BACKGROUND:High-dose melphalan followed by autologous stem cell transplantation (ASCT) is standard in multiple myeloma (MM), but relapse remains inevitable. Second ASCT2 is a salvage option for selected patients with durable remission after ASCT1. Reports from the Asia-Pacific region are limited. METHODS:This retrospective study included six patients with relapsed MM who underwent ASCT2 between 2012 and 2025. Demographics, treatment characteristics, toxicity, engraftment, and outcomes were analyzed. All patients underwent fresh stem cell mobilization with granulocyte colony-stimulating factor and plerixafor without cryopreservation. RESULTS:The median age at ASCT2 was 61 years (range, 47-65 years). The median interval between ASCT1 and ASCT2 was 66 months (range, 31-123 months). Two patients achieved partial remission (PR), 1 achieved very good partial remission (VGPR), and 3 achieved complete remission (CR) before ASCT2. Four patients received melphalan 140 mg/m² and 2 received melphalan 200 mg/m² for ASCT2. The median CD34⁺ cell dose infused during ASCT2 was 2.54 × 10⁶/kg (range, 1.42-21 × 10⁶/kg). Febrile neutropenia developed in 4 patients but was easily controlled with empiric antibiotics. Neutrophil recovery occurred at a median of 11 days (range, 10-14 days), and platelet recovery at 13 days (range, 12-15 days). Hospital stay duration ranged from 15 to 22 days, with a median of 18.5 days. There was no transplant-related mortality. The median follow-up of the study cohort was 28.5 months (range, 1-47 months). Two patients died at 35 and 47 months post-ASCT2, respectively, due to progressive disease. One patient was lost to follow-up after the second bone marrow transplant. Three patients remain alive and in sustained remission. CONCLUSION:ASCT2 is a feasible salvage strategy in selected Indian patients with MM, yielding favorable outcomes with acceptable toxicity.
Abstract We conducted an “Expert Consensus Panel” with transdisciplinary experts to deliberate on a ‘Weakness, Opportunities, Threats, and Strengths’ analysis with Underlying Planning for cancer research in India, to envision a way forward. The panel brought together leading experts from India to deliberate on population, clinical, and molecular research priorities in cancer. The deliberations focused on specific approaches necessary to scale up context-specific cancer research, while proposing a roadmap for the future integration of population science, clinical research and trials, and molecular research, including genomics, with the healthcare system for clinical translation and policy implementation.
PURPOSE:In India, less than 10% of cancer care is accessible to the country's 70% of rural residents. Providing all-encompassing cancer care in a remote setting with limited resources is a difficult undertaking. Despite having the best of intentions, many centers struggle to treat patients in accordance with current standards because they lack the necessary resources and guidance. This leads to a worsened prognosis for millions of cancer patients, with detrimental effects on the person, the family, and society at large. The situation is presumably similar in other developing countries. The purpose of this article is to identify challenges and try to find their solutions that suits practical situation. METHODS:The contents of this article were the result of deliberations in a recently concluded Indian Cancer Congress 2023, Mumbai, which was one of the largest conglomerations of around 6000 oncologists across India and the world. The session included clinicians and other stakeholders with years of experience working in rural India. The contributors worked in groups based on their strengths and experience for the past few months to develop appropriate recommendations for each section. SUMMARY:The ideal system to deliver comprehensive cancer treatment should include various aspects like prevention, early detection, protocol-based treatment, rehabilitation, palliation, data collection, and research. As of now, there are no clear guidelines or structure available for stakeholders in rural areas to build their care delivery. This article proposes a district-based cancer control program that covers all aspects of cancer care using available resources, with the aim of creating a uniform, modular, and multi-tier structure to establish a care delivery pathway for districts that can be replicated in any region.
BACKGROUND:To explore the independent influencing factors of PCa bone metastasis and evaluate the role of prostate imaging. METHODS:The clinic data such as age, prostate volume, tPSA and fPSA . Univariate and multivariate analyses were performed to investigate the independent influencing point of the risk factors. Nomogram and ROC curve were generated to establish the prediction model. The calibration curve, leave-one-out cross validation and independent external validation were performed to evaluate the prediction model. RESULTS:This study enrolled 325 newly diagnosed PCa patients at two hospitals. Univariate and multivariate analyses showed only tPSA , cTx, ALP, and PI-RADS v2 score were the independent influencing factors of PCa bone metastasis. The cut-off points of PI-RADS v2 score to distinguish bone metastasis was 5. The nomogram was established with a sensitivity of 81.3% and a specificity of 74.5% to predict the probability of PCa bone metastasis. The calibration curve and ROC curve displayed a good value of the prediction model. Leave-one-outcross validation showed the prediction model could classify 79.8% cases accurately. External data validation displayed sensitivity of 78.4% and a specificity of 79.1%. CONCLUSIONS:PI-RADS v2 score could predict PCa bone metastasis, the prediction model may help discovered PCa bone metastasis.
ABSTRACT:Head and neck cancers (HNCs) form a major part of cancers affecting Indians and the Southeast Asian populations. Globally, the majority of these cancers are concentrated in these geographical locations too. These are our cancers! However, for evaluation, staging, and treatment protocols, we often depend on Western standards/data which may not be completely applicable (due to various reasons) to our patients. Some choose to formulate "institutional guidelines" that are more apt for our patients. There is an astounding amount of good work being done in several institutions across the country for many decades. Since the problem of head and neck cancers is largely ours, we possibly have the largest experience too. The onus to collaborate, and build a system that enables us to collect, store, access, and study every bit of information about every single patient afflicted with HNC, in any corner of our country, is on us.
BACKGROUND:There are very limited studies examining the sexual dysfunction in female rectal cancer treated with curative chemoradiotherapy (CRT). So, we aimed to evaluate the self-related sexual life quality and vaginal dose-volume relationship in female rectal cancer patients. METHODS:The patients who had been treated with chemoradiotherpay between January 2012 and January 2019 were included. Vaginal contouring was performed according to the Radiation Therapy Oncology Group female pelvic normal tissue contouring atlas. Sexual functioning was evaluated by the European Organization for Research and Treatment Quality of life Questionnaire for Sexual Function Modules (EORTC QOL). RESULTS:Fourty five disease-free female patients volunteered to participate in this study were evaluated. The mean total EORTC QOL score of patients was 19.44 points. The score was <19.44 points accepted as worse sexual functioning and ≥19.44 points accepted as better sexual functioning. We did not find any relationship between sexual functioning and radiotherapy sequence, radiotherapy technique, and total radiotherapy doses. The proximity to anal verge and older patients age were the associated factors for worse sexual functioning in female rectal cancer. Dmin, Dmean, V35, V40, V45, and V50 of vagina were the predictive factors for sexual functioning. According to multivariate regression analyses only the primary tumor distance to anal verge ( P = 0.01), and V50 ( P = 0.02) of vagina were the predictive factors for sexual functioning. CONCLUSIONS:Sexual dysfunctions in female rectal cancer were associated with tumor distance to anal verge, patients age, Dmean, Dmin, and V35-50 of vagina in female rectal cancer treated with curative radiochemotherapy.
BACKGROUND:Exposure of a cell to carcinogens leads to an increase in the chromosomal aberrations, while such karyotypic anomalies and elevated deoxyribonucleic acid content have been observed in a plethora of oral precancerous lesions and conditions, and are expressed in the form of micronuclei. The aim of the present study was to correlate the frequency of these micronucleated cells (MNCs) with the severity of the disease process in oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) patients. METHODS:The present cross-sectional, hospital-based study consisted of 150 subjects in an age range from 15 to 80 years including patients who were clinically diagnosed and histopathologically proven as OSMF and OSCC patients, along with age and sex matched, normal, healthy controls. Also, cytological analysis was carried out using the oral exfoliative cytology procedure, while the frequency of MNCs was calculated using a differential counter. RESULTS:The mean MNC% in the control group was calculated as 0.3% ± 0.35% in the present study as against the mean MNC% of 1.22% ± 0.37% in the OSMF, and 2.0% ± 0.60% in the OSCC groups, while the difference was statistically significant ( P < 0.001). Also, the mean MNC% was calculated to be 0.71% ± 0.08% in Stage I OSMF as against 1.31% ± 0.18% and 1.59% ± 0.17% in Stage II and Stage III OSMF, respectively, with the difference being statistically significant ( P < 0.001). Similarly, the difference in the mean MNC% when calculated between the different stages of OSCC was, also, statistically significant ( P < 0.001) with the mean MNC% in Stage I OSCC being 1.15% ± 0.11% as against 1.59% ± 0.25% in Stage II, and 2.23% ± 0.30% in Stage III and 2.68% ± 0.19% in Stage IV OSCC, respectively. CONCLUSIONS:Based on the results obtained in the present study, it can, thus, be concluded that the mean MNC% increased significantly in OSCC patients when compared with the control and OSMF groups, and in the OSMF group in comparison with control group, thus, suggesting micronuclei assay as a useful diagnostic adjunct for screening populations which are at high risk for developing various oral precancerous lesions and conditions, and frank oral cancers.
ABSTRACT:Gynecological malignancies-including cervical, ovarian, and endometrial cancers-remain a major global health challenge, contributing significantly to cancer-related morbidity and mortality among women. Despite advances in conventional treatments such as surgery, chemotherapy, radiotherapy, and immunotherapy, issues such as drug resistance, tumor recurrence, and limited efficacy in advanced-stage disease necessitate novel therapeutic strategies. The emergence of CRISPR/Cas-based genome editing has revolutionized cancer research by enabling precise, efficient, and programmable modifications of specific genomic loci. In gynecologic oncology, CRISPR/Cas systems have been employed to dissect oncogenic mechanisms, identify therapeutic targets, and develop innovative treatment modalities. In cervical cancer, CRISPR-mediated targeting of HPV E6 and E7 oncogenes has shown potential in restoring tumor suppressor pathways and enhancing chemosensitivity. In ovarian cancer, gene editing has been used to modulate chemoresistance, tumor angiogenesis, and metastasis through the knockout of key regulators such as DNMT1, EGFL6, and BRCA1/2. Similarly, in endometrial cancer, CRISPR tools have elucidated mechanisms of hormonal resistance and facilitated the development of in vivo models via somatic gene editing. This review highlights recent advances in the application of CRISPR/Cas technology to gynecologic malignancies, discussing its potential as both a therapeutic and research platform while acknowledging current limitations and translational hurdles.
BACKGROUND:Postoperative recovery for patients with oral cancer is an arduous process, relying heavily on the involvement of caregivers, who often lack formal training or support. To address this gap, we developed the Cancer Caregiver Support System (CCSS)-a low-cost, mobile-accessible platform designed to empower caregivers with culturally tailored guidance. METHODS:A randomized pilot study was conducted at Homi Bhabha Cancer Hospital and Research Centre (HBCH & RC), (Unit of Tata Memorial Centre, Mumbai) Muzaffarpur, by enrolling 75 postoperative oral cancer patients and their primary caregivers. Participants were randomized into two arms: Arm A received standard care plus the CCSS intervention (A Hindi-language website, printed recovery booklet, and moderated WhatsApp group); Arm B received standard care alone. Primary endpoints included 30-day morbidity and duration of nasogastric tube (NGT) dependency. Secondary endpoints included caregiver burden using the Zarit Burden Interview (ZBI) and swallowing outcomes as measured by Functional Oral Intake Scale (FOIS) scores. Tertiary endpoints included unscheduled follow-ups and readmissions. RESULTS:While 30-day morbidity, delay in NGT weaning, and FOIS scores were comparable across arms, caregivers in the intervention arm reported significantly lower burden (mean ZBI score: 12.26 vs 17.53; P = 0.021) and fewer unplanned follow-ups (mean: 1.23 vs 2.64; P < 0.001). Readmission rates remained low in both groups. CONCLUSION:The CCSS intervention demonstrated feasibility and acceptability, with early signals of benefit in reducing caregiver strain and postdischarge disruptions. This pilot study underscores the potential of context-sensitive, digitally enabled caregiver support in resource-constrained oncology settings. Further scale-up and integration with AI-driven personalization are planned.
ABSTRACT:Malignant mesenchymal tumors of the kidney are rare, diagnostically challenging neoplasms with variable biological behaviors. Here, we present a series of five rare primary renal malignant mesenchymal tumors, comprising one case each of solitary fibrous tumor, synovial sarcoma, and pleomorphic rhabdomyosarcoma, and two cases of Ewing sarcoma. Accurate diagnosis depends on histopathological and immunohistochemical evaluation, and further confirmation is made by molecular studies. Given their aggressive nature and poor prognosis, early recognition and ongoing documentation of such cases are crucial for improving therapeutic strategies and outcomes.
BACKGROUND:Lymphedema is a chronic, progressive condition affecting 90-250 million people worldwide, with women being more frequently impacted. Individuals who undergo mastectomy are at increased risk of developing upper limb lymphedema, leading to swelling, pain, discomfort, and functional limitations. Therefore, it is essential to explore effective strategies for its management. METHODS:This quasi-experimental study included 20 subjects aged 40-55 years with unilateral post-mastectomy lymphedema. Demographic and clinical information was collected through interviews and verified using previous medical records. Subjects were randomly assigned to two groups: Group A (n = 10) received low-intensity resistance training with a compression garment, and Group B (n = 10) received manual lymphatic drainage with compression bandaging. Upper limb volume was measured using circumference measurements with the truncated cone formula; upper limb function was assessed using the Disability of Arm, Shoulder and Hand (DASH) questionnaire; and shoulder pain was evaluated using the Visual Analogue Scale (VAS). Both groups participated in three sessions per week for 8 weeks, after which all outcome measures were reassessed. RESULTS:Both groups showed significant within-group improvements in upper limb volume, upper limb function, and shoulder pain. However, between-group comparisons indicated that Group A demonstrated significantly greater improvement ( P < 0.05) across all outcome measures, including circumference measurements, DASH, and VAS scores. CONCLUSION:Both low-intensity resistance training with compression garments and manual lymphatic drainage with compression bandaging were effective in reducing upper-limb volume, enhancing function, and decreasing shoulder pain. However, the resistance-training protocol resulted in superior overall outcomes compared to manual lymphatic drainage.
BACKGROUND:Papillary thyroid cancer has an established favorable outcome with a 10-year overall survival of more than 90%, but the chances of recurrences are as high as 20%. Traditionally, all intermediary-risk and high-risk category patients undergo vigorous follow-up. A sensitive risk stratification system may predict the patients requiring stringent postoperative surveillance. METHODS:The present study is a retrospective cohort study of papillary thyroid cancer operated and systematically followed for a median period of 135.5 months. The outcomes at the end of the follow-up period were determined based on American Thyroid Association (ATA) guidelines (2015). We used American Joint Committee on Cancer (AJCC) risk stratification (8 th edition), ATA risk stratification (2015), and a modified dynamic risk stratification system. The disease status in the first year of the follow-up was used for reclassification. RESULTS:The overall survival was 95.1%, but the incidence of adverse outcomes which included disease-specific mortality, structural incomplete responses, and biochemical incomplete responses was 11.2% (n: 23). The modified dynamic risk stratification had higher accuracy in predicting the outcomes. CONCLUSION:Patients who had excellent responses in the first year of follow-up are unlikely to develop adverse events in the future. However, those who had overt or evident distant metastases at the time of diagnosis require vigilant surveillance.
BACKGROUND:Oral cavity cancer (OCC) patients are treated with surgery as the primary modality of treatment world over. This study is aimed to compare surgery with adjuvant radiation practiced at center A with Radical radiation practiced at center B in terms of disease control and quality of life (QOL) for OCC patients. METHODS:Wide excision and neck dissection with or without reconstruction was followed by adjuvant radiation with or without chemotherapy in selected cases in center A. Radical chemoradiation was used in center B. Their disease status at 2 years of follow-up was assessed along with QOL. The results were compared between the two centers. RESULTS:A total of 43 patients from center A and 33 patients from center B were looked at and the 2-year survival rate was 66% and 48%, respectively ( P = 0.04). Among QOL scores, pain in the mouth and shoulder was significantly higher in center A, while scores of social contact and weight losses were significantly higher in center B. Lost to follow-up was higher in center B, 52% versus 12%. CONCLUSION:Surgery followed by radiation with or without chemotherapy should be considered for operable OCC and provides better tumor control with a lesser QOL of subscales related to surgery. Wherever surgical expertise is not available, radical chemoradiation is preferred for a better QOL compared to palliative treatment.
BACKGROUND:To assess the efficacy and safety of first-line programmed-death 1 (PD-1)/programmed-death ligand 1 (PD-L1) inhibitors + chemotherapy for driver-gene negative advanced non-squamous non-small cell lung cancer (NSCLC). METHODS:Eligible literature was identified following a systematic search of four electronic databases (PubMed, Embase, Ovid, and Cochrane library databases) from their inception to June, 2023. Unpublished research was searched from the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and the World Conference on Lung Cancer (WCLC) meeting abstracts. Review Manager 5.3 software was used for analysis. RESULTS:Nine randomized controlled trials (RCTs) were identified and included, involving 3443 driver-gene negative advanced non-squamous NSCLC patients. PD-1/PD-L1 inhibitors + chemotherapy had significantly longer progression-free survival (PFS) (hazard ratio [HR] = 0.57, 95% CI = 0.52-0.61, P < 0.00001), and overall survival (OS) (HR = 0.69, 95% confidence interval = 0.63-0.76, P < 0.00001) compared with chemotherapy alone. Analysis was performed based on PD-L1 expression levels; patients with any PD-L1 expression had PFS benefit ( P < 0.00001), while only patients with PD-L1 ≥50% ( P = 0.02) and PD-L1 ≤1% ( P = 0.0009) had OS benefit. Regarding liver metastases, there was no statistically significant benefit of PD-1/PD-L1 inhibitors + chemotherapy regimens for the liver metastases cohort in OS ( P = 0.08). In brain metastasis patients, PD-1/PD-L1 inhibitors + chemotherapy regimens demonstrated an improvement in PFS compared to chemotherapy ( P = 0.03). CONCLUSION:Our results show that PD-1/PD-L1 inhibitors + chemotherapy showed better survival benefits than chemotherapy in driver-gene negative advanced non-squamous NSCLC patients.
ABSTRACT:Berberine (BBR), a bioactive compound from various plants, shows significant therapeutic promise against lung cancer. Research indicates that berberine effectively inhibits cell proliferation in lung cancer cell lines and promotes apoptosis. Its mechanisms of action include inducing apoptosis and inhibiting metastasis-related pathways, showcasing its multifaceted approach to tumor suppression. Berberine also influences important signaling pathways like mitogen-activated protein kinase, phosphoinositide 3-kinase/protein kinase B, and nuclear factor kappa-light-chain-enhancer of activated B cells, thereby boosting its anti-cancer properties. Preclinical animal studies have further demonstrated berberine's effectiveness, especially when combined with conventional chemotherapy, suggesting a synergistic relationship that could enhance treatment efficacy. These promising results have led to ongoing clinical trials exploring berberine's potential as part of lung cancer treatment regimens. However, challenges persist regarding dosage standardization, bioavailability, and the translation of preclinical results into clinical applications. This review highlights the therapeutic mechanisms of berberine, its potential efficacy as a standalone or adjunctive treatment, and the obstacles that must be addressed to leverage its benefits in lung cancer therapy fully. Overcoming these challenges may provide valuable opportunities for improving treatment outcomes, positioning berberine as a key component in future lung cancer therapies. Continued research is essential to better understand its precise mechanisms and enhance its clinical application.
ABSTRACT:Locally advanced squamous cell carcinomas of the head and neck (LA-SCCHN) are one of the most common cancers globally and in India. Though many treatment options are available for LA-SCHHN, chemotherapy administered concurrently with radiotherapy (CCRT) is the most common treatment modality. Cisplatin-based CCRT is the guideline-recommended standard of care (SoC) in definitive and adjuvant settings. However, cisplatin-based CCRT often fails or cannot be administered due to toxicity. Hence, 60% of LA-SCCHN patients experience locoregional recurrence, and 20% experience distant metastasis. Many of these patients are cisplatin-ineligible/unfit due to absolute or relative contraindications; thus, continued cisplatin-based CCRT is unsuitable for them. Hence, alternative treatment strategies have been suggested for cisplatin-unfit LA-SCCHN patients and include docetaxel, carboplatin, and cetuximab-based regimens. Of these, docetaxel and carboplatin-based regimens have an unfavorable toxicity profile when compared with cetuximab-based regimens. Additionally, cetuximab-based regimens have demonstrated good locoregional control (LRC), improved disease-free survival (DFS), and OS (including 5-year OS) in LA-SCCHN patients. Therefore, Indian and international guidelines recommend cetuximab-based regimens for cisplatin-ineligible/unfit LA-SCCHN patients, Cetuximab is a costly drug for Indian patients. However, with the availability of cetuximab biosimilars, it has become possible to extend the drug's benefits to cisplatin-ineligible/unfit LA-SCCHN patients in India. Hence, this Expert opinion from India was organized, and nine consensus statements were drafted to highlight the various clinical settings where cetuximab-based regimens can benefit cisplatin-ineligible/unfit LA-SCCHN patients. An attempt was also made to understand the burden and causes of cisplatin ineligibility and toxicity in Indian patients.
