Sunitinib-induced acute severe hypothyroidism in a case of metastatic gastrointestinal stromal tumor: A case report.

Thyroid abnormalities are found nearly 70% cases receiving sunitinib therapy. Mostly, patients suffer transient hypothyroidism rarely presents with overt acute symptoms requiring levothyroxine replacement. Onset is variable in published literature. We report a case of metastatic gastrointestinal stromal tumor receiving sunitinib with normal baseline thyroid function. The patient developed symptoms of acute severe hypothyroidism with high thyroid stimulating hormone level on the 4th week of therapy. The patient responded with oral levothyroxine. clinical and biochemical parameter resolved rapidly. Patient receiving sunitinib warns baseline and subsequent surveillance of thyroid function (both clinical and biochemical). This rare dreadful condition reverts promptly with thyroxine replacement.

A randomized controlled pilot study to compare capecitabine-oxaliplatin with 5-FU-leucovorin as neoadjuvant concurrent chemoradiation in locally advanced adenocarcinoma of rectum.

CONTEXT: Established as an adjuvant chemotherapy, CapeOX has recently been shown to have radiosensitizer property in a phase I and II studies, with appreciable downstaging and tolerable toxicities. AIMS: The study was designed to evaluate whether the capecitabine-oxaliplatin combination was superior to 5-fluorouracil (5-FU)-leucovorin as radiosensitizer for neoadjuvant chemoradiation in downstaging locally advanced rectal adenocarcinoma and to compare the toxicities between the two arms. SETTINGS AND DESIGN: Single institutional, double blinded, prospective, noncrossover, randomized control pilot study. SUBJECTS AND METHODS: In arm A (n = 21), patients received capecitabine (1,000 mg/m(2) daily) in twice dailydoseon days 1-14 and 25-38 and oxaliplatin (85 mg/m(2)) intravenous ( IV) over 2 h, on D1 and D29. In arm B (n = 21), patients received leucovorin (20 mg/m(2)) and 5-FU (350 mg/m(2)) from D1-5 and D29-33. Patient in both the arms received concurrent radiation (50.4 Gy in 28 #, in conventional fractionation of 1.8 Gy per fraction). Six to eight weeks after concurrent chemoradiation, patients underwent assessment and surgery with total mesorectal resection. Postoperatively, adjuvant chemotherapy with m-FOLFOX 6 of 4 months was given to all patients. STATISTICAL ANALYSIS USED: Chi-square test was used to compare categorical variables between the groups. RESULTS: Objective response rate (ORR) in arm A was 80.95% compared to arm B which had 66.66% (P = 0.3055). Pathological complete response (pCR) rate of arm A was comparable to arm B (23.8 vs 14.28%, P value = 0.6944). Surgery with R0 resection was possible in 80.95% cases of arm A compared to 66.66% cases of arm B (P = 0.4827). Grade III toxicities were quite comparable between two treatment arms. CONCLUSIONS: In terms of ORR, pCR rate, R0 resection, and toxicity profile; both the arms were comparable.

Small cell carcinoma of the urinary bladder: a case report and review of the literature.

Small cell carcinoma of the urinary bladder is extremely rare. In this report, a case of non-metastatic small cell carcinoma of the urinary bladder treated by systemic chemotherapy followed by adjuvant external radiotherapy, with a brief review of the epidemiology, clinical features, diagnosis, pathological features, staging, treatment and prognosis about this neoplasm is reported. A 53 years old man attended with sign and symptoms suggestive of a bladder cancer. Computed tomography of the whole abdomen showed a large tumour at right lateral wall of the bladder. Transurethral resection and histopathological study of the bladder tumour established the diagnosis of a small cell carcinoma. The patient received six cycles of platinum based chemotherapy with adjuvant locoregional external radiotherapy. He had an invasive bladder recurrence thirteen months later and died shortly afterwards.

Demographic and clinical profile of patients with brain metastases: A retrospective study.

CONTEXT: Brain metastases are the most common type of intracranial neoplasm, with the total number outnumbering primary brain tumors by a ratio of 10:1 and occur in about 25% of cancer patients. However, controversies exist regarding demographic and clinical profile of brain metastases. AIMS: The purpose of this study was to analyze retrospectively the demographic and clinical profile of patients with brain metastases. SETTINGS AND DESIGN: Retrospective, single institutional study. MATERIALS AND METHODS: A retrospective study of 72 patients with brain metastasis was carried out from November 2010 to October 2012. The data pertaining to these patients was entered in a standardized case record form. These include History; clinical examination and other investigations including computed tomography/magnetic resonance imaging scan of the brain. STATISTICAL ANALYSIS: A statistical analysis was performed on the data collected using the MedCalc version 11. RESULTS: Brain metastases were more common in male and occur in 6(th) decade of life mostly. There was no relationship of occupation or socio-economic status with the incidence of brain metastases. Carcinoma lung was the most common primary giving rise to brain metastases followed by breast. Adenocarcinoma accounts for most common histology of the primary that give rise to metastases. Multiple metastases were more common than the single group. Supratentorial lesions were more common than infratentorial lesions. Among them, parietal lobe was the most common site of involvement. CONCLUSIONS: The present study highlights that the incidence of brain metastasis is common in elderly population and mostly due to primary lung. Adenocarcinoma was the most common histology of primary. Majority of lesions has been observed at parietal lobe.

Extranodal Rosai-Dorfman Disease presenting as spinal extradural lesion: a case report with a review of the literature.

Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) is a rare, but well-documented entity. We report a male patient who presented with progressive paraparesis, with thoracolumbar extradural lesion (from D11 to L2 level) on magnetic resonance imaging (MRI). He underwent D12-L2 laminectomy followed by total removal of extradural spinal space-occupying lesion (SOL). Histopathological diagnosis of the lesion was RDD. Four weeks after surgery, he was treated with external beam radiotherapy, total dose: 50.4GY in 28 fractions. On three-month follow-up, he did not have any neurological deficits. There was no evidence of other extranodal or lymph node involvement. This case has been reported on account of rare presentation of this disease as spinal extradural lesion. Pertinent literature has been reviewed.

Pure accelerated radiation versus concomitant chemoradiation in selected cases of locally advanced carcinoma cervix: a prospective study.

OBJECTIVE: This non-randomized study was conducted to assess and compare the response and safety of true accelerated radiation alone to concomitant chemoradiation in locally advanced squamous cell carcinoma of the uterine cervix. METHODS: Sixty patients with locally advanced squamous cell carcinoma of the uterine cervix, FIGO Stages (2009) IB2-IIIB were non-randomized to receive six fractions per week of external beam radiation (EBRT) (will be henceforth referred to as Arm A or Study arm or pure accelerated radiation arm) and five fractions per week of EBRT and chemotherapy with inj cisplatin 40 mg/m(2) i.v. every Monday during the course of EBRT (will be henceforth referred to as Arm B or Control arm or chemoradiation arm). RESULTS: The median follow-up was 15 months in both the arms. The overall treatment time was 56.54 days for Arm A and 62.59 days for patients in Arm B (P value < 0.000**). The median EBRT time was 32.25 days in Arm A and 38.85 days in Arm B, a statistically significant delay for patients of chemoradiation Arm B (P value < 0.000**). The response assessment at the end of the study was not statistically different among the patients in both the treatment arms (P value 0.631). CONCLUSION: The early responses to treatment with pure accelerated EBRT are non-inferior to concomitant chemoradiation and the acute toxicities are lesser.

Basaloid squamous cell carcinoma of nasopharynx: an extremely rare variety of tumour of nasopharynx.

Nasopharyngeal carcinoma is the predominant tumour type arising in the nasopharynx with cervical lymphadenopathy present in 60-90% of all cases at the time of presentation. The most pathological varieties include squamous cell carcinoma well-differentiated keratinising, and moderately differentiated non-keratinising and an undifferentiated type. The rare variety of squamous cell carcinoma is basaloid type, according to the "WHO Classification of Tumours Pathology and Genetics: Head and Neck Tumours". In this study, we present a case of basaloid squamous cell carcinoma of nasopharynx in a 41-year female who presented with epistaxis and bilateral cervical lymphadenopathy.

A randomized controlled trial to compare the efficacy of bisphosphonates in the management of painful bone metastasis.

INTRODUCTION: The prospective interventional single-institution randomized control study was carried out to compare the pain relieving efficacy among different bisphosphonates at the cost of incidence of skeletal-related events (SRE). MATERIALS AND METHODS: During June 2008 and May 2011, 256 patients with painful bone metastasis in solid tumors with a pain score of at least 5 were randomized into three arms: zoledronic acid (4 mg, i.v.), ibandronate (6 mg, i.v.) and pamidronate (90 mg, i.v.). Radiation was given to all patients, either 800 cGy single fraction or 20 Gy in five fractions. The ANOVA test was used for analysis. The Pearson test was used to correlate pain scores with proportions of responders as statistical estimation of pain relief. RESULTS: With a mean baseline pain score of 6.5 ± 1.2, there was no difference in pain scores among the three treatment arms, assessed at 3 months and at the end of the study. However, the pain scores at 6 months were statistically reduced in zoledronic acid-receiving patients (1.5 ± 0.4) unlike the scores in patients receiving ibandronate (3.1 ± 0.5) and pamidronate (2.3 ± 0.4), with a P-value of 0.024. The response was statistically significant at 6 months (0.039) and at the end of the study (0.023), in favor of zoledronic acid. Pearson's correlation demonstrated a statistically significant positive correlation between pain scores and response rates. There were no statistical differences in the narcotic scores among the treatment arms during the study period. The overall duration of pain relief was not different in any of treatment arms. The time of detection of hypercalcemia was no different; however, the incidence of hypercalcemia was significantly less in the zoledronic acid arm (28.3%) against 44.6% and 50% in ibandronate and pamidronate arms, respectively, with a P-value of 0.041. CONCLUSION: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

Knowledge and attitude towards cancer: the need for health education.

This study attempts to record the status of knowledge, ideas and opinions of a group of enlightened urban people of Kolkata about different aspects of cancer. Information gathered from 727 persons (341 males and 386 females) showed that most of the subjects consider cancer as the most alarming disease and pain as its most distressing problem. More than half of them think that cancer is curable in only 25% cases and 72% think it is 'sometimes' preventable. The commonest site of cancer, according to 38% of them, is stomach whereas that in female, according to 52% is uterus. Most of them are well aware about the risk of repeated x-ray exposures, smoke and dust but not about oral contraceptives. Majority (92%) opined in favour of a cancer specialist for consultation and more than 98% think that cancer, once diagnosed, must be treated, preferably with radiotherapy (45%), against surgery (29%) and anti-cancer chemotherapy (24%). Early detection was emphasised by 78% for increasing cure rate. Shyness was thought by the majority to be the chief cause of delay in seeking treatment in case of breast cancer cases. As health education media television and cinema slides were considered to be most effective. Most of the subjects advocated for psychological (47%) or medical (34%) support in the terminal stages of cancer.

Posterior mediastinal biphasic synovial sarcoma in a 12 year-old boy: a case report and review of literature.

We report a case of biphasic synovial sarcoma of the mediastinum, a very rare tumor, in a 12-year-old boy with left-sided chest pain of 3 years duration at presentation. Chest X-ray showed left-sided opacity with loss of cardiac silhouette and the mediastinum deviated to the opposite side. Computed tomography (CT) of thorax showed left-sided posterior mediastinal mass with left-sided pleural effusion and pleural thickening. CT guided fine needle aspiration cytology (FNAC) from the mass reported it as spindle cell variant of adenocarcinoma. Ultrasonography (USG) of the whole abdomen revealed no abnormality. The mediastinal tumor was resected by left thoracotomy and histopathological report confirmed it to be a biphasic synovial sarcoma with capsule invasion at places.