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Context Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor most commonly occurring in deep intramuscular plane of lower extremities of adolescents and young adults. It is a highly vascular, slow growing tumor with malignant potential having lung as the most common site of metastases at the time of presentation. Aims The aim is to review the imaging findings of ASPS and determine characteristic imaging features of this rare tumor. Materials and Methods Sixteen patients having histopathological diagnosis and preoperative imaging of ASPS attending the dedicated sarcoma clinic at our institute were included in the study. The demographic, clinical, and imaging data were retrieved from the case records and then evaluated for characteristic imaging features which may raise suspicion of ASPS. Results The patients ranged from 3 to 72 years of age and with a slight male preponderance. Of the eight CECTs evaluated, 62.5% tumors showed well-defined lobulated margins, 87.5% cases showed intense enhancement with presence of feeder vessels. On CEMRI of 10 patients, 70% had well circumscribed lobulated margins with intense enhancement and tortuous flow voids in most of them. All cases showed T2 hyperintense signal. Fourteen of 16 (87.5%) patients had metastatic disease with lung as the most common site (92.8%). Conclusion ASPS is a rare soft tissue sarcoma seen in children and young adults. Imaging may mimic a vascular malformation due to the presence of tortuous feeders. Misdiagnosis at an early stage may lead to later metastatic presentation of the disease, thus emphasizing the need to suspect it on imaging.

Background Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor predominantly affecting the pelvis and perineum of females. Due to its variable clinical presentation, it is often misinterpreted and treated as other pathologies like Bartholin gland cyst, vulvar abscess, and hernia. The tumor is locally infiltrative, making its complete surgical removal difficult. Aim The aim of the study is to highlight and illustrate the imaging and pathological features of AAM. Materials and Methods After obtaining clearance from the Institutional Ethics Committee, a retrospective study was conducted on patients with histopathological diagnosis of AAM, presenting to the dedicated sarcoma clinic between 2016 and 2019. The demographic, clinical, radiological, pathological, and treatment details were obtained from the institute's database. The magnetic resonance imaging (MRI) and computed tomography images were reviewed to assess different imaging parameters. Follow-up imaging was assessed for residual or recurrent mass in the pelvis or perineum and distant metastasis. Results A total of four patients were included with an age range of 28 to 50 years. The baseline MRI of these four patients shows pelvic mass extending into the perineum, infiltrating along the surrounding fascial planes with the characteristic laminated appearance on T2-weighted image and gradual intense enhancement following contrast administration. All patients had residual disease post-surgery and were put on hormonal therapy. Conclusion AAMs are locally aggressive, rarely metastasizing mesenchymal tumor that has a specific predilection for the perineum and pelvis of females. MRI features like laminated or striated appearance, post-contrast enhancement, and finger-like infiltrating projections should raise the suspicion of the diagnosis on baseline imaging.

Introduction Para testicular sarcomas are rare mesenchymal tumors that affect patients of all ages. Unlike other sites of sarcoma, they tend to be of lower grade and have a higher propensity for lymphatic spread. Management is hampered by the small number of patients who differ in terms of tumor grade and histology. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. The consensus on the type of surgery and adjuvant treatment is yet to be determined. The local relapse rates in the scrotum and groin after orchidectomy comes out to be 25%-37%, indicating the need for either aggressive surgery or adjuvant treatment. There is a paucity of data identifying the patterns of failure and risk factors for recurrence, which will help clinicians tailor appropriate treatment. Methods We aim to perform a systematic review and meta-analysis of the available data in the last 50 years in a methodologically rigorous and transparent manner to identify patterns of failure and high-risk factors for recurrence. The protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P) 2015 guidelines. The protocol is registered in the International Prospective Register of Systematic Reviews (CRD42021237134). Highlights Para testicular sarcomas are rare mesenchymal tumors that affects patients of all ages. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. A systemic review was performed in 2013 based on survival rates, prognostic factors, and relapse sites on paratesticular sarcomas. However, it lacks a comprehensive review that can guide radiation oncologists to select in which patient's postoperative radiotherapy is warranted and define the target volume based on histopathological type, stage, and grade of the tumor. After 2013, new case series with improved methodology and sample size are published, which adds new information to the literature. In one case series, 22 patients with spermatic cord sarcoma were discussed, while in another study, long-term outcome analysis of 51 patients was discussed, and another study discussed eight patients.

Introduction:Paratesticular sarcoma are extremely rare malignant tumours. Unlike other sites, they tend to be lower grade and have higher propensity of lymphatic spread. They tend to fail locally and occasionally in the regional lymph nodes. In the absence of target volume delineation guidelines and technical illustration of conformal planning, we have made an attempt to illustrate conformal planning methodology and define target volume based on current evidence in a case of paratesticular sarcoma.Methods:We are presenting a case of 62-year-old male who presented with 15-cm scrotal swelling and underwent high inguinal orchidectomy with ligation of spermatic cord. Histopathology presented a well-differentiated leiomyosarcoma of epididymis. Post-operative radiotherapy target volume included the tumour bed, ipsilateral inguinal nodes and lower pelvic nodes as the clinical target volume.Conclusion:Adjuvant radiotherapy using advanced delivery technique such as volumetric arc technique can provide good dose distribution with good sparing of organs at risk. The downside of conformal radiation delivery is that it is a resource-intensive and has no established target volume delineation guidelines.

Introduction:Giant cell tumour of the tendon sheath (GCTTS) is the second most common tumour of the hand. Despite surgery, local recurrence after excision has been reported in up to 45% of cases. Post-operative radiotherapy (PORT) has been found to be promising in preventing these recurrences in high-risk group. One of the reservations of PORT is secondary effects of radiation which may cause a decreased range of motion of the affected joint, sensory changes and nail changes. Surface mould brachytherapy can provide a high dose to target volume with a rapid fall of dose to surrounding structures. Despite this, it is less used, the possible reason can be less technical proficiency.Methods:We have technically illustrated surface mould brachytherapy in a case of GCTTS of the left index finger, and compared dosimetrically with more widely used conventional photon and electron external beam radiotherapy.Conclusion:The 6-MV photon treatment plan with a bolus plan provided the least dose to skin (106%) and phalanges (103%). It has a Homogeneity index (1·06) closest to 1, whereas the Conformity index of all plans was similar. The dose coverage was adequate in all plans. The second-best plan dosimetrically was the surface mould brachytherapy.

Introduction: Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done. Materials and Methods: Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed. Results: A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300–800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC – 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7–19) for all patients and 12.57 (IQR 6.2–28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival. Conclusion: Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.

Background This study aims to analyze risk factors, clinical profiles, treatment protocols, and disease outcomes in histologically proven resectable vulvar cancer (VC) patients according to tumor stage. This is a retrospective analysis of a prospectively collected database of 20 VC patients from May 2014 to June 2019. Results The mean age of VC diagnosis was 55 years, with a range of 38–84 years. The incidence was four cases per year. The disease incidence was significantly more in post-menopausal (65%) and multiparous (90%) women. According to FIGO staging of vulvar cancer, stages I, II, and III were assigned to 6, 1, and 11 patients respectively. Two patients suffered from stage IVa vulvar melanoma. All patients had undergone surgical interventions. Patients treated with only nonsurgical (chemotherapy/radiotherapy/chemo-radiotherapy) treatment modalities were excluded from the study. Fifteen patients were treated with wide local excision (WLE), bilateral inguinofemoral dissection (B/L IFLND), and primary repair. Four and one patients were treated with radical vulvectomy (RV) and modified radical vulvectomy (MRV) [with or without B/L IFLND and PLND] respectively. Reconstruction with V-Y gracilis myocutaneous and local rotation advancement V-Y fasciocutaneous flaps were done in two patients. Therapeutic groin nodal dissection was performed in 19 patients except in one patient who was treated by palliative radical vulvectomy. In the final histopathology reports, tumor size varies from 0.5 to 6.5 cm (mean 3.35 cm) with the predominance of squamous cell carcinoma (18 out of 20 patients). Only 10 out of 18 eligible patients received adjuvant treatment. Poor patient compliance has been one of the major reasons for adjuvant treatment attrition rate. Systemic and loco-regional metastasis occurred in 3 patients each arm respectively. Poor follow up of patients is the key limitation of our study. Conclusion Vulvar cancer incidence was significantly high in post-menopausal and multiparous women. The most important prognostic factors were tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

Spindle cell carcinoma or sarcomatoid carcinoma (SC) has been recently defined as a monoclonal dedifferentiated form of conventional squamous cell carcinoma (SCC) and termed as spindle cell (sarcomatoid) squamous carcinoma as per the current World Health Organization (WHO) classification. Although the frequency of SC of the breast, larynx, esophagus, and lungs has been reported, the frequency of oral SC with rhabdo-myosarcomatous dedifferentiation of the maxilla is unknown yet because of the less number of reported cases. Microscopic features of spindle cell carcinoma resemble many benign and malignant oral lesions. Therefore, a careful depiction with the help of routine hematoxylin and eosin along with immunohistochemistry using appropriate markers is necessary to diagnose spindle cell carcinoma. SC is itself a rare entity accounting for

Introduction Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases. Methods A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated. Results The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival. Conclusions Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.

Multimodal treatment options in carcinoma esophagus include neoadjuvant chemoradiotherapy or chemotherapy followed by surgery. The degree of pathologic response to different neoadjuvant options and its impact on the oncologic outcome is a matter of debate. With this background we carried out this study to analyze the rate of pathologic complete re-sponse (pCR) and its effect on recurrence in patients with carcinoma esophagus treated with various combinations of neoadjuvant chemotherapy/radiotherapy and surgery. Methods The records of all patients with carcinoma esophagus registered in our clinics between June 2012 and December 2014 were retrieved from a prospectively maintained database and were analyzed. of the 70 patients with histologically proven esophageal cancer who were treated with curative intent during this period, those with pCR (15) were followed up for a minimum of 5 years. These 15 patients are the subjects of this study. Results Forty eight (48) patients received neoadjuvant chemotherapy (NACT), 16 were treated with short course radiotherapy (SRT), and 3 patients received neoadjuvant chemoradiation (CRT). Four patients developed metastatic disease on neoadjuvant therapy. 66 patients (63 after neoadjuvant therapy and 3 upfront) underwent transthoracic esophagect-omy. Pathological CR was seen 12 patients (25%) in NACT-surgery arm, 2 (12%) in SRT-surgery and 1 (33%) in CRT-surgery groups. Three patients had postoperative mortality due to pulmo-nary complications. At 5 yrs, 14 out of 15 patients with pathological CR are alive and disease free. One patient developed brain metastases after 3 years and died. Conclusion Neoadjuvant therapy followed by radical surgery is a safe and effective treatment option for the management of carcinoma esophagus. Pathologic CR strongly correlates with recurrence-free survival. The relative significance of pCR after different types of neoadjuvant therapies need to be tested in future studies.

Aim: Dermatofibrosarcoma protuberans (DFSP) accounts for less than 2% of all soft-tissue sarcomas. Patients & methods: We retrospectively reviewed our database for patients with locally advanced or metastatic DFSP who had presented to our clinic between January 2016 and January 2020. Results: We identified a total of 14 patients, of whom ten had sarcomatous transformation. Eleven cases had metastatic disease and three were locally advanced. The initial partial response rate to first-line imatinib was 76.9% and the overall median progression-free survival on imatinib was 15 months. Conclusion: We had a high proportion of patients with sarcomatous transformation, in contrast to their relative rarity in the West. While most patients had initial good responses to imatinib, second-line therapies were not as effective., Lay abstract Dermatofibrosarcoma protuberans is a rare sarcoma. Most patients have localized disease that can be cured by surgery alone. In those cases where either surgery is not possible or the disease is already metastatic, oral imatinib is the treatment of choice. In this article, we describe our experience with imatinib in such cases. Although most patients do well on imatinib, at least initially, many develop resistance to the drug. There are no established evidence-based therapies for patients who progress on imatinib, and as we describe in our paper, most of our patients did not do well on second-line medications.

Background: Reaching the correct histo-pathological diagnosis of soft tissue sarcomas (STS) is a great challenge and is cornerstone for treatment planning. Need of expertise for diagnosis is limited due to the lack of dedicated expert sarcoma pathologists and oncologists in India. In this study we highlight the pattern of pathological diagnosis and its accuracy outside specialist centre. Methods: We performed retrospective analysis of all patients referred to us with a clinical or histopathologic diagnosis of STS over the period January 2016 to December 2017. According to the protocol, all patients had a review of histopathology diagnosis from our institute. The tissue blocks if available were reviewed and a fresh biopsy was performed when required. The histopathologic diagnosis was also reviewed in the joint clinic, giving clinico-radiological inputs to sarcoma pathologists. For the patients with outside diagnosis and discordant report, we divided them into major discrepancy (including change of diagnosis of sarcoma to benign or other histological entity that could potentially change the treatment plan) or minor discrepancy (like mild change in grade or histopathological diagnosis not affecting the treatment plan). Statistical analysis was done by SPSS ver 23.Results: There were 149 patients with median age of 36 years (range 14-77 years), and 93 patients (62.4%) were males. About 57% (85 cases) of patients had localized disease. Most common subtypes were synovial sarcoma (16%), liposarcoma (9%), soft tissue ewings sarcoma (9%), MPNST (9%), leiomyosarcoma (8%), and undifferentiated pleomorphic sarcoma (8%). Of 149 patients, 47 (31.5%) had not been worked up outside by immunohistochemistry or other molecular studies and thus comparison was not possible; while 4 patients couldn’t retrieve blocks and repeat biopsy could not be performed. Of 97 patients (biopsy = 84, FNAC = 13) who had diagnosis from outside, 37% had major discrepancy and 24% had minor discrepancy as compared with our diagnosis from the sarcoma specialists. Univariate analysis revealed that the major discrepancy was more in non-extremity than extremity STS (p = 0.003).Conclusion: Histopathologic diagnosis in more than half of patients referred from outside centers was discordant with respect to the diagnosis of our centre with major implications on 37% of cases. We believe this is due to the lack of sarcoma pathology experts, and they are virtually non-existent in the multidisciplinary clinic set up outside the tertiary care centres.

To compare the predicted response with observed response to treatment by measuring gross tumor volume-primary (GTVp) using onboard kilovoltage (kV) cone-beam computed tomography (CBCT), to analyze the serial tumor volumes during radiotherapy (RT) with serial tumor volumes during follow-up, and to identify the variables associated with survival outcomes.Between June 2017 and December 2019, 23 patients of histologically proven locally advanced nonsmall cell lung cancer (LA-NSCLC) received definitive chemoradiation. Serial kV-CBCT images X-ray volume imaging (XVI) were generated weekly for image guidance and were used to generate serial GTVp. Posttreatment follow-up images were used to generate follow-up GTVp. Relative volume regression (VR) during RT and relative response assessment (RA) during follow-up were defined from Avg Vol, of planning CT. The predicted progression model was generated from VR and analyzed against observed progression events. Regression-response model was generated to analyze VR against RA.The median XVI volTumor regression during RT is a potential predictor of response in LA-NSCLC. kV-CBCT is a strong tool in assessing tumor regression during RT.

The role of adjuvant radiotherapy (RT) following lumpectomy for ductal carcinoma in-situ (DCIS) was addressed in four major randomized controlled trials (RCTs) which were conducted two to three decades ago. Initial results of these trials suggested the protective role of RT in reducing the ipsilateral breast recurrences. Long-term results of all these four trials, based on more than 10-years follow-up data, have recently been published. A meta-analysis of four published RCTs which have addressed the role of adjuvant RT following lumpectomy for DCIS was conducted. Review manager (Cochrane Collaboration's software) version RevMan 5.2 was used for analysis. Evaluated events were ipsilateral breast recurrences (both DCIS and invasive), regional recurrences, contralateral breast events, distant recurrences, and overall mortality. The events were entered as dichotomous variable. The present meta-analysis included four RCTs and a total of 3680 patients - 1710 received adjuvant RT following lumpectomy while 1970 patients did not receive any adjuvant treatment. Patients who received RT had almost half of risk of ipsilateral breast recurrence (RR = 0.53, 95% CI = 0.45-0.62) and regional recurrence (RR = 0.54, 95% CI = 0.32-0.91) compared to those who did not receive adjuvant treatment - there was absolute risk reduction in 15% (95% CI = 12%-17%) for ipsilateral breast recurrences in adjuvant RT treated patients. There was no significant difference in distant recurrence (RR = 1.06, 95% CI = 0.74-1.53), contralateral breast events (RR = 1.22, 95% CI = 0.98-1.52) and overall mortality (RR = 0.93, 95% CI = 0.79-1.09). Though addition of postoperative RT to lumpectomy does not reduce overall mortality, the present meta-analysis confirms that it decreases the ipsilateral breast and regional recurrence by almost half.

Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

The simultaneous occurrence of carcinoma of the cervix and pelvic kidney is rare. As the pelvic kidney occupies the conventional radiation portal for carcinoma of the cervix, treatment of these patients with radiation presents a therapeutic challenge. A 48-year-old stage IIIB cervical carcinoma patient with an incidental diagnosis of pelvic kidney was treated with radical chemoradiotherapy using intensity-modulated radiotherapy with concurrent weekly cisplatin, followed by intracavitary radiotherapy. The bilateral kidney dose was restricted within a tolerance limit of 16.6 Gy. At the 18-month follow-up, the patient was disease free and had no deterioration in kidney function. Intensity-modulated radiotherapy provided the necessary means for delivering radical radiation doses in this case scenario with adequate sparing of the kidney.

With the advent of targeted therapies there was a paradigm shift in the treatment of metastatic adenocarcinoma of lung. Immuno-histopathology and molecular subtyping in metastatic adenocarcinoma lung have enabled personalized treatment for each patient. Oncogenic driver mutations in non-small cell lung cancer are commonly EGFR (Epidermal Growth Factor Receptor) gene mutation and ALK (Anaplastic Lymphoma Kinase) gene rearrangement, which are mutually exclusive. Almost 60–64% patients have oncogenic mutation, which are mutually exclusive. Here, we present a case with EGFR mutation and ALK gene rearrangement which was expressed sequentially and with metastasis to rarest sites bilateral breast, ovaries and endometrium. Even though presented with upfront metastatic disease, patient was treated with multiple lines of targeted agents, by which patient survived for 5 years with good quality of life.

Background: Head-and-neck soft-tissue sarcomas (HNSTS) are extremely rare and lack definite guidelines. Methods: We retrospectively analyzed consecutive adult patients with HNSTS who presented to our sarcoma medical oncology clinic from January 2016 to October 2017. Results: There were a total of 30 patients. Unresectable localized disease was seen in 13 (43%) patients, metastatic disease 10 (34%) patients, while resectable disease in 7 (23%) patients only. Among unresectable localized disease, 3 (25%) patients could be converted to resectable disease after neoadjuvant therapy. Median follow period was 11 months. Progression-free survival was 19 months in patients with resectable disease and 6 months in patients with the unresectable/metastatic disease. Median OS was not reached. Conclusion: Unresectable HNSTS has a poor outcome. Neoadjuvant therapy can be tried in selected cases for achieving respectability or for vital organ preservation until robust data are available. A multidisciplinary approach for local control is crucial in managing unresectable HNSTS.

Synchronous multiple primaries of female genital tract are uncommon, with the most frequently encountered combination being of endometrium and ovary. Concurrent primary tumours of endometrium and cervix are rare. We report a case of coexistent endometrioid carcinoma of the endometrium and small cell neuroendocrine carcinoma of the cervix in 48-year-old woman who presented with menometrorrhagia and was detected to have metastases to distant sites on imaging. She underwent multimodality treatment which resulted in a significant reduction in the tumour bulk.

Introduction Primary salivary gland type tumors of lung (PSGTTL) are rare intra-thoracic malignant neoplasm. Their description in literature is largely limited to a few case series/case reports. We herewith present our surgical experience of and review its clinical presentation, management options and survival outcomes. Methods This retrospective analysis of prospectively maintained computerized data-base of patients was conducted in a tertiary teaching oncology centre in North India. The case records of all the patients who underwent surgery for PSGTTL were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, histopathological examination, postoperative complications and outcome were retrieved from the case records. Results There were seven patients who underwent surgery for PSGTTL during the period from January 2012 to December 2014. Hemoptysis (n = 6, 85.7%) and dyspnoea (n = 6, 85.7%) were common presenting clinical features. Fiber-optic bronchoscopy revealed endobronchial growth in all patients – five patients had growth in left main bronchus while one each had growth in right main bronchus and right intermediate bronchus. Biopsy confirmed adenoid cystic carcinoma in 4 (57.1%) and muco-epidermoid carcinoma in 3 (42.9%) patients. All but one had R‘0’ resection – pneumonectomy in five and bilobectomy in one patient; one patient was found to be unresectable in view of dense adhesions between lung and heart. Median pathological tumor size was 3.5 cm; none of the patient was found to have metastatic spread to lymph nodes. Overall, six patients are alive after a median follow up of 5 months (range 1–30). Conclusion Radical surgery to achieve R‘0’ resection is the main stay of treatment of PSGTTL to achieve prolonged survival.

Objectives: The objective of this study was to evaluate the prevalence of metabolic toxicities in patients with different nonhematological malignancies admitted in oncology ward of a tertiary cancer care center while on treatment. Methods: We did this cross-sectional study over a period of 7 months (January–July 2013) for all adult patients (n = 280) who, while undergoing anti-cancer therapy at our center, got admitted to our oncology inpatient ward with metabolic toxicity. Grading of toxicity was done using National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Results: A total of 46 events of metabolic toxicities were noted in 31 patients over this period. The most common of them was hyperglycemia (n = 10). The others were hypokalemia (n = 9), hyponatremia (n = 9), hypernatremia (n = 5), hyperkalemia (n = 5), tumor lysis syndrome (n = 4), hypercalcemia (n = 2), and grade ≤2 hypomagnesemia (n = 2). Majority of the patients were asymptomatic (n = 26). However, death occurred in five patients. Treatment interruptions took place in 19 patients. Age ≤40 years (P = 0.03), Eastern Cooperative Oncology Group performance status ≥2 (P = 0.023), history of addiction (P = 0.02), comorbidities (P = 0.037) were associated with increased risk of having metabolic toxicities on univariate analysis. While on multivariate analysis, only age, performance status, and history of addiction retained their statistical significance. Age ≤40 years (P = 0.02), use of more than one modality of treatment (P = 0.013), and hyperglycemia (P = 0.037) were associated with higher risk of death. Conclusion: Metabolic toxicities are common phenomena among cancer patients, especially those with young age, comorbidities, and having history of addictions. In young age, they might even be fatal, especially when they are treated with combined modality of treatment.

Background There is sparse data available on foot sarcomas treated on contemporary protocols. Methods This retrospective analysis involved 27 cases of foot sarcomas managed with multi-modality treatment under Sarcoma Clinic, at tertiary care hospital between January 2014 to May 2019. Baseline demographics, radiographic tumour characteristics, histological diagnosis, type of treatment received and oncological outcomes were noted for all cases. Statistical analysis was done by STATA version 13.0. Survival curves were analyzed by Kaplan Meir test and univariate analysis was done by Log Rank test. Results Median age was 26 years (range: 20 – 46 years). Median duration of symptoms were 11 months (Range: 5 – 24 months). Radiologically mean largest diameter of tumour was 6.5 cm (CI: 1.1 – 12 cm). Seven tumours (26%) arose from bone and 20 form soft tissue (74%). In tumours arising from bone, metatarsal was most commonly site of involvement (3 out of 7). Most common histology was synovial sarcoma (44%) f/b Ewing’s sarcoma (26%) f/b others (RMS, DFSP, MPNST, angiosarcoma). Ten patients (37%) had metastatic disease at presentation, lung being most common site (80%). Histological discordance with review diagnosis was seen in 50 % cases. Amputation was needed in 10 cases (37%) (palliative - 5, curative - 5) while limb salvage surgery was done in 10 (all curative). Adjuvant radiation was given in 7 out of 10 cases (70%). At last follow up 16 out of 27 patients (60%) were alive without disease, 4 (11%) with disease while 8 (29%) have died. With median follow-up of 43 months (Range 8 - 63 months) median PFS was 22 months. Median PFS in non-metastatic group was 48 months, while in metastatic group it was 8 months. On univariate analysis, median OS was significantly different between metastatic vs non-metastatic group (HR 10.93, p = 0.03). Conclusions Foot sarcomas happen in young adults irrespective of pathology with synovial sarcoma and Ewing’s sarcoma being most common histologies. Amputation rates are quite high even considering small size, owing to anatomy of the region as noted in previous studies. The treatment required for non metastatic disease is multimodality including use of radiation. If treated in multidisciplinary clinic outcomes can certainly be improved. Legal entity responsible for the study Sameer Rastogi. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Malignant melanoma is an extremely rare malignancy in the Indian subcontinent and South east Asia. Its already known that Asian countries have different clinical presentation of melanoma. It would be interesting to know the epidemiology and outcome of advanced disease in Indian patients. Methods We retrospectively analysed patients with malignant melanoma who were registered in Medical Oncology clinic at AIIMS, New Delhi between January 2016 and July 2019. We used SPSS version 23 for analysis. Immunotherapy used was single agent Nivolumab as Ipilimumab is unavailable. Results Total of 93 patients (57 males, 36 females) were registered in the study. Median age was 53 (range, 25 to 85 years), with the commonest primary sites being anorectal (n = 23) and foot (n = 23), followed by eye (n = 15), head and neck (n = 12), thigh (n = 9), others (n = 11) respectively. The commonest sites of metastasis were lymph nodes (n = 54, 58.1%), lung (n = 45,48.4%), liver(n = 33,35.5%) and bone(n = 25,26.9%).The median sites of metastasis was two (range 1-5). Most patients had ECOG PS 1-2 (n = 77, 82.8%). Majority of the patients (n = 80,86%) had metastasis.Out of 93 patients, 39(42%) received chemotherapy in first line, 16 (17.3%) received Immunotherapy, 13 (13.9%) underwent surgery and best supportive care was offered to 25 (26.8%) patients. The chemotherapy used were dacarbazine (n = 27), nabpaclitaxel (n = 6) and others (n = 6). Among patients who received chemo, median number of cycles was 5 (range,1-15) and response assessment revealed progressive disease in 17 patients, stable disease in 4 patients, partial response in one patient, and remaining 16 patients defaulted and were not evaluable. Among patients who received Single agent Nivolumab, the median number of cycles was 5 (range,2-15) and response showed progressive disease in all patients, except one. Median follow up was 18 months and median PFS was 3 months. Conclusions This study shows that the site of melanoma in Indian patients is different as compared to western patients with higher number of anorectal, mucosal and acral melanoma. Immunotherapy was feasible for only a fraction of patients in view of exorbitant cost. Non availability of BRAF therapies and Ipilimumab is of great concern in view of poor outcomes. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.