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   2013| January-March  | Volume 2 | Issue 1  
    Online since April 19, 2013

 
 
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CASE REPORTS
Myeloid sarcoma de novo presenting as generalized lymphadenopathy
Shirish Nandedkar, Mallika Kawatra, Kamal Malukani
January-March 2013, 2(1):86-89
DOI:10.4103/2278-0513.110815  
Myeloid sarcoma manifesting as multiple lymphadenopathy is a rare entity. Bilateralism is even rarer. It can mimic lymphoma cytologically and histologically. We present a case of myeloid sarcoma mimicking as lymphoma in a 32-year-old male. The patient presented with bilateral neck masses and generalized lymphadenopathy for the past one month. A clinical diagnosis of lymphoma was made but fine needle aspiration cytology, histopathology of excised lymph node, immunophenotyping and cytochemistry on the FNA smears confirmed it to be a myeloid sarcoma and not lymphoma.
  3 2,233 99
ORIGINAL ARTICLES
A randomized trial comparing radiotherapy alone versus radiotherapy with Geftinib in locally advance oral cavity cancer
Pramod Kumar Singh, AK Dixit, SN Prashad, Tripti Saxena, DP Shahoo, Deepti Sharma
January-March 2013, 2(1):29-33
DOI:10.4103/2278-0513.110768  
Background: Concurrent chemo radiation is the current standard of care in locally advanced head and neck cancer, but in our set-up, all patients cannot be admitted for chemotherapy or cannot tolerate chemo radiation, or do not want surgery and/or surgery is not possible. The present study was planned to compare the efficacy of concomitantly administered Gefitinib with radiation therapy and radiation alone in locally advanced oral cavity cancer that are not fit or able to tolerate concurrent chemotherapy. Material and Methods: This was a single center, nonstratified, single blind, nonplacebo-controlled, parallel group intervention study with imbalanced randomization performed at our institute. Adult patients aged 40-65 years, male or female, irrespective of epidermal growth factor receptor (EGFR) status, Karnofsky scale score more than 70, biopsy-proven SCC, locally advance oral cavity cancer, normal hematology parameters, renal function and liver function tests for normal before recruitment were enrolled in the study. Exclusion criteria were patients who were previously treated with either chemotherapy or radiotherapy (RT). Arm1 include only RT, whereas arm 2 includes Gefitinib with RT. Results: Sixty patients were included in the study, 30 in each arm. In Gefitinib plus RT arm, complete response was seen in 18 patients (60%), in only RT arm, complete response was seen in 10 patients (33.33%). There was no significant difference in acute toxicities and late toxicities. Conclusion: This study shows significant response to treatment and improvement in the Gefitinib plus RT as compared with RT alone. However, the findings of this study need to be confirmed by a study with a larger group of patients and a longer period of follow-up.
  3 1,995 111
REVIEW ARTICLES
Volumetric intensity modulated arc therapy in lung cancer: Current literature review
Suresh B Rana
January-March 2013, 2(1):9-13
DOI:10.4103/2278-0513.110758  
The volumetric intensity modulated arc therapy (VMAT) is a novel radiation technique that delivers a highly conformal radiation dose to the target by allowing the simultaneous variation of gantry rotation speed, dose rate and multiple-leaf collimators leaf positions. The aim of this study was to review the current literature on two VMAT systems, RapidArc and SmartArc with main focus on planning studies of lung cancer. A systematic review of available data was conducted using MEDLINE/PubMed with the keywords ''lung'' and "VMAT". The published data show that VMAT techniques have clear superiority over three-dimensional conformal radiation therapy with regard to improving dose conformity and sparing of organs at risks (OARs). The data indicates that for lung tumor VMAT and intensity modulated radiation therapy (IMRT) provide equivalent dose homogeneity, dose conformity and target volume coverage; however, contradictory results were obtained in terms of OARs sparing. The major advantages of VMAT over IMRT are the reduction in the number of monitor units and faster treatment delivery times without compromising the quality of the treatment plans. Moreover, faster delivery time is more patient-friendly and it minimizes intra-fractional patient motion allowing treatment volumes stay within their respective treatment margins. Current literature data shows that VMAT can be a good option to treat lung cancer; however, data on clinical trials are still lacking. The clinical trials are essential to confirm the safety and efficacy of VMAT techniques.
  2 6,044 868
ORIGINAL ARTICLES
Management of neuroblastoma. Comparative study between first- and second-line radioionated meta-iodobenzylguanidine therapy and chemotherapy alone
Khaled El-Sabban, Hijji Al Sakhri, Adnan AlAmin Alsulaimani, Talal Al Malky
January-March 2013, 2(1):41-47
DOI:10.4103/2278-0513.110777  
Context: Neuroblastoma is a high-grade malignancy of childhood; it is chemo- and radio-sensitive, but prone to relapse after initial remission. Aim : The aim of this study was to document the impact of first- or second-line radioionated [ 131 I] meta-iodobenzylguanidine ( 131 I-MIBG) therapy or chemotherapy alone on the short-term response and long-term survival in untreated children and to further characterize the side-effects of MIBG treatment. Materials and Methods: In this interventional randomized controlled study, 123 children with advanced neuroblastoma were divided into three groups according to the treatment strategy: 65 were treated by chemotherapy alone (group I), 30 children who were not responding or had relapsed after chemotherapy were treated by second-line 131 I-MIBG (group II), and 28 children were treated by 131 I-MIBG as first-line from the start (group III). External beam radiotherapy was given to bone and brain secondaries when detected. Staging work up was done before, during, and after management with a follow-up period of 5 years. Statistical Analysis Used: All statistical tests were done using Whitney test for the continuous variants to compare the same group pre- and post-therapy. Total actuarial survival and disease-free survival were calculated using Kaplan-Meier analysis. Results: The number of treatments with 131 I-MIBG varied between 1 and 4 per patient (mean 3). Toxicity was seldom severe. Mainly myelosuppression was noticed. Response was documented before surgery for the primary tumor was performed. There was 9, 6, and 14 complete response (CR); 10, 18, and 16 partial responses (PR); 3, 2, and 23 with a stable disease (SD); and 6, 4, and 12 progressed in each group, respectively. Total actuarial survival was found to have a median of nearly 60, 55, and 33 months for groups I, II, and III, respectively, with a statistical significant difference between the three groups. Conclusion: The current study showed the effectiveness of MIBG as a first-line treatment in the management of locally advanced neuroblastoma cases with limited metastasis as initial response and long-term survival for the cases was favorable, while in cases with multiple metastases, chemotherapy should be given first-line and, in case of failure or relapse, second-line MIBG therapy is warranted.
  1 1,566 99
REVIEW ARTICLES
Post-mastectomy radiotherapy for one to three axillary node positive early breast cancer: To radiate or not to radiate?
Sayan Paul, Kirti Srivastava, Tamojit Chaudhuri, Srinivas Rathor
January-March 2013, 2(1):14-19
DOI:10.4103/2278-0513.110760  
Post-mastectomy radiotherapy (PMRT) in early breast cancer has long been a matter of debate among oncologists. The American Society of Clinical Oncology (ASCO) and the American Society for Therapeutic Radiology and Oncology (ASTRO) recommend the use of PMRT for patients, whose primary tumor is larger than 5 cm and/or patients who have four or more involved axillary lymph nodes (ALNs). Recently, few trials have been published showing the positive impact of PMRT on overall survival (OS) even in patients having 1-3 positive ALNs with T1-T2 primary disease or early breast cancer (EBC). So, it has become a matter of controversy whether to radiate or not to radiate? We have made an extensive search in the internet in Pubmed and other sites of medical publication mentioning our topic of discussion and reviewed the relevant articles. We nearly got 3,220 articles. After reviewing the available publications in the internet, we blended the elixir with our experience and tried to find an answer of our question. In conclusion, PMRT significantly and substantially improved loco-regional control and overall survival in patients with 1-3 positive nodes as in patients with 4 or more positive nodes, and nearly the same number of patients is needed to treat to avoid a loco-regional recurrence and/or death in both groups. We should reconsider the current guidelines for the indication for PMRT.
  1 4,546 311
CASE REPORTS
Papillary carcinoma of thyroid with paranasal sinus metastases
Renu Madan, Shikha Goyal, Amit K Dinda, Bidhu K Maohanti
January-March 2013, 2(1):90-92
DOI:10.4103/2278-0513.110817  
Tumors that metastasize to paranasal sinus (PNS) are rare, with fewer than 200 cases reported worldwide. Of these, thyroid malignancies contribute 8%. We discuss here a patient aged 45 years with PNS mets from follicular variant of papillary carcinoma thyroid who had undergone surgery and radioiodine ablation. He presented with nasal obstruction and epistaxis 2 years after local treatment. CT scan of PNS showed a large heterogeneously enhancing mass lesion in PNS, which on further evaluation was found to be consistent with metastases from primary thyroid cancer. He was given palliative radiotherapy to the metastatic lesion. Patient was alive after eighteen months of radiotherapy but there was no response to radiotherapy on imaging. To conclude PNS metastases from thyroid cancer are rare. But it should be always kept in mind in symptomatic patients. Also, patients with PNS mets can have a long disease free survival after palliative radiotherapy.
  - 2,373 83
A rare case of mandibular metastasis in adenocarcinoma of lung
Kaushik Saha, Debraj Jash, Sourindra Nath Banerjee, Saumen Nandi
January-March 2013, 2(1):48-50
DOI:10.4103/2278-0513.110779  
Mandibular metastasis may give an important clue to the diagnosis of an underlying occult malignancy. A 70-year-old female presented with painful swelling of right jaw for last 4 months and right-sided chest pain for last 1 month. CT scan thorax showed homogenous mass lesion in right lower lobe. FNAC from radiographically evident osteolytic lesion in mandible was suggestive of metastatic carcinoma. CT-guided trucut biopsy with immunohistochemistry from lung mass revealed primary adenocarcinoma of lung. Patient received palliative chemo-radiation for her advanced stage of cancer.
  - 1,196 90
Idiopathic necrotizing sialometaplasia of parotid gland
Shailja Puri Wahal, Kavita Mardi
January-March 2013, 2(1):51-52
DOI:10.4103/2278-0513.110783  
Necrotizing sialometaplasia (NS) is an uncommon non-neoplastic, self-limiting inflammatory condition of the salivary glands. NS of major salivary glands is rare and simulates malignancy. If it is seen at this location, most of the cases are due to ischemia caused by vessel injury secondary to previous dental procedure or parotid gland surgery. We present a case of a parotid swelling that appeared as Warthin tumor on fine needle aspiration cytology (FNAC). On histology it turned out to be NS of parotid gland. The well known etiologies were absent in this case and hence it was labeled as idiopathic.
  - 1,685 79
Synovial sarcoma of the abdominal wall: An unusual presentation
Parag J Karkera, Paras R Kothari, Gursev Sandlas
January-March 2013, 2(1):53-56
DOI:10.4103/2278-0513.110786  
Synovial sarcoma (SS) is a malignant mesenchymal neoplasm which commonly occurs in the extremities in close association with tendon sheaths, bursae, joint capsules, and fascial structures. Rarely, SS may be present in unexpected location such as the abdominal wall. Surgical resection with wide margins is the initial standard treatment; however, a multimodal approach including radiotherapy and chemotherapy is often favored. Here, we present a case of SS of the anterior abdominal wall in a 14-year-old patient with a right upper abdominal lump. He underwent wide surgical excision and has received adjuvant chemotherapy. He is doing well on follow-up of six months.
  - 1,883 76
Adenomyoepithelioma of breast: Report of a rare case
Milind A Bhatkule, Manjusha S Dhawle, Rajan S Bindu
January-March 2013, 2(1):57-59
DOI:10.4103/2278-0513.110787  
Breast adenomyoepithelioma is a rare benign proliferative tumor. It usually presents as a solitary unilateral painless mass at the periphery of the breast. It is characterized by proliferation of epithelial and myoepithelial cells. This benign tumor is known for its recurrence and metastatic potential. Hence accurate diagnosis with close follow up is mandatory. We report a rare case of adenomyoepithelioma in a 38-year-old female who presented with a painless lump of 3 × 2 cm size in the left breast for 3 months.
  - 1,686 95
Rectal adenocarcinoma with extensive choriocarcinomatous differentiation: Report of a rare occurrence
Kavita Mardi, Saurabh Gupta, Neelam Gupta, Vidisha Mahajan
January-March 2013, 2(1):60-62
DOI:10.4103/2278-0513.110790  
We report a rare case of choriocarcinomatous differentiation of tumor cells in the rectal adenocarcinoma of a 54-year-old female who presented with pain abdomen and passage of bloody stools. CT scan was suggestive of a malignant tumor in the rectum. Histologic examination of the tumor revealed a minor component of moderately differentiated adenocarcinoma that showed extensive trophoblastic differentiation. Positive immunostaining for beta-hCG of tumor cells in these areas confirmed the diagnosis. Since such tumors behave aggressively and confer bad prognosis, they constitute a distinct clinical entity of a gastrointestinal tumor.
  - 1,277 70
Intra-temporal facial nerve abscess due to basal cell carcinoma of external auditory canal: A unique presentation
Amit Keshri, Sushil Kumar Aggarwal
January-March 2013, 2(1):63-66
DOI:10.4103/2278-0513.110794  
Infranuclear facial palsy following facial nerve abscess in intra-temporal course has not been described in literature as per our knowledge. After extensive search of literature, only one case of facial nerve sheath abscess was found in a case of leprosy, but the abscess was in the intra-parotid course of the nerve. Basal cell carcinoma (BCC) is a rare malignant tumor of external auditory canal (EAC). Facial nerve palsy in BCC occurs only in advance stages when the tumor erodes the floor of EAC to involve the nerve. Contrast enhanced computed tomography of the temporal bone is useful in diagnosing the entity pre-operatively and in planning the management in such cases. This case is being reported as facial nerve sheath abscess in intra-temporal course due to malignancy of the EAC has not been reported as yet.
  - 1,663 73
Palmoplantar keratoderma and pleomorphic adenoma of submandibular salivary gland: A rare association in a pediatric patient
Krushnakumar V Kesan, Abhaya Gupta, Rahul Kumar Gupta, Paras Kothari, Ritesh Ranjan, Parag Karkera, Kedar Mudkhedkar
January-March 2013, 2(1):67-69
DOI:10.4103/2278-0513.110799  
Palmoplantar keratoderma (PPK) is a rare disorder in which dry, thick patches of skin develop on the soles of the hands and feet. Our patient, an 11-year-old boy was undergoing treatment for progressive PPK by a dermatologist since the age of 1 year. He presented to us with swelling in the left submandibular region. Incision biopsy was suggestive of pleomorphic adenoma (PA). Patient was managed with complete surgical excision of the left submandibular gland. The association of both the diffuse and punctate forms of PPK with internal neoplasia has been described by a number of reports. We report the occurrence of PA of the submandibular salivary gland in a case of diffuse PPK. To the best of our knowledge this association has never been described before.
  - 2,876 92
A rare cause of Cauda equina syndrome: Epidural high grade primary non-Hodgkin lymphoma
Ambarish A Mathesul, Dhiraj V Sonawane, Pradip S Nemade, Sandeep R Biraris
January-March 2013, 2(1):70-72
Cauda equina syndrome (CES) may be caused by herniated disc, tumor, trauma, and spinal infections. However, CES due to epidural high-grade non-Hodgkin lymphoma (NHL) is very rare. Up to our knowledge, few cases have been reported in the literature. We report a case of epidural high-grade NHL presenting as CES. A 55-year-old man presented with CES caused by extradural compression by primary NHL. The patient underwent an L4-L5 laminectomy. The operative findings were suggestive of well-demarcated epidural tumor. The final histopathological diagnosis revealed epidural high-grade NHL. NHL causing CES is rare. This report highlights the importance of keeping afresh the various causes of CES for prompt diagnosis and management.
  - 1,495 96
Synchronous HPV-associated cancer of the cervix and anal canal in a non-HIV infected patient treated simultaneously
Bhavana Rai, Promod Singh, Firuza Darius Patel, Suresh Sharma, Nalini Gupta, Mini P Singh
January-March 2013, 2(1):73-75
DOI:10.4103/2278-0513.110804  
Synchronous malignancies are uncommon. The oncogenic viruses like Human Papilloma Virus (HPV) 16 and 18 have been implicated in the development of cancers of the cervix and anal canal and an increased risk occurs in Human Immunodeficiency Virus-infected (HIV) individuals. Though cervical screening for HPV infection is recommended in female patients with anal cancers, synchronous presentation of cancer cervix and anal canal is rare. We present a case of a 72-year-old lady with synchronous cancer cervix and anal canal with HPV 16 positivity by polymerase chain reaction (PCR) treated with external radiotherapy, followed by brachytherapy to both the sites.
  - 1,334 90
Isolated post burn contracture groin presenting with squamous cell carcinoma
Wani Sajad, Hamid Raashid, MA Darzi, Hafeez Adil
January-March 2013, 2(1):76-77
DOI:10.4103/2278-0513.110805  
Post burn contracture of groin is a burn sequel. Ulceration of contracture can occur as contracture is not in a stabilized position. Squamous cell carcinoma, an unusual complication of long-standing post burn groin contracture, is described. Contracture and tumoral mass was excized and the resulting raw area was covered by split thickness skin graft.
  - 1,836 55
Severe superior vena cava obstruction in thymoma - long term control and survival with combined modality treatment
Ritesh Kumar, Narendra Kumar, Anjan Bera, Shreekant Bharti, Rakesh Kapoor
January-March 2013, 2(1):78-80
DOI:10.4103/2278-0513.110806  
Thymoma is a tumor of thymus and is a rare anterior mediastinal tumor. Locally advanced thymoma with superior vena cava obstruction (SVCO) is an uncommon presentation. We here present a case of locally advanced case of thymoma with SVCO, which was managed with radiotherapy (RT) and chemotherapy (CCT). The patient had radiological complete response and is disease free for eight years.
  - 1,440 87
Right atrial metastasis in a case of hepatocellular carcinoma
Sanjay Kumar Mandal, Siddhartha Mani, Sumanta Chatterjee, Souma Sarathi Mandal, Pankaj Sarkar, Koushik Chatterjee
January-March 2013, 2(1):81-82
DOI:10.4103/2278-0513.110812  
Hepatocellular carcinoma (HCC) is a well-known complication of chronic hepatitis B. Most cases of HCC are diagnosed at an advanced stage and the tumor spreads most frequently to the lungs, peritoneum, adrenal glands, and bones. Intra-cavitary cardiac extension of HCC is a very rare entity. We present a case of HCC in the background of chronic hepatitis B with the atypical presentation of metastasis to right atrium, with inferior vena cava and hepatic veins having normal patency.
  - 1,550 90
Oral carcinoma in two young recipients of stem cell transplant
Sushmita Ghoshal, Ritesh Kumar, Vivekanand Jha, Ashok Kumar Gupta, Mahendra Kumar, Amanjit Bal, Suresh Chander Sharma
January-March 2013, 2(1):83-85
DOI:10.4103/2278-0513.110813  
Patients with stem cell transplantation have an increased risk of developing new malignancies. Oral squamous cell carcinoma is rare after stem cell transplantation. We herein report two cases of oral squamous cell carcinoma developing in young patients after stem cell transplantation.
  - 1,215 89
LETTER TO THE EDITOR
Supravital-stained wet film study of fine needle aspirates
Somsri Wiwanitkit, Viroj Wiwanitkit
January-March 2013, 2(1):93-93
DOI:10.4103/2278-0513.110818  
  - 728 62
ORIGINAL ARTICLES
Comparing the expression of myoepithelial cell markers CD10 and smooth muscle actin with the estrogen receptor status in the invasive carcinoma breast: An immunohistochemical study
Gaurav Arora, Monika Girdhar, Aditi Baghla, Khayati Lajpal, Mridu Manjari, Kapil Jagga
January-March 2013, 2(1):20-24
DOI:10.4103/2278-0513.110764  
Background: Breast cancer is the most frequent cancer in females throughout the world. Around 20% of breast carcinomas are estrogen receptor alpha (ER)-negative. Thus, theoretically this negativity could be either the result of down-regulation of ER expression in the tumor cells, or the result of the tumor being derived from cells which normally lack that expression. Normal basal, including myoepithelial cells of the breast is ER-negative. CD10 and smooth muscle actin (SMA) are used as markers for the demonstration of these basal cells. Aims: To compare the expression of positive staining for CD10 and SMA in ER-negative and ER-positive invasive breast carcinomas. Materials and Methods: The study was performed on 40 paraffin-embedded tissues of already diagnosed cases of invasive breast carcinomas with known ER status, i.e., thirty ER-negative and ten ER-positive cases. Expression of CD10 and SMA was demonstrated using avidin-biotin-peroxidase complex (ABC) technique. Tumor was considered to be positive for both markers only when more than 10% of tumor cells were stained positive. Results: Overall, CD10 tumor cell staining was seen in eight, 23.3% (7/30) ER-negative cases and in 10% (1/10) ER-positive cases. Also the staining intensity was considered to be strong. SMA tumor cell staining was seen in only 6.7% (2/30) ER-negative cases and the staining intensity was considered to be moderate. Percentages of positively stained tumor cells varied between 13% to 72% and 23% to 45% for CD10 and SMA, respectively. Conclusion: CD10 is a better marker when compared to SMA, as it is expressed in more number of cases and gives strong positivity in tumor cells. Higher expression of CD10 and SMA is correlated with higher tumor grade and ER negativity.
  - 2,168 145
Assessment of Protein C, Protein S, and prothrombin levels in gastrointestinal carcinoma with and without metastasis
Mohammad Yusuf, Ashutosh Kumar, Madan Lal Brahma Bhatt, Abhijit Chandra, Surya Kant, Wahid Ali
January-March 2013, 2(1):25-28
DOI:10.4103/2278-0513.110766  
Background: A hypercoagulable or prothrombotic state of malignancy with metastasis occurs due to the ability of tumor cells to activate the coagulation system. It has been hypothesized that hypercoagulation contributes to the significant percentage of morbidity in cancer patients due to their role in metastasis. Materials and Methods: A total of 80 patients with gastrointestinal carcinoma such as malignant carcinoma rectum, malignant carcinoma esophagus, and malignant carcinoma colon with and without metastasis from Surgical Gastroenterology Department C.S.M. Medical University, Lucknow, UP, India, were studied in order to evaluate the presence and extent of hemostatic abnormalities in case of gastrointestinal carcinoma. Results: The average prothrombin time, activated partial thromboplastin time, Protein C, and Protein S in patients of gastrointestinal carcinoma was less as compared with control. The mean level of Protein C and Protein S ranged from 55% to 90% and 48% to 95%, respectively. Out of the total 80 patients, 7 were Protein C deficient and 5 were Protein S deficient. However, three were Protein C and S both deficient. The Protein C level was significantly lower (P < 0.0001) in Protein C deficient patients with metastasis compared with patients without metastasis. Similarly, the Protein S level was significantly lower (P < 0.0001) in Protein S deficient patients with metastasis as compared with patients without metastasis. The Protein C and S levels were also lower in those who were deficient with metastasis. Conclusion: Our study infers that activated Protein C resistance in gastrointestinal carcinoma with metastasis may contribute to thrombotic episodes in these patients. Cancer patients including GI malignancy are at increased risk for the development of thrombotic events that contribute significantly to the morbidity and mortality of malignancy in these patients.
  - 1,429 134
Clinico-pathological study of breast carcinoma: A prospective two-year study in a tertiary care hospital
Kaushik Saha, Gargi Raychaudhuri, Bitan Kumar Chattopadhyay
January-March 2013, 2(1):34-40
DOI:10.4103/2278-0513.110773  
Background: Breast cancer is the most frequent cancer in female, both in developed and developing regions, and ranks second overall next only to lung cancers. International variation in both incidence and mortality is one of the most striking features of breast cancer. Aims: To assess the clinical profile of the patients of breast carcinoma as well as relevant macroscopic and microscopic features of the mastectomy specimens. Materials and Methods: The present prospective study was carried out on clinically suspected and pre-operative FNAC-confirmed 120 cases of breast carcinoma who were admitted in the department of surgery for mastectomy during the study period of two years. In addition to relevant clinical features, macroscopic and microscopic features of mastectomy specimens were noted. Results: Mean age of the study population was 46.53 years. Most of the patients presented with breast lump with or without other features. Mean tumor size in the study population was 5.91 cm with standard deviation ± 2.59. Most of the cases (90.8%; 109 cases out of 120 cases) were diagnosed as IDC, NOS (Infiltrating ductal carcinoma, not otherwise specified). Mostly (62 cases; 51.7%), we got the histological grade 3 tumors. Lympho-vascular invasion was identified in 25.8% cases (31 cases out of 120 cases). Skin and nipple areola was involved in 15.0% cases (18 cases). Conclusion: IDC, NOS is the most common histologic type of breast cancer in our study population. Most commonly affected age group by breast cancer is 35-50 years. In most of the cases, size of the mass was more than 5 cm involving multiple quadrants of breast and with positive lymph nodes. Histologically, grade 3 tumor is most prevalent in this population.
  - 7,632 1,550
REVIEW ARTICLES
Concurrent chemo-radiotherapy in the treatment of early breast cancer: Current status
Nabil Ismaili
January-March 2013, 2(1):1-8
DOI:10.4103/2278-0513.110756  
Concurrent chemo-radiotherapy (CCRT) in early breast cancer was investigated by few authors and remains controversial. This treatment is more commonly used for locally advanced breast cancer and showed high rate of complete pathological response. A search of articles published in English literature, between 1980 and November 2012, was conducted on Medline using the following terms: "breast cancer", "chemotherapy", "concurrent radiotherapy", and "Trastuzumab". We identified five phase I/II trials and three randomized phase three trials evaluating concurrent chemoradiotherapy in the adjuvant of breast cancer. In patients with early breast cancer having positive lymph nodes, phases III clinical trials showed that CCRT improved local control after conservative breast surgery. However, these randomized trials used non-standard regimen: Cyclophosphamide, methotrexate and fluorouracil (CMF) or fluorouracil, mitoxantrone and cyclophosphamide (FNC). In addition, in phases II clinical trials, concurrent use of taxanes and anthracycline with standard whole-breast irradiation showed high rate of toxicity: Pulmonary toxicity with taxane; and cardiac and skin toxicity with anthracycline. Consequentely, CCRT is not be used in practice because of concerns of toxicity with the standard drugs (anthracyclines and taxanes) and radiation. Anthracyclines with partial breast irradiation (PBI) was feasible according to one phase I clinical trial, and should be investigated in randomized clinical trials. Concurrent Trastuzumab plus radiotherapy is safe and can be used in HER2-positive breast cancer; in this case, cardiac volume sparing and patient selections for internal mammary chain irradiation are highly recommended. The present paper aimed to review the current data evaluating the efficacy and safety of CCRT in early breast cancer.
  - 3,348 233
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