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   2017| April-June  | Volume 13 | Issue 2  
    Online since June 23, 2017

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Differential diagnoses of elevated lesions of the upper lip: An overview
Gowri Pandarinath Bhandarkar, Kushal Vasanth Shetty
April-June 2017, 13(2):170-174
DOI:10.4103/0973-1482.204890  PMID:28643729
This paper comes with a purpose to help the clinician as how to arrive at a logical differential diagnosis when an upper lip mass is encountered in day-to-day practice. The labial mucosa is commonly traumatized. One must be aware of the type of structures contained in the mucosa of the area of a lesion as well as the patients habits since they may relate to a lesion presented for diagnosis. It also helps them to procure a sound knowledge of the lesions by describing the lesions according to their clinical appearance and to aid the clinician in arriving at a differential diagnosis by considering that certain lesions have a predilection for the upper lip. All clinically similar appearing lesions are discussed according to their relative frequency of occurrence. This paper covers only a minority of plethora of elevated lesions that may appear on the upper lip since almost any soft tissue lesion or neoplasm (benign and malignant) may occur here.
  37,341 742 -
Cardiotoxic effects of radiotherapy and strategies to reduce them in patients with breast cancer: An overview
Katarzyna Rygiel
April-June 2017, 13(2):186-192
DOI:10.4103/0973-1482.187303  PMID:28643731
Cardiotoxicity of various anticancer therapies, including radiotherapy (RT), can lead to cardiovascular (CV) complications, and their severity depends on many factors, including the site of action, the applied dose, the method of administration, the presence of pre-existing CV diseases, or CV risk factors, the individual patient characteristics, and the current or previous use of antineoplastic therapies. Cardiotoxicity can occur immediately upon administration of the anticancer therapy or it may have a delayed onset (months or years after the treatment). For an oncology treatment team, it is essential that the patients with cancer are in their best cardiac condition before they initiate anticancer therapy, during remission, and after its termination, and thus, a collaboration with cardiologists is of utmost importance. This article reviews cardiotoxicity associated with RT, focusing on patients with breast cancer. In addition, it outlines the main management strategies to assess, monitor, reduce, or possibly prevent RT-induced cardiotoxicity, based on the current research evidence. Medline literature review relating to this subject was performed, using the electronic search for the keywords “radiotherapy” and “cardiotoxicity” on PubMed for inclusion of the previous publications, and further search of reference articles on the detection and management of radiation-related heart disease in patients with breast cancer was conducted.
  8,632 579 -
An overview on small-field dosimetry in photon beam radiotherapy: Developments and challenges
Hamed Bagheri, Azadeh Soleimani, Nahideh Gharehaghaji, Asghar Mesbahi, Farhad Manouchehri, Babak Shekarchi, Banafsheh Dormanesh, Habib Alah Dadgar
April-June 2017, 13(2):175-185
DOI:10.4103/0973-1482.199444  PMID:28643730
Small fields are more repeatedly used for radiation therapy as small segments in intensity-modulated radiotherapy or as in the form of independent fields in stereotactic radiosurgery and other novel equipment such as cyberknife and tomotherapy. Nevertheless, the application of small fields for radiotherapy of lung makes the dose calculation and planning inaccurate due to the existence of electronic disequilibrium and intrinsic deficiencies within most of the analytical dose calculation algorithms. The current review attempts to gather the information in this regard and focuses on the current progresses and retaining issues associated with this type of photon beams.
  8,420 549 -
Thrombocytosis in gynecological cancers
Deepti Sharma, Garima Singh
April-June 2017, 13(2):193-197
DOI:10.4103/0973-1482.189234  PMID:28643732
Thrombocytosis has been suggested to be a poor prognostic indicator in malignancies. Studies have shown that thrombocytosis is associated with a poor prognosis in various gynecological malignancies such as carcinoma ovary, cervical cancer, and endometrial cancer. The aim of this study is to analyze the impact of thrombocytosis on the prognosis of gynecological cancer. All the relevant data were retrieved by PubMed, MEDLINE, and Web of Science, and then studies were chosen in this analysis of association between thrombocytosis and gynecological malignancy. Thrombocytosis is common in advanced disease in patients with ovarian cancer, endometrial cancer, and cervical cancer. Therefore, it may be a marker of tumor burden or biologically more aggressive disease. Thrombocytosis is bad prognostic factor and associated with poorer outcomes.
  7,350 225 -
Awareness of cervical cancer and willingness to participate in screening program: Public health policy implications
Somdatta Patra, Madhu Upadhyay, Pragti Chhabra
April-June 2017, 13(2):318-323
DOI:10.4103/0973-1482.187279  PMID:28643754
Background: Cervical cancer is one of the most common malignancies among women in India. There is a high mortality as patients usually present at an advanced stage because of lack of awareness and nonexistent screening programs. Aim: This study was planned to find out awareness about cervical cancer among women and their willingness to utilize screening services in an urban resettlement colony of Delhi, India. Settings and Design: A community-based, cross-sectional study was carried out in a resettlement colony of North-West Delhi. Materials and Methods: Semi-structured interview schedule was used to collect information regarding different aspects of cervical cancer. Analysis was done using SPSS package (SPSS version 16 (UCMS and GTBH, Delhi, India)). Results: A total of 373 women were included in the study. Mean age of study participants was 39.14 years. Two-third of the study population were illiterate. Half of the study population was aware of cervical cancer, and only one-fourth of population were willing to participate in a screening test. Willingness was higher among educated, ever user of family planning method and having knowledge about at least one risk factor, signs or symptoms, or possibility of early diagnosis of cancer cervix. Conclusions: The country's national program advocates for opportunistic and targeted screening of women. An understanding of the factors that influences womens' willingness to participate in screening program is essential for the success of such programs. Hence, this study emphasizes the need for dissemination of knowledge about various aspects of cancer cervix which is critical for uptake of any screening program in a developing country.
  6,294 460 -
Clear cell odontogenic carcinoma: A rare case report with emphasis on differential diagnosis
Uma Vasant Datar, Mamata Sharad Kamat, Sampada Shriram Kanitkar, Sanjay Satappa Byakodi
April-June 2017, 13(2):374-377
DOI:10.4103/0973-1482.187381  PMID:28643764
Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic malignancy with a female predilection, typically presenting as swelling in anterior region of mandible. CCOC was classified as a malignant neoplasm of odontogenic origin by the WHO in 2005 as it exhibits an aggressive growth pattern, local recurrence, and tendency of distant metastasis. Histologically, CCOC is characterized by sheets and islands of vacuolated/clear cells. Since clear cells are present in few odontogenic tumors, salivary gland neoplasms, and metastatic tumors to the jaws; presence of clear cells in a lesion of head and neck area poses a diagnostic challenge. Knowledge about the clinical course, histopathologic pattern, and immunoprofile of CCOC aids in differentiating it from other clear cell tumors. Herein, we present a case of CCOC in anterior mandibular region of 60-year-old female patient with an emphasis on its differential diagnosis from other clear cell lesions of the jaws.
  6,045 378 -
Oral cryotherapy for preventing chemotherapy-induced oral mucositis: An effective but yet neglected strategy
Hassan Sharifi, Abbas Heydari, Roham Salek, Amir Emami Zeydi
April-June 2017, 13(2):386-387
DOI:10.4103/0973-1482.188301  PMID:28643769
  5,865 363 -
Breast cancer screening practices amongst female tertiary health worker in Nnewi
Chimezie Innocent Madubogwu, Amobi Ochonma Egwuonwu, Ngozi Ukamaka Madubogwu, Ifeoma A Njelita
April-June 2017, 13(2):268-275
DOI:10.4103/0973-1482.188433  PMID:28643746
Background: Breast cancer in Nigeria and other developing countries is characterized by late presentation and poor outcome due to ignorance, superstition, self-denial, fear of mastectomy, and unavailability of treatment facilities. The mortality of breast cancer in Western world is decreasing due to early detection and better management. Objective: This study aims at accessing the knowledge, attitude, and practice of breast cancer screening among female tertiary health workers. Materials and Methods: A cross-sectional descriptive study carried out using a structured, pretested, self-administered questionnaire to assess the knowledge, attitudes, and practice of breast cancer and screening methods among female health workers. Results: The mean age of respondents was 31.70 ± 7.62 years. The level of awareness of breast cancer screening methods was high: 158 (98.75%), 127 (79.4%), and 144 (90.0%) for breast self-examination (BSE), clinical breast examination (CBE), and mammography, respectively. However, only 47 (35.9%), 36 (22.5%), and 3 (1.9%) correctly practiced BSE, CBE, and mammography, respectively. The level of education and occupation showed significant correlations with the knowledge and practice of breast cancer screening methods. Conclusion: Breast cancer screening still needs to be promoted to improve the attitude and practice among both health workers and general population.
  5,419 641 -
Treatment of high-risk neuroblastoma: National protocol results of the Turkish Pediatric Oncology Group
Serap Aksoylar, Ali Varan, Canan Vergin, Volkan Hazar, Ferhan Akici, Ayhan Dagdemir, Mustafa Buyukavci, Rejin Kebudi, Nilgun Kurucu, Betul Sevinir, Emel Unal, Sema Vural, Elif Guler, Hilmi Apak, Haldun Oniz, Ceyda Karadeniz, Cengiz Canpolat, Sema Anak, Inci Ilhan, Dilek Ince, Emre Cecen, Nur Olgun
April-June 2017, 13(2):284-290
DOI:10.4103/0973-1482.183205  PMID:28643749
Background: The national protocol aimed to improve the outcome of the high risk neuroblastoma patients by high-dose chemotherapy and stem cell rescue with intensive multimodal therapy. Materials and Methods: After the 6 induction chemotherapy cycles, patients without disease progression were nonrandomly (by physicians' and/or parent's choices) allocated into two treatment arms, which were designed to continue the conventional chemotherapy (CCT), or myeloablative therapy with autologous stem cell rescue (ASCR). Results: Fifty-six percent (272 patients) of patients was evaluated as high risk. Response rate to induction chemotherapy was 71%. Overall event-free survival (EFS) and overall survival (OS) at 5 years were 28% and 36%, respectively. “As treated” analysis documented postinduction EFS of 41% in CCT arm (n = 138) and 29% in ASCR group (n = 47) (P = 0.042); whereas, OS was 45% and 39%, respectively (P = 0.05). Thirty-one patients (11%) died of treatment-related complications. Conclusion: Survival rates of high-risk neuroblastoma have improved in Turkey. Myeloablative chemotherapy with ASCR has not augmented the therapeutic end point in our country's circumstances. The adequate supportive care and the higher patients' compliance are attained, the better survival rates might be obtained in high-risk neuroblastoma patients received myeloablative chemotherapy and ASCR.
  5,267 356 -
Regulation of various DNA repair pathways by E3 ubiquitin ligases
Chandramouli Natarajan, Kenichi Takeda
April-June 2017, 13(2):157-169
DOI:10.4103/0973-1482.204879  PMID:28643728
DNA repair is the most important mechanism to maintain the normal cellular homeostasis. Owing to its complicated network, series of posttranslation modifications is required for proper function of the DNA repair proteins. One of such important posttranslation modifications is ubiquitination (attachment of ubiquitin). E3 ubiquitin ligases (UBLs) are a group of proteins that transfer ubiquitin from E2 conjugating enzymes to highly specific substrates such as DNA repair proteins. In this review, we have updated the role of different E3 UBL and how it regulates different DNA repair pathways.
  5,202 195 -
Bowen's disease: Two case reports of a giant and dwarf lesions
Sundar Nagakeerthana, Gurumoorthy Rajesh, Sankar Madhavi, Kaliaperumal Karthikeyan
April-June 2017, 13(2):371-373
DOI:10.4103/0973-1482.187237  PMID:28643763
Bowen's disease is a form of intraepidermal squamous cell carcinoma (SCC). It usually presents as a well-demarcated, slow growing erythematous patch, or plaque with a scaly or crusted surface. The size of the tumor varies from a few millimeters to several centimeters. The risk of progression into an invasive carcinoma is 3–5% in extragenital lesions and about 10% in genital lesions. We present two cases of Bowen's disease where the pattern, size, and perception of the disease between the patients varied. The two cases demonstrated two varying spectrum of the disease, one being a giant lesion and other a dwarf. One patient was more concerned about the lesion, whereas the other patient neglected the lesions, though widespread. High index of suspicion is required to diagnose such atypical presentations of Bowen's disease. As Bowen's disease has tendency to progress to SCC, it should be diagnosed and treated as early as possible.
  4,717 171 -
Dosimetric characterization of optically stimulated luminescence dosimeter with therapeutic photon beams for use in clinical radiotherapy measurements
Retna Ponmalar, Ravikumar Manickam, KM Ganesh, Sathiyan Saminathan, Arun Raman, Henry Finlay Godson
April-June 2017, 13(2):304-312
DOI:10.4103/0973-1482.199432  PMID:28643752
Aim: The modern radiotherapy techniques impose new challenges for dosimetry systems with high precision and accuracy in in vivo and in phantom dosimetric measurements. The knowledge of the basic characterization of a dosimetric system before patient dose verification is crucial. This incites the investigation of the potential use of nanoDot optically stimulated luminescence dosimeter (OSLD) for application in radiotherapy with therapeutic photon beams. Materials and Methods: Measurements were carried out with nanoDot OSLDs to evaluate the dosimetric characteristics such as dose linearity, dependency on field size, dose rate, energy and source-to-surface distance (SSD), reproducibility, fading effect, reader stability, and signal depletion per read out with cobalt-60 (60 Co) beam, 6 and 18 MV therapeutic photon beams. The data acquired with OSLDs were validated with ionization chamber data where applicable. Results: Good dose linearity was observed for doses up to 300 cGy and above which supralinear behavior. The standard uncertainty with field size observed was 1.10% ± 0.4%, 1.09% ± 0.34%, and 1.2% ± 0.26% for 6 MV, 18 MV, and 60 Co beam, respectively. The maximum difference with dose rate was 1.3% ± 0.4% for 6 MV and 1.4% ± 0.4% for 18 MV photon beams. The largest variation in SSD was 1.5% ± 1.2% for 60 Co, 1.5% ± 0.9% for 6 MV, and 1.5% ± 1.3% for 18 MV photon beams. The energy dependence of OSL response at 18 MV and 60 Co with 6 MV beam was 1.5% ± 0.7% and 1.7% ± 0.6%, respectively. In addition, good reproducibility, stability after the decay of transient signal, and predictable fading were observed. Conclusion: The results obtained in this study indicate the efficacy and suitability of nanoDot OSLD for dosimetric measurements in clinical radiotherapy.
  3,997 287 -
In vitro activity of probiotic Lactobacillus reuteri against gastric cancer progression by downregulation of urokinase plasminogen activator/urokinase plasminogen activator receptor gene expression
Bahareh Sadat Rasouli, Ali Ghadimi-Darsajini, Reza Nekouian, Gholam-Reza Iragian
April-June 2017, 13(2):246-251
DOI:10.4103/0973-1482.204897  PMID:28643742
Background: Gastric cancer (GC) is the third leading cause of cancer death, and most patients represent metastatic phenotype at the time of diagnosis. Urokinase plasminogen activator (uPA) system is well known for its critical roles in cancer cells invasion since uPA/uPA receptor (uPAR) overexpresses in several cancers. Subsequently, suppression of uPA/uPAR gene expression improves patients overall survival and prevents cancer progression. Objectives: The aim of the current study was to investigate possible effects of live Lactobacillus reuteri as a probiotic in inhibition of GC cells proliferation and invasion. Materials and Methods: Human gastric adenocarcinoma epithelial cell line (AGS) cells were treated with different ratios of live L. reuteri and were incubated for 24, 48, and 72 h. Viability of cancer cells was measured with 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide assay, and the effects of L. reuteri on uPA/uPAR gene expression were assessed by real-time polymerase chain reaction. Results: Our results showed that L. reuteri inhibits cell proliferation significantly in dose-dependent manner. Expressions of uPA and uPAR were downregulated followed by co-incubation of AGS cells and live L. reuteri compared to untreated-based line level. Conclusion: This study provides strong support in the role of L. reuteri in suppression of GC cell invasion by downregulation of pathways which is involved in extracellular matrix degradation such as uPA and uPAR.
  3,932 249 -
Diagnostic efficacy of free prostate-specific antigen/total prostate-specific antigen ratio for the diagnosis of prostate cancer in low concentration (≤4 ng/ml) and intermediate levels of total prostate-specific antigen (4.01–10.0 ng/ml)
Selahattin Caliskan
April-June 2017, 13(2):279-283
DOI:10.4103/0973-1482.183177  PMID:28643748
Aim of Study: Serum prostate-specific antigen (PSA) is a useful tumor biomarker for prostate cancer (PCa) diagnosis. In this study, I aimed to compare the free/total PSA (fPSA%) with PSA alone for their usefulness in diagnosis for PCa. Methods: The patients who underwent prostate biopsy between January 2010 and January 2015 were evaluated retrospectively. Data were expressed as a mean + standard error and P < 0.05 as considered with statistical significance (Med Calc 14.12–2014). The receiver operating characteristic curves were calculated to study the sensitivity and specificity of fPSA and PSA and compared to each other in different PSA levels. Results: There were 1055 patients in the study. The mean age of the patients was 64.2 + 7.5 and 66.3 + 6.4 years in Groups 1 and 2. The mean PSA and free/total PSA of the patients was 2.79 + 1 ng/ml, 0.2 + 0.08 and 6.49 + 1.59 ng/ml and 0.19 + 0.09 in Groups 1 and 2, respectively. I found the optimal cutoff for fPSA% was ≤18 and ≤14 in Groups 1 and 2 with a sensitivity of 62–45% and specificity of 58–79%. There was a statistical significant difference for fPSA when comparing the area under curve in the PSA level of 4.01–10 ng/ml (P = 0.0009). Conclusion: In this study, serum fPSA% has advantages for diagnosis of PCa when comparing PSA alone in different levels of PSA. These advantages are significant in PSA level of 4.01–10 ng/ml.
  3,819 142 -
A prospective randomized controlled study of cisplatin versus carboplatin-based regimen in advanced squamous nonsmall cell lung cancer
Amr Shafik Saad, Ramy R Ghali, May Ahmed Shawki
April-June 2017, 13(2):198-203
DOI:10.4103/0973-1482.187287  PMID:28643733
Background: The use of cisplatin (Cis) versus carboplatin (Carb) in the treatment of advanced nonsmall cell lung cancer (NSCLC) is controversial. The aim of the study was to compare the safety and efficacy of Cis versus Carb in squamous NSCLC. Patients and Methods: A prospective, randomized, controlled, open-label study was conducted on advanced squamous NSCLC patients who were randomly assigned to receive Cis (40 mg/m 2 [day 1 and day 8]) or Carb (area under the curve = 5 [day 1]) combined with gemcitabine [Gem] (1000 mg/m 2 [day 1 and day 8]) of a 3-week schedule for six cycles. Study objectives were a radiological response after three cycles and six cycles, 1-year progression-free survival (PFS), 1-year overall survival (OS), and quality of life (QOL) assessment using functional assessment of cancer therapy-lung at baseline, after three cycles, and after six cycles. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Science version 15. A P < 0.05 was considered statistically significant. Results: Seventy-one patients were enrolled (Gem/Cis group [n = 36], Gem/Carb group [n = 35]). Response rates were comparable in both arms. Nonsignificant differences were found regarding 1-year PFS (P = 0.308) and 1-year OS (P = 0.929) between the two groups. Neutropenia was significantly higher in Gem/Carb group, while vomiting and ototoxicity were significantly higher in Gem/Cis group. The effect on QOL was similar in both groups. Conclusion: Cis and Carb have similar efficacy, tolerability, and effect on QOL and both can be used as a first-line treatment of squamous NSCLC.
  3,783 164 -
Is neuroglial antigen 2 a potential contributor to cilengitide response in glioblastoma?
Hatice Sevim Nalkiran, Kerrie Leanne McDonald
April-June 2017, 13(2):329-336
DOI:10.4103/0973-1482.188438  PMID:28643756
Background: Determining the expression levels of neuroglial antigen 2 (NG2) in glioma cell lines and to evaluate the potential contribution of NG2 to cilengitide response were aimed. Materials and Methods: Endogenous expression level of NG2 was determined using quantitative reverse transcription polymerase chain reaction and immunoblotting. Cilengitide responses of the cells were monitored to determine half maximal inhibitory concentration values. Whether the suppression of NG2 expression alters the response of A172 cells to cilengitide was examined. Results: The effect of cilengitide on inducing apoptosis of the cells was determined by TUNEL staining. High mRNA and protein expression of NG2 was detected in A172 and U-87MG cells, while T98G, M059K and M059J cells demonstrated low levels of NG2. A172, U-87MG and positive control MG-63 were relatively sensitive to cilengitide compared to T98G, M059K and M059J. MG-63, A172 and U-87MG were unexpectedly found to be more susceptible to cilengitide. In addition, NG2 knock-down showed no significant difference in cell death between small interfering RNA (siRNA)-transfected and cilengitide-treated groups. The results showed that cilengitide caused detachment and subsequently initiated apoptosis. Glioma cell lines express variable levels of NG2 and differ in their responses to cilengitide. Although increased numbers of apoptotic cells were found in untransfected cells compared to siRNA-transfected cells upon exposed to cilengitide, the difference was not documented to be significant between two groups. Conclusion: It may be proposed that the combination therapy of NG2 suppression and cilengitide treatment showed no considerable effect on glioblastoma compared to cilengitide therapy alone. Response to therapy may be further improved by targeting other factors act in concert in this signaling pathway.
  3,849 79 -
Dual association of serum interleukin-10 levels with colorectal cancer
Shabnam Abtahi, Forogh Davani, Zahra Mojtahedi, Seyed Vahid Hosseini, Alimohammad Bananzadeh, Abbas Ghaderi
April-June 2017, 13(2):252-256
DOI:10.4103/0973-1482.199448  PMID:28643743
Background: Interleukin 10 (IL-10) is considered an immune modulator cytokine, showing both antitumor and pro-tumor characteristics. Its role in the pathogenesis and progression of colorectal cancer depends on microenvironmental milieu. Materials and Methods: A case–control study with 58 newly diagnosed colorectal cancer (CRC) patients, and 30 healthy individuals was conducted to compare the serum IL-10 levels between patients and controls. Furthermore, the correlation of the cytokine levels with the pathological features and prognosis of the CRC was investigated. IL-10 levels in the sera of patients and controls were measured by Enzyme-linked immunosorbent assay. Results: Mean serum IL-10 levels were significantly lower in CRC patients than in controls (P = 0.04). CRC patients with worse prognosis at the time of diagnosis tend to have higher levels of circulating IL-10 than those with better prognosis (P = 0.008). Receiver operating characteristics curve analysis demonstrated that IL-10 levels in the sera of CRC patients can be used as a prognostic biomarker in CRC patients (area under the curve = 0.71; P = 0.01). Conclusions: Our results demonstrated a dual association of serum IL-10 levels in the initiation and progression of CRC. While lower IL-10 levels were associated with higher risk of the disease, its higher levels were associated with a poorer prognosis.
  3,616 187 -
Patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city: A comparative study
Mohammed Junaid, Kalaiarasi Periyanan, Anil Raj, PD Madan Kumar
April-June 2017, 13(2):230-234
DOI:10.4103/0973-1482.184519  PMID:28643739
Objective: To determine the patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions through a comparative study design. Methods: The study was carried out in a span of 2 months on a sample of 120 subjects; 60 in case group (30 subjects with leukoplakia and oral submucous fibrosis [OSMF], respectively) and 60 subjects in control group (30 current smokers and current chewers, respectively), attending the tobacco cessation clinic at a private dental college hospital in Chennai city. Demographic data, details of tobacco usage, and Fagerstrom nicotine dependence scores (FNTD) were recorded in a prevalidated tobacco cessation intake form. Results: Cases with leukoplakia had a higher mean FNTD score when compared to the control group (P = 0.0001). The most common form of smokeless tobacco used by case (OSMF) subjects was found to be mawa (53%) significantly higher than the control group (P = 0.05). Mean FNTD scores of mawa users were higher than other tobacco users in both case and control group. Conclusion: The current study has hence put forth the role of mawa form of tobacco in causation of OSMF at a time when implementation of tougher anti-tobacco laws is the talk of the town.
  3,603 180 -
The effects of gene therapy with granulocyte-macrophage colony-stimulating factor in the regression of tumor masses in fibrosarcoma mouse model
Saiedeh RaziSoofiyani, Tohid Kazemi, Farzaneh Lotfipour, Leila Mohammadnejad, Somayeh Hallaj-Nezhadi, Siamak Sandoghchian Shotorbani, Akbar Mohammad Hosseini, Behzad Baradaran
April-June 2017, 13(2):362-366
DOI:10.4103/0973-1482.159083  PMID:28643761
Introduction: Cytokine gene therapy is one of the cancer treatment strategies. Recently, granulocyte-monocyte colony-stimulating factor (GM-CSF), as an important cytokine in activating dendritic cells and boosting the anti-tumor immune responses, has been utilized as an immunotherapeutic agent in cancer gene therapy. The purpose of the present investigation was to study the GM-CSF gene therapy effects in regression of tumor masses in fibrosarcoma mouse model. Materials and Methods: To investigate the therapeutic efficacy of GM-CSF, WEHI-164 tumor cells were transfected with murine GM-CSF plasmid. For cytokine production by transfected cells, enzyme-linked immunosorbent assay test was used. Fibrosarcoma mouse model established with transfected cells which were injected subcutaneously into Balb/c mice. Tumor sizes were measured by caliper. Mice were sacrificed and the tumors were extracted. The expression of GM-CSF was studied by real-time polymerase chain reaction (PCR) and immunoblotting. The expression of Ki-67 (a tumor proliferative marker) in tumor masses was studied by immunohistochemical staining. Results: The group treated with GM-CSF indicated a decrease in tumor mass volume (P = 0.001). The results of western blotting and real-time PCR showed that GM-CSF expression increased in the group treated with GM-CSF (with a relative expression of 1.36). Immunohistochemical staining showed that Ki-67 expression has reduced in the group treated with GM-CSF. Conclusion: Monotherapy with GM-CSF has therapeutic effects on the regression of tumor masses in the fibrosarcoma mouse model.
  3,523 129 -
Prognostic and predictive markers of response to treatment in patients with locally advanced unresectable and metastatic pancreatic adenocarcinoma treated with gemcitabine/nab-paclitaxel: Results of a retrospective analysis
Ana Fernández Montes, Paula González Villarroel, Manuel Valladares Ayerbes, Juan De la Cámara Gómez, Guillermo Quintero Aldana, Lidia Vázquez Tuñas, Mercedes Salgado Fernández, Mónica Jorge Fernández
April-June 2017, 13(2):240-245
DOI:10.4103/0973-1482.181181  PMID:28643741
Background: Recent studies support the use of gemcitabine and nab-paclitaxel in adults with locally advanced unresectable or metastatic pancreatic adenocarcinoma although insufficient data are available on prognostic and predictive markers of response to treatment. Objective: The objective of this study is to identify treatment response markers in patients with locally advanced unresectable or metastatic pancreatic adenocarcinoma. Materials and Methods: This is an observational, retrospective, and multicenter study. Sociodemographic, clinical, and therapeutic data were collected. Cox regression models were applied to determine associations. Results: In total, 39 patients were included; 23.1% presented locally advanced pancreatic cancer and 76.9% metastatic disease. They received a mean of 6 ± 3 treatment cycles; 59% required dose reduction, 59% treatment delay, and 20.5% switched to a biweekly regimen. The overall response rate was 23% and the disease control rate was 81%. Median progression-free survival was 9 months and median overall survival (OS) was 15 months. A higher neutrophil/lymphocyte ratio (NLR) was significantly associated with lower OS. We reported Grades 1–4 nonhematological and hematological toxicities. Conclusion: NLR is a useful prognostic factor for OS in patients with locally advanced unresectable or metastatic pancreatic adenocarcinoma treated with gemcitabine and nab-paclitaxel. Moreover, we suggest that a biweekly regimen is an option for certain groups of patients.
  3,488 131 -
Evaluation of clinical process in osteosarcoma patients treated with chemotherapy including cisplatin, adriamycin, ifosfamide, and etoposide and determination of the treatment sequels in a long-term 11-year follow-up
Mozaffar Aznab, Maryam Hematti
April-June 2017, 13(2):291-296
DOI:10.4103/0973-1482.199447  PMID:28643750
Aim: The aim of this study was to evaluate the effect of adding etoposide and ifosfamide chemotherapy drugs to treatment regimen of patients affected with osteosarcoma and to determine the clinical process and response to treatment during a follow-up period of 11 years. Materials and Methods: Forty patients with osteosarcoma participated in this study from July 2005 to 2016. Treatments were started based on the following schema and after initial examinations including biochemical profile, checking for lung metastasis by simple radiography, chest computed tomography scan, and bones scan. The initial chemotherapy which consisted of four cycles of cisplatin and adriamycin alternative with ifosfamide and etoposide was provided. Afterward, resection of the primary tumor and also the metastatic lesions was performed in patients with lung metastasis in case they had radiological evidence of response to the treatment. Results: The mean of follow-up duration in this study was 50 months. Thirty-four patients did not have metastasis and six were metastatic. Of 34 patients, 18 had relapse and 16 patients never had relapse. Five patients experienced only local relapse, nine had only systemic relapse, and two patients had simultaneous systemic and local relapses. Thirteen patients had died. The mean of overall survival in patients was 81 months. The mean of survival in patients with and without primary metastasis was 30 and 90 months, respectively. Conclusion: Favorable response to the treatment was obtained with an appropriate multiple disciplinary works in the osteosarcomas of extremities, and there were no considerable side effects and sequels in the long-term follow-up of these treatments.
  3,256 161 -
Modeling of lung cancer risk due to radon exhalation of granite stone in dwelling houses
Akbar Abbasi
April-June 2017, 13(2):208-212
DOI:10.4103/0973-1482.204851  PMID:28643735
Aims: Due to increasing occurrences of lung cancer, radon exhalation rates, radon concentrations, and lung cancer risks in several types of commonly used granite stone, samples used for flooring in buildings, have been investigated. Subjects and Methods: We measured the radon exhalation rates due to granite stones by means of an AlphaGUARD Model PQ2000 in a cube container with changeable floor by various granite stones. The lung cancer risk and percentage of lung cancer deaths (LCRn) due to those conditions were calculated using Darby's model. Results: The radon exhalation rates ranged from 1.59 ± 0.41 to 9.43 ± 0.74 Bq/m 2/h. The radon concentrations in the standard room with poor and normal ventilation were calculated 20.10–71.09 Bq/m 3 and 16.12–47.01 Bq/m 3, respectively. Conclusions: The estimated numbers of lung cancer deaths attributable to indoor radon due to granite stones in 2013 were 145 (3.33%) and 103 (2.37%) for poor and normal ventilation systems, respectively. According to our estimations, the values of 3.33% and 2.37% of lung cancer deaths in 2013 are attributed to radon exhalation of granite stones with poor and normal ventilation systems, respectively.
  3,134 120 -
Quick, efficient and effective patient-specific intensity-modulated radiation therapy quality assurance using log file and electronic portal imaging device
Rajesh Kumar, HI Amols, M Lovelock, SD Sharma, D Datta
April-June 2017, 13(2):297-303
DOI:10.4103/jcrt.JCRT_1045_16  PMID:28643751
Aim: The aim of work is to explore a quick, efficient, and effective patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA). Materials and Methods: Software tools were developed to extract and analyze the multi-leaf collimator (MLC) leaf positions (LPs) from electronic portal imaging device (EPID) images for Varian C-series machine and TrueBeam, to extract useful data from MLC log file of C-series linear accelerator (LINAC), to extract useful information from the trajectory log binary file of TrueBeam LINAC, to compare LPs derived from EPID images with log file/trajectory log data, and to analyze IMRT treatment files using the MATLAB programming language. The difference in LP determined from the trajectory log and EPID images was proposed for patient-specific QA. Results: It was found that the differences in LP for regular radiation fields generated using stationary leaves are <0.5 mm for all the field sizes while for regular radiation fields generated using the moving leaves are more but <2 mm. The differences in LPs for IMRT field were also determined and found to be <2 mm. Conclusions: The methodology demonstrated can be used for establishing the accuracy of trajectory log data and for independent routine IMRT QA by generating single number like gamma index to indicate pass or fail of an IMRT treatment plan. The QA indices such as numbers of occurrences of ≥2 mm error in LPS are found more than 5% of total number of occurrences; the dosimetric review of planned treatment is advisable.
  3,019 143 -
Dosimetric characteristic of physical wedge versus enhanced dynamic wedge based on Monte Carlo simulations
Seied Rabie Mahdavi, Ghazale Geraily, Ahmad Mostaar, Arman Zia, Golbarg Esmaili, Somayeh Farahani
April-June 2017, 13(2):313-317
DOI:10.4103/0973-1482.183562  PMID:28643753
Aim of Study: Physical wedges (PWs) are widely used in radiotherapy to obtain tilted isodose curves, but they alter beam quality. Dynamic wedges (DWs) using moving collimator overcome this problem, but measuring their beam data is not simple. The main aim of this study is to obtain all dosimetric parameters of DWs produced by Varian 2100CD with Monte Carlo simulation and compare them to those from PWs. Subjects and Methods: To simulate 6 MV photon beams equipped with PW and DW, BEAMnrc code was used. All dosimetric data were obtained with EDR2 films and two-dimensional diode array detector. Results: Good agreement between simulated and measured dosimetric data for PW and DW fields was obtained. Our results showed that percentage depth dose and beam profiles at nonwedged direction for DWs are the same as open fields and can be used to each other. Conclusion: From Monte Carlo simulations, it can be concluded that DWs in spite of PW do not have effect on beam quality and are good options for treatment planning system which cannot consider hardening effect produced by PWs. Furthermore, BEAMnrc is a powerful code to acquire all date required by DWs.
  3,005 157 -
Validation of microsatellite instability histology scores with Bethesda guidelines in hereditary nonpolyposis colorectal cancer
Mustafa Kaya, Fatih Basak, Abdullah Sisik, Mustafa Hasbahceci, Gurhan Bas, Orhan Alimoglu, Cumhur Selçuk Topal, Gozde Kir
April-June 2017, 13(2):356-361
DOI:10.4103/0973-1482.174558  PMID:28643760
Aims: Hereditary nonpolyposis colorectal cancer (HNPCC) is a subgroup of colorectal cancer (CRC) which should be differentiated because of the high risk for additional cancers and risk evaluation for other family members, especially for CRC. It is not practical to perform genetic testing for all CRC patients; therefore, various prediction modalities, for example, Bethesda guideline (BG) were studied in the literature. We aimed to assess the association of microsatellite instability (MSI), histology scores, and BG for predicting HNPCC risk. Subjects and Methods: Data were collected from CRC patients between 2009 and 2012. A total of 127 patients were retrospectively reviewed for BG status and the MSI scores, MsPath, and PathScore. Statistical Analysis Used: Definitive statistical methods (mean, standard deviation, median, frequency, and percentage) were used to evaluate the study data. Comparison used Student's t-test, Continuity (Yates) correction, Fisher-Freeman-Halton test, Pearson correlation, and receiver operating characteristics curve analysis. Results: Patients who were detected as Bethesda-positive had significantly higher MsPath and PathScore scores (P = 0.001 and P = 0.007, respectively). According to the cut-off value of 2.8 and 2.9 for MsPath and PathScore, respectively, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90%, 43%, 22.8%, 95.8%, and 50.4% for MsPath, and 55%, 83.2%, 37.9%, 90.8%, and 78.7% for PathScore, respectively. Conclusions: The MSI scoring systems, MsPath, and PathScore, are reliable systems and effectively correlated with BG for predicting patients who need advanced analysis techniques because of the risk of HNPCC.
  2,955 186 -
Serum butyrylcholinesterase and zinc in breast cancer
Rupesh Kumar, Sairoz Razab, Krishnananda Prabhu, Satadru Ray, Bhanu Prakash
April-June 2017, 13(2):367-370
DOI:10.4103/0973-1482.165869  PMID:28643762
Context: Even though, a large number of serological, molecular markers have been proposed for breast cancer screening, most of them lack specificity, sensitivity, prognostic value, and cost effectiveness. Butyrylcholinesterase (BChE) and its genes are aberrantly expressed in a variety of human cancers. It has-been linked to tumorigenesis, cell proliferation, and cell differentiation. Zinc (Zn) is a cofactor for superoxide dismutase, an enzyme that protects cellular components against free radical-induced damage and carcinogenesis. Therefore, the aim of present study was to estimate and compare serum BChE and serum Zn levels in healthy controls and biopsy proven breast cancer patients before definitive therapy. Aims: To estimate and compare serum BChE and serum Zn levels in healthy controls and biopsy proven breast cancer patients before definitive therapy. Settings and Design: Serum BChE and Zn were estimated in 46 newly diagnosed (preoperative) female patients with breast cancer and 50 healthy female volunteers. Subjects and Methods: Serum BChE and Zn were estimated by spectrophotometric method. Statistical Analysis Used: Data was expressed as median and inter quartile range. Comparisons between different stages of cancer were done using Kruskal–Wallis test. Results: There was a significant increase in serum BChE and Zn in breast cancer patients compared to controls (P < 0.001). Serum BChE showed a significant increase and Zn was significantly decreased in different stages of breast cancer. Conclusions: Both BChE and Zn are inexpensive and can easily be analyzed and may play a role in the management of breast cancer.
  2,940 173 -
Telomere length variation and expression analysis of shelterin complex genes during gallbladder carcinogenesis
Satish S Poojary, Gunja Mishra, Tekcham Dinesh Singh, Sanjiv Gupta, Braj Raj Shrivastav, Pramod Kumar Tiwari
April-June 2017, 13(2):235-239
DOI:10.4103/0973-1482.184512  PMID:28643740
Background: Telomeres, which are bound with shelterin protein complex, play an important role in maintaining genomic stability and its dysfunction may lead to carcinogenesis. Here, we aimed to analyze whether shelterin complex gene expression and telomere length variation, play any role in gallbladder carcinogenesis. Methods: Telomere length analysis was carried out by monochrome multiplex qPCR, whereas expression analysis of shelterin genes was carried out using RT-qPCR. Statistical analysis was carried out using SigmaPlot 11 software. Results: We found significantly reduced telomere length in tumor tissues, and this reduction was seen in both, tumors with or without gallstones in comparison to adjacent non tumor and gallstone (chronic calculous cholecystitis: Inflamed) tissues. Inflamed tissues showed increased telomere length as compared to both adjacent non tumor and tumor tissues. Expression analysis of five shelterin genes showed significant downregulation of TERF1, POT1, and TINF2 genes in inflamed tissues as compared to non tumor and tumor tissues. POT1 was also found to be significantly upregulated in tumor tissues and specifically in tumor tissues with gallstones compared to inflamed tissues. Conclusion: This study, thus, suggests that, gallstone does not affect telomere length and even after having increased telomere length, decreased expression of some shelterin genes in inflamed tissue might cause telomeres to cap improperly, possibly leading to telomere dysfunction and further, gallbladder carcinogenesis. Also, increased expression of POT1 in tumor tissues with gallstones could act as a diagnostic marker in patients with gallstones.
  2,903 118 -
Adjuvant hypofractionated radiation in carcinoma breast – Photon versus Electron: Comparison of treatment outcome
G Prameela Chelakkot, Rahul Ravind, K Sruthi, Namrata Chigurupati, Sanketh Kotne, Raghavendra Holla, Ram Madhavan, M Dinesh
April-June 2017, 13(2):262-267
DOI:10.4103/0973-1482.192851  PMID:28643745
Background: Breast cancer tissue is sensitive to hypofractionation. This is an analysis of patients treated with hypofractionated protocols since 2009, at our tertiary cancer center. Methods: Details of breast cancer patients treated with adjuvant hypofractionated external beam radiation therapy (EBRT) from January 2009 to December 2014 were retrieved and analyzed. Results: One thousand seven hundred and eighty patients received adjuvant EBRT during this period. Three hundred and eight were offered hypofractionated schedule. One hundred and eighty-eight had modified radical mastectomy (MRM) and 120 had breast conservation surgery (BCS). Dose was 40 Gy in 15 fractions to chest wall/breast, and tumor bed boost of 10 Gy in 5 fractions, where indicated, using three-dimensional conformal radiotherapy (3DCRT). Electrons were used in 159 and photons in 149. Single en face electron field was used for chest wall in MRM patients, and tangential photon beams for the whole breast. Patients on follow-up were assessed for locoregional recurrence, chest wall, breast or ipsilateral upper limb edema, brachial neuralgia, local skeletal events, pulmonary and cardiac symptoms, and cosmetic results. Two developed chest wall recurrence, one each in electron and photon arms. No skeletal, cardiac, or pulmonary adverse events were recorded. About 13.6% had arm edema, which was staged according to the International Society of Lymphology lymphedema staging, as Stage I-7.8%, Stage II-3.9%, and Stage III-1.9%. Twenty-six treated with electrons had arm edema. Increased incidence of arm edema in MRM patients could be attributed to combined surgical and radiation morbidity. Five-year overall survival was 81.9%. Conclusion: Hypofractionation is an accepted cost-effective standard of care in adjuvant breast radiation. Single en face electron field is well tolerated, and 3DCRT planning ensures homogeneous chest wall coverage, respecting dose constraints to organs at risk.
  2,809 159 -
The pitfalls in cytology diagnosis of poorly differentiated neuroendocrine carcinoma of lung and their treatment response
Debarshi Saha, Ankit Kumar, Sourjya Banerjee, M Nirupama, HB Sridevi, Priya Garg, Flora D Lobo
April-June 2017, 13(2):213-217
DOI:10.4103/0973-1482.192761  PMID:28643736
Context: Lung is the most common site of small cell carcinoma (SCLC) – a poorly differentiated neuroendocrine carcinoma (PDNEC). SCLC comprises 15–20% of the invasive cancers of the lung. Aim: This study was conducted to appraise the accuracy and pitfalls of the diagnosis of PDNEC on cytology along with treatment responses if available. Settings and Design: Retrospective study for 2 years yielded 21 cases on cytology. Subjects and Methods: Slides of fine-needle aspiration of lymph nodes, the tumor, bronchial brush, and bronchoalveolar lavage specimens were used. The histological correlation was obtained as were treatment responses. Results: Eighteen SCLCs were confirmed on review. Of these, 13 initial reports were concordant and five, discordant. The rest three cases which initially reported as SCLC were found to be negative (2) and combined SCLC (1). One SCLC with concordant initial and reviewed diagnoses failed to confirm on histopathology. The patients, all heavy smokers, were predominantly males in the seventh to eighth decade age group. The sensitivity and specificity of reviewed diagnoses were better than that of the original. The difference between histopathology and cytology diagnoses (reviewed and original) was statistically insignificant. All patients were categorized as “extensive stage” by positron emission tomography-computerized tomography, and five were treated with etoposide and cisplatin with/without radiotherapy. Conclusion: Age group (61–70) and gender (males) distribution were statistically significant. Intermediate variants of SCLC may be misdiagnosed as adenocarcinoma. Similarly, combined SCLC may be missed on cytology if the observer does not sustain a high index of suspicion. Unequivocal cytology diagnosis opposed to negative histopathology report demands repeat biopsy.
  2,748 117 -
Five versus ten fractions per week radiotherapy in locally advanced head and neck cancer
Ramanjis Viranna Tallari, OP Singh, Veenita Yogi, Suresh Yadav
April-June 2017, 13(2):224-229
DOI:10.4103/0973-1482.199785  PMID:28643738
Introduction: Conventional fractionated radiotherapy (CFRT) is in use since a long time, but the invention of altered fractionation such as hyperfractionation has improved survival in head and neck squamous cell cancer (HNSCC). Aims: Our aim of this prospective randomized study is to compare conventional 5 fractions per week (CFRT) with hyperfractionation 10 fractions per week (hyperfractionated radiotherapy [HFRT]) in locally advanced head and neck cancer. Patients and Methods: The study period is from November 2013 to April 2015. Totally, 100 patients with proven head and neck cancer were submitted to radiotherapy on theratron 780 (cobalt 60) machine. Fifty patients in each CFRT group and HFRT group randomized to receive radiotherapy following induction chemotherapy. Patients in CFRT group have received 66–70 Gy/33–35 fractions Monday to Friday, while HFRT group have received 70.4 Gy/64 fractions Monday to Friday. Results: Our results show manageable toxicity profile of a combined therapy consisting of cisplatin and paclitaxel, followed by concomitant chemoradiotherapy in the form of either CFRT or HFRT with cisplatin as a radiosensitizer in both treatment groups. The overall response at the completion of radiotherapy was 95.7% in HFRT versus 89.5% in CFRT with 76.6% complete response in HFRT versus 64.6% in CFRT. Conclusions: After induction chemotherapy, HFRT seems to be more efficacious than CFRT in locally advanced HNSCC, by increasing significantly the probability of progression-free survival and locoregional control.
  2,716 146 -
Adult rhabdomyosarcoma: Multimodality management and results
Abhijeet Ashok Salunke, Jaymin Shah, Nayan Gupta, Jyotindra Pandit
April-June 2017, 13(2):384-386
DOI:10.4103/0973-1482.180606  PMID:28643768
  2,661 113 -
Changes in pharyngeal constrictor volumes during head and neck radiation therapy: Implications for dose delivery
Akila Kumarasiri, Chang Liu, Mona Kamal, Correen Fraser, Stephen Brown, Indrin J Chetty, Jinkoo Kim, Farzan Siddiqui
April-June 2017, 13(2):218-223
DOI:10.4103/0973-1482.183176  PMID:28643737
Objective: The objective of this study was to evaluate the anatomical changes and associated dosimetric consequences to pharyngeal constrictor muscles (PCMs) that occur during head and neck (H and N) radiotherapy (RT). Materials and Methods: A cohort of 13 oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) was retrospectively studied. On every 5th CBCT image, PCM was manually delineated by a radiation oncologist. The anterior-posterior PCM thickness was measured at the midline level of C3 vertebral body. Delivered dose to PCM was estimated by calculating dose on daily images and performing dose accumulation on corresponding planning CT images using a parameter-optimized B-spline-based deformable image registration algorithm. The mean and maximum delivered dose (Dmean, Dmax) to PCM were determined and compared with the corresponding planned quantities. Results: The average (±standard deviation) volume increase (ΔV) and thickness increase (Δt) over the course of 35 total fractions were 54 ± 33% (11.9 ± 7.6 cc) and 63 ± 39% (2.9 ± 1.9 mm), respectively. The resultant cumulative mean dose increase from planned dose to PCM (ΔDmean) was 1.4 ± 1.3% (0.9 ± 0.8 Gy), while the maximum dose increase (ΔDmax) was 0.0 ± 1.6% (0.0 ± 1.1 Gy). Patients who underwent adaptive replanning (n = 6) showed a smaller mean dose increase than those without (n = 7); 0.5 ± 0.2% (0.3 ± 0.1 Gy) versus 2.2 ± 1.4% (1.4 ± 0.9 Gy). There were statistically significant (P = 0.001) strong correlations between ΔDmean and Δt (Pearson coefficient r = 0.78), as well as between ΔDmean and ΔV (r = 0.52). Conclusion: The patients underwent considerable anatomical changes to PCM during H and N RT. However, the resultant increase in dose to PCM was minor to moderate. PCM thickness measured at C3 level is a good predictor for the mean dose increase to PCM.
  2,597 108 -
Overall treatment duration with multimodality treatment approach and outcome results in oral cavity carcinoma: A study from an institute from central India
Vandana Jain, Digpal Dharkar, Hamsa Nandini, Shailendra M Jain
April-June 2017, 13(2):351-355
DOI:10.4103/0973-1482.180613  PMID:28643759
Objective of the Study: To see the different age groups, gender, sites, disease stage, treatment outcome of various oral cavity sites carcinoma by combined modalities and the overall treatment duration. Materials and Methods: A total of 212 oral cavity carcinoma patients (169 males and 43 females) with complete records (from September 2009 to December 2012) were analyzed for age, sex, histopathology, associated medical illnesses, various subsites with disease stage, various treatment modalities with the duration and follow-up records for disease control as well as disease failure at local, nodal, local + nodal, and distant metastasis. Results: The most common site in oral cavity cancer was buccal mucosa 81 (38.20%). 149 (69%) patients reported were in advanced Stages III and IV of the disease. The majority of patients 149 (70.28%) were given chemotherapy + radiotherapy postoperatively (S-CRT group). The mean follow-up for all patients was 41 months (range = 21–59 months). In terms of overall disease control and metastases-free survival, the best results were (80%) for Stage I in all oral cavity sites. Irrespective of disease stage best results (59.57%) were in alveolar ridge subsite of oral cavity carcinoma. Conclusion: Challenges are still lie ahead in treating head and neck carcinoma, as in spite of using multimodality treatment approach and biological and molecular research, the overall survival percentage has not changed much. In India as oral cavity carcinoma is in increasing trend in younger individuals massive health promotion and awareness programs targeting the risk population along with financial support for those already affected are required.
  2,592 88 -
Significance of expression of suppressor of cytokine signaling proteins: Suppressor of cytokine signaling-1, suppressor of cytokine signaling-2, and suppressor of cytokine signaling-3 in papillary thyroid cancer
Toral Pundrik Kobawala, Trupti I Trivedi, Kinjal Kevin Gajjar, Girish H Patel, Nandita R Ghosh
April-June 2017, 13(2):337-345
DOI:10.4103/0973-1482.174172  PMID:28643757
Purpose: Uncontrolled cytokine signal transduction largely associated with oncogene activation, can have disastrous biological consequences. The suppressor of cytokine signaling (SOCS) proteins represent one of the mechanisms by which this rampant signaling can be dissipated. Thus, we aimed to study the expression of SOCS-1, SOCS-2, and SOCS-3 in patients having benign thyroid disease and papillary thyroid cancer. Materials and Methods: SOCS protein expression was studied in 45 patients with benign thyroid disease and in 83 papillary thyroid cancer patients by immunohistochemistry and their association with clinicopathological characteristics and overall survival in cancer patients were analyzed using SPSS software. Results: Expressions of SOCS proteins were significantly higher in papillary thyroid cancer than in patients having benign disease. SOCS-1 expression was predominantly higher in males (P = 0.004), unilateral tumors (P = 0.030), and noninflammatory conditions (P = 0.028). SOCS-1 expression was also able to predict poor overall survival in subgroup of papillary thyroid cancer patients having larger tumor size (P = 0.013) and advanced stage disease (P = 0.033). Expression of SOCS-2 significantly correlated with tumor size (P = 0.017), extrathyroidal extension (P = 0.000), residual disease (P = 0.043), and treatment (P = 0.007), while preponderance of SOCS-3 expression was observed in males (P = 0.030) and in patients having extrathyroidal extension (P = 0.011) and absence of metastasis (P = 0.032). Conclusion: Expression of the studied SOCS proteins may be a consequence of activation of Janus kinase-signal transducers and activators of transcription and other pathways supporting growth and survival of cancer cells that are sustained by several cytokines. Thus, SOCS-1, SOCS-2, and SOCS-3 proteins may directly or indirectly, have important roles in development and pathogenesis of papillary thyroid cancer.
  2,475 124 -
Complexity of chromosomal rearrangements in Down syndrome leukemia
Bani Bandana Ganguly, Nitin N Kadam, Prakash K Mandal
April-June 2017, 13(2):381-383
DOI:10.4103/0973-1482.193110  PMID:28643766
Reports on imbalanced HSA21 gene expression and chromosomal rearrangements on leukemogenesis, drug sensitivity, and treatment outcome of leukemia in Down syndrome (DS) are limited. DS has been recognized as one of the most common leukemia-predisposing syndromes with unique clinical features, significant differences in treatment outcome and treatment-related toxicity profiles. Acute myeloid leukemia (AML), especially acute megakaryocytic leukemia, is reported with high cure rates presenting 80%–100% event-free survivals (EFSs); however, acute lymphoid leukemia indicates a worse prognosis in DS patients compared to non-DS children. Complex rearrangements are responsible for poor-to-very poor prognosis in all cases, irrespective of genetic predisposition or type of hematopoietic subunits affected. We report a 2-year-old female DS diagnosed with acute erythroleukemia (French–American–British: AML-M6) with highly complex chromosomal rearrangements in the bone marrow with 39 chromosomes. Parental consanguinity and genetic predisposition might be responsible for origin of multiple clones. Genetic instability and heterogeneity of complex clonal developments might cause poor prognosis. The case is a rare one with acute erythroleukemia in DS patient where too many rearrangements had masked identification of three 21s.
  2,445 120 -
The significance of serum leptin level in patients with early stage nonsmall cell lung cancer
Fatih Karatas, Bulent Yalcin, Suleyman Sahin, Hakan Akbulut, Gungor Utkan, Ahmet Demirkazik, Fikri Icli
April-June 2017, 13(2):204-207
DOI:10.4103/0973-1482.196859  PMID:28643734
Backgrounds: The serum leptin level (SLL) has been shown to increase in patients with nonsmall cell lung cancer (NSCLC). However, available data regarding the relation between SLL and tumor subtypes, survival, cachexia, and tumor respectability in NSCLC are still under debate. The aim of this study is to evaluate SLL in NSCLC patients with and without cachexia. Materials and Methods: A total of 71 patients with early stage NSCLC were enrolled in this prospective study. SLL was measured by enzyme-linked immunosorbent assay. The relationship between SLL and clinicopathological factors including histopathological subtypes, weight loss, overall survival, and tumor resectability were evaluated. Results: Of the 71 patients, 57 (81%) were male with a mean age of 63.3 ± 8.2 years. The rates of histological subtypes of NSCLC were as follows: Squamous cell carcinoma 60.5%, adenocarcinoma 32%, and others 7.2%. Mean SLL was 12.9 ± 38.4 pmol/mL. There was no distinctive difference between SLL, weight loss, and survival. However, when stratifying the groups according to the lung cancer histological subtypes, mean SLL was significantly higher in patients with adenocarcinoma than those with squamous cell subtype (26.9 ± 6.2 pmol/mL vs. 5.1 ± 9.1 pmol/mL, P = 0.004). Conclusions: SLL might be beneficial as a useful biomarker in preclinical setting of NSCLC to guide detecting the lung cancer subtypes as well as monitoring the patients.
  2,439 122 -
Effects of EF-24, RAD001, and paclitaxel on the expression profiles of apoptotic and anti-apoptotic genes
Ebru Alp, Akin Yilmaz, Hacer Ilke Onen, Emine Sevda Menevse
April-June 2017, 13(2):346-350
DOI:10.4103/0973-1482.176172  PMID:28643758
Context: Cancer cells exert differential responses to chemotherapeutics and inhibitors. To the best of our knowledge, a few or no research has been performed until now to determine the effect of EF-24 and RAD001 on MDA-MB-231 breast cancer cells with regard to mRNA expression of apoptotic and anti-apoptotic genes. Aims: In this study, we aimed to investigate the mRNA expression levels of apoptotic (caspase 2 [CASP2], CASP8, and CASP9) and anti-apoptotic (B-cell lymphoma 2 [BCL2] and BCL2-like protein 1 [BCL2L1]) genes after exposure to paclitaxel, EF-24, and RAD001 in MDA-MB-231 cells. Materials and Methods: After treatment, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to measure cell viability. mRNA expressions were analyzed using quantitative real-time polymerase chain reaction. Results: Decrease in cell viability ratios was seen in a dose-dependent manner for all chemicals. MDA-MB-231 cells responded slightly different to paclitaxel, EF-24, and RAD001 at the transcriptional level of apoptotic and anti-apoptotic genes. Conclusions: Our results showed that response of these cells to paclitaxel, EF-24, and RAD001 was found different at the transcriptional level of apoptotic and antiapoptotic genes. Therefore, understanding transcriptional changes after these drug exposure may give us a change to figure out more realistic results of the apoptotic pathway inhibition.
  2,335 187 -
Correlation of serum intercellular adhesion molecule 1 and vascular endothelial growth factor with tumor grading and staging in breast cancer patients
Alireza Rastgoo Haghi, Amir Vahedi, Ali Akbar Shekarchi, Aziz Kamran
April-June 2017, 13(2):257-261
DOI:10.4103/0973-1482.204894  PMID:28643744
Background: Breast cancer is the most common cancer among women. There are several prognostic factors for this disease. The aim of this article is to explore the correlation of serum level of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule 1 (ICAM1) with tumor, node, metastasis staging and grading of breast cancer. Materials and Methods: Serum samples of 51 patients with breast cancer were assessed with enzyme-linked immunosorbent assay for the level of VEGF and ICAM1 preoperatively. After the operation, histopathologic specimens stained with hematoxylin and eosin were evaluated for tumor size, histopathologic subtype, grade, lymph node, vascular and lymphatic involvement. Then, the correlation of tumor stage and grade and serum level of markers was analyzed. Results: There was no significant correlation between serum level of markers with vascular invasions, lymph node involvement, and menstruation. There was a weak correlation between tumor size and serum level of ICAM1 with Pearson score correlation, but there was no significant correlation with VEGF. There was no significant correlation between tumor grading and staging with the level of markers. There was a significant correlation between the level of VEGF and ICAM1 and histologic type of tumors in invasive through in situ tumors. Conclusion: Levels of VEGF and ICAM1 can be used as a predictor of tumor invasion and also for target therapy.
  2,360 138 -
Leiomyosarcoma of scrotum: A rare in-field second malignancy in a previously irradiated carcinoma of prostate and review of literature
Chelakkot G Prameela, Rahul Ravind
April-June 2017, 13(2):276-278
DOI:10.4103/0973-1482.189401  PMID:28643747
Background: Curative intent treatments for malignancies using radiation therapy while achieving longer disease-free survivals, may also lead to solid second malignancies, a dreaded late complication. Both in-field as well as out-field second malignancies are encountered and lead to diagnostic dilemma, and delay in treatment. Materials and Methods: Details of a case of rare, in-field, radiation induced leiomyosarcoma, a rare soft tissue sarcoma, in a treated case of high risk carcinoma of prostate, who presented to our tertiary care centre was retrieved and analysed. Conclusion: Increasingly sophisticated radiotherapy techniques, while providing state of the art treatment options, does increase the potential risk of radiation-induced second-malignancies. Respecting integral-dose carries priority, until further studies elucidates mechanism of tumorigenesis.
  2,363 80 -
Prognostic significance of tumor volume as determined on 3D ultrasound scan in uterine cervix cancer treated by radiotherapy
Shelly Srivastava, Surendra Kumar Saini, Awadhesh Kumar Dixit, Deepti Dwivedi
April-June 2017, 13(2):324-328
DOI:10.4103/0973-1482.183201  PMID:28643755
Aims: The aim of this prospective study is to evaluate prognostic significance of tumor volume determined by three-dimensional (3D) ultrasound scan in uterine cervix cancer patients treated by radiotherapy. Patients and Methods: A total of 67 patients of Stage IB2-IIIB were studied and analyzed. Cervical tumor volume was determined by 3D ultrasound scan. Two groups were made on the basis of volume on ultrasound scan (Group 1 <40 cc = 36 and Group 2 >40 cc = 31). Both groups received external beam radiotherapy (EBRT) and intracavitary radiation therapy (ICRT). Cisplatin 40 mg/m 2 every week was given concurrently with external irradiation. Tumor volumes were taken by 3D USG every week during EBRT, after each fraction of ICRT, and after 8 weeks of completion of treatment. Primary end point was disease-free survival (DFS), and secondary endpoints were 5-year survival and toxicities. Results: After 2 months of completion of treatment, 1 out of 36 patients of Group A was having residual and 7 out of 31 of Group B were having residual diseases (P = 0.034). DFS and 5-year survival were significantly different in the groups (log rank test P = 0.0014, hazard ratio (HR) =2.3622 95% confidence interval (CI) 1.3090–4.2625 and P = 0.0421, HR = 1.9274 95% CI 0.9998–3.7156, respectively). Conclusions: Ultrasound is a cheap, simple, and useful in predicting the outcome of treatment and DFS based on the tumor volume.
  2,183 98 -
Significant plasmacytosis in an early induction marrow of acute myeloid leukemia: Diagnostic and therapeutic implications
Namrata Punit Awasthi, Sumaira Qayoom, Ankita Jaiswal, Sunil Dabadghao
April-June 2017, 13(2):384-384
DOI:10.4103/0973-1482.177498  PMID:28643767
  2,051 84 -
Intrapancreatic mass: A rare cause
Maximilian Sohn, Martin Fuchs, Helmut Rohrbach, Igors Iesalnieks, Ayman Agha, Friederieke Liesche
April-June 2017, 13(2):378-380
DOI:10.4103/0973-1482.193124  PMID:28643765
We found a case of pancreatic extraintestinal gastrointestinal stroma tumor (pEGIST) in 2014. The patient, initially suspected to suffer from pancreatic adenocarcinoma, underwent open left hemipancreatectomy and en bloc splenectomy in May 2014. Postoperative histopathology showed the unexpected manifestation of a pEGIST. Recovery was well, and a 23-month follow-up was free from recurrency by now.
  1,638 60 -