|Year : 2015 | Volume
| Issue : 7 | Page : 101-103
|Date of Web Publication||24-Nov-2015|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Miscellaneous. J Can Res Ther 2015;11, Suppl S3:101-3
Exploring the role of phycocyanin in modern oncology
thA. Soni , M. Verma, A. Kumar Dhull, R. Dhankhar, V. Kaushal, R. Atri, M. Dubey
Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, E-mail: [email protected]
Background: Phycocyanin is extracted from Spirulina and is used as a dietary supplement for individuals who are undergoing chemotherapy and radiation for cancer and is used to ease negative symptoms during treatment as well as rejuvenate post treatment. Its nutritional values and therapeutic values are well documented. Phycocyanin is a non-toxic molecule with anticancer, antioxidant, antiviral and anti-inflammatory activities and it provides protection from a number of diseases including cancer. Aim: Most of the studies are based on the laboratory experimental results and, very less literature is available for Phycocyanin use in oncological practice. This article reviews the role of phycocyanin in today's oncological practice. Materials and Methods: This literature review was performed by conducting a systematic search of PUBMED, MEDLINE and PMC, including all articles up to November 2014. All articles were reviewed and were included if they were relevant to the topic, and deemed to be of good quality. Results: Studies have shown that phycocyanin can induce apoptosis in cancer cells such as a mouse macrophage cell line (RAW 264.7), prostate cell line (LNCaP), breast cell line (MCF-7), and erythromyeloid leukemia cell line (K562). Phycocyanin is used in treatment of hepatocellular carcinoma, rectal cancer, colon cancer, leukemia (CML, CLL), myeloproliferative neoplasm, melanoma, cervix cancer and prostate cancer (with topotecan). Phycocyanin mediated photodynamic therapy is approved as a potential therapy for cancer. Phycocyanin acts via interference of DNA synthesis, activation of caspase-dependent programmed cell death pathways (apoptosis), inhibition of tumor cell growth and by membrane destruction. Phycocyanin is usually non-toxic, but may cause liver damage, stomach pain, nausea, vomiting, weakness, thirst, rapid heartbeat, shock, and death. Phycocyanin may cause systemic anaphylaxis, diarrhea and diffuse erythema. Conclusion: The antioxidant properties of phycocyanin have been investigated for their anti-inflammatory, anti-proliferative and anti-cancer effects. The results revealed for the first time that the C-phycocyanin activities and its antitumor actions such as in leukemia, colon cancer, pancreatic cancer etc. could be a promising natural antitumor agent with a potential for future pharmacological and medical applications. Phycocyanin being a natural product, should be more acceptable as an anticancer compound.
Knowledge, attitude and awareness of cancer and its prevention among resident doctors in North India: A prospective survey
thM. Annamalai , D. Chouhan 1 , H. Kunhiparambath, S. Krishnan,
S. Mallick, P. Ventrapati, S. Gupta, D. Sharma
All India Institute of Medical Sciences, 1 Ram Manohar Lohia Hospital, New Delhi, India, E-mail: [email protected]
Background: Cancer is among the top three killers in both rural and urban India and potentially the most preventable disease. Resident doctors significantly contribute to cancer prevention & to create awareness among the people. Aim: This survey was designed to benchmark current levels of knowledge, attitude and awareness of cancer among resident doctors in north India and to provide a basis for health education on cancer prevention. Materials and Methods: The survey was carried out in April-July 2015. A questionnaire was designed to assess the awareness, understanding of resident doctors towards cancer prevention. Resident doctors include both junior & senior residents. Questionnaire was simple to understand and had 25 points addressing the above issues. The multiple choice questions format was used. It was handed over personally or sent by E-mail to resident Doctors of Medical Colleges in North India. Total of 570 questionnaires were distributed. Results: Total of 316 respondents (55%) sent their responses of which 76.04% responses were by junior residents. Only 9.26% received oncology training in their curriculum. Regarding the most common cancer in India, among males 74.6% & 19.8% opined as lung and head & neck cancers and for females, 62.8% & 33.9% opined as cervix and breast cancer respectively. Diet and lifestyle (65.6%) was cited as major reason for increasing incidence followed by environmental factors (23.2%). 3% of residents opined as cancer is not preventable and 44.1% answered only 20% of cancers as preventable. 89.1% answered tobacco as single most important preventable cause. 96.3% of residents were aware of HPV vaccination but only 57.7% are referring patients for vaccination and 68.2% opined that lack of awareness as the major obstacle. More than one-third (35.2%) were not referring their patients for screening of breast & cervical cancer. More than two thirds (70%) suggested lack of awareness as the most important barrier to screening and health education is the best way to increase awareness. For tobacco control, complete ban (47.7%) was opined as best strategy. Over 95% suggested preventive oncology need to be more refined and Oncology training essential for under graduates. Conclusion: Among residents of various departments, there is lack of training & cancer awareness. Majority of residents are interested to have oncology training and MCI should consider this in undergraduate curriculum to promote the cancer awareness.
Desmoplastic small round cell tumor: A rare case report
thS. Dikkala , S. Surana, G. Nethula, P. R. Thammineni
Krishna Institute of Medical Sciences, Secunderabad, Telangana, India, E-mail: [email protected]
Background: Desmoplastic small round cell tumor (DSRCT) is a rare aggressive malignant tumor that occurs in young adults. First described in 1989 by Gerald and Rosai, less than 200 cases have been reported till date and hence no prospective data is available. Multi modality treatment with chemotherapy and maximal surgical debulking followed by Whole Abdominopelvic radiation is the current line of management. The 3-year and 5-year overall survival (OS) rates after multimodality treatment are in the order of 55% and 15%, respectively. The 3 year survival rate in those patients who did not receive all three therapies is 27%. DSRCT has high propensity to spread intra peritoneally and hence consolidative WAP-RT to a dose of 30 Gy with a further boost of 12 to 24 Gy to the residual tumor is being used. We present a recurrent case of DSRCT treated with WAP-RT using Rapidarc technique. Case Report: A 23 yr old female presented with pain abdomen of 1 month duration. On evaluation she was found to have a 17 x 12 x 8 cms pelvic mass, which was excised. Characteristic histopathologic features and poly phenotypic immunohistochemical expression of antibody markers were consistent with a diagnosis of DSRCT. She received chemotherapy with Ewing sarcoma/PNET protocol. Post chemotherapy PET CT did not show any residual disease. She developed recurrence 4 months after completion of chemotherapy and re surgery was done. Planning PET-CT scan did not show any gross residual disease. WAP-RT was planned. Entire peritoneal cavity with pelvic lymph nodal regions, pouch of Douglas, vaginal vault including surface of liver and kidneys was contoured as Target. Organs at risk were delineated and VMAT Rapidarc planning was done respecting normal tissue tolerances especially Liver and Kidneys. Setup was verified with KV imager and CBCT. A dose of 30 Gy was delivered in 20 fractions @ 150 cGy per fraction. She developed grade 2 GI toxicity and was managed symptomatically. She also received G-CSF for grade 2 neutropenia. Conclusion: DSRCT is a rare and fatal disease that mainly affects young adults. WAP-RT after multi agent chemotherapy and surgical resection has improved overall survival. WAP RT with VMAT is associated with better tolerance.
Primary nonmetastatic angiosarcoma of the spleen
thK. L. Jayakumar , V. George Kuriakose, D. V. Somasekharan Nair
Government Medical College, Trivandrum, Kerala, India, E-mail: [email protected]
Background: Primary splenic angiosarcoma is an extremely rare, highly aggressive malignancy hypothesized to be originating from the splenic vascular endothelium. Splenectomy is the mainstay of treatment but majority of the cases will have already metastasized at the time of presentation and hence they carry a very dismal prognosis. We wish to report a non metastatic primary splenic angiosarcoma. Case Report: A 69-year-old post-menopausal female with a past history of hypothyroidism on oral thyroxine presented with complaints of fatigue and vague left upper abdominal pain and fullness. Splenomegaly on palpation was confirmed by imageology. Laboratory investigations revealed anemia. She underwent splenectomy through an open laparotomy. Histopathological examination confirmed angiosarcoma with gross, microscopy and immunohistochemistry. A whole-body positron emission tomography scan, done three weeks after operation, ruled out metastasis. She underwent six cycles of chemotherapy with ifosfamide and adriamycin. She has completed four months of post-chemotherapy follow up and remains non-metastatic till date. Conclusion: Early detection and splenectomy prior to a splenic rupture is the best chance for maximizing survival, as spontaneous or traumatic splenic rupture carries the worst prognosis, with a high likelihood of immediate mortality due to hypovolemia. Pathogenesis is yet to be established. Benefit of adjuvant chemotherapy and radiotherapy is doubtful. There is no phase 2 or 3 data regarding the management protocol due to its rare incidence. Prognosis is dismal with survival of two to fourteen months.
Injectable liposome-in-in situ gels as a platform for regional delivery of paclitaxel as a radiosensitizer for synergistic chemoradiotherapy: A preclinical study
thJ. S. Goda , V. Gota, S. Guha Sarkar 1 , N. Sudhalkar, R. Banerjee 1
Tata Memorial Centre, 1 Indian Institute of Technology, Mumbai, Maharashtra, India, E-mail: [email protected]
Background: In clinical radiotherapy, effects of radiation can be enhanced by the use of radiosensitizers, but current chemoradiation approaches are limited by their systemic toxicity. The objective of the present study was to develop a novel liposome-in-in situ gel (LG-PTX) as an injectable system for regional delivery of radiosensitizers and evaluating its efficacy when used concurrently with radiation therapy. Materials and Methods: Paclitaxel (PTX) was chosen as the model radiosensitizer. The formulation LG-PTX was developed to contain PTX-loaded liposomes, with sizes around 120nm, incorporated into a porous hydrogel matrix. In vitro radiosensitization of LG-PTX in conjunction with radiation was evaluated by apoptotic assays in B10F16 murine melanoma cells. In vivo radiosensitization was studied with tumor growth delay in C57BL/6 mice xenografts, and was carried out with a two hour interval between drug administration and irradiation. The mice were treated with 40 mg/kg of LG-PTX followed by incremental doses of focal external radiation to a total dose of 15 Gy in five daily fractions (5 x 3 Gy). Results: The LG-PTX formulation was found to have an IC50 of 325 117nM on B16F10 murine melanoma cells, as a model radio-resistant tumor, and in vitro studies with concurrent fractionated doses of radiation showed a significant increase in the percentage of apoptotic cells (75%) compared to cells treated with radiation (39%) or paclitaxel (43%) alone. In vivo intra-tumoral injection in mice showed accumulation of PTX in the tumor two hours after administration, while no drug was detected in the plasma or other organs, indicating localization of the drug at the site of the tumor. In vivo efficacy studies with concomitant doses of fractionated radiation showed significant reduction in tumour volume (p < 0.05) on application of the LG-PTX formulation along with radiation, compared to both the control (6.6 fold lower) and radiation alone (1.4 fold lower) groups. The use of the formulation along with radiation also significantly increased tumor inhibition and improved animal survival compared to control and radiation alone groups. Conclusion: The novel LG-PTX formulation has potential use as a local injectable regional drug delivery system for enhancing efficacy of radiotherapy without any systemic toxicity.
Retroperitoneal follicular lymphoma: A case report
thJ. Sebastian , M. G. Janaki 1 , R. Charith 1
MS Ramiah Medical College, 1 Alva, Bengaluru, Karnataka, India, E-mail: [email protected]
Background: Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma. The disease has been seen as incurable, apart from the relatively infrequent patients with early stage disease. They are very rarely reported in Asian countries like India and presents a diagnostic challenge. Aim: Here we are reporting a case of early stage retroperitoneal follicular lymphoma treated with radical radiotherapy and demonstrate the gross reduction in size of the lymphoma as shown by the verification Cone Beam CT. Materials and Methods: A 60 yr male was incidentally detected with a retroperitoneal mass in an ultrasonography abdomen done as part of routine check-up. This mass was diagnosed as Follicular Lymphoma following further imaging studies and histopathological and immunohistochemical studies. Patient was treated with external beam radiation therapy to a dose of 45 Gy in 25 fractions on 6MV LINAC using VMAT technique with daily CBCT verification. Results: Patient was treated with external beam radiation therapy to a dose of 45 Gy in 25 fractions on 6MV LINAC using VMAT technique with daily CBCT verification. Verification CBCT showed near total response by the last week of radiotherapy. Conclusion: Radiotherapy is a very effective treatment modality in the management of early stage Follicular Lymphomas. Cone Beam CT which is routinely used for setup verification was helpful in response evalution to radiotherapy and demonstrated near total response.
Bowen's disease: A rare case presentation
thM. Aal , G. Krishnamurty, R. Ravind, S. C. Reddy, V. Priyadarshini,
V. L. Bhaskr, R. S. Bilimagga, G. Aparna
Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India, E-mail: [email protected]
Introduction: In India, skin cancers constitute about 1-2% of all diagnosed cancers. The exact incidence of Bowen's disease is unknown, approximate incidence being 142 per 1,00,000 persons. It was first described by John T. Bowen in 1912. Bowen's disease is a squamous cell carcinoma in situ, affecting both skin and mucous membranes. Extra genital Bowen's disease is a rare entity. Case Report: A 68 year old gentleman, presented to the hospital with multiple brownish skin lesions on the abdominal wall of 1 years duration. The lesion appeared initially as an asymptomatic small plaque, which gradually progressed in size, not associated with itching or pain. On examination, the patient had multiple well defined erythematous plaques, largest of size 4 * 5 cms size on the right anterior abdominal wall. There was no regional lymphadenopathy. Discussion: Bowen's disease, a pre-malignant skin lesion usually affects fair skinned individuals. The etiology includes sun/arsenic exposure, ionizing radiation & HPV16. Typically presents as a discrete, slowly enlarging, erythematous plaque with well-demarcated borders. The risk of Bowen's disease progressing to invasive squamous cell carcinoma has been estimated to be approximately 5%. Taking into consideration, the presence of multiple skin lesions, patient was started on 5% topical 5-FU and is kept on close follow up. Conclusion: We are highlighting this case because of its rarity in photo-protected areas, especially abdomen. The potential of transformation into malignancy should always be taken into consideration during follow up.
A case report on disseminated cutaneous malignancy
thN. Sharma , S. Gupta, D. Sachan, L. Pandey, P. Singh
Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, E-mail: [email protected]
Background: Squamous cell carcinoma is the second most common skin cancer, after basal cell carcinoma and its incidence is increasing throughout the world. It is well accepted that cutaneous squamous cell carcinoma arising in previously injured skin (e.g., a burn site, scar, chronic wound, or ulcer) have an increased risk of metastasis, with a recurrence rate of 58% and an overall five-year survival of 52%. The most common sites are the lung (21%), bone (18%), central nervous system (6%) and liver (4%). Multiple squamous cell carcinoma of the skin is an exceedingly rare entity. The diagnosis of metastasized cutaneous SCC hinges on histopathologic evaluation of involved skin. Most patients with primary cutaneous SCC have an excellent prognosis but SCC developing as cutaneous metastasis; the long-term prognosis is poor. Aim: The aim of reporting this case lies in its extremely rare presentation of multiple cutaneous metastasis. We present a case of disseminated marjolin's ulcer in a 46yr old male who presented with a painless non-healing warty growth on abdomen persisting for the last 2 years. According to the patient, he developed non healing ulcer in his left ankle following thermal burn 2 yr back for which he underwent amputation of left lower limb. The histopathology report showed well differentiated squamous cell carcinoma. Physical examination revealed multiple non tender lumps on multiple sites of the body, i.e., epigastrium, left hypochondrium, right scapular, right cubital and left clavicular region. FNAC from left hypochondrial lump and left clavicular lump showed smears suggestive of metastatic poorly differentiated carcinoma. On USG Abdomen sub diaphragmatic hypoechoic deposits were seen likely metastatic deposits and on chest x ray multiple cannon ball secondaries were seen on bilateral lung fields. Conclusion: Although in-transit metastasis in cutaneous squamous cell carcinoma is unique presentation of metastatic SCC and is associated with poor prognosis but disseminated cutaneous metastasis is an unusual presentation and its management is still undefined.
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