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   Table of Contents - Current issue
January-June 2021
Volume 4 | Issue 1
Page Nos. 1-60

Online since Saturday, July 31, 2021

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Human telomerase reverse transcriptase and telomeres in cancer p. 1
Anurag Mehta, Shrinidhi Nathany
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Role of laparoscopic radical prostatectomy in locally advanced and high-risk prostate cancer: Whether safe and effective approach? p. 5
Gurunam Singh Girniwale, Alok Srivastava, Anjana Singh, Chandrakant Munjewar, Sanjeet K Singh
Introduction: Historically, patients with locally advanced and high-grade diseases have not been viewed as a good candidate for radical prostatectomy (RP). The role of RP for locally advanced and high-grade diseases is controversial and the focus of debate. The objective of this study is to evaluate the role of RP in the treatment of locally advanced and high-grade disease. Materials and Methods: In this retroprospective study, all the laparoscopic RPs done for prostate cancer between January 2014 and January 2016, in the Department of Urology, DRRMLIMS, Lucknow, were enrolled and followed for five years. A total of 116 patients were included in this study. They were divided into two groups: group 1 includes 78 patients with localized carcinoma prostate and group 2 includes 38 patients with locally advanced and high-grade prostate cancer. The following characteristics were noted in both groups: margin status, biochemical progression, local recurrence, distant metastasis, clinical progression, and overall and cancer-specific survival (CSS). The primary endpoints were CSS and overall survival. Postoperative survival was estimated using Kaplan–Meier method and compared using log-rank test. Univariate and multivariate analysis of features associated with outcomes were conducted using Cox proportional hazards regression models. Result: The resulting survival estimates at the last follow-up after RP were 83%, 81.58% and 76.92%, 76.31% in groups 1 and 2 for prostate CSS and overall survival, respectively. Overall, 3.85% in group 1 and 21.05% in group 2 patients received salvage radiotherapy for biochemical recurrence, whereas 7.69% in group 1 and 15.79% in group 2 patients were treated with salvage androgen deprivation therapy during clinical follow-up. Margin status was positive in 10.25% and 21.05% of cases in groups 1 and 2, respectively. Conclusion: RP forms an important part of the multimodality approach to locally advanced prostate cancer. It can provide a better outcome (combined with adjuvant and salvage treatment if needed) than radiotherapy (RT) or hormonal therapy (HT) alone or a combination of RT and HT.
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A study of complications associated with peripherally inserted central catheters in patients receiving chemotherapy in a tertiary hospital p. 10
Jeffrey Lewis, Nishitha Shetty
Background: Chemotherapeutic agents are often caustic or irritant solutions that require large high flow venous conduits for safe delivery, provided adequately by central venous access. Peripherally inserted central catheters (PICCs) are widely used among hospitalised patients and out-patients for chemotherapy and parenteral nutrition. In this study, we aimed to evaluate the rates of PICC-related complications in a tertiary hospital. Materials and Methods: This was an observational study of 100 patients in whom peripherally inserted central catheters was conducted over a period of two years at a tertiary care hospital. Pertinent demographics as well as catheter related data was collected and analysed. Results: The most commonly inserted line was Groshong 4 Fr, with the most common indication being poor venous access, followed by infusion of 5-fluorouracil and adriamycin chemotherapy. The PICC line was removed in 94 cases after completion of chemotherapy, three lines were removed due to infection (0.29 per 1000 catheter days), and one due to catheter blockage (0.097 per 1000 catheter days). Conclusions: This study showed that PICC lines have a number of advantages, including ease of insertion by trained nursing staff and can be used for various indications, including but not limited to chemotherapy and parenteral nutrition. Proper care ensures fewer complications, which leads to lesser instances of removal.
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Basics of survival statistics for oncologists p. 13
Anurag Mehta, Anurag Sharma
In clinical practice, survival curves show the fraction of patients who experienced the outcome of interest. As survival data contain “censored” observations where a patient is lost to scrutiny before experiencing the outcome, a sensible survival curve cannot be computed through simple division. This article aimed to provide various important aspects of survival analysis, censoring and various survival estimation techniques that are simple to calculate and understand, and a better visualization of statistical significance.
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FGFR inhibitors: Emerging treatments in advanced or metastatic cholangiocarcinoma p. 22
Yasar Ahmed, Raza Khan, Mary O’Reilly, Shane O’Sulivan, Thamir Mahgoub
Cholangiocarcinoma (CCA) is an aggressive cancer with poor prognosis, where the median overall survival remains less than 1 year with standard treatment for unresectable or metastatic disease. This highlights the need for new therapeutic approaches. The fibroblast growth factor receptor (FGFR) family of transmembrane receptors, which are implicated in tumorigenesis, may represent one such target. In this article, we summarize the therapeutic rationale for targeting these receptors in CCA and the role of molecular testing to identify potential responders to treatment. We examine the current available safety and efficacy data on the several small molecule tyrosine kinase inhibitors under investigation for this disease. With a move toward identifying and targeting tumor specific mutations, FGFR inhibitors represent an exciting development which may be available for patients in the near future.
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Carcinoma of unknown primary with N1 neck node: A case-specific short review p. 30
Sajal Goel, Anchal Aggarwal, Shikha Chawla, Christy Alekchander, Shamit Chopra, Bhubnesh Kumar
Carcinoma of unknown primary (CUP) with N1 neck node is rare, and management of patients generates interest as well as poses challenges. It can also be a topic of debate between radiation oncologists and surgeons. Both radiation and surgery can be used for management, but in some cases, treatment can be multimodality especially if the surgeon is unsure of the microscopic disease, a small ulcer, or a node with microscopic extracapsular extension. We hereby discuss and review an interesting case on CUP with a N1 neck node that was managed using multimodality treatment.
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Prohibitin gene regulation in cancer and its possible therapeutic potential p. 35
Mohammad Zeeshan Najm, Sadaf , Naseem Akhtar, Poonam Kashyap, Vyas M Shingatgeri, Komal Sharma, Anjali Raghav, Vishal Kumar Rout, Farah Parveen
Prohibitin (PHB), an evolutionary conserved gene, is mapped at the chromosomal location 17q21–q22 and is present with two isoforms, namely, PHB1 and PHB2. Both of these isoforms have their individual roles in tumor suppression and cell proliferation. The presence of these isoforms is not restricted to single cellular organelle but can be located in the nucleus, mitochondria, and cytosol. Importantly, loss of heterozygosity in the prohibitin gene has been noted in a significant number of different cancer types. Along with this, there are other mutations that contribute to tumorigenesis and cancer cell proliferation. Sporadic breast cancer, lung cancer, and prostate cancer are a few examples in which regulation of PHB plays a major role. PHB has shown to be both up-regulated and down-regulated depending on the type of cancer or disease. PHB acts as the biomarker for several types of cancers and is also seen as a potential therapeutic target. Along with cancer, PHB has also been seen to play an important role in other diseases such as neurological diseases, cardiac diseases, and renal diseases. The link between PHB and a plethora of diseases opens a new window in which PHB can be actually targeted in treatment as well as disease management. Here, we review the regulation of PHB in different types of cancers along with its significant interaction in other disorders.
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Esophageal cancer: Treatment challenges and controversies p. 41
Piyush Kumar, Ankita Mehta
The poor outcomes of esophageal malignancies in terms of local control and survival rates have perplexed radiation oncologists since long time. Chemoradiation has been recognized as a key definitive treatment modality with outcomes comparable to that of surgery. It offers a potential radical treatment option to patients unfit for surgery with the advantage of organ preservation. However, a clear consensus in terms of indications, dose schedules, and techniques of radiation is lacking. In pre- and post-operative settings, lower dose schedules of radiation are recommended. Some evidences suggest that patients receiving radical dose of radiation may derive survival benefit from increased doses. Low-quality emerging evidence suggests promising outcomes with brachytherapy but it needs to be testified further. A detailed review of the existing literature might help to address the controversies in clinical practice.
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Kaleidoscope beyond the microscope: Colorectal cancer p. 49
Anurag Mehta, Divya Bansal, Dushyant Kumar
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Penile metastases in a case of carcinoma colon: A rare occurrence p. 56
Jitin Goyal, Ankush Jajodia, Sumit Goyal, Sunil Pasricha
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Robotic radical parametrectomy with pelvic lymphadenectomy: Technique and feasibility p. 58
Vandana Jain, Subrata Debnath, Nidhi Gupta, Sudhir Rawal
Cervical cancer can be detected incidentally after simple hysterectomy carried out for benign gynecological conditions or preinvasive cervical lesions. The risk of recurrence is high, and survival is poor in the absence of further treatment in the form of radiation therapy or radical parametrectomy. Though both forms of treatment result in similar survival, surgery has the advantage to stage the disease and guide the need for adjuvant therapy and also avoids the radiation-associated complications. Though traditionally performed by laparotomy, laparoscopic and robotic approaches have been found to be feasible and safe for this complex procedure.
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