First-line therapy outcomes in patients with advanced stage nonsmall cell lung cancer treated at nongovernment tertiary care centrer in India: Experience from a real world practice.

INTRODUCTION: Reports on first line or subsequent treatment and their outcomes for patients with advanced nonsmall cell lung cancer (NSCLC) in India are scarce. The present study is an attempt to understand real world practice scenario of first-line therapy and outcome in advanced stage NSCLC patients. METHODS: Observational study was conducted at a nongovernment tertiary cancer care center. Totally 83 patients with newly diagnosed advanced NSCLC who were evaluated for further treatment from 2008 onward were included in the study. RESULTS: Best supportive care was the only treatment received in 11/83 patients. Sixty-three patients received platinum-based doublet chemotherapy and nine received epidermal growth factor receptor tyrosine kinase inhibitor (TKI) as first-line therapy. Pemetrexed and platinum was the most common first-line chemotherapy (56%) regimen used. First-line chemotherapy had to be discontinued in these eight patients due to Grade III/IV toxicity. Disease control rate with the first-line chemotherapy was 70% (partial response 38%, stable disease 32%). Median overall survival (OS) was 17 months with OS at 1 and 2 years was 52% and 29.5%, respectively. CONCLUSION: First-line platinum-based chemotherapy is feasible and does achieve disease control in the majority of patients with advanced NSCLC. Strategies of selection of therapy based on histology and the presence of driver mutations, use of small molecule TKI, maintenance therapy and multiple lines of therapies are being increasingly implemented in clinical practice and thus improving survival of Indian patients of NSCLC.

Surgical treatment of glottic cancer: retrospective analysis of 192 cases in a multidisciplinary tertiary care centre in Pune, India.

OBJECTIVES: A multidisciplinary team approach is required for the preservation of voice and appropriate management of glottic cancer. This study aimed to investigate the outcomes of surgically treated glottic cancers of all stages. All aspects of surgical management, such as laser cordectomy, partial laryngectomy, total laryngectomy with voice prosthesis, and salvage laryngectomy, conducted at a single tertiary care institute in India, were reviewed. METHOD: A retrospective analysis of hospital records was performed for 192 glottic cancer patients who were surgically treated between 2003 and 2007. RESULTS: Patients with tumour stages 1 or 2 glottic cancer treated with laser cordectomy had a local control rate of 85 per cent and five-year survival rate of 98.6 per cent. The findings suggest that the number of partial laryngectomies performed for stage 3 tumours is declining. Patients with a tumour stage 3 lesion with a fixed hemilarynx or a tumour stage 4 lesion, treated with total laryngectomy, were found to have a five-year survival rate of 61.6 per cent. Nodal status was significantly associated with five-year survival rate. CONCLUSION: Surgery offers a viable five-year survival rate in glottic cancer patients.

Prevalence and causalities of tobacco consumption (TC) among adolescents: a cross sectional study at Pune.

BACKGROUND AND OBJECTIVES: Health risks associated with tobacco consumption (TC) are well known. The aim of this study was to assess the prevalence and causality of tobacco consumption among adolescents. METHODS: A cross-sectional study was conducted with 6577 participants aged 12 to 20 years from 21 schools and colleges in Pune during year 2005/6. Data on socio demographic profile, family members' tobacco habits and respondents' tobacco consumption habits were collected by self-administered questionnaire. Convenience sampling method was used for data collection. RESULTS: Complete information on age, gender and participants' consumption of tobacco was available for 6119 students. This data was used for analysis. Average age of the students was 16.9 +/- 1.79 years. 51% were boys. 9% lived in the hostels. Prevalence of TC was 4.2% (256). Prevalence increased from 2.1% at < 14 years to 9.8% at 18 to 20 years of age. Respondents aged < 14 years spent about Rs. 110 per month on tobacco while those over 18 years of age spent about Rs.142 per month (P < 0.05). Significantly (p < 0.0001) more boys (85.2%) consumed tobacco compared to girls (14.8%). Hostel residents consumed tobacco more than those not living in hostel (13% Vs 8.6%). Significantly more (p < 0.0001) number of fathers and brothers of TCs consumed tobacco than non TCs. (Fathers: 53.1% Vs 29.7%), (Brothers: 5.7% Vs 1.1%). CONCLUSION: Tobacco consumption among adolescents in Pune is low. However to reduce it further, intervention should start prior to teenage before they form their opinion and start consuming tobacco.

A study of tubercular lymphadenitis: a comparison of various laboratory diagnostic modalities with a special reference to tubercular polymerase chain reaction.

OBJECTIVE: The purpose of our study was to compare various laboratory diagnostic methods, namely histopathological examination, Ziehl-Neelsen (ZN) stain, AFB culture by conventional Lowenstein-Jensen (LJ) method and fluorescence-based mycobacterial growth indicator tube (MGIT) technique and polymerase chain reaction (PCR) in clinically suspected cases of tubercular lymphadenitis. MATERIALS AND METHODS: A total of 65 lymph nodes biopsied from patients clinically suspected of having tubercular lymph nodes were included. Specimens were processed for AFB culture after NaOH-NALC concentration and inoculation on LJ medium and using the MGIT system. PCR was performed on all specimens using a commercial nested PCR kit targeting IS6110 insertion element of Mycobacterium tuberculosis complex. All lymph node specimens were subjected to histopathological examination. RESULTS: Of the 65 lymph nodes, 37 (56.9%) were positive on MGIT culture and 45 (69.2%) were positive by PCR. Histopathology showed maximum sensitivity (96%) but with compromised specificity (78.5%). PCR showed 90.1% sensitivity and 100% specificity. The mean turnaround time for mycobacterial growth in smear negative specimens was 30 days determined by LJ and 20 days by MGIT techniques. CONCLUSION: PCR is a rapid and useful method for diagnosis of TB lymphadenitis and definitely increases the positive predictive value of a positive histopathology report. MGIT is better than LJ culture as regards time to positivity and higher yield.

Stage I testicular tumours: the Tata Memorial Hospital experience.

One hundred and fifty-six patients with stage I testicular germ cell tumours--81 seminomas and 75 nonseminomatous tumours--were treated at the Tata Memorial Hospital, Bombay over a 5 year period. Among the seminomas, 71 were treated with post-orchidectomy prophylactic radiation therapy to the retroperitoneum and/or mediastinum, while 10 patients refused radiation therapy and were put on surveillance. The disease-free and total survival in seminomas were 92.6% and 100%, respectively. Among the patients with nonseminomatous tumours, 58 had normal levels of serum biomarkers while 17 had raised biomarkers. In the normal marker group, 20 patients underwent retroperitoneal lymph node dissection (RPLND) with a nodal positivity of 30%, while the other 38 patients refused surgery and were either placed on unplanned surveillance (33 patients) or chemotherapy (5 patients). In this group, the patients undergoing RPLND had a survival rate of 100% as compared to 93.9% in those with surveillance. The overall disease-free and total survival rates in patients with normal markers were 86.2% and 96.6%, respectively. In the raised marker group, 6 patients underwent RPLND with a survival rate of 100% and 11 patients received chemotherapy with a survival of 90%, with the overall survival for patients with raised markers being 94.1%. The overall disease-free and total survival rates for all patients with stage I nonseminomatous tumours were 88% and 96%, respectively.