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

Real-world data on the pattern of recurrence of colorectal cancer at a tertiary cancer center in South India: A retrospective observational study

Background: Recurrent colorectal cancer may be amenable to curative treatment. As the debate on the ideal set of investigations and frequency of follow-up continues, it is important to review the pattern of recurrence in the real-world setting, which could help tailor future follow-up strategies. Objectives: Our primary objective was to study the varying clinical presentations and patterns of recurrence of colorectal cancer. The secondary objectives were to study the site of recurrence, method of diagnosis of recurrence, incidence of second primary colorectal cancer, and salvage rates after recurrence of colorectal cancer. Material and Methods: We reviewed the data of patients who were treated from January 2010 to December 2016 at the Malabar Cancer Center, a tertiary cancer center in Kerala, India. We recorded the clinicopathologic details of patients who were treated with curative intent and had serologic (carcinoembryonic antigen [CEA] elevation), clinical, or radiological evidence of disease recurrence. We also studied the timing and anatomical location of recurrence, symptoms, and the method by which the recurrence was diagnosed. Results: We included 675 patients in the study. There were 324 (48%) female patients; the median age was 55 years (interquartile range [IQR], 47.2-65). The primary diagnosis was colon cancer in 326 (48.3%) and rectal in 349 (51.7%) patients. Multimodality therapy was administered to 393 (58.2%) patients in the form of surgery with or adjuvant neoadjuvant chemoradiation adjuvant radiation, or neoadjuvant short-course radiation with neoadjuvant and adjuvant chemotherapy. Recurrences occurred in 109 (16.1%) patients, only 50 (45.9%) of whom were symptomatic. Recurrences were diagnosed by CEA elevation in 65 (59.6%), imaging in 12 (11%), clinical examination in 4 (3.7%), and colonoscopy in 1 (0.9%) patient. The median time to recurrence was 17 months (95% CI, 14-22). Local and distant recurrences occurred in 29 (4.2%) and 80 (11.9%) patients, respectively; 22 (27.5%) patients developed multisite distant recurrences. Recurrences occurred within the first 5 years of completion of therapy in 96 (88.1%) cases. Twelve (11%) patients received salvage therapy with curative intent. Six patients (0.9%) had a metachronous colorectal primary tumors. Conclusions: Colorectal cancer recurs most commonly in the first 5 years after therapy. Multisite distant recurrence and isolated liver metastases predominate. Recurrences are often asymptomatic and most commonly manifest as elevated CEA. Regular clinical evaluation, CEA testing, colonoscopy, and symptom-based cross-sectional imaging detect up to three-quarters of patients with recurrences, but the overall salvageability remains low

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