Human papilloma virus (HPV) related head and neck squamous cell cancer (HNSCC) has varying etiology, genetic as well as environmental factors involved and differential clinicicopathological features. HNSCC came in the limelight recently due to increased incidence rate and insucient diagnostic methods. This review will comprehensively focus on the characteristics of HPV associated HNSCC. It will provide an updated review of our understanding of HPV role in Oral squamous cell carcinoma (OSCC) known to date. Curruntly, three vaccines are available (Gardasil, Gardasil 9 and Cervarix). These vaccines prevent infections with HPV types 16 and 18 HPV-16 is most common type associated with HNSCC. HPV related HNSCC has better prognosis, does not mutate but inactivatestumor suppressor genes and therefore has comparatively better treatment options. However, there is still a need to improve our methods of sampling, HPV molecular assay and type of specimen to be used.

Benign and primary malignant breast tumors are rather common, but secondary tumors in the breast from extramammary malignancies are uncommon. Breast metastases from melanoma are rare but could reflect a widespread disease. We present a case of melanoma of the right lateral chest wall with metastasis to the right breast and subcutaneous tissue in a postmenopausal female. She was planned for palliative chemotherapy with cisplatin and dacarbazine. Interim imaging after three cycles of chemotherapy showed stable disease. The long-term prognosis of patients with breast metastasis from malignant melanoma is extremely unfavorable.

Background: This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC).Methods: Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used.Results: Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age <= 50 years (P = .041); >= 4 positive nodes (P = .029); and overall treatment time (OTT) >= 100 days (P = .042).Conclusion: Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs.

Gliosarcoma is a rare central nervous system (CNS) malignancy. It is characterized by classical biphasic histological pattern with both glial and sarcomatous components, often seen in fifth and sixth decade of life. They are generally located in the supratentorial region. Due to its rarity, exact treatment recommendations are not available in literature. Since it is considered as a variant of glioblastoma multiforme (GBM), it is treated with surgery followed by adjuvant radiotherapy and temozolomide-based chemotherapy. We present a series of four cases of this rare malignancy that were treated at our institute.

Endometrial adenocarcinoma metastasizing to bones is rare, and isolated metastasis to clavicle is even more uncommon. We report a case of a 60-year-old woman diagnosed with endometrial adenocarcinoma found to have isolated metastasis to the clavicle during adjuvant radiotherapy. Following radiation therapy to the clavicle, patient was started on injection zoledronic acid. She was then planned for chemotherapy comprising of Paclitaxel and Carboplatin for six cycles. Due to lack of compliance, 5months after the initial diagnosis, she developed severe dyspnea due to disease progression and expired. We hereby discuss the treatment options as well as review the literature of prior published reports on endometrial adenocarcinoma with bone metastasis.

Primary cutaneous adenoid cystic carcinoma (ACC) is an extremely rare and indolent cutaneous malignancy with very infrequent distant metastasis. We present a case of primary cutaneous ACC with bilateral lung metastases in a 57-year-old male along with literature review. To the best of our knowledge this is the tenth case of primary cutaneous ACC reported presenting with distant metastasis.

Purpose: This study aimed to analyze cancer pattern among adolescents and young adults (AYA) in a tertiary care center in North India. Materials and Methods: A retrospective study from January 2011 to December 2014 was undertaken on AYA cancer patients (aged 15-39 years). Results: Totally 1077 cases of AYA cancers were identified for analyzing the frequency and pattern of cancer distribution. The most common cancer was head and neck (32%) followed by breast (14.2%). The distribution pattern was observed to be varying in different age groups with lymphoma, leukemia, bone tumors, and sarcomas in adolescents while carcinomas being more frequent in young adults. Conclusion: Cancer distribution patterns are distinct among AYA in terms of epidemiology and biology.

Epithelial myoepithelial carcinoma (EMC) is a rare biphasic tumor of salivary glands with low malignant potential. Although known to occur in submandibular gland and minor salivary glands, its most common location is parotid. Clinical and radiological findings often mimic a benign tumor. Because of rarity of EMC a standard treatment guideline is not yet known. Surgical resection is the most widely used approach. Although it is a low grade tumor, local recurrence rates of 23-50 % have been reported with 25 % chance of distant metastasis. Patients with histo-pathologic markers of aggressive disease should be considered for adjuvant radiotherapy. We report a case of epithelial myoepithelial carcinoma of parotid in a 40 year male that was treated with surgery followed by post-operative radiotherapy.

Introduction Primary Pancreatic Lymphoma (PPL) is an extremely rare disease and accounts for only 2% of extra-nodal lymphomas and 0.5% of all cases of pancreatic masses1. Most of the cases are intermediate or high grade nonHodgkin’s Lymphoma, with diffuse large B cell type being the predominant histological type2,3. Clinically, PPL is most commonly misdiagnosed as pancreatic cancer. However, unlike carcinoma, PPLs are potentially treatable with chemotherapy and radiotherapy. Using combined modality treatment, cure rates of upto 30% are reported for patients with PPL which is much better than the dismal 5-year survival rate of 5% in patients with pancreatic carcinoma4-6.

Metastatic carcinoma is the most common malignancy of the bone. Metastases to the upper limbs of the skeleton are extremely uncommon, with only 10-15% occurring in this region. Metastases to the hand and wrist comprise about 0.15% of all hand tumours, and only 0.1% of all metastases. Carpal bone metastases are much rarer than those to the metacarpal and phalangeal bones. They usually masquerade as more common hand pathology such as arthritis or osteomyelitis. Given the bleak prognosis of carpal metastatic disease in lung cancer, treatment of a metastasis to the hand is usually palliative. Contrary to earlier beliefs, palliative radiotherapy plays a significant role in pain relief and improving hand mobility in patients diagnosed with metastatic disease of the hand. We report a case of adenocarcinoma of the lung with metastases to the capitate bone of the carpus treated with palliative radiotherapy.

BACKGROUND:This pilot study looked into the physical, social, psychological and economic issues of Indian adult cancer survivors. MATERIALS AND METHODS:Assumed cancer free patients, after cancer directed therapy (CDT), were assessed on the basis of a questionnaire developed by the investigators. The mental status of the survivors was elicited by modified MINI international neuro-psychiatric interview. This cross sectional assessment was conducted as a direct interaction with each patient for 30 to 45 minutes at a cancer hospital in 2012. RESULTS:Thirty one adult cancer survivors participated in this study. Median age was 53 years with a median follow up duration of 21.8 months (Range 2.3-194.1 months). The majority (68%) did not receive financial support for treatment. Median interval after CDT to start of activity of daily living was 1.5 months (range: 0-24 months). Fatigue and loss of appetite were reported by 52% and 29% respectively. The cancer diagnosis and its treatment adversely impacted the financial condition in 42% of patients. Nineteen percent each showed social anxiety and post-traumatic stress disorder and another 13% patients reported depression. CONCLUSIONS:This prospective assessment highlights survivorship issues and the need to address those issues particularly in the context of developing countries where resources and manpower are limited.

Purpose Spinal hemangiopericytoma is a rare neoplasm that behaves similar to intracranial hemangiopericytoma, with approximately 60 cases being reported in the literature of which only 10 are located in the intradural extramedullary (IDEM) location. Methods We report a rare case of recurrent IDEM hemangiopericytoma of dorsal spine in a 16-year-old boy treated with surgery and adjuvant radiotherapy. Results Patient is disease free at 5 years posttreatment with residual neurological deficit, but is able to carry out his activities of daily living. Conclusion Gross total resection, if feasible, followed by radiotherapy is the initial treatment of choice as radiotherapy improves recurrence free survival as well as overall survival.

AIMS:To determine the clinical characteristics, pathological features, local and distant failure patterns in patients with carcinoma of major salivary glands treated with surgery and postoperative radiotherapy (PORT).MATERIALS AND METHODS:We retrospectively reviewed 106 cases of major salivary gland tumor seen at our centre (1998-2008). Sixty five cases of major salivary gland carcinoma were selected for analysis (exclusions: benign, palliative, non-carcinomas). The patient population treated by surgery and PORT was divided into two groups: 1) Patients who underwent surgery and immediate PORT (Primary PORT); 2) Patients with recurrent carcinoma who underwent at least two surgeries and received PORT in the immediate post-operative period of the last performed surgery (Recurrent PORT). Recurrence free survival (RFS) was assessed using the Kaplan-Meier method.RESULTS:Median age was 35 years with a male: female ratio of 1.3:1. The majority of cancers were located in the parotid gland (86.2%) and the most common histology was mucoepidermoid carcinoma (43%). Thirty nine cases (60%) were primary while 26 (40%) were recurrent. Optimal surgery was performed in 59/65 patients (90.8%). 43 patients (66.2%) underwent neck dissection, of which 14 (32.5%) had nodal metastasis. Overall, 61 (93.8%) patients complied with the prescribed radiotherapy. Median dose of PORT was 60 Gy. Median follow-up was 13.1 months (range 2-70). Relapse free survival was 50.4% at 60 months. Some 12 cases (18.5%) recurred with a median time to recurrence of 16.9 months.CONCLUSIONS:Surgery and PORT is an effective treatment for major salivary gland carcinoma with over 90% compliance and <20% recurrence. Early treatment with postoperative radiotherapy may increase the survival rate in major salivary gland carcinoma patients.

Incidence of laryngeal squamous cell cancer (SCC) in childhood is rare, more so in children below 10 years of age. Due to the rarity of the disease and nonspecific symptoms diagnosis often gets delayed. Treatment is challenging and demands expert multi‐modality care. We describe the clinico‐pathologic findings and management of laryngeal cancer with chemo‐radiation in an 8‐year‐old male. After 18 months of completion of treatment the child is in complete remission clinically and radiologically. This report aims at increasing awareness of head and neck SCC in paediatric population and also underscores the importance of multi‐modality care in managing such cases. Pediatr Blood Cancer 2014; 61:1481–1483. © 2014 Wiley Periodicals, Inc.

e15138 Background: A significant number of patients diagnosed with esophageal cancer (EC) presents with locally advanced disease. Nonsurgical curative therapy for unresectable EC has limited outcome. Methods: Phase II randomized control trial to assess early locoregional response (LRR) to neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiation (CRT) versus definitive CRT in surgically unresectable squamous cell carcinoma of esophagus (ESCC). A total of 30 patients were randomly assigned to two arms. Arm 1: 2 cycles NACT regimen of 5-fluorouracil (750mg/m2 D1-4) and cisplatin (80mg D1-2) followed by CRT, radiation of 56Gy/ 28 Fr concurrent with weekly paclitaxel 50mg/m2 and carboplatin AUC2. Arm2: CRT; consisting of radiation 56Gy/28Fr and weekly paclitaxel 50mg/m2 and carboplatin AUC2. All the patients were followed till 6 months post treatment. LRR assessment was done at 1, 3 and 6 months post treatment. Wilcoxon multivariate analysis was carried out and difference of the factors were assessed by chi square test (x2 p<0.05). Results: Mean age in two arms were 52 and 54 years respectively. The study had median follow up of 6.6 months. Conclusions: In unresectable EC, CRT showed higher LRR, treatment completion and lesser toxicity compared to NACT combined with CRT. In this pilot cohort of locally advanced unresectable EC paclitaxel and carboplatin combined with radiotherapy has good tolerance and compliance. [Table: see text]

The objective was to analyze the radiotherapy (RT) practice at the cancer centre of a tertiary academic medical institution in Delhi. This audit from an Indian public institution covered patient care processes related to cancer diagnosis, integration of RT with other anti-cancer modalities, waiting time, overall treatment time, and compliance with RT. Over a period of one year, all consecutively registered patients in radiotherapy were analyzed for the audit cycle. Analysis of 1,030 patients showed median age of 49.6 years, with presentation as stage I and II in 14.2%, stage III and IV in 71.2% and unknown stage in 14.6%. A total of 974 (95%) were advised for RT appointment; 669 (68.6%) for curative intent and 31.4% for palliation. Mean times for diagnostic workup and from registration at cancer centre to radiotherapy referral were 33 and 31 days respectively. Median waiting time to start of RT course was 41 days. Overall RT compliance was 75% and overall duration for a curative RT course ranged from 50 days to 61 days. Non-completion and interruption of RT course were observed in 12% and 13% respectively. Radiotherapy machine burden in a public cancer hospital in India increases the waiting time and 25% of advised patients do not comply with the prescribed treatment. Infrastructure, machine and manpower constraints lead to more patients being treated on cobalt (74%) and by two-dimensional (78%) techniques.