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   2009| July-September  | Volume 5 | Issue 3  
    Online since October 16, 2009

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Malignant melanoma: A retrospective series from a regional cancer center in India
Kuldeep Sharma, Bidhu K Mohanti, Gaura K Rath
July-September 2009, 5(3):173-180
DOI:10.4103/0973-1482.57122  PMID:19841558
Purpose : To present our experience in treating malignant melanoma patients. Methods and Materials : All melanoma patients treated at the Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India, from 1995 to 2007 were studied retrospectively. The endpoints were loco-regional recurrence, distant recurrence, recurrence-free survival (RFS), and duration of follow-up (DOFU). RFS and DOFU were analyzed with respect to the factors like age, sex, tissue of origin, site of disease, number of nodes, lymphadenopathy, ulceration, stage, and operability to find out any association. Results : Seventy-two patients were found evaluable with 40 males and 32 females (median age 46.5 years). Eye was the commonest primary site with visual disturbance as the commonest symptom. Overall, 87% of the lesions were single, with most of the nonocular lesions presenting in the advanced stage. During the disease course, regional lymphadenopathy and distant metastases were seen in 33% and 32% of cases, respectively. Highest incidence of lymphadenopathy was seen in skin lesions and in primaries from trunk and extremities. Of all treated patients, 47% achieved complete response, 18% partial response, and others had either stable or progressive disease. The median DOFU was 6.2 months. RFS was studied only in curatively treated cases with a median of 10 months. Operability at presentation was the only prognostic factor influencing DOFU. Conclusion : Malignant melanoma is an uncommon disease in India carrying a lot of morbidity due to late presentation. Its management is still not clear regarding the optimum use and schedule of treatment modalities. More prospective studies in the future are required to come to a definite conclusion.
  9,278 598 3
Epitrochlear lymph node metastases from invasive ductal breast cancer
Pavan Kumar, Shalini Singh, NR Datta, Ashwani Tandon
July-September 2009, 5(3):203-205
DOI:10.4103/0973-1482.57127  PMID:19841563
Metastasis to an epitrochlear lymph node from a primary invasive breast cancer has not been reported earlier. We report a case of epitrochlear lymph node metastasis that presented 10 years after the primary breast malignancy had been treated with radiotherapy, chemotherapy, and hormonal therapy. The patient was successfully treated and continues to remain asymptomatic more than 2 years after she presented with the metastasis.
  9,451 319 -
Reirradiation for progressive brain metastases
Amit Bahl, Milind Kumar, DN Sharma, KS Jothy Basu, MS Jaura, GK Rath, PK Julka
July-September 2009, 5(3):161-164
DOI:10.4103/0973-1482.57120  PMID:19841556
Brain metastases constitute one of the most common distant metastases of cancer and are increasingly being detected with better diagnostic tools. The standard of care for solitary brain metastases with the primary disease under control is surgery followed by radiotherapy. Radiotherapy is also the primary modality for the treatment of multiple brain metastases, and improves both the quality of life and survival of patient. Unfortunately, more than half of these treated patients eventually progress leading to a therapeutic dilemma. Another course of radiotherapy is a viable but underutilized option. Reirradiation resolves distressing symptoms and has shown to improve survival with minimal late neurotoxicity. Reirradiation has conventionally been done with whole brain radiotherapy, but now studies with stereotactic radiosurgery have also shown promising results. In this review, we focus on reirradiation as a treatment modality in such patients. We performed a literature search in MEDLINE (www.pubmed.org) with key words brain metastases, reirradiation, whole brain radiotherapy, stereotactic radiosurgery, interstial brachytherapy, and brain. The search was limited to the English literature and human subjects.
  6,897 709 8
Surgery for malignant liver tumors
Parul J Shukla, Savio G Barreto
July-September 2009, 5(3):154-160
DOI:10.4103/0973-1482.57119  PMID:19841555
Recent decades have witnessed an increase in liver resections. There is a need for an update on factors related to the management of liver tumors in view of newer published data. A systematic search using Medline, Embase, and Cochrane Central Register of Controlled Trials for the years 1983-2008 was performed. The IHPBA classification provides a suitable nomenclature of liver resections. While one randomized trial has provided an objective time of 30 min as optimal for intermittent pedicle occlusion, another randomized study has demonstrated the feasibility of performing liver resections without pedicle clamping. A randomized trial has demonstrated the benefit of clamp crushing over newer techniques of liver transection. Cohort studies support anatomical resections when feasible in terms of outcomes. Nonrandomized studies also support nonanatomical and ablative therapies in patients with cirrhosis and small remnant livers. A randomized trial has shown comparable long-term outcomes of radiofrequency ablation (RFA) and surgery for tumors <5 cm. No randomized trials comparing laparoscopy and open surgery exist. Surgery remains an important treatment modality for malignant hepatic neoplasms. While anatomical resections provide improved survival, the choice of nonanatomical versus anatomical resections should be individualized taking into account factors such as cirrhosis and function of the liver remnant. A clear margin of resection is essential in all surgically resected cases. RFA is emerging as a useful, often complimentary tool, to surgery when dealing with complex tumors or tumors in patients with a poor liver function. Laparoscopic ultrasonography is useful in staging and performance of RFA.
  5,529 879 9
Clinicopathological correlates of pediatric head and neck cancer
Subhabrata Sengupta, Ranabir Pal
July-September 2009, 5(3):181-185
DOI:10.4103/0973-1482.57123  PMID:19841559
Background : The spectrum of head and neck tumors in children continues to be the cause of diverse, diagnostically challenging issues. Aims : To demonstrate and compare the unique clinicopathological features in our study population and their correlations with the final histopathological diagnosis. Methods : Fifty-three children with head and neck cancer were examined thoroughly at the Otorhinolaryngology department in a tertiary care teaching hospital followed by histopathological studies. Results : Lymphomas were the most common malignant lesions seen followed by rhabdomyosarcomas, nasopharyngeal carcinomas, and others like thyroid carcinomas and eosinophilic granulomas. In the neck, the commonest cause of primary malignant disease was lymphoma; however, the most frequent lesion was reactive lymphadenitis. In the sinonasal region, the commonest malignancy was rhabdomyosarcoma, which often had extension to the orbit and the face. Recurrent epistaxis was found universally in the malignant cases of this region. In the facial region, disfiguring swelling with proptosis was mainly caused by rhabdomyosarcoma. The only case of tonsillar malignancy was due to non-Hodgkin lymphoma. The duration of disease was less than 1 year. Conclusion : The most common manifestation of the malignant lesions in the pediatric age group was with a history of an enlarging, painless neck swelling. Still, an insignificant lump in the neck or recurrent bleeding from nose may be the manifestation of an underlying cancer.
  5,531 661 7
Invasive papillary carcinoma of the male breast: Report of a rare case and review of the literature
Ishita Pant, Sanjeev Chandra Joshi
July-September 2009, 5(3):216-218
DOI:10.4103/0973-1482.57132  PMID:19841568
Breast masses occur in men far less commonly than women. Papillary lesions of the male breast are rare and comprise a spectrum of lesions ranging from benign intraductal papilloma to intraductal papillary carcinoma and invasive papillary carcinoma. In this case report, a 78-year-old man presented with a subareolar painless mass. Fine needle aspiration cytology (FNAC) was performed. Cytologic examination revealed a cellular aspirate. A diagnosis of papillary lesion favoring papillary carcinoma was rendered. The patient underwent modified radical mastectomy, which showed invasive papillary carcinoma. As far as we know, only a few cases of invasive papillary carcinoma of the male breast have been published in the literature. To the best of our knowledge, this is the first case report of invasive papillary carcinoma of male breast in Malaysia. In this purview, we discuss papillary carcinoma of male breast with review of the relevant literature.
  5,328 568 3
Primary Ewing's sarcoma of the frontal bone with intracranial extension
Amit Agrawal, Rajesh Dulani, Anitha Mahadevan, SJ Vagaha, Jayant Vagha, SK Shankar
July-September 2009, 5(3):208-209
DOI:10.4103/0973-1482.57129  PMID:19841565
Primary Ewing's sarcoma arising from the skull is extremely rare. We report a case of an 11-year-old male child with primary Ewing's sarcoma of the frontal bone with intracranial extension. We also discuss the imaging and intraoperative findings and describe our use of a split calvarial graft in the present case.
  5,233 447 8
Preliminary results of SIB-IMRT in head and neck cancers: Report from a regional cancer center in northern India
Santam Chakraborty, Sushmita Ghoshal, Vijay M Patil, Arun S Oinam, Suresh C Sharma
July-September 2009, 5(3):165-172
DOI:10.4103/0973-1482.57121  PMID:19841557
Background : Intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT) is an attractive method for the treatment of head and neck cancers with sparing of the salivary function. Aims : To assess the feasibility, toxicity, and tumor control using SIB-IMRT in locally advanced head and neck cancers in the Indian setting. Settings and Design : The study was conducted in a regional cancer center in northern India. A review of the treatment result of the first 20 patients is presented. Methods and Materials : SIB-IMRT was planned for 20 patients-14 patients were treated with the SIB-72 schedule delivering a dose of 72 Gy, 66 Gy, and 57 Gy to the PTV GTV , PTV CTV1 , and PTV CTV2 in 33 fractions. Six patients were treated with the SIB-66 schedule delivering 66 Gy, 60 Gy, and 54 Gy to the above-mentioned volumes in 30 fractions. Patients were monitored for toxicity using the CTCAE v 3.0 criteria. Descriptive analysis of toxicity and actuarial estimates of the loco-regional control and survival are presented. Results : Grade III mucositis was seen in 65% patients. None of the patients had Grade III dermatitis. The projected 2-year overall survival was 95%. Conclusion : SIB-IMRT schedules evaluated were found to be safe and effective and are being subjected to further prospective studies.
  4,858 541 2
Role of chelates in magnetic resonance imaging studies
Laxmi Tripathi, Praveen Kumar, Ranjit Singh
July-September 2009, 5(3):148-153
DOI:10.4103/0973-1482.57118  PMID:19841554
Imaging studies are tests performed with a variety of techniques that produce pictures of the inside of a patient's body. Magnetic resonance imaging (MRI) is an imaging technique based on the principles of nuclear magnetic resonance. MRI uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures of organs, soft tissues, bone, and virtually all other internal body structures. Chelates have a wide application in such imaging techniques. Chelates in imaging studies are used alone as radioactive agents or conjugated to monoclonal antibodies or to DNA as radioactive agents. Technetium chelates and gadolinium chelates are being widely used as magnetic resonance contrast media.
  4,638 451 1
RET genetic screening in patients with medullary thyroid cancer: The Moroccan experience
Ainahi Abdelhakim, Barlier Anne, Kebbou Mohamed, Benabdeljalil Nadia, Timinouni Mohammed, Fechtali Taoufiq, Roche Catherine, El Antri Said
July-September 2009, 5(3):198-202
DOI:10.4103/0973-1482.57126  PMID:19841562
Background : Germline RET gene mutations are well known to be the genetic causes of multiple endocrine neoplasia type 2 (MEN2) and may be identified by genetic screening. Aim : The purpose of the present study was to screen nine MTC patients for RET sequence changes. Materials and Methods : In this study, our sample was composed of 30 individuals: 9 index patients with medullary thyroid carcinoma (MTC) corresponding either to 3 subjects with clinical evidence of MEN2, 6 with apparently sporadic MTC (sMTC), and 21 relatives have been investigated for RET mutations. After DNA extraction from peripheral blood leukocytes, RET exons 8, 10, 11, 13-16 and exon/intron boundaries were analyzed by direct PCR sequencing. Results : Three different known RET germline mutations in exon 11 (codon 634), p.Cys634Arg (c1900 T→C) (de novo case), p.Cys634Phe (c1901 G→T), p.Cys634Trp (c1902 C→G), were detected in three individuals with MEN2 phenotype. Of the 21 relatives, 2 cases presented mutation. Among the six probands with sMTC, none was found to carry mutation. There was no difference between RET polymorphisms detected among both MEN2 and sMTC patients. Conclusions : These preliminary data suggest that the RET mutation spectra observed in Moroccan patients with MEN2 are similar to those previously reported in other countries.
  4,488 495 1
Spermatocytic seminoma with rhabdomyosarcomatous differentiation: A case report with a review of the literature
Santosh Menon, Arti Karpate, Sangeeta Desai
July-September 2009, 5(3):213-215
DOI:10.4103/0973-1482.57131  PMID:19841567
Spermatocytic seminoma is an uncommon testicular germ cell tumor associated with a favorable outcome. Sarcomatous transformation in a spermatocytic seminoma is extremely rare with only 13 cases being reported in English literature. The presence of a sarcomatous component is associated with an aggressive behavior, metastasis, and poor prognosis. We present a case of a spermatocytic seminoma with rhabdomyosarcomatous transformation in a long-standing testicular swelling in a 55-year-old male.
  4,194 344 6
Treatment outcome with low-dose-rate interstitial brachytherapy in early-stage oral tongue cancers
Rajendra I Bhalavat, Umesh M Mahantshetty, Sanjay Tole, Swamidas V Jamema
July-September 2009, 5(3):192-197
DOI:10.4103/0973-1482.57125  PMID:19841561
Purpose : Although radical radiotherapy is known to be equally effective for early-stage oral tongue cancers (T1-2 N0) with the added advantage of organ and function preservation, surgery remains the preferred treatment. We present outcome of patients treated with brachytherapy (BT) either radical or boost. Materials and Methods : Fifty-seven patients (T1/T2 31/26) were studied. Seventeen patients (30%) were treated with radical BT (50-67 Gy) while 40 (70%) with external beam radiation therapy (EBRT) + BT (36-56 Gy + 15-38 Gy]. Low-dose-rate (LDR) BT was delivered with 192 Ir wires, using plastic bead technique with varied dose rates (<60 cGy/h in 29 patients, 60-90 cGy/h in 17, and >90 cGy/h in 11). Results : The overall local control (LCR) was achieved in 59.7% (34/57) patients. LCR for T1 and T2 was 67.8% and 50%, respectively. A total of 23 patients had failures [local: 20 (T1: 8; T2: 12 patients), node: 5 (T1:2; T2: 3), and local + nodal: 3]. Overall 5-year disease-free survival and overall survival (OAS) were 51% and 67%, respectively and those for T1 and T2 was 64.5/77.4% and 38.5/54% respectively (P = 0.002). All 16 patients were salvaged. Median survival after salvage treatment was 13.5 months (6-100 months). Soft tissue necrosis was observed in 12.3% (7/57) and osteoradionecrosis in two patients. Conclusion : BT, as an integral part of radical radiation therapy in early-stage tongue cancers, appears to be an effective alternative treatment modality with preservation of the organ and function without jeopardizing the outcome.
  3,863 387 9
Micromultileaf collimator-based stereotactic radiosurgery for selected arteriovenous malformations: Technique and preliminary experience
Rakesh Jalali, Debnarayan Dutta, C Srinivas, Anusheel Munshi, Uday Limaye, A Goel, Deepak Deshpande, Rajiv Sarin
July-September 2009, 5(3):186-191
DOI:10.4103/0973-1482.57124  PMID:19841560
Purpose : To report our experience of stereotactic radiosurgery (SRS) in consecutively treated patients with arteriovenous malformations (AVMs). Materials and Methods : Of the 87 patients, 23 patients qualified and were treated with SRS as per predefined protocol according to AVM size, location, neurological status, prior bleeding, and the AVM score. All had Spletzer-Martin grade II/III and AVM scores <2.5. Patients underwent SRS using micromultileaf collimators delivering multiple noncoplanar fixed fields. Doses were prescribed using the Flickinger model. Patients were followed up with magnetic resonance angiography (MRA) and digitally subtracted angiography (DSA). Results : The mean nidus volume was 3.65 cc. The mean prescribed maximum dose was 22 Gy and the marginal dose was 19.24 Gy; 12 Gy normal brain volume was 8.39 cc and 12 Gy marginal volume was 5.03 cc. Mean dose to brain stem, pituitary hypothalamic axis, and optic chiasm was 2.5, 0.72, and 0.49 Gy, respectively. At a median follow-up of 22 months (range 1.5-71.2 months), 7 of 10 patients presenting with a neurological deficit showed significant improvement. All 15 patients who underwent MRA 1.5-2 years after SRS had no residual nidus yielding an MRA complete obliteration rate of 100%. Twelve patients also underwent a check DSA, which confirmed obliteration in 11 of them resulting in an accuracy of MRA of 92%. One patient after SRS had transient deterioration of motor power, which resolved completely after a short course of steroids and another had mild worsening of the hemiparesis. All patients are able to lead an active functional life. Conclusions : Careful selection of cases suitable for SRS provides optimum obliteration rates with low toxicity.
  3,846 399 5
Significance and prognostic impact of co-morbidity in head and neck cancer
Rehan Kazi, Chris M Nutting, Peter Rhys-Evans, Kevin J Harrington
July-September 2009, 5(3):145-147
DOI:10.4103/0973-1482.57117  PMID:19841553
  3,431 544 3
Metachronous bilateral testicular germ cell tumors: Report of two cases
Francis V James, Aswin Kumar, PG Jayaprakash, Anitha Mathews
July-September 2009, 5(3):206-207
DOI:10.4103/0973-1482.57128  PMID:19841564
Metachronous bilateral testicular germ cell tumors is a rare known problem. However, no report of metachronus bilateralism was identified in the PubMed database published from India so far, where testicular cancer is relatively rare. We report the cases of two gentlemen. One had stage 1 nonseminomatous germ cell tumor (NSGCT) at the age of 32 in 1990 and developed marker relapse on surveillance and had chemotherapy using cisplatin and etoposide for four cycles. He developed contralateral seminoma in the testis 13 years later. Another patient had left orchidectomy in 2003 for NSGCT, had adjuvant BEP for two cycles, and developed a contralateral testicular tumor 5 years later, which was also seminoma. As more patients with germ cell tumors are cured with chemotherapy, long-term problems become important. Contralateral testicular tumor is one of them. As it can be very late, many years of continued follow-up examination and patients' awareness are necessary.
  3,358 270 3
Oncogenous osteomalacia
Soumitra Ghosh, Ramanuj Sinha, Ranjana Bandyopadhyay, Mainak Malhotra
July-September 2009, 5(3):210-212
DOI:10.4103/0973-1482.57130  PMID:19841566
Oncogenous osteomalacia is a rare paraneoplastic renal phosphaturic condition, often associated with highly vascular benign mesenchymal tumors. We report a case of a 48-year-old male who presented with debilitating osteomalacia unresponsive to standard therapy. Two years later, sinonasal hemangiopericytoma was diagnosed; the patient underwent complete surgical excision with rapid symptomatic improvement.
  3,238 311 4
Turbid serum in a patient of acute lymphoblastic leukemia on treatment-What to look for?
Tejinder Singh, CT Satheesh, DS Madhumathi, Mukul Goyal, LK Rajeev, KC Lakshmaiah, TM Suresh, K Govind Babu
July-September 2009, 5(3):219-220
DOI:10.4103/0973-1482.57133  PMID:19841569
  2,740 253 3
How Doctors Think
Meena Tiwari
July-September 2009, 5(3):221-221
  1,380 213 -