The world is fighting the onslaught of COVID 19 for the last 10 months, ever since the first case was reported in December 2019 in Wuhan, China. Now, it has spread to over 200 countries. COVID 19-associated respiratory syndrome is causing a lot of mortality and morbidity. There are reports suggesting that the complications and ARDS associated with COVID 19 is an immune response reaction. The cytokine storm associated with severe cases of COVID 19 acts as a cause of death in many sick patients. It has been shown that COVID 19 is associated with a peculiar immune profile: Decrease in CD3, CD4, CD8, natural killer cell and B-cells; Rise in interleukin (IL)-4, IL-6 and tumor necrosis factor (TNF) alpha; Decrease in IL-10; Decrease in interferon-gamma. Low-dose radiotherapy (LDRT) immunosuppressive features resulting from M2 macrophage phenotype activation, increase in IL-10, transforming growth factor beta, a decrease in IL-6, TNF alpha and an increase in CD3, CD4, and CD8 T cell counts may negate the harmful effects of cytokine release syndrome. Literature review shows that radiation was previously used to treat viral pneumonia with a good success rate. This practice was discontinued in view of the availability of effective antibiotics and antivirals. As there are no scientifically proven treatment for severe COVID 19-associated respiratory distress today, it is prudent that we understand the benefits of LDRT at this critical juncture and take rational decisions to treat the same. This article provides an radioimmunological rationale for the treatment of immune crisis mediated complications in severe cases of COVID 19.

Dose-escalated prostate radiotherapy (RT) can improve treatment outcomes, but rectal toxicity is the main limiting factor for introducing dose-escalated RT. Pushing rectal wall away from the prostate reduces the volume of the rectum in high-dose region, which can decrease both short- and long-term rectal toxicities after RT. This review focuses on the literature using different rectal displacement devices such as endorectal balloons, tissue spacers, rectal retractor, and ProSpare during prostate External beam radiotherapy, with regard to dosimetric effects, clinical benefits, prostate motion, and postoperative RT setting.

Polycomb group proteins (PcG) are multi-subunit structure, consisting of polycomb repressive complex 1 (PRC1), PRC2/3, and pleiohomeotic repressive complex. PRC1 is made up of PHC, BMI-1, CBX, and Ring 1A/B. PRC2 protein complex included embryonic ectoderm development, PCL, SUZ12, SET domain, enhancer of zeste homolog-2 protein (EZH2), and Nurf55. The third subunit PhoRC consists of Pho and DSFMBT subunits. One of the important subunits of PcG group of protein is EZH2 (a histone methyltransferase), which catalyzes tri-methylation of histone H3 at Lys 27 (H3K27me3) to regulate gene expression through epigenetic machinery and induces silencing of specific gene transcription. In case of breast cancer and prostate cancer, EZH2 is very well studied. Evidence shows that EZH2 is overexpressed and mutated in a variety of human cancers, rendering EZH2 an attractive target for the design of new chemotherapeutic drugs in cancer. EZH2 also functions both as a transcriptional suppressor and a transcriptional co-activator, depending on H3K27me3 or its absence. In this review, we summarized various studies reported till date, elucidating the structure of PRC2 complex, various mechanisms involved with this, and highlighting the role of EZH2 in breast cancer and prostate cancer progression. An increased understanding of the mechanisms that underlie the pathogenesis of wide spectrum of cancers is therefore needed to develop novel therapeutic approaches for this disease and to improve the quality of life in patients.

Turmeric exhibits a big promise as a therapeutic agent in the management of oral submucous fibrosis (OSMF). The primary aim of our study is to synthesize the evidence of the use of turmeric/curcumin in the management of OSMF. The secondary goal of this study is to assess the limitations of previous studies to identify gaps in evidence for future research and give an evidence-based recommendation regarding the usage of turmeric/curcumin for OSMF patients and outline the direction of research. A comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library database, Google Scholar, clinical trial registries, and hand searching was conducted from inception until December 2018. This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (guidelines). In this review, 11 articles were selected for qualitative analysis and 3 out of 11 were selected for meta-analysis. Of these 11 studies, involving 428 patients, 7 were randomized control trials (RCTs), 1 was a nonrandomized trial, and 3 were observational studies. Turmeric was found to be effective in reducing signs and symptoms of OSMF in all 11 studies. All the studies included in this review have reported improvement in mouth opening after treatment with turmeric formulations. This could also be concluded from the meta-analysis of three RCTs. Similar improvement in tongue protrusion, burning sensation, and cheek flexibility has been reported. The lack of reliable evidence for the effectiveness of turmeric for the management of OSMF is illustrated by the paucity and poor methodological quality of studies retrieved for this review. We recommend that RCTs are needed using larger sample size with longer duration follow-up with special attention to the recurrence of signs and symptoms.

Many research studies have looked into the epidemiological aspects including various potential risk factors associated with cancers, namely environmental, dietary, genetic, and hormonal. The present article studies the magnitude and pattern of various cancers registered at tertiary health-care centers in three South Indian states. Data from hospital-based cancer registries compiled by the ICMR-National Centre for Disease Informatics and Research for the time periods 2007–2011 and 2012–2014 for three South Indian states, namely Tamil Nadu, Kerala, and Karnataka, were analyzed using R software. Summarizing the type and proportions of cancers seen at the three registries during the periods 2007–2011 and 2012–2014, it was found that, among men, hypopharyngeal cancer, esophageal cancer, lung cancer, stomach cancer, and oral cancer were the major cancer types prevalent and, among females, cervical cancer, mouth cancer, breast cancer, ovary cancer, and thyroid cancer were the common cancer types. With multidisciplinary approach, cancers can be prevented to a certain extent by insisting behavioural changes through recommendation of increase in physical activities and intake of micro nutrient-rich food items with fiber component.

Aim: The aim of this study is implementation and establishment of standard operating procedure for permanent prostate implant brachytherapy technique using BARC I-125 Ocu-Prosta seeds. Materials and Methods: The transrectal ultrasound (US)-guided procedure was used for permanent implant procedure. The Best^® Sonalis™ US Imaging System and Best NOMOS™ Treatment Planning system was used for volume study and implant procedure. The BARC provided I-125 Ocu-Pro radioactive seeds were implanted into the patient with help of Mick^@ Applicator. The implant was performed based on pre-implant dosimetry and intraoperative planning performed during implant procedure. Results: The necessary quality assurance tests were performed for US system before clinical use. The boost dose of 110 Gy was prescribed to the prostate volume of 34.71 cc. About 48 seeds with activity of 0.35 mCi (each) implanted into the prostate volume with reference to intraoperative planning. At the end of procedure, the patient underwent abdomen fluoroscopic examination, to ensure the seed counts in the prostate volume. The day after the implant, the patient was discharged. One month later a planning computed tomography and treatment planning was performed for seed position and dose verification. Conclusions: Low dose rate permanent implant brachytherapy has the advantage of being a one-time procedure and the existing long term follow-up supports its excellent outcome and low morbidity. BARC-BRIT is supplying the loose ¹²⁵I seeds. These seeds can be easily implanted into the patient using Mick applicator. However, the pre-implant seed preparation and implant procedure may result some radiation exposure to staff involved. The radiation dose can be minimized with good practice. This report is one patient pilot study and intended to test the implant systems and standard operative procedure henceforth for permanent implant brachytherapy procedure.

Aim of Study: There is limited information regarding the α-emitter radiopharmaceuticals dose calculation used in the setting of men with prostate cancer (PCa). The present study investigates the α-emitter radiopharmaceuticals absorbed dose distribution in the body organs. Materials and Methods: The α-emitter radiopharmaceuticals dose coefficient and absorbed doses biokinetics distribution, which are used for the treatment of PCa in all over the world, were performed using the “Internal Dose Assessed by Computer” (IDAC-Dose 2.1) program. The results of absorbed dose distribution in any organ of the body, were compared in studied α-emitter radiopharmaceuticals. Results: The absorbed dose value of ²²³Ra radiopharmaceutical in the prostate organ was evaluated 9.47E-9 Gy/Bq. The maximum and minimum absorbed doses due to biokinetics distribution of ²²³Ra were found in the thymus (9.53E-8 Gy/Bq) and eye lenses (1.30E-10 Gy/Bq) organs, respectively. Furthermore, the ²²⁵Ac absorbed dose in the prostate organ was obtained 1.91E-9 Gy/Bq, where this value is 1% of total body dose. While the absorbed dose distribution of ²²⁵Ac in body organs shows the highest concentration in the spleen (1.47E-8 Gy/Bq) and lowest in the eye lenses (7.93E-12 Gy/Bq). Conclusion: The absorbed dose in the body organs due to ²²³Ra and ²²⁵Ac α-emitter radiopharmaceuticals which are used in metastasized castration-resistant prostate cancer (mCRPC), calculated in this study. The results of this study will assist in evaluating and analyzing human body organ doses from application of ²²³Ra and ²²⁵Ac that used in mCRPC patients.

Purpose: The present study evaluates procedure-associated pain and side effects in the gastrointestinal–genitourinary system in patients with early-stage prostate cancer who were treated with image-guided radiotherapy (IGRT), accompanied by an ultrasound-guided transrectal implantation of fiducial markers, without local anesthesia. Materials and Methods: A total of 46 patients who referred to our clinics between 2012 and 2017 with a diagnosis of early-stage prostate cancer were included in the study. Before undergoing radiotherapy, all patients were implanted with three intraprostatic fiducial markers through the ultrasound-guided transrectal approach without local anesthesia. The patients underwent radiotherapy after the clinical target volumes were established, in accordance with the respective risk groups, and localization of the markers was confirmed before each therapy session. The levels of procedure-associated pain and side effects were graded immediately after the procedure through the use of a patient-based scoring system. Results: The faces pain scale – revised version was used for the measurement of the severity of procedure-associated pain. Of the total study sample, the facial expressions of 38 patients (35%) corresponded to level 0 in the study, seven (15%) to level 2, and a single patient (2%) to level 4. None of the facial expressions of the patients corresponded to levels 6, 8, or 10. The evaluation of procedure-related genitourinary and gastrointestinal system side effects indicated that nine patients (20%) experienced side effects, while no side effects were reported in 37 patients (80%). The reported side effects included rectal bleeding in two patients (4%), dysuria in three patients (6%), hematuria in five patients (11%), and frequent urination in five patients (11%). None of the patients experienced fever or hematospermia. All side effects were reported by the respondents as “a little,” while only one patient answered positively to the question on the frequency of urination. Among the patients who answered “yes” and “a little” to the questions evaluating genitourinary and gastrointestinal system side effects, the severity of these events was reported as Grade 1, corresponding to mild adverse, in only 9 (20%) patients. None of the patients experienced a Grade 2 or higher severe adverse event. In the comparison of the severity of pain of the patients during the fiducial marker procedure without local anesthesia with the severity of pain during the biopsy, 24 patients (80%) reported “lower” levels of pain, while five patients (20%) reported “equal” levels of pain. None of the patients stated that they had experienced “more” pain. Conclusion: IGRT accompanied by an ultrasound-guided implantation of fiducial markers without local anesthesia can be considered a safe method, given the associated acceptable levels of pain, low side effect profiles, and high prostate-specific antigen control rates.

Objectives: The objective was to evaluate the diagnostic performance of surveillance¹¹ C-choline positron emission tomography/computed tomography (PET/CT) for the detection of disease relapse in patients with a history of biochemically recurrent (BCR) prostate cancer (PCa) and prostate-specific antigen (PSA) ≤0.1 ng/ml. Materials and Methods: We included patients who had been treated for BCR PCa and had a surveillance¹¹ C-choline PET/CT at serum PSA ≤0.1 ng/ml. Positive surveillance PET/CT was defined as a study that identified a new tracer-avid lesion or new tracer uptake in a previously treated lesion or both. Findings were confirmed against a composite radiologic-pathologic gold standard. Time to recurrence association analyses were performed for disease relapse risk with the use of Cox proportional hazards regression. Results: In total, 13 (12.1%) of the 107 patients had positive surveillance PET/CT scans, confirmed on pathologic assessment (n = 5) and subsequent imaging (n = 8). Among these 13 patients, ten had distant metastases, two had local recurrence, and one had both. Nine of the ten patients with metastases had oligometastatic disease defined as the presence of ≤3 metastases. Serum PSA became detectable again in only seven patients with positive surveillance PET/CT, after a mean interval from surveillance PET/CT of 292 days (range: 105–543 days). We identified an association of N stage with increased risk of recurrence (hazard ratio = 3.85; P = 0.036) although this was not significant after accounting for multiple testing. Conclusions: Surveillance¹¹ C-choline PET/CT can detect early disease relapse at serum PSA ≤0.1 ng/ml in patients with a history of BCR PCa.

Background: Radiation plays a major role in the management of localized prostate cancer (CaP). There are limited studies reporting the quality of life (QOL) and toxicity with CaP tomotherapy. Materials and Methods: This is a single-institutional prospective observational study evaluating the acute toxicity and QOL of patients with CaP receiving tomotherapy from May 2018 to October 2019. Toxicity assessed using radiation therapy oncology group toxicity grading. QOL assessed using International Prostate Symptom Score (IPSS) and QOL score. Results: A total number of 74 patients received radiation therapy (RT), of which 25 had postoperative RT and 49 had radical RT. The median age was 71 years. During RT, 8 (10.8%) had Grade 2 gastrointestinal (GI) and 4 (5.4%) had Grade 2 genito urinary (GU) toxicities. At 3 months, 1 (1.4%) had Grade 2 GI, 1 (1.4%) had Grade 2 GU, and 1 (1.4%) had Grade 3 GU toxicities. At 6 months, 1 patient had Grade 2 GU and no Grade 2 GI toxicity noted. In postoperative RT Group, 2 (8%) Grade 2 GI and 1 (1.4%) Grade 2 genitourinary toxicity reported during radiation. At 3 months, 1 (1.4%) Grade 2 GI, 1 (1.4%) G2 GU, and 1 (1.4%) G3 GU toxicities noted. At 6 months, no ≥ Grade 2 noted. In radical RT group, during radiation 6 (12.2%) Grade 2 GI and 3 (6.1%) Grade 2 GU recorded. At 3 and 6 months, no ≥ Grade 2 GI/GU toxicity was recorded. No Grade 3/Grade 4 observed in radical RT group. One patient in radical RT and one in postoperative RT had severe IPSS symptom score. Results are comparable to reported studies. Conclusion: Our initial clinical experience with helical tomotherapy in CaP confirms lower rate of toxicities and no significant worsening of QOL with RT.

Objective: The objective of the study was to validate PIRADS v2 on 3T MRI with secondary assessment if combination of the PIRADS v2 and PSA density improves detection of clinically significant prostate cancer. Materials and Methods: We conducted a prospective study evaluating 58 patients with PSA value of >4 ng/ml from July 2017 to December 2019. Transrectal ultrasonography (TRUS) guided targeted biopsy was performed via cognitive targeting followed by systemic 12 core biopsy. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Results: Total of 112 lesions of 58 patients were assessed via mpMRI followed by TRUS guided biopsy. A PI-RADS v2 score of ≥4 irrespective of PSA density categories and a PI-RADS v2 score of 3 with PSA density of ≥0.15 ng/mL/cc, yielded the highest overall prostate cancer and clinically significant prostate cancer detection rate. Contrary to, a PI-RADS v2 score of ≤3 and a PSA densitay of <0.15 ng/ mL/mL(low risk group), which yielded no clinically significant prostate cancer. Conclusion: Both PIRADS v2 score and PSA density are eminently sensitive and specific in the detection of clinically significant prostate cancers individually. However the combination of PIRADS v2 and PSA density significantly improved the accuracy of clinically significant prostate cancer detection. Patients with combination of PIRADS v2 score ³3 and PSA density ³0.15 ng/ml/cc should undergo prostate biopsy.

Aim: The aim of the present study was to evaluate the impact of magnetic resonance imaging (MRI) on radiotherapy target volume changes in prostate cancer. Materials and Methods: Ten patients with localized prostate cancer receiving radical radiotherapy were included in the study. Computerized tomography (CT) simulation was done with adequate immobilization, and pelvic MRI was also done at the same time. The two were then registered on eclipse planning system and fused. Target delineation (gross tumor volume [GTV] and clinical target volume [CTV]) was done on both the image sets separately and their volumes were compared. Results: In the current study, it has been found that the CT image-based contouring overestimated the GTV and CTV with 35.4% and 21.7%, respectively, as compared to that by MRI images. The difference observed was statistically significant in the case of GTV, whereas it was not statistically significant for CTV. Conclusions: It can be concluded that MRI is found to be a better modality for GTV delineation, as it gives superior soft-tissue contrast.

Purpose: The objective of the study was to evaluate the effectiveness of a rectal retractor (RR) designed to protect rectal tissue in intensity-modulated radiotherapy (IMRT) by pushing rectal wall (RW) away from the prostate. Materials and Methods: Twelve patients with localized prostate cancer were enrolled into this study. Patients underwent two computed tomography (CT) scans without and with RR. A prescription of 80 Gy in 40 fractions was planned on CT scans with and without RR. This study evaluates the ability of the RR in RW dose reduction, in particular reduction of the RW V_70Gy≥ 25% in comparison with the plan without RR dose-volume histograms were generated with and without RR. The patient's tolerance was assessed by patient-reported outcomes. Results: The planning target volume coverage was equal for both without and with RR (P = 0.155). The mean dose to the RW was statistically significantly lower for the plan with RR than that for the plan without RR, a mean reduction of 5.8 Gy (P = 0.003). Significant relative reductions in rectal dose-volume parameters whether in absolute volume (cc) or as a percentage of contoured RW were detected. A relative reduction more than 25% in RW V_70Gy(%) in 100% of patients was achieved. The rectal retraction resulted in a significant increase in the prostate to the rectum space at the prostate midgland level, an absolute increase of 2.7 mm. The retraction of the rectum induced a mean (±standard deviation) pain score of 2.7 (±1.3) according to the visual analog score. Conclusion: The application of a RR showed a remarkable rectal sparing effect during prostate IMRT. This may lead to reduced acute and late rectal toxicities in prostate IMRT.

Background: The addition of docetaxel or abiraterone to androgen deprivation therapy (ADT) achieves superior survival outcomes in metastatic hormone-sensitive prostate cancer (mHSPC) in predominantly Western population. We sought to evaluate the treatment outcomes of adding docetaxel or abiraterone to ADT in Indian population. Methods: We reviewed the medical records of ninety patients with newly diagnosed mHSPC who received treatment between January 2015 and June 2018. Patients received ADT alone or ADT + docetaxel or ADT + abiraterone as initial treatment. Monthly clinical evaluation and prostate-specific antigen (PSA) measurement were done. Outcome measures analyzed included PSA decline <90%, serological complete response (sCR) (PSA <0.2 ng/ml), and progression to CRPC. Outcome variable was compared using Fisher's exact test. Results: Patients received ADT alone (n = 37) or ADT + docetaxel (n = 31) or ADT + abiraterone (n = 22). The median age was 67.5 years (range, 41–87 years) and the median PSA was 88.5 ng/ml (range, 1.12–4000). PSA decline <90% was seen in 22 (73%), 24 (86%), and 17 (94%) patients in the ADT alone, ADT + docetaxel, and ADT + abiraterone groups. sCR was achieved in 5 (17%), 10 (36%), and 9 (50%) patients in the ADT alone, ADT + docetaxel, and ADT + abiraterone groups. Progression to CRPC was observed in 18 (60%), 11 (39%), and 2 (11%) patients in the ADT alone, ADT + docetaxel, and ADT + abiraterone groups. Conclusion: The addition of docetaxel or abiraterone to ADT achieves a deeper serological response and reduces progression to CRPC compared to ADT alone in mHSPC patients of Indian origin. Longer follow-up is required to comment on overall survival and also to determine which combination (ADT + docetaxel or ADT + abiraterone) is superior to others, if at all.

Aim: The combination of phototherapy and chemotherapy (chemophototherapy), presents a promising multimodal method for comprehensive cancer treatment. The aim of this study is to investigate the influence of low doses of zinc oxide (ZnO) nanofluids and ultraviolet A (UVA) irradiation on the cytotoxicity and cellular uptake of doxorubicin (DOX) on human prostate cancer DU145 cells. Materials and Methods: ZnO nanoparticles were prepared by the solvothermal method and 10% bovine serum albumin was used as the dispersant. The cytotoxic effect of DOX alone and in combination with different concentrations of ZnO nanofluids (0.95-15.6 μg/ml) in the presence and absence of UVA irradiation on DU145 cells was evaluated by -(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. DOX residue inside and outside of DU145 cells was explored by fluorescence microscopy and UV-Vis absorption spectroscopy, respectively. The role of ZnO nanofluids and UVA irradiation in DOX-induced apoptosis and cell cycle arrest were evaluated by DAPI staining, comet assay, and flow cytometry. Results: The results revealed that low dose of ZnO nanofluids (0.95 μg/ml) accompanied with irradiation enhanced the cytotoxicity and intracellular delivery of DOX in DU145 cells. The percentage of chromatin fragmentation/condensation and DNA tail of DU145 cells treated simultaneously with DOX and ZnO nanofluids was increased after UVA irradiation, whereas no significant changes in cell cycle progression were observed. Conclusion: The results indicate that ZnO nanofluids in the presence of UVA irradiation could increase DOX efficiency in DU145 cells, suggesting such modality combinations as a promising approach in cancer treatment.

Context: Rational screening of arylidene derivatives for biological activities has resulted in many lead molecules with anticancer properties with effective therapeutic window. Aims: In the current study, FCX, an arylidene derivative, was screened for anticolon and prostate cancer activity. Settings and Design: Prostate and colon cancer cell lines were used to check the FCX effect on proliferation, apoptosis, and mechanism of drug action. Subjects and Methods: LNCaP, PC-3, HCT-8, and HT-29 cells were treated with various concentrations of the FCX. MTT assay was performed to check proliferation, propidium iodide and Hoechst dual staining for DNA fragmentation, and Annexin V binding assay for apoptosis, and cell cycle assay was done using flow cytometry. Functional androgen-mutated receptor cells were used mechanistic pathway elucidation. Statistical Analysis Used: A minimum of three individual replicates at different time periods were taken as mean value. The data were expressed in mean ± standard deviation. Student's t-test and one-way ANOVA were used to assess the statistical difference between the groups. Results: FCX inhibited proliferation of prostate cancer cell lines in a dose-dependent manner with more selectivity toward LNCaP cells. Nuclear fragmentation and dose-dependent increase in Annexin V-positive LNCaP cells revealed apoptosis. Cell cycle G2/M phase arrest along with sub-G0/G1 population augmented the antiproliferative observations. Addition of FCX in the presence of estradiol, testosterone, and dehydroepiandrosterone, LNCaP cells markedly caused a dose-dependent increase in cell proliferation indicating the compound activity to be facilitated through androgen receptor pathway. Conclusions: Together with the results, it is evident that FCX has a wide therapeutic window in the in vitro inhibition of the prostate cancer cells mediated by hormone-dependent effects.

Objective: Sunitinib is a novel oral multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activities. This study evaluates ezrin expression in sunitinib-treated metastatic clear cell renal cell carcinoma (ccRCC) patients and elucidates its role as a possible marker for survival. Materials and Methods: The expression of ezrin was measured by immunohistochemistry in 80 patients with ccRCC treated by first-line sunitinib between January 2007 and June 2012. Kaplan–Meier curves and log-rank tests were used for analysis of progression-free survival and overall survival (OS), and a multivariate Cox proportional hazard model was employed to identify factors with an independent effect on the survival. Results: In multivariate analysis, liver metastasis (P = 0.018; hazard ratio [HR]: 3.707 (1.257–10.931) and overexpression of ezrin (P = 0.006; HR: 2.993 (1.373–6.523 95% confidence interval) were remained significant factors influencing OS. Overexpression of ezrin in the patients who had progressed in the first 3 months was higher than in the patients who had progressed after 3 months (P = 0.003). The median OS was longer in patients with low levels of ezrin expression (27 months) compared to patients overexpressing ezrin (12 months) (P = 0.001). Conclusion: This is the first study in the literature showing that ezrin status is related with prognosis in patients with metastatic ccRCC.

Context: Some patients diagnosed with small renal solid masses or complex cystic lesions may benefit from active surveillance (AS) instead of immediate treatment. Aims: Report our series of patients undergoing AS for small renal solid and complex cystic lesions, and compare growth rates and outcomes between both types of lesions. Materials and Methods: A retrospective review AS database for renal lesions was conducted. From 1995 to 2017, a total of 82 patients with 89 renal lesions were included. We describe our AS protocol, patient and tumor characteristics, comparisons between solid and cystic lesions, and final outcome of patients who underwent delayed intervention (DI). Statistical Analysis Used: Categorical and continuous data were analyzed by the Chi-square and the Student's t-test, respectively. The Wilcoxon/Kruskal–Wallis test was used for growth rate comparisons of solid and complex cystic lesions. Results: Median age of patients at the beginning of AS was 77-year-old, median size for solid and cystic lesions was 2.3 cm (0.08–3.8) and 2.6 cm (1.2–4.0), respectively. No differences in annual growth rate between solid and complex cystic lesions (0.04 cm [0.00–1.5] and 0.05 cm [0.01–1.7]) were observed at a similar median follow-up of 61 months for both groups (range: 15–182, and 14–254). Five patients with solid lesions underwent DI, 3 for rapid growth (>0.5 cm/year), 1 demanded treatment, and 1 due to hematuria. Adherence to AS protocol was high (94%). No cancer-related deaths or metastatic progression was observed, six patients died of another medical condition, being cardiovascular disease the most frequent cause. Conclusions: AS is a reasonable and safe option for the management of small renal masses. No difference was observed in the growth rate between solid and complex cystic lesions during AS. Centers offering AS should present a standardized protocol and give exhaustive information to patients regarding benefits and risks.

Objectives: To investigate the relationship between gender, body mass index (BMI), and prognosis in renal cell carcinoma (RCC) patients. Materials and Methods: We retrospectively reviewed 1353 patients with RCC who underwent a partial or radical nephrectomy between 1988 and 2015. The association among sex, BMI, stage, grade, overall survival (OS), and recurrence-free survival (RFS) was analyzed. Results: The median age of the patients was 59.4 ± 11.9 years. Female patients had proportionally lower grade tumors than male patients (Grade I–II in 75.5% vs. 69.3% in women and men, respectively, P = 0.022). There was no relationship between Fuhrman grade and BMI when substratified by gender (p > 0.05). There was a nonsignificant trend toward more localized disease in female patients (p = 0.058). There was no relationship between T stage and BMI when stratified by gender (p > 0.05). Patients with higher BMI had significantly better OS (p = 0.0004 and P = 0.0003) and RFS (P = 0.0209 and P =0.0082) whether broken out by lower 33^rd or 25^th percentile. Male patients with higher BMI had significantly better OS and RFS rates. However, there was no relationship between BMI and OS or RFS for female patients (P > 0.05). Multivariate analysis of the entire cohort demonstrated that a BMI in the lower quartile independently predicts OS (hazard ratio 1.604 [95% confidence interval: 1.07–2.408], P = 0.022) but not RFS (P > 0.05). When stratified by gender, there was no relationship between BMI and either OS or RFS (P &> 0.05). Conclusions: Increasing BMI was associated with RCC prognosis. However, the clinical association between BMI and oncologic outcomes may be different between men and women.

Introduction: Although several studies have been conducted to evaluate the feasibility of Raman spectroscopy (RS) for the diagnosis of bladder cancer (BCa), it is difficult to use RS in real clinical settings based on the current limited evidence. Therefore, we performed a systematic review and meta-analysis to assess the diagnostic accuracy of RS in BCa. Materials and Methods: Comprehensive literature searches were performed in the PubMed/Medline, Embase, and Cochrane Library databases up to March 2019. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this study included reports according to the participant, intervention, comparator, outcomes, and study design approach. The methodological quality of the included studies was evaluated according to questionnaires and criteria suggested by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The quantitative outcomes included diagnostic accuracy (sensitivity and specificity). Results: Fifteen studies were included for qualitative analysis and four studies (BCa cases, n = 139; control cases n = 107) were included in this analysis by screening the full text of the remaining articles based on the inclusion and exclusion criteria through a systematic review. The pooled sensitivity and specificity of RS were 0.91 (95% confidence interval [CI]: 0.85–0.95) and 0.93 (95% CI: 0.86–0.97), respectively. The among-study heterogeneity was statistically significant in the specificity results (Cochran Q statistic, P = 0.015; I² statistic, 71.3%) but not in the sensitivity results (Cochran Q statistic, P = 0.189; I² statistic, 37.2%). Conclusions: RS showed the potential to be an efficient tool with high accuracy for detecting malignant bladder lesions. More studies with in vivo real-time settings are warranted to validate our results.

Purpose: To investigate the prognostic and clinicopathologic value of Ki-67 and profilin 1 immunohistochemical expression in primary pT1 papillary urothelial bladder cancer. Materials and Methods: This study included 88 male and 13 female pT1 primary bladder cancer patients. Demographic characteristics, tumor histological grade, tumor number, presence of concomitant carcinoma in situ, tumor size, and status of recurrence or progression were recorded for each patient. Expression of Ki-67 and profilin 1 was evaluated by immunohistochemical analysis of paraffin-embedded tumor tissues. The Pearson's Chi-square test was used for the analysis of qualitative data, and the Kaplan–Meier method and the log-rank test were used for the survival analysis. Results: In the mean follow-up period of 52 months, 52 (51.5%) patients experienced recurrence, 24 (23.8%) patients experienced progression, and 17 (16.8%) patients died from bladder cancer-related causes. Ki-67 expression was significantly associated with tumor histological grade (P = 0.001). In multivariate analysis, Ki-67 positivity had significantly worse outcome for recurrence (P = 0.006) and mortality (P = 0.022). Ki-67-positive (Ki-67 index ≥15%) patients had shorter recurrence-free (P = 0.003), progression-free (P = 0.002), and cancer-specific (P = 0.003) survival. However, no statistically significant relationship was found between profilin 1 expression and clinicopathologic features and prognosis. Conclusions: Ki-67 is a highly predictive biomarker for recurrence-free, progression-free, and cancer-specific survival in pT1 bladder cancer patients, in whom prediction of recurrence and progression are difficult. Ki-67 expression can be safely combined with other prognostic factors. However, in pT1 bladder cancer patients, no significant relationship was found between profilin 1 expression and tumor characteristics or prognostic parameters.

Aim: Bleomycin, etoposide, and cisplatin (BEP) regimen is the standard treatment for germ-cell tumors (GCTs). Bleomycin-induced pulmonary toxicity (BPT) is fatal and dose-limiting toxicity associated with this regimen. In this study, we aimed to identify the frequency and risk factors of BPT in South Indian GCT patients receiving BEP regimen. Patients and Methods: The study was carried out in the Department of Medical Oncology, Regional Cancer Centre at a tertiary care hospital in South India. All the patients with GCT (testicular and ovarian) who were receiving BEP regimen from December 2014 to May 2018 were included in the study. BPT was defined as the presence of radiological features and/or clinical symptoms during or post-treatment. Results: BPT was observed in 11 (27%) patients of 41 analyzed patients. Five (12%) patients developed BPT during treatment whereas six (15%) patients developed BPT post-treatment. Cumulative bleomycin dose ≥240 mg (relative risk 3.8, confidence interval: 1.2–12.2,P =0.02) was found to increase the risk of BPT. Three-year overall survival in patients with and without toxicity was 82% and 93%, respectively. Conclusions: The frequency of BPT in the study population is 27%, and cumulative bleomycin dose ≥240 mg has been found to be associated with increased risk of developing BPT. BPT does not negatively impact survival outcome in GCT patients receiving BEP regimen.

Aim of the Study: Some cancerous patients have hip prosthesis of metal elements when they undergo radiation therapy. Metal implants are a cause of metal artifacts in computed tomography (CT) images due to their higher density compared to normal tissues. The aim of this study is to evaluate the quantitative effects of metal artifacts on dose distribution of the pelvic region. Materials and Methods: Seven patients with metal implants in the pelvic region were scanned and CT images were exported to the Monaco treatment planning system. Based on the diagnosis of each patient, three-dimensional plans were implemented on CT images and dose distributions were extracted. At the next step, metal artifacts were contoured and electron densities of these new structures were modified to the extent of soft tissue. Finally, dose distributions and the differences were investigated by VeriSoft software. Results: The results of this study showed that if the electron density to metal artifacts is not assigned properly, it will increase the calculated monitor units (MUs) by almost 3.78 MUs/fraction which will significantly affect total dose distribution of treatment. Conclusion: For the precise implementation of the treatment and in order to minimize the systematic errors related to the calculated MUs, necessary corrections on the electron density of metal artifacts should be considered before the treatment planning. The issue will be more critical in advanced treatment modalities where dose escalation is needed.

Purpose: To classify the available plan evaluation indices and compare the dosimetric suitability of these indices. Materials and Methods: Available published plan evaluation indices were categorized. Conformity index (CI) into two groups, one group contains those CI formulas which do not consider critical structure and other group contains those CI formulas which consider planning target volume (PTV) coverage, normal tissue and critical structure sparing simultaneously. Various homogeneity index (HI) formulas extracted from literature. Structure data sets of 25 patients were taken under consideration comprising of various sites. For each patient, two plans were created using Volumetric Arc Therapy technique. First type of plan (Plan-A) were generated considering all tissue objectives for targets and Organ at Risks (OARs) whereas second type of plan (Plan-B) were generated considering only targets tissue objectives and excluding OARs tissue objectives during plan optimization and dose calculation. Planning evaluation parameters were compared between Plan-A and Plan-B. Results: CI calculated by various formulas in two different scenarios presented <2% variation. Any commonly used CI formula failed to differentiate the two different planning situations. On comparison between HI of two different scenario, it is observed that there are four formulas of HI which showed negligible variation but two formulae: S-index and HI (D) showed marginal variation. It is also observed that when OARs are removed from optimization dose homogeneity improved which is specifically pointed by sigma index formula. Conclusion: CI, which has assimilated the presence of OAR in their formulation, shows more reliability in plan evaluation. Sigma index was found to be more efficient formula while evaluating homogeneity of a treatment plan.

Purpose: High-dose rate remote afterloading brachytherapy machine and advanced treatment planning system help in getting optimum dose to tumor and low dose to normal structures. Inverse planning simulated annealing (IPSA) optimization technique has a unique feature of dwell time deviation constraint (DTDC). In this study, six IPSA-based plans having different DTDC values with routinely practiced geometric plus graphical optimization (GO + GrO) have been compared using various dosimetric parameters. Materials and Methods: For this retrospective study, we have generated IPSA-optimized interstitial brachytherapy plans for ten cancer cervix patients. Routinely practiced GO + GrO-based plans were compared with six different IPSA plans having varying DTDC values from 0.0 to 1.0 using different dosimetric indices. Results: Conformity index and homogeneity index (HI) were higher in GO + GrO plans, compared to IPSA-optimized plans. However, HI of IPSA plans was increasing with increasing DTDC values. High-dose volumes were well controllable using DTDC parameter in IPSA-optimized plans. Dose to the rectum and bladder was smaller for IPSA-optimized plans than GO + GrO plans. Conclusions: One of the benefits of applying DTDC in IPSA-optimized plan is that it reduces high-dose volumes. Another advantage is the reduction in rectum and bladder dose.

Purpose: This study systematically reviews the distribution of racial/ancestral features and their inclusion as covariates in genetic–toxicity association studies following radiation therapy. Materials and Methods: Original research studies associating genetic features and normal tissue complications following radiation therapy were identified from PubMed. The distribution of radiogenomic studies was determined by mining the statement of country of origin and racial/ancestrial distribution and the inclusion in analyses. Descriptive analyses were performed to determine the distribution of studies across races/ancestries, countries, and continents and the inclusion in analyses. Results: Among 174 studies, only 23 with a population of more one race/ancestry which were predominantly conducted in the United States. Across the continents, most studies were performed in Europe (77 studies averaging at 30.6 patients/million population [pt/mil]), North America (46 studies, 20.8 pt/mil), Asia (46 studies, 2.4 pt/mil), South America (3 studies, 0.4 pt/mil), Oceania (2 studies, 2.1 pt/mil), and none from Africa. All 23 studies with more than one race/ancestry considered race/ancestry as a covariate, and three studies showed race/ancestry to be significantly associated with endpoints. Conclusion: Most toxicity-related radiogenomic studies involved a single race/ancestry. Individual Participant Data meta-analyses or multinational studies need to be encouraged.

Introduction: Andrographis echioides is a prevalently used medicinal herb in South Asian countries. Scientific researches with the extracts of A. echioides revealed its antipyretic, anti-inflammatory, antimicrobial, ulceroprotective, and hepatoprotective properties. This study was done to elucidate antiproliferative and antiangiogenic potential of ethanolic extracts of A. echioides (EEAE) by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and chorioallantoic membrane (CAM) assay. Materials and Methods: EEAE was prepared using Soxhlet apparatus with ethanol after being sun-dried and powdered. MCF 7 (human invasive breast ductal carcinoma) cell lines retaining attributes of differentiated mammary epithelium with both estrogen and progesterone receptors were treated with EEAE, and antiproliferative effect was seen using Mosmann method of MTT assay using 5-fluorouracil (5-FU) as a comparator. The evaluation of antiangiogenic potential of EEAE was done by comparing mean vessel density (MVD) in chick CAM after treatment with EEAE, thalidomide, and vascular endothelial growth factor (VEGF) using CAM assay, an in ovo assay. Results: EEAE displayed antiproliferative activity from low to high concentrations with MTT assay. The IC₅₀ of EEAE and 5-FU was 62.5 and 15.6 μg/ml, respectively (P < 0.05). The exhibition of its antiangiogenic activity increased proportionately with increasing concentration. VEGF increased MVD by 45.94%; thalidomide decreased it by 53.76%. There was a decrease of MVD by 5.91%, 20.46%, and 35.95% at concentrations of 25, 50, and 100 μg of EEAE, respectively. Conclusion: EEAE possessed significant antiangiogenic and antiproliferative activity, making them a promising substrate in the development of a novel anticancer drug and can be successfully used in the therapy of various cancers after establishment of the anticancer effects in animal models and subsequently in clinical trials.

Aim of the Study: The aim of the present study was to explore the antitumor activity of the ethanolic extract of Albizia lebbeck L. pods against Ehrlich ascites carcinoma (EAC) in Swiss albino mice and its cytotoxic effect against HeLa and A549 cell lines in vitro. Materials and Methods: Antitumor activity of ethanolic extract of A. lebbeck L. (ALEE) pods was evaluated in Swiss albino mice against EAC cell lines at the doses of 200 and 400 mg/kg body weight which were given by intraperitoneal route of administration and was compared with 5-fluorouracil (5-FU), the reference standard. The extract and 5-FU were administered for 14 consecutive days. After 24 h of the last dose and 18 h of fasting, the mice were sacrificed and the antitumor effect of ALEE was assessed by evaluating tumor volume, viable and nonviable tumor cell count, increase in life span, and hematological parameters of EAC-bearing hosts.In vitro cytotoxicity has been assessed using (2,3-bis[2-Methoxy-4-nitro-5sulfophenyl]-2H-tetrazolium-5-carboxyanilide inner salt assay method and was compared with cisplatin, the reference standard. Results: ALEE showed direct cytotoxicity on EAC cells in a dose-dependent manner. ALEE exhibited a significant (P < 0.001) decrease in the body weight, tumor volume, viable cell count, tumor weight, and elevated the life span of EAC tumor-bearing mice. Hematological profile such as red blood cell, hemoglobin, white blood cell, and platelet count was reverted to the normal level in ALEE-treated mice. Conclusion: The results showed that the ethanolic extract of A. lebbeck L. has a powerful antitumor activity because it was effective in significantly inhibiting the tumor growth in both in vivo and in vitro cancer cell lines.

Background: Liver cancer is considered as one of the most widespread malignancies across the globe. According to a recent estimate, about 782,000 people were diagnosed with liver cancer, out of which 746,000 people died. Conventional anticancer therapy cannot fulfill all the clinical needs due to accessibility, clinical efficacy, and safety issues. Hence, the need of novel inexpensive drugs from traditional medicine as potential chemotherapeutic agent becomes utmost urgent. Root of Saussurea lappa, C.B. Clarke (Unani name, qust) has been used in the Unani medicine for the treatment of chronic liver diseases (warm-e-jigar sulb) including hepatocellular carcinoma since centuries. Objective: The objective is to study the anti-cancerous, antioxidant, and hepatoprotective activity of different extracts of SLE in vitro. Materials and Methods: MTT assay was used to determine the anticancer activity and EC₅₀ of SLEs. Cell viability and cell inhibition were calculated. Apoptosis was studied by DAPI 4',6-diamidino-2-phenylindole (DAPI) staining. Thein vitro hepatotoxicity of CCl4 was produced and hepatoprotective properties of different concentrations of ethanolic (ESL), aqueous (ASL), and hydroethanolic extract of Saussurea lappa (HSL) have been evaluated by measuring cell viability in HepG2 cells. Results: MTT assay revealed that the molecule reduced the cell viability of HepG2 cancer cells. Test drugs induced apoptosis in a concentration-dependent manner, as indicated by DAPI staining. In addition, ESL, ASL, and HSL also reduced the colony-forming potential of the HepG2 cell. ESL, ASL, and HSL were observed to protect the HepG2 cells from CCl4 induced injury in a dose-dependent manner. Conclusion: The observed effect substantiated the anti-cancerous, antioxidant, and hepatoprotective activity of SLEs in HepG2 Cells.

Background: Autophagy has an essential role in cellular energetic balance, cell cycle, and cell death, so the change in autophagy level is crucial in many human diseases such as cancer. Herbal medicine has been widely used to treat cancer. Bowman–Birk protease inhibitor (BBI), a protease inhibitor extracted from soybean, has antitumorigenic, anti-inflammatory, and anti-angiogenic activities. In this study, we evaluated the effect of BBI on the growth of breast cancer cell line and transcript level of autophagy and apoptosis-related genes. Materials and Methods: BBI was purified from soybean by ion-exchange chromatography method. The viability of MDA-MB-231 cells that were treated with BBI was measured by MTT assay, and the transcript level of genes involved in autophagy and apoptosis was measured by real-time–polymerase chain reaction (PCR) technique. Results: The results of BBI purification showed that 100 g of the ethanolic fraction yielded 300-mg BBI with more than 95% purity. MTT results revealed that BBI inhibited the cell growth of MDA-MB-231 cell line in a dose-dependent manner, with an IC₅₀ of 200 μg/mL. The results of real-time reverse transcription-PCR exhibited that BBI altered the expression of Atg5, Beclin1, light chain 3-II, and sequestosome1 and increased the Bax/Bcl2 ratio in MDA-MB-231 cell line. Conclusion: According to our results, BBI could inhibit autophagy and induce apoptosis in MDA-MB-231 cell line. Thus, BBI may be used as a therapeutic drug in the treatment of breast cancer whether alone or with chemotherapeutic drugs.

Aim: We aimed to evaluate whether tumor markers and inflammation parameters effect on survival in patients with metastatic pancreatic cancer (MPC). Patients and Methods: This retrospective analysis included 170 patients with pancreatic cancer who were admitted to the oncology clinic at the metastatic stage. Basic patient demographic characteristics, chemotherapy (CT) that patients received in the first line, complete blood count, neutrophil/lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin/globulin ratio (AGR), prognostic nutritional index (PNI), tumor markers (carcinoembryonic antigen [CEA], carbohydrate antigen 19-9 [CA19-9]), and survival were analyzed. Receiver operating characteristic analysis was used to determine the optimum cutoff value of NLR, PLR, AGR, PNI, CEA, and CA 19-9, which could predict survival. Results: The median age of the patients was 63 years (range, 33–87). About 63.5% of the patients were male and 44.5% were female. 161 (94.7%) patients died, and the median overall survival (OS) was 8.0 months (95% confidence interval = 6.6–9.4) for all patients. In univariate analysis, age (P < 0.001), CT regime (P < 0.002), AGR (P < 0.006), PNI (P < 0.017), NLR (P < 0.001), PLR (P < 0.062), and CA19-9 (P < 0.002) were statistically significant. In multivariate analysis, age (hazard ratio [HR] 1.534 95% 1.079–2.182 P < 0.017) CA19-9 (HR1.410 95% 1.001-1.989, P ≤0.005) and, NLR (HR 1.569 95% 1.001–2.463, P < 0.049) were significant. Conclusion: We determined, age, CA19-9, and basal high NLR as independent adverse prognostic factors for OS in APC. Fluorouracil, leucovorin, irinotecan, and oxaliplatin CT resulted in a significant increase in OS.

Background: Bone and soft-tissue sarcoma are rare tumors. Complementary and alternative medicine (CAM) is often used in cancer patients however limited data are available in sarcoma patients. The aim of the present study is to explore the use of CAM in patients with bone and soft-tissue sarcoma. Methods: Patients in follow-up visit for high grade bone or soft-tissue sarcoma at the Rizzoli outpatient clinic from September 1, 2014, to December 31, 2015, were asked, after written consent, to fill out a questionnaire with items pertaining to sociodemographic factors and their use of CAM before, during, or after chemotherapy. Results: Four hundred and sixty-nine participated to the survey: 409 were adults and 60 were <18 years old. The percentage of use of CAM in adults was 44.7% and in minors 38.3%. The most common type of CAM was vitamins and minerals, followed by phytotherapy and homeopathy. The majority of patients used CAM after the sarcoma diagnosis. None used CAM alone instead of conventional chemotherapy. Benefits from use of CAM were reported by 75% of patients (some benefit in 53% plus high benefit in others 22%) and side effects in 6.7%. A significant correlation was found with CAM use and female gender, young age (18–44) and higher education. Disclosure to the oncologist was 56% and 69% to their family doctors. Conclusions: This study shows that CAM use is frequent among adults and pediatric patients with bone and soft tissue sarcoma as in other cancer patients. Moreover, the profile of these Italian CAM consumers in sarcoma patients is similar to other studies. Patients disclosure to their oncologist or physician about the use of CAM was similar to other Italian studies, but higher compared to other international studies.

Purpose: We present our data for every single fraction for every patient treated at our center for the past 4 years, analyzing the waiting and treatment times. Materials and Methods: Between January 2014 and February 2018, all patients and their corresponding recorded measurements of waiting time and machine treatment time were analyzed. Times recorded included actual arrival time, designated arrival time, linac entry time, and last beam treatment time. The complete waiting time information was divided into two categories (1) first day treatments and (2) subsequent day treatments. SPSS version 18 was used for statistical calculations, correlations, and assessing significance. Results:First day treatments - of 1982 patients following treatments were carried out; 1557 volumetric-modulated arc therapy (78.6%), 88 three-dimensional conformal radiotherapy (RT) (4.4%), 14 electron (0.7%), 10 intensity-modulated RT (0.5%), 264 stereotactic irradiation (13.3%), 17 stereotactic body RT (0.7%), and 32 total body irradiation (1.6%). The mean (± standard deviation) times for early/late time, total spent time (TST), wait time gross (WTG), and wait time net (WTN) were 11.0 ± 49.6 min, 74.7 ± 44.8 min, 47.46 ± 43.9 min, and 24.1 ± 44.4 min, respectively. Subsequent day treatments - a total of 34,438 sessions of treatment delivery were recorded. Overall average WTG was 37.4 ± 32.7 min. Overall WTN was 12.1 ± 62.7 min. Overall mean total spent time (TST) was 52.4 ± 33.0 min, overall mean setup and treatment time was 15.1 ± 10.9 min. Conclusion: We have presented our results of patient-related times during RT. Our study covers the daily waiting times before RT as well as the actual treatment times during modern-day RT. This consecutive patient data from a large series shall be an important resource tool for future planners and policymakers.

Aim: The aim was to study the pattern of adverse drug reaction (ADR) provoked by anticancer therapy and to assess the quality of life (QoL) in cancer patients. Materials and Methods: This study was conducted in Tamil Nadu on 75 patients from February to July 2019 taking into account their demographic profile, ADR occurrence and its causality, outcome, organ system-wise distribution of ADRs, and others. The causality assessment was done by using Naranjo's scale and QoL was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale. The QoL was compared in any two consecutive cycles between the 2^nd and 5^th cycles of chemotherapy. Results: Out of the 75 patients, 17 male and 56 female patients developed ADR. A total of 228 ADRs were observed in 73 patients. The most commonly occurred ADR was nausea and vomiting (45%) and the most commonly affected system was gastrointestinal tract (37%). According to causality assessment, the ADR that occurred falls mostly in the category of probable (66.7%) followed by possible (29.3%) and the outcome of the ADR was mostly recovering (49.3%). The QoL was higher in females and in the age group of 40–49 years. The physical and emotional well-being of the patient were affected more. The overall QoL was improved in the 2^nd visit when compared to the 1^st visit. Conclusion: Cancer is known to cause a significant impact on the health and socioeconomics of a nation. To boost the QoL in patients, it is essential to identify and manage the ADRs by taking appropriate measures to promote judicious use of drugs.

Introduction: In the present study, the radioadaptive role of the immune system induced by low dose (LD) was investigated for its in vivo protective activity. Materials and Methods: Quantitative analysis of cytokine gene expression was assessed for their in vivo activity in BALB/c mice. To evaluate the adaptive response induced by LD on the mice spleen lymphocyte, the cytokine interleukin (IL)-4, interferon (IFN)-γ, and transforming growth factor (TGF)-β expression was measured by a real-time quantitative polymerase chain reaction. To verify the radioadaptive effect of LD, animals were preirradiated at 10 cGy from a ⁶⁰ Co source and then challenge dose at 200 cGy was delivered. Independent sample student's t-test was employed to compare cytokine gene expression in radioadaptive (10 + 200 cGy), LD (10 cGy), high-dose (HD, 200 cGy), and control groups of animals. Results: Following the HD, the cytokine gene expression of IFN-γ, IL-4, and TGF-β was significantly decreased compared to the control group (P = 0.0001). However, TGF-β expression was also decreased significantly in the LD and adaptive groups compared to the control group (P = 0.0001). IFN-γ/IL-4 ratio in the adaptive group was significantly decreased compared to the HD group (P = 0.0001). Conclusion: These results indicate that the immune system plays an important role for radioadaptive response induction by LD radiation to adjust the harmful effects of HD irradiation.

Objective: The objective of this study is to explore the radiosensitization effects of duramycin against the liver cancer hepatoma cells and relationship to reactive oxygen species (ROS) generation. Materials and Methods: MCA-RH 7777 cells were treated with various combinations of duramycin concentrations and radiation doses. After the treatment, cell viabilities were determined by a cell proliferation assay; intracellular ROS levels were detected with the flow cytometric method. Results: MCA-RH 7777 cell viability was found significantly reduced after combining duramycin and radiation exposure (comparing to that of either treatment alone). Increased intracellular ROS levels were observed in cells treated with combinations of duramycin and radiation. Conclusion: Duramycin increased the intracellular ROS generation and also increased the radiosensitivity of MCA-RH 7777 cells.

Purpose: Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications. Objective: To assess the health care activities in the “peak” of the pandemic during 3 months. Materials and Methods: we collected data from the electronic health record. Results: There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes. Conclusions: The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.

Background: The coronavirus disease 2019 (COVID 19) is a zoonotic viral infection that originated in Wuhan, China, in December 2019. It was declared a pandemic by the World Health Organization shortly thereafter. This pandemic is going to have a lasting impact on the functioning of pathology laboratories due to the frequent handling of potentially infectious samples by the laboratory personnel. To deal with this unprecedented situation, various national and international guidelines have been put forward outlining the precautions to be taken during sample processing from a potentially infectious patient. Purpose: Most of these guidelines are centered around laboratories that are a part of designated COVID 19 hospitals. However, proper protocols need to be in place in all laboratories, irrespective of whether they are a part of COVID 19 hospital or not as this would greatly reduce the risk of exposure of laboratory/hospital personnel. As part of a laboratory associated with a rural cancer hospital which is not a dedicated COVID 19 hospital, we aim to present our institute's experience in handling pathology specimens during the COVID 19 era. Conclusion: We hope this will address the concerns of small to medium sized laboratories and help them build an effective strategy required for protecting the laboratory personnel from risk of exposure and also ensure smooth and optimum functioning of the laboratory services.

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients. Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively. Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29–9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29–27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31–12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively). Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease.

Introduction: Complications in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) cause serious morbidity and mortality. Predicting patients at risk in advance and changing the symptomatic care and/or preparation regimen according to this risk assessment have been emphasized recently. Several single-nucleotide polymorphisms have been studied, and some were found to be responsible for early complications. Glutathione S-transferase P1 (GSTP1) is an enzyme involved in the detoxification process that reduces oxidative stress by reducing the number of free oxygen radicals. Aim: This study aimed to investigate the relationship between GSTP1 polymorphism and early complications of allo-HSCT, iron parameters, overall survival (OS), and transplantation-related mortality (TRM). Materials and Methods: A total of 50 patients diagnosed with acute myeloid leukemia (n = 23) or acute lymphoblastic leukemia (n = 27) who underwent allo-HSCT between May 2008 and February 2011 at Gazi University Faculty of Medicine, Stem Cell Transplantation Unit, were included. Results: Of the 50 patients, 24 (48%) were women and 26 (52%) were men. The median age of the patients was 26 (16–74) years. GSTP1 polymorphism was detected in 23 (46%) patients, and 27 (54%) had no polymorphism (wild type). The two groups were compared in terms of early toxicity after transplantation, according to the preparation regimen. The group with GSTP1 polymorphism was found to have a high transferrin saturation index (P < 0.05). Patients with no GSTP1 polymorphism showed a high grade III–IV anemia ratio (P < 0.05). The presence of sinusoidal obstruction syndrome and graft–versus–host disease was similar in both groups (P > 0.05). OS and TRM were higher in the GSTP1 polymorphism group, but no statistical difference was found between the two groups (P > 0.05). Conclusions: TSI was higher in the GSTP1 polymorphism group. GSTP1 polymorphism had no effect on early transplantation complications. Although the OS and TRM ratios were higher in the GSTP1 polymorphism group, no statistically significant difference was found between the groups. Further studies with larger sample size are needed.

Prostate cancer is a very common cause of morbidity and mortality in India. The commonest type of prostate carcinoma is adenocarcinoma, most of them are confined to prostate at the time of presentation. Bone is the preferred site for metastasis. The following is a case of neuroendocrine carcinoma of prostate arising in a 36 years old male who presented with ascitis and jaundice to the emergency department. The ascitic tap was positive for malignant cells. CECT done to detect primary showed osteoblastic secondaries in the spine along with lesions in the liver. DRE revealed grade 2 prostatomegaly. A TRUS guided biopsy showed neuroendocrine carcinoma of the prostate. Neuroendocrine carcinoma is a very rare type of prostatic carcinoma, with presentation of the same as ascitis is very uncommon. The following case is presented due to its rarity.

We report the case of a 22-year old female presenting with an embryonal rhabdomyosarcoma of the cervix that was successfully treated by surgery followed by adjuvant radiation therapy and chemotherapy. She subsequently developed radiation cystitis after 10 years of follow-up. She was successfully treated with cystoscopic fulguration. In this report, we discuss a review of management strategies for cervical rhabdomyosarcoma and also throw some light on incidence and management of radiation cystitis after pelvic radiotherapy. We discuss the dose independence of radiation cystitis, which can be seen after as low as 4500 cGy of pelvic radiation.

Renal cell carcinoma (RCC) is the most common primary renal neoplasm. About a half of our patients relapse after primary treatment. We present here a case of RCC with solitary metastasis to the pleura which occurred 32 years after nephrectomy. Our patient is an 86-year-old male who presented to us with a cough of 2 months and a history of having undergone a right nephrectomy 32 years back. Imaging of the chest showed left pleural effusion with a left pleural nodule. Computed tomography-guided fine-needle aspiration cytology from the pleural nodule was suggestive of malignancy with a clear cell morphology, suggestive of clear cell RCC. The patient was started on sunitinib 25 mg once daily. After the 1^st month, the patient's performance status improved markedly, with no cough and improved appetite. He had developed Grade II hand–foot syndrome, which was managed conservatively, and the dose was deescalated to 25 mg once daily – 5 days on and 2 days off. An X-ray of the chest taken 6 weeks after the start of therapy showed complete resolution of the pleural fluid and regression of the pleural nodule. The patient is alive and well 5 years into therapy. The case highlights the unusual propensity for very late metastasis in RCC. Metastasis after 30 years is extremely rare. Another highlight of the case is the good tolerability of the dose-modified schedule of sunitinib. Wise patient selection and dose modification can certainly add “life to the years” in our very elderly patients.

Transitional urothelial carcinoma frequently metastasizes to pelvic and retroperitoneal lymph nodes usually within 2 years of primary diagnosis but isolated metastasis to upper cervical lymph node after 5 years of primary diagnosis is extremely rare. We report here a case of a 53-year-old male who presented with Level II cervical node enlargement after 5 years of being diagnosed and treated for urothelial carcinoma. The diagnosis of cervical metastasis from urothelial carcinoma was suggested by fine-needle aspiration cytology and confirmed by immunocytochemistry.

Paratesticular rhabdomyosarcoma is a very rare mesenchymal tumor. It is an intrascrotal tumor that is localized in paratesticular structures such as the epididymis or spermatic cord. Rhabdomyosarcoma is most often observed in children and adolescents, presenting as a painless scrotal mass. An 18-year-old man presented with a painless left scrotal mass and lump abdomen that had evolved over four months. A histological examination of the lesion revealed rhabdomyosarcoma. Chemotherapy with alternative cycles of Vincristine, Adriamycin, Cyclophosphamide followed by Ifosphamide, Etoposide was given. Paratesticular rhabdomyosarcoma is a rare aggressive tumor manifesting in children and very young adults. Localized forms have a good prognosis whereas metastatic tumors show very poor results. A well-defined treatment based on surgery and chemotherapy yields good results.

Renal cell carcinoma (RCC) accounts for about 85% of all renal neoplasms, 60% of which are diagnosed incidentally. Most are unilateral, but bilateral tumors, synchronous or asynchronous, have been found in 2%–4% of reported sporadic cases. The occurrence of synchronous bilateral renal neoplasms with different histology in the same individual is very rare. We report one such case in a 45-year-old male patient, who was successfully managed by performing bilateral partial nephrectomy in two sittings. The histopathological examination revealed different histology on each side. Both preservations of renal parenchyma and tumor eradication should be considered in bilateral synchronous sporadic RCC before formulating a therapeutic regime. Management by nephron-sparing surgery approach performed in a staged manner offers adequate cancer-specific survival while ensuring good renal function.

Mucinous adenocarcinoma of the prostate is one of the rare variants of the prostatic carcinoma, and its incidence among all prostatic carcinomas is reported to be 0.3% in the literature. If the tumor variant containing extracellular mucin in <25% of the resected tumor mass, the histology is defined as adenocarcinoma with mucinous features. The mucinous adenocarcinoma of the prostate displays similar prognostic features with the classic adenocarcinoma. In this study, the treatment and surveillance processes of our three patients with prostatic adenocarcinoma with mucinous features were presented along with a literature review.

Penile cancer is a rarely diagnosed cancer that affects 0.4%–0.6% of all male population. Metastases to the bones from various human cancers are common; however, acrometastases are extremely rare with the most common primary tumor from lung, kidney, and breast. We report the first case of a patient with acrometastases to the left wrist reported from penile cancer.

Chromophobe renal cell carcinoma (RCC) with sarcomatoid differentiation is an infrequent entity. In the current era of advanced imaging techniques, RCCs are usually detected in early stages, and a localized giant tumor is rarely encountered. Recently, we encountered a patient with a localized giant RCC, which was 36 cm in the largest dimension and weighing 5.1 kg, which was resected entirely but presented relapse and succumbed within 3 months of surgery.

Kaposi sarcoma (KS) is a low-grade vascular neoplasm commonly involving mucocutaneous sites, while adrenal gland involvement is exceptional. The anaplastic variant is a rare entity characterized by marked cellular pleomorphism, increased mitosis, worse prognosis, and an increased metastatic potential. The diagnosis remains on histology and immunohistochemistry. We describe two cases of primary adrenal KS to report on this exceptional presentation of KS: the first case is a 67-year-old female with anaplastic KS wit fatal outcome. The second case is a 56-year-old male who presented a classic KS of the adrenal gland. Until now, no standard efficient treatment regimens have been clearly identified. There is a need for a further understanding of anaplastic KS's biology, and collecting a sizable patient cohort remains essential to review treatment outcome.

Intravesical instillation of Bacillus Calmette–Guérin (BCG) immunotherapy remains the most effective adjuvant treatment for noninvasive bladder cancer. Systemic BCG-related complications are rare and usually related to infective agent or an immune-mediated reaction. We discussed a case with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) vasculitis, developing after instillation of BCG for non-invasive bladder cancer. A 68-year-old man presented with nephritic syndrome a few months after BCG instillations which was performed for his non–muscle-invasive bladder cancer adjuvant therapy. The renal function had declined slowly after the first instillation and urinary sediment reveals the new onset of nephritic proteinuria and hematuria. High titer of p-ANCA was present. His renal biopsy was consistent with acute renal vasculitis. The patient's creatinine level regressed with immunosuppressive therapy and he was clinically followed up without hemodialysis. Here, we presented a patient that diagnosed as p-ANCA related vasculitis occurred after BCG instillation.