estimates for each region were divided by the proportion of countries in that region for which direct estimates were made using the methods described above. The incident population was stratified by FLT3-ITD and FLT3-TKD mutation status, based on estimates from the systematic literature review. Results: The incidence of AML in Africa, Latin America, lower-income Asia Pacific countries, high-income Asia Pacific countries, Europe, and North America is 0.4, 1, 1, 2, 4 and 5 cases per 100,000/ year. The prevalence of AML in Africa, Latin America, lower-income Asia Pacific countries, high-income Asia Pacific countries, Europe, and North America is 1, 4, 4, 7, 10, and 11 cases per 100,000. Africa is expected to see the highest growth in prevalent cases over the next ten year: 33% by 2027. Conclusion: The incidence and prevalence of AML is expected to increase globally. Improvements in the survival of AML patients will result in 81 thousand additional cases surviving by 2027 worldwide.

 > Abstract Id: YUGP1402 Top

Can Ultrasound Accurately Assess Tumor Thickness In Carcinoma Tongue To Predict Lymph Node Metastasis: A Validation Study.

Presenter- *Dr. Tapan Singh

Co-author - Ramesh Kaswan, Rajen A Tankshali,

Introduction Management of neck in clinically node negative, early stage oral cavity squamous cell carcinomas (SCC), especially tongue subsite has been a long-standing controversy. Tumor depth in tongue is shown to predict lymphatic spread but it is difficult to determine pre-operatively and therefore not routinely used in decision-making. We conducted a prospective study to compare the tumor thickness using ultrasonography (USG) and pathological nodal status. Materials and Methods Prospective analysis included 100 patients of early SCC tongue (cT1-T2) with clinically negative neck (cN0), who attended the surgical oncology department at Gujarat Cancer and Research Institute, Ahmedabad, India between September 2013 and September 2015. All the patients underwent USG of tongue pre-operatively to assess the depth of tongue lesion followed by wide local excision of tumor with elective neck dissection (MND). Histopathological findings like pT, pN, differentiation and depth of invasion were compared with pre-op clinical and radiological findings. Relevant statistical tests were used for analysis. Results The study had male predominance (62 M: 38 F), with majority in their 5th & 6th decade. Clinically, 44 patients had T1 and 56 had T2 tongue lesion with node negative neck. Pathologically 35 patients were T1 of which 5 had metastatic lymph nodes and 65 were T2 of which 20 had positive nodes. Level II was the most common site for cervical node involvement (48%) followed by level III (28%). Patients were classified according to tumor depth into 4mm i.e. 22:55:23 sonographically and 20:60:20 histopathologically respectively. Sensitivity of USG for depth< 2mm, 2-4 mm and >4 mm were 100%, 92.3% and 92.3% respectively whereas specificity were 97.6%, 100% and 96.4% respectively. On comparing depth of lesion with node positivity, all the 20 patients with 4 mm depth were node positive. Total 13 patients had recurrence on follow up. Of these, 10 occurred in pN+ patients while 3 in pN0 patients. Conclusion Tumor thickness/depth is a significant predictor of nodal metastasis and elective neck dissection should be considered when this depth is 3mm or more. In the present study, ultrasonography was validated as a reliable diagnostic tool in assessing the depth of tumor pre-operatively, with sensitivity and specificity more than 90%.

 > Abstract Id: YUGP1404 Top

Epidemiological Profile Of Cancers In Eastern Rajasthan (Year 2009-2013)

Presenter- *Prof. Raj Govind Sharma

Co-author - Dr Bhairu Lal Gurjar, Dr. Suresh Singh, Dr Pinakin Patel

Background: With Global cancer burden doubling in the last thirty years it has become mandatory to collect epidemiological data to detect any preventable factors. Cancer Data from Rajasthan is limited. Material & Methods: A study to find the pattern of malignancies at various sites in the body for the years 2009 to 2013 was conducted by the Dept. of Surgical Oncology, SMS Medical College, Jaipur. Data was collected from major Hospitals, Pathology centres and from the dept. of Pathology SMS Medical College, Jaipur. Only histopathology or cytology confirmed cases were included in the study. Results: A total of 34834 cases of cancers were recorded during the study period 2009-2013. Male female ratio was 1.31:1. Females in the 4th decade had more number of malignancies as compared to males. Males were maximum in 5th to 7th decade. Overall Head & Neck cancers were highest as a group (22.3%) followed by Genitourinary(19.64%) and GI tract cancers (12.43%). In females Genito urinary cancers as a group (27.15%) were highest followed by Breast (22.34%). As an individual site Breast Cancer was the commonest cancer in Females followed by Cervix (9.87%). In the Head & neck region, Oral Cavity cancers were highest both in Males (25.9%) and Females (27.2%). Second commonest in Males was Larynx . In Females Tongue cancers were higher on the list of Head & Neck Cancers. In the Genito urinary group, Prostate followed by Urinary Bladder and Kidney were commonest in Males. In Female Genitourinary group, Cancer Cervix followed by Ovary and Endometrium were the commonest. In GI tract, Esophageal and Stomach malignancies were the commonest in both males and females. Followed by Ano Rectum & Colon in Males but in females Gall Bladder Cancer was the third commonest. Lung cancer as an individual site was the commonest cancer in males (5.6%). It was low in females (1.03%). It was observed that Malignancies of Unspecified Site were 3886 cases. This shows the lack of proper documentation, systematic data collection and recording. Conclusions: In the absence of Cancer Registry, an attempt has been made to compile cancer data from Jaipur region. It was felt that Cancer should be declared as a notifiable disease so that accurate data of malignancies can be obtained.

 > Abstract Id: YUGP1406 Top

Mri Versus Clinical Assessment In Staging And Response Evaluation In Locally Advanced Cervix Cancer Patients Treated With Concurrent Chemo-Radiation In A Tertiary Cancer Center- A Prospective Study

Presenter- *Dr. Mintu Abraham


Purpose or Objective This prospective study aimed to evaluate the correlation between MRI and clinical assessment in staging and response evaluation of locally advanced carcinoma cervix. It also aimed to assess the role of MRI as a predictor of recurrence free survival. Material and Methods 58 women with locally advanced carcinoma cervix were studied from January 2014 to October 2015 after obtaining informed consent. After MRI abdomen & pelvis ,patients were started on chemo-radiation. Pelvic External beam radiation (EBRT) to a dose of 45Gy/23 fractions with concurrent weekly cisplatin 40mg/m2 was given, followed by intracavitary brachytherapy 7Gy/fraction x 3 fractions weekly once. Treatment response was assessed as per RECIST criteria clinically and radiologically with MRI after 4-6 months. Both pre and post treatment radiological evaluation was done by independent radiologists. Any suspected recurrence was subjected to MRI assessment and biopsy for proof. Results Of the 58 patients available for evaluation by RECIST criteria, 32 patients (55.2%) had complete response, 22 patients had partial response and 3 patients had stable disease. It was found that 70% of patients had complete response clinically and 15% had a partial response and only 1 patient had stable disease. While comparing clinical response assessment to MRI assessment the kappa value obtained was 0.08 signifying poor agreement. One sample t-test comparing the differences in response assessment with 0 (complete agreement) revealed a mean difference of agreement of 0.28 with a significant p-value of 0.002 (Bland-Altman analysis). Kaplan Meir survival analysis showed a recurrence free survival of 69.6%. The hazard ratio of recurrence was 8.667 times between non-responders and responders by MRI (p=0.001. 95% CI 2.82 to 35.1)and 1.667 between non responders and responders by clinical assesment (p=0.438). Kaplan Meir analysis for recurrence free survival separately done for patients who had achieved complete response (on MRI) vs. those who did not, showed only 10.7% percent of the responders and 50 % of the non-responders had recurrence. When assessing the clinical response , it was seen that the 27.9% of the responders and 38.5 % of the non-responders had recurrence showing MRI was more useful in predicting recurrences. The kappa analysis showed a value of 0.18 for initial staging and 0.08 for response evaluation was which signified poor agreement between MRI and clinical assessment in both staging and response evaluation. Bland-Altman analysis revealed a mean difference of agreement of 0.28 (0 being complete agreement) between MRI and clinical response evaluation [p= 0.002] Conclusion There are significant differences both in staging and response evaluation between FIGO and MRI in carcinoma cervix. In assessment of response to the standard treatment, MRI was found to be a better predictor of recurrence and thus ultimately, the outcome of treatment .This study proves that MRI may be used as a tool in assessment of treatment response thus predicting patients who may go for treatment failure, and may benefit from close follow up and early salvage. Declarations Funding: None Conflict of interest: Authors have no conflict of interest to declare Ethical approval: The study was approved by the institutional human ethics committee and institutional review board. All procedures performed in the study were in accordance with the ethical standards of the institutional ethics committee and with the1964 Helsinki declaration and comparable ethical standards

 > Abstract Id: YUGP1408 Top

A Confirmatory Randomized Controlled Trial With Mistletoe Extract On Overall Survival In Patients With Locally Advanced Or Metastatic Pancreatic Cancer

Presenter- *Dr. Stephan Baumgartner

Co-author - Danijel Galun, Marcus Reif, Wilfried Tröger

Background Current second line treatments for late-stage pancreatic cancer patients are often so toxic that their risk-benefit ratios are unfavourable. Therefore, effective but non-toxic therapeutic approaches should be examined. Mistletoe extract (ME) therapy claims to be both, effective and non-toxic. The aim of this study was to assess the efficacy of ME regarding the overall survival (OS), quality of life (QoL), and safety in patients with locally advanced or metastatic adenocarcinoma of the pancreas. Methods In this randomized study (ISRCTN70760582) patients were stratified according to a binary prognosis index and evenly randomized to receive s.c. injections of ME (Iscador® Qu) in a dose-escalating manner from 0.01 mg up to 10 mg three times per week, or no antineo-plastic therapy (control). All patients received best supportive care. The primary endpoint was 12-month OS. Results Baseline characteristics were well balanced between the ME and control group. Median OS for ME versus control patients was 4.8 vs. 2.7 months (prognosis-group adjusted hazard ratio, HR=0.49; p

 > Abstract Id: YUGP1410 Top

Pain, Appetite Loss And Fatigue In Patients With Locally Advanced Or Metastatic Pancreatic Cancer In A Randomized Controlled Trial With Mistletoe Extract

Presenter- *Dr. Stephan Baumgartner

Co-author - Danijel Galun, Marcus Reif, Wilfried Tröger

Background Pain, appetite loss and fatigue are the most prominent symptoms in patients with locally advanced or metastatic pancreatic cancer. Quality of life has been assessed from these patients during a confirmatory randomized controlled trial on survival. Methods In a randomized study (ISRCTN70760582) 220 patients were evenly randomized to receive s.c. injections of ME (Iscador® Qu) in a dose-escalating manner from 0.01 mg up to 10 mg three times per week, or no antineoplastic therapy (control). All patients received best supportive care. The primary endpoint was 12-month OS. Secondary efficacy parameters were the QoL dimensions of the core questionnaire of the European Organization for Research and Treatment of Cancer assessed at baseline and month 1, 2, 3, 6, 9, and 12 including pain, appetite loss and fatigue. The difference of the mean of the post baseline values „dPBL“ (month 1-12 after baseline) to the basline itself were calculated. Negative values indicate an improvement of the symptom. Differences of more than 20 points are of big clinical relevance. The results of pain were verified by the documentation by the consumption of analgesics and the results of appetite loss by body weight. Results Baseline characteristics were well balanced between the ME and control group. OS for ME versus control patients was 4.8 vs. 2.7 months (HR=0.49; p< 0.0001. Patients in the ME group gained weight (mean 3.53%) and control patients lost weight (-2.76%); group difference: 6.29 %. Conclusion ME therapy drastically improves pain, appetite loss and fatigue in patients with locally advanced or metastatic pancreatic cancer. The application of ME is safe and non-toxic and should become a standard in therapy of this devastating disease, where additional burdens of conventional therapies are not desired anymore.

 > Abstract Id: YUGP1412 Top

€Œquasi Experimental Non Randomized Study On Effectiveness Of €Œinstructional Strategy†On Knowledge, Practice And Quality Of Life Of Head And Neck Cancer Patients Receiving Radiotherapy In Selected Cancer Research Institute, Uttarakhand.€

Presenter- *Ms. KAVETA NIGAM


“Quasi Experimental Non Randomized study on Effectiveness of “Instructional Strategy†on knowledge, practice and Quality of life of Head and Neck Cancer patients receiving radiotherapy in selected Cancer Research Institute, Uttarakhand.†Kaveta Nigam, Kamli Prakash, Priya JPN Nursing Tutor, Vivekananda College of Nursing, Associate professor, Himalayan College of nursing ABSTRACT The cancer is a disease of cell in which the normal mechanism of the control of growth and proliferation has been altered. Annually, nearly 3,000,000 people die of cancer in India. The Indian Council of Medical Research said in 2016 the total number of new cancer cases is expected to be around 14.5 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020. Over 7.36 lakh people are expected to succumb to the disease in 2016 while the figure is estimated to shoot up to 8.8 lakh by 2020. Data also revealed that only 12.5 per cent of patients come for treatment in early stages of the disease. Purpose: The Purpose was to educate the patients with Head and Neck Cancer undergoing radiation therapy about management of side effects to improve their quality of life. Cancer is one of the leading causes of adult deaths worldwide. In India International Agency for Research on cancer estimated that average life expectancy of Indian population will increase to 70 Years by 2021-25. In India more than 75% cases of oral cancers are associated with smoke and tobacco consumption. According to the National Cancer Institute, head and neck cancer accounts for nearly 3 to 5 percent of all cancer in the United States. These types of cancer are more common in men and in people older than age 50. Around 47,560 men and women in this country develop head and neck cancer every year.1 Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck. Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. Oral cavity, Pharynx, Larynx, Paranasal, sinuses and nasal cavity, Salivary glands.2The three main types of treatment for managing head and neck cancer are radiation therapy, surgery and chemotherapy.3 Surgery, where a part or all of the tumor or cancer cells are removed. Chemotherapy, where certain drugs are used to kill cancer cells. Radiation therapy works in two ways: Radiation can stop or slow the growth of the cancer. Radiation can shrink tumors, reduce some symptoms, and relieve pain.1 Nurses in radiation therapy departments apply evidence-based practice when pro¬viding patient and family education and managing side effects.4,5 Dry mouth (xerostomia) is a common and significant consequence of head and neck radiotherapy. Because of the loss of saliva, patients with xerostomia are more susceptible to periodontal disease, rampant caries, and oral fungal and bacterial infections.6 Mucositis, characterized by inflammation and ulceration of the oral mucosa, is the most significant acute side effect reported by patients and is a potential source of life-threatening infection. Almost all patients undergoing head and neck radiation therapy experience confluent mucositis by approximately the third week of treatment.7,8 Modern equipment and sophisticated treatment planning techniques produce a “skin-sparing†effect, with the therapeutic dose delivered to the target organ, minimizing the dose to the skin. Still, approximately 95% of patients receiving radiation therapy may experience some degree of skin reaction, ranging from mild erythema to more serious and uncomfortable moist desquamation.9 Severe moist desquamation results in pain and discomfort, and may require a break in treatment, pos¬sibly compromising the effectiveness of treatment.10 Treatment-related factors, such as type of energy, daily dose, size of the treatment field, and use of bolus material affect the degree of skin reaction. Individual patient characteristics also play a role in the development of skin reactions.11 QOL is defined by the World Health Organization’s Quality of Life Group ( 1993) as follows: “Quality of life is an individual’s perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concern. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, level of independency, social relationship and their relationship to salient features of their environmentâ€12 Objective â€Â¢ To determine the effectiveness of instructional strategy on the knowledge of head and neck cancer patients receiving radiation therapy. â€Â¢ To determine the effectiveness of instructional strategy on the practice of head and neck cancer patients receiving radiation therapy. â€Â¢ To determine the effectiveness of instructional strategy in term of quality of life of cancer patients before and after intervention. â€Â¢ To find correlation between post-test knowledge score and post-test practice score. Hypothesis All the hypotheses was tested at p

 > Abstract Id: YUGP1416 Top

Quality Of Life Post Breast Cancer Surgery: Comparison Of Breast Conservation Surgery Versus Modified Radical Mastectomy

Presenter- *Dr. Nitish Ranjan Acharya

Co-author - Dr Kurian Cherian, ,

INTRODUCTION: Breast-conserving therapy (BCT) is now a well-established alternative to mastectomy. Better treatment modalities have improved survival in breast cancer patients. There is a multitude of studies examining quality of life (QOL) outcomes in these patients in the US and European population. There is a scarcity of such studies in Indian population. AIMS & OBJECTIVES: The objective of our study was to compare the quality of life between patients undergoing modified radical mastectomy and breast conservation at 6 months and 1 year post surgery period. METHODS: This was a prospective study which included consecutive 138 early breast cancer patients (biopsy/FNAC proven) who underwent primary modified radical mastectomy (76) or breast conservation (68). The EORTC QLQ C30 and the BR23 ( validated Malayalam version), filled in person by the patient, was used to assess the QOL at three different time periods, immediate presurgery, at 6 months and at 1 year post surgery interval. The data was entered and scored as per the scoring manual. Student t test was used for comparing the QOL between the two patient populations. RESULTS: 138 patients, 76 undergoing MRM and 62 undergoing BCS were included for the final comparison. The baseline QOL of both the groups was adequately matched. At the 6 months comparison patients undergoing BCS fared better in terms of physical functioning ( p - .039), body image ( p < .001) of the disease at 1 year comparison. CONCLUSION: Patients undergoing breast conservation fare better in terms of global health status, and various functional and symptom scales in addition to having a better body image perception. Patients undergoing MRM in turn tend to perform better in terms of having a better future perspective of their disease. Disclosure: Conflict of interest-none Copyright of abstract assigned to ICC-2017 Address of author: Dept of surgical oncology, Regional Cancer Centre, Trivandrum-695011 Mail id-drnitishra05@gmail.com

 > Abstract Id: YUGP1420 Top

Immunological Effects Of Laparoscopic Colo-Rectal Surgery - A Leap In Lap

Presenter- *Dr. Sanjeev B Kulkarni

Co-author - Dr Chandramohan k, ,

INTRODUCTION: Laparoscopic approach has developed into an interesting therapeutic alternative as it allows for rapid return to preoperative activity with significantly shorter hospitalisation due to limited surgical trauma. Despite promising clinical results, only limited information is available regarding perioperative immunological effects of laparoscopic surgery when compared to open colorectal surgery. This is one of the first study conducted in India. AIMS & OBJECTIVES: The objective of our study was to compare the immunological effects of laparoscopic surgery with open colorectal surgery. METHODS: A prospective study was conducted on 52 patients. All were above 18 years and had non metastatic Colo-rectal malignancy treated with curative intent. Patients with known immunological dysfunction, on immunosupressants were excluded. Blood samples were taken from all eligible patients on pre-op day and POD 1,3 and 5. CRP was done and NK cells were quantified by profiling of CD3-CD16+ and CD56+. Minimally invasive Colo-rectal surgery was performed as a laparoscopic-assisted procedure with removal of the resected specimen via a horizontal Minilaparotomy or Perineum in case of APR. Conventional colorectal surgery was performed via a vertical midline incision. After removal of the resected specimen, stapler or hand sewn anastomosis was performed. RESULTS: Serum CRP showed trend of return to normal value early in laparoscopic compared to open arm with a significant p value of 0.041, 0.001 on POD 3 & 5. Drop in NK cells percentage was less in laparoscopic arm with a significant p value of 0.003, 0.002 on POD 1 & 3. CONCLUSION: Immune function seems to be well preserved after laparoscopic approach compared to open approach. This study highlights that immunological effects seen post operatively with benign conditions is consistent with malignancy also. Long term follow-up is required to assess whether preserved immunological effects translate into overall survival advantage.

 > Abstract Id: YUGP1424 Top

Use Of 18F Fluorodeoxyglucose Positron Emission Tomography In Assessing The Treatment Response Of Neoadjuvant Chemoradiation/ Chemotherapy In Locally Advanced Esophageal And Gastroesophageal Junction Cancers

Presenter- *Dr. RAJIV PAUL


Background: For patients with locally advanced esophageal carcinoma undergoing neoadjuvant chemoradiation/chemotherapy followed by surgical resection, complete pathological response is associated with favorable overall survival(OS). PET scan is considered an important modality in staging of esophageal cancers. Off late, its use in assessing the response of neoadjuvant therapy is coming up. Whether the radiological response shown in PET scan before and after neoadjuvant chemoradiation or chemotherapy actually transforms into histopathological response and whether it would act as a predictor of overall survival is yet to be established. Aim: To evaluate the role of positron emission tomography (FDG-PET) in assessing the response to neoadjuvant chemoradiation/ chemotherapy and comparing it with histopathological response and its relation to overall prognosis. Methods: Retrospective data from October 2011 to December 2016 of operable patients with locally advanced carcinoma esophagus or gastroesophageal junction cancers was analyzed. All patients underwent FDG PET for initial staging and 4-6 weeks after completion of neoadjuvant chemoradiation or chemotherapy followed by definitive surgery. Results: The study included 96 patients. Most tumors were squamous cell carcinoma (62%) and stage T3(75%). All patients received neoadjuvant treatment (68 chemoradiation and 28 neoadjuvant chemotherapy). Post neoadjuvant treatment, PET scan showed complete metabolic response in 31 patients (32%), good response in 61 patients (63%) and stable disease in 4 patients (5%). 28 patients (29%) showed complete pathological response, 44 (46%) showed partial response and 24(25%) showed no response at all. PET CT response did not corroborate with the final histopathological response (p=0.235). Overall survival of patients showing complete metabolic response is 512.87 days, 526.7 days for patients with good response. 2 out of 3 patients with stable disease have expired. Conclusion: FDG PET response to neoadjuvant treatment in carcinoma esophagus and GE junction does not effectively correlate with the final histopathological response and to overall survival. Surgical decision should not be based on PET CT response and should be offered to all the patients irrespective of metabolic response.

 > Abstract Id: YUGP1426 Top

Surgical Morbidity Associated With Neck Dissection In Oral Cavity Cancers

Presenter- *Dr. Sanjeev B Kulkarni

Co-author - Dr Nivedita Sharma, Dr Paul Sebastian, Dr Nebu Abraham George

BACKGROUND Owing to high incidence of oral cavity cancer in India, neck dissection is the most commonly performed procedure in any head and neck oncology setup. Therefore, it is imperative that complication of such surgery and its attendant morbidity should be analysed and every effort should be made to minimise them. AIM To study the various short term and long term morbidities associated with neck dissections at Regional Cancer centre, Trivandrum. MATERIAL AND METHODS A total of 105 cases of oral cavity cancers who underwent neck dissection between 1 January to 31 December 2015 at surgical oncology division, RCC were evaluated prospectively and were followed for 6 months. Demographic data, tumor characteristics, type of neck dissection, complications including nerve injury and vascular injury were recorded. RESULTS Of 105 patients, 73% underwent selective neck dissection and 27 % modified radical neck dissection. Marginal mandibular weakness was recorded in 17 % cases at 6 months. Most had only slight angle of deviation while smiling, with only 2 patients had drooling of saliva. Phrenic nerve palsy as determined by chest xray was present in 4.7% in immediate post op which decreased to 2.8 % at 6 months. No patient developed any pulmonary complication. 13% patient had shoulder dysfunction at 6 months and no correlation was found between type of neck dissection, contrary to what proposed by many studies. There was no chyle leak and only one patient developed IJV thrombosis in immediate post-op period and that too resolved at 6 months. Current study showed that wound infection developed in 5 patients, with 3 of whom had uncontrolled diabetes status . Also, wound complications were found to be significantly higher in MRND group compared to SND CONCLUSION Majority of complications in present study were lower or same as recorded in previous studies. Also, there was no significant correlation with type of neck dissection except for wound complications. Despite the best planning, complications can still occur but their impact can be minimised by a vigilant, proactive and protocol driven approach in perioperative period .

 > Abstract Id: YUGP1438 Top

Determination Of Planning Target Volume Margin Using Implanted Fiducial Based Daily Marker Matching For Dose Escalated Image Guided Radiotherapy In Patients Of Prostate Cancer



Objective: Image guided radiotherapy (IGRT) is current standard of care in locally advanced prostate cancer patients. We analyzed 12 consecutive patients of prostate cancer treated by dose escalated IGRT using 3 implanted fiducial marker daily matching to generate planning target volume (PTV) margin in our setup. Material and methods: Three gold fiducial markers were placed under transrectal ultrasonography by an experienced uro-oncologist, first at the base of right lobe, second at middle of left lobe and third at the apex of right lobe. At least one week gap between fiducial marker placement and radiotherapy planning CT scan was kept to take care of localized edema and marker shift. Patients were immobilized using knee rest in supine position. When pelvis lymph nodes were treated, Radiotherapy (RT) volume was the whole pelvis to a dose of 50.4 Gy/28# followed by prostate boost 26Gy/13# by IGRT. For tumor limited to prostate only, prostate only RT to a dose of 76Gy/38# by IGRT was delivered. A Population based PTV margin of 10 mm was given in all direction except posteriorly where 5 mm margin was given. Daily on board KV images (OBI) were taken before treatment and on line shifts were applied before treatment. Analysis of data sets of Daily on board KV images (OBI) was done. Systematic error, random error and PTV margins in medio-lateral, cranio-caudal, anterior-posterior direction were calculated using Von Herk formula. Results — Analysis of the our data revealed Systematic error in medio-lateral, cranio-caudal, anterior-posterior direction was 2.94, 3.48 & 2.31 mm and random error was 3.74,3.63 & 2.66 mm and PTV margin required using Von Herk formula was 9.97,11.24 and 7.64 mm in medio-lateral, cranio-caudal, anterior-posterior direction respectively. Conclusions — Population based PTV margin may not be accurate for dose escalated IGRT using 3 implanted fiducial marker matching in prostate cancer patients and generation of its own PTV margins by each institute is desirable.

 > Abstract Id: YUGP1440 Top

Chemoradiotherapy With Brachytherapy Boost For Anal Canal Carcinoma Treated At Tertiary Cancer Center In India: A Single Institution Experience.

Presenter- *Dr. Vinay Babu AV

Co-author - Dr V Kannan, Dr Vivek Anand, Dr Ranjeet Bajpai

Chemoradiotherapy with Brachytherapy Boost for anal canal carcinoma treated at tertiary cancer center in India:a single institution experience. Dr V Kannan, Dr V Anand, Dr R Bajpai, Dr Vinay Babu, Dr Ajay Kolse, Dr S Goswami, S Deshpande, Dr A Kapadia, Dr S Almel, Dr M Shaikh, Dr M Lala. P.D. Hinduja Hospital, VS Marg, Mahim, Mumbai, 400016. Purpose:The aim of this study is to determine overall survival, disease-specific survival and stoma-free survival after treatment of anal canal cancer with chemoradiotherapy followed by brachytherapy boost. Methods: A total of 17 patients with histologically confirmed anal canal cancer, who received concurrent chemoradiotherapy followed by HDR brachytherapy boost from May 2005 until December 2016, were analyzed. 70.6% patients had squamous carcinoma histology and remaining 29.4% patients had adenocarcinoma. 11 pts were T2 (64.7%) and 6 pts (35.3%) were T3. Two patients (11.8%) presented with inguinal lymph node involvement. 12(70.6%) patients were treated with IMRT, 2(11.8%) patients with 3D CRT and 3(17.6%) patients received conventional treatment. After chemoradiation, all patients were treated with HDR brachytherapy to a dose of 8Gy-16Gy in 2-4 fractions over 2 days. The primary end point was overall survival; secondary end points were progression-free survival, colostomy free survival, safety and tolerability. Results: Among 17 eligible patients, median planned dose of radiation was 45Gy over 5 weeks, range 30.0 to 55Gy, and median brachytherapy boost was 10Gy. Median follow-up was 42 months (range; 4-101 months) and 64.7% of patients had no evidence of relapse. 5-year overall survival, disease-free survival and stoma-free survival were 68% (95%CI, 54.9-93.8%), 62% (95%CI, 46.7-88.9%), and 82.3%, respectively. Three patients (17.6%) had an abdominoperineal resection with definitive colostomy. Conclusions: Outcomes of patients with anal canal cancers treated with concurrent chemoradiation followed by brachytherapy boost in our institution were comparable to the available data in the literature. Keywords: .Anal cancer, Brachytherapy, Chemoradiation, Overall survival, Stoma free survival, Squamous cell carcinoma.

 > Abstract Id: YUGP1448 Top

A Case Of Adult Wilms Tumor

Presenter- *Dr. Vijayakumar Subramaniam


INTRODUCTION: Wilms tumour is the most common renal tumour in children. Wilms tumour in adults is extremely rare; accounts for less than 1% of all wilms tumor. There are diagnostic and therapeutic difficulties in older age group. Histopathologically, there is no difference between adult and childhood Wilms tumor. Because of the paucity of literature, there are no standard protocols for the management of adult Wilms tumour, and therefore, it is managed as per paediatric Wilms tumour. It has a poorer prognosis than paediatric Wilms tumour. CASE REPORT: 64 year old female presented with left sided flank pain and haematuria of 6 months duration. On evaluation CT scan abdomen showed exophytic well defined mass lesion arising from lower pole of left kidney. She underwent left radical nephrectomy and pathology was reported as adult wilms tumor with strong positivity of WT1 on IHC (Immuno Histo Chemistry). Bone scan showed metastasis in L2 and L3 vertebra. Patient received palliative radiotherapy to spine metastases and she is now on chemotherapy as per NWTS-5, stage 4 protocol. This case is presented for its rarity. KEY WORDS: Adult Wilms’ tumour, Renal tumour, Nephroblastoma.

 > Abstract Id: YUGP1450 Top

Olanzapine Ondansetron Dexamethasone Regime Versus Aprepitant Palonosetron Dexamethasone Regime For The Prevention Of Chemotherapy-Induced Nausea And Vomiting: A Single Institute Based Study

Presenter- *Dr. Vishnu Harilal

Co-author - dr rajesh kumar, dr vishnu h lal, dr h.s kumar

Abstract BACKGROUND: CINV is a daunting problem for all patients receiving chemotherapy, especially highly emetogenic drug based chemotherapy. The background for this study are the recent phase 3 studies which proved the efficacy of olanazapine as a highly effectivie antiemetic agent in the CINV setup and hence its recent inclusion in NCCN guidelines. This study would compare a highly Economical regime comprising of olanzapine , ondansetron and dexamethasone (OOD) against the very popular but more costlier aprepitant palonosetron dexamethasone (APD) regime . Though many studies have proved that ondansetron is slightly inferior to palonosetron in the CINV scenario , this study would see whether this shortcoming can be compensated with the wide antiemetic spectrum of olanzapine. The study would also try to include a larger sample size and see whether the results extend to local population as well. OBJECTIVE: To compare the efficacy of olanzapine, ondansetron, dexamethasone (OOD) regimen with aprepitent, palanosetron and dexamethasone (APD) regimen for prevention of CINV in patients receiving HEC. METHODS: At prospective single institute study was performed in chemotherapy-naive patients receiving cisplatin ? 70 mg/m(2) or cyclophosphamide ? 600 mg/m(2) and doxorubicin ? 50 mg/m(2) or dacarbazine (DTIC) comparing OLN to APR in combination with ondensatron (OND) and dexamethasone (DEX). The OLN, OND, DEX (OOD) regimen was 10 mg of oral OLN, 8 mg of IV OND, and 20 mg of IV DEX prechemotherapy, day 1, and 10 mg/day of oral OLN alone on days 2-4 postchemotherapy. The APR, PAL, DEX (APD) regimen was 125 mg of oral APR, o.25 mg of IV PAL, and 12 mg of IV DEX, day 1, and 80 mg of oral APR, days 2 and 3, and 4 mg of DEX BID, days 2-4. One hundred forty patients consented to the protocol and were randomized. One hundred seventeen patients were evaluable. RESULTS: In OOD arm 29(48%), 48(52%) while in APD arm were 26(45%), 32(55%) were male and female respectively. Breast cancer and head-neck malignancies were 26(43%), 21(34%) and 26(45%), 19(33%) in OOD, APD arm respectively. Complete response (CR) (no emesis, no rescue) was 85% for the acute period (24 hours postchemotherapy), 79% for the delayed period (days 2-5 postchemotherapy), and 72% for the overall period (0-120 hours) for 61 patients receiving the OOD regimen. CR was 81% for the acute period, 74% for the delayed period, and 69% for the overall period in 58 patients receiving the APD regimen. Patients without nausea (0, scale 0-10, MD Anderson Symptom Inventory) were OOD: 80% acute, 51% delayed, and 51% overall; APD: 78% acute, 50% delayed, and 41% overall. There were no grade 3 or 4 toxicities. OOD was comparable to APD in the control of CINV. DISCUSSION: In this study, OLN combined with a single dose of DEX and a single dose of OND was very effective in controlling acute as well as delayed CINV in patients on highly emetogenic chemotherapy. CR rates in OOD were noninferior to the APD regimen and also is cost effective.

 > Abstract Id: YUGP1454 Top

Dynamic Lateral Suspension Of Posterior Reconstruction Suture In Robotic Radical Prostatectomy & Impact On Early Continence: Evaluation Of 100 Cases Performed At A Single Institute.

Presenter- *Dr. Yuvaraja TB

Co-author - Santosh Waigankar, Abhinav Pednekar, Vinayak Wagaskar

Introduction & Objectives: Post-prostatectomy urinary incontinence has an effect on the patient’s quality of life and can be associated with moderate to severe postoperative morbidity. Search for techniques to achieve maximum continence after robotic radical prostatectomy (RRP) is ongoing. In this study we evaluate a novel technique “Dynamic lateral suspension of posterior reconstruction suture (DLSPRS)†after vesico-urethral anastomosis during robotic radical prostatectomy and compare early continence rates in patients who underwent DLSPRS versus those with only posterior reconstruction group (PRS). Material & Methods: Continence rates of 100 consecutive patients who underwent DLSPRS was compared with 100 patients with PRS. In brief technique include posterior Rocco repair of sphincter complex. After urethrovesical anastomosis is completed, needles of posterior suture are passed through levator ani muscle and lateral arcuate ligament pulled to elevate the entire sphincter complex. It is presumed that while contracting pelvic floor muscles the entire complex elevates still further helping continence mechanism. Early continence was assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3 and 6 months. Results: Patients' characteristics and perioperative outcomes were comparable. In DLSPRS group, the continence rates at 1, 3 and 6 months were 65%, 76% and 88% in PRS group it was 38%, 60% and 69% respectively. DLSPRS group had significantly higher continence at 1 and 3 months with p value of 0.04. There were no complications related to suspension of posterior suture. Conclusions: Dynamic lateral suspension of the posterior reconstruction sutures may acts like bladder neck sling. Our very early experience performing this suspension technique at the time of RRP had better early continence recovery. Further prospective non randomized study is underway in our institute to give further insight.

 > Abstract Id: YUGP1458 Top

Robotic-Assisted Laparoscopic Radical Cystoprostatectomy With Neobladder Formation (Modified Karolinska Technique): Surgical Technique & Outcomes In A Single Institute Series.

Presenter- *Dr. Yuvaraja TB

Co-author - Santosh Waigankar, Abhinav Pednekar, Vinayak Wagaskar

Introduction & Objectives: At present, robotic assisted laparoscopic orthotopic neobladder is emerging as the preferred and challenging method of urinary diversion. We share our single-institute experience of Robotic assisted neobladder reconstruction. Materials and Methods: Robotic assistance was used to construct a studer pouch in 20 cases of muscle invasive bladder cancers using the Modified Karolinska technique. Steps of Technique includes Isolation of terminal ileum loops, Urethral—neobladder and enteric anastomosis, Ileal detubularisation, Posterior wall Construction, Anterior wall folding and construction, Ureteroenteric anastomosis (Bricker’s), Ureteric stent and suprapubic catheter, Final anterior wall completion. Extended pelvic lymph node dissection was done in all cases. The follow-up period was 6months to one year. Results: Mean operating time was 190.4 minutes (range 180 to 220), blood loss was 460 cc (range 200 to 600) and hospital stay was 10 days. Clavien-Dindo Complications [Minor (Grade I & II) & Major (Grade III and above)] were 11% and 6% respectively upto 30days and 6% and 1% respectively between 30 - 90 days. Mean nodal yield was 24 (range 15to 30). Final diagnosis showed pT1-pT2 and pT3 — pT4 in 8% and 14% of specimens with a node positivity rate of 7% and no positive surgical margins. During follow-up there was no evidence of tumor recurrence. The day-time continence and potency at 12months was 72% and 80% respectively. Conclusion: This technique has good functional and oncological outcomes and appears to be a viable alternative to an open approach, offering patients the advantages of a minimally invasive approach.

 > Abstract Id: YUGP1460 Top

The Role Of Flt-Pet/Ct Scan In Avoiding Radical Surgery In Masquerading Pancreatobiliary Lesions

Presenter- *Dr. Gautham Krishnamurthy

Co-author - Vineeth Kumar, Ganga Ram Verma, B R Mittal

Background Gallbladder cancer in endemic in northern India, hence, to be on safer side, surgeons tends to perform radical resections even in benign lesions, i.e. XGC and resolving acute cholecystitis, masquerading as malignancy. Conventional imaging including FDG PET CT scan fails to differentiate benign from malignant pancreato biliary pathology. Our pilot study had shown that functional imaging with 3'-Fluoro-3'-deoxythymidine (FLT) PET CT scan can differentiate with accuracy of 92% and it has potential to avoid radial surgery in benign pancreato biliary lesions. Methodology Patients suspected of pancreaticobiliary malignancy admitted from July 2012 to Dec. 2016 were included. Diagnosis was made on clinical examination, contrast-enhanced computed tomography (CECT) abdomen and ancillary investigations. FDG-PET/CT and FLT-PET/CT was done in all patients. Management decisions were based on clinical evaluation and conventional imaging including FDG PET scan. Surgeons were blinded to the results of FLT-PET/CT scan. Histopathology of the resected specimen or fine-needle aspiration cytology (FNAC) in inoperable cases was considered as the gold standard for the final diagnosis. Results A total of 42 patients harboring 44 lesions of suspected pancreaticobiliary malignancy were included in the study. It included 31 gallbladder carcinoma, 3 distal cholangiocarcinoma, one hilar cholangiocarcinoma and 9 lesions of pancreatic adenocarcinoma. Two patients had synchronous lesions. 12 patients (28.5%) had either metastatic or unresectable disease. A total of thirteen out of forty four lesions (29.5%) were confirmed as benign on histological examination. The overall specificity, PPV and NPV of FLT-PET/CT was 100%, 100% and 81.3% respectively and it was sig. more (p

 > Abstract Id: YUGP1462 Top

Robot Assisted Laparoscopic Radical Prostatectomy In Patients With Previous History Of Transurethral Prostate Resection (Turp): Single Centre Experience And Outcomes.

Presenter- *Dr. Ninad Gadekar

Co-author - Amol Padegaonkar, Abhinav Pednekar, Santosh Waigankar

Robot assisted Laparoscopic Radical Prostatectomy in patients with previous history of Transurethral Prostate Resection (TURP): Single centre experience and outcomes. Ninad Gadekar, Amol Padegaonkar, Abhinav Pednekar, Santosh S. Waigankar, T.B. Yuvaraja Introduction & Objectives: Prostate which have undergone transurethral resection (TURP) may pose technical challenges during robot-assisted laparoscopic prostatectomy (RALP). We describe our single-institute experience with post-TURP prostates during RALP. Materials and Methods: A retrospective review of 360 consecutive patients who underwent robot-assisted radical prostatectomy at our institute from Jan 2012 to Jan 2017 was performed. Of these 15 (4.1%) had undergone TURP. These 15 patients (Group 1) were compared with 50 consecutive patients (Group 2) without any prior history of TURP in terms of preoperative parameters, intraoperative parameters, and the pathologic and clinical outcomes. Follow-up period from 5 months to 12 months. Results: The mean operative time and blood was more in group 2 (194 v/s 164 mins & 150 v/s 100ml). Preoperative clinical parameters were comparable between both groups. All Group 2 patients underwent bladder neck reconstruction. Complications did not differ significantly between two groups. The specimen size was comparatively small in group 2 as compared to group 1 but the surgical margins were negative in both the groups. A nerve-sparing technique was significantly less successfully performed in Group 1 patients than in Group 2 (27.3% vs 90.0 %, p = 0.002). No significant difference was found in the postoperative urinary bother score. The post-operative urinary function recovery and sexual function recovery rates were similar between the two groups. Conclusion: RALP is feasible but challenging after TURP. It entails a longer operating time, greater operative difficulty and compromised oncological or continence outcomes. Good experience is needed.

 > Abstract Id: YUGP1464 Top

Surgico-Pathological Outcomes Of 148 Radical Cholecystectomies Using Systematic Regional Lymphadenectomy Protocol

Presenter- *Dr. Pankaj Kumar Garg

Co-author - Durgatosh Pandey, ,

Introduction Surgery is the only curative treatment available for the management of gallbladder cancer (GBC), and presently, provides the only ray of hope for long term survival. Radical cholecystectomy necessitates cholecystectomy (already removed in incidental GBC) with a limited hepatic resection, regional lymphadenectomy, and adjacent organectomy if required to include the tumor with negative margins — R ‘0’ resection. Lymph node metastasis is an important prognostic marker of survival in GBC. The aim of this paper is to present our experience of radical cholecystectomies using a systematic regional lymphadenectomy protocol. Methods In this retrospective study, 148 GBC patients who underwent radical cholecystectomy using a systematic regional lymphadenectomy protocol from January 2007 to June 2017 were analyzed in regard to surgico-pathological outcomes. Results There were 148 gallbladder cancer patients who underwent radical cholecystectomy. Median age of the patients was 52 (range 22-78). Male to female ratio was 1.78. Upfront surgery was undertaken in 63 (42.5%) patients while revision surgery was performed in 85 (57.4%) patients with incidentally detected GBC. Adjacent organectomy was undertaken in 32 patients (bile duct resection in 21, colectomy in 5, tangential duodenal resection in 4, partial diaphragmatic resection in 1, and pancreaticoduodenectomy in 1 patient). Common postoperative complications were surgical site infection (n=10) and bile leak (n=5). There was no perioperative mortality. Median lymph nodes harvested were 16 (range 3-32). Margins were positive or close (

 > Abstract Id: YUGP1466 Top

Robot Assisted Partial Adrenalectomy For Adrenal Tumours €” Single Centre Initial Experience

Presenter- *Dr. Ninad Gadekar

Co-author - Amol Padegaonkar, Abhinav Pednekar, Santosh Waigankar

Introduction & Objective: Recent reports in literature have described adrenal-sparing surgery as a surgical option for patients with hereditary syndromes, small benign lesions or bilateral tumors to preserve unaffected adrenal tissue. We report our early outcomes & experience of robot assisted partial adrenalectomy (RAPA) technique. Materials and Methods: We performed 5 RAPA procedures on 4 patients presenting with bilateral pheochromocytoma in one patient (two sittings), two patients with Cohn’s syndrome and one patient with adrenal adenoma at our institute between 2012 and 2017. Surgical approach included transperitoneal approach, exposure of adrenal gland, careful excision of mass, and haemostasis by clips, cautery and suturing the cut edge. Results: Mean age of the patients was 32 years (24-48), mean console time was 80 mts (60-130), mean blood loss of 60 ml (30-100), mean hospitalization of 3 days (2-5). Patient with pheochromocytoma had hypertension during surgery which was controlled. There were no other intra- or post-operative complications. Frozen section was not done. Functional assessment was normal in all other patients except one with adrenal adenoma in whom studies were not performed. At median follow up of 18 months (5-32), none of the patient had biochemical or local recurrences. Conclusions: RAPA is feasible, safe and provides encouraging functional and oncologic outcomes in patients with a adrenal lesion/s. It may decrease the risk of the development of adrenal insufficiency. Our experience showed good short term outcomes. However more number of patients with long term outcomes data is necessary.

 > Abstract Id: YUGP1468 Top

Da Vinci Robotic Assisted Laparoscopic Hemi-Nephrectomy For Upper Pole High Risk Tumors: Single Centre Experience.

Presenter- *Dr. Yashasvi Choudhary

Co-author - Kalyan Chakradhar, Abhinav Pednekar, Santosh S. Waigankar

Introduction & Objectives: Da Vinci Si Robot assisted laparoscopic Heminephrectomy is gaining popularity in managing high risk upper polar renal tumours. It reduces the technical difficulty of parenchymal suturing during renorrhaphy. We aim to present the single centre experience & outcomes of Laparoscopic (robot assisted) heminephrectomy. Methods: We analyzed 12 heminephrectomies (5-Left and 7-right sided) done from 2012 to 2017 for 12 Renal tumors (8-incidental & 4-hematuria) (All upper pole tumors) in 12 male patients. Our surgical approach included colon reflection, hilar dissection, tumour identification, tumour scoring, arterial clamping, tumour dissection, inner and outer renorrhaphy with PCS closure, declamping and specimen retrieval. These were then analyzed for intra- and post-operative parameters. Results: The mean age was 42 years (24-54). The median RENAL Nephrometry score was 10P with angiography showing single renal artery. The mean age & eGFR of the patient was 42 years & 112 ml/min/1.73m2 respectively. The mean console time, warm ischemia time, blood loss & hospitalization time was 143 mins, 26mins, 70 ml and 5 days respectively. Intra-operative and post-operative period were uneventful. On histopathology all tumour were Conventional Clear cell renal carcinomas. The patients were discharged on postoperative day 3. At 1 and 3 months of follow-up the patient were disease-free with minimal change in eGFR. Conclusion: In the hands of experienced surgeons, robotic heminephrectomies is a safe and reproducible approach for the treatment of challenging renal tumors. It is also effective in renal function preservation and oncologic control at an early follow-up interval. However more number of patients with long term outcomes data is necessary.

 > Abstract Id: YUGP1470 Top

Robot Assisted Laparoscopic Radical Prostatectomy In Prostates With Large Median Lobe: Single Centre Experience & Outcomes.

Presenter- *Dr. Yashasvi Choudhary

Co-author - Kalyan Chakradhar, Abhinav Pednekar, Santosh S. Waigankar

Introduction & Objectives: Large prostate size and median lobes may pose technical challenges during robot-assisted laparoscopic prostatectomy (RALP). We describe our single-institute experience with prostates with median lobe during RALP. Materials and Methods: A retrospective review of 360 consecutive patients who underwent robot-assisted radical prostatectomy at our institution from Jan 2012 to Jan 2016 was performed. Of these 20 (4.1%) had enlarged median lobe. These 20 patients (Group 1) were compared with 20 consecutive patients without a median lobe (Group 2) in terms of preoperative parameters, intraoperative parameters, and the pathologic and clinical outcomes. Follow-up period from 6 months to 12 months. Results: Group 1 showed an increase in the operative time required for bladder neck dissection or anastomosis (including reconstruction) but it was insignificant (164 v/s 170 mins p=0.013). Average blood loss was not significant between two groups (100ml v/s 120ml p=0.0142). In group 1 all patients required bladder neck reconstruction compared to 2 (6%) in group 2. The Gleason score and the prostate size in the specimen were not different (60 cm3 versus 26 cm3; P = 0.782). The surgical margins were negative in all. No difference was found in the postoperative urinary bother score (p=0.0221). The post-operative urinary function and sexual function recovery rates were similar between the two groups. Conclusion: Although median lobe prolonged RALP procedure times and increased EBL, it did not affect PSM or urinary and sexual function. Robotic assistance helps to deal with the complexities of dealing with enlarged median lobe during RALP.

 > Abstract Id: YUGP1472 Top

Phyllodes Tumour Of The Breast: Analysis Of 30 Cases From A Single Institution


Co-author - Dr. Yugandar Reddy, Dr. M. Ramesh, Dr M. Srinivasulu

Author - Dr. Nived Rao B, Mch post-graduate, Dept. of Surgical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad-500004. E-mail: nivedrao82@gmail.com and phone no.: 09949597778. Background: Phyllodes tumor, previously known as cystosarcoma phyllodes, is a rare fibro-epithelial tumor of breast constituting

 > Abstract Id: YUGP1478 Top

Limb Salvage Surgery And Extracorporeal Radiotherapy For Metaphyseal Bone Malignancy : A Case Report

Presenter- *Dr. Niju Pegu


Background En-bloc resection, extracorporeal irradiation, and re-implantation in limb salvage for bony malignancies is an oncologically safe option, without compromising long-term survival. This method was first reported by Spira and Lubin. This treatment is an alternative to replacement by prosthesis or allograft bridging techniques. One area of concern is avascular necrosis and resorption of the graft. Patient and Methods A young boy with ewing sarcoma of upper end of tibia planned for limb salvage surgery with megaprosthesis but megaprosthesis not used due to unaffordable .They also refused to give consent for amputation. The methods involved wide en-bloc resection of the tumour, curettage of the tumour from the resected bone, extracorporeal irradiation and re-implantation of the irradiated bone and fixation with plates and screws. The resected segment is wrapped in 2 wet sterile drape to minimise air gaps and placed in polycarbonated box and delivered for radiotherapy. The segment has a single midplane dose of 50 Gy at a rate of 1.8 to 2.0 Gy per minute and reimplanted. Conclusions A biological reconstruction with a precise anatomical fit is possible even in metaphyseal tumour and long term endoprosthetic problems and maintenance of bone banking facilities for allografts are avoided. Extracorporeal irradiation is an oncologically safe and inexpensive technique for limb salvage even in metaphyseal sarcoma with a considerable functional outcomes.

 > Abstract Id: YUGP1482 Top

Clinical And Oncological Outcomes Of Young Patients With Hepatocellular Carcinoma After Hepatectomy

Presenter- *Dr. Jayanand Sunil

Co-author - Rama Ranganathan, Ravishankar Pichaiya, Balasubramaniam

Aims/Objectives: The aim of the study was to analyze the clinical and oncological outcomes of young patients (Age ? 45 years) with hepatocellular carcinoma (HCC) after curative surgical resection. Methods: Young patients who underwent curative surgery between 1991 and 2014 for hepatocellular carcinoma were analyzed. Follow up data has been updated till November 2016. Their clinical characteristics and survival was compared with those aged > 45 years. The UICC TNM classification 7th edition was used in the study. Data analysis was performed using the SPSS software version 17. Results: The crude incidence rate of HCC in the Madras Metropolitan Tumor Registry is 3.1 per 1, 00,000 population. Of the twenty patients included in the study, ten were aged ? 45 years. Six of these patients were males and four were females. All the patients who underwent resection had Child-Pugh score A. The prevalence of Hepatitis B positivity, cirrhosis, major and minor liver resections, blood loss at surgery, presence of lymphovascular invasion, tumor size, stage distribution, recurrence rates and mean time to recurrence were not statistically significant between young and older HCC patients. Although serum AFP were higher in younger patients, it was not statistically significant between the two groups (Mean: 47143.4ng/ml versus 92.3ng/ml). The mean operating time was found to be higher in younger patients compared to older patients (304 minutes versus 236.43minutes, p = 0.033). The mortality rate was nil and there was no instance of post-hepatectomy liver failure in either groups. The five year overall survival in patients ? 45 years was 34.6% and that in patients > 45 years was 42%, but the difference was not statistically significant. The median follow up of the entire study population was 23 months (Range 6 to 153 months). Conclusion: In areas with low incidence of HCC, younger patients were found to have similar clinical characteristics as older patients. Serum AFP was higher in younger patients. However, younger and older patients with HCC after surgical resection did not exhibit any significant differences regarding overall survival.

 > Abstract Id: YUGP1486 Top

Assessment Of Biochemical Profile In Head And Neck Cancer Patients Receiving Concurrent Cisplatin Chemotherapy

Presenter- *Ms. Janhavi Moharir

Co-author - , ,

Title: Assessment of Biochemical profile in Head and Neck Cancer Patients receiving concurrent Cisplatin chemotherapy Authors: Ms. Janhavi Moharir Final term, MBBS Objectives: To study and follow the serum magnesium and calcium levels at onset, at different dosage levels of cisplatin and after completion of cisplatin therapy for head and neck cancer patients receiving concurrent radiation. Need for Study: Electrolyte imbalance specifically hypomagnesaemia and hypocalcemia are known events in patients on chemo therapy. A reduced level of magnesium can manifest as symptoms ranging from fatigue, muscle weakness to depression and convulsions and a reduced level of calcium can cause life threatening complications such as laryngospasm, arrhythmias. These effects adversely affect the progress of treatment leading to interruptions and eventual poorer outcomes. Results: Calcium Week Mean Standard Deviation 1 9.24 0.52 2 8.99 0.45 3 8.81 0.48 4 8.66 0.39 5 8.50 0.35 6 8.16 0.53 Magnesium Week Mean Standard Deviation 1 2.06 0.26 2 1.93 0.21 3 1.88 0.22 4 1.81 0.21 5 1.72 0.20 6 1.61 0.21 The results showed a reduction in serum calcium and magnesium levels over the treatment period with a p value of 0.005 with significant error being < 10^-8. Conclusion: Our study has shown that calcium and magnesium are equally important even in Cisplatin chemotherapy with concurrent radiation and one needs to keep a close watch to avoid morbidity.

 > Abstract Id: YUGP1490 Top

The Effect Of Anti Egfr Humanized Monoclonal Antibody To Cellular Immunity Regulation In Uterine Cervical Cancer Therapy

Presenter- *Dr. Arie Munandar

Co-author - Soehartati Gondhowiardjo, Nurjati C Siregar, Alida Harahap

Background: Advances in technology has brought cancer treatment to the era of minimal invasive, specific to tumor, with minimal side effect treatment, however no single therapy can achieve the optimal result and multidiscipline approach with combination of the treatment available still remain as the main strategy. In late stage cancer, the number of recurrence and metastases are still high, one of the example is in uterine cervical cancer that can reach up to 40%. Therefore other approach should be considered to increase the treatment effectivity and disease free period. One of the mechanisms that might have an effect in preventing metastases is through the immunological regulation. It is stated in several studies that there is a relationship between immune cell infiltrations (T cell) in the tumor with response and prognostic of the therapy. Immunology has also play the role in cancer disease. In the first stage development of cancer, there is recognition by the immune cells to the cancer cells. At that phase, cancer cell was eliminated, however surviving cancer cell will develop ways to avoid the immune system and grow further. This so called immunoediting process consists of three steps that is elimination, equilibrium, and escape. MAb h-R3, an anti egfr humanized monoclonal antibody, has the function to block EGFR from epithelial tumor, especially in the condition where there is overexpression in EGFR, and has antitumor, pro-apoptosis and anti-angiogenic activity. Beside those activities, Mab h-R3 is also considered to have the capability to induce the immune mechanism. The monoclonal antibody that attached to the tumor cell can be recognized by the immune system and increase its response (opsonization process). This mechanism was considered related to the response of the therapy and prevents the recurrence. Study in mouse has shown that there was an anti-metastatic effect in using anti-mEGFR specific Mab (7A7) to D122 tumor cell. It is also known that Man h-R3 can induce the mechanism of Antibody Dependent Cellular Cytotoxicity (ADCC), and it is related to the EGFR expression. From all of that background above, it triggers the research question whether giving Radiotherapy combine with Mab h-R3 (Nimotuzumab) in cervical cancer patient can increase the immunological response and related to therapeutical response and disease free survival? Methods: The objective of this research is to analyze the effect of Nimotuzumab combine with Radiotherapy to immunological response in cancer. This is a prospective cohort research in locally advance stage uterine cervical cancer patients receiving Nimotuzumab and Radiotherapy, compare with Radiation only. The number of cellular immunity in tumor tissue and whole blood were analyzed to see the effect of Nimotuzumab in inducing the immunology system and its relation with tumor response. Patients with Histopathologically proven squamous cell carcinoma of the uterine cervix, age 18 — 70 year, FIGO stage IIB — IIIB with EGFR expression +2 or +3 and able to undergo pelvic CT Scan using contrast for RECIST tumor measurement are recruited. This research is being conducted in Department of Radiotherapy Dr. Cipto Mangunkusumo National General Hospital. Prior receiving nimotuzumab, biopsy from the cervical tumor tissue and peripheral blood sample were taken, and were analyzed using immunohistochemistry and flowcytometry to count the Lymphocyte T CD 4, CD8, Dendritic Cell, and Natural Killer Cell as the baseline. One week later, before the second nimotuzumab and the first radiation given, another biopsy and peripheral blood sample were taken again. Nimotuzumab and Radiation were given as schedule, Nimotuzumab every one week and external radiation every day for 5 days a week up to 25 fractions. After 20 fractions brachytherapy can be started if possible. Before the first brachytherapy, biopsy from the cervical tissue and peripheral blood collection were done again. After that the subject will receive brachytherapy every one week for three times. The workflows are the same for the Control Group but without the giving of Nimotuzumab. Result: This is a progress analysis of the research. Until June 2017, 21 subjects have been recruited. 16 subjects have finished the treatment while the rest of 5 subjects are ongoing. 3 subjects have died due to disease progression, 15 subjects are available for whole blood flowcitometry analysis, 11 subjects are available for 1 month post treatment response analysis, and 7 subjects are available for 3 months post treatment response analysis. One week after Nimotuzumab administration, there is an increase in mean CD4 and CD8 number in treatment group (194/ul and 114/ul increment, respectively) compared to control group, while for mean CD56 number there is no difference in treatment versus control group. In the 1 month post treatment response analysis showed that the treatment group has 37.5% complete response compared to 33% complete in the control group. In the 3 month post treatment response analysis showed that the treatment group has 100% complete response compared to 50% complete response in the control group. Conclusion: From this temporary analysis there seems to be a different between treatment and control group in terms of CD4 and CD8 number. There is an increase in CD4 and CD8 number in treatment group, which might show that there is an systemic immunologic response from the targeted therapy given. Radiotherapy combined with targeted therapy showed better response compared to radiotherapy alone, and there seems to be a continuing effect even after the therapy has been stopped which showed by the response changes in 1 to 3 months post therapy.

 > Abstract Id: YUGP1492 Top

Pallium'S I'S Through Psycho-Oncology

Presenter- *Ms. Sumitha TS

Co-author - Sumitha.T.S., Anjali Krishnan. R,

A medical student during his learning and unlearning years used to hear the call of pain from his neighbor. As he was in the beginning stage of his graduation and the ignorance to say “I do not know†pulled him away from the crying neighbor. He knew it was cancer pain but did not know how to cure or care. But that cry resonated in his ears throughout. Even the basic medical education did not help him find a solution. His distant dream of gaining insights to cure pain paved the way for a distinguished concept. Every patient’s worrisome face reminded him that cry. He learnt the skills to crimp pain during higher studies but the norm did not allow him to take independent decisions. Few years passed, his dreams started becoming realistic when he could lead. He sharpened his ears to listen to the cry due to physical pain so that he and his team can reach them to heal. As his reign was continuing by healing all the physical pain that came across, he was stopped by a guru-a teacher with tongue cancer died himself even after getting rid of his pain. This made him think; he understood that he and his group did nothing different except for their passion to heal pain through something they learnt. The guru taught them that there are many things beyond physical and it is inevitable to consider them if they wish to cure the actual pain. They started taking care of psycho-social and spiritual needs along with the physical needs of patients through community involvement. This innovation helped in evolving a new concept in the land called “palliative care†with home care. World Health Organization recognized their efforts as a model project in developing countries which helped them gain visibility. Later, the passionate healer initiated “Pallium India†in the heart of the state which spearheaded a phenomenon, the “Kerala State Palliative Care Policyâ€. Their activities was not confined to a state but reached many, liaised the formation of a national palliative care strategy and moreover the amendment of narcotic policy for improving access to pain medications as excruciating pain is a common symptom in oncology patients. Though he and his team achieved many laurels but it is painful to say aloud that their work to integrate with the health system is still in the infancy. But they have faith in the fact that “together we can do so much†to alleviate the needless suffering in India.

 > Abstract Id: YUGP1494 Top

Association Of Mean Platelet Volume With Colon Cancer

Presenter- *Dr. PINAKIN PATEL


BACKGROUND: Activated Platelets play a key role in inflammation and atherothrombosis . Mean Platelet Volume (MPV) is an early marker of platelet activation. Aim of study was to find out an association of MPV in patients of Colon cancer. MATERIAL AND METHOD: A total of 45 patients who were clinically diagnosed as patients of Colon cancer and age and sex matched healthy controls were studied in Department of Surgical Oncology ,S M S Medical college and hospital, Jaipur. MPV was estimated in all patients and compared with controls. These values were subjected to statistical analysis. RESULTS: MPV in Colon cancer patients were significantly higher as compared to controls and application of t test showed that this difference was statistically significant p

 > Abstract Id: YUGP1506 Top

Cervical Cancer Screening : Bangladesh Perspective

Presenter- *Dr. Md. Golam Zel Asmaul Husna


Cervical cancer is one of the most important cause of cancer death in females in low socio-economic countries like Bangladesh. A study suggests that more than 17000 new cases of Cervical cancer is diagnosed every year and almost 11000 death occurs due to cervical cancer each year. It is projected, by 2025 number of new cases would be 31000 and death will reach to 18000. As we know, Human Papilloma virus is the leading cause for cervical cancer, and if proper screening program is taken, it can be prevented. If abnormalities like CIN are addressed and treated accordingly, this high death burden can be reduced dramatically. In 2004, UNFPA initiated and funded a nation wide cervical cancer screening program. This project took VIA as their operational tool to detect cervical abnormality. Bangladesh is one of the first countries to run nation-wide cervical cancer screening program by VIA. It started in 44 districts. In different Medical colleges, District hospitals and Maternal and child welfare centers. BSMMU played the lead role to train the paramedics and technological support. In 2008 an evaluation was made by UNFPA by local and international experts, who described it as very effective project though having some limitations. They suggested some quality assurance tools and protocols to run the project effectively. Even though VIA is not very specific or sensitive in compared to screening programs in developed countries, we adopted VIA in three visit setting (ie. if VIA positive then referred to PAP smear; and if Positive, then treatment or referral) that made the system very cost effective and complaint for target population. We lack standardize case definitions and treatment protocols for CINs, if these are corrected accordingly our program would be more effective.

 > Abstract Id: YUGP1510 Top

Approaches To Minimize Post Rt Complications In Patients With Head And Neck Cancer

Presenter- *Dr. Sabiha Sal Sabil

Co-author - R. Qazi Mushtaq Hussain, ,

Worldwide approximately 6 lac new patients are diagnosed annually with squamous cell head and neck cancer. RT and surgery are the major curative modalities in treatment of head and neck cancer. With the currently available photon technology, sparing of non-target tissues is frequently difficult, as target volumes in head and neck cancers are generally large, complex in shape, and surrounded by critical normal structures which may lead to higher incidence of toxicities. So patients suffer from both acute and late toxicities during and following radiotherapy like mucositis, xerostomia, radiation dermatitis, trismus etc. which largely compromise their qualities of life. Hence necessitates the emergence of new and modified radiation techniques along with some pharmacological approaches and life-style modifications to combat this problem. Over the last few decades, conventional RT which used simpler rectangular treatment fields has changed significantly to conformal RT techniques. The use of 3D CRT,IMRT,IGRT, Adaptive RT, VMAT, Proton beam therapy etc. and improved imaging techniques for target volume and organ at risk delineation have accompanied efficacy improvements in decreasing acute and late toxicities by sparing normal tissues and hence dose escalation to tumors. Along with advancements in RT techniques, some simple life-style modifying education and a few pharmacological approaches also help to alleviate poor quality of life of these patients. In this context, this article will focus on some of these technical advancements along with other general approaches to minimize post-RT complications in head-neck cancer patients. The scope of improved treatment delivery in the perspective of Bangladesh will also be mentioned briefly.

 > Abstract Id: YUGP1514 Top

Can Total Laparoscopic Radical Hysterectomy Be A Standard Surgical Modality In Stage Ib1€”Iia Cervical Cancer? : A Retrospective Analysis Of 324 Patients From Single Center

Presenter- *Dr. BOLENENI NAREN

Co-author - Dr T Subramaneyeswarao, Dr KVVN Raju, Dr Satish Pawar

Abstract Objectives To determine if total laparoscopic radical hysterectomy (TLRH) can be substitute for open radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1—IIA cervical cancer. Methods We retrospectively reviewed the medical records of early stage cervical cancer patients who underwent TLRH with laparoscopic pelvic lymphadenectomy (LPL) from APRIL 2010 to JUNE 2016. Analysis was done on 31MARCH 2017. Results There were 324 patients who underwent TLRH with LPL 194 (59.8%) were in IB1, 69 (21.9%) were in IB2, 46(14.3%) was in IIA1, and 15(4%) were in IIA2 clinical stages. The median operating time, operative blood loss, post operative day(POD) of oral liquids starting, POD of flatus passage, days of hospital stay, the number of harvested pelvic lymph nodes were 3.30 hrs (range 2-5 hrs), 100ml (range 20-400 ml), 1 day (range 1-6), 2days (range 1-4), 6days (range 4-16), 10 nodes (range 0-29) respectively. There was no un-planned conversion to laparotomy. No peri-operative mortality was present and grade 1-2 morbidity was seen in 33 patients (10.3%). Out of 324 patients, recurrence was seen in 30 (recurrence percentage 11.1%). In a median follow-up of 24.5 months (range 0—56), 44 patients (13.9%) were lost to follow up. Out of remaining 280 patients (86.1%), 45 patients (15.2%) were died & 235 patients (84.8%) were alive for final analysis. Disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 84.9%, respectively. Statistical analysis was done by using Graph pad software’s Fischer’s t test. Parametrial involvement (p=0.0367), vaginal margin positivity (p=0.0045) & Lymph node positivity (p=0.0471) were significantly associated with DFS but not OS rates. Lymphovascular invasion, histological tumor type & grade of tumor were not significantly associated DFS or OS rates. Figo stage was significantly associated with both DFS (p=0.0355) & OS (p=0.0376) rates. Conclusions Total laparoscopic radical hysterectomy with pelvic lymphadenectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer in terms of survival with a far lower morbidity and better surgical outcomes than reported for the open approach. Our data suggest the need for larger prospective randomized trials which could support this approach as a new standard of care for stage IB1—IIA cervical cancer.

 > Abstract Id: YUGP1516 Top

Our Experiance Of Sentinal Lymphnode Biopsy(Slnb) In Breast Cancer.

Presenter- *Dr. PINAKIN PATEL


BACKGROUND: Carcinoma breast is the most common Malignancy in Females. Axillary lymphnode status is an important prognostic factor. Axillary Lymph Node Dissection (ALND) associated with several morbidities as intercosto-brachial nerve paresthesia, decreased shoulder motion and Lymphedema, challenging the long term survival advantages of ALND, especially node negative patients. Sentinal Lymph Node (SLN) biopsy is a reliable and minimal invasive diagnostic method to determine the regional nodal status in Breast cancer. This study to assess diagnostic accuracy of SLN biopsy with Methylene blue dye in predicting Axillary nodal status in operable breast cancer. MATERIAL & METHOD: 70 patients with Breast cancer were subjected to SLN biopsy (using Methylene blue dye) followed by complete ALND and Lymphnode stained with dye identified.SLN assessed for tumor positivity and compared with other axillary lymphnodes . Statistical analysis was done. RESULTS: Of 70 patients with dye injected in 64 (91.43%) patients SLN identified.16 (22.86%) patients with stained dye was positive for malignancy. 48 (68.57%) patients with stained node show no evidence of malignancy. 6 (8.57%) patients were identified with Axillary lymph node positive inspite SLN biopsy was negative. In this study, methylene blue dye was accurately identified sentinel lymph node in 91.43% cases with sensitivity of 72.7%. CONCLUSION : Methylene blue dye was found to be a cheaper and safer alternative for the SLN biopsy. In our study, overall accuracy of the SLN biopsy was 96.6% which revealed that Methylene blue dye accurately predicts the status of axillary nodes and procedure can be used with confidence in surgical practice. SLNB can be considered in breast carcinoma as reliable and cost effective and safe method for lymph node status.

 > Abstract Id: YUGP1518 Top

A 60 Years Old Male Presenting With Abdominal Pain, Dyspnoea And Limb Weakness

Presenter- *Dr. Muhammad Abdullah-Al Noman

Co-author - Dr. Qazi Mushtaq Hussain, ,

Md. Tajul Islam, 60 years old male, Muslim, married, service holder, a hypertensive, non-diabetic, non smoker hailing from Muradnagar, Comilla, admitted in this hospital on 2nd May, 2017 with the complaints of right upper abdominal pain for 3 months, which was intermittent, aching in nature, radiating beneath the right scapula and there was no aggravating factor. He developed respiratory distress with cough and right sided chest pain for the same duration. He also developed back pain, swelling the back of the neck and weakness of all limbs for 1 month. The swelling at his back of the neck was painful and gradually increasing in size. His limb weakness wasalso gradually increasing and now he cannot walk. He also noticed progressive abdominal distension with bilateral leg odema for 1 month. He has a history of asthma in his young age but not noticeable after adulthood. He has no H/O contacted with TB patient, no H/O surgery, blood transfusion or extra marital exposure. On examination, patient is ill-looking, anxious, mildly anaemic and generalized oedematous. His respiratory rate is increased. On local examination there is a hard, fixed, tender, irregular swelling at the level of C7 vertebral spine. His abdomen is distended but soft, liver is enlarged and liver span is 18cm, tender, irregular surface and firm in consistency. His shifting dullness is present. He has tenderness at 4th to 5th posterior rib and breath sound is bronchial at this region. There is diminished breath sound at bilateral lower lung field with Basal crepitation. His muscle power of all limbs reduced significantly with signs of UMNL. There is no sensory function loss. Other systemic examination revealed no abnormality. Provisional Diagnosis - Carcinoma right Lung with Liver and Vertebral metastases. Final Diagnosis Hepatocellular carcinoma with Lung (RUL) and bone (Rib & vertebrae) metastases. Discussion â€Â¢ Now, To confirm the diagnosis and to search if there is any second primary, we sent the Slides and blocks for Immunohistochemistry on 14.05.17 which is still pending. Treatment Plan- â€Â¢ Palliative radiotherapy to lumbar and cervical vertebrae followed by oral TKI depending upon IHC report. â€Â¢ The patient already received single fraction (800 cGy) palliative radiotherapy to L5 vertebrae on 12.05.17 for pain relief along with zoledronicacid. After wound healing of his cervical incision, he is planned to give radiation to cervical vertebrae.

 > Abstract Id: YUGP1520 Top

Adjuvant External Beam Radiotherapy In Differentiated And Medullary Thyroid Cancers: An Audit Of Clinical Practice


Co-author - JP Agarwal, A Budrukkar, G Pantvaidya

Basis of the study: The role of adjuvant External beam radiotherapy (EBRT) is controversial in the management of differentiated and medullary thyroid cancers. Hence, we conducted an audit of patients with differentiated and medullary carcinoma thyroid who had received adjuvant EBRT at our center and analyzed the indications of EBRT and acute toxicities. Materials and Methods: We identified 48 patients of thyroid carcinoma who had received adjuvant EBRT between March 2012 and April 2017. Twenty-seven of these patients were suitable for this audit. Data was collected from electronic medical record and radiotherapy prescriptions. There were twelve papillary, twelve medullary, two follicular and one mixed medullary and papillary thyroid carcinoma. Twenty-four patients (89%) were treated with intensity modulated radiotherapy(IMRT) to a median dose of 60Gy (range: 50 — 64 Gy) at 2Gy/fraction with median overall treatment time of 45 days (range: 40 - 50 days). Results: The median age was 47 years (range: 24 - 73 years). Fourteen females and thirteen males were included. The median follow-up was 13 months (range: 2 - 58 months). The indications for EBRT were gross extrathyroidal extension (ETE) (n=21, 77.8%), residual disease (n=13, 48.1%), extracapsular extension at multiple lymph nodes (ECE) (n=22, 81.5%), loco-regional recurrence (n=2, 7.7%), ECE+ ETE+ residual disease (n=10, 37%), ECE+ETE (n=7, 25.9%), ETE+ residual disease (n=2, 7.4%). Eighteen patients had lateral neck and central compartment disease with ECE. All patients were referred for radioiodine ablation prior to consideration for EBRT. Acute skin toxicities less than grade 3 was commonly reported (87.5%). Grade 1 and 2 mucositis was reported in 95.6% patients and none developed grade 3 toxicity. Twenty (87%) patients developed grade 1 or 2 dysphagia. Twenty-five patients remained controlled at last follow-up. Conclusion: Adjuvant EBRT in thyroid carcinomas is feasible with acceptable acute toxicities. It merits consideration in cases of locoregionally advanced disease at high risk for recurrence.

 > Abstract Id: YUGP1522 Top

Radical Radiotherapy For Stage I Glottic Cancer : 12 Year Data Of Various Hypofractionated Dose Schedules & Outcomes

Presenter- *Dr. PUSHPAJA K U

Co-author - Binitha Baby, Dr Anoop R, Renil Mon P.S

INTRODUCTION Hypofractionated radiation has shown its efficacy in treating early glottic cancer in various centres world wide . METHODS All patients with stage 1 glottic cancer , who underwent hypofractionated Radiotherapy from 2005 to 2016 in the Department of Radiation Oncology at Amrita Institute of Medical Sciences were included. Total 220 patients were identified. All were treated either with Lateral or oblique wedged pair fields in Linac using 4 MV or 6 MV xrays, after 3D planning, using fraction size varying from 2.4 Gy to 3.4 Gy/fraction, 5 days per week, to a total dose range from 52.5 Gy to 60 Gy. BED varied from 69.73 Gy to 78 Gy and EQD2 from 58.11 Gy to 65 Gy. Acute toxicity were evaluated according to RTOG Toxicities Scales. All Patients were followed up periodically. DFS and OS were calculated using the Kaplane Meier method. The Log-rank test was used to define the statistical significance of differences in local control in univariate analysis. RESULTS Out of total 220 patients , 210 were Males and 92% of patients were above 50 years of age. The anterior commissure was involved in 45 % patients. Six dose fractionation schedules were used of which 48% patients received 60Gy in 20 Fractions. The 5 and 10 year OS is 94% and 88.7% respectively. The corresponding 5 and 10 year DFS is 95% and 93% respectively. On univariate analysis for overall survival , dose > 55 Gy and dose with BED > 71Gy & EQD2 > or = 60 Gy showed statistical significance. Site (anterior commissure involved or not involved), technique, beam energy, did not achieve statistical significance. CONCLUSION In this study of hypofractionated radiation for early glottic cancer , the results are similar to those published in the literature, showing that hypofractionation gives excellent OS and DFS with no increased toxicities

 > Abstract Id: YUGP1523 Top

Hepatitis B Virus Quasispecies In Hbsag Negative Dlbcl

Presenter- *Dr. Mahua Sinha

Co-author - Keerthana Sundar, Premalata CS, Vikas Asati

Basis: Once infected with Hepatitis B virus (HBV), virus often remains latent within hepatocytes and lymphocytes in the form of Occult HBV infection (OBI). Host immune pressure and the virus’ error-prone replication/mutation trigger evolution of quasispecies within the host. Quasispecies with potentially oncogenic mutations may contribute to hepatocellular carcinoma or lymphomagenesis. Aim of this study was to determine association of HBV/OBI with DLBCL using molecular tools and to identify HBV quasispecies in different tissue compartments within patients. Methods: From viral DNA extracted from different body compartments of DLBCL patients - B cells, plasma and formalin fixed paraffin embedded (FFPE) lymphoma tissues — viral genes, S, P, C, X genes and covalently closed circular DNA were amplified by nested PCR. Next generation sequencing (NGS) of the amplified products was outsourced (SciGenom, Cochin). Results: 40 patients of DLBCL were enrolled in a year; all HBsAg negative. Plasma was available in all 40 cases, B cells in 31 and FFPE in 23. Twenty six patients showed two or more HBV gene products, characterizing OBI (65%). HBV DNA positivity was found in 72% of plasma, 74% of B cells and 56% of FFPE. Nineteen sets of genes/amplicons from 16 patients were subjected to NGS and compared for HBV quasispecies detection. In addition, 8 amplicons from FFPE and 9 S gene amplicons (irrespective of compartments) are being sequenced. Conclusion: Despite being HBsAg negative, 65% DLBCL patients showed evidence of OBI. HBV positivity was highest in B cells. Sequencing results are being analysed. We hope it sheds light on reasons for HBsAg negativity, molecular signatures in FFPE compartment and HBV quasispecies in DLBCL patients. HBV quasispecies evolution is clinically important with regard to emergence of viral mutants that are potentially oncogenic, resistant to antivirals and vaccine escape mutants and needs thorough study.

 > Abstract Id: YUGP1527 Top

Two Fractions Versus Three Fractions Hdr Brachytherapy In Locally Advanced Carcinoma Of Uterine Cervix After Pelvic Concurrent Chemoradiotherapy- A Rct

Presenter- *Dr. ISRAT JAHAN

Co-author - , ,

Aim and objective: Uterine cervical cancer is the commonest form of gynecologic malignancy in Bangladesh. In locally advanced cases radiotherapy with a combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICRT) is the mainstay of treatment. The aim of this study is to compare the treatment outcome and acute complications following treatment with 9 Gy (gray) in two fractions of ICRT with EBRT. Material and methods: A randomized controlled trial was carried out in the Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Department of Radiation Oncology, National Institute of Cancer Research and Hospital, Dhaka during the period of July 2015 to June 2016. Biopsy proven a total number of sixty patients of uterine cervical cancer were included and all patients received EBRT and inj.Cisplatin 40 mg/mÂ2 weekly followed by HDR intracavitary brachytherapy. EBRT treatment was delivered by Co-60 teletherapy with 50 Gy in 25 fractions of 2Gy per fraction over a period of 5 weeks. Then two fractions of ICRT with 9 Gy in two fractions weekly for 2 weeks was given to the patients of arm A and 7 Gy in three fractions weekly for 3 weeks to arm B. Treatment (RT) was completed in 7 weeks in arm A and 8 weeks in arm B. Every patient was evaluated weekly during treatment. Then follow up was done at week 6, 12 and at 6 months after completion of treatment to see the response and toxicities. Result: The mean age of patient at diagnosis was 50 years. Majority of patients in this study belongs to low to middle class population group. Follow up at 6 month after completion of treatment, complete remission was 90% and 86% respectively for arm A and arm B. The overall complete response was 88%. The common toxicities associated with treatment were bladder and rectal toxicities, skin reaction, and haematologic complications which were managed well. During follow up after 6 months, 3 patients in arm A and 2 patient in arm B developed grade II bladder toxicities and only 2 patients in arm A developed rectal grade II toxicities, but there was no rectal toxicity in arm B. Conclusion: This study showed that a total dose of 18 Gy ICRT in two fractions of 9 Gy over 2 weeks is equally effective in short term local control with acceptable toxicities in comparison with a total dose of 21 Gy in three fractions of 7 Gy ICRT .

 > Abstract Id: YUGP1531 Top

Effect Of Mistletoe Extract (Iscador) On Cancer Patient’S Survival. A Meta-Analysis.

Presenter- *Prof. Thomas Ostermann

Co-author - Thomas Ostermann, Sebastian Appelbaum, Desiree Poier

Introduction: Extracts from white-berry mistletoe (Viscum album) are used as a complementary and supportive cancer treatment. A first meta-analysis from 2009 found positive effects with respect to survival of cancer patients, however, not in randomized clinical trials. The current meta-analysis therefore aims at updating the clinical evidence on the effect of mistletoe extract (Iscador) on cancer survival. Material and Methods: The databases EMBASE, PubMed, CAMbase, Scopus, AMED and Cochrane were searched for clinical studies in cancer patients treated with Iscador. Outcome data were extracted as they were given in the publication, and expressed as hazard ratios (HR) and the respective standard errors (SE). Meta-analysis was carried out using a random effect model. Sensitivity analysis was carried out for study design (RCTs versus non RCTs). The effect of sample size and cancer entities on the HR was analyzed using meta-regression models. Results: 60 studies met the inclusion criteria. Of those, 31 studies with 59 strata provided data to extract HR and their SE. The majority of studies reported positive effects in favor of Iscador. Heterogeneity of study results was moderate (I2=48.1%; p< 0.0001). The overall hazard ratio was given as HR = 0.59 (CI: 0.54 to 0.65, p < 0.0001). Randomized studies showed less effects (HR=0.70; CI: [0.61; 0.79]) than non-randomized studies (HR=0.63; CI: [0.59; 0.67], without being significantly different (p=0.18). In addition, meta-regression did not reveal an effect of sample size on the HR (p=0.34). Significant differences, however, were found with respect to cancer entities (p

 > Abstract Id: YUGP1541 Top

Haematological Outcome Of Ccrt With Temozolomide Versus Rt Alone In Patients With High Grade Gliomas

Presenter- *Dr. MD. MAMUN OR RASHEED

Co-author - , ,

Abstract: High grade gliomas(HGG) are the most common primary CNS tumors in adult. Even with multidisciplinary approach the outcome is miserable. However recently concomitant chemoradiation (CCRT) with temozolomide has been effectively used. Temozolomide is an oral alkylating agents reported as second line therapy for patients with recurrent anaplastic astrocytomas(AA) and glioblastoma multiformie(GBM). It has found to increase median survival with good clinical outcome in patients with malignant gliomas. This was a quasi experimental study done in the department of radiation oncology in National Institute of Cancer Research & Hospital ( NICRH) Mohakhali , Dhaka during January 2014 to December 2014. Patients with newly diagnosed, histologically proved high grade (WHO grade III & grade IV) were assigned to receive radiation therapy alone (fractionated focal irradiation in daily fractions of 2 Gy in five fractions per week for six weeks, for a total 60 Gy) or radiation therapy plus temozolomide( 75 mg/m2 from 1st day of radiation therapy to last day of radiation therapy). ,followed by six cycles of adjuvant temozolomide (150 to 200mg per square meter for five days during each 28 day cycle).The primary end point was haematological and neurotoxicities .A total sixty patients were enrolled for study, haematological toxicities were compared between the patiens of two arms. Patients treated by CCRT with temozolomide showed more toxicities than the radiation therapy alone in some stages. As a whole the differences were not statistically significant. Key words: High grade gliomas, concurrent chemoradiation radiation therapy, temozolomide.

 > Abstract Id: YUGP1543 Top

Hypofractionated Radiotherapy In Inoperable Locally Advanced Head And Neck Cancer

Presenter- *Dr. Tusar Das

Co-author - , ,

Introduction: Standard treatment for inoperable advanced head and neck squamous cell carcinoma (HNSCC) is chemoradiotherapy but a significant proportion of patients are not suitable for curative treatment due to factors including tumour stage, performance status and co-morbidity of the patient. Hypofractionated radiotherapy for head and neck cancer is widely used. It has a useful role in the control of primary tumour as well as control of pain and other local symptoms. Aim: To assess the effectiveness of treatment with hypofractionated radiotherapy in locally advanced inoperable HNSCC. Material and Method: A cross sectional hospital based study was carried out in the Department of Oncology, BSMMU and Department of Radiation Oncology, NICRH, Dhaka, during the period January, 2015 to December, 2015. Patients with histologicaly or cytologicaly confirmed HNSCC without distant metastasis were included in this study. A total of 30 patients, each patient received 37.5 Gy in 15 fractions at 2.5 Gy per fraction over 3 weeks. Every patient was evaluated routinely to see the response and toxicities. Result: At the end of treatment all 100% patients with pain, 93% patients with insomnia and hoarseness of voice, dysphagia had greater than 50% relief after radiotherapy. CR was observed in 09 case, PR in 17 cases and PD in 04 cases. Acute and late reactions were acceptable. Conclusion: Hypofractionated radiotherapy is effective in relief of symptoms and loco-regional control of disease in locally advanced HNSCC.

 > Abstract Id: YUGP1545 Top

Study Of Concurrent Chemoradiation With Cisplatin Versus Capecitabine In The Treatment Of Stage Iia- Ivb Carcinoma Uterine Cervix

Presenter- *Dr. Rokaya Sultana

Co-author - , ,

Aim and Objectives: In Bangladesh, cervical cancer is the most common malignancy among female and the second most common female malignancy in the world. Concurrent chemoradiation plays an important role in the treatment of locoregionally advanced carcinoma uterine cervix. This study was carried out to compare the complete and partial response, efficacy of CCRT with capecitabine and; toxicities following treatment with concurrent chemoradiation with cisplatin versus with capecitabine in locoregionally advanced stage of carcinoma cervix. Materials and Methods: A total number of 60 patients (30 patients in Arm-A & 30 patient in Arm-B) who have biopsy proven squamous cell carcinoma of uterine cervix with no history of previous treatment were chosen for the study. In this study, patients of Arm-A of stage IIB- IVA uterine cervical cancer during external-beam radiotherapy (50 Gy in 25 daily fractions over five weeks by 10 MV photon energy of LINAC machine) received - Inj. cisplatin 40 mg/m2 in IV infusion on the first day of each treatment week. And patients of Arm-B of stage IIB-IVA cervical cancer received capecitabine, 825 mg/m2 twice daily (Saturday- Wednesday), orally during external-beam radiotherapy (50Gy in 25 daily fractions over five weeks by 10 MV of LINAC machine). After completion of EBRT, three insertions (one insertion per week) of HDR intracavitary brachytherapy each 7Gy, total 21 Gy (HDR) in both arms were given. Total treatment duration with concurrent chemoradiation and ICRT of both arms were completed within 8 weeks from the first day of treatment. Results: In this study, out of 30 cases in each arm the overall response (complete and partial) in both groups was more or less equal. Complete response of Arm-A was 22 (73.33 %) and of Arm- B was 25 (83.33 %). Regarding toxicity, common toxicities with concurrent chemoradiation were more or less same for both arms except patients of Arm-A became more anemic during treatment period may be due to cisplatin based chemoradiation causes more Myelosuppression. Reversible vomiting (grade 3) 13.3%, nephrotoxicity 20%, neurotoxicity 3.33% was observed in patients of Arm- A, And only 13.3% reversible grade 1 & 3.3% of grade 2 hand-foot syndrome seen in patients of Arm-B , this indicates that the use of concurrent chemoradiation with capecitabine was equally effective and a well tolerated option for patients of locoregionally advanced carcinoma uterine cervix. Conclusion: Capecitabine based concurrent chemoradiation is effective in achieving complete response in the treatment of locally advanced carcinoma cervix. There was no nephrotoxic patient seen in capecitabine based concurrent chemoradiation during toxicity evaluation. It can be the better treatment option for those patients who could not take treatment for their renal impairment having carcinoma cervix. So considering effectiveness, safety profile, convenience the capecitabine based concurrent chemoradiotherapy may be the better treatment option than cisplatin based concurrent chemoradiotherapy for treatment of locally advanced cervical cancer.

 > Abstract Id: YUGP1549 Top

Comparative Effectiveness Vs Cost Effectiveness Of Using Adjuvant Tamoxifen Vs Switching To Letrozole Once Into Menopause- In The Perspective Of Low Resource Countries.

Presenter- *Dr. ANM Kaiser Anam

Co-author - , ,

Aim Use of adjuvant Tamoxifen after radiotherapy beyond the initial 5 years irrespective of menstrual status was clinically compared with switching to Letrozole for 5 years in hormone receptor sensitive breast cancer patients. Background There are studies showing that Tamoxifen can be used both in pre-menopausal and post-menopausal women with hormone receptor sensitive breast cancer as adjuvant therapy and in metastatic disease. Studies show that aromatase inhibitors like Letrozole can be used in post-menopausal women for the same indications with more efficacy and favorable side effect profile. The price difference of these two drugs is substantial for the people of lower socio- economic standing. The comparative effectiveness and cost effectiveness of these two approaches should be explored in resource constratint setups eg. developing and underdeveloped countries. More studies dealing with this issue are needed. Method 50 patients presenting in the outpatient department from July/2016 to May/2017 for long term follow up after completion of adjuvant radiotherapy were evaluated cross-sectionally. None of them had distant metastasis at the time of radiotherapy. 30 patients had continued Tamoxifen after menopause. 20 patients switched to Letrozole for at least 2 years. The major criteria for comparison of effectiveness were development of local recurrence, distant metastasis and side effect profile. Major side effects like thrombolembolic events, endometrial changes were recorded and compared. Loss of bone mineral density which is a side effect of letrozole was not evaluated. Common minor side effects like hot flushes, unusual tiredness, headache, constipation were also noted. Cost was compared by calculating the expected total expenditure over the course of ten years of adjuvant therapy for both approaches. Conclusion In the whole group receiving adjuvant therapy with either Tamoxifen or Letrozole, comparative effectiveness vs cost effectiveness was seemingly favorable for the Tamoxifen receiving group in the context of a lower socio-economic group of population. Although, further long term study is warranted to quantify and validate these observations.

 > Abstract Id: YUGP1555 Top

€Œrole Of Serum Ca-125 Levels In Predicting Optimal Cytoreduction To No Gross Residual Disease In Advanced Stage Ovarian Cancers Treated With Neoadjuvant Chemotherapy Followed By Interval Debulking Surgeryâ€

Presenter- *Dr. Shah Naveed

Co-author - Shah Naveed, Preeti Jain, Ghanish Panjwani

TITLE : “ROLE OF SERUM CA-125 LEVELS IN PREDICTING OPTIMAL CYTOREDUCTION TO NO GROSS RESIDUAL DISEASE IN ADVANCED STAGE OVARIAN CANCERS TREATED WITH NEOADJUVANT CHEMOTHERAPY FOLLOWED BY INTERVAL DEBULKING SURGERY†. Objectives of the study:- 1)To study the role of serum CA-125 levels at presentation in predicting optimal interval cytoreduction to no gross residual disease in advanced epithelial ovarian cancers. 2) To study the role of pre-IDS serum CA-125 levels post neoadjuvant chemotherapy in predicting optimal cytoreduction to no gross residual disease in advanced ovarian cancers. 3) To study the clinical profile of patients presenting with advanced ovarian cancer in our population. Material and Methods:- Data collection technique and tools: All patients of adenexal mass suspicious of ovarian carcinoma who came to our O.P.D underwent thorough clinical examination and CA-125 levels at initial evaluation. Karnofsky performance score was calculated and recorded. Contrast Enhanced Computed Tomography of abdomen was done to evaluate extent of disease. Chest X Ray was done to look for any pleural effusion and cytology was obtained. USG guided FNAC of the adenexal mass was done to establish cytological diagnosis before sending patients for neo-adjuvant chemotherapy. When ascitis was present, fluid was sent for cytology. All patients received three cycles of Paclitaxel 175 mg/m2 and Carboplatin (AUC 6). After completing three cycles of NACT, patients were reassessed by the same surgical team. Thorough clinical examination and pre-IDS serum CA-125 levels were done. Contrast Enhanced Computed Tomography of abdomen was done to evaluate extent of disease. Chest X Ray was done to look for any pleural effusion. Based on decision taken by surgical team, patients underwent interval cytoreductive surgery oradditional cycles of neoadjuvant chemotherapy ( record was kept of any additional cycles of chemotherapy being given). Patients recieving additional cycles of chemotherapy were reassessed for interval cytoreductive surgery and pre-IDS serum CA-125 levels was done. The present study was a prospective, observational study conducted to assess the role of serum CA-125 levels in predicting optimal cytoreduction to no gross residual disease in advanced stage ovarian cancers treated with neoadjuvant chemotherapy followed by interval debulking surgery. Total of 100 patients of advanced stage ovarian cancers were included who underwent 3-6 cycles of NACT followed by interval debulking surgery. RESULTS : 1) In our study comparing patients with no gross residual disease (NRD) vs optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis. 2) The mean CA-125 level prior to interval debulking surgery was lower inNRD patients compared to OMD patients and it was statistically significant. Conclusions:- 1) In our series, after treatment with taxane and platinum-based chemotherapy, patients who were completely cytoreduced with no gross residual disease left, had pre IDS (post NACT) serum CA-125 levels significantly lower than those patients in whom some gross residual disease (? 1cm) was left. 2) The serum CA-125 levels obtained at presentation of the patient to OPD was not significantly different between the two groups of patients , that is one group in whom N.R.D was achieved and one in whom O.M.D was achieved.

 > Abstract Id: YUGP1559 Top

A Comparative Analysis Of Different Fractionation Schedules Used In Treatment Of Post-Mrm Carcinoma Breast Patients-A Prospective Randomized Study

Presenter- *Dr. SURABHI GUPTA

Co-author - Dr.Surabhi Gupta, Dr.Laxman Pandey, Dr.Mridul Chaturvedi

ABSTRACT:INTRODUCTION :- Breast cancer in female is a major medical problem. Worldwide it is the most common form of cancer in females.In India it is the second most common cancer after cervix accounting for 19% of the total cancer burden. The frequency of advanced breast carcinoma is 10 - 25% in the developed countries and 40 - 50% in developing countries like India[5]. Radiotherapy is usually given to the breast after conservative surgery or to the chest wall and drainage region after mastectomy to complete loco-regional treatment. Hypofractionated breast radiation therapy following mastectomy has been used by many institutions for several decades and have demonstrated equivalent local control, cosmetic results and normal tissue toxicities when compared with standard protocol of 50 Gy in 25 fractions.In the view of equivalent outcomes, patient compliance and proper resource utilisation benefits, hypofractionated radiotherapy can be considered the new standard treatment following modified radical mastectomy. Aims and objective-The aims and objectives were to compare conventional Radiotherapy with two different hypofractionated protocols treating chest wall & nodal areas in post mastectomy carcinoma breast patients in terms of:- 1. Loco-regional disease control , Distant failure,event free survival 2 Early and late toxicities of radiation in these patients. 3. Cost and work load both for the patients and hospital’s satff MATERIALS AND METHODS; This study was conducted on 70 histo pathologically proven patients of carcinoma of breast, treated surgically with modified radical mastectomy. These patients were randomized into three treatment arms. Arm I patients (23 pts ) were given a dose of 50Gy/25#/5wks, Arm II patients (16 pts) were given 42.5Gy/17# /3.2 wks while Arm III patients(31 patients) received 40Gy/15#/3wks external Beam Radiotherapy to chest wall and regional lymph nodes respectively. The trial compared two hypo fractionated protocols with conventional protocol in post radical mastectomy for adjuvant radiation for ca breast patient. Results: The Loco-regional failures were 0%,6.25%,3.23% in Arm I,Arm II , Arm III consecutively while distal relapses were 13.04%,18.75%,12.9% respectively.Patients alive without disease were 86.95%,75% and 83.87% in Arm I,Arm II and Arm III.Mortality in three arms were 8.69%,6.25% and 9.67%. While comparing the toxicities, pulmonary as well as cardiac toxicities were similar in all three arms. The use of 15 # protocol instead of 25# protocol saved 240 treatment sessions per 24 patients that is 16 more patients could be treated with same no.of fractions. Conclusion: In this study we observed that almost similar results were obtained in all the three arms in term of loco-regional control and toxicities. By adopting hypo-fractionated Radiotherapy protocol more numbers of patients can be benefitted particularly in a government setup. KEY WORDS: Breast cancer, Hypo fractionated Radiotherapy,conventional Radiotherapy, ,Modified Radical Mastecteomy

 > Abstract Id: YUGP1562 Top

Socio-Cultural Barriers To Seeking Medical Attention In Indian Breast Cancer Patients

Presenter- *Ms. Annie Alexander

Co-author - Annie Alexander, Rohini Kaluve, Jyothi S Prabhu

Introduction: Breast cancer is now the most frequently diagnosed cancer in urban Indian women. Advanced breast cancer in women under the age of 50, comprises approximately half of all new cancers. Attempts at increasing awareness have not yet translated into early reporting. We examined the psychosocial and cultural factors acting as barriers to seeking early care. Method: 378 patients were enrolled into a longitudinal study between the years 2008-2012, at two tertiary care hospitals in Bangalore, India. The median follow up as of May 31st 2017 is 78 months with only 2% loss to follow up over the past 8 years. Follow up was maintained by frequent meetings between the patient and a counsellor. The frequency was monthly during the initial treatment and then quarterly over the next 5 years. All patients were met in-person annually. Information on demographics was collected during the treatment phase and the psychosocial aspect was collected in non-structured interactions subsequently. This information included perceptions of the patient on barriers to seeking medical help - Information on awareness of the disease, denial of the disease, cultural beliefs, taboos and other social priorities. Results: 48/378 (13%) of our patients were younger than 40 years at initial diagnosis. Despite the vast majority of them having completed 12 years of schooling (>80%), almost half of them (48%) presented with advanced disease. Though a significant proportion (89%) were aware of the presence of a lump in the breast and its association with cancer, only 12% presented in early stages. Lack of personal priority (5%) formed a minor reason while the cultural taboo associated with exposure of breast to a stranger (27%) and denial of the disease was reported in significant proportion (32%) of our patients. Most of these sensitive details were shared with the counsellor after establishment of a close rapport. Conclusion: Our findings support the role for long-term one-on-one contact between patient and counsellor as an important element in providing support. In addition to building awareness and improving access, it may be equally important to focus on circumventing entrenched socio-cultural beliefs to help women seek medical attention for breast lumps early.

 > Abstract Id: YUGP1568 Top

Perceived Social Support And The Need For Support Groups In Cancer Patients.

Presenter- *Dr. Rucha Sule

Co-author - Dr Raj Nagarkar, Ms Dnyanada Joshi, Mr Ajay Dhilpe

OBJECTIVES- Professionally led support groups have been found to be useful for cancer patients in improving their quality of life, coping and affect . However, very few cancer patients utilise support groups . It is important to identify the factors which determine an individual’s willingness to participate in professionally directed support groups, more so in the Indian setting. MATERIAL & METHODS-As part of a pilot project, 110 patients diagnosed with different types of cancer, undergoing various forms of treatment, willing to participate in the study were randomly selected from a tertiary care cancer centre. These patients were given a semi structured questionnaire to assess their awareness about support groups and also their willingness to participate in such a group in future and what they would like as part of these support groups along with the multi-dimensional scale of perceived social support . The data obtained, was pooled tabulated and analysed using appropriate computerised software. RESULTS- The mean scores of the study group on the multi-dimensional scale of perceived social support were High (6.14). However, patients had very poor awareness on the concept of a support group and only 6.36% of them had attended one previously. Out of the study population, 70.90% voiced their willingness to participate in a support group run by the hospital, while 29.10% were either unwilling or unsure if they would like to attend. CONCLUSION- This pilot study helped us in understanding the various factors which determine a patient’s willingness to attend support groups and will help to structure the support groups upon the needs voiced by the patients, thus benefiting them.

 > Abstract Id: YUGP1570 Top

Assessment Of Psychological Distress And Quality Of Life In Newly Diagnosed Cancer Patients.

Presenter- *Dr. Rucha Sule

Co-author - Dr Raj Nagarkar, Ms Dnyanada Joshi, Mr Ajay Dhilpe

OBJECTIVES- Cancer is still considered a dreaded disease in the Indian context in spite of the recent advances in treatment modalities and the improving survivor-ship all around the world. This study endeavours to explore the psychological distress and quality of life in newly diagnosed cancer patients. MATERIAL & METHODS- Out of the newly diagnosed cancer patients, 160 individuals with different types of cancer, undergoing various forms of treatment, willing to participate in the study were selected from a tertiary care cancer centre. These patients were given a semi structured along with the Depression, Anxiety & Stress Scale 42 (DASS 42) questionnaire and the FACT G. The data thus obtained was pooled tabulated and analysed using appropriate computerised software. RESULTS-The mean Anxiety levels of the study population were severe (14.51) and mean depression levels were moderate (13.62).The mean total score on FACT G was 69.73 and that in the physical well-being (PWB) was 14.66 which was much lower than the established normative scores in adult population . CONCLUSION- Patients newly diagnosed with cancer show high levels of psychological distress and poorer overall quality of life. These findings reiterate the need of professional psychological and emotional support especially for newly diagnosed cancer patients.

 > Abstract Id: YUGP1574 Top

Chemo-Radiation Therapy In Combined Treatment Of Rectal Cancer In Young Patients

Presenter- *Dr. Abror Abdujapparov

Co-author - Botir Korakhadjaev, Yakov Ten,

Background: For a long time considered a CRC is characteristic for the older age group of people over the last few years the CRC rapidly ”younger”. Today the disease is increasingly diagnosed in people younger than 50 years. Based Cancer Registry data Uzbekistan incidence rate of CRC per year per 100 000 young people rose by 1.8% in men and 1.9% for women in the period from 2004 to 2014. A retrospective analysis from 1999 to 2010, cancer incidence rate of colon and rectal cancer in young people has grown by 17% and 35%, respectively, unfortunately, their number continues to grow. Materials and Methods: The study of the efficacy of the developed neoadjuvant method of treatment of colorectal cancer with the use of remote large-fraction radiotherapy SD 4gr every other day to achieve cumulative dose 36-4gr conducted in patients receiving capecitabine at a dose of 1700 mg/m2 during the entire course of radiation therapy (21 days), 3 infusion of oxaliplatin at a dose of 50 mg/m2 in 3, 10 and 17 days of treatment and 4-5 sessions of local microwave hyperthermia with course of metronidazole intrarectal administration radiosensitizing mixture consisting in 2 and 3 days of the course microwave hyperthermia. The treatment included 53 patients age of patients is from 25 to 35 with II-III stage of rectal cancer. (LFRT + CT + OXA + microwave hyperthermia + metronidazole). After a neoadjuvant treatment, all patients were operated in a radical amount within 4-5 weeks. Results: The results of our study were as follows: complete clinical response in patients wasn't observed, a partial response in 38 patients, the stabilization of process in 13 and progression of disease in 2 patients. In 30 patients due to clinical response was restaging disease decrease from III to II stage and from II to I stage. Postoperative complications were seen in 5 (9.4%) cases. In study group the use of preoperative large-fraction radiotherapy in patients receiving capecitabine, oxaliplatin, microwave hyperthermia and metronidazole has increased the 5-year survival rate of up to 64.5%. The incidence of local recurrence was 37.6%, and the frequency of distant metastases of 21.8%. Conclusions: Method of neoadjuvant treatment (LFRT + CT + OXA + microwave hyperthermia + metronidazole) in combination therapy of colorectal cancer in young patients does not affect intra-and postoperative complications and slightly increases the frequency of the 5-year survival. Thus today, the question of the introduction of patients with rectal cancer at young age remains an important issue.

 > Abstract Id: YUGP1582 Top

Chemo-Radiation Therapy In Combined Treatment Of Rectal Cancer In Young Patients

Presenter- *Dr. Abror Abdujapparov

Co-author - Botir Korakhadjaev, Yakov Ten,

Background: For a long time considered a CRC is characteristic for the older age group of people over the last few years the CRC rapidly ”younger”. Today the disease is increasingly diagnosed in people younger than 50 years. Based Cancer Registry data Uzbekistan incidence rate of CRC per year per 100 000 young people rose by 1.8% in men and 1.9% for women in the period from 2004 to 2014. A retrospective analysis from 1999 to 2010, cancer incidence rate of colon and rectal cancer in young people has grown by 17% and 35%, respectively, unfortunately, their number continues to grow. Materials and Methods: The study of the efficacy of the developed neoadjuvant method of treatment of colorectal cancer with the use of remote large-fraction radiotherapy SD 4gr every other day to achieve cumulative dose 36-4gr conducted in patients receiving capecitabine at a dose of 1700 mg/m2 during the entire course of radiation therapy (21 days), 3 infusion of oxaliplatin at a dose of 50 mg/m2 in 3, 10 and 17 days of treatment and 4-5 sessions of local microwave hyperthermia with course of metronidazole intrarectal administration radiosensitizing mixture consisting in 2 and 3 days of the course microwave hyperthermia. The treatment included 53 patients age of patients is from 25 to 35 with II-III stage of rectal cancer. (LFRT + CT + OXA + microwave hyperthermia + metronidazole). After a neoadjuvant treatment, all patients were operated in a radical amount within 4-5 weeks. Results: The results of our study were as follows: complete clinical response in patients wasn’t observed, a partial response in 38 patients, the stabilization of process in 13 and progression of disease in 2 patients. In 30 patients due to clinical response was restaging disease decrease from III to II stage and from II to I stage. Postoperative complications were seen in 5 (9.4%) cases. In study group the use of preoperative large-fraction radiotherapy in patients receiving capecitabine, oxaliplatin, microwave hyperthermia and metronidazole has increased the 5-year survival rate of up to 64.5%. The incidence of local recurrence was 37.6%, and the frequency of distant metastases of 21.8%. Conclusions: Method of neoadjuvant treatment (LFRT + CT + OXA + microwave hyperthermia + metronidazole) in combination therapy of colorectal cancer in young patients does not affect intra-and postoperative complications and slightly increases the frequency of the 5-year survival. Thus today, the question of the introduction of patients with rectal cancer at young age remains an important issue.

 > Abstract Id: YUGP1584 Top

Clinical Outcomes And Prognostic Factors In Young Patients With Carcinoma Oral Cavity: An Audit

Presenter- *Dr. Akash Dhuru

Co-author - Dr. Rakesh Katna, Dr Nikhil Kalyani, Dr Bharat Bhosale

Aim: The predominant pattern of failure for carcinoma oral cavity following surgery and adjuvant treatment has been loco-regional failure. Age is an important prognostic factor determining the outcomes for locally advanced carcinoma oral cavity. With an aim to study oncological outcomes, prognostic factors for young patients (age less than 40 years) with carcinoma oral cavity, present analysis was carried out. Material and methods: The treatment charts of prospectively maintained data of 290 patients who underwent surgery for carcinoma of oral cavitybetween August 2013 to March 2017 were evaluated. All these patients underwent wide excision / bite composite resection as per stage of disease. Of these, 91 patients were younger than 40 years. 79 patients had underwent per primum surgery followed by adjuvant therapy as per histopathology report. Remaining 12 patients received neoadjuvant therapy [chemoradiotherapy/ chemotherapy]. Results: Ten patients had early disease (stage I and II), while remaining patients had stage III and IV disease. At last follow up, 59 patients were aliveof which 45were disease-free. Eighteen patients had loco-regional recurrence, 10 patients had distant metastasis and 18 patients had both local-regional recurrence and distant metastasis. The median follow up was 15 months. Two year loco-regional control, disease free survival and overall survival were 54%, 47% and 58% respectively. On univariate analysis.thickness of tumour, advanced nodal stage (N2 and N3) and perinodal extension were associated with inferior disease free survival and overall survival. Conclusion: The oncological outcomes in young patients with carcinoma oral cavity is poor with high incidence of distant metastasis (31%). Advanced nodal stage and perinodal extension predicts poor survival outcomes in young patients.

 > Abstract Id: YUGP1588 Top

Predictive Factors And Measures To Decrease Acute Skin Toxicity For Head And Neck Patients Treated With Tomotherapy.

Presenter- *Ms. MEGHA P V

Co-author - , ,

Predictive factors and measures to decrease acute skin toxicity for Head and neck patients treated with Tomotherapy. Background: Tomotherapy treatment induced skin toxicity was a prominent clinical problem reported at our clinic for few of head and neck cancer patients receiving Intensity Modulated radiotherapy IMRT. Acute skin toxicity of Grade 3 and above could lead to temporary cessation of treatment for few patients. Severe skin reactions may be painful, lead to localized or occasionally systemic infection, and cause permanent scarring. The incidence of Tomo IMRT-related toxicity may be reduced by refinements in radiation techniques, such as improving dose conformity and dose homogeneity within the irradiated area. There are other factors involved, say the material used for immobilization, any adjuvant chemotherapy agent etc. In this study, we aim at analyzing causative factors for skin toxicity and to improve the treatment efficacy. Objective: To assess the factors affecting the incidence of radiation-induced dermatitis in head and neck patients treated with Intensity Modulated Radiotherapy by Tomotherapy and to compare with cohort of patients treated with C-Arm Linac. Materials and Methods: The study population consist of 20 patients who had undergone Helical Tomotherapy for treatment of Head and Neck site. All patients underwent immobilization procedure with thermoplast set followed by a planning CT with or without intravenous contrast along with or without secondary images like PET CT, MRI. Planning CTs were obtained with 2.5 mm slices, and treatment planning to Planning target volume (PTV) was then performed on Volo ® treatment-planning system. Patients treated with helical tomotherapy IMRT underwent daily megavoltage CT treatment scans for position verification and offsets corrected as needed before each radiation treatment delivery. Treatments were delivered with 6 MV un-flat photons. Acute skin toxicity levels were monitored during the entire course of radiotherapy treatment. For each patient, we measured the setup errors using the daily MVCT acquired for image guidance of the treatment. Uncertainty associated with air gap, for patients who was having gradual weight loss and soft tissue reduction were addressed via re-immobilization, re-simulation and re-plan. Most of the patients were re-simulated with Tomotherapy Megavoltage Helical Tomography (MVCT) and adaptive plans were delivered. Results and discussion: We observed various influencing factors that includes PTV to skin proximity distance, thermoplast material, setup accuracy etc. Our department adapted to keep a distance of 4 to 5mm proximity of target away from skin. Improvement were seen after changing thermoplast material for immobilization. It is also recommended that skin in the irradiated area be kept clean and free from trauma. Topical therapy at the clinical onset of radiation dermatitis may decrease the incidence of radiation-induced skin toxicity in a clinical set up.

 > Abstract Id: YUGP1594 Top

Why Altered Fractionation Have Not Gained Popularity In Bangladesh

Presenter- *Dr. Nazirum Mubin

Co-author - , ,

Abstract: The rising incidence of head & neck cancer all over the world, more so in developing countries, and its diagnosis mostly being at advanced stage in a developing country like Bangladesh. Concurrent chemoradiation therapy (CCRT) has become the standard of care for advanced Head & Neck Squamous Cell Carcinoma (HNSCC). Conventional concurrent radiotherapy in Head and Neck region include 70 Gy in 35 fractions over 7 weeks. Several other altered fractionation schedules were prescribed; of which two are prominent, namely Hyperfractionation started by University of Florida and Accelerated Concomitant Boost inspired by M.D. Anderson cancer center. Hyperfractionation schedule delivers 81.6 Gy in 68 smaller fractions twice daily over 7 weeks. On the other hand Accelerated Concomitant boost technique provides 72 Gy in 42 fractions twice daily over 6 weeks where first fraction given over PTV and second fraction of the day is given over GTV. RTOG 9003 trial showed that both of these techniques decreases loco-regional failure and increase disease free survival and overall survival. But none of this altered fractionation have gained popularity in Bangladesh. The first and foremost reason behind this may be increased acute toxicities. Although altered fractionation decreases delayed toxicities and improve long-term quality of life in comparison to conventional fractionation, increased acute toxicities due to altered fractionation that happens during treatment causes high dropout from treatment. Another influencing factor is the cost of altered fractionation schedule. When number of fraction increases it increases the cost and resulting higher dropout from treatment. Another important cause is that very few center and inadequate trained personnel who can deliver altered fractionation radiation. Last but not the least, to get the best out of altered fractionation IMRT is needed but Bangladesh have very few centers which can provide this facilities.

 > Abstract Id: YUGP1598 Top

Roll Setup Error Correction Validation For Tomotherapy

Presenter- *Ms. DONA SUNIL

Co-author - , ,

ROLL SETUP ERROR CORRECTION VALIDATION FOR TOMOTHERAPY. Aim & Objective: Highly conformal radiotherapy treatments necessitate a high degree of setup certainty in order to accurately target the tumor while sparing healthy tissue. As past studies have shown, misalignment in intensity-modulated radiation therapy (IMRT) treatments are not uncommon and can result in clinically relevant dose delivery errors. In this study, we intend to design a test phantom to perform an end to end evaluation of Tomotherapy HDA (Accuray Inc., Sunnyvale, CA ) roll correction. Material and Methods: A treatment plan was designed for delivery on the TomoTherapy cylindrical “cheese†phantom that would provide a very high gradient region in the film plane, thus making the measured dose distribution in this plane most sensitive to rotations in the “roll†direction. The cylindrical structure as drawn on the phantom and designated as a target. Three other structure drawn as a Organ at risk. A treatment plan was developed and optimized for these structures in the same manner as any clinical treatment plan, with the primary goal being the maximization of the gradient across the film plane. Two film measurements of the treatment delivery were made at each angle, one with roll correction applied and one without. The measurements made without roll correction will illustrate the effects of the induced rotational misalignment on the delivered dose distribution. We intend to establish a threshold at which these misalignments result in a statistically significant change in the delivered dose. The measurements made with roll correction applied will show how well the TomoTherapy roll correction feature corrects for the induced rotational misalignment through comparison with the baseline dose distribution. Result and discussion: TomoTherapy is able to detect rotational misalignment at the level of 0.2°—0.3° using the automatic registration system, and this system showed good agreement with measured induced rotations. Statistical analysis of point data and gamma analyses both show that TomoTherapy's roll correction feature is able to accurately correct for rotational misalignment to within the sensitivity of the test described here.

 > Abstract Id: YUGP1608 Top

Thromboembolic Events In Patients Of Advanced Stage Non-Small Cell Lung Cancer (Nsclc) Treated With Platinum Based Chemotherapy: A Prospective Observational Study. Dr Shruti Kate :Dm Registrar , Department Of Medical Oncology ,Tata Memorial Hospital Dr.

Presenter- *Dr. Shruti Kate

Co-author - Dr. Shruti Kate, Dr. Amit Joshi, Kumar Prabhash

Background: Cancer is a pro-thrombotic condition and its treatment with chemotherapy is frequently complicated by both arterial and venous thromboembolic events (TEs). Aim: We aimed to determine the incidence of TEs in patients of lung cancer treated with platinum-based chemotherapy and to study patients’ baseline and treatment attributes correlating with the onset of thromboembolic events. Material and Methods: Advanced lung cancer patients started on platinum based chemotherapy were evaluated at baseline and during routine outpatient visits for development of TEs. Patients with prior history of thromboembolism or on anticoagulation were excluded from the study. Duration of follow up was till 4 weeks from the last chemotherapy. A thromboembolic event was considered associated with chemotherapy, if it occurred between the time of first dose of chemotherapy and 4 weeks after the last dose. Results: Of the 165 patients, who completed follow up, 67.8% (112/165) received chemotherapy regime of carboplatin with gemcitabine, 30.3% (50/165) received carboplatin with pemetrexed, 1.2 % (2/165) received cisplatin with pemetrexed and 0.6 % (1/165) received carboplatin with paclitaxel. TEs occurred in 4.8% of patients (8 out of 165 patients). Three patients had developed venous pulmonary thromboembolism and 5 patients had developed cerebral infarction, out of which 4 had arterial cerebral infarction and one patient had a superior sagittal sinus thrombosis. The majority of events (7 out of 8) occurred within the first 100 days of starting platinum chemotherapy. Overall, the median time until occurrence of thromboembolic event was 48 days (range, 10 to 130 days). None of the presumed risk factors associated with thrombosis were found be related to the occurrence of TEs on univariate analysis. Conclusions: This study suggests that patients of advanced Non- Small Cell Lung Cancer on platinum based chemotherapy are predisposed to development of thromboembolism due to many factors. Despite the lower incidence of thromboembolism in our study, exclusion of patients with a thrombotic predisposition establishes the incidence of de novo thrombosis in lung cancer patients who are treated with platinum based chemotherapy and hence raises a valid question of the need of thromboprophylaxis in this group of patients.

 > Abstract Id: YUGP1612 Top

Role Of Tissue Inhibitor Of Metalloproteinases 1 (Timp1), Epidermal Growth Factor Receptor Pathway Substrate 8 (Eps8) And Axl Receptor Tyrosine Kinase (Axl) In Chewing Tobacco Induced Oral Cancer.

Presenter- *Dr. Arjun Agarwal

Co-author - , ,

1. Title of the Topic: Role of Tissue Inhibitor of Metalloproteinases 1 (TIMP1), Epidermal growth factor receptor pathway substrate 8 (EPS8) and AXL receptor tyrosine kinase (AXL) in chewing Tobacco induced Oral cancer. 2. Authours * Arjun Agarwal (Authour for correspondence) MBBS,MS, Resident in Surgical Oncology Department of Surgical oncology , Vydehi Institute of Oncology ,Bengaluru * Vishalakshi Nanjappa Ph.D, Institute of Bioinformatics , Bengaluru * M.S.Ganesh MBBS,MS,McH, Professor and Head, Department of Surgical Oncology,Vydehi Institute of Oncology,Bengaluru * Cheena Garg Assistant Professor, Department of Pathology, Vydehi Institute of Medical Sciences , Bengaluru * Aditi Chatterjee Ph.D, Institute of Bioinformatics , Bengaluru 3. Basis of the study It is well established that chronic exposure to tobacco induces head and neck cancers but the exact etiopathogenesis is not known. Though studies have shown the role of TIMP1, EPS8 and AXL receptor tyrosine kinase in oral and oropharyngeal cancers, the role of these proteins in tobacco induced cancers is not known especially in Indian population where the prevalence of tobacco use is high. In the reference study, mass spectrometry-based analysis revealed over expression of TIMP1, EPS8 and AXL at 2.7, 2.0 and 1.6-fold, respectively in response to chewing tobacco in an in vitro cell line. In the present study, the role of these proteins will be evaluated in cancerous and noncancerous tissues exposed to tobacco by immunohistochemistry, thereby trying to understand the links in the etiopathogenesis of tobacco induced oral cancer. Materials and methods- Source of data- Study was done in patients coming to Oncology Center at Vydehi Institute of Medical Sciences and Research Center, Bangalore,India Duration of study- January 2016 to January2017. Methodology- Punch biopsies were taken from cancerous and non cancerous tissues .Paraffin blocks were made and Tissue Microarray (TMA) were constructed using these blocks. 2 mm cores from each paraffin block were embedded into a recipient paraffin block. Immunohistochemistry was then carried out on these tissue microarrays. The paraffin embedded tissue was then deparaffinised followed by antigen retrieval using the Heat induced epitope retrieval (HIER) method. The endogenous peroxidase was quenched using hydrogen peroxide. The tissue section was incubated with primary antibodies specific for the target protein overnight, followed by HRP conjugated secondary antibody. The signal was developed using DAB chromogen. The intensity of staining was scored by on a grading scale ranging from 0 to 3+, where 0 represents negative staining, 1+ represents weak staining, 2+ represents moderate staining and 3+ represents strong staining signifying No , mild , moderate and strong response related to expression of each of the above three molecules described. Sample size — 30 INCLUSION CRITERIA- 1. All tobacco chewers with oral and oropharyngeal cancers irrespective of the stage of the disease EXCLUSION CRITERIA- 1. Patients without a history of tobacco chewing but other risk factors such as smoking, leucoplakia and chronic dental conditions. 2. Patients who have received prior treatment in the form of radiotherapy and chemotherapy STATISTICAL ANALYSIS- SPSS version 21 was used for analysis. The immunohistochemistry of cancerous and normal biopsied tissue will be compared between the study molecules using Chi Square test/ Mann Whitney U test. 5.Results There was a statistically significant difference in the immunohistochemistry staining of TIMP 1, EPS8 and AXL receptor tyrosine kinase in the the cancerous mucosa exposed to tobacco vs normal buccal mucosa.(p=0.000). 6.Conclusion- We have found a significant correlation between the expression of of our study molecules in the tobacco exposed cancerous mucosa of oral cavity. This highlights the importance of these molecules in the Pathogenesis of oral squamous cell cancers. Future studies on a larger cohort are required to initiate research on screening and preventive aspects of these molecules.

 > Abstract Id: YUGP1614 Top

T-Cell Prolymphocytic Leukemia: An Experience From A Tertiary Cancer Centre In South India

Presenter- *Dr. Rajesh Patidar


Background - T-cell prolymphocytic leukemia (T-PLL) is a rare lymphoid malignancy with dismal prognosis. Most patients have increased lymphocyte count (>1,00,000/dL) and widespread disease at presentation. Despite high response rate seen with alemtuzumab, the disease relapse is inevitable. Methods - This was a retrospective observational study done at a tertiary cancer centre in South India. All patients diagnosed with T-PLL from August 2010 to July 2015 were studied for the clinical characteristics, pathological findings and treatment outcomes. Results — Seven patients were diagnosed as T-PLL over a period of 5 years. The median age at diagnosis was 51 years. In the present series, 6 patients (86%) had splenomegaly and 3 had hepatomegaly (43%). Generalized lymphadenopathy was seen in 4 (57%) patients at presentation. Skin lesions were seen in 5 (71%) patients whereas pleural effusion in only one patient (14%). All had elevated total leukocyte count, with more than 1,00,000/dL in 4 patients. The median survival was 5 months with different chemotherapy (CT) regimens (5 received CT and 2 patients on best supportive care). Conclusion - T-PLL is a rare diagnosis with no definite treatment guidelines. Treatment with alemtuzumab and stem cell transplant have the best outcome at present, but invariably the disease relapse

 > Abstract Id: YUGP1616 Top

Porcelain Gallbladder: A Case Report Authors: Dr. Prateek Gupta (Mbbs, M.S.) , Dr. Prakash M.G. (Mbbs, M.S.)

Presenter- *Dr. PRATEEK GUPTA

Co-author - Prateek Gupta, Prakash M.G.,

ABSTRACT INTRODUCTION: Porcelain gallbladder i.e. calcification of the gallbladder wall has been discussed as it is historically been associated with gallbladder malignancy. Its incidence is low (0.06 -0.08%). It is found more commonly in females as compared to males (5:1 ratio) and the mean age at presentation varies from 38-70 years. There is still controversy regarding its aetiopathogenesis. CASE REPORT:We hereby report a case of 28 year old male with pain abdomen where ultrasound showed features suggestive of porcelain gallbladder and was surgically intervened with laparoscopic cholecystectomy with a good post-surgical outcome. DISCUSSION: The incidence of gallbladder cancer in porcelain gallbladder has been reported in literature to be between 12-62%. But recent studies in this regard have indicated the risk of gallbladder cancer may be significantly lower than what the previous studies had shown in 1950’s and 1960’s. Hence, the previously advocated routine prophylactic cholecystectomy in all cases of porcelain gallbladder and the approach of cholecystectomy i.e. open or laparoscopic is a matter of debate. CONCLUSION: We have reported this case in view of its rarity and the recent controversy regarding the lower incidence of gallbladder malignancy in porcelain gallbladder than what was previously thought. The appropriate management of porcelain gallbladder is discussed as well in view of the results of the recent studies.

 > Abstract Id: YUGP1620 Top

Verrucous Carcinoma Of Oral Cavity: Role Prophylactic Neck Dissection.

Presenter- *Dr. Yeshwanth Rajagopal

Co-author - PRAKASH.B.V, K.S.SABITHA, Nadimul Hoda

Verrucous carcinoma [VC] is a very well differentiated variant of squamous cell carcinoma [SCC] which is locally infiltrative with no metastatic capability. Oral cavity is the most common site of VC followed by larynx in head and neck. Oral cavity VCs are typically bulky grey to greyish red lesions reaching up to several centimetres in size. They may or may not be associated with cervical lymphadenopathy. VC by definition should not metastasize to lymph nodes. VCs are diagnosed microscopically by the benign appearance of the squamous epithelium [no cytological atypia typical of malignancy] which has pushing margins into the submucosa. Hence for a proper pathological diagnosis an adequate biopsy with adequate epithelial stromal junction is required. Treatment of choice for VCs is surgical excision, as radiotherapy is classically contraindicated. Most VCs are bulky usually more than 2 cm. Complete resection of these lesions with adequate margins requires general anaesthesia. As an incision biopsy might miss foci of squamous cell carcinoma, cases found to be SCC on final histopathological evaluation will require the neck to be addressed, either by surgery or radiotherapy. T2-T3 SCC of the oral cavity typically mandate prophylactic neck dissection as risk of occult metastasis is more than 20%. Prophylactic neck dissection at the same setting of primary resection is associated with minimal complications as compared to a second surgery or adjuvant radiotherapy. In our institution as a protocol all cases of VCs more than 2 cm in size undergo resection of the primary lesion along with prophylactic neck dissection. We did a retrospective study of all oral VCs which were diagnosed as VC on initial biopsy and which underwent neck dissection along with resection of the primary lesion. An analysis of final histopathology was done to: 1. Determine the percentage of cases that were found to have foci SCC. 2. True cases of VCs which did not mandate prophylactic neck dissection.

 > Abstract Id: YUGP1624 Top

Prognostic Significance Of Residual Nodal Burden Using Lymph Node Ratio In Locally Advanced Breast Cancer After Neoadjuvant Chemotherapy

Presenter- *Dr. Reshu Agarwal

Co-author - Reshu Agarwal, Anupama Rajanbabu, Pavithran K

Objective: To investigate the prognostic value of LNR in LABC patients receiving NAC followed by definitive surgery with adequate axillary dissection (defined as more than 10 lymph nodes) across various breast cancer intrinsic subtypes. To investigate whether LNR can give any additional prognostic information along with pathological nodal (ypN) stage in adequately sampled axilla. Methods: This was a single institution retrospective analaysis done at Amrita Institute of Medical Sciences. Records of locally advanced breast cancer patients, who underwent definitive surgery following neoadjuvant chemotherapy from 2004 to 2014, were analysed and 224 eligible patients were identified. Patient, tumor and treatment specific data were collected. According to pathological nodal status patients were divided into node negative (ypN0) and node positive (ypN+) and according to LNR patients were categorized into low (0.2 to 0.65) risk category and patient, tumor, treatment and outcome characteristics were compared. Disease free survival and overall survival were analysed using Kaplan Meier method and compared using log rank test for ypN0 and ypN+ cohort; LN =10 group; LNR risk groups in ypN+ patients ?10 LN dissected; LNR risk groups across various molecular subtypes; and single cut-off of LNR across various molecular subtypes. Result: Out of 224 analysed patients 72 (32.1%) were ypN0 and 152 (67.9%) were ypN+. Median age of diagnosis was 48.5 years (range, 25- 81 years). Median follow up period was 48.5 months (Range, 3- 151 months). Factors found to significantly differ in the two cohorts in decreasing order of significance were ypN (p

 > Abstract Id: YUGP1630 Top

Locally Advanced Colorectal Cancer : Is Second Look Surgery And Prophylactic Hipec Warranted?

Presenter- *Dr. Rahul Bhamre

Co-author - Karthik Chandra Vallam, Manish Bhandare, Avanish Saklani

Aims and objectives: Peritoneal recurrence (PR) after curative surgery for colorectal cancer is the second most common site of recurrence and carries a poor prognosis. PR present relatively in the later stage, is difficult to detect by conventional imaging on follow up, and have limited options to treat after diagnosis. Second look surgery is the only definite option to diagnose early PR and presents an opportunity for disease control by cytoreductive surgery (CRS) and HIPEC. Multiple studies have attempted to identify clinico-pathological risk factors that predict high risk of PR. Our aim is to analyze the recurrence patterns and survival in locally advanced colorectal cancer and to identify high risk factors for PR, which can be used as an indication for second look surgery and prophylactic HIPEC in such cases. Methods : Retrospective analysis of a prospectively maintained data of all colorectal cancer patients presenting to a tertiary cancer care referral center in India, from May 2010 to October 2015 was done. All patients who underwent surgery with curative intent and were clinico-pathological stage T4 and/or N2 M0 were included in the analysis. All upfront metastatic patients who underwent surgery with palliative intent or curative intent were excluded from the study. Results : 182 patients underwent curative resection with a clinico-pathological staging of T4 and/or N2 M0. 104 were males, while 78 were females. There were 71 recurrences, out of which 30 (42.2%) were peritoneal recurrences, 7 (9.9%) were liver only recurrences while 34 (47.9 %) were non-hepatic systemic or multiple site recurrences. For a median follow up of 26 months, the estimated 3 year Overall Survival was 78 % while the 3 year DFS was 50.4 %. The median time to diagnosis of peritoneal recurrence was 13 months (4.7 — 55.7). The 3-year OS for patients with peritoneal recurrence was 48.6 % as against 57 % for liver only recurrence and 59.9 % for non liver systemic and multiple site recurrence, with a trend towards poorer survival for peritoneal recurrences, although non-significant (p — 0.377). The 3-year OS for PD/Signet ring cell/Mucinous adenocarcinoma was 64.7 % as compared to 86.2 % for WD/MD adenocarcinoma (p -0.003) Conclusion : Locally advanced colorectal cancer has a high risk of peritoneal recurrence which negatively impacts the survival. Well-designed RCTs need to be conducted to identify the high risk factors for PR and whether second look surgery and prophylactic HIPEC in such patients will improve survival with acceptable morbidity and mortality.

 > Abstract Id: YUGP1632 Top

Prephase As A Simple Method To Reduce Early Treatment Morbidity During The Definitive Treatment Of Diffuse Large B Cell Lymphoma (Dlbcl)

Presenter- *Dr. Vikas Asati

Co-author - Dr. K. C. Lakshmaiah, Dr. Govind Babu K, Dr. Premalatha CS

Context: Treatment related toxicity during the treatment of high grade lymphoma like DLBCL is highest during the initial phase of treatment (First cycle effect). The toxicity can be in the form of febrile neutropenia, tumour lysis syndrome, deterioration in performance status, delay in further chemotherapy and death. Historically different methods have been tried to reduce this initial toxicity. The introduction of prephase treatment is one of the most popular methods routinely used in Germany and other European countries. This study was undertaken to evaluate the benefit of prephase treatment in newly diagnosed DLBCL in Indian patients before the definitive chemotherapy or chemoimmunotherapy. Aims: The aim of this study was to know the role of prephase treatment in newly diagnosed DLBCL patients prior to definitive chemotherapy. Methods and Material: Newly diagnosed patients of DLBCL, who were being planned for chemotherapy (CHOP/R-CHOP), were eligible for the study. Out of 50 patients, 25 patients received prephase treatment consisting of vincristine (1 mg) on -6th days and prednisone 100 mg daily for 7 day (-6 day to day 0). All patients received CHOP/R-CHOP chemotherapy on day 1. ECOG performance status, nadir absolute neutrophil count (ANC) on day 10, febrile neutropenia, and hospitalization, the requirement of antibiotics and mortality within 30 days of chemotherapy were compared in both the groups. Results: There was a significant improvement in performance status of the patients who received prephase treatment. The incidence of any grade neutropenia on D10 of chemotherapy in experimental arm was 44% (as compared to 88% in control arm) while the grade 3/4 neutropenia was 12% (as compared to 48% in control arm). Febrile neutropenia in the experimental arm was lower (12%) as compared to control arm (32%) (p value

 > Abstract Id: YUGP1634 Top

Efficacy And Safety Of Myl 1401O Versus Trastuzumab As First-Line Therapy In Asian Patients With Her2+ Metastatic Breast Cancer

Presenter- *Ms. Lisa Medlen

Co-author - Subramanian Loganathan, C.T. Satheesh, Sankar Srinivasan

Background: MYL-1401O is a proposed trastuzumab biosimilar. In the multicenter, double-blind, randomized, parallel-group, phase 3 HERITAGE study of patients (pts) with HER2+ metastatic breast cancer, overall response rates (ORR) at week (wk) 24 were similar between those receiving MYL-1401O and trastuzumab. These analyses compare best ORR with MYL 1401O and trastuzumab in combination with taxane at wk 24 and safety up to wk 48 in the Asian population of HERITAGE from India, Thailand, and the Philippines Methods: Pts were randomized 1:1 to MYL-1401O or trastuzumab (6 mg/kg over 30 minutes intravenously) every 3 wks plus weekly taxane for 24 wks and then without taxane (monotherapy) for 24 wks. Cox proportional hazards models, Kaplan-Meier plots, and log-rank tests were used to evaluate secondary endpoints of time to tumor progression (TTP), progression-free survival (PFS), duration of response (DR), and overall survival (OS). Safety and immunogenicity outcomes were descriptive. Results: Of the 153 pts randomized, 142 were included in the intent-to-treat population (MYL-1401O, n=70; trastuzumab, n=72) and 149 in the safety population (pts receiving ?1 treatment dose). Baseline characteristics and disease history were generally similar between groups. At wk 24, best ORR was similar between groups (MYL-1401O, 67.1%; trastuzumab, 63.9%; ratio [90% CI], 1.05 [0.86, 1.28]; difference in best ORR, 3.3% [90% CI, -9.76%, 16.08%]). No significant differences were observed between groups for TTP, PFS, DR, or OS at wk 48. Safety and immunogenicity were similar between groups through wk 48 (Table). Conclusions: The ORR in the Asian population receiving either MYL-1401O or trastuzumab was similar between groups and similar to results for the overall population, with no new safety differences.

 > Abstract Id: YUGP1636 Top

The Effectiveness Of 3% Citric Acid Versus Sodium Bicarbonate (Baking Soda) Mouthwash For The Prevention Of Radiation-Induced Xerostomia Among Patients Receiving Conventional Radiation Therapy For Head And Neck Malignancies

Presenter- *Dr. Veronica Vera Cruz

Co-author - John Vincent A. Gan, Lilian V. Rodriguez, Emjad T. Torrefranca

Purpose/Objectives: Majority of head and neck malignancies require Radiation Therapy (RT). Conventional radiotherapy produces toxicities such as xerostomia, which leads to multiple complications if left untreated. In this study, we determined the effectiveness of using 3% citric acid versus NaHCO3 (baking soda) mouthwash in the prevention of xerostomia for patients undergoing conventional radiation therapy to the head and neck area. Materials/Methods: 32 patients with head and neck malignancies were randomized to two groups (16 per group). The first group received 3% citric acid mouthwash whereas the 2nd group received sodium bicarbonate mouthwash. Salivary flow rate and RTOG Scoring for xerostomia were collected. Results: Salivary flow rates were comparable at baseline but decreased steadily as treatment progressed. A significant difference in flow rates were observed (P=.010) on the 5th day which coincided with the incidence of xerostomia, wherein the proportion in the control arm was more than double of that in the experimental arm (69% vs. 31%). Also, majority in the citric acid group (75%) reported RTOG score of 0, while most in the control group (69%) had an RTOG score of 1 (P=.013). On the 10th day, all participants had varying degrees of mouth dryness. Mild xerostomia was more frequently noted in the citric acid group on day 15 (94% vs. 56%, P=.037). On the 20th day, 75% in the experimental arm had mild xerostomia, while most in the control arm (81%) had moderate signs and symptoms of mouth dryness (P=.001). From day 25 onwards, moderate xerostomia in the experimental and control groups were 81% and 94%, respectively. The average dose on either parotid gland is > 40 Gy. Profiles of mouth dryness were significantly better in the citric acid arm on days 5, 15, and 20. Conclusion: The comparison of the experimental versus control group demonstrated the citric acid’s higher effectiveness as a sialagogue as evidenced by higher salivary flow rate, delayed and milder symptomatology. However, its effectiveness is dependent on the functionality of the viable salivary glands

 > Abstract Id: YUGP1642 Top

A Rare Case Report Of An Aggressive Malignant Spiradenoma Chest Wall Masquerading As Carcinoma Of Unknown Origin -Course Of Events And Review Of Literature

Presenter- *Dr. Md basheeruddin Inamdar

Co-author - Dr H Narendra, Dr Ramana Reddy Naru,

Malignant eccrine spiradenomas are exceedingly rare and aggressive tumours normally arising in long-standing benign eccrine spiradenomas. We present a case of malignant eccrine spiradenoma(MES) who was initially misdiagnosed as carcinoma of unknown origin inspite of extensive workup to look for primary and presented with a large exophytic tumour on the right side of his chest wall which had fungated. Radiological imaging of the chest region revealed extensive involvement of the local tissues.Patient underwent wide local excision with a 1cm margin along with right sided axillary lymph node dissection. Histopathological findings were consistent with MES with tumour deposits in multiple lymph nodes in the axilla. Our case report shows MES is a rare and aggressive cancer which is difficult to diagnose, highly aggressive with propensity to involve the lymph nodes. May present with local recurrence and also develop distant metastases significantly compromise the quality of life of the patient. It requires the surgeons to have a high index of suspicion for its initial diagnosis, and a multidisciplinary management with surgery ,radiotherapy and chemotherapy is required for complete treatment and needs close follow up. Keywords: Malignant eccrine spiradenoma; wide local excision; Radiotherapy; chemotherapy.III. TEXT Introduction Eccrine spiradenoma is a benign sweat gland tumor that commonly affects young adults. The presentation is often a single nodule that may or may not be tender. In contrast, the malignant eccrine spiradenoma (MES) is an extremely rare tumor, which almost always arises from a pre-existing eccrine spiradenoma. The overall prognosis of MES is poor [1].Our case report describes one such aggressive presentation of MES with lymph nodal metastases who develop local recurrence as well as distant bony metastases. Case description A 67 old male presented to surgical oncology department at our tertiary care centre with chief complaints of swelling over right side of chest wall since 3 years, it was insidious in onset,gradually progressing in size but over the last one year it has rapidly progressed to attain the present size.It is not associated with pain.Patient does not have any history of shortness of breath,cough and haemoptysis. There was no history of loss of appetite or loss of weight and his bowel and bladder habits are regular. He is a known smoker, 30 pack years.On local examination a swelling of size 10x8 cm is present over right chest wall with skin involvement of area 4x 4cm which is covered with slough. It is variable in consistency hard to firm, mobile, non tender. A single,mobile lymphnode of size 2x1cm is palpable in the right axilla.Other systemic examination was unremarkable. Biopsy from lesion showed possibility of adenocarcinoma deposits and Immunohisto chemistry(IHC) with CK7,CK20 and CEA were done.IHC with CK7 showed intense cytoplasmic positivity in tumor cells and CK20 and CEA were negative.We further suggested IHC with ER, PR, TTF-1 to rule out primary from adeno carcinoma lung andwhich were all found to be negative. Contrast enhanced computed tomography (CECT)chest showed a heterogenously enhancing soft tissue density lesion with central necrosis and calcification measuring 6.6x5.3cm over the anterior chest wall on rightside. Enlarged right axillary(2.6x1.8cm) lymphnode. For metastatic workup CECT Abdomen, Esophagogastroduodenoscopy and Colonoscopy were done and were normal.Tumour markers with serum carcino embryonic antigen( 3.7ng/ml),serum prostate specific antigen ( 0.3ng/ml ) were within normal limits.Other blood investigations were within normal limits. Based on clinical, radiological and pathological workup we diagnosed this case as carcinoma of unknown primary(adenocarcinoma) presenting as right chest wall mass with axillary lymphadenopathy. We referred the case to medical oncology for further management,they started the patient on chemotherapy with carboplatin and paclitaxel. However after one cycle of chemotherapy with the above mentioned drugs the lesion was progressing in size, the ulcer with foul smelling discharge had increased. As the lesion was increasing in size after having interdisciplinary discussion in tumour board it was decided to have a second opinion of the histopathology slides and blocks. The slides and blocks were sent to a higher tertiary care centre there it was opined as possibility of skin adnexal neoplasm probably of sweat gland origin suggestive of benign tumor, however possibility of low grade malignancy cannot be ruled out.After extensive workup patient was taken up for surgery and a wide local excision and right sided axillary lymph node dissection was done.Microscopic sections showed stratified squamous epidermis with an infiltrating ill circumscribed lesion in the dermis comprising of lobules, sheets,islands, ill defined ducts, tubules and nests of tumor cells displaying two distinct cellular patterns peripherally placed dark basaloid cells displaying moderate bluish cytoplasm.Centrally placed large cells with round to mild pleomorphic vesicular nucleus,abundant pale eosinophilic to vacuolated cytoplasm. Lymphovascular emboli were present.The final histopathologyimpression was Spiradenocarcinoma of chest wall with5/27 axillary lymphnodes showing tumor deposits. Postoperative recovery was uneventful. After having an interdisciplinary discussion after surgery it was decided to proceed with adjuvant radiotherapy and it was decided to include chest wall, right axilla and right supraclavicular fossa in the radiotherapy field. But the patient defaulted from receiving adjuvant radiotherapy and was lost to follow up for one year. One year later he presented to surgical oncology department with history of recurrence.On examination a swelling of size 8x4 cms is present over the right chest wall which was fixed to underlying ribs clinically, located from clavicle superiorly till the 4th intercostals space.Another swelling on the lower aspect of right side of the neck measuring 6x5 cms, fixed and hard at level V cervical lymph node region on right side.We further investigated with fine needle aspiration cytology(FNAC) right cervical node and left axillary node it was opined as recurrence. Hence we further investigated with Bone scan F18 it revealed local infiltration of 1st and 2nd ribs,with evidence of distant metastases involving left ala of sacrum and left ilium. In view of metastatic disease patient was referred to medical oncology for further management.Patient received 3 cycles of chemotherapy with cisplatin and paclitaxel. Defaulted for 3 months and presented with a large mass over right side of the chest which was fungating and foul smelling and thereafter received 2 more cycles of chemotherapy, thereby completing a total of five cycles.Palliative radiotherapy was planned in view of symptomatic bony metastases with 39 gray in 13 fractions, patient completed radiotherapy and patient is on follow up at present and doing well. Discussion Spiradenocarcinoma (also known as malignant spiradenoma and sweat gland carcinoma ex eccrine spiradenoma)[2] was first described by Dabska[3] in 1972, 16 years after Kersting and Helwig[4]originally described its benign precursor.Malignant eccrine spiradinoma is a rare adnexal carcinoma of the skin. It is normally considered to be a malignant transformation of a pre-existing benign eccrine spriradenoma[5]. MES presents at an average age of 59 years (range: 21-92 years) and shows no sex predilection [6].It tends to preferentially involve the trunk and extremities (92% of reported cases) [7], but there are also published case reports of MES arising in the breast [6], scalp [7, 9], and eyelids.Overall prognosis of malignant eccrine spiradenoma is poor[2]. Primary treatment includes local excision, with or without regional lymphadenectomy [1], with recurrence reported in 17.5% of the cases [6]. Malignant eccrine spiradenoma metastasizes to regional lymph nodes [5], lungs, brain, skin [4] , bone [4] and liver [7] (in descending order of frequency). Distant metastases of MES are uncommon even in extensive tumours, such as the one reported here,metastasis are rare but carry a poor prognosis [7]. Radiation therapy alone or in combination with chemotherapy has been used with no benefit in the treatment of patients with metastatic MES[9]. Sridhar et al reported symptomatic improvement and shrinkage of the tumor with tamoxifen therapy in a patient with estrogen receptor-positive eccrine adenocarcinoma[10]. However, the role of hormonal therapy still remains to be determined. Close follow-up of these patients for early detection of recurrence and metastases cannot be overemphasized. Conclusion: Our case report shows malignant spiradenoma is a rare and aggressive cancer which is difficult to diagnose, highly aggressive with propensity to involve the lymph nodes. May present with local recurrence and also develop distant metastases significantly compromising the quality of life of the patient. It requires the surgeons to have a high index of suspicion for its initial diagnosis, and a multimodality mode of treatment with surgery,radiotherapy and chemotherapy is required for complete treatment and needs close follow up. Conflict of Interest The authors declare that they have no conflict of interest. Ethical approval: Institutional ethical committee approval obtained. Consent Written informed consent was obtained fromthe patient for publication of this case report and any accompanying images. References 1. Meyer TK, Rhee JS, Smith MM, Cruz MJ, Osipov VO, Wackym PA. External auditory canal eccrine spiradenocarcinoma: a case report and review of literature. Head Neck 2003;25:505-510. 2. Agarwal S, Khanna R, Arya NC, Khanna AK. Malignant eccrine spiradenoma. An unusual presentation. Indian J Dermatol Venereol Leprol. 2002; 68: 290- 291. 3. Dabska M. Malignant transformation of eccrine spiradenoma. PolMed J. 1972;11:388-396. 4. Kersting E, Helwig EB. Eccrine spiradenoma. Arch Dermatol.1956;73:199-227. 5. Yildirim S, Akoz T, Akan M, Ege GA. De novo malignant eccrine spiradenoma with an interesting and unusual location. DermatolSurg 2001;27:417-420. 6. Mirza I, Kloss R, Sieber SC. Malignant eccrine spiradenoma. Arch Pathol Lab Med 2002;126:591-594. 7. Russ BW, Meffert J, Bernert R. Spiradenocarcinoma of the scalp. Cutis 2002;69:455-458. 8. Gupta S, Radotra BD, Kaur I, Handa S, Kumar B. Multiple linear eccrine spiradenomas with eyelid involvement. J EurAcadDermatolVenereol 2001;15:163-166. 9. Otero-Garcia JE, Carlo VJ, Trinidad-Pinedo J. Malignant eccrine spiradenoma of the neck: a case report. Otolaryngol Head Neck Surg 2001;125:428. 10. Sridhar KS, Benedetto P, Otrakji CL, Charyulu KK. Response of eccrine adenocarcinoma to tamoxifen. Cancer 1989;64:366-370.

 > Abstract Id: YUGP1662 Top

An Analysis Of Surgical Outcome And Morbidity After Sacral Resection Surgery For Primary Locally Advanced And Recurrent Rectal Cancer

Presenter- *Dr. SACHIN KADAM

Co-author - DR SATHEESAN B, ,

INTRODUCTION Local recurrence is the most common cause of failure following surgical resection of rectal cancer. Patients with primary cancers that do not extend beyond the muscularis propria have good clinical outcome with resection alone. If the tumour has infiltrated, or lays very close to, the sacrum, abdominosacral resection might be the only curative treatment option in these patients. In 1874, the Swiss surgeon Theodor Kocher introduced the transsacral resection with coccygectomy, which was further extended by Paul Kraske to facilitate the operative exposure. Criteria for an abdominosacral resection is very close to sacrum , invasion into the or when difficult to get plane away from sacram and the need for wider dorsal access to improve visualization to enable complete tumour resection. Aim of the study To study the surgical outcome and morbidity associated with sacral resection surgery for primary locally advanced and recurrent rectal cancer. Objectives of the study â€Â¢ To evaluate the Margin free status . â€Â¢ To estimate Mortality associated with sacral resection. â€Â¢ To estimate Recurrance free survival (RFS) . Materials and Methods Retrospective study of patients with carcinoma rectum undergone sacral resection surgery from 2009 to 2015 at Malabar Cancer Centre, Thalassery, Kerala, India and these patients were followed till December 2016. Source of Data Collection. The demographic profile, details of malignancy, details of surgery and follow up data were retrieved and updated from the case records of the patients from medical records department. Inclusion criteria â€Â¢ Patients who undergone sacral resection surgery at Malabar Cancer Centre. â€Â¢ Patients who are having at least One year follow up. Exclusion criteria Any patient died of any other cause and not followed will be excluded. Statistical analysis Descriptive statistical analysis was used for data exploration. Kaplan Meier method was used to calculate the survival (RFS and DFS). Log Rank test was used to compare the survival RESULTS Sacral resection surgery was done in 15 cases in which Males were 12 (80%) and females were 3 (20%) with Mean male age was 52 years and Mean female age was 53 years. Co-morbidity was associated with 6 (40%) patients and diabetes mellitus was a common co-morbidity. 10 patients (66.66%) had primary rectal cancer in which 8 patients had lesion in lower rectum and 2 patients had lesion in middle rectum. 5 patients ( 33.33% ) had recurrent rectal cancer and all were having lesion in lower rectum. All patients had received neoadjuvant chemoradiation and after 4-6 weeks duration , they had undergone surgery. 10 patients ( 66.66%) had undergone extralevator abdominoperineal resection (ELAPR) , 2 patients (13.33%) had undergone total pelvic exenteration , 2 patients (13.33% ) had undergone posterior pelvic exenteration and one patient (66.66% ) had undergone low anterior resection with liver metastatectomy with excision of periostium of sacrum and coccyx. In 6 patients (40% ) isolated S5 sacral segment was resected and in 9 patients (60%) S4 +S5 sacral segments were resected. Pathological ‘T’ stage was as follows- T4 in 5 cases (66.66%), T3 in 3 cases (20%), T2 in 4 cases (26.66%) and no residual neoplasm in 3 cases (20%). Positive lymph nodes were found in 4 cases (26.66%) and one was with extracapsular extension. One patient had positive proximal margin and received adjuvant treatment. There was no recurrence till the last date of follow up. One patient had positive distal margin and she expired on postoperative day 12 due to myocardial infarction. In all patients , circumferential resected margin and resected bone segments were free from the tumor. Only one mortality occurred within 30 days of postoperative period. Patient was expired on postoperative day 12 . Patient had myocardial infarction and in spite of all resuscitative measures, we could not save her. 8 patients (53.33%) had perineal wound infection and wound dehiscence which was managed conservatively with dressing and in 3 cases with resuturing. 3 patients (20%) had urinary incontinence and 2 patients (13.33%) had sexual impotency. 4 patients (33.33%) had recurrence which were detected during follow up after symptomatic evaluation. One case had 2nd recurrence in recurrent rectal cancer and it was detected after 7 months of completion of treatment. No adJuvant treatment was given to him. Patient had recurrence at presacral region and left lung metastasis. He has been treated with palliative chemotherapy. Rest of the 3 cases had first recurrence. 2nd case had recurrence after 13 months of completion of treatment. No adjuvant treatment was given to him. Patient had liver metastasis and splenic surface deposits. He has been treated with palliative chemotherapy and targated therapy. 3rd case had completed adjuvant treatment and recurrence was detected after 1 year 11 months of completion of treatment . He had lung and brain metastasis and treated with palliative chemotherapy along with radiation to brain . 4th case had recurrence at presacral region detected after 2 months of completion of adjuvant treatment. He has been advised chemotherapy but the patient lost follow up. Disease free survival time was 23.8 months . Overall survival was 86.7 % for a median follow up period of 13.7 months. CONCLUSION Sacrectomy for primary or recurrent rectal cancer can achieve clear resection margins with low mortality in selected patients. Perineal wound infection is the most frequent complication. Sacral resection may provide local disease control with acceptable morbidity.

 > Abstract Id: YUGP1664 Top

Predicting Sentinel And Non-Sentinel Lymph Node Metastasis €” Are Mskcc Nomograms Valid For Non-Screened Breast Cancer Patients?

Presenter- *Dr. Amit Choraria

Co-author - Sanjit Agrawal, Indu Arun, Sanjoy Chatterjee

Aims: To explore the risk factors for SLN and non-SLN metastasis in Indian women with breast cancer, by analysis of clinical and pathological data. To assess the validity and clinical utility of two MSKCC Nomograms that predicts axillary lymph node status for Western patients. Methods: Clinical data, and pathological data available from core biopsy, for a consecutive series of women having SLNB was analysed, and was plotted on two MSKCC nomograms. Univariate analysis was done by Chi Square and Fischer Exact Tests and Multivariate analysis was done by Logistic Regression method. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve (AUC). Results: 34% (89 out of 256) of our patients had SLN positivity. When correlated with SLN metastasis by univariate analysis, LVI (?2=80, p=

 > Abstract Id: YUGP1672 Top

Enhanced Quality Of Life In Oncology Patients Through Early Palliative Care Intervention

Presenter- *Mr. SARATH MOHAN S

Co-author - Sarath Mohan S, M.R. Rajagopal, Sreedevi Warrier

Title : Enhanced quality of life in oncology patients through early palliative care intervention Authors : Sarath Mohan. S, MSW M.R.Rajagopal, MBBS, MD Coauthor : Sreedevi Warrier BDS Background : Medical management often tends to be focused on disease. Considering that eighty percent of cancer in India is incurable at the time of diagnosis, the focus on disease leaves behind a vast burden of suffering which is currently mostly unaddressed. Methodology : In-depth psycho-social interview and observation Study Design : Case Study Mrs. R had a retroperitoneal high grade liposarcoma in 2008. Thanks to available facilities in Trivandrum. She got good treatment for the disease which included resection and end-to-end anastomosis. When it recurred she underwent an en bloc resection and adjuvant chemotherapy. These years were precious to her: her youngest son could grow to 16 years of age. After the second recurrence she got concurrent treatment by palliative care and oncology teams. The gradual transition helped her to cope. Eventually a detailed evaluation by the oncologist ruled out further surgery. Her suffering was compounded by the fact that at this time, her main source of strength, her husband, was diagnosed with tongue cancer and he died within a few months. The tumor grew and often made her breathless. But a combination of morphine and corticosteroids kept her pain- free and effectively treated her breathlessness. But her suffering was more than physical. The pain of leaving her 16-year-old son was her biggest burden. There was no way in taking all the worries away. But the promise by the Pallium India that his education would be supported including even a tuition when he needed was reassuring. What we believe helped her most was encouraging her life review. Only at this point, we found that the youngest son had been adopted as a baby who was about to be abandoned by an unwed mother whom she met at a hospital. Mrs. R will die before long.The control of pain and support for her spiritual and emotional problems enabled her to have that smile even in the evening of her life. We could prepare her and the whole family for death, and even made arrangements for the funeral according to her wish. She is still under our care even after 9 years from diagnosis and living with dignity and prepared to die with dignity. With the help of palliative care team, she acquired insight, integrated that into her life and for us it was an innovation. Correspondence: SARATH MOHAN S, Medical Social Worker, Pallium India, Arumana Hospital Building, West Fort, Trivandrum — 695008, Email: sarathmohans72@gmail.com

 > Abstract Id: YUGP1674 Top

Prognosis And Multiariant Analysis Of N2C Nodal Disease In Oral Squamous Cell Carcinoma: A 10 Year Study In Tertiary Cancer Centre In South India.

Presenter- *Dr. JAGADISH SINGH


PROGNOSIS AND MULTIARIANT ANALYSIS OF N2c NODAL DISEASE IN ORAL SQUAMOUS CELL CARCINOMA: A 10 YEAR STUDY IN TERTIARY CANCER CENTRE IN SOUTH INDIA. DR. A. JAGADISH SINGH., RESIDENT IN SURGICAL ONCOLOGY, GOVERNMENT ROYAPETTAH HOSPITAL, KILPAUK MEDICAL COLLEGE AND HOSPITAL, CHENNAI.TAMIL NADU. PROFESSOR & HOD. DR. SUBBIAH SHANMUGHAM.,MCh., PROF. G. GOPU.,MCh., DR. SYED AFROZE HUSSAIN.,MCh., DR. P. SENTHILKUMAR.,MCh., ABSTRACT CONTEXT: Surgery plays a pivotal role in the management of advanced oral cancers. The incidence of contralateral nodal disease in oral scc is quite predictable in relation with certain variables, helping us in addressing this nodal disease. The mortality associated with N2c disease is relatively high , hence optimising the treatment of N2c disease can have impact in the survival of this subset of patients. AIM: The aim is to identify the factors associated with N2c nodal disease and mortality associated with the disease. MATERIALS AND METHODS: A retrospective audit of 484 oral sccc patients treated at Royapettah cancer centre, Chennai from 2007-2017. All cases with N2c disease (40patients) at presentation /relapsed at opposite node were analysed. The parameters analysed were anatomical subset in oral cavity, age(50 yr>, habits, performance score, midline crossing tumors, skin/bone involvement of primary tumor,T3 and above, ipsilateral nodal numbers, disease positivity, extra capsular involvement, size . RESULTS: Mortality with N2C disease was nearly 80% . Amongst the N2c tongue subset buccal mucosa and floor of mouth cancer were significantly associated with N2c disease by virtue of their anatomical site whereas alveolus, palate and lip were not significant. Midline crossing tumors were the single most independant factor significantly associated with N2c disease. T3 and above tumors were also significantly associated. Ipsilateral node parameters were all significant in determining the N2c disease particularly extra capsular extension and pathologically positive nodes, (size of more than 6cm were 9/40, extracapsular extension were 19/40, pathological nodal positivity was 2/40).In our audit we found 26:14 M:F ratio. Almost all of them had tobacco chewing history. CONCLUSION: N2c nodal disease is associated with mortality nearly equal to distant metastases in our study. By identifying the parameters associated with development of N2c disease and initiating treatment early we can achieve survival in this subset of patients.

 > Abstract Id: YUGP1682 Top

Congenital Anomalies And Aberrant Anatomy In Urogynaec-Oncology €”€Œ The Bottle Neck In Surgery

Presenter- *Dr. JAGADISH SINGH


CONGENITAL ANOMALIES AND ABERRANT ANATOMY IN UROGYNAEC-ONCOLOGY —“ THE BOTTLE NECK IN SURGERY DR. A. JAGADISH SINGH., RESIDENT IN SURGICAL ONCOLOGY, DEPARTMENT OF SURGICAL ONCOLOGY, KILPAUK MEDICAL COLLEGE, CHENNAI 10 PROFESSOR AND HOD,DR. S.SUBBIAH, MCh., PROF G.GOPU, MCh., DR.SYED AFROZE HUSSAIN MCh., DR. P.SENTHILKUMAR, MCh., ABSTRACT CONTEXT: Congenital anomalies are defined as structural or functional defects which are present at the time of birth. Congenital anomalies of the kidney and urogenital system range from mild, asymptomatic malformations to severe, life-threatening pathologies entities. congenital anomalies may be the result of one or more genetic, infectious, nutritional or environmental factors. It is often difficult to identify the exact cause. In oncological point of view, it is important for surgeons to keep in mind and to appreciate the possible anatomical variations and aberrations that can be encountered during surgery. We have also elicited few congenital anomalies and associated cancers. AIM: To understand about anatomical anomalies, a sound knowledge of normal embryological development and anatomy is of paramount importance. MATERIALS AND METHODS: In this study, we have presented a series different congenital anomalies and anatomical aberrations which we have encountered during various oncological resections and its implications. This will serve as an eye watch for any surgeon in identifying anatomic variations and thereby preventing major havocs during surgical procedures. CONCLUSION: The purpose of presenting this case series is to bring out a plethora of congenital anomalies and anatomical aberrations which are of importance during surgical resections. So far, only few case reports, confined to particular organ are available on congenital anomalies and surgical encounters. There are only very few studies, in reported literature, that too only in pediatric cases which has analyzed comprehensively about anatomical anomalies and cancer.The identification and interpretation of such abnormalities constitute a real challenge to the surgeon. Figure1:Table showing list of congenital anomalies in our series: S No Congenital anomaly Total number of cases 1 Ureteric duplication 6 2 Pelvic kidney 4 3 Undescended testis 6 4 Intersex disorders 2 5 Persistent urachus 2 6 Iliac Venous anomaly 3 7 Developmental retroperitoneal cyst 1 8 Phocomelia 1

 > Abstract Id: YUGP1684 Top

Clinical Staging In Head And Neck And Oral Cancer- How Accurate Are We? Are We Underestimating Our Clinical Target Volume?

Presenter- *Dr. Poornachandra Tejaswi


Objectives: To compare radiological [Computed Tomography CT] Tumor and Nodal dimensions in Head and Neck and Oral Cancer with the post-operative pathological status and explore the ramifications associated with the disparity. Design: This prospective analytical study was conducted on a cohort of 90 patients of operable Oral and Head & Neck Cancer. Forty patients with Head and Neck cancer and 50 Oral cancer patients were radiologically evaluated pre-operatively and assigned a clinical TNM staging which was subsequently compared with the corresponding pathological TNM components. Conclusions: A significant comparative disparity was seen in 38[42%] of the patients with relation to T category. Pathologically larger tumor dimensions were evidenced in both categories. Sixteen Oral cancer patients and 16 patients with Head and Neck cancers had a greater than 30% increase in tumor dimensions on post-operative pathological staging. This did achieve statistical significance [p= 0.00]. The specificity of CT scan in defining low risk Nodal volumes [cNo Neck] was 76% for Oral cancers and 53.8% in Head and Neck cancer subjects. The false positives rates for both categories were fairly high, 48% and 37.9% respectively. By theoretically extrapolating the inferences of this study to situations where radiotherapy would be the primary treatment, it would draw caution towards considering overtly conservative/uniform clinical tumor dimensions and estimating intermediate nodal target volumes at risk based solely on CT based evaluation.

 > Abstract Id: YUGP1686 Top

Atypical Presentation Of Retroperitoneal Tumor: Diagnostic Dilemma Of Malignant Teratoma With Giant Cell Tumor And Rhabdomyosarcomatous Components.



Introduction: Teratoma is a tumor with components derived from more than one germ layer. Although the teratoma may be monodermal or polydermal (originating from one or more germ layers), its cells may differentiate in ways suggesting other germ layers. The tissues of a teratoma may be quite different from surrounding tissues and may be highly disparate. Teratomas belong to a class of tumors known as nonseminomatous germ cell tumor. All tumors of this class are the result of abnormal development of pluripotent cells: germ cells. Here we report an extremely rare combinations of component in a metastatic malignant teratoma of retroperitoneum adhered to the duodenal wall. Case Report: A 24 year old male presented with complaints of abdominal pain. The patient was previously underwent right orchidectomy for non-seminomatous germ cell tumor and received chemotherapy for the same. CECT abdomen showed a retroperitoneal mass adhered to third part of duodenum. Punch biopsy was taken from the lesion. On histopathology it showed a malignant spindle cell tumor with moderate nuclear pleomorphism and brisk mitotic activity. On immunohistochemistry, the tumor cells showed positivity for Myogenin, Desmin (Focal) while, negative for SALL4, S100 and CD34. Based on these findings, a diagnosis of rhabdomyosarcoma was offered. Later patient underwent resection of tumor (6.2x5.1x3 cm) with part of duodenum and ileum measuring 10.5cm in length. On histopathology tumor showed teratomatous component comprising of islands of hyaline cartilage with binucleation and multinucleation. In addition, rhabdomyosarcomatous component comprising of malignant spindle cell with positivity for Myogenin and Desmin were also identified. Giant cell component comprised of mononuclear cells and multinucleated cells with similar nuclear morphology. No residual germ cell component was identified. Final diagnosis of malignant teratoma with component of rhabdomyosarcoma and giant cell tumor was given. Patient has been given chemotherapy and is fine at three months of follow up. Conclusion: This tumor had unique combinations of component in malignant teratoma. Arriving at a definitive diagnosis is a big challenge for both surgeon and pathologist, especially in small punch biopsy. At times management becomes difficult because of different components. Multimodal therapy is often required. Prompt management and close follow up is of utmost important in these cases.

 > Abstract Id: YUGP1688 Top

Neoadjuvant/Perioperative Chemotherapy With D2 Lymphadenectomy In Gastric Cancer: A Study Of Feasibility, Safety And Outcomes Of 122 Indian Patients From A Single Institution

Presenter- *Dr. Yenkekalya Yugandar reddy


NEOADJUVANT/PERIOPERATIVE CHEMOTHERAPY WITH D2 LYMPHADENECTOMY IN GASTRIC CANCER: A STUDY OF FEASIBILITY, SAFETY AND OUTCOMES IN 122 INDIAN PATIENTS FROM A SINGLE INSTITUTION BACK GROUND: Gastric cancer is the fourth most common cancer globally, and is the second most common cause of death from cancer worldwide. With a high mortality-to-incidence ratio, management of gastric cancer is challenging and use of multimodal therapy and its sequencing is not yet standardised. Patients with borderline or resectable gastric cancers are increasingly offered neoadjuvant/ perioperative chemotherapy following the MAGIC and REAL-2 trials. However its tolerability, effects on perioperative surgical outcomes after D2 lymphadenectomy, tumor responses and survival outcomes is not widely reported in literature. MATERIALS AND METHODS: Analysis of a prospective database of 122 locally advanced gastric cancer patients undergoing Neoadjuvant/periopChemotherapy followed by radical D2 gastrectomy over 3 years at our institute (from Jan 2014-Dec 2016) was performed. Chemotherapy tolerability, perioperative D2 lymphadenectomy outcomes, histopathological responses to CT, adjuvant chemotherapy, recurrences and survivals were analyzed. RESULTS: In this study, 122 patients with gastric adenocarcinoma received NACT. 115 (94.2%) patients completed planned 3 cycles of NACT and 7 (5.8%) patients tolerated only 2 cycles. Of these 122 patients, 49 were inoperable during surgical exploration and 73 were operable and underwent radical gastrectomy & D2 lymphadenectomy with 9.5% (7patients) morbidity and mortality in one patient. The lymph node yield was more than standard D2(>15) in 54 patients(73.98%) & less than D2 (

 > Abstract Id: YUGP1690 Top

Field Cancerization In Colon Cancer: Morphologic And Immunohistochemical Analysis Of Peri-Tumoral Colonic Mucosa In Humans


Co-author - Shouriyo Ghosh, Janvie Manhas, Sudip Sen

Introduction: Colorectal cancer (CRC) is third most common cancer worldwide. Field cancerization is a phenomenon, in which the histologically normal tissue in an organ is primed to undergo malignant transformation in individuals with a personal history of colonic adenomas or cancer. In the present study, we studied changes of colonic mucosa in fresh colectomy specimens, up to a distance of 10 centimeters, both proximally and distally, from a tumor mass and examined the topographic changes and various markers, indicative of carcinogenesis, including the cancer stem cell (CSC) markers, to appreciate the field cancerization. Methods: Mucosal flaps, up to a distance of 10 cm, both proximally and distally, shaved from fresh colectomy specimens of 96 CRC, over period of 3 years were examined under 40x magnification of light microscope. Any topographic and microscopic changes in the visibly unremarkable colonic mucosa stained with methylene blue and alcian blue stains were noted. Immunohistochemical stains for markers of CSC (CD24, CD44 and CD166) and beta-catenin were studied. Results: The grossly appearing normal colonic mucosa in specimens of CRC, under magnification, showed 421 foci of aberrant crypts (ACF) [44/96 (45.83%)], with a mean ACF density of 0.46/cm2 and crypt multiplicity of 8.5. Majority of ACF were elevated (92.7%), while only 7.3% were flat. On histological examination, 39.9% of these foci had normal epithelial lining, while 32.3% showed hyperplastic and 27.8% low grade dysplasia. Alcian blue stain showed mucin depleted foci (MDF) in 10 of these colon specimens. beta-catenin nuclear and cytoplasmic expression was increased both in the CRC, as well as in the ACF identified. Among the CSC markers, CD44 was significantly upregulated in the ACF, in addition to the main CRC foci, while others didn’t show significant change. These changes were identified on both proximal and distal mucosal flaps examined. Conclusion: The grossly visible normal human colonic mucosa, adjacent to a tumor, up to a distance of 10 centimeters, showed both evidences of microscopic pre-neoplastic lesions, nuclear beta-catenin localization, as well as upregulation of CSC markers. All these changes, may be attributable to the cancer field effects. Findings of such microscopic change deserves awareness, as, if incompletely excised, may lead to future tumor recurrence. Understanding the field cancerization may also improve our understanding regarding pathogenesis of CRC.

 > Abstract Id: YUGP1698 Top

Criteria For Pathological Complete Response (Pcr) Cr And Its Impact On Relapse Rates In Breast Cancer Patients Undergoing Neo-Adjuvant Chemotherapy €” Surgical Oncology-Aiims-New Delhi Experience.

Presenter- *Dr. Manoj Gowda S

Co-author - SVS Deo, NK Shukla, Ajay Gogia

INTRODUCTION: Pathological complete response (pCR) has been used as an endpoint in various neo-adjuvant trials for carcinoma breast. Till date, there is no universally accepted definition of pCR, which has made reporting and interpretation of data from neoadjuvant trials challenging. The objective of the study was to establish the association between different types of pCR and event free survival(EFS) in breast cancer patients undergoing Neo-adjuvant chemotherapy (NACT) . MATERIALS AND METHODS: A prospectively maintained computerized Breast Cancer database was accessed and clinical data of 504 Breast cancer patients undergoing NACT followed by surgery between 1995 to 2014 were included for analysis. Rates of pCR in primary only (ypTo) and pCR in both primary and axilla (ypToNo) were calculated and relapse rates during follow-up were documented. An analysis was performed to elucidate the relationship between relapse rates in pCR vs non pCR patients using 2 different pCR criteria. STRATA software was used to analyse the data. RESULTS: Out of 504 patients receiving NACT a total of 113 (22.42%) patients achieved pCR in primary ( ypTo) and 68 (13.4%)patients had achieved pCR in both primary and axilla(ypToNo). Using pCR criteria 1 ( ypTo) 35 patients had recurrence out of 113 patients (30%) in comparison 178 patients had recurrence among 390 patients (45.64%) who didn’t achieve a pCR [p=0.007]. When criteria 2 of pCR (ypT0N0) was used 16 out of 68 patients had recurrence (23.53%) who had pCR in both primary and axilla, whereas 197 out of 436 patients (41.51%) had recurrence who didn’t had pCR [p=0.02] CONCLUSION: pCR rates among breast cancer patients receiving NACT vary significantly using different pCR criteria . The frequency of pCR decreased with usage of increasingly stringent criteria (ypT0=22.42% vs ypT0N0=13.4%) . Overall Patients who achieved pCR had less recurrences in comparison to non pCR patients . While both ypT0 and ypT0N0 were associated with relatively low rates of relapse ypT0 has stronger association with decreased relapse rates.

 > Abstract Id: YUGP1700 Top

Development Of Bifunctional Magnetic Nanostructures As Contrast For High Resolution Magnetic Resonance Imaging And Precision Based Hyperthermia/Thermoradiotherapy In Cancer Theranostics

Presenter- *Dr. Bhaskar Vishwanathan

Co-author - Pradipta Ranjan Rauta, ,

Background Nanoparticle research involving cancer therapy, has limitation in targeting cancer cells and uniform distribution within the tumor. We propose combined use of iron oxide(IO) nanoparticles(NPs) and nonspecific extracellular lanthanides(gadolinium(Gd)) NPs in order to improve the sensitivity and specificity of tumor imaging and thermoradiotherapy application. Material and Methods Bifunctional magnetic nanostructures (MNS) were constructed by conjugating APTES-Gd2O3 NPs with OA- Fe3O4 NPs by EDC/NHS catalysis and characterized for size, zeta potential(DLS), morphology(electron microscopy), XRD(magnetite structure), FTIR(functionalization) and cell viability. The final magnetic nanostructure;(APTES- Gd2O3 NPs)-(OA- Fe3O4 NPs) were evaluated for high-resolution magnetic resonance imaging(MRI) and hyperthermia applications in cancer cells(MTT colorimetric assay). Results Iron oxide functionalized nanoparticles, size 10-20 nm synthesized by optimizing co-precipitation method, OA functionalization. The average size of the particles 15.45±5.4 nm, confirmed by DLS and SEM. Signature peaks of magnetite(Fe3O4) observed from XRD patterns and OA functionalization by FTIR analysis. Synthesis of bifunctional magnetic nanostructures(MNS) achieved through EDC/NHS catalysis. Gd2O3 -OA- Fe3O4 NPs had average diameter of 75 ± 12 nm (DLS analysis) and zeta potential of -27.2 ± 5.93 mV and nontoxic from MTT assay (up to 1000 Âμg/mL). MRI studies on NP samples showed excellent contrast uptake with temperature upto 45 degrees. In vivo study in tumor xenografted rabbits is currently on to evaluate the imaging potential(MRI) of MNS and hyperthermia. Conclusions The magnetic nanostructures reveal favorable properties e.g. size, structure, functionalization The ongoing invivo study on rabbits evaluate the functionality of the system, for imaging and treatment in cancer. Gd NPs specifically and uniformly disperse in cancer cells, since it is conjugated with iron oxide NPs cause cancer cell kill by induction hyperthermia with temp at 45 degrees.

 > Abstract Id: YUGP1704 Top

Association Of Epstein Barr Virus With Mucosal Squamous Cell Cancers Of Head And Neck

Presenter- *Dr. Saquib Zaffar Banday

Co-author - , ,

ABSTRACT: Head and neck cancer is the commonest cancer in India and consists of about one-third of all cancers. Among viral infections, Epstein Barr virus (EBV) has been implicated in the association of many head and neck cancers. Role of EBV as etiological factor in our population remains unknown. AIMS & OBJECTIVES: To determine the EBV related etiology of mucosal Head and Neck Squamous Cell Carcinoma (HNSCC) in Kashmir Valley and if positive to define sub-typing of EBV and to find a correlation between the burden of EBV and disease status. MATERIAL METHODS: Observational single centre retrospective —prospective study. The study included 53 tissue samples from patients with Squamous Cell carcinoma of Head and Neck region. An equal number of blood samples were taken from healthy volunteers as a control for the reaction process. Sample collection and storage was done as per standard protocol. DNA amplification was done by Polymerase chain reaction. RESULTS: We did not observe any sample which tested positive for EBV. All samples were negative for EBV DNA. CONCLUSION: EBV has no role in the pathogenesis of Head and Neck Cancers in Kashmiri ethnic population of India. Different Genetic makeup of our population may be responsible for it. Further studies are needed to elucidate the etiology of head and neck Carcinoma in our population. KEYWORDS: EBV, Head and Neck Carcinoma, Kashmiri population.

 > Abstract Id: YUGP1710 Top

Surgical Management Of Sacral Tumours -Perspectives And Outcome Analysis For 15 Years Period €” A Single Institutional Experience

Presenter- *Dr. Bharathiraja Kalyanam

Co-author - Prof Subbiah Shanmugam, Prof Gopu Govindasamy, Dr Syed Afroze Hussain

Objective: Sacral tumours are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages. The evaluation and complex treatment of these rare tumours require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Aim of this study is to analyse the perspectives and out come after surgical management of sacral tumours over the period of 15 years from our institution. Methods & Materials: A retrospective study of the patients who underwent sacrectomy between 2002 and 2016 in our institution. Patients underwent one of the three types of following sacrectomy: Total, subtotal or partial. Sacrectomy was performed by either one of the following approaches: posterior, abdomino lateral, abdominosacral - either as sequential or staged approach. Spino-pelvic reconstruction was not performed in any of the patients. Patients were analysed for morbidity, functional outcome (MSTS score) and survival (Kaplan Meier method). Results: Twenty seven patients underwent sacrectomy of which 12 were partial, 8 were subtotal and 7 were total sacrectomy. Most common histology was Giant cell tumour followed by chordoma. There were fourteen males and thirteen females. 51.8% of patients had bowel and bladder disturbances post operatively. 70.3% had wound complications. Median follow up was 36 months (range 6-180 months). Five year OS was 72.1%. Distant metastasis occurred in 1 patient (3.71%). Mortality rate (n=6) was 22.22%. Based on MSTS Score 11 patients (40.7%) had excellent outcome, 10(37.03%) had good outcome and 6(22.22%) had poor outcome. Staged approach had reduced morbidity. Conclusion: Sacral tumours are locally aggressive and rarely metastasizing lesions. En bloc resection with adequate margin can achieve long term local oncological control. sacrectomy, once considered as a morbid procedure, can now be safely performed with improved surgical techniques. Our experience in sacrectomy with staged approach despite deferring spino pelvic reconstruction has shown to achieve lesser perioperative morbidity, better functional outcome and comparable long term survival.

 > Abstract Id: YUGP1711 Top

Mr Imaging Features Of Brain Metastases In Nsclc Patients And Its Correlation With Molecular Alterations In Driver Oncogenes: Potential Targetable Imaging Biomarker For Egfr Status.

Presenter- *Dr. Abhishek Mahajan

Co-author - Kumar Prabhash, Vanita Noronha, Amit Joshi

BACKGROUND Brain is a common site of metastases with EGFR mutated lung cancer. Oral targeted therapies have broadened the treatment options in the advanced setting with the potential for periods of long term response. Literature on MR imaging metrics or feature analysis of brain metastasis as a biomarker for predicting driver oncogenic mutation in patients with NSCLC is limited and less investigated. The purpose of the study was to study MRI imaging biomarkers of brain metastases in patient with NSCLC and their correlation with molecular subtyping (EFGR status). To correlate these imaging features with response to therapy and clinical outcomes. METHODS We analyzed clinical data on 75 patients who were tested for EGFR mutation and underwent brain magnetic resonance imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between EGFR mutation status and clinical features, specifically age, sex, smoking, TNM stage, and imaging variables, as well as brain metastasis, were analyzed using logistic regression analysis. Clinical factors known to be associated with EGFR mutation status in NSCLC patients and staging factors of TNM were included in the logistic regression multivariate analysis. RESULTS 38 patients were EGFR positive and 37 were EGFR negative. EGFR positive cases showed early development of brain metastasis (within 6 months after 1st presentation). Compared with wild-type tumors, EGFR-mutated tumors showed wide spread of brain lesions (p- 0.00).  Statistically significant difference (p- 0.00) was observed in border/ margins of metastatic lesions on T2W images. Metastases in EGFR positive cases showed fuzzy and infiltrative borders while in EGFR negative cases, metastatic lesions were well defined. Statistically significant number of metastatic lesions in EGFR wild group showed show focal restriction on DW images (p-0.001). In EGFR wild cases, metastatic lesions showed good response to WBRT with most of the cases showing response on follow up scan and clinical examination (p< 0.00). Incidence of recurrent metastatic disease was also higher in EGFR positive cases (p- 0.00). Incidence of meningeal involvement in the form of Patchy or leptomeningeal carcinomatosis was significantly higher in EGFR positive cases (p- 0.04). On multivariate analysis, statistically significant association was found between T2 border, number, restricted diffusion, meningeal positivity and time from diagnosis to development of metastasis (p < 0.05). CONCLUSIONS EGFR positive brain metastases have characteristic MR imaging features that can be potential non-invasive diagnostic, predictive and prognostic imaging biomarkers. These MR based Radiogenomic imaging biomarkers have potential role in personalized therapy of EGFR positive brain metastasis in lung cancer patients.Â

 > Abstract Id: YUGP1714 Top

Optimising Morbidity In Re-Do Surgery For Thyroid Cancer €” Quality And Quantity Of Surgery Matters

Presenter- *Dr. SEEMA SINGH

Co-author - S.V.S Deo, N.K. Shukla, Seema Singh

Abstract for ICC 2017 Optimising Morbidity in Re-Do surgery for Thyroid cancer — Quality and quantity of Surgery matters SVS Deo, Shukla NK, Seema Singh, Sunil Kumar, Bal CS, Sushma Bhatnagar. Introduction; Thyroid cancer is the most common endocrine cancer. Surgery is the mainstay of therapy for differentiated thyroid cancers with long-term survival in a significant proportion of patients. Surgical Morbidity is a major determinant of outcomes especially in patients undergoing Re-do thyroid surgery. Volumes and surgical expertise can affect surgical outcomes . We present our experience of re-do thyroid surgery for cancer with specific reference to surgical morbidity. Material & Methods; All the records of recurrent carcinoma thyroid who underwent revision surgeries in the department of surgical oncology between 2009 to 2016 were analysed for clinical spectrum, prior surgical intervention pattern, morbidity during first surgery, revision surgery details and morbidity data at our centre. Majority of the surgeries were performed by one senior consultant surgeon. Results ; A total of 132 patients had re-do surgery for thyroid cancer during the study period. Median age at presentation was 40 years ( mean ;39.59 +/- 14.15) and 52.27% were females and 47.73% were males ( M:F = 1: 1.15). Histopathologically 83 % were Papillary carcinoma thyroid (PTC), 8 % Medullary carcinoma thyroid, 7 % Follicular carcinoma thyroid and 2 % Hurthle cell carcinoma. The spectrum of surgery prior to referral was (i)Lobectomy 29.54%, (ii) Total thyroidectomy(TT) 59.09% (iii) Near total thyroidectomy (NTT) 7.58% (iv) subtotal thyroidectomy (STT) in 2.27%. Neck nodes were addressed in 56 cases ( 42.43%). Documented postoperative complications at the time of first surgery including recurrent laryngeal nerve injury ( RLN palsy), transient or permanent hypocalcemia and combination of these were; 7.57%, 9.85% and 8.33% respectively. Spectrum of Revision surgeries for primary done at our institute were Total Completion Total Thyroidectomy 35%, Total Thyroidectomy in 10 % and extended resections (Trachea, skin, esophagus ,larynx) in 5 cases. All patients (132) had some form of Neck dissection (ND) at our centre in various combinations of uni or B/L MND , ALND, CND . Reported postoperative complications at our institute were - transient hypocalcemia in 8.33% , permanent hypocalcemia 2 % and RLN palsy in 2 % . Conclusion: Re-do thyroid surgery for thyroid cancer is challenging and associated with high rates of morbidity in literature. Results of our study indicate that high volume, meticulous quality controlled surgery and surgical experience can result in excellent outcomes . We recommend that these patients should be treated in tertiary care referral centres with expertise for optimal outcomes. Key words: Re-Do thyroid surgery, Morbidity , Surgical expertise, Volume of surgery.

 > Abstract Id: YUGP1720 Top

Impact Of Imaging Based Sarcopenia Measurement On Clinical Outcomes In Patients With Advanced Non-Small Cell Lung Cancer: A Occult Killer And A Prognostic Biomarker.

Presenter- *Dr. Abhishek Mahajan

Co-author - Kumar Prabhash, Vanita Noronha, Vijay Patil

BACKGROUND Sarcopenia is described as severe skeletal muscle wasting, classified based on the skeletal muscle index (SMI). Combined sarcopenia and obesity have been shown to be both predictive and prognostic marker in patients cancer. Objectives: â€Â¢ To evaluate the role of sarcopenia and skeletal muscle density in predicting clinical outcomes in advanced NSCLC â€Â¢ To determine the correlation between sarcopenia index and skeletal muscle density, with diabetes and smoking. METHODS A total of 100 patients who had baseline CECT or PET-CT and underwent treatment for advanced NSCLC were included. The morphometric parameters such as Skeletal Muscle Density (SMD), Skeletal Muscle Index (SMI/ Sarcopenia), Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were measured by CT at the L3 vertebra and were correlated to clinical parameters and chemotherapy response. The factors contributing to Progression free (PFS) and overall survival (OS) were analyzed by univariate and multivariate analysis. RESULTS Prevalence of sarcopenia was 57 (57%) with male preponderance. The mean sarcopenia index was 49.9 cm2/m2. for males 51.8 cm2/ m2 and females 44.98 cm2/ m2 with p

 > Abstract Id: YUGP1722 Top

Epidemiological Profile Of Head And Neck Cancers At A Tertiary Care Hospital

Presenter- *Dr. Saquib Zaffar Banday

Co-author - , ,

ABSTRACT: INTRODUCTION: Head and neck cancer is the fifth most common malignancy globally among adults and comprises 5% of all malignancies worldwide. There is scarcity of data regarding the clinico epidemiological profile of head and neck carcinomas in our population. The demographic presentation & exact prevalence of these malignancies in our population is not known. AIMS & OBJECTIVES: To study the clinico- epidemiological profile of head and Neck carcinoma in Kashmiri ethnic population of India. MATERIAL & METHODS: This study was conducted at Cancer center at SMHS Srinagar, J & K, India from 2012 to 2014. The study included total of 106 patients with Head and Neck Squamous Cell Carcinoma (HNSCC) registered with the department from 2012 to 2014. It was a prospective and retrospective study. Patients having histopathological (HPE) confirmation of the disease were enrolled for the study. All the demographic & clinical details of the recruited patients were studied thoroughly including history, physical examination, investigations and mode of treatment. RESULTS: Male to female ratio was 2.7:1. The mean age was 55.3 years. Among both males and females, the highest incidence of HNSCC was seen within the age group of 51-60 years. The most common primary site of disease was Oral Cavity—36(33.96%), Larynx-28 (26.41%), Pharynx in 16(15.09%), Nasopharynx in 10(9.43%) , Sinonasal in 10(9.43%), and Tonsil in 6 cases(5.66%). Patients usually presented with advanced stage of disease {(Stage III, IV-(64.15%) 68 versus stage I, II-(35.84%) 38}. Tobacco consumption in any form was present in 89% of our population. Lack of balanced diet (28%) and poor dental hygiene (50%) and belonging to low socioeconomic class (57%) were also thought to be significant factors for the disease burden. Most of our patients were treated with surgery followed by adjuvant chemo-radiotherapy (37.73%), chemo and radiotherapy (28.31%), radiotherapy alone (16.98%) & surgery alone (9.4%). CONCLUSION: Cancers of oral cavity and larynx are most common head & neck carcinoma in our population. Male Sex, tobacco consumption, lack of balanced diet & poor orodental hygiene are significantly associated with head and neck carcinoma in our population. KEYWORDS: Head and neck carcinoma, Kashmiri population

 > Abstract Id: YUGP1725 Top

Clinical Utility Of Staging Laparoscopy For Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool

Presenter- *Dr. Pavan Sugoor

Co-author - Aditi Chaturvedi, Ashish Pokharkhar, Rahul Bhamre

Aim The importance of multimodal treatment for advanced rectal adenocarcinoma mandated accurate preoperative staging with contrast-enhanced computed tomography of thorax, abdomen, and pelvis, and magnetic resonance imaging of pelvis. Staging laparoscopy (SL) could detect occult peritoneal metastases in patients with advanced rectal cancer (RC). This study aimed to determine the clinical value of SL in treatment decision-making for advanced RC. Method Prospective observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of advanced near or complete obstructing RC. Of 274 cases, 34% (94/274) underwent SL with diversion stoma (DS) and 66% (180/274) underwent exploratory laparotomy with DS. Results Of the 94 patients with advanced RC, conventional imaging studies staged 73.5%(69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and futile laparotomy was thus avoided. Conclusion In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented futile laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.

 > Abstract Id: YUGP1732 Top

High-Resolution Real-Time Optical Imaging In Ovarian Cancer Surgery Using Carbon Nanotubes

Presenter- *Dr. Neelkanth Bardhan

Co-author - Young Jeong Na, Lorenzo Ceppi, Andrew Siegel

Ovarian Cancer is one of the most challenging cancers to diagnose and treat, although it is the 7th most common form of cancer in women. The survival rates for this disease have barely changed in the past 30 years, with median 5-year survival < 30% in patients diagnosed with Stage III or IV metastatic ovarian cancer. The standard clinical approach to disease management involves 2 steps: tumor removal surgery, followed by combination chemotherapy. The amount of residual disease remaining after surgery is an important prognostic variable in predicting long-term survival. Established clinical imaging modalities, such as contrast-enhanced computed tomography (CT), offer poor sensitivity ~ 10% at under centimeter-sized tumors. In this work, we present a first approach utilizing a combination of biotemplated, near-infrared (NIR) fluorescent, targeted nanomolecular probes, along with a custom-designed real-time intraoperative system for image-guided surgical debulking, resulting in enhanced survival. M13 bacteriophage was used as a multifunctional scaffold, to prepare single-walled carbon nanotubes (SWNTs) as NIR contrast agents for imaging during tumor debulking surgery. A targeting peptide against secreted protein, acidic and rich in cysteine (SPARC), which is overexpressed in highly-invasive ovarian cancers, was engineered onto the minor capsid protein, p3, of the virus, to allow for intraperitoneal targeting. We demonstrate that our SWNT-based probe offers sub-millimeter scale resolution, with very high sensitivity ~ 97%, and with acceptable specificity ~ 71%. In an orthotopic ovarian cancer mouse model, using our image-guided surgery we report an enhancement in median survival by 40%, compared to the control group receiving visible eye-only (non-guided surgery). Taken together, our results provide strong support towards the clinical translation of NIR-imaging in guided surgery.

 > Abstract Id: YUGP1734 Top

Spectrum Of Cutaneous Metastasis From Internal Malignancies In 63 Patients

Presenter- *Dr. VEENITA YOGI

Co-author - Veenita Yogi, O. P.Singh,

Cutaneous metastasis from internal malignancy are relatively uncommon and accounts for 0.7% to 9%.Cutaneous metastasis may herald the diagnosis of internal malignancy,and early recognition can lead to accurate and prompt diagnosis and timely treatment.The most common cancer metastasizing to the skin are breast,lung,colorectal and melanoma. Material and Methods: This study retrospectively assesed 63 patients of cutaneous metastasis registered in the Department between year 2009 to 2016.All patients were histopathologically proven primary and cutaneous lesions both.Cutaneous metastasis were analyzed on the basis of type and site of presentation ,associated distant and visceral metastasis,time interval between primary malignancy and development of cutaneous metastasis and prognosis. Results: Our study included 63 patients of cutaneous metastasis ( 25 males and 38 females), median age was 46.5 years (range 16-80 years).In descending order primary malignancy sites were breast (24%),gastrointestinal tract (20%),genitourinary (16%),head and neck (14%),lung (7%) and others (13%).Histological distribution were infiltrating ductal carcinoma breast (24%),adenocarcinomas(21%),sarcomas (21%),malignant melanomas (14%),squamous cell carcinoma (11%) and others (9%).The common clinical presentation was cutaneous nodule in 93% patients.The cutaneous site of metastatic presentation was abdomen,chest,extremities,face scalp and incisional scar in decreasing order. 95% of the patients presented with other distant and visceral metastasis.In this study the time taken to development of cutaneous metastasis from primary malignancy, varies as a first clinical manifestation of internal malignancy to 36 months in follow up duration .Poor survival was noticed in the patients ,presented with cutaneous metastasis as a first clinical feature. Conclusion: In this study we have noticed some rare presentations of cutaneous metastasis.Cutaneous metastasis are important to recognize early,they often dramatically alters treatment plan .The appearance of these cutaneous metastasis signals widespread distant and systemic metastatic internal malignancy,resulting in poor outcome and patient survival.

 > Abstract Id: YUGP1739 Top

Cancer Screening Beliefs And Barriers Assessment

Presenter- *Dr. Ajay Vidyarthi

Co-author - Braj Kishore Sinha, Shriti Choudhary,

ABSTRACT A study was undertaken to explore the beliefs, barriers and acceptance of educated people in Ranchi district, Jharkhand towards screening for common cancers. These psychological constructs were studied using a vignette-based self —administered questionnaire developed in the form of a factorial survey. Responses were designed to vary in content from strong agreement to strong disagreement on a 5-point Liekert scale.The questionnaire was administered to all volunteers who could fluently read and write English. The questionnaire was validated in 339 volunteers using Principle Component Analysis and Cronbach alpha. Beliefs and barriers were tested by extending the sample size to 535 volunteers. The subjects were tested for their ‘attitude to cancer’ (A), ‘barriers to screening’ (B), and ‘acceptance of screening’ (H). Using these three psychological constructs the authors were able to derive an equation giving the probability of a respondent accepting cancer prevention and screening activities.

 > Abstract Id: YUGP1743 Top

Nivolumab In Sorafenib-Naive And -Experienced Patients With Advanced Hepatocellular Carcinoma (Hcc): Checkmate 040 Study

Presenter- *Dr. Akhil Chopra

Co-author - Todd S. Crocenzi, Anthony B. El-Khoueiry, Thomas Yau

Akhil Chopra,1 Todd S. Crocenzi,2 Anthony B. El-Khoueiry,3 Thomas Yau,4 Ignacio Melero, 5, 6 Bruno Sangro,7 Masatoshi Kudo,8 Chiun Hsu,9 Jörg Trojan,10 Tae-You Kim,11 Su-Pin Choo,12 Tim Meyer,13 Yoon-Koo Kang,14 Winnie Yeo,15 Adyb Baakili,16 Christine dela Cruz,16 Lixin Lang,16 Jaclyn Neely,16 Theodore H. Welling, III17 1Johns Hopkins Singapore International Medical Centre, Singapore; 2Providence Cancer Center, Portland, OR, USA; 3USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA; 4University of Hong Kong, Hong Kong, China; 5ClÃnica Universidad de Navarra and CIBERONC, Pamplona, Spain; 6Center for Applied Medical Research (CIMA), Pamplona, Spain; 7ClÃnica Universidad de Navarra and CIBEREHD, Pamplona, Spain; 8Kindai University Faculty of Medicine, Osaka, Japan; 9National Taiwan University Hospital, Taipei, Taiwan; 10Goethe University Hospital and Cancer Center, Frankfurt, Germany; 11Seoul National University Hospital, Seoul, Korea; 12National Cancer Center, Singapore; 13Royal Free Hospital, London, UK; 14Asan Medical Center, University of Ulsan, Seoul, Korea; 15Chinese University of Hong Kong, Hong Kong, China; 16Bristol-Myers Squibb, Princeton, NJ, USA; 17University of Michigan School of Medicine, Ann Arbor, MI, USA Background: Many patients with advanced HCC progress on standard-of-care therapy. Nivolumab is a fully human anti—programmed death-1 (PD-1) IgG4 monoclonal antibody that demonstrated durable responses (objective response rate [ORR], 20%; median duration of response [DOR], 9.9 mo; 9-mo overall survival [OS] rate, 74%) in patients with advanced HCC in the dose-expansion (EXP) phase of the CheckMate 040 study (NCT01658878; El-Khoueiry, Sangro et al. 2017). Here we present survival and durability of response data in both sorafenib-naive and -experienced patients with advanced HCC in CheckMate 040. Methods: Patients naive to or previously treated with sorafenib received nivolumab in phase 1/2 dose-escalation (ESC; 0.1—10 mg/kg) and -EXP (3 mg/kg) cohorts every 2 weeks regardless of PD-1 ligand 1 (PD-L1) status. Primary endpoints were safety/tolerability (ESC) and ORR (EXP; ORR was reported by investigator [INV] and blinded independent central review) using RECIST v1.1. Secondary endpoints included DOR, disease control rate (DCR), and OS. Biomarkers were assessed using pretreatment tumor samples. Results: Patients (N=262) had median follow-up durations of 14—16 mo across the cohorts. Overall, 98% of patients (258/262) had Child-Pugh scores of 5—6. In sorafenib-naive patients (n=80), the ORR (INV) was 23%, with 39% of responses (7/18) ongoing. The DCR was 63%; 40% of patients had stable disease ?6 mo. In sorafenib-experienced patients (n=182; 91% progressed on sorafenib), the ORRs (INV) were 16%—19%. Overall, responses occurred regardless of etiology or tumor-cell PD-L1 expression. Nivolumab had a manageable safety profile consistent with that reported in other tumor types. Conclusion: Nivolumab demonstrated durable responses with long-term survival and favorable safety in both sorafenib-naive and -experienced patients with advanced HCC.

 > Abstract Id: YUGP1750 Top

Bilateral Breast Cancer €”Incidence, Clinical Spectrum And Challenges In The Management

Presenter- *Dr. Ashutosh Mishra

Co-author - SVS Deo, NK Shukla, Ajay Gogia

Background:- Bilateral Breast cancer (BBC) is a rare entity with incidence of 1-2% in reported literature. There are conflicting and inadequate data regarding the incidence, behaviour, molecular subtypes, management policies and their outcomes. We present our experience of treating 87 BBC with multimodality management. Materials and Methods:- An audit of prospectively maintained computerized breast cancer database of the department of surgical oncology, AIIMS, New Delhi was performed . The medical records of patients with histo-pathologically proven Bilateral Breast Cancer (synchronous or metachronous) were analyzed to assess the clincal profile, molecular sub-types, treatment patterns and outcomes. Results: A total 87 (2.68%) patients presented with BBC out of 3235 breast cancer patients treated between January 1996 and December 2016. Out of 87 BBC patients 67 had metachronous (MBBC) and 20 had synchronous breast cancer (SBBC). Family history of breast cancer was present in 13 patients (15%). Similar Molecular types were found in 56 BBC patients (64%) while this pattern was relatively higher in SBBC group (70%). Screen detected Contralateral breast cancer (CBC) was detected in 16 patients only and rest all presented with breast mass. Most contralateral breast cancer patients had early stage breast cancer in comparison to the index side cancer (64% versus 36%). Among 20 SBBC patients 3 had B/L BCS and 13 had B/L mastectomy where as in 67 MBBC group majority had B/L mastectomy. All patients undergoing BCS and LABC were given postoperative radiotherapy. All patients received adjuvant chemo and or hormonal therapy both for index and CBC based on the stage and hormone receptor status. Conclusion:- BBC is an uncommon clinical entity and with effective therapeutic interventions and improving survival we are likely to see more BBC in future. Majority present with MBBC during follow-up and positive family history is present in a small proportion of BBC patients. Treatment of BBC is challenging including choice of surgery, issues of bilateral breast irradiation and re-chemotherapy and hormonal therapy decisions for MBBC. BBC patients require individualized treatment planning in a multidisciplinary treatment setting.

 > Abstract Id: YUGP1754 Top

Co-Relation Of Clinico-Pathological Analysis Of Oral Squamous Cell Carcinoma Among The Younger Age Group And Overall Survival.

Presenter- *Dr. Saini Mondal

Co-author - Dr. Rishna K, ,

First author- Dr. Saini Mondal Qualification- Post Graduate Trainee in Oral and Maxillofacial Pathology Institution — Yenepoya Dental College and Hospital Address- Derlakatte, Mangalore, Karnataka — 575018 Email- mondal.saini@gmail.com ABSTRACT- Objectives: Oral squamous cell carcinoma (OSCC) primarily occurs in older age group. An alarming increase in the incidence of oral cancer in young people is being observed worldwide in the recent years. The objective of this study is to make a descriptive analysis of the clinical and histopathological characteristics of oral squamous cell carcinoma in patients less than 45 years of age. Methods: The retrospective records of patients diagnosed with oral squamous cell carcinoma in the Department of Oral Pathology and Microbiology, Yenepoya Dental College hospital, Mangalore, India, between 2001- 2017 will be reviewed. The clinical and histological features of patients with 45 years and younger age group will be analysed and considered as target group. The overall prognosis of this target group will be correlated by comparing TNM staging, histopathological grading and survival rate. Results and Conclusion: All patients who were treated for oral squamous cell carcinoma in the 16-year period (2001-2017) are considered and younger group patients under 45 years of age will be further categorized on the basis of their primary site of occurrence, clinical staging, histological grading and risk habits. The most common site involved will be evaluated from various sites of occurrence of oral squamous cell carcinoma from the target group and clinical grading will be evaluated using TNM staging criteria. Histopathological grading of the cases will be done under three broad categories; well, moderate and poorly differentiated squamous cell carcinoma. The smoking history, tobacco chewers, alcohol consumers and a combination of these habits will be evaluated under risk category . An overall correlation among the males and females with or without habit history will also be analysed. The overall survival rate of this target group is analysed from the follow up and feedback system and this result will be compared with the clinico-pathological data. The following table provides the detailed overview of the analysis of the different parameters in oral squamous cell carcinoma as found. PRIMARY SITE TNM STAGING GRADING HABITS SURVIVAL Tongue Stage 0 Well Differentiated Chewing tobacco only Below 2 years Buccal Mucosa Stage l Moderately Smoking only Within 2-5 years Differentiated Mandibular alveolar Stage ll Poorly Differentiated Smoking Above 5 years ridge and Alcohol Floor of the mouth Stage lll Smoking and Chewing Retromolar Region Stage lV Chewing and alcohol Palate Smoking, Chewing and alcohol Maxillary alveolar ridge No habits Gingiva Unknown Lip

 > Abstract Id: YUGP1758 Top

Incidence And Predictors Of Ccr & Pcr And Validation Of Neo! Adjuvant( Igr / Mdacc Nomogram ) In Patients Undergoing Surgery For Breast Cancer After Neo Adjuvant Chemotheraphy

Presenter- *Dr. Manikandan Murugesan

Co-author - Dr.Madhu Muralee, ,

Incidence and predictors of cCR & pCR and validation of NEO! ADJUVANT( IGR / MDACC Nomogram ) in patients undergoing surgery for breast cancer after neo adjuvant chemotheraphy Author: -- Manikandan Murugesan, Post Graduate, Department of Surgical Oncology, Regional Cancer Centre, Trivandrum. drmanikandan85@gmail.com , Mobile — 9092511262 Co Author: -- Madhu Muralee, Associate Professor, Surgical Oncology, Regional Cancer Centre, Trivandrum, madhumuralee@gmail.com, Mobile - 09447070407 Introduction Neoadjuvant chemotherapy (NAC) is considered to be the standard of care for locally advanced invasive breast cancers1. Neoadjuvant chemotherapy is useful in assessing, tumour chemosensitivity and its biology. It causes tumour shrinkage and this may render inoperable tumours amenable to surgery and may allow breast conservation surgery with better cosmetic outcome for patients with operable tumors2. NAC has also got the advantage that a proportion of patients may attain clinical complete response (cCR) and pathological complete response (pCR) after the chemotherapy. pCR after NAC acts as a surrogate marker for long-term survival and could be considered as a marker of benefit from chemotherapy 3,4. The response to NAC is not uniform across patient population. Some patients may respond well, some may not and some others may progress on NAC as well. There are various pre-treatment clinical and pathologic variables that are consistently associated with better response to NAC. In addition several nomogram are being used to predict response to NAC .The most commonly used nomogram being the Institute Gustave Roussy/ M D Anderson Cancer Centre (IGR/MDACC) nomogram5. Aims and objectives This study intends to :-- 1. Identify the proportion of patients attaining cCR and pCR 2. Identify the clinical, and pathological predictors of cCR and pCR 3. Correlate cTNM/ and ycTNM/ with ypTNM# 4. Validate the IGR/MDACC nomogram (# -- cTNM — Clinical TNM, rTNM — Radiological TNM, ycTNM — Postchemo Clinical TNM, yrTNM — Postchemo Radiological TNM,ypTNM — post chemo pathological TNM) Study design: Prospective Observational Study-200 Patients Methodology Prospective observational study total of 200 patients were included. A clinical examination, radiological examination (sono mammogram), histological assessment (core needle biopsy) and metastatic evaluation will be done at presentation and the relevant parameters documented. Patients will be taken up for NAC as per the current treatment protocols at the institute. Three weeks after completion of NAC, the patients will be reassessed for surgery and their post chemotherapy clinical and radiological parameters documented. These patients will undergo the planned surgery. The final histopahtological report will be correlated with the pre-treatment clinical, radiological and pathological factors. The nomogram-predicted pCR rates to the observed rates will be analysed to assess the validity of the nomogram. Pathological complete response -- pCR will be defined as the absence of invasive tumour in the breast surgery specimen and axillary nodes (ypT0/is,ypN0 or ypT0ypN0) RESULTS 44 patients (44/200) had pathological complete response (21.69%). IGR/MDACC nomogram correlation ? 61% of patients with pCR had corelation with IGR /MDACC nomogram with score >200 ? 39% of patients had no relation with nomogram ? Where 26% of patients received Finher regimen ? patients with finher regimen had pCR (60%) ? Her 2 +ve pts treated with Finher regimen having high chance of pCR inspite of nomogram scoring < 200 ? CONCLUSIONS ? ER-ve pts, HER2 +ve pts,Neo adjuvant Trastuzumab(Finher regimen),High grade III tumours,4 cycles of adriamycin regimen had higher rate of pCR ? Finally both IGR nomograms and NEO!ADJUVANT calculators can be applicaple in indian populations also. ? Finher regimen had high percentage of pCR rate in HER 2+ ve patients even with low nomogram score . ? New nomogram should be invited with including Her 2+ status and Trastuzumab theraphy References 1. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 2005;97:188—94. 2. Rouzier R, Mathieu MC, Sideris L, et al: Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors. Cancer 101:918-925, 2004 3. Rouzier R, Extra JM, Klijanienko J, et al: Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 20:1304-1310, 2002 4. Kuerer HM, Newman LA, Smith TL, et al: Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17:460- 469, 1999 5. Roman Rouzier, Lajos Pusztai, Suzette Delaloge,et al Nomograms to Predict Pathologic Complete Response and Metastasis-Free Survival After Preoperative Chemotherapy for Breast Cancer J Clin Oncol 23:8331-8339, 2005 Appendix — II IGR/MDACC NOMOGRAM Disclosure: Conflict of interest-none Copyright of abstract assigned to ICC-2017

 > Abstract Id: YUGP1760 Top

Co-Relation Of Clinico-Pathological Analysis Of Oral Squamous Cell Carcinoma Among The Younger Age Group And Overall Survival.

Presenter- *Dr. Saini Mondal

Co-author - Rishna K, Dr. Riaz Abdullah, Dr. Sonia Adyanthaya

First author- Dr. Saini Mondal Qualification- Post Graduate Trainee in Oral and Maxillofacial Pathology Institution — Yenepoya Dental College and Hospital Address- Derlakatte, Mangalore, Karnataka — 575018 Email- mondal.saini@gmail.com ABSTRACT- Objectives: Oral squamous cell carcinoma (OSCC) primarily occurs in older age group. An alarming increase in the incidence of oral cancer in young people is being observed worldwide in the recent years. The objective of this study is to make a descriptive analysis of the clinical and histopathological characteristics of oral squamous cell carcinoma in patients less than 45 years of age. Methods: The retrospective records of patients diagnosed with oral squamous cell carcinoma in the Department of Oral Pathology and Microbiology, Yenepoya Dental College hospital, Mangalore, India, between 2001- 2017 will be reviewed. The clinical and histological features of patients with 45 years and younger age group will be analysed and considered as target group. The overall prognosis of this target group will be correlated by comparing TNM staging, histopathological grading and survival rate. Results and Conclusion: All patients who were treated for oral squamous cell carcinoma in the 16-year period (2001-2017) are considered and younger group patients under 45 years of age will be further categorized on the basis of their primary site of occurrence, clinical staging, histological grading and risk habits. The most common site involved will be evaluated from various sites of occurrence of oral squamous cell carcinoma from the target group and clinical grading will be evaluated using TNM staging criteria. Histopathological grading of the cases will be done under three broad categories; well, moderate and poorly differentiated squamous cell carcinoma. The smoking history, tobacco chewers, alcohol consumers and a combination of these habits will be evaluated under risk category . An overall correlation among the males and females with or without habit history will also be analysed. The overall survival rate of this target group is analysed from the follow up and feedback system and this result will be compared with the clinico-pathological data. The following table provides the detailed overview of the analysis of the different parameters in oral squamous cell carcinoma as found. PRIMARY SITE TNM STAGING GRADING HABITS SURVIVAL Tongue Stage 0 Well Differentiated Chewing tobacco only Below 2 years Buccal Mucosa Stage l Moderately Smoking only Within 2-5 years Differentiated Mandibular alveolar Stage ll Poorly Differentiated Smoking Above 5 years ridge and Alcohol Floor of the mouth Stage lll Smoking and Chewing Retromolar Region Stage lV Chewing and alcohol Palate Smoking, Chewing and alcohol Maxillary alveolar ridge No habits Gingiva Unknown Lip

 > Abstract Id: YUGP1764 Top

Craniofacial Resection For Orbital Tumours €” Results Of A Multidisciplinary Surgical Approach


Co-author - Dr SVS Deo, Dr N K Shukla, Dr S S Kale

INTRODUCTION- Orbital tumours comprise a rare and heterogenous group of tumors. The complex anatomy of orbit poses a challenge to surgical resection and reconstruction. A subset of patients with advanced orbital tumours require craniofacial resection. Craniofacial resection using a multidisciplinary approach offers the advantage of optimal oncologic and functional outcomes. We performed an audit of our experience with orbital tumours requiring craniofacial resections and present the outcomes. MATERIALS and METHODS- A prospectively maintained database in the Department of Surgical Oncology , BRA IRCH , AIIMS , New Delhi from 2012 to 2017 was accessed and all patients undergoing craniofacial resection for orbital tumors were analysed. A two team multidisciplinary surgical approach involving Surgical oncology and neurosurgery was adopted in all cases. RESULTS- A total of 5 out of 31 patients undergoing orbital exenteration for orbital tumours required craniofacial resection. Mean age of presentation was 53years (18 — 69) with a male preponderance ( M:F= 3:2). The tumours were of varied histopathologic sub-types- Adenoid cystic carcinoma, Pleomorphic adenoma, mesenchymal Chondrosarcoma, Apocrine carcinoma, sebaceous cell carcinoma. Four out of 5 patients presented with recurrent/ residual disease after a prior sub-optimal surgical intervention. Craniofacial resection was performed by trans-facial followed by trans-cranial approach in 4 patients and in 2 patients dura was resected. R-0 resection could be achieved in all patients with no significant post operative morbidity. Temporalis muscle flap was used in all patients for soft tissue reconstruction and in 2 patients each titanium mesh and cranioplasty using calvarial graft was used. Four patients received adjuvant radiotherapy. One patient relapsed and four patients were disease free at last follow-up. CONCLUSION-A subset of orbital tumours with varied histologies can present with intracranial extension creating challenges in management. A multidisciplinary aggressive surgical approach for resection and expertise for soft tissue and rigid reconstruction is necessary for optimal outcomes.

 > Abstract Id: YUGP1770 Top

A Study Of Role Of Change In Ca 125 And Molecular Biomarkers P53 And Ki 67 Index As Predictors Of Optimal Cytoreduction Following Neoadjuvant Chemotherapy In Stage Iii And Iv Ovarian Cancer

Presenter- *Dr. Suneel Kaushik Komanduri


A STUDY OF ROLE OF CHANGE IN CA 125 AND MOLECULAR BIOMARKERS p53 AND KI 67 INDEX AS PREDICTORS OF OPTIMAL CYTOREDUCTION FOLLOWING NEOADJUVANT CHEMOTHERAPY IN STAGE III AND IV OVARIAN CANCER BACKGROUND: Ovarian cancer that constitutes a heterogeneous group is the most lethal of gynecologic malignancies. With a majority of patients diagnosed in advanced stage, it poses a surgical challenge, with high morbidity associated with primary cytoreduction and on occasion an incomplete surgery that merits no surgical advantage. The concept of neoadjuvant chemotherapy (NACT) in such potentially unresectable cases is gaining significance with few randomized studies demonstrating improved PFS and reduced surgical morbidity. In this study, we aimed to assess the optimal cytoreduction rate following NACT and also to predict the response to chemotherapy using CA125, Ki 67 and p53. MATERIALS AND METHODS: Study design: Prospective interventional study Site: Department of Surgical Oncology, JIPMER Duration: January 2015 to December 2016 Sample size: 60 patients with advanced ovarian cancer. Aim of the study: It was aimed at identifying optimal cytoreduction rates following NACT-IDS protocol and clinico-radiological and immunohistochemical markers that could predict response to chemotherapy. Inclusion criteria— i. Age Group (18 — 70 yrs.) ii. FIGO stage IIIc and IV where optimal cytoreduction is not feasible as decided by multidisciplinary team (MDT) discussion (based on imaging or intraoperative findings at laparotomy) iii. Histologically proven epithelial ovarian cancers Exclusion criteria — i. Patients not fit to receive chemotherapy ii. Limited lifespan 8 (25%;p=0.02). The initial CA125 at presentation cannot be used as a predictor of optimal cytoreduction thereupon. However, rate of change in CA125 with each cycle of chemotherapy and proportional reduction in initial CA125 at the end of chemotherapy predicted complete response and optimal cytoreduction with reasonable accuracy. There was a significant difference in the final CA125 among those who had a clinical complete response compared to those who did not (82.94 U/ml vs 171.1U/ml, p=0.001). The rate of change of CA 125 was an indicator of response as 82.9% of patients who had >80% reduction in initial CA125 following NACT had an optimal cytoreduction compared to 26.3% amog those who had 40% have a higher chance of achieving complete response and optimal cytoreduction following NACT. A statistically significant difference was observed in the mean Ki67 index of patients who had clinical complete response (60 vs. 39.09)(p=0.000), pathological complete response (71.42 vs. 41) (p=0.000) and optimal cytoreduction (53.72 vs. 41.13) (p=0.000) compared to those who did not. CONCLUSION: Neoadjuvant chemotherapy in advanced ovarian cancer patients is a well-tolerated treatment protocol. NACT followed by IDS reduces surgical morbidity associated with cytoreduction with non-inferior optimal cytoreduction rates. The CA125 levels post NACT, proportional reduction in CA125 levels and high proliferative index predict with reasonable accuracy the optimal cytoreduction and complete pathological response. The lower surgical morbidity and non-inferior optimal cytoreduction rates with NACT-IDS defends its place in the treatment algorithm.

 > Abstract Id: YUGP1772 Top

Chemo-Radiation After Upfront Rectal Resections €” A Clinical Dilemma

Presenter- *Dr. Pavan Sugoor

Co-author - Ashish Pokharkhar, Manish Bhandare, Reena Engineer

Abstract Aim To compare the impact of adjuvant chemo-radiotherapy (ACRT) versus adjuvant chemotherapy (ACT) alone on recurrence and survival in patients with stage II and III rectal adenocarcinoma undergoing upfront curative resection. Method Prospective observational review of colorectal database at Tata Memorial Hospital from July 2010 to March 2015 identified 84 patients who underwent upfront curative resection for stage II or III rectal cancer. None of the patient received preoperative chemo-radiation. Of these, adjuvant chemo-radiotherapy was administered to 29 patients (ACRT group) and 55 patients received CAPEOX / FOLFOX based adjuvant chemotherapy (ACT group) alone. Results At a median follow-up of 20 months there were 10 recurrences (3 local recurrence) in the ACRT group and 15 (2 local recurrence) in ACT group. The estimated Disease free survival at 3 years in the ACRT group was 62.7% and in ACT group was 48.4% (p = 0.347) with an estimated 3-year overall survival of 82.1% and 87.7%in the ACRT and ACT group, respectively (p = 0.462). Subgroup analysis was performed after risk stratifying prognostic features (pT4, pN2, poor differentiation, involved resection margin). Conclusion Our study does not show any benefit of adjuvant chemo-radiotherapy over chemotherapy alone on local control, disease free and overall survival after upfront rectal cancer resection for low risk stage II -III. In the subgroup analysis local recurrence did not occur in patients who did not have poor prognostic features irrespective whether they received ACRT or ACT. Adjuvant chemo-radiation can be avoided in low risk stage II-III rectal cancer after upfront resection

 > Abstract Id: YUGP1778 Top

Palliative Gastrectomy Should Be The Choice In Locally Advanced Gastric Cancers

Presenter- *Dr. PRABIR BIJOY KAR

Co-author - , ,

Presenter and author : Dr Prabir Bijoy Kar , MS , FAIS , Oncosurgeon HOD , Dept of Oncosurgery, Barasat Cancer Research and Welfare Centre. Kolkata - 700126 Visiting consultant : AMRI Cancer centre, Desun Hospital, Kolkata Addresss : 114/1, Bosepukur Purbapara Rd , Kolkata — 700107 Email : drpbkar@yahoo.co.in In India most of the patients of gastric cancer report to the surgeon at a relatively advanced stage. Very few patients present in early stage ( stage I & IIa) who can be treated and cured by radical surgical procedures. But a very large number of patients ( nearly 80%) present in either locally advanced ( stage IIb to IIIb ) or with metastasis ( stage IV ). . Many of them have vomiting, electrolyte imbalance , anaemia and low general condition to tolerate chemotherapy. As a result curative surgery is not possible in these cases and hardly 50% of these advanced gastric cancer patients can be subjected to chemotherapy as neoadjuvant. Often these patients are subjected to safe and shorter surgical procedures like Anterior gastro-jejunostomy or a feeding jejunostomy for nutritional purpose leaving behind the main disease. As the growth is not excised bleeding from it persists and anaemia is not corrected in spite of repeated blood transfusions , thereby hampering proper chemotherapy in proper dose, drug and at regular intervals. Many of these cases become refractory to chemotherapy and gradually turn to stage IV . Some of these lead to penetration into pancreas and celiac nerves and even perforations at the growth site. The overall survival of these patients are approx. 6-8 months . This is a ongoing study to see the effectiveness of palliative gastrectomy ( partial, subtotal or total) in locally advanced conditions. Here most of the time the fixed nodes of D2 /D3 regions are left behind and the adhesions from the pancreas and adjacent structures are released by R1 resection. All these patients are subjected to palliative chemotherapy after surgery, which are tolerated well without much side effects and the overall survivals are found be extended to 15-18 months . Moreover the chances of penetration and perforation are avoided. The most important contraindications to gastrectomy in this group are ascites and widespread peritoneal dissemination. This paper presentation is intended to share the experience of palliative gastrectomies in more than 300 cases performed in last 25 yrs. in locally advanced gastric cancers and highlight the effectiveness of such ventures, which involves lot of surgical skill and risk as well . Hence all patients of gastric cancers on whom a radical surgery is not possible, every attempt should be made for at least a palliative gastrectomy with or without nodal clearance. The usual practice of anterior gastro-jejunostomy or a feeding enterostomy are often not helpful and therefore should be discouraged. ………………………………………………………………………………………………………………………… I declare that there is no conflict of interest involved.

 > Abstract Id: YUGP1781 Top

Signet Cell Adenocarcinoma Gall Bladder: Rare Histology & Rare Presentation

Presenter- *Dr. Itisha Chaudhary

Co-author - Dr Manu Shankar, ,

Introduction Gall Bladder cancers are the 5th most common malignancy of Gastrointestinal tract with Conventional adenocarcinoma of Gall Bladder also referred to as pancreatobiliary type adenocarcinoma being most common malignancy of the hepato-bilary complex and Signet ring carcinoma being rarest and most aggressive variant. Case Presentation We present here a case of 70 year Indian male with Signet cell Adenocarcinoma of Gall Bladder. His presentation was of large bowel obstruction, due to ascending colon wall thickening ? inflammatory etiology. Laparotomy done revealed firm thickened gall bladder with involvement of adjacent bowel with no evidence of metastasis. Right Hemicolectomy, ileostomy and mucous fistula with cholecystectomy and CBD stenting was done. Histopathology confirmed the diagnosis and the patient refused for further treatment and died on 59th postoperative day. Conclusion Signet cell adenocarcinoma of Gall Bladder is rare entity with poor prognosis. Presentation as intestinal obstruction is the first time being reported till date. Management guidelines and chemotherapy is still not much standardised due rarity of the condition.

 > Abstract Id: YUGP1784 Top

Cytotoxic Effect Of Adenanthera Pavonina Seed Extracts On Cancer And Normal Cell Lines

Presenter- *Mr. Ashish Nair

Co-author - Devi Arikketh, Ayisha Basheer Vakkath, Kartik Sachdeva

Adenanthera Pavonina is a tropical tree which is of religious importance in Kerala and of medical importance in Ayurveda. It is colloquially called as “Manjadikuru†and several research papers state its blood pressure lowering effect and anti-diabetic effect. My team was interested to analyze the effect of crude seed extract on cancer cells. Methanolic extraction was performed at 50% and 100% concentration of boiled and unboiled crude Manjadikuru seed extracts. MTT Assay was performed and IC50 values were analyzed with respect to the boiled and unboiled crude seed extracts on HepG2 (cancerous) cell line and HEK (normal) cell line. Cytotoxic effect was expected to be higher in HepG2 than in HEK; but as per the IC50 values of MTT Assay the effect was more in HEK than HepG2 cell line. Cytotoxic activity is evident in cancer cell line (HepG2) and normal cell line (HEK). Boiled samples were safer than unboiled samples as per the IC50 values of cancer (HepG2) and normal (HEK) cell lines respectively. This paves way for a higher potential for further research on other cell lines and relevant cytotoxicity assays. IC50 (mg/ml) (boiled/unboiled) : 464.5849/266.7395; 337.15/76.15

 > Abstract Id: YUGP1788 Top

Clinical Study Of Ovarian Masses

Presenter- *Dr. SHIVA KUMAR

Co-author - , ,

Introduction The incidence of ovarian tumours is increasing in developing countries1.Ovarian tumours account for 30% of all cancers of female genital tract2. Ovarian malignancy ranks fifth in cancer death worldwide and in India it ranks third among the female genital tract malignancies1. This study has been done to analyse the age distribution, presenting symptoms and the various histopathological types of ovarian tumours in patients who underwent surgical management. Objective of the study To study the incidence, clinical presentation and histopathological pattern of ovarian masses. Materials and methods It is a prospective study conducted in the Obstetrics and Gynecology Department at VIMS,Bellary during two year period. All patients who are surgically managed are included in this study. Those patients who are conservatively managed and those with non-ovarian masses were excluded from this study.The details such as age, presenting symptoms, surgical details and histopathological reports were noted. Based on the HPE reports ovarian malignancies were analysed. Study design This is a prospective study. Inclusion Criteria All patients who are surgically managed. Exclusion Criteria 1.Patients who are conservatively managed 2.Non-ovarian masses .

 > Abstract Id: YUGP1790 Top

Health Related Quality Of Life And Its Determinants In Patients With Head And Neck Cancers

Presenter- *Dr. Ashwani Sachdeva

Co-author - Ashwani Kumar Sachdeva, Prasanth Penumadu, P Jagadesan

Introduction The concept of Health-Related Quality of Life (HRQOL) has been recognized with great importance, and many studies have been reported in different parts of the world. With this study, we intend to assess and evaluate the impact of treatment on HRQOL in Indian population. Material and methods This was single tertiary care institution based prospective analytical study from January 2015 to December 2016. A total of 122 patients were recruited but only 87 patients who were alive without disease were analyzed at the end of study. HRQOL assessment was done using the European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire (QLQ), both the Main Module (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H&N35) at four times in one year follow-up. Results: Majority of patients aged above 50 years, were predominantly males (62%). oral cavity tumors consisted 80% of the study cohort with majority having tumors of buccal mucosa followed by tongue cancers. Primary closure of primary surgical defect was done in 52% cases followed by free flap (26%) and pedicled flap (22%). Majority of patients had advanced disease at presentation with stage III and IV in 53% and 29% respectively. QOL assessment for the complete study cohort showed initial deterioration following therapy in 21 variables of EORTC QLQ-30 and H&N-35 questionnaires which subsequently improved at one year follow-up with problems with dry mouth being most significant deterioration from baseline. Based on various clinicopathological variables, Males had better HRQOL than females; Oral cavity tumor had more problems with dentition, dryness of mouth, mouth opening and sticky saliva while pharyngeal tumor had more problems with eating. Both laryngeal and pharyngeal cancers recorded lowest scores in speech domain. Early stage tumors had better scores in all functioning ad symptom scales than advanced stage even at 1 year follow up. Patients receiving radiotherapy had more problems with swallowing, dental problems, dry mouth and sticky. Choice of reconstruction also had impact with free flap reconstruction having better HRQOL than pedicled flap reconstruction. Conclusion Treatment in any form produced a major effect on QOL improving it over the baseline in patients who are cured of disease. Health-related quality of life should be a supplement to survival analyses in the evaluation of patients with head and neck cancer.

 > Abstract Id: YUGP1796 Top

Spectrum Of Extranodal Non Hodgkin'S Lymphoma: Evaluation Of Prognostic Factors And Treatment Response

Presenter- *Prof. O P SINGH

Co-author - O.P.Singh, Veenita Yogi, Pallavi Redhu

Primary extranodal lymphoma is defined when it arises from extranodal sites ,confirmed after staging procedures.It occurs in usually 20-40% patients present with non Hodgkin's lymphoma. Head and neck and gastrointestinal involvement is very common but it may arise from other sites of body also.We have analyzed impact of site on their behaviour and treatment response. Material and Methods: In this study 62 patients were analyzed ,who were treated between 2008 to 2016 .The distribution among different sites were head and neck,intestine,stomach,bone,CNS and others.All the patients were properly staged and treated with chemotherapy and or involved field radiotherapy. Results: Out of 62 patients ,65% males and 35% females.Median age was 42.5 years (range 4-80 years).Sites involved by extranodal lymphoma were head and neck (38%),gastrointestinal(35%),and other sites (27%).Patients presented with more than one extranodal sites were 37% and patients with both extranodal and nodal involvement were 25%.Diffuse large B cell was common histologic finding in 70% cases.Poor prognostic factors were advanced Ann Arbor stage,presence of B-symptoms,abnormal lactate dehydrogenase level ,poor performance status and presence of DLBCL histiotype.Head and neck patients with nodal involvement responded better than gastrointestinal lymphoma ,when treated with chemotherapy and IFRT. Conclusion: This study concluded that extranodal NHL accounts for 25% of all NHL,hence before initiation of treatment all the NHL cases should be properly investigated and staged .Extranodal NHL responded well with chemotherapy as NHL and it was observed that whenever IFRT was given, it accrues the progression free survival.

 > Abstract Id: YUGP1797 Top

Thyroid Malignancy Masquerading As Primary Renal Neoplasm : An Unusual Presentation


Co-author - PROF.DR.E.HEMANT RAJ, ,

Purpose : Thyroid malignancies are known for their classical mode of presentation as goitre. Distant metastases account for 4-15% of patients, which has a significant negative impact on their overall survival. Most common sites of distant metastases include lung and bone; However rare sites include brain, breast, liver, kidney, adrenal, muscle & skin. Clinically apparent renal metastases from a primary well differentiated thyroid malignancy is a very rare clinical entity and to the best of our knowledge less than 25 cases have been reported in the literature. In majority of these cases, renal metastases was diagnosed in the background of known primary thyroid cancers. We report a 39 year old lady who presented with pain abdomen and was diagnosed to have a primary renal neoplasm. Most authors reported renal metastases synchronous with multiple other sites of distant metastases; However, isolated renal metastases from a primary thyroid cancer is an unusual presentation as in our case. Also most reported bilateral and multiple renal metastases unlike our patient who had an unilateral solitary site of disease. Study design : This is a case report. Results : Patient underwent right partial nephrectomy for a right renal mass. Post operative histopathology revealed metastatic follicular variant of papillary thyroid carcinoma. Subsequently, patient underwent thyroidectomy which revealed primary follicular variant of papillary thyroid carcinoma. Conclusion : Well differentiated thyroid cancers can present unusually with the site of distant matastases on presentation. Renal metastases are extremely rare and should be considered in the differential diagnosis of a renal mass. Keywords : Renal metastases, Primary thyroid malignancy, Unusual presentation

 > Abstract Id: YUGP1807 Top

A Novel Approach To Locally Advanced Technically Inoperable Oral Squamous Cell Cancers Using Neoadjuvant Radiochemotherapy : Results From A Tertiary Cancer Centre Of India

Presenter- *Dr. SHASHI PAWAR


Background: Locally advanced technically unresectable oral cavity cancers continue to be a major therapeutic challenge despite the implementation of novel multi-modal treatment approaches.It has poor prognosis with median overall survival of 2-12 months. To improve loco-regional control and to allow functional reconstruction after ablative surgery, neoadjuvant protocols have been developed implementing radiochemotherapy prior to definitive surgery. Our aim was to assess whether neoadjuvant radiochemotherapy regimen improves overall outcomes and operability rates in such patients. Material and Methods: 144 patients were enrolled in this trial during the period from May 2014 to May 2016 and received four cycles concurrent Cisplatin (40 mg/m2) with conventional radiotherapy (40 Gy in 20 #, Cobalt-60). This was followed within 4-6 weeks with resection of the primary tumor and the regional neck nodes with appropriate reconstruction. Results: 132 patients were evaluable for toxicity and response. Twelve patients defaulted while on neoadjuvant therapy. Complete clinical response was seen in 54 of 132 patients ( CR- 40.9%), and partial response in 63 of 132 patients ( PR-47.7%). In 60 of the 132 patients complete pathological response (pCR- 45%) was documented in the resected specimen. Resectability was achieved in 144 of the 132 patients Toxicity seen were of low grade and reversible. Conclusions: Neoadjuvant radiochemotherapy has been very effective in downstaging locally advanced technically unrtesectable oral cavity cancers in almost 88.6% ( 117/132) patients. It was also associated with excellent clinical and pathological response rates and acceptable side effects ( Grade I/II toxicity).

 > Abstract Id: YUGP1811 Top

Prognostic Factors Determining Survival Outcomes Following Radical Antegrade Modular Pancreatosplenectomy For Tumours Involving Body And Tail Of Pancreas.

Presenter- *Dr. Sivasanker Masillamany

Co-author - Ashwin Desouza, Mahesh Goel, Shailesh V Shrikhande

Original article title: Prognostic factors determining survival outcomes following radical antegrade modular pancreatosplenectomy for tumours involving body and tail of pancreas. Authors : Masillamany Sivasanker1, Ashwin Desouza2, Mahesh Goel2, Shailesh V Shrikhande2 Affiliation : 1-Department of Surgical Oncology, JIPMER, Pondicherry; 2-Department of GI and HPB Oncology, Tata Memorial Centre, Mumbai, India Introduction: In a seminal report by Strasberg et al in 2003, Radical antegrade modular pancreatosplenectomy has been described as a modified form of distal pancreatosplenectomy for resections of tumors involving the body and tail of pancreas. The propagated advantages of this procedure includes the high tangential margin negativity since the posterior dissection plane lies posterior to the anterior renal fascia and also the high lymph nodal yield which leads to better staging. This procedure has shown to yield good long term survival benefits in a limited cohort in many reports although the distal cancers are rather uncommon as compared to pancreatic head malignancy.The characteristic feature of this procedure includes the dissection that proceeds from right to left with early vascular control and also lymphadenectomy being conducted based on the described lymphatic drainage of the region. The purpose of this article is to study the perioperative and long term survival outcomes following this procedure in a cohort of 65 patients performed in a tertiary cancer centre in Asia. Methods: This is a retrospective study from the analysis of prospectively maintained database of patients treated for tumors involving the body and tail of pancreas. The relevant data of all patients operated for distal pancreatic tumors from 2007 till 2016 were entered in a prospectively maintained database. It was retrieved from the electronic medical records of the Tata Memorial centre and also the follow-up data from standard protocols at the institute. The data included details collected from operative notes, anesthesia records, histopathology details and follow-up visits. The preoperative workup of the patients with distal pancreatic tumors included tumor markers, baseline investigations and pancreatic protocol CECT scan and chest CT. The management of these patients were discussed in a dedicated multidisciplinary hepatopancreatobiliary oncology team comprising of surgeons,medical oncologists, radiation oncologists, radiologists, anaesthesiologists and they were planned for surgery . In this cohort, staging laparoscopy was performed selectively in cases where tumor marker CA 19-9 was elevated. The decision to perform surgery by minimally invasive approach (laparoscopic or robotic ) was at the discretion of the operating surgeon. The pathological assessment of the specimen had been done in accordance with the synoptic reporting with appropriate diligence rendered for the histology, pancreatic cut margins, tangential margins, lymph node yield, pancreatic intraepithelial neoplasia, lymphovascular invasion and perineural invasion . The data on postoperative complications such as postoperative pancreatic fistula was classified and documented in accordance with the ISGPF classication and other complications have been documented based on clavien-Dindo grading. The details of adjuvant therapy and the recurrence data were retrieved and analysed. The overall and disease free survival were calculated for pancreatic cancers. The overall survival denotes the time period from the procedure till death due to any cause and disease free interval denotes the time interval from the procedure till death or recurrence. The survival estimates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses have been performed over the overall and disease free survival functions using logrank test and Cox proportional hazards model. All statistical analysis were performed using SPSS version 20. Results: In this series, 65 patients with lesions involving the body and tail of pancreas have underwent radical antegrade modular pancreatosplenectomy. The median American society of anaesthesiologists(ASA) score was 2. 17 patients (26.2% )had underwent multivisceral resections involving colonic and gastric wedge resection.There was no 30 day perioperative mortality or in-hospital deaths. Clinically relevant postoperative pancreatic fistula was observed in 17 patients. (26.1%) (POPF-B in 16 patients and POPF-C in 1 patient). Among the 65 patients, other complications such as local collections occurred in 4 patients, septic shock in 1 patient, wound infection in 2 patients, respiratory complications in 1 patient, cardiac complication in 1 patient and reoperation for bleeding in 3 patients and for bowel gangrene in one patient. Interventional radiologic procedures including pigtailing was done in 18 patients for managing various complications such as local collections and CR-POPF. The various final histopathology comprised of adenocarcinoma (38.4%), neuroendocrine tumors(16.9%), Solid pseudopapillary epithelial neoplasm (15.4%), cystic neoplasms(16.9%),GIST (1.5%), leiomyosarcoma (1.5%), adrenocortical carcinoma(1.5%),liposarcoma(1.5%), benign(3.1%). Among this cohort of 65 patients, 27 patients had adenocarcinoma of pancreatic origin. In this 27 patients with pancreatic cancer, the mean nodal yield was 6.7 +/- 5.5 and the median CA19-9 value was 146 U/L. Among these 27 patients, 7 patients (26%) had nodal metastases. With respect to the T stage, 2 patients (7.4%) had T1 lesion, 17 patients (63%) had T2 lesion, 6 patients (22.2%) had T3 lesion, and 2 patients (7.4%) had T4 lesion. With respect to the grade of differentiation, tumor was well differentiated in 4 patients(14.8%), moderately differentiated in 11 (40.7%), and poorly differentiated in 6 (22.2%). Among the 27 patients, lymphovascular invasion was noted in 5 patients (18.5.%) and perineural invasion was noted in 12 patients(44.4%). There was no pancreatic intraepithelial neoplasia noted in any of these cases. The R0 resection rate was 85.2%. Adjuvant chemotherapy was administered in 13 patients (48%). The chemotherapeutic regimen followed was gemcitabine in 9 patients, GEMCAP in 1 patient and FOLFIRI in 1 patient. During the followup, recurrence was observed in 9 patients (33%). The median survival for the distal pancreatic cancers following RAMPS procedure was 10 months. The 3 year overall survival was 56% and 3 year disease free survival was 38% following resections for distal pancreatic cancers. On univariate analyses of various prognostic factors affecting overall survival and disease free survival,the margin status (p=0.014, 95% CI 9.5-28.4 ), perineural invasion (p= 0.048, 95% CI 9.3-18.6) and tumour differentiation ( p=0.019, 95% CI 8.7-19.2) have shown to be significant prognostic factors for disease free survival . On multivariate analysis, margin status ( R0 vs R1) remains the most important prognostic factor determining disease free survival (p=0.023, 95% CI 1.24-17.83 ) in patients undergoing resections for cancers involving distal pancreatic body and tail. Conclusion: RAMPS procedure aids to achieve high negative tangential margins for tumors involving the body and tail of pancreas and also a satisfactory median survival for these aggressive cancers. Since margins status remains the most important prognostic factor, aggressive surgery is indicated in fit patients.

 > Abstract Id: YUGP1815 Top

Neuropsychological Changes In Children With Acute Lymphoblastic Leukemia Treated With Bfm-95 Protocol

Presenter- *Dr. Sundaramoorthy C

Co-author - Dr. E. Vidhubala, Associate Professor, Cancer Institute (WIA), Dr.V.Surendran,Assitant Professor, Cancer Institute (WIA),

Background: CNS prophylactic treatment has decreased the risk of CNS relapse and is responsible for the remarkable increase in survival rates. However, improved survival rates have not been achieved without neuropsychological sequelae. This study examines the neuropsychological changes in children with Acute Lymphoblastic Leukemia treated with BFM-95 protocol in the Indian context. Method: ALL children (n=44) who received CRT and HD-MTX as part of their treatment protocol were included. Neuropsychological assessments were done to evaluate neurocognitive functioning. Behavioral problems and MRI changes were also assessed. Five assessments were done during the induction, end of re-induction I and II, commencement of maintenance, and end of maintenance phases. ALL children were compared to a group of healthy children (n=60) at the baseline and post assessment. Results: A significant deterioration was observed in the performance intelligence, visuo-spatial, processing speed and verbal retention domains after the completion of CNS-prophylactic treatment. Three children had white matter changes and showed reduced functioning in visuo- spatial, processing speed and verbal retention. Behavioral problems such as somatic complaints, rule-breaking and aggressive behavior significantly increased during the intensive phase of treatment and decreased after completion of the treatment. Children with ALL had poorer neuropsychological functioning when compared with healthy children. Conclusion: CNS-Prophylactic treatment along with HD MTX reduced the neuropsychological functioning of children with ALL and when CRT was added to the treatment, the effects were more pronounced. Behavior problems such as somatic complaints, aggressive and rule-breaking behavior were of concern at diagnosis and during the intensive phase of treatment. Regarding the white matter changes in three children, further studies need to be conducted to make any association.

 > Abstract Id: YUGP1827 Top

Response To Neo Adjuvant Chemotherapy Of Osteosarcomas Treated In A Single Institution

Presenter- *Dr. REMYA KRISHNAN

Co-author - DR SURESHKUMAR, ,

Response to Neoadjuvant Chemotherapy of Osteosarcoma treated in a single institution Retrospective study of 8 Patients Treated at a Single Institution STUDY CONDUCTED AT MEDICAL COLLEGE KOTTAYAM BY DR REMYAKRISHNAN JUNIOR RESIDENT DEPT OF RADIOTHERAPY MEDICAL COLLEGE KOTTAYAM BACKGROUND The primary and secondary objectives of the current study were to improve the 90% tumor necrosis rate following neoadjuvant chemotherapy with IAP Regime METHODS 8 patients with AJCC Stage IIB high-grade osteosarcoma were included in the current study. Three to four cycles of an induction chemotherapy regimen including cisplatin, doxorubicin, and ifosfamide peripheral blood stem cell support were given After engraftment was achieved, the patients underwent limb-sparing surgery (LSS)followed by three to six cycles of postoperative chemotherapy depending on the tumor necrosis rate RESULTS A 5 year study conducted in a single institution in 8 patients to asses the response to chemotherapy in osteosarcoma reveals that about 12.5% patient got pathological complete response 12.5% got >90%necrosis and 75% patient got adequate margins 50% patient undervent limb salvage surgery following chemotherapy CONCLUSIONS The results of the current Phase II study suggest that NACT provides a greater than 90% necrosis rate with acceptable toxicity. A short duration of therapy and the feasibility of LSS in all patients are additional advantage of this approach. Cancer 2005;104:1058—65. INRODUCTION Adjuvant and neoadjuvant chemotherapy, introduced in the early 1970s, have significantly improved the long-term survival rate for patients with osteosarcoma. Nevertheless, recurrent disease still occurs in about 30—40% of patients and more than 70% of them die of their tumor, despite second-line treatment Neoadjuvant chemotherapy combined with complete surgical excision followed by adjuvant chemotherapy is the gold standard treatment modality in patients with extremity osteosarcomas . Agents that are widely used and accepted as being efficacious in osteosarcoma patients include doxorubicin, cisplatin, ifosfamide, and high-dose methothrexate. Many authors consider the post chemotherapy tumor necrosis rate to be a reliable prognostic indicator Intensified first-line chemotherapy regimens could improve prognosis, but the risk is overtreatment of patients who could benefit from less aggressive regimens.The aim of this study is retrospective analysis of response to neoadjuvant treatment in a single institution MATERIALS AND METHODS Patient Selection and Pathology Records of the 8 patients who entered our institution with neo adjuvant studies of non metastatic osteosarcoma of the extremities between2013 and 2017 were reviewed. The results achieved in the single studies, previously reported in detail were updated Patients were considered eligible when fulfilling the following criteria: typical radiographic and histologic features of primary, high-grade, central osteosarcoma tumor located in the extremity, no previous history of cancer and no prior treatments no coexisting disease contraindicating chemotherapy, and no evidence of metastases at diagnosis All the eligible patients were offered neo adjuvant chemotherapy after having been informed of the potential advantages and risks of this treatment The diagnosis of osteosarcoma, established by clinical and radiologic findings, was always confirmed on histologic slides of tumor tissue obtained from an open or needle biopsy, as well as from the resected specimen According to Fletcher et al5 osteosarcomas were classified as ‘classic,’ or conventional, telangiectatic, and small-cell osteosarcoma. On the basis of predominant cells and intercellular material, the ‘classic’ osteosarcomas were subclassified as osteoblastic, fibroblastic chondroblastic, and telangiectatic. This distinction, always made on surgical specimens, was possible in all cases Tumor volume was retrospectively evaluated in 7method described by Gobel et al 6 on CT-scan measures of the three diameters of the lesion 9 patients Multivariate analysis Preoperative Evaluation A complete medical history was obtained for all patients, who also underwent a thorough physical examination and several chemical laboratory tests. The primary tumor was evaluated on standard radiographs and Technetium 99-MDP bone scans CT was performed in the 8 patients treated Magnetic resonance imaging (MRI) was also performed in All patients. These exams were repeated before surgery. Bone metastases were investigated by total body scans, whereas standard chest radiographs and CT scans of the chest were used to exclude lung metastases for the 8 patients treated. Preoperative treatment After a histopathologic diagnosis was established, cisplatin at a dose of 30 mg/m2/day, doxorubicin at a dose of 20 mg/m2/day, ifosfamide at a dose of 2.5 g/m2/day, and mesna at a dose of 2.5 g/m2/day were administered for 2 cycles over the course of 3 days, every 3 weeks. Granulocyte—colonystimulating factor(G-CSF) was used in those patients with a leukocyte count of less than 1000/L Surgery and Pathologic Evaluation of the Response to Chemotherapy The type of surgery (amputation, rotationplasty, or limb salvage), as well as the type of reconstructionafter resection of load-bearing bones (prosthesis, Kuntscher rod, or plate and cement, vascularized fibula combined with allograft, and allograft and autograft) were chosen depending on the location and extent of the tumor, neurovascular structure involvement, skeletal maturity, desired lifestyle, and presence of complicating factors, such as displaced pathologic fractures or infected biopsy sites The margins were classified as ‘adequate’ if radical or wide and ‘inadequate’ if margins were marginal, intralesional, or contaminated, regardless of histologic response, i.e., when margins still contained tumor cells even if completely necrotic. The response to preoperative chemotherapy was evaluated following the criteria previously reported16 graded as ‘good’ (90% or more tumor necrosis) or ‘poor’ (less than 90% tumor necrosis RESULTS Surgery, Surgical Margins, and Histologic Response to Chemotherapy Out of 8 patients treated in our institution 4 patients undervent limb salvage surgery 3 of them had AK amputation 6 patients had adequate margin and 1 patient had >90% necrosis 1 patient had pathological complete response after neo adjuvant chemotherapy References 1 Bacci G, Picci P, Ferrari S, et al. Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993;72:3227—3238 Ferrari S, Mercuri M, Picci P, et al. Nonmetastatic osteosarcoma of the extremity: results of a neoadjuvant chemotherapy protocol (IOR/OS-3) with high-dose methotrexate, intraarterial or intravenous cisplatin, doxorubicin, and salvage chemotherapy based on histologic response. Tumori. 1999; 85:458—464. 2. Bacci G, Briccoli A, Ferrari S, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli’s 4th protocol. Eur J Cancer. 2001;37:2030—2039. 3 Bacci G, Ferrari S, Longhi A, et al. High-dose ifosfamide in combination with high-dose methotrexate, doxorubicin and cisplatin in the neoadjuvant treatment of extremity osteosarcoma: preliminary results of an Italian Sarcoma Group/ Scandinavian Sarcoma Group pilot study. J Chemother. 2002;14:98—206

 > Abstract Id: YUGP1837 Top

Chest Wall Reconstruction And A North East Based Tertiary Care Hospital Experience

Presenter- *Dr. Niju Pegu


Background Chest wall defect may be sternal defect, anterior defect, lateral defect and posterior defect. Reconstruction of chest wall defects requires attention to management of the pleural cavity, skeletal support and soft tissue coverage. Basic principles in chest wall reconstruction are sufficient amount of tissues resection, ideal replacement to restore the rigid chest wall and adequate soft tissue coverage. The goals are to maintain adequate chest wall stability, water and air tight closure of the chest cavity, and acceptable cosmetic appearance. Decision for most appropriate reconstructive options depends on assessment of the defect in terms of location, depth, aetiology and a thorough understanding of chest wall mechanics and physiology. The choice of prosthetic material is often based on surgeon’s preference. The ideal characteristics of a prosthetic material for chest wall reconstruction is a) malleability so that it can be fashioned to the appropriate shape at the time of operation b) rigidity- to abolish paradoxical chest motion and c) inertness- to allow in- growth of fibrous tissue and decrease the likelihood of infection d) radiolucency- to allow radiographic follow-up of the underlying problem. Appropriate pre-operative pulmonary, cardiovascular and nutritional assessment will estimate the patients’ ability to tolerate certain resections. For Soft tissue reconstruction musle transposition, omental transposition and free flap are used. Back wound defect reconstruction is challenge to the reconstructive surgeon. ? upper 1/3rd defect- the trapezius muscle flap ? middle 1/3rd defect-reverse latissimus dorsi muscle flap ? lower 1/3rd defect- gluteus maximus muscle flap The complications are respiratory complications, atelectasis, air leak, wound complications, infection, seroma PATIENTS AND METHODS Last 5 years, many cases presented to our institute, 12 cases undewent surgery. Diseases are Chondrosarcoma Rib (6 cases), Giant Cell Tumour Rib (4 cases) and Ewing sarcoma ( 2 cases ). The Defects are Lateral ( 9 cases), Anterior ( 2 cases) and Sternal (1 cases). For reconstruction, bone cement and prolene mesh are used for skeletal support and muscle flap and myocutaneous flaps are used for soft tissue coverage. Morbidity â€Â¢ soft tissue wound infection( 3 cases) â€Â¢ mesh infection ( 2 cases) â€Â¢ Respiratory Difficulty — Nil â€Â¢ Paradoxical Movement - Nil Conclusion Chest wall reconstruction with or without prosthesis can be performed as a safe effective one stage procedure in varieties of chest wall defects

 > Abstract Id: YUGP1839 Top

Single Lung Stereotactic Body Radiotherapy (Slabr)

Presenter- *Dr. Meetakshi Gupta

Co-author - M Gupta, JP Agarwal, N Mummudi

M Gupta*, JP Agarwal**, N Mummudi**, A Tibdewal** *MD Radiation Oncology, Senior Resident, Department of Radiation Oncology, Tata Memorial Centre, Mumbai; **MD Radiation Oncology Introduction: Management of a second primary lung cancer (SPLC) after prior pneumonectomy (PP) poses a significant clinical challenge. Early diagnosis is imperative for radical treatment in order to save large part of the remaining lung tissue. Tissue diagnosis is another hurdle since biopsy entails a high risk for pneumothorax in the diseased single lung. Non-surgical method like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to be useful in patients with new mediastinal/ hilar lymphadenopathy after initial treatment. It is minimally invasive, does not require general anaesthesia and has diagnostic accuracy of over 95% with low complication rate. Native methods like liquid based cytology and FDG-PET scan are also being explored to act as surrogates to tissue biopsy. Surgery is not feasible in majority of cases because of low cardiopulmonary reserve. SBRT is now standard treatment for medically inoperable early stage NSCLC, hence is considered a viable alternative in patients with single lung. However, radiation toxicity of SBRT in single lung and dose constraints to organs at risk are still under evaluation . Methodology: We treated a patient with metachronous SPLC after PP with SBRT to a dose of 60 Gy in 8 fractions on alternate day basis using 4DCT planning and VMAT technique using isocentre based prescription. Volumetric imaging was used at every fraction for image guidance. Results: The dose received by 100% of PTV was 95%. Mean single lung dose, V20, V10 and V5 were 4.6 Gy, 10%, 16% and 21% respectively. These dose constraints met the criteria proposed in literature for SBRT of patients with both lungs. There was no acute pulmonary and oesophageal toxicity. Conclusion: Curative SBRT appears a safe and technically feasible option for patients with single lung with a toxicity profile similar to those with both lungs.

 > Abstract Id: YUGP1841 Top

The Dosimetric Impacts Of Vertebral Implants (Pedicle Screw And/Or Bone Cement) On Spinal Cord

Presenter- *Mr. Zhao Bo Zhao

Co-author - Zhang Min, Gao Xianshu,

Purpose/Objective(s): The aim is to study the dosimetric impact of vertebral implants on spinal cord. Materials/Methods: An entire lumbar spine specimen was used. The vertebrae were implanted with pedicle screws and/or bone cement, and divided into 3 groups: A) pedicle screw; B) bone cement; C) pedicle screw combined with bone cement. Then, the vertebrae were immobilized in water tank for CT simulation. After that, PTV and spinal cord were contoured for treatment planning. Three treatment plans (5-fields IMRT, 9-fields IMRT and VMAT) were designed with prescription dose of 2Gy, by using different TPS algorithms (MC and AAA). The dose calculation was performed with two types of image: 1) no correction image; 2) detailed correction image (a tool was developed to auto-correct electronic density of artifacts, implants, bone and soft-tissue). To verify the accuracy of the planned dose, a semi-conductor in-vivo dose detector was put into the vertebral foramen, at the same position as interest points (before measuring, kV-CBCT was used to assure the consistency of position between interest points and measuring points). The measured doses were obtained from the in-vivo dose measuring system, and then compared with the planned doses for different groups, IMRT techniques, types of image and algorithms. Results: The results were shown : 1) planned dose with detailed correction image was more accurate than no correction image (p

 > Abstract Id: YUGP1843 Top

Intrafractional Prostate Motion And Dose Variation During The Radiotherapy For Prostate Cancer Using 4D-Tpus

Presenter- *Mr. Zhao Bo Zhao

Co-author - Qi Xin, Gao Xianshu,

Purpose: This study was to investigate the prostate motion model and dose variation during radiotherapy using a 4D transperineal ultrasound system (4D-TPUS). Methods: From July 2014 through December 2016, 57 prostate cancer patients were enrolled. During treatment delivering, 4D-TPUS were used to collect data of prostate's real-time motion . Then, the real delivered doses were calculated according to the real-time motion data and the leaf sequences/MUs. The delivered doses were compared with the planned doses by using the clinical acceptance criteria. Results: A total of 1207 fractions were evaluated. The mean (±SD) of the infraction displacements were [mm]: SI: (0.03 ± 0.92); LR: (0.12 ± 1.03); and AP: (-0.01 ± 1.37), respectively. There were 41, 29, and 66 fractions with deviation exceeded 3 mm in the SI, LR, and AP directions, respectively. The AP direction has the largest extent of prostate displacement. We classified our patients into three groups according to the motion model: stable (n=50), irregular (n=3) and intention (n=4). The intention group was defined as persistent deviation to the same direction (the maximal displacement should exceed 3 mm) that repeated in at least 50% fractions. All these patients had obviously anxiety and urinary frequency and urgency. Delivered doses showed that all the 4 patients in the intention group did not meet our clinical requirements. Conclusion: The present study demonstrated that for over 90% of fractions, a CTV-PTV margin of 3 mm would be good coverage with the planned prescribed dose. However, it is important to identify the patients belonging to the intention group. Pre-treatment with anti-anxiety drugs and ? receptor blocker may be useful in relief the prostate motion.

 > Abstract Id: YUGP1845 Top

Radiologic Outcomes After Linac-Based Stereotactic Radiosurgery (Srs) For Vestibular Schwannomas

Presenter- *Dr. J Richelcyn Baclay

Co-author - Calaguas, Miriam Joy C., Torcuator, Roy Allan,

Objectives: Traditional treatment of vestibular schwannomas is surgery, which provides excellent tumor control rates when excision is complete. However, numerous studies have shown that stereotactic radiosurgery (SRS) has a well-established role as an alternative to microsurgical resection to vestibular schwannomas. This study aims to review the radiologic outcomes of patients with vestibular schwannoma treated with Linear Accelerator (LINAC)-based SRS in a single institution. Methods: This is a retrospective review of patients treated with LINAC-based SRS from 2010-2017. A total of 31 vestibular schwannoma patients were identified, from whom only 10 patients have post-SRS magnetic resonance imaging (MRI). Two patients were post-subtotal excision. The rest (80%) received SRS as initial treatment. Post-SRS MRI were evaluated by measuring the antero-posterior, transverse, and craniocaudal dimensions of the mass, computing for the volume, and comparing the pre- versus the post-SRS volumes. Results: All were treated with single fraction SRS, with a median marginal dose of 12Gy (range: 10-15Gy), and mean treatment volume of 10.65 cc (range: 0.17-27.5cc). Median follow-up was 12 months (range: 3 — 72 months). Two patients had prior surgery, both subtotal excision, prior to radiation therapy. Patients had a median number of 4 follow-up MRIs (range: 1-6). Five patients (50%) have unchanged size of the mass at a mean follow-up MRI of 3.6 months (range: 4-72 months). Five patients (50%) reported regression in size of the mass, with a mean follow-up of 27.2 months (range: 3-57 months). In patients who had a decrease in size of the mass, there was a mean reduction in volume of the mass to 49% from the baseline (range: 14-87%). No increase in volume was reported in any of the patients. Conclusions: LINAC-based SRS of vestibular schwannomas show good local control radiologically. Further studies can be undertaken to correlate these radiologic findings to clinical outcomes.

 > Abstract Id: YUGP1853 Top

Impact Of Overall Treatment Time On Quality Of Life In Head And Neck Cancer Patients



NEED FOR STUDY-Post op radiotherapy for head and neck cancer patients is indicated when there is a high chance of loco regional reccurence.Ideally radiation should begin with in 6 weeks after surgery.Delay in adjuvant radiation decreases the therapeutic effect due to hypoxia of scarring tissue and repopulation in tumor cells. OBJECTIVE-TO EVALUATE THE EFFECT OF TIME BETWEEN SURGERY AND POST OP RADIOTHERAPY ON QUALITY OF LIFE IN HEAD AND NECK CANCER PATIENTS. MATERIALS AND METHODS-All head and neck cancer patients who underwent surgery in MS RAMIAH HOSPITAL between january 2016 to december 2016 who recieved adjuvant radiotherapy have been included in this study. EXCLUSION CRITERIA-1.Patients who recieved treatment with palliative intent. 2.patients who did not complete their full course of treatment. CONCLUSION AND RESULTS-results awaited from the statestician and will be presented.

 > Abstract Id: YUGP1859 Top

Dose-Volume Relationship Of Urinary Bladder To Organs At Risk In Image-Guided Brachytherapy For Cancer Of The Uterine Cervix

Presenter- *Dr. Dorothy Faye Tan

Co-author - Jaemelyn Marie O. Fernandez, Miriam Joy C. Calaguas, Anthony Albert N. Abad

Background: Concurrent chemotherapy and radiotherapy followed by brachytherapy is the standard of care for locally advanced cervical cancer. Significant long term side effects have been noted, hence there is a need to lessen the doses received by normal tissues. This study aims to determine the optimal volume of the urinary bladder that will result to least dose to organs at risk namely: rectum, sigmoid colon, small intestines and bladder using conventional (Point A) and 3D Image-guided brachytherapy(3D-IGBT) plans. Methods: 24 Cervical Cancer patients with Stage IB2 —IIIB were treated using external beam radiation therapy and 3D-IGBT brachytherapy. Patients were treated with different bladder volumes per fraction namely: 0-20cc (empty), 50-70cc, 100-120cc and 150-170cc of normal saline. The D2cc received by the urinary bladder, rectum, sigmoid colon and small intestines were obtained per bladder volume. Results: Using 3D-IGBT, a dose reduction trend was noted in the small intestines by increasing bladder volume from a mean dose of 2.18 Gy (empty bladder) to 1.17 Gy (150-170cc). However, this decrease did not lead to a statistically significant difference (p= 0.068). Varying bladder volumes did not influence the doses received by the rectum and sigmoid. Increasing bladder volume resulted to increased in radiation dose received by the bladder from a mean dose of 5.32 Gy (empty) to 5.95 Gy (150-170cc) which was not significant. For Point A based plan this increased dose to the bladder from mean dose of 6.42 Gy (empty) to 7.63 Gy (150-170cc) was observed to be statistically significant (p = 0.0495). Conclusion: A trend of better sparing of the small intestines was observed with increasing bladder volume (50-150cc) but this was not seen on the rectum and sigmoid. The dose received by the urinary bladder is directly proportional with its volume. Table 1. Dose received by organs at risk Image Guided Brachytherapy (IGBT) 0-20cc 50-70cc 100-120cc 150-170cc Mean + SD P value Small intestine 2.18 ± 1.79 2.03 ± 1.67 1.40 ± 1.24 1.17 ± 1.18 0.068 Rectum 4.80 ± 0.65 4.68 ± 0.78 4.70 ± 0.73 4.67 ± 1.07 0.944 Sigmoid colon 2.72 + 1.38 2.88 + 1.72 2.62 + 1.49 2.50 + 1.26 0.513 Bladder 5.32 ± 1.15 5.53 ± 1.16 5.79 ± 0.99 5.95 ± 0.77 0.165

 > Abstract Id: YUGP1861 Top

Evaluation Of Chemoprotective Effect Of Nbriqu16 Againstn-Methyl-N-Nitro-N-Nitrosoguanidine (Mnng) Andnacl-Induced Gastric Carcinomas In Wistar Rats

Presenter- *Ms. Lubna Azmi

Co-author - Ila Shukla, Aniruddh chaudhary, Padam Kant

Abstract: To investigate the chemo protective potential of NBRIQU16 chemo type isolated from Aegle marmelos (Rutaceae, 'Bael')) on N-methyl-N-nitro-N-nitrosoguanidine (MNNG) and NaCl-induced gastric carcinomas in Wistar rats. Forty-six male 6-week-old Wistar rats were divided into 2 groups. Thirty rats in group A were fed with a diet supplemented with 8 % NaCl for 20 weeks and simultaneouslygiven N-methyl-N’-nitro-N-nitrosoguanidine (MNNG) in drinking water at a concentration of 100 ug/ml for the first 17 weeks. After administration of the carcinogen, 200 and 400 mg/kg of NBRIQU16 were administered orally once a day throughout the study. From week 18, these rats were given normal water. From week 21, these rats were fed with normal diet for 15 weeks. Group B containing 16 rats was fed standard diet for thirty five days. It served as control. Ten rats from group A were sacrificed after 20 weeks. Sacrifaction of remaining animals was conducted after 35 weeks. Entire stomach and some part of duodenum were incised parallel to the greater curvature and the samples were collected. After opening the stomach location and size of tumors were recorded. The number of tumors with their locations and sizes were recorded. Expression of survivin was examined by recording the Immunohistochemistry of the specimens. The treatment with NBRIQU16 significantly reduced the nodule incidence and nodule multiplicity in the rats after MNNG administration. Surviving expression in glandular stomachs of normal rats, of rats in middle induction period, in adenocarcinomas and NBRIQU16 treated tissues adjacent to tumor were 0, 42.0 %, 79.3 % and 36.4 %, respectively. Expression of survivin was significantly different as compared to the normal rats. Histological observations of stomach tissues too correlated with the biochemical observations. These finding powerfully supports that NBRIQU16 chemoprotetive effect by suppressing the tumor burden and restoring the activities of gastric cancer marker enzymes on MNNG and NaCl-induced gastric carcinomas in Wistar rats Keywords: Gastric Carcinoma, Immunochemistry, NBRIQU16

 > Abstract Id: YUGP1869 Top

Optimizing Neck Management In Early Buccal Carcinoma - The Jury Is Still Out.

Presenter- *Dr. Naveen Padmanabhan

Co-author - Dr. NK Shukla, Dr SVS Deo, Dr. Manjunath NML

Introduction: Squamous cell carcinoma (SCC) of the buccal mucosa is most common subsite of oral malignancies in Indian sub-continent. Majority present with locally advanced disease and surgery plays an important role in management of buccal cancer. Most common site of spread is to cervical lymph nodes and neck dissection is treatment of choice in node positive patients. However there are controversies in the management of neck in early stage buccal cancer with node negative neck. The purpose of this study was to present our experience of neck dissection patterns, nodal positivity rates in early buccal SCC (cT1-2 N0-1) to facilitate future treatment strategies. Methods: A prospectively maintained computerized oral cancer database was reviewed and all histo-pathologically proven SCC of Buccal mucosa patients with T1 and T2 lesions undergoing neck dissection were included for analysis. Analysis was performed pertaining to patterns of neck dissection, and node positivity rates in early stage buccal cancers. Results: A total of 100 patients with T1-2 buccal carcinomas had neck dissection during the study period (1995-2015). Modified neck dissection was the commonest procedure done in 61 patients (61%), followed by supra-omohyoid neck dissection in 32 (32%). Over the period 1995-2015 there was a gradual shift towards more conservative approach in neck dissections (1995-2005 — SOHND - 19% vs. 2006-2015- SOHND 55%). Overall nodal positivity rate was only 33% (33/100). In specific neck dissection types the node positivity rates were as follows — RND 100% (4/4), MND 41%(24/58) , SOHND 6.4% (2/31). Neck node relapse was documented in 4 patients (4%). Conclusion: Results of the current study indicate that there is a overall shift towards conservative neck dissections like SOHND in patients with early stage buccal cancer. Approximately two thirds of early stage buccal cancer patients undergoing neck dissection have no pathologically proven nodal involvement resulting in gross overtreatment. These significant findings should be considered in formulating neck node management strategies for early buccal cancer patients.

 > Abstract Id: YUGP1873 Top

Management Of Insomnia In Cancer Patients

Presenter- *Ms. Radhika T K

Co-author - Anagha C C, Amrita Asok, Sreelakshmi Sreekumar

ABSTRACT Introduction Sleep is fundamental for normal functioning, repair and maintenance of our body. As insomnia tends to be a high-flying but neglected issue among the cancer population, it seeks crucial attention. Cancer and its therapy related factors like depression, anxiety, pain, fatigue, hot flushes, nocturia, gastric irritation, cough as well as other co-morbidities tampers with the sleep. Nowadays, non-benzodiazepines (non-BZDs) like Zolpidem are preferred over other hypnotics for its relatively safer side effect profile. Also, practicing a proper sleep hygiene may help rewire your brain to follow normal circadian rhythm. Aim To manage insomnia in patients with cancer Objectives Primary objective To study the prevalence of insomnia in cancer patients Secondary objectives 1. To study the effectiveness of zolpidem in treating cancer patients with insomnia. 2. To study the effectiveness of counseling on sleep hygiene in patients not receiving zolpidem. 3. To assess the risk factors associated with insomnia in cancer patients. Methodology This is a questionnaire-based prospective cohort study conducted in a tertiary care hospital. Consecutive patients were recruited and the prevalence of insomnia was determined using Pittsburgh Sleep Quality Index (PSQI) questionnaire. The Hospital Anxiety and Depression Scale (HADS) and Wong Baker FACES® Pain Rating Scale were used to assess anxiety and depression, and pain, respectively. Later, consecutive patients with insomnia (PSQI score ? 5) who were prescribed with zolpidem 5mg were identified and an equal number of successive patients without any treatment were counselled on sleep hygiene. Both groups were provided with a Sleep and Adherence Diary. The PSQI global score was reassessed for evaluating effectiveness of zolpidem and patient counselling after a week, either by direct or telephonic conversation with the patients. The outcomes were evaluated for individual patients based on PSQI, HADS and pain scores. Inclusion criteria Patients satisfying these criteria were included in the study: o All cancer patients above the age of 18 years. o Patients who can read, write and speak either English or Malayalam Exclusion criteria o Haematology patients o Patients previously prescribed with sedative or hypnotics o Patients previously diagnosed with sleep disorders o Patients with psychiatric illness o Patients not willing to give consent o Patients whose cancer diagnosis is not confirmed Results and Discussion The prevalence of insomnia in our population was found to be 65.9% and had a significant relation with anxiety, depression and pain with P < 0.001. There was significantly more patients (34.3%) in the insomnia group who were experiencing breathing difficulty (P = 0.005) at night relative to those without insomnia (14.3%). Similarly, patients on chemotherapy and radiation therapy had significant correlation with insomnia. Sleep latency > 30 minutes was one of the major complaints experienced by the patients (85.3%). Significant improvement was seen in the sleep latency, quality and daytime dysfunction after treatment with zolpidem (P < 0.05). On the other hand, patient counselling technique was able to bring down the PSQI score to less than 5 points in 9 patients out of 36. But on a closer look at the sleep components, there was no significant improvement in patient sleep characteristics except sleep latency (P = 0.013). The mean PSQI difference in score was found to be 4.03 in patients using zolpidem and 1.5 in counselled patients. Conclusion From our study we concluded that more than half the cancer population suffered from insomnia and most of them are untreated. Risk factors such as breathing difficulty anxiety, depression, pain, chemotherapy, radiation therapy, hypertension, diabetes, dyslipidemia were found to have a correlation with insomnia. Patients on zolpidem showed a reduction in their PSQI scores thereby suggesting it as an effective treatment alternative for insomnia in these patients. Patient counseling, though not as effective as zolpidem, made a slight difference in the overall sleep.

 > Abstract Id: YUGP1875 Top

Impact Of Anatomical Sub-Site Distribution On Limb Salvage Surgery Rates In Extremity Soft Tissue Sarcomas: Surgical Oncology, Aiims New Delhi Experience

Presenter- *Dr. Naveen Kumar


Introduction: Soft tissue sarcoma (STS) comprises a rare and heterogeneous group of malignant tumors and extremities are the most common site of involvement. Even though Limb salvage surgery (LSS) is the preferred treatment option but various limiting factors like tumor size, extent of spread, neurovascular and bony involvement can influence LSS rates. The impact of anatomical location (sub-site distribution) on LSS rates is not well studied. The aim of this study is to see the impact of sub-site distribution on limb salvage surgery. Methods: Analysis of prospective maintained soft tissue sarcoma computerized database was performed and records of biopsy proven extremity sarcoma treated between 1995 to 2013 were analyzed for demographics, clinical profile including sub-site distribution, limb salvage surgery rates and impact of sub-site on limb salvage surgery rates. Results: Total 409 extremity sarcoma patients were included for analysis. Mean age was 40yrs (range 10-85 yrs) and 68% were male. The predominant site was lower extremity involving 281 patients (68.70%) and predominant sub-site among lower extremity was thigh with 48% followed by leg (34.51%) and foot (7.11%). In patients with upper extremity sarcomas, 32% had tumors in arm region followed by forearm in 30.04% and shoulder girdle in 23.43%. Mean tumor size was 9 cm.History of prior suboptimal surgical intervention was present in 58%.Overall Limb salvage surgery rate was 72.86% and 24.93% had amputations. As per sub site distribution, highest LSS rates could be achieved in the arm (90%) and thigh (84%) followed by leg (54%) and forearm (66.66%). Maximum numbers of amputation were performed for patients with sarcomas involving foot (85%) and hand (67%). Conclusion: Conventional factors for predicting LSS for extremity sarcoma does not include anatomical sub-site distribution. Results of the present study indicate that the anatomical sub-site distribution is a strong predictor of LSS in patients with extremity soft tissue sarcoma.

 > Abstract Id: YUGP1877 Top

Prediction Of Residual Disease In Unsuspected €Œincidental†Gallbladder Cancer: Experience Of A Tertiary Care Hospital In Northern India

Presenter- *Dr. Aditya Kulkarni

Co-author - G R Verma, Harjeet Singh, Rajinder Singh

Introduction Unsuspected Gall bladder carcinoma (UGBC) is erroneously leveled as incidental carcinoma gallbladder. An attempted radical surgery later is not possible in sizable number of cases as the tumor is either disseminated or locally unresectable at laparotomy. Purpose of this report was to study the preoperative imaging and to predict the presence of residual disease from retrospective analysis of prospectively maintained database. Materials and Methods The study comprises of retrospective analysis of 16 patients of UGBC out of 84 patients of Gallbladder carcinoma (GBC) admitted from 2011 to 2016. Ultrasound (USG) abdomen and intraoperative findings prior to initial cholecystectomy were studied. The clinical evaluation and CECT± FDGPET scan was performed in all as a protocol to stage the tumor prior to definitive surgery. Resectable patients were subjected to laparotomy. Results Laparoscopic cholecystectomy was performed in 7, open in 6 and in three patients; laparoscopy was converted to open cholecystectomy. All but one patient were operated outside. The median time from cholecystectomy to attempted radical surgery was 7 weeks (5 days-4.5 months). All patients were referred with histopathological report for further surgery, out of these 6 had persistent pain, 2 had postoperative jaundice and 4 patients had severe anorexia and weight loss. 81.25% (13/16) patients presented with their ultrasound report prior to cholecystectomy. 43.75% patients (7/16) had features of uncomplicated cholelithiasis (normal gallbladder wall thickness, single or multiple stones or mucocele) and suspicious clinical features of malignancy were reported in 56.25% (9/16) cases prior to cholecystectomy. On staging CT, 68.75% (11/16) had gall bladder wall thickening (asymmetrical=6) with or without associated periportal lymphnodes and loss of interphase with adjoining liver. 85.71% (6/7) patients with uncomplicated cholelithiasis reported on preoperative U/S underwent R0 resections and 4 of them had no evidence of residual diseases in resected specimen while remaining 3 patients had e/o resectable residual or recurrent GB mass. Surgery could not be contemplated in 1 patient due to locally unresectable disease. 44.45% (4/9) patients with suspicious U/S findings underwent R0 resections. All of them had residual/recurrent diseases without or with GB fossa mass. The remaining 5 patients (55.55%), could not undergo surgery (distant metastasis=3, locally unresectable disease=2) Conclusions: The incidental GBC masquerading as uncomplicated cholelithiasis on U/S can later develop GB mass in 42.8% cases (3/7). The incidence of finding GB mass increases to 100% (8/15) in presence of suspicious lesions on U/S. Intra operative frozen calot’s triangle, duodenal adhesions and thickened GB wall should raise the suspicion of tumor. The study reinforces alertness and calls for high index of suspicion of GBC on U/S in patients undergoing cholecystectomy in endemic region and recommends further investigations in cases of suspicious lesions on U/S prior to cholecystectomy.

 > Abstract Id: YUGP1883 Top

Quality Of Death Of Patients With Advanced Cancers- An Exploratory Study

Presenter- *Ms. Revathy Sudhakar

Co-author - Dr. Surendran Veeraiah, Dr. Prasanth Ganesan, Dr. Kalpana Balakrishnan

Background: Dignified death is an important right of advanced cancer patients. Quality of Death analysis would give us an insight on the impact of the disease and palliative treatment on end-of-life care. This study aims to explore the Quality of Death of patients with advanced cancers. Method: Caregivers (n=108) of advanced cancer patients, who expired either during hospitalization or at home, were chosen through purposive sampling and interviewed to assess the Quality of Death by telephonic method using validated caregiver ratings of patients’ physical and mental distress. The transcripts and scores were analyzed through thematic analysis and descriptive statistics respectively. Results: The most commonly reported reason by the caregivers for the patients’ distress was physical suffering. Pain, lack of appetite, difficulty in breathing and compromised mobility, irrespective of the site, was reported by 41.6%, 38.8%, 25.9% and 27.7% respectively. Majority of the patients (65.7%) were not aware of their prognosis, thus leading to psychological distress pertaining to anticipation about survival and worsening of physical symptoms. Despite the distress, 60% reportedly had moderate to high quality of life in their last week of life. Conclusion: Although the quality of life of patients under end of life care was reported to be good, they suffered physically and psychologically as reported by the caregivers. Efforts must be undertaken to focus on the physical and psychological sufferings of terminally ill cancer patients, as effective interventions are available to tackle many of these issues.

 > Abstract Id: YUGP1889 Top

Psychosocial Issues Of Primary Caregivers Of Pediatric Patients With Advanced Cancer €” An Exploratory Study


Co-author - Dr. Surendran Veeraiah, Dr.Venkatraman Radhakrishnan, Dr. Kalpana Balakrishnan

Background: Primary caregivers in paediatric setup experience psychological, social, emotional and physical turmoil while taking care of cancer patients under palliative intent. Providing care to the cancer patients is demanding and has both positive and negative impact on the caregivers, which tends to be mirrored by the patients. This study is set out to explore qualitatively, the experiences of primary caregivers of paediatric patients diagnosed with cancer and are receiving treatment with palliative intent. Method: The experiences of 6 primary caregivers of advanced paediatric cancer patients were explored using a one to one semi-structured in-depth interview schedule. The interview was audio recorded, drafted, transcribed and translated by experts and the results obtained were thematically analyzed. Results: Caring for a paediatric cancer patient under palliative treatment leads to high distress among the primary caregivers. Major reasons pertaining to the distress of the caregivers include the prognosis, nature of the disease and the physical sufferings of the patient. Loss of religious belief and social withdrawal were prominent among the primary caregivers. Despite the awareness of the poor prognosis, caregivers reported to have hope regarding the patient’s condition. Caregivers tend to withhold their emotions and distress from patients, thus have trouble articulating their true feelings. Conclusion: Primary caregivers go through an emotional turmoil while caring for a paediatric cancer patient under palliative treatment, which requires an intensive intervention, aimed at improving their quality of life. Such a tailored intervention would aid in providing appropriate care and support during the grief and bereavement period.

 > Abstract Id: YUGP1891 Top

Surgery For Intracranial Metastases: A Single Institution Experience

Presenter- *Dr. Sivasanker Masillamany

Co-author - Subi T, Venkatesh Madhugiri, Prakash Shetty

Original article title: SURGERY FOR INTRACRANIAL METASTASES: A SINGLE INSTITUTION EXPERIENCE Authors : Masillamany Sivasanker MCh1, Subi T MCh2, Venkatesh Madhugiri MCh3,Prakash shetty MCh3, Aliasgar Moiyadi MCh3 Affiliation : 1-Department of surgical oncology, JIPMER, Pondicherry; 2- Rajagiri hospitals, Kochi,India; 3-Department of Neurosurgery, Tata Memorial Centre, Mumbai, India Introduction: The outcomes for patients who develop brain metastases from solid cancers have always been dismal. Several options are now available for the management of brain metastases and include surgical resection, whole brain radiotherapy, stereotactic radiotherapy, stereotactic radiosurgery, etc. The outcomes following whole brain radiotherapy alone (without surgery) have been poor with a median survival in the range of 3-6 months. In a seminal trial for solitary brain metastases, surgical resection followed by radiotherapy showed promising results in terms of better survival, fewer recurrences and better quality of life when compared to radiotherapy alone. With the recent advances in multimodal and targeted therapy, the role of surgery for brain metastases has evolved significantly. The decision regarding surgery is influenced by several factors including the site of primary tumor, disease free interval (DFI), size and number of metastases, performance status of the patient, location of the metastasis within brain, etc. The quality of life (QoL) of these patients following surgery is also a major consideration during the decision making process. The objective of this study was to identify factors affecting the outcomes following surgery for intracranial metastases. Methods: This study is a retrospective analysis of data obtained from a prospectively maintained database of patients with intracranial metastases who underwent surgery in Tata Memorial Hospital between 2007 and 2015. The database was queried for demographic details, preoperative neurologic deficits, performance status, details regarding the primary malignancy, timing of metastases (synchronous or metachronous), disease free interval (DFI), PET scan data, presence of metastases at sites besides the brain, size and location of the brain metastasis, operative notes, anesthesia records, histopathology details, extent of surgical resection (EOR), postoperative neurological deficits, postoperative morbidity and mortality, status of postoperative whole brain radiotherapy (WBRT), hormonal receptor status in breast cancers, data on progressive disease, overall survival and progression free survival, and follow-up visits. The overall survival (OS) was defined as the time interval between resection of the brain lesion and death due to any cause. Progression free interval (PFI) denotes the time interval between surgery and death or progressive disease. The survival estimates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify factors influencing OS and the PFI using the log rank test and Cox proportional hazards model. All statistical analyses were performed on SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Results: One hundred and twenty-four patients had undergone surgery for brain metastases over the selected period; the median age of the cohort was 53 years and 53 of the patients were male (42.7%). There were several primary sites that were responsible for the brain lesions including breast, lung, kidney, thyroid, sarcoma, larynx, maxilla, ovary, esophagus, stomach, uterus, testis, etc. The most common sites were breast (45 patients, 36.3%), lung (25 patients, 20.2%) and ovary (10 patients, 8.1%). At presentation, neurologic deficits were present in 53 patients (42.7%) and 19 patients (15.3%) presented with seizures. The median disease free interval was 15.6 months from completion of treatment for the primary malignancy to the appearance of intracranial metastases. In 22 patients (17.7%), the metastases were synchronous. Extracranial metastases were found in 15 patients (12.1%). Only 5 patients were detected to have 2 lesions while the rest had solitary metastasis. PET CT was performed for evaluation in 62 patients (50%). All patients underwent pre-op MRI without and with Gd contrast, using a standard tumor protocol. Nearly 40% of the metastases were >4 cm in size (n=49, 39.5%). The location of the intracranial lesion was supratentorial in 89 patients (71.8%) and in the posterior fossa in 25 patients. The lesions were located on the right side in 67 patients, on the left in 51 patients and in the midline in 3 patients. The EOR was classified based on a postoperative MRI performed within 72 hours. The EOR was gross total in 118 patients (95.2%) and near-total in the rest. The all-cause postoperative mortality rate was 2.4%. In the immediate postoperative period, neurological status improved in 43 patients of 53 patients who had deficits (81% of patients with deficits improved), remained the same in 60 patients and worsened in 21 patients (16.9%). The fresh postoperative deficits were classified as major in 8 patients and minor in 13 patients. Eleven of the 21 patients who developed fresh deficits in the immediate postoperative period (52.4%) improved within a short period of time and in the remainder (n=10), the recovery was either more prolonged or the deficit was permanent. Four patients (3%) had underwent re-exploration in the postoperative period for varied indications. Overall, at discharge, neurological status had either improved [compared with the baseline deficits or symptoms and signs] or remained stable in 92.7% of patients. Four patients (3.2%) were worse at discharge that prior to surgery. Of the entire cohort, 41 patients (33%) developed progressive or recurrent brain disease and 5 patients underwent redo resection. Univariate analyses were performed for various factors that could possibly affect OS, including age, gender, site of primary malignancy, stage of the primary, timing of metastases, pre-op KPS Score, DFI, presence of neurologic deficits at presentation, size of the metastasis, location of metastases, number of metastases, presence of extra-cranial metastases, EOR and whether patients received WBRT or not . Among these factors, EOR (gross total vs others, p=0.044), receiving adjuvant WBRT (p=0.007) and presence of extracranial metastasis (p=0.007) were identified to affect OS. The median OS was 11.7 months for patients who received WBRT versus 5.9 months for those who did not. The median OS for patients who underwent gross total resection was 12.5 months versus 4.2 months for patients who had near-total resection. The median OS was poor in patients who had extracranial metastases (6.6 months) compared with those who did not (12.5 months). Receiving adjuvant WBRT was the only factor which significantly influenced PFS on a univariate model (12.3 months for those who received WBRT vs 5.9 months for those who did not, p=0.034). On multivariate analysis, adjuvant WBRT (p=0.003) and extracranial metastasis (p=0.006) were the factors that significantly affected OS. Breast cohort: Within the group with metastases from breast cancer (n=45), triple negative cancers (TNBC) constituted 35.6% (n=16). Within the breast group itself, there was no statistically significant difference in the OS between patients with TNBC (12.7 months) versus the remaining patients (17.033 months, p=0.3). Similarly, there was no statistically significant difference in the PFS between patients with TNBC (11.5 months) versus the remaining patients (14.7 months, p=0.4). However, the group with TNBC did have worse OS and PFS compared with the remainder of the group. Conclusions: Surgical resection should be considered for carefully selected patients with solitary intracranial metastases without any extracranial metastases. Gross total resection should be the goal of surgery since it provides the best chance of survival. Adjuvant WBRT is mandatory for all these patients since it is the most significant factor which improves overall survival and progression free survival.

 > Abstract Id: YUGP1893 Top

: A Rare Case Report Of Premenopausal Synchronous Endometrial Carcinoma With Invasive Ductal Carcinoma Of Breast

Presenter- *Dr. DIMPY BEGUM

Co-author - Dr. Debabrata Barmon, Dr. Pankaj Deka, Dr. AC Kataki

Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days. They can be divided into synchronous or metachronous according to time interval between the diagnoses: synchronous if interval is less than or equal to six months and metachronous if interval is more than six months. Combined ovarian and endometrial cancers, is an example of a well known synchronous cancers in women, especially when both are endometrioid type. Breast cancer and endometrial cancer are commonly diagnosed cancers in women and both are commoner in older women, but diagnosis of both cancer in the same woman is extremely rare. Only few such cases have been reported. The overall survival outcomes of women who have been diagnosed with breast and endometrial cancer have been rarely reported in literature. Here, we report a case of synchronous endometrial and breast cancer in a 37 years old female. She was initially diagnosed with endometrial cancer and treated for it. During the first follow-up, she complained of lump in the breast and subsequently diagnosed to have invasive ductal carcinoma and treated for it later she developed lung metastasis. It is important that patients with a primary malignant tumour should be thoroughly, closely, and regularly followed. The effect of 1st tumour on the 2nd or vice versa are not yet fully understood. The 2nd primary tumour is usually more aggressive, treatment resistant, and metastasizes early. Therefore clinicians must be aware about such cases so that they can adopt a more aggressive treatment stratergy. Key words- synchronous carcinoma, metachronus carcinoma, endometrial carcinoma, breast carcinoma.

 > Abstract Id: YUGP1895 Top

Title: Primary  Fallopian tube More Details Carcinoma With Omental Metastasis : A Case Report.

Presenter- *Dr. Debabrata Barmon

Co-author - Dr Amal Chandra Kataki, Dr Pankaj Deka, Dr Taba Todak

Introduction Although there is no data about the incidence of Primary fallopian tube carcinoma in India but in the United States the incidence is 0.41 per 100,000 population with less than 2000 cases reported all over the world. It is said that Primary fallopian tube carcinoma (PFTC) is very difficult to diagnose preoperatively, so while treating a case of adnexal mass, PFTC should be kept in mind. Case Report Mrs SB, a 57 yrs postmenopausal lady, presented with a history of lower abdominal pain and abnormal discharge per vaginum for 6 weeks. On clinical examination she had mild pallor, Per abdominal examination revealed tenderness on the left illiac fossa, Per vaginally cervix normal, uterus deviated towards the right side with a left adnexal mass with restricted mobility, it was tender on examination. MRI examination revealed a mixed echogenic mass on the left adnexae with normal uterus. PAP smear was normal and S CA125 was 354 U/ml. Patient was taken up for exploratory laparotomy, intraoperatively uterus was normal looking with normal right sided ovary and tube. On the left side ovary was normal however the left fallopian tube was enlarged and firm in consistency with open fimbrial end. Omental nodule was detected on inspection. She had undergone Total abdominal hysterectomy along with B/L salpingooporectomy, omentectomy plus nodal dissection. The postoperative period was uneventful and she was discharged on 5th post operative day. Her final HPE revealed Primary fallopian tube carcinoma (moderately diffentiated papillary adenocarcinoma) with omental metastasis, rest of the specimen was negative for malignancy. She was taken up for adjuvant chemotherapy and she completed six cycles of Paclitaxel plus Carboplatin. At present she is on regular followup for the last six plus years without any evidence of disease. Conclusion : In spite of advanced stage, in our case we had a good prognosis propably due to the absence of lymph nodal metastasis which is one of the important poor prognostic criteria in PFTC also a complete surgical debulking along with proper adjuvant chemotherapy is the key factor in the management of PFTC.

 > Abstract Id: YUGP1903 Top

Skin Sparing Mastectomy With Immediate Breast Reconstruction €” Is It Safe? A Single-Institution Comparative Study Of 825 Patients With Long-Term Follow-Up Dr Sankar Narayanan Dr Mihir Chandarana Dr Soni Soumian Dr Sekhar Marla Mr Deepak Malhi Universit

Presenter- *Mr. Sankaran Narayanan

Co-author - Dr Mihir Chandarana, Dr Soni Soumian, Mr Sekhar Marla

Introduction Immediate breast reconstruction (IBR) after a mastectomy is a standard of care and should be offered to all eligible patients. The last decade has seen a rise in skin-sparing mastectomies (SSM) and implant-based IBR. There is a concern among clinicians that the thicker skin flaps left during SSM might increase the incidence of local recurrence, which affects overall survival in breast cancer. This study compares the recurrence rates of SSM and simple mastectomy from a single institution with a long-term follow-up. Methods A review of a prospectively maintained database of all patients treated at University Hospital of NorthMidlands Stoke UK (UHNM) who had a mastectomy with or without immediate breast reconstruction in Somerset cancer database between 2009 and 2014 was performed. Patient and tumour characteristics, treatment details and patterns of recurrence were noted. Patients undergoing mastectomy for risk reduction were excluded from the analysis. A comparative analysis of the local, locoregional and distant recurrences was performed between the two groups. Results A total of 2400 patients underwent surgery in UHNM for breast cancer of which 1467 had partial excision, and 825 had a mastectomy. 696 patients had mastectomy alone, and 153 patients had immediate reconstruction following mastectomy. 105 patients underwent SSM and immediate reconstruction and 48 patients had Immediate reconstruction with simple mastectomy. The median follow-up was 56 months. Tumour and patient characteristics of the mastectomy and SSM groups were comparable. The locoregional recurrence and distant recurrence rates in patients undergoing a mastectomy were 1.72% and 5% respectively. The corresponding figures in patients with SSM were 2.9% and 4.8%. The recurrence rates were not statistically significant. Discussion The locoregional rates of SSM and simple mastectomy are comparable in our study after a long-term follow-up, overall patients are not taking additional risk by choosing to have immediate breast reconstruction Conclusions Many large single-institution series have confirmed the above findings, but major multicentre studies have to be done with longer follow-up period to establish the safety of SSM

 > Abstract Id: YUGP1911 Top

Impact Of Oncotype Dxâ® On Mdt Decision For The Need Of Adjuvant Chemotherapy In Patients With Early Breast Cancer Dr Sankar Narayanan Dr Mihir Chandarana Dr Soni Soumian Dr Sekhar Marla Prof Rmkirby Mr Deepak Malhi University Hospital Of Northmidl

Presenter- *Mr. Sankaran Narayanan

Co-author - Dr Mihir Chandarana, Dr Soni Soumian, Professor RM Kirby

Introduction Oncotype Dx® is a validated multiple gene assay to predict recurrence and benefit of adjuvant therapy for breast cancer patients. It has been shown to reduce chemotherapy use in EBC. Financial constraint is a major barrier limiting its use in developing nations. The objective of this analysis was to study the impact of recurrence scores on pre-Oncotype adjuvant therapy decisions made by clinicians. Materials and Methods All eligible patients 680 patients with EBC treated with curative intent were discussed in University Hospital of NorthMidlands Stoke UK (UHNM) multidisciplinary breast tumour board. Oncotype DX test is recommended mainly for patients with intermediate risk with NPI 3.4 to 4.4 as per NICE guidelines. Eight patients with micrometastasis and positive nodes were also included. An initial treatment decision taken by the treating oncologist (without an Oncotype score) was documented as hormone therapy only, chemotherapy and hormonal therapy or could not decide. The decision was compared with the need for chemotherapy based on the recurrence score in the subsequent meeting. The decision of adjuvant treatment was compared pre and post-Oncotype testing. Patients with recurrence score 30 and below were not offered chemotherapy. Results Eighty-three patients had Oncotype DX test. Mean pathological tumour size was 25.8 mm. Oncotype Dx result changed adjuvant decision in 39.8% of patients. Moreover, of the patients planned for adjuvant chemotherapy, 74% did not receive it based on their Oncotype scores. Similarly, of the patients planned for hormonal therapy, 12% did receive chemotherapy as they had a high recurrence score. There were seven patients in the ‘could not decide’ group, of whom 5 (71%) needed only hormonal therapy. Eight patients had a positive node disease. Of these, only three patients needed adjuvant chemotherapy. Conclusions Oncotype Dx significantly impacts treatment decisions for adjuvant therapy in EBC. Adjuvant chemotherapy can be avoided in the majority of patients with EBC based on recurrence scores as compared to traditional clinicopathologic criteria. For individual patient avoiding unnecessary, a toxic treatment with life long side effects which would not benefit them is a huge bonus.These patients would be able to invest their time the treatments which would help them.

 > Abstract Id: YUGP1913 Top

€Œcomparison Of Psychological Outcomes In Breast Cancer Patients After Breast Conservation Surgery Versus Mastectomyâ€

Presenter- *Dr. Ankit Gangwar


Introduction: Quality of life (QOL) is an important indicator of treatment efficacy in breast cancer patients. For Early breast cancer(EBC), mastectomy is usually chosen option both by patients and doctors. Post mastectomy body image changes are often associated with decreased quality of life(QOL). The aim of this study is to compare the QOL in patients undergoing BCS versus MRM for early breast cancer Materials & Methods: 52 patients with EBC were enrolled in either group (BCS or MRM) based on informed choice by patients and followed up 2weeks (FU1) and 12 months (FU2) after surgery. Translated copies of European Organization for Research and treatment (EORTC) QLQ-C30 to measure general QOL and QLQ-BR23 for breast cancer specific symptoms were filled by patients. The parameters were analysed for both groups(BCS vs MRM) using spss24 Results: Body image (BCS 76.50+19vsMRM 71.50+20.1,p=0.01), global health (BCS 46+18.6vs MRM 39.50+17.5,p

 > Abstract Id: YUGP1915 Top

Role Of Intra-Operative Frozen Section In Defining The Extent Of Surgery In Endometrial Carcinoma: An Indian Experience.

Presenter- *Dr. Nataraj Naidu

Co-author - Somashekhar SP, Shabber S Zaveri, Vijay Ahuja

ABSTRACT Purpose: The role of frozen section in the intraoperative decision making about the extent of surgical staging is controversial. The study was undertaken to evaluate the role of the frozen section and its agreement to histopathology in determining the tumor grade and depth of the tumor invasion in carcinoma endometrium at our center Methods: A retrospective review of the 100 consecutive cases of carcinoma endometrium from Jan 2011 to October 2016 were considered. The results of the intraoperative frozen section were compared with the final histopathology report in terms of the grade of the tumor and myometrial involvement. Results: Our study results showed that, the assessment by frozen section with final histopathological grading for grade 1, grade 2 and grade 3 was found to have a sensitivity of 100%, 90% and 84.2% and a specificity of 94.3%, 90% and 97.5% respectively. However the positive and negative predictive values were 68.75%, 95.4%, 88.8% and 100%, 84.3% and 96.3% respectively. The overall agreement between both frozen section and histopathology for tumor grading and myometrial involvement was computed to 90% and 97%. On application of Kappa statistics, the value was 0.794 with a standard error of 0.062 and P=0.001, suggesting a significant and moderately high agreement between two methods. On application of kappa statistics for agreement of myometrial involvement, the value was 0.925, with a standard error of 0.043 and P=0.001, suggesting a significant and extremely high agreement between two methods. Conclusions: Our study adds to a high concordance, extremely significant agreement between frozen section and Histological grading by Kappa statistics with high sensitivity for the same, and thus the study adds on to the evidence favoring the reliance on frozen section. Key words: Carcinoma endometrium, frozen section, Indian study, kappa statsistics, myometrial involvement.

 > Abstract Id: YUGP1919 Top

Working Towards Zero Central Line Infections In Patients With Hematological Malignancies: Feasibility Of An Intensive Patient Education Based Approach

Presenter- *Ms. Vidhya Gopalakrishnan

Co-author - Dr.E.Grace Sahaya Vidhubala, Dr.Prasanth Ganesan, Mrs.Varalakshmi Vijayakumar

Background: Central Venous Catheters (CVC) can be complicated by infections (central line related blood stream infections, CLABSI) leading to increased morbidity. Patients with hematological malignancies retain CVCs for long periods, often in an outpatient setting. Central line care “bundles†have been shown to reduce CVC infections. To achieve our set target of zero-CLABSI, we planned (in addition to the strict implementation of the central line care bundle) an intensive education program to empower patients on CVC care. Methods: Patients with hematological malignancies who had CVC insertion between Mar-Jul 2015 were either provided with standard information or were intensely counselled regarding various aspects of CVC care. CLABSI rates (number of central lines infected divided by total number of central line days scaled by a factor of one thousand) were compared with the pre-implementation time period. Results: Thirty seven patients had CVC insertion during the period of which half (n=19) received intensive counseling (experimental group) and the other half received standard care (prospective controls). CLABSI rates reduced from 2.26/1000 central line days (pre-implementation period) to 0.98 and 0.85/ 1000 central line days respectively in the experimental and control groups of this study. Conclusion: Within a short observation period at a single center, an intensive patient-directed educational approach was able to greatly reduce CLABSI among patients undergoing therapy for hematological malignancies. Continued efforts are required to achieve the goal of “zero†CLABSI.

 > Abstract Id: YUGP1921 Top

Adequate Margins For Ptv Based On Set Up Errors Detected By Portal Imaging During Imrt Treatment: A Retrospective Single Institute Observational Study


Co-author - , ,

Purpose/Objective: To present our experience and results in the daily portal imaging during intensity modulated radiation therapy (IMRT) for various sites treatment and detecting adequate margins for PTV based on results. Materials/Methods: During simulation three fiducial markers were placed at appropriate sites prior to CT-based treatment planning. CT-simulation was performed and an orthogonal pair (anterior and lateral) of digitally reconstructed radiographs (DRR) was generated. Field borders and anatomical markings were drawn on the DRRs. Prior to radiation treatment in Elekta Synergy platform Linear accelerator, portal images were taken both anteriorly and laterally with 4MV energy (Initially on three consecutive days and then based on average set up errors of the initial 3 days).These were compared to that of the DRRs. Quantitative measurements of the set up errors were made by manual correction and anatomical matching. Shifts of 3 mm or more were corrected with couch adjustments and an additional portal image was taken prior to treatment delivery to confirm the adjustments. The frequency, range, and average set up errors were analyzed for each site. The time required to deliver therapy was measured for each sites. This retrospective analysis enabled us to calculate PTV margins for different sites. We also aimed to determine whether the percentage of weight loss over course of treatment correlated with average set up errors. Correlation between different sites and average set up errors were analyzed. Results: A total of 228 patients were analyzed. A 1500 total of portal images were analyzed and compared to their corresponding DRRs. The average set up error for head & neck, pelvis &abdomen , thorax and brain were as follows : 2.5mm lateral(y), 2mm cranial-caudal(z) ,3mm anterior-posterior(x);3.5mm,3mm&4mm;3.5mm,3mm&4mm;1.5mm,1.5mm&1.5mm respectively. More than one portal image was often required for matching with an average of 1,2.5,2&1images taken per treatment time for head & neck, pelvis ,abdomen , thorax and brain respectively. The average time elapsed during filming per treatment fraction was 4.6minutes (SD5.6). The average time elapsed during filming and couch adjustments, when required, was 6minutes (SD 7).We calculated mean percentage weight loss for all patients over the course of treatment and compaired average set up error to percent weight loss. Conclusion: This retrospective analysis helped us to calculate PTV margins for head and neck, pelvis& abdomen thorax and brain by finding the setup errors using portal imaging. We calculated correlation between treatment site and average set up errors. We also compared correlation between averages set up error to percent weight loss.

 > Abstract Id: YUGP1925 Top

Cancer Patterns, Risk Habits, Treatment, And Follow Up Rate Of Tribals At A Tertiary Cancer Care Centre In Northern Kerala, India -A Retrospective Analysis.


Co-author - Dr.Saina Sunil Kumar, Bindu.T, Ratheesan.K

BACKGROUND: The purpose of this study is to compare the socio-demographic, risk habits, cancer patterns, acceptance of treatment and follow up rate of tribal cancer patients with the total patients registered. To assess the association between life style habits, duration of addictions and site of tumour. MATERIALS AND METHODS: A semi structured questionnaire used to collect patient’s information from medical records division of the hospital. The demographic and lifestyle related information are collected at the time registration. Used SPSS and Excel for data analysis. RESULTS: Malabar Hospital based cancer registry of 2014 report showed a total of 4042 cases (Males-52.9% and Females-47.1%) out of which 70 cases (1.8%) belonged to tribal population. Leading cancer in the total patients registered was among males lung(20.7%) and in females breast cancer (31.5%).Whereas among the tribals the leading site in both the sexes was mouth(Males -19.4% and Females-29.4%).Predominant between the age group 35-64yrs(Males-52%,Females-61%) in total patients ;but among the tribals between 35-64yrs (Males -55.5%, Females-88.2%).Data under evaluation .Results pending. CONCLUSIONS: There is a significant variation on cancer patterns, addiction habits and other demographic parameters of tribal people with the total patients registered in the hospital. KEY WORDS: Cancer patterns, demographics, risk habits, follow up, tertiary cancer centre.

 > Abstract Id: YUGP1927 Top

External Beam Radiation Therapy To Hepatocellular Carcinoma Involving Inferior Vena Cava And/Or Right Atrium: A Meta-Analysis And Systemic Review

Presenter- *Dr. Chai Hong Rim

Co-author - , ,

Introduction Heptatocellular carcinoma (HCC) involving inferior vena cava (IVC) and/or right atrium (RA) is a rare but serious clinical condition. It is a therapeutic challenge with a possibility of systemic complications. External beam radiotherapy (EBRT) has been performed to palliate venous invasion and/or primary HCCs. The objective of this meta-analysis was to review the published studies about EBRT performed for HCCs with IVC and/or RA invasion and assess its efficacy and safety. Materials and Methods Systematic search of Pubmed, MEDLINE, EMBASE, and Cochrane library published was performed. Primary endpoints were 1-year overall survival (OS) rate and 2-year OS rates. Secondary endpoints were response rate, local control (LC) rate, and grade >3 toxicities. According to heterogeneity evaluated with Cochran Q test and I2 statistics, meta-analysis was performed using either random or fixed model to calculate aggregated OS, LC, and response rates. Results A total of 8 studies and 9 cohorts were included, encompassing 164 patients. The number of patients in the included studies ranged from 5 to 42. Pooled 1- and 2- year OS rates were 53.6% (95% CI: 45.7 — 61.3%) and 34.4% (95% CI: 27.2 — 42.4%), respectively. Pooled response rate and LC rate were 59.2% (95% CI: 39.0 — 76.7%) and 91.7% (95% CI: 78.8 — 97.1%), respectively. Only one study reported grade >3 toxicities, which are a pulmonary embolism and an esophageal rupture cases. No grade >3 toxicities were reported in other studies; the overall rate of grade >3 complications was 1.2% (2 of 164). Conclusion Application of EBRT for HCC with IVC and/or RA invasion was safe with satisfactory survival rate. An active treatment including local therapy should be considered without excessive concerns about systemic complications.

 > Abstract Id: YUGP1935 Top

An In Vitro Study Of The Cytotoxic And Anticancer Effects Of A Secondary Metabolite From Penicillium Sp. Ju9

Presenter- *Ms. Prerana V

Co-author - Varalakshmi K.N., ,

Filamentous fungi such as Penicillium are one of the most incredible chemical factories known today. Accordingly, numerous bioactives such as mycotoxins, antifungal and anticancer agents have been reported in the literature in the last 100 years. It has been estimated that approximately 1.5 million or likely as many as 3 million fungal species exist on Earth, of which only around 100,000 species have been described so far. A multitude of new species are likely to be discovered from diverse habitats, such as tropical forest plants and soils, associated to insects and in the marine environment. Anticancer agents from microbial sources are gaining importance based on their safety and efficacy and also based on the broad range of novel metabolites produced by them. In the present study, the cytotoxic and anti-cancer potential of a bioactive compound from a Penicillium sp. isolated from soil was assessed on HeLa, HepG2 and MCF-7 cell lines. The purified compound was tested for its cytotoxic and anticancer potentials by MTT assay on all three cancer cell lines at varying concentrations (1, 10 and 25 Âμg/ml). The percentage viability of the purified compound was found to be the least at 66.9 % for HeLa, 55.7 % for HepG2 and 56.93% for MCF-7 cell line at 48 h treatment period. The bioactive compound was further subjected to other in vitro assays such as DNA Fragmentation, LDH, Caspase activity, cell cycle analysis by flow cytometry and clonogenic assay to confirm its anticancer potential. The fraction was also tested on normal healthy lymphocytes which revealed the non-toxic effect of the fraction expressing a percentage viability of 112% limiting the cytotoxic effect of the bioactive fraction only to cancer cells. This bioactive compound needs to be characterized for future anticancer applications.

 > Abstract Id: YUGP1939 Top

Transhiatal Oesophagectomy €” A Single Institute Experience

Presenter- *Dr. Suresh M

Co-author - , ,

TRANSHIATAL OESOPHAGECTOMY — A SINGLE INSTITUTE EXPERIENCE Authors: Dr. ARULRAJ. P*, Dr. SURESH. M *Corresponding Author: HOD, Dept. of Surgical Oncology, V.N.Cancer Centre, G.Kuppuswamy Naidu Memorial Hospital, Pappanickenpalayam, Coimbatore — 641 037 BACKGROUND: The optimal approach for Carcinoma at lower Oesophagus and OG Junction remains controversial. Despite Oncological advances, Surgical resection is the only treatment that has repeatedly been shown to prolong survival, albeit in only 30% of patients. Transhiatal oesophagectomy is often advocated as the preferred surgical approach in patients with early tumours (or) the patients with more advanced disease who would not tolerate a thoractomy. Transhiatal oesophagectomy has been favoured operative approach in our Institution for managing on carcinoma of oesophagus below the level of carina and type I and type II tumours of OG junction AIM OF THE STUDY: The aim of the study was to assess a single unit experience and outcome of transhiatal oesophagectomy in an era when the use of systemic oncological therapies has been increased dramatically. MATERIALS AND METHODS: Between July 2008 and December 2016, 204 consecutive patients (116 males, 88 females, median age = 57 years) underwent transhiatal oesophagectomy. A further 13 patients underwent transthoracic oesophagectomy during the same period and were excluded from analysis. Invasive Squamous Cell Carcinoma in 117 patients, Adenocarcinoma in 83 patients, malignant melanoma in 1 patient and adeno squamous cell 3 patients. 89 patients received Neo adjuvant chemotherapy. RESULTS: There were no operative and peri operative mortality within one month after surgery. Major complications included: Respiratory complications in twenty three patients, clinically apparent anastomotic leak in sixteen patients, recurrent laryngeal nerve neuropraxia in eleven patients and hiatus hernia in five patients. Median length of hospital stay was 10 days. Ro resection was achieved in all patients except in eleven patients who had multicentric disease. CONCLUSION: Transhiatal oesophagectomy is an effective operative approach for tumours of the infra carinal oesophagus and the oesophagogastric junction. It is associated with low mortality and morbidity and two year survival rate of nearly 50% when combined with neoadjuvant chemotherapy.

 > Abstract Id: YUGP1941 Top

Breast Cancer In Young Women €” Special Attention Needed.

Presenter- *Dr. Pooja Agarwal

Co-author - Dr.Sanjit Kumar Agarwal, Dr.Rosina Ahmed,

Background: Although the overall incidence of breast cancer in India is low compared to Western countries, breast cancer in young women (YBC) (<40 year) is relatively frequent. YBC has different pathological features and a relatively unfavorable outcome. The aim of this study was to analyze clinico-pathological characteristics and outcomes in YBC. Materials and Methods: Data for YBCs treated in a tertiary care cancer center in Eastern India from June 2011 to June 2015 was analyzed. Clinical, pathological and outcome data was retrieved from the institutional database and analyzed by SPSS 23. Results: Of 1825 patients, 242 (13.6%) were <40 years, 45 were lost to follow up and 197 were included in study. The median tumor size for YBC was 4 cm (IQR 2.5, 5.5), compared to 3.2cm (IQR 2,4) for older women. At presentation, the proportion in stage 0, 1, 2, 3 & 4 were 2.5%, 3%, 32%, 53.5% and 9%. Invasive ductal carcinoma (92%) was the most common histological type. 65% of tumors were grade 3, 30% were ER negative, and 31% were HER2 positive. Of women treated curatively, 48% had surgery first, 52% received neoadjuvant Chemotherapy (NACT). Breast?conserving surgery (BCS) was performed in 61% of patients. 59/72 (87.5%) eligible patients received adjuvant chemotherapy & only 9/60 (15%) of HER 2 positive patients received Trastuzumab due to financial constraints. 143 (92%) patients received postoperative radiotherapy. All ER and/or PR positive patients received endocrine therapy. At 3 years median follow up, 29 patients had expired and 51 were alive with recurrences. Projected Disease Free Survival was 77% at 5 years & Overall survival was 83% at 3 years. CONCLUSIONS: With high risks of recurrence and inferior OS, YBCs need special attention for early diagnosis, and financial support for appropriate treatment in Indian subcontinent.

 > Abstract Id: YUGP1942 Top

Correlates Of Cancer-Related Stigma In The Community In Two Major Cities Of India: Data From The Carrs Study

Presenter- *Prof. Shivani Patel

Co-author - Preet Dhillon, Dipika Bumb, Theresa Gillespie

Background: The burden of cancer in India is growing. Cancer-related stigma may limit use of screening and treatment and thus contributes to worse prognosis after diagnosis. Objective: We examined the correlates of four measures of stigma in the general population of adults in Chennai and New Delhi. Methods: We analyzed data from 5497 participants aged 24-98 years surveyed in 2016 for the fourth follow-up of the community-based, representative Cardiometabolic Risk Reduction in South Asia Surveillance Study (CARRS). Cancer-related stigma was assessed through: unwillingness to share a hypothetical cancer diagnosis to neighbors, belief that cancer could spread from person to person contact, reluctance to eat meals with someone with cancer, and belief that cancer was caused by past sins. We used linear probability models to estimate the association (prevalence differences [PD]) of sociodemographic factors with stigma measures, accounting for survey design. Results: Respondents were 52.0% women, mean age of 42.7 (SD=13.1) years, and 20% had at least a college education. Prevalence (%) ± standard error estimates of the cancer stigma measures were: 46.8±5.4 unwillingness to share diagnosis; 6.4±0.8 avoidance of someone with cancer; 5.8±0.9 belief that cancer can spread from person to person; 4.6±0.7 belief that cancer was retribution for a past sin; and 52.3±4.8 any measure. Among residents of Chennai compared with Delhi (reference), unwillingness to disclose a cancer diagnosis was substantially higher (PD=86.0%; p

 > Abstract Id: YUGP1944 Top

Feasibility Of Sparing Lung And Other Thoracic Structures With Intensity Modulated Radiotherapy, Rapid Arc And 3D Conformal Radiotherapy For Locally Advanced Non—Small-Cell Lung Cancer Treated With Concurrent Chemoradiotherapy

Presenter- *Dr. REJIL RAJAN


Purpose/Objective: To compare dosimetric improvements with respect to normal tissue sparing using Rapid Arc, intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy (3D-CRT) for locally advanced-stage non-small-cell lung cancer (NSCLC) treated concurrently with chemotherapy. Materials and methods: A retrospective treatment planning study was performed to compare IMRT, Rapid Arc, and 3D-CRT for 10 locally advanced NSCLC patients treated concurrently with chemotherapy. 10 patients who had previously undergone 3D CRT were selected. In IMRT plans, three to nine coplanar beams were designed to treat 95% of planning target volume with 60 Gy. Planning was done accordingly to minimize the volumes of normal lung, heart, esophagus and spinal cord above their tolerance doses The plans are compared with respect to DVH parameters such as total lung V5, V10, V20, Mean lung dose, Esophagus V45, Heart V45, Spinal cord maximum dose. For statistical analysis, all dosimetric results from different irradiation techniques were compared with each other. The paired, two-tailed Wilcoxon signed-rank test was applied. Results were considered statistically significant with p < 0.05. Result: Compared to 3D CRT, in the IMRT the median absolute reductions of total lung V20, V10, V5, Mean lung dose are 3%, 6%, 4.5% and 1.5 Gy respectively. All these differences are statistically significant (p value 5, >10, >20 Gy. Heart, Esophagus V45=% volume at 45 Gy. Data presented as the median, with the range in parentheses. Total Lung DVH= (left lung + right lung)-PTV Conclusion: It is possible to reduce the volume of normal lung irradiated by IMRT and Rapid Arc as compared to 3D CRT. But normal lung Dose-Volume parameters are similar in IMRT and Rapid Arc. There is no advantage of one technique over another. To spare heart and esophagus, IMRT and Rapid Arc both are useful but Rapid Arc has dosimetric advantage for Heart. But further clinical trials are required to assess whether the dosimetric advantages of modern techniques (IMRT, RA) over 3D conformal techniques are clinically significant or not. # The Authors doesn’t have any conflicts of interest # Copyright given to ICC 2017/AROI by first author and all co-authors.

 > Abstract Id: YUGP1948 Top

Functional Relevance Of Dna Damage Response In Obesity Associated Colon Cancer


Co-author - , ,

Cancer is characterized by abnormal cell division and is mainly attributed to genetic lesion. In 2012, 14.1 million new cancer cases were diagnosed and 8.2 million deaths were recorded. By 2030 new cases of 21.7 million and 13 million deaths are expected. An important factor which has been consistently considered to have an association with cancer is obesity. According to National Institutes of Health, Obesity and overweight are second leading cause of death in United States, after tobacco use as first cause of death. The risk of developing colorectal cancer in an obese individual is 1.5-2 times higher than normal. Chronic inflammation, serum factors and oxidative stress in obese individuals pave the way for carcinogenesis, creating imbalance in DNA Damage Response (DDR) and cell cycle regulation. Increased level of Reactive oxygen species (ROS) leads to high oxidative stress by-products. Based on previous information we hypothesized that in case of obesity, DDR plays a key role in carcinogenesis. We investigated the DDR by cell cycle regulatory molecules in High Fat Diet (HFD) and Normal Diet (ND) fed mice serum treated colon cancer cells. This study throws light on functional relevance of DNA damage and repair events in obese condition and its role in colon carcinogenesis and the mechanism underlying in this process might provide therapeutic target for treatment of cancer in obese condition.

 > Abstract Id: YUGP1954 Top

Ovarian Teratoma With Malignant Transformation €” A Rare Case Report

Presenter- *Dr. Helen Kamei

Co-author - Dr. Debabrata Barmon, Dr. Pankaj Deka, Dr. AC Kataki

Mature cystic teratoma is the most common ovarian tumor in both adolescents and women of reproductive age group. Most of these are usually benign and treated surgically. Mature cystic teratoma with malignant transformation is a rare complication. Malignant transformation has been reported in 0.17% to 3% cases. Its appearance depends on age, size of tumor, levels of serum tumor marker. Squamous cell carcinoma is the most frequent histology arising in mature cystic teratoma. While most patients show no signs or symptoms, abdominal discomfort, palpable mass and pain can occur. Malignant transformation typically occurs in post menopausal women. A 33years old female was referred as a case of ovarian teratoma with abdominal swelling. She was pregnant with ovarian tumor and during caesarean section, ovariotomy with omental biopsy were done. Post delivery she noted gradual swelling of abdomen for which she was referred to our Institute. Slides review noted mature cystic teratoma with omental biopsy reading squamous cell carcinoma. Diagnosis and treatment of such cases present a big challenge to clinicians not only because it is a rare entity but also due to aggressive course of such entity. Preoperative diagnosis is difficult. Due to rare nature, there is lack of data on optimal treatment and hence, appropriate adjuvant therapy has not been systematically assessed. Reported cases have a role in that,collective data may help in understanding and adoption of an effective treatment to counter such rare and lethal entity.

 > Abstract Id: YUGP1958 Top

Profiling And Documenting The Information Gap Amongst Gynecological Cancer Patients In An Apex Institute Of North India

Presenter- *Dr. Amudeep Singh

Co-author - Vanita Suri, Sushmita Ghoshal, Sukhpal Kaur

Background: Gynecology OPDs of tertiary care hospitals are usually overburdened with patients. Doctors are not in a position to provide quality counseling to cancer patients. This compromises the quality of care. Objectives: To document pattern and profile of gynecological cancer cases admitted in PGIMER, Chandigarh To identify information gap in cancer patients and care givers reporting at Gynecology OPD of PGIMER, Chandigarh Methods: Profiling was done by taking retrospective data of five years (2012-2016). Information gap was identified by conducting case studies on common problems faced by patients during and after therapy. A prototype of Self Instruction Manual (SIM) was developed to counsel cancer patients and their care givers. The SIM was then circulated amongst experts for validation. Results: At PGIMER maximum gynaecological cancer case load is seen from Punjab (37%), followed by Haryana (22%), Chandigarh (16%), HP (15%) and others (10%). A total of 3973 patients got admitted out of which 95 died in hospital only. Among gynecological cancers, majority were cervical cancer (63%) followed by ovarian cancer (22%), uterine cancer (12%), vulval cancer (2%) and vaginal cancer (1%). Average length of stay was of 5.22 days. Maximum (56%) cases were 40-60 years old. No significant co-relation with socio economic status was seen. Case study 1: A 38 year old educated cancer uterus woman was not aware why her uterus was removed. She was worried about the risk of recurrence and spread of cancer. Case study 2: A 16 year old schoolgirl with cancer ovary and her mother were anxious about the complications of surgery and its impact treatment on fertility. Case study 3: Another 72 year old woman undergoing radiotherapy for cancer cervix was scared about the side effects of treatment. She was also not aware about the diet she should take. A definite information gap was seen among patients and their care givers. Accordingly a protocol was evolved and tried in a special counseling room in Gynaecology OPD where their queries were successfully resolved. Conclusion: It is feasible (and there is an urgent need) to establish a special room in hospitals where cancer patients and their care givers can be counseled.

 > Abstract Id: YUGP1960 Top

Interaction Of Fat1, Hif1A And P53 In Glioma Progression

Presenter- *Dr. Srinivas H

Co-author - Nargis malik, Yakhlesh Gupta, Chitrangda Srivastava

Background: FAT1 is a transmembrane protein and function as an adhesion molecule. FAT1 gene is located on chromosome 4q35.2 encoding a 506KDa protein. The role of FAT1 in tumors is not fully characterized. Few reports suggest it behaves as a tumor suppressor and few reported it as oncogenic. Here in our study we are characterizing the role of FAT1 in primary brain tumors. There are studies showing altered expression of FAT1 in human gliomas with ~30% of them showing LOH at the FAT1 locus. TP53 is mutated in 50% of primary brain tumors. P53 being a transcription factor, regulates the expression of a number of target genes including regulating biological functions such as cell cycle arrest, apoptosis, senescence, differentiation and antiangiogenesis. Glioma is known to have hypoxic environment in its tumour core and hypoxic tumour micro environment and HIF1A is believed to play role in tumour progression . So, in this study we are analysing the interaction between FAT1, P53 and HIF1A in glioma progression. Methodology: In order to delineate molecular crosstalk among factors driving glioma progression, we used knockdown and overexpression strategies in glioma cell lines followed by expression analysis by Q-PCR, Immunofluorescence and Western Blot. Migratory potential of cells was assessed by Migration assay and invasion potential were assessed using Matrigel invasion assay and images were captured using Nikon fluorescence microscopy and confocal microscopy. For cell proliferation and viability assay MTT/XTT were used. Cell cycle analysis was carried out using PI staining in Flow cytometry (BD canto FACS) Sample Collection: - Glial tumor samples were collected from Department of Neurosurgery/Pathology of All India Institute of Medical Sciences, India. Tissue were collected in 1 ml of RNA-Later solution and incubated for 24 hours at 4°C. After removing RNA-Later solution the tumor tubes were immediately stored at -70°C till further use. For the control, normal human brain RNA was purchased commercially. Transfection of cell lines: - 1) For Knockdown: Selection of target siRNA and corresponding control- We have been using commercially available siRNA (Invitrogen) for FAT1 knockdown in our lab. FAT1 and control siRNA Oligos are designed by Genscript siRNA construct builder software(http://www.genscript.com/siRNA_construct_builder.html). 2) FAT1_trunc (Truncated FAT1) transfection: plasmid containing truncated FAT1 gene in pcDNA vector 3.1 was used (gifted by Dr Timothy A Chan). Truncated FAT1 plasmid contains first two repeats of cadherins at N terminals and around 22 repeats of cadherins are removed retaining last few cadherin repeats along with intercellular region of FAT1 gene. The vectors is tested for its expression and also known to retain all its functions. Transfection is carried out for 48 hr. Empty vector PCDNA is used as control. Transfection was carried out after plating 40000 to 50000 cells in 6 well plates for U87MG cells line and 1.2-1.5 lakhs cells for GOS and U373 Cell lines. The total duration of transfection was 72 hr (excluding plating) for knockdown and 48 hr for overexpression experiments. Hypoxia exposure was given with 0.2% oxygen for 48 hr After transfection following experimental techniques were done â€Â¢ MTT/XTT assay - For Cell survival â€Â¢ Flow cytometry- For Apoptosis assay/cell cycle analysis â€Â¢ RNA isolation and lysate preparation- For pathway(s) analysis by Real-Time PCR and Western blotting. â€Â¢ Migration and invasion assay — BD Matrigel â€Â¢ ICC Results Hypoxic treatment exhibited a significant increase in expression levels (7 to 9-fold) of FAT1 in U87MG, U373MG and GOS3 glioma cell lines. On FAT1 Knockdown under severe hypoxia, P53 and HIF1A expression was decreased and on Fat1 Knockdown under normoxia the expression of p53 and HIF1A was increased. The downstream targets of P53 (Noxa, Puma, p21 and MDM2) and downstream targets of HIF1A (VEGF, Ca9, GLUT1 and PGK3) also showed similar trend as p53 and HIF1A. On western blot analysis, protein levels of HIF1A and p53 showed increased levels after FAT1 knockdown under normoxia and no significant change was observed under FAT1 Knockdown in hypoxia. Our array data showed differential gene expression on FAT1 after knockdown. We observed reduction in HIF1A expression after FAT1 Knockdown under hypoxia and increased p53 and HIF1A on FAT1 Knockdown under normoxia. Increased in FAT1 expression under hypoxia and reduction of HIF1A after FAT1 Knockdown seems to suggest a direct link of FAT1 and HIF1A. Further, on subjecting U87 MG (grade IV GBM cell line) to hypoxia, we observed the shift in subcellular localization of FAT1 from perinuclear and plasma membrane location to inside the nucleus on ICC experiments suggesting FAT1 itself act as a transcription factors or help other transcription factors to increase or decrease gene expression involved in hypoxia and tumour progression. On over expressing FAT1 trunc we observed increased p53 [removed]1.49 fold) in normoxia and 1.87 fold increase under hypoxia (0.2%O2). MDM2 (downstream target gene of p53) also increased after FAT1 over expression by 1.629 fold in normoxia and 1.42 in hypoxia. We also observed elevated HIF1A in U87 and GOS3 along with their downstream molecules. RNA was isolated from histopath positive glioma grade IV tumors samples and gene expression analysis was performed in 18 tumour samples. We observed in GBM patients samples a positive correlation between FAT1 expression and P53 (r2 0.723 p=0.0029) and positive correlation of p53 with HIF1A (r2 =0.620, p=0.0106) and correlation of FAT1 expression with HIF1A showed r2 0.44, p=0.063. The expressions correlating analysis for patient samples and qPCR analysis of glioma cell lines suggests an existence of an intermediary molecule connecting the HIF1A and p53 regulation by FAT1. We examined p300 a co transcription factor necessary for both p53 and HIF1A transcription activity. P300 is upregulated when FAT1 is knockdown under normoxic condition. Absence of FAT1 (knockdown) under normoxia in U87MG cell lines increased p53 (1.7fold) and HIF1A (1.5 fold) and also p300 (1.8 fold). Increase in P53 in FAT1 Knockdown under normoxia is due to C/EBP beta. C/EBP is a known transcription factor and has two binding site in p53 promotors and C/EBP beta expressions is increased on FAT1 knockdown under normoxia to 1.56 fold. HIF1A being onocogene should promotes proliferation/migration and invasion but in our study we observed decreased in migration and invasion (Matrigel assay) and decreased in proliferation (MTT/XTT cell proliferation assay) and increased in apoptosis (Annexin FITC and PI flowcytometry assay) and increased Sub G0 population (PI cell cycle assay) on Knock down of FAT1 in normoxia. Increased p53 and its downstream genes after FAT1 Knockdown activated p300/p53 combination over p300/HIF1A resulting in decreased oncogenicity in normoxia in absences of FAT1. On other hand after FAT1 over expressions we observed decreased p300 and decreased p53 and its downstream and increased migration/invasion and viability. The cell viability was 74.61 % after FAT1 over expression compared to control under normoxia. In hypoxia, the cell viability was increased after FAT1 over [removed]91% compared to control). Migratory properties also showed significant increase in over expression sample (4.19 times) then mock control under normoxia. This observation points to the critical and important role of FAT1 in cell migration. In conclusion FAT1 plays an oncogenic role in glioma and HIF1A and p53 plays and important role. The exact mechanism involved in the oncogenesis by FAT1 is under study. Keywords: FAT1, HIF1A, P53, Glioma.

 > Abstract Id: YUGP1962 Top

Interobserver Variation Of Volume And Mean Dose In Parotid Gland Delineation €” A Study Of Its Impact On Imrt Planning In Radically Treated Head And Neck Cancers

Presenter- *Dr. Sanjay Hunugundmath

Co-author - Sumit Basu, Bhooshan Zade, Amit Nirhali

Interobserver variation of volume and mean dose in parotid gland delineation — A study of its impact on IMRT planning in radically treated head and neck cancers Sanjay M H1 ,S Basu1, B Zade 1, A.Nirhali2 ,V Sathiyanarayanan2 1 Department of Radiation Oncology, Ruby Hall Clinic, Pune/India 2Department of Medical physics ,Ruby Hall Clinic, Pune/India OBJECTIVE Consistent delineation of parotid has become important in the growing era of highly conformal and adaptive radiotherapy techniques. This study investigates the interobserver variation of volume and mean dose in parotid gland delineation with its impact on IMRT, in head and neck cancers. METHODS AND MATERIALS The CT volumetric data sets of 20 patients with oropharyngeal Squamous cell carcinoma who had been treated with parotid sparing IMRT were used. Three radiation oncologists and 2 radiologists delineated the parotid gland, which was spared using IMRT. The dose volume histogram (DVH) for each study contour was calculated using the IMRT plan actually delivered for that patient , which inturn was compared with the original DVH obtained when the plan was used clinically RESULTS 100 study contours were analysed. The mean parotid dose achieved during the actual treatment time was within 10% of 24 Gy . Using this cutoff constraints for study contours , the mean parotid dose obtained was within 10% of 24 Gy for only 40% of volumes by radiation oncologists and 45% of volumes by radiologists .We found that there was 35% variation in volume delineated by radiologists and 28% variation in volume contoured by radiation oncologists.There was a significant variation of the study contours from those used clinically , to an extent that different IMRT plan would have been produced. CONCLUSION Interobserver variation in parotid gland delineation is significant and is due to many regional causes. Measures to reduce this variations like adherence to guidelines, joint delineation review sessions are needed , to improve the interobserver consistency, the delineation practice , which inturn helps to standardize patient treatments. Keywords — Interobserver , Radiation Oncologist, Radiologists, Mean parotid dose, Dose volume histogram.

 > Abstract Id: YUGP1964 Top

Risk Factors Assessment Of Cervical Lymph Nodes Metastases In Cases Of Squamous Cell Carcinoma Of Oral Cavity

Presenter- *Dr. Gajendra Anuragi


Head and neck cancers account for significant burden of cancers in India . Amongst head and neck cancers ,oral cavity cancer is the most common with Squamous cell variety . India has the highest rate of oral cavity cancer of any country of Asia. This study was conducted on 140 patients of oral cavity cancer from 2014 to 2015 attending a tertiary center to find out proportion of lymph nodes metastases positivity in oral cavity cancer, to determine association between various clinico-pathological features of oral cavity cancer with neck nodes metastases and to measure risk ratio for lymph nodes metastases in oral cavity cancer. All 140 patients underwent surgical excision with neck dissection and then study of pathological features of biopsy was done. Seven variables were studied and then association with cervical lymph nodes metastases were find out. Our study suggested that smoking and chewing tobacco are strong risk factors in the development of oral cavity cancer. The habit of chewing betel nut leaves rolled in lime & tobacco known pan [Betel Quid] results in prolonged contact of the carcinogens with buccal mucosa & is thought to be the principal cause of oral cancers in India. Most of the cases were 41-50 years of age. Most of the cases were smokers 76(54.3%). Male female cancer ratio was 3.37:1, thus male were more commonly affected due to higher rate of tobacco abusing in India. In clinicopathological features clinical tumor size, tumor grade ,tumor thickness, inflammatory infiltration, intravascular invasion , perineural invasion and tumor interphase were studied and it was found that increase in T-staging, tumor thickness, poorly differentiated tumor , intravascular invasion and perineural invasion lead to more propensity of tumor to cervical lymph nodes metastases while well differentiated tumor and tumor interphase other than uniform front had less propensity to cervical lymph nodes metastases. In this study ,60 out of 140 {42.85% }cases had cervical lymph node metastasis. The status of cervical lymph nodes is one of the prognostic factors in oral cavity cancer. No gold standard exist , except the histopathological examination to identify nodal status .

 > Abstract Id: YUGP1966 Top

Initial Experience Of Complete Cyto Reductive Surgery (Crs) With Hyperthermic Intraperitoneal Chemotherapy (Hipec) From A Tertiary Cancer Care Centre In India

Presenter- *Dr. M D RAY


Initial Experience of Complete Cyto reductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) from a Tertiary Cancer Care Centre in India M D Ray, Seema Singh, Ashutosh Mishra, S.V.S Deo, N.K Shukla Introduction; Peritoneal metastasis in intraperitoneal visceral malignancies was earlier thought as incurable terminal disease but with the advent of Cytoreductive surgery and Hyperthemic Intraperitoneal chemotherapy (CRS+HIPEC) in the recent past, the approach to such cases have been changed with better oncological outcomes and acceptable morbidities and mortality. Materials and Methods: A prospective study was conducted between January 2015 to January 2017 in the department of Surgical Oncology at AIIMS; New Delhi. A total of 55 patients underwent CRS + HIPEC procedure at our centre. Preoperative assessment for cytoreduction was done using contrast CT-scan of the abdomen and PET scan as indicated. All procedures were performed by the same surgical team. After cytoreduction, HIPEC was performed by semi open method where different chemotherapeutic drugs were instilled and circulated in peritoneal cavity at the core temperature of 42 0C for 60 min . Results: Median patient age was 46 with 14.55 % male and 85.45 % female (F:M; 5.87). Majority (90.91 % were Performance status (ECOG 1 ) and remaining were ECOG 2. Median PCI was 7.5 (5-21). Ovarian cancers comprising the commonest one inclusive of both primary, after NACT and recurrent cases;65.45%; followed by Carcinoma Colo rectum, Pseudomyxoma peritonei , Peritoneal mesothelioma and Carcinoma Appendix in decreasing order. Fifty ( 90.91%) patients had a complete cytoreduction(CC 0) and acceptable cytoreduction (CC1)was achieved in 9.09% cases. Median duration of CRS and HIPEC was 7.3 hrs and patients were discharged after a median hospital stay of 7 days. Nausea and vomiting was the most common complication in early post operative period; followed by deep venous thrombosis in 10.09%, paralytic ileus in 9.09% and subacute intestinal obstruction in 5.45% cases in late post operative period. Most common cause of readmission was subacute intestinal obstruction (9.09%), which was managed conservatively. Three ( 5.45%) patients died in early postoperative period due to cardiopulmonary compromise . Seven ( 12.73%) patients developed recurrence ( local, 7.27%; local and systemic in 3.64%; systemic in 1.82%) which were managed either by systemic chemotherapy , surgery or palliative chemotherapy. Conclusion: Our initial results indicate that CRS + HIPEC procedure can be performed with acceptable morbidity however diffuse peritoneal disease is a predictor of high incidence of recurrence. Appropriate case selection by a multi-disciplinary team is vital to achieve complete cytoreduction and expected outcomes. Key words- peritoneal carcinomatosis, cytoreduction , hyperthermic intraperitoneal chemotherapy.

 > Abstract Id: YUGP1976 Top

Diffuse Intrinsic Pontine Glioma

Presenter- *Ms. TANVI GUPTA

Co-author - Tanvi Gupta, barbiegupta95@gmail.com, Sanjeev Singh, sanjeev.15935@lpu.co.in,

Review on: An Idealistic Approach of Diffuse Intrinsic Pontine Glioma Tanvi Gupta*, Sanjeev Singh School of Bioengineering & Biosciences, Lovely Professional University, Jalandhar, Punjab-144411 Diffuse Intrinsic Pontine Glioma (DIPG) affects the children at any infancy in the childhood. The diagnosis of DIPGs reports for 10% of Central Nervous System (CNS) tumors originating in the area of brain’s Glial tissue called Pons which governs the eye activity, gesture movements, breathing, blood pressure and blood rate. The tumor’s prevalence is still limitless but the statistics propounded 300-400 children are spotted with DIPG year after year. Authenticated competent medication method in DIPG debris Radiation Therapy. As long as for the larger part of the convalescent, this medication method is sole of short term effect. Modernistic Development in the era of molecular biology of DIPG have embossed unaccustomed belief moreover unlocked different boulevard for curative opportunities. Keywords: Infant cancer, DIPG, Radiation, Pons. Correspondence: barbiegupta95@gmail.com

 > Abstract Id: YUGP1988 Top

Trismus-Exercise Prescription And Its Influence On Quality Of Life

Presenter- *Mr. Madhavan Sasidharan Satish

Co-author - Srinivasan Vijay, Anitha.D, Ashwin

BACK GROUND: In south central asia cancer of oral cavity ranks among the three most common types of cancer. In India the age standardised incidence of oral cavity cancer is 12.6/100000 population1. Mouth opening of 35mm or less is regarded as trismus. Radiationtherapy induced fibrosis in head and neck area is identified as one of the most common causes of trismus2. Currently there is no standardised treatment for trismus. Exercises, several jaw mobilization devises and stretching techniques are available but their effectiveness on trismus is still largely unknown. AIM: The aim of this study is to analyse the effect of exercise therapy on trismus among oral cavity cancer patients and its influence on quality of life. METHODOLOGY: Oral cavity cancer patient (stage I to 1VA), (n=69) aged between 18 to 65 planned for chemoradiation therapy were assessed for trismus and QOL on 4 occasions — from baseline before treatment at the time of diagnosis, 3rd week of treament, at treatment completion(chemoradiotherapy) and at 6 months follow-up, using RTOG trismus scale and cancer institute quality of life questionnaire. Patients with trismus were treated with cancer Institute mouth opening exercise protocol. Results analysed using student ‘t’test, RMANOVA and chi square test. RESULTS & CONCLUSION: 8% of the patients had trismus before treatment.42% developed trismus during the treatment, while 64% of the patients had trismus at completion of treatment and in follow up 71% of the patients had no trismus.67% reported high quality of life during follow up. With mouth opening exercises most of the patients with trismus were able to achieve adequate mouth opening . Reference: 1. World cancer report 2014:Stewart, B, & Wild, Christopher P. (2016). 2.The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: A systematic review. Scherpenhuizen A etal.,J.oraloncology.2015.05.001. E pub 2015 Jun 6.

 > Abstract Id: YUGP1992 Top

Ayurvedic Plant Extract Tinospora Cordifola As A Potential Anti-Cancerous Agent Against Hormone Independent Metastatic Breast Cancer

Presenter- *Dr. Jyotsana Singh

Co-author - Brijesh Kumar, Nikhil Kumar, John F Marshall

Ayurvedic plant extract Tinospora cordifola as a potential anti-cancerous agent against hormone independent metastatic breast cancer Jyotsana Singh (Ph.D.)1$, Brijesh Kumar (Ph.D.)2, Nikhil Kumar (Ph.D.)3, John F Marshall (Ph.D.)4* and Rituraj Konwar1(Ph.D.)* 1Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow 2Sophisticated Analytical Instrument Facility, CSIR-Central Drug Research Institute, Lucknow 3CSIR-National Botanical Research Institute, Lucknow. 4Tumor Biology, Barts Cancer Research Institute, University of Queen Mary, London. * Corresponding authors. $First Author-Jyotsana Singh (jyotsana.singh2018@gmail.com), LSS-105, CSIR-CDRI, Sector 10, Jankipuram Vistar, Sitapur Road, Lucknow, 226031. Basis of the study-Biological heterogeneity of metastases and epithelial mesenchymal transition (EMT) in breast cancer are two evil faces responsible for poor patient management. Targeting EMT in the breast cancer till now is very challenging and therapeutic interventions are immediately required. Although there are a number of anti-metastatic drugs and chemo-therapeutic agents but they have failed to cure the aggressive metastatic tumors compelling the direction of drug discovery towards a newer approach, where the EMT targeting seems to be a promising approach. In present study we have studied the anti-metastatic potential of Tinospora cordifolia Miers (Menispermaceae), also popular as amrita, gurcha, guduchi or jetwatika. The stem extracts were selected for investigation since it has been documented for its immunomodulatory activity. The wide distribution, perennial nature and dioecy of T. cordifolia have led to critically investigate the seasonal and gender based impact on the activity and the content of bioactive compounds by various groups. Recently, our group has successfully developed a statistical approach based on phytochemical markers for confident prediction of variations in metabolic profile and cytotoxicity against MCF-7, MDA-MB-231, DU-145 and PC-3 cancer cells due to geographical, seasonal and gender difference in T. cordifolia stem. Material and Method- Plant materials and chemicals The extract, in form of CDRI-TCSF (Tinospora cordifolia, stem, female) and CDRI-TCSM (Tinospora cordifolia, stem, male) were provided by SAIF (Sophisticated analytical instrument facilities, CSIR-CDRI) division. Male and female plants bearing flowers and fruits (only female plants) were collected from naturally growing population on the banks of the Gomati River, Lucknow in 2012, 2013 and 2014. The plant samples were identified and deposited in the departmental herbarium of the Botany Division of CSIR-CDRI, Lucknow, India. Certified reference material (CRM) of T. cordifolia stem was purchased from Tulsi Amrit Pvt Limited, Indore, India (Batch No. 10TC 1438). Cell culture, cytotoxicity assay and cell cycle analysis MDA-MB-468 were cultured in DMEM media supplemented with 5ml L-glutamine/ 500ml and MCF-10A-CA1a cells were cultured with DMEM:F12 (1:1), 5ml L-glutamine/ 500ml, chlorea toxin (100ng/ml), EGF (20ng/ml), hydrocorticosone (0.5 Âμg/ml), insulin (10Âμg/ml). The CAF (Cancer associated fibroblast) cells were maintained in DMEM:RPMI (1:1ratio) supplemented with 10% FBS and 2.5% penicillin-streptomycin. The cells were grown in 5% without any antibiotics.The test plant extracts were diluted with DMSO in 10mg/mk stock solution and the MTT protocol were followed as already described. The cytotoxicity is performed at 24h, 48h, 72h and 92h. The cells were maintained in humidified environment of 5% CO2and 370C temperature in incubator. Cell cycle assay The propidium iodide dye was used to assay the cell cycle arrest at 48h. In brief, the 1X105cells were seeded, grown for 24h and treated with different concentrations of the PETC for another 48h. Next the cells were harvested and samples were prepared and flow cytometric analysis was performed. Wound Healing Assay The MDA-MB-468 and MCF-10A-Ca1a cells were used for the wound-healing assay at 48h. In short, 1x105 cells per well were seeded onto 6-well plates and grown until 80% of confluency in respective cell culture media supplemented with 10% FBS. One horizontal and one vertical scratch were created using a 10?l sterile micropipette tip on the confluent cell monolayer in each well to ascertain the area under study. The cells were treated with test plant extract. Cells were washed thrice with PBS, added with test compound in medium supplemented with 5% FBS, and monitored for 48h. Images were captured using phase-contrast microscopy at 0 and 48h after treatment with test compound. Cell migration distance was measured using Image-J software (NIH, USA). The result was drawn from three independent experiments and the image is representation of one of the results. EMT path-scan assay Cells (100 cells/well) were seeded in 4 well-chambered slides and grown till cells acquired complete morphology. The cells were then treated with either with test plant extract or without, for 48h, washed thrice with PBS, fixed with 4% paraformaldehyde for 15 min at RT, followed by blocking as per manufacturer instruction (CST, 7771). The cells were next stained with the antibody cocktail; E-cadherin(Alexa Fluor® 488, Ex(max) (nm) 495, Em(max) (nm)-519)/Vimentin (Alexa Fluor® 555, Ex(max) (nm) 555, Em(max) (nm)-565)antibody cocktail overnight at 4?C in dark. The cells were washed with PBS and counter probed with 2? antibody; the detection cocktail for 2 h in dark. The slides were removed from the cassette and mounted with Prolong® Gold Antifade Reagent having DAPI for nuclear stain. The images were taken on the confocal microscope. Colony formation assay The in-vitro colony formation potentials of the MDA-468 cells and CA1a were analyzed by anchorage-dependent colonogenic assay. 500 cells were counted and seeded into the six well plates in triplicates. After 48h, the cells were exposed to different concentration of CDRI-TCSF and CDRI-TCSM. The cells were cultured in CO2 incubator at 370C. After the experimental exposure time, the treatment media was removed and the cells were left for 7 more days with serum free media, with the media being changed after every 2 days. After incubation, the colonies were fixed with 100% methanol for overnight at -200C. Next the cells were stained with 0.1% crystal violet dissolved in the methanol (Sigma-Aldrich). The colonies were counted manually with ?50 cells/colony and expressed as percent control. 3D organotypic assay The 3D organotypic assay was performed with MDA-MB-468 and MCF-10A-CA1a cells along with two CAFs, 2276 and 1939. Briefly, the gel was prepared with Matrigel (BD 354243) and collagen Type I (BD 355236). The transwell chamber were coated with 300?l collagen Type I (1:100 dilution in PBS) and incubated at 370C, 1h. Excess collagen wad removed and 120 ?l/well matrigel/collagen was added without any bubble formation. The gel was left for 1-2 h to set followed by addition of media without letting it to be dried out. The cells were trypsinised and counted. Total 100,000 cells/well cells were required in 200 Âμl (culture media was same as required to grow the cells under study) of media. For cell mixture, 67,000 fibroblast (i.e. (100,000/3)*2) and 33,000 cancer cells were required. 600?l of same media was added underneath transwell through top slit of transwell. The cells were left to grow for 24 h. Next, after 24h the media was removed and added with fresh 350 ?l culture media (either with test plant extract or without) at the bottom and top surface of the organotypic culture gel was feeded with plain cell culture media without any FBS (either with test plant extract or without). The media is replaced after every 2 day until the termination of the experiment. At the end of the experiment, the transwells were placed in the formalin with 200 ?l above and 600 ?l below the transwell surface inside the chamber dishes, overnight. Next day, formalin was discarded and replaced by 70% ethanol for atleast 10 minutes with 200 ?l above and 600 ?l below the transwell surface inside the chamber dishes. After fixation the gel is embedded in the paraffin and sectioned for the further study. LA-7 induced syngenic mammary tumor model In brief, animal were injected 106 cells/ animal in the mammary fat pad with 10ml syringe in form of cell suspension in the LA-7 culture media of female SD rats. The animals were administered with ciclosporin subcutaneously (80mg/kg animal body weight, dissolved in olive oil, 100Âμl with insulin syringe). The animals were left for 10 days for tumor formation and regularly monitored for tumor growth; measured after every 3 day. Tumors were measured with vernier calipers. After attaining a measurable tumor size, test plant extracts were administered in the animals orally at the dose of 75mg/kg either CDRI-TCM or CDRI-TCF or PTX weight with gamacasia to enhance the bioavailability of treatment in animal body. The control group was vehicle (0.01% DMSO) treated. After 21 days of study the animals were sacrificed by cervical dislocation. The animal body weights were recorded at regular interval with survival index. The weight of vital organs like lung, liver, kidney, heart, spleen and tumor were harvested in saline solution and recorded at the termination of the experiment. The lungs were further studied for any neoplastic lesions with Bouin’s solution for overnight. The lesions were counted manually. Primary cell culture The ER/PR-ve breast tumor samples were collected and assayed to evaluate the impact of TCSF and TCSM after 48h of treatment. In brief, the tumor tissues were collected, minced, digested and re-suspended DMEM-high glucose medium. Supernatant was discarded, the pellets were washed in cold PBS and centrifuged again at 750 g for 10min at RT. Pellets were then suspended in PBS and filtered. The cell suspension was then centrifuged at 40 g (1min); only supernatant was transferred into new 50mL tubes and centrifuged at 100 g (2min) obtained the pellet consist of epithelial fraction The entire procedure was done in sterile conditions. The cells were culture at 370 C, 5% CO2 and under humidified condition. Statistical analysis The statistical significance of difference between the experimental groups were determined with one way ANOVA, Tukey multiple tests on GraphPad Prism Version 5.0 software. Two-way ANOVA analysis was used to determine the tumor volume and total tumor burden in the in vivo animal groups. All the experiments were done at-least thrice. Results- We have studied the influence of gender variations of PETC on anti-breast cancerous activity. The aggressive breast cancer cells, MDA-MB-468 and MCF-10A-CA1a were selected for 2D and 3D studies and female syngenic tumor bearing SD rats were selected as in vivo model. TCSF and TCSM induced significant cytotoxicity to the breast cancer cell and both resulted in the induction of G2/M arrest in highly aggressive MDA-MB-468 cells, conferring the anti-cancerous potentials. The extracts resulted in significant inhibition of cancer cell migration and colony formation in both the cell lines with much higher significant inhibition in MDA-MB-468. The key regulators of EMT, E-cadherin and Vimentin were significantly modulated by both TCSM and TCSF with significant higher activity in the TCSM. Vimentin was down regulated and E-cadherin was found to up regulated. In 3D organotypic model, we observed that the invasive and migratory potential were significantly reduced by TCSM extract as compared to the TCSF. Our in vivo study on syngeneic rat model also validated the results that the TCSM possesses better potential to be developed as therapeutic intervention against breast cancer when compared with the TCSF. We have next studied activity on highly metastatic ER/PR negative patient-derived primary tumor culture where TCSM significantly inhibited the proliferation. However, we have worked on the crude plant extract of T. cordifolia, hence validation of the anti-cancerous property on pure compounds derived from T. cordifolia and their comparison among TCSM and TCSF plant is warranted. Conclusion- 1. First experimental evidence against the anti-cancerous activity of the ayurvedic medicinal plant is affected by regional variation as well as dioecious nature of plant. 2. In vitro results show that both PETC extracts has potent anti-cancerous activity with significantly higher potency in the TCSM. 3. Significantly reduced EMT-MET and metastases in 2D and 3D microenvironment. 4. Studies on syngeneic SD rat mammary tumor model showed significant tumor regression in TCSF and TCSM with much higher reduction in TCSM. 5. We are first to report that the male plant possesses better anti-tumor potential and could be developed as therapeutic intervention against metastatic and aggressive breast cancer.

 > Abstract Id: YUGP1996 Top

Baseline Hemoglobin As A Predictive/Prognostic Marker For Early Tumour Control And Survival Outcome In A Case Of Squamous Cell Carcinoma Of Head And Neck Carcinoma - An Institutional Review At Rajiv Gandhi Cancer Institute And Research Centre

Presenter- *Dr. Sarthak Tandon

Co-author - Dr Munish Gairola, Dr Parveen Ahlawat, Dr Manoj Pal

Purpose/Objective: Anemia is very common in head and neck cancer (HNC) patients, and seems to be correlated with intratumoral hypoxia. It is one of the main prognostic factors of locoregional recurrence and poor survival and affects the outcomes with radiotherapy (RT). This is an institutional review of HNC already treated with RT to assess the early tumour response with baseline hemoglobin (Hb). Material and Methods: Hundred patients of proven squamous cell HNC who were treated with definitive RT with/without chemotherapy were selected between the periods of January’16 to May’16. All patients had their tumour response assessed at 12 week after completion of RT. Results: A logistic regression was performed to ascertain the effect of Hb on the likelihood that patients have residual disease. The results showed, for each unit reduction in the Hb level, the odds of having residual disease increases by a factor of 1.34 (Odd Ratio 0.742; CI = 0.593 - 0.927; p = 0.009). A receiver operating characteristics (ROC) analysis was performed to determine an ”Optimal threshold cut-off value of Hb level” for which there was greatest difference in response at 12 weeks of completion of RT. AUC, sensitivity and specificity were also calculated to analyze the predictive ability of this cut off. The results showed that Hb level ? 13.2 g/dl predicted the CR with a sensitivity of 75.4 %, specificity of 53.5 % and with an AUC of 0.632 (95% CI, 0.518 - 0.747; p = 0.024). There was greatest magnitude of difference in early outcome in patients having Hb level above and below this cut-off of 13.2 g/dl. Conclusions: Low baseline Hb (less than 13.2 g/dl in our study) is poor prognostic marker for response to treatment with RT

 > Abstract Id: YUGP1998 Top

Role, Accuracy And Feasibility Of Sentinel Lymph Node Biopsy In Post Nact Patients With Locally Advanced Breast Cancer-A Tertiary Centre Experience Of 185 Patients

Presenter- *Dr. Ghanish Panjwani

Co-author - BB Pandey, ,

Introduction For patients presenting with early breast cancer for up-front surgery, Sentinel Lymph Node biopsy (SLNB) is now a standard procedure in most centres significantly reducing the morbidity associated with Axillary Lymph Node dissection (ALND). Many single institutional studies and multicentric trials have now stressed upon the feasibility, accuracy and efficacy of Sentinel Lymph Node biopsy in post NACT patients with N0 axilla. Yet, the costs and difficulty in procuring radio labelled dyes forbade widespread applicability of this procedure. . Material & Methods This is a prospective study to determine the feasibility and accuracy of SLNB following Neo-Adjuvant chemotherapy (NACT) for Locally Advanced Breast Cancers (LABC) using methylene blue dye alone. USG guided FNAC was done to classify patients into N0/N+ before starting NACT and again carried out post NACT and those found N+ were be considered for a formal axillary clearance. A total of 185 patients were finally selected for SLNB from april 2014 to may 2016. After SLNB, ALND was done in all subjects to determine the sensitivity, specificity and accuracy of SLNB. Data was analysed with Graph-Pad-Prism(ver6.05). Results 42.39% women were pre menopausal with mean age being 46 years. T4 disease was found in 68.47% with N2 disease in 39.67% and N1 in 58.61%. After NACT, 7.60% patients showed CCR with 80.4% being downstaged and 27.6% patients converted from node positive to node negative axilla. The node identification rate for SLNB was 91.4% with median number of nodes harvested being 2. The false negative rate was 12.50%. False negative rates were less when two or more SLN were found but relatively higher when only a single SLN was harvested. Patients classified as node positive on clinico-sonological examination prior to starting NACT had SLN Identification rate of 89.77% and sensitivity, specificity and accuracy of 87.50%, 100% and 93.67% respectively. Conclusions Acceptable SLN identification rates are achievable using methylene blue dye alone to perform SLNB in post NACT patients of LABC. False negative rates are acceptable when two or more SLN are found. Thus, when blue dye alone is used, cost and availability issues are solved and acceptable sensitivity and specificity and accuracy is achieved.

 > Abstract Id: YUGP2002 Top

Do Cancer Patients Who Use Tobacco Quit After Diagnosis?

Presenter- *Ms. Bincy Mathew

Co-author - Dr. E. Vidhubala, ,

Background: Continued tobacco usage after cancer diagnosis and treatment leads to secondary malignancies and treatment failure. Although, many quit after cancer diagnosis, the reason why some continue to use is yet to be understood. The current study aims to understand the prevalence of quit status and to explore the reasons for quitting and continue to use tobacco even after cancer diagnosis. Methods: A total of 71 patients was diagnosed with tobacco related cancers, twenty-five (7 - current users & 18 — recent quitters) patients who were under treatment were interviewed using a semi-structured questionnaire. Results: Of the 71 patients, 67.60% quit tobacco habit after the diagnosis, whereas 32.4% continued to use even during the treatment. Thematic analysis revealed 3 major categories for current users: psychological distress, no perceived benefits and understanding about cancer and its association with tobacco. In contrast, six themes emerged for recent quitters: impact of cancer diagnosis, perceived benefits and risks, future concerns, advice from a health care professional and understanding about cancer and its association with tobacco. The current users considered cancer as a tantamount to a death sentence, while recent quitters were able to comprehend the benefits of quitting and prioritize their needs post-diagnosis, which helped them in quitting tobacco. Conclusion: By understanding the perception of current users and recent quitters on tobacco usage and its association with cancer would help us to design an effective tobacco cessation intervention for hospitalized patients in turn improving their overall quality of life.

 > Abstract Id: YUGP2004 Top

The Application Of Recursive Partitioning Analysis, Graded Prognostic Assessment And Basic Score For Brain Metastases As Prognostic Indices Among Patients With Brain Metastases Treated With Radiotherapy At Departement Of Radiotherapy Rscm 2012-2014

Presenter- *Mr. Arry Setyawan

Co-author - Soehartati Gondhowiardjo, Renindra Ananda Aman,

Background : The incidence of intracranial metastasis has increased annually, which also followed by the increased number of patient’s disability and mortality. Standard therapy in brain metastasis are Whole Brain Radiotherapy (WBRT), Stereotactic Radio Surgery (SRS), surgery, or combination of all. With all these treatment options available, it is very important to consider the prognosis in order to decide which therapy is appropriate. One of the methods that can be used to determine the prognosis is by using the prognostic indices. Currently, there has been no data or report about the demographic and survival profile of patients with brain metastastis in Indonesia using the available index prognosis. Methods : This is a retrospective cohort study to evaluate the survival analysis in patients with brain metastasis that are undergoing treatment in Radiotherapy Department, RSUPN Dr. Cipto Mangunkusumo in 2012-2014 based on RPA, GPA, and BSBM index. Results Sixty-two patients are included in this study after obtaining the approved consent. The median of survival rate is 9.16 months. Survival analysis based on RPA index showed median class I, II, and III are 16.3, 11.2, and 4.7 months, respectively. Characteristics and median observer based on GPA, from GPA 0-1 to GPA 3.5-4 are 4.3, 10.4, 12.4, and 16.3 months, respectively. These findings are similar with the previous studies. However, BSBM index does not able to illustrate the result that is appropriate when it is being applied to the subjects of this study. Conclusions : RPA and GPA index can be used to predict the prognosis in patients with brain metastasis that are undergoing treatment in RSUPN Dr. Cipto Mangunkusumo because it provides characteristics, which correspond to the reference data. GPA index is considered better because it uses more objective variables. Keywords: Prognostic indices, Brain metastases, cancer patient survival

 > Abstract Id: YUGP2006 Top

Is Tripleâ Negativeâ Breastâ Cancerâ Anâ Indianâ Problemâ €” A Prospective Analysis Fromâ Aâ Tertiaryâ Careâ Oncologyâ Centre.

Presenter- *Dr. Sameer Gupta

Co-author - Jeetendar Paryani, Prof Arun Chaturvedi, Vijay Kumar

Background: Breast cancer is a heterogeneous disease with distinct biological subtypes as determined by gene expression profiling studies. Breast cancer is most common cancer in Indian females and is believed to be biologically different from west, notably in terms of high prevalence of Triple negative subtype (TNBC). Reliable data on clinical and epidemiological profile of TNBC in Indian population is scarce. Aim of this study was to analyze the epidemiological and clinical profile of TNBCs Methods: Data of 355 patients of breast cancer registered in our department between 2013 and 2015 and followed up until December 2016 was collected and reviewed for epidemiological and clinical features. Results: Total 355 patients were analysed. TNBC subgroup was most common (n = 152) (43%) followed by Luminal A (25%) subtype. Nearly 60% patients were hormone negative. Median age at disease presentation in TNBC was 42.4 years compared to overall age of 45.3 years (24–73 years). In TNBC subgroup, 48% patients presented in locally advanced and 15% in metastatic stage, with premenopausal patients accounting for majority of these patients. Overall 268 (76%) patients underwent surgery with Modified radical mastectomy being preferred surgical option (86%), followed by adjuvant chemotherapy. TNBC subgroup demonstrated low response rate to neoadjuvant chemotherapy with only 9% of patients having complete response and 25% patients having progressive disease. Median follow up was 34 months (6 - 50 months). Of the total recurrences (n = 19), nearly 2/3rd (n = 13) were documented in TNBC subgroup. Disease free survival (DFS) of TNBC subgroup was lower than of other luminal subtypes (p = .043) Conclusions: TNBC was the most common breast cancer subtype (43%) in Indian population which is nearly twice the rate reported in Western countries. This finding has significant clinical relevance as it may be contributing to comparatively poor outcomes in Indian breast cancer patients. Our study also corraborated this fact with markedly higher prevalence of premenopausal breast cancer, younger age at presentation, poor response to neoadjuvant chemotherapy, high recurrence rates and decreased disease free survival. Additional research is needed to understand the determinants of TNBC in India as it is a prognostic group with aggressive behaviour that commonly lack the benefit of any specific targeted therapy

 > Abstract Id: YUGP2008 Top

Double-Blind Concordance Study Of Breast Cancer Treatment Recommendations Between Multidisciplinary Tumour Board And An Artificial Intelligence Advisor-Watson For Oncology

Presenter- *Dr. Rohit Kumar C

Co-author - Dr Somashekhar S P, Sepðlveda M-J,, Norden AD

Background: Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Cognitive clinical decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the cognitive CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer. Patients and methods: Treatment recommendations were provided for 638 breast cancers between 2014-2016 at the Manipal Comprehensive Cancer Center, Bengaluru, India. WFO provided treatment recommendations for the identical cases in 2016. A blinded second review was performed by the center's tumor board in 2016 for all cases in which there was not agreement, to account for treatments and guidelines not available before 2016. Treatment recommendations were considered concordant if the tumor board recommendations were designated ”recommended” or ”for consideration” by WFO. Results: Treatment concordance between WFO and the multidisciplinary tumor board occurred in 93% of breast cancer cases. Subgroup analysis found that patients with stage I or IV disease were less likely to be concordant than patients with stage II or III disease. Increasing age was found to have a major impact on concordance. Concordance declined significantly (p?0.02; p

 > Abstract Id: YUGP2012 Top

Short Term Outcomes Of Robotic Surgery For Rectal Cancers : A Single Institution Experience

Presenter- *Dr. Rohit Kumar C

Co-author - Dr Somashekhar S P, Dr Shabber S Zaveri, Dr Ashwin R

Background : Robotic surgical systems have dramatically changed minimally invasive surgery as they could potentially address limitations of laparoscopic rectal surgery. Inspite of many evidences that are being published it is still in its infancy when it comes to its acceptancy in terms of safety, feasibility and oncological outcomes. This prospective observational study is conducted to evaluate the safety, feasibility,technique, and outcomes (operative, oncological short-term and post-operative) of robotic-assisted rectal surgery for carcinoma rectum in the Indian set up. Materials and Methods : This was a prospective observational study conducted between February 2012 to June 2017, including 60 patients, diagnosed of rectal carcinoma .All patients who were diagnosed of rectal carcinoma where evaluated and worked up for staging and metastatic survey. Patients underwent robotic rectal cancer surgery in form of either low anterior resection or abdominoperineal resection. Results : Out of 60 patients, 42 were male and 18were female, aged between 34-80 years. All patients had adenocarcinoma rectum, with 18 having carcinoma in upper rectum, 10 in mid rectum and 32 in lower rectum. 53 patients had T3 lesion, 4 had T2 and 3 had T4 lesion. 47 out of 60 patients received neo-adjuvant chemoradiation before surgery. 46 patients had low anterior resection and 14 patients underwent abdomino-perineal resection. Average operative time including docking time and surgery time was 226.32 minutes (170- 300 minutes), mean blood loss was 146.76 ml (120-200), there was one conversion to open surgery. Bowel sounds appeared on average on 3rd day, with patients requiring iv analgesics on a average for 3.7 days ( 2-5 days ) and oral analgesics for 3.6 days ( 2-5 days ). 2 patients had anastamotic dehiscence. Minor complications was noticed in 20 patients. All margins were negative (proximal, distal, circumferential ) in all patients, mesorectal grade was complete in 58 patients and 2 patients had moderate grade. Mean number of lymph nodes harvested is 9.5 (2 -32) . Conclusion : In conclusion, robotic rectal surgery has several benefits in the treatment of rectal cancer and should be part of the armamentarium of the experienced surgeon dealing with this disease. We conclude that the robotic-assisted rectal cancer surgery is safe and an oncologically feasible technique. However, large study group and long-term follow-up data are required to evaluate the recurrence and survival rates. Key words: robotic rectal surgery, carcinoma rectum

 > Abstract Id: YUGP2016 Top

Effectiveness Of Physiotherapy On Breast Cancer Related Lymphoedema

Presenter- *Ms. Anitha D

Co-author - M.S.Satish, Srinivasan Vijay, Dr.V.Sridevi

BACKGROUND: Breast cancer is one of the most common cancer in India, with an incidence of 1, 55, 000 new cases per year. Although early detection and multimodality treatment has resulted in an overall improvement in the survival of breast cancer patients to 89%, “lymphoedemaâ€, one of the common complications associated with the treatment is on the rise. 41.1% of the patients in India were found to develop lymphoedema, which has a serious hold on their physical functioning and body image thus compromising their quality of life. The effectiveness of lymphedema management techniques are yet to be studied in tropical country like India. Hence, the present study was carried out to assess the effectiveness of compression therapy, compression sleeve and structured exercise on lymphoedema and its influence on body image and quality of life. METHOD: Breast cancer patients with post mastectomy related lymphoedema (n=25) attending physiotherapy out-patient department were assessed for upper limb circumferential measurement, Shoulder ROM (goniometer) and quality of life (CI-QOL), before and after physiotherapy (Sequential pneumatic compression therapy, Compression sleeve and Structured exercises). The data was analysed using descriptive statistics, t-test and chi square. RESULTS: During the pre-assessment, 40% of the breast cancer patients with lymphedema were found to have good QoL. However, 64% of the patients reported body image issues. There is a significant reduction in the lymphoedema post intervention, in both Fore arm (t=2.823; p< 0.000). Body image also differed significantly at the follow up (t=5.253; p

 > Abstract Id: YUGP2018 Top

Serum Lipids And Lipoprotein Derangment In Oral Cancer Patients-A Case Control Study

Presenter- *Dr. Suresh singh Damachayan

Co-author - Dr Shanti Lal Jeengar, Dr Pinakin Patel, Dr Raj Govind Sharma

INTRODUCTION: Lipids are major cell membrane components essential for various biological function including cell growth and division of normal and malignant tissues. Our study is a Case Control study to find out association between Lipid profile with Oral cancers. Also to assess and compare lipid profile of patients with matched healthy control. METHO AND MATERIAL: Our study conducted on 25 subjects with proven Oral malignancy with age and sex matched healthy controls in Dept. of Surgical Oncology S M S Medical College and Hospital, Jaipur. Lipid profile and TNM staging in Head and Neck cancer patients were also estimated. These values were subjected to statistical analysis and independent‘t’ test and Chi-square test used to analysis. RESULTS: Mean serum TGC,TC and HDLC levels showed statistically significantly reduced in oral cancer group as compared with control group. LDL and VLDL showed statistically non-significant results. CONCLUSION: Our study find inverse relationship between TGC, TC and HDLC with Oral cancer patients. The Low serum Lipid status may be considered a useful indicator for initial changes occurring in the neoplastic cells. These findings strongly suggest to in-depth study of pattern of lipid profile alteration in Oral cancer patients.

 > Abstract Id: YUGP2020 Top

Cystosarcoma Phylloid Of Breast-Case Reports And Review Of Literature

Presenter- *Dr. Pradeep Tanwar

Co-author - Dr. Suresh Singh, Dr. Pinakin Patel, Dr. Jyoti Sharma

Objective-To present a series of 3 cases of Cystosarcoma of Breast. Clinical presentation and intervention-We are reporting a series of 3 cases of cysto-sarcoma phylloides in women of different age group (58, 37 & 17 yrs) who presented with complaint of lump breast. Out of three cases, one was a case of recurrence. Core biopsy examination was done. One case was having 7 kg, large tumour with significant axillary lymphadenopathy so MRM was done. In case of recurrent cystosarcoma breast, mastectomy with shoulder disarticulation was done as tumour was involving upper limb vessels. 3rd case of 17 years old patient was very aggressive & operated for mastectomy. Histopathological examination showed one case was having low grade and 2nd case was having high grade cystosarcoma phylloid. 3rd case of 17 years old patient was histopathological challenge as first histopathlogical examination showed cystosarcoma phylloid but on review and marker study proved it being mataplastic carcinoma. Postoperatively all 3 patient are to be given chemotherapy and radiotherapy. Conclusion-Malignant cystosarcoma phylodes tumour is a very rare but aggressive breast malignancy. Either wide local excision with adequate margins or mastectomy is an appropriate treatment for patients with malignant phylliodes tumour. Histopathological & clinical correlationship is of critical importance and review histopathological examination should be advised if any suspicion before adjuvant treatment. Adjuvant radiotherapy & systemic chemotherapy appear to improve disease-free survival and recurrence.

 > Abstract Id: YUGP2022 Top

Prognostic Utility Of Stromal Tumour Infiltrating Lymphocytes (Tils), Neutrophil - Lymphocyte Ratio (Nlr), Platelet - Lymphocyte Ratio (Plr) In Oral Squamous Cell Carcinoma (Oscc) .

Presenter- *Dr. Sameera Begum

Co-author - Dr Riaz Abdulla, Jagadish kudkuli, Varsha mohanty

PROGNOSTIC UTILITY OF STROMAL TUMOUR INFILTRATING LYMPHOCYTES (TILS), NEUTROPHIL - LYMPHOCYTE RATIO (NLR), PLATELET - LYMPHOCYTE RATIO (PLR) IN ORAL SQUAMOUS CELL CARCINOMA (OSCC) . BACKGROUND: Oral Squamous Cell Carcinoma (OSCC) is the sixth most common cancer worldwide. Over the past few decades, hematological components of the systemic inflammatory response have been combined to form inflammation-based prognostic scores to predict cancer survival. Studies have shown that the presence of systemic inflammation and platelet status correlate with poor survival in various cancers. Oral cancer has been associated with an immune response both systemically and within the tumour microenvironment. Recent data suggest stromal TILs have a prognostic role in OSCC. PURPOSE: To establish a feasible method to assess utility of stromal TILs (sTILs) and correlate with preoperative peripheral blood Neutrophil - Lymphocyte ratio (NLR), Platelet Lymphocyte ratio ( PLR) in Lymph Node Metastasis (LNM) positive and negative OSCC patients for the prognostic evaluation. MATERIALS AND METHODS : In this study, 34 patients diagnosed with OSCC who underwent curative resection between 2016-2017 were enrolled. Ethical clearance was obtained from institutional ethical clearance committee, Yenepoya University. Patient consent was obtained from all the participants. Clinical and demographic characteristics of all patients were collected. Complete blood count (CBC) was performed preoperatively. NLR and PLR were calculated. Resected tumour specimens from all 34 OSCC patients were subjected to routine tissue processing sectioned and stained with H& E. The stained sections were evaluated for the percentage of the (sTILs) following the 2014 international working group guidelines. High (>50%) and low (2.7) and (>135) respectively is seen among patients with lymph node positive. The histopathological grading of OSCC when compared with the NLR, PLR & sTILs showed that all the three parameters were high in moderately differentiated OSCC. CONCLUSIONS: Preoperatively increased NLR and/or PLR are significant prognostic predictors in cancers. Increased level of sTILS are associated with improved prognosis in OSCC. sTILs should be regularly reported by pathology laboratories as an additional indicator of prognosis.

 > Abstract Id: YUGP2026 Top

Management Of Hepatic Adenoma(S): Single Centre Experience Of 10 Cases From Tata Memorial Centre, Mumbai

Presenter- *Dr. KAMLESH VERMA

Co-author - Shraddha Patkar, Ashwin Polnaya, Amit Gupta

Introduction: Hepatic adenoma is a rare benign tumour of liver with estimated incidence of 3 per 10,00,000 population. Although being benign in nature it warrants surgery as it is associated with risk of spontaneous bleeding in 28% and malignant transformation in around 10% of cases. We performed retrospective analysis of patients presenting to our institute between July 2011 — April 2017 Results: Ten patients were diagnosed as hepatic adenomas in the above mentioned period. Of these 3 patients had multiple lesions and 7 had single large adenoma. All patients were females. 80% of patients presented with abdominal pain as the presenting complaint. In all patients surgical resection was attempted. In one patient surgery was abandoned after frozen section confirmation of hepatic adenoma and intra-op ultrasound showing diffuse bilateral disease. Three patients underwent TAE for large size for improving surgical safety. Four patients underwent extended hepatectomy ( 3 right and 1 left), two left lateral hepatectomy, one right hepatectomy and two segmentectomy of liver. Apart from these 10 patients one patient underwent right hepatectomy as biopsy was suggestive of hepatic adenoma but on final HPR it turned out to be focal nodular hyperplasia. Median intra-operative blood loss was 1500 ml (range 600 -3500) with median duration of hospital of 6 days (range 3-130). There was no post operative morbidity or mortality. The Median tumour size was 12.4 cm (range 4.5 — 19.0). Conclusion: All hepatic adenomas should be resected as they have high propensity to develop life threatening complications and have a 10% risk of developing malignancy. Hepatic resection in non cirrhotic liver can safely be performed in a high volume centre. TAE can be used as an adjuct especially for large tumours in view of high vascularity of these tumours.

 > Abstract Id: YUGP2030 Top

Exploring The Role Of Organochlorine Pesticides In Breast Fibroadenoma Causation: A Pilot Case Control Study

Presenter- *Dr. Sugandha Arya

Co-author - Dr. Pankaj Kumar Garg, Dr. Sanjay Gupta,

Introduction Fibroadenomas are the most common benign tumors of the breast. They are usually seen in women of reproductive age group and present as painless, well defined, firm and mobile tumors. Unopposed action of estrogens increases the risk of fibroadenoma due to expression of estrogen receptor beta by the stromal cells of fibroadenoma. The present study was designed to assess the role of xenoestrogenic organochlorine pesticides (OCPs) in the causation of breast fibroadenoma. Method The study included 20 histopathologically proven patients of breast fibroadenoma (cases) and 20 age and gender matched healthy volunteers (controls). The serum levels of eleven organochlorine pesticides — Hexachlorohexane (HCH): ?-HCH, ?-HCH, ?-HCH and total HCH, Dieldrin, Endosulfan: Endosulfan I, Endosulfan II, DDT and its metabolites - p,p'-DDT, p,p'-DDE, p.p’-DDD and Heptachlor were determined in all subjects estimated by Gas chromatography equipped with electron capture detector. Polymorphic variations in OCP metabolising genes GST T1 and GST M1 was determined by PCR. Result The two groups were comparable with respect to age (mean age of fibroadenoma patients was 21.28 vs mean age of controls was 21.36 with p=0.907). There were significantly higher serum levels of organochlorine pesticides in patients with breast fibroadenoma as compared to controls - a-HCH ( 5.543 vs 4.126, p=0.001) ?-HCH (4.938 vs 3.940, p=0.008 ), total HCH (13.335 vs 11.633, p=0.001), DDT (5.982 vs 3.987, p=0.001), DDD (3.510 vs 1.521, p=0.001), Endosulfan 1 (5.280 vs 3.290, p=0.001) and Endosulfan (2.563 vs 1.877, p=0.003). Also, significantly higher numbers of fibroadenoma patients were found to be having GST T1 null genotype as compared to controls. Conclusion The present study suggests that the organochlorine pesticides may play a role in the causation of breast fibroadenoma facilitated by nonfunctional metabolizing genes as GST T1. Further studies with larger sample size are warranted to further analyze the role of Organochlorine pesticides in the pathogenesis of fibroadenoma breast, especially in agrarian countries where these pesticides are commonly used.

 > Abstract Id: YUGP2032 Top

Role Of F18 Fdg Pet Ct To Identify High Risk Patients For Infection In Pre Autologous Stem Cell Transplant Evaluation Setup Of Patients With Hematological Malignancies

Presenter- *Dr. Thangalakshmi Sivathapandi

Co-author - Dr.Shelley Simon, Dr.Indirani Elangovan,

AIM: Several risk factors like intensive chemotherapy, tissue damage and advanced underlying disease predispose to infections in hematological malignancy patients. The objective of study is to investigate the role of F18 FDG PET CT in identifying high risk patients for infection in pre autologous stem cell transplant evaluation of patients with hematological malignancies. MATERIALS AND METHODS: Thirty one patients with various hematological malignancies and planned for autologous stem cell transplant (SCT) were prospectively included in this study. All these patients underwent 18F-FDG PET CT using standard protocol before autologous SCT and reading was performed by two nuclear medicine physicians. The median follow-up after autologous SCT was 18 months. RESULTS Among 31 patients, 23 had lymphoma, 6 had leukemia and 2 had multiple myeloma. The patients were categorized into FDG-PET negative (N=15) and positive (N=16) groups. Among these PET positive (n=16) patients, 11 patients had pulmonary infections, 4 patients had FDG positive nodes which were confirmed to be granulomatous by histopathology and 1 patient had liver abscess. These patients underwent appropriate directed treatment and were subjected for autologous stem cell transplant. Amongst PET negative (n=15) patients, 12(80%) patients had favorable and 3(20%) had unfavorable prognosis on follow up. In PET positive group, 13(81%) had favorable and 3(19%) had unfavorable prognosis. CONCLUSION 18F-FDG PET CT aids in early detection of foci of infection in pre stem cell transplant patient which guides appropriate treatment and favorable outcome of autologous SCT. Detecting the foci of infection by F18 FDG PET CT in prior hand also avoids flaring up of hidden infections which is common post autologous SCT due to granulocytopenia and immune compromised status. Keywords: 18F-FDG PET/CT, autologous stem cell transplant, infection

 > Abstract Id: YUGP2034 Top

Comparison Of Ajcc 8Th And 7Th Edition Staging For Carcinoma Breast- Predictor Of Overall And Disease Free Survival

Presenter- *Dr. Kunal Choudhary

Co-author - Sanjit Kumar Agarwal, Rosina Ahmed,

BACKGROUND: Since 1977, TNM classification of AJCC has been used as a comprehensive tool for prognostication and planning of management of cases of carcinoma Breast. Although the importance of tumour biology is well recognised the first edition of the staging manual in which biological factors have been incorporated is the 8th edition of the AJCC staging manual. OBJECTIVE: The objective of the study was to compare the 7th and 8th edition of AJCC staging for carcinoma Breast as a prognostic indicator for overall survival (OS) and disease free survival (DFS) METHODS: Prospectively maintained data for patients having upfront surgery, treated in a single centre from June 2011 to June 2014, was re-analysed. Variables were tumor size, nodal status and distant metastasis for staging as per 7th edition and for 8th edition grade, ER, PR and HER2 status were used additionally. OS and DFS were calculated and their correlation to the stage was seen using Kaplan Meier method. RESULTS: A total of 262 patients’ data was analysed. Mean age was 54 (28-70) years and median follow up was 32 (1.5-60.47) months. The stage to stage comparison between the anatomical and prognostic staging revealed that staging remained unchanged for only 54(21%) patients. Prognostic staging downstaged 98(37%) patients and upstaged 110(42%) patients as compared to anatomical staging. Log rank test done separately for anatomical and prognostic staging showed that both anatomical (p

 > Abstract Id: YUGP2037 Top

Ros1 Gene Rearranged Lung Adenocarcinomas: Demographic, Clinicopathologic, And Treatment Profile In A Cohort Of 101 Indian Patients

Presenter- *Dr. SHIVANI SHARMA

Co-author - Bekleswar Salona, Mukesh Singh, Shiv Murti Kumar

Introduction: ROS1 gene rearrangement in lung adenocarcinomas is one of the targetable genomic alterations (1-3%). However, the data on the incidence, and clinicopathologic features of a cohort of ROS1-rearranged lung adenocarcinomas across the South Asian region has been very rarely explored. This is the first study in Indian patients with such large numbers. Materials and Methods: A total of 101 pulmonary adenocarcinomas were screened for ROS1 gene rearrangement utilizing ROS1 break-apart FISH probe. Demographics, clinicopathologic features and incidence, were recorded. Results: Of 101 cases screened, 3 cases exhibited ROS1-gene rearrangement (2.9%) by break-apart FISH assay. Male to female ratio of the total population was 1.9:1 and the patients’ age ranged from 26 years to 87 years (mean = 60.2 years). The three positive cases were females with age range from 57 to 63 years. All the three were non-smokers. On histomorphology, these exhibited a solid pattern (3/3). The first positive case was started on crizotinib but could not tolerate the drug due to various side effects like nausea and vomiting, hence was given chemotherapy. The second case was on chemotherapy when the test was performed, but was lost to follow up. The third case had a concurrent EGFR mutation and therefore, was started on Tyrosine kinase inhibitors therapy. All the three cases had stage IV disease. Conclusions: ALK-rearranged lung adenocarcinomas account for a minor proportion of Non Small Cell Lung Carcinoma. This is the first study from India that depicts similar prevalence of ROS1 gene rearrangement as reported in the literature.

 > Abstract Id: YUGP2039 Top

A Prospective Comparative Study Of Concurrent Chemoradiation With Weekly Cisplatin Versus Weekly Gemcitabine In Locally Advanced Squamous Cell Carcinoma Of Cervix.

Presenter- *Dr. Shartaj Ahamed

Co-author - Prof.(Dr)P.K.Maiti, Dr.Biswamit Bhattacharya,

Abstract Objective The use of non-platinum drugs in concurrent chemoradiation in locally advanced squamous cell carcinoma of cervix has not been investigated in much detail earlier. Therefore, a two arm study was performed to compare the efficacy as well as toxicity of concomitant gemcitabine compared to cisplatin in locally advanced squamous cell carcinoma of cervix. Methods Eighty three patients were initially enrolled in this study for response rates and complications. 11 patients failed to turn up for regular follow up, hence excluded from the data analysis. Amongst the remaining 72 patients, 40 patients received concurrent cisplatin (control arm) and 32 patients received concurrent gemcitabine (study arm). Cisplatin and Gemcitabine were given as i.v. infusion at doses of 40 mg/m2/week and 150 mg/m2/week respectively for five weeks concomitant with radiotherapy. All patients had received whole pelvis radiotherapy to a dose of 50 Gy/25 fraction/5 weeks by parallel opposed AP/PA technique and followed by high-dose-rate brachytherapy (3 sessions, each of 7.5 Gy to point A). First follow-up was done after 6 weeks following completion of Brachytherapy. Results Median follow up was of 13 months (range, 11 to 17 months) and 14 months (range, 12to 18months) in the Cisplatin and Gemcitabine arms, respectively. At first follow up, 67.5% in the Cisplatin arm and 68.8% in the Gemcitabine arm had achieved complete response (p=0.53). Similar response rates were noted in both arms. None of the patients except two in Cisplatin arm developed grade 4 toxicity. Similar toxicity profiles were observed in both arms. Progression free survival (PFS) and overall survival (OS) at 1 year were 92.5% vs. 84.3%, 70% vs. 62.5% in the cisplatin and gemcitabine arms, respectively. Conclusion Weekly Gemcitabine had similar disease control and tolerable toxicity profile with Cisplatin. Gemcitabine may be used as an alternative to Cisplatin in patients with compromised renal function.

 > Abstract Id: YUGP2045 Top

Assessment Of The Quality Of Life In Patients Diagnosed With Breast Cancer In A University Teaching Hospital

Presenter- *Ms. Abinaya Sivakumar

Co-author - Dr. Ramya R., ,

Background: Breast cancer being one of the most common cancers prevalent in the female population worldwide, is on the rise in the major metropolitan cities of our country. As of 2012, it is estimated that 1 in 28 women is likely to develop breast cancer during her lifetime. Many patients struggle to cope up with their everyday lives and have to deal with the socio-economical aspects of their treatment that may affect their quality of life. This study aims to describe the quality of life among breast cancer patients in a university teaching hospital and the role of sociodemographic, medical and psychosocial factors on their quality of life. Materials and methods: This questionnaire-based study was carried out for a period of one year between June 2016-17 at a university teaching hospital after obtaining the Institutional Ethics Committee approval (REF: CSP/16/APR/46/99). 78 patients undergoing treatment for breast cancer were interviewed using the EORTC QLQ-C30 Version 3.0 and its supplementary QLQ-BR23 questionnaires after obtaining their informed consent. The data was analyzed using SPSS Version 16. Results: From the QLQ-C30, the mean Global Health status was 46.47, the mean score in the functioning scale was 76.24, highest for ‘physical’ while the mean score in the symptom scale was 63.25, highest for ‘financial difficulties’. From the QLQ-BR23, the mean score in the functioning scale was 83.55, highest for ‘body image’ and the mean score in the symptom scale was 37.24, highest for ‘systemic therapy side effects’. Patients of the younger age group significantly complained more of the breast symptoms while the elderly were more dyspneic. The patients who were employed had more symptoms of nausea and vomiting and particularly had a more troubled future perspective of life when compared with the unemployed mainly consisting of homemakers who had disturbed role functioning. Many of the patients belonging to the lower socioeconomic statuses may not have been remarkably affected financially as they could have been covered by the Chief Minister Scheme run by the Government of Tamil Nadu. By religion, Hindus were significantly more upset by hair loss whereas Muslims seem to have been more emotionally affected. Among those who underwent surgery, MRM patients had more pain symptoms while BCS patients had more financial difficulties and more side effects from the chemotherapy. Conclusions: Age and employment were found to be important factors affecting the overall quality of life of the patients among other sociodemographic factors. It reflects the need for more psychosocial support to be given by the healthcare providers to enhance the daily living of the patients. References: 1. Globocan 2012 data; National Institute of Cancer Prevention and Research (NICPR) http://cancerindia.org.in/cp/index.php/know-about-cancer/statistics#breast-cancer 2. Dubashi B, Vidhubala E, Cyriac S, Sagar TG. Quality of life among young women with breast cancer: Study form a tertiary cancer institute in south India. Indian Journal of Cancer, April-June 2010, Volume 47, Issue 2. 3. Sri Ganesh, Munn-Sann Lye, Fen Nee Lau. Quality of Life among Breast Cancer Patients In Malaysia. Asian Pacific Journal of Cancer Prevention, Vol. 17, 2016. 4. G. Damodar, T. Smitha, S. Gopinath, S. Vijayakumar, Yedukondala A. Rao. Assessment of quality of life in breast cancer patients at a tertiary care hospital. Archives of Pharmacy Practice, Vol. 4, Issue 1, Jan-Mar 2013. 5. Sajani Manandhar et al. Quality of Life among Breast Cancer Patients Undergoing Treatment in National Cancer Centers in Nepal. Asian Pacific Journal of Cancer Prevention, Vol. 15, 2014.

 > Abstract Id: YUGP2047 Top

Molecular Subtypes As A Predictor Of Response To Neoadjuvant Chemotherapy In Breast Cancer



Molecular subtypes as a Predictor of Response to Neoadjuvant Chemotherapy in Breast Cancer Abstract Purpose The objective of this study was to assess the response to neoadjuvant chemotherapy (NACT) in molecular subtypes of breast cancer . Methods This study included 60 locally advanced and metastatic breast cancer patients. We excluded patients who had recurrence and been treated by surgery or given prior chemotherapy / radiotherapy.We analyzed the clinical and immuno histochemical characteristics using core biopsy specimens to determine their correlations with the response to chemotherapy. Results Total patients were 60, of them clinical stage III were 34 [56.7%] and stage IV patients were 26[43.3%]patients . 16 patients [26.7%]were luminal—A, 11[18.3%] patients were luminal-B, 21 patients were Her2 enriched, 12 patients were triple negative{ of them 9 were basal like} molecular subtypes. All patients received anthracycline -based chemotherapy{toxol containing regimen 38,non taxol-22 patients. Clinical complete response was observed in 19 patients (31.7%); a clinical partial response, in 30 patients (50%); clinical stable disease, in 8 patients (13.3%) and progressive disease 3 patients (5%). 8 out of 11 patients who showed no response were HER2 negative. A pathological complete response (pCR) was observed in 7(21.87%) out of 32 patients who underwent surgery. High ki67 was associated with HER2 positive status[p=0.027] and triple negative breast cancer[p=0.006]. No pCR was observed in TNBC. Luminal tumors were associated with 13.3% pCR. Multiple logistic regression analysis showed pCR was correlated with HER2 positive status[odds ratio26.589,CI=1.606-44.190] p value= 0.022. Taxol containing regimen had 33.3% pCR as against 7% pCR for non Taxol containing regimen. Conclusion Molecular subtypes in breast cancer is an effective factor for predicting the response to NACT. Taxol must be included in NACT to improve pCR. Good response in Her2 enriched and poor response in luminal subtypes to chemotherapy should be further validated in large study population. Keywords: Carcinoma Breast , Ki-67 antigen, Molecular subtypes, Neoadjuvant chemotherapy , Response assessment

 > Abstract Id: YUGP2051 Top

Algorithmic Segmentation Of Liver Tumor Pet/Ct Medical Images.

Presenter- *Prof. Deepthi Sehrawat

Co-author - Abhishek Sehrawat, ,

The motive of this paper is to present an effective technique to segment liver on PET/CT images.Segmentation of liver is a challenging task in PET as well as in CT. Segmentation is based on the intensity of the pixel and whose values may be equal / similar to other structures in case of the liver. Thus, the difference between pixel values may not be sufficient to enable algorithm-based segmentation which makes it quite challenging to segment the liver in different part to identifythe tumor out of it. In this paper we have proposed a method of liver segmentation using thefuzzy C mean clustering which is completed in two phases. First phase is to read the image andconvert it into the gray-scale image and find its level of intensity of each pixel of liver tissue. Insecond phase, use of thresholding technique, contrast enhancement, Fuzzy C-means clusteringand mathematical morphological operation is done to make a binary mask that can extract liverfrom PET/CT fused images. Finally, the results were validated on the basis of ground truth andvisual interpretation by Nuclear Medicine Physicians.

 > Abstract Id: YUGP2053 Top

Thermo Mammogram As A Tool To Assess Response To Neoadjuvant Chemotherapy In Carcinoma Breast


Co-author - Prof Subbiah Shanmugam, Prof Gopu Govindasamy, Dr.Sujay Susikar

Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in carcinoma breast Abstract Introduction : Response to neoadjuvant chemotherapy (NACT) is predicted by clinical examination alone in locally advanced carcinoma breast. This study uses thermo mammogram (TMG) to assess the response . Aim & Objectives : To study thermo mammographic changes during NACT in breast cancer and predict response to NACT in locally advanced carcinoma. To compare clinical response with TMG response/changes in any form. Materials and methods: All patients with locally advanced breast cancer who had treated with NACT were included in this study. Baseline TMG picture was taken using MAMRIT system before chemotherapy. TMG was repeated before next cycle. All patients were also assessed clinically during and after each cycle of chemotherapy. To assess the potential of TMG in predicting tissue response to chemotherapy, the pre-cool, post cool and the temperature difference between pre-cool and post cool before every cycle were analyzed. Results: Total of 19 patients were analysed . 8 patients had complete clinical response, 6 patients had partial response, 5 patients had static disease [Resist—clinical criteria1.1]. Median of pre-cool, temperature difference between pre-cool and post cool for patients between no response and complete response did not show statistically significant difference. However, the median of Post cool spot temperature for patients in visit 1 (34.0 vs 31.5) p

 > Abstract Id: YUGP2065 Top

Evaluation Of Response To Neoadjuvant Chemotherapy In Technically Unresectable Moderately Advanced Oral Cavity Cancers

Presenter- *Dr. Puneet Takkar

Co-author - Dr. Puneet Takkar, Dr. Abhishek Kadian,

BACKGROUND: Moderately advanced and technically unresectable oral cavity cancers have a poor prognosis. Neoadjuvant chemotherapy might be beneficial in such patients by reducing tumour bulk and allowing definitive surgery AIM: To evaluate the response of neoadjuvant chemotherapy in moderately advanced technically unresectable oral cavity cancer MATERIALS AND METHODS: Prospective observational study - secondary data analysis of patients with moderately advanced oral cavity cancer, which were treated with neoadjuvant chemotherapy (NACT) during the period November 2014 - April 2016. Data was analysed for information on patient characteristics, chemotherapy received, toxicity, clinical response rates, local treatment offered and pathological response rates. The statistical analysis was performed with SPSS version 20 RESULTS: 30 patients, with a median age of 52 years were analyzed. Buccal mucosa was the most common sub site (50%). Three drug regimen was utilized in all patients. Resectability was achieved in 14 patients (46.67%). Febrile neutropenia was seen in 3 patients (10%). The overall response rate was 31% CONCLUSION: NACT was effective in converting moderately advanced technically unresectable oral cavity cancers to operable disease in approximately 47% of patients.Post NACT, there is significant association between clinical and pathological findings of response rates. There is no increase in surgical complication rates following NACT. Table 2: Clinical response after receiving NACT and pathological response in patients who achieved resectability Response Clinical Response Pathological Response Number of patients Number of patients (n = 29)(%) (n = 14)(%) CR 0 (0.00) 1 (7.14) PR 9 (31.00) 9 (64.29) PD 9 (31.00) 0 (0.00) SD 11 (37.90) 4 (28.57) Total 29 14 CR - complete response, PR - partial response, PD - progressive disease, SD - stable disease

 > Abstract Id: YUGP2069 Top

Clinical, Radiological, Pathological Correlation Of Nodal Status In Operable Epithelial Ovarian Cancer

Presenter- *Dr. BRIGHT SINGH R S


ABSTRACT Background : The aim of this prospective study, is to correlate radiological and intra operative nodal characterization with pathological examination of pelvic and paraaortic nodes in operable epithelial ovarian cancer. Methods : All the 27 patients with epithelial ovarian cancer admitted in Government Royapettah Hospital between October 2015 and October 2016 were included in the study. All the patients during the study period underwent CT scan of abdomen and pelvis. For lymph nodes that measured more than 1 cm in short axis were considered metastatic. All the patients were surgically staged according to FIGO standard surgical procedures. Early stage operable patients had undergone upfront staging laparotomy and for advanced cases, interval cytoreduction done following neoadjuvant chemotherapy. Inspection and palpation of nodes in pelvic and paraaortic region were done before and after opening of retro peritoneum and classified as significant and insignificant nodes. Significant palpable nodes (more than 1 centimeter) were recorded. All the patients underwent pelvic and paraaortic lymph nodal dissection. All the lymph nodes in the corresponding areas were grossed in to significant and insignificant lymph nodes depending upon size, consistency, and perinodal spread. The lymph nodes were sent for histopathological examination and correlated with the radiological and clinical parameters to get the reliability of the above modalities in predicting malignant deposits. Results : Statistical analysis was done with SPSS package12. Significant correlation was obtained (P value

 > Abstract Id: YUGP2071 Top

The Role Of Bursectomy In Radical Gastrectomy On Survival And Recurrence In Gastric Cancer: A Meta-Analysis

Presenter- *Dr. Saqib Shahab


Introduction Though the multimodality management of gastric cancer has gradually become the standard of care, surgery continues to be at the forefront of it. Radical gastrectomy is the only potentially curable treatment available for an operable non-metastatic gastric cancer. The practice of bursectomy during radical gastrectomy varies across the centers in the absence of its verified therapeutic value. The present meta-analysis was conducted to evaluate the role of bursectomy in radical gastrectomy on survival and recurrence in gastric cancer. Methods A literature search was performed in Pubmed for the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric cancer, published prior to December 2015. Review manager (Cochrane Collaboration’s software) version RevMan 5.2 was used for analysis. The generic inverse variance method was used to calculate the estimate of overall survival and disease recurrence in patients undergoing bursectomy in radical gastrectomy. The data was entered as natural logarithm of relative effect size and standard error of mean for each of the studies. Results There were four studies available for the analysis: three were non-randomized while one was randomized controlled trial (RCT). A total of 1340 patients were included in the meta-analysis — 491 had bursectomy and 848 did not undergo bursectomy during radical gastrectomy. There was no statistically significant difference in either overall survival (HR=0.89, 95% CI 0.72-1.09) or in disease recurrence (HR=0.95, 95% CI 0.82-1.10) in bursectomy group compared to no-bursectomy group; however, subgroup analysis of RCT did show a survival benefit in bursectomy group (HR=0.79, 95% CI 0.64-0.98). Conclusion Though the overall results of the present meta-analysis do not suggest the significant advantage of bursectomy in radical gastrectomy in improving survival, subgroup analysis of RCT shows a trend towards improved survival after bursectomy. Further high-quality RCTs with adequate sample size are warranted to better define the therapeutic role of bursectomy in gastric cancer.

 > Abstract Id: YUGP2078 Top

Congenital Anomalies And Anatomical Aberrations In Head & Neck Oncology €” A Single Insituition Experience

Presenter- *Dr. BRIGHT SINGH R S


ABSTRACT: BACKGROUND: Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. Awareness of such variations will decrease intraoperative dilemma and complications. In this article we have presented our experience in congenital anomalies and anatomical aberrations in head and neck malignancies. We have reviewed literature and discussed relevant embryology & their clinical significance. MATERIALS AND METHODS: All patients with head and neck malignancies operated at our institution in the past three years, who had congenital anomalies and anatomical aberrations detected during preoperative evaluation or intra operatively were included in this study. RESULTS: Eight types of congenital anomalies were encountered, with most common anomaly being the aberrations in pattern of facial nerve branches (43%). Thyroglossal cyst and non recurrent laryngeal nerves were the next common anomalies noted (13%). Preoperative suspicion and diagnosis was evident in three patients. CONCLUSION: Though rare, congenital anomalies may pose significant challenges to the surgeon. Since most of them are noticed intra operatively , a thorough knowledge of anatomy and its variation will help prevent injury to these structures. When promptly recognised and appropriately dealt, congenital anomalies do not produce surgical morbidity.

 > Abstract Id: YUGP2081 Top

Comprehensive And Sensitive Detection Of Somatic Mutations For Monitoring Minimal Residual Disease

Presenter- *Dr. Satish Sankaran

Co-author - Pooja Agrawal, Arun Hariharan, Disha Awasthy

There is growing evidence that somatic mutations in cfDNA extracted from peripheral blood plasma (liquid biopsy) can be used for evaluating Minimal Residual Disease (MRD) as well as response to treatment in different cancer types. The MRD work flow involves testing in two phases; a. profiling of the tumor tissue and selection of somatic variant/s that can be used for tracking, b. tracking the variant at a later time point using a liquid biopsy. We evaluated different technologies and assays that would be suitable for developing a monitoring product. For evaluation, the data from >200 solid tumor samples across various tumors tested on our comprehensive StrandAdvantage 152 gene somatic cancer panel was analyzed. The overall positive detection rate using the 152 gene panel was >80% comprising of both single nucleotide variants across 36 genes and copy number variants. Loss-of-function TP53 variants were detected in >55% of cases. On comparison of different commercially available cancer hotspot panels, the Swift 56G panel covered the majority of single nucleotide variants detected (>95%) with a positive detection rate of 79%, covering all the detected TP53 variants. The added advantage of this panel was the ability to use on both the FFPE tissue as well as liquid biopsy sample. The 56G Swift panel was validated in our lab using both FFPE tissue as well as blood using characterized control and clinical samples with a input DNA requirement of as low as 20 ng. We could achieve 96% sensitivity and 100% specificity with a limit of detection (LOD) of 3% for FFPE tissues. The clinical samples analyzed showed >90% concordance when compared with data from runs using the in-house validated TruSeq Cancer Amplicon Panel (Illumina). The sensitivity, specificity and LOD for liquid biopsy samples were 93.9%, 99.9% and 0.5% respectively. In summary, we have validated a protocol for monitoring residual disease that works well with low sample amounts, across both FFPE tissue and blood samples.

 > Abstract Id: YUGP2087 Top

Characterization Of The Actionable Landscape Of Solid Tumours: An Indian 1000-Patient Study

Presenter- *Dr. Urvashi Bahadur

Co-author - Aarthi Ravichandran, Shataparna Bannerjee, Shreya Paliwal

Next Generation Sequencing (NGS) allows for comprehensive profiling of a tumour genotype across multiple genes. Such molecular profiling can identify key mutations that have the potential to impact therapeutic decisions. We examined the clinical utility of multi-gene sequencing for suggesting additional therapy options. Towards this, we have profiled over a 1000 tumour samples over a wide variety of tumour types (31) using a commercial 48 gene panel and assessed mutations for actionability. The most common tumour types analysed were breast (328), lung (180) and colon (152) and the most commonly mutated genes were TP53, PIK3CA, KRAS. Targeted therapy options were given in 60% of these cases. A potentially attenuated response to approved therapy was suggested in 61% of colon, 15% of head and neck and 10% of lung cancers. EGFR was the most frequently altered gene in lung cancer with L858R and exon 19 deletions observed in 33% and 45% of EGFR positive cases respectively. In colon, BRAF, NRAS and extended KRAS mutations were observed in 10% of the cases, indicating that testing for more than the standard KRAS mutations is also valid in the Indian context. Therapy was recommended in 48% of the less frequently observed cancer types. Further, a larger panel covering more genes and capable of detecting fusions and copy number variations may offer greater utility when additional therapy options are of particular interest. Our custom-designed, validated 152 gene panel provides actionability in 90% of the cases with more alterations detected, allowing for more therapeutic avenues to be explored. Thus, these data suggest that multi gene testing is a clinically meaningful approach and it can not only provide recommendations for new drugs but also aid informed decision making for standard of care therapy in certain cases. Wider adoption of such testing will allow for personalised treatment planning.

 > Abstract Id: YUGP2091 Top

Stereotactic Body Radiation Therapy For Oligometastatic Pulmonary Tumors From Cervical Cancer

Presenter- *Mr. Wang Weiping

Co-author - Hou Xiaorong, Hu Ke, Zhang Fuquan

Objective: To evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) for pulmonary metastases from cervical cancer. Methods: Nineteen patients with 29 oligometastatic pulmonary lesions form cervical cancer were treated with SBRT in our institute from July 2011 to July 2016. Before pulmonary metastases, all patients experienced a period of disease free survival after initial treatment. Thirteen patients (68.4%) suffered with solitary lung metastasis, 3 patients (15.8%) with multiple unilateral lesions and 3 patients (15.8%) with bilateral lesions. The median size of lung lesions was 2cm (0.7-5.6cm). Patients underwent cone-beam CT before the delivery of SBRT. The most common dose fractionation schemes were 64Gy in 8 fractions (8 lesions) and 56Gy in 7 fractions (7 lesions). Nine patients (47.4%) received systemic chemotherapy. Results: The median follow-up was 9.5 months (3.0-62.4months). The median follow-up of survival patients was 18.9 months (3.6-62.4months). The 1-year overall survival (OS), progression free survival (PFS), regional control (RC) and local control (LC) were 76.8%, 55.8%, 68.1% and 75.6%, respectively. The median OS and PFS were 62.4 and 12.7 months, respectively. Six patients (31.6%) gained more than 20 months disease-free survival. Eleven patients (57.9%) experienced tumor relapse, including 7 patients with pulmonary relapse and 4 patients with extra-pulmonary disease. Only 1 patient (5.3%) suffered with symptomatic radiation pneumonitis (grade 2). Conclusion: SBRT was an efficacy treatment approach with low toxicity for oligometastatic pulmonary disease from cervical cancer. It should be considered as an important approach for pulmonary disease from cervical cancer beside surgery.

 > Abstract Id: YUGP2095 Top

Signaling Through The Hedgehog Pathway In Ovarian Cancer

Presenter- *Ms. Sneha S

Co-author - Sneha Smarakan, Rohit Pravin Nagare, Krishna Priya Syama

SIGNALING THROUGH THE HEDGEHOG PATHWAY IN OVARIAN CANCER Sneha S, Nagare R. P, Krishna Priya S and Ganesan TS. Departments of Medical Oncology & Clinical Research, Cancer Institute (WIA), Chennai tsganesan@gmail.com Background: The signaling pathways that cancer stem cells (CSCs) employ may be similar to those in embryonic stem cells. These are ‘wnt’, ‘notch’ and ‘hedgehog’. Objective: Evaluate signaling by CSCs, using specific small molecule inhibitors in serous ovarian cancer cells. Methods: Serous ovarian cancer cell lines (N=7) were cultured as spheroids under stem cell conditions in the presence or absence of small molecule inhibitors and counted after two weeks. The effect on cell proliferation was evaluated by the MTT assay. In addition, cells from malignant ascites from patients with serous adenocarcinoma of the ovary (PMC) were cultured as monolayer in the presence or absence of inhibitors. Assays were performed to analyse effect on CSCs. These were ALDH1A1 assay (N=20), Hoechst exclusion assay (N=3), expression of surface markers (N=20), wound healing assay (N=6), and colony assay (N=7). The effect on the cell cycle of CSCs was analysed using Hoechst and Pyronin Y. Results: Spheroid formation in OVCAR3 and UC1101 cells was inhibited completely by the smoothened inhibitor (SMO) GDC0449 (3ÂμM) despite lack of cytotoxic effect when evaluated by the MTT assay. Flow cytometry analysis of PMC cultured in the presence of GDC0449 showed significant reduction in the expression of ALDH1A1 (2.5±0.9), CD44 (18.6±5.5), CD9 (1.6±0.8), CD133 (0.5±0.3), CD117 (18.8±13.4), CD24 (0.1±0). Similar results were obtained with inhibitors, LDE225 (SMO, 2.5nM) and GANT61 (Gli, 5ÂμM). Significant reduction in migration of PMC was observed in the scratch assay and clonogenic assay in the presence of inhibitors (P< 0.001). Side population assay revealed a reduction in CSCs following treatment with GANT61 (P< 0.05). In PMC, GANT61 also decreased the quiescent (Hoechst33342low/PyroninYlow) cell population (P< 0.05). Discussion and Conclusion: These results demonstrate that the hedgehog pathway is important in maintaining the integrity of CSCs in ovarian cancer.

 > Abstract Id: YUGP2097 Top

An Investigation Into The Mutational Spectrum And Sub-Types Of Tnbcs In Indians; A Population With High Proportion Of Tnbcs

Presenter- *Dr. Aruna Korlimarla

Co-author - Jyothi S Prabhu, Savitha Rajarajan, Hari P S

TNBC is a heterogeneous disease and the subtypes reported by Lehman B et al in 2014 differ in their gene expression profiles, mutational spectrum and the extent of immune infiltrates. Indians have a higher proportion of TNBC (~ 30%) with a greater number of younger women and clinico-epidemiological features that resemble that of the ethnic African American (AA) population (Kakarala M et al 2010). We have earlier reported the use of the BRCA1/ID4 transcript ratio, as a measure of BRCA1 deficiency in TNBCs (Korlimarla A et al 2016). Here we examined the mutational spectrum in a fraction of our TNBC tumors. We sequenced somatic DNA from 25 TNBCs (FFPE Specimens) on Illumina MiSeq V2 150x2, from a non-consecutive retrospective case-series of close to 200 tumors (comprising 30% TNBC) from a regional cancer centre in Southern India. The TruSeqAmplicon - Cancer Panel Kit (Illumina) comprising of 212 DNA-specific amplicons covering hotspots in 48 cancer associated genes was used to construct the libraries. Variant calling was done following ACMG guidelines. Data from our series was compared to TCGA. The most frequently mutated genes were TP53, followed by PIK3CA and KRAS indicating similarity in the biology of the disease compared to that reported in the TCGA set (N=102). At 80%, the frequency of TP53 mutations in our set was comparable with that of Caucasians (70%) and AA (73%). However, we noted a statistically significantly higher proportion of PIK3CA mutations (7/25 =28%) as compared to ~8% in TCGA set (8/102) of which, there were none in AA (0/20), (p=0.003). Curiously enough frequency of KRAS mutations was also high at 24% which has not been earlier reported. Is the mutation profile of Indian TNBCs different from that of the west? A more detailed analysis of this work validated on a cohort with outcomes and survival data is underway. Since very little is known about the mutation landscape of Indian TNBCs, analysis of the mutational spectrum and identification of actionable mutations in TNBCs can help target therapy.

 > Abstract Id: YUGP2099 Top

The Efficacy And Toxicity Of Image-Guided Intensity Modulated Radiation Therapy Combined With High Dose Brachytherapy For Figo Stage Iib Cervical Cancer

Presenter- *Mr. Wang Weiping

Co-author - Wang Dunhuang, Liu Xiaoliang, Meng Qingyu

Objective: We evaluated the efficacy and toxicity of image-guided intensity modulated radiation therapy (IMRT) combined with high dose intracavitary brachytherapy (ICBT) for FIGO stage IIB cervical cancer. Methods: We retrospectively analyzed 373 patients with stage IIB cervical cancer treated with IMRT combined with high dose ICBT and concurrent chemotherapy in our institute from May 2005 to December 2013. A dose of 50.4Gy in 28 fractions was delivered to clinical target volume with IMRT technique. A dose of 59-61 Gy was prescribed to the involved regional lymph nodes with simultaneous integrated boost. Weekly cone-beam computed tomography (CBCT) or daily mega voltage computed tomography (MVCT) was used for image guide. A second CT simulation and planning was conducted after IMRT of 20 fractions and ICBT of 1-2 fractions. With high-dose-rate ICBT, 30-36Gy in 5-7 fractions was prescribed to point A. All patients received concurrent chemotherapy. Results: The median follow-up was 32.5 months (range, 3.1-119.8 months). The 3-year overall survival (OS), disease-free survival (DFS) and local control (LC) were 87.5%, 82.2% and 92.5%, respectively. A total of 60 patients (16.1%) experienced treatment failure, including 21 patients (5.6%) with pelvic relapse, 37 patients (9.9%) with distant metastasis and 2 patients (0.5%) with pelvic relapse and distant metastasis. Of the 108 patients with positive regional lymph nodes, 7 patients (6.5%) experienced regional lymph nodes failure. There was 1 patient died of treatment-related renal failure. The incidence of ?grade 3 chronic gastrointestinal and genitourinary toxicity were 2.7% and 2.4%. Conclusion: IMRT combined with high dose ICBT and concurrent chemotherapy resulted in a good survival and acceptable toxicity for stage IIB cervical cancer.

 > Abstract Id: YUGP2101 Top

Evaluation Of Brca1, Stat-1 And Stat-3 Expression In Non Familial Breast Cancer: An Observational Study From North India

Presenter- *Dr. Sameer Gupta

Co-author - Preeti Agarwal, Prof. Arun Chaturvedi, Vijay Kumar

Background: Targeted therapy against ER/PR/HER-2/neu for carcinoma breast is well established but there is continuing search for optimal targeted therapeutic options for triple negative breast cancer (TNBC) patients. TNBC is reported to be the most common breast cancer subtype in Indian population which is nearly twice the rate reported in Western countries. We evaluated the expression of BRCA-1 in non-familial female breast cancer patients along with down the line molecular targets (STAT 1 and 3) with the objective of identifying potential therapeutic targets in TNBC. Methods: Immunohistochemistry performed for Estrogen receptor (ER), Progesterone receptor (PR), Her-2/neu receptor (HER2), Cytokeratin (CK5/6), Ki67, BRCA1, STAT1, STAT3, pSTAT1 and pSTAT3 in 145 sporadic IDC-NOS breast cancer cases with appropriate positive and negative controls with objectives to study inter marker co-relation and their correlation with clinic-pathological variables and clinical outcomes. Results TNBC was most frequent subtype (37%) followed by equal distribution of HER2 and Luminal type B (21.7% each) and luminal A type (19.4%). BRCA nuclear loss was observed in 62.68% (89/142) and STAT1-loss in 68.6% (59/86). Cases with BRCA1 nuclear loss and STAT1-loss had larger tumor size, higher grade, axillary nodal metastasis (pN2, pN3), high Ki67 and poor clinical outcome as compared to cases with BRCA1 nuclear protein / STAT 1 expression. Expression of pSTAT1was studied in 60 cases. BRCA1 nuclear loss and STAT1 down regulation was seen in 88.3% (38/43; p=0.044). STAT 3 expression was seen in 115/137 (83.94%) cases. Association of STAT3 nuclear expression with Nottingham grade, BRCA1nuclear loss, Ki67 was found to be statistically significant. STAT 3 phosphorylation showed that STAT 3 up-regulated tumors were aggressive with larger tumor size and proliferative activity. Conclusions Therapeutic targeting of BRCA1 pathway and STAT 3 up regulation by PARP and STAT-3 inhibitors may be useful way forward in sporadic breast cancers. Total 74% (40/54) TNBC cases displayed BRCA1 nuclear loss with nine cases (9/54; 16%) harbouring STAT 3 up-regulation. Targeted agents against BRCA 1 and STAT 3 may be especially relevant for TNBC which are not only hormone treatment deprived but also have limited chemotherapy treatment options.

 > Abstract Id: YUGP2103 Top

Value Of 18F-Fdg Pet-Ct Parameters To Predict Prognosis In Patients With Locally Advanced Cervical Cancer

Presenter- *Mr. Wang Dunhuang

Co-author - Wang Weiping, Liu Xiaoliang, Meng Qingyu

Objective:The aim of this study was to predict prognosis in patients with locally advanced cervical cancer by the relevant parameters of 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET-CT),such as maximum standardized uptake values(SUVmax),mean standardized uptake values(SUVmean),metabolic tumor volume(MTV) and total lesion glycolysis(TLG). Materials and methods:We retrospectively investigated 125 patients with locally advanced cervical cancer who underwent 18F-FDG PET-CT before definitive chemoradiotherapy in our institution from February 2010 to December 2015.SUVmax,SUVmean,MTV and TLG of the primary tumor were analyzed to evaluate the relationship between these factors and prognosis. Receiver operating characteristic(ROC) curves was used to calculate the optimal cut-off values of SUVmax, SUVmean, MTV and TLG for DFS. The survival data was analyzed by the Kaplan-Meier method and COX regression analysis. Results: The median follow-up was 29 months (range, 3-77 months). Univariate analysis indicated that MTV more than or equal 18.8cm3 showed worse overall survival (OS),disease free survival(DFS) and disease metastasis free survival(DMFS). TLG more than or equal 113.5 implied worse DFS and DMFS. In multivariate analysis, TLG more than or equal 113.5 was independent predictive factor for DFS and DMFS, while there was no significant relevance for OS. Conclusion: Pretreatment TLG more than or equal 113.5 related with more distant metastasis in patients with locally advanced cervical cancer.

 > Abstract Id: YUGP2107 Top

Giant Cell Tumor - Lung

Presenter- *Dr. Vijayakumar Subramaniam

Co-author - Professor Dr.K.KALAICHELVI, Dr.S.SURESH KUMAR, Dr.G.RAGA

INTRODUCTION : Primary extraosseous benign giant cell tumors have been described in many internal organs, (e.g. pancreas, liver, gallbladder, uterus, kidney, ovary, large intestine, heart, lung, thyroid and salivary gland) the skin and soft tissues. These tumors, apart from the minute epithelial elements, are histologically indistinguishable from the skeletal giant cell tumor, ”osteoclastoma”. The main components of these tumors were osteoclast-like muitinucleated giant cells and mononuclear stromal cells. Until now, Only 8 cases of giant cell tumor of the lung were reported in the literature. Surgery is curative. CASE REPORT: A 33 year old female presented with cough and haemoptysis of 2 months duration with past history of lower lobectomy of right lung for the same complaints, 3 years ago. Pathology of lobectomy specimen was reported as giant cell tumor of the lung. Present CT scan of the chest showed mass lesion in the right upper lobe. Patient underwent right completion pneumonectomy and pathology was reported as recurrent giant cell tumor of the lung with negative margins. Now the patient is on regular follow up. This case is reported for its rarity. KEY WORDS: Osteoclastoma, Giant cell tumor, Lung

 > Abstract Id: YUGP2109 Top

Fat1 Knockdown Led To Reduce Micro-Rna Expression In Glioblastoma

Presenter- *Ms. NARGIS MALIK

Co-author - Srinivas H, chitrangda srivastava, yakhlesh gupta

Background: FAT1 gene is localized at chromosome 4q35.2 encoding a 506 KD a transmembrane protein and functions as oncogene and tumor suppressor depending on tissue types in human cancers. Our lab has identified an oncogenic role of FAT1 in glioblastoma. miR-221-3p/222-3p has been reported to have oncogenic role and targeting tumor suppressor (e.g. CDKN1B, PTEN, PUMA etc.) in many cancers along with glioblastoma multiform. miRNAs are noncoding RNA which are bound to the 3’UTR of target mRNA and repress their expression Here, we have elucidated the role of FAT1 gene in the regulation of miRNAs in glioma. Methodology: In order to delineate regulation of miRNA by FAT1 in glioma we used knockdown strategies followed by expression analysis by q-PCR. miRNA 221-3p/222-3p are isomiRs and acts as OncomiRs in human cancer. FAT1 specific siRNA and scramble siRNA were used in this study purchased from Invitrogen, USA. Glioma cell lines were maintained in Dulbecco’s modified Eagle’s Medium (DMEM) with 10% fetal calf serum (FCS). The Knockdown experiment were carried out in U87MG, U373, A172, T98, LN229 and GOSIII glioma cell lines. We have used Exiqon total RNA isolation kit to isolate miRNA and followed by preparing cDNA by using Exiqon cDNA synthesis kit. We have used LNA-primer (locked nucleic acid) to analyze the expression of miR-221/222-3p in glioma cell lines. We have done in-silico analysis to identify potential miRNA target molecules by using miRNA target prediction software (microrna.org, Diana-micro, Target Scan Human, and miRDB). GBM (Glioblastoma) tumor samplesv(n=18) were collected from Department of Neurosurgery/Pathology of All India Institute of Medical Sciences, India. GBM tissue were collected in 1 ml of RNA-Later solution and incubated for 24 hours at 4°C. After removing RNA-Later solution the tumor tubes were immediately stored at -70°C till further use. For the control, normal human brain RNA were purchased commercially (Clonetech, USA). Results: We have observed increased expression of FAT1 and miRNA in different glioma cell lines (U87MG, U373MG, A172, LN229, T98G and GOS3). In order to validate the FAT1 and miRNA correlation we have used knockdown strategy in glioma cell lines. We have analyzed the expression of miRNA in glioma cell lines after FAT1 knockdown and compared with siControl. We have observed more than 80% FAT1 knockdown in U87MG, U373MG, A172, T98G and GOS3 and almost 70% FAT1 knockdown in LN229. We observed decreased expression of miR-221/222-3p after FAT1 knockdown in different glioma cell. We have done in-silico study to identify potential miRNA targets and found CDKN1B, TIMP, PDCD10, PUMA and PTEN molecules are the significant targets of miRNA. In order to validate these findings we have analyzed expression of PDCD10, PUMA and PTEN in FAT1 knockdown cells and compared with siControl cells. We observed increase expression PDCD10, PUMA and PTEN after FAT1 knockdown in glioma cell lines. Our observation suggests that FAT1 expression affects the miRNA and its target in glioma cell lines. In order to confirm our in-vitro observation and its clinical relevance, we have done correlation study in GBM tumors. GBM tumors (n=18) were collected and expression of FAT1, mRNA and its targets were analyzed by q-PCR. We have observed negative Pearson correlation of FAT1 with PDCD10 (correlation value -0.720), PTEN showed (correlation value -0.267) and PUMA (correlation value -0.218). In conclusion:- Taken together our in-vitro and GBM tumor data for the first time suggesting FAT1 to be a novel molecule regulating the expression of miRNA in GBM and FAT1 may emerge as a target for therapeutic intervention.

 > Abstract Id: YUGP2111 Top

A Dosimetric Comparison Of Fixed-Field Intensity-Modulated Radiotherapy, Rapidarc Therapy And Helical Tomotherapy For Extended-Field Irradiation In Cervical Cancer

Presenter- *Mr. Wang Dunhuang

Co-author - Dong Tingting, Liu Nan, Yang Bo

Objective:To compare dosimetric parameters of fixed-field intensity-modulated radiotherapy(FF-IMRT),rapid arc therapy(RA) and helical tomotherapy(HT) for extended-field irradiation in cervical cancer, aiming at investigating the suitable radiation technique. Materials and methods: We chose 15 patients with para-aortic lymph node for cervical cancer who underwent definitive chemoradiotherapy in our institution since 2015. FF-IMRT,RA and HT plans were designed basing on the same CT simulation image for each patient. To evaluate isodose distribution, conformity index (CI), homogeneity index (HI) and dose of organs at risk(OARs) by dose volume histogram(DVH) of three plans. The three plans were also compared in terms of Monitor units(MU) and time of single treatment. Results: HT showed significantly better CI and HI than FF-IMRT and RA, and RA was also superior to FF-IMRT. HT was superior to FF-IMRT and RA for protecting OARs, such as small intestine and kidney. But there was little difference between FF-IMRT and RA. RA provided shortest time of single treatment and least MU,and there was significantly difference between three plans. Conclusion: Three plans all satisfied requirement of clinical dosimetry for extended-field irradiation in cervical cancer,but HT was superior to FF-IMRT and RA. HT achieved superior OARs sparing while maintaining the best CI and HI,may reduce related toxicity of radiotherapy. RA could realize the goal of clinical dosimetry, meanwhile shorten the treatment time, probably reduce the influence of uncertain factors and patients’ discomfort.

 > Abstract Id: YUGP2115 Top

Survival Outcomes In Localised Pediatric Osteosarcoma

Presenter- *Dr. Rachana Chennamaneni

Co-author - Dr. Stalin Bala, Dr. Sadashivudu Gundeti, Dr. Meher Lakshmi

Background Osteosarcomas are primary malignant tumors of bone that are characterized by the production of osteoid or immature bone by the malignant cells. They account for 3% of all childhood cancers, but are the most common primary malignancy of bone in children and adolescents. Historically surgery was the mainstay of therapy, but addition of effective chemotherapy lead to dramatic improvement in survival. The purpose of this study is to determine the effect of pre and postoperative chemotherapy on outcomes in localised osteosarcoma in children and adoloscents. Materials and methods This is a single institutional retrospective study of patients diagnosed with localised osteosarcoma under 21 years of age, presented at our institute between January2011- January 2016. Results Of the 102 pediatric patients with osteosarcoma, 71 had localised disease at presentation. The median age at presentation was 17 years (range 6-21 years), with a male predominance (male to female ratio-1.7:1). Conventional osteosarcoma was the most common variant seen in 52(73%) patients, followed by telangiectatic variant in 7(10%) patients. Extremities were involved in 58(82%) patients with distal femur being the most common site of the primary in 26(45%), followed by tibia in 24(41%), fibula in 5(9%), radius in 2(3%) and humerus in 1 (2%), while axial skeleton was affected in 13(18%). Neoadjuvant chemotherapy, with 2 cycles of cisplatin and doxorubicin, was administered in all patients. Post neoadjuvant therapy, 59(83%) patients underwent surgery. Post surgery 4 cycles of cisplatin and doxorubicin were given. The three year event free survival and overall survival were 46% and 54% respectively. The most common toxicity with chemotherapy was mucositis in 20(28%) patients, while grade 3 or 4 toxicities were seen in 8(11%) patients. Conclusion Chemotherapy, before and after surgery, improve survival in pediatric patients with localised osteosarcoma. The outcomes in this study were similar to the other studies using non methotrexate based dual drug therapy.

 > Abstract Id: YUGP2117 Top

The Clinical Outcomes Of Cervical Cancer Patients With Para-Aortic Lymph Nodes Metastasis Treated By Definitive Extended Field Intensity-Modulated Radiation Therapy

Presenter- *Mr. Liu Xiaoliang

Co-author - Wang Dunhuang, Wang Weiping, Meng Qingyu

Objective:To analyze and evaluate the clinical outcomes of cervical cancer patients treated by definitive extended field intensity-modulated radiation therapy(EF-IMRT). Methods:We retrospectively analyzed 81 cervical cancer patients with para-aortic lymph node metastasis treated by EF-IMRT in Peking Union Medical College Hospital between May 1st 2008 and Dec 31st 2014 .The external beam irradiation dose was 45-50.4Gy, and involved lymph nodes were received a concomitant boost to 56-61.6Gy, some patients with stage IIIB received a related parametrium boost of 10Gy. High dose rate(HDR) brachytherapy with Ir192 was prescribed to point A at a dose of 30-36Gy/5-6F.Most patients received chemotherapy based on cisplatin. Results: by the end of the last follow-up, 49 patients were alive, the median follow-up time was 29 months(10.6-101.3months). The 2-year overall survival rate(OS), diseases free survival rate(DFS), local control rate(LC) were 61.8%, 46.2%, 82.3%,respectively. The 3-year OS, DFS, LC were 57.5%, 44,1%, 82.3%. There were 39 patients relapsed, among which, 8 patients(20.5%) had local recurrence only, 1 patients(2.6%) had both local recurrence and distant metastasis and 30 patients(76.9%) had distant metastasis only.Tumor size and number of chemotherapy courses were independent predictors of DFS and LC. The percentage of acute grade 3 or greater gastrointestinal(GI), genitourinary(GU) and hematologic complications were 4.9%, 3.7%, 49.4%. Only 1 patient developed late grade 3 GI and GU complications, and received an operation. Conclusion: Reasonable clinical outcomes can be achieved with EF-IMRT for cervical cancer patients with para-aortic lymph node metastasis, and the toxic complications are acceptable. Distant metastasis is the major failure patterns. The tumor size and number of chemotherapy courses are independent predictors of DFS and LC.

 > Abstract Id: YUGP2119 Top

Dermatofibrosarcoma Protuberans: Clinical Profile And Management Outcomes; A Single Institutional Experience Of 82 Cases

Presenter- *Dr. Suman Kharkwal

Co-author - Dr SVS Deo, Dr NK Shukla, Dr DN Sharma

Background —Dermatofibrosarcoma Protuberans (DFSP) is a rare cutaneous tumor of low malignant potential . Surgery is curative in majority of cases but sub optimal surgical interventions and high recurrence rates are often encountered due to rarity of the disease , paucity of literature and innocuous clinical presentation. We present a single institution experience of managing 82 DFSP patients. Material and method- The medical records of all biopsy proven DFSP patients treated at our centre between 1995 to 2016 were accessed from the prospectively maintained soft tissue sarcoma data base. Data regarding clinical profile, treatment details and relapse patterns were analysed. Result- A total of 82 patients of DFSP were treated between 1994 to 2016 constituting 14 % of all soft tissue sarcomas. Two thirds were in 3rd to 5th decade and males were more commonly affected (74%) . Chest wall and trunk was the most common site ( 51%) . Mean tumor size was 6.5 cm . 82 % patients had history of previous sub-optimal surgical intervention. Wide local excision was performed in all patients and 35 patients required soft tissue reconstruction using flaps. External beam radiotherapy (EBRT) was given to 57% high risk cases. At a mean follow up of 55 months 7% had local relapse and 2 patients had systemic relapse. Conclusion- DFSP is a rare variety of Soft tissue sarcoma and often mismanaged at community level. Optimal surgical resection with negative margins and judicious use of reconstructive surgery and radiotherapy can result in excellent outcomes. Keywords: DermatofibrosarcomaProtuberans (DFSP), Wide local excision ,External beam radiotherapy (EBRT).

 > Abstract Id: YUGP2123 Top

He Clinical Outcomes Of Cervical Cancer Patients Treated By Prophylactic Extended Field Intensity-Modulated Radiation Therapy

Presenter- *Mr. Liu Xiaoliang

Co-author - Meng Qingyu, Wang Weiping, Wang Dunhuang

Objective: To analyze and evaluate the clinical outcomes of cervical cancer patients treated by prophylactic EF-IMRT. Methods: We retrospectively analyzed 122 cervical cancer patients treated by prophylactic EF-IMRT in Peking Union Medical College Hospital between Apr 1st 2008 and Dec 31st 2014. All patients received external beam irradiation of 45-54Gy, and a concomitant boost to 54.8-66Gy was delivered to involved lymph nodes. Some patients with stage IIIB were received a related parametrium boost of 6-10Gy. HDR brachytherapy with Ir192 was prescribed to point A at a dose of 24-42Gy/4-7F. Most patients received concurrent chemotherapy of weekly cisplatin or paclitaxel. Results: The median follow-up time was 31.6months(3.7-96.1months), the 3-year OS, DFS, LC were 88.0%, 77.7%, 91.2%, respectively. The expected 5-year OS, DFS, LC were 85.6%, 75.9%, 89.0%. By the end of the last follow-up, there were 26 patients relapsed, among which, 9(34.6%) patients had local recurrence only, 16(61.5%) patients had distant metastasis only, 1(3.9%) people had both local recurrence and distant metastasis.The percentage of acute grade 3 or greater GI, GU and hematologic complications were 7.9%, 6.7%, 67.4%. The percentage of late grade 3 or greater GI, GU and complications were 2.7% and 1.8%. The HGB level before treatment was an independent predictors of OS and DFS. Conclusions: EF-IMRT for cervical cancer patients with high risk of para-aortic lymph node metastasis, has good clinical outcomes, but it still needs prospective study to identify.

 > Abstract Id: YUGP2133 Top

Role Of Gefitinib In Non-Small Cell Lung Carcinoma: A Retrospective Study

Presenter- *Dr. DURGESH KUMAR

Co-author - A.K. Arya, Anuj kumar, Indira Yadav

Background: Lung cancer is the leading cause of death due to cancer in India. We analyzed 33 patients of lung cancer, receiving oral Gefitinib for advanced Non-small cell lung cancer in department of Radiotherapy(LPRI). Materials and Methods: Patients who were diagnosed from January 2012 to may 2017 were evaluated. 33 patients were evaluable. All patients received Gefitinib 250 mg/day until disease progression, unacceptable toxicity, or death of the patient. Response of treatment was evaluated by chest X-ray, Symptomatic improvement (Kernofsky scale) and according to the clinical judgment. Results: Out of 33 patients, 22 were male, and male to female ratio was 2:1. The mean age at the time of diagnosis was 59.98yr (range 40-75 yr).4 (12.1%) of the patients were non smoker. Out of 28smokers, 14 patients have history of alcohol consumption. Mean year of smoking was 25 yr. Majority of the patients had advanced disease, 56.6% patient presented with Squamous Cell Carcinoma and 43.3% Adenocarcinoma. The mean duration of treatment was 180 days (range 90-288days). Out of 33, 18Patient had received prior chemotherapy in form of Cisplatin and Etoposide. Follow-up duration ranges from 105-458 days (mean 278 Days). PFS was 125 days (range 90-262days). 25/33 (75.7%) patient responded well to treatment without any morbidity. Conclusion: In case of advanced and recurrent Non-small cell lung cancer patients, Tab. Gefitinib is better option. It is well tolerated and toxicity profile is also low.

 > Abstract Id: YUGP2135 Top

Multimodality Management Of Pnet Chest Wall : Aiims-New Delhi Experience.

Presenter- *Dr. Suman Kharkwal

Co-author - Dr SVS Deo, Dr NK Shukla, Dr.Sunil Kumar

Background: Askin tumour or peripheral primitive neuroectodermal tumour (PNET) of Thoraco-pulmonary region is a rare ,highly aggressive tumour belonging to Ewings sarcoma family of tumour (EFT). A paradigm shift to successful outcomes was possible in recent times due to introduction of Multimodality management .We present our experience of treating 24 cases of PNET with multimodality management. Materials and method : Data of Histo-pathologically proven cases of PNET involving chest wall was extracted from the prospectively maintained Computerized soft tissue sarcoma data base and analysed for clinical profile , details of multimodality management and relapse patters. Result: A total of 24 cases of PNET chest wall were treated between 2010 to 2015. The mean age was 24Years (range 12 to 37 yrs) . Disease was equally distributed in both sexes. Most common presentation was chest pain ( 61 %) followed by Chest wall mass. All patient except one received Neo adjuvant chemotherapy followed by surgery with or without radiotherapy . VAC ( vincristine, Actinomycin D,cyclophosphamide ) alternating with IE ( ifosamide ,etoposide ) was the chemotherapeutic regimen given. All patients responded to NACT and had chest wall resection and reconstruction . Three 3 patients required lung resections. Radiotherapy was given in 6 Patients Out of 14 Patients . At a median follow-up of 22.5 months .8 Patients had relapse of disease . Conclusion: Askins tumours are highly aggressive type of tumors affecting younger population . These tumors are highly chemosensitive hence NACT followed by radical surgery results in optimal outcomes. These cases should ideally be treated in tertiary care cancer centres with expertise for successful outcomes. Keywords: Askin tumour, PNET , Ewings sarcoma , NACT

 > Abstract Id: YUGP2137 Top

A Leukemic Dilemma- Rare Case Of Alk Negative Anaplastic Large Cell Lymphoma In Leukemic Phase

Presenter- *Dr. Roshan Koshy Jacob

Co-author - Dr Manjunath N, Dr Shashidhar V K, Dr Sunit Lokwani


 > Abstract Id: YUGP2143 Top

Role Of Hypofractionated Palliative Radiotherapy In Patients With Advanced Head And Neck Cancer

Presenter- *Dr. Ankur Mudgal


AIM : The aim of present study is to evaluate the role and feasibility of palliative radiotherapy in patients with advanced head and neck cancer who are not fit for radical treatment . MATERIAL AND METHODS : This study was conducted on histopathologically proven squamous cell carcinoma of the Head and Neck region who were surgically unresectable. All patients having performance status range between 60-100 (as per Karnofsky Performance scale). Presenting symptoms were recorded and graded on pragmatic scale of mild, moderate, and severe. All patients received 40 Gy in 10 fractions,2 fractions per week by two lateral field covering primary and secondary disease. Tumor response was assessed using WHO criteria . Toxicity were assessed weekly using RTOG criteria. RESULTS : Total 40 patients were enrolled in this study out of which 38 completed the planned treatment of 40 Gy/10 fractions . Response was assessed 4 weeks after completion of radiotherapy. 89% of patients got excellent symptomatic relief in their presenting symptoms, none of them experienced grade 3 mucostits or skin toxicity . 32 % patient got partial response , 52% having stable disease and 16% having progressive disease . CONCLUSION : It is concluded that this short course palliative radiotherapy regimen is an effective treatment option in patients with advanced head and neck cancer who are not fit for radical treatment . The proposed radiotherapy regimen showed sustained symptom palliation with no acute toxicity.

 > Abstract Id: YUGP2145 Top

Health Related Quality Of Life And Functional Outcome Following Radical Cystectomy With Orthotopic Neobladder For Invasive Bladder Cancer.

Presenter- *Mr. Srinivasan Vijay

Co-author - M.S.Satish, Dr.Surendra Veeraiah,

Back ground: Bladder cancer is estimated to be the ninth most common cancer worldwide. The global incidence of bladder tumours is 4.4%. In Chennai the age standardised incidence of bladder tumour among male is 3/100000 population. Orthotopic neobladder (ONB) reconstruction is the most favoured mode of urinary diversion following radical cystectomy . Studies reveal that Scientific advancement in uro-rehabilitation has improved the Quality of life (QOL) and Functional status in urinary Incontinence. However, the quality of life of ONB patients is yet to be understood. Hence, present study aims to investigate the quality of life and functional outcomes in male patients following ONB. METHODS: Bladder cancer patients(n=20) underwent radical cystectomy with Neo bladder reconstruction were assessed for quality of life during 3rd month and 9th month following surgery using Cancer Institute QOL questioner and author constructed urinary continence score for Functional outcome . ONB patients were taught and emphasised on kegel’s exercise preoperatively and also advised to follow the same postoperatively. Data were analysed using descriptive statistics and paired ‘t’test . RESULTS: It was found that 45% of patients had high QOL while, 5% had very high QOL, and 45% of patient reported average QOL. The overall QOL (t=7.847; p< 0.000) found to differ significantly between 3rd and 9th month. The mean score is indicative of improvement in post assessment. CONCLUSION: Most of the patients with bladder reconstruction on a regular Kegel’s exercises had acceptable continence level and good QOL.