Asian Pacific Journal of Cancer Care

An Audit of Efficacy and Toxicity of Neoadjuvant Paclitaxel and Trastuzumab in HER- 2 Postive Locally Advanced Breast Cancer

2025-04-16T04:38:29+00:00

Background: Her 2 positive Carcinoma breast patients are different subgroup of patients, with poorer disease outcome. Locally advanced Breast cancer (LABC) patients are treated with Neoadjuvant chemotherapy (NACT). Hence with this study we intented to know the efficacy of this Neoadjuvant regimen for Her2 positive LABC.

Materials and Methods: This was a retrospective study including Her 2 positive LABC patients who received NACT with weekly Paclitaxel and Trastuzumab.

Results: Median age of the total 105 patients was 50 years. Except one patient, rest all underwent surgery after NACT. Pathological complete response (p CR) was seen in 40 (38 %) patients. Overall survival at 1 year, 2 years, 3 years and 5 years were 96.2%, 91.3%, 86.6% and 81.4% respectively. In p CR group of patients OS at 1 year and 2 years were 100% and 96.3% respectively , did not change at 3 years and 5 years, whereas in partial response patients OS at 1 year, 2 years, 3 years and 5 years were 93.7%, 85.7%, 77.7% and 70% respectively. Overall DFS at 1 year, 2 years, 3years were 87.4%, 84.3% and 82.1 % respectively.DFS in pCR group at 1 year was 92.3% and it was same at 2years and 3 years, while in p PR group at 1year, 2 years and 3 years were 84.1%, 80.9% and 75.3% respectively.

Conclusion: Neoadjuvant weekly Paclitaxel and trastuzumab combination was well tolerated and resulted in excellent pathological response in Her 2 positive LABC with minimal Grade III/ IV toxicities. Overall DFS and OS was good with significantly better, DFS & OS in p CR group of patients compared to others. Hence NACT with Paclitaxel and Trastuzumab is a well tolerated and effective regimen for Her 2 positive LABC patients. This study shows that p CR translates to better DFS and OS.

Dosimetric Comparison with Different ARC and Beam VMAT Optimization in the Monaco Treatment Planning System

2025-04-16T04:45:59+00:00

Introduction: The Monaco Treatment planning system provides the sequencing parameter ‘Max Number of Arcs’ in volumetric modulated arc therapy optimization. Using this, we can have a maximum of four arcs per beam. In this study, different arc and beam combinations are evaluated.

Aim: To compare the dosimetric parameters of VMAT plans in oral cavity radiotherapy treatment planning using single beam multiple arcs and two beam single arcs, and thereby evaluate the effects of the ‘Max Number of Arcs’ optimization parameter in the Monaco treatment planning system.

Materials and methods: Data from 10 previously treated head and neck cancer (oral cavity) patients were used for this study. For each patient, four plans were generated with different arc and beam arrangements (one beam with 4 arcs, one beam with 3 arcs, one beam with 2 arcs, and two beams with a single arc). Plans were generated with similar constraints and dose coverage objectives, and all plans were normalized to receive 95% of the PTV receiving 100% of the prescription dose. Plans were evaluated using different dosimetric parameters.

Results and discussion: Using one beam with four arc optimization parameter, homogeneous plans were generated, compromising delivery time and MU. One beam three arc plan gives comparative dose coverage, reduced delivery time, and MU compared to one beam four arc plan. One beam with two arc shows poor coverage. Two beam, one arc doesn’t give the expected result with a higher Dmax value, but MU and delivery times are on par with the three beam, one arc plan.

Conclusion: For complex head and neck plans, one beam with three arcs is recommended for obtaining the optimum dose coverage, delivery time, and MU. This leads to reduced patient-on-table time and quality assurance time.

Primary Extranodal Lymphoma – A Three Year Study in a Tertiary Care Centre

2025-04-16T04:50:31+00:00

Introduction: Primary extranodal lymphoma ( pENL ) is a group of lymphomas arising from tissues other than lymph nodes. Although the incidence of extranodal non Hodgkin lymphoma (ENL) is increasing worldwide, data is minimal.

Aims and objectives: To study the prevalence, anatomical distribution, clinical factors, and histological subtypes of extranodal lymphoma.

Materials and methods: This was a retrospective observational study conducted in the Department of Oncopathology in a regional cancer centre where we retrieved 103 cases of primary extranodal lymphoma ( pENL ) out of 380 cases of lymphoma from the institute’s data registry that were diagnosed over a period of three years from January 2017 to December 2019.

Result: There were 103 patients with primary extranodal lymphoma out of 380 patients with lymphoma, including 68 males and 35 females (M: F = 1.9:1), and the peak incidence occurred during the 4th to 5th decades of life. The age range was 4-80 years, and the mean age was 45.9 years. The median age was 50 years ± 19.2 years. The commonest site was the gastrointestinal tract (GIT) (31.8%), followed by the breast (15.5%). B-cell lymphoma was more common than T-cell lymphoma. The most frequent histopathological types of B-cell lymphoma were diffuse large B-cell lymphoma (DLBCL) (47%), Burkitt lymphoma (BL) (13%) and marginal zone lymphoma (MZL), (6%). Most of the patients in the pENL group were diagnosed to have Stage I/II lymphoma whereas Stage III/IV was more common in patients with nodal NHL. Most of the patients were treated with chemotherapy following the diagnosis. The most common chemotherapy used was cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen, and rituximab was a part of chemotherapy.

Conclusion: Primary extranodal lymphomas constitute a diverse group of haematolymphoid malignancies. The diagnosis is a frequent challenge for pathologists, due to their morphological, characteristics and varied clinical presentations. Immunohistochemistry plays a major role in the diagnosis of primary extranodal lymphoma. Compared to the published series, no difference was noted regarding sex predilection or morphology. However, as this was mostly an epidemiological and morphological study, data about the detailed therapeutic outcomes are lacking.

Tobacco-free School Training Program for Teachers and Tobacco-use among Adolescent Students in the Rural Indian Context: A Quasi-experimental Study

2025-04-16T04:56:57+00:00

Introduction: The Indian government has implemented laws banning tobacco sales and advertising to children and adolescents and also mandated guidelines for a tobacco-free school (TFS) to create tobacco-free environments. This study investigated the impact of creating tobacco-free schools on actual tobacco use by students.

Methods: The study, using a post-only quasi-experimental design, was conducted in four rural districts of Maharashtra state in western India. Teachers in two intervention districts received annual TFS training for five years, while two comparison districts did not. A cross-sectional survey was conducted in 41 schools, at the end of the five-year period, with 536 students in intervention districts and 516 in comparison districts.

Results: Intervention schools reported lesser tobacco use with 14.7% of students self-reporting tobacco use versus 24.2% of students in comparison schools. Logistic regression analysis revealed that lower exposure to TFS, greater peer pressure, and presence of adults using-tobacco at home predicted adolescent tobacco use (p<.001).

Conclusion: Creating a tobacco-free school environment seems to positively impact student tobacco-use behavior. However, combining TFS with assertiveness, refusal, and life-skills training to resist peer pressure and involvement of families will be required for successful tobacco-use prevention.

Personalised Oncology Care: A Case Study on Using an AI-Based App for Chemotherapy Management and Lifestyle Managemen

2025-04-16T05:02:51+00:00

This case report explores the use of Mebot, an AI-based mobile application, to enhance medication adherence and lifestyle management in a patient undergoing chemotherapy. Over one week, Mebot was utilised by a patient to manage a complex chemotherapy regimen, providing timely reminders for medication intake and generating personalised exercise plans to support weight reduction. The app’s “connected dots” functionality allowed for integrating related tasks like medication and exercise into a seamless health management approach. Multiple users, including the authors of this report, tested the app and reported consistent, satisfactory results, highlighting Mebot’s reliability and effectiveness. The study findings suggest that Mebot could be a valuable tool in managing non-communicable diseases (NCDs) by improving adherence to treatment protocols and supporting lifestyle interventions. However, further research involving more prominent and diverse populations is necessary to validate these preliminary observations and explore the broader applicability of AI-driven mobile applications in personalised oncology care.

Squamous Cell Carcinoma Bartholin’s Gland: Management Challenges: Case Report and Review of Literature

2025-04-16T05:09:22+00:00

Bartholin gland carcinoma is an unusual malignancy, accounting for less than 5% of all vulval cancers. Squamous cell carcinoma is the most common histological type, followed by adenocarcinoma. Bartholin’s gland carcinomas develop into masses of varying sizes and may be ulcerated or deep to the surface with the overlying skin intact. Because little is known about bartholin’s gland cancer, it is frequently misdiagnosed as an abscess or a cyst. Diagnosis is often delayed until discovered at advanced stages. To add to the literature, we report a case of locally advanced stage bartholin’s gland carcinoma in a postmenopausal lady, who is managed with radical partial vulvectomy with bilateral inguinofemoral lymphadenectomy with vulvar-vaginal reconstruction by gracilis myocutaneous flap followed by adjuvant concurrent chemoradiation. We aim to create awareness among clinicians and provide new insights for the diagnosis and treatment of this rare malignancy.

Patient Engagement and Radiotherapy Adherence in Low-middle Income Countries: A Narrative Review

2025-04-16T05:18:29+00:00

Introduction: As a cost-effective means of cancer control, radiotherapy forms a critical component of treatment for many cancers in low-middle income countries. However, its success largely depends on patient adherence. This review aimed to identify the major factors that affect radiotherapy adherence in these settings, and discuss possible means by which these may be addressed.

Methods: The Pubmed, Scopus, Web of Science, Cochrane Library, and BioMed Central databases were searched for articles pertaining to radiotherapy adherence in low-middle income countries, that were published within the last decade.

Results: Published data pertaining to radiotherapy adherence are largely lacking in these countries. However, the available data show that non-adherence has an adverse impact on cancer outcomes in these settings. Low radiotherapy capacity, inequitably distributed resources, access barriers, and financial constraints often disrupt adherence with planned radiotherapy schedules. Research pertaining to the major causes of non-adherence to radiotherapy in this setting indicates that they can be addressed by effective patient communication and engagement. Nevertheless, the potential of these basic approaches in improving outcomes remains largely underutilized.

Conclusions: Appropriate and timely policies for improving patient education and engagement may make a meaningful improvement in radiotherapy acceptance, and thereby cancer control, in these countries.