Comparative Study of Adjuvant Temozolomide Six Cycles Versus Extended 12 Cycles in Newly Diagnosed Glioblastoma Multiforme.

INTRODUCTION: Studies have shown promising survival with the use of Extended Temozolomide (E-TMZ) as compared to Conventional six cycles of Temozolomide (C-TMZ) in malignant gliomas; however, the reports are mostly limited to retrospective studies with significant bias. AIM: This study assesses the impact of six versus 12 cycles of adjuvant Temozolomide (TMZ) on Overall Survival (OS) in newly diagnosed postoperative patients of Glioblastoma Multiforme (GBM). MATERIALS AND METHODS: Between January 2012 and July 2013, 40 postoperative patients of GBM between age 18-65 years and Karnofsky Performance Score (KPS) ≥70 were included. Patients were randomized to receive radiation (60 Gray in 30 fractions over six weeks) with concomitant TMZ (75 mg/m2/day) and adjuvant therapy with either six (C-TMZ arm) or 12 cycles (E-TMZ arm) of TMZ (150-200 mg/m2 for five days, repeated four weekly). Twenty patients were treated in each arm. Toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. OS and Progression Free Survival (PFS) were calculated from the time of diagnosis. Kaplan Meier method was used for survival analysis. A p-value of <0.05 was taken as significant and SPSS version 12.0 was used for all statistical analysis. RESULTS: Median number of adjuvant TMZ cycles was six and 12 in C-TMZ and E-TMZ arm respectively. Overall, 5% and 15% patients respectively in C-TMZ and E-TMZ arm had haematological toxicity ≥ 3 in grade. Median follow up in C-TMZ and E-TMZ arm were 14.65 months and 19.85 months. Median PFS was 12.8 months and 16.8 months in C-TMZ and E-TMZ arm respectively (p=0.069). Median OS was 15.4 months vs. 23.8 months in C-TMZ and E-TMZ arm respectively (p=0.044). CONCLUSION: Our study showed that E-TMZ is well tolerated and leads to a significant increase in PFS as well as OS in newly diagnosed patients of GBM. Further prospective randomized studies are needed to validate the findings of our study.

Burden of preventable cancers in India: Time to strike the cancer epidemic.

India has a rapidly growing population inflicted with cancer diagnosis. From an estimated incidence of 1.45 million cases in 2016, the cancer incidence is expected to reach 1.75 million cases in 2020. With the limitation of facilities for cancer treatment, the only effective way to tackle the rising and humongous cancer burden is focusing on preventable cancer cases. Approximately, 70% of the Indian cancers (40% tobacco related, 20% infection related and 10% others) are caused by potentially modifiable and preventable risk factors. We review these factors with special emphasis on the Indian scenario. The results may help in designing preventive strategies for a wider application.

Pulsed-dose-rate vs. high-dose-rate intracavitary radiotherapy for locally advanced carcinoma of cervix: A prospective randomized study.

PURPOSE: To compare late radiation toxicities in patients with carcinoma of cervix treated with pulsed-dose-rate (PDR) vs. high-dose-rate (HDR) intracavitary radiotherapy (ICRT). METHODS AND MATERIALS: Between July 2010 to April 2012, 37 patients with Stage IIB-IIIB (International Federation of Gynecology and Obstetrics 2009) squamous cell carcinoma of cervix were randomized to receive either HDR (7 Gy each in three fractions, repeated weekly) or PDR (70 cGy hourly pulses for 39 hours, total 27 Gy) ICRT after external beam radiotherapy. Late rectal and bladder toxicities were assessed using Radiation Therapy Oncology Group criteria, and vaginal toxicity was graded as per common terminology criteria for adverse events. Overall survival and disease-free survival were estimated using Kaplan-Meier method. RESULTS: Nineteen patients received HDR and 18 received PDR ICRT with median followup 34 and 29 months, respectively. In HDR vs. PDR arm, late rectal toxicities grade ≥2 (16.7% vs. 21.1%, p = 1.000), grade ≥3 (10.5% vs. 0%, p = 0.486), late bladder toxicities grade ≥2 (10.5% vs. 0%, p = 0.486), and late vaginal toxicities grade ≥2 (15.8% vs. 5.6%, p = 0.604) were not statistically different. For HDR and PDR ICRT groups, 4-year disease-free survival was 67.1% vs. 71.8% (p = 0.195) and overall survival was 77% vs. 75% (p = 0.322), respectively. CONCLUSION: In this small group of patients, there were fewer events in form of late radiation toxicities in PDR arm, although statistically not significant. Further studies are required to define role of PDR compared to HDR ICRT in cervical carcinoma.

Invasive lobular carcinoma of the male breast: A rare histology of an uncommon disease.

Male breast carcinoma is a rare malignancy comprising less than 1% of all breast cancers. It is a serious disease with most patients presenting in advanced stages. Infiltrating ductal carcinoma is the most common histology while lobular carcinoma represents less than 1% of all these tumors. We report a case of locally advanced lobular carcinoma of breast in a 60 year old male.