BackgroundTyrosine kinase inhibitors like imatinib have become the cornerstone of therapy in chronic phase-chronic myeloid leukemia (CML-CP). However, the role of hydroxyurea (HU), a deoxyribonucleic acid synthesis inhibitor, has been less explored in the disease. Hence, the present study was conducted to compare the efficacy of structured dose of HU based on baseline total leukocyte count (TLC) with imatinib in CML patients.MethodAn open-label randomized controlled trial was conducted in 90 newly diagnosed CML-CP patients, aged ≥ 18 years. Patients were randomized to receive either baseline leucocyte count-based structured dose of HU with imatinib or imatinib monotherapy for 3 months. Quantitative real-time polymerase chain reaction forBCR-ABL1to assess early molecular response (EMR) and safety evaluation according to the Common Terminology Criteria for Adverse Events version 5 was done.ResultsMedian age of patients was 36.5 years (36 [interquartile range [IQR]: 30–45] in I-HU, 38 [IQR: 31–47] in imatinib monotherapy) with male predominance. Fatigue was the most common symptom at diagnosis. Splenomegaly was seen in 89% (median spleen size: 10 [IQR: 6–15] cm). At 3 months, complete hematological response was seen in 74 patients (36 in I-HU, 38 in imatinib monotherapy). Overall, 68 patients achieved EMR (34 in I-HU, 34 in imatinib monotherapy,p = 0.53). The most common hematological toxicity, anemia, was seen in 80 patients (41 in I-HU, 39 in imatinib monotherapy). In 37 patients, nonhematological toxicities seen were nausea and vomiting (20 in I-HU, 17 in imatinib monotherapy). No dose limiting toxicities were reported.ConclusionAddition of upfront TLC-based dosing of HU to imatinib was not found to significantly improve the hematological response and EMR at 3 months. However, long-term studies with a larger sample size with structured dose of HU can be undertaken as it forms a preferred adjunctive therapy for initial, rapid cytoreduction in hyperviscosity or leukostasis-related symptoms in patients of CML.

ObjectivesThere are no standard guidelines on oro-dental care during induction therapy of acute leukemia (AL). This study aimed to assess the effect of intensive oral hygiene practice on oral mucositis, infection, and disease outcomes compared to standard clinical practice.Materials and MethodsNewly diagnosed patients with AL were randomized to receive either standard oral hygiene protocol (group A,n = 92) or comprehensive oral hygiene protocol (group B,n = 91). In group A, the oral hygiene indexes were measured by the dentist at baseline and at the end of treatment. In group B, weekly monitoring of oral hygiene indexes by the dentist and interventions in the form of oral cavity inspection, probing for gum health, and use of a soft toothbrush and education on oral hygiene practices were carried out.ResultsThe frequency of mucositis was higher in group B (60%) than in group A (40%;p = 0.09). There was no difference in the median Simplified Oral Hygiene Index (OHI-S; 0.5 vs. 0.6) and Silness and Loe plaque index (0.4 vs. 0.25) between the groups. The local (11 vs. 1%;p = 0.005) and systemic infection rate (82.2 vs. 65.2%;p = 0.009) were higher in group B than in group A.ConclusionThis study failed to show the superiority of a comprehensive oral hygiene protocol compared to standard protocol in reducing oral mucositis in patients receiving induction therapy for AL. We hypothesize that frequent intervention in the oral cavity may lead to the dissemination of infection.

ObjectiveThe aim of the study was to construct a nomogram that is easily reproducible, accurate, and cost-effective in predicting cervical lymph nodal metastasis in buccal mucosa cancer.MethodologyPatients who underwent radical resection of a primary tumor of the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with lymph nodal metastasis in multivariate analyses were adopted to build the model.ResultsPatients who underwent surgery (January 2021–December 2021) were included as the model development cohort (n = 127). Depth of invasion, perineural invasion, lymphovascular invasion, and the worst pattern of invasion were independent predictors of lymph nodal metastasis. The nomogram model based on these four predictors showed good discrimination accuracy in percentage prediction of lymph nodal metastasis.ConclusionThis study proposes a simple predictive model for the risk of nodal metastasis in buccal mucosa squamous cell cancer. The study has strength that, it is based on a large sample, proposed model being simple size, and based on parameters empirically supported as well as established in literature, easy to use in routine clinical practice, and cost-effective.

Introduction Epithelial ovarian cancer (EOC) is one of the leading causes of mortality among women worldwide. The present study aimed to estimate the frequency of various histopathological types, clinical and surgico-pathological factors, and spectrum of lymph node (LN) metastasis in early and advanced EOC.Material and Methods Women with EOCs who underwent cytoreductive surgery (CRS) between January 2019 and May 2022 were included. The distribution of Clinico-demographic parameters, histological type, stage, and LN metastasis were analyzed.Results A total of 101 women with EOCs underwent CRS, out of which 5 (4.95%) with coexistent endometrial cancer were excluded (N = 96). Fifty women (52%) underwent primary CRS and 46 (48%) women underwent interval CRS. The mean age of the women was 48.42 ± 11.6 years. Initial serum cancer antigen 125 (CA 125) level was elevated (>35 U/mL) in 88 (91.67%) women and normal in 8 (8.33%) women. Complete cytoreduction was achieved in 75 (78.12%) cases. High-grade serous carcinoma was the most common histology (66/96, 68.75%), followed by mucinous carcinoma (15/96, 15.63%), endometrioid carcinoma (6/96, 6.25%), low-grade serous carcinoma (4/96, 4.17%), and carcinosarcoma (2/96, 2.08%). The majority of women, 69 (71.88%), were in stages III and IV at presentation. Most serous carcinomas were diagnosed at stage III (71.22%) or IV (13.64%). In contrast, the majority of endometrioid, mucinous, and clear cell carcinomas were diagnosed at stages I and II. Seventy-five women (78.13%) with EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. Three out of 23 patients (13%) with early-stage disease showed positive LNs.Conclusion Serous carcinoma ovary is the most common histological subtype, presenting mostly in the advanced stage. A significant number of affected women were younger at presentation and diagnosis was made a decade earlier than the western population. A systematic pelvic and para-aortic lymphadenectomy in apparently early-stage (pelvic confined) ovarian cancer could detect additional LNs in 13% of women, especially in high-grade tumors and serous histology, suggesting the role of systematic lymphadenectomy for accurate staging in apparently early-stage ovarian cancer.

Osimertinib is approved in the first line in patients with mutations in the sensitive gene epidermal growth factor receptor (EGFR) mutation. There is lack of real-world evidence to illustrate the effectiveness and safety of osimertinib that can reflect the current medical practice especially in resource-constrained setting. A total of 129 patients with histology-proven metastatic non-small cell lung cancer with EGFR mutation registered at Tata Memorial Hospital between from March 2018 and May 2023 were analyzed. The parameters studied included demographics, outcomes, safety analysis, and secondary mutations. Most common EGFR mutation was exon 19 deletion 58.9% followed by EGFR exon 21 L858R 39.5% and others 1.5%. The overall median progression-free survival was 21.9 months (95% confidence interval [CI]: 16.0–58.1) and median overall survival was 31 months (95% CI: 17.8–45). The median duration of response was 21.3 months (95% CI: 17.1–25.5). Of 129 patients, 77.5% had partial response (PR), 10.1% had stable disease (SD), and 6.2% patients had progressive disease (PD) as the first best response with overall disease control rate was 87.2%. In patients with baseline central nervous system disease, 8.9% had complete response, 75.5% had PR and 8.9% had SD, and 2.2% had PD as best response. The overall intracranial response rate was 84.4% and disease control was 93.3%. Skin toxicities (27.1%) and gastrointestinal toxicities (17%) were most frequently observed toxicities. Overall, 63 patients had progression of disease on osimertinib. Subsequently, 58.7% (n = 37) patients received second line of therapy and 27% (n = 17) patients received third line of therapy. Platinum-based combination chemotherapy was the most common subsequent treatment after progression on osimertinib. Repeat biopsy was done in 33 patients (52.3%) and next-generation sequencing was done in 30 patients (47.6%). The most common resistance alteration detected was TP53 in 30% cases followed by mesenchymal epithelial transition (MET) amplification which was seen in 20% cases. Our study confirms similar efficacy and safety of osimertinib as first-line treatment of mutated non-small cell lung cancer in real-world setting irrespective of the type of common EGFR mutation and similar intracranial activity as well.

A team of gastroenterologists, oncologists, pathologists, radiologists, and surgeons from a university teaching hospital in western India make an appeal, through the Journal, to the statutory bodies and the scientific societies related to surgery, oncology, gastroenterology, radiology, and pathology for considering measures, which, if implemented, can help in early diagnosis of gallbladder cancer, the most common nongender organ cancer in women in some parts of India.

BackgroundOral squamous cancers remain the most common cancers among males in India and the third most common cancer among men and women combined, with an age standardized ratio of 9.1 per 100,000 population. Surgery and chemoradiation have not improved survival rates significantly and hence, newer therapeutic targets are needed. Cyclin D1 (CCND1) is a proto-oncogene which is located on chromosome 11q13 and has been found to be amplified in many cancers including oral cancers. It is said to correlate with aggressive tumor growth and a poorer prognosis.AimThis article correlates cyclin D1 (CCND1) gene copy number alteration with clinicopathologic prognostic factors in oral squamous cancers.Materials and MethodsSixty-three patients who underwent surgery for oral cancer between January and June 2022 were included in the study after obtaining informed consent and ethics approval. Copy number alteration of CCND1 was assessed using quantitative polymerase chain reaction (Qf PCR) and correlated with clinical and histopathological prognostic factors, including short-term recurrence. Statistical analysis was performed using the SPSS software.ResultsA statistically significant correlation was determined between the Qf PCR values of CCND1 gene and locoregional recurrence. Gene copy number alteration also correlated strongly with a higher grade of the primary tumor. There was also a significant correlation between the Qf PCR values and the immunohistochemistry for cyclin D1.ConclusionCyclin D1 offers a new therapeutic target in oral cancers and may improve survival without significant treatment-related morbidity.

BackgroundIn locally advanced nasopharyngeal cancer (LANPC), concurrent chemoradiotherapy (CCRT) has been established as the current standard of care, but recently, the addition of induction chemotherapy to CCRT has presented an attractive multidisciplinary approach.ObjectivesThe aim of the study was to explore the clinical outcome of induction chemotherapy (IC) followed by CCRT and CCRT followed by adjuvant chemotherapy (AC) in LANPC.Material and MethodsIn this propensity score–matched retrospective cohort study, we enrolled LANPC patients from October 2016 to June 2022. Study variables were evenly distributed by propensity score matching. Independent prognostic factors were identified using Cox regression analysis, and the outcome between the two chemotherapy treatment combinations was compared for patients in different subgroups.ResultA total of 80 patients were included in the study. Survival outcomes indicated that the IC followed by CCRT group (IC + CCRT) achieved a higher 5-year overall survival (OS; 90 vs. 81%,p = 0.253), failure-free survival (FFS; 80 vs. 77.50%,p = 0.17), and distant metastasis-free survival (DMFS; 88 vs. 82.50%,p = 0.314) compared with the CCRT followed by AC group (CCRT + AC), although it was not statistically significant. The stratified analysis revealed that IC followed by CCRT (IC + CCRT) was associated with significantly improved OS (hazard ratio [HR] = 0.212; 95% confidence interval [CI] = 0.014–3.16;p = 0.0026) in N2 disease. However, the superiority of CCRT followed by AC (CCRT + AC) was only observed in LRRFS (HR = 0.45; 95% CI = 0.05–0.89;p = 0.036) for the T4 subgroup.ConclusionIn patients with LANPC, especially with T3 or N2 disease, IC should be strongly considered followed by CCRT.

BackgroundThe standard of care for locally advanced cervical cancer is concurrent chemoradiation followed by intracavitary brachytherapy (BT). BT forms an integral part of management as it improves local control and overall survival. In recent times, image-guided BT (IGBT) has been recommended as the standard of care. Computed tomography (CT) scan-based BT is a cost-effective and easily available modality for IGBT. The aim of the study was to do a dosimetric analysis of CT scan-based BT for patients with cervical cancer.MethodsThis was a retrospective study and included patients with cervical cancer treated with radical chemoradiation followed by BT. CT scan was done before every fraction after applicator placement, and CT-based planning was done for all fractions. Clinical details were abstracted from the case records, and dosimetric details were collected from the treatment planning systems. Total equivalent dose in 2 Gy per fraction (EQD2) was calculated for external beam radiation therapy and BT target volumes and organs at risk (OARs).ResultsThis study included 50 patients. The mean age was 45 years. The majority of the cases were stage III. The mean high-risk clinical target volume (HRCTV) for the 1st, 2nd, and 3rd fraction was 53.1, 52.1, and 51.3 mL, respectively. Mean D90 HRCTV (dose received by 90% of the HRCTV) dose was 81.4 Gy (EQD2 10 Gy) and D2cc was 75.8 Gy (EQD2 3 Gy) for the rectum and sigmoid and 86.2 Gy (EQD2 3 Gy) for the bladder.ConclusionCT-based BT is a reasonable option in high-volume and low-resource settings where the availability of magnetic resonance imaging is limited. CT-based BT at every fraction can ensure proper applicator placement and aid in optimizing the dose to the target volumes and OARs.

IntroductionWith the increase in the number of pediatric cancers in India, there is a need for a multimodal approach involving various disciplines of therapy in which radiotherapy is one of the important areas of treatment. As there is a paucity of studies in South India about the profile of pediatric cancer patients who have undergone radiotherapy the present study was undertaken.MethodsA record-based retrospective study was conducted at the department of pediatric hematology-oncology and radiotherapy at a tertiary care hospital in South India using a data abstraction form which consisted of sociodemographic details of study participants, primary diagnosis, confirmed diagnosis, site of radiotherapy, current status of the patient, etc. Chi-square test or Fisher's exact test was used to find out significant association between current status of study participants and various determinants influencing it.ResultsHighest proportion,n = 35 (30.4%), of cases were in the age group of 10 to 14 years. Among them, 48 children were primarily diagnosed to have hematolymphoid malignancy while 67(%) had solid tumor. Majority of the patients,n = 110 (95.6%), were treated on curative intent.ConclusionRadiotherapy remains an important modality of cancer-directed therapy in children with cancer. Radiotherapy still forms an integral part of cancer-directed treatment in children with cancer as demonstrated in our population.