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Introduction: Chemoradiotherapy (CRT) with concurrent cisplatin-based chemotherapy is the treatment of choice of locally advanced head and neck cancers (LAHNC), but the optimal regimen of cisplatin remains contentious. Though 3-weekly cisplatin is the recommended schedule, it is associated with severe adverse reactions. A lower dose weekly schedule is generally accepted to be more tolerable and is widely used in our country. Methodology: Our study retrospectively compares the 3-weekly and the weekly concurrent cisplatin schedules in patients of LAHNC treated with CRT. Patients were selected for either schedule based on the treating physician’s preference. The two schedules were compared for treatment-related toxicities, radiotherapy interruptions, cumulative cisplatin doses delivered and overall survival (OS) as well as disease-free survival (DFS) at 2 years. Results: In our study, 43 patients received the 3-weekly schedule while 40 received the weekly schedule. Age, gender, disease stage or site did not affect selection for either regimen, except cancers of the nasopharynx and salivary glands, who almost exclusively received the 3-weekly schedule (90.1%). Patients who received adjuvant CRT after radical surgery were more likely to receive the weekly schedule (66.7%) while patients treated with up-front CRT were more often given the 3-weekly schedule (57.6%). Overall, the 3-weekly arm was associated with more toxicities and treatment breaks, but was more successful in delivering an adequate cumulative dose of cisplatin and had a better OS and DFS at 2 years follow up compared to the weekly arm. It also appeared that treating physicians were more likely to withhold one or more of the weekly cycles to manage treatment toxicity which lead to inadequate cumulative dosing in a high (45%) percentage of patients. Conclusion: Our study reiterates that the 3-weekly cisplatin arm has a better outcome profile than the weekly cisplatin arm at the price of increased toxicity. Weekly schedules have lower toxicities but may not achieve outcomes equivalent to 3-weekly unless adequate cumulative doses are achieved. As our study is retrospective and non-randomized, selection bias may have affected our results.

Introduction: Head and neck cancers (HNCs) are some of the commonest cases requiring palliative radiotherapy (PRT) in an Indian radiotherapy practice. A variety of PRT protocols have been explored with varying success. Methods: The study objective was to evaluate the efficacy and tolerability of a short-course hypofractionated PRT schedule in HNC patients in terms of symptom relief, tumour response, acute side effects and survival and to compare results with other PRT regimens. All patients received 30 Gy in 10 fractions over 2 weeks followed by another 20 Gy in 5 fractions after a 4 weeks gap. Results: Seventy-five percent of patients completed both phases of treatment. Symptom relief was seen in 71% (pain) to 76% (dysphagia) of patients. Tumour response was recorded in 73% of patients. At 12 months, the mean overall survival was 10·29 months for patients who responded to PRT compared to 7·87 months for those who did not. Results were comparable to other regimens reported in the literature, but no radiobiological advantage of a higher dose was discernible. Conclusions: Short-course hypofractionated PRT is effective in reducing tumour burden and relieving symptoms in HNC patients and possibly in lengthening survival. Selection of any schedule should be decided by treating oncologists based on clinical, logistic and socio-economic factors.

The health of mothers and children is a key indicator of general health in any society. Throughout the world, there is increasing concern and interest in maternal and child health care. Despite that, the morbidity and mortality rates especially in developing countries continue to be alarming. Given the magnitude of these problems and the services available, much improvement has not been witnessed. The present study seeks to assess knowledge, attitude and practices of rural women towards maternal and child health and examined KAP about the process of reproduction, family planning methods, antenatal care, perinatal care, hygiene and nutrition of child. Towards this end, an intervention module was developed and implemented. Pre and post-test were conducted to study the impact of the intervention. The results revealed that during the pretest phase majority of the respondents had moderate knowledge about the signs of pregnancy, importance of first trimester of pregnancy, however gaps were found in knowledge regarding immunization and welfare programmes and services for mothers and young children. A paradigm shift in the knowledge, attitude and practices of rural women towards maternal and child health was observed post intervention. The proportion of women believing in myths like feeding sweetened water or honey to new born, putting oil in baby’s ear decreased post intervention. Inappropriate practices followed pertaining to hygiene and sanitation like non sterilization of feeding bottle before every feed and irregular napkin changes also improved between pre and post intervention.

Carcinoma esophagus is a common malignancy of the Indian subcontinent. The role of positron-emission tomography–computed tomography (PET-CT) in the assessment of response to radiotherapy has been widely studied and accepted. However, its precise use as a predictive tool for actual histopathological response to radiotherapy needs further evaluation, especially in an Indian population. The aim of this study was to identify a quantum of metabolic response on PET-CT that can also predict for a good pathological response. Forty-four patients of carcinoma esophagus treated with neoadjuvant chemoradiotherapy followed by surgery were included in the study. All patients underwent a PET-CT before starting treatment as well as at 4–6 weeks after completion of radiotherapy. The percentage change in pre and posttreatment maximum standardized uptake value (SUVmax) value (ΔSUV%) of the primary tumor was correlated against histopathological tumor regression grade (TRG) as per the Mandard's system. Seventy-five percent of the patients with a significant metabolic response, i.e., a ΔSUV% of 60% or more, also had a good pathological response to treatment. Thus, by considering a ΔSUV% of 60%, we could predict for a good pathological response (TRG of 1 or 2) to chemoradiotherapy in our patient set with a sensitivity of 95.45% and a specificity of 72.72%.

Background: Encountering more than one malignancy in a cancer patient is no longer uncommon; this increasing incidence is mostly attributable to the improvements in life expectancy, awareness, and diagnostic facilities. This article aims to highlight this institute’s experience in diagnosis and treatment of patients of multiple primary malignancies and a comprehensive review of literature. Materials and Methods: This is a descriptive study of retrospectively collected data of a single institution over 4 years from 2013 to 2016. Known cases of cancer who were diagnosed with a second primary malignancy were included in the study. Various details such as age, sex, site of disease, temporal relation of two cancers (synchronous or metachronous), family history, tobacco use, treatment given, and survival at 1 year were recorded, organized in a tabular form, analyzed, and described. Results: A total of 29 cases of dual malignancies comprising 0.74% of a total of 3879 patients of cancer were encountered. Seventy-two percent of the cases were metachronous and 5 years was the mean time interval between tumors. There was a female preponderance, and the average age was 56 years. Breast was the most common site of malignancy. At 1 year from diagnosis of second primary, 69% of the patients were alive and 27% were disease-free. Conclusion: Second primary in a patient of cancer is becoming increasingly common and the suspicion of the same should always be borne in mind during follow-up. Prognosis as well as intent of treatment depends on respective stages of the two malignancies.

Stress is an inevitable part of human life. Every individual encounters different level of stress and has a tendency to develop unique style to respond and cope with it. Dropping out of school is one such stressful event. Despite universalisation of elementary education in India, there are still a significant number of school dropouts in the country. Hence, the research team of Child Development Unit of All India Coordinated Research Project, Pantnagar conducted a study to study the coping strategies used by school dropouts. It also implemented group interventions for the promotion of effective coping strategies. The study included a sample of 52 school dropout adolescents from four purposively selected villages of Distt. Udham Singh Nagar, Uttarakhand. Standardized scales were used for identifying their coping strategies. School dropouts were seen to usually avoid the stressor to reduce its impact. Rarely did they go for understanding the problem and working for more converting it into a challenge to accept and win over. Post intervention there was significant shift in their coping strategies. It led to significant increase in practice of coping styles like logical analysis, positive appraisal, seek guidance & support, problem solving and significant decline in the use of coping strategies like cognitive avoidance, acceptance, seek alternative rewards, emotional discharge post intervention.

The present study was undertaken to assess the differences in the level of spirituality and psychological well-being among institutionalized and non- institutionalized elderly (above 65 years of age) across gender. The study was based on the sample of 200 respondents: Institutionalized elderly (n1=100) drawn from the Society Registration Act (SRA) recognized old age homes of Uttarakhand through census method and equivalent sample of non-institutionalized elderly (n2=100) drawn through lottery method from the nearby localities adjacent to the old age homes. The level of spirituality and psychological well-being was assessed through standardized scales. The findings of the study revealed that females irrespective of residential setting were found to have higher levels of spirituality whereas males irrespective of residential setting were found to have significantly higher level of psychological well-being.

Cancer of the tongue and other parts of the oral cavity are a leading cause of death in the worldwide population. The common sites of metastasis from oral cavity cancers are lung and bone. Endobronchial metastasis of an extra-thoracic malignancy is a rare phenomenon and such metastases from a malignancy of the tongue are almost unheard of. We present a case of carcinoma oral cavity with subsite tongue that after radical therapy of local site had an unusual site of distant metastasis in the right main bronchus, along with metastases to the lung parenchyma and right third rib.

Malignant peripheral nerve sheath tumor (MPNST) is a neurogenic tumor arising from peripheral nerves or nerve sheaths. MPNSTs are highly aggressive sarcomas mainly associated with neurofibromatosis type-1 (NF-1) with high rates of local recurrence and distant metastasis carrying a dismal prognosis. Lung is the most common metastatic site. Bone metastasis although documented in the literature is still very rare, while dissemination to brain without the involvement of lungs and that too in a non-NF-1 case is extremely unusual. A 48-year-old female was diagnosed with a case of non-NF-1 MPNST left thigh with bone metastases including sphenoid. Despite showing complete resolution of skeletal and primary lesions postpalliative chemoradiotherapy, she developed brain metastases and succumbed to her disease. This case is discussed to highlight an unusual scenario we encountered, the clinical course of the disease with its management, and overall poor prognosis. To the best of our knowledge, this may be the earliest case of MPNST with sphenoid metastases detected by 18-fluorodeoxyglucose positron-emission computed tomography scan and a sporadic case of brain metastases reported in the world literature.

Cervical carcinoma is one of the commonest cancers affecting women in the low- and middle-income countries. The standard treatment of locally advanced cases by external beam radiotherapy (EBRT) along with single-agent cisplatin-based concurrent chemotherapy is effective, but rates of treatment failure and recurrence remain high. There exists a need to augment the treatment protocol. One modality to do that is by addition of another radiosensitizer/chemotherapeutic agent. In total, 40 women with histologically proven locally advanced cervical cancer were included in the study. The first 20 (Arm 1) were treated with EBRT along with concurrent cisplatin at 40 mg/m2 (maximum 70 mg). The next 20 patients (Arm 2) received the same treatment but also received oral capecitabine 460 mg/m2 during EBRT. Treatment-related toxicity and disease response rates at 6 months were compared in the two arms. Overall survival at 5 years of patients in the two arms was also compared. During treatment, 40% of patients in Arm 1 developed anemia compared to 45% in Arm 2. In total, 5% patients in Arm 1 and 10% in Arm 2 developed grade 2 leucopenia. A higher incidence of proctitis and diarrhea was seen in Arm 2 (30%) than in Arm 1 (15%). The grade of proctitis and diarrhea was also higher in Arm 2 than in Arm 1. None of the patients developed hand-foot syndrome. All the complications were managed symptomatically and did not cause significant treatment break in either treatment arms except in one patient in Arm 2. At 6-month follow-up, four patients (20%) in both arms had residual or progressive disease. At the end of 5 years, the mean overall survival in the two Arms 1 and 2 was 47.9 and 48.4 months, respectively. The addition of capecitabine to standard concurrent chemoradiotherapy with cisplatin for locally advanced cervical cancer is well tolerated even on an OPD basis though there is increased incidence of acute proctitis and diarrhea with this combination. No difference in treatment efficacy or improvement in survival between the two protocols was seen in our study though this may have been influenced by the small sample size and short period of follow-up of our study. We recommend a phase II/III study to further evaluate the efficacy and tolerability of this regimen.

This is a retrospective study carried out at a tertiary care cancer center to assess weight loss in patients of head and neck cancers (HNCs) during treatment with chemoradiotherapy (CRT) and study various factors affecting it. Treatment and follow-up records of 77 patients of HNCs were studied and assessed for demographic, disease-specific variables, treatment parameters, weight loss during CRT, as well as survival at 2 years after treatment completion. A statistical analysis was conducted to assess the association of study variables with weight loss. It was also assessed if a correlation existed between weight loss during treatment and patient survival at 2 years. Of the study patients, 62.3% (48) suffered 5% or more weight loss during CRT while 23.4% (18) suffered a weight loss of 10% or more. No particular factor was identified having a statistically significant association with weight loss. Nutritional impairment is an important factor affecting the morbidity and possibly the mortality of patients of HNCs undergoing CRT. More robust studies are required to identify which factors affect weight loss during treatment and whether weight loss can be used as a parameter to prognosticate patients.

Adenocarcinoma lung with upfront metastases to skeletal muscle is rarely encountered in clinical practice since skeletal muscles are highly resistant to dissemination from solid organs. Moreover, these muscle metastatic lesions generally present with pain and palpable mass to get detected clinically. However, silent skeletal muscle metastases without any symptoms or signs getting detected by functional imaging with whole body 18F-fluorodeoxyglucose positron emission/computed tomography (18FDG-PET/CT) scan have been scarcely described in literature, while we present such an interesting case in a 45-year-old female. She was diagnosed as a case of biopsy-proven metastatic adenocarcinoma lung after evaluation by 18FDG-PET/CT. Despite treatment with palliative chemoradiotherapy, her disease progressed, and she finally succumbed to her illness. This case is discussed to highlight an unusual scenario we encountered, the clinical course of the disease with its management and overall poor prognosis.

Serous papillary carcinoma of the cervix is a rare variant of the adenocarcinoma of the cervix with less than 50 cases reported worldwide. There are no clear guidelines for the management of this particular subtype, and the treatment is tailor-made based on retrospective analysis and the physician’s discretion. We present a case of locally advanced papillary serous cancer cervix that was managed radically with concurrent chemoradiotherapy and is presently disease free on follow-up.

Neuroendocrine tumors are a broad family of tumors arising most commonly in the gastrointestinal tract and the bronchus pulmonary tree. The other common sounds are the parathyroid, pituitary and adrenal gland. Inguinal node as a primary presentation of a neuroendocrine tumor is an extremely rare presentation. We present the case of a 43-year-old-male who presented with the complaints of an inguinal node swelling without any other symptoms and on further evaluation was diagnosed to have a non-metastatic neuroendocrine tumor of the inguinal node. He was treated with a combination of chemotherapy and surgery and is presently awaiting completion chemotherapy.

Squamous cell carcinoma is a histological diagnosis rarely seen in bladder cancers. It is classically associated with chronic mucosal inflammation or urinary retention. Very few studies have clearly defined the management guidelines, however multimodality treatment is frequently offered along the lines of more common transitional cell cancer. We report the case of a 50-year-old male who presented with obstructive urinary symptoms and on evaluation was found to have a large vesical calculus associated with squamous cell cancer of the bladder. He was treated with surgery in the form of radical cystectomy followed by adjuvant locoregional radiotherapy. He has remained on regular follow-up for the last 2 years and has been disease free.

Invasive or infiltrating ductal carcinoma is the most common type of breast cancer while primary squamous cell carcinoma of breast is extremely rare occurring in 0.04%-0.1% of all breast cancer cases known for aggressive behaviour and poor prognosis. We hereby report a case of primary squamous cell carcinoma of breast in a 31-yearold female who presented with a left breast lump of 2 months duration. Lumpectomy done at another non-oncology centre showed invasive ductal carcinoma with margin positivity for which she underwent modified radical mastectomy at our institute. Post-operative immune-histopathology revealed triple negative squamous cell carcinoma. Her metastatic work-up with whole-body positron emission tomography scan was negative. She was treated with adjuvant chemotherapy doxorubicin, cyclophosphamide and docetaxel followed by loco-regional radiotherapy to left chest wall which she tolerated well. No hormonal therapy was given in view of hormone receptor negativity. She is presently on follow-up for more than 6 months without any evidence of recurrence or distant metastasis. This case is being presented to highlight its extreme rarity, it’s occurrence in a young female, the diagnostic and therapeutic challenges it presented and the overall prognosis of this neoplasm.

Mucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists due to very few reported cases without definite therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal malignancies and are historically known to arise from chronic anal fistulas and ischiorectal or perianal abscesses. We hereby report a sporadic and interesting case of perianal mucinous adenocarcinoma in a 56-year-old male initially treated with alternative medicines and local surgery for recurrent fistula in ano of 2 years duration. He presented with complaints of discharging growth in perianal region, painful defecation associated with occasional blood mixed stools of 6 months duration. Incisional biopsy from the ulcer revealed mucinous adenocarcinoma. Contrast enhanced computed tomography (CT) scan and whole body positron emission tomography (PET) scan showed a localized perianal growth which was further confirmed with colonoscopy. With no pre-set treatment protocol for this rare entity, he was managed with neo-adjuvant concurrent chemo-radiation (CCRT) followed by abdominoperineal resection (APR) and adjuvant chemotherapy. Presently he is on 3 monthly follow-up since last 1 year post APR and adjuvant chemotherapy without any evidence of recurrence or distant metastasis. To the best of knowledge, our report may be one of the rarest cases of this disease entity where the duration of anal fistula was merely 2 years in contrast to the established criteria that the fistula precedes carcinoma by at least 10 years.

Cutaneous T-cell lymphoma (CTCL) is the most common primary cutaneous lymphoma but rarely encountered. It is often misdiagnosed with allergic or infectious dermatological conditions and is usually a diagnosis of exclusion. The subsets of CTCL primarily consist of CD4 + and CD30 + lymphoproliferative disorders including mycoses fungoides. Herein, we report a case of CD 8 + ve CTCL stage IA that was previously misdiagnosed with cutaneous tuberculosis with no response to antitubercular therapy. After a confirmatory diagnosis of CTCL with multiple sites involved, he was treated with definitive local radiotherapy alone and had a complete response to treatment with no recurrence at 5 year's follow-up.

Osteosarcomas comprise of a heterogeneous group of tumors with a predilection for involving long bones commonly. The jaw remains a rare site of involvement, and these tumors can be considered a distinct entity. The key for managing them lies in histological and radiological correlation for an early diagnosis. Surgery and chemotherapy remain the main modalities of treatment. We present a case of osteogenic sarcoma of the mandible that after radical treatment had local recurrence and distant metastasis.