Tata Memorial Hospital

About: Tata Memorial Hospital is a healthcare organization based out in Mumbai, India. It is known for research contribution in the topics: Cancer & Breast cancer. The organization has 3187 authors who have published 4636 publications receiving 109143 citations.

Sentinel-node biopsy in breast cancer.

Abstract: Axillary lymph node dissection (ALND) is an important tool in staging patients with breast cancer. However, this procedure has several sequelae and complications and improvement in early diagnosis has led to an increasing number of cases of ALND in which axillary nodes are found to be negative. Sentinel node (SN) biopsy appears to be a less invasive alternative to ALND. The aim of the present study was to assess whether SN is a reliable indicator for axillary staging. We studied 126 consecutive patients with T1-T2 breast cancer and clinically negative axilla. In each case, 30-70 MBq of 99mTC-labelled colloidal albumin was injected subdermally close to the tumour and SN was visualised by lymphoscintigraphy. Surgery was performed 24 h after injection and the SN was removed under the guidance of a gamma ray-detecting probe. ALND was then undertaken in all cases. A histopathologic examination of the SNs was then made and the findings compared with the status of the other axillary nodes. SNs were identified and biopsied in 115/126 patients (91.3%) and correctly predicted the axillary status in 110/115 cases (95.6%). In five cases (4.4%), SNs were found to be negative, but other axillary nodes were positive. Our data confirm that SN biopsy is a good method for staging the axilla in patients with breast cancer. However, before SN biopsy can replace ALND in daily clinical practice, some technical aspects must be standardized, and clinical trials are required in order to clarify the prognostic impact of false-negative cases.

Prospective analysis of incidence of central nervous tumors presenting in a tertiary cancer hospital from India.

Abstract: Tumors of the central nervous system (CNS) are rare neoplasms constituting 1–2% of all neoplasms [1]. They are however quite heterogeneous with a wide variety of primary tumors and a large number of secondary tumors. CNS tumors are the second commonest overall and the most common solid tumors in the pediatric population [1]. Approximately, 25% of all cancer related deaths in pediatric population occur due to CNS tumors [2]. CNS is also perhaps among the few sites where a significant number of patients with benign tumors are managed in the neurooncology practice. With the advent of refinements in the diagnostic, neuro-surgery, radiotherapy, chemotherapy and a greater understanding of biology, the outcomes of these tumors have improved over a period of time. There is also a greater recognition of incorporating ancillary expertise in the form of physiotherapy, occupational therapy and rehabilitation in the management paradigm for these patients. Against such a background, it is important to devise a system to impart tailored therapies for different patients and different tumor types. Organizing optimum management and care for these patients involving various health professionals and utilization and planning different material and human resources necessitates comprehensive and reliable data collection. The database should preferably be in a prospective manner to have accurate information about the demographic and clinical profile of patients. Such information is generally available in the most of the developed world. On the other hand, such information is scarcely available in the vast majority of the medium and low resource income countries. Lack of uniform and wellstructured system of reporting cases have a distinct possibility of under reporting, even grossly in some instances. While some of these statistics may be available sometimes on a well to quasi-structured national systems, in many an instance, data from hospital-based practice may be lacking in many countries [3]. In India, the incidence of cancers is generally recorded from national cancer registries and hospital records [4, 5]. In the recent past, the incidence of patients with CNS tumors appears to be somewhat increasing [6]. In addition, the ability to characterize different pathologies of various CNS neoplasms has broadened immensely, which are not captured completely by the existing data recording systems. We initiated a comprehensive prospective recording of demographic and appropriate clinical data for all patients with CNS tumors visiting our hospital, which happens to be the largest dedicated cancer center in India and hereby report our findings.

Sclerosing Epithelioid Fibrosarcoma–A Report of Two Cases with Cytogenetic Analysis of FUS Gene Rearrangement by FISH Technique

Abstract: Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue sarcoma. Recently, a link has been suggested between SEF and low-grade fibromyxoid sarcoma (LGFMS) on the basis of the finding of the characteristic translocation t(7;16) (FUS-CREB3L2) of LGFMS in a small number of studied cases of SEF. The frequency of this translocation in SEF is still unknown. We present 2 cases of SEF with cytogenetic analysis for FUS rearrangement. The tumors occurred in 12 and 58 year old patients, respectively and consisted of a well to partially circumscribed, non-encapsulated mass, comprising monomorphic, polygonal cells arranged in aggregates, cords and single file arrays in a variably sclerotic stroma. The cells exhibited minimal nuclear atypia with moderate amount of clear to eosinophilic cytoplasm and rare mitotic figures. One case also showed bland spindle cell areas with myxoid change, as seen in LGFMS. By immunohistochemistry (IHC), the tumor cells were diffusely positive for vimentin, focally for S-100 in 1 case and negative for cytokeratin (CK), epithelial membrane antigen (EMA), HMB-45, desmin, smooth muscle actin (SMA), H-caldesmon, Myo D-1, CD34 and CD 168. By fluorescent in-situ hybridization (FISH) technique, the case with mixed SEF and LGFMS histology was positive for FUS rearrangement. Our study reinforces the previously reported relationship between SEF and LGFMS, and suggests that SEF may represent a variant of LGFMS in at least some cases, rather than an entirely distinct fibrosarcoma variant.

EGFR mutation in squamous cell carcinoma of the lung: does it carry the same connotation as in adenocarcinomas?

Abstract: BACKGROUND EGFR tyrosine kinase inhibitors (TKIs) have greatly improved the outcomes of EGFR mutation-positive adenocarcinomas of the lung. In contrast, the significance of EGFR mutation in metastatic squamous cell carcinoma (SCC) of the lung has been debated. METHODS All patients with metastatic SCC who underwent EGFR mutation testing at our center from 2010 to 2015 were included for analysis. EGFR kinase domain mutations were tested using Taqman-based real-time polymerase chain reaction (PCR). Response assessment was done using Response Evaluation Criteria In Solid Tumors (RECIST) 1.1. Kaplan-Meier method was used for calculating progression-free survival (PFS) and overall survival (OS). RESULTS EGFR mutation was detected in 29 out of 639 patients with SCC. Furthermore, 19 out of the 29 patients received TKIs at some point during their treatment. TKI therapy led to a partial response in 5 out of 19 patients and stable disease in 4 out of 19 patients. The median PFS of patients treated with TKIs was 5.0 months. The median OS of the whole EGFR-positive SCC cohort was 6.6 months. On univariate analysis, patients having received TKI therapy was the only factor associated with a significantly better OS of 13.48 months versus 2.58 months (P=0.000). On multivariate analysis, patients receiving TKI therapy, Eastern Cooperative Oncology Group-Performance Scale (ECOG-PS) score <2, EGFR exon 19 mutation and nonsmoking status were associated with significantly better OS. CONCLUSION EGFR mutation in SCC of the lung predicts a better outcome if the patient is given TKI, but it may be inferior to the outcomes seen in EGFR-positive adenocarcinomas treated with TKI.

Brain metastasis-Evidence based management

Abstract: Advances in cancer management have resulted in a significant increase in median survival of number of diseases. Consequently we are seeing more patients living long enough to develop symptomatic brain metastases. The management of such patients will be discussed here. The most important definitive investigation is contrast enhanced MRI scan of brain. Management consists of supportive care and disease directed treatment. Surgical resection remains the gold standard for the treatment of solitary brain metastases. Whole brain radiotherapy is considered standard treatment for all patients with brain metastases. The role of chemotherapy was limited in the past. Recently several new agents have been identified as potentially useful. Preliminary results indicate that drugs like temozolomide and topotecan have antitumor activity against the brain metastases as well as the primary systemic malignancies. The goal of multimodality treatment for brain metastases is to palliate local symptoms and prevent consequences of neurological involvement.