Patterns of failure in patients with nasopharyngeal cancer of Northeastern region of India: a retrospective observational study.

PURPOSE: We aimed to analyze patterns of failure and disease volume-treatment outcomes in patients with Nasopharyngeal carcinoma (NPC) treated with definitive radiation with or without concurrent chemotherapy at a tertiary cancer centre in northeast India. METHODS: From February 2018 to February 2022, 99 histopathologically proved non-metastatic NPC patients treated with curative-intent RT with or without chemotherapy were retrospectively analyzed. Locally advanced patients received neoadjuvant or adjuvant chemotherapy. The Cox proportional hazards model was used to investigate the impact of various prognostic factors on locoregional free survival (LRFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). The log-rank test and Kaplan-Meir curves compared outcome variables based on ROC analysis-classified tumor volume. RESULTS: During a median follow up of 25.4 months (17.3-39.2), 35(35.4%) patients developed recurrence. Twenty-three patients developed locoregional failures, of which 11 were in-field; 12 patient showed an out-field failure. The 3-year LRFS, DMFS, PFS and OS was 71.10%, 70.90%, 64.10% and 74.10% respectively. There was statistically significant difference in LRFS according to T staging (p < 0.0001). Gross tumor volume (GTVp) and gross nodal volume (GTVn) were an independent prognostic factor for OS, PFS, LRFS and DMFS. The cut-off volumes for GTVp and GTVn for distant metastases and locoregional failure, respectively, were found to be 13 and 22.7 mL and 3.7 and 39.2 mL, respectively, by ROC curve analysis. Based on this, 99 patients were divided into three subgroups. OS demonstrated significant differences among patients in different volume subgroups for GTVp (p = 0.03) and GTVn (p = 0.00024). CONCLUSIONS: For NPC patients who undergo curative IMRT, primary tumour and nodal volumes are independent prognostic indicators. GTVp and GTVn are highly predictive of local control, distant metastases, disease-free survival, and overall survival. This justifies their use as quantitative prognostic indicator for NPC.

Prognostic Significance of Neutrophil-Lymphocyte Ratio in Patients of High-Grade Glioma Undergoing Adjuvant Chemoradiation: A Prospective Study.

PURPOSE: High-grade gliomas are highly fatal disease with poor prognosis despite multimodality management. Inflammatory biomarkers are widely used for prognostication in various solid malignancies to stratify high risk patients. The current research was conducted to investigate whether any change in neutrophil-lymphocyte ratio (NLR) during adjuvant chemoradiotherapy has any prognostic significance in high-grade glioma patients. MATERIALS AND METHODS: Seventy-three biopsy proven high-grade glioma patients treated with adjuvant chemoradiotherapy were enrolled in this study. Haematological parameters were collected before treatment, weekly during treatment, and at 4th week after chemoradiotherapy along with baseline characteristics. Overall survival (OS) was determined using Kaplan-Meier curve. Variables found statistically significant in univariate analysis by Cox regression model were subjected to final multivariable analysis. RESULTS: The median follow-up was around 17 months with a median OS of 17.2 months (95%CI 14.7-23). The best prognosis was seen in patients who had a baseline NLR< 3.5 with decline in NLR during treatment achieving a 1-year survival of 100% and median overall survival of 36.5 months. Patients who had baseline NLR ≥3.5 without a decline in NLR had worst prognosis with a 1-year survival of 25% (95%CI 9.4%-66.6%) and median OS of 7.1 months. On multivariate analysis, age [HR 1.025, p=0.040)], ECOG performance status≤1 [HR 0.089, p<0.001], extent of surgery [HR 0.305, p=0.001] and decline in NLR during treatment [HR 0.452, p=0.026] were found to be significant predictors of OS. CONCLUSION: This study demonstrated that NLR is a cost-effective biomarker that has prognostic significance in predicting overall survival for high-grade glioma patients.

Factors Associated With Neurocognitive Impairment Following Chemoradiotherapy in Patients With High-Grade Glioma: Results of a Prospective Trial.

BACKGROUND: High-grade gliomas (HGG) are highly fatal tumors despite advanced multimodality management. They are also associated with neurocognitive impairment, both due to disease pathology and treatment. We aimed to assess various risk factors responsible for neurocognitive decline in HGG patients undergoing adjuvant chemoradiation. METHODS: Newly diagnosed HGG patients who underwent maximal safe resection were included. Patients received volumetric modulated arc therapy to a dose of 60 Gy in 30 fractions, along with concurrent temozolomide (TMZ) at a dose of 75 mg/m²/day orally; thereafter adjuvant TMZ (150-200 mg/m² for 5 days), given every 28 days for 6 to 8 cycles. The Mini-Mental State Examination questionnaire was used to measure cognitive impairment of each study patient at various time points. Cox regression model was used for univariate and multivariable analysis of data to establish possible risk factors. RESULTS: Fifty-three patients were enrolled and analyzed. At a median follow-up of 15 months, 30 patients (56.6%) developed cognitive impairment, and 23 patients (43.4%) did not. On univariate analysis, HGG with WHO grade 4, glioblastoma and diffuse midline glioma histology, IDH-wild type, recursive partitioning analysis class IV/V, and only biopsy of primary tumor were significantly associated with neurocognitive impairment, but none of them were independent risk factors on multivariable analysis. Planning target volume and dose received by ipsilateral hippocampus were also significantly correlated with cognitive decline in HGG patients. CONCLUSION: Decline in neurocognitive functions in HGG patients is multifactorial and can be attributed to an amalgam of various tumor, patient, and treatment-related factors.

Liposarcoma of Larynx-A Case Report and Updated Review of Literature.

Liposarcomas of the larynx is an extremely rare entity, and less than 50 cases have been published in English language literature. It is a malignant mesenchymal tumour arising from adipose tissue with a very high propensity for local recurrence. Well-differentiated liposarcomas are the most common variety but are challenging to diagnose because of their resemblance with benign tumors like lipoma and other malignant soft tissue sarcomas like myxoid chondrosarcoma. Therefore, immunohistochemistry (IHC) should be considered for confirmation. Wide local excision is the treatment of choice, and post-operative radiotherapy can be considered in cases of positive resection margins not amenable for revision surgery, high tumour grade, and myxoid variant. We are reporting a case of well-differentiated liposarcoma of the left aryepiglottic fold (AEF) in a 66-year-old man who was diagnosed to have a benign lipomatous lesion in the same location 3 years back. Based on the reports of the published cases, we are presenting a management algorithm for this entity.