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Abstract A primary thoracic origin occurs only in 20% of neuroblastomas, and their classical presentation is mediastinal or cord compression. Skeletal metastases of neuroblastomas are characteristically multiple, and calvarial deposits [...]

This prospective randomized trial compared neoadjuvant chemotherapy followed by local-regional radiotherapy (study group) with radiotherapy alone (control group) in 506 patients with locally advanced non-small-cell lung cancer. The study group received three cycles of cisplatin, ifosfamide with Mesna, and mitomycin C at 21-day intervals. Radiotherapy was delivered up to a dose of 60 Gy. Evaluable patients numbered 460. In the study group, 228 patients were assessed for tumor response after chemotherapy: 13 (5.7%) had a complete response; 103 (43.2%), a partial response; 48 (21%) showed no change; and 74 patients (31.1%) had progressive disease. These patients then received chest irradiation, which was well tolerated. On completion of radiotherapy, 16.2% of the study group and 6% of the control group had a complete response. No change was seen in 10.1% of study patients and 15.5% of control patients. Respective rates for disease progression were 27.6% and 42.3%. Actuarial 2-year survival was 20% in the study group and 7.4% in the control group. [ABSTRACT FROM AUTHOR]

Introduction: Biomedical waste poses physical, chemical, radiological, and microbiological risks to the public and health-care workers (HCWs) for current and future generations., Aim: The aim was to gauge the depth of understanding amongst HCWs on biomedical waste management (BMWM)., Materials and Methods: A predesigned questionnaire on knowledge, attitude, and practices on BMWM Rules, 2016 (Principle), and 2018 (Amendment), Solid Waste Rules, 2016, and health hazards in HCW was distributed to all participants., Results: Only 68% of the participants knew that the most important step in waste management is waste segregation. Eighty-two percent of the HCWs working in this setup knew of the different color-coded bins used for segregation. However, awareness was lacking with respect to health hazards associated with improperly segregated and disposed off biomedical waste as only 49% answered the questions on the hazards of waste correctly. Laboratory waste handling was found to be the least understood area of the newer guidelines., Conclusions: Training aspects of health-care waste management should be strengthened so that the current, existing, and future regulations are practiced diligently and uniformly. Periodic evaluation and assessment should become routine to enforce adherence to waste management., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Laboratory Physicians.)

We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region., Competing Interests: There are no conflicts of interest.

Background & Objective: The current study aimed to perform an immunohistochemical analysis of patterns of apoptotic and cell proliferative related protein expression in different histological grades and immune phenotypes of malignant lymphomas and other lymphoproliferative disorders., Methods: This observational study was carried on 60lymph node biopsies of lymphoproliferative disorders. The biopsies were analyzed histologically and immunohistochemically., Results: A total of 60 lymph node biopsies were included in the study, of which 81.6% were of malignant lympho-proliferative lesions. The majority of the biopsies were B-cell (66%) and were grouped in the intermediate grade. Bax and BCL-2 protein expression was presented by percentage of immune positive neoplastic cells per 10fields and graded on a scale of 1 to4. A Bcl-2, Bax Protein Ratio (BBPR) was determined for each case by dividing the estimated Bcl-2 protein (percentage of Bcl-2 positive cells x Bcl-2 staining intensity) by the estimated Bax protein (percentage of Bax positive cells x Bax immunostaining intensity). The mean BBPR was found to be significantly higher in indolent lymphomas (2.64 ± 1.3) as compared to aggressive lymphomas (0.47 ± 0.9) (P<0.01). The expression of P53 and PCNA in 35 biopsies of Non Hodgkin Lymphomas (NHL) was found to increase from low to high grade tumors., Conclusions: A significant correlation was found between BBPR and predicted biological behavior of indolent and aggressive lymphomas. This indicates the important role of Bcl-2 and Bax in biological behavior of lymphomas. Furthermore, P53 and PCNA expression were found to increase from low to high-grade tumors suggesting their prognostic value in NHL., Competing Interests: All the authors contributed to the study with no conflict

Unregulated biomedical waste management (BMWM) is a public health problem. This has posed a grave threat to not only human health and safety but also to the environment for the current and future generations. Safe and reliable methods for handling of biomedical waste (BMW) are of paramount importance. Effective BMWM is not only a legal necessity but also a social responsibility. This article reviews the current perspectives on BMWM and rules, conventions and the treatment technologies used worldwide. BMWM should ideally be the subject of a national strategy with dedicated infrastructure, cradle-to-grave legislation, competent regulatory authority and trained personnel. Improving the management of biomedical waste begins with waste minimisation. These standards, norms and rules on BMWM in a country regulate the disposal of various categories of BMW to ensure the safety of the health-care workers, patients, public and environment. Furthermore, developing models for the monitoring of hospital health-care waste practices and research into non-burn eco-friendly sustainable technologies, recycling and polyvinyl chloride-free devices will go in long way for safe carbon environment. Globally, greater research in BMWM is warranted to understand its growing field of public health importance.

This article deals with practices related to cytotoxic drug dispersal, cytotoxic safety, and cytotoxic waste management and attempts at India-specific guidelines for their dispersal and disposal. The articles related to cytotoxic drug dispersal, cytotoxic safety, and cytotoxic waste management were reviewed from PubMed and their applicability in Indian health-care facilities (HCFs) was also reviewed. All HCFs dealing with cytotoxic drugs should consider cytotoxic policy, patient safety and health-care worker safety, and environmental monitoring program as per the available international guidelines customized as per Indian conditions. Utmost care in handling cytotoxic waste is quintessential. The formation of India-specific cytotoxic guidelines requires the inputs from all stakeholders. Cytotoxic waste, cytotoxic safety, and cytotoxic waste management should be the subject of a national strategy with an infrastructure, cradle-to-grave legislation, competent regulatory authority, and trained personnel., Competing Interests: There are no conflicts of interest.

Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity., Objective: MATERIALS AND METHODS: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week)., Results: Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection., Conclusion: The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity., (Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)

Radiotherapy is one of the modalities of treatment of malignancies. Radiation-induced malignancies (RIMs) are late complications of radiotherapy, seen among the survivors of both adult and pediatric cancers. Mutagenesis of normal tissues is the basis for RIMs. The aim of this review of literature was to discuss epidemiology, factors affecting and different settings in which RIM occur., Competing Interests: All authors declare that they have no conflicts of interest.

Carcinoma tonsil with visceral metastasis is a rare entity, and cutaneous metastasis is seen even more infrequently. We present a case of a 55-year-old male with carcinoma tonsil having received concurrent chemo radiotherapy, presenting with multiple cutaneous metastases to the scalp and thigh. To the best of our knowledge, till date only two similar cases of carcinoma tonsil with cutaneous metastasis have been reported in the English literature., (Copyright © 2016 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)

Traditional approaches to palliative care may not meet the unique needs of poor cancer patients in developing countries. Cancer patients treated in India are often unable to make repeat visits to the hospital, pay for drugs, or understand and follow complex treatments. Many are from rural areas and may lack basic financial or social support. Our palliative care clinic has taken a series of innovative first steps towards meeting these unique needs, from providing treatment without complete diagnosis, accelerating through the World Health Organization (WHO) analgesic schedule, systematically simplifying prescriptions, and providing treatment free of charge. This paper describes these first steps, presents an initial evaluation of their impacts, and articulates a number of opportunities for additional improvements.

Introduction: Metastatic lesions to oral cavity from distant tumours account for 1% of all oral cavity malignancies. Oral cavity is a rare site of metastasis from the breast. We describe case report of breast cancer patient with metastasis to buccal mucosa., Presentation of Case: We report a case of pre-menopausal woman with left side infiltrating ductal carcinoma breast - T4aN1M0. She received three cycles of neo-adjuvant chemotherapy followed by modified radical mastectomy (MRM) and three cycles of adjuvant chemotherapy and loco-regional EBRT. She presented with a lump in region of MRM scar and a painful swelling in the right cheek, one year afterwards. Core needle biopsy from scar site revealed infiltrating ductal carcinoma. CECT revealed a heterogeneous lesion (1.1cm×1.7cm) in right masticator space, which on biopsy revealed metastatic deposit consistent with infiltrating ductal carcinoma., Discussion: Metastatic lesions to oral cavity from distant tumours are uncommon. They mainly involve bony structures. Primary metastases to soft tissues are rare and accounts for 0.1% of oral malignancies. In our case, patient presented with scar recurrence and distant metastasis at an unusual site. Had it not been for scar recurrence, patient might not have presented to the OPD with oral swelling. A high degree of clinical suspicion and previous history of breast cancer led to detection of metastatic deposit., Conclusion: Diagnosis of a metastatic lesion in buccal mucosa is challenging and requires a high degree of clinical suspicion., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

50 patients of advanced squamous cell carcinoma of the head and neck were randomised cither to receive chemotherapy followed by radiation therapy or chemoimmunotherapy followed by radiotherapy. In the chemoimmunotherapy arm, the patients received recombinant interferon alpha 2b 3 M.U. subcutaneously, thrice a week on alterante days for 5 weeks from Day 1, Cisplatinum 70 mg/ m(2) on Day 1 and 21, and 5 - flurouracil 1000mg/m(2) on Day 1, 2, 3 and Day 21, 22, 23, followed by from Dav 36, radiotherapy'by Co bait 60 to a tumour dose of 65 Gy in 30 # over 6 weeks. In the control arm, patiens received Cisplatitnum 70 mg/ m(2) on Day 1 and Day 21, 5 flurouracil 1000 mg/ m(2) on Dav 1, 2, 3 and Day 21, 22, 23 followed by radiotherapy by Cobalt 60 to a tumour dose of 65 Gy in 30 # over 6 weeks from Day 36. Only Grade II and III toxicity was observed in the two arms which were manageable Patients treated with chemoimmunotherapy followed by radiotherapy showed 60% complete response, 20% partial response and 12% no change/ progressive disease; while the patients on the control arm treated with chemotherapy and radiotherapy showed 12% complete response 44% Partial response and 32% no change" progressive disease. This trial concludes that chemoimmunotherapy followed by radiotherapy is an excellent alternative therapeutic strategy for the management of advanced head and neck cancers with manageable toxicity.

One thousand six hundred ninety-four (1694) cases of carcinoma cervix have been reviewed out of a total of 11919 malignancies, over a period of 4 years (1992-1995), in the department of radiotherapy, Safdarjung Hospital, New Delhi. The epidemiological features studied showed that there was a gradual decline in the total number of cases, age at presentation and parity. There has been a definite increase in the proportion of adenocarcinoma cases. Adenocarcinoma of cervix showed statistically significant preponderance in comparatively younger age group viz, 40-60 years (p < 0.005); 76% of overall cases were illiterate; 77% of cases belonged to rural/urban slum settings compared to 23% which were purely urban in origin. About 65% cases had haemoglobin levels below 10 g/dl at the time of presentation.

Hematological and lymphoid malignancies rarely present with manifestations outside these tissues. We report a patient with chronic lymphocytic leukemia (CLL) presenting with jaundice and generalized lymphadenopathy. The liver profile was suggestive of hepatitis; biopsy showed mild cholestasis. The findings suggest paraneoplastic jaundice with CLL.