Journal of Cancer and Allied Specialties
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INTRAOSSEOUS HAEMANGIOMAS ON HYBRID IMAGING: A PICTORIAL REVIEW
Full text linkOsseous haemangiomas are benign skeletal tumours, usually identi ed as incidental ndings on different imaging modalities. Bone scan is the most frequent radionuclide procedure performed as metastatic workup in patients with various malignancies. Not every hotspot on a staging bone scan is malignant. Haemangiomas with variable degree of radiotracer uptake on technetium-99m (Tc-99m) bone scintigraphy may be falsely labelled as metastases in background of known malignancy. The addition of single-photon emission computed tomography computed tomography (SPECT-CT) enhances the specificity of bone scan which allows accurate detection and anatomical localisation of scintigraphic findings. We present a case series as pictorial review of osseous haemangiomas identi ed on Tc-99m methylene diphosphonate SPECT CT at our department. Key words: Haemangioma, methylene diphosphonate, bone scan, single-photon emission computed tomography- computed tomograph
CLINICOPATHOLOGICAL CHARACTERISTICS OF PATIENTS WITH SYNCHRONOUS PRIMARY OVARIAN AND ENDOMETRIAL CANCERS
Full text linkPurpose: Synchronous primary endometrial and ovarian cancers are infrequent. The objective of this study is to evaluate clinicopathological characteristics of synchronous endometrial and ovarian cancers treated in our institution.Materials and Methods: The clinicopathological characteristics of 12 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from July 2005 to July 2015, were reviewed retrospectively in depth from hospital database. The WHO committee classification was used for the histologic determination and staged based on International Federation of Gynaecology and Obstetrics (FIGO) staging. Results: The median age at the time of diagnosis was 50 years (range 23–66 years). The incidence of synchronous primary endometrial and ovarian cancers was 2.01% in patients with endometrial cancer. A total of seven patients were menopausal (58%) and eight patients were nulliparous (66%); the median body mass index (BMI) was 29 kg/m2 (range, 20–38). Abnormal uterine bleeding was the most common presenting symptom. According to FIGO stage, 10 cases of endometrial were Stage I/II (84%) and two cases were Stage III (16%). Of the ovarian cancers, nine cases were Stage I/II (83.3%) and two cases were Stage III (16.7%). Endometrial cancer was the main pathological type in uterine carcinoma (86%) followed by serous carcinoma (14%), and similarly, for ovarian cancer, endometrial was the most common pathology (67%) followed by serous/clear cell (16%) and mucinous (16.7%). Most endometrial and ovarian primaries in our series were Grade I and II tumours, 83% and 66%, respectively. 8 patients (66%) had similar histology in both primaries. All patients underwent surgical intervention. Only one patient did not receive any post-operative adjuvant therapy. 10 patients received platinum-based adjuvant chemotherapy and six patients received adjuvant radiotherapy. Conclusion: Synchronous primary endometrial and ovarian cancers are infrequent and distinct set of patients. Abnormal per vaginal bleed was the most common symptom which helped in early detection. Majority of the patients belong to concordant endometrial histology, low grade, had younger age and high BMI. Treatment should be tailored to the stage, histology and grade of the individual tumours. Key words: Endometrial cancer, ovarian cancer, synchronous tumour
ORAL METHOTREXATE AS SECOND LINE CHEMOTHERAPY IN PLATINUM-REFRACTORY OR RELAPSED SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
Full text linkPurpose: Platinum-refractory or relapsed squamous cell carcinoma of the head and neck (SCCHN) is considered to have poor prognosis. Although cetuximab is currently recommended as category 1 in this group of patients, the use of it is hampered in low- and middle-income countries (LMICs) like Pakistan due to nancial constraints. Further, majority of the population of these countries is unable to tolerate toxicity related to other intravenous chemotherapeutic agents due to lower socioeconomic background with poor nutrition status. The aim of this study is to evaluate the response rate and toxicity of oral methotrexate (MTX) in platinum-refractory or relapsed SCCHN. Methods: Between June 2008 and December 2012, 71 patients received palliative oral MTX either due to recurrent or persistent disease. With a median age of 51 years (range 22–75), there were 68% of males and 32% of females. Site distribution was as following; oral cavity 58%, nasopharynx 25%, hypopharynx 7%, paranasal sinuses 6%, larynx 3%, Oropharynx 1%. Patterns of recurrence; local 32%, regional 07%, loco regional 10%, distant 15% and persistent disease in 36% of the patients. All the patients received oral MTX 10 mg once a day, 4 days a week. To contain the possible side effects associated with MTX, folinic acid 15 mg per oral every 6 hourly on day 5 was prescribed. Response assessment was done on two monthly basis. Response, toxicity, mean response time and mean time to progression were determined. Results: Response to MTX was as following; complete response 3%, partial response 4%, stable disease 11% and progressive disease in 82% of the patients respectively. Toxicity related to oral MTX includes neutropenia Grade III in 1% while mucositis Grade III in 10% of the patients, respectively. None of the patient had Grade IV mucositis or haematological toxicity. Treatment was stopped in 13% of the patients due to poor compliance. Mean response time was 4 months (range 1 – 20) and mean time to progression was 5 months (range 1–23). Conclusion: Oral MTX is a simple, cost-effective and well-tolerated regimen to be used on outpatient basis for palliation in platinum refractory or relapsed SCCHN in LMICs and debilitated patients. This treatment merits further evaluation in large-scale clinical trials. Key words: Oral methotrexate, platinum refractory, relapsed squamous cell carcinoma of head and neck
PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)
Full text linkPurpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young
PRIMARY MALIGNANT MELANOMA UTERINE CERVIX
Full text linkA 40-year-old premenopausal female presented with foul-smelling per vaginal discharge for 3 months. Diagnostic work revealed a locally advanced primary malignant melanoma of uterine cervix. The patient declined pelvic surgery and was treated with Dacarbazine. Malignant melanoma is a rare tumour of skin and has been ranked in the top ve cancers of Australia and Sweden. It is a tumour of melanocytes which forms melanin pigment in the skin. In men, the most common site is trunk while in females common site is limbs. However, melanoma can arise from mucosal surfaces where the melanocytes are present. Most common mucosal sites are head and neck followed by female genital tract. Key words: Cervix, dacarbazine, malignant melanoma
SURVIVAL OUTCOMES IN EARLY GLOTTIC CARCINOMA; A SINGLE INSTITUTION EXPERIENCE
Full text linkPurpose: Laryngeal cancers are amongst the most common cancers affecting head and neck region. In this study, we analyse the overall survival (OS) following hypofractionated radiotherapy (RT) in early stage glottic carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Methods: Between October 2003 and June 2009, 87 patients with early stage glottic carcinoma were treated with hypofractionated RT. All patients were included in the study. The ratio of male: female is 94%:6%. Mean age was 62 years (range 31–83 years). 66% of the patients were smokers. AJCC stage was T1a in 76%, T1b 20% and T2 in 4% of the patients. Histological distribution was; squamous cell carcinoma 97%, verrucous carcinoma 2% and squamous cell spindle variant 1%. Median follow-up time was 59 months (range 4–122 months). RT dose was 55 Gy in 20 fractions over a period of 4 weeks. Median RT treatment time was 28 days (range 23–35 days). Patients that lost to follow-up were contacted through telephone. Results: The 10-year OS was 83%. Patterns of failure was 7 local and 1 distant while 1 patient had persistent disease. 15 patients were dead at the time of study. Cause of death; 13 patients died due to Ischemic heart disease and 2 due to primary disease. Conclusion: Hypofractionated RT 55 Gy in 20 fractions seems to achieve good OS while offering potential for optimizing resources usage. Key words: Glottic carcinoma, hypofractionated, overall survival, radiotherapy
HIGH INFECTION RELATED MORTALITY IN PAKISTANI CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DURING REMISSION INDUCTION CHEMOTHERAPY: REVIEW OF DATA FROM A SINGLE INSTITUTION
Full text linkPurpose: Despite advances in the treatment of acute lymphoblastic leukaemia (A.L.L.), the outcome for children living in the developing countries is still poor. This is in large part due to high treatment-related mortality (TRM). This study was carried out to review the data and analyze the factors resulting in high TRM during remission induction chemotherapy. Methods: Data for children treated at our centre during the calendar year 2007 were retrospectively analysed. Standard four-drug induction chemotherapy was used without risk strati cation. Bone marrow evaluation was carried out at days 8 and 28. Cerebrospinal uid analysis was carried out on day 1 and with each subsequent intrathecal chemotherapy injection. Modern supportive care facilities including antibiotics, nutritional support and intensive care unit were available. Results: Eighty-one children were eligible for analysis. Median age was 5 years (range 2–16), 72% were male with M:F ratio of 2.5:1. Seventy- five (92%) children had precursor B-cell A.L.L. Only 2 children had central nervous system leukaemia at presentation. Median presenting white blood cell count was 8.83 (range: 1–446). Severe malnutrition (weight <5th centile for age) was seen in 42% of children. Median symptom duration was 6 (range 1–30) weeks at the time of presentation. Induction mortality was 25%. Induction mortality was 25.6% (n = 21). Twenty were related to infections, while more than half (52%) occurred as a result of an outbreak of Acinetobacter infection. Severe malnutrition and Acinetobacter infection (due to an outbreak in our unit during the study period) were highly predictive of TRM during remission induction chemotherapy. Conclusions: Infection control measures, health education and reduction in treatment intensity may improve survival for children with A.L.L. in Pakistani population. Key words: Acute lymphoblastic leukaemia in children, malnutrition, Pakistan, treatment-related mortalit
SHORT TERM OUTCOME OF PATIENTS WITH HEPATOPANCREATOBILIARY MALIGNANCIES TREATED IN A MULTIDISCIPLINARY HEPATOBILIARY UNIT IN A TERTIARY REFERRAL CENTER
Full text linkPurpose: Specialisation in hepatopancreatobiliary (HPB) surgery has evolved over the past few decades based on better understanding of the biology and the behaviour of the diseases. In this review from a specialised HPB service, we aim to provide an overview of the HPB oncological cases managed in a tertiary care cancer hospital. Methods: All cases of HPB malignancies treated in our hospital between October 2014 and September 2015 were included in the study. Clinical findings, operative details and short-term post-operative outcomes were assessed from a prospectively managed database. Results: A total of 65 oncological procedures were performed over 1 year. These included 23 hepatic resections, 27 pancreaticoduodenectomies, 5 radical surgeries for gallbladder cancer, 2 distal pancreatectomy and 8 nephrectomies with exploration of the inferior vena cava. One patient successfully underwent Associated Liver Partition with Portal vein ligation and staged hepatectomy (ALPPS Procedure), which to our knowledge was the rst ALPPS procedure carried out in Pakistan. Conclusion: The short-term experience of patients managed in specialised HPB unit has shown good outcomes.There is a need for establishing HPB units in most tertiary care hospitals in the country. Key words: Associated liver partition with portal vein ligation and staged hepatectomy procedure, hepatic resections, hepatopancreatobiliary surgery, pancreaticoduodenectomy
USE OF PEG SITE FOR SPECIMEN RETRIEVAL AND EXTRACORPOREAL GASTRIC CONDUIT FORMATION, IN MINIMALLY INVASIVE ESOPHAGECTOMY
No full textPurpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer.Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group.Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-speci c complications. The rate of procedure speci c complications (Abdominal excision wound complications or conduit failure) was low 11%. PEG site excision biopsy was positive in two cases; one adenocarcinoma and one squamous carcinoma, both were mid to lower oesophageal tumours not involving gastroesophageal junction.Conclusions: Bene ts of the approach are ease of gastric conduit formation along with an additional second layer with less operative time through the small wound, avoidance of tumour specimen removal all the way through mediastinum from the cervical incision, and excision of a potential site of oesophageal cancer metastasis, without any added morbidity.Key words: Extracorporeal gastric conduit, minimally invasive oesophagectomy, percutaneous endoscopic gastrostom
NEOADJUVANT WEEKLY NAB-PACLITAXEL PLUS CARBOPLATIN FOLLOWED BY DOXORUBICIN PLUS CYCLOPHOSPHAMIDE WITH BEVACIZUMAB ADDED CONCURRENTLY TO CHEMOTHERAPY FOR OPERABLE TRIPLE-NEGATIVE INVASIVE BREAST CANCER
Full text linkPurpose: This phase II neoadjuvant study investigated whether nab paclitaxel, carboplatin and bevacizumab given before neoadjuvant doxorubicin/cyclophosphamide (AC) produced higher pathologic complete response (pCR) rates in triple- negative breast cancer (TNBC) compared with historical results achieved with standard anthracycline/taxane regimens. Patients and Methods: Eligible patients with operable TNBC ≥2 cm received four cycles of carboplatin (area under the curve 6, day 1) plus nab-paclitaxel (100 mg/m2, days 1, 8 and 15) every 28 days, followed by four 14-day cycles of AC neoadjuvantly, with bevacizumab 10 mg/kg every 14 days for the rst 6 cycles of neoadjuvant chemotherapy, resuming postoperatively to complete 1 year of antibody treatment. In breast pCR and pCR (breast + nodes) were primary and secondary endpoints, respectively. Results: Due to slow accrual, the study was closed after enrollment of 42 of 60 planned patients. Of the 38 patients who underwent surgery (ef cacy population), 22 (58%) achieved an in-breast pCR and 19 (50%) achieved a pCR (breast + nodes). Neutropenia was the most common Grade 3/4 adverse event (57% Grade 3 and 31% Grade 4), but only 1 patient required hospitalisation and IV antibiotics for neutropenic fever. Other Grade 3/4 events included anaemia (24%), thrombocytopenia (29%) and peripheral neuropathy (Grade 3, 5%). Conclusion: Our results demonstrate a substantially higher pCR rate, both in-breast and breast + nodes, with the combination of nab paclitaxel plus carboplatin followed by AC, with concurrent bevacizumab, versus historic pCR rates with anthracycline-taxane regimens alone, supporting further investigation of this regimen, preferably in molecularly driven subsets, for the neoadjuvant treatment of patients with TNBC. Key words: Bevacizumab, breast cancer, carboplatin, nab-paclitaxel, neoadjuvant, triple-negative