Search

Aims: To study the role of neoadjuvant chemotherapy (NACT) followed by surgical cytoreduction in the management of advanced epithelial ovarian cancers.Materials and Methods: A retrospective analysis of 82 patients with advanced epithelial ovarian cancers (stage IIIC and IV) who were treated with NACT followed by surgical cytoreduction between 1995 and 2004 was performed. Response to NACT, optimal cytoreduction rate, disease-free survival and overall survival were analyzed.Results: There were 59 patients (72%) with stage IIIC disease and 23 (28%) with stage IV disease. Diagnosis was established by imaging, ascitic fluid cytology and CA-125 estimations in 75% and by laparotomy in 25% of the patients. After NACT, complete response occurred in 17 patients (20.7%), 50 (61.0%) had partial response and no response was documented in 15 (18.3%) patients. Optimal surgical cytoreduction could be achieved in 72% of the patients. At the median follow-up of 34 months (range 6-102 months), 5-year disease-free and overall survivals were 31 and 32% respectively. The median disease free interval was 25.4 months. On multivariate analysis, degree of optimal cytoreduction was the only factor (P < 0.05) affecting survival.Conclusions: NACT followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers. A significant number of patients exhibit response to NACT. Downstaging following NACT leads to higher optimal cytoreduction rates and improved survival in comparison to historical controls. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gastrointestinal tract (GI) is the most frequently involved extra nodal site in non-Hodgkin's lymphoma (NHL). Surgery, radiotherapy and chemotherapy (CT) have been used mostly in various combinations, but lately chemotherapy alone has emerged as an effective option. The purpose of this study is to evaluate efficacy of CT alone in treatment of primary GI-NHL and to compare the results with combined CT + surgery. SETTING AND DESIGN: Retrospective analysis of case records of GI NHL patients. MATERIALS AND METHODS: Over a 15-year period (1986-2000), 77 new cases of primary GI-NHL were registered at our center. GI-NHL was defined according to standard criteria. All patients received chemotherapy. RESULTS: The median age was 32 years (Range 9-80). Endoscopy / CT guided biopsies were performed in 42% (32) of patients for the purpose of diagnosis. Laparotomy was done in 58% (45) of patients to establish a diagnosis or as primary or debulking treatment. Stomach and intestines were involved in 47% (36) and 53% (41) patients respectively. Early stage disease was present in 37% (29). Seventy eight percent of tumors were intermediate to high grade, 43% (33) received only CT while 57% (44) received CT + surgery. Five years EFS and OS were: 72% and 65% for all patients; 72% and 67% for CT only group; 60% and 64% for CT + surgery group (P=0.05). Four patients died of neutropenic infection. CONCLUSION: Organ-preservation strategy using chemotherapy alone (CT) can be successfully employed in a significant number of patients with primary GI-NHL. [ABSTRACT FROM AUTHOR]

Background: Unresectable and metastatic gastric cancers carry a poor and dismal prognosis. Several phase II studies have identified effective anticancer drugs.Aims: To evaluate safety and efficacy of low-dose cisplatin, etoposide and paclitaxel (CEP) based combination chemotherapy in locally advanced or metastatic adenocarcinoma of gastric/gastroesophageal junction.Setting and Design: Prospective single-arm phase II study.Materials and Methods: Thirty-three patients were enrolled onto this study, out of which, all but one received cisplatin 15 mg/m 2, etoposide 40 mg/m 2 and paclitaxel 50 mg/m 2, given on day 1 and 4 every week for three weeks in a 28-day cycle. Survival analysis was done using SPSS program.Results: Median age of group was 56 years. Twenty-five were males. Twenty-nine had metastatic/inoperable disease and four patients had recurrent disease. Liver was the commonest metastatic site seen in 15 patients. With a median of 2 cycles per patient, a total of 76 cycles was administered. Grade III or IV toxicity were seen in 11 (35%) patients; diarrhea, 5 patients; vomiting, 3 patients; and neutropenia, 7 patients, 5 of whom also had fever). One patient died of neutropenic fever. Best responses, seen in 32 evaluable patients, were 2 CR (6.1%), 21 PR (63%) and 3 SD (9.2%). Four patients were considered operable after chemotherapy. With median follow-up of 11 months in surviving patients, median OS was 10 months and PFS was 8 months. Median OS was 13 months in responders versus 8 months in nonresponders (P =0.04). Seven patients survived> 12 months.Conclusion: Combination of low-dose CEP shows good clinical response and an acceptable toxicity profile in advanced or metastatic adenocarcinoma of gastric/gastroesophageal cancers. Whether addition of 5 FU or capecitabine adds to the benefit should be explored. This may be tested with other standard/conventional protocols in a randomized fashion. [ABSTRACT FROM AUTHOR]

Objective: TheMEMD gene was reported to be overexpressed in human esophageal squamous cell carcinoma (ESCC), using differential display. The aim of this study was to determine the clinical significance of MEMD/ALCAM in esophageal tumorigenesis. Methods: Analysis of MEMD/ALCAM expression in esophageal tissues was carried out at protein and RNA level using immunohistochemistry and semiquantitative RT-PCR, respectively. Results: Increased MEMD/ALCAM expression was observed in 42/65 (65%) ESCCs (p = 0.000, odds ratio, OR = 3.665) and in 17/25 (68%) dysplasias (p = 0.000, OR = 4.248) compared to paired distant histologically normal esophageal tissues. Increased MEMD mRNAlevels were observed in ESCCs and dysplasias showing overexpression of MEMD/ALCAM protein. Interestingly, increased membranous MEMD/ALCAM expression was observed in dysplasias in comparison with ESCCs (p = 0.002, OR = 3.177). MEMD/ALCAM overexpression in ESCCs was associated with late clinical stage (p = 0.002, OR = 3.619), enhanced tumor invasiveness (p = 0.002, OR = 3.619), and nodal metastasis (p = 0.000, OR = 4.206). Conclusion: To our knowledge, this is the first report showing MEMD expression at pre-malignant stage (dysplasia), suggesting that MEMD/ALCAM expression is an early event in the development of esophageal cancer. Furthermore, in ESCCs its correlation with late clinical stage, enhanced tumor invasiveness and nodal metastasis suggests an association with aggressive tumor behavior. Our data suggest that MEMD/ALCAM may serve as a potential marker for early diagnosis, tumor invasion and nodal metastasis in ESCCs. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

BACKGROUND: Pregnancy-associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. There is a paucity of data on PABC from India. The aim of our study was to assess the clinical-pathological parameters and outcome of PABC at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences. MATERIALS AND METHODS: We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patients' records were obtained from the computer database using International Classification of Diseases code (C-50). RESULTS: The median age was 26 years (range 20-35). The median duration of symptoms was 11.5 months. The American Joint Committee on Cancer stage distribution was Stage I - 1, Stage II - 3, Stage III - 14 and in Stage IV - 8 patients. Median clinical tumor size is 5.5 cm. Four patients were presented with the inflammatory breast cancer. Positive family history was elicited in three patients. Twenty-one patients were diagnosed after delivery, two patients in the first trimester, two patients in the second trimester and three patients in the third trimester. Estrogen receptor (ER), progesterone receptor (PR) negativity and human epidermal growth factor receptor 2 (HER2/neu) positivity was 56% and 38%, respectively. Nearly, 40% of patients had a high-grade tumor and 70% had pathological node positivity. With a median follow-up of 33 months, 3 years relapse free survival and overall survival was 40% and 50% respectively. Bone was the most common site for systemic relapse. CONCLUSIONS: PABC constituted 0.7% of all breast cancer patients. It is associated with advanced stage at presentation. Half of them were ER/PR negative and one-third was HER2/neu positive. [ABSTRACT FROM AUTHOR]

Carcinoma of the cervix is the most common malignancy among women in India. Although metastatic disease is common, metastasis to breast is rare. A limited number of case reports are published in the world literature. Most of the previous reports of metastatic cervical carcinoma to breast are either autopsy series or widely disseminated disease where no treatment options were available. A rare case of cervical carcinoma presenting as metastasis in breast is reported here where palliative mastectomy improved the general condition of the patient. A female patient aged 58 years was diagnosed and treated for cervical carcinoma, FIGO stage 2B. Four months after the treatment which included both external beam and intracavitory radiotherapy, the patient presented with breast and lung metastasis. Palliative mastectomy was done which improved the general condition of the patient. Metastatic carcinoma of the cervix can present as a case of breast carcinoma. In an appropriate setting, this possibility should be kept in mind. Palliative mastectomy should be offered for patients of cervical carcinoma with metastasis to breast when needed. [ABSTRACT FROM AUTHOR]

Background: Askin tumour or peripheral primitive neuroectodermal tumour (PNET) of Thoraco-pulmonary region is a rare, highly aggressive tumour belonging to Ewings sarcoma family of tumour (EFT). A paradigm shift to successful outcomes was possible in recent times due to introduction of Multimodality management .We present our experience of treating 24 cases of PNET with multimodality management. Materials and method : Data of Histo-pathologically proven cases of PNET involving chest wall was extracted from the prospectively maintained Computerized soft tissue sarcoma data base and analysed for clinical profile, details of multimodality management and relapse patters. Result: A total of 24 cases of PNET chest wall were treated between 2010 to 2015. The mean age was 24Years (range 12 to 37 yrs) . Disease was equally distributed in both sexes. Most common presentation was chest pain ( 61 %) followed by Chest wall mass. All patient except one received Neo adjuvant chemotherapy followed by surgery with or without radiotherapy . VAC ( vincristine, Actinomycin D, cyclophosphamide ) alternating with IE ( ifosamide, etoposide ) was the chemotherapeutic regimen given. All patients responded to NACT and had chest wall resection and reconstruction . Three 3 patients required lung resections. Radiotherapy was given in 6 Patients Out of 14 Patients . At a median follow-up of 22.5 months .8 Patients had relapse of disease . Conclusion: Askins tumours are highly aggressive type of tumors affecting younger population . These tumors are highly chemosensitive hence NACT followed by radical surgery results in optimal outcomes. These cases should ideally be treated in tertiary care cancer centres with expertise for successful outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Soft tissue sarcoma (STS) comprises a rare and heterogeneous group of malignant tumors and extremities are the most common site of involvement. Even though Limb salvage surgery (LSS) is the preferred treatment option but various limiting factors like tumor size, extent of spread, neurovascular and bony involvement can influence LSS rates. The impact of anatomical location (sub-site distribution) on LSS rates is not well studied. The aim of this study is to see the impact of sub-site distribution on limb salvage surgery. Methods: Analysis of prospective maintained soft tissue sarcoma computerized database was performed and records of biopsy proven extremity sarcoma treated between 1995 to 2013 were analyzed for demographics, clinical profile including sub-site distribution, limb salvage surgery rates and impact of sub-site on limb salvage surgery rates. Results: Total 409 extremity sarcoma patients were included for analysis. Mean age was 40yrs (range 10-85 yrs) and 68% were male. The predominant site was lower extremity involving 281 patients (68.70%) and predominant sub-site among lower extremity was thigh with 48% followed by leg (34.51%) and foot (7.11%). In patients with upper extremity sarcomas, 32% had tumors in arm region followed by forearm in 30.04% and shoulder girdle in 23.43%. Mean tumor size was 9 cm. History of prior suboptimal surgical intervention was present in 58%.Overall Limb salvage surgery rate was 72.86% and 24.93% had amputations. As per sub site distribution, highest LSS rates could be achieved in the arm (90%) and thigh (84%) followed by leg (54%) and forearm (66.66%). Maximum numbers of amputation were performed for patients with sarcomas involving foot (85%) and hand (67%). Conclusion: Conventional factors for predicting LSS for extremity sarcoma does not include anatomical sub-site distribution. Results of the present study indicate that the anatomical sub-site distribution is a strong predictor of LSS in patients with extremity soft tissue sarcoma. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Orbital tumours comprise a rare and heterogenous group of tumors. The complex anatomy of orbit poses a challenge to surgical resection and reconstruction. A subset of patients with advanced orbital tumours require craniofacial resection. Craniofacial resection using a multidisciplinary approach offers the advantage of optimal oncologic and functional outcomes. We performed an audit of our experience with orbital tumours requiring craniofacial resections and present the outcomes. MATERIALS and METHODSA prospectively maintained database in the Department of Surgical Oncology, BRA IRCH, AIIMS, New Delhi from 2012 to 2017 was accessed and all patients undergoing craniofacial resection for orbital tumors were analysed. A two team multidisciplinary surgical approach involving Surgical oncology and neurosurgery was adopted in all cases. RESULTS- A total of 5 out of 31 patients undergoing orbital exenteration for orbital tumours required craniofacial resection. Mean age of presentation was 53years (18 - 69) with a male preponderance ( M:F= 3:2). The tumours were of varied histopathologic sub-types- Adenoid cystic carcinoma, Pleomorphic adenoma, mesenchymal Chondrosarcoma, Apocrine carcinoma, sebaceous cell carcinoma. Four out of 5 patients presented with recurrent/ residual disease after a prior sub-optimal surgical intervention. Craniofacial resection was performed by trans-facial followed by trans-cranial approach in 4 patients and in 2 patients dura was resected. R-0 resection could be achieved in all patients with no significant post operative morbidity. Temporalis muscle flap was used in all patients for soft tissue reconstruction and in 2 patients each titanium mesh and cranioplasty using calvarial graft was used. Four patients received adjuvant radiotherapy. One patient relapsed and four patients were disease free at last follow-up. CONCLUSION-A subset of orbital tumours with varied histologies can present with intracranial extension creating challenges in management. A multidisciplinary aggressive surgical approach for resection and expertise for soft tissue and rigid reconstruction is necessary for optimal outcomes. [ABSTRACT FROM AUTHOR]

Introduction; Thyroid cancer is the most common endocrine cancer. Surgery is the mainstay of therapy for differentiated thyroid cancers with long-term survival in a significant proportion of patients. Surgical Morbidity is a major determinant of outcomes especially in patients undergoing Re-do thyroid surgery. Volumes and surgical expertise can affect surgical outcomes . We present our experience of re-do thyroid surgery for cancer with specific reference to surgical morbidity. Material & Methods; All the records of recurrent carcinoma thyroid who underwent revision surgeries in the department of surgical oncology between 2009 to 2016 were analysed for clinical spectrum, prior surgical intervention pattern, morbidity during first surgery, revision surgery details and morbidity data at our centre. Majority of the surgeries were performed by one senior consultant surgeon. Results ; A total of 132 patients had re-do surgery for thyroid cancer during the study period. Median age at presentation was 40 years ( mean ;39.59 +/- 14.15) and 52.27% were females and 47.73% were males ( M:F = 1: 1.15). Histopathologically 83 % were Papillary carcinoma thyroid (PTC), 8 % Medullary carcinoma thyroid, 7 % Follicular carcinoma thyroid and 2 % Hurthle cell carcinoma. The spectrum of surgery prior to referral was (i)Lobectomy 29.54%, (ii) Total thyroidectomy(TT) 59.09% (iii) Near total thyroidectomy (NTT) 7.58% (iv) subtotal thyroidectomy (STT) in 2.27%. Neck nodes were addressed in 56 cases ( 42.43%). Documented postoperative complications at the time of first surgery including recurrent laryngeal nerve injury ( RLN palsy), transient or permanent hypocalcemia and combination of these were; 7.57%, 9.85% and 8.33% respectively. Spectrum of Revision surgeries for primary done at our institute were Total Completion Total Thyroidectomy 35%, Total Thyroidectomy in 10 % and extended resections (Trachea, skin, esophagus, larynx) in 5 cases. All patients (132) had some form of Neck dissection (ND) at our centre in various combinations of uni or B/L MND, ALND, CND . Reported postoperative complications at our institute were - transient hypocalcemia in 8.33%, permanent hypocalcemia 2 % and RLN palsy in 2 % . Conclusion: Re-do thyroid surgery for thyroid cancer is challenging and associated with high rates of morbidity in literature. Results of our study indicate that high volume, meticulous quality controlled surgery and surgical experience can result in excellent outcomes . We recommend that these patients should be treated in tertiary care referral centres with expertise for optimal outcomes. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) has emerged as the most common malignancy among females. The genomic profile of BC is diverse in nature and complex due to heterogeneity among various geographically different ethnic groups. The primary objective of this study was to carry out a comprehensive mutational analysis of Indian BC cases by performing whole exome sequencing. The cohort included patients with a median age of 48 years. TTN, TP53, MUC16, SYNE1, and OBSCN were the frequently altered genes found in our cohort. The PIK3CA and KLC3 genes are driver genes implicated in various cellular functions and cargo transportation through microtubules, respectively. Except for CCDC168 and PIK3CA, several gene pairings were found to be significantly linked with co-occurrence. Irrespective of their hormonal receptor status, RTK/RAS was observed with frequently altered signaling pathways. Further analysis of the mutational signature revealed that SBS13, SBS6, and SBS29 were mainly observed in our cohort. This study supplements the discovery of diagnostic biomarkers and provides new therapeutic options for the improved management of BC. [ABSTRACT FROM AUTHOR]

Background -Dermatofibrosarcoma Protuberans (DFSP) is a rare cutaneous tumor of low malignant potential . Surgery is curative in majority of cases but sub optimal surgical interventions and high recurrence rates are often encountered due to rarity of the disease, paucity of literature and innocuous clinical presentation. We present a single institution experience of managing 82 DFSP patients. Material and method- The medical records of all biopsy proven DFSP patients treated at our centre between 1995 to 2016 were accessed from the prospectively maintained soft tissue sarcoma data base. Data regarding clinical profile, treatment details and relapse patterns were analysed. Result- A total of 82 patients of DFSP were treated between 1994 to 2016 constituting 14 % of all soft tissue sarcomas. Two thirds were in 3rd to 5th decade and males were more commonly affected (74%) . Chest wall and trunk was the most common site ( 51%) . Mean tumor size was 6.5 cm . 82 % patients had history of previous sub-optimal surgical intervention. Wide local excision was performed in all patients and 35 patients required soft tissue reconstruction using flaps. External beam radiotherapy (EBRT) was given to 57% high risk cases. At a mean follow up of 55 months 7% had local relapse and 2 patients had systemic relapse. Conclusion- DFSP is a rare variety of Soft tissue sarcoma and often mismanaged at community level. Optimal surgical resection with negative margins and judicious use of reconstructive surgery and radiotherapy can result in excellent outcomes. [ABSTRACT FROM AUTHOR]

Background:- Bilateral Breast cancer (BBC) is a rare entity with incidence of 1-2% in reported literature. There are conflicting and inadequate data regarding the incidence, behaviour, molecular subtypes, management policies and their outcomes. We present our experience of treating 87 BBC with multimodality management. Materials and Methods:- An audit of prospectively maintained computerized breast cancer database of the department of surgical oncology, AIIMS, New Delhi was performed . The medical records of patients with histo-pathologically proven Bilateral Breast Cancer (synchronous or metachronous) were analyzed to assess the clincal profile, molecular sub-types, treatment patterns and outcomes. Results: A total 87 (2.68%) patients presented with BBC out of 3235 breast cancer patients treated between January 1996 and December 2016. Out of 87 BBC patients 67 had metachronous (MBBC) and 20 had synchronous breast cancer (SBBC). Family history of breast cancer was present in 13 patients (15%). Similar Molecular types were found in 56 BBC patients (64%) while this pattern was relatively higher in SBBC group (70%). Screen detected Contralateral breast cancer (CBC) was detected in 16 patients only and rest all presented with breast mass. Most contralateral breast cancer patients had early stage breast cancer in comparison to the index side cancer (64% versus 36%). Among 20 SBBC patients 3 had B/L BCS and 13 had B/L mastectomy where as in 67 MBBC group majority had B/L mastectomy. All patients undergoing BCS and LABC were given postoperative radiotherapy. All patients received adjuvant chemo and or hormonal therapy both for index and CBC based on the stage and hormone receptor status. Conclusion:- BBC is an uncommon clinical entity and with effective therapeutic interventions and improving survival we are likely to see more BBC in future. Majority present with MBBC during follow-up and positive family history is present in a small proportion of BBC patients. Treatment of BBC is challenging including choice of surgery, issues of bilateral breast irradiation and re-chemotherapy and hormonal therapy decisions for MBBC. BBC patients require individualized treatment planning in a multidisciplinary treatment setting. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pathological complete response (pCR) has been used as an endpoint in various neo-adjuvant trials for carcinoma breast. Till date, there is no universally accepted definition of pCR, which has made reporting and interpretation of data from neoadjuvant trials challenging. The objective of the study was to establish the association between different types of pCR and event free survival(EFS) in breast cancer patients undergoing Neoadjuvant chemotherapy (NACT) . MATERIALS AND METHODS: A prospectively maintained computerized Breast Cancer database was accessed and clinical data of 504 Breast cancer patients undergoing NACT followed by surgery between 1995 to 2014 were included for analysis. Rates of pCR in primary only (ypTo) and pCR in both primary and axilla (ypToNo) were calculated and relapse rates during follow-up were documented. An analysis was performed to elucidate the relationship between relapse rates in pCR vs non pCR patients using 2 different pCR criteria. STRATA software was used to analyse the data. RESULTS: Out of 504 patients receiving NACT a total of 113 (22.42%) patients achieved pCR in primary ( ypTo) and 68 (13.4%) patients had achieved pCR in both primary and axilla(ypToNo). Using pCR criteria 1 ( ypTo) 35 patients had recurrence out of 113 patients (30%) in comparison 178 patients had recurrence among 390 patients (45.64%) who didn't achieve a pCR [p=0.007]. When criteria 2 of pCR (ypT0N0) was used 16 out of 68 patients had recurrence (23.53%) who had pCR in both primary and axilla, whereas 197 out of 436 patients (41.51%) had recurrence who didn't had pCR [p=0.02] CONCLUSION: pCR rates among breast cancer patients receiving NACT vary significantly using different pCR criteria . The frequency of pCR decreased with usage of increasingly stringent criteria (ypT0=22.42% vs ypT0N0=13.4%) . Overall Patients who achieved pCR had less recurrences in comparison to non pCR patients . While both ypT0 and ypT0N0 were associated with relatively low rates of relapse ypT0 has stronger association with decreased relapse rates. [ABSTRACT FROM AUTHOR]

Introduction: Squamous cell carcinoma (SCC) of the buccal mucosa is most common subsite of oral malignancies in Indian sub-continent. Majority present with locally advanced disease and surgery plays an important role in management of buccal cancer. Most common site of spread is to cervical lymph nodes and neck dissection is treatment of choice in node positive patients. However there are controversies in the management of neck in early stage buccal cancer with node negative neck. The purpose of this study was to present our experience of neck dissection patterns, nodal positivity rates in early buccal SCC (cT1-2 N0-1) to facilitate future treatment strategies. Methods: A prospectively maintained computerized oral cancer database was reviewed and all histo-pathologically proven SCC of Buccal mucosa patients with T1 and T2 lesions undergoing neck dissection were included for analysis. Analysis was performed pertaining to patterns of neck dissection, and node positivity rates in early stage buccal cancers. Results: A total of 100 patients with T1-2 buccal carcinomas had neck dissection during the study period (1995- 2015). Modified neck dissection was the commonest procedure done in 61 patients (61%), followed by supra-omohyoid neck dissection in 32 (32%). Over the period 1995-2015 there was a gradual shift towards more conservative approach in neck dissections (1995-2005 - SOHND - 19% vs. 2006-2015- SOHND 55%). Overall nodal positivity rate was only 33% (33/100). In specific neck dissection types the node positivity rates were as follows - RND 100% (4/4), MND 41%(24/58), SOHND 6.4% (2/31). Neck node relapse was documented in 4 patients (4%). Conclusion: Results of the current study indicate that there is a overall shift towards conservative neck dissections like SOHND in patients with early stage buccal cancer. Approximately two thirds of early stage buccal cancer patients undergoing neck dissection have no pathologically proven nodal involvement resulting in gross overtreatment. These significant findings should be considered in formulating neck node management strategies for early buccal cancer patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 71-year-old male diagnosed with intrascrotal paratesticular malignant fibrous histiocytoma. Topics discussed include the medical record of the patient, the diagnosis of his intrascrotal paratesticular malignant fibrous histiocytoma, his physical examinations, his treatment options, and an overview of the disease.

A letter to the editor is presented which discusses a case study of a 19-year-old female who was diagnosed with primary mammary rhabdomyosarcoma.

The objective of this research was to study the contrast enhancement patterns of the different molecular subtypes of breast cancer on contrast-enhanced ultrasound (CEUS) using both qualitative and quantitative parameters. This prospective study included females with a single breast mass which was histopathologically proven carcinoma. B mode ultrasound (USG) and CEUS were performed in all patients during baseline assessment. Qualitative CEUS assessment encompassed enhancement pattern, presence of fill-in and washout. Quantitative assessment included measurement of peak enhancement, time to peak; area under the curve and mean transit time. A p-value < 0.05 was considered statistically significant for differentiating the subtypes. The included thirty masses were categorised into two subtypes--triple negative breast cancer (TNBC) (36.7%) and non-TNBC (63.3%) subtypes. With B-mode USG, a statistically significant difference was observed between the two groups with respect to their shape and margins. TNBC lesions showed an oval shape, circumscribed margins and peripheral nodular enhancement on CEUS with the absence of fill-in even in the delayed phase (p-value - 0.04). The two subtypes did not significantly differ in terms of quantitative perfusion parameters. The various subtypes of breast cancer therefore possess distinct contrast enhancement patterns. CEUS potentially allows differentiation amongst these molecular subtypes that may aid in radiology-pathology (rad-path) correlation and follow up of the patients. [ABSTRACT FROM AUTHOR]

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location. [ABSTRACT FROM AUTHOR]

In the era of evidence based medicine documentation of clinical data is extremely important. The field of Health informatics is a discipline at the intersection of information science, computer science and health science. Current health informatics field is mainly catering to the general needs of hospital setups. Development of disease / organ/ specialty based computerized clinical data base is still in its infancy and there is a need for clinicians to actively involve in this field to generate authentic and analyzable clinical data. In this article we present our experience of computerized oncology clinical data base development. [ABSTRACT FROM AUTHOR]

Oral cavity squamous cell carcinoma (OSCC) is the most common type of head and neck cancer worldwide. Smokeless tobacco (SLT) has been well proven for its role in oral carcinogenesis due to the abundance of several carcinogens. However, the role of inhabitant microorganisms in the oral cavity of smokeless tobacco users has not yet been well explored in the context of OSCC. Therefore, the present investigation was conceived to analyze the oral bacteriome of smokeless tobacco users having OSCC (CP group). With the assistance of illumina-based sequencing of bacterial-specific V3 hypervariable region of 16S rDNA gene, 71,969 OTUs (operational taxonomic units) were categorized into 18 phyla and 166 genera. The overall analysis revealed that the oral bacteriome of the patients with OSCC, who were smokeless tobacco users, was significantly different compared to the healthy smokeless tobacco users (HTC group) and non-users (HI users). The appearance of 14 significantly abundant genera [FDR (false discovery rate) adjusted probability value of significance (p value) < 0.05] among the CP group showed the prevalence of tobacco-specific nitrosamines forming bacteria (Staphylococcus, Fusobacterium, and Campylobacter). The functional attributes of the oral bacteriome of the CP group can also be correlated with the genes involved in oncogenesis. This study is the first report on the oral bacteriome of Indian patients with OSCC who were chronic tobacco chewers. The results of the present study will pave the way to understand the influence of smokeless tobacco on the oral bacteriome of OSCC patients. Key points: • Oral bacteriome of OSCC patients differ from healthy smokeless tobacco (SLT) users and SLT non-users. • Smokeless tobacco influences the oral bacteriome of OSCC group. • Oral bacteriome specific diagnostics may be developed for pre-diagnosis of oral cancer. [ABSTRACT FROM AUTHOR]

Introduction: Pseudomyxoma peritonei (PMP) is a generalized term, usually known as "jelly belly" since 1884. Incidence is very low, 1–3 per million people per year. Because of its indolent nature, it is usually diagnosed at an advanced stage, thereby impacting the quality of life. The 5-year survival rate varies from 23 to 86% in world literature. Even 10 years and 20 years of survival have been described. With our experience, we like to propose rename of PMP as abdomino-peritoneal mucinous carcinoma (APM) as we strongly feel the time has come to specify the term and standardize the management strategy. Methodology: In the premier institute of India and as a tertiary referral center, we experienced the maximum number of advanced cases of APM. From 2012 to 2021, we analyzed all the APM patients based on a prospectively maintained computerized database in the department of surgical oncology and found the reasons for renaming from this traditional one. Results: We included a total of 87 patients who underwent surgical intervention. Thirty-five patients underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), and 52 patients underwent debulking. In CRS-HIPEC patients, CC-0 was achieved in 28 patients (80%), CC-1 in 4 patients (11.4%), and CC-2 in 3 patients (8.6%). Palliative intent HIPEC was done in 3 patients (8.6%). Clavien-Dindo grade III and IV morbidity was observed in 18.8% of patients with 90 days mortality of 5.7%. Conclusion: With our long-term experience and advancement of scientific evidence, we like to propose a new name for PMP as APM. We strongly believe this paper will give a clear picture of this rare disease and standard management outlines. [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]

Poor oral health has broad consequences that can be seen at personal as well as societal levels, especially in developing countries like India. We have limited information on the healthy oral cavity's inhabitant microorganisms that play a crucial role in overall oral health. In a comprehensive culture-independent approach, the bacterial composition of healthy human oral cavities was determined from a sub-population of northern India. During this study, 20 mouthwash-derived metagenomes were explored for identifying bacterial diversity using the 16S rRNA hypervariable V3 region with the MiSeq Illumina platform. On the taxonomy assignment of operational taxonomic units (OTUs), 20 assigned phyla and 162 genera were recovered among the participants. The mean relative abundance revealed that Streptococcus was the dominant genera among the participants. However, at inter-individual analysis, Neisseria and Haemophilus exhibited first-order dominance among five and three healthy individuals, respectively. Correlation studies indicate that Streptococcus shares a strong relationship with Rothia, Corynebacterium, Prevotella, and Veillonella, whereas it was negatively correlated with Neisseria, Aggregatibacter, Porphyromonas, and Fusobacteria like Gram-negative bacteria. Bacterial diversity showed insignificant differences at the level of age and gender within and between the participants. The results support several of the major findings of previous reports on the healthy oral microbiome of the Indian population, however, the present investigation further illustrates that demographic region leaves an impact on overall bacterial composition. The study will assist in a better understanding of the oral microbiome from region-specific Indian population that was otherwise highly under-represented. [ABSTRACT FROM AUTHOR]

This prospective study was conducted in collaboration with the Department of Surgical Oncology and Nursing. A total of 60 patients (30 patients in each group selected in consecutive fashion) were included based on assumption of α error and power of 5% and 90% respectively. A structured questionnaire for knowledge assessment of primary caregivers before and after intervention was used in the intervention group. The control group received routine care. The demographic profile, tumor location, and surgical intervention were comparable in both groups. At the initial assessment, 76.3% of patient's caregivers did not have prior knowledge of post-operative care. With the specific educational intervention, 68% of the caregivers in the interventional group obtained poor (0–11) knowledge score which was improved to good score (19–25) in 73% of caregivers after the administration of the educational package but this improvement was not seen in the control group which received routine care. This study suggested that there is a need for specific educational package for the primary caregivers to improve their knowledge regarding home-based post-operative care of oral cancer patients that helps in the early recovery of the surgical patients. [ABSTRACT FROM AUTHOR]

Management of extremity sarcoma has shifted from amputation to limb salvage surgery with improvements in surgical techniques and multimodality treatment protocols. For tumors involving major neurovascular bundles, it has not been accepted as a routine practice uniformly due to fear of oncological outcomes, postoperative morbidity, and lack of expertise in microvascular surgery. We analyzed our experience of limb salvage surgery with vascular reconstruction for extremity sarcomas. Retrospective analysis of patients with extremity sarcomas undergoing limb salvage surgery through vascular reconstruction was done. The feasibility, surgical, oncological, and functional outcomes of these patients was studied. Out of 176 patients undergoing limb preserving surgery for extremity sarcoma, limb salvage using vascular resection and reconstruction was done in 14 patients. Mean age of these 14 patients was 35.4 years (19–49). Arterial reconstruction was done in 7 patients, venous in 5, and in 2 patients both arterial and venous reconstructions were performed. All the 14 patients had tumor-free margins, and none had immediate post-operative graft failure requiring amputation. Post radiation graft exposure occurred in one patient. Involvement of major vascular bundle in extremity sarcomas should not always be considered a contraindication for limb preservation. Optimal oncological outcome with preserved limb function can be achieved by arteriovenous reconstructive procedures. In places with limited resources, autologous grafts are preferred because of constraints of availability and cost. [ABSTRACT FROM AUTHOR]

Background: The Androgen Receptor (AR) has emerged as an endocrine therapy target in Breast Cancer, exhibiting up to 80% expression in clinical cases. AR-V7, a constitutively activated splice variant of AR with a truncated ligand-binding domain (LBD), demonstrates ligand-independent transcriptional activity and resistance to nonsteroidal antiandrogens like Bicalutamide or Enzalutamide, targeting the LBD. In metastatic prostate cancer, elevated AR-V7 levels lead to therapeutic resistance and increased metastasis., Methods: In this study, we evaluated the expression of AR and AR-V7 in cell lines and a cohort of 89 patients undergoing surgical intervention for treatment-naïve breast cancer. Further clinicopathological correlations and survival analysis were performed to evaluate the relationship between the AR and AR-V7 expression and clinical outcomes., Results: AR-V7/AR-FL ratio was elevated in the TNBC cell line and downregulation of AR-FL upon AR antagonists' treatment led to a compensatory increase in AR-V7. Clinical samples showed significantly elevated expression of AR and AR-V7 in tumors compared to control cases. Further clinicopathological correlation revealed aggressive clinical traits, higher pathological grades, and poor survival with AR-V7 expression., Conclusions: Our study unravels AR-V7 as a marker for poor clinical outcomes, predicting breast cancer aggressiveness, and encourages consideration of AR-V7 as a probable target for therapeutic intervention., Competing Interests: Declarations Ethics approval and consent to participate This study was ethically approved from the Institute Ethics Committee for Postgraduate Research, All India Institute of Medical Sciences, New Delhi, vide Ref. No. IECPG-177/27.03.2019, RT-08/22.04.2019 dated April 29, 2019. Informed written consent from participants was obtained from the subjects prior to the recruitment into the study. The c. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce., Methods: This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023., Results: 200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores., Conclusions: Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tansir, Sharma, Biswas, Sah, Roy, Deo, Agarwala, Khan, Bakhshi and Pushpam.)

Introduction: A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a significant challenge, particularly because of to lack of knowledge and awareness in low- to middle-income countries., Methods: This prospective study conducted at a high-volume tertiary care cancer center in North India to assess the knowledge, awareness, and attitudes of female breast cancer patients and impact of a brief educational intervention. The study involved three phases: pre-interventional assessment, educational intervention, and post-interventional assessment utilizing a structured questionnaire., Results: The study involved 300 newly diagnosed breast cancer patients; 16.7% were familial. At the outset, 87.0% patients had low knowledge of risk factors, 90.3% about screening, and 32.7% about treatment. Awareness levels were low: 13.7% aware of familial risk and 2.7% of breast cancer genes. Affordability of genetic testing was low (15.2%), and interest in testing for self and family members was limited (32.0% and 26.3%). Following educational intervention, a significant positive percentage change was noticed in knowledge (risk factors: 12.8%, screening: 36.2%, treatment: 82%), awareness (familial risk: 66.7%, BRCA gene: 12.3%), and attitude (testing for self: 17.8%, family: 19.5%)., Conclusions: This study highlights the significant knowledge gaps among breast cancer patients regarding genetics. The educational intervention led to notable improvements in knowledge, awareness, and attitudes, underscoring the importance of tailored patient education in breast cancer care., (© 2024. Society of Surgical Oncology.)

Background: Chest wall tumors are a heterogeneous group of tumors that are managed by surgeons from diverse specialties. Due to their rarity, there is no consensus on their diagnosis and management., Materials: This retrospective, descriptive analysis includes patients with malignant chest wall tumors undergoing chest wall resection. Tumors were classified as primary, secondary, and metastatic tumors. The analysis includes clinicopathological characteristics, resection-reconstruction profile, and relapse patterns., Results: A total of 181 patients underwent chest wall resection between 1999 and 2020. In primary tumors (69%), the majority were soft tissue tumors (59%). In secondary tumors, the majority were from the breast (45%) and lung (42%). Twenty-five percent of patients received neoadjuvant chemotherapy, and 98% of patients underwent R0 resection. Soft tissue, skeletal + soft tissue, and extended resections were performed in 45%, 70%, and 28% of patients, respectively. The majority of patients (60%) underwent rib resections, and a median of 3.5 ribs were resected. The mean defect size was 24 cm 2 . Soft tissue reconstruction was performed in 40% of patients, mostly with latissimus dorsi flaps. Rigid reconstruction was performed in 57% of patients, and 18% underwent mesh-bone cement sandwich technique reconstruction. Adjuvant radiotherapy and chemotherapy were given to 29% and 39% of patients, respectively., Conclusions: This is one of the largest single-institutional experiences on malignant chest wall tumors. The results highlight varied tumor spectra and multimodality approaches for optimal functional and survival outcomes. In limited resource setting, surgery, including reconstructive expertise, is very crucial., (© 2023. Society of Surgical Oncology.)

Enhanced Recovery After Surgery (ERAS) protocols have emerged as a promising approach to optimize perioperative care and improve outcomes in various surgical specialties. Despite feasibility studies on ERAS in various surgeries, there remains a paucity of research focusing on gastrointestinal cancer surgeries in the Indian context. The primary objective is to evaluate the compliance rate of the ERAS protocol and secondary objectives include the compliance rate of individual components of the protocol, the complications, the length of hospital stay, and the challenges faced during implementation in patients undergoing gastrointestinal cancer surgeries in our tertiary care cancer center. In this prospective interventional study (CTRI/2022/04/041657; registered on 05/04/2022), we evaluated 50 patients aged 18 to 70 years undergoing surgery for gastrointestinal malignancies and implemented a refined ERAS protocol tailored to our institutional resources and conditions based on standard ERAS society recommendations for gastrointestinal surgeries and specific recommendations for colorectal, pancreatic, and esophageal surgeries.Our study's mean overall compliance rate with the ERAS protocol was 88.54%. We achieved a compliance rate of 91.98%, 81.66%, and 92.00% for pre-operative, intraoperative, and post-operative components respectively. Fourteen (28%) patients experienced complications during the study. The median length of stay was 6.5 days (5.25-8). Challenges were encountered during the preoperative, intraoperative, and postoperative phases. The study highlighted the feasibility of implementing the ERAS protocol in a cancer institute, but specific challenges need to be addressed for its optimal success in gastrointestinal cancer surgeries., Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-024-01897-y., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Cancer treatment is challenged due to immunosuppressive inflammatory tumour microenvironment (TME) caused by infiltration of tumour-promoting and inhibition of tumour-inhibiting immune cells. Here, we report the engineering of chimeric nanomicelles (NMs) targeting the cell proliferation using docetaxel (DTX) and inflammation using dexamethasone (DEX) that alters the immunosuppressive TME. We show that a combination of phospholipid-DTX conjugate and PEGylated-lipid-DEX conjugate can self-assemble to form sub-100 nm chimeric NMs (DTX-DEX NMs). Anti-cancer activities against syngeneic and xenograft mouse models showed that the DTX-DEX NMs are more effective in tumour regression, enhance the survival of mice over other treatment modes, and alter the tumour stroma. DTX-DEX NMs cause a significant reduction in myeloid-derived suppressor cells, alter the polarization of macrophages, and enhance the accumulation of cytotoxic CD4 + and CD8 + T cells in tumour tissues, along with alterations in cytokine expression. We further demonstrated that these DTX-DEX NMs inhibit the synthesis of prostaglandins, especially PGE2, by targeting the cyclooxygenase 2 that is partly responsible for immunosuppressive TME. Therefore, this study presents, for the first time, the engineering of lithocholic acid-derived chimeric NMs that affect the prostaglandin pathway, alter the TME, and mitigate tumour progression with enhanced mice survival., Competing Interests: Declaration of competing interest The authors declare no conflict of interest in this work., (Copyright © 2023. Published by Elsevier B.V.)

Aims: Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey., Materials and Methods: This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified., Results: In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors., Conclusion: This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Introduction: The lateral intercostal artery perforator flap (LICAP) has emerged as one of the safest and less morbid flaps for lateral and central breast defects. We hereby describe a reproducible no Doppler single position (NDSP) technique to harvest it in single position without handheld Doppler, making it a versatile flap for lateral breast defects in resource-limited setting also., Materials and Methods: With this technique, we performed a total of 22 LICAP turnover flaps over a period of 18 months from January 2020 to June 2021. In all 22 cases, the indication of flap was to fill the post-breast conservation surgery (BCS) defects in outer quadrant of breast. All LICAP flaps were harvested by surface marking of anatomical landmarks and without handheld Doppler., Results: Out of 22 LICAP turnover flaps, thirteen were harvested for left breast and nine for right breast. The median width and length of the flap were 12.2 cm and 19.6 cm, respectively. The additional mean operative time was 41 min. All LICAP flaps survived well, and grade 1 Clavien-Dindo morbidity was documented in four cases. Mean hospital stay was 2.6 days. All patients received radiotherapy on their stipulated schedule. Early cosmetic outcome was good, and long-term outcomes are awaited., Conclusion: NDSP-LICAP flap is a workhorse for lateral breast defects. Precise knowledge of perforators and anatomical landmarks can be used for harvesting these flaps, thus avoiding ultrasound Doppler and dedicated training for perforator localization. This technique has short learning curve without the need for any plastic surgery training. The early cosmetic outcomes are good., (© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

The treatment of advanced epithelial ovarian cancer (EOC) has evolved over time. With advent of platinum-based chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC), there is a paradigm shift in the patterns of care with improved survival. In this study, we analysed our advanced EOC patients aiming to gain insights into the pattern of care. An ambispective study of 250 patients of advanced EOC was done from our prospectively maintained computerised database in the Department of Surgical Oncology, tertiary care referral centre from 2013 to 2020. We analysed the demographic profile, treatment patterns, and perioperative outcomes. In this study, there were 83.6% stage III and 16.4% stage IVA. There were 62 (24.8%) upfront and 112 (44.8%) in interval settings. There was a higher number of patients receiving neo-adjuvant chemotherapy. One hundred twenty-six (50.4%) underwent cytoreductive surgery (CRS) only and 124 (49.6%) underwent CRS and HIPEC. CC-0 was achieved in 84.4% and CC-1 in 15.6% patients. HIPEC programme was started in 2013. With advent of RCTs in HIPEC, there was a substantial increase in the number of patients receiving HIPEC from 2015 ( n  = 10), 2017 ( n  = 20) to 2019 ( n  = 41). We offer secondary CRS in a limited subset of patients, n  = 76 (30.4%). There was 24.8% early and 8.4% late postop complications. We have median follow-up of 50 months with attrition rate of 4%. With practice changing updates, the treatment of advanced EOC has been evolving over time. Though the primary CRS followed by systemic therapy is the standard to date, there is change in pattern of care with neo-adjuvant chemotherapy followed by interval CRS and HIPEC because of various RCTs. The addition of HIPEC has acceptable morbidity and mortality. There is a definite learning curve and the team has to evolve as a whole. In a tertiary care referral centre from LMIC, good patient selection, logistics, and implementing recent advances will definitely add to improved survival., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

To compare features of clinically defined subtypes of breast cancer on mammography (MG) and ultrasonography (USG). After obtaining approval from the institute ethics committee, a retrospective observational study was performed on biopsy-proven breast cancer patients who underwent baseline MG from 2016 to 2020. MG and USG features were evaluated and the patients were classified based on immunohistochemistry profile into luminal like (LL) -oestrogen receptor (ER)/progesterone receptor (PR) + , Her2neu-; basal like (BL) -ER/PR-, Her2neu-; Her2 like (HL) -Her2neu + . A total of 479 patients (mean age, 51.4 ± 11.7 years; all females) were included: LL-198 (41.3%), BL-121 (25.2%) and HL-160 (33.3%). On MG, round shape (21/115, 18.3%, p  < 0.001); circumscribed (16/115, 13.9%, p  < 0.001) and microlobulated margins (28/115, 24.4%) were associated with BL tumours. Associated suspicious calcifications (96/160, 60%, p  < 0.001) and skin thickening or retraction (75/149, 50.3%, p  < 0.001) were more common in HL. On USG, round shape (12/95, 12.8%, p  = 0.005); circumscribed (8/94, 8.5%) and microlobulated margins (44/94, 46.8%) and posterior acoustic enhancement (7/95, 7.5%, p  = 0.012) were associated with BL. The logistic regression analysis revealed that spiculated margins on MG favoured LL (OR: 8.5, p  = 0.001); round shape (OR: 6.8), circumscribed (OR: 10.8) or microlobulated margins (OR: 3.5) ( p  < 0.001 for each) favoured BL; whereas associated features of calcifications (OR: 3.3) ( p  = 0.019) and skin retraction or thickening (OR: 1.8) ( p  < 0.001) favoured HL. On USG, circumscribed (OR: 5.9, p  = 0.005) or microlobulated margins (OR: 3, p  < 0.001) and posterior acoustic enhancement (OR: 9.5, p  = 0.006) favoured BL. Clinically defined subtypes of breast cancer show significant differences in the imaging appearances on mammography and USG. BL tumours may not show the typical imaging features of malignancy, necessitating clinicopathological correlation for accurate diagnosis., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Importance: Carboplatin increases the pathological complete remission (pCR) rate in triple negative breast cancer (TNBC) when added to neoadjuvant chemotherapy, however, evidence on its effect on survival outcomes is controversial., Methods: The study was prospectively registered at PROSPERO (CRD42021228386). We systematically searched PubMed, Embase, Cochrane Central Register of Clinical Trials, and conference proceedings from January 1, 2004 to January 30, 2022 for relevant randomized clinical trials (RCTs) of (neo)adjuvant chemotherapy in TNBC patients, with carboplatin in the intervention arm and standard anthracycline taxane (AT) in the control arm. PRISMA guidelines were used for this review. Data were pooled using fixed and random effects models as appropriate on extracted hazard ratios (HR). Individual patient data (IPD)for disease free survival (DFS) and overall survival (OS) were extracted from published survival curves of included RCTs; DFS and OS curves for each trial and the combined population were reconstructed, and HR estimated. The primary outcome was DFS; OS, pCR, and toxicity were secondary outcomes., Results: Eight trials with 2425 patients were included. Carboplatin improved DFS (HR 0.60; 95% CI 0.47 to 0.78; I 2 45%, p < 0.001) compared with AT at trial level and IPD level (HR 0.66; 95%CI, 0.55 to 0.80, p < 0.001) analysis. The OS also improved with carboplatin at both trial level (HR 0.69, 95%CI 0.50 to 0.95, I 2 41%, p = 0.02) and IPD level (HR 0.68; 95%CI, 0.54 to 0.87, p = 0.002) analysis. The pCR as expected, was better in the carboplatin arm (OR 2.11; 95% CI = 1.44-3.08; I 2 67%, p = 0.009). Anaemia and thrombocytopaenia were higher in the carboplatin arm., Conclusion: and relevance: Carboplatin added to (neo)adjuvant chemotherapy in TNBC improves survival, as shown in both trial level and IPD analysis., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Phthalates are known endocrine-disrupting chemicals used indiscriminately as constituents in consumer products including food processing, and packaging, cosmetics, personal care and household items. Although, few studies have assessed the risk of breast cancer on exposure to phthalates, their association with breast cancer risk in Indian women have not yet been evaluated., Methods: We conducted a case-control study involving 171 participants. Urinary concentrations of six phthalate dieters; DMP (Dimethyl phthalate), DEP (Diethyl phthalate), DBP (Dibutyl phthalate), BBP (benzyl butyl phthalate), DEHP (Di-2-ethyl-hexyl phthalate), DINOP (Di-n-octyl phthalate) were estimated by GC-MS and geometric means were calculated. Univariate and multivariable logistic regression was performed to assess breast cancer risk on exposure to phthalates. Genes responsive to phthalates were identified through literature search and matched with NGS data, and gene-enrichment analysis was performed., Results: Significant associations were observed between urinary phthalate concentrations and increased risk of breast cancer for di-butyl phthalate (OR=1.5, 95% CI; 1.06, 2.11, p = 0.002) and di-2-ethyl-hexyl phthalate (>median vs ≤ median; OR=2.97, 95% CI; 1.18, 7.47, p = 0.005) in multivariable analyses. We also found several phthalate-responsive gene mutations in paired breast tumor tissues, which include PTPRD (76.19%), AR (42.86%), CYP1A1 (42.86%), CYP19A1 (23.81%), AHRR (19.05%), PIK3CA (19.05%), CYP1B1 (9.52%), RB1 (9.52%) and MMP9 (9.52%). Gene-enrichment analysis revealed that these genes form a major part of ER/PR, PPAR and HIF-1α-TGF-β signaling cascades involved in breast cancer CONCLUSION: Although the sample size is small, in this first case-control study from India, DBP and DEHP were found to be associated with increased risk of invasive breast cancer and tumor tissues revealed mutations in several phthalate-responsive genes. It is, therefore suggested that human biomonitoring in India and larger studies evaluating the early life genetic and epigenetic alterations on phthalates exposure are required to establish their role in breast carcinogenesis., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The burden of hereditary breast cancer in India is not well defined. Moreover, genetic testing criteria (National Comprehensive Cancer Network [NCCN] and Mainstreaming Cancer Genetics [MCG] Plus) have never been validated in the Indian population., Methods: All new female breast cancer patients from 1st March 2019 to 28th February 2020 were screened. Those providing informed consent and without previous genetic testing were recruited. Multigene panel testing (107 genes) by next-generation sequencing was performed for all patients. The frequency of pathogenic/likely pathogenic (P/LP) mutations between patients qualifying and not qualifying the testing criteria was compared and their sensitivity was computed., Results: Overall, 275 breast cancer patients were screened and 236 patients were included (median age 45 years); 30 patients did not consent and 9 patients previously underwent genetic testing. Thirty-four (14%) women had a positive family history and 35% had triple-negative breast cancer. P/LP mutations were found in 44/236 (18.64%) women; mutations in BRCA1 (22/47, 46.8%) and BRCA2 (9/47, 19.1%) were the most common, with 34% of mutations present in non-BRCA genes. Patients qualifying the testing criteria had a higher risk of having a P/LP mutation (NCCN: 23.6% vs. 7.04%, p = 0.03; MCG plus: 24.8% vs. 7.2%, p = 0.01). The sensitivity of the NCCN criteria was 88.6% (75.4-96.2) and 86.36% (72.65-94.83) for MCG plus. More than 95% sensitivity was achieved if all women up to 60 years of age were tested. Cascade testing was performed in 31 previous (16/44 families), with 23 testing positive., Conclusions: The frequency of P/LP mutations in India is high, with significant contribution of non-BRCA genes. Testing criteria need modification to expand access to testing., (© 2021. Society of Surgical Oncology.)

COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12-50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© Indian Association of Surgical Oncology 2021.)