Clinicopathologic Profile and Treatment Outcomes of Colorectal Cancer in Young Adults: A Multicenter Study From India.

PURPOSE: Colorectal cancer (CRC) in young adults is a rising concern in developing countries such as India. This study investigates clinicopathologic profiles, treatment patterns, and outcomes of CRC in young adults, focusing on adolescent and young adult (AYA) CRC in a low- and middle-income country (LMIC). METHODS: A retrospective registry study from January 2018 to December 2020 involved 126 young adults (age 40 years and younger) with CRC. Patient demographics, clinical features, tumor characteristics, treatment modalities, and survival outcomes were analyzed after obtaining institutional ethics committees' approval. RESULTS: Among 126 AYA patients, 62.70% had colon cancer and 37.30% had rectal cancer. Most patients (67%) were age 30-39 years, with no significant gender predisposition. Females had higher metastatic burden. Abdominal pain with obstruction features was common. Adenocarcinoma (65%) with signet ring differentiation (26%) suggested aggressive behavior. Limited access to molecular testing hindered mutation identification. Capecitabine-based chemotherapy was favored because of logistical constraints. Adjuvant therapy showed comparable recurrence-free survival in young adults and older patients. For localized colon cancer, the 2-year median progression-free survival was 74%, and for localized rectal cancer, it was 18 months. Palliative therapy resulted in a median overall survival of 33 months (95% CI, 18 to 47). Limited access to targeted agents affected treatment options, with only 27.5% of patients with metastatic disease receiving them. Chemotherapy was generally well tolerated, with hematologic side effect being most common. CONCLUSION: This collaborative study in an LMIC offers crucial insights into CRC in AYA patients in India. Differences in disease characteristics, treatment patterns, and limited access to targeted agents highlight the need for further research and resource allocation to improve outcomes in this population.

Computed tomographic study of posterior cranial fossa, foramen magnum, and its surgical implications in Chiari malformations.

OBJECTIVE: The aim of this study is to measure the height and volume of the bony part of the posterior cranial fossa (PCF) and the surface area of the foramen magnum (FM) using computed tomography (CT) scans and to correlate our clinical findings with the available current literature. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care referral hospital in the Southern part of India during the period from January 2015 to August 2015. A total of 100 CT scans of the suspected head injury patients were collected retrospectively form the basis for this study. The height, volume of PCF and the anteroposterior (AP), transverse diameter, and surface area of the FM were measured. The values of all parameters were subjected to statistical analysis using SPSS version 16. RESULTS: The age of the patients were ranged between 18 and 70 years with the mean age of 41.22 ± 13.93 years. The dimensions of the posterior fossa and FM were larger in males compared to females. The mean height of the posterior fossa was 38.08 (±4.718) mm (P = 0.0001), and the mean volume of the posterior fossa was 157.23 (±6.700) mm3 (P = 0.0001). The mean AP, transverse diameter, and the surface area of the FM were 33.13 (± 3.286) mm, 29.01 (± 3.081) mm, and 763.803 (±138.276) mm2, respectively. CONCLUSION: The normal dimensions of the posterior fossa and FM were less in females than males and were useful to radiologists and neurosurgeons to better their diagnostic inferences, as well as to determine the proper treatment options in Chiari malformation type I (CMI) and other posterior fossa anomalies. The posterior fossa tissue volume can be reliably measured in patients with CMI using our method. More studies were required because there were variations in dimensions among individuals of different races in different regions of the world.