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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 2 | Issue 1
Page Nos. 1-36

Online since Wednesday, June 26, 2019

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EDITORIAL  

Li–Fraumeni syndrome: A lesser known and investigated “cancer predisposition syndrome” p. 1
Anurag Mehta, Garima Gupta
DOI:10.4103/JCO.JCO_10_19  
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ORIGINAL ARTICLES Top

Perception, attitude and knowledge regarding radiotherapy among physicians at a tertiary care center p. 6
Kuldeep Sharma, Anita Malik
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.
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A retrospective case cohort analysis on the clinical utility of fosaprepitant in CINV prophylaxis in day care center of South India p. 15
Anita C Ramesh, Sagar B Bhagat
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.
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COMMENTARY Top

Resurgence of role of radiotherapy in neoadjuvant treatment of pancreatic cancer p. 19
Rohit Avinash Vadgaonkar, Kaustav Talapatra
DOI:10.4103/JCO.JCO_23_18  
Borderline resectable pancreatic cancer (BRPC) is a clinically distinguished malignancy. With limited role of aggressive surgical intervention, neoadjuvant treatment is warranted. Various studies and their meta-analysis addressing this issue have shown limited benefit. However, recently two prospective multiple randomized trials have evaluated benefit of neoadjuvant chemoradiotherapy in BRPC with a positive clinical response. This article gives a brief insight into these studies and discusses future prospects for role of radiation in neoadjuvant setting in pancreatic cancer.
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CASE REPORTS Top

Pseudoangiomatous stromal hyperplasia presenting as an enlarging breast mass: A case report p. 22
Mala M Sharma, Ajit Nambiar, Janaki P Dharmarajan
DOI:10.4103/JCO.JCO_25_18  
Pseudoangiomatous stromal hyperplasia (PASH) is an occasional histological finding in the breast tissue, which rarely presents as a clinical mass. We here report a case of progressively increasing breast lump that had radiological ambiguous findings but on excision proved to be PASH on histology and immunohistochemistry (IHC). On microscopy, PASH has to be distinguished from low-grade vascular tumors as stromal spaces in it mimic the endothelium-lined vascular spaces. In view of nonspecific radiological picture, histopathological confirmation by core needle or excision is mandatory. It may coexist with in situ or invasive breast malignancies also. IHC with stromal and vascular markers is the key to diagnosis of PASH; also these tumors show positivity with progesterone markers pointing to endocrine stimulation as a possible etiology. In asymptomatic PASH, expectant management is indicated; however, in symptomatic and enlarging masses, surgical treatment should be preferred.
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Escalating erythrocytosis after start of pazopanib-treatment in metastatic renal cell carcinoma p. 26
Pepijn M Langbroek, Marco B Polée, Hiltje de Graaf
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.
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Radiotherapy as a primary treatment modality for squamous cell carcinoma of tongue in a case of xeroderma pigmentosum p. 29
Sakina Mankada, Ankita Parikh, Parag Roy, Amit Kichloo, Ubrangala Suryanarayana
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.
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LETTER TO EDITOR Top

Intracavitary brachytherapy can be a useful additive to simultaneous integrated boost with volumetric modulated arc therapy as dose escalation boost dose during primary irradiation for selected nasopharyngeal carcinoma cases p. 33
Ashutosh Mukherji, Vijayaprabhu Neelakandan
DOI:10.4103/JCO.JCO_19_18  
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