Estimating unknown heterogeneity in head and neck cancer survival: a parametric shared frailty approach

The term frailty was introduced by Vaupel et al. to indicate that dierentindividuals are at risks even though on the surface they may appear tobe quite similar with respect to the measurable attributes such as age, sex,habits etc. The term frailty can be utilized to represent an unobservablerandom eect shared by subjects with similar risks in the analysis of timeto event data and/or mortality rates. In this article, we make use of theparametric shared frailty models to a real life data for identifying the distributionalform of baseline hazard function. The gamma shared frailty, withdisease stages as clusters, with log-logistic baseline hazard model came outto be the best choice for modeling survival data of head and neck cancerpatients treated with radiotherapy. The suitability of the best-chosen modelis justied considering two signicant covariates, namely age of the patientsand habit of their alcohol consumption. We obtain the estimates of frailty(or unknown heterogeneity) for ve stages of disease taken as clusters forGamma- log-logistic shared frailty model

Factors associated with survival and lost to follow-up of cervical cancer patients in a tertiary cancer centre in rural Kerala

Cancer cervix is the second common cause of cancer death in India. It is the most curable form of any human cancer if detected at the precancerous stage. Although several factors determine the survival of the disease, the clinical stage at presentation is the single most important predictor of long-term survival. The present study aimed to describe the performance and follow-up status and 5-year survival experience of the cervical cancer patients registered between 2010 and 2011 by the hospital registry of Malabar Cancer Centre, Kerala, and factors affecting lost to follow-up and survival among them. The case sheets of 227 patients retrospectively scrutinized during May–July 2014. The mean age of patients was 58.8 years (standard deviation = 11.67 years). The majority of the patients completed the initially planned treatment, but a low proportion of patients were likely to be on regular follow-up. This study revealed that most of the patients registered at the hospital only at an advanced stage. Using Kaplan–Meier method, the estimated 5 years survival rate was found to be 66.8%. It was noted that performance status before treatment and Federation of Gynecology and Obstetrics staging were significantly associated with lost to follow-up and survival rate majority of the cervical cancer patients are observed to be highly noncomplaint to complete treatment and on follow-up. Thus, these findings stress the importance of counseling family members regarding the importance of follow-up and formulating public health policies aimed at increasing the awareness and implementation of cervical cancer screening programs in North Malabar

Cystic renal neoplasm causing hypertension in a 2-year-old child

Cystic neoplasms of kidney in pediatric age group include a wide variety of tumors, both of benign and malignant pathology. In a child, renal neoplasms with associated hypertension are rare. Here, we present a 2-year-old child who had a multicystic renal tumor with hypertension. She underwent radical nephrectomy subsequent to which hypertension disappeared. The postoperative pathology revealed multicystic nephroma

Non Iodine Avid Bone Metastasis from Differentiated Thyroid Cancer: A Case Series

Differentiated Thyroid Carcinoma (DTC) constitute up to 90 per cent of all thyroid malignancy. The overall prognosis of patients with DTC is good, but when bone metastases are present, the overall survival at 10 years ranges from 13 to 21%. Treatment of metastatic thyroid cancer that are non iodine avid offers a surgical challenge. This paper reviews a series of three cases of DTCs with bone metastasis treated by surgery

Age-adjusted charlson comorbidity index and 30-day morbidity in pelvic surgeries

Introduction: Charlson comorbidity index (CCI) is a validated tool enabling clinicians for prediction of adverse events posttherapy. In this study, we planned to estimate the predictive value of age-adjusted CCI (ACCI) in assessing the perioperative complication in oncological patients undergoing major pelvic surgeries. Methods: This was a single arm, prospective, observational study, in which adult patients with pelvic malignancies undergoing pelvic surgeries were selected. The relationship between the ACCI and Grade 3–5 adverse events were tested using Fisher's test. Results: The rate of Grade 3–5 adverse event rate was 16.7% (11 patients, n = 66). Among the whole cohort, 11 patients (16.7%) had high score on ACCI. The rate of Grade 3–5 adverse events was higher in the cohort of patients with high ACCI score (45.5% vs. 10.9%, P = 0.014). The sensitivity, specificity and negative and positive predictive values were 45.5%, 89.1%, 89.1%, and 45.5%, respectively. Conclusion: ACCI can predict for postsurgical adverse events. It has a high negative predictive value for nonoccurrence of adverse events

Volumetric modulated arc therapy for prostate cancer patients with hip prosthesis

AimTo study the use of RapidArc techniques in the treatment of prostate cancer patients with hip prosthesis.BackgroundAn important aspect of treatment planning is to achieve dose homogeneity inside the planning target volume (PTV). Especially for those patients presenting with hip prosthesis, it becomes a challenging task to achieve dose uniformity inside the PTV.Materials and methodsFive prostate patients presenting with hip prosthesis who had undergone radical radiotherapy were selected for this study. Depending on the composition of prosthesis, a predefined set of Hounsfield values were assigned to each study set. RapidArc plans were generated on an Eclipse treatment planning system. Two arcs that include clockwise and counter-clockwise arcs were used in all these cases. To avoid beams passing through the prosthesis, a simple structure was defined around it with 1[[ce:hsp sp="0.25"/]]cm margin and a strict dose constraint applied to the block during VMAT optimization.ResultsThe mean D2/D98 ratio of PTV for all the patients was 1.06[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.01. The mean percentage rectum volume receiving 50[[ce:hsp sp="0.25"/]]Gy, 60[[ce:hsp sp="0.25"/]]Gy, 70[[ce:hsp sp="0.25"/]]Gy and 75[[ce:hsp sp="0.25"/]]Gy for all the patients were 33.1[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]5.9, 21.7[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]5.5, 13.8[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]4.4 and 9.5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]3.0, respectively.ConclusionsThis study shows that using a double arc RapidArc technique is a simple and effective treatment method of treating prostate cancer in patients presenting with a hip prosthesis. The definition of a beam avoidance structure encompassing the prosthesis and applying strict dose constraints to it reduces the beam contribution to the prosthesi

Unique Surgical Issues in the Management of a Giant Retroperitoneal Schwannoma and Brief Review of Literature

Ancient Schwannoma, though benign, can cause diagnostic dilemma because of its clinical presentation and imaging features. We report the management of a giant retroperitoneal schwannoma in a 19-year-old young lady who presented with lower abdominal distension. CT scan reported a large heterogenous lesion in the abdominopelvic retroperitoneum (42 cm × 16 cm × 16 cm) as a malignant tumor. The unique problems we encountered were the enormous size, the location of major part of the tumor in the pelvis, the need for fertility preservation, the external iliac vessels stretching over the tumor making mobilization surgically demanding, and the prospects of neurological deficits. An en bloc resection of schwannoma with common iliac, external iliac and internal iliac veins, internal iliac artery, femoral and obturator nerves, and iliopsoas muscle was done maintaining oncological principles. External iliac artery that was cut to facilitate tumor mobilization was reanastomosed at the end of the procedure. Postoperatively patient had uneventful recovery with patchy sensory loss, foot drop, and quadriceps weakness which was rehabilitated with a foot drop splint and active physiotherapy