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   Table of Contents - Current issue
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January-February 2021
Volume 10 | Issue 1
Page Nos. 1-52

Online since Friday, February 19, 2021

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REVIEW ARTICLE  

Low-dose radiation therapy for COVID-19 pneumonia p. 1
Rohit Mahajan, Sapna Marcus
DOI:10.4103/ccij.ccij_126_20  
The new coronavirus COVID-19 disease was declared a global public health emergency by the World Health Organization on January 2020. In the current dismal situation of the COVID-19 pandemic, effective management of patients with pneumonia and acute respiratory distress syndrome is of utmost importance. Due to the current lack of effective pharmacological concepts, this situation has caused interest in re-considering historical reports on the treatment of patients with low-dose radiation therapy for pneumonia. Although these historical reports are of low-level evidence per se, hampering recommendations for decision-making in the clinical setting, they indicate effectiveness in the dose range between 0.3 and 1 Gy, similar to more recent dose concepts in the treatment of acute and chronic inflammatory/degenerative benign diseases with, for example, a single dose per fraction of 0.5 Gy. Thus, we review the effects and mechanism and highlight the evidence for low-dose radiation that may be viable and useful in counteracting the acute inflammatory state induced by critical stage COVID-19 in the treatment of COVID-19 pneumopathy.
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ORIGINAL ARTICLES Top

Serum level of programmed death-ligand 1 in patients with gastric cancer in Mazandaran Province as a High-Risk Region in Iran p. 5
Ramin Shekarriz, Akbar Hedayatizadeh-Omran, Omolbanin Amjadi, Reza Alizadeh-Navaei, Gholamali Godazandeh
DOI:10.4103/ccij.ccij_128_20  
Background: Gastric cancer is one of the most common cancers in the world. Programmed death-ligand 1 (PD-L1) is the main ligand of the programmed death-1 receptor that plays a key role in apoptosis in patients with gastric cancer. Materials and Methods: In this study, forty gastric cancer patients and forty healthy controls were enrolled. Serum PD-L1 was measured by enzyme-linked immunosorbent assay. Results: The mean (interquartile range) value of expression level of PD-L1 was 70.6 (36.6–127.3) in patients and 47.7 (29.9–92.1) in controls. There were no significant differences in PD-L1 expression between the two groups and tumor characteristics, but there was a statistically significant difference between the high expression level of PD-L1 and gastric cancer development (P = 0.044, odds ratio = 2.77, 95% confidence interval = 1.12–6.86). Conclusions: PD-L1 level increases in gastric cancer patients, so it could be used as a predictor factor.
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Diagnostic value of beta-catenin immunohistochemical staining in papillary thyroid carcinoma p. 11
Leila Mehrandish, Seyed Hamid Madani, Sedigheh Khazaei, Elahe Saleh, Narges Eskandari Roozbahani
DOI:10.4103/ccij.ccij_117_20  
Background: The gold standard of diagnosing Papillary thyroid carcinoma (PTC) is achieved through pathologic evaluation using routine hematoxylin and eosin (H and E) staining. The determination of papillary carcinoma by the histological study is mainly based on architectural changes along with nuclear clearing, overlapping, grooving, and pseudoinclusions. In the absence of these changes, papillary carcinoma is difficult to distinguish from the benign thyroid lesion (BTL). Objective: This study aimed to assess the expression of β-catenin in BTL and PTC to evaluate its diagnostic values. Materials and Methods: One hundred H&E staining slides prepared from paraffin blocks (including 48 with PTC pathology, diagnosis and 52 with BTL pathology diagnosis) that met all inclusion criteria were selected. Paraffin blocks were sectioned and stained with a β-catenin marker using the immunohistochemistry method. Data were analyzed using the SPSS (V.18). Then, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated to describe the diagnostic value of β-catenin. Results: Cytoplasmic and membranous expression of the β-catenin protein was observed in 98.1% and 84.6% of BTL, respectively. Related to PTC, this record was observed in 97.9% and 93.7%, respectively. The sensitivity and specificity of cytoplasmic expression were 97.9% and 1.92%, respectively. The sensitivity and specificity of membranous expression were 93.7% and 15.3%, respectively. Conclusions: β-catenin can be used as a morpho-immunohistochemical marker to detect specific structural features such as papillae and pseudoinclusion, which are not well seen in H and E staining.
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The association between androgen receptor expression and some pathological characteristics in patients with breast cancer Highly accessed article p. 15
Mahdokht Azizi, Seyed Hamid Madani, Babak Izadi, Sedigheh Khazaei, Elahe Saleh, Mitra Tarlan
DOI:10.4103/ccij.ccij_103_20  
Context: Breast cancer is the most current malignancy in women all around the world. Considering the presence of the androgen receptor as a possible prognostic marker, attention has been given to its association with other molecular markers such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (Her 2)/neu, and clinicopathological characteristics and the target of cancer therapy. Aims: This study aimed to assess the level of androgen receptor (AR) and its association with other clinicopathological factors in patients with breast cancer. Settings and Design: Samples from 100 breast cancer patients were studied to evaluate the expression of AR using immunohistochemistry. Subjects and Methods: The association of AR was evaluated with ER, PR, and Her2 levels; age; tumor size; tumor grade; histological grade; nuclear grade; vascular invasion; perineural invasion; and lymph node involvement. The correlation between the expression of AR and other factors was assessed using t, Mann–Whitney, and Chi-square tests using SPSS. Results: Among 100 patients, 50 (50%) cases were AR positive. There was a significant correlation between AR expression and triple-negative breast cancer and the expressions of ER, PR, and Her2. However, there was no significant association between AR expression and other clinicopathological markers such as age, tumor size, type of tumor, and histological grade. Conclusion: Owning to the expanded expression of AR in 50% of patients with breast cancer in this study as well as the significant association between AR expression and triple-negative breast carcinoma, AR ER, PR, and Her 2, could be considered as a promising prognostic factor.
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Immunotherapy during COVID-19 pandemic: An experience at a tertiary care center in India p. 22
Abhishek Pathak, Alpana Gupta, Anvesh Rathore, Rahul Sud, Shiv Shankar Swamy, Tejas Pandaya, AP Dubey, Bhupesh Guleria
DOI:10.4103/ccij.ccij_125_20  
Introduction: COVID-19 pandemic has been a curse for cancer patients. The lack of understanding and unawareness in handling cancer patients during this pandemic has worsened their conditions. To analyze the real-world scenario, we studied 13 patients who were given immunotherapy during this COVID pandemic era and tried to analyze their outcome or any serious adverse effect that they suffered. This was a pilot study which would pave the way for further bigger studies in future. The aim of the study was to collect the details of patient receiving immunotherapy during COVID-19 pandemic. The data collected included the diagnosis, certain investigations, and the effects of the immunotherapy drugs and its side effects. Results: During this COVID pandemic period starting from March 20 to June 20, we have been regularly giving immunotherapy drugs such as nivolumab, pembrolizumab, and atezolizumab to our patients. We had given six patients nivolumab, six patients pembrolizumab, and one patient atezolizumab. Of the 13 patients who continued to receive immunotherapy in COVID pandemic era, 4 patients were receiving immunotherapy for lung cancer, 3 for head-and-neck malignancy, 2 for relapse lymphoma, and 1 each for hepatocellular carcinoma, renal cell cancer, malignant melanoma, and soft-tissue cancer. One of the patients receiving atezolizumab had actually progressed after receiving pembrolizumab. There was no Grade 3 or 4 toxicity to these drugs and most of our patients continued to be in stable disease/partial remission. One patient had died just after receiving one cycle of nivolumab. Conclusion: COVID-19 infection has posed an unforeseen predicament both for the patients and the treating oncologist. In absence of any previous data, it is very difficult to manage cancer patients where the treatment itself is thought to harm the patients. This is a humble effort to bring to the notice of the world that immunotherapy can be continued during COVID pandemic, provided we take all due precautions.
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Patient-reported shoulder morbidity and fatigue among the breast cancer survivors: An insight from a Tertiary Care Cancer Hospital p. 29
Bidyut Mandal, Annesha Sen, Shinjini Chakrabarty, Bhukya Swetha, Janmenjoy Mondal, Abhishek Basu, Debjit Ghosh, Subhendu Gangopadhyay
DOI:10.4103/ccij.ccij_80_20  
Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm and shoulder stiffness and arm pain and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospital. Aims: The study aims to evaluate the predictive factors of arm and shoulder morbidity and fatigue among the survivors. Settings and Design: Retrospective analysis from a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Statistical Analysis Used: Predictive factors of shoulder morbidity and fatigue were analyzed by independent sample t-test and univariate analysis. Significant predictive factors were selected for further validation in the multivariate cox regression model. A P ≤ 0.05 was considered significant. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34 and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy, and radiotherapy to axilla were significantly associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.
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“A comparative study using conventional concomitant chemoradiotherapy (using cisplatin-based chemotherapy) with accelerated (six fractions a week) chemoradiotherapy in inoperable or nonresectable locally advanced non-small cell lung cancers:” A prospective randomized trial p. 36
Anup Negi, Shabnum Thakur, Rajeev Kumar Seam, Manoj Kumar Gupta, Manish Gupta, Vikas Fotedar, Poorva Vias, Harpreet Singh Angural
DOI:10.4103/ccij.ccij_127_20  
Context: The conventional concomitant chemoradiotherapy (CCRT) is the standard treatment for locally advanced non-small cell lung cancer. Accelerated CCRT results in shortening of overall treatment time which can contribute in controlling accelerated tumor repopulation. The increase in tumor control probability (TCP) can be expected with no or little effect on late normal tissue injury for a given total dose. Aim: The aim of this study was to compare the disease response, toxicity profile, quality of life (QoL), and overall survival in accelerated versus conventional CCRT. Subjects and Methods: Total 42 patients were randomized into two groups – study group (n = 21): Accelerated CCRT, radiation was given as 6 fractions per week (60 Gy/5 weeks/30#) with injection cisplatin 20 mg/m2 intravenous (iv) days 1–5 and days 29–33 + injection etoposide 50 mg/m2 iv days 1–5 and days 29–33 and control group (n = 21): Conventional CCRT, radiation was given as 5 fractions per week (60 Gy/6 weeks/30#) along with the same chemotherapy. External beam radiation therapy was delivered by cobalt-60 machines. Results: The overall response rate (complete and partial response) for all patients was 66.6%. In the control group, it was 66.2%, and in the study group, it was 66.6%. Grade ≥II pulmonary, hematological, and esophageal toxicities were seen in 57%, 43%, and 24% in patients of the control group and 53%, 53%, and 33% in the study group, respectively. In QoL analysis, maximum improvement was noted for hemoptysis, arm/shoulder pain, dyspnea, and chest pain in both the groups. Statistical Analysis Used: The data were analyzed by Student's t-test and Chi-square test. P < 0.05 was taken as statistically significant. Conclusion: As response rates and disease progression were similar in both the groups, accelerated chemoradiotherapy can be considered as an alternate therapy, especially in high-volume centers.
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CASE REPORTS Top

Maxillary ameloblastoma with lung metastasis: Case report of a rare tumor p. 42
Karpal Singh Sohal, Salvatory M Mlaga, Edda A Vuhahula
DOI:10.4103/ccij.ccij_108_20  
Ameloblastomas are low-grade neoplasms of odontogenic epithelium that account for about 1% of all oral tumors and about 10% of odontogenic tumors. Rarely, these tumors have a potential of distance metastasis, and once they do metastasize, they are termed as metastatic ameloblastoma. This article aims at describing a case of a rare form of maxillary ameloblastoma that metastasized to the lung and challenges in its management in settings with limited resources. A 24-year-old African male presented with a massive swelling on the right side of the face for 2 years in 2018. He was previously operated on for a swelling on the right side of the maxilla in 2012, which was histologically diagnosed as ameloblastoma. Clinical and radiological evaluation revealed a massive maxillary tumor that had a local extension to the brain. X-ray and computed tomography (CT) scan of chest pointed out to metastatic mass in the lungs. Histology of the recurrent tumor mass revealed it to be follicular ameloblastoma, and CT-guided fine-needle aspiration cytology of the lung mass showed microscopic features of ameloblastoma similar to the primary jaw tumor.
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Bilateral choroid metastasis in a young nonsmoker male: A rare site of metastasis from squamous cell carcinoma lung p. 47
Nafees Ahmad Khan, Huma Firdaus, Mohammad Shameem, Abdul Waris, Rakesh Bhargava
DOI:10.4103/ccij.ccij_111_20  
Choroidal metastases from the lung are very rare accounting about 0.1%–7%. The most common site of ocular metastasis is choroid due to its abundant blood supply. Lung cancers commonly metastasize to the liver, bone, brain, and adrenals. Here, we present a very rare case of squamous cell carcinoma lung in a young nonsmoker patient with metastasis only to eye and no evidence of distant metastasis. This is a very rare case as metastasis to eyes itself is a very rare occurrence and has been mainly reported with adenocarcinoma and small-cell carcinoma. The other features which make this case rare are that squamous cell carcinoma is common in smokers and usual age of diagnosis is >50 years of age and this patient was only 38 years of age and nonsmoker. The aim of this case report is to emphasize the importance of thorough patient evaluation and effect of systemic chemotherapy on ocular metastatic lesions.
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LETTER TO EDITOR Top

Thoracoabdominal flap: A simple reconstruction technique for chest wall osteoradionecrosis p. 51
Navin Kumar, Kanak Lata, S V. S Deo
DOI:10.4103/ccij.ccij_121_20  
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