Journal of Cancer and Allied Specialties
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PEPTIDE BASED TARGETED RADIONUCLIDE THERAPIES; SCIENCE BEHIND THE SUCCESS.
Full text linkThe radionuclide therapies for solid and liquid malignancies are emerging field nowadays. The targeted radionuclide therapies have been in use since 1945. In the past 20 years, due to advancement in the nanotechnology and targeting cell receptors; radionuclide therapies have emerged as a subspecialty in nuclear medicine. Through this article, we would like to briefly describe the evolution of peptide-based radionuclide therapies, with a little emphasis on their clinical applications. Key words: Peptide-based radiopharmaceuticals, radionuclide therapy, somatostatin-receptor-positive neuroendocrine tumour
EFFICACY AND SAFETY OF MULTI-TARGETED KINASE INHIBITORS IN PROGRESSIVE, RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCERS: A META-ANALYSIS
Full text linkPurpose: A meta-analysis was conducted to evaluate the impact of oral multitargeted kinase inhibitors (MTKIs) in radioactive-iodine refractory locally advanced, recurrent/metastatic differentiated thyroid cancer (DTC) on disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) rates. Materials and Methods: The PubMed/MEDLINE, CANCERLIT, EMBASE, Cochrane Library database and other search engines were searched to identify randomised controlled trials (RCTs) comparing MTKIs with placebo in locally advanced, recurrent/metastatic DTC. Pooled data were expressed as odds ratio (OR), with 95% con dence intervals (CIs, Mantel–Haenszel xed-effect model). Results: Three RCTs with a total patient population of 954 patients were identi ed. The use of MTKIs was associated with improved PFS (OR: 0.262, 95% CI: 0.19–0.35; heterogeneity (I2) = 22.4%; P < 0.0001), improved DCR (complete and partial responses + stable disease, P < 0.0001) and improved OS 0.66, 95% CI: 0.46–0.96 (I2 = 43%, P = 0.034). Lenvatinib (compliance = 87%) was associated with more grade ≥3 hypertension. However, its other adverse effects were much lower than sorafenib (compliance = 56%) and vandetanib. Conclusion: In radioactive iodine-refractory recurrent, metastatic DTC patients, lenvatinib and sorafenib were associated with improved PFS, DRC and OS rates, while the compliance was better with lenvatinib. Key words: Meta-analysis, multitargeted kinase inhibitors, progressive differentiated thyroid cancer, radioactive iodine- refractory
ARTERY FIRST TECHNIQUE FOR MANAGEMENT OF ABERRANT HEPATIC ARTERIAL ANATOMY DURING PANCREATICODUODENECTOMY-EXPERIENCE FROM A SPECIALIZED HEPATO-PANCREATO-BILIARY UNIT
Full text linkPurpose: Aberrant hepatic arterial anatomy poses a challenge for surgeon during pancreaticoduodenectomy (PD). These anomalies are best picked up on pre-operative imaging to avoid inadvertent injury to the aberrant vasculature resulting in liver ischaemia or biliary-enteric anastomotic failure. We present our experience of dealing with aberrant hepatic vessels during PD. Methods: Patients with aberrant hepatic vasculature who underwent PD between September 2014 and August 2015 were included in the study. We used artery rst technique for dissection in cases identified on pre operative imaging. Aberrations were classed according to Hiatt classi cation. Results: A total of 23 PD were performed with aberrant arterial anatomy in 10 (43%) cases. These vessels were recognised and preserved in nine cases. In one patient, the replaced right hepatic artery (RRHA) arising from superior mesenteric artery (SMA) was coursing through pancreatic parenchyma needing resection and reconstruction with uneventful post-operative recovery. We also identified one RRHA arising from SMA coursing lateral to common bile duct and entering liver parenchyma in gallbladder fossa. Conclusion: Aberrant hepatic arterial anomalies are common and should ideally be picked up by pre-operative imaging. It is possible to preserve these vessels in most cases with careful surgical dissection using artery first technique. Surgeons performing PD should be well versed with the aberrant vascular anatomy to minimise any inadvertent damage. Key words: Aberrant hepatic artery, artery first technique, pancreaticoduodenectomy
MORPHOLOGIC SPECTRUM AND CLINICO-PATHOLOGICAL CORRELATION OF GASTROINTESTINAL STROMAL TUMOURS: AN EXPERIENCE OF SIX YEARS AT A TERTIARY CARE HOSPITAL.
Full text linkObjective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (6.5%) and pancreas 1 (3.2%). According to risk categorisation, one was categorised as (3.2%) very low risk, 3 (9.7%) low risk, 5 (16.1%) intermediate risk and 22 (71%) high risk. Follow-up was available in 21 patients. 7 patients (22.5%) lost to follow-up. 8 (25%) had recurrence and 4 (12.9%) died. Conclusion: Majority of cases diagnosed at our centre were gastric in origin followed by small intestine, and as per risk categorisation, most were high risk. Patient survival with high-risk tumours was dismal. Key words: Gastrointestinal stromal tumour, immunohistochemistry, risk categorisation
SURVIVAL IMPACT OF SKELETAL METASTASIS ON BONE SCINTIGRAPHY IN PATIENTS WITH GERM CELL TUMOURS
Full text linkObjective: Our aim was to determine the frequency of skeletal metastasis in germ cell tumours (GCT) at baseline and relapse on conventional technetium-99m methylene diphosphonate (Tc-99m MDP) whole body bone scan (bone scan) and to evaluate the effect of bone metastases on survival. Materials and Methods: Electronic medical records of histologically proven GCT over 64 months were retrospectively analysed. Basic demographic and histologic information were correlated with the presence of osseous and visceral metastases. 5-year disease-free survival (DFS) and overall survival (OS) were calculated in presence, the absence of bone metastases at baseline and at relapse. Results: A total of 130 gonadal and extragonadal GCT patients underwent Tc-99m MDP bone scans; four with insuf cient data were excluded from the study. 47% were females and 53% were males with the age range of 1 month – 72 years. 105 (83%) were under 18 years of age. Osseous metastasis was detected in 12 (9.5%). Two (17%) had solitary and 10 (83%) had multifocal skeletal metastases. Clinically, 83% had localised bone pain. Osseous metastases were more frequently associated with mixed GCT and yolk sac tumour. 50% of mediastinal GCT developed bone metastases. 42% died within 4–18 months. There was a statistically signi cant impact of visceral metastases on DFS and OS. OS at 5 years in patients without bone metastases, with bone metastases at baseline and bone metastases at relapse, was 77%, 38% and 75%, respectively. 5-year DFS for the same cohort groups was 63%, 38% and 20%, respectively. Conclusion: Osseous involvement was found in 9.5% of GCT patients undergoing diagnostic Tc-99m MDP bone scan. Baseline skeletal evaluation for metastases should be done, particularly in the case of bone pains or known systemic metastases. Although skeletal relapses are rare, they have a grim outcome. Key words: Bone scintigraphy, germ cell tumours, skeletal metastases
AN UNUSUALLY PROLONGED SURVIVAL IN METASTATIC PERIAMPULLARY PANCREATIC ADENOCARCINOMA
Full text linkPeriampullary cancer is the term used for neoplasms arising from the head of pancreas, ampulla of Vater, distal bile duct and periampullary region of duodenum. Of these, the pancreatic adenocarcinoma carries the worst prognosis with majority of mortalities within the 1st year. The overall 5-year survival is <3%. Studies have shown that pancreatic carcinoma has the shortest median survival of 17.1 months of all periampullary carcinomas. With the development of metastasis, the median survival tends to reduce to 3–6 months. We are reporting a case of metastatic periampullary pancreatic adenocarcinoma that received minimal and interrupted chemotherapy due to poor tolerance and yet managed to survive far beyond the reported median survival. Key words: Adenocarcinoma, pancreas, periampullary, prognosis
