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Abstract Background Breast cancer represents a significant public health concern in India, accounting for 28% of all cancer diagnoses and imposing a substantial economic burden. This study introduces a novel approach to forecasting the number of breast cancer cases (based on prevalence rates) and estimating the associated economic impact in India using the autoregressive integrated moving average (ARIMA) model. Methods Data on the prevalence of breast cancer in India from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) database. This dataset provided annual estimates of the number of patients with breast cancer, serving as the basis for modeling future prevalence and estimating the economic burden. The ARIMA (Auto-Regressive Integrated Moving Average) model was employed to analyze and predict breast cancer prevalence in India up to the year 2030 (time-series forecasting). Data were visualized and checked for stationarity using the Augmented Dickey-Fuller (ADF) test. Using the autocorrelation function (ACF) and partial autocorrelation function (PACF) plots, the appropriate parameters (p, d, q) were determined. Several ARIMA configurations were tested to identify the model with the best fit. The goodness-of-fit of the model was assessed using standard metrics such as the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). The residuals were tested using the Box-Ljung test to confirm the absence of autocorrelation and verify that they followed a white noise distribution. Using the fitted ARIMA model, prevalence rates were forecasted from 2022 to 2030, with 95% confidence intervals to capture prediction uncertainty. Direct costs were calculated based on medical expenses for breast cancer patients, such as hospital visits, diagnostic tests, treatment costs, and follow-up care. A bottom-up approach was applied, which involves aggregating individual cost components from each stage of care to estimate the total direct burden of disease. A bottom-up approach was applied, which involves aggregating individual cost components from each stage of care to estimate the total direct burden of disease. Indirect costs were estimated using the human capital approach, which assesses productivity losses due to morbidity and premature mortality. The Disability-Adjusted Life Years (DALY) associated with breast cancer were also predicted using the ARIMA model. Results The results of coefficient of determination (0.99), mean absolute percentage error (69%), mean absolute error (5229), and root mean squared error (6451.2) showed that the ARIMA (0,2,0) model fitted well. Coefficient of determination (0.99) indicated that 99% of the variance in the data was explained by the model. Akaike information criterion (411.54) and Bayesian information criterion (412.53) indicated the ARIMA (0,2,0) model was reliable when analysing our data. The result of the relative error of prediction (2.76%) also suggested that the model predicted well. The number of patients with breast cancer from 2021 to 2030 was predicted to be about 1.25 million, 1.1.29 million,, 1.34 million, 1.39 million, 1.44 million, 1.48 million, 1.53 million, 1.58 million, 1.63 million, 1.68 million, and respectively. The total economic burden of breast cancer from 2021 to 2030 was estimated to be $8 billion, $8.72 billion, $9.05 billion, $9.84 billion, $10.20 billion, $11.07 billion, $11.49 billion, $12.44 billion, $12.91 billion, $13.95 billion, respectively is estimated to rise significantly. Conclusion Breast cancer prevalence and its economic impact are projected to grow substantially in India. Between 2021 and 2030, the number of breast cancer patients is expected to increase by approximately 0.05 million annually, with an annual increase rate of about 5.6%. The associated economic burden will also rise, averaging an additional $19.55 billion per year, underscoring the need for intensified healthcare and economic strategies to manage this growing challenge.

Background: The prognostic significance of human epidermal growth factor receptor 2 (HER2) as assessed by immunohistochemistry (IHC) in high-risk endometrial carcinoma (EC) is worth evaluating, owing to limited literature for the Asian population. Objectives: The primary objective of the study was to evaluate the role of HER2 expression as a prognostic indicator of recurrence-free survival in patients with high-risk endometrial cancer. The secondary objectives were to evaluate overall survival and the frequency of HER2 expression, along with other clinicopathological profiles. Materials and Methods: This retrospective cohort study was conducted in Gynecological oncology Department of Amrita Institute of Medical Sciences, Kochi, India, a tertiary care oncology center. The study included high-risk prognostic group of patients with EC from January 2014 to December 2020. HER2 immunohistochemistry was done using EP3 (HER2 neu antibody) clone, with complete basolateral membrane staining of >30% of tumor cells (3+) considered positive. Outcome data were analyzed for both HER2-positive and HER2-negative groups. Results: Thirty-one HER2-positive and 39 HER2-negative patients were eligible for survival analysis. HER2-positive status was significantly associated with non-endometrioid histotype (P, 0.044). HER2 positivity was observed in 42.9% (18/42) of serous carcinomas, and 40% (4/10) of carcinosarcomas. In the HER2-positive group, 22.5% (7/31) experienced recurrence, compared to 43.5% (17/39) in the HER2-negative group. Mortality rates were 38.4% (15/39) in the HER2-negative group and 41.9% (13/31) in the HER2-positive group. Mean recurrence-free survival (RFS) at 4 years and overall survival (OS) at 5 years were not statistically significant between the two groups (P, 0.097, and P, 0.813, respectively). The mean RFS at 4 years was 34.89 months (95% CI, 30.11- 39.66 months) in the HER-2 negative group and 38 months (95% CI, 31.36-44.64 months) in HER2-positive group. Mean OS at 5 years was 41.68 months (95% CI, 34.83-48.52 months) in HER2-negative and 39.58 months (95% CI, 31.08-48.09 months) in HER2-positive group. Conclusion: HER2 overexpression was not found to be an independent prognostic indicator of RFS or OS in high-risk EC in this study.

Objective: This study aims to determine the oncological outcomes of Stage IVB (FIGO 2009) Endometrial cancer patients and its comparison with the new (FIGO 2023) staging. Methods: A Retrospective analysis was conducted between May 30, 2011, and December 30, 2020 on all patients with stage IVB (FIGO 2009 Staging) endometrial cancer. Overall survival (OS) was the primary outcome. Progression-Free Survival (PFS) and comparison with new staging FIGO 2023 were the secondary outcomes. Kaplan-Meier curves and log-rank tests were used to compare the average OS time and PFS between the groups. Results: Fifty-one patients with Stage IVB endometrial cancer (2009 FIGO Staging) were included. Median age was 68 years. Serous histology was found in 24 (47.1 %) patients. After a median follow-up period of 24 months, median OS was 36 months and median PFS was 15 months. FIGO 2023 staging criteria reclassified the stages of 23 patients (45 %). Patients were restaged into Stage IIIB2 (9.8 %), IVA (5.8 %), IVB (55 %) and IVC (29.4 %). Median OS and PFS were not reached for stages IIIB and IVA, while the median OS and median PFS for stage IVB were 36 months and 18 months, respectively. However, patients with stage IVC had lower median OS and PFS of 10 months and 4 months, respectively. Conclusion: The clinical outcomes of patients with Stage IVB are varied depending mainly on the disease distribution. Patients with abdominal or pelvic disease had better survival outcomes and therefore, needed a different categorisation. Thus, FIGO 2023 Staging considers this varied disease distribution and appears to be a better prognostic indicator for this group.

Cancer remains a public concern and leading cause of death worldwide. Hepatocellular carcinoma, the most common form of liver cancer, is the third leading cause of cancer-related deaths. The number of cases is expected to double by 2040, according to GLOBOCAN 2020. Patients are usually diagnosed with advanced-stage HCC, which limits the number of effective treatment options. Oral-targeted therapies involving sorafenib and lenvatinib remain the first-line treatment option, which has recently been replaced by immunotherapy. Due to economic issues and ease of administration, the vast majority prefer oral systemic therapy. Sorafenib and lenvatinib, which belongs to tyrosine kinase inhibitors have few limitations of having large inter-individual variability in absorption, genetic polymorphisms, poor patient adherence to oral regimen limiting its long-term therapy. Therapeutic Drug Monitoring can overcome the limitations of TKIs and help individualise the dosage regimen with minimal adverse events. Therefore, this simple and rapid method using latest equipment enabled with ultra-high speed, high-sensitivity analysis (LCMS-8045) is expected to bring a change in clinical practice to improve the efficacy and safety of medication for optimal patient benefits.

Abstract Non‐small‐cell lung cancer (NSCLC) accounts for the majority of lung cancer cases worldwide, with a significant proportion of patients harbouring actionable oncogenic alterations. Among these alterations, the ROS1 rearrangement represents a distinct subset with therapeutic implications. Here, we present the case of a 52‐year‐old man diagnosed with advanced NSCLC harbouring the ROS1 fusion gene. Despite the initial poor response to conventional chemotherapy, the patient exhibited an exceptional and sustained response to crizotinib, with a progression‐free survival of 94 months and complete metabolic response on PET scan. This case underscores the importance of molecular profiling in guiding treatment decisions and highlights the efficacy of targeted therapies for ROS1‐positive NSCLC.

Abstract Meningioma is the most common benign primary brain tumour and does not usually metastasise. We report the case of a 69‐year‐old male patient with a history of meningioma who presented respiratory symptoms. He was found to have diffuse pleural metastasis from meningioma, which occurred 10 years after surgical management of recurrent meningioma. This case study provides insights into the clinical profile, workup and management of metastatic meningioma.

Background: Unmet needs of cancer patients prompt them to seek care from Traditional, Complementary and Alternative Medicine (TCAM) practitioners. Objective: To investigate the prevalence of TCAM use in a multi-specialty tertiary cancer center in South India. Materials and methods: A cross-sectional survey of cancer patients who used TCAM during the study period. The patients were recruited based on covenience sampling method. Result: 320 cancer patients were approached, out of which 279 (87.2%) patients responded, and the prevalence of TCAM use was 34.4%. Home remedies (36%) figure prominently, with family advice (40%) being the primary influence for the TCAM use. The key expectation was an improvement in the quality of life (49%). TCAM use was pronounced during the chemotherapy phase (50%). Most patients (76%) using TCAM reported satisfaction with the treatment. Majority of the patients did not disclose concomitant use of TCAM to their treating physicians (71%). Conclusion: TCAM use by cancer patients is prevalent in Kerala. The study results point towards a need for large scale surveys, implementation of pharmacovigilance, patient education and research to identify and integrate TCAM interventions in cancer care that are safe and have beneficial effects.

Gastrointestinal stromal tumors (GISTs) are rare primary neoplasms of the gastrointestinal tract, mesentery, or omentum. In the past, for patients with resectable tumors, surgery was the only viable treatment option. However, therapy of GISTs has undergone a fundamental change with the advent of receptor tyrosine kinase inhibitors primarily targeting the tyrosine-protein kinase KIT and the platelet-derived growth factor receptor alpha (PDGFRA). Ripretinib is one such novel Type-II tyrosine switch control inhibitor which is used in the treatment of advanced KIT proto-oncogene-driven and PDGFRA-induced tumors, including GISTs. The Food and Drug Administration approved ripretinib on May 15, 2020, for the treatment of adult patients with progressive GISTs who had undergone prior treatment with three or more kinase inhibitors. A comprehensive search in PubMed and other sources were done, using the search terms, “GIST” and ripretinib. On combining all the abstracts and conference proceedings, here we present a comprehensive review on ripretinib's history, pharmacology, and clinical applications.

BACKGROUND: Postmastectomy radiation therapy (PMRT) is delivered routinely with photon techniques, chest wall radiation with electron techniques have the advantage of reduced deeper tissue doses and can be tried in suitably selected cases. This study is to retrospectively evaluate the locoregional control, toxicity, disease-free survival (DFS), and overall survival of patients treated with postmastectomy chest wall electron radiation at a single center. MATERIALS AND METHODS: The data of 450 patients who received PMRT with electron therapy from 2004 to 2014 were analyzed. Patients were treated with three-dimensional (3D) conformal radiation therapy with 6–8 MeV electrons to chest wall and 6 MV photons to supraclavicular fossa and medial axilla. Data collection was done from hospital medical records and analyzed with IBM SPSS 20.0. The results are given in mean ± standard deviation for continuous variables or as percentage for categorical variables. Kaplan–Meier survival analysis and log-rank tests were used. P < 0.05 was considered as statistically significant. RESULTS: Patients' median age was 64 years (range: 24–74 years). Early stage accounted for 108 (24%) patients, 306 (68%) were advanced stage, and for 36 (8%) patients, stage was unknown. Of these, 174 (38.7%) patients were offered hypofractionated schedule and 276 (61.3%) with conventional fractionation. No Grade 3–4 skin reactions were reported over the irradiated area on treatment completion. Twenty-three (5.1%) patients had chest wall recurrence and 33 (7.3%) patients developed locoregional recurrence. Overall recurrence including systemic metastasis was 127 (28.2%). Long-term data did not show any cardiac or pulmonary mortality documented as radiation related. The median follow-up of our group was 67 months (6–173 months). DFS at 5 and 10 years was 81.4% and 79.5%, respectively. OS at 5 and 10 years was 85.2% and 79.7%, respectively. CONCLUSION: PMRT with chest wall enface electron is feasible, and the advantage of electron field is better sparing of deeper structures, especially cardia in left-sided postmastectomy irradiation, thus more complex techniques such as Intensity Modulated Radiation Treatment (IMRT) and respiratory gating can be reserved for patients with more complicated anatomy where routine 3DCRT technique is unacceptable in terms target coverage and critical normal tissue sparing.

Abstract Background Multiple acyl-CoA dehydrogenase deficiency (MAAD) is a rare metabolic disorder resulting from an abnormality in fatty acid oxidation. There are three types of presentations: neonatal onset with or without congenital anomalies and the late-onset type. There is much clinical heterogeneity in the presentation of late-onset variants; hence, the diagnosis is often delayed or missed. Case presentation Here, we report the successful management of a 41-year-old female with late-onset MAAD due to mutation in the ETFDH gene who presented with carcinoma of the breast. Chemotherapy was challenging because there were no previous reports regarding the treatment of such cases. Conclusion The diagnosis was made based on metabolic workup and gene mutation analysis. Unplanned surgery and chemotherapy can be fatal in these patients due to metabolic complications. With proper precautions and monitoring, the patient tolerated surgery and chemotherapy without any complications.

Byline: Debnarayan. Dutta, Sruti. Reddy, Ram. Kamath, Yarlagadda. Sreenija, Haridas. Nair, Ajay. Sashidharan, R. Remesan Nair, K. Pushpuja, Rajesh. Kannan, Annex. Edappattu, Nikhil. Haridas, Wesley. Jose, Pavithran. Keechilat Background: Prospective [...]

Background: Though cancer-related insomnia is a grave issue, it is often overlooked by caregivers and patients alike. This study examined insomnia's prevalence in solid tumor patients and the risk factors associated with it. Methods: The prevalence of insomnia and overall sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). The Hospital Anxiety and Depression Scale (HADS) aided in measuring anxiety and depression, while the Wong-Baker FACES® Pain Rating Scale was employed to measure pain. Analysis was carried out using SPSS 21.0 version software. Result: The prevalence of insomnia over two months in a group of solid tumor patients comprising 56 (34.1%) males and 108 (65.9%) females with a mean age of 57.72 ± 12.78 years was found to be 65.9%, and the group's mean PSQI score was 9.12 ± 5.38. The mean anxiety, depression, and pain scores were 7.60 ± 4.09, 7.50 ± 4.07, and 2.51 ± 2.78, respectively. We found a significant influence of anxiety, depression, and pain on insomnia (P

Background: Extramedullary plasmacytoma (EMP) is an uncommon presentation and usually occurs in conjunction with multiple myeloma (MM). An EMP without developing MM at any point is an extremely rare presentation, and only seven such cases have been reported in the literature to date. Presentation of Case: : We present a case of EMP, who presented with multiple recurrent lesions in rare sites like nasal cavity, testis and skin without the involvement of bone marrow at any point of disease course. He was treated with multiagent chemotherapy (DT-PACE) and continues to be in remission at 29 months post-chemotherapy, which is the longest amongst all the cases reported so far. Discussion and conclusions: : There are no clearly defined guidelines to treat EMP. Our case had a clinical presentation at very unusual sites and was treated with DT-PACE regimen as against the previous seven reported cases and had the most prolonged period of remission.

Sarcoidosis is a multi-system granulomatous disorder characterized by involvement of multiple systems with or without lymphadenitis. Pulmonary complications are common and may lead to morbidity. Breast cancer is one of the commonest malignancy among women across the world. There is an increased risk of malignancies in sarcoidosis. This association with cancer creates a diagnostic dilemma due to the predominant involvement of nodes and organ systems in both conditions. Here we report three cases of sarcoidosis with breast cancer diagnosed over one year.

Fanconi anaemia is a rare autosomal recessive disorder associated with bone marrow failure and congenital malformations. The impaired DNA repair pathways in Fanconi anaemia predispose patients to a high risk of cancers of squamous cell origin, particularly in the head and neck region. Cancers of the vagina and vulva are rare in Fanconi anaemia. Here, we report a case of a 44-year-old female with Fanconi anaemia who developed an ulcerated lesion on the clitoris that extended into the labia majora. A biopsy of the lesion showed well-differentiated squamous cell carcinoma. The patient was treated with wide local excision of the vulval lesion. The patient developed neutropenia post-procedure but recovered in one week time. We have followed up the patient regularly since the procedure. No further issues have been detected to date.

Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring among predominantly adolescent and young adult men, accounting for 1%–2% of all non-Hodgkin's lymphomas. In contrast to B-LBL, T-cell LBL is much more common, accounting for up to 90% of disease in adults. Mediastinal mass, pleural and/or pericardial effusions are the major characteristics of T-LBL. We report an 27-year-old male with a pleural effusion, mediastinal lymphadenitis, and a normal hemogram. The cytology of the pleural effusion initially was lymphocytic exudative and ADA was high. For definitive diagnosis a medical thoracoscopy was done. The partial pleura showed multiple irregular nodules and thickening in sheets. It was picked and immunophenotypic study revealed the following: CD3, TdTþ, CD7 with Ki 67 index of 70–80%. The patient was finally diagnosed with T-LBL. He was treated with chemotherapy and is on regular follow up with resolution of effusion. The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy yielded the correct diagnosis.