No abstract

Purpose. Neuroendocrine neoplasms (NENs) of the esophagus are very uncommon with only a few studies published worldwide. Studies on clinical profile, management, and outcomes are very uncommon. Methods. We report the largest single institution retrospective review of 43 patients of pure esophageal NENs out of our registry of gastrointestinal neuroendocrine tumors treated between 2005 and 2014. Data on the incidence, tumor location, clinical symptoms, stage at presentation, grading, treatment protocol, and treatment outcomes was collected and analyzed. Results. Among 1293 cases of esophageal cancers, pure esophageal NENs were diagnosed in 43 cases. The mean patient age was 55.8 years. The male : female ratio was 1.5 : 1. 81.4% of the tumors were located in the lower third of the esophagus and gastroesophageal junction. Neuroendocrine carcinomas (NEC; G3) accounted for the vast majority of NENs (83.7%). 53.5% patients were Stage IV and 32.5% were Stage III at presentation. The combined median survival of stages II and III patients was 18.25 months, with treatment. The median survival of treated patients with metastatic disease was 6.5 months. Conclusion. Esophageal NENs most commonly were neuroendocrine carcinomas, presented in metastatic stage and were associated with poor prognosis. Grade 2 (G2) tumors had better outcomes than NEC (G3). In nonmetastatic disease, presence of lymph node metastasis and unresectable disease had poorer outcomes.

Context:Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer with significant geographical variation. There are limited data on epidemiology and outcomes of NPC reported from Southern India.Settings and Design:Retrospective analysis.Materials and Methods:We analyzed our hospital data between January 2005 and December 2011 with NPC and analyzed their demographic parameters and outcomes with therapy.Results:A total 143 cases of NPC were identified. Median age at presentation was 35 years with male predominance. Majority (84%) of the cases had the WHO Type 3 histology. Nodal metastasis at presentation was seen in 90% of the cases, majority being bilateral. Distant metastasis was seen in 16% of the cases, most commonly at bone, lung, and liver. Concurrent chemoradiation with weekly cisplatin was offered to 84.7% of localized disease while 80% of these also received adjuvant chemotherapy. Complete remission and partial remission were achieved in 66.1% and 15.2% of the cases, respectively. Weekly cisplatin was well tolerated with Grade 3–4 toxicity seen in 22% of cases. At a median follow-up of 20 months, 2-year progression-free survival and overall survival were 67.2% and 79.5%, respectively.Statistical Analysis Used:SPSS software version 20.Conclusion:NPC is a rare head and neck malignancy in Southern India, presenting with advanced stage and more propensity to distant metastasis. It has good outcomes to concurrent chemoradiation with weekly schedule of cisplatin being well-tolerated regime. Further prospective studies to test this schedule and other novel agents in this potentially curable malignancy are warranted.

Chronic myeloid leukaemia (CML) is a myeloproliferative disorder. Over the years many prognostic models have been developed to better risk stratify this disease at baseline. Sokal, Euro, and EUTOS scores were developed in varied populations initially receiving various therapies. Here we try to identify their predictive and prognostic implication in a larger population of Indian patients with CML-CP (chronic phase) in the imatinib era.

Background:Colorectal cancer (CRC) is considered a disease of elderly. There has been a steady decrease in the incidence in those aged >50 years, with an alarming increase noted in adults aged <50 years.Subjects and Methods:We retrospectively analyzed 89 patients diagnosed with CRC aged <40 years between the years 2010 and 2014. Their clinical profile, treatment, and outcomes were studied.Results:The median age was 33 years with a male preponderance (56.2%). Most common symptoms were lower gastrointestinal bleed (48.3%) followed by abdominal pain (46.1%). Most common sites were rectum (50.6%) followed by colon. Histology in all was adenocarcinoma. Most tumors were moderately differentiated (54%) and were stage 4 (36%). Most common sites of metastases were liver (46.9%) followed by peritoneum and ovaries. Majority underwent surgery with adjuvant chemotherapy, with/without radiotherapy. Chemotherapy was administered in 70 patients, majority receiving FOLFOX-4 regimen (88.6%). Median survival was 23 months. Survival in early stage[1],[2] was significantly higher than in advanced stages (3 and above), 34 and 19 months (P = 0.0287), in those aged >40 years compared to <40–35 versus 23 months (P = 0.0029), nonmetastatic compared to metastatic disease – 26 versus 14 months (P = 0.00196), and females compared to males – 26 and 18 months (P = 0.0242). There was no significant difference in survival with respect to tumor grade or site of metastases (hepatic versus extrahepatic).Conclusions:Colorectal carcinoma in young seems to be an emerging problem in India. Any young patient presenting with symptoms suggestive of a colonic malignancy should be evaluated promptly and treated aggressively.

BackgroundWith the widespread use of antiretroviral therapy in patients with HIV-AIDS, a prolonged life expectancy is now evident. This has led to an increased incidence of malignancies in this patient population. The spectrum of malignancies in these patients differs worldwide. Objective To study the patterns of AIDS-de ning malignancies (ADMs) and non-AIDS-de ning malignancies (NADMs) in patients in India with HIV-AIDS and to analyze the correlation of CD4 counts with the malignancies. Methods This retrospective study included patients presenting with a malignancy and coexisting HIV-AIDS from January 2013 through December 2016. Patients with CD4 counts at the time of diagnosis of malignancy and having received treatment were analyzed. Analyses of the patient characteristics and correlation of CD4 counts with ADM and NADM were performed. Results A total of 285 patients were evaluated. The median age was 44.8 years (range, 5-80 years). The mean CD4 count was 235.4 cells/mm 3 (range, 50-734 cells/mm 3 ; reference range, 500-1,500 cells/mm 3 ). Cervical cancer was the most common malignancy in women, and non-Hodgkin lymphoma (NHL) was the most common among men. There was a statistically signi cant difference in CD4 counts between ADMs and NADMs (P = .03). A statistical difference was also noted when the CD4 counts of patients with NHL were compared with other malignancies. However, there was no statistically signi cant difference noted when CD4 counts of patients with cervical cancer were compared with NADM (P = .914). Limitations This was a retrospective study and included only patients receiving treatment for malignancies at a single institution. Conclusions NHL and cervical cancer continue to be the most common malignancies in patients with HIV-AIDS in developing countries. NHL tends to occur in patients with lower CD4 counts. Funding/sponsorship None.

Background:Limited repertoires of targets are available in the management of squamous cell carcinoma lung. In this study, we analyzed epidermal growth factor receptor (EGFR), RAS, BRAF mutations in lung cancer patients of squamous cell histology using next-generation sequencing (NGS) on the circulating cell-free DNA (cf-DNA).Materials and Methods:In this prospective observational study, patients with squamous cell carcinoma lung, either newly diagnosed or having a progressive disease on prior therapy were eligible. Cf-DNA was extracted from peripheral blood and analyzed for EGFR, KRAS, NRAS, and BRAF mutations using NGS.Results:Sixteen patients were enrolled over a period of 1 month. The mean cf-DNA quantity extracted from the plasma was 96.5 ng (range, 15–200 ng). Eight clinically relevant mutations in the EGFR pathway were identified. These include Exon 21 mutations in 4 patients, Exon 20 mutation in onepatient, complex mutations with coexisting Exon 21 and Exon18 in one patient and KRAS Exon 2 mutations in two patients.Conclusion:cf-DNA is a minimally invasive technique for detection of clinically relevant mutations in lung cancer patients. The use of novel advanced techniques such as NGS may help in detecting EGFR pathway mutations in patients with squamous cell carcinoma lung.

PBL was seen to have a uniformly aggressive clinical course with poor outcomes even with optimal treatment. The prognosis of immunocompetent patients appears to be worse than that of HIV-AIDS patients. Although the most common histologies seen with GI lymphomas are mucosa-associated lymphoid tissue type lymphomas or diffuse large B-cell lymphoma, rarer and more aggressive histologies like PBL need to be kept in mind.