Low-grade malt lymphoma of the nasopharynx in young adults: Successful treatment of a rare diagnosis at a rare site by radiotherapy.

INTRODUCTION: Mucosa Associated Lymphoid Tissue (MALT) lymphoma is the third most common subgroup of Non-Hodgkin's lymphoma and is the most common type of primary extranodal lymphoma. They are rarely found in the nasopharyngeal region and their mean age at presentation is the sixth decade of life. MATERIALS AND METHODS: We present the clinical, pathological, treatment and 5-year follow-up data of 5 cases of nasopharyngeal MALT lymphoma treated with definitive radiotherapy at our hospital, between 2009 and 2011. RESULTS: The average age of diagnosis was 27 years which is more than a decade earlier than what has been reported previously. Clinical symptoms included nasal obstruction, tinnitus and hearing loss. All five patients had locoregional disease. They were treated by definitive radiotherapy to a dose between 30 to 40 Gy. At 5 years of follow-up, 4 patients were in complete remission while one had disease relapse. CONCLUSION: The younger age of presentation compared to older reports in this rare subsite was an interesting finding in our study. The authors speculate that rising levels of particulate air pollution may have played a part in the etiology in this younger population. Our series shows that despite the younger age, the disease displays an indolent course and responds well to radiotherapy alone as the primary treatment. Recurrence or disseminated disease is also highly treatable with systemic chemotherapy.

Utility of 18-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18 FDG PET-CT) in Gallbladder Cancer: Experience from a Tertiary Care Hospital.

Introduction Gallbladder cancer (GBC) is one of the most common and aggressive malignancies of the Indo-Gangetic plains. Despite its widespread use in GBC cases, the role of 18-flurodeoxyglucose positron emission tomography-computed tomography ( 18 FDG PET-CT) in the management of this disease is not well defined. In our study, we present the practice trends of the utilization of this investigative modality in our hospital and its benefits in aiding diagnosis, staging, and surveillance for recurrence. Materials and Methods All cases of suspected and biopsy-proven GBCs who underwent PET-CT at our institute between 2016 and 2019 were retrospectively evaluated for the indication of PET-CT testing and its impact on the management of the case. The indications were classified into three categories: (i) staging and metastatic workup, (ii) response assessment post-chemotherapy, and (iii) post-therapy surveillance of patients. Results A total of 79 PET-CT scans were carried out during the study period. PET-CT was used for less than one-third of the total patients of GBC presenting at our center. Initial staging and workup (49%) was the most common indication followed by surveillance (28%) and response assessment (23%). PET-CT had a substantially better sensitivity in detecting distant metastases compared to conventional imaging in both initial workup and during follow-up. PET-CT provided additional information in 42% scans that led to change in the management of the patient. As a response assessment tool PET-CT aided not only in evaluating efficacy of therapy but also for documenting progressive disease for patients on therapy. Conclusion PET-CT is a valuable tool to not only rule out metastatic disease while selecting patients for surgery but also for post-therapy surveillance for recurrence in patients of GBC. Larger prospective studies may help in finally elucidating the exact role of PET-CT in this disease.

Association of tobacco exposure with demographic and clinicopathological factors in patients of oral squamous cell carcinoma - A single-center experience.

INTRODUCTION: Almost a third of the global load of oral squamous cell carcinoma (OSCC) occurs in India and can be attributed to the widespread use of tobacco and tobacco-related products in this part of the sub-continent. MATERIALS AND METHODS: Records of 274 patients of OSCC treated between January 2018 and December 2019 in our institute were analyzed for the study for history of tobacco abuse and distribution of associated demographic, clinical, and pathological factors. RESULTS: The age of the patients in the study ranged from 31 to 82 years with a median age of 60 years. The ratio of oral cancer in males: females was 3:1. Exposure to tobacco was seen in the majority of patients (89%) who reported with oral carcinoma. Smokeless tobacco in the form of gutka was the most common abused tobacco, followed by bidi in our study. Tongue and buccal mucosa (38% and 36%, respectively) were the most common sites. Significant statistical correlation of tobacco use was seen with age, gender, clinical, and pathological tumor stages. CONCLUSION: With tobacco being the main cause of OSCC, further studies with a larger number of patients and preferably with a comparison arm of non-tobacco OSCC would help in elucidating the exact clinical and statistical correlation of tobacco with the clinicopathological factors.

Sociodemographic, clinical profile, and treatment characteristics of oncology patients developing radiation recall phenomenon: Two tertiary care center's experience of an eternal unpredictable phenomenon of cancer treatment.

Objectives: To determine the socio-demographic and clinical profile of cancer patients developing radiation recall phenomenon or radiation recall dermatitis following chemotherapy administration, previously treated with external irradiation. We assessed its incidence, severity, frequency, differentiation from radio-sensitization and radiation-dermatitis, its correlation with radiation dose and chemotherapeutic agent, and various parameters affecting its occurrence. Materials and Methods: This observational prospective study was designed for 1092/2676 (50.2%) patients of histologically proven carcinoma breast, carcinoma lung, lymphomas, chest wall sarcomas, thymomas, thymic carcinomas, nasopharyngeal cancer, bladder carcinoma, rectal cancer, and metastatic cases who received radiation therapy followed by chemotherapy. Intake, treatment, observation, and follow-up were done from July 2014 to July 2021 for 7 years in two tertiary care cancer institutes of government setup. Results: In our study, majority of recall phenomena were reported in breast carcinoma 43/71 (60.5%) followed by carcinoma esophagus with 07/71 (9.8%) cases. Females developed 54.9% grade-I/II and 90% grade-III/IV recall cases compared to males with 45.1% and 10% cases, respectively (P = 0.005). Median radiation dose used was 45 Gy (dose range 8-70 Gy) (P = 0.656). Docetaxel resulted in 55% recall cases followed by paclitaxel with 12.7% of cases. Combination therapy reported 71.8% of cases compared to monotherapy with 28.2% of cases. Recall-cases recorded in the time period of 3-4 weeks between radiation and chemotherapy were 59/71 (83%) and those reported in >4 weeks were 12/71 (17%). Time-gap between 3 and 4 weeks reported 49% grade-I/II and 100% grade-III/IV recall-cases while time-gap >4 weeks resulted in 26% and 0% cases respectively (P = 0.000). Conclusion: In this study, taxanes and platinum-agents were the most common chemotherapeutic drugs involved in the occurrence of the recall phenomenon. Multi-drug regimens resulted in higher recall cases compared to monotherapy. Radiation dosage did not cause any significant impact. The risk and severity of recall reactions increased with female gender and shorter time-interval between radiation and systemic therapy, while early-onset recall cases displayed greater severity. This precedented but unpredictable phenomenon ceases to be a topic to be discarded in this modern era of highly conformal radiation therapy techniques and targeted cancer therapy.

Use of a Checklist Approach on a Telecobalt in an Attempt to Reduce Human Errors in Radiotherapy Delivery and Improve Therapeutic Ratio.

BACKGROUND: The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine. MATERIALS AND METHODS: A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings. RESULTS: The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min. CONCLUSIONS: The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a "safety culture," with voluntary error-reporting and a willingness to learn from such errors.

Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer.

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) has evolved as a major diagnostic and prognostic tool in cervical cancer. The aim of our study was to compare the change in mean apparent diffusion coefficient (ADC) value before and after concurrent chemoradiation therapy (CCRT) in carcinoma cervix thereby establishing its role as a cancer biomarker. MATERIALS AND METHODS: A hospital-based prospective study was conducted in 35 patients diagnosed with cervical cancer. All 35 patients underwent pelvic MRI before and after 6 months of CCRT. The study was done over a period of 12 months. Conventional axial and sagittal T2 imaging was followed by DW-MRI. In the axial DW/ADC images at "b-value" of 800 s/mm2, a circular region of interest was drawn covering more than 60% of the tumor volume to calculate the ADC values. Statistical Package for the Social Sciences (version 21.0) was used for statistical evaluation. Chi-square test, independent samples t-test, and analysis of variance were used to analyze the data. The results are depicted as frequencies (number), proportion (percentages), and mean ± standard deviation. RESULTS: Pre-CCRT mean ADC value was 0.814 × 10-3 mm2/s. Post-CCRT mean ADC value was 1.294 × 10-3 mm2/s. Mean ADC value of patients having lymph node involvement and parametrial extension was significantly lower when compared with those without lymph node involvement and parametrial extension (P = 0.001). Nonresponders with residual lesion had lower ADC values than responders with no residual lesion. An interesting and unique observation was that pre-CCRT mean ADC value of responders was higher than nonresponders. CONCLUSION: An increase in mean ADC value of 0.480 × 10-3 mm2/s after CCRT was found to be statistically significant (P < 0.001) thereby proving its role as an imaging biomarker in cancer cervix.

Tolerance of Chemoradiation in Advanced Head and Neck Cancers: Comparison Between Inpatients and Outpatients.

Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value-0.6 (Yate's corrected); P value-0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value-0.2 (Yate's corrected) P value-0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.

Occupational Stress in the Indian Army Oncology Nursing Workforce: A Cross-sectional Study.

OBJECTIVE: This cross-sectional, quantitative epidemiological study was aimed at finding out the degree of work-related stress among the staff nurses working in oncology. METHODS: This study was conducted on 81 out of 100 oncology-trained nurses working in various oncology centers of Indian Army who consented to participate in it. It was carried out in five oncology centers of our organization where oncology-related facilities are available. Predesigned and pretested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. The association between stress and various variables was found using Chi-square test. RESULTS: Risk for professional stress was found more among unmarried young respondents of 20-30 years age group. No statistically significant association (P < 0.131) was found between department of posting and level of stress. Nurses reported that they had no time for rest, of whom 62.96% were suffering from moderate range of stress for a busy professional while only one admitted to have severe stress requiring remedial action. While 82.7% felt that they are able to achieve major objectives in life, 71.6% of them reported that they feel inadequately valued for their commitment at work. CONCLUSIONS: The main nurses' occupational stressors were criticism, feeling of not being appreciated for hard work, and having time for self. This type of assessment should be carried out in all hospitals so that working conditions for this important component of health care can be improved.