Study of pathological complete response rate with neoadjuvant concurrent chemoradiation with paclitaxel in locally advanced breast cancer

Background

Neoadjuvant concurrent chemoradiation (CTRT) is not widely practiced in breast cancers. The current study presents our experience with the use of neoadjuvant CTRT in patients with locally advanced breast cancers (LABC) treated at our center.

Methods

The study included all consecutive female patients with inoperable stage III LABC treated at Cancer Institute (W.I.A), Chennai, India, from December 2015 to September 2016. Data were collected retrospectively from the patients' case records. The impact of neoadjuvant CTRT on the pathological complete response (pCR) and survival was analyzed. Neoadjuvant chemotherapy consisted of 4 cycles of adriamycin and cyclophosphamide given either before or after 4 cycles of paclitaxel. All chemotherapy cycles were given once in 3 weeks. Concurrent radiotherapy was incorporated with 2 cycles of paclitaxel.

Results

The study included 100 patients with a median age of 49 years, among whom 9 (9%) had IIIA disease, 73 (73%) IIIB, and 18 (18%) had IIIC disease. The hormone receptor-positive disease was observed in 36 (36%) patients, triple-negative in 24 (24%), and Her2/neu positive disease in 40 (40%) patients. All patients were operable after completing the planned neoadjuvant treatments. Ninety-one out of 100 (91%) patients underwent modified radical mastectomy whereas 9 (9%) did not consent for surgery. Among the patients who underwent MRM, 34/91 (37.7%) patients had a pCR. Moreover, pCR was observed in 12/22 (54.5%) patients with triple-negative disease, 10/34 (29.4%) patients with hormone receptor-positive disease, and 12/35 (34.2%) patients with Her2/neu positive disease (P = 0.19). Most common morbidity observed was grade 3 skin reactions. The 2-year event-free survival and overall survival for the entire cohort was 73.1% and 88%, respectively.

Conclusion

Neoadjuvant CTRT is associated with a higher pCR rate than what has been reported with neoadjuvant chemotherapy alone. Further prospective studies are required to confirm our findings.

A Tertiary Cancer Center Experience of 52 Cases of Primary Ovarian Mucinous Adenocarcinomas

Background  Primary mucinous epithelial ovarian adenocarcinoma (mEOC) constitutes a small percentage (2–5%) of ovarian cancer. Our aim is to understand the clinicopathological characteristics and survival results of patients with mEOC after a long-term follow-up.

Materials and Methods  This is a retrospective study of primary mEOC cases treated at a tertiary cancer center in India, from January 1, 2005, to December 31, 2012.

Results  Out of 958 malignant ovarian tumors, 52 (5.43%) were mucinous adenocarcinoma. Nearly 71.2% of cases were of early-stage disease, and the remaining were of advanced-stage disease. After a follow-up period of 63 months (range: 1–138 months), the 5-year actuarial overall survival for stages I, II, III, and IV was 92.5, 70, 38.5, and 0%, respectively. Among advanced-stage tumors, half of them progressed without undergoing cytoreductive surgery and died.

Conclusion  Most of the mEOC cases present in early stages and have good clinical outcome. Patients with advanced-stage disease do not respond well to standard chemotherapy regimens in use and have poor survival figures. The use of primary cytoreduction should be considered in the place of interval cytoreduction for advanced mEOC.

Neoadjuvant concurrent chemoradiation in male breast cancer: Experience from a tertiary cancer center

BACKGROUND

Male breast cancers (MBC) account for 1% of all breast cancers. Neoadjuvant concurrent chemoradiation (CTRT) is not the standard of care for treating breast cancer. However, in our center, it has been routinely used in patients with locally advanced breast cancer to downsize the tumor and make it amenable to surgery.

AIM

This study was conducted to examine the clinical and pathological profile and outcomes of patients with MBC treated at our institute with neoadjuvant CTRT.

SETTINGS AND DESIGN

The study was conducted at a tertiary cancer center and was retrospective in nature.

MATERIALS AND METHODS

All MBC patients treated with neoadjuvant CTRT at our center between 2001 and 2016 were enrolled in the study. Data were retrospectively extracted from the patients' case records.

STATISTICAL ANALYSIS

Kaplan-Meier method was used for survival analysis and the outcome variables were compared using the log-rank test.

RESULTS

Thirty-one MBC patients who received neoadjuvant CTRT were analyzed in this study. The median age of the patients was 53 years. Stage IIB disease was observed in 8/31 (26%) patients, stage III in 20/31 (64%), and stage IV in 3/31 (10%) patients. There was no grade 3 or 4 toxicity due to CTRT. Surgery was performed in 29/31 (94%) patients and none of the patients had a pathological complete response. The median duration of follow-up was 95.3 months. The 8-year event-free survival and overall survival for stage IIB, III, and IV were 75%, 50%, and 0% and 87.5%, 69%, and 0%, respectively.

CONCLUSION

This is the first study to report on the use of neoadjuvant CTRT in MBC. Prospective evidence from phase-3 randomized controlled trials on the safety and efficacy of CTRT in breast cancer is required before its routine use can be recommended.

Ameloblastic fibrodentinoma involving anterior maxilla: a rare case report

Ameloblastic fibroma (AF) and related lesions comprise a complex group of mixed odontogenic tumors. Ameloblastic fibrodentinoma (AFD) is a rare tumor and is considered as a histological variant of AF showing inductive changes that lead to the formation of dentin. Although the most common site for this tumor is the posterior mandible, hereby we are reporting a case of AFD in the anterior maxillary region which is a very rare site for this group of tumors. The present case report highlights the clinical, radiological and histological presentation of AFD in order to raise awareness for the earlier diagnosis and precise management of this rare pathological entity.

Breast cancer in young women less than 30 years from southern India: Study on clinical profile and outcome

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Background: Breast cancer in young patients have an aggressive behaviour with poorer outcome. The patients are in their reproductive age group and are concerned with fertility issues,pregnancy and lactation. The literature pertaining to patients less than 30 years is limited. Methods: 213 Patients under the age of 30 years with breast cancer were studied for Demographics, clinical presentations, pathological profiles, treatment and survival. The case records were retrospectively analyzed between Jan 1993 - Dec 2003 at Cancer Institute (WIA) Chennai. Results: The mean age of the study population was 28 years and ranged between 17 to 30 years. Early menarche, defined as less than 12 years (17.5 %), Nulliparity (21.1%), first child birth less than 18 years (26.8%) were the major risk factors noted. Family history of breast and ovarian cases were seen in 6.6% of the patients. The Stage distribution included Stage I (1.4%), Stage II (31%), Stage III (49.6) and Stage IV (11%) and unclassifiable (7%). Node positive tumours constituted 158 patients (74.1%). Hormone receptor studies were negative in 62% of the patients. Modified radical mastectomy was performed in 164 (77%) of the patients. Non infiltratring ductal carcinoma histopathology was noted in 13.6%. Surgical and radiocastration was performed in 35.2% and 17% of the cases respectively. Of 201 (94.3%) patients who received chemotherapy anthracycline based chemotherapy was delivered in 30.3%. Recurrence pattern included local, local and distant and distant recuurences in 8.5%, 23.5% and 2.3% respectively. The 5 year over all survival for the evaluable patients was 53.2%. Conclusions: Very young Indian patients less than 30 years constitute a unique subset of breast cancer patients with majority being hormone receptor negative and locally advanced stage at presentation. The over all outcome is inferior compared to older patients with breast cancer. More aggressive adjuvant treatment may help in improving survival.

No significant financial relationships to disclose.

Biosorption of nickel and copper ions from single metal aqueous solutions by fungi

Batch biosorption studies were carried out for the removal of nickel and copper using biosorbents, from single metal aqueous solutions. Treated and untreated effluent, soil and sludge samples were collected from selected points of chrome plating unit located at Visakhapatnam. The collected samples were analyzed for physico-chemical quality. The effects of some of the major parameters of biosorption, viz. contact time, dose of biosorbent, pH and initial metal concentration were studied and optimized. The optimum contact time, biosorbent dosage and pH were found to be 1 hr, 5 g/L and 10 respectively. The percentage removal of nickel and copper for an initial concentration of 20 ppm, for a dosage of 5 g/ L of dry fungal biomass at pH 10 and for a contact time of 1 hr was found to be 75.5% and 55.5% respectively, whereas, for an initial concentration of 100 ppm under the same optimum conditions, it was found to be 71% and 50% indicating that even at high concentration of metal ions the efficiency of biosorption is high. The dry fungal biomass has more favorable sites for nickel than copper ions.

Electrochemical oxidation for the treatment of textile industry wastewater

This study elucidates the reduction of organics from textile effluents through electrochemical oxidation technique. Effect of pH and current intensity were investigated in this system. It was found that degradation was maximum at the current intensity of 0.6 A and at a pH of 1.3. Under the same experimental conditions the removal of chemical oxygen demand (COD), total solids, total dissolved solids and total organic carbon were found to be approximately 68%, 49.2%, 50.7% and 96.8%, respectively. Effect of current intensity on color removal was also investigated as a function of electrolysis time (30-210 minutes) and it showed that maximum removal efficiency (96%) was reached within 60 minutes at 0.6 A. While studying the effect of pH on COD removal, it was observed that a decrease in pH to an optimum of 1.3 showed maximum COD reduction of 68%. These results suggest an important role of these parameters in electrochemical process for removing organic pollutants.

Does "ichthyosis uteri" have malignant potential? A case report of squamous cell carcinoma of endometrium associated with extensive ichthyosis uteri

Ichthyosis uteri is a rare condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium. Though the condition often is considered as benign, anaplastic and dysplastic changes have been reported. We describe herein a rare case of low-grade squamous cell carcinoma of endometrium associated with extensive ichthyosis uteri with dysplasia. The cervix showed moderate to severe dysplastic changes while the right fallopian tube showed extensive squamous metaplasia with dysplastic changes. We conclude that squamous cell carcinoma could develop into pre-existing ichthyosis uteri.

Clinical and pathologic prognostic factors in adult granulosa cell tumors of the ovary

The objective of this study was to determine the clinicopathologic prognostic factors in adult granulosa cell tumors of the ovary. A retrospective review of the records of patients of granulosa tumors who were treated at our institute over a period of 10 years (1995-2005) was done. Clinical, pathologic, and follow-up data were collected. A total of 34 patients who were treated during this period were subjected to analysis. Cox univariate analysis and Wilcoxon's test for multivariate analysis were used as part of the SPSS software for examining the data. It was found that optimal cytoreduction (P = 0.02), presence of nuclear atypia (P < 0.001), and increased mitoses (P = 0.03) were the three factors that impacted significantly on survival. Age, stage of the tumor, parity, and size of the tumor had no significant effect on survival. Patients who received chemotherapy had a better median disease-free survival than those who did not (60 vs 48 months), but this did not reach statistical significance (P = 0.08). Optimal cytoreduction, nuclear atypia, and increased mitoses are the statistically significant prognostic factors and may be used for selecting patients for adjuvant therapy.

Organization and running of the first comprehensive hereditary cancer clinic in India

Hereditary cancers are thought to account for around 5% of cancers, particularly breast/ovarian and colorectal cancers. In India there is a paucity of data on hereditary cancers and the mutations in some of the common genes linked to hereditary cancers, such as BRCA1, BRCA2, hMSH2 and hMLH1. The country's first comprehensive hereditary cancer clinic was established in February 2002. The article describes the organization and running of the Clinic. It also discusses some of the social issues relevant to the given population in running the Hereditary Cancer Clinic.

Effect of high temperature and water stress on in vitro germination and growth in isolates of the entomopathogenic fungus Beauveria bassiana (Bals.) Vuillemin

In non-irrigated agricultural fields in tropical zones, high temperature and water stress prevail during the main cropping season. Natural epizootics of Beauveria bassiana on lepidopteran pests occur during winter. Application of B. bassiana during hot months when pest populations are at their climax may prove an effective management strategy. Therefore, 29 isolates of B. bassiana were tested for their ability to germinate and grow in temperature and water availability conditions prevailing during the pest season in these fields. The effect of temperature cycles with 8 h duration of high temperature fluctuating with 16 h duration of lower temperature (similar to field conditions); low water availability; and a combination of these two stress conditions was studied. Germination and growth assays were done at fluctuating temperature cycles of 32, 35, 38, and 42+/-1 degrees C (8 h)/25+/-1 degrees C (16 h) and in media with water stress created by 10, 20, 30, and 40% polyethylene glycol (PEG 6000). Assays set at a continuous temperature of 25+/-1 degrees C with no PEG in the medium served as controls. Stress was assessed as percentage germination or as growth relative to control. Isolates showing 90% growth relative to the control at temperature cycles including high temperatures of 35 and 38+/-1 degrees C were identified. One isolate (ARSEF 2860) had a thermal threshold above 43 degrees C. At 25 degrees C, all but one isolate of B. bassiana showed >90% growth relative to the control in 10% PEG (-0.45 MPa). Some isolates were found with >90% growth relative to control in medium having 30% PEG with water availability (1.33 MPa), nearly equivalent to that in soils which induce permanent wilting point of plants. When isolates that showed >90% growth relative to the control at both stress conditions, were stressed simultaneously, a decrease in growth was observed. Growth was reduced by approximately 20% at 35+/-1 degrees C (8 h)/25+/-1 degrees C (16 h) and 10% PEG and was affected to a greater degree in combinations of harsher stress conditions. The isolate ARSEF 2860 with a thermal threshold of >43 degrees C showed approximately 80% relative growth at a combined stress of 38+/-1 degrees C (8 h)/25+/-1 degrees C (16 h) and 10% PEG. These findings will aid the selection of isolates for use in field trials in hot or dry agricultural climates.

Esterase-mediated tolerance to a formulation of the organophosphate insecticide monocrotophos in the entomopathogenic fungus, Beauveria bassiana (Balsamo) Vuill: a promising biopesticide

The use of biopesticides compatible with chemical pesticides is recommended in pest management as an effective and ecologically sound strategy. The entomopathogenic fungus Beauveria bassiana (Balsamo) Vuill, which is used as a biopesticide, was found to exhibit and lose tolerance to two organophosphorus insecticides widely used in Indian fields. The pattern of response is similar to the esterase-mediated organophosphate tolerance in aphids achieved through esterase gene duplication. Therefore the role of esterase in the tolerance exhibited by isolates of B. bassiana to the organophosphate, monocrotophos, was studied. Both the total soluble protein content and esterase activity were found to increase significantly in B. bassiana cultures that were able to grow in the presence of monocrotophos. With the hitherto established linkage between esterase overproduction and organophosphate tolerance in insects and the observed similarity in response of the insects and B. bassiana to the chemical, it is concluded that tolerance to monocrotophos in B. bassiana may be due to a mechanism similar to that operating in insects. Habituation of the fungus to monocrotophos to initiate expression of esterase gene may help in achieving compatibility between the two.

Screening for tolerance to bavistin, a benzimidazole fungicide containing methyl benzimidazol-2-yl carbamate (MBC), in Beauveria bassiana: sequence analysis of the beta-tubulin gene to identify mutations conferring tolerance

The entomopathogenic Beauveria bassiana is a potential biopesticide. Fungicide-tolerant isolates of this fungus would have an added advantage of being compatible with the conventional chemical methods of pest control. Therefore, 30 isolates of the fungus were screened for tolerance to bavistin a commonly used benzimidazole fungicide containing methyl benzimidazol-2-yl carbamate (MBC). Germination and growth bioassays in the presence of 0.05% bavistin were conducted for screening. Three tolerant isolates were identified, showing tolerance up to 2% bavistin. Mutation in the beta-tubulin gene is known to confer tolerance to MBC; the nine known mutation sites in the gene involved were sequenced in the tolerant strains. The beta-tubulin gene from codons 1-405 was amplified using two pairs of degenerate primers, designed for the conserved region of the beta-tubulin gene and sequenced. From the sequence suitable primers were designed for the regions flanking the nine known sites involved in mutations conferring MBC tolerance. The amplified products with these primers from the MBC-tolerant isolates were sequenced and in two (ARSEF 1315 and ARSEF 1316) a mutation was detected in the 198 codon resulting in replacement of glutamic acid with lysine. In the third tolerant isolate (ITCC 913) no mutation could be detected in any of the nine known sites conferring tolerance to MBC. To complete the sequencing of the beta-tubulin gene, the remaining part (from codon 405 onwards) of the gene was isolated by a three-prime gene walk. The gene sequence showed a close homology to fungal beta-tubulin genes with four introns.

Effect of support materials on cephamycin C production by immobilized Streptomyces clavuligerus

In order to know the effect of supports on cephamycin C production, under similar experimental conditions, S. clavuligerus cells were immobilized with--sponge, 2% agar, 2% and 4% alginate support materials. An experimental set of free cell was also maintained as control. Cephamycin C production by these immobilized and free cells was estimated at 48, 96 and 120 hr of fermentation. In all the cases cephamycin C production was found to be high at 120 hr of fermentation. Sponge was found to be a better support material than other supports used for immobilization.