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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 1 | Issue 1
Page Nos. 1-74

Online since Wednesday, December 12, 2018

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EDITORIAL  

From the Editor's Desk p. 1
Vanita Noronha
DOI:10.4103/CRST.CRST_12_18  
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REVIEW ARTICLES Top

Current management strategies in gallbladder cancers p. 2
Vikas Ostwal, Sanyo Dsouza, Shraddha Patkar, Sherly Lewis, Mahesh Goel, Krunal Khobragade, Anant Ramaswamy
DOI:10.4103/CRST.CRST_4_18  
Gallbladder cancers (GBC) are common in the Indo-Gangetic belt of India. Most consensus guidelines in the West have considered GBC as part of the biliary tract cancer spectrum; however, considering the markedly higher burden of GBC in India, there is a need to have specific management treatment strategies in the Indian scenario. The extent of surgical resections, the use of staging laparoscopies, the optimum adjuvant therapy for resected high-risk GBC (T3 or T4 disease and node-positive disease), as well as the preferred second-line chemotherapeutic regimens for advanced GBC are questions that remain incompletely defined and answered. The current review presents a synopsis of currently available evidence and emerging approaches in the treatment of GBC.
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Novel therapeutic options for recurrent metastatic salivary gland tumors: Review of ongoing clinical trials p. 10
Avinash Pandey, Manish Kumar, Heena Shahi, Aishwarya Kumari, Shivkant Singh
DOI:10.4103/CRST.CRST_1_18  
The clinical behavior and biology of recurrent malignant salivary gland tumors are myriad with slow-growing indolent disease at the one end of spectrum and aggressive symptomatic illness with metastases to bone, lung, and liver at the other end. Several different agents and combination chemotherapy regimens have been explored in patients whose disease is symptomatic with response rates between 15% and 40%. Recently, molecular studies have evolved to reveal targetable biomarkers which can be further explored in the therapeutic landscape with specific targeted therapies. A subset of tumors also expresses hormone receptors and hence is amenable to conventional antihormonal agents to obtain a possibly meaningful benefit. We searched for all ongoing and completed clinical trials involving chemotherapy, targeted therapy, hormonal therapy, and immunotherapy valid for patients with recurrent metastatic salivary gland tumors. We present the current viable therapeutic options for such a cohort of patients in routine clinical practice.
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PROFESSIONAL RESOURCE Top

Adjuvant chemotherapy protocols for lung cancer p. 19
Sameer Shrirangwar, Manasi Sharma, Sunny Jandyal, Shruti Kate
DOI:10.4103/CRST.CRST_8_18  
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STATISTICAL RESOURCE Top

A step-wise guide to performing survival analysis p. 41
Santam Chakraborty
DOI:10.4103/CRST.CRST_5_18  
Survival analysis refers to statistical techniques which have been designed to circumvent the issues arising out of incomplete information regarding the time until which a desired event or endpoint occurs. The reasons for this may be manifold, for example, lost to follow-up, dropouts from the study, lack of sufficient research budget, and short follow-up period. It is one of the common but complicated analysis done in trials. The current article provides a step-wise guide toward understanding survival functions and performing it.
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ORIGINAL ARTICLES Top

Quality of life without toxicity or symptoms analysis of a randomized controlled clinical trial comparing efficacy of cabazitaxel versus docetaxel in recurrent head and neck cancer p. 46
Vijay Patil, Amit Joshi, Vanita Noronha, Sachin Dhumal, Arun Chandrasekharan, Nikhil Pande, Sameer Shrirangwar, Anup Toshniwal, Siddharth Turkar, Kushal Gupta, Vikas Talreja, Abhishek Mahajan, Shashikant Juvekar, Atanu Bhattacharjee, Kumar Prabhash
DOI:10.4103/CRST.CRST_7_18  
Background: This analysis was done with the aim to study the overall impact of docetaxel and cabazitaxel treatment using quality-adjusted time without symptoms and toxicity (QTWiST) analysis in head and neck cancer patients receiving second-line treatment. Methods: Overall survival (OS) was partitioned in three health states for QTWiST analysis. Toxicity (TOX) state was defined as the cumulative number of days spent in grade 3 or above toxicity postrandomization and before progression. TWiST state was defined as the cumulative number of days spent postrandomization and before progression without grade 3 or above toxicity. REL state was defined as the time spent in days postprogression till death. A threshold utility analysis was performed. Results: The restricted mean TOX state duration in cabazitaxel arm was 2.26 days (95% confidence interval [CI] 1.12–3.40) versus 1.54 days (95% CI 0.56–2.53 days) in docetaxel arm. In threshold utility analysis, the mean difference in QTWiST was in favor of docetaxel arm and ranged from −7.194 (utility for TOX) to −35.96. For any combination of utility score of REL >0, with any combination of utility score of TOX, the difference in mean QTWiST between the two arms was >14 days (i.e. >10% of OS), in favor of docetaxel arm which is considered clinically meaningful. Conclusion: Patients randomized to docetaxel arm had a higher QTWiST score than patients in cabazitaxel arm. There was a suggestion that docetaxel led to better quallity of life without toxicity or symptoms, which would require confirmation in a larger study.
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A Bayesian approach for dynamic treatment regimes in the presence of competing risk analysis p. 51
Atanu Bhattacharjee, Gajendra K Vishwakarma, Souvik Banerjee
DOI:10.4103/CRST.CRST_6_18  
Background: A sequencing rule is considered to formulate the dynamic treatment regime (DTR). This sequence rule is based on the clinical relevance, prior evidence about the best performing therapy, and the requirement to treat a patient in a specific scenario. The challenge occurs when the study offers a concluding remark about best effective therapy among all possible combinations of treatment management schedules treated with a sequence rule. The time-to-event data analysis is the only available method to figure out the best effective treatment in the context of oncology research. However, the presence of the competing risk event of death in the time-to-event analysis is unavoidable, and it becomes challenging to decide regarding the best effective treatment strategy. Methodology: In this article, we describe the statistical methodology to handle the competing risk time-to-event data analysis in DTR. The analysis is performed with the Bayesian approach to help determine the best effective treatment strategy. Results: We introduce the OpenBUGS function, which provides the comparison and estimation of different treatment sequences in time-to-event competing risk data analysis adopting the newly proposed statistical approach. Conclusion: This method is efficient to guide the personalized medicine in oncology setup through the supportive decision rule.
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Cancer care: Challenges in the developing world p. 58
Chepsy C Philip, Amrith Mathew, M Joseph John
DOI:10.4103/CRST.CRST_1_17  
Objective: Cancer care in the developing world remains a challenge. Limitations in the diagnosis, poverty, and knowledge are recognized as some of the challenges. Health-care financing and treatment facilities are limitations toward availing cancer care. An assessment of the extent of the burden and strength of available infrastructure is limited. We performed an assessment to gather information from young oncologists in the developing world to identify similarities and differences among the countries. Methods: Information on services was gathered using a questionnaire from young oncologists participating in the American Society of Clinical Oncology annual meet selected to represent various developing countries. Descriptive statistics were used to report results. Results: The median doctor: outpatient ratio was 1:20 (1:2–1:80). Median: staffing ratio in an oncology ward was 1:6 (1:2–1:20). Four (22.2%) respondents reported complete social security support for health care in oncology. Stem cell transplant facility was reported as available in 8 (44.4%) centers out of 20. South Asian respondents reported the highest out-of-pocket expenditure (65%) and the least doctor: outpatient ratio at 1:20. Conclusion: Cancer care challenges appear similar in the regions surveyed. Additional strategies to improve the health-care infrastructure and provide a health security net to treat all cancer patients are required to benefit the efforts to tackle the growing burden of cancer in the developing countries.
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Once-a-week versus once-every-3-weeks cisplatin in patients receiving chemoradiation for locally advanced head-and-neck cancer: A survey of practice in India p. 63
Gautam Goyal, Vijay M Patil, Vanita Noronha, Amit Joshi, Satvik Khaddar, Sajak Kakkar, Ritesh Pruthy, Purvish Parikh, Kumar Prabhash
DOI:10.4103/CRST.CRST_15_18  
Purpose: High-dose (100 mg/m2) cisplatin with radiotherapy is the standard practice in locally advanced head-and-neck squamous cell carcinoma. Use of this regimen in resource- constrained and economically constrained countries like India is difficult. Methods: This study was a cross-sectional survey conducted among Indian oncologists treating head-and-neck cancer. The survey consisted of 25 questions relevant to general day-to-day practice in head-and-neck oncology. It included questions regarding the most common drug used in the concurrent chemoradiation (CRT) setting, the most common schedule of administration of cisplatin, the doses used in once-a-week or once-every-3-week cisplatin chemoradiotherapy, toxicities, and preventive strategies. Descriptive analysis was performed using SPSS software version 20. Results: Responses were obtained from 257 oncologists practicing in various oncology centers throughout the country. The agent most commonly used for radiosensitization was cisplatin (n = 243; 94.6%). The once-a-week regimen of cisplatin was the favored regimen (87.9%, n = 226). The reason for favoring the once-a-week regimen was better tolerance (n = 153, 59.5%). The once-every-3-weeks cisplatin schedule was prescribed for >50% of head-and-neck cancer patients by 23 participants only (8.9%). Conclusion: In this nationwide Indian survey, the majority of clinicians preferred the once-a-week cisplatin schedule for CRT in locally advanced head-and-neck cancer patients, due to better tolerance.
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IMAGE CHALLENGE Top

Pleural mass imaging - A quick primer p. 68
Raajit Chanana, Vijay Patil, Vanita Noronha, Amit Joshi, Kumar Prabhash
DOI:10.4103/CRST.CRST_3_18  
A 35-year-old female patient with no comorbidities and no history of addictions presented with a 2 week history of intermittent right-sided chest pain without any associated symptoms. On local examination, there was dullness over the right infrascapular and right infra-axillary area along with decreased breath sounds over the corresponding areas. Computed tomography scan revealed a well-defined lobulated heterogeneously enhancing pleural-based mass. What is the most likely diagnosis?
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MUSINGS Top

Making a case for cancer research in India p. 71
Vanita Noronha
DOI:10.4103/CRST.CRST_14_18  
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