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Article | IMSEAR | ID: sea-205590


Background: In adults most common intracranial malignant lesion is brain metastasis, far outnumbering primary brain tumor. The most common primary site is lung cancer (18–64%), followed by breast (25–21%), malignant melanoma (4–16%), and colorectal cancer (2–12%). It is hypothesized that the incidence of brain metastasis might be increasing, as a result of increasing survival from recent advance in cancer treatment, more frequent brain screening for specific primary malignancy that known to have a higher prediction for brain metastasis and greater availability and use of magnetic resonance imaging (MRI) of brain. In clinical oncology, understanding brain metastasis is important, because it has profound effect on length of survival, quality of life, and in one-third to one-half of affected patients, they represent the direct cause of death despite current improvement in therapeutic approach. Epidemiological data of brain metastasis are lacking in India. Objectives: Aims of our retrospective analysis are to study epidemiology and pattern of care of brain metastasis over last one decade in Nil Ratan Sircar Medical College and Hospital, Kolkata. Materials and Methods: Between 2006 and December 2017, a total of 710 patients of brain metastasis treated in our department with palliative intent were analyzed retrospectively. New-onset neurological symptoms in a known case of cancer we always presumed that, symptoms were due to brain metastasis until proven otherwise. Hence, all patients presenting with acute neurological signs and symptoms underwent through clinical examination, contrast-enhanced (CE) computed tomography brain, and/or CEMRI of brain. Epidemiology, pattern of care, and outcome in the form of overall survival (OS) and disease-free survival were determined. Results: Fifty-seven percent patients were male. The median age was 62 years at the time of diagnosis. Lung carcinoma was most common primary site seen in 52% patients, followed by carcinoma breast second most common primary site, seen in 32% patients. Headache (73%) and motor weakness were most common presenting symptoms. Supratentorial location most common site, out of which parietal region is most common. The only small number of patients was offered best supportive care alone whereas majority of the patients were considered fit for palliative therapy. Treatment consisted of metastasectomy when possible and palliative whole-brain radiotherapy (WBRT) alone or followed by systemic therapy. Optimal supportive care in addition to chemotherapy or radiotherapy is given to all patients. A total of 254 patients were given blood product, erythropoietin, granulocyte-colony-stimulating factor following chemotherapy. Hospitalization required in 71% patients and tumor-related problem was most common cause (46%). Remaining patients were hospitalized for delivery WBRT or CCT. The median OS is 9 months. Patients with younger age and breast primary associated with better prognosis than lung primary. Conclusions: We can conclude that carcinoma lung in male and carcinoma breast in females was most common cause of brain metastasis. Because advance in palliative therapy, outcome of patients with brain metastasis has improved, and patients with brain metastasis benefit from palliative radiotherapy and chemotherapy and this treatment could be delivered easily on outpatients basis.

Article | IMSEAR | ID: sea-205578


Background: Breast cancer is a major public health problem for women throughout the world. According to GLOBOCAN 2012, India along with the United States and China is responsible for almost one-third of global breast cancer burden. There has been 11.54% increase in incidence and 13.82% increase in mortality due to breast cancer in India from 2008 to 2012. According to GLOBOCAN 2018, for both sexes, breast cancer second most common cancer after lung cancer accounting for 11.6% of total cases. Most of the cases diagnosis at an advanced stage because of inadequate screening, lack of appropriate medical facilities thereby increasing breast cancer mortality. It is the second most common malignancy among Indian women accounting for 7% of global burden of breast cancer. Incidence of breast carcinoma varied in the different regions of the world with lowest incidence in Africa, Asia and highest incidence in North America and Europe. This geographic variability is not only to environmental factors but also to lifestyle. There is a paucity of epidemiological data regarding carcinoma of breast. Objectives: The aims of our study were to evaluate the prevalence and epidemiology of breast cancer in our institution, N.R.S. Medical College Kolkata. Materials and Methods: We have analyzed 4172 newly diagnosed breast carcinoma cases, registered at N.R.S. Medical College and Hospital, Kolkata, West Bengal, India, over one decade, in between January 2008 and December 2017 retrospectively. A total of 4172 cases confirmed by pathological examination were included for analysis. Demographic and clinicopathological profile and management offered to the breast cancer patients were recorded from the medical records file. The staging was performed using American Joint Committee on Cancer tumor, node, and metastasis classification staging system. Results: In our study, about 63% of the patients came from urban areas and 37% from rural areas. The mean age at diagnosis was 52 ± 9.5 years, with a range from 26 to 82 years. The age at menarche in this study ranged from 10 to 16 years, mean being 12 ± 1.5 years. Age at the time of first pregnancy ranged from 19 to 32 years, with the mean age being 22 ± 6.2 years. Family history of breast carcinoma in first and second degree relatives was found in 92 (2.2%) patients in this study. Approximately 5% (216) patients were nulliparous. About 63% of the patients were postmenopausal while 36% were premenopausal. Common presenting symptoms include breast lump (100%) and axillary swelling (33%). Histologically, 99.5% cases were infiltrating ductal carcinoma, and it was most common histology. Most patients were diagnosed with Grade II tumors (45%) followed by Grades I and III, and approximately 75% of the patients were in Stages II and III and 10% patients in Stage IV. The most common site of metastasis was lung (33%), bone (26%), liver (23%), and brain (14%). Conclusions: The majority of the breast carcinoma patients presented with Stages II and III disease, approximately 99% cases were infiltrating ductal carcinoma, not otherwise specified and were mainly Grade II followed by Grade III disease. The prevalence of estrogen receptor, progesterone receptor hormone receptor status and Her2/neu status in the population needs further investigation in the future. The government needs to urgently strengthen and augment the existing facilities including screening, which is inadequate at present to handle the current breast cancer load in India.

Article | IMSEAR | ID: sea-205575


Background: Globally, cervical cancer is the most common gynecological cancer and the 4th most common malignancy in women with over 526,000 cases diagnosed in 2015 and 239,000 dying of carcinoma cervix every year. Cervical cancer is more common in areas where women have less access to screening, including parts of Asia, Africa, and Central and South America. Cervical cancer is the second most common cancer among women in India and also the second most common cancer among women between 15 and 44 years of age and one of the leading causes of cancer mortality, accounting for 17% of all cancer death among women aged between 30 and 69 years. Nearly, all cases of cervical carcinoma can be attributable to human papillomavirus (HPV), and type 16 and 18 cause 70% of cervical cancer and precancerous cervical lesion worldwide. It is now well-established fact that persistence of HPV infection is a causative factor for cervical neoplasia. Epidemiological data regarding cervical cancer are lacking in India. Objectives: The aim of our study was to evaluate the prevalence and epidemiology of cervical cancer in our institution. Materials and Methods: Newly diagnosed carcinoma cervix cases registered at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India, between January 2009 and December 2018, were analyzed retrospectively. A total of 4082 cases confirmed by histopathological examination included for analysis. Age, parity, age at marriage, residential area, symptoms, stage, and histological types collected from patient’s record file. Staging was done using Federation of Gynecology and Obstetrics staging system. Results: About 92% of patients came from rural areas and rest of the patients came from urban areas. Median age of diagnosis is 48 years. Most patients presented in Stage II and Stage III disease (85%). Squamous cell carcinoma found in 85% of patients and most common histology; adenocarcinoma second most common histology (14%). Lymph node metastasis seen in pelvic nodes (48%) followed by para-aortic node (9%) and supraclavicular metastasis in <1% of patients. The most common sites of distant metastasis seen in lung (19%) followed by bone (14%) most commonly to pelvic bone and lumbar vertebra. Conclusion: Most carcinoma cervix patients presented in Stages II and III and squamous cell carcinoma is the most common histology seen in 85% of patients. HPV related and molecular risk factors are needed further investigation in future. Multi-institutional and longer period of study may represent population-based data. Awareness of our society regarding needs for screening of asymptomatic patients and HPV vaccination initiative from government is needed for the reduction of incidence and death from cervical cancer.

Article | IMSEAR | ID: sea-205400


Background: Esophageal carcinoma is high prevalence in Asia, including India and most of the patients present in advanced and inoperable stage. Most of the patients have poor nutritional status and low performance status. These patients are unable to tolerate radical treatment. Prognosis of these patients is very poor. There are no enough data of prospective study in palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy in Eastern India. Objectives: The main objective of our study was palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy. Materials and Methods: The study was done with 43 patients with histopathologically proven squamous cell carcinoma and/or adenocarcinoma at thoracic esophagus, intraluminal brachytherapy feasible. Patients were received external beam radiotherapy palliative dose 30 Gy in 10 fractions for 2 weeks followed by intraluminal high-dose rate brachytherapy 6 Gy per fraction per week for 2 weeks. Results: In our study, the mean age of the patients was 58 years (age range 48 years–70 years). 1 month after completion of intraluminal brachytherapy, a number of patients with improvement of dysphagia were 34 (79%). The improvement of dysphagia was maintained 25 (73.5%) patients at 3-month completion of treatment and 14 (56%) patients at 6-month completion of treatment. The median duration of dysphagia relief was 5.2 months. Post-radiotherapy complications as chest pain were seen in 10 (23.2%) patients, esophageal strictures were developed in 7 (16.3%) patients, ulcerations were in 4 (9.3%) patients, and esophageal fistula was developed in 1 (2.3%) patient. Conclusion: The patients with advanced inoperable or metastatic esophageal carcinoma and poor performance status, palliative radiotherapy are effective modality of treatment for the improvement of dysphagia.