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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 2 | Issue 1
Page Nos. 1-61

Online since Wednesday, June 15, 2022

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EDITORIAL  

Cancer: Plethora of factors p. 1
Amal Chandra Kataki
DOI:10.4103/aort.aort_12_22  
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REVIEW ARTICLES Top

An overview of systematic evidence on oral microbial composition for orodigestive tract cancer risk p. 2
Steena Kuriakose, RS Vinutha, Krithiga Shridhar
DOI:10.4103/aort.aort_11_22  
We summarized published systematic reviews of studies evaluating oral microbial composition for orodigestive cancer risk. A PubMed literature search was conducted for the most recent time period between January 1, 2019 and April 25, 2022, for systematic reviews in English language using keywords and MeSH terms in combination. Seven systematic reviews included all published observational studies until June 2021 with 8–34 individual studies evaluated in each of those reviews. The individual studies were primarily hospital-based case–control studies with only six population-based evaluations (five prospective; one case control). The oral cavity, oro-and hypopharynx, esophagus, stomach, colorectum, liver, and pancreas were the cancer sites investigated. Saliva, oral rinse, subgingival and dental plaque, surface tissue swabs, biopsy tissue specimens, and tongue-coating samples were analyzed for oral microbial composition using next-generation sequencing techniques primarily 16S rRNA sequencing. The total sample size in different reviews ranged between 578 and 2769 cases and 261 and 3519 controls with small individual studies (3–250 cases and 2–465 controls). To date, there were four hospital-based case–control studies from India. The overall findings were restricted to bacterial communities. Compared to controls, the alpha-and beta-diversity for these cancer sites either showed no difference or inconsistent patterns. A few noteworthy differential abundances at the genus level for selected cancer sites included oral cavity – increased Fusobacterium, Parvimonas, and Peptostreptococcus and decreased Streptococcus, colorectum – increased Fusobacterium, Gemella, Peptostreptococcus, Prevotella, and Lautropia, pancreas – increased Porphyromonas and Alloprevotella, and esophagus – increased Tannerella. For clinical and public health translation, the identified leads might require validations in prospective population-based studies with rigorous methods, species-level characterizations, and functional analysis to prove causal associations.
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Progress in multidisciplinary treatment of hemorrhagic radiation proctitis p. 10
Qiulian Li, Guangjie Liao
DOI:10.4103/aort.aort_9_22  
With the development and wide application of radiotherapy technology, the incidence of radiation proctitis (RP) caused by radiotherapy for pelvic malignant tumors tends to increase, especially the treatment of hemorrhagic RP (HRP) is very difficult. Complications such as intestinal necrosis and perforation cause great pain and inconvenience to patients. How to effectively and safely treat HRP is an urgent clinical problem to be solved. This article reviews the progress of multidisciplinary treatment of RP, especially HRP, in recent years, and focuses on the progress of formalin in the treatment of hemorrhagic radiation proctitis.
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ORIGINAL ARTICLES Top

A prospective observational study on Hypo-fractionated Radical Radiotherapy for non-metastatic prostate cancer using Image Guided Radiotherapy: Assessing the toxicity and Quality of life p. 17
Beena Kunheri, JS Lakshmi, Rajashree Rajan, Athira Krishnan, Shabin K Sidhique, Bibin Rose
DOI:10.4103/aort.aort_28_21  
BACKGROUND: Prostate cancer is the second most frequent cancer in men. There are no randomized data comparing the outcome, toxicities, and quality of life (QOL) of these patients receiving treatment. This is a prospective study evaluating acute toxicities and QOL of patients receiving radical Radiotherapy (RT) for localized prostate cancer. MATERIALS AND METHODS: All localized prostate patients reporting for radical radiotherapy were included for this analysis. All patients received image-guided RT. Toxicity analyzed weekly during RT and then at 3 and 6 months. QOL was assessed pre- and post-RT, then at 3 and 6 months. RESULTS: A total number of 54 patients received radical radiation were included. The median age of presentation was 71 years. Majority of our patients belong to high risk grouping and all patients received image-guided radiotherapy. The highest reported toxicity as Grade 2 and no Grade 3 or 4 genitourinary (GU) or gastrointestinal (GI) toxicities were reported. During RT six patients (11.1%) had Grade 2 GI toxicity and 3 (5.6%) patients had Grade 2 GU toxicity. At 3 months and 6 months, no Grade 2 GI/GU toxicity was recorded. Overall, no Grade 3 or 4 GI and GU toxicity was observed. Regarding QOL, we observed a statistically significant difference in IPSS symptom score between the pre-RT and at completion (P < 0.001) of treatment, 3 months (P < 0.001) and 6 months (P < 0.001) indicating improvement in the symptoms following treatment. Similarly, we noted a significant association in IPSS QOL between the pre-RT and on completion (P < 0.001) of treatment and at 3 months (P < 0.001), 6 months (P < 0.001) indicating improvement in the QOL following treatment. CONCLUSION: Radical RT is well tolerated with no significant toxicity pattern reported in patients receiving hypo-fractionated RT. QOL assessment showed improvement in IPSS symptom score and QOL scoring and it is well tolerated.
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Delays and disruptions in breast cancer care due to coronavirus disease-2019 pandemic: Real-World data from India p. 23
Ankita Gupta, Budhi Singh Yadav, Venkata Krishna Vamsi Gade, Diksha Rana, Divya Bharti, Divya Dahiya
DOI:10.4103/aort.aort_29_21  
PURPOSE: This study aimed to identify and categorize the delays and disruptions in breast cancer care and its impact on disease outcome during the first wave of the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Patients with newly diagnosed or relapsed breast cancer who were treated between May 2020 and March 2021 were evaluated. Patients who had experienced COVID-19 related delays in cancer diagnosis or treatment initiation and/or disruption in ongoing treatment were included for analysis. All delays in cancer diagnosis, surgery, or a delay/disruption in radiotherapy or systemic therapy for each patient were identified. The reasons for delays and disruptions were evaluated. Any modification (s) in ongoing treatment, failure to complete planned treatment, and the effect on disease status were noted. RESULTS: Of the 415 eligible patients with breast cancer, we identified 70 (15.5%) patients who experienced COVID-19-related delay in diagnosis, or a delay or disruption in cancer-directed therapy. Forty (57.1%) patients experienced delays in initiation of their breast cancer treatment and ongoing treatment was disrupted in 30 (42.9%) patients. Majority of the delays (17, 42.5%) and disruptions (17, 60%) were noted in chemotherapy. The median duration of treatment delays was 156 days (interquartile range [IQR] 82–209 days) and that of treatment disruptions was 90 days (IQR 48–261 days). Logistic constraints were responsible for majority of the delays and disruptions. Overall, 32 (45.7%) patients suffered cancer upstaging or progression. CONCLUSION: We observed significant rates of disease progression among patients with breast cancer who suffered treatment delays and disruptions during the first wave of the COVID-19 pandemic. It is critical to identify and characterize these unprecedented delays and their impact to alienate them in the present and future surges, and to inform strategies to overcome the long-term oncological consequences of the pandemic.
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Different treatment planning strategies for whole-brain radiation therapy with simultaneous integrated boost for multiple brain metastases to protect neurocognitive function with hippocampal sparing p. 29
Ilknur Harmankaya, Ozge Atilla, Sumeyra Can, Didem Karacetin
DOI:10.4103/aort.aort_8_22  
PURPOSE: The aim of this study is to provide the dosimetric evaluation of the compound therapeutic concept of hippocampal avoidance for the whole brain radiotherapy (WBRT) with a simultaneous integrated boost (SIB) in patients with multiple brain metastases more than 3. MATERIALS AND METHODS: Ten patients with multiple brain metastases previously treated with conventional WBRT followed by SIB on Radixact Tomotherapy Unit were selected. The whole-brain (WB) clinical target volume was generated by contouring the WB and excluding the hippocampal avoidance structure for the sake of WBRT while plan optimization of both approaches was performed with the aim of delivering 95% of the WB and receiving the prescription dose of 30 Gy; in addition, planning target volumes (PTVs) were given 45 Gy using SIB technique in 10 fractions. Dmax ≤16 Gy and D100% ≤9 Gy for hippocampi and V37 Gy for the WB-PTVs were evaluated in this study as well. RESULTS: The D95% was 44.8 ± 0.15 Gy in helical tomotherapy (HT) which was calculated as 44.9 ± 0.11 Gy in volumetric modulated arc therapy (VMAT) plan. The volume receiving 37 Gy for brain-PTV was 3% ± 0.55% in HT and 10% ± 1.55% in the VMAT plan. The D2% and D100% values of hippocampi were calculated <2 Gy in HT plan compared to the VMAT plan. CONCLUSION: Techniques used in both plans are feasible. However, the VMAT plan owns the ability to deliver SIB dose to each individual metastasis as well while it adequately delivers WBRT and conformably spares the hippocampus. On the negative side, providing the dosimetric criteria of hippocampus is not possible in some cases due to the close proximity of tumor locations to the hippocampus.
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CASE REPORTS Top

Primary gastric mucosal melanoma: A rare histopathological diagnosis p. 35
Andleeb Abrari, Fauzia Talat Ekram, Kafil Akhtar
DOI:10.4103/aort.aort_3_22  
Primary mucosal melanoma in the gastrointestinal (GI) tract is very rare, as most of the melanomas diagnosed in the GI tract are metastases, secondary to cutaneous melanomas. We report a rare case of primary gastric mucosal melanoma in a 58-year-old male patient who presented with a short history of upper abdominal tightness and pain for 15 days. Upper GI endoscopy revealed a polypoid mucosal mass with ulceration at the gastric antrum of 2 cm × 2 cm dimension, which was diagnosed histopathologically as malignant melanoma. A detailed clinical and laboratory workup did not reveal any other primary site elsewhere and there was no relevant history suggesting a cutaneous melanocytic lesion. Upper GI endoscopy and microscopic tissue examination with immunohistochemistry formed the mainstay of diagnosis of this exceedingly rare neoplasm.
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Unusual sites of metastases at initial presentation in Ewing-like sarcoma of extremity in an elderly male p. 38
PG Nandakumar, Kamaxi Trivedi, Amitkumar Choudhari, Amitkumar Janu
DOI:10.4103/aort.aort_1_22  
Ewing and Ewing-like sarcoma are high-grade sarcomas with the histological presence of small round blue cells with a higher propensity for hematogenous metastases. The most common pattern is appendicular skeleton involvement with or without metastases. In this case report, we present a 55-year-old gentleman with Ewing-like sarcoma of the left femur with metastases to rare sites.
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Inflammatory myofibroblastic tumor presenting as malignant intestinal obstruction: A rare case report p. 41
Zeeshan Nahid, Sadaf Abbas, Asfa Shams, Kafil Akhtar
DOI:10.4103/aort.aort_4_22  
Inflammatory myofibroblastic tumor (IMFT) is an unusual solid tumor of mesenchymal origin seen in children and young adults. It occurs primarily in the lungs with equal gender predisposition. It has been proposed that the development of IMFT occurs after trauma, surgery, or infection with Epstein‒Barr virus and human herpesvirus, related with reactive cytokine production. Because of its rarity, it is important to distinguish IMFT from other colonic tumors. We report a rare case of IMFT in a 50-year-old man who presented with features of intestinal obstruction.
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Spindle cell hemangioendothelioma presenting as fracture femur – A rare case presentation p. 45
Kafil Akhtar, Anjum Ara, Shivani Gupta, Mazhar Fahim
DOI:10.4103/aort.aort_6_22  
Hemangioendothelioma (HE) is a vascular malignancy which shows a borderline biological behavior. Spindle cell HE (SCHE) is a type of hemangioendothelioma, first described by Weiss and Enzinger in 1986. We present a case of 58-year-old male, who presented with fracture right femur. The biopsy showed necrotic bone with features of soft-tissue SCHE. Immunohistochemistry showed diffuse positivity of cluster of differentiation 31 in the tumor cells. Although SCHE has been pondered as a low-grade/borderline malignancy, few cases have been reported as locally aggressive and invasive behavior in the literature. The overall prognosis is excellent and no metastases from this locally aggressive tumor have been reported till date.
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PERSPECTIVE Top

Breast Cancer Hub – meeting the challenges to screening, diagnosis, treatment, and support to cancer patients during the COVID-19 pandemic in North-East India Highly accessed article p. 49
Sanalembi Devi, Sapna Pashi, Ranjita Singha, Rakesh S Ramesh, Lopamudra Das Roy
DOI:10.4103/aort.aort_16_22  
We report the challenges faced in the villages' Breast Cancer Hub (BCH) adopted in Cachar, Assam, India, since February 2020 during the coronavirus disease 2019 (COVID-19) outbreak. We also present the overall challenges, during COVID-19, even in the urban sectors, with good financial conditions. We report the challenges faced at the grassroots level and how we addressed the concerns. The villages BCH adopted for door-to-door cancer screening, BCH takes care end to end, starting from generating the income certificate, accompanying the patients to the hospitals, helping with registration, communication with doctors, treatment management, covering all the supplemental expenses, with diligent follow-ups, and counseling, making sure that the re-visits to hospitals are also carried out by the BCH team, or in most cases, the patients are negligent to continue their treatment and miss out on the follow-up dates. COVID-19 pandemic worsened the prevailing difficult situation of cancer diagnosis and treatment in North East India.
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LETTER TO EDITOR Top

Oncocytic variant of gastrointestinal stromal tumor of jejunum masquerading as uterine mass p. 56
Kavita Mardi
DOI:10.4103/aort.aort_32_21  
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PATIENT PERSPECTIVE Top

Cancer can be conquered p. 58
Mukuta Goswami
DOI:10.4103/aort.aort_7_22  
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SPECIAL SECTION Top

Editorial clarification p. 61
Manigreeva Krishnatreya
DOI:10.4103/aort.aort_10_22  
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