Cancer

What's new at the Indian Journal of Cancer? Indian Journal of Cancer 2019 56(1):1-1

Testing alternate biochemotherapy combinations in recurrent/metastatic head and neck cancer - Putting the best foot forward HS Darling Indian Journal of Cancer 2019 56(1):2-3

Biweekly cetuximab in combination with platinum and 5-fluorouracil in metastatic head and neck carcinoma Zeki G Surmeli, Ahmet Ozveren, Cagatay Arslan, Mustafa Degirmenci, Burcak Karaca, Ruchan Uslu Indian Journal of Cancer 2019 56(1):4-8 Background and Aim: The combination of cetuximab with platinum and 5-fluorouracil (5-FU) chemotherapy prolongs survival in patients with metastatic or recurrent squamous-cell carcinoma of the head and neck (SCCHN). Biweekly (once in 2 weeks) administration of cetuximab requires fewer hospital visits and decreases treatment costs; therefore, it is more convenient both for the patients and for the healthcare providers. Here, we assessed the efficacy, safety, and tolerability of an alternative biweekly regimen of cetuximab in combination with platinum and 5-FU chemotherapy as a first-line treatment for these patients. Methods and Materials: Medical records of patients with metastatic or recurrent non-nasopharyngeal SCCHN who were treated with a biweekly regimen of cetuximab (500 mg/m2 on day 1), cisplatin (40 mg/m2 on day 1) or carboplatin (target area under the curve 3.5 mg/ml × min on day 1), folinic acid (400 mg/m2 on day 1), and 5-FU (400 mg/m2 bolus on day 1 followed by continuous infusion of 2,400 mg/m2 5-FU over 46 h) were retrospectively reviewed. Survival estimates were calculated with the Kaplan–Meier method. Results: In total, 60 patients were included. The median age of the patients was 60.5. The objective response rate was 53.3% (95% confidence interval [CI] = 40.7–65.9). The median progression-free survival duration was 6.8 months (95% CI = 5.5–8.1) and the median overall survival duration was 13.3 months (95% CI = 8.4–18.2). The most common grade 3 or 4 adverse events were neutropenia (28.3%) and leucopenia (13.3%). Grade 3 or 4 rash was observed in 3.3% of the patients. Conclusion: Biweekly administration of cetuximab, cisplatin, and 5-FU is an effective regimen with a favorable toxicity profile for the first-line treatment of metastatic or recurrent SCCHN. These results warrant further evaluation of this regimen in prospective trials.

Oncological outcome following TORS in HPV negative supraglottic carcinoma Surender Dabas, Karan Gupta, Reetesh Ranjan, Ashwani K Sharma, Himanshu Shukla Indian Journal of Cancer 2019 56(1):9-14 Objective: The aim of this study was to determine the oncological and functional outcomes following transoral robotic surgery (TORS) in human papilloma virus negative supraglottic cancers. Study Design: A prospective observational study at a tertiary cancer care center, New Delhi, India. Materials and Methods: From February, 2013 to December, 2015, 45 patients with supraglottic lesions underwent TORS using the da Vinci® surgical system. Results: Forty-five patients underwent TORS for supraglottic laryngectomy (SGL), with all patients undergoing bilateral neck dissection. The most common site was Ary-epiglottic fold. 47.9% were cT1 and 52.1% were cT2. Average robotic set-up time was 8.8 min and average robotic operative time was 42.9 min. A positive or close margin was seen in 12 patients (26.7%) on frozen, which were revised intraoperatively. On final histology, 3 (6.7%) patients had a margin of <5 mm. The average closest margin was 5.7 mm. Patients tolerated oral feeds within 2 weeks of procedure. All patients were HPV negative. Postoperatively, all patients had adequate swallowing and speech. Follow-up ranged from 24 to 58 months. Thirty-eight (84.4%) patients were alive and disease free. Conclusion: TORS is a safe, feasible, minimally invasive, and oncologically safe procedure in patients with early HPV supraglottic cancers. It has less morbidity and offers benefits in terms of early airway and feeding rehabilitation and avoids complications resulting from radiation therapy for these patients.

Prevalence of oromucosal lesions in relation to tobacco habit among a Western Maharashtra population KA Kamala, S Sankethguddad, Ajay G Nayak, Abhijeet R Sanade, SR Ashwini Rani Indian Journal of Cancer 2019 56(1):15-18 OBJECTIVES: This study was conducted to determine the number and types of oromucosal lesions (OMLs) in relation to tobacco habits in patients who attended the outpatient department. METHODOLOGY: A total of 1730 patients visiting the Department of Oral Medicine and Radiology were interviewed and screened for tobacco habits (smoking and smokeless). Clinical oral examination was conducted with diagnostic instruments using the Color Atlas of Common Oral Diseases as a guide for diagnosis. When clinical features were not diagnostic, a biopsy was done. RESULTS: Of the 1730 outpatients, 975 (56.3% ) individuals used tobacco in one or other forms and 687 (70.4%) of these had OMLs. CONCLUSION: The results of this study provide important information on the prevalence of OMLs in patients seeking dental care. This provides baseline data for future studies on the prevalence of oral lesions in the general population.

Frozen section is not cost beneficial for the assessment of margins in oral cancer Sourav Datta, Aseem Mishra, Pankaj Chaturvedi, Munita Bal, Deepa Nair, Yogesh More, Pranav Ingole, Sandeep Sawakare, Jai Prakash Agarwal, Shubhada V Kane, Poonam Joshi, Sudhir Nair, Anil D'Cruz Indian Journal of Cancer 2019 56(1):19-23 BACKGROUND: Routine use of frozen section (FS) is a costly procedure and sparsely available in resource poor countries. A proper cost benefit analysis may help to reduce its routine use and would empower surgeons to perform oral cancer surgeries without having FS facility. FS is performed to identify microscopic spread beyond gross disease that cannot be assessed clinically. OBJECTIVE: Our primary aim was to determine the cost benefit analysis of FS in the assessment of margins in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Retrospective study of prospectively collected data of 1311 consecutive patients who were operated between January 2012 and October 2013. The gross and microscopic margin status of each patient was extracted from the patient's chart. The cost estimates were performed to calculate the financial burden of FS as well as expenses incurred on adjuvant treatment resulting from inadequate margins. RESULT: Microscopic spread changed the gross margin status in 5.2% (65/1237) patients. Of this entire cohort of 1237 patients, FS helped 29 (2.3%) patients to achieve tumor free margin, and it changed the adjuvant treatment plan in 9 (0.7%) patients. The cost of FS for each patient was INR 11052. The cost-benefit ratio of FS was 12:1. Gross examination alone could have identified majority of the inadequate margins. CONCLUSION: Frozen section for assessment of margin status bears poor cost-benefit ratio. Meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.

Multiple logistic regression analysis predicts cancer risk among tobacco usage with glutathione S-transferase p1 genotyping in patients with head and neck cancer Argi Anuradha, Veerathu L Kalpana, Natukula Kirmani Indian Journal of Cancer 2019 56(1):24-28 INTRODUCTION: Numerous studies have been investigated to understand the association between glutathione S-transferase P1 (GSTP1) polymorphism and risk of head and neck cancer (HNC) but yielded contradictory results, and no studies could confirm polymorphism in GSTP1 and that tobacco usage increases the risk of HNCs. Therefore, this study aimed to understand the association of GSTP1 Ile105Val polymorphism with or without tobacco usage in carcinogenesis and clinicopathological characteristics of patients with HNC. MATERIALS AND METHODS: Binary logistic regression analysis was performed to predict HNC risk with tobacco use and GSTP1 genotyping. Five predictor variables such as gender, age, tobacco usage, familial, and GSTP1 genotypes were included in the model. RESULTS: The results of the logistic regression analysis show that the full model which considered all the five independent variables together was statistically significant, log-likelihood = −111.820, and all slopes are zero: G = 74.297, degree of freedom (DF) = 5, P = 0.000. The strongest predictor in this model is tobacco usage (odds ratio = Z = −5.16, P = 0.000). CONCLUSION: The study concludes that multiple logistic regression analysis model could predict the risk factors in case–control studies where control samples are compromised.

Second primary malignancies in laryngeal carcinoma patients treated with definitive radiotherapy Yurday Ozdemir, Erkan Topkan Indian Journal of Cancer 2019 56(1):29-34 INTRODUCTION: Second primary malignancy (SPM) is associated with decreased overall survival (OS) in laryngeal carcinomas (LC). METHODS: One hundred eighty three LC patients were analyzed retrospectively. The primary and secondary endpoints were the incidence of SPM and the OS difference between patients with and without SPM. RESULTS: SPM developed in 22 (12.0%) patients at median 52 months (range, 4–131 months), with a yearly 2.8% incidence, of which 19 (10.4%) and 3 (1.6%) were metachronous and synchronous, respectively. Lung was the commonest SPM (72.7%). Of 47 deaths, 12 (25.5%) were SPM related. Comparatively SPM patients had significantly shorter median OS (68.0 months vs. median not reached; P = 0.005), with lower 5-year (67.0% vs. 78.9%) and 8-year (32.6 vs. 69.8%) survival rates. CONCLUSION: The present findings suggested the SPM as a competing risk factor for death in index LC patients with its annual incidence rate of 2.8% and for accounting one of every four deaths in this patients group. Emergence of lung carcinoma as the most frequent type of SPM and the ability to treat >50% of them with an estimated long-term outcomes emphasizes the importance of early diagnosis and curative treatment of SPMs.

Second primary malignancies in patients with radiotherapy-treated laryngeal carcinoma - A commentary Deepti Sharma, Neha Sharma, Vineeta Goel Indian Journal of Cancer 2019 56(1):35-36

Neoadjuvant concurrent chemoradiation in male breast cancer: Experience from a tertiary cancer center Priya Iyer, Ananthi Balasubramanian, Ganesarajah Selvaluxmy, V Sridevi, Arvind Krishnamurthy, Venkatraman Radhakrishnan Indian Journal of Cancer 2019 56(1):37-40 BACKGROUND: Male breast cancers (MBC) account for 1% of all breast cancers. Neoadjuvant concurrent chemoradiation (CTRT) is not the standard of care for treating breast cancer. However, in our center, it has been routinely used in patients with locally advanced breast cancer to downsize the tumor and make it amenable to surgery. AIM: This study was conducted to examine the clinical and pathological profile and outcomes of patients with MBC treated at our institute with neoadjuvant CTRT. SETTINGS AND DESIGN: The study was conducted at a tertiary cancer center and was retrospective in nature. MATERIALS AND METHODS: All MBC patients treated with neoadjuvant CTRT at our center between 2001 and 2016 were enrolled in the study. Data were retrospectively extracted from the patients' case records. STATISTICAL ANALYSIS: Kaplan–Meier method was used for survival analysis and the outcome variables were compared using the log-rank test. RESULTS: Thirty-one MBC patients who received neoadjuvant CTRT were analyzed in this study. The median age of the patients was 53 years. Stage IIB disease was observed in 8/31 (26%) patients, stage III in 20/31 (64%), and stage IV in 3/31 (10%) patients. There was no grade 3 or 4 toxicity due to CTRT. Surgery was performed in 29/31 (94%) patients and none of the patients had a pathological complete response. The median duration of follow-up was 95.3 months. The 8-year event-free survival and overall survival for stage IIB, III, and IV were 75%, 50%, and 0% and 87.5%, 69%, and 0%, respectively. CONCLUSION: This is the first study to report on the use of neoadjuvant CTRT in MBC. Prospective evidence from phase-3 randomized controlled trials on the safety and efficacy of CTRT in breast cancer is required before its routine use can be recommended.