3%). T-cell ALL constituted 24% (351 cases) of ALL. Common subtypes of AML included AMLM2 (27%), AMLM5 (15%), AMLM0 (12%), AMLM1 (12%), APML (11%), and AML t(8;21) (9%). CMLBC was commonly of myeloid blast crisis subtype (40 cases).Conclusion: B-cell ALL was the commonest subtype in children and AML in adults. Overall incidence of AML in adults was low (53% only). CD13 was most sensitive and CD117 most specific for determining myeloid lineage. A minimal primary panel of nine antibodies consisting of three myeloid markers (CD13, CD33, and CD117), B-cell lymphoid marker (CD19), T-cell marker (CD7), with CD45, CD10, CD34, and HLADR could assign lineage to 92% of AL. Cytogenetics findings lead to a change in the diagnostic subtype of myeloid malignancy in 38 (1.5%) cases. q
It is often difficult for people with cancer to make decisions for their care. The aim of this review is to understand the importance of shared decisionmaking (SDM) in Indian clinical scenario and identify the gaps when compared to practices in the Western world. A systematic search (2000-2019) was executed in Medline and Google Scholar using predefined keywords. Of the approximate 400 articles retrieved, 43 articles (Indian: 5; Western: 38) were selected for literature review. Literature review revealed the paucity of information on SDM in India compared to the Western world data. This may contribute to patientreported physical or psychological harms, life disruptions, or unnecessary financial costs. Western world data demonstrate the involvement and sharing of information by both patient and physician, collective efforts of the two to build consensus for preferred treatment. In India, involvement of patients in the planning for treatment is largely limited to tertiary care centers, academic institutes, or only when the cost of therapy is high. In addition, cultural beliefs and prejudices impact the extent of participation and engagement of a patient in disease management. Communication failures have been found to strongly correlate with the medicolegal malpractice litigations. Research is needed to explore ways to how to incorporate SDM into routine oncology practice. India has a high unmet need towards SDM in diagnosis and treatment of cancer. Physicians need to involve patients or their immediate family members in decision making, to make it a patient-centric approach as well. SDM enforces to avoid uninformed decisionmaking or a lack of trust in the treating physician's knowledge and skills. Physician and patient education, development of tools and guiding policies, widespread implementation, and periodic assessments may advance the practice of SDM.
Aim : Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor. Methods : A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed. Results : The overall median survival time was 55.16 months. The 5-year overall and disease-free survival rate for the cohort was 49% and 23%, respectively. The 5-year survival is 67% for low-stage versus 33% for high-stage tumors and is significantly different ( P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P -value of 0.02. Conclusion : The tumor location and clinicopathological stage were the most important predictors of the disease-free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.
The multidisciplinary approach to treating squamous cell carcinoma of the head and neck is complex and evolving. Chemotherapy is increasingly being incorporated into the treatment of squamous cell carcinoma of the head and neck. Previously, radiotherapy following surgery was the standard approach to the treatment of loco regionally advanced resectable disease. Data from randomized trials have confi rmed the benefi ts of concurrent chemo radiotherapy in the adjuvant setting. Chemo radiotherapy is also the recommended approach for unresectable disease. Advanced loco regional disease is the most frequent clinical situation in Head and Neck cancer. The standard of care for most clinicians is a multidisciplinary treatment with concomitant chemotherapy plus radiotherapy (CRT). However, retrospective studies have shown that in patients treated with CRT there was a relative increase in systemic relapse due to a lack of systemic control. For this reason a renewed interest has appeared for the incorporation of induction chemotherapy in the treatment of locally advanced Head and Neck Cancer. Furthermore new combination regimens with taxanes have shown to be more active than the classical cisplatin and 5-fl uorouracil induction regimen. Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both loco regionally advanced and recurrent/metastatic squamous cell carcinoma of the head and neck.
This suggests that empirical antibiotic therapy needs to be changed on the basis of the age of the patient. It also appears that combination therapy is essential for the empirical treatment of infections in elderly patients with cancer.
249 CMYK Zoledronic acid induced osteonecrosis of tibia and femurSir Zoledronic acid has a classical adverse effect on jaw osteonecrosis. Osteonecrosis of bones, other than of the jaw, has hardly been reported. A 51-year-old female with left side triple negative breast cancer, with multiple bone metastases diagnosed seven months back, presented to us with a history of progressive painful swelling in both knee joints, from the last one month. She was unable to extend her knees and had backache and weakness in both lower limbs. She was bedridden at the time of presentation. She was on intravenous zoledronic acid, with a dosage of 4 mg every month, and had also received palliative radiotherapy to the upper dorsal spine six months ago. There was no history of trauma or steroid use.On examination, she was bedridden with flexed position of both knees. Both knee joints had synovial effusion with marked tenderness. Other bones and joints were normal. Breast examination revealed a hard lump in the left upper quadrant, with a mobile axillary lymph node. Systemic examination revealed bilateral paraparesis without bladder or bowel involvement. There were no other neurological deficits. Investigations including complete blood count, serum biochemistry, electrolytes, calcium and phosphorus, antinuclear antibody, and rheumatoid factor were all normal. Urinalysis was normal. Synovial fluid microscopy was performed and cultures were negative. Skiagrams of the knees was normal. The whole body Tc-99m MDP bone scan revealed metastases to the dorsolumbar spine, ribs, skull, and acetabulum.A magnetic resonance scan revealed altered signal intensity of all vertebrae from T2 to L1 spines with cord indentation and collapse of T11 and T2 to T5, and the knee joints revealed altered marrow signal intensity involving a 21 centimeter long segment of the distal right femur, 22 centimeter long distal left femoral shaft, a 15 centimeter segment of proximal tibia shaft, and subarticular bones bilaterally, appearing heterogeneously hyperintense on STIR (Short T1 Inversion Recovery) [ Figure 1] and T2W images, with sharply defined hypointense borders. A diagnosis of bone necrosis was favored over bone metastases due to absence of cortical breaks, periosteal reaction, or mass lesion, with presence of diffuse, medullary, serpigineous lesions without any uptake on bone scan. Bilateral knee joint effusion was seen. The patient was advised to undergo knee replacement surgery, but she opted for palliative care and expired two months back.Bisphosphonate-induced osteonecrosis of the jaw is a known complication of bisphosphonate treatment in patients with [1,2] multiple myeloma and bone metastases. It is seen more often with longer durations of treatment with zoledronic acid than with pamidronate. [3] Mandible and maxilla are commonly involved. [4] Avascular Figure 1: STIR images showing both femoral shaft osteonecrosis al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med 1990;322:1195-201...
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