Background: Incidence of Oropharyngeal Cancer varies greatly worldwide showing an increasing trend. This increasing trend in epidemiology of Oropharyngeal Cancer has been attributed to the infection by human papillomavirus [HPV]. In this study we aimed to determine the impact of the presence of HPV DNA and p16 in oropharyngeal cancer on response to treatment and toxicity in patients receiving radical chemo-radiotherapy at regional cancer center. Methods: 80 patients of squamous cell carcinoma of oropharynx were enrolled. HPV DNA and p16 status of all patients was evaluated using polymerase chain reaction and immunohistochemistry. The selected patients for this study were treated with concurrent chemoradiation therapy with weekly cisplatin. Results: Among 80 cases, 17cases (21.2%) shows positive results for p16 P16 was positive in 64.7 % cases of males and 35.3% cases of female on the other hand in p16 negative cases 84.1% cases were male while 15.9% cases were female. Overall, 83.8% of patients were tobacco users (smoking, n = 30 (44.8%); smokeless, n = 18 (26.9%), both, n = 19 (28.3%)). Tonsils (70%) is the most common site involved. Response of treatment was evaluated after 6 weeks of concurrent chemoradiation. Complete response was observed in 14 patients which were p16 positive and 47 patients which were p16 negative. Partial response in 3 (p16 positive) and 15 patients (p16 negativity). Stable disease was observed in 1 patient (p16 negative) and no cases with progression of disease was evaluated in response to treatment. Evaluation of toxicity was done and toxicity was graded in both HPV positive and HPV negative cases according to CTC. In both p16 positive and negative stomatitis (p = 0.75) was the most common adverse event. Oral stomatitis of Grade 1&2 (100% in p16 +ve and 96.8% in p16 -ve patients) and grade 3&4 (58.8% in p16+ and 49.20% in p16_ patients). Conclusions: We concluded that patients with HPV positive and p16 positive OPSCC show better response to treatment. Risk of severe late toxic effect is low after treatment of oropharynx cancer as due to the escalation of therapy risk of late toxic effects are decreased. This may have implication in doing p16 routinely in clinical practice and implication while considering for treatment de-intensification strategies. Legal entity responsible for the study: Priyanka Yadav, Surender Beniwal. Funding: Indian Council of Medical Research, New Delhi, India. Disclosure: All authors have declared no conflicts of interest.

Background: Plasminogen activator inhibitor-1 (PAI-1) is corelated with inflammation and tumorigenesis. We investigated the role of PAI-1 in tumor regulating immune component of tumor microenvironment. Methods: Protein expression data proteins and phosphoproteins, tumor infiltrating immune cells with relative fraction of immune cell types and major clinical outcome endpoints were obtained from The Cancer Genome Atlas project. A statistical correlation analysis was performed between the expression and distribution of PAI-1, immune checkpoint expression, tumor infiltrating immune cells fraction and their distribution in each tumor. We used Cox proportional hazards model to evaluate the association of PAI-1 with clinical survival outcomes. Results: The expression and distribution patterns of PAI-1 was measured in 7858 samples from 32 cancer type. PAI-1 had an enrichment in the squamous cancers. Increased expression of PAI-1 was associated with higher tumor stage and grade. Analyses of the tumor microenvironment revealed unanticipated correlation of PAI-1 with immune checkpoint expression and infiltrating immune cells. PAI-1 expression was tightly correlated to TGF-beta response (corr=0.40; p < 0.01), tumor leucocyte fraction (corr=0.33; p < 0.01) and PD-L1 expression (corr=0.29; p < 0.01). PAI-1 was positively corelates with intra-tumor heterogeneity (p < 0.01), proliferation(p < 0.01), stroma fraction (p < 0.01) and macrophages (p < 0.01). PAI-1 was also negatively correlated with lymphocyte fraction, activate CD4 cells, T cells (FH, gamma-delta and CD8). These correlations were also found with individual cancer type. PAI-1 was associated with poor Overall survival (Hazards ratio (HR)= 1.4; p < 0.01), Progression free interval (HR = 1.3; p < 0.01), disease free interval (HR = 1.26; p < 0.01) and disease specific survival (HR = 1.42; p < 0.01). PAI-1 was also associated with poor clinical outcomes in individual cancer type. Legal entity responsible for the study: Narender Kumar. Conclusions: PAI-1 is correlated with PD-L1 and influences the tumor progression by modulating tumor microenvironment. PAI-1 might be valuable target indicating opportunities for personalised combination therapy of cancer. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Background: DNA double-strand break (DSB) is the most critical type of genotoxic stress. Clinical studies have revealed a link between genomic instability and response to anti-PD-1/PD-L1 therapy in cancer management. We investigated role of DBS repair and ATR/Chk1 DNA damage checkpoint in regulating PD-L1 expression and their use in therapy selection and study design. Methods: Protein expression data proteins and phosphoproteins with major clinical outcome endpoints were obtained from The Cancer Genome Atlas project. A statistical correlation analysis was performed between the expression and distribution DBS repair and ATR/Chk1 DNA damage checkpoint pathway and PD-L1. Signaling network was also analysed for of therapeutic target identification. Results: The expression and distribution patterns of PD-L1 was measured in 7694 samples from 32 cancer type. Increased expression of PD-L1 was associated with higher tumor stage and grade. Analyses of the DNA damage ATR/Chk1 checkpoint signalling revealed strong correlation of PDL1 expression. PD-L1 expression in was upregulated in response to DSBs with strong correlation with MRE11 (correlation coefficient (r) =0.39, p < 0.01), RAD51 (r = 0.33, p < 0.01). This upregulation requires ATM/ATR/Chk1 kinases (Chk2_pt68; r = 0.36, p < 0.01 and Chk1_ps296; r = 0.33, p < 0.01). Interestingly Jab-1 expression was corelated with both Chk-1(r = 0.27, p < 0.01) and PD-L1 (r = 0.22, p < 0.01). We further investigate for the possible signaling mechanism for the correlation and found activation of oncogenic signaling in a cancer type specific manner. PI3K/AKT/mTOR/S6K, INFgamma/ JAK/STAT/IRF1 and Ras/BRAF/MEK/ERK were involved in mechanism of increased PD-L1 expression. Conclusions: DSB-mediated immune activation is balanced by concomitant inhibitory signaling, via the checkpoint kinases ATM, ATR, and Chk1 drived PD-L1 expression in tumors. These observations have important clinical implications for therapy selection, particularly following progression on DNA damaging agents suggesting that PD-1/PD-L1 inhibitors may be a useful therapeutic strategy (with or without concurrent DNA damaging agents) for tumors. Legal entity responsible for the study: Narender Kumar. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Background: The aim of this study was to describe the prevalence of comorbidity in newly diagnosed female breast cancer patients in north-west India. The second end point of the study was compliance for multimodality treatment. Comorbidity assessed by counting the number of coexisting diseases diagnosed in a cancer patient or by using a comorbidity index that combines the number and severity of the diseases. The most widely used index is the Charlson Comorbidity Index (CCI). Materials and Methods: The data of female patients with breast cancer were recorded, having comorbidities during the cancer registration or comorbidities diagnosed during the treatment at the host institute between January and December 2012. The patients were distributed on the basis of physical parameters such as age, stage, tumor grade, hormone receptor status, ECOG status at diagnosis and CCI. Scores of CCI are summed to provide a total score to predict mortality. Results: During the period of January to December 2012, 156 biopsy-proven breast cancer patients were included in the study. During this period, female breast cancer patients enrolled were 13.94% out of total patient enrollment. The most prevalent comorbidities associated with breast cancer are hypertension (21.8%), chronic obstructive pulmonary disease (COPD) (19.9%), rheumatologic disease (18.6%), and diabetes mellitus (16.7%), all four conditions have been reported in around 75% of the cases. The planning of multimodality management in comorbidity arm was significantly lower (P > 0.01) as compared to patients without comorbidity. Conclusions: The planning of multimodality management in comorbidity arm was significantly lower as compared to patients without comorbidity. Because of the comorbid condition, the definitive treatment of breast cancer was not given so this will also affect the treatment of breast cancer. When the CCI score increases with an increase in the number of comorbidities will decrease survival.

BACKGROUND:A dramatic improvement in the survival of acute lymphoblastic leukemia (ALL) patients in the last three decades has been observed. MCP 841 protocol is an old but effective tool with tolerable toxicities. The objective of this study was to estimate the relapse-free survival of ALL patients treated uniformly with MCP 841 protocol on the basis of various prognostic factors. MATERIALS AND METHODS:The study design was retrospective and it was conducted in a regional cancer center of Northwest India. Three hundred and ten ALL patients who underwent treatment with MCP 841 protocol and regular follow-up for up to 5 years were selected for this study. Relapse-free survival was calculated by Kaplan-Meier analysis and Cox regression analysis was used to calculate the hazards ratio (HR) using Statistical Package for the Social Sciences (SPSS) software for windows version 20.0. RESULTS:Fifty-four percent patients were <15 years of age and 69% were males. 53.2% patients were in remission at the end of 5 years of starting the treatment. Relapse-free survival at 5 years by Kaplan-Meir analysis for B-cell ALL was 62% [HR 0.67 {95% confidence interval (CI) 0.47-0.95}] with patients with unknown lineage taken as reference] while for T cell it was 28% [HR 1.41 (95% CI 1.19-1.63), P 0.001]. Patients with total leukocyte count (TLC) <1 lakh/cmm at presentation, relapse-free survival was 68% and those with TLC >1 lakh/cmm had 41% survival [HR 2.14 (1.76-2.48) with, P < 0.001]. CONCLUSION:MCP 841 protocol is a useful tool for the treatment of ALL in children when more aggressive protocols can not be used.

Background: Bone metastasis is a rare occurrence in head and neck squamous cell carcinoma (HNSCC). This retrospective study was performed to analyze the frequency and patterns of skeletal metastasis in HNSCC. Materials and Methods: We analyzed records of 8326 HNSCC patients attending our oncology outpatient department from January 2000 to December 2013. All statistical calculations were performed using MedCalc software for windows, version 12.5.0 (Osterd, Belgium). Results: Bone metastasis was found in 25 patients (0.3% of total HNSCC patients, nasopharynx excluded). 10 patients (0.66%) of carcinoma tonsil had skeletal metastasis. The patients of younger age groups had higher frequency of bone metastasis; 1.56% patients of age group 20-29 years while 0.26% patients of 60-69 years age group had skeletal metastasis (P < 0.001). However, no patient of > 70 years age was found to have bone metastasis. Most common site of metastasis was spine (56%) followed by pelvis (32%). Isolated involvement of a single bony site was present in 64% of the metastatic cases. Conclusion: Bone metastasis though very rare, should be considered for evaluation in patients of HNSCC especially in younger patients.

Aim/Background: The aim of this study is to evaluate the efficacy of geftinib in previously treated patients of advanced squamous cell carcinoma of lung (SCCL) in an epidermal growth factor receptor (EGFR)-unselected Asian Indian patients. Histologically confirmed patients with SCCL were enrolled and randomized in this study. Patients with good responses to first-line chemotherapy, good performance status, and a long disease-free period between initial chemotherapy and relapse are the candidates for second-line chemotherapy with geftinib and best supportive care or best supportive care alone. Methods: Between October 2012 and December 2013, newly diagnosed or previously platinum based chemotherapy treated patients having ECOG performance status 2/3, age >65 years with stage IIIB/IV SCCL were randomized 1:1 to geftinib (150 mg daily) (till progression or intolerable toxicity) and best supportive care (BSC) or BSC alone. The primary endpoint was the comparison of progression free survival (PFS) between the two arms and the secondary endpoints included overall survival (OS), toxicity and analyses on EGFR wild-type tumors. All statistical analyses were performed by using SPSS version 20.0. Results: 73 patients were enrolled in this study (median age: 70.3 years, males 80.8%. EGFR wild-type SCCL patients was identified in 89% patients in the geftinib (n = 36) and BSC alone (n = 37) arms, respectively. In patients receiving geftinib and BSC, the median PFS and OS were 2.3 months (95% confidence interval, 1.5-2.5 months) and 12.2 months (95% CI, 0.6-20.2 months), in patients receiving BSC alone, the median PFS and OS were 2.0 months (95% CI, 1.0-2.5 months) and 10.3 months (95% CI, 0.56-18.4 months). Patients who never smoked seemed to have better clinical response and longer survival than those who had smoking history (P = 0.08 and 0.09, respectively). Geftinib was well tolerated with grade 3-4 neutropenia (11.1%) and grade 3-4 diarrhea (11.1%). Conclusions: Geftinib with best supportive care showed better PFS and OS as best supportive care alone in an EGFR-unselected Asian Indian patient population. Geftinib may be used as second or third line chemotherapy in Asian Indian patients of advanced squamous cell carcinoma of lung. Disclosure: All authors have declared no conflicts of interest.

Aim: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality. At the time of diagnosis, most of the patients of NSCLC have advanced disease (stage IIIB or IV). Palliative chemotherapy and Best Supportive Care (BSC) are treatment options for these patients. Therapeutic response relies on the extension of disease and ECOG status of the patients. We did a non-blinded, randomized, phase III clinical trial to compare the BSC versus palliative chemotherapy in terms of overall survival (OS) and ECOG performance status regression analysis. Methods: Newly diagnosed patients with stage IIIB/IV NSCLC from January 2002 to December 2010 were randomly assigned to platin (P) based doublet chemotherapy, geftinib or BSC alone. ECOG status of patients was assessed on every follow-up. The primary endpoint was the comparison of OS among therapies. Analysis was performed to observe the impact of therapy on OS by Kaplan-Meier survival and log rank tests, Cox proportional analysis using SPSS (20.0) (IBM, Armonk, NY). ECOG performance status regression analysis was performed by linear and quadratic regression models. Results: 1610 patients were enrolled (median age 67.2 years, males 91.78%, ECOG performance status 0/1, 2/3, 4: 11%, 34% and 55%, respectively). The median OS (95% CI) of 1610 patients was 9 (8.48-9.52) months. The median OS (95% CI) in months for BSC 15 (14.13-15.87), geftinib 12 (8.6-15.34), P + pemetrexed 12 (9.15-14.85), P + gemcitabine 9 (7.26-10.73), P + paclitaxel 9 (8.28-9.72) and P + etoposide 6 (5.35-6.64); (Chi-square = 358.5, P < 0.001). ECOG performance status regression with R2≥ 0.90 was analysed for all therapies. Geftinib follows linear quadratic model for all ECOG status. BSC follows polynomial quadratic regression model with power of two for all ECOG status. All other chemotherapies follow polynomial quadratic regression model with power of two for ECOG status 0/1 and with power of three for ECOG status 2/3 and 4. Conclusions: BSC alone is a feasible option in elderly patients with advanced NSCLC. Geftinib is suitable in all ECOG status while other chemotherapeutic drugs fare better only in ECOG status 0/1. Disclosure: All authors have declared no conflicts of interest.

Neurofibromatosis is a genetic disorder of neural crest-derived cells that predominantly affect growth and development of neural tissues. We report a case of 64-year-old patient, had several soft tissue cutaneous nodules (neurofibroma) on the body including the face, head, and neck, extremities and multiple hyperpigmented macules on trunk and back (Cafe-au-lait pigmentation), who was accidentally diagnosed as chronic myeloid leukemia, on routine investigation for surgical management. He did not have any systemic manifestation either of diseases.

Background: Palliative radiotherapy (PRT) is the eventual requirement in 30-50% of all cancer patients. PRT is primarily aimed to relieve pain and prevent/treat collapse or fracture in case of bone metastasis, to reduce edema in patients with cranial metastasis, and to control distressing symptoms of rapid primary growth. An audit of PRT planned in a busy cancer center can help in the characterization of the requirements of the patients and the formulation of institutional policies. Materials and Methods: In total, 516 patients who received PRT in our regional cancer center from January 2012 to December 2012 and whose complete records were available for analysis were selected for this retrospective study. Medical records and radiotherapy files were analyzed to obtain data such as sociodemographic parameters, prescription of PRT, and follow up. Descriptive statistics were evaluated in terms of frequencies and percentages to allow comparisons. Results: Of the 516 patients, 73% patients were male; the median age of the patients receiving PRT was 62 years (range 13-83 years). About 48% (n = 248) patients received PRT at the primary site while rest (52%) were given PRT at the metastatic site. The most common indication of PRT was pain (56.8% cases), followed by cytostatic PRT (19.8%) and raised ICT (12.4%). The median dose prescribed was 30 Gy (range 8-36 Gy) delivered in 1-12 fractions over the duration of 1-18 days. The overall response rate was about 43% at 2 weeks of completion of PRT; the median follow-up of the patients was 154 days (range 9-256 days). The long-term symptom relief at median follow up was 8%. Conclusions: Good clinical judgment and expertise is required in prescribing correct fractionation schedule to achieve effective symptom palliation with lowest possible cost and inconvenience to the patients and relatives. Hypofractionated radiotherapy is a feasible treatment option in patients with advanced incurable disease to achieve effective palliation.

Aim: Selected patients with good responses to first-line chemotherapy, good performance status, and a long disease-free period between initial chemotherapy and relapse are the candidates for second-line chemotherapy with docetaxel or pemetrexed. The aim of this study is to evaluate the efficacy of geftinib versus docetaxel in previously treated patients of advanced non small cell lung cancer (NSCLC) in an epidermal growth factor receptor (EGFR)-unselected Asian Indian patient population. Methods: Between October 2011 and December 2012, previously platinum based chemotherapy treated patients with stage IIIB/IV NSCLC were randomized 1:1 to geftinib (150 mg daily) or docetaxel (75 mg/m2) every 3 weeks. The primary endpoint was the comparison of progression free survival (PFS) between the two arms and the secondary endpoints included overall survival (OS), toxicity and analyses on EGFR wild-type tumors. All statistical analyses were performed by using SPSS version 20.0. Results: 107 patients were enrolled in this study (median age: 56 years, males 80.4%, stage IV disease 73.8%, ECOG performance status 0/1: 68.5%). EGFR wild-type NSCLC was identified in 37% and 32.1% patients in the geftinib (n = 54) and docetaxel (n = 53) arms, respectively. Median PFS for geftinib versus docetaxel was 2.3 vs. 3.1 months (hazard ratio [HR], 1.12; 95% CI, 0.77-1.45; P = 0.06), and median OS was 12.8 vs. 11.3 months (HR, 0.89; 95% CI, 0.49 to 1.29; P = 0.47), respectively. In a subset analysis of EGFR wild-type tumors, PFS for geftinib versus docetaxel was 1.7 vs. 3.3 months (HR, 1.36; 95% CI, 1.05 to 1.67; P = 0.03), and OS was 9.7 vs. 10.6 months (HR, 0.96; 95% CI, 0.49 to 1.43; P = 0.88), respectively. Geftinib was well tolerated with grade 3-4 neutropenia (5.5% vs. 22.6%, P < 0.001) and grade 3-4 diarrhea (5.5% vs. 3.8%, P = 0.78). Conclusions: Geftinib showed similar PFS and OS as docetaxel in an EGFR-unselected Asian Indian patient population. Also, the hematological Grade 3/4 toxicities were significantly lesser with Geftinib. Thus, Geftinib may be used as second or third line chemotherapy in Asian Indian patients of advanced NSCLC. Disclosure: All authors have declared no conflicts of interest.

Aim: The ABO system is controlled by a single gene at the ABO locus at 9q34 region of the chromosome. Genetic alteration of this region is common in many cancers. Thus, the blood group antigen expression may be affected by the nature of genetic changes in the cell. Non Small Cell Lung Carcinoma (NSCLC) presents at an advanced stage at diagnosis; it is important to identify the high risk group for early diagnosis and improving the chances of cure. In this study, we aimed to investigate relationship between NSCLC and ABO-Rh blood groups and their allele frequency. Methods: We analyzed 520 NSCLC patients with serologically confirmed ABO/Rh blood group. The distribution of blood groups of these patients were compared with that of 55568 healthy donors at the regional blood bank. The blood group frequencies were compared by Chi-square test and odds ratio (OR) with 95% confidence intervals (CIs) using SPSS software for windows version 20.0. The gene and allele frequencies of blood group were calculated by Hardy-Weinberg model. Results: Blood group O was identified in 39% patients; B, A and AB in 34.5%, 19.5% and 7% patients, respectively. Rh status was negative in 9.37% patients. There were statistically significant difference in the status of Rh blood group among the patients and general population (P = 0.006). Control population had blood group O (31.9%), B (37.1%), A (22.1%), AB (8.9%) and Rh negative (5%). Odds Ratio (95% CI) was 1.97 (1.2–3.2) for absence of Rh antigen relative to its presence. The gene frequencies for blood group antigen A [p], B [q] and O [r] were 0.143, 0.234 and 0.623 (P = 0.715) for NSCLC patients and 0.169, 0.265 and 0.565 for general population, respectively. The gene frequencies for A [p], B [q] and O [r] with relation to absence of Rh factor were 0.183, 0.237 and 0.580 (P = 0.914) and with presence of Rh factor 0.139, 0.234 and 0.627 (P = 0.675) respectively. There were no statistically significant differences on the basis of gender. Conclusions: The absence of Rh factor has two-fold increased risk for NSCLC. However, no relationship between the ABO blood group and NSCLC could be found. Further studies are warranted to define the mechanisms by which absence of Rh factor may influence the lung cancer risk. Disclosure: All authors have declared no conflicts of interest.

Aim/Background: Selected patients with good responses to first-line chemotherapy, good performance status, and a long disease-free period between initial chemotherapy and relapse are the candidates for second-line chemotherapy with taxane based regimen. The aim of this study was to evaluate the efficacy of three weekly versus weekly paclitaxel as second line therapy in previously treated patients of advanced non small cell lung cancer (NSCLC) in patient population. Methods: Between October 2012 and December 2013, previously platinum based chemotherapy treated patients with stage IIIB/IV NSCLC were randomized 1:1 to three weekly paclitaxel (175 mg/m2 for 4 cycles) or weekly paclitaxel (80 mg/m2 for 3 months). The primary endpoint was the comparison of progression free survival (PFS) between the two arms and the secondary endpoints included overall survival (OS) and toxicity analyses. All statistical analyses were performed by using SPSS version 20.0. Results: 109 patients were enrolled in this study (median age: 59 years, males 78.8%, stage IV disease 70.6%, ECOG performance status 0/1: 66.9%). The patients were randomized in the three weekly paclitaxel (n = 55) and weekly paclitaxel (n = 54) arms. Median PFS for three weekly paclitaxel versus weekly paclitaxel was 3.1 vs. 4.3 months (hazard ratio [HR], 1.42; 95% CI, 1.07-1.75; P = 0.03), and median OS was 6.8 vs. 7.6 months (HR, 1.19; 95% CI, 0.79 to 1.29; P = 0.47), respectively. Weekly paclitaxel was well tolerated with grade 3-4 neutropenia (5.5% vs. 8.6%, P = 0.07) and grade 3-4 diarrhea (5.5% vs. 3.8%, P = 0.78). Conclusions: Weekly paclitaxel demonstrated better PFS in comparison to conventional three weekly paclitaxel as second line therapy in patients with advanced non small cell lung cancer with acceptable toxicity profile. However, it failed to reach the significance level for overall survival benefit. Disclosure: All authors have declared no conflicts of interest.

Perivascular epithelioid cell tumor (PEComa) is a group of sarcomas that exhibit a myomelanocytic phenotype and possess a unique cell type in the perivascular epithelioid cell. Traditionally HMB-45 immunoreactivity is the first criteria required to consider a tumor to be PEComa. We report a case of multifocal PEComa with negative HMB-45 marker. The patient presented with three big ulceroproliferative lesions; two over right thigh and one over the scalp in the right frontal region. The patient was prescribed with oral sirolimus to which good response was seen. To the best of our knowledge, this is the first case of HMB-45 negative multifocal malignant PEComa from India.

Background: Nasopharyngeal carcinoma (NPC) is an aggressive tumor with a significant proportion of patients presenting with distant metastasis. The skeleton is one of the most common sites of distant failure. This retrospective study was performed to analyze the incidence and patterns of skeletal metastasis in NPC detected by bone scintigraphy in resource-poor settings. Materials and Methods: We analyzed records of 301 NPC patients attending our oncology outpatient department from January 2002 to December 2012. Of these, 33 patients who presented with bony pain underwent bone scan (BS) for suspect of skeletal metastasis. In patients with positive scans, histological diagnosis to confirm metastasis was attempted. Results: Bone metastasis (BM) was found in 19 patients (57.6% of patients undergoing BS, 6.3% of total NPC patients). About 36.8% and 15.8% of BM cases were in the age group 20-29 and 30-39 years, respectively (P = 0.27). 63.1% of metastatic cases were of World Health Organization type-II histology (P = 0.021). Of the patients diagnosed with BM, 52.6% belonged to stage IV at presentation (P = 0.022). Spine was involved in 56% of the positive cases, followed by the pelvis (32%), and ribs (24%). On univariate analysis, histology (P < 0.001), stage at diagnosis (P = 0.007) and age group (P = 0.001) were identified as significant factors affecting BM. However, on multivariate analysis, only stage (P = 0.001) was a significant factor. Conclusion: Bone scintigraphy can be considered in limited resource settings for the evaluation of distant metastasis in the patients of advanced NPC.

Background. ABO blood group and risk of squamous cell carcinoma of esophagus have been reported by many studies, but there is no discipline that had provided association with the genotype and gene frequency by population statics. Methods. We conducted a case-control study on 480 patients with squamous cell carcinoma of the esophagus and 480 noncancer patients. ABO blood group was determined by presence of antigen with the help of monoclonal antibody. Chi-square test and odds ratio (OR) with 95% confidence intervals (CIs) were calculated by statistical methods, and gene frequencies were calculated by Hardy-Weinberg model. Results. We observed significant associations between ABO genotype and squamous cell carcinoma of esophagus. OR (95% CIs) was 1.69 (1.31–2.19) for presence of B antigen allele relative to its absence (P<0.0001); in female subgroup OR (95% CIs) observed at 1.84 (1.27–2.65) was statistically significant (P=0.001). SCC of esophagus shows significant difference in comparison to general population; blood group B is found to be higher in incidence (P=0.0001). Increased risk of cancer was observed with absence of Rh antigen (P=0.0001). Relatively increased gene frequency of q[B] allele is observed more significantly in female cancer patients (P=0.003). Conclusion. Statistically significant association between squamous cell carcinoma of the esophagus and ABO and Rh genotype is identified by this study. Sex and anatomical site of cancer also present with statistically significant relative association. However, larger randomised trials are required to establish the hypothesis.

Background: Introduction of cross-sectional imaging provides a new dimension in evaluation structural anatomy of the tissue. This study was designed to assess the role of contrast enhanced computed tomography (CT) in the evaluation of neck masses in respect of characterization based on location, morphological characteristics and enhancement pattern; outlining the extent in terms of involvement of adjacent structures, vessels and possible lymphadenopathy; surgical and histopathological correlation whereever possible.Materials and Methods: An observational prospective study was conducted in 100 patients with clinically suspected neck lesions or patients who were referred for CT scan for further characterization. A standard proforma was maintained in reporting CT scan to allow documentation and comparison with histopathological reports. The site of lesion, the size of primary disease, the extent of involvement, enhancement pattern, calcification, necrosis, local extension and distant metastasis were recorded by CT scan.Results: Mean age of the patients who had undergone CT scan for the neck was 44.5 +/- 1.9 years ranging from 4 to 86 years normally. Higher incidence of malignant lesions between 46 and 60 years of age was observed, and the higher incidence of malignant cases was noted among males, with a male to female ratio of 2.5:1. Most common clinical presentation was neck swelling in both benign (92%) and malignant lesions (93%). Visceral space was the most common space to be involved in both benign (19%) and malignant (30%) lesions. Necrosis was the most common feature in malignant lesions. The sensitivity and specificity of the study are 95.7% and 77.5% respectively, with positive predictive value and negative predictive value of 90.4% and 88.9% respectively. Accuracy was found to be 90% (P < 0.001).Conclusions: Contrast enhanced CT scans for the neck has improved the localization and characterization of neck lesions. Since CT is fast, well tolerated, and readily available; it can be used for initial evaluation, preoperative planning, biopsy targeting, and post-operative follow-up. However, histopathology remains the gold standard as CT has the accuracy of 90% only.

INTRODUCTION: Rectal foreign bodies are common, but foreign body made of glass with uneven sharp distal end and complicated with hypovolemic shock is very rare. It is very challenging to be removed by laparotomy and poses extra difficulty in emergency. PRESENTATION OF CASE: A 45-year-old man with complains of rectal foreign body and bleeding per rectum reported in emergency room. On examination patient was in hypovolemic shock and continuous bleeding through anal opening. Emergency laparotomy was per-formed and foreign body was retrieved successfully. DISCUSSION: Rectal foreign body made of glass with uneven sharp distal end towards distal end of rectum is very rare. Retrieval of these foreign bodies will be very difficult, especially for the emergency cases that are complicated with hypovolemic shock. Emergency laparotomy can be successfully performed to stop the bleeding and minimize rectal and anal canal trauma. To the best of our knowledge, such rectal foreign body has been rarely reported. CONCLUSION: Rectal foreign body with uneven sharp edges towards anal opening are difficult to retrieve trough transanal route. Hypovolemic shock due to bleeding and rectal perforation is major complications of these foreign bodies. Emergency laparotomy should be done in these cases.