Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial.

AIMS: The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial. MATERIALS AND METHODS: Paclitaxel at 80 mg/m2 on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916). RESULTS: In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2). CONCLUSION: Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.

Gastric Cancer: a retrospective analysis from AIIMS, New Delhi.

Carcinoma of stomach is the leading cause of cancer related death in the last century worldwide. However in many parts of the world, the incidence has gradually decreased due to changes in food habit and the environment. The proximal gastric and gastro-esophageal junction (GE junction) cancer has markedly increased in the last three decades. The only proven curative treatment is surgery, but due to high recurrence rate, efforts are still going on regarding better systemic and regional adjuvant therapies. The present study is a retrospective analysis of all the post-operative (post-op) cases of carcinoma stomach and the GE junction being registered and treated in our department from June 1995 to February 2008. The total number (no.) of patients (pts) were 69 (54 stomach, 15 GE junction), males 49, females 20, KPS 50-90 (median 80), length of the lesion was <5cm in 28 pts, transmural infiltration along with serosa involvement was found in 40 pts. Histologically, adenocarcinoma was detected in 61 pts and metastatic spread in 50 pts. Thirty-six pts had surgery in another center prior to registration. Forty-nine pts had subtotal gastrectomy, while lymph nodes dissection was done in 64 pts. Chemo-radiotherapy (CRT) was given in 49 pts, and 54 pts received >30 Gy dose of radiation. Macdonald's regimen was used in 49 pts. Treatment compliance was found in 53 pts, but only 05 pts were hospitalized for supportive management. Pts were followed up from 01-69 months (median 12 months) and the recurrence was found in 13 pts (median 14 months). The multimodality intervention is better treatment option in the management of carcinoma of stomach.

Disease profile and treatment results of anal canal SCC: experience from AIIMS, New Delhi.

INTRODUCTION: Anal Canal squamous cell carcinoma (SCC) accounts for nearly 2% of all cancers of the alimentary tract. Over the past few years, the management of anal canal cancer has changed from primary surgery to primary chemo-radiotherapy (CRT). METHODS: A total of 83 patients' (pts) records (62 males, 21 females) were retrospectively reviewed. Length of disease was <5 cm in 44 pts and confined to primary in 46 pts. Ten pts have anti-cancer therapy outside. We delivered radiotherapy (RT) alone to 16 pts, chemotherapy (CT) alone to 4 pts, CRT in 51 pts and pre-operative (pre-op) RT in 2 pts. RT dose was up to 30 Gray (Gy) =16; 30-50 Gy=12 and >50 Gy=41 pts. RESULTS: RT compliance was optimal in 64/69, grade (Gr) ≤ 2 toxicity in 56/69 and Gr ≥ 2 in 13/69 pts. Thirteen pts (18.84%) were hospitalized during RT. No response (NR) was found in 4/83, <50% in 18/83, >50-<100% in 39/83 and complete response (CR) in 22/83 pts. Recurrence at primary site was seen in 7 and loco-regional in 2 pts. Salvage therapy was done in all 9 pts (surgery=8 and CT=1). Status at last follow up, alive without disease = 22/83 and with disease = 61/83 pts. CONCLUSION: This retrospective analysis revealed that the advanced disease was in 47%, the optimal anti-cancer therapy could be delivered to 63.9%. Despite heterogeneity of patient population and management, the overall disease-free survival (DFS) with sphincter-preservation was achieved in 26.5% pts.

Primary orbital calcified synovial sarcoma: a case report.

A 32-year-old woman presented with a progressively increasing recurrent swelling of the left eye. An orbital tumor was detected and histologically classified as a synovial sarcoma, confirmed by immunohistochemistry and electron microscopy. Isolated cases of synovial sarcoma have been reported in the retroperitoneum, mediastinum, pharynx and orofacial region. However, the orbit is an extremely rare site. The authors report a case of recurrent primary orbital calcified synovial sarcoma in a young lady treated with surgery and radiotherapy.

Prognostic factors influencing the outcome of thalamic glioma.

Retrospective analysis of 27 patients of thalamic glioma including adults and children treated over a period of 7 years from 1991-1997 was done. The study group included 19 males and 8 females; 9 patients were less than 15 years and 18 patients more than 15 years of age at the time of diagnosis. The commonest symptoms were headache and vomiting. 12 patients underwent VP shunt as an initial procedure and 7 underwent total or partial surgical resection. Confirmed histopathological examination was possible in 16 patients; while 12 had low grade astrocytoma, 4 cases had high grade histology. All patients were treated with radiotherapy to a total dose of 50-60 Gy in 25-30 fractions. Median follow up was 9.63 months. The disease free survival in these patients was 28% at 2 years. Prognostic factors which included age, sex, duration of symptoms, surgical procedures, histology and radiotherapy dose were evaluated for significance. A subtotal resection conferred a better prognosis.

Carcinoma cervix with metastasis to deltoid muscle.

Skeletal muscles are rare metastatic sites despite their rich blood supply and the fact that the muscular mass of the body accounts for a large percentage of the total body weight. They account for less than 1% of all malignant metastases of haematogenous origin. Menard and Parache, Ann Med Interne Paris 1991;142:423-428. Skeletal muscle metastasis in cervical cancer have been infrequently reported. In this case report, we detail a case of cervical cancer who developed a painful swelling of the right shoulder which on investigation, was found to be skeletal muscle metastases.

Medical disorders associated with endometrial carcinoma.

UNLABELLED: From January, 1990 to December, 1995, 113 cases of endometrial carcinoma were registered. Of them, 24 patients (20%) had associated medical disorders. A total of 37 medical disorders were found in these 24 patients. The distribution was as follows: diabetes mellitus in 15 patients, hypertension in 13 patients, coronary artery disease in two, asthma in one, RBBB in one and hypothyroidism in five patients. Age of the patients ranged from 48-76 years (Median 62 years). Fifteen patients underwent surgery and rest nine were inoperable due to medical illnesses. Eleven patients received radiotherapy and four received chemotherapy. Of the two failures, one developed metastasis to lung and another to bone. No local recurrence was observed. Median survival was 20 months. Late radiation morbidity was noticed in four patients (36%), all of them were diabetic. CONCLUSION: Hypothyroidism which was unexpectedly found in five patients may also be a risk factor associated with endometrial carcinoma. This finding has never been reported in the literature and it needs to be curiously studied in future series. The risk of late radiation complications is higher in diabetic patients. Overall prognosis of endometrial carcinoma associated with medical illnesses is not very good.

Hypertension and associated diseases in elderly patients.

Hypertension is a cardinal risk factor in the genesis of cardiovascular morbidity and mortality. The presence of concomitant risk factors greatly increases the incidence of vascular events, and associations of age, hypertension, obesity and smoking are particularly lethal combinations. Accelerated atherosclerotic change characterizes sustained hypertension, and ischaemic heart disease, aortic dissection, stroke and multi-infarct dementia are major sequelae. Major studies in the United States, Australia and the United Kingdom have shown that treatment of hypertension significantly reduces the occurrence of strokes. Obesity and excess alcohol consumption closely correlate with hypertension. The relative importance to hypertension of type II diabetes and obesity is difficult to evaluate.