The European Organization for Research and Treatment of Cancer prostate-specific quality of life module (PR-25) in Hindi and Marathi: translation and pilot testing process.

BACKGROUND: The side effects of various treatments for prostate cancer have a measurable impact on the general as well as disease-related quality of life, which is of pivotal concern as an outcome measure. AIM: Translation and pilot testing of the European Organization for Research and Treatment of Cancer (EORTC) prostate cancer-specific module (PR-25) into Hindi and Marathi. MATERIALS AND METHODS: The translation procedure described by the EORTC was adopted; this comprised two forward translations of the original English questionnaire into Hindi and Marathi each with formation of first intermediary questionnaires and two back translations of the first intermediary questionnaires into English. The first intermediary questionnaires were adapted as the second intermediary questionnaires and pilot tested in ten prostate cancer patients as no modifications were suggested by the back translators. RESULTS: Each patient, after completing the questionnaire, was interviewed by the local project coordinator who questioned them about each item in the second intermediary questionnaire. The patients were asked whether there was any difficulty in answering, confusion while answering, or difficulty in understanding the questions; whether the questions were upsetting; and if the patients themselves would have framed the question in a different way. Based on the suggestions or interpretations of this pilot testing, the necessary changes were incorporated and the final Hindi and Marathi questionnaires were formed. CONCLUSION: Both the translations were submitted to the EORTC for review and have been subsequently approved for clinical studies.

Estimation of survival rates of breast cancer patients--a hospital-based study from Mumbai.

PURPOSE: To estimate the survival rates of breast cancer patients with reference to various factors like age, literacy status, residential status, T-stage and treatment. This is because there are very few studies reported from Indian subcontinent. METHODS: Survival rates were obtained by using the actuarial method and loss-adjusted survival rate method (LAR) for the above factors and the rates were compared. The present study carried out at the Tata Memorial Hospital (TMH), includes newly diagnosed (who were not treated elsewhere before attending TMH) primary breast cancer patients and having completed the initial treatment. RESULTS: The survival rates, actuarial survival and rates corrected for losses to follow-up (LAR) are presented. It showed that younger patients (<or=50 yrs) had a better 5-year survival ( 81%) than the older patients (> 50 years), with statistical significance ( p=0.024). There was no variation in survival with regard to the residential status but literate patients had a better ( non-significant) survival (77%) than their illiterate counterparts. T3-stage patients had the worst prognosis showing a 5-year survival of 60% (p=0.0002). Survival for those treated with surgery as the only modality and also in combination with other modalities did not show any remarkable differences except for the group that were treated with 'surgery in combination with chemotherapy'. The 5-year survival for those treated with surgery as the only modality was 83%. This study yielded useful information on breast cancer survival, especially in a situation with incomplete follow-up. The method applied (LAR) also clearly demonstrates the bias in estimates obtained by direct application of the standard actuarial method.

Role of IL-10 in immune suppression in cervical cancer.

Cervical cancer is the second most common cancer in the women worldwide and the most frequent in developing countries, including India. Human papilloma virus (HPV) is the major etiological factor in cervical cancer patients. Host factors are also critical in regulating tumor growth and cytokines that modulate immunologic control may be of particular importance. In the present study, we investigated the correlation between the presence of HPV and type of cytokines expressed in cervical carcinomas and attempted to elucidate the possible reasons for the immune suppression. Cytokines investigated were type-1 cytokine IFN-gamma (shows immunostimulatory function and capable of limiting tumor growth) and type-2 cytokines IL-4, IL-10 and IL-6 (show immunosuppressive function and capable of stimulating tumor growth). Our data demonstrated the presence of HPV sub-types 16 and 18 in 86% and 13.8% of cervical tumor biopsies, respectively. The cervical tumor biopsies showed increased presence for mRNA for IL-10 and IL-1alpha, while none of the biopsies showed expression for IFN-gamma. A correlation was observed between the presence of HPV in cervical tumor biopsies and mRNA for IL-10. Increased percentages of CD4+CD25+ regulatory T cells (Tregs) were observed in circulation in cervical cancer patients, providing evidence for increased immune suppression. IL-10 may play a key role in maintenance of Tregs and explains the immunosuppressive state of cervical cancer patients.

Age related macular degeneration: a study of patients managed with radiotherapy.

INTRODUCTION: Age-related macular degeneration (ARMD) is the leading cause of blindness in the west. Radiotherapy affects the evolution of exudative macular degeneration directly by its effect on the endothelium and inflammation modulation. We conducted a retrospective study to evaluate the improvement in visual acuity and healing of sub retinal neovascular membrane (SRNV) following fractionated radiotherapy. MATERIALS AND METHODS: 47 patients (58 eyes) of ARMD were retrospectively analyzed. One of the following radiotherapy fractionation schedules was employed in all the patients in this study. a) 15 Gy/5 fractions/1 week (five patients) b) 20 Gy/5 fractions/1 week (19 patients) c) 22.5 Gy/5 fractions/1 week (21 patients) d) 25 Gy/5 fractions/1 week (two patients). VA and funduscopy was taken at each follow-up for objective improvement and to assess the healing of SRNV. RESULTS: The median follow-up was 7.23 months. The mean improvement in the VA in the entire group was of 0.44 line. (Median 1, SD 1.04). Overall 75% of the eyes showed either steady vision or an improvement in subjective vision analysis. The deterioration free survival was significantly better in the group that had a relatively short duration of symptoms (P = 0.01). Scarring at presentation was a significant adverse factor for improvement in vision after radiotherapy (P = 0.001). CONCLUSIONS: In patients of ARMD treated with radiotherapy, the initial duration of symptoms and scarring of eyes at presentation were significant prognostic variables for improvement in VA after radiotherapy.

Vanishing bone disease involving the pelvis.

Vanishing bone disease is a rare condition characterized by progressive osteolysis of the bony structures by vascular tissue and their replacement by fibrous, vascular connective tissue. A 38-year-old lady who had a previous history of angioma of the left iliac bone presented with vague symptoms of a limping gait and pain during walking since 2 years duration. The radiologic findings were suggestive of degenerative changes. A possibility of metastatic disease was also considered. However the biopsy and Positron emission tomography (PET) scan ruled out any active disease. Like in most other cases this was possibly a self-limited disease where bone resorption had spontaneously arrested.

Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix.

BACKGROUND: Patients with locally advanced cervical cancer are often severely distressed with incessant vaginal bleeding, offensive discharge and pelvic pain and are in some instances are beyond curative potential. At our institution we routinely use monthly palliative pelvic radiotherapy for these patients. METHODS AND MATERIAL: One hundred patients treated between 2000 & 2004 were included in this analysis. Patients were treated with parallel-opposed pelvic portals with megavoltage radiation monthly up to a maximum of three fractions (10 Gy/fraction). Patients with good response after second fraction were considered for intracavitary brachytherapy delivering 30 Gy to point A. Response was documented with regard to relief of bleeding, vaginal discharge and pelvic pain. The other aspects evaluated were patient compliance, disease response, toxicity and survival. RESULTS: Sixty-eight percent had FIGO stage IIIB, 12% had stage IVA and 14% had IVB disease. Twenty patients had metastatic disease. The median symptom duration was 5 months. Majority (67%) presented with vaginal bleeding, followed by discharge (69%) and pelvic pain (48%). All patients received at least one fraction of palliative pelvic radiotherapy. Sixty-one patients received the second fraction and 33 the third. Five patients received an intracavitary application. The overall response rates in terms of control of bleeding, discharge and pain were 100%, 49% and 33% respectively. The treatment was generally well tolerated with a median survival of 7 months. CONCLUSIONS: Monthly palliative pelvic radiotherapy results in satisfactory control of symptoms in patients with locally advanced carcinoma of cervix with acceptable complications.

Management of locally advanced breast cancer: evolution and current practice.

Locally advanced breast cancer (LABC) accounts for a sizeable number (30-60%) of breast cancer cases and is a common clinical scenario in developing countries. The treatment of LABC has evolved from single modality treatment, consisting of radical mutilating surgery or higher doses of radiotherapy in inoperable disease to multimodality management, which along with the above two included systemic therapy. Neoadjuvant chemotherapy (NACT) has made a tremendous impact on the management of LABC. NACT was initiated to institute systemic therapy upfront at the earliest in this group of patients with a high risk of micrometastasis burden. While NACT did not yield a survival advantage, it has however made breast conservation possible in selected group of cases. Large number of studies and many randomised trials have been done in women with LABC in order to improve the therapeutic decisions and also the local control and survival. With this background we have reviewed various treatment options in patients with LABC which should possibly help in guiding the clinicians for optimal management of LABC.

Isolated prostatic metastasis from primary sigmoid colon carcinoma.

Metastasis to the prostate is extremely uncommon. We report a 38-year-old man with sigmoid colon carcinoma, treated with surgery and adjuvant chemotherapy, who developed isolated metastasis to the prostate four years after initial treatment. He was treated with chemoradiation and remains disease-free three years after detection of metastasis.