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   Table of Contents - Current issue
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July-September 2021
Volume 17 | Issue 4
Page Nos. 819-1140

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REVIEW ARTICLES  

Autoantibodies in the diagnosis, prognosis, and prediction of colorectal cancer p. 819
Roshan Niloofa, M Ishan De Zoysa, L Suranjith Seneviratne
DOI:10.4103/jcrt.JCRT_64_19  PMID:34528528
Colorectal cancer (CRC) is the second-most commonly diagnosed cancer worldwide. Early diagnosis improves prognosis and long-term outcomes. Several studies have found tumor-associated autoantibodies in CRC patients. We aimed to provide an overview on CRC-associated autoantibodies and their reported diagnostic, prognostic, and predictive performance when used singly or in combination. We systematically reviewed studies on CRC-related autoantibodies published till March 2018 and critically analyzed the role of these autoantibodies in CRC. In general, autoantibodies were of low sensitivity when tested individually and the diagnostic characteristics improved when tested in combination. Autoantibodies against CCD83, carcinoembryonic antigen, MAPKAPK3, RPH 3AL, SEC61b, and SPAG9 showed high sensitivity and specificity when tested alone. When tested in combination, autoantibodies against three antigens (PIM1, MAPKAPK3, and ACVR2B) showed high sensitivity and specificity. So far, most CRC-associated autoantibodies have been evaluated in single or in a small number of studies. In contrast, anti-p53 antibodies have been studied in a larger number of CRC studies, but, so far, none of them have high diagnostic characteristics. CRC-associated autoantibodies are detectable from the early stages of malignancy, pointing to their possible use in the early detection of CRC. Some studies suggest that CRC-associated autoantibodies may be a guide to prognosis in CRC.
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Cancer immunotherapy: Recent advances and challenges p. 834
Ruby Dhar, Ashikh Seethy, Sunil Singh, Karthikeyan Pethusamy, Tryambak Srivastava, Joyeeta Talukdar, Goura Kishor Rath, Subhradip Karmakar
DOI:10.4103/jcrt.JCRT_1241_20  PMID:34528529
Immunotherapy is a treatment that uses specific components of a person's immune system to fight diseases. This is usually done by stimulating or assisting one's immune system is attacking the offending agent – for instance, in the case of cancer – the target of immunotherapy will be cancer cells. Some types of immunotherapy are also called biologic therapy or biotherapy. One of the fundamental challenges that a living cell encounters are to accurately copy its genetic material to daughter cells during every single cell cycle. When this process goes haywire, genomic instability ensues, and genetic alterations ranging from nucleotide changes to chromosomal translocations and aneuploidy occur. Genomic instability arising out of DNA structural changes (indels, rearrangements, etc.,) can give rise to mutations predisposing to cancer. Cancer prevention refers to actions taken to mitigate the risk of getting cancer. The past decade has encountered an explosive rate of development of anticancer therapy ranging from standard chemotherapy to novel targeted small molecules that are nearly cancer specific, thereby reducing collateral damage. However, a new class of emerging therapy aims to train the body's defense system to fight against cancer. Termed as “cancer immunotherapy” is the new approach that has gained worldwide acceptance. It includes using antibodies that bind to and inhibit the function of proteins expressed by cancer cells or engineering and boosting the person's own T lymphocytes to target cancer. In this review, we summarized the recent advances and developments in cancer immunotherapy along with their shortcoming and challenges.
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Diagnostic reference levels for computed tomography examinations in pediatric population - A systematic review p. 845
Priyanka , Rajagopal Kadavigere, Suresh Sukumar, Saikiran Pendem
DOI:10.4103/jcrt.JCRT_945_20  PMID:34528530
Computed tomography (CT) has vital role in diagnosis of various pathologies using cross sectional images. Besides the advantages of CT in pediatric radiology, radiation dose has a significant adverse effect as children are more vulnerable than adults. Establishing Diagnostic Reference levels (DRLs) will determine unusual increase in radiation doses and therefore helps in optimizing the radiation dose by maintaining optimum diagnostic image quality. The objective of the review is to explore the literature on DRLs in pediatric CT examinations and techniques that have been used to establish them. Detailed search was done in PubMed-Medline, Scopus CINAHL, Web of Science, and the Cochrane Library databases to find studies that have established DRLs for pediatric CT examinations. The Preferred Reporting Items for Systematic Review and Meta-Analyses methodology was used to assess the relevant articles. The articles which assessed DRLs in pediatric CT examinations were included. A total of 501 articles were identified, of which 21 articles were included after a detailed screening process. Our review showed increased in pediatric patient dose surveys across the world and also increased in awareness for establishing DRLS among pediatric CT examinations. The review also demonstrated wide variation in DRLs and also deviation in the scanning techniques, protocols used and categorization methods used for establishing DRLs. As the pediatric population is more sensitive to radiation, the current review emphasizes the need for optimization of protocols and international standardization for establishing DRLs to facilitate a more feasible way of comparison of dose globally across CT sites.
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ORIGINAL ARTICLES Top

Comparison of fast-neutron contamination of different models of Siemens medical linacs with CR-39 film Highly accessed article p. 853
Nafiseh Aftabi, Mohammad Hadi Yazdi, Mahdi Ghorbani, Sara Abdollahi
DOI:10.4103/jcrt.JCRT_342_18  PMID:34528531
Background: Nowadays, radiotherapy has an important role in the treatment of cancer. The use of medical linacs in radiotherapy can have risks for patients. When radiotherapy is performed with photons with energies higher than 8 MeV, due to the photonuclear reaction of photons with various components in the head of the accelerator, the neutron is produced. This imposes an unwanted neutron dose to the patient. The purpose of this study is evaluation and comparison of fast-neutron contamination with increasing of field size and depth for Siemens Primus (15 MV), Siemens Primus Plus (18 MV), and Siemens Artiste (15 MV) linacs. Materials and Methods: Neutron dosimetry was carried out with CR-39 films, as a fast-neutron dosimeter, using chemical etching technique. Measurements were performed in depths of 0.5, 2, 3, and 4 cm and source-to-surface distance of 100 cm. Field sizes were 10 cm × 10 cm and 30 cm × 30 cm. Results: The results of measurements showed that, with increasing depth, equivalent dose is reduced. In addition, fast-neutron equivalent dose decreases with increasing the field size. Conclusion: Siemens Primus Plus had the highest neutron contamination in comparison with the two other linacs. Deeper tissues receive less fast-neutron doses. In radiation therapy with high-energy photon beams, neutron dose delivered to the patients should be taking into account.
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Validation of absolute point dosimetry by the analytical anisotropic algorithm and Acuros XB algorithm employing intensity-modulated radiotherapy technique on an in-house develop cost-effective heterogeneous thorax phantom p. 859
Priyusha Bagdare, Swati Dubey, Sanjay Ghosh
DOI:10.4103/jcrt.JCRT_1072_19  PMID:34528532
Introduction: Dose validation inside the human body needs a medium which can simulate the actual heterogeneities of a specific body site. The aim of the present work is to study the properties of a cost-effective heterogeneous thorax phantom (HTP) developed in-house by the author and its application for the evaluation of patient-specific absolute point dosimetry by employing analytic anisotropic algorithm (AAA) and Acuros XB (AXB) algorithm. Materials and Methods: HTP was made from the dust of porous pinewood, rib cage, and honeybee's wax. Density and central axis isodose depth distribution was measured on computed tomography images of actual patient and on HTP. Absolute point dose verification of 35 patients was done using AAA and AXB algorithm. The difference in the calculated dose by AAA and AXB was compared using the Wilcoxon signed-rank test. Results: Density distribution and central axis depth dose inside the HTP compare well with that of an actual patient. The mean percentage variation between the planned and the measured doses inside the HTP was found to be 4.85 (standard deviation [SD] = 3.38) and 1.3 (SD = 2.93), respectively, using AAA and AXB algorithm. The difference in the measured dose and the planned dose was found to be significant for AAA with the significance level of 0.01 (p-value < 0.00001), whereas it was found to be insignificant (p-value < 0.00001) for AXB. Conclusion: The results of this study showed that the HTP is resembled with the human thorax in terms of its heterogeneities and radiological properties and can be used for pretreatment plan verification.
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Combined effect of oral famotidine and cimetidine on the survival of lethally irradiated mice: An in vivo study p. 865
Karim Afsar dizaj, Ali Shabestani Monfared, Hossein Mozdarani, Ali Naeiji, Abolfazl Razzaghdoust, Karimollah Hajian-tilaki, Bahareh Aboufazeli, Fatemeh Niksirat, Sajad Borzoueisileh
DOI:10.4103/jcrt.JCRT_349_19  PMID:34528533
Aims: The study aims at evaluating the effects of the combinatory famotidine/cimetidine diet on radiated mice's survival. Materials and Methods: Two hundred and seventy male mice were categorized into 11 groups, a number of which were comprised of subgroups too. The groups under analysis were posed to varying doses of gamma-radiation, including 6, 7, 8, and 9 Gy, followed by treatments using various drug doses 2, 4, and 8 mg/kg, with survival fractions as long as a month after irradiation being measured and recorded. Results: LD50/30 was calculated as 7.47 Gy for the group with radiation only. Following mouse treatment with a concentration of 4 and 20 mg/kg for famotidine and cimetidine, respectively, the survival fraction for the mice grew significantly compared to LD50/30. The combinatory famotidine/cimetidine diet had a higher dose-reduction factor (DRF) than single doses of the drug in radioprotection. The DRF for combinatory famotidine/cimetidine, famotidine, and cimetidine diets was 08.09, 1.1, and 1.01, respectively. Conclusions: Results imply that the combined regimen of famotidine + cimetidine in radioprotection had no significant higher DRF than with regimens including each of them separately. In addition, we did not find a synergic effect of combined oral famotidine and cimetidine on irradiated mice.
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Output factor measurements with multiple detectors in CyberKnife® Robotic Radiosurgery System p. 870
Muthukumaran Manavalan, Manigandan Durai, Ganesh Narayanasamy, Sotirios Stathakis, Henry Finlay Godson, Vikraman Subramani
DOI:10.4103/jcrt.JCRT_962_20  PMID:34528534
Aim: The aim of this study was to measure and compare the output factor (OF) of a CyberKnife Robotic Radiosurgery System with eight different small field detectors and validate with Technical Report Series (TRS) report 483. Background: Accurate dosimetry of CyberKnife system is limited due to the challenges in small field dosimetry. OF is a vital dosimetric parameter used in the photon beam modeling and any error would affect the dose calculation accuracy. Materials and Methods: In this study, the OF was measured with eight different small-field detectors for the 12 IRIS collimators at 800 mm SAD setup at 15 mm depth. The detectors used were PTW 31016 PinPoint 3D, IBA PFD shielded diode, IBA EFD unshielded diode, IBA SFD unshielded diode (stereotactic), PTW 60008 shielded diode, PTW 60012 unshielded diode, PTW 60018 unshielded diode (stereotactic), and PTW 60019 CVD diamond detector. OF was obtained after correcting for field output correction factors from IAEA TRS No. 483. Results: The field OFs in CyberKnife are derived from the measured data by applying the correction factors from Table 23 in TRS 483 for the eight small field detectors. These field OFs matched within 2% of peer-reviewed published values. The range and standard deviation showed a decreasing trend with collimator diameter. Conclusion: The field OF obtained after applying the appropriate correction factor from TRS 483 matched well with the peer-reviewed published OFs. The inter-detector variation showed a decreasing trend with increasing collimator field size. This study gives physicists confidence in measuring field OFs while using small field detectors mentioned in this work.
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Relative effect of Malayer Shahani and Asgari grapes seed extract on inducing apoptosis in human leukemia cells p. 875
Maryam Rahimi, Narges Pakravan, Arash Babaei, Mitra Mohammadi, Elham Atafar
DOI:10.4103/jcrt.JCRT_766_19  PMID:34528535
Background: Previous studies have suggested that consuming fruit and vegetable can lower the risk of several cancers, including breast, colorectal, and lung cancers. Aims: The present study aims to investigate the in vitro anticancer effects of Shahani and Asgari grape seed extract (GSE) grown in Malayer City of Iran on HL-60 cancer. However, to the best of the author's knowledge, it is the first time in this study that the antiproliferative effect of Shahani and Asgari GSE is compared. Materials and Methods: Shahani and Asgari GSE Was extraction white method of Liquid/liquid extraction with ethyl acetate. Then assessing cytotoxic activities of Shahani and Asgari GSE on the HL-60 cells was tested using MTT assay. Results: The results show that compared with the control group, seed extract of both Shahani and Asgari at the various concentrations (25, 50, 100, and 200 μg/ml) had a significantly inhibitory effect on HL-60 cell proliferation that was dose dependent. However, Shahani GSE at different concentrations (50, 100, and 200 μg/ml) indicated a significantly higher inhibitory effect compared to Asgari GSE. In addition, GSE can induce cell cycle arrest at G0/G1 cells. Furthermore, GSE of Asgari and Shahani remarkably increased the induction of HL-60 cell apoptosis depending on its dose. However, at the concentration of 200 μg/ml, GSE induced cell necrosis rather than apoptosis. Conclusion: Seed extract of both Shahani and Asgari at the various concentrations had a significantly inhibitory effect on HL-60 cell proliferation that was dose dependent.
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Anticancer, anti-proliferative activity of Avicennia marina plant extracts p. 879
Tahani H Albinhassan, Kamel A Saleh, Zouhaier Barhoumi, Mohammed Ali Alshehri, Adel M Al-Ghazzawi1
DOI:10.4103/jcrt.JCRT_659_19  PMID:34528536
Purpose: Medical halophytes plants are potent sources of bioactive secondary metabolite components used against different diseases. Avicenniamarina one of the typical halophytes plant species used in folk medicine to treat smallpox, rheumatism, and ulcer. Despite the richness of A.marina with polyphenolic, flavonoids, terpenoid, and terpene, contents remain poorly investigated against cancer types. Consequently, to explore the function-composition relationship of A.marina hexane leaves crude extract, the current study designed to investigate the cytotoxicity, apoptotic and antiproliferative impacts on the colon (HCT-116), liver (HepG2), and breast (MCF-7) cancer cell lines. Materials and Methods: Therefore, the cytotoxicity impact screening carried out by Sulforhodamine-B assay. While, the initiation of the apoptosis evaluated by chromatin condensing, early apoptosis, late apoptosis and the formation and appearance of apoptotic bodies. On the other hand, the flow cytometry used to identify the phase of inhibition where the determined IC50 value used. While, the chemical composition of the hexane extract was detected using liquid chromatography-mass spectrometry/mass spectrometry. Results: Revealed that hexane extract showed a weak induction of apoptosis despite the formation of apoptotic bodies and the high cell inhibitory effect on all tested cell lines with IC50 values (23.7 ± 0.7, 44.9 ± 0.93, 79.55 ± 0.57) μg/ml on HCT-116, HepG2, and MCF-7, respectively. Furthermore, it showed the ability to inhibit cell cycle in G0/G1 for HCT-116, S phase for HepG2, and MCF-7. Conclusion: In the light of these results, the current study suggests that A.marina leaves hexane extract may be considered as a candidate for further anticancer drug development investigations.
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Expression of CD10 in urothelial carcinoma of the bladder and its correlation with histopathological grade, pathological stage, and survival of patients p. 887
Sushil Kumar Shukla, Smita Chandra, Neena Chauhan, Rajeev Sarpal
DOI:10.4103/jcrt.JCRT_619_18  PMID:34528537
Background: CD10 plays a role in signal transduction pathway and regulation of cell growth apoptosis, and therefore, it has been evaluated in different malignancies. The present study was conducted to study the immunoexpression of CD10 in urothelial carcinoma and to correlate it with histological grade, pathological stage, and survival of patients. Materials and Methods: The study included 51 cases of urothelial carcinoma diagnosed on histopathology along with 50 controls having nonneoplastic urothelium. All the cases and controls were subjected to CD10 immunostaining. The CD10 expression was compared between the cases and controls and was also correlated with histological grade, pathological stage, histomorphological features, and 1-year survival. Results: The study included 78.4% of high-grade urothelial carcinoma (HGUC) and 21.6% of low-grade urothelial carcinoma. The positive score of CD10 expression was observed in 68.6% of cases, while 96% of controls observed negative immunostaining. About 90.9% of low-grade carcinoma observed score 0, while 83.7% of high grade observed positive score of 1 and 2. Although there was statistical significant difference between CD 10 score and stage of tumor, its expression did not correlate with 1-year survival of cases. Conclusion: CD10 expression increases with the grade of tumor and thus may be helpful in differentiating low grade from HGUC. Its expression also increases with stage and poor prognostic factors suggesting its possible role in pathogenesis and progression of urothelial carcinoma. CD 10 may be further analyzed for molecular targeted therapy against urothelial carcinoma.
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Dosimetric analysis of three-dimensional conformal radiotherapy, intensity-modulated radiotherapy-step and shoot, helical tomotherapy, and volumetric modulated arc therapy in prostate cancer radiotherapy p. 893
Fenny Gozal, Soehartati Argadikoesoema Gondhowiardjo, Henry Kodrat, Wahyu Edy Wibowo
DOI:10.4103/jcrt.JCRT_57_19  PMID:34528538
Introduction: There is limited study comparing dosimetry parameters in detail. In regard to prostate cancer, there are four different techniques, namely three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy-step and shoot (IMRT-SS), IMRT-helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT). Materials and Methods: Experimental study with intervention on ten prostate cancer patients' computed tomography planning data. 78 Gy dose in 39 fractions was given for planning target volume.Experimental study with intervention on ten prostate cancer patients' computed tomography planning data. 78 Gy dose in 39 fractions was given for planning target volume. Results: The mean V75 Gy rectum and bladder between 3D-CRT and the other three abovementioned techniques all showed significant results (P < 0.05). V5 Gy remaining volume at risk (RVR) between 3D-CRT versus VMAT and HT, IMRT-SS versus HT, and VMAT versus HT is statistically significant (P < 0.0001). The longest radiation time was done with HT (mean 4.70 ± 0.84 min). Conclusion: V75 Gy rectum bladder between 3D-CRT techniques differ significantly compared to the three other techniques and may not be suitable to the implementation of escalation doses. The HT technique produced the highest V5 Gy RVR and needed the highest monitor unit amount and the longest radiation duration. The VMAT technique was considered capable of realizing dose escalation in prostate cancer radiotherapy by minimizing toxicity in the rectum and bladder with the shortest radiation duration.
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Differentiating renal pelvic cancer from renal cell carcinoma with 18-fluorodeoxyglucose positron emission tomography-computed tomography p. 901
Murat Dursun, Emin Ozbek, Alper Otunctemur, Huseyin Besiroglu
DOI:10.4103/jcrt.JCRT_217_16  PMID:34528539
Background: The differential diagnosis of pelvis renalis cancer (PRC) from renal cell cancer (RCC) is difficult. Because of that, in this study, we compared the standardized uptake value (SUV) with positron emission tomography-computed tomography (PET-CT) of the RCC and PRC. Methods: Twenty-one patients (12 males, 9 females; age range: 33–74 years; mean age ± standard deviation [SD]: 57.14 ± 17.6) with suspected primary renal cell cancer as Group 1 and 8 patients (6 male, 2 female; age range, 61–81; mean age ± SD, 71.5 ± 5.65) with suspected renal pelvis cancer as Group 2 detected by conventional imaging techniques (CT, magnetic resonance [MR] imaging, ultrasound, intravenous urogram, CT urography, MR urography) underwent fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT imaging between August 2010 and October 2012. Results: Mean age is 57.14 (33–74) years in Group 1 and 71.5 (61–81) years in Group 2, respectively. The mean maximum SUV (SUVmax) value was 4.6 ± 2.1 in RCC group and 16.6 ± 6.9 in PRC group. At the 18-FDG PET/CT scanning, SUVmax value higher in patients with PRC than in the patients with RCC. It was statistically different (P < 0.001). Conclusion: We suggested that PET/CT can be used for the differential diagnosis of renal pelvis tumor and RCC. However, further studies with larger patient number are needed to confirm our suggestion. To clarify the mechanisms of underlying these differences, molecular advanced molecular studies are needed.
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Incidence of melanoma and nonmelanoma skin cancers in Indian and the global regions Highly accessed article p. 906
Satyanarayana Labani, Smita Asthana, Kushal Rathore, Kabir Sardana
DOI:10.4103/jcrt.JCRT_785_19  PMID:34528540
Background: Incidence of common types of skin cancers in India is not reported and its comparison with global load would be helpful statistics. Aim: The aim of this study is to summarize and report recent skin cancer incidence in India and to compare it with the incidence globally. Materials and Methods: Age-specific rates and age-adjusted rates (AARs) of the incidence of skin cancer for all ages (0–75 years) were collected from India and the world, respectively, from the National Cancer Registry Programme and GLOBOCAN 2018. Results: The AAR per 100,000 of melanoma of the skin was highest in the North region of India for both males and females with 1.62 and with 1.21, respectively. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the East region with 6.2 and for females in Northeast with 3.49. Among nonmelanoma, northeast region showed the maximum incidence for both male (75.6) and female (43.6) sexes. Globally, AAR of melanoma of skin for males was highest in the Western Pacific region with 36.9 and for the females; AAR was highest in the European region with 31.7. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the Western pacific region with 225.4 and 68.6 for females. Conclusion: Summary of the incidence rates of melanoma and nonmelanoma skin cancers which shows that though there are regional variations of incidence in India is lower than that of in the West.
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Clinical and histopathological profile of dysembryoplastic neuroepithelial tumor: An experience from a tertiary care center p. 912
Pooja Gupta, Fouzia Siraj, Akanksha Malik, KB Shankar
DOI:10.4103/jcrt.JCRT_632_19  PMID:34528541
Introduction: Dysembryoplastic neuroepithelial tumor (DNT) is a rare benign brain tumor predominantly involving children and young adults. Histologically, it corresponds to WHO Grade I tumors; however, it may masquerade aggressive neural tumors such as oligodendroglioma, oligoastrocytoma, pilocytic astrocytoma, and ganglioglioma. The literature on clinical, radiological, and pathological spectrum of DNT is described mostly in the form of case reports, with only a few case series reported till date. Methods: A retrospective review of files with diagnosis of DNT (2016 to 2018) was made in the Department of Pathology, National Institute of Pathology, New Delhi. A total of ten cases were retrieved, and their clinical, radiological, and histopathological features were reviewed and studied. Special stains and immunohistochemistry were done, wherever required. Results: The mean age was 14.8 (±7.9) years, with a male-to-female ratio of 1.5:1. The most common mode of presentation was recurrent, intractable seizures. The most common site of lesion was parietal lobe followed by temporal and frontal lobes of the brain. On histology, mucoid matrix admixed with floating neurons and oligodendrocyte-like cells was a consistent feature; however, the presence of specific glioneuronal elements was observed in only a few cases. Conclusions: DNT is a benign, low-grade, nonrecurrent neuroepithelial neoplasm. It is important to differentiate this rare entity from other mimickers, as it is surgically curable and carries an excellent prognosis without the need for adjuvant chemotherapy and radiotherapy. The study helps to enrich the clinicopathological aspects of this rare but important entity.
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Magnetic resonance imaging for the study of mediastinal adenopathies in lung cancer: Comparison with standard tests p. 917
Tara Pereiro-Brea, Anxo Martínez de Alegría, Luis Valdés, Antonio Golpe-Gómez, José Martín Carreira-Villamor, Alberto Ruano-Raviña
DOI:10.4103/jcrt.JCRT_1626_20  PMID:34528542
Background: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. Purpose: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. Materials and Methods: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. Results: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). Conclusions: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.
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Prognostic impact of the 18F-fluorodeoxyglucose positron-emission tomography/computed tomography metabolic parameters and correlation with hematological inflammatory markers in lung cancer p. 925
Sibel Goksel, Arzu Cengiz, Hakan Ozturk, Yakup Yurekli
DOI:10.4103/jcrt.JCRT_1046_20  PMID:34528543
Introduction: Hematological inflammatory markers and metabolic parameters in positron-emission tomography/computed tomography (PET/CT) are important indicators predicting the prognosis of the disease in lung cancer as in many cancers. This study aimed to evaluate the correlation between pretreatment hematological inflammatory markers and PET/CT metabolic parameters in nonsmall cell lung cancer (NSCLC) patients and to predict the prognostic value of these parameters. Materials and Methods: A total of 132 patients with diagnosed NSCLC who underwent PET/CT at staging were retrospectively evaluated. Hematological parameters were obtained from the hemogram taken no more than 2 weeks prior to PET/CT. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were recorded. Maximum standard uptake value, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Clinical stage, tumor pathology, and overall survival were analyzed with these parameters. Results: NLR and PLR were significantly positively correlated with MTV and TLG (all P < 0.001), MPV was negatively correlated with TLG (P = 0.021). While TLG, MTV, NLR, and PLR were increased in advanced stage disease, MPV was decreased. Univariate Cox-regression analysis demonstrated that greater age (P = 0.015), advanced stage (P < 0.001), low MPV (P = 0.017), high NLR (P < 0.001), PLR (P < 0.001), MTV (P = 0.004), TLG (P = 0.001) values, multivariate Cox-regression analysis revealed that NLR (P < 0.001) and advanced stage (P < 0.001) were significant predictors of poor prognosis in patients with NSCLC. Conclusions: There were significant associations between hematological inflammatory markers and PET/CT metabolic parameters in the patients with NSCLC at the time of diagnosis. These indicators can contribute to predicting prognosis in patients with NSCLC.
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TP53 lacks tetramerization and N-terminal domains due to novel inactivating mutations detected in leukemia patients p. 931
Yasir Hameed, Samina Ejaz
DOI:10.4103/jcrt.JCRT_536_19  PMID:34528544
Background: TP53 is a highly conserved tumor suppressor gene present on chromosome 17 and comprised 11 exons and 12 introns. The TP53 protein maintained the genomic integrity of the cell by regulating different pathways. The association of TP53 with leukemia and the increasing prevalence of leukemia in Pakistan instigated us to initiate the current study. Materials and Methods: The TP53 gene of acute myeloid leukemia patients (n = 23) and normal individuals (n = 30) was amplified through polymerase chain reaction (PCR). The PCR amplified products of 3 samples 1 normal (NC-30) and 2 cancerous (LK-6 and LK-19) were subjected to deoxyribonucleic acid (DNA) sequence analysis. Bioinformatics analysis of the obtained DNA sequences helped to identify nature, type, and functional impact of mutations, if any. Results: Results revealed 2 novel mutations in Case No. 1 (c. G >A10987 and c. InsA13298_13299) and Case No. 2 (c. InsC13284_13285, c. T >A13365) which generate a premature codon (ocher) at position 239 and lead to truncated TP53 protein. In Case No. 3, 16 novel mutations were identified and c. delC11093 mutation created a premature codon (opal) at 59th position. Hence, the resultant protein will lack its tetramerization and N-terminal domain required for its normal functioning. Moreover, some intronic mutations were noticed and found to have a negative impact on splicing related regulatory sequences. Conclusion: Results suggest the role of TP53 inactivating mutations in pathogenesis of leukemia.
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Pattern of extranodal involvement and its impact on survival in diffuse large B-cell lymphoma from a tertiary cancer center in rural India p. 938
Chandran K Nair, Anju R Kurup, A Manuprasad, Praveen Kumar Shenoy, Vineetha Raghavan
DOI:10.4103/jcrt.JCRT_428_19  PMID:34528545
Introduction: Extranodal (EN) involvement in diffuse large B-cell lymphoma (DLBCL) carries poor prognosis. Both the number and the specific sites of EN involvement are important in predicting prognosis. Given that the epidemiologic pattern of DLBCL in India is different from the rest of the world and such data correlations are scarce from developing countries, we aimed to find out if specific site and number of EN involvement could predict survival in DLBCL. Methods: Patients with DLBCL treated with combination chemotherapy plus rituximab were included. Site and number of EN involvement were noted. Univariate analysis for survival was performed for EN involvement or not, specific site of involvement, and number of EN involvement (0/1 vs. ≥2). Results: Among a total of 177 patients, 92 (52%) patients had EN disease. When patients with 2 or more EN sites were compared against patients with 0 or 1 site, there was significant reduction in both progression-free survival (PFS) and overall survival (OS) (3-year OS of 55% vs. 79%, P = 0.001, 3-year PFS of 42% vs. 65%, P = 0.001). When specific EN sites were studied for correlation with survival, involvement of skin/soft tissue, and serosa were associated with significant reduction in 3-year OS (33% vs. 74%, P = 0.011, and 63% vs. 75%, P = 0.03, respectively) and 3-year PFS (25% vs. 62%, P < 0.001, and 46% vs. 62%, P = 0.01, respectively). Conclusion: Two or more EN sites in DLBCL predicted inferior survival. Serosal and skin/soft tissue involvement also predicted poor survival.
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Camptothecin enhances 131I-rituximab-induced G1-arrest and apoptosis in Burkitt lymphoma cells p. 943
Chandan Kumar, Rohit Sharma, Krishna Mohan Repaka, Aanchal Udaynath Pareri, Ashutosh Dash
DOI:10.4103/jcrt.JCRT_1012_19  PMID:34528546
Background: Rituximab is a chimeric monoclonal antibody against CD20. It is an established immunotherapeutic agent for non-Hodgkin's lymphoma. Even though rituximab has been used in clinics for decades, only 50% of the patients respond to rituximab therapy. To enhance the in vitro effect of rituximab, it was labeled with Iodine-131 (131I) and combined effect of 131I-rituximab and camptothecin (CPT) was studied on a tumor cell line expressing CD20. Objective: The aim is to study the magnitude of cell killing and the underlying mechanism responsible for enhancing in vitro therapeutic efficacy. Materials and Methods: Rituximab was labeled with 131I by the iodogen method. Raji cells were pretreated with CPT (250 nM) for an hour followed by 131I-rituximab (0.37 and 3.7 MBq) and incubated for 24 h in a humidified atmosphere of CO2 incubator at 37°C. Subsequently, Raji cells were harvested and thoroughly washed to carry out studies of cellular toxicity, apoptosis, cell cycle, and mitogen-activated protein kinase (MAPK) pathways. Results: Maximal inhibition of cell proliferation and enhancement of apoptotic cell death was observed in the cells treated with the combination of CPT and 131I-rituximab, compared to controls of CPT-treated and 131I-rituximab-treated cells. Raji cells undergo G1 arrest after 131I-rituximab treatment, which leads to apoptosis and was confirmed by the downregulation of bclxl protein. Expression of p38 was decreased while an increase in phosphorylation of p38 was observed in the combination treatment of CPT and 131I-rituximab. Conclusions: It was concluded from the findings that CPT enhanced 131I-rituximab-induced apoptosis, G1 cell cycle arrest and p38 MAPK phosphorylation in Raji cells.
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Evaluation of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus seroprevalence in patients with diffuse large B cell lymphoma and Hodgkin's lymphoma p. 951
Duygu Mert, Alparslan Merdin, Sabahat Ceken, Mehmet Sinan Dal, Mustafa Ertek, Fevzi Altuntas
DOI:10.4103/jcrt.JCRT_465_19  PMID:34528547
Backgrounds: Non-Hodgkin's lymphoma and Hodgkin's lymphomas (HL) are lymphoid neoplasms. Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are viruses that could proliferate in lymphoid tissues. These viruses may cause lymphoproliferative diseases. The aim of this study was to evaluate the seroprevalence of HBV, HCV, and HIV in patients with diffuse large B-cell lymphoma (DLBCL) and HL, to compare the relationship between these two disease groups and to determine the relationship between the three viruses and their characteristics. Materials and Methods: The study was a retrospective study. Patients who were followed up in hematology and hepatitis outpatient units between January 01, 2012, and May 01, 2019, were included in the study. Results: A statistically significant relationship was observed between the disease groups in terms of hepatitis B surface antigen (HBsAg), hepatitis B core (HBc) IgG antibody, hepatitis B e antigen (HBeAg), and anti-HBe seropositivities (P = 0.004, P = 0.006, P = 0.041, and P = 0.014, respectively). There was also a statistically significant relationship between the disease groups in terms of anti-HCV seropositivity (P = 0.029). HBsAg, anti-HBc IgG, HBeAg, anti-Hbe, and HCV seropositivity rates were higher in patients with DLBCL than in patients with HL. Conclusion: These findings suggest that there may be a relationship between hepatitis viruses and DLBCL. Evaluation of HBV and HCV infections in these patients before starting treatment is thought to be beneficial in initiating antiviral prophylaxis to prevent reactivation in seropositive cases. In addition, care should be taken for the development of lymphoma in the follow-up of HCV and HBV infections.
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Self-esteem, metacognition, and coping strategies in cancer patients: A case–control study p. 956
Habibe Inci, Fatih Inci, Süleyman Ersoy, Fatih Karatas, Didem Adahan
DOI:10.4103/jcrt.JCRT_618_19  PMID:34528548
Background: Self-esteem refers to a person's positive and negative attitudes towards the self, and metacognition is an upper system providing awareness and direction of events and mental functions. Coping refers to the specific and psychological efforts used to deal with stressful events or the negative effects of the agents of these. The aim of this study was to evaluate self-esteem, metacognition status and coping attitudes in patients with cancer, which is known to have severely destructive psychological effects. Materials and Methods: Fifty adult cancer patients who were followed up in the medical oncology clinic between July 2018 and June 2019 and 50 age- and gender-matched healthy controls as control group were included in this study. All the participants were applied with a sociodemographic data form, the Rosenberg self-esteem scale, the Metacognition Assessment Scale, and the Copying Orientation to Problems Experienced (COPE) inventory, and their results were compared between the groups. Results: The groups comprised 50% females with a median age of 58 (33–82) years. The values related to the degree of participation in discussions, problem-focused coping, active coping, planning, and state of emotional vulnerability were low in the cancer patient group compared to the control group (P < 0.005 for all). The sustaining of their self-image, feeling threatened in interpersonal relationships, and degree of daydreaming were higher, and in the metacognition tests, the positive beliefs related to anxiety, uncontrolled or dangerous negative thoughts, nonfunctional coping, religious coping, joking, reckless behavior, substance use, denial, and mental disengagement scores were higher (P < 0.05 for all). Conclusion: Self-esteem was lower in cancer patients and upper level cognitive functions and problem-focused coping were determined to be worse compared to healthy controls. In the light of these results, psychosocial support given to cancer patients in this respect could contribute to quality of life and social conformity.
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Epidemiology and trends of gastrointestinal cancer in Iran (2004–2008) p. 963
Fatemeh Sadat Asgarian, Mehrdad Mahdian, Neda Amori
DOI:10.4103/jcrt.JCRT_509_19  PMID:34528549
Aim: Gastrointestinal (GI) cancer is among the most common cancers in Iran. The main purpose of this study was to evaluate changes in the time trends of stomach, colon and rectum, and esophageal cancer during the past decade in Iran. Materials and Methods: In this cross-sectional study, the study population was all cases of GI cancers diagnosed in Iran between 2004 and 2008. Cancer incidence data for the years 2004–2008 were obtained from the cancer registry system of the Ministry of Health. All incidence rates were directly age standardized to the world standard population. Age-Satndardized incidence rate (ASR)per 105 persons was calculated using direct standardization and the world standard population. The crude rate was calculated in this study. Data were analyzed using SPSS (version 17) and Microsoft Office Excel 2007. Results: During the 2004–2008 period, the ASR and crude rates of GI cancers, including esophagus, stomach, colon and rectum, among males were 5.05, 15.02, and 8.29 and 4.01, 11.81, and 6.4, respectively, and among females were 6.52, 7.055, and 7.75 and 4.40, 4.85, and 5.49, respectively. The most common cancers in women were colon and rectum, and stomach cancer had the highest incidence in males. In this study, most cases of stomach cancer were adenocarcinoma adenocarcinoma (Nos) in both women and men. The most common type of colorectal cancer was adenocarcinoma, which was greater in men than women. The most common type of esophageal cancer was squamous cell carcinoma in both sexes. The north and northwestern regions of Iran have the highest risk of GI cancer. Conclusion: According to this study, a significant increase was observed in the incidence of cancers in the north and western regions of Iran. Hence, screening and early detection programs are highly recommended in these high-risk areas.
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Xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma – Analysis of 8 cases p. 969
Sabina Khan, Inara Abeer, Musharraf Husain, Mohd Jaseem Hassan, Sujata Jetley
DOI:10.4103/jcrt.JCRT_1180_19  PMID:34528550
Background/Aim: Xanthogranulomatous cholecystitis (XGC) is a rare destructive inflammatory disease of the gallbladder. It is frequently misdiagnosed as gallbladder carcinoma (GBC) as it mimics latter with regard to clinical manifestations, imaging and intraoperative findings, often leading to extended surgical resection in these patients. The aim of this study was to evaluate the diagnostic dilemma of XGC cases clinico-radiologically diagnosed with GBC. Materials and Methods: From January 2017 to June 2019, a total of eight cases histopathologically diagnosed as XGC, were misdiagnosed with GBC based on preoperative and intra-operative findings. The clinical characteristics, imaging, intra-operative findings, and surgical data of these patients were collected and analyzed. Results: A total of 2154 cholecystectomy specimens were received in the histopathology section during the study period. Sixty-nine cases (3.2%) were histologically diagnosed as XGC, of which 8 cases (11.6%) were preoperatively diagnosed with GBC. These cases were predominantly seen in males in the age range of 24–62 years. The most common clinical presentation was chronic cholecystitis. Gallstones were present in all the 8 cases. Six cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging. Intraoperatively, adhesions to adjacent organs were observed in seven cases. All these eight cases misdiagnosed with GBC underwent aggressive surgical treatment following which histopathology ultimately revealed XGC. Conclusion: Neither clinical manifestations nor laboratory tests/radiological methods can provide an effective means of differentiating between XGC and GBC. Preoperative diagnosis is difficult, and histopathology remains the gold standard to differentiate the two entities.
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Intensity modulated radiotherapy in anal canal squamous cell carcinoma: Implementation and outcomes p. 975
Avipsa Das, Moses Arunsingh, Tapesh Bhattacharyya, S Sriram Prasath, Arun Balakrishnan, Indranil Mallick
DOI:10.4103/jcrt.JCRT_212_19  PMID:34528551
Objective: Concurrent chemoradiotherapy (CCRT) is the standard curative treatment option for nonmetastatic anal squamous cell carcinoma (SCC). Intensity modulated radiotherapy (IMRT) can reduce doses delivered to bowel and skin and reduce toxicities associated with conventional fields. Here, we present our institutional data on dosimetry, toxicity, and clinical outcomes with IMRT for anal cancer. Materials and Methods: We analyzed 23 patients of anal SCC treated with curative-intent CCRT/radiation therapy alone, utilizing IMRT, between August 2011 and December 2016. The standard prescription dose was 54 Gy/27Fr/5.5 weeks, delivered in two phases, and concurrent chemotherapy with 5-fluorouracil and mitomycin-C. Acute and late toxicities and dosimetric data were compiled and analyzed. Results: The median age was 65 years. Fourteen (60.7%) patients had Stage IIIC disease. Eighteen patients received concurrent chemotherapy. No patient had any treatment breaks. Grade 3 acute perianal dermatitis was recorded in 11 (47.8%) patients. Proctitis, diarrhea, and cystitis were limited to Grade 1 in 73.9%, 47.8%, and 8.6% patients, respectively. The only late Grade 2+ toxicities were gastrointestinal toxicities in 4 (17.4%) patients. Twenty (87%) patients had complete response at 6 months. The 3-year local control, nodal control, and distant metastases-free survival were 85.9%, 86.6%, 84.7%, respectively, with 3-year disease-free survival and overall survival of 63.4% and 81%, respectively. Conclusion: In this report on IMRT in anal cancer from India, treatment was well tolerated with lower acute toxicity than reported in other prospective studies. Long-term results are at par with other published studies.
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Comparison of hazard models with and without consideration of competing risks to assess the effect of neoadjuvant chemotherapy on locoregional recurrence among breast cancer patients p. 982
Mona Pathak, Surya Narayana V S. Deo, Sada Nand Dwivedi, Sreenivas Vishnubhatla, Bhaskar Thakur
DOI:10.4103/jcrt.JCRT_49_19  PMID:34528552
Context: While analyzing locoregional recurrences (LRRs), it is necessary to consider distant metastasis as a competing event. Because, later one is more fatal than LRR. It may change ongoing treatment of breast cancer and may alter the chance of LRR. Although some earlier studies assessed the effect of neoadjuvant chemotherapy (NACT) on LRR, they did not use competing risk regression model for it. Aims: To identify the risk factors and predict LRR using competing risk hazard model and to compare them with those using conventional hazard model. Settings and Design: This was a retrospective study from a tertiary care cancer hospital in India. Subjects and Methods: Data of 2114 breast cancer patients undergoing surgery were used from patient's record files (1993–2014). Statistical Analysis: Fine and Gray competing risk regression was used to model time from surgery to LRR, considering distant metastasis and death as the competing events. Further, cause-specific Cox regression was used to model time from surgery to LRR without considering competing risk. Results: Greater than ten positive nodes (hazard ratio [HR] [95% confidence interval (CI)]: 2.19 [1.18–4.03]), skin involvement (HR [95% CI]: 2.75 [1.50–5.05]), NACT (HR [95% CI]: 1.90 [1.06–3.40]), invasive tumor in inner quadrant (HR [95% CI]: 1.78 [0.98–3.24]), and postoperative radiotherapy (HR [95% CI]: 0.52 [0.29–0.94]) were found to be significantly associated with LRR. However, conventional survival analysis ignoring competing risk overestimated cumulative incidence function and underestimated survival. Competing risk regression provided relatively more precise CI. Conclusions: Competing risks, if any, need to be incorporated in the survival analysis. NACT was found to be associated with higher risk for LRR, which may be because of administering it mainly to patients with bad prognosis. Conclusions: Competing risks, if any, need to be incorporated in the survival analysis. NACT was found to be associated with higher risk for LRR, which may be because of administering it mainly to patients with bad prognosis.
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Comparison of the effects of rutaecarpine on molecular subtypes of breast cancer p. 988
Erdem Cokluk, Zeynep Ozman, Gamze Guney Eskiler, Asuman Deveci Ozkan, Mehmet Ramazan Sekeroglu
DOI:10.4103/jcrt.JCRT_1182_20  PMID:34528553
Objective: Natural compounds have gained considerable attention in recent years due to disadvantages and properties of current chemotherapy drugs in cancer therapy. In addition, the impact of these compounds is specific for each type and/or subtypes of cancer due to different treatment response. Rutaecarpine, an alkaloid obtained from Evodia Rutaecarpa Chinese herb, has anticancer activity by inhibiting topoisomerase and/or cyclo-oxygenase-2 levels. However, the effectiveness of rutaecarpine has not been well known in breast cancer in terms of subtype. Therefore, we investigated the potential therapeutic effects of rutaecarpine on two different subtypes of breast cancer cells. Materials and Methods: The cytotoxic and apoptotic effects of rutaecarpine on MCF-7 and MDA-MB-231 cells were analyzed by WST-1, Annexin V, cell cycle, and acridine orange staining. Results: WST-1 results indicated that rutaecarpine significantly inhibited the growth of both cancer cells for 48 h (P < 0.05). In addition, rutaecarpine treatment caused apoptotic cell death through chromatin condensation and nuclear blebbing and G0/G1 arrest in both breast cancer cells. However, the efficacy of rutaecarpine was more profound in MCF-7 cells than MDA-MB-231 cells. Conclusions: Consequently, rutaecarpine has a potential therapeutic effect on breast cancer. However, the effectiveness of rutaecarpine is dependent on the subtype of breast cancer.
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Metastatic hormone receptor-positive breast cancer in CDK 4/6 era: An outcome audit p. 994
Rajeev Krishnappa Lakkavalli, Jitendra Kumar Pehalajani, Venkatesh Tirumala, Govind K Babu, Dassappa Loknatha, Linu Abraham Jacob, Suresh M C Babu, AH Rudresha, Lokesh Nagendrappa Kadabur, Smitha C Saldanha, GV Giri
DOI:10.4103/jcrt.JCRT_853_18  PMID:34528554
Background: The treatment landscape of metastatic hormone receptor (HR) positive breast cancer has been changed in recent years. Availability of CDK 4/6 inhibitor and other hormone therapy has changed the treatment algorithm for these patient, we retrospectively analyzed our metastatic HR positive breast cancer patients. Materials and Methods: In this study, we retrospectively analyzed the case records of hr positive metastatic breast cancer patient treated at department of medical oncology from October 2016 to September 2018. Demographical characteristics, site of metastasis, objective response and clinical benefit response and toxicity profile were analyzed. Results: We treated a total of 178 patients of MBC with HT at our center during the study period. One hundred fifty-two patients received HT alone (control group) and 26 patients received HT and CDK 4/6 inhibitor (study group). The median age of patients was 56 and 58 years in the control group and study group. The ORR was 41.7 versus 57.9 (95% CI [1.01–2.56]), and the CBR was 66.1% versus 78.9%; (CI [1.18–3.56]) (P < 0.05) of the patients in control and study groups, respectively. Conclusions: Among patients with HR-positive, advanced breast cancer, hormone therapy is efficacious addition of CDK 4/6 inhibitor improve the efficacy with tolerable side effects.
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Perception, magnitude, and implications of cancer-related fatigue in breast cancer survivors: Study from a developing country p. 998
Alok Gupta, Shaik Maheboob Hussain, Harleen Kaur Nayyar, Neha Sonthwal, Radhika Manaktala, Harit Chaturvedi
DOI:10.4103/jcrt.JCRT_151_19  PMID:34528555
Background: We have analyzed perceptions, magnitude, interventions adopted, and overall implications of cancer-related fatigue (CRF) in breast cancer survivors (BCSs). Methodology: BCSs who attended follow-up clinic at our institute between January and June 2018 were asked to fill a questionnaire focused on assessing an individual's perception, severity, potential causes, implications on quality of life, and measures taken to deal with CRF. Results: Sixty-five patients were included. Fifty-four (83%) had undergone surgery, 59 (91%) chemotherapy, 43 (66%) radiation therapy, and 36 (55%) hormonal/targeted therapy. Sixty-two (95%) patients experienced any grade CRF. Fifty-five (85%) patients experienced moderate to severe CRF affecting work (58%) and activities of daily living (27%). CRF was perceived as generalized weakness by 54 (83%) patients, diminished concentration/attention span by 24 (37%) patients, decreased motivation and interest in usual activities by 29 (45%) patients, and emotional labiality by 16 (25%) patients. Fifty-six patients (86%) believed that fatigue was due to the effect of cancer treatment on the body, while only 8 (12%) attributed it to underlying cancer. CRF had negative impact on mood, daily activities, interpersonal relationships, and professional work in 40 (62%), 39 (60%), 13 (20%), and 10 (15%) patients, respectively. Measures taken to overcome CRF were increased physical exercise, psychosocial interventions, mind–body interventions, and pharmacological interventions in 32 (49%), 8 (12%), 28 (43), and 17 (26%) patients, respectively. Thirty-nine (60%) patients reported persistence of CRF after completion of treatment while it took up to 6 months, 6–12 months, and more than 12 months for resolution of CRF in 13, 10, and 3 patients, respectively. Conclusion: Development and persistence of CRF remains a major health concern, and current interventions are not able to mitigate this problem. Further research in this field is warranted.
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Diagnostic potential of differentially regulated microRNAs among endometriosis, endometrioid ovarian cancer, and endometrial cancer p. 1003
Priti Kumari, Indu Sharma, Subhas Chandra Saha, Radhika Srinivasan, Priyanka Minhas
DOI:10.4103/jcrt.JCRT_969_19  PMID:34528556
Background: There is an increased risk of developing endometrioid ovarian and endometrial cancer in patients with endometriosis and there are no definitive diagnostic biomarkers available for these three associated diseases. Therefore, we evaluated the diagnostic potential of differentially expressed microRNAs (miRNAs) from the tissue samples of endometriosis, endometrioid ovarian cancer, and endometrial cancer to establish them as biomarkers for these diseases. Materials and Methods: Ten samples of each, i.e., endometriosis, endometrioid ovarian cancer, endometrial cancer and control healthy endometrium were enrolled after obtaining ethical clearance. Differential expression of miR-16, miR-20a, miR-99b, miR-125a, miR-143, and miR-145 and some of their target genes, i.e., vascular endothelial growth factor (VEGF), hypoxia inducible factor 1A (HIF1A), cyclooxygenase 2 (COX2), and tumor necrosis factor (TNF) were quantified using quantitative reverse transcription polymerase chain reaction. Receiver operating characteristic (ROC) curve analysis was performed to predict the diagnostic potential. Results: miR-16 and miR-20a were significantly downregulated, whereas miR-99b, miR-125a, and miR-143 were significantly upregulated in all three diseased samples. miR-145 was significantly upregulated in endometriosis and endometrioid ovarian cancer but significantly downregulated in endometrial cancer. mRNA levels of VEGF, HIF1A, COX2, and TNF were significantly increased in all three diseased samples as compared to control samples. ROC curve analysis revealed that for endometriosis, miR-99b, and miR-125a were giving highest area under curve (AUC) (0.950 and 0.733, respectively), for endometrioid carcinoma of ovary miR-143 was giving highest AUC (0.933) and for endometrioid endometrial cancer miR-16 (AUC = 0.815), miR-99b (AUC = 0.920), and miR-145 (AUC = 0.985) were found to be best predictors. Conclusion: These findings suggest that these miRNAs can act as good predictors and discriminators of these three diseases and might serve as potential biomarkers for them.
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A prospective randomized trial comparing accelerated concurrent chemoradiotherapy with conventional concurrent chemoradiotherapy in locally advanced carcinoma cervix (IIA–IVA) p. 1012
Poorva Vias, Harpreet Angural, Rajeev Kumar Seam, Manoj Kumar Gupta, Manish Gupta, Vikas Fotedar, Anup Negi
DOI:10.4103/jcrt.JCRT_626_19  PMID:34528557
Introduction: Cervical cancer ranks fourth in women worldwide. The management requires a multidisciplinary approach. Concomitant chemoradiotherapy with cisplatin, followed by brachytherapy, is the standard approach. Accelerated radiotherapy (ART) can be used to decrease the treatment duration which can further lead to better outcomes. Materials and Methods: Stages II, III, and IVA of carcinoma cervix were studied for 1 year. Ninety patients were randomized in control and study arms, 45 patients in each arm. The total dose of radiation was 50 Gy/25#/5 weeks from Monday to Friday in the control arm and 50 Gy/25#/4 weeks from Monday to Saturday in the study arm, with injection cisplatin 40 mg/m 2 intravenous infusion weekly in both the arms. Results: The response was similar in both the arms at the first follow-up as well as at median follow-up. However, acute toxicities in the ART arm were more, but they were managed conservatively. Conclusion: ART can be used in patients of cervical cancers to decrease the total treatment time. The results were similar in both the groups but need to be studied over more number of patients.
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Salivary detection of high-risk human papillomavirus 16 in oral squamous cell carcinoma using polymerase chain reaction in the South Indian population p. 1017
Soujanya L Krishnappa, Chaya M David, BK Ramnarayan, Alekhya Kanaparthi, Suprith L Krishnappa, Divya Dukkireddy
DOI:10.4103/jcrt.JCRT_957_19  PMID:34528558
Introduction: Human papilloma virus (HPV) has been associated with oral squamous cell carcinoma (OSCC) as a potential carcinogen. There are several types of HPV, of which type 16 has been strongly implicated in carcinogenesis. HPV16 in saliva can potentially facilitate early detection of subclinical cases that may warrant further diagnosis, monitoring and intervention. Aim: The aim of this study was to evaluate the presence of HPV 16 in saliva and lesional tissue of OSCC and to determine the use of saliva as an alternative non invasive diagnostic tool in HPV16 identification. Materials and methods: 30 cases of Histopathologically confirmed OSCC with HPV positive on ELISA were taken up for the study. The tumour tissue and saliva sample of each patient were obtained to detect the presence of specific HPV16 genotype by polymerase chain reaction (PCR). The data was subjected to statistical analysis using Student t-test. Results: In our study we found 28/30, 26/30 positive for HPV 16 in tissue and saliva samples respectively on PCR analysis. The P value was statistically significant (0.00). Conclusion: The study revealed significant prevalence of HPV 16 among both tissue and salivary specimens of OSCC patients in south Indian population. Though, the yielded content was relatively less in saliva, it can be concluded that, saliva being a non invasive tool proved to be as useful as tissue specimen and can be used as an alternative indicator of HPV16 positivity in OSCC.
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Functional and biochemical changes in the thyroid gland following exposure to therapeutic doses of external beam radiotherapy in the head-and-neck cancer patients p. 1025
Amritjot Singh Randhawa, Hanuman Prasad Yadav, Raja Paramjeet Singh Banipal, Gitanjali Goyal, Pardeep Garg, Sapna Marcus
DOI:10.4103/jcrt.JCRT_148_19  PMID:34528559
Context: Majority of the head-and-neck cancers are locoregionally advanced at the time of diagnosis. Hence, radiotherapy (RT) portals will invariably cover the whole neck and thus, the thyroid gland which may lead to its dysfunction. Aims: The purpose of this study is to identify the functional and biochemical changes in the thyroid gland following RT to the neck using single-photon emission computed tomography-computed tomography (SPECT-CT) and thyroid function tests (TFTs). Subjects and Methods: In this prospective study, 45 patients of the head-and-neck cancer, receiving RT with or without chemotherapy were investigated. Baseline TFTs and thyroid scans (on SPECT-CT) were done, and the same were repeated at the completion of RT, at 3 and 6 months. Results: All patients received a minimum of 30 Gy to the whole neck. Baseline TFTs and thyroid scans were normal. None of them developed hypothyroidism clinical or subclinical (C/S) at the completion of RT. Six patients developed hypothyroidism (four subclinical, two clinical) at 3 months of the completion of treatment. At 6 months of follow-up 14 patients (31.1%) developed hypothyroidism (ten subclinical, four clinical) with P≤ 0.01. All patients having clinical or subclinical hypothyroidism had decreased uptake on thyroid scan. Patients having decreased uptake on thyroid scan only, with normal TFTs and no symptoms of hypothyroidism were zero at the completion of RT, 1 at 3 months follow-up, and seven at 6 months follow-up. Conclusions: Hypothyroidism (C/S) is an under-recognized but significant complication of therapeutic doses of RT to the neck. In our study, we recognized hypothyroidism as early as 3 months following the completion of RT. Hence, tests to evaluate functional and biochemical changes in the thyroid gland should be instituted as early as 3 months following RT.
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Nonhomologous end joining repair pathway molecules as predictive biomarkers for patients with oral squamous cell carcinoma p. 1031
Jigna S Joshi, Hemangini H Vora, Nandita R Ghosh, Rajen N Tankshali, Dhaval H Jetly, Trupti I Trivedi
DOI:10.4103/jcrt.JCRT_582_19  PMID:34528560
Purpose: Nonhomologous end-joining (NHEJ) is critical for the repair of either pathologic double-strand breaks (DSBs) and/or for the repair of physiologic DSBs created during radiotherapy to kill the tumor cell. Therefore, patients with higher expression of NHEJ repair proteins might develop resistance to ionizing radiation, allowing the disease to recur. As cancer of the oral cavity is a serious health problem globally, the present study aimed to examine the expression of Ku70/80, X-ray repair cross-complementing protein 4 (XRCC4) and DNA ligase IV-core molecules of the NHEJ pathway in patients with oral cancer. Materials and Methods: Protein expression of Ku70/80, XRCC4, and DNA ligase IV were studied by Immunohistochemistry and mRNA expression of Ku70 and Ku80 were studied using reverse transcription polymerase chain reaction. Data were analyzed statistically using SPSS. Results: A univariate survival analysis revealed an association of Ku70 mRNA with shorter overall survival (OS). While protein expression of XRCC4 showed an association with reduced relapse-free survival and shorter OS. Multivariate survival analysis demonstrated that XRCC4 and DNA ligase IV are independent prognosticators for predicting adverse disease outcomes. Conclusion: Strong expression of repair proteins – XRCC4 and DNA ligase IV is associated with unfavorable disease outcome in patients with oral squamous cell carcinoma.
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Assessment of the perceived stress and burden of family caregivers of the head-and-neck cancer patients at a tertiary care cancer center: A cross-sectional study p. 1039
S Sathiya Priya, Girish R Shavi, Ranganath Sanga, S Shankar, G Lalithambigai, C Rahila, S Santhakumari
DOI:10.4103/jcrt.JCRT_309_19  PMID:34528561
Introduction: Cancer is a major life-threatening disease and has an impact on both patients and their family members. Caring for cancer patients may lead to several levels of stress which may affect their own health as well as their quality of life. Aim: To assess the perceived stress and burden of family caregivers of head and neck cancer patients (HNC) attending cancer care centre at a tertiary care centre, Tamil Nadu. Objectives: To assess the perceived stress and the burden among caregivers of patients with head and neck cancer using the Perceived Stress Scale (PSS) and Caregiver Strain Index (CSI) respectively. Materials and Method: A Cross-sectional study was carried out for a period of three months among the caregivers of head and neck cancer patients at a cancer care centre, Madurai. A total of 200 caregivers were selected by Convenience sampling method. Data was collected using a pretested, self-structured, closed-ended questionnaire by face to face interview method. Results: The study population consisted of Caregivers aged 21-60 years, mostly females (80%), spouses (54%), employed (57%) and uneducated (66%). Most of the caregivers were from lower socioeconomic status (66%) and those who are providing care for 1 to 6 months were more in number. In this study, 82% of caregivers reported high caregiver burden (CSI ≥7) and 67% of caregivers reported high stress (PSS ≥ 26 - 40). Conclusion: Caregivers are experiencing significant burden, particularly with respect to their physical and psychological well-being, economic circumstances, social and personal relationships.
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Analysis of intrapatient heterogeneity of circulating tumor cells at the single-cell level in the cerebrospinal fluid of a patient with metastatic gastric cancer p. 1047
Jang Ho Cho, Moon-Hee Sim, Sun Young Kim, Kyung Kim, Taehyang Lee, Jeeyun Lee, Won Ki Kang, Seung Tae Kim
DOI:10.4103/jcrt.JCRT_108_19  PMID:34528562
Background: The aims of this study were to detect circulating tumor cells (CTCs) at the single-cell level in cerebrospinal fluid (CSF) and to identify intrapatient heterogeneity of CTCs in a patient with gastric cancer (GC) with leptomeningeal metastasis (LM) using Di-Electro-Phoretic Array technology. Materials and Methods: The CSF samples were drawn from a patient who was diagnosed with GC with LM. The CSF samples were centrifuged and stained with antibody cocktail to recognize 4',6-diamidino-2-phenylindole, cytokeratin, and epithelial cell adhesion molecule (EpCAM). Gene sequencing was also conducted to evaluate the status of the gene alteration profile of CSFCTCs as compared with those of the CSF non-CTCs and the primary tumor tissue. Results: Among total 38 cells from the samples, 25 cells represented CK+ (EpCAM+), which boiled down to 0.53 CTCs in 1 mL of CSF. Each CTC was heterogeneous in terms of morphology and degree of marker expression. Some CTCs have a spindle-like shape, whereas others have a round shape. Based on molecular profiling between the 25 CK+ (EpCAM+) CTCs and 13 CK−/EpCAM− cells (i.e., the non-CTCs), CSFCTCs harbored mutations such as MDM2, TP53, KRAS, STK11, and ALK, whereas mutation of these genes was not observed in the CSF non-CTCs. Four genes of nine mutational genes totally observed in the CSFCTCs were also noted in the primary tumor tissue. Conclusions: We enriched CTCs through a single-cell sorting process in CSF samples of a GC patient with LM. We also demonstrated the intrapatient heterogeneity of the CTCs at the single-cell level.
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Prognostic factors and clinical nomogram predicting survival in high-grade glioma p. 1052
Thara Tunthanathip, Sanguansin Ratanalert, Sakchai Sae-Heng, Thakul Oearsakul, Ittichai Sakarunchai, Anukoon Kaewborisutsakul, Thirachit Chotsampancharoen, Utcharee Intusoma, Amnat Kitkhuandee, Tanat Vaniyapong
DOI:10.4103/jcrt.JCRT_233_19  PMID:34528563
Background: Genomic-based tools have been used to predict poor prognosis high-grade glioma (HGG). As genetic technologies are not generally available in countries with limited resources, clinical parameters may be still necessary to use in predicting the prognosis of the disease. This study aimed to identify prognostic factors associated with survival of patients with HGG. We also proposed a validated nomogram using clinical parameters to predict the survival of patients with HGG. Methods: A multicenter retrospective study was conducted in patients who were diagnosed with anaplastic astrocytoma (WHO III) or glioblastoma (WHO IV). Collected data included clinical characteristics, neuroimaging findings, treatment, and outcomes. Prognostic factor analysis was conducted using Cox proportional hazard regression analysis. Then, we used the significant prognostic factors to develop a nomogram. A split validation of nomogram was performed. Twenty percent of the dataset was used to test the performance of the developed nomogram. Results: Data from 171 patients with HGG were analyzed. Overall median survival was 12 months (interquartile range: 5). Significant independent predictors included frontal HGG (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.40–0.60), cerebellar HGG (HR: 4.67; 95% CI: 0.93–23.5), (HR: 1.55; 95% CI: 1.03–2.32; reference = total resection), and postoperative radiotherapy (HR: 0.18; 95% CI: 0.10–0.32). The proposed nomogram was validated using nomogram's predicted 1-year mortality rate. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve of our nomogram were 1.0, 0.50, 0.45, 1.0, 0.64, and 0.75, respectively. Conclusion: We developed a nomogram for individually predicting the prognosis of HGG. This nomogram had acceptable performances with high sensitivity for predicting 1-year mortality.
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Histomorphological patterns of hepatoblastoma in a tertiary care hospital p. 1059
Dimple Chaudhary, Latika Gupta, Radhika Agarwal, Varuna Mallya, Reena Tomar, Shramana Mandal, Nita Khurana, YK Sarin
DOI:10.4103/jcrt.JCRT_120_19  PMID:34528564
Background: Hepatoblastoma (HB), rare malignancy in itself, is the most common primary liver tumor in children. Most common presenting features are abdominal distension or abdominal mass. Several patterns are associated with HB with different prognosis. Furthermore, some patterns have overlapping features with other childhood tumors. Aims and Objectives: The aim of this study is to discuss various patterns of HB which we came across in a tertiary care hospital during our study. H and E slides were reviewed with respect to different patterns, postchemotherapy changes including extramedullary hematopoiesis, necrosis, osteoid metaplasia, necrosis, and fibrosis. Conclusion: Different patterns of HB should be kept in mind by the pathologists to avoid any misdiagnosis.
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Influence of adjuvant therapy on pattern of failure and survival in curatively resected gallbladder carcinoma p. 1064
Sunil Choudhary, Neha Gupta, Chandra Prakash Verma, Avipsa Das, Lalit Mohan Aggarwal, Mallika Tewari, Abhijit Mandal, Anupam Kumar Asthana
DOI:10.4103/jcrt.JCRT_550_19  PMID:34528565
Purpose: The study was done to evaluate the role of adjuvant therapy in curatively resected Stage II and III gallbladder carcinoma (GBC). Materials and Methods: This was a retrospective analysis of patients of GBC registered between 2008 and 2017 in outpatient department of a tertiary cancer hospital in India. Patients who had any of the following adjuvant treatment after radical surgery: (a) external beam radiotherapy (RT) alone, (b) chemotherapy (CT) alone, and (c) RT with CT (CRT) were considered for the study. Results: A total of fifty patients could meet the selection criteria. It was seen that seven patients were treated with RT, 20 with CT, and 23 with CRT. Median follow-up for patients who were alive was 26.7 months. Nineteen patients had locoregional failure while eight had distant failure. Patients treated with CRT had a significantly better mean overall survival compared to those treated with RT or CT (44.0 months, 12.5 months, and 15.1 months, respectively; P = 0.003). Similarly, mean disease-free survival was superior in CRT arm compared to RT and CT arms (43.6 months, 9.6 months, and 12.4 months, respectively; P = 0.002). Conclusions: Adjuvant CRT had better survival outcome compared to patients treated with either RT or CT with Stage II and III disease after curative cholecystectomy.
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The impact of lymph node ratio on overall survival in patients with colorectal cancer p. 1069
Goksen İnanğ İmamoğlu, Arzu Oğuz, Sanem Cimen, Tülay Eren, Cengiz Karacin, Dilşen Colak, Mustafa Altşbaş, Sema Türker, Doğan Yazılıta
DOI:10.4103/jcrt.JCRT_11_19  PMID:34528566
Background: Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution. Materials and Methods: We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan–Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively. Results: Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15–8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value. Conclusions: This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for “PLNR,” prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.
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Prognostic significance of the preoperative C-reactive protein-to-albumin ratio in patients with colorectal cancer p. 1075
Hiroshi Tamagawa, Toru Aoyama, Masakatsu Numata, Yukio Maezawa, Keisuke Kazama, Yosuke Astumi, Kentaro Hara, Kazuki Kano, Norio Yukawa, Hiroyuki Saeki, Tenii Godai, Takashi Oshima, Motohiko Goda, Yasushi Rino, Munetaka Masuda
DOI:10.4103/jcrt.JCRT_355_19  PMID:34528567
Background: The aim of the present study was to determine the utility of the C-reactive protein-to-albumin ratio (CAR) for predicting the overall survival (OS) in locally advanced colorectal cancer (CRC) patients. Patients and Methods: This retrospective multicenter study was performed using data from a prospectively maintained database of pathological Stage II or III patients undergoing CRC surgery at the Yokohama City University, Department of Surgery, and its affiliated institutions between April 2000 and March 2016. The risk factors for the OS were identified. Results: A CAR of 0.03 was considered to be the optimal cutoff point for classification based on the 1-, 3-, and 5-year survival rates and receiver operating characteristic curve. The OS rates at 3 and 5 years after surgery were 92.4% and 85.7% in the CAR-low group, respectively, and 86.7% and 81.1% in the CAR-high group. A multivariate analysis showed that the CAR was a significant independent risk factor for the OS. When comparing the patients' demographic and clinical characteristics between the CAR ≤0.03 and >0.03 groups, the incidence of patients who received adjuvant chemotherapy and the incidence of postoperative complications were significantly different between the two groups. Conclusion: The present study showed that the preoperative CAR was a risk factor for the OS in patients who underwent surgery for CRC. To improve the patients' survival, CAR might be a useful tool for devising treatment strategies.
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Identification of potential targets with high centrality indicated by diethylnitrosamine + thioacetamide-induced hepatocellular carcinoma model p. 1081
Sandhya Hora, Mohammad Asad, Swatantra Kumar Jain, Deepshikha Pande Katare
DOI:10.4103/jcrt.JCRT_948_20  PMID:34528568
Background and Aim: Hepatocellular carcinoma (HCC), a primary liver malignancy, represents a continuous challenge to clinicians as it is a leading cause of death due to cancer widely. Early detection is the only hope to cure patients from this deadly disease or possibly increase life expectancy. Mouse models are most acceptable studies as they have ability to manipulate their genome and transcriptome to evaluate mechanistic changes. In addition, system biology can improvise the understanding of molecular mechanism of HCC and also can reveal the protein hub involved in every stage of HCC. Materials and Methods: Herein, diethylnitrosamine and thioacetamide (TAA) were used to develop stage-specific HCC in Wistar rats. Histopathological changes, biochemical parameters, and the oxidative stress were measured in hepatocytes. We have reanalyzed the microarray dataset to identify the complex signaling pathways involved in hepatocarcinogenesis induced by TAA. GSE45050 dataset was downloaded from Gene Expression Omnibus database, and the gene expression profile of nontumor, cirrhosis, and HCC was compared. Results: The study reveals stage-specific development of chronic HCC rat model and promising stage-specific targets (EHMT2, GMPS, and SPRY2) of HCC. Conclusions: EHMT2, GMPS, and SPRY found as high centrality nodes in protein-protein interaction studies using high-throughput microarray data which tend to be present in signaling pathways and co-occur in a biological state of HCC. These genes can be targeted to understand the possible pathology, molecular changes, and target strategy under cirrhosis and HCC condition.
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Immunosuppressive effects and mechanisms of three myeloid-derived suppressor cells subsets including monocytic-myeloid-derived suppressor cells, granulocytic-myeloid-derived suppressor cells, and immature-myeloid-derived suppressor cells p. 1093
Yoshiaki Nagatani, Yohei Funakoshi, Hirotaka Suto, Yoshinori Imamura, Masanori Toyoda, Naomi Kiyota, Kimihiro Yamashita, Hironobu Minami
DOI:10.4103/jcrt.JCRT_1222_20  PMID:34528569
Context: Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immune cells of myeloid lineage. Recent reports have suggested that human MDSC are divided into three subsets: monocytic MDSC (M-MDSC), granulocytic MDSC (G-MDSC), and immature MDSC (I-MDSC). However, the characteristics of each human MDSC subset still remain unclear. Materials and Methods: To evaluate the immunosuppressive effects and mechanisms, we first performed a T-cell suppression assay using cells obtained from healthy donor peripheral blood samples. The levels of immune inhibitory molecules in the culture supernatant of each MDSC subset were measured to reveal the T-cell suppressive mechanisms. Then, we compared these results with the results from cells obtained from cancer patient blood samples. Finally, we investigated the difference in the frequency of each MDSC subset between the healthy donors and the cancer patients. Results: Although M-MDSC and G-MDSC suppressed T-cell activation, I-MDSC had no T-cell suppressive effect. We found that the culture supernatant of M-MDSC and G-MDSC contained high levels of interleukin-1 receptor antagonist (IL-1RA) and arginase, respectively, in both healthy donors and cancer patients. No inhibitory molecules were detected in the culture supernatant of I-MDSC. The population of functional MDSC (M-MDSC and G-MDSC) in the total MDSC was significantly increased in cancer patients compared with that in healthy donors. Conclusions: Although M-MDSC and G-MDSC, which released IL-1RA and arginase, respectively, suppressed T-cell activation, I-MDSC did not have an immunosuppressive effect. The population of functional MDSC was increased in cancer patients compared with that in healthy donors.
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CASE REPORTS Top

A case of duodenal adenocarcinoma treated with primary chemoradiation p. 1101
Janaki Gururajachar Manur, Harshitha M Jain
DOI:10.4103/jcrt.JCRT_695_19  PMID:34528570
Duodenal adenocarcinoma represents <1% of total gastrointestinal malignancies. Given the rarity of the disease, a definitive treatment guideline is lacking. Surgery plays a major role and radiotherapy was not included in the treatment due to the presence of many critical structures near the vicinity of the duodenum such as the liver, kidneys, and bowel. However, with the advent of newer techniques, adjuvant chemoradiation has shown a promising result with improvement in locoregional control by 20%. We are herewith presenting the details of the radiation planning of a patient treated with chemoradiation who had good long-term outcome.
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Hepatic necrosis following yttrium-90 radioembolization for hepatocellular carcinoma in a patient with a recent history of external radiotherapy p. 1104
Zhongzhi Jia, Weiping Wang
DOI:10.4103/jcrt.JCRT_27_19  PMID:34528571
Hepatobiliary complications from yttrium-90 (90Y) radioembolization have been described previously but are often clinically inconsequential. This report describes the case of a patient in whom a large area of hepatic necrosis occurred after the patient underwent both stereotactic body radiotherapy and glass-based90Y radioembolization for the management of hepatocellular carcinoma. This case suggests that90Y microspheres can cause severe local hepatic injury when administered after external radiotherapy.
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Basaloid squamous cell carcinoma in the maxillary gingiva p. 1108
GB Protyusha, B Sivapathasundharam
DOI:10.4103/jcrt.JCRT_893_19  PMID:34528572
Basaloid squamous cell carcinoma (BSCC) is a rare, unique, and aggressive variant of squamous cell carcinoma which mostly occurs in the upper aerodigestive tract. Histologically and immunologically different from conventional squamous cell carcinoma, it is mostly seen in men of the sixth and seventh decades and is commonly associated with tobacco and alcohol usage. BSCC usually presents as a high stage disease with distant metastasis, high recurrence rate, and poor prognosis. In the head-and-neck region, BSCC has a strong predilection for sites such as the base of the tongue, soft palate, and epiglottis. Less commonly, it may also occur on the floor of the mouth, gingiva, and tonsils. In the present article, we report a case of BSCC in the right maxillary anterior gingiva of a 57-year-old female for its rarity.
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A case of trastuzumab-induced dermatomyositis p. 1112
Ioannis Panagiotis Trontzas, Nikolaos Konstantinos Syrigos, Elias Alexandros Kotteas
DOI:10.4103/jcrt.JCRT_209_19  PMID:34528573
Human epidermal growth factor receptor 2 (HER-2) is a checkpoint, controlling cell proliferation and differentiation. Trastuzumab, a humanized monoclonal antibody directed against HER-2, is nowadays standard treatment for breast cancer patients whose tumors express HER-2. It is generally well tolerated, with a small number of patients developing mild adverse reactions. Dermatomyositis is a rare adverse event of trastuzumab therapy not well described in the literature. We herein present a case of a patient treated for hormone-sensitive invasive ductal carcinoma, who presented with symptoms of proximal muscle weakness, arthralgias, skin rash, and generalized fatigue. The symptoms started after the sixth cycle of trastuzumab and progressively deteriorated. The patient's medical and family history was unremarkable. Disease progression as a possible cause of dermatomyositis had been ruled out, and laboratory evaluation revealed moderate elevation of serum muscle proteins and acute-phase reactants. Trastuzumab treatment was discontinued, and 3 months later, the patient was free of symptoms without any further intervention.
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Acinic cell carcinoma of the parotid gland with neuroendocrine differentiation p. 1115
Ashutosh Rath, Reena Tomar, Radhika Agarwal, Meeta Singh, Shyama Jain, Nita Khurana, Praveen Kumar Rathore
DOI:10.4103/jcrt.JCRT_645_19  PMID:34528574
Acinic cell carcinoma (ACC) is a malignant salivary gland tumor characterized by tumor cells displaying acinar features. Usually presenting as a slow-growing tumor, ACC, however, may show dedifferentiation to a higher grade including neuroendocrine carcinoma. In addition, ACC may rarely show focal neuroendocrine differentiation without any frank evidence of neuroendocrine carcinoma. We describe such a case of ACC of the parotid gland in a 65-year-old female, which showed neuroendocrine differentiation. The diagnostic clues, immunohistochemistry panel, and prognostic and treatment aspects are also presented.
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BRIEF COMMUNICATIONS Top

Trends in the characteristics of skin melanoma in accordance with time intervals: A single Turkish tertiary referral center experience p. 1119
Faruk Tas, Kayhan Erturk
DOI:10.4103/jcrt.JCRT_555_19  PMID:34528575
Aim: The incidence of skin melanoma has increased dramatically in recent years. The aim of this study was to analyze the trends in the features of Turkish cutaneous melanoma patients in a 25-year period Materials and Methods: A total of 1258 adult melanoma patients who had been managed and followed up at a tertiary referral center between 1993 and 2017 were included in the study. Results: Males were predominant which did not vary between time intervals. There was an increase in the percentage of older patients over the years, whereas no change was observed in the percentage of younger patients. As the percentage of lower extremity melanoma dropped, the percentage of truncal melanomas rose. Both the incidences of thick (T3–T4) and thin melanomas (T1) were found to increase over time by 13.4% and 3.8%, respectively. There was no significant change in the percentage of the metastatic disease; however, Stage III disease was found to multiply by 10.1% and local disease was found to fall by 8.5% over the period. The percentages of patients with nodular histopathology and tumor-infiltrating lymphocytes were found to plummet, and there was a slight decline in the percentages of patients with high mitotic rate and lymphovascular invasion. Conclusions: Most likely because of the delayed diagnosis, cutaneous melanoma was found to be associated with less favorable prognostic features as the time lapsed. We suggest that effective campaigns for public awareness of melanoma be implemented so the screening and early diagnosis of the disease can be promoted.
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Rucabarib: A new lease of life for ovarian cancer patients p. 1123
Sandeep Sachdeva, Tamkin Khan Rabbani
DOI:10.4103/jcrt.JCRT_458_19  PMID:34528576
Background: Rucaparib is a drug with potential as maintenence monotherapy in ovarian cancers irrespective of genetic mutation. Methods: The results of the ARIEL 3 trial were analysed for the drug's prospects towards cure in ovarian and other pelvic malignancies. Results: Ovarian cancer patients with highly malignant tumors and relapses on platinum based chemotherapy exhibited statistically significant reductions in tumor size with maintenance Rucaparib therapy vis a vis placebo. Conclusion: Genetic heterogeneity of the tumor did not have an impact upon Rucaparib efficacy in ovarian carcinoma. More malignant and relapsed variants can effectively be treated with Rucaparib, thereby improving survival rates and quality of life.
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A mathematical formulation for volume expansions in contouring for radiotherapy planning p. 1125
Anusheel Munshi, Biplab Sarkar, Sayan Paul, Bhavini B Chaudhari, Rohit Singh Chauhan, Tharmarnadar Ganesh, Bidhu Kalyan Mohanti
DOI:10.4103/jcrt.JCRT_614_19  PMID:34528577
Context: This research describe the characteristic volume expansion of a moving target as a function of differential margins. Aim: We aimed to ascertain the volume change after giving margin for clinical and set up uncertainties including generating internal target volume (ITV) for moving target. Materials and Methods: Settings and Design – Spheres of diameter (0.5–10 cm) with differential expansion of 1–15 mm were generated using a mathematical formula. Moving targets of radius 1–5 cm were generated, and the resultant volume envelopes with incremental motion from 1 to 20 mm were obtained. All relative volume change results were fitted with mathematical functions to obtain a generalized mathematical formula. Statistical Analysis Used: None. Results: The percentage increase in volume (%ΔVp) was much more pronounced for smaller radius target. For moving target with relatively smaller radius, %ΔVp is predominant over the absolute volume change and vice versa in case of larger radius. Mathematical formulae were obtained for %ΔVp as a function of radius and expansion and for %ΔVp in ITV volume as a function of radius and tumor movement. Conclusions: This study provides an idea of volume change for various expansions for various size targets and/or moving target for different range of movements. It establishes a correlation of these volume changes with the changing target size and range of movements. Finally, a clinically useful mathematical formulation on volume expansion has been developed for rapid understanding of the consequence of volume expansion.
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LETTERS TO THE EDITOR Top

Nothing is permanent except for change: Disease-free survival in cancer, time to change? p. 1132
Manigreeva Krishnatreya
DOI:10.4103/jcrt.JCRT_318_19  PMID:34528578
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Association of hypoxia-inducible factor-1α polymorphisms with susceptibility to nonsmall-cell lung cancer: A summative analysis p. 1134
Pathum Sookaromdee, Viroj Wiwanitkti
DOI:10.4103/jcrt.JCRT_607_19  PMID:34528579
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Human epidermal growth factor receptor 2 is frequently over-expressed in gastric carcinoma in north Indian patients p. 1136
Pragya Jain, Tanvi Arora, Neelam Wadhwa, Mohit Kumar Joshi
DOI:10.4103/jcrt.JCRT_23_19  PMID:34528580
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STRASS trial: Preoperative radiotherapy in retroperitoneal sarcoma: A commentary p. 1138
Sorun Shishak, Sameer Rastogi, Kaushal Kalra, Manasa Parisa
DOI:10.4103/jcrt.JCRT_573_19  PMID:34528581
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ERRATUM Top

Erratum: M-ds-P21 induces cell apoptosis in bladder cancer T24 cells through P53 independent pathway p. 1140

DOI:10.4103/0973-1482.325935  PMID:34528582
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