Suryanarayana V. S. Deo

Gastroesophageal junction (GEJ) cancers have shown a rising global incidence, with unique anatomical and biological features distinguishing them from esophageal and gastric carcinomas. This study evaluates the clinicopathological characteristics, treatment modalities, survival outcomes, and recurrence patterns of GEJ cancers in an Indian population. This study was conducted on 107 patients with histologically confirmed GEJ carcinoma treated at a tertiary cancer center in India between 2012 and 2024. Demographic, clinical, radiological, surgical, and survival data were reviewed. Staging was based on endoscopy and contrast-enhanced CT. Multimodality treatment strategies were implemented, including neoadjuvant chemoradiotherapy (CROSS), chemotherapy (FLOT), and definitive chemoradiotherapy for unresectable cases. Survival was analyzed using Kaplan–Meier methods, and predictors of recurrence were assessed using Cox regression. The cohort had a male-to-female ratio of 3.45:1 with a mean age of 53 years. Adenocarcinoma was the predominant histology (63.6%). Curative resection was achieved in 79.4%, with an R1 rate of 2.4%. The most common surgical approach was Ivor Lewis esophagectomy (63.6%). The 2-, 3-, and 5-year disease-free survival (DFS) rates were 82%, 75%, and 56%, respectively; overall survival (OS) rates were 88%, 77%, and 59%. Recurrence occurred in 35.3% of patients, predominantly systemic. On multivariate analysis, lympho-vascular invasion, extent of lymphadenectomy, and pathological stage significantly predicted recurrence. Gastroesophageal junction cancers in India predominantly affect middle-aged males and are mostly adenocarcinomas. Multimodality treatment, including neoadjuvant therapy and extended lymphadenectomy, shows promising survival. However, systemic recurrence remains a major challenge. Early detection, personalized treatment, and standardized follow-up are essential to improve outcomes. These findings highlight the urgent need for resource-sensitive national strategies to tackle the rising burden of GEJ cancers.

Background: Soft tissue sarcomas recur despite optimal multimodality treatment. Being rare, and heterogeneous, there is no consensus on follow‐up protocol and management of recurrences.Materials: This is a retrospective analysis of the adult soft tissue sarcoma database. All the patients undergoing curative surgery between 1993 and 2020 were included. We studied the recurrence patterns in terms of time and anatomical location concerning age, gender, site, size, histology, grade and treatment and identified the predictive factors for local (LR) and systemic recurrences (SR).Results: A total of 984 patients were included. In a median follow‐up of 37 months, 31% (305) of patients developed recurrence. Of these, there were 12% LR and 19% SR. The median time to LR and SR was 1.07 years (0.581–2.30) and 1.03 years (0.529−1.80) respectively. The median time to recurrence was least in retroperitoneum, 0.827 years (0.471−2.34), followed by extremity, 1.60 years (0.495–3.73); trunk, 1.95 years (0.696–4.27) and head & neck, 2.21 years (0.909−4.05). Extremity and head & neck STS had more SR, while RP & trunk had a higher rate of LR. Common subtypes associated with LR were extraskeletal chondrosarcoma/osteosarcoma (n = 14, 27.27%), DFSP (n = 5, 26.32%), and leiomyosarcoma (n = 22, 24.44%) and; with SR were rhabdomyosarcoma (n = 4, 50%), angiosarcoma (n = 2, 33.33%), and pleomorphic liposarcoma (n = 23, 27.71%). Recurrence was curatively treated in 32% of patients. The 5‐year overall survival in patients with LR and SR were 76.3% and 41.2% respectively. In a multivariate analysis, age > 50 years and extremity site were predictors of local recurrence whereas male sex, high grade, and adjuvant chemotherapy were predictors of systemic recurrence.Conclusions: The study shows a higher incidence of early LR in RP and late LR in the trunk while a higher incidence of early SR in extremities and late SR in the head and neck. The highest risk for SR and LR is associated with synovial sarcoma and liposarcoma respectively. This pattern of recurrence may guide in individualizing the follow‐up frequency and imaging modality as well as in doing the timely intervention.

There is a paucity of definitive guidelines on how to approach an architectural distortion detected on mammography. The purpose of this study was to identify any imaging features that can assist in devising a pattern-based approach to image-detected architectural distortion. This prospective study included females who underwent screening or surveillance mammography in the department. Patients with architectural distortion (AD) not attributed to treatment or primary breast cancers were included. Recorded imaging features included lesion size, presence or absence of central lucency, and convergence of radiating spicules with or without thickened periphery. Biopsy of ADs was performed using image guidance with core needle (CNB) or vacuum-assisted biopsy (VAB) techniques. Fisher’s exact test was used for statistical evaluation. Out of a total of 1307 ADs, a cohort of 25 patients was eventually included for evaluation, amongst which 14 underwent tissue sampling. The final histopathology confirmed five malignant and nine benign lesions. ADs associated with malignancy demonstrated statistically significant differences in lesion size (p value, 0.02) and spicules converging to a thickened periphery (p value, 0.03) as compared to the ADs with no evidence of malignancy. No significant difference was observed for presence of a correlate on conventional mammography and ultrasound. We concluded that the potential imaging features to be considered when evaluating ADs were lesion size, lucent center, and spicules converging to a thickened periphery. Whenever considering biopsy, VAB allows better yield as compared to CNB for histopathological assessment of these findings.

A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a sign

Background and Objectives: The role of cell‐free DNA (cfDNA) in operable nonsmall cell lung cancer (NSCLC) is unclear. This study was aimed to evaluate the feasibility for identification of cfDNA in pleural lavage fluid and its correlation with plasma in resectable NSCLCs.Methods: Consecutively resected NSCLCs were evaluated for cfDNA levels in preoperative plasma (PLS1), intraoperative pleural‐lavage (PLV) and postoperative (at 1 month) plasma sample (PLS2). CfDNA was isolated and measured quantitatively by qPCR in a TaqMan probe‐detection approach using the human β‐actin gene as the amplifying target.Results: All (n = 34) except one were negative for malignant cells in PLV cytology. CfDNA could be isolated from all the three samples (PLS1, PLV, and PLS2) successfully in each patient. The median cfDNA levels in PLS1, PLV and PLS2 were 118 ng/mL (IQR 61−158), 167 ng/mL (IQR 59.9−179.9) and 103 ng/mL (IQR 66.5−125.4) respectively. The median follow‐up was 34.1 months (IQR 25.2−41.6). A significant overall‐survival (OS) and disease‐free survival (DFS) were recorded for patients with cfDNA level cut‐offs at 125, 170, and 100 ng/mL, respectively for PLS1, PLV, and PLS2. Patients with raised cfDNA in PLS1 (>125 ng/mL) and PLV (>170 ng/mL) had significantly poorer 2‐year OS, p = 0.005 and p = 0.012, respectively. The hazards (OS) were also higher for those with raised cfDNA in PLV (HR = 5.779, 95% CI = 1.162−28.745, p = 0.032). PLV (>170 ng/mL) had increased pleural recurrences (p = 0.021) and correlated significantly with poorer DFS at 2‐years (p = 0.001) with increased hazards (HR = 9.767, 95% CI = 2.098−45.451, p = 0.004). Multivariable analysis suggested higher cfDNA in PLV as a poor prognostic factor for both OS and DFS.Conclusions: Among patients with operable NSCLC, it is feasible to identify cfDNA in pleural lavage and correlate PLV cfDNA with pleural recurrences and outcomes.

Enhanced Recovery After Surgery (ERAS) protocols have emerged as a promising approach to optimize perioperative care and improve outcomes in various surgical specialties. Despite feasibility studies on ERAS in various surgeries, there remains a paucity of research focusing on gastrointestinal cancer surgeries in the Indian context. The primary objective is to evaluate the compliance rate of the ERAS protocol and secondary objectives include the compliance rate of individual components of the protocol, the complications, the length of hospital stay, and the challenges faced during implementation in patients undergoing gastrointestinal cancer surgeries in our tertiary care cancer center. In this prospective interventional study (CTRI/2022/04/041657; registered on 05/04/2022), we evaluated 50 patients aged 18 to 70 years undergoing surgery for gastrointestinal malignancies and implemented a refined ERAS protocol tailored to our institutional resources and conditions based on standard ERAS society recommendations for gastrointestinal surgeries and specific recommendations for colorectal, pancreatic, and esophageal surgeries.Our study’s mean overall compliance rate with the ERAS protocol was 88.54%. We achieved a compliance rate of 91.98%, 81.66%, and 92.00% for pre-operative, intraoperative, and post-operative components respectively. Fourteen (28%) patients experienced complications during the study. The median length of stay was 6.5 days (5.25–8). Challenges were encountered during the preoperative, intraoperative, and postoperative phases. The study highlighted the feasibility of implementing the ERAS protocol in a cancer institute, but specific challenges need to be addressed for its optimal success in gastrointestinal cancer surgeries.