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Purpose: We aimed to analyze patterns of failure and disease volume-treatment outcomes in patients with Nasopharyngeal carcinoma (NPC) treated with definitive radiation with or without concurrent chemotherapy at a tertiary cancer centre in northeast India. Methods: From February 2018 to February 2022, 99 histopathologically proved non-metastatic NPC patients treated with curative-intent RT with or without chemotherapy were retrospectively analyzed. Locally advanced patients received neoadjuvant or adjuvant chemotherapy. The Cox proportional hazards model was used to investigate the impact of various prognostic factors on locoregional free survival (LRFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). The log-rank test and Kaplan–Meir curves compared outcome variables based on ROC analysis-classified tumor volume. Results: During a median follow up of 25.4 months (17.3–39.2), 35(35.4%) patients developed recurrence. Twenty-three patients developed locoregional failures, of which 11 were in-field; 12 patient showed an out-field failure. The 3-year LRFS, DMFS, PFS and OS was 71.10%, 70.90%, 64.10% and 74.10% respectively. There was statistically significant difference in LRFS according to T staging (p < 0.0001). Gross tumor volume (GTVp) and gross nodal volume (GTVn) were an independent prognostic factor for OS, PFS, LRFS and DMFS. The cut-off volumes for GTVp and GTVn for distant metastases and locoregional failure, respectively, were found to be 13 and 22.7 mL and 3.7 and 39.2 mL, respectively, by ROC curve analysis. Based on this, 99 patients were divided into three subgroups. OS demonstrated significant differences among patients in different volume subgroups for GTVp (p = 0.03) and GTVn (p = 0.00024). Conclusions: For NPC patients who undergo curative IMRT, primary tumour and nodal volumes are independent prognostic indicators. GTVp and GTVn are highly predictive of local control, distant metastases, disease-free survival, and overall survival. This justifies their use as quantitative prognostic indicator for NPC. [ABSTRACT FROM AUTHOR]

Purpose: Surgery has a negative effect on the mental, physical, and functional health of patients with oral cancer, which affects their quality of life (QOL). The study aimed to assess the effect of comprehensive nursing intervention on anxiety and QOL in postoperative patients with oral cancer. Methods: We investigated the level of anxiety and QOL of 200 postoperative oral cancer patients. After the comprehensive nursing intervention, the Beck Anxiety Inventory scale and European Organization for Research and Treatment of Cancer tools were used to assess the level of anxiety and QOL, respectively. Results: There was a statistically significant difference in terms of educational status (p=0.02), monthly income (p<0.01), cancer stage (p<0.01), and tumor metastasis (p=0.02). The experimental group experienced a significant decrease in anxiety (p=0.04), and their QOL was significantly higher (p=0.05) than that of the control group. Conclusion: Our study indicates that a comprehensive nursing intervention can lower the risk of surgical complications, enhance patients' psychological state by reducing anxiety, and enhance their QOL in patients with oral cancer. [ABSTRACT FROM AUTHOR]

Introduction: Combination of abiraterone with androgen deprivation therapy (ADT) has better survival outcomes than ADT alone in metastatic Hormone-sensitive prostate cancer (mHSPC) in the Western population. In this prospective (Clinical Trials Registry-India [CTRI] registered) observational study, we present the comparative oncological outcomes of ADT alone and ADT + abiraterone in Indian patients, which is not available currently. Methods: This study (CTRI-number-CTRI/2020/07/026545) included newly diagnosed mHSPC patients from January 2020 to June 2023 in a tertiary care hospital, urology department. Patients fulfilling inclusion criteria were advised ADT with abiraterone (A + ADT), and those not affording received ADT monotherapy (ADT). The primary endpoint was overall survival (OS). Secondary outcomes included prostate-specific antigen (PSA) decline >90%, radiographic progression-free survival (rPFS), and PSA progression-free survival (pPFS). Results: Out of278 patients with mHSPC, 163 patients were excluded and 115 were analyzed (ADT = 40 vs. A + ADT = 75). After a median follow-up of 20.3 months, 11 of 40 (27.5%) in ADT-only arm and 15 of 75 (20%) in ADT + abiraterone arm had died (Hazard-ratio of death 0.72; 95% confidence interval 0.68-0.88; P < 0.001). A PSA decline of >90% was seen in 85% in the ADT alone group and 93.3% in the ADT + abiraterone group. Significantly better outcomes of the ADT + abiraterone were seen in the secondary endpoints of rPFS (P < 0.001) and pPFS (P < 0.001). The OS benefit was 28% reduction in risk of death in our study versus 37% and 38% in STAMPEDE and LATITUDE, respectively. pPFS and rPFS were also poorer in Indian subsets. Conclusions: Abiraterone with ADT improves OS, PSA response, rPFS, and pPFS in the Indian population akin to the Western data but with poorer OS, rPFS, and PSA progression-free survival on comparison. [ABSTRACT FROM AUTHOR]

Purpose: This study describes the epidemiology, clinical extent at diagnosis, and treatment modalities for prostate cancer in India. Methodology: This study is a secondary analysis of primary prostate cancer data sourced from the National Cancer Registry Programme. Data from population-based cancer registry for the period 2012-2016 were used to estimate the incidence rates, including crude incidence rate (CR), age-adjusted incidence rate (AAR), age-specific rate, and cumulative risk. Trends in the AAR were assessed using join-point regression. Hospital-Based Cancer Registry data from 2012 to 2019 were used to describe the clinical extent of the cancer at diagnosis and the treatment modalities. Results: The incidence of prostate cancers was higher in urban registries such as Delhi, Kamrup Urban, and Mumbai (AAR of 11.8 per 100,000, 10.9 per 100,000, and 9.7 per 100,000, respectively). Prostate cancer incidence showed a rise after the age of 50, with a notable acceleration after age 64. The overall annual percentage change for prostate cancer incidence from 1982 to 2016 was 2.6. Around 43.0% of all prostate cancers were diagnosed at the distant metastatic stage. Surgery and radiotherapy, either as standalone treatments or in combination with other modalities, contributed to the treatment of 78.5% of localized cancer, 74.2% of locoregional cancer, and 57.2% of distant metastatic stage of prostate cancer. Conclusion: There is heterogeneity in the incidence of prostate cancer, as evidenced by urban registries. Additionally, there is a need for downstaging the disease, without risking overdiagnosis. [ABSTRACT FROM AUTHOR]

Objective: Alveolar soft part sarcoma (ASPS) is characterized by distinctive histomorphology of variably discohesive epithelioid cells arranged in nests and translocation of t(x;17) (p11.2;q25) resulting in ASPSCR1-TFE3 fusion. The aim of the present study is to review the clinical, histopathological, and immunohistochemical profile of ASPS with a focus on unusual histological features. Material and Methods: The present study is retrospective and descriptive. All cases with a diagnosis of ASPS were retrieved with clinical and radiology details. Results: 22 patients of ASPS were identified. The most common site was the lower extremity and the size range was 3-22 cm. 54.5% of the patients had metastasis, with the lung as the most common site. Metastasis preceded detection of primary tumour in two cases. All cases showed similar histopathology of monomorphic epithelioid cells arranged in nests encircled by sinusoidal vasculature. Architecturally, the organoid pattern (81.8%) was followed by the alveolar pattern. 68.2% of the cases showed apple bite nuclei as the predominant nuclear feature. Rare nuclear features included binucleation (n=13), multinucleation (n=8), pleomorphism (n=4), nuclear grooves in three cases and intranuclear inclusion in one case, mitosis (n=5), and focal necrosis (n=6). All cases were positive for TFE3 and negative for AE1/AE3, EMA, HMB45, PAX8, MyoD1, SMA, synaptophysin, and chromogranin. Only two cases showed focal S100 positivity while one showed focal desmin positivity. Conclusion: Diffuse strong nuclear TFE3 positivity is sensitive for ASPS in an appropriate clinicoradiological context. Due to the high propensity for early metastasis, complete metastatic work-up and long term follow up is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Breast carcinoma is one of the most prevalent types of carcinoma and the leading cause of death among all carcinomas. Recently, vitamin D deficiency has been reported as a risk factor for breast carcinoma. Vitamin D, as an anticarcinoma agent, prevents cellular differentiation, stimulates cell death, reduces angiogenesis, tumour progression, and metastasis. Aim: To investigate the relationship between vitamin D deficiency and the risk of breast carcinoma. Materials and Methods: An observational study was conducted at the Armed Forces Medical College, Pune, Maharashtra, India, between November 2018 and October 2020. A total of 57 cases diagnosed with breast carcinoma and 57 healthy controls were analysed. Physical and reproductive health parameters were compared, along with vitamin D status using student's t-test and Mann-Whitney U test. Logistic regression was used to assess the risk of breast carcinoma. Results: Out of 114 women, 57 were cases and 57 were controls with a mean age of 52 vs 48 years. The mean value of serum vitamin D levels was significantly lower (19.45 vs 27.91 ng/mL, p<0.001) than controls. The percentage of serum Vitamin D deficiency was significantly higher in cases (28 (49.1%) vs 12 (21.1%), p<0.001) compared to controls. Vitamin D concentration <20 ng/mL was significantly associated with a higher risk of breast carcinoma (OR 10.8, 95% CI 3.1-37.6). Multiparity =3 was associated with a decreased risk of breast carcinoma (OR 2.250, 95% CI 0.599-8.447) compared to parity =2 (OR 3.241, 95% CI 0.916-11.466). In luminal A and triplenegative subtypes, severe vitamin D deficiency (<20 ng/mL) was observed (p=0.045) compared to other subtypes. Conclusion: The present study findings showed that women diagnosed with breast carcinoma had low vitamin D levels, which were linked to an increased risk and prognosis of breast carcinoma. Furthermore, multiparity lowers the risk of breast carcinoma. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous Metastasis (CM) is the spread of malignant cells from a primary site of malignancy to the skin. The incidence of CM ranges from 0.5% to 9% of all patients with cancer. CM may be the first sign of clinically silent visceral cancer or can even be a clue to tumour recurrence and heralds a poor prognosis requiring intense chemoradiotherapy. Aim: To study the spectrum of CM of internal malignancies, including haematolymphoid neoplasms. Materials and Methods: This cross-sectional study was conducted at Department of Pathology, Command Hospital Kolkata, West Bengal, India, over a period of two years from April 2020 to March 2022 and data was analysed over the next six months. A total of 16 patients who developed CM secondary to underlying solid organ or haematological malignancy were analysed. Categorical variables were summarised as percentages. Data in tables were presented as the frequency of variables (categories) or as absolute numbers. Results: The parameters studied included the primary site of malignancies, the frequency of various histological types at the primary site, and the common cutaneous metastatic regions. The mean patient age was 55.25 years (ranges 24-72 years) with no gender predilection (M:F=1:1). The most common primary cancer site was the kidney and the oral cavity 4 each (25%), followed by breast, lung, and haematolymphoid malignancy, 2 each (12.5%), and 1 each of thyroid and gallbladder (6.25%). The most common site of CM was the head, abdomen, and epigastric wall 07/16 each (43.75%). The majority of the CM were identified as adenocarcinoma on histopathology. Conclusion: The CM occurs rarely and can be the initial presentation of an occult internal malignancy or may suggest recurrence if diagnosed later. Renal cell carcinomas and squamous cell carcinomas of the oral cavity are the tumours that have a high predisposition for CM, and hence these patients require close follow-up and surveillance. [ABSTRACT FROM AUTHOR]

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Introduction: Chemotherapy, postchemotherapy retroperitoneal lymph node dissection (pcRPLND), and metastasectomy remain the standard of care for the management of advanced nonseminomatous germ cell tumor (NSGCT). Methods: We retrospectively studied 73 patients who had pcRPLND at a single tertiary-care center (2003-2022). Surgical and clinicopathological features and oncological outcomes are presented. Results: The mean age was 28.27 years (15-48). Three-fourths had Stage III disease at diagnosis. International Germ Cell Cancer Collaborative Group risk stratification was 54.54% and 21.21% in intermediate risk, and poor risk, respectively. Sixty-two patients had Standard, 7 had Salvage and 4 underwent Desperation pcRPLND. Eleven patients (15.06%) required adjunctive procedures. Thirteen patients (17.8%) had ≥ class 3 Clavien--Dindo complications and postoperative mortality occurred in 5 (6.8%) patients. The histopathologies (HPE) of the pcRPLNDs were necrosis, teratoma, and viable tumor in 39.7%, 45.2%, and 15.1%, respectively. Seven patients underwent metastasectomy. An 85% size reduction in the size of RPLN predicted necrosis. There was 71.4% concordance between pcRPLND and metastasectomy HPEs. The median follow-up was 26.72 months (inter-quartile range -- 13.25-47.84). The 2-year recurrence-free survival (RFS) rate was 93% (95% confidence interval [CI]-83%-97%) and the overall survival (OS) rate was 90% (95% CI-80%-95%). This is the largest series of pcRPLND for NSGCT in India to our knowledge. Conclusion: Although most of the cohort belonged to stage III, an RFS and OS rate of >90% at 2 years was achieved. We believe that successful management of postchemotherapy residual masses in NSGCT is contingent on the availability of multidisciplinary expertise and is therefore best done at tertiary-care referral centers. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]

Introduction: Hepatocellular Carcinoma (HCC) is a major worldwide health problem due to its high incidence and mortality rates. The liver often becomes a site for metastasis from various primary locations, benefiting from its abundant blood supply. Distinguishing liver metastatic tumours from HCC can pose a diagnostic challenge, significantly impacting prognosis and treatment decisions. Aim: To differentiate between HCC, Intrahepatic Cholangiocarcinoma (ICC), and metastatic colonic adenocarcinoma in the liver using Hep par-1, Cytokeratin (CK) 7, CK19, and CK20 as immunohistochemical markers. The manual Tissue Microarray (TMA) technique was employed for present study. Materials and Methods: The present cross-sectional study was conducted in Department of Pathology at Government Stanley Medical College, Chennai, Tamil Nadu, India, spanning a three-year duration from July 2012 to June 2015. A total of 60 cases diagnosed histologically with HCC, ICC, and metastatic colonic adenocarcinoma in the liver were included. The manual TMA technique was used to create recipient blocks, and immunohistochemistry was performed to assess the expression of Hep par-1, CK7, CK19 and CK20. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Values (NPV) of these markers in HCC, ICC, and metastatic colonic adenocarcinoma in the liver were analysed and tabulated using statistical software Statistical Package for Social Sciences (SPSS) version 16.0. Results: The study included a total of 60 cases, with 40 (66.7%) males and 20 (33.3%) females, ranging in age from 27 to 73 years with a mean age of 51.3 years. Among the cases, there were 30 (50%) cases of HCC, 14 (23%) cases of ICC, and 16 (27%) cases of metastatic colonic adenocarcinoma in the liver. The sensitivity, specificity, and PPV of Hep par-1 in distinguishing HCC from ICC and metastatic deposits were 80%, 100%, and 100%, respectively. The NPV of Hep par-1 in distinguishing HCC from ICC and metastatic deposits was 70% and 72%, respectively. The sensitivity, specificity, PPV, and NPV of CK7 in distinguishing ICC from HCC were 3.3%, 50%, 6.3%, and 34.1%, respectively. The sensitivity, specificity, PPV, and NPV of CK19 in distinguishing HCC from ICC and metastatic deposits were 0%, 50%, 0%, and 33.3%. The sensitivity, specificity, PPV, and NPV of CK20 in distinguishing HCC from ICC and metastatic deposits were 0%, 53.3%, 0%, and 34.8%, respectively. Conclusion: In conclusion, it was found that a panel of markers including Hep par-1, CK7, CK19 and CK20 can differentiate between HCC, ICC, and metastatic colonic adenocarcinoma in the liver. This differentiation is crucial for determining the appropriate treatment for patients by understanding the exact behaviour of the tumour. [ABSTRACT FROM AUTHOR]

Colorectal cancer is the third most commonly diagnosed cancer worldwide, and its incidence is increasing in developing countries. Chemotherapy plays a significant role in the treatment of locally advanced and metastatic colorectal cancer. Oxaliplatin has remained the backbone of the treatment of colorectal carcinoma. The primary dose-limiting toxicity of oxaliplatin is neuropathy, which can reduce compliance during therapy and impair daily living activities. With limited data regarding the occurrence of oxaliplatin-induced peripheral neuropathy (OIPN) in the Indian population, we aimed to determine the incidence and severity of oxaliplatin-induced neurotoxicity and its clinical correlation with various clinical parameters in patients with colorectal carcinoma in a cancer care centre from North-East India. Material and Methods: A prospective observational analysis was performed on all histologically confirmed cases of colorectal adenocarcinoma who received oxaliplatin-based chemotherapy either in an adjuvant setting or first-line palliative setting at Dr. B. Borooah Cancer Institute between April 2019 to March 2020. Results: Our study evaluated 76 patients with colorectal carcinoma with a mean age of 54.07 ± 10 years. The majority (65.8%) of the patients had adenocarcinoma of the colon, and 34.2% had rectal adenocarcinoma. Twenty-three (30.3%) patients presented with metastatic disease. Oxaliplatin-based chemotherapy regimens were either CAPOX (72.4%) or FOLFOX (27.6%). Acute OIPN was observed in 59 patients (77.6%), and the most common symptom was cold-induced perioral paraesthesia. The most frequent grade for acute OIPN was grade II (30.3%). Chronic OIPN was seen in 47 (61.8%) patients, with the majority developing grade II neuropathy and was manifested mainly after 4th cycle of chemotherapy. The incidence of OIPN was higher in the patients aged ≥60 years, with a cumulative oxaliplatin dose of > 1000 mg/m² and baseline low serum magnesium or calcium level. Conclusion: Oxaliplatin is one of the essential chemotherapy drugs used in colorectal cancer with significant dose-limiting toxicity of peripheral neuropathy. Well-timed identification of neuropathic symptoms can increase treatment adherence and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: Lymphadenopathy is a very common, routinely observed clinical finding which may be caused by a variety of pathological conditions, either a primary lymph node pathology or an underlying systemic disease. Fine-needle aspiration is a simple cost-effective diagnostic tool to screen these lesions, to enhance our knowledge, to understand lymph node pathology, as well as to assist clinicians for an effective management. Aim: The aim of our study was to evaluate the patterns of pathological lesions on lymph node cytology and also to assess any particular trend of diseases in comparison with demographic variables, lymph node size, and consistency in this geographic area. Materials and Methods: In this retrospective study, we studied the reports of 131 lymph node cytology samples collected over a duration of 1 year. All parameters were entered in the Excel sheet and were analyzed for descriptive statistics. Results: The mean age of the patients was 32 years. Reactive lymphadenitis was the most common (42%) pathology, followed by tubercular lymphadenitis, metastatic lymph nodes, and lymphomas. Infectious or inflammatory lesions were noted in younger age groups, whereas malignancies were prominent in elderly patients. Conclusion: This study threw light on diseases, whether infectious, inflammatory, or lymphoproliferative in etiology, which presented with lymphadenopathy in this coastal area and also unveiled the patterns of metastatic lymph nodes, their primary site, and predilection for a particular nodal site. [ABSTRACT FROM AUTHOR]

Background: Fine needle aspiration cytology (FNAC) is very useful for the pre-operative diagnosis of breast cancer. The efficacy of FNAC to determine the prognosis in breast carcinomas has to be explored. Aims: The present study is designed to determine the prognostic role of FNAC by correlation of the cytological features of Invasive Ductal carcinoma of Breast (IDC) with the axillary lymph nodal metastasis, which is a known prognostic marker. Materials and Methods: A total of 68 cases of IDC of breast diagnosed on FNAC with subsequent modified radical mastectomy in our hospital were included in the study group. Both FNAC and histopathology slides were retrieved for all the cases. The FNAC smears were assigned cytological grades according to Robinson's grading system. The histopathological sections of axillary lymph nodes were assessed for metastasis. Correlation was done between cytological grade and lymph nodal metastasis. Results: Cytological grading of IDC and axillary lymph nodal metastasis showed a statistically significant correlation (P <0.05). Individual features like nuclear size, cell uniformity, nucleoli and nuclear margin showed positive correlation with axillary lymph node metastasis (P < 0.05). Conclusion: Positive correlation is observed between Robinson's cytological grading of IDC on FNAC with axillary lymph nodal metastasis, hence cytological grading on FNAC can be used as a prognostic tool. Possibility of axillary lymph nodal metastasis in cases with high cytological grade of IDC on FNAC must be considered by the treating oncologist for the adequate patient management. [ABSTRACT FROM AUTHOR]

Objectives: Pain is classified as nociceptive, neuropathic, or nociplastic. Neuropathic pain presents as variable phenotypes (characters) based on specific aetiology and pathophysiology. This study aimed to find out among cancer patients the incidence of different phenotypes of neuropathic pain and form specific phenotypic clusters based on the underlying neurophysiology and association of sensory profile with various organ systems – A prospective observational study. Materials and methods: The Institutional Ethical Committee clearance (IEC code: 2020-49-MD-EXP-15) https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=44886&EncHid=88651.15716&userName=CTRI/2020/09/027964 approval was obtained. After written and informed consent, patients of age group 18–80 years, registering in the pain and palliative outpatient department or radiotherapy department with complaints of pain and not taking any anti-neuropathic pain medications, were enrolled. They were assessed using Leeds assessment of neuropathic symptoms and signs (LANSS) pain score, and a score of >12 was eligible for assessment of neuropathic pain phenotypes. Results: Out of 210 cancer patients complaining of pain, a neuropathic component with LANSS >12 was found in 73 (34.76%). The most predominant phenotypes, allodynia> tingling> pricking = burning, were found in 72.60%, 56.16%, and 43.84% of patients, respectively. Phenotypes were clustered into Nodes 1 and 2 based on clinically significant separation of phenotypes. Node 1 had neuropathic pain of spontaneous origin found predominantly in gastrointestinal tract (GIT) and genitourinary tract (GUT) cancers. Node 2 had stimulus-evoked negative and positive characters which occurred in head and neck, thoracic, and spinal metastatic cancers. Conclusion: Careful patient assessment reveals the incidence of neuropathic pain in 34.76%; allodynia and tingling astable the most prominent phenotypes. Broadly, sensory characters were clustered into spontaneous and stimulus-evoked sensations with GIT and GUT cancers presenting with Node 1 symptoms. [ABSTRACT FROM AUTHOR]

Solid organ transplant patients are at an increased risk of developing various types of malignancies. Herein, we have reported the case of a 32‑year‑old male patient, who presented with a nodular mass in the left shoulder 4 months after undergoing deceased donor renal transplantation. Local excision and biopsy were performed which revealed a malignant spindle cell tumor. Immunohistochemistry revealed S100 faint nuclear positivity in a few cells, CD34 positive, Ki67 1% low, and SMA negative suggestive of low‑grade fibroblastic origin spindle cell tumor. This is a rare low‑grade sarcoma with a high rate of local recurrence, rarely leading to amputation. Metastasis to the lungs and liver has been seldom reported. Our patient had local recurrence twice posttransplant for which he underwent wide local excision. [ABSTRACT FROM AUTHOR]

Oral cavity squamous cell carcinoma (OCSCC) demonstrates a high propensity to metastasize to regional lymph nodes. Despite technological and scientific advances, identification of pathological adverse features preoperatively remains elusive. This study intended to identify the true occurrence of extra-nodal extension (ENE) in clinically and radiologically N0 OCSCC patients and to investigate its impact and prognostic significance. A prospective, single-centre, non-randomized study was conducted at a tertiary cancer centre in South India to include all untreated operable patients of OCSCC without clinical, radiological, or cytological evidence of nodal metastasis (cN0). All the patients underwent tumor resection surgery with neck dissection and received adjuvant therapy when indicated. Patients were followed up and neck dissection specimens were histopathologically analyzed. The primary outcome was to assess the presence of ENE in cN0 OCSCC patients and its extent. The secondary outcomes were 2-year disease-free survival (DFS) and tumor characteristics. A total of 237 patients with operable OCSCC were evaluated. Out of these, 80 patients who were clinically and radiologically N0 were included in the study and they underwent tumor resection surgery and neck dissection. The final histopathological evaluation revealed that 21.25% of patients (n = 17) had metastatic neck disease and 7.5% of patients (n = 6) had ENE, and all were reported as microscopic ENE. Within the node-positive group, the 2-year DFS for patients with and without ENE were 50% and 90.9%, respectively (p = 0.0362). The results suggest that ENE remains a strong predictor of adverse outcomes, recurrence, and survival in oral cancer patients. [ABSTRACT FROM AUTHOR]

This study describes the epidemiology, clinical extent of disease at diagnosis and treatment modalities of cancer among older adults (aged 60 years and older) in India. Secondary data analysis of the National Cancer Registry Programme, which includes 28 Population-Based Cancer Registries (PBCRs) and 96 Hospital-Based Cancer Registries (HBCRs). PBCR data were used to estimate the incidence in terms of crude rate (CR), age-adjusted incidence rate (AAR), age-specific rate (ASpR) and cumulative risk. Trends in the AAR were calculated with the Annual Percentage Change (APC) using join-point regression. HBCR data were used to describe the clinical extent of the disease at diagnosis and the treatment modalities. There is a wide heterogeneity across the country for the incidence of cancer and for the leading cancer sites among older adults. Males had a higher incidence rate compared to females in the majority of the registries. Aizawl had the highest AARs among both genders (males: 1388.8; females: 1033.0). Females had the highest ASpR at 65–69 years (482.8), whereas for males it was above 75 years (710.4). Cervical, stomach and oesophageal cancers were on the decline. The incidence of cancer among older adults was estimated to increase by 13.5% in 2025 as compared to 2020. The increasing cancer incidence among older adults in India poses a huge burden on the health system. There is a need to increase their participation in clinical trials, advocating comprehensive geriatric assessment and strengthening geriatric oncology within programs addressing older adult's care to deal with the rising cancer burden on the health system borne by them. [ABSTRACT FROM AUTHOR]

Objective: Out of all newly diagnosed colorectal cancer cases globally, 20% of the patients present with metastasis, and 25% develop metastasis later. The 5-year survival rate after diagnosis for mCRC patients is <20%. Although many studies using population-based cancer registries from India are available on various cancers, data on mCRC in India is scarce. Therefore, the purpose of the ReCoRD registry is to obtain real world data on demographics, treatment pattern and outcomes in Indian patients with mCRC. Methods: This is a prospective, multicenter, observational study on 1000 participants with mCRC, who are enrolled in the registry in up to 15 centers for 2 years. The recruitment will be stopped 2 years following the first patient enrollment. A minimum follow-up of 12-18 months is being carried out post-enrollment in the registry. Data on the demography, clinical features, molecular profile, treatment options, and outcomes of treatment for these patients is being collected from the study sites by investigators. The Kaplan-Meier Plot will be utilized to examine the survival data, and the median time computed by the Kaplan-Meier technique will be presented with a confidence interval of 95%. Conclusion: Although mCRC remains incurable in most cases, survival rates have improved with the advent of newer cytotoxic chemotherapeutic drugs and targeted agents. The ReCoRD registry will collect details of the demography, tumor characteristics, molecular aspects, treatment, and treatment outcomes in individuals with mCRC, which can guide the clinicians in decision making and treatment based on Indian patient data. [ABSTRACT FROM AUTHOR]

Introduction: Testicular Germ Cell Tumor (GCT) is a disease of young adults and is also highly curable. But in India, most of the patients present in an advanced stage and succumb to the disease as compared to the Western nations where patients present at an earlier stage and are mostly cured. Also, there is a scarcity of literature on testicular GCT from the Indian subcontinent. We present our experience from the Tata Memorial Centre of North-east India. Methods: This retrospective study was conducted at Tata Memorial Centre - BBCI, Guwahati for the period of 5 years from January 2018 to December 2022. The study focused on epidemiology, clinical presentation, and treatment outcomes. Results: Seventy-two cases of testicular GCTs were studied (28 cases were seminoma, and 44 were non-seminoma). Most common presenting stage was stage I in seminoma (53.6%), and stage III (77.2%) in non-seminoma. As per the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, 25%, 35%, and 40% of patients were good-risk, intermediate-risk, and poor-risk in non-seminoma. In patients with seminoma, 54% and 46% were in good and intermediate-risk, respectively. Seventy-two percent and 21% had achieved a radiologic complete response (CR) and partial response (PR) with conventional chemotherapy in patients with seminoma. Radiologic CR and PR rates were 20% and 61% among non-seminoma patients. The median recurrence-free survival (RFS) was 43 months. RFS was better in seminoma versus non-seminoma, stage I versus stage III, and good-risk versus high-risk group. Conclusion: Most of our patients presented with an advanced stage of the disease and a high nodal burden. In patients with non-seminoma GCT, the best response to conventional chemotherapy was a partial response. The use of an alternative chemotherapy regimen to improve outcomes for such patients can be further explored. [ABSTRACT FROM AUTHOR]

Male breast cancer is a rare disease, accounting for less than 1% of all cases of breast cancer. However, the incidence of male breast cancer is increasing. In this study, we systematically analyzed the cases of male breast cancer and evaluated the management of operable male breast cancer in daily clinical practice according to the international clinical guidelines. Data of male breast cancer characteristics and management were recorded from our electronic database. We present a case series of male breast cancer patients treated at our institution between 2013 and 2021 and summarize the recommendations on management of male patients with breast cancer. Twenty-six patients met the search criteria. The majority of tumors were hormone-receptor positive and human epidermal growth factor receptor 2 negative. Two tumors were derived from axillary accessory breast. All patients underwent mastectomy. Fifteen patients received adjuvant chemotherapy containing anthracycline or taxane. Ten patients received adjuvant radiotherapy for lymph node metastasis. Twenty-five patients received adjuvant endocrine therapy. None of patients received anti-human epidermal growth factor receptor 2 therapy. During the median follow-up period of 37 months, one patient died of previous lung cancer recurrence and one patient developed lung metastases 2 years after breast surgery. No recurrence or distant metastasis occurred in the other twenty-four patients. The incidence of male breast cancer is low. In this study, we present twenty-six cases of male patients with operable breast cancer in our department. All of them received surgery and adjuvant treatment. Early diagnosis and combined therapy benefit male patients with breast cancer. Surgery together with adjuvant treatment can bring a good prognosis. [ABSTRACT FROM AUTHOR]

Synovial sarcoma is a rare and high-grade soft tissue tumour that rarely affects the head and neck region. Approximately 90% of synovial sarcomas are seen in the extremities. About 5 to 10% occur in the head and neck region with high incidences in the parapharyngeal space and hypopharynx. In the oral cavity, synovial sarcoma has been reported in the buccal mucosa, tongue, floor of the mouth, the retromolar region, hard and soft palates, the gingivobuccal sulcus and the mandible. In this paper, we report 4 very rare cases of monophasic synovial sarcoma of the oral cavity and highlight the need for proper diagnosis and treatment plan in the cases of synovial sarcoma. So far, around 250 cases of synovial sarcoma of head and neck have been reported in the literature. In India, on extensive literature search we could retrieve 18 cases of synovial sarcoma involving the head and neck region, of these 11 cases of primary synovial sarcoma involving the oral cavity have been reported previously. To our knowledge, this is the first series of primary synovial sarcoma of the oral cavity in the Indian literature. [ABSTRACT FROM AUTHOR]

Background: There are many lacunae in our current understanding of the shifting epidemiological trends of lung cancer as well as lack of data among Northeast Indian patients. Aims and Objectives: This study tried to assess the clinicodemographic and treatment outcomes of advanced lung cancer cases. Materials and Methods: This was a retrospective hospital-based study. Patients with histopathologically confirmed locally advanced and metastatic lung cancer and were registered at Dr. Bhubaneswar Borooah Cancer Institute between January and December 2017 who were included in the study. A record was made of patient demographic-, clinical-, and treatment-related parameters. Kaplan-Meier survival curves were obtained. A two-tailed P<0.05 was considered statistically significant. Results: Majority of the patients were elderly males (median=60 years), with a history of smoking in three quarter of them. Non-small-cell lung carcinoma (94%) type was the most common histology. About 93% of patients presented with TNM stage IV disease. The most common palliative chemotherapy (CT) regimen used was taxanes and platinum doublet (n=24, 35%). With a median follow-up of 6 months (range 0-37), the median progression-free survival and overall survival were 8 months and 10 months, respectively. The median survival was significantly longer in patients younger than 60 years. (13 months; P=0.021) and in those with nonsmall-cell histology (10 months). Conclusion: In this audit of resource-limited population with advanced lung cancer, palliative CT remains the mainstay of treatment. There is a further need to improve the survival of these advanced cases in a cost-effective manner. [ABSTRACT FROM AUTHOR]

Presence of free gastric cancer cells in the peritoneal cavity of patients who undergo surgical treatment for gastric cancer is considered as a negative prognostic factor. It manifests as peritoneal metastasis and causes rapid recurrence of diseases. The aim of this study was to analyse factors associated with positive peritoneal cytology and identify patients in whom diagnostic peritoneal lavage could affect therapeutic decisions. The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, over a period of 18 months from November of 2017 to May of 2019. During the laparotomy, 200 mL of physiological saline at 37 °C was administered in the tumour region. About 100 mL fluid was recovered from several regions of the abdominal cavity which was sent to the Department of Pathology where the samples were processed by liquid-based cytology technique. Results of peritoneal cytology were analysed jointly on the basis of clinical and pathological factors. Analysis of the peritoneal fluid for presence of free cancer cells was done in 52 patients. Positive peritoneal cytology was found in 9 (17.3%) patients. In the group of patients with positive cytology, all patients had T4 tumours and all were found to have lymph node metastases, whilst as grade 3 cancer was found in 55.5% patients. In patients with positive cytology, diffuse gastric cancer was seen in 7 out of 9 patients (77.7%), whilst in patients with negative cytology, intestinal type was seen in 41 of 43 patients (95.3%). Amongst the 9 patients with positive peritoneal cytology, 7 (77.7%) patients had tumour located in the distal part, and one (11.1%) patient had tumour located in the proximal part, whilst the lone patient with diffuse involvement of the stomach was also positive for malignant peritoneal cells. Based on this study, we can conclude that determinants of positive peritoneal cytology include tumour stage (T4), positive nodal status (N +). Knowing the peritoneal cytology status can alter the treatment strategy and can vary from curative to a palliative one and vice versa. [ABSTRACT FROM AUTHOR]

* Context.--Alveolar soft part sarcoma is a rare soft tissue tumor involving mainly deep soft tissue of the lower extremities. Primary bone involvement is extremely rare. Objective.--To discuss histopathologic and immunohistochemical features of alveolar soft part sarcoma along with challenges in diagnosis and management in the context of primary bone origin. Design.--Our study constituted 8 patients. Data were collected from the Tata Memorial Hospital, Mumbai, India, during a 10-year period. Results.--Five patients in our study were female and 3 were male. Their ages ranged from 13 to 56 years. Primary bone involvement was seen in the humerus, tibia, fibula, radius, calcaneus, and rib. Radiologic impression was that of a primary malignant bone tumor in all patients. Conventional histopathologic features were seen in 7 of 8 patients. Positive immunohistochemical expression for TFE3 was demonstrated in 6 patients. All patients had distant metastasis either at presentation or later in the course of the disease. Surgical excision of the primary tumor and adjuvant chemotherapy formed the basis of treatment. Four patients succumbed to disease and 2 were alive with disease. Conclusions.--Rare occurrences of primary bone alveolar soft part sarcoma posed a diagnostic challenge in the form of differential diagnoses of metastatic tumors resembling it either morphologically or immunohistochemically. The combined application of clinical and radiologic features along with characteristic histomorphology and immunohistochemistry helps to arrive at a definite diagnosis of alveolar soft part sarcoma. Aggressive behavior of this tumor and its refractoriness to conventional chemotherapy were evident from our series. [ABSTRACT FROM AUTHOR]

Oral cavity is the most common site of cancer in India, tongue forms the most common single subsite. Neck node involvement plays an important prognostic role in disease-free survival and overall survival. Most of the nodal metastasis are occult and only an elective neck dissection can disclose the nodal metastasis, which is accepted only when the risk of metastasis exceeds 15–20%. Contralateral nodal metastasis(CLNM) are rarely analyzed due to sparse event.Retrospective analysis of data of patients who underwent surgery for carcinoma tougue with a curative intend between April 2017 and March 2019 were collected. Factors influencing CLNM in carcinoma tongue were studied.The study included 149 patients, with 102 men and 47 women. The mean age of study subjects was 51.5 ± 11.8 years. Thirteen (8.7%) patients had CLNM. With respect to tumor, advanced stage(p < 0.001), floor of mouth involvement(p = 0.001) and lesion crossing midline(p < 0.001) had an increased risk of CLNM. Extranodal extension(ENE)(p < 0.001) and lymphnode ratio(p = 0.002) in ipsilateral node ratio influenced CLNM. Multivariant analysis showed that in addition to lesion crossing midline(p = 0.03), ENE played significant role in CLNM (p < 0.001), with a risk of 12.8 times compared to no ENE. Suspicion of CLNM either clinically/radiologically was a good predictor of metastasis(p < 0.001).CLNM in tongue cancer was significantly influenced by lesion crossing midline and ENE. Contralateral neck dissection should be performed in any case with clinical/radiological suspicion of nodal involvement and above mentioned risk factors. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy is the standard of care for axillary staging in clinically node-negative breast cancer. SLNB is predictive of axillary node status. Major concern is the occurrence of a false negative SLN. The objective of this study is to determine the rate of axillary recurrence in our series of patients in Indian cohort. The present study was conducted at Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, a tertiary referral cancer centre in India, from Jan 2008 through December 2018. A total of 496 patients diagnosed with early breast cancer with clinically negative axilla underwent the SLNB procedure using both ICG and dual dye. Four hundred ninety-six patients with negative SLNB did not receive ALND. After a median follow-up of 48.8 months, 18 patients had distant metastases, one had axillary relapse, and 13 had an in-breast recurrence. The patients with axillary recurrence received axillary dissection and systemic adjuvant therapy. Data from this series, thus, showed that isolated axillary node recurrence after negative SLNB is rare (< 1%) and comparable with referral cancer institutions. We confirm that SLNB for the treatment of early breast cancer patients of a tertiary referral hospital is safe and reliable. [ABSTRACT FROM AUTHOR]

Background: Older patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis. Methods: This retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of <23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test. Results: A total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60–100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.086. Conclusion: Older persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy. [ABSTRACT FROM AUTHOR]

The article focuses on lung cancer therapy which began with the discovery of actionable genomic alterations. Topics include examines the two most well described molecular alterations are the epidermal growth factor receptor mutation and ALK fusion as initially thought that these oncogenic drivers are mutually exclusive, i.e. only a single driver per tumor.

Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients' life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients' disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, "Gender" (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), "Presence of metastases" (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), "Metastasis site: Liver" (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), "Lymphovascular permeation" (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and "CEA-level" (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient's comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC. [ABSTRACT FROM AUTHOR]

Background: The lymph node is one of the major anatomic components of the immune system. Lymph nodes are the most widely distributed and easily accessible component of lymphoid tissue and hence they are frequently examined for diagnosis of lymphoreticular disorders. Lymph node swellings are one of the commonest clinical presentation of patients and it encompasses a wide spectrum ranging from inflammation to a malignant lymphoma or a more obnoxious metastatic malignancy. Aims and objectives: The aim of this study is to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in correlation with histopathology in cases of cervical lymphadenopathies. Material and methods: Patients referred to the Department of Pathology, GMERS Medical College and Hospital, Sola Ahmedabad for period of 12 months from June 2021 to May 2022 for palpable lymph node swelling on whom FNAC procedure was performed were included in the study. FNAC diagnosis of patients was compared with histopathology in cases which underwent surgical excision and its diagnostic accuracy was studied. Results: Out of 100 cases which were included in the study, lymph node biopsy was carried out in all 100 cases. Most were in age group of 21 to 30 years. Gender wise, there was male preponderance. Benign lymphadenopathies were diagnosed in 93% of cases. Metastatic deposits were diagnosed in 7% of cases. On correlation of FNAC findings with histopathology, overall correlation rate was 85.2%. Conclusions: FNAC is especially helpful as lymphnode biopsy is a difficult and invasive procedure. Although excision biopsy is the gold standard, FNAC is preferred as first-line investigation. [ABSTRACT FROM AUTHOR]

Spontaneous rupture of a metastatic liver tumour is rarely documented in the literature when compared to hepatocellular carcinoma and other liver lesions, especially from a lung primary. We report a case of ruptured liver metastasis from an adenocarcinoma of the lung mimicking ruptured liver abscess, challenging the clinical diagnosis. A 42-year-female patient presented to a tertiary care institute in 2020 with complaints of abdominal pain, breathlessness and fever. On examination, the patient was tachypnoeic with a right hypochondriac mass. A contrast-enhanced computed tomography of abdomen and thorax revealed an ill-defined heterogeneously enhancing lesion in the liver with a communicating subcapsular collection and hypo-enhancing lesions in the left lobe and heterogeneously enhancing lesion in the left lung. Adenocarcinoma of the lung with hepatic metastasis was confirmed with a core needle biopsy. The patient was managed conservatively with intravenous antibiotics, intercostal drainage tube and gefitinib. However, despite best efforts, the patient succumbed to the disease. [ABSTRACT FROM AUTHOR]

Propolis is a natural compound collected by honeybees from different parts of plants. Honeybees produce a sticky component besides honey by mixing the tree resin and other botanical sources with saliva called propolis or bee glue. Propolis was traditionally used as a wound healing substance, cosmetic, medicine, and many other conditions. Till now, there is no definite curable treatment for most cancers and chemotherapeutic drugs and drugs used for targeted therapies have serious side effects. According to a recent research, natural products are becoming increasingly essential in cancer prevention. Natural products are a great source of potential therapeutic agents, especially in the treatment of cancer. Previous studies have reported that the presence of caffeic acid phenethyl ester (CAPE), artepillin C, and chrysin is responsible for the anticancer potential of propolis. Most of the previous studies suggested that propolis and its active compounds inhibit cancer progression by targeting multiple signaling pathways including phosphoinositide 3-kinases (PI3K)/Akt and mitogen-activated protein kinase (MAPK) signaling molecules, and induce cell cycle arrest. Induction of apoptosis by propolis is mediated through extrinsic and intrinsic apoptotic pathways. The aim of this review is to highlight and summarize the molecular targets and anticancer potential of propolis and its active compounds on cell survival, proliferation, metastasis, and apoptosis in cancer cells. [ABSTRACT FROM AUTHOR]

Introduction: With the availability of an increasing number of therapeutic options for advanced prostate cancer (APC), optimal sequencing and combination of therapies have emerged to be the areas of challenges. In the Indian context, there is a dearth of consensus recommendations to guide clinicians regarding optimal sequencing of therapy in APC management. A Delphi-based consensus regarding optimal therapy sequencing in APC management was developed by an expert panel of medical oncologists from across India. Methods: An expert scientific committee of 11 medical oncologists and an expert panel of 53 medical oncologists from India constituted the panel for the Delphi consensus. In the first phase, a questionnaire with 41 clinical statements was developed in several critical controversial areas in APC treatment. In the second phase, 29 clinical statements were reworked and sent to eight experts to obtain their opinions on best practices. The consensus ratings were based on a 9-point Likert scale. Based on the overall response, statements with a mean score of ≥ 7 with 1 outlier were considered as "consensus." Results: Degarelix was the preferred androgen deprivation therapy (ADT). While ADT plus docetaxel was the preferred option for metastatic castrate-sensitive/naïve prostate cancer patients with high-volume disease, ADT with abiraterone was the preferred choice for low-volume disease. Docetaxel was the preferred first-line treatment option in men who received ADT alone in the castrate-sensitive/naïve setting. For patients progressing on or after docetaxel for metastatic castrate-resistant prostate cancer (without prior abiraterone or enzalutamide), the experts reached a consensus on the use of enzalutamide as the preferred second-line treatment option. No consensus was reached for the third-line treatment options. Conclusion: This article is intended to serve as a guide to help clinicians discuss with their patients as part of the shared and multidisciplinary decision-making for improved APC management in India. [ABSTRACT FROM AUTHOR]

Introduction: This study assessed the long-term survival and the prognostic variables affecting survival following pulmonary metastasectomy (PM) secondary to childhood solid tumors. Materials and Methods: A retrospective analysis was done on 22 children who underwent PM for solid tumors between January 2007 and February 2020. The overall survival (OS) and event-free survival (EFS) at the end of the study period were noted. Tumor histology, completeness of resection, disease-free interval, laterality, location, number, and size of lung nodules were assessed for their significance in contributing to survival. Results: High-grade osteosarcoma (54.5%), followed by Wilms' tumor (18.2%), was the most common histological types. Unilateral nodules (59.1%) situated in a peripheral, sub-pleural location (91%) were the most common presentation. Pleural extension was noted in 12 (54.5%) patients. Synchronous pulmonary metastases were noted in 12 (54.5%) patients. Two developed metastases while undergoing chemotherapy and eight after the completion of therapy. The EFS and OS were both 31.8% at a median follow-up of 15.5 months (range 3–129 months). The median time required for an event to occur was 4 months (95% confidence interval [CI]: 1.4, 6.6 months) and median post-PM survival interval was 17 months (95% CI: 6.6, 27.4 months). Significant association was noted between preoperative tumor response to chemotherapy (P = 0.002) and survival. Conclusion: PM can improve survival in a select group of children with metastatic solid tumors. Favorable tumor response to chemotherapy was found to be a significant prognostic factors influencing survival. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) is the most common malignancy in the Indian males. Most of the cases of HNC present in locally advanced stage and requires a multidisciplinary management approach. Radical or adjuvant external beam radiotherapy (EBRT) is one of the important integral components of the management of HNC. Aim: To find the incidence of hypothyroidism (HT) in patients of HNC treated with radiotherapy with or without concurrent chemotherapy. Methods: A prospective, single institutional longitudinal observational study conducted at the department of radiotherapy, Institute of Post Graduate Medical Education and Research, Kolkata. Results: In this study, data of 118 patients were analysed. The median age at presentation was 56 years. The most common primary site of malignancy was oral cavity (39%). The patients were stage I, stage II and stage III as 11, 37·3 and 51·7% respectively. The median dose of EBRT was 66 Gy. HT statistically significantly correlated with primary site of malignancy (p = 0·001), dose of EBRT (p = 0·005). At the end of follow-up of 6 months, 39·8% developed HT. Conclusion: The thyroid gland is an important organ at risk while considering EBRT to neck region. The inclusion of thyroid function test in routine follow-up is mandated. [ABSTRACT FROM AUTHOR]

Introduction: Inflammatory cell infiltrate in tumours may be involved in immunosurveillance or tumourigenesis. Tumour Infiltrating Lymphocytes (TILs; within the tumour) and peritumoural lymphocytes (at the invasive margin) are associated with improved prognosis and response to therapy. Aim: To estimate the presence of peritumoural lymphocytes and TILs in breast carcinoma, identify their subsets by Immunohistochemistry (IHC) and assess the relationship between them and tumour grade, lymphovascular emboli and axillary lymph node metastasis. Materials and Methods: This was a cross-sectional study with a sample size of 75 done in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India from November 2017 to April 2019 with the approval of Institutional Ethics Committee. The demographic data of the patients were collected and histopathological assessment of tumour type, grade, lymphovascular emboli, nodal metastasis and lymphocytic infiltrate was done on Haematoxylin and Eosin (H&E) stained sections. Immunohistochemical evaluation was performed using antibodies against Cluster of Differentiation 4 (CD4) and CD8 and cells were scored separately in the stromal and peritumoural areas. The results were analysed by Analysis of Variance (ANOVA) and Chi-square test. Association between the immune infiltrate and histopathological variables were assessed separately in stromal and peritumoural compartments. Association between the score obtained on H&E and subpopulation score obtained on IHC was also analysed in both the compartments. Results: Total of 75 subjects were included and the mean age was 52.31 years with a standard deviation of 9.774 years. The degree of stromal TIL infiltrate ranged from 10% to 95%, with a mean of 48.47%. High grade peritumoural infiltrate was seen in 66.67% (50 out of 75 cases). The stromal TILs were significantly higher in higher grade tumours and tumours without nodal metastasis. The peritumoural lymphocytes were also significantly higher in high grade tumours. The scoring of the immune infiltrate on H&E sections and subpopulation score on IHC showed significant association for both stromal and peritumoural compartments. Conclusion: Stromal TILs and peritumoural lymphocytes were significantly higher in high grade tumours. Stromal TILs were also significantly higher in tumours without axillary lymph node metastasis. No significant association was found between the lymphocytic infiltrate and lymphovascular emboli. The immune infiltrate within breast carcinoma has association with tumour grade and lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background: Tumour induced lymphangiogenesis plays a crucial role in metastasis and tumour progression. The intratumoural and peritumoral lymphatics are supposed to have different biological effects. The aim of present study was to investigate the correlation of intratumoral lymphatic vessel density (I LVD), peritumoral lymphatic vessel density (P LVD), intratumoral mast cell density (I MCD) and peritumoral mast cell density (P MCD) with prognostic parameters in primary breast carcinoma. Methods: Lymphangiogenesis was detected using D2-40 monoclonal antibody and mast cell by using toludine blue stain in 50 cases of primary breast carcinoma. Positively stained lymphatic vessels were counted at 40 x in dense lymphatic vascular foci (hot-spot) within the tumour. Chi square, ANOVA test and Pearson’s correlation was applied to determine the relationship amongst various variables, with statistical significance set at p <0.05. Results: Mean P LVD was significantly higher than I LVD (6.25±21 vs 2.75±2.27, p <0.005). Significant correlation was noted between I LVD and P LVD and age, tumour laterality, tumour size and overall staging. However, there was no correlation between I LVD and P LVD with other important clinicopathologic prognostic markers like grade, lymph node status and lymphovascular invasion. MCD was higher in both intratumoral and peritumoral location as compared to normal tissue. There was an association noted between P MCD with pathological staging and perineural invasion. However, there was no significant association of I MCD and P MCD with other prognostic markers like grade and lymphnode status. No significant correlation was noted between I LVD, P LVD, I MCD and P MCD. Conclusion: The evidence from our study supports the utility of D2-40 stain in determining the lymphatic density in IBC. The study findings also establish the existence of lymphangiogenesis in both intratumoral and peritumoral location. For now, the data presented herein do not permit us to promote the utility of LVD and MCD as predictors of prognosis in invasive breast carcinoma. [ABSTRACT FROM AUTHOR]

Background: Extranodal extension (ENE) has been included as a factor for the staging of head-and-neck cancer (HNC) considering its prognostic value. Aim: The present study aimed to find out the percentage of patients with HNC getting upstaged because of ENE and their treatment outcome. Patients and Methods: A retrospective analysis of all patients with HNC registered in the Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India, between January 2018 and January 2019. American Joint Committee on Cancer (AJCC) criteria were used for defining clinical and radiological ENE. The site, subsite, stage and presence of ENE were documented. The clinical outcome of all these patients was collected and analysed. Results: A total of 562 patients were registered with HNC. Among them 45 patients were identified to have ENE (8%). The majority of the cases were oral cavity (44.4%) and oropharyngeal tumours (26.8%). Thirty-three patients had clinically documented ENE and 11 were radiological and one patient had pathological ENE. Among those who got upstaged to N3b disease due to ENE, 29 patients (64.4%) had N2 disease as per the 7th edition AJCC. When stage grouping was considered, 28 patients (62.2%) who got upstaged had stage Isovaleric acidaemia (IVA) disease as per the AJCC 7th Edition. Twelve patients were treated with radical intent and 16 received palliative treatment and rest did not complete the treatment or defaulted. Overall, the outcomes of these patients remained poor. Conclusion: A significant proportion of HNC patients got upstaged when ENE was included in the staging. Patients with ENE had a poor prognosis irrespective of the treatment modality. [ABSTRACT FROM AUTHOR]

Introduction: Oral Squamous Cell Carcinoma (OSCC) is one of the most common malignant diseases of head and neck region. Management of OSCC involves removal of the Submandibular Gland (SMG) along with lymph nodes. The submandibular salivary gland is routinely removed, considering metastatic involvement from OSCC. Many studies showed there is no or rare involvement of the submandibular gland. aim: To find the incidence of metastasis of oral squamous cell carcinoma in the submandibular salivary gland during neck dissection. Materials and Methods: This cross-sectional, observational, descriptive study will be conducted in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi, Maharashtra, India. The research started from November 2018. Data will be compilated in tabular form in term of descriptive statistics with frequency and proportion of submandibular gland involvement. It will be conducted on 90 operated cases of OSCC in whom one or both the submandibular glands will be removed during neck dissection. The outcome parameters will be the nature and site of lesion, clinical nodal status, clinical stage of disease, preoperative and postoperative histopathological examination of lesion, histopathological examination of resected lymph nodes and proportion of involvement of submandibular gland. [ABSTRACT FROM AUTHOR]

This article gives an overview of consensus statements reached for twelve difficult clinical scenarios discussed at Indian perspective of St. Gallen consensus for customizing local and systemic therapies for breast cancer patients. Pathological states in which breast cancer patients should/should not undergo chemotherapy were analysed. It was agreed upon that post-operative radiation is associated with decreased recurrence rates across all subgroups of DCIS and was found to have a survival benefit too. Surgeons recommended re-sentinel procedures instead of complete axillary dissection in women with ipsilateral breast recurrence and negative nodes on imaging after previous treatment with breast conserving surgery and sentinel node mapping. Radiation oncologists established that hypofractionation is a safe and effective radiation technique for breast cancer. Indian experts advised against the addition of carboplatin to standard "dose-dense AC and paclitaxel" or other cyclophosphamide-/anthracycline-/taxane-type regimen and recommended the usage of anthracyclines in a case of HER2-positive node-negative breast cancer receiving taxane-based chemotherapy and anti-HER2 antibodies. They supported adjuvant chemotherapy after neoadjuvant endocrine therapy if there was any evidence of any residual lymph nodal involvement or residual breast lump > 5 cm. Indian oncologists favoured that de novo oligometastatic disease with single bone-only metastases should be treated with curative intent. In patients with more sites of metastatic cancer, such as three or more bone lesions, experts were split between curative and palliative intents. [ABSTRACT FROM AUTHOR]

Introduction: Haematogenous spread of tumours to bone marrow is a common phenomenon and implies advanced stage of disease with poor prognosis. In most instances, the site of primary malignancies is known and is demonstrated in the bone marrow, when the procedure is carried out as a part of the staging process. However In some cases, detection is incidental and bone marrow involvement may be the first clue to these unsuspected non haematopoietic malignancies. Objective: In this study, we aim to analyse the clinico-pathological spectrum of non-hematopoietic neoplasms detected in bone marrow biopsies carried out in our setting. Methods: This is a descriptive cross-sectional study, where the Laboratory Information System (LIS) was used to screen all the bone marrow trephine biopsies done over the last 7 years, from January 2014 to December 2020. Out of total 4370 bone marrow trephine biopsies performed, 53 cases of bone marrow metastases by nonhematopoeitic malignancies were detected. All the stained slides and the tissue blocks of metastases were retrieved for observation and their laboratory parameters were retrieved from the Laboratory Information System (LIS). Results: Out of these 53 cases, primary was known in 16 (30.2%) cases prior to performing marrow biopsies. 15 (28.3%) cases presented with severe backache and/or presence of lytic lesions on radiological examination and underwent marrow examination with a clinical suspicion of multiple myeloma verses metastases. 16 (30.2%) cases were incidentally detected while evaluating for causes of cytopenias and leucoerythroblastic blood picture. Adenocarcinoma prostate was the most common tumour with first presentation as bone marrow metastases followed by adenocarcinomatous deposits from gastrointestinal tract. Conclusion: Bone marrow metastases by non-hematopoietic neoplasms can be the first presenting feature in many cases as seen in our study. So, performing a trephine biopsy routinely along with aspiration for any unexplained cytopenias is of paramount importance in clinching the primary diagnosis. [ABSTRACT FROM AUTHOR]

Background: The Z0011 trial results have shown that axillary lymph node dissection (ALND) can be avoided in cT1-2 patients undergoing breast conservation surgery with 1–2 metastatic sentinel lymph nodes (SLNs). We compared the clinicopathological characteristics of the Z0011 eligible non-screen detected breast cancer patients’ cohort with the Z0011 trial study population. Additionally, we have explored the effect of non-sentinel metastasis on adjuvant treatment decisions and survival. Methods: The details of early breast cancer (EBC) patients fulfilling Z0011 eligibility criteria were retrieved from a prospectively maintained database (2013–2017) and electronic medical records. We used Statistical Package for the Social Sciences 25 and Stata V15 for the data analysis. Results: 128/194 (66%) sentinel lymph node biopsy positive patients had fulfilled the Z0011 inclusion criteria. Compared to the Z0011 study, our cohort patients were younger, with more aggressive disease (higher T2, Grade 3), had a higher rate of macrometastasis (82.8% versus 58.8%) and non-SLN metastasis (48% versus 27%). The information gained by ALND had changed decisions for chemotherapy in 3% and no change of radiotherapy in Z0011 eligible patients. Further nodal positivity in completion ALND was not significantly associated with overall survival (p = 0.86) and disease-free survival (p = 0.5). Conclusion: Z0011 eligible Indian EBC patients are significantly different from the Z0011 study population, with younger age of presentation, higher grade, a higher rate of both SLN macro metastasis and non-SLN positivity. The impact of non-sentinel metastasis on adjuvant treatment decisions and survival is minimal. [ABSTRACT FROM AUTHOR]

Oral Cancer is the sixth most common type of cancer worldwide and 90% of it is represented by Oral Squamous Cell Carcinoma (OSCC). India has the highest prevalence of OSCC as per the World Oral Health Report. OSCC has few risk factors associated with it such as high metastasis rate, high probability of recurrence, less survival rate and lack of public awareness. Despite many advancements in therapeutic strategies, there is a tremendous increase in the mortality and morbidity rate due to the availability of tobacco and related products that elevate the occurrence of the disease. The majority of patients are diagnosed and treated for this disease at the terminal stages (III or IV). These are the main reasons for the escalating mortality rates. Due to this, there is an immense necessity for early diagnosis of OSCC which should be given utmost importance. Biomarkers are indispensable biological molecules that can be used to identify normal cellular alterations. Histological examination using biomarkers is considered as one of the most reliable technique for the diagnosis of OSCC. These biomarkers can also be analyzed by other means such as solid biopsy and liquid biopsy which contains DNA, RNA or proteins used for examining the expression pattern of particular genes or proteins. There are three broad categories of biomarker discoveries: Genomic, Proteomic and Metabolomic which is expressed during progression and metastasis of OSCC. This chapter deals with different potentially malignant disorders in the development of OSCC, diagnostic methods of OSCC, the pertinence of biomarker in OSCC therapy, classification of biomarkers, existing biomarkers in different stages of OSCC and the challenges of developing new biomarkers. [ABSTRACT FROM AUTHOR]

Background & objectives: Imaging has been added to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system of cervical carcinoma. This study was performed to assess the impact of imaging in staging and to ascertain the prevalence and pattern of nodal metastasis on contrastenhanced computed tomography (CECT) in patients with cervical carcinoma who were treated based on FIGO 2009 staging system. Methods: This retrospective study was conducted to evaluate all patients with biopsy-proven cervical carcinoma who underwent CECT of abdomen at a tertiary cancer centre in north India from April 2017 to April 2019 and for whom either baseline or follow up scans were available. In patients with enlarged or necrotic lymph nodes, the location, size and pattern of infiltration of adjacent organs were recorded. Results: A total of 602 patients of cervical carcinoma had undergone CT during the study period, of whom 138 (22.9%) underwent CT at baseline and 464 (77.1%) patients during follow up. The FIGO (2009) stage distribution at the time of presentation was stage IB: 109 (18.1%); stage IIA: 14 (2.3%), stage IIB: 118 (19.6%), stage IIIA: 12 (2%), stage IIIB: 277 (46%), stage IVA: 20 (3.3%) and stage IVB: 52 (8.6%). Ninety of the 138 (65.22%) patients underwent a stage shift according to the FIGO 2018 because of the presence of enlarged lymph nodes at baseline scan. Sixteen (2.7%) patients had infiltrative nodal masses most commonly involving the blood vessels (n=14) followed by ureter (n=8), bones (n=5), muscle and bowel (n=3, each). The majority (14/16) of these patients presented with vague abdominal pain, discomfort and vomiting, while two had bone pain. Interpretation & conclusions: CECT at baseline helps in accurately assessing the stage in cervical carcinoma. It helps in the identification of lymph node metastasis in cervical carcinoma, which is crucial for guiding accurate management. [ABSTRACT FROM AUTHOR]

Introduction: Prognostic evaluation of Oral Squamous Cell Carcinoma (OSCC) is mainly based on [Tumour (T), Nodes (N), and Metastases (M)] staging. To predict the biological and clinical behaviour of a tumour, histological grading systems plays an important role. Modified Anneroth's grading system includes three parameters each for histologic features and tumour-host relationship. Aim: To compare and analyse the histological features of tumour center and periphery of non metastatic and metastatic OSCC according to Anneroth's histopathological classification and its association with regional lymph node metastasis. Materials and Methods: A retrospective pilot study was conducted on 20 histopathologically proven cases of OSCC collected from the Department of Oral Pathology and Oral Microbiology, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India. The OSCC cases that reported from March 2018 to June 2020 were included in the study. Among 20 cases, 10 non metastatic and 10 metastatic cases, were retrieved from archival blocks. Scores for the morphology and tumour-host relationship of non metastatic and metastatic tumours was assessed and graded by Anneroth's grading system; then compared with the Broders histopathological grading system. The histopathological scoring of lymph node was based on TNM staging. Chi-square test and Spearman's correlation coefficient analysis was done. Results: Anneroth's grading system showed a significant difference in pattern of invasion in tumour periphery of metastatic OSCC (p-value=0.01). Compared to Broder's, Anneroth's classification showed a highly significant corelation with lymph node metastasis (p-value=0.001). Conclusion: Hence, Anneroth's histopathological grading system can be used to predict the biological changes in metastatic and non metastatic OSCC and its increased possibility of regional lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background: Uncommon histopathological subtypes account for less than 5% cases of soft tissue sarcoma (STS) and unclassified STSs comprise another 16%, these are often chemotherapy-resistant, with a dismal outcome in unresectable/metastatic disease. Prospective studies on the use of pazopanib in this cohort of patients are lacking in the literature. Here, we describe the safety and efficacy of pazopanib in rare histologies of advanced STS. Materials and methods: We conducted a retrospective study at two tertiary cancer centres in India, evaluating 33 cases of rare subtypes of STS, who received pazopanib as per institutional protocol between January 2013 and December 2019. Patients who received pazopanib for unresectable/metastatic disease were enrolled in this study for clinicopathologic features, treatment outcome and evaluation of prognostic factors. Results: Out of 33 patients, there were seven cases of undifferentiated pleomorphic sarcoma, four cases each of myxofibrosarcoma, epithelioid sarcoma and malignant peripheral nerve sheath tumour, three cases each of haemangiopericytoma and spindle cell sarcoma, two cases of haemangioendothelioma and a case each of clear cell sarcoma, retroperitoneal sarcoma, angiosarcoma and pleomorphic rhabdomyosarcoma-adult type. The objective response rate was 27%. Most of the patients (67%) received pazopanib in second or subsequent lines of therapy. The majority (70%) were started at a lower dose of 400/600 mg and only 43% of these (10/23) could be escalated to a full dose of 800 mg based on tolerance. On univariate analysis, pazopanib's starting dose didn't predict progression-free survival (PFS)/overall survival (OS)/response rate. At a median duration of follow-up of 18.8 months (range 1.9-150.4 months), the median PFS and median OS were 10.3 months (95% confidence interval (CI): 5.9-14.8) and 17.8 months (95% CI: 10.7-29.3), respectively. 27% of the patients experienced grade ¾ toxicities, 12% required dose modification of pazopanib and 21% needed permanent discontinuation due to toxicity. Conclusion: Our study shows that pazopanib is active in rare subtypes of STS. [ABSTRACT FROM AUTHOR]

Background  Presence of extramural venous invasion (EMVI) is a poor prognostic factor for rectal cancer as per literature. However, India-specific data are lacking. Aim  The aim of the study is to determine the prognostic significance of EMVI in locally advanced rectal cancer on baseline MRI. Materials and Methods  We retrospectively reviewed 117 MRIs of operable non-metastatic locally advanced rectal cancers in a tertiary cancer institute. Three dedicated oncoradiologists determined presence or absence of EMVI, and its length and thickness, in consensus. These patients were treated as per standard institutional protocols and followed up for a median period of 37 months (range: 2–71 months). Kaplan-Meier curves (95% CI) were used to determine disease-free survival (DFS), distant-metastases free survival (DMFS), and overall survival (OS). Univariate analysis was performed by comparing groups with log-rank test. Results  EMVI positive cases were 34/114 (29%). More EMVI-positive cases developed distant metastasis compared with EMVI-negative cases (14/34–41% vs. 22/83–26%). The difference, however, was not statistically significant (p  = 0.146). After excluding signet-ring cell cancers (n  = 14), EMVI showed significant correlation with DMFS (p  = 0.046), but not with DFS or OS. The median thickness and length of EMVI was 6 and 14 mm, respectively in patients who developed distant metastasis, as compared with 5 and 11 mm in those who did not, although this difference was not statistically significant. Conclusion  EMVI is a predictor of distant metastasis in locally advanced non-metastatic, non-signet ring cell rectal cancers. EMVI can be considered another high-risk feature to predict distant metastasis. [ABSTRACT FROM AUTHOR]

Objective: Dermatofibrosarcoma protuberans (DFSP) of the vulva is an uncommon soft tissue tumor with fewer than 60 cases reported previously. Distant metastasis is rare with a high propensity for local invasion. Surgical management is the gold standard with adequate margin excision to prevent future recurrences. We report a case of vulvar DFSP requiring three resections to achieve primary clearance. To the best of our knowledge, this is the first case report from India. Case report: A 35-years-old female, presented with nodular vulvar mass for the third time arising from the upper part of right labia majora for the last year. She had a history of two similar episodes in the past for which excision was done and histopathology confirmed DFSP. The third wide local resection was performed with 3 cm margins and the margins were sent for intra-operative frozen section analysis, which was confirmed clear by the pathologist. The patient has been free of recurrence for two years. Conclusion: DFSP is a challenging condition presenting as a non-tender nodular mass characterized by local invasion and recurrence. Early diagnosis and appropriate management using wide local excision with accurate margin assessment can achieve optimal results and prevent future recurrences. [ABSTRACT FROM AUTHOR]

Background: No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics.Methods: This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival.Result: Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (< 2).Conclusion: The outcome of mCRC is inferior to the published literature. We found a relatively higher proportion of patients with the following characteristics; younger, rectum as primary tumor location, the signet, and mucinous histology, higher incidence of peritoneum involvement. The routine use of targeted therapies is limited. Government schemes (inclusion of targeted therapies in the Ayushman scheme), NGO assistance, and availability of generic low-cost targeted drugs may increase the availability. [ABSTRACT FROM AUTHOR]