Diagnosis of Oral Cancers by Targeting VPAC Receptors: Preliminary Report

Introduction: Oral cancer is a major health problem. The study of exfoliative cytology material helps in the differentiation of premalignant and malignant alterations of oral lesions. The objective of this study was to assess the feasibility of detecting oral cancer by targeting genomic VPAC (combined vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide) receptors expressed on malignant oral cancer cells. Patients & methods: All patients with suspected oral cavity cancers/lesions formed the study group. The samples from the oral cavity lesion or suspicious area were collected with a cytology brush. The harvested material was examined for malignant cells by 1. the standard PAP stain and 2. targeting the VPAC receptors on the cell surface using a fluorescent microscope. Similarly, malignant cells were identified from cells shed in oral gargles. Results: A total of 60 patients with oral lesions were included in the study. The histopathological diagnosis was squamous cell carcinoma in 30 of these. The VPAC receptor positivity both on the brush cytology staining as well oral gargle staining was more sensitive than the brush cytology PAP staining. The accuracy of the various techniques was as follows, brush cytology PAP staining at 86.67%, brush cytology VPAC staining at 91.67% and oral gargle VPAC staining at 95%. Conclusions: This preliminary study validates our belief that malignant cells in the saliva can be identified by targeting the VPAC receptors. The test is simple, easy, non-invasive and reliable in the detection of oral cancers

A Rare Giant Pleural Thymoma in Posterior Mediastinum

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Unusually, thymomas can also be found in other locations. Surgical excision, when feasible, appears to provide good results. We encountered a rare case of a thymoma that developed in the right thoracic cavity, and originating from the pleura in posterior mediastinum. We describe the clinical scenario, investigations, and our management of the patient

Concurrent Weekly Cisplatin and Simultaneous Integrated Boost-IMRT in Locally Advanced Head and Neck Squamous Cell Carcinoma—An Institutional Experience

Introduction Concurrent chemoradiation with weekly cisplatin in locally advanced head and neck squamous cell carcinoma (LA-HNSCC) is widely practiced in India. Radiation with simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) has the advantage of executing IMRT in single phase with better dose distribution. Material and Methods 150 patients with LA-HNSCC treated between April 2015 and December 2019 were retrospectively evaluated. All patients received 70Gy in 33 to 35 fractions with SIB-IMRT and concurrent weekly cisplatin at a dose of 40 mg/m2. Treatment compliance and toxicities were assessed. Overall survival (OS) was evaluated using Kaplan-Meier estimates; univariate and multivariate analysis of prognostic factors were also evaluated. Results Median age was 58.5 years. Forty-five percent had primary oropharyngeal cancer. Sixty-two percent had T3 disease, 41% had N2 disease, and 51% had stage IV disease. All patients received 70Gy dose of RT. Median chemotherapy cycles were six, 84.7% received 200 mg/m2. Acute grade 2 xerostomia was seen in 79%, grade 3 neutropenia, mucositis and pharyngitis were seen in 11, 15, and 21%, respectively. Complete response was seen in 66.6%. At median follow-up of 21.4 months (3–71) OS was 60% and median OS was 33.2 months. Estimated 2 and 3 year OS was 56 and 48%. On univariate analysis, absence of node, N0–N1, stage III, cisplatin use, dose per fraction 2.12Gy ,and complete response showed good OS (p <0.05). On multivariate analysis dose per fraction 2.12Gy and complete response showed good OS (p <0.05). Conclusion Definitive chemoradiation with weekly cisplatin and SIB-IMRT in LA-HNSCC is well tolerated with good clinical outcomes

Predictive factors for loco regional recurrence and distant metastasis following primary surgical treatment of cutaneous melanoma

Background: Cutaneous melanoma (CM) has a high propensity for regional and systemic spread. This is one of the largest series of CM reported from India. Aims: To predict factors for loco regional recurrence (LRR) and distant metastasis in patients with CM primarily treated with surgery. Study Design: Retrospective analysis of patient database at a tertiary care cancer center with evaluation of factors for LRR and distant metastasis for CM. Materials and Methods: Data from 68 patients treated for CM between January 2006 and December 2010 were reviewed. Data recorded included age, sex, symptoms, investigations, treatment given, histopathology, recurrence and follow-up. Patient factors, tumor factors, pathologic variables, and adjuvant treatment were investigated as predictors′ of LRR and distant metastasis. Results: Mean age of patients was 54 years. Melanoma was more common in males (44). Tumor thickness > 4 mm was found in 43 patients. Lymph node involvement was found in 43 patients. Adjuvant radiotherapy was given in seven patients. At mean follow-up of 16.5 months, LRR was seen in 34 patients and distant metastasis in 28 patients. LRR and distant metastasis were more commonly found in females, age > 40 years, Clark′s level IV and V, Breslow′s depth > 4 mm, patients with lymph node involvement and extra-capsular spread. Conclusion: The age, sex, site, thickness of lesion, involvement of lymph node, and extra-capsular spread were important factors in predicting LRR and distant metastasis. Distant metastasis was also more commonly found in patients with LRR

Diagnosis of cancer of the cervix by targeting VPAC receptors on exfoliated cervical cells

Introduction: Cervical cancer is a major cause of cancer morbidity and mortality in women. Screening for cervical cancer reduces mortality through early detection and treatment. The success of the screening for cervical cancer has been largely attributed to the use of Pap smear (Papanicolaou). The objective of this study was to assess the feasibility of detecting cervical cancer by targeting genomic VPAC receptors and compare the results with those of Pap-test. Material and Methods: Women ≥40 years of age underwent routine screening for cervical cancer. The cellular material obtained from the cervix was gently smeared on a clean glass slide. The slides were then stained according to Papanicolaou’s technique. Similarly, another set of prepared smears were used for VPAC receptor detection. Histopathological examination of the cervical biopsy was done and the results of all three tests were compared. Results: A total of 114 women attending the Gynaecology outpatient department of our hospital were included in the study. Histopathological examination (HPR) of the cervical biopsy revealed that 25 patients had cervical cancer and the remaining 89 were negative for cervical cancer. The Pap smear gave positivity for malignant cells in 20 (80%) of cases reconfirmed on HPR. The false positive rate and false negative rates were 4.5% and 20%, respectively. The VPAC receptors were positive in 23 (92%) of the 25 cases with cancer of the cervix. The false positive and false negative rates were 2.2% and 8%, respectively. Conclusions: Diagnosis of cancer of the cervix can be reliably made by targeting the genomic VPAC receptors. The test is simple to perform, reliable, reproducible and with minimal false positivity having a higher diagnostic accuracy