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   2010| January-March  | Volume 6 | Issue 1  
    Online since May 15, 2010

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Gemcitabine and treatment of diffuse large B-cell lymphoma in relapsed or refractory elderly patients: A prospective randomized trial in Algeria
Mourad Aribi, Naima Mesli, Nesrine Remla, Badr-Eddine Sari, Abdesselam Taleb, Hadj Touhami, Mohamed-Amine Bekadja, Zahia Zouaoui-Benhadji, Kamel Bouzid, Kaoual Meguenni
January-March 2010, 6(1):41-46
DOI:10.4103/0973-1482.63572  PMID:20479546
Context: Support for non-Hodgkin's lymphoma (NHL) with large cells that is refractory or relapsed after first-line chemotherapy poses a greater therapeutic problem with bone marrow transplant therapy or when old age is a contra-indication for high-dose chemotherapy, especially among developing countries such as Algeria. Aim: To show that the regimen, including gemcitabine, could be more effective in treating elderly patients with diffuse large B-cell lymphoma (DLBCL) in relapse / refractory, without complete remission, when compared with the ESHAP (etoposide, cisplatine, solumedrol, aracytine) regimen. Materials and Methods: Ninety-six patients in the age group of 60-70 years were volunteers for a prospective randomized single-blind study, carried out for three years. Patients were divided into two groups by the drawing of lots. The first group (GA, n = 48, relapse; n = 27 [56.3%], refractory; n = 21 [43.7%]) received treatment with ESHAP protocol and the second one (GB, n = 48, relapse; n = 28 [58%], refractory; n = 20 [42%]) with GPD (gemcitabine, dexamethasone, cisplatine) protocol. Results: The overall response rates and mean survival at three years were significantly higher among patients subjected to GPD treatment compared with those subjected to ESHAP treatment (63% vs. 55%, P = 0.01 and 20.5% [95% CI 16.5-24.5] vs. 11.8% [8.9-14.6], respectively). Additionally, three-year progression-free and event-free survival rates were 20.5% (16.3-24) and 19.7% (15.9-23.5), respectively, for the GPD regimen and 10.9% (8.2-13.7) and 11.1% (95% CI 8.5-13.7), respectively, for the ESHAP regimen. Moreover, the GPD regimen was associated with improving overall survival (RR=2.02, 95% CI 1.59-2.56; P = 0.000), event-free survival (2.03, 1.64-2.52; P < 0.001) and progression-free survival (1.86, 1.46-2.37; P < 0.001). Conclusion: In cases of contra-indication for high-dose chemotherapy for elderly patients with DLBCL, without complete remission, the Gemcitabine-based therapy protocol represents a more effective and less toxic than that of ESHAP.
  10,317 977 6
Non-Hodgkin's lymphoma: Is India ready to incorporate recent advances in day to day practice?
Saraschandra Vallabhajosyula, Gunjan Baijal, BM Vadhiraja, Donald J Fernandes, MS Vidyasagar
January-March 2010, 6(1):36-40
DOI:10.4103/0973-1482.63571  PMID:20479545
Background : Non Hodgkin's Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base. Methods and Results : We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%. Conclusions : NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues.
  9,765 437 1
Renal toxicity in patients with multiple myeloma receiving zoledronic acid vs. ibandronate: A retrospective medical records review
Rudolf Weide, Hubert Koppler, Lucia Antras, Michael Smith, MPH Eva Chang, Jesse Green, Neil Wintfeld, Maureen P Neary, Mei Sheng Duh
January-March 2010, 6(1):31-35
DOI:10.4103/0973-1482.63570  PMID:20479544
Aims : This retrospective study investigated the rates of renal impairment in patients with multiple myeloma treated with zoledronic acid and ibandronate. Materials and Methods : We retrospectively reviewed medical records in a German oncology clinic, from May 2001 to December 2005. Creatinine measurements were analyzed from baseline (before zoledronic acid or ibandronate treatment) to last evaluation for each patient. A total of 84 patients were included. Results : Zoledronic acid increased the risk of renal impairment by approximately 3-fold compared with ibandronate (renal impairment rates: zoledronic acid 37.7% vs. ibandronate 10.5%, relative risk [RR]=3.6, P=0.0029 serum creatinine [SCr]; 62.3% vs. 23.7%, RR=2.6, P=0.0001 glomerular filtration rate [GFR]). Ibandronate-treated patients switched from zoledronic acid had a significantly higher risk of renal impairment than patients receiving ibandronate monotherapy (zoledronic acid over ibandronate 39.1% vs. ibandronate monotherapy 6.7%, RR= 5.9, P=0.028 [SCr]; 65.2% vs 26.7%, RR=2.4, P=0.022 [GFR]). Multivariate analysis found significantly higher hazard ratios for zoledronic acid over ibandronate (SCr: Cox = 4.38, P=0.01; Andersen-Gill=8.22, P < 0.01; GFR: Cox = 4.31, P < 0.01; Andersen-Gill = 3.71, P < 0.01). Conclusions : Overall, this retrospective study suggests that multiple myeloma patients are more likely to experience renal impairment with zoledronic acid than with ibandronate. The risk of renal impairment increased if patients had received prior therapy with zoledronic acid.
  5,909 853 27
Prospective subjective evaluation of swallowing function and dietary pattern in head and neck cancers treated with concomitant chemo-radiation
Jaiprakash Agarwal, Debnarayan Dutta, Vijay Palwe, Tejpal Gupta, Sarbani Ghosh Laskar, Ashwini Budrukkar, Vedang Murthy, Pankaj Chaturvedi, Prathemesh Pai, Devendra Chaukar, AK D'Cruz, Suyesh Kulkarni, Aniruddh Kulkarni, Gurmit Baccher, Shyam Kishor Shrivastava
January-March 2010, 6(1):15-21
DOI:10.4103/0973-1482.63563  PMID:20479541
Aim : Prospective subjective evaluation of swallowing function and dietary pattern in locally advanced head and neck cancer patients treated with concomitant chemo-radiotherapy (CRT). Materials and Methods : Prospective evaluation of swallowing function with performance status scale for head and neck cancer patients (PSSHN) at pre-CRT, CRT completion and at subsequent follow-ups in adult with loco-regionally advanced head and neck squamous cell carcinoma (HNSCC) patients. Results : In 47 patients (40 male, seven females; mean age 53; 72% smoker 53%, oropharyngeal cancer), the mean total PSSHN score at pre-CRT was 258.5 and decreased to 225.2 and 219.2 at two and six months respectively. Understandability of speech, normalcy in diet and eating in public at pre-CRT and six months were 91.5 and 84.4; 80.4 and 63.1; 87.3 and 76.6 respectively. In univariate analysis, pre-CRT PSSHN scores were significantly lesser in patients with severe pre-CRT dysphagia (P = 0.001), hypopharyngeal cancer (P = 0.244) and advanced T-stage (T3/4) disease (P = 0.144). At CRT completion, there was significant reduction of PSSHN scores in patients with severe pre-CRT dysphagia (P = 0.008), post-CRT weight loss (>10%) and disease progression (P = 0.039). At two months and six months, 17 (57%) and 11 (73.5%) patients respectively showed change in dietary habit. Mean increase in meal time was 13% and 21% at two and six-month follow-up. Conclusions : HNSCC patients show deterioration in swallowing function after CRT with normalcy of diet in maximum and eating in public least affected. Pre-CRT severity of dysphagia, weight loss >10% and disease progression have significant correlation with higher swallowing function deterioration after CRT.
  5,383 585 10
Non-Hodgkin's lymphoma of the sino-nasal tract in children
Olaf Zagolski, Raghav C Dwivedi, Somasundaram Subramanian, Rehan Kazi
January-March 2010, 6(1):5-10
DOI:10.4103/0973-1482.63553  PMID:20479539
Childhood head and neck cancers are relatively uncommon. Of all head and neck cancers occurring in children, non-Hodgkin's lymphoma (NHL) is the most common, others being rhabdomyosarcoma and nasopharyngeal carcinoma. In the head and neck region, sinuses are the second commonest primary site of NHL after neck lymph nodes. These can be of several different types depending on the predominant cell type and histologic appearance, the most common histological variant being diffuse large B-cell lymphoma. In an attempt to simplify the classification and to develop a universally acceptable classification and staging, they have been classified and staged numerous times over the last three decades, adding more confusion to the topic. Clinical presentations vary according to the histological type. The low grade lymphomas present with a nasal cavity or para-nasal sinus mass associated with obstructive symptoms and/or lymphadenopathy, while high grade lymphomas present with aggressive signs and symptoms including non-healing ulcer, epistaxis, septal perforation and bony destruction. The primary treatment consists of chemotherapy and / or radiation therapy, which is able to achieve remission in two-third of the patients, however, prognosis remains poor with cumulative five-year survival rates at about 30% for all the types of sino-nasal NHLs. Newer targeted therapy (monoclonal antibodies) and combination therapies (including stem cells) are currently being tested in order to improve survival rates in these patients. This article aims at providing an overview of clinico-epidemiologic characteristics, staging system currently in use, management, prognosis and possibilities of future research in the field of childhood sinonasal NHLs.
  5,174 780 11
Biomarkers of oxidative stress and smoking in cancer patients
Elena B Burlakova, Galina P Zhizhina, Svetlana M Gurevich, Lyudmila D Fatkullina, Antonina I Kozachenko, Lena G Nagler, Tatiana M Zavarykina, Viktor V Kashcheev
January-March 2010, 6(1):47-53
DOI:10.4103/0973-1482.63569  PMID:20479547
Context: Increased oxidative stress is a significant part of pathogenesis of smoking-related cancer. Aim: The study aims to investigate changes in antioxidant status induced by chronic cigarette smoking in cancer patients and healthy subjects. Setting and Design: We examined the venous blood samples of 54 healthy subjects, both smokers (25) and non-smokers and of 50 patients with smoking-related cancer, both smokers (34) and non-smokers. Materials and Methods: We measured the activities of five antioxidant (AO) enzymes: glutathione peroxidase, glutathione transferase (GST), glutathione reductase, superoxide dismutase and catalase in the blood of 50 cancer patients and 54 healthy persons. Damage to cellular structures (level of malonic dialdehyde, micro viscosity of erythrocyte membranes, number of leukocyte DNA breaks) was determined. Statistical analysis of results obtained was performed using conventional and multi-factorial statistical methods. Results: Statistically significant increase in GST activity and DNA breaks, but decrease of membranes micro viscosity in cancer patients, compared with healthy subjects were obtained. In the cancer patients, no influence of smoking on studied parameters was found. Correlations of parameters within cancer patients and healthy subjects group did not coincide with each other. Conclusions: Changes of AO status parameters and oxidative damages in cell structures are related to tumor processes indicating the augmentation of oxidative stress in human blood. This study demonstrated potential applicability of a statistical model based on the evaluated biomarkers of oxidative stress to determine a smoking-induced harm of cancer incidence in healthy subjects.
  5,065 649 13
Magnitude of fatigue in cancer patients receiving radiotherapy and its short term effect on quality of life
MG Janaki, Amrit R Kadam, S Mukesh, S Nirmala, Arul Ponni, BS Ramesh, AG Rajeev
January-March 2010, 6(1):22-26
DOI:10.4103/0973-1482.63566  PMID:20479542
Background : Fatigue is one of the most common, ongoing symptoms reported by patients undergoing radiotherapy and has profound effects on the quality of life. Aims : This study attempts to identify the magnitude of fatigue and its implication on the quality of life during radiotherapy. Methods and Materials : A prospective study was conducted from March 2004 to September 2005, on 90 patients with histologically proven cancer, receiving radiotherapy. Pretreatment and weekly assessment of fatigue and QOL was done during radiation treatment using Brief Fatigue Inventory Scale and EORTC QLQ C30 respectively and repeated one month after completion of radiotherapy. All the scores were measured in the 0 to 100 scale. Statistical Methods Used : Trimean, SPSS 11.0 and Sysstat 8.0 were used for statistical analysis. Results : Fatigue was present in 87.8% of patients initially and increased gradually over the course of radiotherapy and peaked in the last week. However at follow up it was nearing the pretreatment level. There was significant reduction in the functional scores ( P < 0.001) of QOL (physical, role and emotional function), which returned to pretreatment level at follow up. In the seventh week impairment of cognitive function (P=0.059) was noted. Significant reduction of social function (P < 0.001) at second week and global health status (P < 0.001) at fifth week was noted while financial difficulty was seen from second week onwards. Conclusion : Fatigue is transiently increased by radiotherapy before reaching pretreatment level after few weeks of completion of radiotherapy. QOL is also affected by fatigue which follows the same pattern.
  5,020 453 11
Spindle cell sarcoma of esophagus: A rare case presentation
V Lokesh, T Naveen, YS Pawar
January-March 2010, 6(1):100-101
DOI:10.4103/0973-1482.63558  PMID:20479559
Sarcomas of the esophagus, including carcinosarcoma, are rare neoplasm cases and comprise 0.1-1.5% of all esophageal tumors. Leiomyosarcoma is the most common of the pure mesenchymal tumors of the esophagus, but sarcomas with combined histological types such as carcinosarcoma occur more frequently than pure sarcomas. We report a rare case of spindle cell sarcoma of esophagus in a 55-year-old woman, managed with radical radiotherapy alone.
  4,950 361 3
Paget disease of the male nipple
T El Harroudi, F Tijami, A El Otmany, A Jalil
January-March 2010, 6(1):95-96
DOI:10.4103/0973-1482.63561  PMID:20479557
Breast cancer occurring in the mammary gland of men is infrequent. It accounts for 0.8% of all breast cancers, which is less than one per cent of all newly diagnosed male cancers and 0.2% of male cancer deaths. However, Paget disease of the male nipple is extremely rare. We report a single case of Paget disease with infiltrative ductal carcinoma of the breast in a 61-year-old man.
  4,394 392 3
Feasibility and safety of GliaSite brachytherapy in treatment of CNS tumors following neurosurgical resection
A Gabriella Wernicke, David L Sherr, Theodore H Schwartz, Susan C Pannullo, Philip E Stieg, John A Boockvar, Jana Ivanidze, Jennifer A Moliterno, Bhupesh Parashar, Samuel Trichter, Albert M Sabbas, Dattatreyudu Nori
January-March 2010, 6(1):65-74
DOI:10.4103/0973-1482.63547  PMID:20479550
Purpose: To investigate feasibility and safety of GliaSite brachytherapy for treatment of central nervous system (CNS) tumors following neurosurgical resection. We report mature results of long-term follow-up, outcomes and toxicity. Materials and Methods: In the period from 2004 to 2007, 10 consecutive adult patients with recurrent, newly diagnosed, and metastatic brain malignancies underwent GliaSite brachytherapy following maximally safe neurosurgical resection. While 6/10 (60%) patients were treated for recurrence, having previously been treated with external beam radiotherapy (EBRT), 4/10 (40%) received radiotherapy (RT) for the first time. A median dose of 52.0 Gy (range, 45.0 - 60.0 Gy) was prescribed to 0.5 cm - 1.0 cm from the balloon surface. Radiation Therapy Oncology Group (RTOG) criteria were used to assess toxicities associated with this technique. Follow-up was assessed with MRI scans and was available on all enrolled patients. Results: Median follow-up was 38 months (range, 18 - 57 months). Mean size of GliaSite balloon was 3.4 cm (range, 2.0 - 4.0 cm). Median survival was 14.0 months for the entire cohort after the treatment. The 17.6 and 16.0 months average survival for newly diagnosed and recurrent high grade gliomas (HGG), respectively, translated into a three-month improvement in survival in patients with newly diagnosed HGG compared to historical controls (P = 0.033). There were no RTOG grades 3 or 4 acute or late toxicities. Follow-up magnetic resonance imaging (MRI) imaging did not identify radiation necrosis. Conclusions: Our data indicate that treatment with GliaSite brachytherapy is feasible, safe and renders acceptable local control, acute and long-term toxicities. We are embarking on testing larger numbers of patients with this treatment modality.
  4,132 320 5
18 F-FDG avid lesion due to coexistent fibrous dysplasia in a child of embryonal rhabdomyosarcoma: Source of false positive FDG-PET
Sandip Basu, NS Baghel, Ajay Puri, Tanuja Shet, NH Merchant
January-March 2010, 6(1):92-94
DOI:10.4103/0973-1482.63564  PMID:20479556
With increasing use of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the current oncological practice, there is a growing body of evidence of false positive scans due to various benign conditions. In this communication we present intensely avid 18 F-FDG uptake in fibrous dysplasia of right tibia in a 12-year-old child suffering from embryonal rhabdomyosarcoma (ERMS) that could have been easily mistaken to be a metastatic focus if not carefully correlated. The patient was a case of ERMS (presenting with left cervical mass with intrathoracic extension) who was treated successfully with chemotherapy and was referred for FDG-PET to evaluate the disease status. His whole body survey was unremarkable except for an intensely avid FDG uptake (SUV max 8.5) in shaft of right tibia. The scan was extended up to foot in view of the fact that a prior bone scan had shown a focal uptake in the similar location. Efforts were undertaken to elucidate the exact etiopathology of the aforementioned 18 F-FDG uptake because the rest of the whole body survey was unremarkable. A plain radiograph (both anteroposterior and lateral views) of the right tibia showed patchy sclerosis involving the middle diaphysis of the right tibia suggesting a fibrous defect. The computed tomography (CT) scan of the same region showed cortical thickening and increased density within the medullary cavity in the shaft of the tibia. A histopathological diagnosis was sought for and the lesion was subsequently proven to be fibrous dysplasia by histopathology of the bone piece obtained from the right tibial lesion by J needle biopsy. The present case is a useful addition to the current body of literature of false positive 18 F-FDG-PET study due to a benign skeletal pathology and underscores the importance of high index of suspicion and careful clinicoradiopathologic correlation, whenever one comes across such an unusual PET finding.
  4,110 277 3
Primary angiosarcoma of the breast in a postmenopausal patient
Vinayak S Rohan, Abhinandan M Hanji, Jayesh J Patel, Rajen A Tankshali
January-March 2010, 6(1):120-122
DOI:10.4103/0973-1482.63543  PMID:20479566
Primary angiosarcoma of the breast is a rare entity forming 0.04% of primary breast tumors. It is a highly aggressive tumor with a high propensity for locoregional and distant metastasis. Surgery in the form of mastectomy or wide excision remains the cornerstone of treatment. Radiotherapy and chemotherapy have been tried with varying results.
  3,901 386 6
PEComa of the lung
R Vijayabhaskar, Sanket S Mehta, Kedar K Deodhar, CS Pramesh, Rajesh C Mistry
January-March 2010, 6(1):109-111
DOI:10.4103/0973-1482.63548  PMID:20479562
Perivascular epithelioid cell tumor (PEComa), also called clear cell ''sugar'' tumor of the lung, is a rare benign tumor arising from perivascular epithelioid cells (PECs). We report a case of a 15-year-old boy who presented with right lower lobe lesion which turned out to be a clear cell tumor of the lung. An [18F]-fluoro-2-deoxy-D-glucose (FDG) - positron emission tomography (PET) scan revealed mild FDG uptake in the lung lesion (SUV<1) with no active uptake elsewhere in the body. We discuss the clinical, radiologic and immunohistochemical features of clear cell ''sugar'' tumor of lung and compare them with published literature.
  3,904 370 5
High-dose intensity-modulated radiotherapy as primary therapy for prostate cancer: Report on dosimetry aspects and acute toxicity in the Indian scenario
Sandeep De, Venkatesan Kannan, Sudesh Deshpande, Vivek Anand, Yogesh Ghadi
January-March 2010, 6(1):58-64
DOI:10.4103/0973-1482.63565  PMID:20479549
Background and Purpose: Dose escalation improves local control in prostate cancer. In this study we assess the feasibility of dose escalation to prostate and / or seminal vesicles to 76 Gy with intensity-modulated radiotherapy (IMRT); report data on dosimetry and acute toxicity in 40 patients at P. D. Hinduja National Hospital and Medical Research Center, Mumbai. Materials and Methods: In the period from May 2006 to September 2008, 40 consecutive patients with localized prostate adenocarcinoma (T1- 3 N0) were definitively treated with IMRT to a dose of 76 Gy / 38 fractions. Patients were seen on a weekly basis during treatment, and one month (M1) and three months (M3) thereafter. The radiation therapy oncology group (RTOG) toxicity scale was used to evaluate acute gastrointestinal (GI) and genitourinary (GU) toxicities. Additional symptoms such as rectal blood loss, urgency, dysuria, urinary frequency, nocturia, incontinence were scored as well. Results: All 40 patients completed treatment successfully. Acute RTOG Grade 1 and Grade 2 GI toxicities were noted in 47.5% (19 patients) and 12.5% (five patients) respectively, leaving 40% (16 patients) free of any acute toxicity. Thirty-six (90%) and four patients (10%) had Grade 0-1 and Grade 2 acute RTOG-scaled GU toxicity respectively. There was no Grade 3 or higher GI / GU toxicity. Conclusions: The escalated dose of 76 Gy to the prostate with IMRT was very well tolerated by all our patients with acceptable acute GU and GI toxicity, thereby, establishing the feasibility of dose escalation in the Indian scenario.
  3,926 326 -
Pulmonary metastasis from renal synovial sarcoma treated by stereotactic body radiotherapy: A case report and review of the literature
Tejinder Kataria, Nandigam Janardhan, Ashu Abhishek, Gautam K Sharan, Swarupa Mitra
January-March 2010, 6(1):75-79
DOI:10.4103/0973-1482.63551  PMID:20479551
Primary synovial sarcoma of kidney is an uncommon neoplasm, metastasizing most commonly to lung. Surgery and/or palliative chemotherapy for pulmonary metastases is commonly used to improve tumor control and survival. Stereotactic body radiotherapy (SBRT) is a relatively new approach to treat pulmonary metastasis, encouraged by the results of cranial and spinal stereotactic radiosurgery. The local control and toxicity profile of patients with pulmonary metastasis treated with SBRT are comparable to pulmonary metastatectomy. Furthermore, with advancement of imaging techniques, immobilization techniques, tumor-tracking techniques, and treatment planning and delivery system, SBRT can now be alternatively employed for the treatment of pulmonary metastasis as a comparable substitute to surgical resection.
  3,777 464 2
Malignant extrarenal rhabdoid tumor of the vulva in an adult
H Narendra, Satadru Ray, Lakshmi Rao, V Geetha
January-March 2010, 6(1):82-85
DOI:10.4103/0973-1482.63557  PMID:20479553
Sarcomas of the vulva account for only 1-3% of all vulvar malignancies. Most common vulvar sarcomas are leiomyosarcomas, malignant fibrohistiocytomas, and aggressive angiomyxomas. Malignant rhabdoid tumor (MRT) of the kidney is a distinctive clinicopathological entity that is recognized as a highly aggressive renal tumor of childhood. Extrarenal malignant rhabdoid tumors have been proposed to exist at several sites, including soft parts. MRT of the vulva is a rare and very aggressive neoplasm. Median survival reported in other studies is 9 months. Only 10 cases have been reported thus far in the English literature. We are reporting the 11 th case who remains disease free 30 months following surgery and radiotherapy till the time of reporting.
  3,790 328 6
Breast hamartoma with intrathoracic extension in a 13-year-old boy
Shilpi Singh Gupta, Onkar Singh, Ankur Hastir, Gaurav Arora, Glossy Sabharwal, Harshit Mishra
January-March 2010, 6(1):86-88
DOI:10.4103/0973-1482.63559  PMID:20479554
Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs.
  3,697 201 1
Follicular dendritic cell sarcoma of the neck with an aggressive and fatal course
Sanju Cyriac, David Praveenkumar, Urmila Majhi, T Gnana Sagar
January-March 2010, 6(1):114-116
DOI:10.4103/0973-1482.63545  PMID:20479564
Dendritic cell neoplasms are rare malignancies described with an increased frequency. They often involve the lymph nodes, but extranodal presentations are also described. The disease often has an indolent course. Surgery is the main modality though chemotherapy and radiation have also been tried. We present here a case of a 69-year-old male diagnosed to have follicular dendritic cell sarcoma of the neck which had a rapid and fatal course inspite of chemotherapy and radiotherapy. More studies are required to assess the biology of this rare tumor.
  3,296 349 5
Effect of inhomogeneities and source position on dose distribution of nucletron high dose rate Ir-192 brachytherapy source by Monte Carlo simulation
RM Chandola, S Tiwari, MK Kowar, V Choudhary
January-March 2010, 6(1):54-57
DOI:10.4103/0973-1482.63567  PMID:20479548
Background: The presence of least dense dry air and highly dense cortical bone in the path of radiation and the position of source, near or far from the surface of patient, affects the exact dose delivery like in breast brachytherapy. Aim: This study aims to find out the dose difference in the presence of inhomogenieties like cortical bone and dry air as well as to find out difference of dose due to position of source in water phantom of high dose rate (HDR) 192 Ir nucletron microselectron v2 (mHDRv2) brachytherapy source using Monte Carlo (MC) simulation EGSnrc code, so that the results could be used in Treatment Planning System (TPS) for more precise brachytherapy treatment. Settings and Design: The settings and design are done using different software of the computer. Methods and Materials: For this study, the said source, water phantom of volume 30 x 30 x 30 cm 3 , inhomogeneities each of volume 1 x 2 x 2 cm 3 with their position, water of water phantom and position of source are modeled using three-dimensional MC EGSnrc code. Statistical Analysis Used: Mean and probability are used for results and discussion. Results : The % relative dose difference is calculated here as 5.5 to 6.5% higher and 4.5 to 5% lower in the presence of air and cortical bone respectively at transverse axis of the source, which may be due to difference of linear attenuation coefficients of the inhomogeneities. However, when the source was positioned at 1 cm distance from the surface of water phantom, the near points between 1 to 2 cm and 3 to 8 cm. from the source, at its transverse axis, were 2 to 3.5% and 4 to 16% underdose to the dose when the source was positioned at mid-point of water phantom. This may be due to lack of back scatter material when the source was positioned very near to the surface of said water phantom and overlap of the additional cause of missing scatter component with the primary dose for near points from the source. These results were found in good agreement with literature data. Conclusion: The results can be used in TPS.
  3,281 353 11
Bilateral testicular metastasis from prostatic adenocarcinoma mimicking an intertubular pattern of seminoma and expressing Rhamm
Santosh Menon, Sumeet Gujral, Ganesh Bakshi, Hemant B Tongaonkar
January-March 2010, 6(1):97-99
DOI:10.4103/0973-1482.63560  PMID:20479558
Adenocarcinoma of prostate metastasizing to testis is a rare occurrence and is incidentally detected in orchiectomy specimens. The pattern of metastasis may mimic a primary neoplasm of testis like a seminoma or lymphoma and pose a diagnostic difficulty for the pathologist. A rare case of bilateral testicular metastasis of prostatic adenocarcinoma is presented wherein the metastatic cells expressed CD168, a receptor for hyaluronan mediated motility (Rhamm), implicated in the development of androgen independence in prostate cancer.
  3,233 324 2
Late solitary testicular metastasis from rectal cancer
Ramachandran Venkitaraman, Mathew George, Suranga Weerasooriya, Sid Selva-Nayagam
January-March 2010, 6(1):89-91
DOI:10.4103/0973-1482.63562  PMID:20479555
Isolated testicular metastasis from rectal cancer is rare. We describe the case of a patient who presented with a locally advanced rectal malignancy and underwent multimodality treatment with low anterior resection, postoperative radiotherapy and adjuvant chemotherapy. He developed a painless testicular nodule while on follow-up, five years after the diagnosis of primary rectal cancer. Histopathology and immunohistochemistry of orchidectomy specimen were compatible with a metastatic adenocarcinoma of rectal origin. We hypothesize that this phenomenon of isolated relapse in a sanctuary site could be due to the altered biology and pattern of metastasis as a result of effective adjuvant systemic chemotherapy. Treatment of late isolated relapse in the testis needs to be ascertained.
  3,226 224 1
Survey of undergraduate medical students on their understanding and attitude towards the discipline of radiotherapy
Daya Nand Sharma, Goura Kishor Rath, Akhil Parashar, Prashant Singh
January-March 2010, 6(1):11-14
DOI:10.4103/0973-1482.63556  PMID:20479540
Aim : The discipline of radiotherapy (RT) in India is considered a low priority subject. Postgraduate (PG) students rarely choose RT as a career option. The possible reasons could be: 1) limited availability of PG course training centers, 2) limited job prospects, etc. We decided to conduct a survey of undergraduate (UG) medical students to find out their awareness, understanding, and attitude toward the subject of RT. Materials and Methods : A simple 12-point questionnaire was designed to assess the level of awareness, understanding, and attitude. It was handed over personally or sent by e-mail or post to UG students of various medical colleges in India. The data provided by respondents was analyzed. Results : During the period from January to June 2008, 400 questionnaires were distributed. A total of 155 respondents sent their responses. Twenty-eight of them (18%) opined that RT is not a part of the bachelor of medicine and bachelor of surgery (MBBS) curriculum at their institute. About 84% replied that not more than 10 theory lectures/practical classes are assigned to RT during the entire UG period. About one-third of the respondents stated that there are no separate clinical postings for RT. According to 54% of the respondents, RT is still a low priority subject in the PG setting and the majority (70%) thought that inadequate exposure at the UG level and lack of awareness about the current prospects of RT are the main reasons for this. Conclusion : The results of our survey indicate that the RT is still a low priority subject in India, mainly due to the poor exposure to the discipline and low awareness of the subject of RT during the UG program. The Medical Council of India (MCI) needs to ensure that adequate importance is given to RT in the MBBS curriculum so as to enhance awareness regarding the subject and increase exposure to this specialty.
  3,041 329 2
Alveolar soft part sarcoma of the retro peritoneum
Fan Yu Xin, Netra Rana, Zhang Ming, Yu Bo Lang
January-March 2010, 6(1):117-119
DOI:10.4103/0973-1482.63544  PMID:20479565
Alveolar Soft Part Sarcoma (ASPS), also called Alveolar Soft-Tissue Sarcoma, is a rare type of soft-tissue neoplasm with a poor long term prognosis. Such tumors originating in the retro peritoneal space are extremely rare. In this article we discuss a 34-year-old woman who was referred to our hospital with an increasing mass in her left lower abdomen. Ultrasonography and conventional Computed Tomography revealed a large hard mass occupying the left retroperitoneal space with a clear border. The pathological diagnosis was ASPS.
  2,991 243 -
Fatal non-occlusive mesenteric ischemia after esophagectomy
Sajid S Qureshi, Rakesh S Neve, Sudip A Raina, Rajesh C Mistry
January-March 2010, 6(1):112-113
DOI:10.4103/0973-1482.63546  PMID:20479563
Non-occlusive mesenteric ischemia (NOMI) is a disorder with an extremely high mortality. Salvage of affected patients requires early recognition and aggressive intervention to prevent intestinal gangrene. We present a case of NOMI developing after esophagectomy and discuss the pathophysiology diagnosis and therapy.
  2,879 274 3
Capecitabine and sixth cranial nerve palsy
Sonali Dasgupta, Chineme Adilieje, Amlan Bhattacharya, Bruce Smith, Moeen ul Haq Sheikh
January-March 2010, 6(1):80-81
DOI:10.4103/0973-1482.63555  PMID:20479552
Capecitabine is an oral chemotherapeutic agent converted to 5 flourouracil (5-FU). Neurotoxicity associated with the medication encompasses both central and peripheral nervous systems. We describe a 60 year old man with colonic carcinoma who developed diplopia due to a sixth nerve palsy following the use of capecitabine which is an orally administered prodrug of 5-FU. An MRI of brain did not reveal a space occupying lesion or vascular insult to account for his cranial nerve palsy. The sixth nerve palsy resolved spontaneously once capecitabine was withdrawn. Physicians in all walks of life are increasingly likely to come across such patients and should familiarize themselves with toxicities consequent to chemotherapy. Further research is needed to elucidate the cause of capecitabine associated neurotoxicity.
  2,829 266 1
Workload modeling for teletherapy unit
Abhijit Mandal, Anupam Kumar Asthana, Rashmi Singh, Lalit Mohan Aggarwal
January-March 2010, 6(1):27-30
DOI:10.4103/0973-1482.63568  PMID:20479543
Aims : This study aims to derive a radiotherapy workload model using a prospectively collected dataset of patient and treatment information from a teletherapy treatment unit. Materials and Methods : Information about all individual radiotherapy treatment was collected for two weeks from the Phoenix unit in our department. This information included diagnosis, treatment site, treatment time, fields per fraction, technique, use of blocks and wedges. Data were collected for two weeks (10 working days) in January 2008. During this time, 45 patients were treated with 450 fractions of external beam radiotherapy in Phoenix unit. Results : The mean fraction duration, irradiation time and setup time were 9.55 minutes, 1.84 minutes and 7.66 minutes respectively. A mathematical workload model was derived using the average fraction duration time, total irradiation time and setup time of different types of treatment. A simple software program (Workload Calculation Chart) was also constructed in Microsoft Excel using the derived algorithm. The model based software program was tested and applied for one year and found that it can be used effectively to describe workload of teletherapy unit. Conclusion : Proposed methodology for workload modeling of teletherapy unit and the workload calculation software is very effective to quantitatively plan/calculate the optimal workload which will satisfy both the patient care administrator and radiation therapy technologists.
  2,771 221 -
Percutaneous transfemoral repositioning of malpositioned central venous access device: A report of two cases
Ashutosh Chauhan, Kamal Pathak, Manomoy Ganguly
January-March 2010, 6(1):102-105
DOI:10.4103/0973-1482.63554  PMID:20479560
Placement of long term central venous access devices (CVAD) such as chemo ports and Hickman's catheters are associated with a definite risk of catheter tip malpositioning. As such, malpositioning runs a risk of venous thrombosis and related complications; it is imperative to reposition the catheter. Percutaneous transfemoral venous approach has been described as a minimally invasive and safe method for the repositioning. We present two cases in which the CVAD implanted in one subclavian vein got malpositioned in contra lateral subclavian vein. A percutaneous transfemoral venous approach utilizing 5 Fr angiographic catheter was successful in repositioning of the catheters in both cases.
  2,673 192 -
Synchronous multicentric giant cell tumor
Ranjana Bandyopadhyay, Saumitra Biswas, Sanjay K Bandyopadhyay, MM Ray
January-March 2010, 6(1):106-108
DOI:10.4103/0973-1482.63552  PMID:20479561
Multicentric giant cell tumors represent less than 1% of all giant cell tumors of bones. We report a case of multicentric giant cell tumors around both the knee joints in a mentally and physically challenged adult male that resulted in rapidly progressive painful swelling, restricted mobility and, ultimately, fixed deformity. These tumors had typical radiological appearance and the diagnosis was confirmed on histopathology.
  2,452 259 4
Evolution of radiation oncology: Sharp gun, but a blurred target
Anusheel Munshi, Jai Prakash Agarwal
January-March 2010, 6(1):3-4
DOI:10.4103/0973-1482.63550  PMID:20479538
  2,285 324 6
In search of human face for health care
Nagraj Huilgol
January-March 2010, 6(1):1-2
DOI:10.4103/0973-1482.63549  PMID:20479537
  1,832 282 -
The Oncology Knowledge Bank
Sapna Gupta
January-March 2010, 6(1):123-123
  1,059 184 -