Disease characteristics and treatment outcome of testicular germ cell tumors treated with platinum-based regimens

Objective: To determine the disease characteristics of testicular germ cell tumor, biochemical/radiological response to chemotherapy and common toxicity profile. Study Design: Case series. Place and Duration of Study: Institute of Nuclear Medicine and Oncology [INMOL], Lahore, from January 2010 to December 2013

Methodology: Fifty-one patients with histologically proven testicular germ cell tumor, who fulfilled the pre-defined eligibility criteria, were selected. Presenting symptoms and disease stage were studied. Patients were staged according to the AJCC 2010 staging criteria and prognosis was classified according to the IGCCCG Classification of Metastatic Germ Cell Cancer. Initial chemotherapy treatment was based upon the International Germ Cell Consensus Classification, 1997. Patients were also evaluated for chemotherapy-induced toxicity based on Common Toxicology Criteria version 4. SPSS version 16.0 was used for statistical analysis

Results: Main presenting symptoms included testicular pain [37.3%], testicular swelling [25.5%], and abdominopelvic pain [11.8%]. Most of the patients had mixed germ cell histology [p<0.001] and presented with advanced disease stage. Out of 51 patients, 41 [80.3%] achieved complete clinical remission after first line chemotherapy. All patients having complete response achieved 2-year survival and 37 [90.2%] had no evidence of recurrent disease. Four patients with recurrent disease achieved complete remission with second line chemotherapy. Five [9.8%] had partial response after first line chemotherapy while 2 [3.9%] progressed on treatment. All patients developed alopecia, 21 [41.1%] experienced other toxicities which were managed symptomatically and with minor dose modifications

Conclusion: Many patients with germ cell tumors presented with pain, and in an advanced stage, with mixed histology. Overall response rate was 90.2% with platinum-based chemotherapy

Efficacy and toxicity of concurrent chemoradiation in inoperable oral carcinoma in pakistani population

Objective: To evaluate the efficacy of concurrent Chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity

Study Design: Case series

Place and Duration of Study: Institute of Nuclear Medicine and Oncology [INMOL], Lahore, from January 2008 to December 2013

Methodology: Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study

Concurrent Chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin [50 mg/m[2]] during the course of radiation

Tumor response was calculated by RECIST criteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as [G]

Results: Thirty-six [52.17%] patients showed complete response; while 19 [27.54%], 8 [11.59%] and 6 [8.7%] were observed with partial response, stable and progressive disease, respectively. Treatment response was significant [p<0.001] in terms of responders vs. nonresponders to treatment. Median overall survival was 18.00 months; whereas, median disease-free survival remained 14.00 months. Main toxicities included mucositis [G3 and G4, 71%], xerostomia [G2 and G3, 82.5%], vomiting [G3 and G4, 51%], myelosuppression [G3 and G4, 26.2%], dermatitis [G3 and G4, 49.2%], and fatigue [G3 and G4, 57.9%]

Conclusion: Platinum based CCRT remained effective for inoperable oral cancer patients

Unusual presentation of bone metastasis from hepatocellular carcinoma mimicking as breast lump

A 55-year female presented with left breast lump. Her sonomammography was unremarkable. Core biopsy showed it to be metastatic hepatocellular carcinoma [HCC]. Biphasic computerized tomography [CT] of liver confirmed presence of primary liver masses while CT chest showed involvement of left anterior chest wall, rather than primary breast mass. F18-Fluorodeoxyglucose [FDG] positron emission tomography CT [PET-CT] imaging confirmed primary liver tumor with bony metastases

Evaluation of paclitaxel and carboplatin versus combination chemotherapy with fluorouracil doxorubicin and cyclophosphamide as a neoadjuvant therapy in patients with inoperable breast cancer

To compare the results of patients with locally advanced breast cancer receiving two different regimens Fluorouracil, Doxorubicin and Cyclophosphamide [FAC] and Paclitaxel and Carboplatin. Comparative study. The Oncology Department, Institute of Nuclear Medicine and Oncology [INMOL], Lahore, from March 2007 to September 2008. Patients with inoperable locally advanced breast cancer of stage were included. Sixteen patients were given FAC regimen and 9 patients were given Paclitaxel and Carboplatin, each combination was cycled after 21 days for four times. Before enrollment, detailed medical histories, physical examinations and performance status assessments were done as well as postchemotherapy evaluation with regular follow-up visits was done. Complete Response [CR, xLlOO%] is defined as the disappearance of all known disease parameter i.e. disappearance in detectable tumour size, node free disease and surgery is possible. Paratial Response [PR, "L > 50%] was defined by 50% or greater decrease in the sum of the areas of bidimensionally measured lesions i.e. change of N2 to N1 or no status and some surgical procedure is possible to downstage the disease. Minor Response [MR] was defined as a decrease in the tumour insuffieceint to quality for partial responce. Static disease or no evaluable reflected no significant change in disease and no evidence of new disease. Progression of disease [> 25%] was defined as a 25% or greater increase in the area of any lesion > 2 cm or in the sum of the products of the individual lesions or the apprearance of new malignant lesions, surgery not possible. Twenty five patients completed neoadjuvant chemotherapy. Sixteen [66%] patients received FAC and 9 [37%] patients received PC chemotherapy. Overall CR [breast and axilla] was 54%, PR was 16% and minor response [MR] was 8%. FAC treatment induced more emesis, mucositis, alopecia and cardiotoxicity. No death occurred. The Paclitaxel and Carboplatin regimen was better tolerated; both regimens were effective in improving disease and overall survival

Intracranial haemangiopericytoma: a very rare entity having a high malignant/metastatic potential

Intracranial haemangiopericytomas are very rare tumours. Their radiological appearance resembles that of meningioma. Recommended treatment is total surgical excision, if possible, followed by radiotherapy. A vigilant, long term clinical and radiological follow up is very essential due to a high rate of late onset recurrence along with neural and extraneural metastases. A case report and review of literature is presented

Cervical cancer: outcome of treatment and causes of failure

To summarize the data and look into the various treatments offered to cervical cancer patients at Institute of Nuclear Medicine and Oncology [INMOL] to highlight the most likely causes of treatment failure. In this retrospective study, case files of all patients presenting with invasive carcinoma of uterine cervix during 1993-2002 were studied in respect to personal profile, disease related risk factors, pathological characteristics, treatment administered and outcome in the form of tumour response and survival. Early age at marriage, multiple marriages of self or spouse, multiparty, prolonged use of contraceptives and smoking were some of the risk factors for cervical cancer in this group of patients. Out of 618 patients presenting with invasive cervical cancer,65% presented in advanced stages II and III. Apart from advanced stage at presentation, anaemia, poor nutrition, and ignorance about self-hygiene and lack of follow-up were main causes of treatment failure. Outcome of treatment was improved when chemotherapy was added to radiation. Advanced stage at diagnosis and lack of follow-up were main causes of treatment failure. Implementation of screening programs on national level for early detection is therefore recommended