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   2012| July-September  | Volume 8 | Issue 3  
    Online since November 17, 2012

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Value of bone marrow examination in Hodgkin lymphoma: Report of three cases with review of literature
Jyoti R Kini, Pooja K Suresh, Ruchi Sinha, Kausalya Kumari Sahu, Suneet Kumar, Krishna Prasad
July-September 2012, 8(3):457-459
DOI:10.4103/0973-1482.103535  PMID:23174737
Bone marrow involvement by Hodgkin lymphoma is rare with an average incidence of 10%. However, the incidence of bone marrow involvement has been shown to be less than 1% in patients with clinical stage IA or IIA disease. The involvement of the marrow in a patient with Hodgkin lymphoma represents stage IV disease. We report our experience wherein three cases of marrow involvement were picked up on bone marrow aspirates/ -imprints and confirmed on trephine biopsy. In this paper we wish to highlight the significance of bone marrow examination in the initial diagnosis and staging of even clinically early stage Hodgkin lymphoma. Staging investigations performed at the time of diagnosis for patients with Hodgkin lymphoma are vital for determining the appropriate treatment and prognosis.
  11,235 415 -
International Conference on Radiation Biology (ICRB-2012) on Cosmic Radiation to Cancer Therapeutics and 11 th Biennial Meeting of the Indian Society of Radiation Biology

July-September 2012, 8(3):468-506
  10,782 375 -
Repression of death consciousness and the psychedelic trip
Varsha Dutta
July-September 2012, 8(3):336-342
DOI:10.4103/0973-1482.103509  PMID:23174711
Death is our most repressed consciousness, it inheres our condition as the primordial fear. Perhaps it was necessary that this angst be repressed in man or he would be hurled against the dark forces of nature. Modern ethos was built on this edifice, where the 'denial of death' while 'embracing one's symbolic immortality' would be worshipped, so this ideology simply overturned and repressed looking into the morass of the inevitable when it finally announced itself. Once this slowly pieced its way into all of life, 'death' would soon become a terminology in medicine too and assert its position, by giving a push to those directly dealing with the dying to shy away from its emotional and spiritual affliction. The need to put off death and prolong one's life would become ever more urgent. Research using psychedelics on the terminally ill which had begun in the 1950s and 1960s would coerce into another realm and alter the face of medicine; but the aggression with which it forced itself in the 1960s would soon be politically maimed, and what remained would be sporadic outpours that trickled its way from European labs and underground boot camps. Now, with the curtain rising, the question has etched itself again, about the use of psychedelic drugs in medicine, particularly psychedelic psychotherapy with the terminally ill. This study is an attempt to philosophically explore death anxiety from its existential context and how something that is innate in our condition cannot be therapeutically cured. Psychedelic use was immutably linked with ancient cultures and only recently has it seen its scientific revival, from which a scientific culture grew around psychedelic therapy. How much of what was threaded in the ritual and spiritual mores can be extricated and be interpreted in our own mechanized language of medicine is the question that nudges many.
  9,985 515 -
Malignant amelanotic melanoma - A diagnostic surprise: Flurodeoxyglocose positron emission tomography-Computed tomography and immunohistochemistry clinch the 'final diagnosis'
Prathamesh V Joshi, Vikram R Lele, Nusrat J Aland, Ganapathi Bhat, Snigdha Pratap Ajinkya, Roma P Patel
July-September 2012, 8(3):451-453
DOI:10.4103/0973-1482.103533  PMID:23174735
Amelanotic melanoma is a rare malignancy and the prognosis is usually poorer than that of pigmented melanomas, because of delay in establishing the correct diagnosis, and in treatment initiation. In our case report, we present a the Flurodeoxyglocose Positron Emission Tomography-Computed Tomography (FDG PET/CT) findings of a patient suffering from malignant amelanotic melanoma and its histopathological confirmation and immunohistochemistry (IHC) correlation In the described case, amelanotic melanoma masqueraded as adenocarcinoma of the rectum in the pathology as well the clinical course. Our case highlights the importance of obtaining a tissue diagnosis and IHC confirmation whenever unusual PET/CT findings are encountered.
  8,961 273 2
Irradiation-mediated carbon nanotubes' use in cancer therapy
Jin-Gang Yu, Fei-Peng Jiao, Xiao-Qing Chen, Xin-Yu Jiang, Zhi-Guang Peng, Dong-Ming Zeng, Du-Shu Huang
July-September 2012, 8(3):348-354
DOI:10.4103/0973-1482.103511  PMID:23174713
Anticancer drugs such as biological therapeutic proteins and peptides are used for treatment of a variety of tumors. However, their wider use has been hindered by their poor bioavailability and the uncontrollable sites of action in vivo. Cancer nano-therapeutics is rapidly progressing, which is being applied for solving some limitations of conventional drug delivery systems. To improve the bio-distribution of anticancer drugs, carbon nanotubes have been used as one of the most effective drug carriers. This review discusses the carbon nanotubes-mediated methods for the delivery of anticancer drugs, with emphasis on the radiation-induced drug-targeted releasing and selective photo-thermal cancer therapy.
  5,597 407 3
Serum lipid profile in oral cancer and leukoplakia: Correlation with tobacco abuse and histological grading
Priya Kumar, J Augustine, Aadithya B Urs, Shelly Arora, Shalini Gupta, Vikrant R Mohanty
July-September 2012, 8(3):384-388
DOI:10.4103/0973-1482.103517  PMID:23174719
Introduction: Role of alterations in serum lipid profile in oral cancer remains controversial. The present study aimed to evaluate the implications of altered serum lipid profile in patients with oral cancer (OC), oral leukoplakia (OLP), and tobacco habits. Materials and Methods: Thirty patients with OC, 30 with OLP, 30 tobacco abusers (TAs), and 30 age and sex matched healthy controls were included in the study. Serum lipid profile including total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), Very low density lipoprotein (VLDL), and triglycerides (Tg) were evaluated using a fully automatic Biochemistry analyzer. Difference in lipid profile in various types of TA, that is, smokeless tobacco (SLT), smoking tobacco (ST), and a combination (Comb) usage of both forms were also analyzed. Results: TC, HDL, and LDL were much lower in the OC group compared with control. Although these parameters were low in the OPC group compared with controls, the difference was not significant. On histological analysis, TC and HDL were found to decrease marginally with loss of tumor differentiation in OC. No correlation was found between the mean serum lipid profiles and degree of dysplasia in OLP. TC and HDL were significantly lesser in all forms of TA when compared with control. Conclusions: There may be an inverse relationship between serum lipid profile and OC. No significant reduction in lipid profile was observed in the OLP group. This may indicate that hypolipidemia is a late change occurring during carcinogenesis or is an effect rather than the cause of cancer.
  4,561 546 2
Risk factors for malignancy in patients with solitary thyroid nodules and their impact on the management
Jun D Tai, Jin L Yang, Si C Wu, Bin W Wang, Cong J Chang
July-September 2012, 8(3):379-383
DOI:10.4103/0973-1482.103516  PMID:23174718
Background: Presently it is difficult to differentiate malignancy for thyroid nodules by palpation, ultrasonography and fine-needle aspiration cytology (FNAC) at the outpatient department, especially for solitary thyroid nodule (STN). So a great emphasis should be placed on the STN. AIms: The objective of this study was to investigate the predictive clinicopathological risk factors for malignancy in patients with STN and further to provide an appropriate clinical management. Materials and Methods: The records were reviewed from 265 patients with STN who had undergone thyroidectomy in our hospital. All cases were classified as two independent groups in terms of the final pathological results to assess the independent risk factors using a multinomial logistic regression analysis. Results: A multinomial logistic analysis revealed that the male gender, microcalcification and cervical lymphadenopathy were independent risk factors related to malignancy in patients with STN. The incidence of malignancy in patients with 0,1,2,3 risks was 10.71%, 26.6%, 61.43%, and 100%, respectively. Conclusions: Male gender, microcalcification and lymphadenopathy were independent risk factors for predicting the malignancy in patients with STN. Patients with more than two of those risk factors should be subjected to further examination or thyroidectomy. The findings may provide a simple and reasonable management for the STN.
  4,328 399 1
Personalized medicine of esophageal cancer
Lei Wang, Hui-Yi Yang, Yong-Qing Zheng
July-September 2012, 8(3):343-347
DOI:10.4103/0973-1482.103510  PMID:23174712
The fatality rate of esophageal carcinomas is high in developing countries, making effective treatment desirable. Traditional treatment has now entered into the platform, and treatments based on the detection of biomarkers increasingly become a trend. This review presents several biomarkers of esophageal cancer, including chemotherapy-related biomarkers and targeted drug-related biomarkers, and the correlation of these biomarkers with drug response.
  3,911 454 1
Clinical outcomes of reirradiation of brain metastases from small cell lung cancer with Cyberknife stereotactic radiosurgery
Adam C Olson, Rodney E Wegner, Jean Claude M Rwigema, Dwight E Heron, Steven A Burton, Arlan H Mintz
July-September 2012, 8(3):411-416
DOI:10.4103/0973-1482.103522  PMID:23174724
Purpose: To analyze outcomes of reirradiation with stereotactic radiosurgery (SRS) for patients with brain metastases from small cell lung cancer (SCLC). Materials and Methods: We reviewed the clinical outcomes of 27 patients with brain metastases from SCLC treated with CyberKnife® robotic radiosurgery (Accuray Inc., Sunnyvale, CA). Kaplan-Meier analyses were used to estimate local control (LC), intracranial control (IC), and overall survival (OS). The Graded Prognostic Assessment (GPA) prognostic index was determined with a Cox Regression analysis to model predictors of outcome. Results: The median follow-up from SRS was 12 months (2-24 months). Nine patients (32.1%) had Graded Prognostic Assessment (GPA) scores 0-1 and 19 patients (67.9%) had GPA scores 1.5-2.5. 19 patients (70%) received whole brain radiation therapy (WBRT) and 8 patients (30%) received prophylactic cranial irradiation (PCI). The median SRS dose was 20.5 Gy (15-24 Gy) in 1 fraction. Actuarial LC at 6 months and 12 months was 76.5% and 76.5%, respectively. New metastases outside the treated area developed in 60% of assessable patients at a median 3.5 months; 78% received previous WBRT. The median OS was 3 months from SRS with actuarial 6-month and 12-month rates of 25% and 3.6%, respectively. On multivariate analysis no factors were associated with LC, IC, or OS. Conclusions: SRS for reirradiation of brain metastases from SCLC is safe and achieves local tumor control in the majority of patients. Despite SRS, these patients are at high risk of distant brain failure.
  3,860 319 4
Adult primary pleomorphic leiomyosarcoma of forearm with axillary lymph node metastasis: A case report and literature review
Seema Gupta, Nuzhat Husain, Ashish Kumar, Sham Sunder
July-September 2012, 8(3):448-450
DOI:10.4103/0973-1482.103532  PMID:23174734
A rare case of advanced pleomorphic leiomyosarcoma of forearm with axillary lymph node metastasis in a young adult, diagnosed with the aid of immunohistochemistry and electron microscopic examinations together with a review of the literature are reported. The primary tumor involved the extensor and flexor aspect of forearm without bone involvement and metastasized to the axillary lymph nodes. Patient showed poor treatment outcome with adjuvant chemoradiotherapy following incomplete surgery.
  3,895 182 -
Anti-tumor effect of Ardisia crispa hexane fraction on 7, 12-dimethylbenz[α]anthracene-induced mouse skin papillomagenesis
Hamizah Sulaiman, Roslida Abdul Hamid, Yeong Looi Ting, Fezah Othman
July-September 2012, 8(3):404-410
DOI:10.4103/0973-1482.103521  PMID:23174723
Context: Ardisia crispa Thunb. A. DC (Myrsinaceae) or locally known as hen's eyes has been used in local folk medicine as a remedy in various illnesses. Previously, it has been reported to inhibit various inflammatory diseases. However, research done on this plant is still limited. Aims: In the present study, the hexane fraction of the A. crispa root (ACRH) was evaluated on the peri-initiation and promotion phases of skin carcinogenesis. Materials and Methods: This two-stage skin carcinogenesis was induced by a single topical application of 7,12-dimethylbenz(α)anthracene (DMBA) and promoted by repeated treatment with croton oil for 10 weeks in Imprinting Control Region (ICR) mice. Morphological observation would be conducted to measure tumor incidence, tumor burden, and tumor volume. Histological evaluation on the skin tissue would also be done. Results: The carcinogen control group exhibited 66.67% of tumor incidence. Although, in the ACRH-treated groups, at 30 mg/kg, the mice showed only 10% of tumor incidence with a significant reduction (P < 0.05) in the values of tumor burden and tumor volume of 2.00 and 0.52 mm 3 , respectively. Furthermore, the result was significantly lower than that of the carcinogen and curcumin control. At 100 mg/kg, ACRH showed a comparable result to carcinogen control. On the contrary, at 300 mg/kg, ACRH exhibited 100% tumor incidence and showed a significant elevated (P < 0.05) value of tumor burden (3.80) and tumor volume (14.67 ± 2.48 mm 3 ). Conclusions: The present study thus demonstrates that the anti-tumor effect of the chemopreventive potential of ACRH is at a lower dosage (30 mg/kg bwt) in both the initiating and promotion period, yet it exhibits a promoting effect at a higher dosage (300 mg/kg bwt).
  3,638 202 2
Cell cycle analysis of the CD133 + and CD133 - cells isolated from human colorectal cancer
Marjan Gharagozloo, Hamid R Mirzaei, Bahram Bagherpour, Abbas Rezaei, Hamid Kalantari, Mohammad H Sanei, Mohsen Hosseini, Gholamreza Mohajeri, Abbas Tabatabai, Mozaffar Hashemi
July-September 2012, 8(3):399-403
DOI:10.4103/0973-1482.103520  PMID:23174722
Aim: The CD133 antigen has been identified as a putative stem cell marker in colorectal cancer tissues. The aim of this study was to investigate the cell cycle state of CD133 + and CD133 - cells, isolated from primary human colorectal tumors. Materials and Methods: After mechanical and enzymatic dissociation of the tumor samples, CD133 + and CD133 - subsets were identified and separated by magnetic cell sorting. Flow cytometric analysis was performed to compare the cell cycle of both CD133 + and CD133 - cells isolated from primary and liver metastatic cancer cells. Results: The results indicated that CD133 + cells isolated from both primary and liver metastatic colorectal cancers were found in higher percentage in the G0/G1 phases. However, the CD133 - cells isolated from primary colorectal cancers were predominantly found in the S and G2/M phases. Surprisingly, the CD133 - cells isolated from liver metastatic colorectal cancers were mostly found in the G0/G1 phase. Conclusion: The present study provides evidence that CD133 + cells are in a quiescent state in colorectal cancer, representing a mechanism that would at least partially explain chemotherapy resistance and tumor recurrence in post-therapy patients.
  3,532 277 2
Combination of Ononis hirta and Bifidobacterium longum decreases syngeneic mouse mammary tumor burden and enhances immune response
Wamidh H Talib, Adel M Mahasneh
July-September 2012, 8(3):417-423
DOI:10.4103/0973-1482.103523  PMID:23174725
Background: The resistance of solid tumors to conventional therapies has prompted the need for alternative therapies. Aim: To evaluate in vitro and in vivo effect of extracts from Ononis hirta against resistant mouse mammary gland cell line (66 cl-4-GFP) and to use a combination of Ononis hirta extract with Bifidobacterium longum to target resistant solid tumors in mice. Materials and Methods: Different solvent extracts of Ononis hirta were prepared and their in vitro antiproliferative activity was tested against 66 cl-4-GFP cell line using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) were used to identify the active extracts. Balb/C mice were transplanted with 66 cl-4-GFP cell line and in vivo antitumor activity was assessed for the plant extract, Bifidobacterium longum, and a combination of plant extract and Bifidobacterium longum. Histological examination of tumors was performed using standard hematoxylin/eosin staining protocol while gram stain was used to detect the presence of anaerobic bacteria in these sections. Results: A combination of Ononis hirta methanol extract and Bifidobacterium longum showed high ability in targeting solid mammary gland tumors in mice. It also induced extensive necrosis in these tumors. Thirty percent of mice treated with such combination were cured of their cancers. The mechanism underlying this anticancer activity involves immune system activation exemplified by the observed rejection of reinoculated tumors by cured mice. Chemical TLC analysis of the active methanol extract showed the presence of flavonoids, terpenoids, and alkaloids. HPLC analysis confirmed the presence of flavonoids and alkaloids in Ononis hirta methanol extract. Conclusion: The complete regression of the tumor is encouraging and shows that plant extracts in combination with Bifidobacterium longum is an inviting option to treat solid tumors.
  3,390 226 1
Adjuvant pelvic irradiation for cervical cancer in the setting of a transplanted pelvic kidney
Majid M Mohiuddin, Usama Mahmood, Andrea A Hall, Neil Rosenshein
July-September 2012, 8(3):427-429
DOI:10.4103/0973-1482.103525  PMID:23174727
Postoperative radiation therapy is often needed following resection for gynecological cancers. A pelvic kidney, whether ectopic or transplanted, is considered an absolute contraindication for radiation if the organ is left in place. A 45-year-old, immunosuppressed patient with FIGO IB1 cervical adenocarcinoma was treated with intensity-modulated radiation therapy (IMRT) to 45 Gy to the modified whole pelvis with a boost to 59.4 Gy to high-risk areas despite having a transplanted kidney in the right iliac fossa. The irradiation prevented further local failure in the pelvis at 36-month follow-up with no decrement in renal function. Radiation to the modified pelvis using IMRT while avoiding the renal allograft is technically feasible and should be offered to more high-risk patients.
  3,383 183 -
Acute non-ST elevation myocardial infarction following paclitaxel administration for ovarian carcinoma: A case report and review of literature
Kajal Shah, Sudeep Gupta, Jaya Ghosh, Jyoti Bajpai, Amita Maheshwari
July-September 2012, 8(3):442-444
DOI:10.4103/0973-1482.103530  PMID:23174732
We report a case of an acute non-ST elevation myocardial infarction (AMI) induced by paclitaxel in a patient with ovarian cancer. A 45-year-old premenopausal lady without any co-morbidity was started on the first cycle of neoadjuvant chemotherapy with paclitaxel-based regimen for advanced stage ovarian cancer. The patient developed chest pain 3 h after paclitaxel infusion with characteristic electrocardiographic changes of antero-apical myocardial infarction. The patient recovered on conservative medical management with reversion of electrocardiogram (ECG) changes. Cardiac ischemia and myocardial infarction, possibly due to coronary vasospasm, are rare adverse effects of paclitaxel with reported incidence of 0.26%. We have reported a case of paclitaxel-induced myocardial infarction with reversible cardiac dysfunction. The possibility of myocardial infarction should be considered in patients who develop chest pain or other symptoms after paclitaxel infusion.
  3,274 238 2
Clinicoepidemiological analysis of female breast cancer patients in Kashmir
Shaqul Qamar Wani, Talib Khan, Saiful Y Wani, Abid H Koka, Syed Arshad, Liza Rafiq, Lone M Mqabool, Fir Afroz
July-September 2012, 8(3):389-393
DOI:10.4103/0973-1482.103518  PMID:23174720
Aim: The aim of this study was to analyze the demographic features, reproductive history and stage at disease presentation among the female breast cancer patients. Design and Setting: The present prospective hospital-based study was conducted in Department of Radiation Oncology, University Teaching and Tertiary Referral Hospital. Materials and Methods: After approval from the Institute's ethical committee, 132 female breast cancer patients surgically treated either by mastectomy or breast conserving surgery (BCS) and then referred to the department of radiation oncology for further management and/or follow-up as per the hospital protocol, were enrolled in the study (January 2010 to December 2011) after obtaining a written informed consent from the patients. The patients were diagnosed by histology [fine needle aspiration cytology (FNAC), true cut or excision biopsy], mammography and ultrasonography (USG). The patients were analyzed as per the demographic and reproductive history and the stage of disease at presentation. The data collected were expressed as percentage (%), mean, median and standard deviation (SD). Results: The mean age at presentation was 46.6 ± 10.2 years. The majority of patients were from rural areas, married, multiparous and post-menopausal. The commonest stage at disease presentation was IIb. Conclusion: In comparison to the rest of Indian scenario, more awareness related to breast cancer among post-menopausal and the rural females is needed. The role of peri-menopausal status, which represent 10% (n = 14) patients needs to be established in relation to breast cancer.
  3,096 292 -
Methylenetetrahydrofolate reductase gene polymorphisms (677C > T and 1298A > C) in Egyptian patients with non-hodgkin lymphoma
Aml S Nasr, Rania M Sami, Noha Y Ibrahim
July-September 2012, 8(3):355-360
DOI:10.4103/0973-1482.103512  PMID:23174714
Background: Folate metabolism plays an essential role in Deoxyribonucleic acid (DNA) synthesis and methylation processes. Deviations in the flux of the folate may affect the susceptibility to various cancers including lymphoma. Aim: The aim of this study was to investigate the genetic polymorphisms in 5, 10-methylenetetrahydrofolate reductase (MTHFR 677C/T and 1298A/C) and to evaluate its associations with the risk of Non Hodgkin lymphoma. Materials and Methods: The study included 50 patients with diffuse large B cell lymphoma (DLBCL) as well as 50 age matched apparently healthy volunteers (as control). All the subjects included in the study were genotyped for the detection of the MTHFR gene polymorphisms (677C > T and 1298A > C) by using restriction fragment length polymorphism (PCR-RFLP). Results: There were highly statistically significant differences between the 2 groups with respect to results of PCR-RFLP for MTHFR 677C→T polymorphism for CC genotype (P value = 0.001), statistically significant differences for CT (P value = 0.048) and TT (P value = 0.038) genotypes; however, no statistically significant differences regarding CC/CT or TT/CT alleles (P value = 0.052). Also, there were highly statistically significant differences between the patient and control groups with regards to the results of MTHFR1298 A/C polymorphism for the AA, AC genotypes as well as the AA/AC and CC/AC alleles (P value < 0.0001), and statistically significant difference regarding CC genotype (P value 0.0192). Conclusion: In conclusion, this study demonstrated a significant association between the MTHFR polymorphisms and the risk of DLBCL. Thus the study could support that folate intake together with the genetic basis may help in modifying the risk to lymphoma.
  3,136 190 4
Mixed squamous and large-cell carcinoma of the lung: A case study and literature review
Stamatis Katsenos, Iris Karachaliou, Stavros Archondakis
July-September 2012, 8(3):445-447
DOI:10.4103/0973-1482.103531  PMID:23174733
Lung tumors with combined histological pattern are seldom seen exhibiting a more aggressive clinicopathological picture than tumors with a single histology. Herein, we present a 58-year-old male with mixed squamous and large-cell lung carcinoma. The patient was initially diagnosed through fluoroscopy-guided transbronchial lung biopsy with large-cell lung carcinoma of the left upper lobe. He received neo-adjuvant chemotherapy and then underwent left upper lobectomy. Postoperative pathological diagnosis was combined squamous and large-cell neuroendocrine carcinoma. Two months after surgery, restaging revealed brain metastatic deposits. Local radiotherapy was promptly applied with relatively good response and the patient is under observation eight months after diagnosis. A brief review of the current literature is also included with special emphasis on the clinicopathologic aspects and prognosis of lung tumors with mixed histology.
  3,108 188 -
Impact of adjuvant radiation therapy photon energy on quality of life after breast conservation therapy: Linear accelerator versus the cobalt machine
Anusheel Munshi, Debnarayan Dutta, Ashwini Budrukkar, Rakesh Jalali, Rajiv Sarin, Sudeep Gupta, Jaya Ghosh, Jyoti Bajpai, Vani Parmar, Nita Nair, Rajendra Badwe
July-September 2012, 8(3):361-366
DOI:10.4103/0973-1482.103513  PMID:23174715
Background: Breast conservative therapy (BCT) is a standard treatment option in early operable breast cancers (OBC) and a select group of large or locally advanced tumors. The present study deals with prospective evaluation of quality of life (QOL) score in consecutive patients treated with BCT employing adjuvant RT treated with either a cobalt machine or a linear accelerator (LA). Material and Methods: Patients of carcinoma breast who underwent BCT were taken into the study. Patients with larger breasts (inter-field separation >18-20 cm) were treated on LA and those with smaller breasts were treated on cobalt machine. All patients received a uniform RT dose (45-50 Gy/25#/5 weeks) to whole breast followed by tumor bed boost with suitable energy electrons. Prospective evaluation of QOL was done using EORTC QLQ C30 and breast cancer-specific EORTC QLQ BR23. QOL evaluation was done at pre-RT, at half completion of RT treatment (at 20-23 fractions) and at completion of RT. Results: Pre-RT evaluation GQOL scores in patients treated with cobalt and LA were 71.6 and 71.7, respectively (P = 0.8). QLQ C30 functional and symptom domain scores were also similar in the groups. At RT completion, Global quality of life (GQOL) scores were 67.7 in patients treated with cobalt as compared to 77.7 in patients treated with LA (P = 0.75). Physical function domain scores in cobalt and LA patients were 70.8 and 80.3, respectively (P = 0.26). Fatigue score was higher in patients treated with cobalt (39.1 versus 29.7; P = 0.9). However, there was no difference in other functional and symptom domains. There was no significant change in any of the EORTC QLQ C30 domains at RT completion as compared to the pre-RT scores. Conclusion: There is no significant difference in QOL domains between appropriately selected patients treated with cobalt and LA. There are no significant changes in QOL domain scores at RT conclusion as compared to pre-RT baseline in patients treated with cobalt or LA source. A cobalt machine may be effectively used to deliver adjuvant RT in appropriately selected BCT patients especially in developing countries with limited resources.
  2,832 300 1
Metachronous solitary metastasis of papillary thyroid cancer in the cavernous sinus: Case report and review of literature
Mihir N Chandarana, Shridhar Epari, Devendra Chaukar, Aliasgar V Moiyadi
July-September 2012, 8(3):436-438
DOI:10.4103/0973-1482.103528  PMID:23174730
Papillary carcinoma is a well-differentiated type of thyroid carcinoma with very good overall prognosis. The commonest site of metastases is the lymph node, distant metastases being rare. We present a case of a 52-year-old male who presented with a solitary metastasis in the left para-sellar region and cavernous sinus more than three years after treatment of primary. Given the atypical radiological features and longstanding symptoms, a surgical excision was performed and focal radiotherapy was given after confirmation of the diagnosis. We discuss this case and review the relevant literature.
  2,856 169 1
Pericardial effusion and the unsuspected culprit
Boben Thomas, Palaniappan Muthu, Archana Karichala, Pavithran Keechilat
July-September 2012, 8(3):462-463
DOI:10.4103/0973-1482.103538  PMID:23174740
  2,860 124 1
Extra osseous osteosarcoma of the retroperitoneum: An unusual entity
Ranganath Ratnagiri, Vivek Garg, Rashmi Chaturvedi
July-September 2012, 8(3):424-426
DOI:10.4103/0973-1482.103524  PMID:23174726
Extra-osseous osteosarcomas constitute about 1-1.2% of all osteosarcomas. The most common sites are the extremities, thorax, and the abdomen. Retroperitoneal osteosarcomas are rare and very few cases have been reported. They are similar in their biology to high grade soft tissue sarcomas. R0 resection appears to be the best possible treatment for these tumors. All three variants of conventional osteosarcoma-osteoblastic, chondroblastic, and fibroblastic have been described in these tumors. Chemotherapy has been attempted with adriamycin-based regimens with poor results. Unlike extremity osteosarcomas, these tumors have been found to be chemoresistant. The 5 year survival has ranged from a dismal 12% to about 25%. We report a 46-year-old male who presented with a kidney tumor infiltrating the descending colon, but turned out to be an extra osseous osteosarcoma. An R0 resection was done and adjuvant chemotherapy given.
  2,774 165 -
Acrometastasis to hand in vaginal carcinoma: A rare entity
Divya Khosla, Bhavana Rai, Firuza D Patel, Simit Sapkota, Radhika Srinvasan, Suresh C Sharma
July-September 2012, 8(3):430-432
DOI:10.4103/0973-1482.103526  PMID:23174728
Although metastases to bones from solid tumors are very common, involvement of small bones of the hands is extremely rare. We report the first case of acrometastasis in vaginal carcinoma. We present a 65-year-old multiparous woman with FIGO Stage II vaginal carcinoma. The patient received treatment with external beam radiotherapy followed by brachytherapy. She had complete response to above treatment. Eleven months later, she presented with swelling on dorsum of hand. Investigations revealed metastasis to 4th metacarpal bone with lung metastasis. Hence, we present a patient with metastasis of carcinoma vagina to the 4 th metacarpal to draw the attention for the potential of such lesions to be developed in this region. It should be remembered that bone metastasis at unusual sites might be seen in vaginal carcinoma. We present this case because of its rarity and for documentation and discussion.
  2,811 118 3
Epidermal growth factor receptor mutations in female patients with postoperative recurrent non-small-cell lung cancer
Im Il Na, Hye-Ryoun Kim, Jin Kyung Lee, Sun Hoo Park, Cheol Hyeon Kim, Jae Soo Koh, Hee Jong Baek, Du Hwan Choe
July-September 2012, 8(3):373-378
DOI:10.4103/0973-1482.103515  PMID:23174717
Purpose: We did this retrospective study to explore the association between epidermal growth factor receptor (EGFR) mutation and clinical features in postoperative recurrent female non-small-cell lung cancer (NSCLC). Materials and Methods: We reviewed clinical data on 86 female patients who had postoperative recurrent disease between December 1992 and July 2007. The start of tyrosine kinase inhibitor therapy was treated as a censoring event. Corresponding surgical specimens of primary tumors were used to test for EGFR mutations. Results: Thirty patients presented with local recurrence and distant recurrence was identified in 56. Thirty-four of the 86 patients (40%) harbored EGFR mutations. Patients with distant recurrence were more likely to have EGFR mutations than patients with local recurrence (48% versus 23%; P = 0.024). On multivariate analysis, distant recurrence was associated with a high frequency of EGFR mutations (OR, 3.3; P = 0.028). Survival analysis showed poor survival of patients with mutated EGFR (HR, 2.3; P = 0.017) or with non-adenocarcinoma histology (HR, 3.3; P = 0.001). Conclusion: The association between recurrence pattern and EGFR mutation status was suggested in recurrent female NSCLC patients. In addition, our data indicate unfavorable disease process of EGFR mutated tumors. Further studies need to be conducted to validate these findings.
  2,722 205 3
Gemcitabine-induced radiation recall phenomenon in a post-operative and post-radiotherapy case of peri-ampullary carcinoma during adjuvant chemotherapy
Jayanta Biswas, Sumita Dutta, Shyam Sharma, Krishnangshu B Choudhury
July-September 2012, 8(3):439-441
DOI:10.4103/0973-1482.103529  PMID:23174731
Radiation recall phenomenon is an inflammatory process occurring at sites of previous radiation subsequent to administration of pharmacologic agents. The most common chemotherapeutic agents implicated with radiation recall phenomenon are anthracyclines and taxanes. Skin is the most common site for radiation recall. About 63% of the radiation recall events are reported to manifest as dermatitis. This finding differs from radiation recall due to Gemcitabine, in which approximately 70% cases manifested as inflammation of internal organs or tissues and 30% manifested as dermatitis. Here, we report a case of post-operative peri-ampullary carcinoma who developed radiation recall dermatitis during adjuvant chemotherapy with inj. Gemcitabine and inj. Carboplatin after concurrent chemoradiation with capecitabine.
  2,625 170 2
Primary extra-gastrointestinal stromal tumor of the omentum
Jeevan Divakaran, Bal Chander
July-September 2012, 8(3):433-435
DOI:10.4103/0973-1482.103527  PMID:23174729
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors originating from interstitial cells of Cajal or related stem cell-like precursors present in the wall of the gastrointestinal tract. However, identical tumors originating from areas other than the gastrointestinal tract have been reported which are histologically identical to the usual GISTs. We are reporting a case of primary omental GIST in a 57-year-old female.
  2,592 192 -
The effect of rib and lung heterogeneities on the computed dose to lung in Ir-192 High-Dose-Rate breast brachytherapy: Monte Carlo versus a treatment planning system
Hossein Salehi Yazdi, Mojtaba Shamsaei, Ramin Jaberi, Hamid Reza Shabani, Mahmoud Allahverdi, Seyed Ali Vaezzadeh
July-September 2012, 8(3):394-398
DOI:10.4103/0973-1482.103519  PMID:23174721
Aims: This study investigates to what extent the dose received by lungs from a commercially available treatment planning system, Ir-192 high-dose-rate (HDR), in breast brachytherapy, is accurate, with the emphasis on tissue heterogeneities, and taking into account the presence of ribs, in dose delivery to the lung. Materials and Methods: A computed tomography (CT) scan of a breast was acquired and transferred to the 3-D treatment planning system and was also used to construct a patient-equivalent phantom. An implant involving 13 plastic catheters and 383 programmed source dwell positions were simulated, using the Monte Carlo N-Particle eXtended (MCNPX) code. The Monte Carlo calculations were compared with the corresponding commercial treatment planning system (TPS) in the form of percentage isodose and cumulative dose-volume histogram (DVH) in the breast, lungs, and ribs. Results: The comparison of the Monte Carlo results and the TPS calculations showed that a percentage of isodose greater than 75% in the breast, which was located rather close to the implant or away from the breast curvature surface and lung boundary, were in good agreement. TPS calculations overestimated the dose to the lung for lower isodose contours that were lying near the breast surface and the boundary of breast and lung and were relatively away from the implant. Conclusions: Taking into account the ribs and entering the actual data for breasts, ribs, and lungs, revealed an average overestimation of the dose by a factor of 8% in the lung for TPS calculations. Therefore, the accuracy of the TPS results may be limited to regions near the implants where the treatment is planned, and is a more conservative approach for regions at boundaries with curvatures or tissues with a different material than that in the breast.
  2,632 146 -
Influence of smoothing algorithms in Monte Carlo dose calculations of cyberknife treatment plans: A lung phantom study
H Sudahar, PG Gopalakrishna Kurup, V Murali, J Velmurugan
July-September 2012, 8(3):367-372
DOI:10.4103/0973-1482.103514  PMID:23174716
Aim: The Monte Carlo dose calculation algorithm yields accurate dose distributions in heterogeneous media and interfaces. The Monte Carlo calculation algorithm provided in the Multiplan Cyberknife treatment planning system (Accuray, Sunnyvale, CA, USA) has five different dose-smoothing algorithms in it. As the principle of smoothing of these algorithms is different, they can produce a disparity in the final dose distribution. The aim of the present study is to analyze the influence of these Monte Carlo smoothing algorithms in the final dose distribution of cyberknife treatment plans. Materials and Methods: An anthropomorphic lung phantom with a tumor mimicking ball target was taken for this study. The basic optimization was performed with the Ray tracing algorithm. The Monte Carlo calculations were introduced with each smoothing algorithm on the basic plan and the plans were compared. Results: The Monte Carlo doses were found to be lesser than the Ray tracing doses. The dose conformity index was above 4 for all the smoothing algorithms, while it was only 1.19 for Ray tracing. The least coverage of 6.34 was obtained for a weighted average algorithm. The deviation between the V100% values of different smoothing algorithms was higher than the deviation in V80%. Conclusion: The deviations between the smoothing algorithms are higher in the high-dose regions, including the prescribing isodose, than the low-dose regions of the target, as well as in the organs at risk (OAR).
  2,491 182 -
Pitfalls in diagnosing specific subtypes of carcinoma breast on fine needle aspiration cytology: A report of two cases with review of literature
Hemalatha Anantharamaiah, Kalyani Raju, Shruthi Pannayanapalya Suresh, Udaya Kumar Manikyam
July-September 2012, 8(3):454-456
DOI:10.4103/0973-1482.103534  PMID:23174736
Fine needle aspiration cytology (FNAC) is a useful procedure that can be conveniently performed in the outpatient department (OPD) and can be used in the subtyping of breast carcinomas. However, some specific subtypes can cause a hindrance to that. We present two such cases, one of tubulolobular carcinoma breast and the other of squamous cell carcinoma breast that were missed on FNAC, and subsequently diagnosed on histopathology and by immunohistochemistry. A thorough knowledge of the cytological features of the subtypes and the use of immunocytochemistry can appropriately make FNAC a standard, accurate, and simple OPD procedure, thus helping us in arriving at specific diagnosis.
  2,403 181 -
Merkel cell carcinoma of the Auricle: A treacherous skin tumor
Arvind Krishnamurthy, Urmila Majhi
July-September 2012, 8(3):460-461
DOI:10.4103/0973-1482.103537  PMID:23174739
  2,256 125 1
The value of retrospective patient data in oncology
GK Rath
July-September 2012, 8(3):335-335
DOI:10.4103/0973-1482.103508  PMID:23174710
  1,689 340 -
Malignant ectomesenchymoma of paranasal sinuses with proptosis and nodal involvement
Urmila Majhi, Kanchan Murhekar, Shirley Sundersingh, Arvind Krishnamurthy
July-September 2012, 8(3):465-467
DOI:10.4103/0973-1482.103541  PMID:23174743
  1,816 110 -
Somatostatin analog and mTOR inhibitor treatment of Merkel cell tumor
Ladislav Slovacek
July-September 2012, 8(3):460-460
DOI:10.4103/0973-1482.103536  PMID:23174738
  1,704 131 1
Three concerns with regards to the utilization of COX-2 inhibitor (celecoxib) in combination with standard chemoradiotherapy for nasopharyngeal carcinoma
Swaroop Revannasiddaiah, Manoj Gupta, Rajeev Seam, Madhup Rastogi
July-September 2012, 8(3):464-464
DOI:10.4103/0973-1482.103540  PMID:23174742
  1,517 110 1
A vanishing act: The incredible erlotinib
Shitij Arora, Harinder Sawhney
July-September 2012, 8(3):464-464
DOI:10.4103/0973-1482.103539  PMID:23174741
  1,477 118 -