• Users Online: 1318
  • Print this page
  • Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Most cited articles *

 
 
  Archives   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Cited Viewed PDF
REVIEW ARTICLES
Recovery and tolerance of the organs at risk during re-irradiation
Suman Das, Kanhu Charan Patro, Ashutosh Mukherji
January-June 2018, 1(1):23-28
DOI:10.4103/jco.jco_2_17  
In the last few decades, there have been major improvements in diagnosis, staging, and management of cancer which has translated into better disease outcomes and longer survival rates and with better quality of life. This improvement in the quality of life is by better normal tissue sparing caused by the increasing use of newer techniques and technologies, especially in surgery and radiotherapy. Along with higher survival, there is now greater acknowledgment of the need to treat local recurrences and hence the increased use of re-irradiation. Better technology such as intensity modulated radiotherapy translates into better sparing of normal tissue, but at the same time, late toxicity is still of concern. Factors such as residual late damage, total dose, fraction size, technique, type of tissue, and time interval to re-irradiation still guide prescription of the re-irradiation dose. Knowledge of long-term recovery of organ at risk is hence of importance in re-irradiation. This review article has emphasized on the recovery and tolerance of organs at risk such as Spinal cord, Brainstem, and Brain. This is important in prescribing doses for the target volume for re-irradiation and in setting constraints for surrounding critical organs during the planning process.
  14 39,805 5,832
Multiple myeloma: an update
Lalit Kumar, Sukesh Nair, Surya Prakash Vadlamani, Priyanshu Chaudhary
July-December 2020, 3(2):72-80
DOI:10.4103/jco.jco_43_20  
Survival of patients with multiple myeloma has increased significantly during the past two decades. This has been attributed to a better understanding of biology, the introduction of novel agents (immunomodulators, proteasome inhibitors), autologous stem cell transplantation, and maintenance therapy. Supportive care is an important component of overall care for these patients. Most patients have a high burden of symptoms at initial presentation in form of bone pains, fatigue, anemia, renal impairment, and infections, etc. Almost 10–20% of patients may have serious complications in the first 4–6 weeks. A high index of suspicion and timely intervention is important to reduce morbidity and mortality. Therapy-related complications, e.g., neuropathy, thromboembolism, cytopenias, GI symptoms (constipation/diarrhea), and relapse of disease, pose therapeutic challenges. Protocol-based approach, systematic assessment with respect to the quality of life and functioning and coordination with a palliative care team from the beginning may improve overall functioning and outcome.
  6 8,922 669
Re-irradiation in central nervous system tumors
Sayan Paul, B Nanditha Sesikeran, Kanhu Charan Patro, Kausik Bhattacharya, Vijay Anand Reddy Palkonda
January-June 2018, 1(1):40-42
DOI:10.4103/jco.jco_11_17  
Radiotherapy (RT) in relapsed brain tumors has been used sparingly because of the risk of toxicity, particularly white matter necrosis. However, evidence from preclinical animal models and increasing data from clinical series show that brain and spinal cord have marked repair potential, and re irradiation should be considered a valid option in selected patients. The choice of technique and dose fractionation for re irradiation depends on tumor characteristics (volume and location), previous RT dose and volume, and patient characteristics (age and performance status). For small volume tumors in noneloquent areas, single fraction SRS and brachytherapy may be good options. For small and intermediate volume tumors in eloquent areas, FSRT or hypofractionated RT may be used. For large volume recurrences, requiring partial brain irradiation, conventional fractionation is safer and offers palliation with minimal risk of radiation induced toxicitie.
  4 7,609 668
ORIGINAL ARTICLES
Craniospinal irradiation by rapid Arc® technique in supine position: A dosimetric and clinical analysis
Vijayaprabhu Neelakandan, S Sherly Christy, Ashutosh Mukherji, K Sathyanarayana Reddy
January-June 2018, 1(1):16-22
DOI:10.4103/jco.jco_4_17  
Introduction: In craniospinal irradiation (CSI), prone position has been commonly used but, in some patients, especially pediatric cases where anesthesia is needed prone position may not help. In planning CSI by supine technique, beam geometry and field matching have to be considered, and immobilization is essential to ensure reproducibility of treatment. Materials and Methods: Data of four patients (3 with medulloblastoma and 1 with lymphoma) treated between March 2012 and October 2013 were included in this retrospective dosimetric study and analyzed. Patients were evaluated for dose coverage, organs at risks (OARs) sparing, number of monitor units, and daily table position shifts. Results: All patients underwent CSI by volumetric-modulated arc therapy (VMAT) technique in supine position. All four cases developed Grade 1 skin changes, and only one case developed a Grade 2 change at the end of radiotherapy; also both pediatric cases developed Grades 2 and 3 anemia and leukopenia toward their 4th week of treatment onward. The Rapid Arc®-CSI plans were able to generate dose distributions with high planning target volume (PTV) conformity and homogeneity and with sparing of OAR. The cumulative conformity index for all patients was 0.986, and homogeneity index was 0.1007. The mean PTV doses were within 108% with V110% of <12%, and V107% was 20%. On the evaluation of patient setup errors, a maximal shift of 3 mm in longitudinal direction was noted. At 3 years, all medulloblastoma cases except 1 were in remission. One adult patient with medulloblastoma had multiple spinal metastases at 1 year. Conclusions: Treatment of patients in supine position is reproducible and easily maintained with minimal acute reactions. VMAT technique helps avoid junctions, field-matching, and benefits with image guidance for precise dose delivery, conformity, and OAR sparing.
  3 11,723 1,264
Perception, attitude and knowledge regarding radiotherapy among physicians at a tertiary care center
Kuldeep Sharma, Anita Malik
January-June 2019, 2(1):6-14
DOI:10.4103/JCO.JCO_1_19  
Objective: Cancer is a leading health problem of today’s world and radiotherapy (RT) is an integral modality to treat cancers. Unfortunately, RT remains an underutilized specialty worldwide because of the lack of knowledge and wrong perceptions among referring physicians toward this specialty. These concerns and fear may discourage physicians from referring patients for RT. This study was conducted to explore the knowledge, attitude, and perception of non-radiation oncology physicians toward this specialty. Materials and Methods: This was a questionnaire-based study including 63 participants conducted at a tertiary care hospital in New Delhi, India. Results: Although the survey completion rate of 95% was encouraging, our study revealed deficiencies in training and knowledge about cancer, principles of RT, and its beneficial effects. Although most of the participants appreciated the role of RT as a core specialty, many underscored its true potential and cost-effectiveness in cancer care. There were significant concerns regarding its side effects (most important reason for non-referral) and lack of familiarity with this specialty. Conclusion: Fortunately, in spite of knowledge gaps, there was a positive attitude toward learning in future among participants.
  3 8,316 640
REVIEW ARTICLES
Radiobiology of re-irradiations
B Nanditha Sesikeran, Sayan Paul, Kanhu Charan Patro, Manoj K Gupta
January-June 2018, 1(1):35-39
DOI:10.4103/jco.jco_13_17  
The treatment options for recurrent tumors are limited. Re irradiation is being increasingly considered as an option, in view of the advances in treatment techniques, particularly the ability to document doses, overlay plans, intensity modulation, and image guidance. preclinical and clinical studies has been to estimate the total cumulative doses (EQD2) also termed as normalized total dose (NTD) that can be delivered to various tissues. In this review article reirradiation radiobiology of different tissues and dose fractionation have been discussed.
  3 7,986 965
CASE REPORTS
Escalating erythrocytosis after start of pazopanib-treatment in metastatic renal cell carcinoma
Pepijn M Langbroek, Marco B Polée, Hiltje de Graaf
January-June 2019, 2(1):26-28
DOI:10.4103/JCO.JCO_24_18  
Renal cell carcinoma accounts for 2% of adult malignancies in the Netherlands. Metastatic disease is often treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors, such as pazopanib. This treatment is known to cause a slight increase in hemoglobin level during treatment. We present a patient who was diagnosed with metastatic renal cell carcinoma during analyses for erythrocytosis and who developed a further rise in hemoglobin level to 13.2 mmol/L 2 weeks after starting pazopanib treatment. Multiple phlebotomies were necessary before symptoms improved. Preexistent erythrocytosis should be considered as a risk factor for symptomatic erythrocytosis during pazopanib treatment and warrants timely laboratory follow-up and phlebotomies if indicated.
  2 4,044 321
ORIGINAL ARTICLES
A comparative study of ropivacaine and bupivacaine with fentanyl for postoperative patient-controlled epidural analgesia after major abdominal oncosurgery
Anita Kulkarni, Anudita Gupta, Shagun B Shah, Ajay K Bhargava
July-December 2018, 1(2):66-72
DOI:10.4103/JCO.JCO_18_18  
Aim: To compare the analgesic efficacy of epidural ropivacaine–fentanyl with bupivacaine–fentanyl combination administered by patient-controlled epidural analgesia (PCEA) technique for postoperative pain relief after major abdominal oncosurgery. Materials and Methods: A prospective, randomized, interventional, parallel group, active control study was conducted on 60 patients with American Society of Anesthesiologists physical status I–III. Random allocation was carried out into two groups of 30 patients each. Intraoperatively, after administering a loading dose (10mL of 0.5% bupivacaine) in both the groups, continuous infusions of 0.1% bupivacaine plus fentanyl (2 µg/mL) (Group BF) or 0.1% ropivacaine plus fentanyl (2 µg/mL) (Group RF) were started at the rate of 5mL/h. Postoperatively, same drug concentrations were administered via PCEA pump at 4mL/h as a baseline infusion (bolus dose, 3mL; lockout interval, 15min). Visual analog scale (VAS) score at rest and on coughing was recorded at specific time points. Rescue analgesia was administered as per protocol. Results: VAS scores at rest and on coughing were higher in Group BF as compared to Group RF. Group RF had less drug consumption, required fewer PCEA boluses, and had minimal motor blockade as compared to Group BF. Conclusion: Good analgesic efficacy with lower drug consumption makes Group RF well suited for postoperative PCEA with hemodynamic stability and minimal motor blockade.
  2 8,238 681
Risk stratification in early-stage estrogen receptor+/HER2-breast cancer patients: Comparative analysis of cost-effective methods
Chandra Prakash, Aparna Gunda, Arun Kumar Attuluri, Lekshmi Madhav, Charusheila Ramkumar, Chetana Basavaraj, Nirupama Naidu, Manjiri M Bakre
January-June 2018, 1(1):5-15
DOI:10.4103/jco.jco_12_17  
Context: Treatment decisions in early-stage hormone receptor-positive breast cancer patients are dependent on the potential risk of cancer recurrence. Multiple expensive gene expression based or cost-effective methods are used to assess the risk in conjunction with traditional prognostic determinants – age, tumor parameters – size, node, grade, and gold standard biomarkers-estrogen receptor, progesterone receptor (PR), and Human epidermal growth factor receptor 2. Aim: The aim of this study is to compare the performance of multiple economic methods, namely, (1) Ki67; (2) immunohistochemistry 4 (IHC4)-multi-biomarker test; (3) Luminal A/B subtyping (4) PREDICT-an online tool. Settings and Design: IHC was performed as per standard protocol on a retrospective cohort of 401 patients. The Kaplan–Meier analysis and Cox proportional-hazards model were used. Results: The results confirmed that lymph node status is the most useful prognostic indicator among the traditional clinicopathological parameters. IHC4 had a hazard ratio (HR) of 2.847 and separated the low-, intermediate- and high-risk groups significantly (P = 0.0248). Luminal subtyping (HR = 2.530) also stratified the two risk groups significantly (P = 0.0321), but had HR lesser than IHC4. Ki67 and PREDICT could not separate the cohort into low- and high-risk groups with statistical significance. All tools compared separated the low-, intermediate- and high-risk groups with a maximum of 7% difference in metastasis-free survival significantly less compared to Oncotype Dx, which separates with 28% difference in survival. Conclusions: IHC4 is a significant predictor of prognosis among the four tools tested. However, multiple limitations of IHC4 tool about validation and lack of standardized protocols for IHC create a need for a robust, accurate, and cost-effective risk assessment tool.
  2 7,847 661
REVIEW ARTICLES
Approach towards re-irradiation of common cancers
Anis Bandyopadhyay, Kanhu Charan Patro, Poulami Basu, Kaushik Roy
January-June 2018, 1(1):29-34
DOI:10.4103/jco.jco_7_17  
Reirradiation, in combination with systemic therapy or biologicals, in recent years, has become a popular option for locally recurrent cancers and for infield second malignancies in cases where surgical salvage is not feasible. However before embarking onto such a course of second radiation a systematic approach is needed to avoid undesirable consequences and to gain meaningful advantage in terms of survival and local control. An decision making approach for common cancers where re-irradiation is commonly used like the head and neck cancers, the gliomas and in cases of gynecological cancers has been discussed. Proper selection of the cases and the choosing the intention for re-irradiation is probably most important initial step. Care of the details of the initials course of radiation like the dose fractionation schedule, volume irradiated, dose to the Organs at risk along with patient's present general condition is of utmost importance. Issues like dose memory, threshold time interval, maximum effective cumulative dose etc are still areas of research and their importance in each individual site needs to ascertain in future. Finally, the aim is to have a perceived benefit over the potential of harm in a successful course re-irradiation.
  2 7,283 823
Prohibitin gene regulation in cancer and its possible therapeutic potential
Mohammad Zeeshan Najm, Sadaf , Naseem Akhtar, Poonam Kashyap, Vyas M Shingatgeri, Komal Sharma, Anjali Raghav, Vishal Kumar Rout, Farah Parveen
January-June 2021, 4(1):35-40
DOI:10.4103/jco.jco_10_21  
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.
  2 2,544 200
CASE REPORTS
Retinoic acid syndrome followed by scrotal ulcer during treatment of acute promyelocytic leukemia with all-trans retinoic acid
Sudhir K Atri, Nishil Gowda, Anjali Dhanda, Karthik Ambalavana
July-December 2020, 3(2):97-99
DOI:10.4103/jco.jco_11_20  
All-trans-retinoic acid (ATRA) has shown a significant improvement in the outcome of patients of acute promyelocytic leukemia and is associated with certain unique adverse effects. We report one such case of APL, who developed ATRA syndrome on day 7 of ATRA, which was relieved after ATRA withdrawal and dexamethasone therapy. Subsequently, with the reintroduction of ATRA, patient developed an unexplained fever which was followed by multiple painless ulcers over the scrotum on day 28 of ATRA. ATRA was withdrawn so as not to induce Fournier’s gangrene, and ulcers were closely monitored without the administration of systemic or local corticosteroids. Eventually, ulcers improved and completely healed by 4 weeks. This is a rare case report, wherein the same patient develops ATRA syndrome followed by scrotal ulcers, suggesting that the scrotal ulcer is a rare specific adverse effect of ATRA and its monitoring is required especially in patients having unexplained fever and leucocytosis.
  1 2,276 220
Primary Pleural Primitive Neuroectodermal Tumor: Incidental Diagnosis of a Rare Pathology
Prriya B Eshpuniyani, Ramakant Deshpande, Kumar Doshi, Sameer Pathan, Sagar Sharma
July-December 2019, 2(2):71-73
DOI:10.4103/jco.jco_7_19  
Primitive neuroectodermal tumors (PNETs), a part of Ewing’s sarcoma family of tumors (ESFT), are small round cell tumors, arising from embryonic neural crest cells. They usually present with chest pain , and dyspnea. There is tenderness of chest wall. Primary pleural PNETS are a rare entity. We present a rare case of primary PNET which was incidentally diagnosed in a young patient with blunt chest trauma.
  1 3,704 318
Late recurrence and metastasis in a case of acinic cell carcinoma of parotid
Nikhila K Radhakrishna, Kannan Periasamy, Ashutosh Mukherji, Bhawana A Badhe
January-June 2018, 1(1):51-53
DOI:10.4103/jco.jco_2_18  
Acinic cell carcinoma (ACC) of the salivary glands is a low grade malignancy which can present with late recurrences and distant metastasis. Being relatively resistant to chemotherapy, managing metastatic ACC is a clinical challenge, especially considering the long duration of survival of these patients. A 33-year-old female presented with recurrent ACC of the left parotid, eighteen years after initial presentation; with incidentally detected asymptomatic lung metastases. She remained stable after six cycles of triple agent chemotherapy and continues to be clinically asymptomatic at nine months post chemotherapy. We hereby, report this case to highlight the late recurrence and metastatic pattern of ACC and the benefit of achieving stable disease with triple agent chemotherapy. Further clinical studies on other anticancer agents are required to achieve better treatment outcomes.
  1 7,384 466
Prolonged survival with anti-epidermal growth factor receptor therapy in head and neck squamous cell carcinoma: A case series
Pratik Patil, Vineet G Gupta, Ranga R Rangaraju, Waseem Abbas, Peush Bajpai
July-December 2018, 1(2):97-100
DOI:10.4103/JCO.JCO_22_18  
Head and neck cancer (HNC) is the sixth most common cancer worldwide, with approximately 650,000 patients newly diagnosed annually. In the late 1990s, surgery followed by postoperative radiotherapy (RT) or RT alone was the standard therapeutic modality for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). As chemotherapeutic agents were identified to have additional effects when combined with RT, chemoradiotherapy has become the standard treatment over the last decade for patients with LA-HNSCC who were not candidates for surgery. Despite the heterogeneity of both tumor location and genetic aberrations, 90% of HNCs are histologically squamous cell carcinomas. Hereby, we present a case series of patients with HNSCC who were benefited with anti-epidermal growth factor receptor therapy with a prolonged survival.
  1 4,236 341
Radiotherapy as a primary treatment modality for squamous cell carcinoma of tongue in a case of xeroderma pigmentosum
Sakina Mankada, Ankita Parikh, Parag Roy, Amit Kichloo, Ubrangala Suryanarayana
January-June 2019, 2(1):29-32
DOI:10.4103/JCO.JCO_4_19  
Radiation therapy (RT) represents a important modality for treatment of malignancies in patients of xeroderma pigmentosa (XP). There are only few reports of radiation being primary treatment and thus we report a case of twelve year old female with XP presented with squamous cell carcinoma of tongue and lower lip treated with radiation at our institute. DNA damage by radiation is repaired by base excision repair, non homologous end joining and homologous combination in contrast to XP in which defect lies with nucleotide excision repair genes and therefore clinical and cellular response to RT is similar in XP as seen with other patients.
  1 5,515 392
EDITORIAL
Li–Fraumeni syndrome: A lesser known and investigated “cancer predisposition syndrome”
Anurag Mehta, Garima Gupta
January-June 2019, 2(1):1-5
DOI:10.4103/JCO.JCO_10_19  
  1 4,431 535
Lynch syndrome—It’s time we start detecting it
Anurag Mehta, Garima Gupta
July-December 2018, 1(2):55-60
DOI:10.4103/JCO.JCO_26_18  
  1 8,321 674
Androgen receptor: A new player in triple negative breast cancer management
Anurag Mehta, Atika Dogra
July-December 2020, 3(2):51-54
DOI:10.4103/jco.jco_41_20  
  1 4,025 389
ORIGINAL ARTICLES
Can a low-energy photon beam be suitable for the treatment of cervical malignancies? A dosimetric analysis
Manindra Bhushan, Deepak Tripathi, Lalit Kumar, Rahul Lal Chowdhary, Anjali Kakria, Pawan Kumar, Swarupa Mitra, Munish Gairola
July-December 2020, 3(2):55-61
DOI:10.4103/jco.jco_30_20  
Background: Radiotherapy to a patient with cervical cancer can be delivered by four-field “box technique” with a benefit of much less dose to intervening tissues along with a better and homogenous dose distribution at the target location. An important ingredient for a good radiotherapy planning is the choice of beam energy. The present study aims to investigate the feasibility of a 4 MV photon beam for the treatment of cervical cancers. Materials and Methods: A population of 20 patients, with carcinoma cervix, was included in the study. All the patients were planned for a prescribed dose of 45 Gy in 25 fractions. Results: Plans were evaluated for planning target volume and found better in terms of coverage and hot spots using 6 MV. The homogeneity index (HI) was 1.1 for both the energies. Similarly, conformity index (CI) was 2.0 depending on the method used for 4 MV and 6 MV photons. Although the HI and CI were comparable for both the plans, yet it seems significantly better for 6 MV. This indicates that spillage in 6 MV plans is lesser as compare to 4 MV. The present study reveals that there is a significant reduction in total monitor units in the plans with 6 MV photon beams, leading to fewer chances of secondary malignancies. Conclusion: A 6 MV photon beam has some proven mileage over 4 MV in terms of target coverage, dose homogeneity, and conformity and remains the best suitable photon energy for the treatment of cervical malignancies.
  1 3,758 302
Radical brachytherapy for early-stage external auditory canal squamous cell carcinoma: A dosimetric feasibility study using plastic earbud as an applicator
Kanhu Charan Patro, PS Bhattacharyya, Sayan Paul, Chira Ranjan Khadanga, EB Rajmohon, Chitta Ranjan Kundu, Venkata Krishna Readdy P., Madhuri Palla, AC Prabu, Subhra Das, A Anil Kumar, Aketi Srinu, Susovan Banerjee, Sanjukta Padhi, Suman Das
July-December 2019, 2(2):49-52
DOI:10.4103/jco.jco_6_19  
Squamous cell carcinoma (SCC) of external auditory canal (EAC) is extremely rare. Although surgery followed by radio (chemo) therapy is the contemporary standard of care, radical radio (chemo) therapy has been successfully used as an anatomical as well as functional organ preservation modality. Radical brachytherapy is a promising alternative in early-stage SCC-EAC. We report our initial experience on the feasibility of using commercially available plastic earbud along with soft flexible earpiece of stethoscope as a radioactive source career applicator of remote after-loading high-dose rate radioactive sources (Ir192).
  1 4,284 390
A retrospective case cohort analysis on the clinical utility of fosaprepitant in CINV prophylaxis in day care center of South India
Anita C Ramesh, Sagar B Bhagat
January-June 2019, 2(1):15-18
DOI:10.4103/JCO.JCO_2_19  
Background: Control of chemotherapy-induced nausea and vomiting is a crucial factor in ensuring patient’s compliance and adherence to cancer chemotherapy cycle. Fosaprepitant is a water-soluble N-phosphoryl derivative of aprepitant, which is often administered along with 5-hydroxytryptamine 3 antagonist and a steroid in patients with highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC). Materials and Methods: A single-centric, retrospective cohort study was conducted in HCG Cancer Centre in South India, where patients who were prescribed fosaprepitant as a part of standard therapy were enrolled. Results: Among the 290 patients who were included in the analysis, 41.72% were male, 58.27% were female, and 36.20% belonged to 51–60 years of age. Advanced breast carcinoma was the most common diagnosis in 38.96% patients. HEC was prescribed in 222 patients; moderate emetogenic drugs and regimen were prescribed in 62 patients. Among patients who were prescribed HEC and MEC drugs and regimen, fosaprepitant, palonosetron, and dexamethasone were prescribed on day 1 followed by dexamethasone on days 2, 3, and 4. No infusion site reaction, hiccups, or any other adverse reactions were noted. Complete response was noted in all patients (100%) with HEC and MEC regimen cases. The formulation was well tolerated with none reporting any persistent or delayed or breakthrough emesis. Conclusion: Single-dose fosaprepitant used in combination with palonosetron and dexamethasone was well tolerated and effective in preventing chemotherapy-induced vomiting in patients receiving highly and moderately emetogenic drugs and regimen.
  1 4,865 468
Influencing factors while prescribing androgen deprivation therapy for carcinoma prostate in clinical practice: When literature is not enough!
Kuldeep Sharma, Subodh C Pande, Kamal Verma, Sandeep Goel
July-December 2018, 1(2):73-79
DOI:10.4103/JCO.JCO_9_18  
Objective: Androgen deprivation therapy (ADT) is an integral part of prostate cancer management but its clinical use remains controversial. Materials and Methods: We retrospectively analyzed 91 patients with prostate cancer treated between 2007 and 2014 to determine the factors that influenced our physician’s decisions regarding ADT prescription. Results: Of the 55 radically treated cases, the mean age was found to be 67 years with comorbidities present in 67% cases. Overall, 26% patients were symptomatic at presentation with 0%, 19%, and 81% cases in low-, intermediate-, and high-risk (HR) category, respectively. When divided into two groups, ADT (41 cases) and NADT (non-ADT, 14 cases), more HR cases (80% vs. 20%, P = 0.05) and all patients with positive nodes fell in ADT group (P = 0.05). Patients in ADT group had a significantly higher mean initial prostate-specific antigen (iPSA) than that of NADT group (54.2 vs. 13.9ng/mL; P = 0.02). Treatment outcomes and toxicities remained comparable between the two groups. Overall, 74% patients obtained response to primary treatment (75.6% in ADT and 71.4% in NADT) with 10 patients experiencing disease progression during follow-up (FU). Mean progression-free survival was 43 and 32 months in ADT and NADT group, respectively (P = 0.24). Median FU was 54.9 and 35.5 months in ADT and NADT group, respectively (P = 0.29). At last FU, 91% patients were alive (88% in ADT and 100% in NADT) with 67% in disease-free status. Conclusion: Prognostic risk grouping, node positivity, and high iPSA emerged as significant factors that influenced decisions regarding ADT prescription. Other factors such as age, comorbidities, symptoms, Gleason score, and T-stage were found to be insignificant.
  1 4,505 378
REVIEW ARTICLES
Immune checkpoint inhibitors in the driver’s seat: Evaluating the evolving evidence in the treatment of extensive-stage small-cell lung cancer
Yasar Ahmed, Paula Calvert, Colum Dennehy, J Lee
July-December 2019, 2(2):43-48
DOI:10.4103/jco.jco_12_19  
Until recently, improving treatment-related outcomes remained an unmet medical need for patients with extensive-stage small-cell lung cancer (ES-SCLC). Because of its rapid growth profile and tendency to metastasize early in the disease course, ES-SCLC accounts for approximately two-thirds of all SCLC diagnoses. Although treatment-naïve ES-SCLC is highly responsive to initial therapy with a platinum compound in combination with etoposide (EP), most patients experience disease recurrence within six months, and fewer than 5% survive to five years. In the platinum resistant/refractory settings, there are no standard guidelines for treatment, with various studies showing similar response rates (RRs) and survival outcomes for different single agent chemotherapies.Immune checkpoint inhibitors (ICIs) have been shown to improve outcomes in patients with a range of tumor types, especially in those characterized by high tumor mutational burden (TMB). The success of studies evaluating ICIs in multiple treatment settings and tumors, including SCLC, has led to trials assessing their role in ES-SCLC. Results from these trials suggest that this modality can improve outcomes, including in the first-line setting. Recent data show improved survival for patients with treatment-naïve ES-SCLC who received an ICI in combination with standard chemotherapy. Multiple trials evaluating a potential role for ICIs in the first-line setting are currently ongoing, with results expected within the next year.This paper incorporates clinical trial data and current guideline recommendations to show current evidence related to clinical decision making and patient management for those receiving ICI-containing regimens as first-line therapy for ES-SCLC.
  1 3,065 381
Basics of survival statistics for oncologists
Anurag Mehta, Anurag Sharma
January-June 2021, 4(1):13-21
DOI:10.4103/jco.jco_8_21  
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.
  1 2,054 265
* Source: CrossRef