The Cancer Institute (WIA - Womens' Indian Association), also known as the Adyar Cancer Institute, is a non-profit cancer treatment and research centre based in Chennai, Tamil Nadu. The Cancer Institute (WIA) was established in the year 1952 under the leadership of Dr. Muthulakshmi Reddy. In 1974, the institute became the Regional Cancer Centre and declared as a "Centre of Excellence" by the Ministry of Health and Family Welfare.
Abstract Objectives Smokeless tobacco (SLT) products are widely consumed in India, contributing significantly to the burden of oral cancer and systemic diseases. Despite their popularity, limited data exist on heavy metal contamination and associated health risks, particularly for filtered khaini, which is often perceived as safer than traditional khaini. Thus, the objectives of the study are to quantify heavy metal concentrations in khaini and filtered khaini and evaluate the associated non-carcinogenic and carcinogenic health risks. Study design Samples of filtered khaini (FK) and conventional khaini (K) were analysed for 20 heavy metals using inductively coupled plasma mass spectrometry (ICP-MS). Mean concentrations were compared using the Mann–Whitney U test. Estimated daily intake (EDI), hazard quotient (HQ), hazard index (HI), and target cancer risk (TCR) were calculated based on oral (buccal) exposure scenarios at absorption fractions of 6%, 20%, 25%, and 100%. Cancer slope factors (CSFs) were derived from U.S. EPA and WHO databases. Results FK contained significantly higher concentrations (p ≤ 0.05) of Pb, Cd, As, Cr, Ni, Co, Cu, Zn, Fe, Mn, Al, Ba, V, Se, U, and Be than khaini. Non-carcinogenic risk assessment at 25% absorption yielded an HI = 1.224 for FK and 0.592 for khaini, indicating potential chronic health effects for the former. The total target cancer risk at 6% absorption was 0.264 for FK and 0.147 for khaini, dominated by arsenic and cadmium contributions. Conclusion FK exhibits markedly higher heavy-metal contamination and health-risk indices than traditional khaini. Both products present lifetime cancer risks far exceeding acceptable limits (10⁻⁶–10⁻⁴), underscoring the need for regulatory surveillance and public-health intervention to mitigate oral and systemic toxicity from smokeless-tobacco use. Graphical Abstract
To assess the effectiveness and safety of cyclophosphamide and topotecan in children with relapsed or refractory extracranial solid tumors. This study included children with relapsed or refractory extracranial solid tumors treated with cyclophosphamide (250 mg/m2/day) and topotecan (0.75 mg/m2/day) for 5 days, 3-weekly, between January 2012 and February 2024. Event-free-survival (EFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Eighteen patients with median (range) age 6 (2–13) years (72
BACKGROUND:Percutaneous ethanol ablation (PEA) is a minimally invasive option for locoregional nodal recurrence in papillary thyroid carcinoma (PTC) when reoperation carries high risk. Esophagocutaneous fistula is an extremely rare complication of this procedure. METHODS:A woman in her early 70s with a history of total thyroidectomy, radical neck dissection, and radioactive iodine therapy developed an isolated left supraclavicular nodal recurrence. Ultrasound-guided PEA was performed. One month later she presented with purulent neck discharge. Contrast-enhanced CT with oral contrast, oesophagoscopy, and subsequent surgical exploration were performed. RESULTS:Imaging and endoscopy confirmed a 2-cm esophagocutaneous fistula tract. The patient was managed with enteral nutrition followed by primary esophageal closure reinforced with a pedicled pectoralis major myocutaneous flap. The postoperative course was complicated by a surgical site infection that resolved with conservative care. Follow-up Gastrografin swallow showed no leak and the patient resumed a full oral diet. CONCLUSIONS:This is the first reported case of esophagocutaneous fistula following cervical PEA. Although this complication appears exceptionally rare, awareness and preventive strategies are particularly important in previously operated and irradiated necks. Prompt imaging and multidisciplinary surgical repair are essential for successful outcomes.
Peritoneal surface malignancies (PSM) are primary or secondary neoplastic deposits involving the peritoneum and are commonly associated with colorectal, gastric, appendiceal, gynecological, pancreaticobiliary, and other intra-abdominal or extra-abdominal cancers. Malignant bowel obstruction (MBO) is one of the most frequent and clinically consequential emergency presentations in this population, yet diagnostic and therapeutic pathways remain heterogeneous. We aimed to develop evidence-informed recommendations for emergency management of MBO in patients with PSM by integrating a systematic review, meta-analysis and a structured international expert consensus process. This systematic review, meta-analysis, and Delphi consensus followed PRISMA, Cochrane, and relevant MOOSE reporting principles. PubMed/MEDLINE and the Cochrane Library were searched from inception to June 2025 (English language). Five predefined PICO/PIRT questions addressed: (1) the diagnostic role of CT, plain abdominal X-ray, or Gastrografin-enhanced X-ray in PSM-related MBO; (2) nonoperative medical management versus surgical or endoscopic therapy; (3) surgical versus endoscopic treatment after failure of nonoperative management; (4) bowel resection versus stoma or bypass in surgical candidates; and (5) endoscopic stenting versus endoscopic ultrasound-guided bypass with lumen-apposing metal stents in endoscopic candidates. Study selection and data extraction were performed independently and in duplicate. Risk of bias was assessed with ROBINS-I for comparative non-randomized studies and MINORS for non-comparative studies; certainty of evidence was rated with GRADE. Random-effects meta-analyses (REML) produced odds ratios (OR), mean differences (MD), pooled means, or pooled proportions with 95
