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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 12 | Issue 3
Page Nos. 91-136

Online since Thursday, September 23, 2021

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REVIEW ARTICLES  

Cellular sensitivity to low dose ionizing radiation p. 91
Kaushala Prasad Mishra
DOI:10.4103/jrcr.jrcr_15_21  
Cellular sensitivity to ionizing radiation is largely understood in terms of their DNA damage repair capacity. Efficient repair of DNA damage leaves irradiated cells unharmed. The observed differential responses of high doses (>500 mGy) and low doses (<200 mGy) of ionizing radiation are generally accounted by the differences in DNA damage repair processes. High dose radiation-induced cellular toxicity is gainfully employed in cancer radiotherapy. However, effects of low dose radiation (LDR) on cells and organisms have remained controversial. Some studies have reported LDR suppressive effects to high dose radiation-induced cancer. The purpose of this article is to briefly discuss the current understanding of low dose-induced DNA damage in cell survival responses. Evidence is accumulating to suggest that low dose irradiated cells remain insensitive to a window of LDR. Clearly, these findings give support to negate the linear dose effect assumptions followed in radioprotection regulation and also address the question of safety issues in utilizing LDR therapies to treat cancer and noncancer diseases. A range of new LDR technologies seem to be in waiting for improving human health.
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Radiation therapy as an adjuvant treatment after breast-conserving surgery in ductal carcinoma In situ of the breast p. 96
Marwen Benna, Raouia Ben Amor, Zeineb Naimi, Meriem Bohli, Lotfi Kochbati
DOI:10.4103/jrcr.jrcr_24_21  
Ductal carcinoma in situ (DCIS) of the breast is a nonmalignant tumor of the breast with a rising incidence due to systematic mammographic screening. Actual consensus on conservative therapy is based on lumpectomy followed by adjuvant radiation therapy to the whole breast. This approach has been established after multiple large clinical trials and confirmed with subsequent meta-analyses. However, there are still debates on the benefit of adjuvant radiation therapy in a largely undefined “low-risk population.” This review tries to discuss actual data on this matter and discuss the benefits and risks of radiation therapy after lumpectomy in DCIS.
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Preoperative radiotherapy and total neoadjuvant therapy in locally advanced rectal cancer management: So far, so good p. 100
Jyotiman Nath, Gautam Sarma
DOI:10.4103/jrcr.jrcr_20_21  
The treatment outcomes of locally advanced rectal cancer (LARC) have significantly improved in the last few decades due to the continuous evolution of multimodality management. However, the distant failure remains a concern leading to more cancer-related deaths. Conventionally, preoperative chemoradiotherapy followed by total mesolectal excision and adjuvant chemotherapy is the standard of care for LARC patients. However, noncompliance to adjuvant chemotherapy due to various factors leads to more distant failure rates. As an alternative to this, multiple approaches of total neoadjuvant therapy (TNT) were investigated over time, and multiple reports have shown promising results. This review highlights the evolution of the multimodality management approach to LARC patients, emphasising preoperative radiotherapy and TNT.
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Hemostatic radiotherapy p. 108
Aastha Shah, U Suryanarayan
DOI:10.4103/jrcr.jrcr_25_21  
Radiotherapy is one of the widely used modalities of treatment in an oncology setting whether the approach to treat cancer is either curative or palliative. Tumor masses bleeding is not an uncommon emergency in cancer patients and local radiotherapy is very commonly used as a hemostatic therapy. Hemostatic radiotherapy is used in wide variety of cancers such as head-and-neck cancers including oral tongue and base of tongue cancers more commonly, fungating and bleeding neck nodes, bleeding bronchial, and lung tumors presenting as hemoptysis, pelvic malignancies most commonly includes cervical cancers presenting as bleeding per vaginum. teletherapy as well as brachytherapy both can be used for alleviation of symptoms thus avoiding a protracted course and improving the quality of life of patients. The radiotherapy doses of 40 Gray in 15 fractions, 30 Gray in 10 fractions, 20 Gray in 5 fractions, 15 Gray in 5 fractions,8 Gray in single fraction and 4 Gray in single fraction have been used which are equally effective for controlling bleeding but protracted courses should be avoided to prevent treatment dropouts. Long-term side effects are more to be worried of in cases of hypofractionation but such patients have a poor median survival generally so symptom alleviation should be our utmost target. Hypofractionated palliative hemostatic radiotherapy is very effective for the alleviation of symptoms and the purpose of the treatment approach but individualized patient-based decisions should be used for tumor control if to be planned further.
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ORIGINAL ARTICLES Top

To compare the effect of conventional radiotherapy versus concurrent chemoradiotherapy on the thyroid gland after external beam radiotherapy in head-and-neck carcinoma p. 111
Surabhi Gupta, Shashi Bhoosan Upadhyay, Sarvesh Yadav, Hari Singh, Anuj Kumar Tyagi
DOI:10.4103/jrcr.jrcr_13_21  
Introduction: Radiotherapy-induced hypothyroidism has remained underestimated and under reported ailment, because of noninclusion of routine assessment of thyroid function test in baseline workup and during follow-up protocol, which results in failure to detect and treat a reversible cause of morbidity in significant proportion of surviving patients. Greater magnitude and duration of thyroid-stimulating hormone elevation increase the probability of progression to clinical hypothyroidism and therefore increase the potential benefit of treatment of subclinical hypothyroidism. Hence, recognizing subclinical hypothyroidism at an early stage can prevent clinical hypothyroidism and its associated morbidities. Aims and Objectives: The aim of the present prospective study was to evaluate the functional and anatomical changes in thyroid glands in patients with head-and-neck cancer treated with conventional radiotherapy (external beam radiotherapy) and concurrent chemoradiotherapy and to assess the necessity of inclusion of routine thyroid function test in the workup and follow-up protocol of these patients. Materials and Methods: A total of 98 patients were randomly allocated in two arms. In arm I, 50 patients received concurrent chemoradiotherapy and in arm II, 48 patients underwent radical conventional radiotherapy alone. Baseline thyroid function test and ultrasonography of neck along with thoroughly clinical evaluation were done for every patient and these investigations were repeated in the middle of radiotherapy treatment (after 17 #), at the end of radiotherapy treatment, 3 months after completion of radiotherapy, and after that, at every 3rd-month follow-up to determine late changes in thyroid function test and echotexture. Results: In arm I, total 60% patients developed acute hyperthyroidism while in arm II, 68.75% patients developed acute hyperthyroidism. A total of 18.36% patients were found to have subclinical hypothyroidism. At the 9th month of follow-up, 55 out of 98 patients (56.12%) developed hypothyroidism. Among 55 patients, 37 were having clinical hypothyroidism while 18 patients were having subclinical hypothyroidism (P ≤ 0.0001). Maximum number of patients, i.e. 26/98 (47.27%) developing hypothyroidism were between 51 and 60 years of age group. Addition of surgery and chemotherapy had shown no difference in thyroid dysfunction. Patients with clinical hypothyroidism required medical management while patients with subclinical hypothyroidism were kept on close monitoring. Conclusion: Recognizing hypothyroidism (clinical or subclinical) early and treating it timely can prevent associated complications which are often ignored. Hence, thyroid function tests should be done routinely that is before starting of radiotherapy, on completion of radiotherapy, and during follow-up as well.
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Endometrial carcinoma: A single institute experience p. 119
Asifa Andleeb, Kaneez Fatima, Shahida Nasreen, Mushtaq Ahmad Sofi, Sumyra Khurshid Qadri
DOI:10.4103/jrcr.jrcr_19_21  
Aims: This study aims to assess the clinicopathological features, treatment, recurrence pattern, survival, and prognostic factors in patients with endometrial carcinoma (EC). Materials and Methods: This was a retrospective study of 64 patients with EC who were diagnosed and treated at our institute from January 2010 to December 2013 and were followed till December end 2019. Survival analysis was done using Kaplan–Meier estimates and significance between curves by using the log-rank test. Results: The mean age of diagnosis was 60 years. The most common complaint was vaginal bleeding (75%). More than half of the patients (52.6%) had high body mass index (BMI). The majority of patients underwent surgery (90.7%) and had the early-stage disease (Stage I in 82.9%). During a median follow-up of 79 months (range: 4–100 months), 18.8% of patients experienced recurrence and vaginal vault (33.3%) was the most common site for recurrence. The 5-year disease-free survival was 83% and the 5-year overall survival was 84.7%. Elderly age, high BMI, advanced disease stage, more than 50% of myometrial invasion, nonendometrioid histology, Grade II and Grade III tumors, lymphovascular space invasion, and lymph node involvement adversely affected long-term survival. Conclusion: EC is mainly a disease of postmenopausal women, and most of them are diagnosed at an early stage and have good survival outcomes.
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CASE REPORTS Top

Malignant peripheral nerve sheath tumor of mesocolon: A rare case p. 126
Sakshi Rana, Divya Khosla, Kannan Periasamy, Rakesh Kapoor
DOI:10.4103/jrcr.jrcr_5_21  
Malignant peripheral nerve sheath tumor (MPNST) is a soft-tissue sarcoma arising from or differentiating toward peripheral nerve sheath cells. It accounts for 5%–10% of soft-tissue sarcomas. The most common sites of origin are proximal portion of upper, lower limbs and trunk. MPNST arising from the nerve plexus of gastrointestinal tract is extremely rare, and only very few cases have been reported in literature. In this report, we are describing a case of MPNST from mesocolon. An 82-year-old male presented to hospital with complaint of pain abdomen and feeling of lump on the left side of lower abdomen for the past 2 months. On contrast-enhanced computed tomography (CECT) of chest and abdomen, there was 15 cm × 10 cm mass palpable in left lumbar region without ascites and multiple random subpleural nodules in bilateral lung. Intraoperatively, there was 15 cm × 10 cm hard irregular mass in left paracolic gutter infiltrating mesentry of descending colon. Left hemicolectomy was performed with end-to-end anastomosis. Histopathological examination revealed malignant peripheral nerve sheath tumor, and on immunohistochemistry, tumor cells were positive for S-100 and negative for C-kit and Smooth Muscle Actin (SMA). The patient was started on tamoxifen in view of old age and lung metastasis. The patient is on follow-up from 2 years with stable disease. In this report, we highlight the possibility of clinical differential diagnosis of MPNST arising from mesocolon should be kept while dealing with mesenchymal tumors of colon. Radical surgery with negative margins is required for achieving palliation, and adjuvant tamoxifen could offer advantage in patient who cannot tolerate chemotherapy.
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Hormone-secreting ganglioneuroma: A rare entity p. 131
Aastha Shah, Darshan Thummar, Maitrik Mehta, Dishu Shah, U Suryanarayan, Dinesh Anand
DOI:10.4103/jrcr.jrcr_73_20  
Ganglioneuromas are slow-growing benign counterparts of neuroblastoma groups along with ganglioneuroblastomas. Herein, we report a rare case of hormone-secreting benign ganglioneuroma in a 4-year-old kid. A 4-year-old male child was referred to our outdoor patient department from the primary health center to evaluate for the persistent complaint of increase in weight and raised blood pressure. On computed tomography (CT) of the abdomen and pelvis, an 6.4 cm × 6.5 cm mass lesion was seen over the right adrenal gland which was compressing segments VI and VII of the liver, and the right hilar region showed a 1.6 cm × 1.2 cm × 0.9 cm enlarged lymph node. The rest of the scan was clear. The patient was therefore started on cyclophosphamide and vincristine, received two cycles, and 4 weeks following it, a diagnostic CT scan of the abdomen, pelvis, and thorax was undertaken which showed a 5.1 cm × 4.5 cm × 6 cm lesion over the right suprarenal region abutting inferior vena cava, inferior surface of the liver, and superior renal surface. Surgical laparotomy followed by right adrenalectomy was done which on pathological evaluation to a surprise showed features suggestive of maturing ganglioneuroma with no evidence of any blastemal components. However, the posterior resection margin turned out to be positive. Radiation was omitted despite the margins being positive. Very few cases of hormone-secreting pediatric ganglioneuroma have been reported in literature and their management requires a meticulous approach.
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An unusual case of proximal variant of epithelioid sarcoma of the shoulder p. 134
Raja Rao Nudurupati, Sri Sailaja Rani Mattaparti, Tarun Kumar Suvvari, Divya Bala A M R Salibindla, Mani Kruthika Mantha
DOI:0.4103/jrcr.jrcr_2_21  
Epithelioid sarcoma (ES) is a rarely occurring malignant soft tissue tumor of uncertain histogenesis. It is most common among young males and commonly seen on the forearm, hand, and fingers. ES begins as a small lump or ulcer, and most were painless. ES has a high rate of recurrence and can spread to other parts of the body easily. Hence, physicians should take the necessary steps to ensure proper diagnosis and treatment. We present an interesting case of a 26-year-old male diagnosed with a proximal variant of ES of the shoulder.
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