Medulloblastoma outcomes in tertiary care set?up in India using contemporary treatment protocols ? A retrospective study

Background: Medulloblastoma is the commonest embryonal brain tumor in children. It has shown improved outcomes with combined modality treatment. We aimed to study patient characteristics and survival outcomes of patients with this disease across two tertiary care centers in India. Methods: We analyzed data of patients with histological diagnosis of medulloblastoma treated from January 2010 to January 2016. Patient characteristics and follow-up data were retrieved from hospital records. Descriptive statistics were used to describe clinical and pathological characteristics. Overall survival (OS) was calculated from date of diagnosis to death due to any cause. Relapse-free survival (RFS) was calculated from date of diagnosis to occurrence of relapse or death. Result: Out of 26 patients treated, 24 were children and 2 were adults. Median age was 10 years (range = 0.8–22 years). Twenty (76.9%) patients were male. Fifteen (57.7%) patients were stratified as high-risk (HR), rest 11 (42.3%) were categorized as average risk (AR). Histopathology showed classical variety in majority of patients except for 4 (15%) cases, 3 with desmoplastic and 1 with anaplastic subtype. Median follow-up was 49.7 months (range= 4.2–102.5 months). Overall, eight (30.8%) patients relapsed and six (23%) deaths occurred. Five (33.3%) patients in HR category and 3 (27.3%) patients in AR group showed relapse. Median RFS and OS were not yet reached. Five-year RFS was 69.2% whereas five-year OS was 76.9%. Conclusion: This study highlighted patient characteristics and treatment outcomes in Indian patients. With adherence to standard treatment, high remission rates and improvement in mortality rates were achieved.

Relevance of multi?disciplinary team approach in diagnosis and management of Stage III NSCLC

Lung cancer is reported as the leading cause of cancer?related mortality worldwide. Non?small cell lung cancer (NSCLC) constitutes 80%�% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.

Radiotherapy in India: History, current scenario and proposed solutions

The history and current status of a biomedical discipline in a country or region provide important health system indicators. During the last one hundred years, radiotherapy has established its position as a vital specialty in cancer management. It has proved to be one of the most cost effective ways of treating cancer providing both radical and palliative treatments depending on patient stage and performance status. However, access to radiotherapy for cancer patients in India is limited by several factors including physical proximity of centre, cost and availability of required technology. This article gives an outline of the history, existing radiotherapy facilities and future trends related to radiotherapy practice in India.

Secretory carcinoma arising in radial scars of the breast: A case report and review of literature.

Radial scars or complex sclerosing lesions are common benign lesions in the breast with characteristic radiological and pathological features. The pathological diagnosis of carcinoma arising in this setting requires careful amalgamation of clinical, radiological and morphological details. Ancillary techniques like immunohistochemistry aid in the diagnosis. We report an unusual case of a secretory carcinoma arising in the background of a radial scar.

Curability of cancer by radiotherapy and chemotherapy, including in neuraxial neoplasms.

In the October of 1996, Lance Armstrong, celebrated cyclist and one of the greatest athletes the world has ever seen, at the age of 24, was diagnosed with metastatic testicular cancer with disease having already spread to his abdomen, lungs and brain. Lance underwent four cycles of chemotherapy, actually the pretty standard one, pioneered at the Indiana University and not only did he get completely cured of his cancer, he remains extremely well till date, 12 years later. He sure did have a few adverse effects during those cycles of chemotherapy in the form of nausea, vomiting, weakness and fall in blood count but he knew and experienced them only for a short transient time and emerged triumphant and strong. In fact, he went on to win six awe-inspiring and incredible successive Tours de France victories from 1999-2005, one of the most grueling sporting events testing the endurance of the very fittest. After his retirement, he has been so inspired that he has completely devoted himself to educate people about the common myths about cancer, and promised to raise awareness and generate money for furthering research into surgery, radiation therapy and chemotherapy for cancer through his foundation. He says "I am indebted to the doctors, nurses and medicine and would want to pay them back for all their energy and caring." In his successful journey of overcoming cancer, he captures the essence of its treatment so well by declaring "Pain is temporary, it may last a minute, or an hour, or a day, or a year, but eventually, it will subside and something else will take its place. If I quit, however, it will last forever".

External hypofractionated whole-breast radiotherapy: now where does accelerated partial breast irradiation stand?

Breast-conserving therapy (BCT) has emerged as a viable option for suitable breast cancer patients who are desirous of preserving the breast. The major advantage of BCT is the good cosmetic outcome with disease-free and overall survival similar to mastectomy. In this article, I have compared two emerging modalities for treating a preserved breast with radiotherapy. These two techniques in breast cancer - accelerated partial breast irradiation (APBI) and hypofractionated whole breast external beam radiotherapy - have their respective merits and drawbacks, and this article attempts to dissect the issue.

Radiotherapy-induced depigmentation in a patient with breast cancer.

Vitiligo is a common dermatological disorder. A middle-aged woman with preexisting vitiligo was diagnosed with breast carcinoma. After surgery and chemotherapy she received regional radiotherapy. Six months after the completion of radiotherapy she developed depigmentation in the irradiated area. This article discusses the etiology for this phenomenon and the literature in this regard.

Age related macular degeneration: a study of patients managed with radiotherapy.

INTRODUCTION: Age-related macular degeneration (ARMD) is the leading cause of blindness in the west. Radiotherapy affects the evolution of exudative macular degeneration directly by its effect on the endothelium and inflammation modulation. We conducted a retrospective study to evaluate the improvement in visual acuity and healing of sub retinal neovascular membrane (SRNV) following fractionated radiotherapy. MATERIALS AND METHODS: 47 patients (58 eyes) of ARMD were retrospectively analyzed. One of the following radiotherapy fractionation schedules was employed in all the patients in this study. a) 15 Gy/5 fractions/1 week (five patients) b) 20 Gy/5 fractions/1 week (19 patients) c) 22.5 Gy/5 fractions/1 week (21 patients) d) 25 Gy/5 fractions/1 week (two patients). VA and funduscopy was taken at each follow-up for objective improvement and to assess the healing of SRNV. RESULTS: The median follow-up was 7.23 months. The mean improvement in the VA in the entire group was of 0.44 line. (Median 1, SD 1.04). Overall 75% of the eyes showed either steady vision or an improvement in subjective vision analysis. The deterioration free survival was significantly better in the group that had a relatively short duration of symptoms (P = 0.01). Scarring at presentation was a significant adverse factor for improvement in vision after radiotherapy (P = 0.001). CONCLUSIONS: In patients of ARMD treated with radiotherapy, the initial duration of symptoms and scarring of eyes at presentation were significant prognostic variables for improvement in VA after radiotherapy.

Dedifferentiated chondrosarcoma of the maxilla.

A 20-year-old male reported with right-sided facial swelling, epistaxis and right sided proptosis of two months duration. Computerized tomography scan of the face revealed a mass in the right maxillary sinus. The patient underwent surgery and the postoperative histopathology was suggestive of dedifferentiated chondrosarcoma. The present report discusses this rare presentation and the issues in its management.

Trastuzumab: is the new evidence revolutionary?

A few years back, the survival benefit of trastuzumab in HER 2 positive breast cancer patients presenting with metastatic disease was proven in a randomized setting. Recently a number of randomized trials have reported their results in the adjuvant setting in HER 2 positive patients. These trials have been considered by some as a landmark in the evolution of breast cancer management. Although the data is encouraging, it need to be seen in a proper perspective keeping in mind the limitations and the side effects reported. This article stresses the use of Herceptin in carcinoma breast patients in adjuvant setting with a cautionary eye.

Cellular phones and their hazards: the current evidence.

The past decade has seen an exponential increase globally in the use of cellular phones (popularly known as mobile or cell phones). These phones are convenient and trendy. Discarding the wire means that the communication is through electromagnetic waves, which could have potential hazards. Alarmist reports in the lay press and high profile lawsuits, particularly in the West, have attracted attention to the possible harmful effects of cellular phones. Adverse effects investigated by various clinical trials include the possible link to increased risk of vehicular accidents, leukaemias, sleep disturbances and the more serious brain tumours. Available level II evidence suggests that the only proven side-effect is an increased risk of vehicular accidents. So far, all studies have consistently negated any association between cellular phones and brain tumours. Yet, the final word remains to be said.