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REVIEW ARTICLES
Haploidentical stem cell transplant: Established treatment, expanding horizons
Mukul Aggarwal, Narendra Agrawal, Rayaz Ahmad, Dinesh Bhurani
January-March 2016, 2(1):8-13
DOI:10.4103/2454-6798.180583  
Haploidentical stem cell transplantation offers an oppurtunity for transplant for almost all patients for whom transplant is indicated. Traditionally, it is associated with higher incidence of graft failure, graft vs host disease and non relapse mortality as compared to matched donor transplant. However, recent advances in the field have tried to mitigate these issues and offer haploidentical transplant as a safe and viable option. In this review, we shall discuss the basics of haploidentical transplantation, how to choose the best donor amongst various haploidentical donors available and understand the various recent advances in the field of haploidentical transplantation and how they addressed the problems associated with it and make it a feasible alternative to matched sibling or unrelated transplant in various diseases.
  8,312 456 -
Rationale, indications, techniques and applications of interstitial brachytherapy for carcinoma cervix
Indu Bansal, Debashis Panda, Arun Kumar Rathi, Anil Kumar Anand, Anil Kumar Bansal
July-December 2016, 2(2):69-78
DOI:10.4103/2454-6798.197374  
With evolution of different newer radiotherapy techniques, still the role of brachytherapy in different gynecological malignancies has not sublimed. Most commonly used form of brachytherapy in carcinoma cervix patients is intracavitary brachytherapy. However, all the patients do not qualify for the treatment with intracavitary brachytherapy due to certain clinicopathological conditions. This warrants use of interstitial brachytherapy technique for treatment. For getting good results from interstitial brachytherapy, a good expertise and a proper infrastructure are needed. For perineal interstitial brachytherapy, different templates have been designed, used, and published by authors in different literature over the period. Among all these different templates, Martinez Universal Perineal Interstitial Template (MUPIT) has been used in gynecological, urological, and anorectal malignancies. In this literature review, we have discussed mainly MUPIT.
  4,427 460 1
EDITORIAL
Breast cancer: Are we in the best era?
DC Doval
July-December 2015, 1(2):63-64
DOI:10.4103/2454-6798.173281  
  928 2,920 -
REVIEW ARTICLES
Role of reradiation in head and neck cancer from limits to option
Arpana Rameshchandra Shukla, Vivek Bansal
January-June 2015, 1(1):11-20
DOI:10.4103/2454-6798.165084  
Locoregional recurrence (LRR) or second primary malignancy in the previously treated area continues to be a major cause of treatment failure with significant morbidity and mortality in head and neck cancer. Prognosis of recurrent disease is dismal. To manage LRR is a therapeutic challenge for multidisciplinary head and neck team and more so if it is in a previously irradiated area. Though surgery is the mainstay of treatment but curative resection is feasible in only minority of patients. Systemic therapy alone has no long-term response rate or survival advantage in the management of inoperable recurrences. Full dose reradiation (RERT) with or without concurrent systemic therapy (CRERT) remains the only viable treatment option offering long-term survival in carefully selected patients. RERT is not a new concept but traditionally been avoided because of concern regarding toxicity due to limitations of conventional radiotherapy techniques. Initial studies were restricted to brachytherapy with its limitations. During the past two decades with the revolution in radiation therapy treatment delivery, more precise treatment techniques such as intensity-modulated radiation therapy, image-guided radiation therapy (IGRT), adaptive radiation therapy, stereotactic body radiotherapy, stereotactic radiosurgery, tomotherapy, intensity modulated proton therapy, image-guided brachytherapy in combination with better imaging modalities to define the target with the concept of biological target volume, offer various options for RERT with improved survival and limited toxicity. Pattern of failure even after full dose RERT is mainly infield, inside recurrent gross tumor volume (r GTV); radioresistance and tumor hypoxia may be the probable explanation. Though RERT has been established as a mainstream treatment option, there is a lack of prospective multi-institutional studies and absence of phase III randomized trial except one in adjuvant setting. Optimum treatment is yet to be defined. We have reviewed the literature and attempt has been made to provide guidance to the priorities on which future investigation should focus. There is a need to reevaluate prognostic factors for survival, selection criteria for patients undergoing RERT, measures to reduce the infield recurrence and morbidity, reradiation tolerance of normal tissue in IGRT era, toxicity antagonist and molecular marker as a diagnostic and prognostic tool. There is a need of multi-institutional prospective randomize trial with uniform data reporting.
  3,274 382 -
EDITORIAL
Gynecological cancer update
Rupinder Sekhon, Neerja Bhatla
July-December 2016, 2(2):61-62
DOI:10.4103/2454-6798.197372  
  986 2,308 -
REVIEW ARTICLES
Myelodysplastic syndromes: Where do we stand?
Nitin Sood, Bhuvan Chugh, Esha Singhal, Ritesh Sachdev, Shalini Goel, Gajendra Smeeta
January-March 2016, 2(1):14-22
DOI:10.4103/2454-6798.180586  
Myelodysplastic syndromes (MDS) are fairly common hematological disorder of elderly. They are a group of clonal malignant hematopoietic stem cell disorders characterized by dysplastic morphology, variable cytopenia and a variable threat of transformation to AML. These dysplastic changes are a result of chromosomal abnormalities and somatic mutations. MDS is the most common myeloid neoplasm of the older adults with median age at diagnosis being 72 years and an average incidence rate of 0.2 per 100,000 people per year. MDS is diagnosed and classified according to the WHO 2008 classification system, which utilizes peripheral blood and bone marrow findings. Other essential investigations include flow cytometry, genetic profile and chromosomal analysis. Various prognostic scoring system have been developed which help guide the treatment. Treatment of complications associated with MDS also forms an essential component of the management of this disease.
  2,758 402 -
Arm lymphedema after treatment of breast cancer: Etiology, diagnosis, and management
Ashish Goel, Juhi Agarwal, Sandeep Mehta, Kapil Kumar
July-December 2015, 1(2):77-83
DOI:10.4103/2454-6798.173284  
Breast cancer related lymphedema (BCRL) is a chronic debilitating condition seen after treatment of breast cancer. The overall incidence varies from 20% to 56% in all patients treated for breast cancer. Every patient is at a lifelong risk for BCRL and the risk goes on increasing as the followup period increases. Locoregional treatment including surgery or radiotherapy is the most common risk factor for development of arm lymphedema. There are two phases of arm lymphedema. There is increased fluid accumulation in the fluid phase of lymphedema which later on goes into the solid phase where fat and fibrotic tissue is deposited in the subcutaneous tissue. The treatment of BCRL is a challenge both for the patient and the treating surgeon and it needs multidisciplinary team work to be successful. Non-surgical treatment modalities include complete decongestive therapy (CDT) and pneumatic compression therapy. Surgery for BCRL is usually undertaken as a salvage modality after failure of conservative approaches. The surgical spectrum for BCRL varies from extensive excisional operations which were commonly done in the past to newer methods like suction assisted protein lipectomy, lymphatic reconstruction and vascular lymph node transfer (VLNT) using super-microsurgical techniques. There is no consensus regarding the preference of one procedure over other due to lack of randomised control trials. It is however suggested to do lymphovenous anastomosis and complete decongestive therapy for early cases in fluid phase; while patients in the solid phase may be treated with a combination of liposuction with CDT or VLNT alone.
  2,567 451 1
Molecular oncology update: Breast cancer gene expression profiling
Amit Verma, Jatinder Kaur, Kapil Mehta
July-December 2015, 1(2):65-72
DOI:10.4103/2454-6798.173282  
Molecular Oncology has paved its way in the comprehensive cancer care, and its burgeoning role especially in the discovery of novel cellular targets is responsible for emergence of the new Paradigm called "Genomic Paradigm", a shift from the old age "Clinico-Pathological Paradigm". In breast cancer, till recently clinical decisions, prognostications, and predictions were based solely upon histopathologic analysis, or one or a small numbers of genes or their expressions (proteins) in the tumor tissue. With the advent of newer technologies like microarray, which allows us to read the "Molecular Signature" of an individual patient's tumor, the molecular information is exploited for novel targeted treatments and new biomarkers identification. This has led to better classification of cancers for prognostication and treatment selection. In this review we have summarized various Genomic Expression Profiling (GEP) which are available commercially or in different developmental phases.
  1,875 891 1
Neuroendocrine tumor of larynx: A review of literature
L Pavan Kumar, N Armugham, B Triveni, M Rama Krishna
January-June 2015, 1(1):33-36
DOI:10.4103/2454-6798.165092  
Neuroendocrine neoplasms of the larynx are rare but are the most common nonsquamous tumors of this organ. There are 4 different types of laryngeal neuroendocrine tumors composed of paraganglioma, typical carcinoid, atypical carcinoid tumor, and small cell neuroendocrine carcinoma. Carcinoids and small cell neuroendocrine carcinomas are epithelial neoplasms, whereas paragangliomas are of neural origin. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. Precise diagnosis is essential because the natural history, treatment, and prognosis vary widely for the different neoplastic categories. Typical carcinoids are very rare and are treated by wide local excision, usually partial laryngectomy, without elective neck dissection. Atypical carcinoid tumors are more common and more aggressive. They are treated by partial or total laryngectomy with elective or therapeutic neck dissection. Adjuvant chemo/radiotherapy may be of benefit in some cases. Small cell neuroendocrine carcinomas are highly aggressive and should be considered disseminated at initial diagnosis. The treatment is by irradiation and chemotherapy as surgery has proven to be of a little benefit. Paragangliomas are treated by local excision or partial laryngectomy.
  2,329 353 1
ORIGINAL ARTICLES
Attitude of doctors toward euthanasia in Delhi, India
Sheetal Singh, DK Sharma, Vijay Aggarwal, Preeti Gandhi, Sajjan Rajpurohit
January-June 2015, 1(1):49-54
DOI:10.4103/2454-6798.165115  
Introduction: Deliberation over euthanasia has been enduring for an extended period of time. On one end, there are populaces talking for the sacrosanctity of life and on the other end, there are those, who promote individual independence. All over the world professionals from different areas have already spent mammoth period over the subject. A large number of cases around the world have explored the boundaries of current legal distinctions, drawn between legitimate and nonlegitimate instances of ending the life. The term euthanasia was derived from the Greek words "eu" and "thanatos" which means "good death" or "easy death." It is also known as mercy killing. Euthanasia literally means putting a person to painless death especially in case of incurable suffering or when life becomes purposeless as a result of mental or physical handicap. Objective: To study the attitude of doctors toward euthanasia in Delhi. Methodology: It was a questionnaire based descriptive cross-sectional study carried out between July 2014 and December 2014. The study population included Doctors from 28 hospitals in Delhi both public and private. Equal numbers of doctors from four specialties were included in this study (50 oncologists, 50 hematologists, 50 psychiatrists, and 50 intensivists). Demographic questionnaire, as well as the Euthanasia Attitude Scale (EAS), a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995) was used to measure attitude toward Euthanasia. The scale uses both positively (16 items) and negatively (14 items) worded statements to control the effect of acquiescence. The scale also has four response categories, namely "definitely agree," "agree," "disagree," and "definitely disagree." The total score for the EAS was generated by adding all the sub-scales (question's responses). The demographic questionnaire and EAS, a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995) was distributed among the study population to assess the clarity and adequacy of the questions. Reliability and content validity of the questionnaire were established. Reliability was calculated by "Cronbach Alpha" and the value computed was 0.839 the pilot study was conducted in a subset of 30 persons from the same study universe. Data were analyzed using Stata 11.2 and all the P < 0.05 were considered as statistically significant. Association of categorical variables among the groups was compared by using Chi-square/Fisher's exact test. Student's t-test was used to compare mean values in the two independent groups, and one-way ANOVA was used for more than two groups. A total of 200 questionnaires were returned out of 400, giving a response rate of 50%. Analysis and Results: Our study provided the evidence that all doctors who responded to the questionnaire knew term euthanasia. This could be due to the fact that these professionals are in close association with issues pertaining to euthanasia in their day to day work. No significant difference seen in the attitude of doctors of different age group toward euthanasia, although younger doctors endorse robustly for euthanasia. This may be because younger doctors are open for addressing these debatable issues proactively. We found no association between gender and attitude toward euthanasia in our study. Conclusion: It is evident from our study that oncologists, hematologists, psychiatrist, and intensivists do not support active euthanasia at all. There is a strong voice in support of voluntary passive euthanasia among psychiatrists and intensivists in our study. However, oncologists and hematologists are not in favor of passive euthanasia.
  2,199 285 -
Impact of early dysphagia intervention on swallowing function and quality of life in head and neck cancer patients treated with intensity-modulated radiation therapy or image guided radiation therapy with or without surgery/chemotherapy
Rajender Kumar, Hitesh Gupta, Keshavanand Konwar, Ritesh Sharma, Anil Kumar Anand, Sanjay Sachdeva
January-June 2015, 1(1):37-43
DOI:10.4103/2454-6798.165109  
Introduction: Dysphagia is a very common problem associated with head and neck cancer patients. Inspite of best of technologies like Intensity Modulated Radiotherapy (IMRT) or Image Guided Radiotherapy (IGRT), Dysphagia remains a major problem in locally advanced head and neck cancer patients. Materials and Methods: We randomized 50 head and neck cancer patients, including all sites and stages into two groups, 25 patients in each group. In Group-A dysphagia prevention exercises were done from the day of the onset of radiation therapy and continued till 6 months, while in Group-B no dysphagia interventions were given. We analyzed rate of dysphagia, aspiration rate and its impact on quality of life. We used M.D. Anderson Dysphagia Inventory (MDADI) which is a validated and reliable questionnaire designed specifically for evaluating impact of dysphagia on quality of life (QOL) in head and neck cancer patients. American Speech language Hearing Association (ASHA) scale was used for assessing swallowing function. Penetration Aspiration Scale (PAS) was used to assess aspiration during swallowing with the help of Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Results: Quality of life was significantly better in dysphagia preventive exercise arm (group - A). There was significant improvement in the MDADI score, from the baseline to 6 months in exercise arm (14 versus 7.76, p= 0.017). Swallowing function score was also in favour of exercise arm (6.44 versus 5.8, p=0.002). Patients in exercise arm were able to swallow much better by the end of 6 months post radiotherapy. Risk of silent aspiration as evaluated by PAS score at the end of three months was 36% (Group A = 16%, Group B = 20%). At the end of six months, it improved to 24% (Group A = 8%, Group B = 16%). There was a trend towards lesser incidence of aspiration in exercise arm, although it was not statistically significant (p=0.21). Conclusion: Results from this study demonstrated that swallowing exercises, if administered from first week of chemo-radiation and continued till 6 months, results in significant improvement in swallowing function and quality of life. Use of FEES helps in detection of silent aspiration at an early stage and reduces aspiration related morbidities.
  2,084 376 1
REVIEW ARTICLES
Robotic neck surgery: Rationales and evolutions
Hyung Kwon Byeon, Won Shik Kim, Jae Hong Park, Ji-Hoon Kim, Eun Chang Choi, Yoon Woo Koh
January-June 2015, 1(1):2-10
DOI:10.4103/2454-6798.165083  
Conventional operations for various surgical neck lesions adopted the transcervical scar, which were disfiguring and caused various postoperative morbidities. The advent of the surgical robotics as a result of advancement in technology led to a technical breakthrough in the field of head and neck surgery. Together with the application of the robot, we have seen the promising role of the retroauricular (RA) approach from its versatile applications. This review will discuss in detail various robotic head and neck surgeries via RA approach.
  2,170 285 -
CASE REPORTS
Lindsay tumor: An unusual entity: A case study with review of literature
Yasmin Altaf Momin, Sameer A. H. Ansari, Bharat A Ghodke
January-March 2016, 2(1):43-45
DOI:10.4103/2454-6798.180582  
Solid, encapsulated, follicular variant of papillary carcinoma of thyroid is termed as Lindsay tumor. Follicular carcinoma carries a worse prognosis than papillary thyroid carcinoma with higher incidence of hematogenous metastasis. Lindsay tumor being encapsulated follows an indolent course and has a better outcome. We present a rare case of Lindsay tumor in a 30 years adult male who presented with hoarseness of voice.
  1,996 150 -
REVIEW ARTICLES
Multiple myeloma: Looking beyond standards
Esha Kaul, Sanjeev Kumar Sharma
January-March 2016, 2(1):23-28
DOI:10.4103/2454-6798.180585  
Multiple myeloma has been regarded as an incurable disease with frequent relapses. The diagnostic criteria have been revised multiple times to include early stage of the disease where treatment can be effective and can prolong the survival. Newer diagnostic criteria for myeloma have incorporated ≥60% plasma cells in the bone marrow and serum free light chain ratio (involved to uninvolved free light chains) of ≥100. The role of positron emission tomography-computed tomography scans has been recognized, and it has been increasingly utilized upfront in the management of multiple myeloma. Role of minimal residual disease monitoring has been studied in multiple trials and will in near future guide the treatment. Autologous stem cell transplant is still the preferred consolidation therapy after initial three or four drug induction. With the use of novel drugs combinations and with emerging treatment options the standard of care of myeloma patients will change.
  1,789 350 -
An update on newer monoclonal antibodies in lymphoma therapy
Subhashini Archana Kadavakolan, Sonam Puri, Sandeep Sahay, Jitesh Joshi
January-March 2016, 2(1):3-7
DOI:10.4103/2454-6798.180581  
In 2014, an estimated 9.4% of all new cancers in the US were accounted to hematological cancers. Most of these cancers have a B-cell origin and on the cell surface express antigen CD20-known to restrict B-cells. Considering the intrinsic immune status of the patients receiving chemotherapy, monoclonal antibodies (mAbs) are designed to provide active or passive immunotherapy. Clinical success of rituximab-anti-CD20 mAb in the treatment of lymphoma has led to the development of newer generations of mAb to increase the anti-tumor activity. Hence, recent advances in lymphoma therapy are being built on the conventional prototype of anti-CD20 mAb-rituximab. Our review is an update on the advances in lymphoma therapy using mAb against CD20 including the second generation-ofatumumab, veltuzumab, ocrelizumab, and the third-generation mAbs-ocaratuzumab and obinutuzumab.
  1,722 259 1
Surgery for early stage endometrial carcinoma in the obese patient
E Leblanc, F Narducci, L Bresson, N Hudry, R Sekhon
July-December 2016, 2(2):63-68
DOI:10.4103/2454-6798.197373  
Obese patients have increased risk of developing endometrial cancer proportional to the excess in body mass index. In this review, we explored the latest information on surgical management and its adaptation to the obese condition. Mini-invasive treatments (laparoscopic, robotic, vaginal, or combinations) should be systematically considered. Prevention and active treatment of obesity seem an interesting approach to reduce incidence and severity of the disease.
  1,097 859 -
Utilization and incorporation of tumor volume data in staging and prognostication of head and neck squamous cell carcinoma treated with definitive radiotherapy: A systematic review
Parveen Ahlawat, Sheh Rawat, Anjali Kakria, Manoj Pal, Deepika Chauhan, Ruparna Khurana, Sarthak Tandon
January-June 2015, 1(1):21-32
DOI:10.4103/2454-6798.165089  
Head and neck squamous cell cancers (HNSCC) are a group of heterogeneous tumors, evident by their diverse behavior and natural history. The largest diameter of tumor measured for T classification may not necessarily reflect the true tumor dimension. There is a need to take into account certain other feature(s) of these tumors other than the maximum single dimension which can reflect the true tumor burden more accurately. Tumor volume has been shown to be a useful and accurate tool burden because it is a measurement of tumor burden in all three dimensions. This review article has compiled and reviewed the literature published in past on impact of tumor volumes (TVs) on the prognosis of head and neck cancers. A comprehensive literature search was performed in PubMed for terms "clonogens," "TV" or "primary TV (PTV)" or "nodal volume" or "total TV (TTV)" or "volumetric analysis of TV in head and neck" or "predicting response in head and neck cancer" "prognostic factors head and neck cancers" and "outcome in head and neck cancer." We identified 33 studies which have commented on the impact of TV in HNSCC on treatment outcome, 9 of these had analyzed PTV, 11 studies had analyzed total nodal volume, and 14 studies have analyzed TTV. Besides these, we have dealt with laryngeal cancers separately with 9 studies. This review article is also aimed to enhance our knowledge further regarding how best a physician can incorporate TV data in staging and predicting response to radiotherapy.
  1,577 220 1
ORIGINAL ARTICLES
Evaluation of fatigue in head and neck cancer patients undergoing (intensity modulated radiation therapy) radiotherapy: A prospective study
Vipul Nautiyal, Punita Lal, Mranalini Verma, Rajan Yadav, Nirupama Singh, Shaleen Kumar
January-June 2015, 1(1):44-48
DOI:10.4103/2454-6798.165111  
Introduction: Fatigue is a common symptom in cancer patients and persists after the completion of cancer-directed treatment. We attempted to study temporal variation in fatigue levels in head and neck cancer (HNC) patients when they were treated by radiotherapy (RT) using intensity modulated radiation therapy techniques. Materials and Methods: Histologically proven HNC patients (AJCC stage II and III with Karnofsky performance status [KPS] ≥80) receiving RT between August 2009 and October 2011 were included. Fatigue was assessed before, during and at 3, 6, and 12 months following RT and compared with age-matched healthy controls by using EORTC QOLQ C30 (using question number 10, 12, and 18). Results: Twenty-six patients were evaluated, whose baseline average fatigue score was 22.4, which was significantly higher as compared to controls (average fatigue score = 12.8; P = 0.04). During RT, average fatigue score increased to 30 by 3 weeks (P = 0.02) and rising to 33.2 (P = 0.029) towards the end of RT. Three months following RT, average fatigue score decreased to 22.8 and remained between 23 and 20 at 6 and 12 months respectively. Significant higher fatigue scores were observed in patients with advanced stage (P = 0.000). Lower KPS score did not show significantly higher fatigue scores (P = 0.5). Conclusion: Our study shows that HNC patients suffer greater fatigue than age-matched healthy individuals which is further aggravated by RT. It gradually comes back to the pretreatment level by 3 months following treatment, but does not reach to a normal healthy level even at 12 months following treatment.
  1,471 242 -
ABSTRACTS
Abstracts - RGCON 2016

July-December 2016, 2(2):88-126
  1,533 166 -
ORIGINAL ARTICLES
Tailored approach to management of bilateral breast cancer in Indian women
Veda Padma Priya Selvakumar, Shubha Garg, Kahkasha Siddiqui, Ashish Goel, Kapil Kumar, Rajeev Kumar
July-December 2015, 1(2):97-100
DOI:10.4103/2454-6798.173311  
Introduction: Bilateral breast cancer BCC is relatively uncommon with an overall incidence of 5-20% in women with early breast cancer. They are divided into synchronous if cancers are detected simultaneously or within 6 months of each other and metachronous if they are detected more than 6 months apart from each other. Family history and hereditary cancers multicentricity and lobular histology are some of the factors associated with BCC. In this background, we sought to evaluate the incidence, clinicopathological profile, and management of women with bilateral primary breast cancer at our institute. Materials and Methods: We retrospectively reviewed the medical records of women who underwent surgery for BCC at the breast services unit at our institute from October 2010 to April 2015. The clinicopathological profile and outcomes were analyzed using SPSS 22 software and appropriate statistical tests. Results: Out of 1330 women who underwent surgery for early breast cancer between October 2010 and April 2015, 44 were bilateral. Twenty-eight were synchronous and 16 were metachronous. Mean age of the presentation of patients was 53 years (range 30-79 years). The histological type were same in 82.14% of synchronous tumors and 87.5% of metachronous tumors (P = 0.496). The grades were similar in 42.85% of synchronous tumors and 56.25% of metachronous lesions (P = 0.294). The stage concordance among synchronous tumors was 39.28%, whereas it was 60% among metachronous lesions (P = 0.164). Conclusions: The management of BCC is complex and has to be tailored to the individual based on characteristics of index and second tumor, prior therapy, adjuvant treatment, and risk stratification. Moreover, the concordance of receptor expression is higher in synchronous cancers than metachronous cancers.
  1,394 196 2
REVIEW ARTICLES
Pertuzumab: Unprecedented benefit in human epidermal growth factor receptor 2-positive breast cancer
Amit Rauthan, Palanki Satya Dattatreya, Manish Singhal, Ram Prabu, Siddharth Naik, Anil Kukreja
July-December 2015, 1(2):84-91
DOI:10.4103/2454-6798.173299  
Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a more aggressive subtype of breast cancer and targeting the HER2 receptor has proven effective in improving the prognosis of these patients. Pertuzumab, a recombinant humanized monoclonal antibody and the first in a class of HER2 dimerization inhibitors approved for treating HER2+ breast cancer. It blocks ligand-dependent heterodimerization and ligand-independent homodimerization of HER2 with other HER members. When used in combination with trastuzumab and taxane, pertuzumab complements the action of trastuzumab and results in a comprehensive blockade of HER2 signaling pathway. This review article traces the development of pertuzumab from concept to its current use in HER2+ breast cancer treatment. A search of Medical Literature Published since 2007 was performed in PubMed using the keywords "pertuzumab," "HER2+ breast cancer," "HER2 targeted therapy," "metastatic breast cancer," and in search engines for ongoing trials with pertuzumab and incidence of cancer and breast cancer in India. A total of 35 publications and abstracts from the American Society of Clinical Oncology were selected for this review. Pertuzumab is approved in combination with trastuzumab and docetaxel for the treatment of patients with HER2+ metastatic BC, who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. The dual HER2 blockade of pertuzumab and trastuzumab is now accepted worldwide as a standard of care by various guidelines.
  1,358 172 -
Radioguided occult lesion localization and sentinel node and occult lesion localization in breast cancer: The future beckons
Deepak Jha, S.V.S. Deo, Mandeep Singh Malhotra
July-December 2015, 1(2):73-76
DOI:10.4103/2454-6798.173283  
Wire Guided Localisation has been the traditional technique for occult breast lesions. However, ROLL has emerged as a safer alternative to WGL approach. ROLL provides an improvement on margin positive rates and offers better pain and cosmetic advantages to the patient combined with a shorter learning curves for both radiologists and surgeons. SNOLL adds to the advantages of the procedure by combining SLNB with ROLL hence offering an economic advantage. The use of ROLL as primary modality for occult lesion localisation is bound to increase with potential to replace WGL as the primary modality for such lesions.
  1,199 266 -
CASE REPORTS
Cytomorphological features of oncocytic variant of papillary thyroid carcinoma with lymphocytic thyroiditis
Nivedita Patnaik, Preeti Diwaker, Alphy Sara Varughese, Vinod K Arora, Bharat Singh
July-December 2016, 2(2):85-87
DOI:10.4103/2454-6798.197377  
Cytological diagnosis of hurthle cell lesions of thyroid is a diagnostic dilemma. Presence of hurthle cells on fine needle aspiration (FNA) leads to a wide range of differential diagnosis including benign and malignant entities. The oncocytic variant of papillary thyroid carcinoma (PTC) is one entity of the vast list of differentials of which very few cases have been reported to date. We report a case of oncocytic variant of PTC in a 28-year-old female diagnosed on cytomorphology. The findings of FNA smears of the first aspirate were not sufficient for a definitive diagnosis. Repeat FNA was done to rule out the possibility of autoimmune thyroiditis/thyroid neoplasm. The repeat FNA smears showed oncocytic cells present in papillary and loosely cohesive clusters. Many of the cells displayed nuclear features of PTC and the case was finally diagnosed as PTC; oncocytic variant. Thyroidectomy specimen revealed PTC; oncocytic variant with lymphocytic thyroiditis in the surrounding tissue. Thus, in cytology practice, concurrent autoimmune thyroiditis may pose a problem in diagnosis of PTC; oncocytic variant.
  1,197 246 1
REVIEW ARTICLE
Sentinel node biopsy in vulvar cancer: A critical appraisal
Neville F Hacker, Ellen L Barlow
January-June 2017, 3(1):5-11
DOI:10.4103/2454-6798.209328  
Since the incorporation of inguinal-femoral lymphadenectomy into the management of patients with vulvar cancer in the mid-20th century, there have been attempts to modify or eliminate the groin dissection to decrease the risk of lower limb lymphedema. Early attempts were significantly flawed and resulted in much unnecessary loss of life because recurrence in an undissected groin is usually fatal. The best compromise yet to decrease the risk of lymphedema is sentinel node biopsy, but accumulated evidence now suggests that the false-negative rate for this procedure, if used for lesions up to 4 cm in diameter, is between 5% and 10%. Most women, properly informed of risks and benefits, are not prepared to take a 1% risk of dying from recurrent vulvar cancer to avoid lymphedema. This is the risk involved, assuming a false-negative rate of 5% and an incidence of positive nodes of 20%. For this reason, sentinel node biopsy should not be considered to be standard practice for patients with early vulvar cancer.
  1,174 222 -
ORIGINAL ARTICLES
Hypofractionation in postmastectomy breast irradiation. How safe are we in using standard tangentials?
Bindhu Joseph, Nisma Farooq, Muhammed N Shafeeque, S Sathiyan, V Lokesh, C Ramesh, CR Vijay
July-December 2017, 3(2):101-105
DOI:10.4103/ASJO.ASJO_53_17  
Aim: Hypofractionation in breast radiotherapy is gaining increasing relevance in routine clinical practice; however, gray areas remain on its safety. Majority of data regarding the same pertains to the treatment of the conserved breast. This study aimed to compare the use of standard wedge-based tangentials (two-dimensional [2D] TW) versus 3D conformal radiotherapy field in the field (3DCRT FIF) with the intent of evaluating if the latter would provide a dosimetric advantage. Materials and Methods: Twenty-six postmastectomy patients were enrolled in this study. Comparative plans using 2D TW and 3DCRT FIF were generated to deliver 50 Gy in 25 fractions. Dosimetric parameters pertaining target dose, Homogeneity Index (HI), Conformity Index , and dose to normal structures were compared and analyzed. The parameters that achieved significance were evaluated using the hypofractionated plan. Results: The 3DCRT FIF plan showed better planning target volume coverage, V95%(P < 0.001) and less cardiac dose (V30and MD) as well as lung V20,V30,MD, and V5for both lungs (P < 0.001). The dose to the left descending coronary artery (LAD) was also less with a trend toward significance (P = 0.07). The 3DCRT FIF plan also improved HI (P = 0.02). However, the high-dose volume V107%and radiation exposure were not higher. The significant parameters were evaluated in the hypofractionated schedule of 40 Gy/15 Fr. The MD to the heart was 8.96 Gy in FIF plan versus 20.16 Gy in TW plan. The average V20to the ipsilateral lung was 37.8% versus 65.2%. The average dose to the contralateral breast was 50% less, i.e., 3.92 Gy versus 8.96 Gy. Conclusion: The results of this study suggest that there would be a significant benefit of using 3DCRT FIF plans for patients being considered for hypofractionated radiotherapy in the postmastectomy setup.
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