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

Vinin NV — 2025-04-16

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

Silpa Ajay kumar — 2025-04-16

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

Rukmini Bezbaruah — 2025-04-16

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.

Correlation between Radiologic Tumor Regression Grading (ycMRI) and Pathological Tumor Regression Grading (ypTRG) in Rectal Cancer

Kanmani Velarasan — 2025-05-04

Aim: To study the correlation between clinical tumor regression grading by MRI (post RT) and the pathological tumor regression grading post neoadjuvant treatment in patients with rectal cancer.

Materials and Methodology: Patients with histopathologically confirmed adenocarcinoma, locally advanced stages non metastatic were included. Exclusion criteria were patients with poor performance status, recurrence and patients with distant metastasis. Patient planned for radiation therapy with 3D conformal radiotherapy technique. Dose prescribed was 50.4Gy in 28 fractions along with Inj. 5FU and Leucovorin every 28 days. MRI was taken 6 weeks after radiation therapy. Tumor regression grading done using TRG score (MRI). Pathologic tumor response assessed by modified Ryan scheme for tumor regression. Correlation between MRI and pathological grading was done using Pearson correlation test.

Results: Among 38 patients, 30 (89%) patients were males and 8 (11%) patients were females. Stage T3 (60.52%) was seen in 23 patients and T4 in 12 (31.57%) patients. Most common stage was IIIB in 23 (60.5%) patients followed by IIIC in 10 (26.3%) patients. 7 patients did not complete the entire course of radiation therapy and 6 patients defaulted for further clinical response assessment. Out of 25 patients, 19 (76%) patients underwent surgery. 6 patients were not willing for surgery due to fear of permanent colostomy. Among the 19 patients who underwent surgery, near complete response and partial response, were seen in 6 (31.6%) patients and 7 (36.9%) patients respectively and no response was seen in 6 (31.6%) patients. Clinical TRG (MRI) correlated well with pathological TRG (r = 0.97, p - 0.000).

Conclusion: Clinical tumor regression grading by MRI correlated well with pathological tumor regression grading in our study. TRG has to be studied more in relevant to patient specific care.

Low Dose Daily Cisplatin vs Weekly Dose Cisplatin in Radiation Therapy for Head and Neck Squamous Cell Carcinoma, A Comparative Study

Sharath Sreeni — 2025-05-20

Introduction: Head and neck cancer is prevalent in India’s North and North Eastern regions, often treated with concurrent cisplatin-based chemo-radiation therapy. This study compares the efficacy, side effects, and toxicities of daily low-dose cisplatin versus weekly high-dose cisplatin in head and neck cancer patients receiving radiation therapy. Objective: To assess the efficacy and compare the toxicities of daily versus weekly cisplatin dosing in concurrent chemo-radiation therapy.

Materials and Methods: A study of 139 patients with biopsy-proven head and neck squamous cell carcinoma was conducted at Assam Medical College from October 2022 to August 2024. Patients were assigned to either daily (ARM A) or weekly (ARM B) cisplatin regimens. Toxicities were graded using RTOG criteria, and tumour response was assessed with RECIST criteria.

Results: ARM A showed a higher complete response (56%) compared to ARM B (49%). ARM A had lower acute toxicities, including dysphagia and mucositis( p value < 0.05). Both regimens showed similar weight loss and low rates of nephrotoxicity.

Conclusion: Daily low-dose cisplatin offers similar efficacy with fewer severe acute toxicities, making it a preferable option for head and neck cancer patients.

Diagnostic Utility of Lymphoid Enhancer Binding Factor 1 Immunohistochemistry in Chronic Lymphocytic Leukaemia/ Small Lymphocytic Lymphoma

Vishnu V L — 2025-05-27

Objective: Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) is a common mature B-cell neoplasm composed of monomorphic small mature B cells co-expressing CD5 and CD23. Diagnosis is based on morphologic evaluation and immunophenotyping, but no specific immunohistochemical marker is availableTo evaluate the usefulness of LEF1 in the diagnosis of CLL/SLL by immunohistochemistry and in distinguishing CLL/SLL from other small B-cell lymphomas.

Methods: Previously diagnosed 120 cases of small B cell lymphomas by IHC/flowcytometry from 1^st January 2017 to 31^st December 2019 in the RCC, Thiruvananthapuram are included in the study. This includes thirty diagnosed cases of CLL/SLL (lymph node/ bone marrow trephine biopsies). Thirty cases of follicular lymphoma, 30 cases of mantle cell lymphoma and 30 cases of marginal zone lymphoma are also included in the study for comparison. Clinical details, morphological features and IHC already done for these cases (CD20, CD5, CD23 and cyclin D1) were analysed. IHC for LEF1 is done in all 120 cases using Rabbit (EP310) monoclonal antibody. Data is entered into excel sheet and analysis is done using SPSS software.

Result: LEF1 has 100% sensitivity, specificity, NPV, PPV, and accuracy for diagnosing CLL/SLL, with a diagnostic cut-off of 100%, compared to other immunomarkers.

Conclusion: LEF1 is a highly specific and sensitive diagnostic marker for CLL/SLL, aiding in the differential diagnosis of small B-cell lymphomas.

Cutting-Edge Innovations: ICG Fluoroscopy in Colorectal Cancer and Liver Tumors

William Augusto Casteleins — 2025-05-21

Indocyanine Green (ICG) fluorescence imaging has been revolutionizing the surgical management of colorectal cancer and liver metastases by providing a dynamic real-time visualization of tissue perfusion, lymphatic pathways, and tumor margins. This innovative technology has demonstrated significant benefits in colorectal surgeries by reducing anastomotic leakage rates, enhancing vascular assessment, and improving the safety of anastomoses, thereby decreasing postoperative morbidity. In liver surgery, ICG fluorescence enables precise identification of metastatic lesions, particularly small or deep-seated tumors, and aids in achieving R0 resections with better oncological outcomes. Moreover, its capacity to visualize the boundaries of tumors intraoperatively enhances surgical precision while minimizing unnecessary tissue resection. Despite these advantages, widespread adoption of ICG fluorescence imaging is hindered by the lack of standardized protocols and reliance on subjective interpretation of fluorescence signals. Future advancements, such as quantitative fluorescence analysis, integration with artificial intelligence, and robotic-assisted platforms, are expected to overcome these limitations and further enhance the utility of ICG in surgical oncology. As a minimally invasive, cost-effective, and versatile tool, fluorescence represents a paradigm shift in the approach to managing colorectal cancer and liver metastases, offering patients safer and more precise surgical interventions.

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

Nilesh Chatterjee — 2025-04-16

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.

From Mountain to Medicine: Overcoming Radiotherapy Setup Challenges in the Sub-Himalayan Region

Kapil Kumar Soni — 2025-05-27

Cancer is a major public health challenge, particularly in low and middle-income countries (LMICs), where access to essential treatment modalities such as radiotherapy remains inadequate. India, with an increasing cancer burden, faces significant disparities in cancer care due to financial, geographic, and infrastructural limitations. The situation is especially dire in rural regions, including Himachal Pradesh, where a predominantly rural population struggles with limited healthcare resources. Despite an increasing incidence of cancers such as cervical, breast, and head and neck cancers many of which require radiotherapy patients in this region often lack access to timely treatment, leading to poorer outcomes. The primary challenges to establishing effective radiotherapy facilities in the Sub-Himalayan region include economic and financial barriers, regulatory and administrative delays, geographic constraints, and a shortage of trained professionals. The high cost of modern radiotherapy equipment, along with the rugged terrain and fragmented healthcare infrastructure, further complicates the development of treatment centers. Additionally, a lack of trained oncologists, physicists, and radiotherapy technicians limits the availability of high-quality cancer care. To overcome these challenges, a multi-pronged approach is necessary. Infrastructure development, increased funding, and expedited regulatory approvals can facilitate the establishment of radiotherapy centers. Public-private partnerships can help mitigate financial constraints, while training programs, in collaboration with national regulatory bodies, can address workforce shortages. Community outreach initiatives aimed at raising awareness about early cancer detection are also crucial for improving treatment outcomes. Ensuring equitable access to radiotherapy services in the Sub-Himalayan region requires coordinated efforts from policymakers, healthcare providers, and stakeholders. By addressing these barriers, healthcare accessibility can be improved, ultimately enhancing cancer treatment and survival rates in underserved populations.

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

Hari Prakash Gunisetty — 2025-04-16

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

Pallavi Verma — 2025-04-16

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.

A Hit? or A Miss? Learning From Errors: A Misplaced Nasogastric Tube

Ansha Sinha — 2025-05-04

A 76-year-old poorly built female presented to the emergency department with right sided acute chest pain and breathlessness after an episode of unprovoked heavily strained vomiting, consisting of food particles and blood streaks. Chest radiograph showed right sided hydro-pneumothorax. Intercostal drain insertion was done immediately, and her symptoms improved. Patient’s son noticed rice particles in the ICD bag after she had consumed it for lunch that day. A nasogastric tube insertion was done. The chest radiograph obtained after the insertion showed a peculiar course. The tube did not reach its designated goal, but it helped in diagnosis of occult esophageal carcinoma.

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

Aparna Gangopadhyay — 2025-04-16

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.