Clinical study of primary abdominal tumors in children of Kashmir.

The study investigated 40 patients presented on account of abdominal swelling followed by vomiting, fever, pallor, loss of appetite etc. A detailed history was taken and routine as well as specialized investigations were done. The investigation reveals 15 cases of wilms tumour, 6 patients of neuroblastomas, 12 cases of Hodgkin lymphoma, 2 patients of large gut adenocarcinoma pallor was the most evident physical finding in the majority of patients. Anemia was common predominant finding on routine haematological investigations. Chest or bony metastases were noted in a number of patients’ radiogically. Serum levels of bio chemical marks were found moderately sensitive and bone marrow cytology was found to be an important diagnostic tool for staging neuroblastoma and NHL. Surgical debulking was found to be an effective method of local tumour control in the abdomen. Surgical extirpation of tumour in the cases of pheochromocytoma a large gut carcinoma provided a good disease control. The patients who had unwarranted surgical intervention were treated with adjuvant therapy. It concluded that patients with well differentiated histology show a better response while the other with poorly differentiated adenocarcinoma had recurrence on follow-up

Chemoradiation Vs chemotherapy alone in gastric cancer (Adenocarcinoma) after surgical resection.

Background: Out come of carcinoma of stomach has not changed over the past decades and surgery remains the time tested primary modality of treatment. Attempts to improve survival have been strengthened by recent studies of adjuvant Chemoradiation in these patients. Objectives: 1) To compare the survival benefit of adjuvant Chemoradiation Vs Chemotherapy alone in surgically resected adenocarcinoma of stomach. 2) To compare the event free survival of adjuvant Chemo radiation Vs Chemotherapy alone. Study Design: Randomized prospective comparative study. Materials and Methods: Over a 2 years period (Oct 2006 to Nov 2008) 60 patients were enrolled and randomized into two arms with 30 patients in each arm. Arm A received adjuvant chemo radiation and arm B received chemotherapy only. Chemoradiation protocol include inj. 5 – FU 425mg/m2 and inj. CLV 20mg/m2 I/V d1 – d5 followed by EBRT (45 GY) only 20 #. During first 4 days and last 3 days of radiation protocol, patients also received inj. 5 – FU 400mg/m2 I/V and CLV 20mg/m2 I/V. Arm B received chemotherapy only within Cisplatin 100mg/m2 divided over 3 days, inj 5 FU 500 mg/m2 I/V bolus d1 – d3 and inj. CLV 20 mg/m2 /IV d1 – d3 q 21 days x 6 cycles. Results: All patients were followed post treatment for EFS and PFS for a maximum period of 24 months with a median followup of 19 months. EFS and PFS for two arms were; Arm A – 17.7 months and 19.0 months and Arm B – 16.0 months and 17.4 months respectively. Treatment related morbidity was significant in arm B. General well being and surrogate laboratory markers including hemogram were compared as well, favouring arm A. Conclusions: Although interim survival trends favour adjuvant chemo radiation yet results are not statistically significant necessitating a longer follows up to arrive at a definite conclusion as for as decision regarding efficacy of chemo radiation is established

Favorable subset of acute myeloid leukemia with translocation 8;21: An elusive experience

Background: Risk stratification is critical in the management of acute myeloid leukemia (AML) and among the favorable subset translocations known, 8;21 seems elusive in our clinical practice as regards the response remission status. This led us to review our patients retrospectively to highlight this ambiguity. Patients and Methods: A retrospective study was carried out on a total of 20 patients positive for translocation (8;21) and negative for FLT3 and NPM gene mutation. These patients were treated with standard AML treatment protocols. Post induction day 14 and day 28 assessments were done. Four patients died during induction chemotherapy and all the remaining patients were in remission. Subsequently, these patients were subjected to consolidation chemotherapy. Results: Out of total of 16 (80%) survivors, 10 (50%) could not maintain the remission status on a mean follow-up of 6 months and were treated with a different induction protocol. After the second induction, all patients were in remission at day 28, but this remission again was short lasting (<3 months). Conclusion: One needs to be careful in treatment of AML with translocation (8;21) and this should not be taken as a single criterion for treatment of these patients. These patients should be subjected to additional somatic mutation analysis before final risk stratification

Melorheostosis with renal arterio-venous malformation: A case report with review of literature

Melorheostosis, also known as Leri′s disease and flowing periosteal hyperostosis, is a rare cause of pain and stiffness in a limb. The appearance is of "candle greasing" down one side of one or several bones of the body. We describe a case referred to tertiary care center with suspicion of renal cell carcinoma with diffuse bone metastasis. After reassessment, the patient was diagnosed melorheostosis with renal AV malformation. He was reassured about the benign nature of the disease and is asymptomatic

Role of pre-operative chemotherapy in non small cell carcinoma lung; a comparative study.

Background: Lung Cancer remains the most common malignancy killing more people every year than breast, colon and prostate cancers in combine together. It is also the most preventable cancer with more than 80% of cases associated with smoking. In Kashmir more than 150 new cases per year are registered. The use of systemic therapy before definitive local therapy referred to as induction or neo adjuvant therapy aims to prevent the growth of systemic disease, shrink the loco regional macroscopic disease and early eradication of micro metastasis. Objectives: To evaluate the efficacy of preoperative chemotherapy based on cisplatin and paclitaxel in patients with stage IIA –IIIA non small cell cancer with regard to 1) Local tumor control, 2) Overall impact on disease free survival, and 3) Immediate and delayed toxicity due to treatment. Materials & Methods: the present case control study was conducted jointly in the Department of CVTS, Medical Oncology, Radiotherapy and Radio diagnosis of SKIMS The study was conducted over a period of 2 years and included study of 50 cases (Nov 2006 to Dec 2008). Results: The male to female ratio was 5.2: 1, in study group and 7.3:1 in control group. and the age range was 35-70yrs. Chest pain was the main presenting feature in 76% in study and 80% in control group of patients followed by cough in 68% in study group and 76% in control group. Bronchoscopy and CECT Chest was performed in all cases for staging the patient. In 4 cases we had complete response.16 patients had shown partial response and in 4 patients the disease remained static. The overall response rate was 80%. Conclusions: The pre operative chemotherapy is well tolerated and significantly increases the rate of resectibility