A Prospective study of Changes in Pulmonary Function Tests and Diffusion Coefficient of Carbon Monoxide (DLCO) in Hodgkin Lymphoma and Germ cell tumor patients receiving Bleomycin containing chemotherapy

INTRODUCTION: Bleomycin pulmonary toxicity has been quoted to range from 0-46% with a mortality of about 1-2%. Significant decline in PFTs (Pulmonary Function Tests) and DLCO (diffusion coefficient of Carbon monoxide) has been quoted to be predictive of Bleomycin induced lung injury. There are no published studies of PFTs and DLCO in Indian patients receiving bleomycin containing chemotherapy. AIM OF THE STUDY: This is a prospective study to document the changes in serial PFTs and DLCO and also features of bleomycin lung toxicity in patients with Hodgkin lymphoma and Germ Cell Tumors receiving bleomycin containing chemotherapy. MATERIALS AND METHODS: Between June 2010 and October 2011, all the patients with a diagnosis of Hodgkin Lymphoma, Germ cell tumors of Ovary and Testis who were more than 15 yrs of age receiving Bleomycin containing chemotherapy were included in the study. These patients were followed up until Feb 2012 so that at least one set of interim PFTs is obtained of the patients enrolled in the later part of study period. PFTs and DLCO were done at baseline, interim (approximately 80-100U of Bleomycin delivered), end of treatment and at 6 months follow up. RESULTS: 76 patients (52 male, 24 female) were studied. 53 had Hodgkin lymphoma, 16 had Testicular GCT and 7 had Ovary GCT. Median age: 27 yrs, Median Hemoglobin 11.6 gm% (5.6-`16.5 gm%), Median Creatinine 0.7mg% (0.5-1.1 mg%), Median cumulative dose of Bleomycin 180U (60-290U). The decline in serial DLCO and TLC values was not statistically significant. 10 (13%) had pulmonary toxicity. Dyspnea was the commonest symptom. Of these 10 patients, 3 didn’t have PFT DLCO decline, 2 had asymptomatic drop in DLCO. Pulmonary toxicity did not develop in 4 other patients who continued to receive bleomycin even though they had significant DLCO drop. Age>30 yrs was the only significant predictive factor. No patient died of bleomycin pulmonary toxicity. CONCLUSIONS: PFTs and DLCO alone are not predictive of Bleomycin Pulmonary toxicity. A combination of diligently looking out for pulmonary symptoms along with radiologic imaging and pulmonary function tests can pick up Bleomycin lung toxicity

Sarcomatoid carcinoma of the colon: a rare diagnosis

Report of a rare colon tumor treated successfully using conventional chemotherapy regimen.

Retinoblastoma – pattern, presentation and management: a quintessential experience of 5 years

Background: Retinoblastoma (RB) is the most common intraocular malignancy of childhood. It accounts for 10-15% of cancers that occur in infants. Objective of the study was to determine the pattern, presentation and management of Retinoblastoma (RB) patients at a tertiary cancer care center in South India, during a period of 5 years (1st November 2009 to 1st December 2014).Methods: This study was a retrospective analysis of the medical records of patients diagnosed as having retinoblastoma obtained from hospital information system and our cancer registry. Data sought was demographic characteristics, clinical presentation, investigations done, the methods of management and the treatment outcome of retinoblastoma patients.Results: Total number of cases studied was 31 and total number of eyes studied was 47. Out of 31 cases, 58% were female. 52% had bilateral involvement. The median age at presentation was 24 months. The commonest mode of presentation was leukocoria (55%) followed by proptosis (22%). Out of 47 eyes studied, 87% were advanced tumours belonging to Group D or Group E. Metastasis to the central nervous system was noted in 22.6% patients belonging to either Group D or Group E. Out of the 31 patients, 64.6% patients underwent enucleation. 6 out of 31 cases succumbed to death.Conclusions: Retinoblastoma continues to be a challenge in developing countries. Lack of awareness and inaccessibility to proper healthcare facilities are major stumbling blocks in achieving high cure rates. Educating the public and healthcare professionals, importance of early diagnosis and prompt referral are vital in reducing morbidity and mortality associated with the disease

Retrospective study of chemotherapy induced cardiotoxicity from a tertiary cancer centre in South India

Background: Ever increasing therapeutic modalities in treatment of various malignancies has resulted in an enormous number of cancer survivors. Cancer survivors face various issues in their long term health due to the cancer and/or its treatment. Late effects including organ damage, functional disability and risk of second malignancy continue to be elucidated. One of the most debilitating and serious toxicity is cardiotoxicity due to chemotherapy.Methods: This study was a retrospective analysis of all patients who developed chemotherapy induced cardiotoxicity between January 2013 to December 2015.Results: A total of 16 patients developed cardiotoxicity. 13 patients had doxorubicin induced toxicity. Cardiotoxicity was noted to occur at low cumulative doses. 2 patients had complete recovery of left ventricular ejection fraction (LVEF) on follow up. 1 patient had progressive worsening of LVEF. 1 patient died due to cardiotoxicity. On detection of cardiotoxicity, most of the patients received cardiac remodeling drugs - angiotensin converting enzyme inhibitors (mostly enalapril), other drugs used were carvedilol and diuretics.Conclusions: In Indian patients, cardiotoxicity can occur at very low cumulative doses of doxorubicin and in young patients too. Most of the patients did not have any underlying comorbid illnesses. We wish to highlight the need to diligently repeat cardiac screening investigations at frequent intervals to detect asymptomatic cardiotoxicity

Double malignancies: a clinicopathological and outcomes retrospective analysis from a tertiary cancer referral centre in South India

Background: The presence of second synchronous or metachronous primary malignancies in a cancer patient is not a rare phenomenon. Our study is an endeavour to present data on the frequency, types, and outcomes of double primary malignancies in Indian cancer patients.Methods: This was a retrospective study conducted in 28 cancer patients diagnosed with histologically confirmed double malignancy. Retrospective data of the cancer site, patient’s age at the presentation, gender, type of cancer (synchronous/metachronous), treatment, and outcome were recorded from patients presented with double malignancies from January 2012 to January 2019.Results: Among 28 patients (18 females; 10 males) with multiple primary malignancies, 10 (35.7%) and 18 patients (64.3%), respectively, had synchronous and metachronous primary malignancies. Overall, breast, gynecological, head, and neck cancer were the most common primary malignancies. Gastrointestinal tract, breast, and lung cancer emerged to be the most common second primary malignancy sites. Squamous cell carcinoma (SCC) and invasive ductal carcinoma (IDC) were the most common histopathological types of double malignancies. The majority of the patients received appropriate treatment for both the malignancies.Conclusions: Data from the present study clearly suggest that the occurrence of second primary malignancy is not rare in Indian cancer patients. The double malignancies can occur at any stage and for any type of cancer. Hence, we wish to highlight that the clinician should always be aware of the possibility of developing second malignancy either during evaluation or in follow up of a patient with malignancy

Posterior reversible encephalopathy syndrome in cancer patients: experience from a tertiary cancer center, South India

Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on MRI. PRES may be associated with chemotherapy, molecular targeted drugs and immunosuppressive agents used in patients with cancer. PRES is a very rare condition in cancer patients. PRES is usually reversible with appropriate supportive care and most patients can be restarted with treatment

Comparison of standard short infusion versus prolonged infusion of Doxorubicin in relation to its cardiotoxicity in South Indian population

Background: Anthracycline is one of the commonly used chemotherapeutic agents in the treatment of malignancies and their efficacy is undermined by potential life-threatening cardiotoxicity.  The aim of this study is to compare the cardiotoxicity in patients receiving standard short infusion (15-30 minutes) versus prolonged infusion (6 hours) of doxorubicin in the study group.Methods: In this study 80 patients who were planned for treatment with Doxorubicin >200 mg/m2 were included in this study and they were randomly allotted to either of the treatment group. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG ,ECHO prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy.Results: There were 40 patients in each group, and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 271.5 mg/m2 in the group which received standard short infusion and 264 mg/m2 in the group which received the drug by prolonged infusion. However, none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in ejection fraction on serial ECHO.Conclusions: There was no benefit of prolonged infusion of doxorubicin as compared to the standard rapid infusion in terms of doxorubicin induced cardiotoxicity. At present, standard rapid infusion is the best option

Packed red cell blood transfusion practices review in medical oncology unit in a tertiary cancer center, South India

Background: Anaemia is a very common complication in cancer patients. Up to 60% of solid tumor patients and 70-90% of patients receiving myelosuppressive chemotherapy have anaemia. Pathophysiology of anaemia in cancer patients is multifactorial. The treatments for cancer related anaemia include Erythropoietin Stimulating Agents (ESAs), iron supplementing therapies (intravenous iron, oral iron) and blood transfusion. There are various safety concerns regarding usage of ESAs; also, their usage is less in India due to cost factor. There is scant literature regarding blood transfusion practices in patients undergoing chemotherapy.Methods: Patients diagnosed with cancer and patients receiving chemotherapy were included in the study. Retrospective case record review of cancer patients who received chemotherapy between January to March 2019 was done. Type of malignancy, presence of symptoms related to anemia and trigger for packed red cell transfusion were recorded.Results: Among 342 patients received total of 1365 cycles of chemotherapy in this time period. Mean age of patients was 46 years. 46 of the 342 patients received blood transfusion. Only 13% of the patients had symptoms of anemia like weakness and fatigue the average hemoglobin level at which transfusion was given was 6 gm/dL.Conclusions: Packed Red blood cell transfusion was usually administered at Hb <7 gm/dL. Very few patients reported anaemia related symptoms prior to transfusion. No patient received erythropoietin. Further data is needed from other tertiary cancer centres to understand the blood transfusion practices in Indian cancer patients undergoing chemotherapy

Retrospective analysis of clinical manifestations and treatment outcomes of patients diagnosed with langerhans cell histiocytosis from a tertiary cancer hospital in South India

Background: Langerhans cell histiocytosis (LCH) comprises a diverse group of disorders where pathologic Langerhans cells accumulate in a variety of organs. Aims and objectives of the study is to analyse the clinical manifestations and treatment outcomes of patients diagnosed with LCH in a tertiary cancer hospital in South India.Methods: Retrospective analysis of the case records of patients presenting with histological proven case of LCH over a period of 7 years from 2011 to 2018, being treated at Vydehi Institute of Medical Sciences and Research Centre.Results: 10 patients with biopsy proven LCH were included. The median age of diagnosis was 8 years (range 1 to 73 years) and 3 patients aged 18 years or older at the time of diagnosis. The male: female ratio was 3:2. Multisystem involvement was found in 4 patients (40%) and Single system Involvement in remaining 6 patients. Isolated bone lesions were found in 4 patients (40%), 1 patient had isolated Lymph node involvement; 1 patient had oral cavity lesion. None of the 4 patients with multisystem diseases had skin/mucosal involvement; 3 had bony involvement, 2 patients had lung involvement. One patients with multisystem disease expired while 5 patients were lost to follow-up. 4 out of the 10 patients are on regular follow-up and are in remission.Conclusions: Despite limitation by the retrospective nature, this descriptive study was done to provide further disease information regarding Indian population. Data from this study clearly confirms the known fact that most of the patients with Single System LCH have a very good response rate. Patients with multisystem disease have the highest risk of disease related mortality and morbidity as one among the 4 patients with multisystem disease died just after initiating treatment

Clinical profile of hepatocellular carcinoma and experience with sorafenib from a tertiary cancer centre in Southern India

Background: Hepatocellular carcinoma is a major health problem and a major cause of cancer mortality in India. There are no reports published on experience with sorafenib in advanced HCC from India. We analyzed the clinical presentation, possible etiological factors, tumor characteristics, outcomes and tolerability of sorafenib in the patients presenting to present cancer center.Methods: Retrospective chart review of 53 patients was done. 53 patients (male 37, female 16; median age 52 years, range 7-80 years) fulfilling the diagnostic criteria were analyzed for clinical characteristics, hematological and biochemical investigations, tumor characteristics, treatment taken and outcome.Results: 53 patients were diagnosed to have HCC between 2012-2015. Hepatitis B virus infection was the most common underlying etiologic factor (22.6%). Heavy alcohol intake was seen in 5 patients. PS ≥2 was noted in 66% of patients. 68% of the patients had BCLC stage C. Sorafenib was well tolerated with median OS of 3 months in patients taking sorafenib.Conclusions: Most of the patients had advanced inoperable HCC. Majority of the patients presented with BCLC Stage C and D. Hepatitis B infection was the most common underlying etiology. Sorafenib was well tolerated. More prospective studies are required for getting a clearer and correct picture of HCC and experience with sorafenib in Indian scenario