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   Table of Contents - Current issue
July-December 2018
Volume 1 | Issue 2
Page Nos. 55-102

Online since Monday, December 31, 2018

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Lynch syndrome—It’s time we start detecting it p. 55
Anurag Mehta, Garima Gupta
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Intensified versus non-intensified induction therapy with cytarabine and daunorubicin for patients with newly diagnosed acute myeloid leukemia p. 61
Mehrzad Mirzania, Sayyed Reza Safaee Nodehi, Ramezan Ali Sharifian, Farhad Shahi, Amir Hosein Emami, Mohsen Esfandbod, Gholam Reza Togeh, Sahar Tavakoli
Background: The purpose of this study was to compare the efficacy and adverse effects of intensified dose of daunorubicin (DNR) and cytarabine (Ara-C) versus their standard dose in induction therapy for patients with newly diagnosed acute myeloid leukemia (AML). Materials and Methods: In a retrospective review, patients with AML in Hematology and Oncology Department of Imam Khomeini Hospital, Tehran, Iran, who underwent induction therapy with standard dose of Ara-C and DNR (100mg/m2 for 7 days and 45mg/m2 for 3 days, respectively) were compared in terms of overall survival (OS) rate, disease-free survival (DFS) rate, and treatment-related complications with those who underwent double-intensified induction (i.e., Ara-C, 200mg/m2 for 7 days and DNR, 60mg/m2 for 3 days). Results: Among 123 patients, the standard-dose regimen was used for 49 patients, and 74 patients received the dose-intensified regimen. The rate of 2-year DFS, 2-year recurrence rate of the disease, and treatment-related mortality improved significantly in the latter group (P < 0.05). However, between the two groups, OS rate, bone marrow blast cell percentage 14 days after treatment, the number of antibiotics received, fungal infection rate, and the need for bone marrow transplants did not significantly differ. On the other hand, the risk of heart failure significantly increased in the dose-intensified group (P < 0.05). Conclusion: Treatment of AML using combined dose-intensified induction significantly improved DFS rate and decreased the disease-recurrence rate but did not significantly improve OS rate, and more side effects were encountered.
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A comparative study of ropivacaine and bupivacaine with fentanyl for postoperative patient-controlled epidural analgesia after major abdominal oncosurgery p. 66
Anita Kulkarni, Anudita Gupta, Shagun B Shah, Ajay K Bhargava
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.
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Influencing factors while prescribing androgen deprivation therapy for carcinoma prostate in clinical practice: When literature is not enough! p. 73
Kuldeep Sharma, Subodh C Pande, Kamal Verma, Sandeep Goel
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.
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Innovativeness in breast cancer: The prime example of anti-HER2 agents p. 80
Yasar Ahmed, Jonathan Lee, Ahmed Yousif
Since the identification of HER2 in breast cancer pathogenesis and the introduction of the first drugs targeting this receptor, the humanized monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib, many advances have been made in the treatment of HER2-positive breast cancer that have led to a progressive improvement in the outcome of patients with early and advanced breast cancer. One of the major achievements is the development of dual HER2 blockade strategies. Evidence from the neoadjuvant and metastatic setting suggests that by combining trastuzumab with other anti-HER2 drugs such as lapatinib or the humanized monoclonal antibody pertuzumab, the efficacy of treatment may be further improved.
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Reirradiation in breast malignancies p. 84
Venkata Krishna Reddy Pilaka, Kanhu C Patro, Partha S Bhattacharyya, Chitta R Kundu, Madhuri Palla, Rajesh Balakrishnan
Ipsilateral breast or chest wall recurrence remains one the most common site of disease recurrence and significantly increases the morbidity and mortality. The current standard of care for ipsilateral breast tumour recurrence has been mastectomy. However, various recent studies showed that there is feasibility of repeat breast conservation surgery with reirradiation. Reirradiation in breast cancer is complicated approach. Many physicians are reluctant to reirradiate breast with restricted data available. This paper will review the current literature on reirradiation for locally recurrent breast cancer
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Clinical pearls in pediatric anesthetic considerations for peripheral blood stem cell transplant and lacunae in our current knowledge p. 89
Shagun B Shah, Ajay K Bhargava, Sangeeta Bhagat, Dinesh Bhurani, Narendra Agrawal
Clinical introduction of peripheral blood stem cell transplant (PBSCT) has replaced bone marrow as a stem cell source in 99% autologous and 75% allogeneic transplantation cases. Incompliant pediatric donors require general anesthesia for PBSCT. Whether the CD34-positive (CD34+) stem cell yield from PBSC donor is affected by age, weight, and sex of donor and type/duration of anesthesia is not very clear from the current literature. These factors may have significant clinical implications as is evident from the poor yield (0.11 million/kg CD34+ cells) on the second day of stem cell harvest from our 2-year-old donor.
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Cancer prostate metastasis to testis: A rare encounter p. 94
Kshitij Raghuvanshi, Hrishikesh Deshmukh, Abid Raval, Devendra Kumar Jain
Carcinoma of prostate rarely metastasizes to the testis. It is the most common primary cancers among all the solid malignancies contributing the majority of testicular metastases. Here, we report such type of rare case in a 64-year-old man who presented with a history of severe lower urinary tract symptoms and progressively increasing swelling of the right testis. The case was subsequently diagnosed as a prostate cancer with testicular metastasis.
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Prolonged survival with anti-epidermal growth factor receptor therapy in head and neck squamous cell carcinoma: A case series p. 97
Pratik Patil, Vineet G Gupta, Ranga R Rangaraju, Waseem Abbas, Peush Bajpai
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.
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“So near, yet so far”: Palliative care services remain elusive in India p. 101
Sudip Bhattacharya, Sukhpreet Singh, Amarjeet Singh
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