Mouchumee Bhattacharyya

Background: In 2023 FIGO revised the endometrial cancer staging system after 13 years. There is a lacuna of data regarding the performance and practicality of the revised 2023 FIGO staging schema for endometrial cancer from Low Middle-Income Countries (LMIC). Objective: To estimate the shift of stage and adjuvant management of endometrial cancer based on the FIGO 2023 system compared to the FIGO 2009 system and assess the predictive potential of the FIGO 2023 system. Material and methods: A retrospective study was conducted from 1st January 2017 to 31st December 2022. All patients with endometrial cancer were staged according to the FIGO 2023 and FIGO 2009 staging system. Follow-up of patients was done to determine recurrence. Results: A total of 152 patients were included. Aggressive histology was seen in 66 (45%) patients. Eighteen (11%) had subserosal involvement. Substantial LVSI was noted in 23 (15%) of patients. Twenty-four (47%) patients of FIGO 2009 Stage IA and 26 patients (63%) of FIGO 2009 Stage IB were upstaged. Eleven (50%) patients of FIGO 2009 Stage IIIA were down staged to IA3. Overall 23 patients (15%) had a shift of stage. Fifteen out of 152 patients (15%) would have had a possible risk stratification change which would imply 23 patients (15%) would have needed a more radical treatment. Molecular classification was done in 32 patients; however, only 2 patients could afford POLE testing. Kaplan–Meier curves showed significant PFS differences in FIGO 2009 Stage IB and Stage IIIA when restaged according to the FIGO 2023 system. Conclusion: The FIGO 2023 endometrial staging is a more robust prognosticator; however, the practicality of molecular classification in LMICs is still a distant dream.

Head and neck squamous cell carcinoma (HNSCC) exhibits a higher degree of local aggressiveness as compared to a tendency for distant metastasis. Cavernous sinus metastasis from HNSCC is exceptionally rare, with only a handful of cases reported worldwide. This case series presents five instances showcasing an unusual metastatic pattern of HNSCC to the cavernous sinus, documented over one year in a single tertiary cancer care centre in Northeast India. Typically, the treatment of cavernous sinus metastasis involves radiotherapy and chemotherapy with a palliative intent. Unfortunately, the prognosis for this entity is grim, with survival typically measured in months. Notably, all five patients were diagnosed with cavernous sinus metastasis manifested within 6 to 18 weeks post-completion of their definitive treatment. Among these five patients, four patients developed left-sided cavernous sinus metastasis and had the primary disease on the left side with nodal positivity and extranodal extension. Given the rarity of metastasis in this region, maintaining a vigilant follow-up is imperative for the early identification and treatment of these patients, especially in patients with left-sided primary with nodal positivity and extracapsular extension.

Purpose Gallbladder cancers (GBC), unique to certain geographical regions, are lethal digestive tract cancers, disproportionately affecting women, with limited information on risk factors. Methods We evaluated the association between household cooking fuel and GBC risk in a hospital-based case–control study conducted in the North-East and East Indian states of Assam and Bihar. We explored the potential mediation by diet, fire-vents, ‘daily exposure duration’ and parity (among women). We recruited biopsy-confirmed GBC (n = 214) men and women aged 30–69 years between 2019 and 2021, and controls frequency-matched by age, sex and region (n = 166). Information about cooking fuel, lifestyle, personal and family history, female reproductive factors, socio-demographics, and anthropometrics was collected. We tested associations using multivariable logistic regression analyses. Results All participants (73.4% women) were categorised based on predominant cooking fuel use. Group-1: LPG (Liquefied Petroleum Gas) users in the previous 20 years and above without concurrent biomass use (26.15%); Group-2: LPG users in the previous 20 years and above with concurrent secondary biomass use (15.9%); Group-3: Biomass users for ≥ 20 years (57.95%). Compared to group-1, accounting for confounders, GBC risk was higher in group-2 [OR: 2.02; 95% CI: 1.00–4.07] and group-3 [OR: 2.01; 95% CI: 1.08–3.73] (p-trend:0.020). These associations strengthened among women that attenuated with high daily consumption of fruits-vegetables but not with fire-vents, ‘daily exposure duration’ or parity. Conclusion Biomass burning was associated with a high-risk for GBC and should be considered as a modifiable risk factor for GBC. Clean cooking fuel can potentially mitigate, and a healthy diet can partially reduce the risk among women.

Objective: The aim is to assess the radiation dose received by the dysphagia–aspiration-related structures (DARS) and radiation-related dysphagia in intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) arms and compare the results between both the techniques in patients with oropharyngeal cancer. Materials and Methods: A hospital-based prospective approach and histologically proven oropharyngeal carcinoma patients were selected for the analysis. A total of 30 patients were equally allocated to the two treatment arms: Intensity-modulated radiotherapy (IMRT) and 3-Dimensional conformal radiotherapy (3DCRT). Patients were treated to a dose of 70 Gy in 35 fractions with or without chemotherapy. DARS comprises superior pharyngeal constrictor muscle, middle pharyngeal constrictor muscle, inferior pharyngeal constrictor muscle, larynx, and esophagus. Results: IMRT has shown an advantage over 3DCRT in reducing the dose to the DARS with significant P values (except for the esophagus). The P value of DARS was significant for V30, V65, V70, D50, and D80, whereas the P value was insignificant for V50 and V60. Dysphagia in the 3DCRT arm was higher in grades than in the IMRT arm when assessed with the National Cancer Institute common terminology criteria for adverse events, version 5.0 (CTCAE v5.0) grading system. Conclusion: IMRT has an advantage over 3DCRT in terms of the dose received by the DARS, resulting in reducing the incidence of dysphagia. It is improving the quality of life of patients with oropharyngeal cancers.

Background In our study, we examined the 5-year survival of OSCC patients with HPV positive or negative status along with p16 protein expression. Method A total of 72 biopsy tissue specimens from histologically confirmed oral squamous cell carcinoma (OSCC) patients were collected. HPV detection and genotyping were performed using HPV E6/E7 and HPV-type specific multiplex primer for nested-PCR. Immunohistochemistry evaluation of pl6 was conducted. SPSS statistical software (ver 20) was used for data analysis. Results High risk-HPV (hr-HPV) DNA positivity was found in 27.7% (n=20) of OSCC patients. Stage III OSCC patients were 7.80 times more likely to survive 5 years than stage IV patients (OR-7.80 CI-95%; P-0.03). Among the hr-HPV positive OSCC patients, we found that the median survival time for the 1st year (95%), 3 years (78.5%), and 5 years (38.5%) was significantly higher than that of the hr-HPV negative [1st year (78.6%), 3 years (45.2%) and 5 years (38.5%)] OSCC patients (P-0.03 The survival of male patients with hr-HPV positive OSCC is 9.75 times greater than the survival of patients with HPV negative OSCC (OR-9.75; CI-95%; P-0.05). The p16 expression level (low to overexpression) group and negative P16 expression group of OSCC patients have not demonstrated a significant association with 5-year survival. Conclusion We conclude that in OSCC cases of North-East India, the presence of hr-HPV in OSCC cases could be a good predictor of 5-year survival rate. Expression of p16 does not appear to have any significant association with 5-year survival.

Context: In advanced radiotherapy techniques such as three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), geometrical uncertainties are very crucial as they may lead to under dosing of tumor and over dosing of the nearby critical structures and hence, it is important to determine planning target volume (PTV) margins which are specific for every center. Aims: The aim of this study is to determine adequate clinical target volume (CTV) to PTV margins specific to our radiotherapy center. Settings and Design: To calculate CTV to PTV margins for rectal cancer patients in prone position using kV cone beam CBCT data sets. Materials and Methods: With the Patient immobilized in prone position using thermoplastic mask, a CT simulation was done and a comprehensive 3DCRT plan was generated. Daily kV CBCT was done to check the patient setup error. Daily setup errors were recorded and evaluated retrospectively. Results: CTV-PTV margin calculated for pelvis in the prone position was calculated using van Herk Formula and were found to be 0.5, 1.8, 0.7 cm in the lateral, longitudinal, and vertical directions, respectively. Conclusions: Image guidance is an effective method to evaluate patient setup errors. Good quality immobilization devices and stringent patient setup policies can help to reduce PTV margins further.