DR. B.R.A. Institute Rotary Cancer Hospital

Radiation-associated sarcomas (RAS) are rare tumors developing in previously irradiated areas. Most data come from high-income countries, with limited reports from low- and middle-income countries (LMICs). To our knowledge, this is the largest RAS cohort from India, examining clinical features, genetic predisposition, systemic therapies, and outcomes, in a resource-limited setting. We conducted a retrospective analysis of a sarcoma database at AIIMS, New Delhi, from January 2015 to June 2025. Patients ≥18 year with biopsy-confirmed RAS, meeting modified Cahan criteria, were included. Twenty-three patients (0.32% of 7,138 sarcoma cases evaluated) were diagnosed with RAS. The median age at diagnosis was 51.1 years, with a median latency of 13.25 years following radiotherapy. Breast cancer was the most common antecedent malignancy (21.7%). Soft tissue sarcomas were predominant (14, 60.9%), with undifferentiated pleomorphic sarcoma (8, 34.8%) being the most frequent histologic subtype. At presentation, 12 patients (52.2%) had metastatic disease, while three (13.1%) had locally unresectable tumors. The majority of tumors were high-grade (20, 87.0%), with a median tumor size of 6.9 cm. Among eight patients with resectable disease, seven underwent surgery, achieving R0 resection in 62.5% of cases. Re-irradiation was performed in three patients (13.0%). Sixteen patients (69.6%) received systemic therapy: 12.5% had partial response, 25% had stable disease, and two patients on immunotherapy had progressive disease. At a median follow-up of 68.2 months, the median overall survival was 59.2 months and 13.4 months for patients with nonmetastatic and metastatic disease, respectively. Despite large, high-grade, and advanced tumors, curative surgery was feasible in most nonmetastatic cases, and systemic therapies were widely used. The favorable survival outcomes underscore the importance of centralized, multidisciplinary sarcoma care in LMICs. Lack of immunotherapy responses calls for investigation into resistance mechanisms and histology-specific treatments.

Despite advances in neonatal care, delayed diagnosis and treatment of congenital hypothyroidism (CH) remain prevalent in regions lacking universal screening. This retrospective study evaluated catch-up growth patterns in 65 children with a delayed diagnosis of CH. Study children were stratified into four groups based on age at thyroxine initiation: Groups A (< 1 year), B (1-<3 years), C (3-<5 years), and D (5-10 years). Growth outcomes, in terms of serial height z scores, skeletal maturation, proportion achieving catch-up growth, and time to catch-up, were assessed at baseline and after 3 years of thyroxine. Within 3 years of treatment initiation, 64.6% (42/65) of children achieved complete catch-up in linear growth, and 56.9% (37/65) attained optimum catch-up. Among those treated before 1 year of age (Group A), 76% (19/25) achieved complete and optimum catch-up over a median (IQR) duration of 22 [12-33] months. In children diagnosed after 1 year of age (Groups B-D combined), 57.5% (23/40) attained complete catch-up, of whom 78.3% (18/23) achieved optimum growth, with time to catch-up increasing progressively with later age at diagnosis (median range-25-34 months). The greatest change in height z-scores was observed in the first-year post-treatment across all groups, with a decline thereafter. Catch-up in skeletal maturation was observed in 72.3% (47/65) of children and occurred earlier than catch-up in linear growth. Early thyroxine initiation in CH is critical for optimal linear and skeletal growth. Delayed diagnosis is associated with slower, suboptimal recovery and an increased risk of compromised final adult height.

Background and Aims:The sacral multifidus plane block (SMPB) is an emerging regional anaesthesia technique targeting the dorsal rami of sacral spinal nerves, with potential applications in lower limb, pelvic, and perineal surgeries. Evidence from randomised controlled trials (RCTs) has not been systematically synthesised.Methods:We conducted a systematic review and meta-analysis following the PRISMA 2020 guidelines, and the study was registered prospectively in PROSPERO. PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov were searched (January 2019–May 2025) for RCTs comparing SMPB with other regional techniques or no block. The primary outcome was time to rescue analgesia. Secondary outcomes included 24-h opioid consumption, postoperative pain scores, patient satisfaction, and adverse events. Data were pooled using a random-effects model; trial sequential analysis (TSA) and GRADE assessment were performed.Results:Twelve RCTs (n = 768; 348 received SMPB) were included. SMPB significantly prolonged time to first rescue analgesia, reduced 24-h opioid consumption, and lowered pain scores at rest and movement during the first postoperative day, particularly during the intermediate (6–12 h) and late (24 h) postoperative periods. Patient satisfaction was generally higher with SMPB, correlating with improved analgesia and reduced opioid use. TSA confirmed the robustness of findings for time to rescue analgesia and opioid consumption, although the required sample size was not reached. No serious block-related complications were reported.Conclusions:SMPB appears to be a safe, effective regional anaesthesia technique, offering opioid-sparing benefits, prolonged analgesia, and high patient satisfaction. However, current evidence is limited by small sample sizes, methodological heterogeneity, and potential publication bias.