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   Table of Contents - Current issue
Coverpage
Jul-Sep 2020
Volume 3 | Issue 3
Page Nos. 421-669

Online since Saturday, September 19, 2020

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MUSINGS  

Music as a bed ‘rock’ of relaxation and awe Highly accessed article p. 421
Anant Ramaswamy
DOI:10.4103/CRST.CRST_138_20  
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Head-and-neck cancer radiotherapy recommendations during the COVID-19 pandemic: Adaptations from the Indian subcontinent Highly accessed article p. 424
Shwetabh Sinha, Sarbani Ghosh Laskar, Naveen Mummudi, Ashwini Budrukkar, Monali Swain, Jai Prakash Agarwal
DOI:10.4103/CRST.CRST_277_20  
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Doctoring in the time of COVID-19 – Lessons learned p. 427
Sharada Mailankody
DOI:10.4103/CRST.CRST_254_20  
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Dental measures during the COVID-19 pandemic in cancer patients Highly accessed article p. 429
Kanchan P Dholam, Madhura R Sharma, Sandeep V Gurav, Gurkaran Preet Singh, Nimisha Manjrekar
DOI:10.4103/CRST.CRST_217_20  
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Bad science in the time of COVID-19 Highly accessed article p. 434
Arya Mariam Roy, Aju Mathew
DOI:10.4103/CRST.CRST_272_20  
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ORIGINAL ARTICLES Top

Exploring the prognostic significance of the pretreatment inflammatory markers in hypopharyngeal cancers: A retrospective analysis Highly accessed article p. 437
Saket Mittal, Arvind Krishnamurthy, Sri Kamakshi Kothandaraman, Manikandan Dhanushkodi, Alexander John
DOI:10.4103/CRST.CRST_152_20  
Background: There is increasing evidence pertaining to the prognostic significance of pretreatment inflammatory markers such as platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and the combination of platelet count and neutrophil-to-lymphocyte ratio (COP-NLR) in many solid tumors, including head and neck cancers. However, there are limited data related to these markers in hypopharyngeal cancers. Objectives: We aimed to explore the association of the pretreatment inflammatory markers with survival outcomes in our cohort of hypopharyngeal cancers. Materials and Methods: The electronic medical records for the consecutive patients with carcinoma of the hypopharynx, treated at our center between January 1, 2016, and December 31, 2016, were accessed. The association between the clinico-demographic-laboratory variables and pretreatment inflammatory markers was analyzed using the Chi-square test, and the survival analysis was performed using the Kaplan–Meier method. Results: Seventy-nine eligible patients were included in the study. The median age of our cohort was 45 years; the male-to-female ratio was 2.9:1. There was a significant association of NLR with sex, hemoglobin, and the primary site; however, no such association was observed between PLR and these variables. Further, our study showed that higher values of NLR, PLR, and COP-NLR were predictive of poor outcomes, both in terms of the disease-free and overall survival. Conclusion: The readily available pretreatment systemic inflammatory markers, such as NLR, PLR, and COP-NLR, can be used as prognostic tools in patients with squamous cell carcinoma of the hypopharynx. The role of these potential markers, especially PLR, appears interesting and warrants further evaluation in other subsites of the head and neck as well.
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Construction and validation of a quality of life tool for pediatric patients of Indian origin with cancer: A single-center prospective study p. 445
Chindhu Shunmugasundaram, Vidhubala Elangovan, Venkatraman Radhakrishnan
DOI:10.4103/CRST.CRST_191_20  
Background: Quality of life (QOL) is an important clinical end point in pediatric oncology. The lack of a culture-specific measure to assess the QOL of Indian pediatric patients with cancer has led to this study. Objectives: This study was aimed at constructing and validating a QOL tool for Indian pediatric patients with cancer. Materials and Methods: This was a single-center prospective study conducted at the Cancer Institute, WIA, in Chennai, India, between July and October 2013. The study was conducted in two phases. Phase I consisted of generating and drafting of items, face validity, and field and pilot testing. Phase II involved establishing the validity and reliability of the measure. A total of 264 pediatric cancer patients aged 10–17 years were included for the construction of this measure. Factorial analysis, “t” test, Spearman's product moment correlation, and Cronbach's alpha coefficient were employed for data analysis. Results: A reliable, valid, and internally consistent measure containing 31 items named Cancer Institute Pediatric Oncology Quality of Life Questionnaire-31 (CI-Ped Onc QLQ 31) was developed to assess the QOL of pediatric patients with cancer. The Cronbach's alpha and the Guttman split-half reliability of the developed measure were 0.83 and 0.80, respectively. The four factors that emerged after factor analysis (eigenvalues ranging from 7.495 to 1.495 with 46.53% variance) were grouped into three: “physical well-being,” “psychosocial well-being,” and “treatment-related concerns.” Discriminant validity was established within the gender and treatment status. Conclusions: The CI-Ped Onc QLQ 31 was constructed and validated. It was found to be suitable for pediatric patients of Indian origin with cancer. This measure can be used for screening by health professionals across various spectra, to plan interventions and for future research in the field.
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Cognitive score in patients with primary brain tumors undergoing systemic therapy – a cross-sectional study p. 455
Supriya Adak, Gunjesh Kumar Singh, Nandini Menon, Ochin Dale, Sujay Srinivas, Sudeep Das, Somnath Roy, Dilip Harindran Vallathol, Vijay Maruti Patil
DOI:10.4103/CRST.CRST_196_20  
Background: The systemic treatment of brain tumors is complex. Apart from the disease burden and adverse effects of systemic therapy, cognitive decline of patients undergoing treatment is an added liability. However, there is limited literature on the cognitive assessment of the patients receiving systemic therapy. Objectives: We performed this cross-sectional analysis to assess the perceived cognition status and quality of life (QOL) of patients with brain tumors receiving systemic therapy and the factors affecting them. Materials and Methods: Adult patients receiving systemic therapy in the outpatient department of the neuro-medical oncology unit at the Tata Memorial Hospital (Mumbai, India) were enrolled in this study. The patients were administered the functional assessment of cancer therapy cognitive function issues (FACT-Cog) QOL questionnaire. A multiple linear regression analysis was performed to determine the best combination of age, gender, education, and the affected lobe for predicting the different cognitive QOL scores. Results: The study cohort comprised a total of 100 patients with a median age of 39 (range, 18–64) years. Of these, 68 were men and 32 were women. The mean scores with standard deviations (SDs) calculated for the perceived cognitive impairment, the impact of perceived cognitive impairment on QOL, the comments from others, and the perceived cognitive abilities, were 61.96 (SD; 15.43), 11.8 (SD; 5.16), 13.82 (SD; 3.92), and 21.79 (SD; 5.16), respectively. There was no significant association between the various FACT-Cog subscales and the selected factors, namely older age (>60 years), gender, education, and the affected lobe (frontal, temporal, parietal, and others). Conclusions: This is the first Indian study to report the perceived cognitive scores and QOL assessment for patients with brain tumors that can be useful for generating hypotheses and calculating the sample size for future studies. As none of the evaluated factors could reliably impact the cognitive score, an assessment of the cognitive QOL should be done for each patient.
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Evaluating the role of topical tranexamic acid in cancers of the head-and-neck: A single-center randomized controlled trial p. 461
S Anand, Vikrant Singh, Pankaj Kumar Sahu
DOI:10.4103/CRST.CRST_216_20  
Background: Closed suction drains can reduce the complications associated with neck dissection (ND) by facilitating the removal of bodily fluids from the operated site. A lower drain output helps in faster wound healing, thereby leading to early drain removal and better recovery. Topical application of tranexamic acid (TXA) to the raw area created by surgery has been shown to be beneficial in reducing the bleeding in cardiac, orthopedic, and endoscopic nasal surgeries. Objectives: This study aimed at assessing whether the topical application of TXA after ND reduced the drain output, time to drain removal, and postoperative complications in patients undergoing surgery for head and neck cancers. Materials and Methods: The present study was performed in a tertiary care teaching hospital in north India between August 2014 and December 2017. One hundred patients with head and neck cancer who underwent ND were randomized into two groups. Group 1 received 20 ml of 25 mg/ml topical TXA per neck after hemostasis, and Group 2 underwent routine neck closure. Primary end points included the daily drain output until postoperative day 5 and the day of drain removal. Age, lymph node yield, operative time, type of reconstruction, and postoperative complications till 30 days postoperatively were also recorded. Results: The demographic and clinicopathological profiles were comparable between the two groups. Output from the neck drains was significantly lower in the TXA group compared to the standard closure group (208.29 ± 84.18 ml vs. 344.56 ± 110.93 ml; respectively, P < 0.0001). In addition, drain removal in the tranexamic acid group was done earlier than in the standard closure group (6.11 ± 1.20 days vs. 7.56 ± 1.42 days, respectively,P < 0.0001). Postoperative complications and requirement of secondary procedures were comparable between the two groups. Conclusions: Topical TXA effectively reduces the postoperative drain output after ND in patients with head and neck cancer. It facilitates the early removal of the drain and helps in better recovery without any significant difference in the rate of postoperative complications.
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The impact of COVID-19 pandemic on the practice of radiotherapy: A retrospective single-institution study p. 467
Richa Chauhan, Vinita Trivedi, Rita Rani, Usha Singh, Vasudha Singh, Santosh Shubham, Sucheta Kumari, Anjali Uniyal
DOI:10.4103/CRST.CRST_255_20  
Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 led to the imposition of a nationwide lockdown as a control measure, which in turn disrupted the diagnosis and treatment of other diseases including cancer. Objectives: The primary objective of this study was to assess the impact of the COVID-19 pandemic on patients receiving radiotherapy and whether it correlated with the patients' age, gender, site of disease, and intent of radiotherapy. The secondary objective was to assess the compliance to radiotherapy and the treatment modifications, if any. Materials and Methods: This is a retrospective analysis of all patients planned for radiotherapy at the Mahavir Cancer Sansthan, a tertiary cancer center, in Patna, India from January 1, 2020, to May 31, 2020. The study cohort was divided into two groups: Group A comprised patients who received radiotherapy in the period before the lockdown and Group B comprised patients who received radiotherapy during the lockdown. Data regarding the age, gender, site of disease, intent of treatment, completion of planned treatment, use of concurrent chemotherapy, and modifications of the radiation protocol, if any, were analyzed. The categorical variables were compared using the Chi-square test. Results: A total of 1412 patients were planned for radiotherapy during the study period. Of these, 1020 patients, 759 in Group A and 261 in Group B, actually received radiotherapy during the entire study period. The proportion of female patients decreased by 10.5% and that of patients receiving palliative intent radiotherapy increased by 12% during the lockdown. Head and neck, gynecological, and breast cancers were the most common cancer types in both the periods. There was no significant difference in the compliance to radiotherapy between the two groups (88.2% in Group A and 90.8% in Group B). Similar protocols were used during both the periods in patients being treated with a curative intent, but there was a significant increase in the use of single fraction radiation treatment in patients being treated with palliative intent with conventional fields. Conclusions: There was a sharp decline in the number of patients, especially women, during the lockdown. The number of patients being treated with palliative intent increased significantly, with an increased use of single-fraction radiation treatment.
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Concordance of epidermal growth factor receptor mutation detection in bodily fluids other than blood with tissue biopsy: A retrospective analysis p. 475
Anuradha Chougule, Priyanka Pange, Shrutika Kale, Vinita Jagtap, Kavya Nambiar, Ankita Nikam, Priyanka Tiwrekar, Vaishakhi Trivedi, Vichitra Behel, Akhil Kapoor, Nandini Menon, Vijay Patil, Vanita Noronha, Kumar Prabhash, SD Banavali
DOI:10.4103/CRST.CRST_262_20  
Background: The concept of liquid biopsy as a surrogate for tumor tissue is not only restricted to blood-derived samples but also includes other malignant bodily fluids such as cerebrospinal fluid, pleural fluid, pericardial fluid, and ascites. The application of liquid biopsy in patients with metastatic lung cancer, with disease progression on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment, is unexplored in India. Objective: We aimed to determine the presence of EGFR gene mutations in various bodily fluids of patients with EGFR-mutant progressive metastatic lung adenocarcinoma. Materials and Methods: In this retrospective study conducted at the Tata Memorial Hospital in Mumbai, India, data from 11 patients with advanced EGFR-mutant lung adenocarcinoma were analyzed. Between December 2017 and June 2018, the cell-free DNA (cfDNA) obtained from the malignant bodily fluids and plasma of 11 patients were tested for the presence of EGFR-sensitizing mutations using real-time reverse transcription-polymerase chain reaction. The status of EGFR-sensitizing mutations in plasma and other bodily fluids was compared with that of the baseline tissue biopsy. In addition, the status of the acquired T790M resistance mutation in exon 20 at disease progression was determined using plasma and other bodily fluids. Results: Of the 11 patients, at disease progression, EGFR sensitizing mutations (exon 19 deletion and exon 21 L858R insertion) could be detected in the plasma of 7 (63%) and in other bodily fluids of all the 11 (100%) patients. Thus, the concordance for EGFR-sensitizing mutation detection in the plasma and other bodily fluids with the baseline formalin-fixed paraffin-embedded tissue was 63% and 100%, respectively. In addition, the acquired T790M resistance mutation was detected in the plasma of 3 (27.3%) patients and other bodily fluids of 9 (81.8%) patients. Conclusion: The rate of detection of the T790M mutation is higher in the free DNA obtained from malignancy-involved bodily fluid supernatant as compared to the plasma cfDNA. Our results suggest that cfDNA obtained from bodily fluids other than plasma can be used for the detection of EGFR mutations and that the mutation status may be a useful predictor of the response to TKIs.
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POETRY IN ONCOLOGY Top

Cancer undone p. 481
Mathangi Kumar
DOI:10.4103/CRST.CRST_105_20  
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ORIGINAL ARTICLE: GERIATRIC ONCOLOGY SECTION Top

Safety and efficacy of concurrent chemoradiotherapy for head-and-neck cancers in older versus younger patients: Post hoc analysis of a randomized controlled trial p. 482
Gunjesh Kumar Singh, Vanita Noronha, Vijay Maruti Patil, Nandini Menon, Amit Joshi, Kumar Prabhash
DOI:10.4103/CRST.CRST_208_20  
Background: Head-and- neck squamous cell carcinoma (HNSCC) is a commonly occurring malignancy in the geriatric population. However, there is a scarcity of data regarding the efficacy and safety of concurrent chemoradiotherapy (CRT) in these patients. Objectives: We performed a post hoc analysis of a randomized study conducted at our institution to compare the outcomes and toxicities of concurrent CRT in older versus younger patients with HNSCC. Materials and Methods: The present analysis is based on a study conducted at Tata Memorial Hospital, Mumbai, India, on patients with locally advanced HNSCC, planned for radical concurrent CRT. The patients were randomized to receive cisplatin either once-a-week at a dose of 30 mg/m2 or once-in-3-weeks at a dose of 100 mg/m2. The database of this study was used for the post hoc analysis. We evaluated the differences in the demographic and clinical features, grade 3 or worse adverse events, compliance to treatment, locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) between the older (aged ≥ 60 years) and the younger patients. Results: Out of 300 patients, 283 (94.3%) comprised the younger cohort (age <60 years) and 17 (5.7%) comprised the older cohort. There was no difference in the occurrence of severe (grade 3/4) toxicities between the two groups. At a median follow-up of 22 months (range, 3–51 months), the cumulative LRC at 2 years was 67.1% and 100% for the younger and older groups, respectively (P = 0.018). The estimated median PFS in younger patients was 24.4 months (95% confidence interval, 12.5–36.3), while it was not reached in the older group (P = 0.53). The estimated median OS was 41.3 months in the younger patients but was not reached in the older group (P = 0.613). Conclusions: Cisplatin-based concurrent CRT appears to be as efficacious in carefully selected fit older patients as in younger patients; moreover, toxicities appear to be similar in both the groups.
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ORIGINAL ARTICLE: REAL WORLD DATA Top

Endometrial stromal sarcoma: Retrospective analysis of a tertiary care experience from India p. 489
Rajit Rattan, Pragyat Thakur, Ankita Gupta, Raviteja Miriyala, Nagarjun Ballari, Bhavana Rai
DOI:10.4103/CRST.CRST_70_20  
Background: Endometrial stromal tumors are rare tumors of mesenchymal origin, conventionally classified as low-grade and high-grade tumors based on the mitotic count. Objective: In this study, our objective was to analyze the clinical characteristics and outcomes of patients with endometrial stromal sarcomas (ESS) treated at our institute. Materials and Methods: Records of histologically proven cases of ESS treated at out institute between January 2011 and July 2015 were studied. The data were reviewed to ascertain the patient and disease characteristics and the treatment received before and after coming to the tertiary care hospital. Overall survival (OS) was assessed using the Kaplan–Meier method, and the differences were evaluated using the log-rank test. Results: A total of 25 patients with ESS were identified, and the data for 23 of these were analyzed; 15 (65%) patients had low-grade tumors, and eight (35%) had high-grade tumors. About 53% of the patients with low-grade ESS (LG-ESS) had early stage disease, and 75% of those with high-grade ESS had Stage III/IV disease. All patients underwent at least a total abdominal hysterectomy. Adjuvant radiation and chemotherapy were given to 11 and 7 with LG-ESS and HG-ESS patients, respectively. Nine (39.1%) patients received hormonal therapy. Fifteen (65%) patients received some form of treatment before reporting at our institute. At the median follow-up of 22 months (range, 5–62 months), four patients died because of disease progression. The median OS for patients with high-grade tumors was 25 months; it was not reached for patients with low-grade tumors. Conclusions: LG-ESS present at an earlier stage and have a better outcome than high-grade ESS, which receive more aggressive treatment. However, the general lack of awareness among practitioners has led to many patients not receiving standard treatment and counseling. Therefore, the treating oncologists must properly assess the risk management strategies before instituting treatment.
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PATIENT/CAREGIVER CORNER Top

Be the master of your own destiny p. 495
MK Surendran
DOI:10.4103/CRST.CRST_205_20  
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Cancer – My experience p. 498
Jitendranath Nayer
DOI:10.4103/CRST.CRST_40_20  
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REVIEW ARTICLES Top

Cancer thrombosis: Narrative review Highly accessed article p. 501
Pritesh Naresh Munot, Vanita Noronha, Vijay Patil, Amit Joshi, Nandini Menon, Kumar Prabhash
DOI:10.4103/CRST.CRST_18_20  
Venous thromboembolism (VTE) is a common disease in patients with cancer and carries a poor prognosis. Although the exact incidence of VTE in patients with cancer lies between 10% and 40%, it is prevalent in a substantial number of patients, either before starting treatment or during the treatment. Vitamin K antagonists have been traditionally used as the preferred agents for the treatment of VTE. However, multiple studies have revealed that low-molecular-weight heparin (LMWH) is a better alternative for controlling and treating the thrombotic process. Direct oral anticoagulants (DOACs) have aroused considerable interest ever since their introduction. Despite the higher risk of bleeding associated with DOACs, patients prefer taking an oral tablet over parenteral therapy. The data from direct comparative studies are slowly emerging but are currently in favor of LMWH as compared to DOACs. However, in certain scenarios, such as renal failure and thrombocytopenia, other drugs should be considered before prescribing LMWH. Here, we have tried to analyze the current treatment strategy for cancer-associated thrombosis by reviewing articles, studies, and the guidelines based on them. We searched in MEDLINE for articles related to thrombosis and anticoagulation in patients with cancer, published between January 2000 and May 2020, with the full text available in the English language.
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Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature p. 517
Akheel Mohammad, Mohd Athar Iqbal, Ashmi Wadhwania
DOI:10.4103/CRST.CRST_149_20  
Schwannomas are slow-growing, encapsulated, benign tumors that can originate from any nerve covered with a sheath of Schwann cells. These tumors can originate from the cranial, peripheral, or autonomic nerves; about 25%–45% of schwannomas originate in the head-and-neck region, of which about 10% originate from either the vagal or sympathetic nervous system. They are rare tumors and are often asymptomatic, but depending on the location, they may produce secondary symptoms, such as swelling in the neck, dysphagia, and hoarseness of voice. The preoperative diagnosis of schwannomas is usually difficult because they often do not present with associated neurological deficits and can be misdiagnosed as other pathological conditions. Schwannomas should, therefore, be considered in the differential diagnosis of unilateral and slow-growing masses in the head and neck. The preferred modality for the treatment of schwannomas is surgical excision, and the recurrence of the tumor after complete resection is very rare. Vagal nerve injury is a common complication associated with surgical excision despite preserving nerve integrity. Therefore, the patients should be counseled preoperatively regarding the risk of developing neurological deficits. We searched in PubMed for articles related to schwannomas of the head and neck region, and extracted information regarding the symptoms, workup, management, and postoperative outcomes. We also discuss two cases, one with vagus nerve schwannoma and the other with supraclavicular cervical plexus schwannoma.
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Radiation dermatitis: A narrative review of the Indian perspective p. 526
Kaustav Talapatra, Pritanjali Singh, Isha Jaiswal, Sama Rais, Saket Pandey
DOI:10.4103/CRST.CRST_209_20  
One of the common and visible symptoms of radiation toxicity is radiation-induced dermatitis, which varies in intensity from slight erythema to dry and moist desquamation, ulceration, and sometimes skin necrosis. Radiation depletes the basal cell layer of the skin and initiates a complex sequence of events, leading to dose-dependent acute or late sequelae. These skin reactions may cause irritation and pain, delay treatment, and also reduce the quality of life of the patient undergoing radiotherapy. It is also a subject of major concern for female patients undergoing radiotherapy for the treatment of head-and-neck and breast cancers. Despite the technological advancements achieved in planning and delivery in the field of radiotherapy, most patients still experience radiation dermatitis (RD) as a side effect of the treatment. The severity of RD depends on multiple patient- and treatment-related factors. Although severe RD is rare in the current practice of megavoltage radiotherapy, some occasions necessitate active intervention by a multidisciplinary group to manage both acute and late radiation effects over the epidermis and sometimes the dermis. Management policies vary as per the institutional guidelines and personal preferences and are mostly based on individual experiences and reviews. This is a narrative literature review of the various articles focusing on the diverse spectrum of RD. The primary search for the articles was carried out via Google Scholar, PubMed, and MEDLINE with keywords such as “radiation dermatitis,” “radiation-induced skin toxicity,” and “radiation recall phenomenon,” “radiation erythema,” and “radionecrosis.” Additional articles were found through references from the relevant articles. In this review, we discuss the incidence of RD, its presentation, the key aspects that put Indian patients at an increased risk of RD, and the management strategies for the prevention and treatment of radiation dermatitis.
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DRUG REVIEW Top

Dabrafenib: A narrative drug review p. 537
Lakhan Kashyap, Saswata Saha, Anne Srikanth
DOI:10.4103/CRST.CRST_210_20  
Activating mutations in the BRAF gene lead to an unregulated downstream signaling of the MAPK/extracellular-signal-regulated kinase pathway. This pathway is implicated in a range of solid tumors, and BRAF inhibitors are an attractive option in the treatment of these cancers. At present, three BRAF inhibitors have received the Food and Drug Administration approval for the treatment of cancer, namely, dabrafenib, vemurafenib, and encorafenib. Dabrafenib is approved for the treatment of advanced melanomas, anaplastic thyroid cancers, non-small cell lung cancers, and for the adjuvant treatment of melanomas harboring the BRAF V600E/K mutation. This review of dabrafenib describes its chemistry, pharmacokinetics, interactions, clinical indications, and safety profile. We identified and included studies from the PubMed database using search terms “dabrafenib”, “trametinib” or “pharmacology” for qualitative synthesis.
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STATISTICAL RESOURCE Top

Critical appraisal of a clinical research paper: What one needs to know Highly accessed article p. 545
Jifmi Jose Manjali, Tejpal Gupta
DOI:10.4103/CRST.CRST_211_20  
In the present era of evidence-based medicine (EBM), integrating best research evidence into the clinical practice necessitates developing skills to critically evaluate and analyze the scientific literature. Critical appraisal is the process of systematically examining research evidence to assess its validity, results, and relevance to inform clinical decision-making. All components of a clinical research article need to be appraised as per the study design and conduct. As research bias can be introduced at every step in the flow of a study leading to erroneous conclusions, it is essential that suitable measures are adopted to mitigate bias. Several tools have been developed for the critical appraisal of scientific literature, including grading of evidence to help clinicians in the pursuit of EBM in a systematic manner. In this review, we discuss the broad framework for the critical appraisal of a clinical research paper, along with some of the relevant guidelines and recommendations.
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RESIDENT CORNER Top

Things I wish I had learned during residency-practical tips p. 552
Rushabh Kothari
DOI:10.4103/CRST.CRST_117_20  
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MOLECULAR TUMOR BOARD Top

Molecular tumor board: Case 4 Salivary Gland Cancer: Novel therapeutic options as a result of comprehensive molecular profiling p. 554
Akhil Kapoor, Vanita Noronha, Anuradha Chougule, Pratik Chandrani, Omshree Shetty, Vijay M Patil, Amit Joshi, Nandini Menon, Munita Bal, Richa Vaish, Amit Kumar, Kumar Prabhash
DOI:10.4103/CRST.CRST_258_20  
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EDITORIALS Top

Reevaluating how we define inflammation in head-and-neck cancers p. 564
Ranee Mehra
DOI:10.4103/CRST.CRST_230_20  
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Quality of life of Indian children with cancer: Measuring what matters p. 566
Revathy Krishnamurthy, Rajiv Sarin
DOI:10.4103/CRST.CRST_275_20  
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Impact of systemic therapies on cognition in patients with primary brain tumors p. 569
Debnarayan Dutta, Rakesh Jalali
DOI:10.4103/CRST.CRST_263_20  
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Utility of topical tranexamic acid in head-and-neck cancer surgery: A myth or reality? p. 572
Snehal Shah, Shivakumar Thiagarajan
DOI:10.4103/CRST.CRST_266_20  
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Radiotherapy during the COVID-19 pandemic: What we know and what we practice after four months p. 574
Shwetabh Sinha, Sarbani Ghosh Laskar
DOI:10.4103/CRST.CRST_270_20  
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Circulating tumor DNA in non-small-cell lung cancer: A step beyond blood p. 577
Alfredo Addeo, Alex Friedlaender
DOI:10.4103/CRST.CRST_276_20  
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Does chemoradiotherapy benefit older patients with squamous cell carcinomas of the head-and-neck? p. 580
Vijay K Srinivasalu, Keechilat Pavithran
DOI:10.4103/CRST.CRST_267_20  
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Endometrial stromal sarcoma: A rare tumor with therapeutic conundrums p. 583
Sunil Pasricha, Dinesh Chandra Doval
DOI:10.4103/CRST.CRST_228_20  
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IMAGE CHALLENGE Top

Radiologic progression in a patient with non-small-cell lung cancer p. 586
Alok K Shetty, Vanita Noronha, Vijay Patil, Nandini Menon, Amit Joshi, Abhishek Mahajan, Rajeev Kumar, Kumar Prabhash
DOI:10.4103/CRST.CRST_193_20  
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Cervical adenocarcinoma- a paradigm shift p. 590
Kriti Chauhan, Komal Kathuria
DOI:10.4103/CRST.CRST_201_20  
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ONCOLOGY UPDATES Top

Melanoma at American Society of Clinical Oncology 2020 – An update and its implications in the Indian setting p. 594
Abhenil Mittal, Aarushi Gupta, Sameer Rastogi
DOI:10.4103/CRST.CRST_239_20  
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Sarcoma and gastrointestinal stromal tumor update: Lessons from the American Society of Clinical Oncology 2020 and implications for practice p. 598
Azgar Abdul Rasheed, Ankur Varshney, Sameer Rastogi
DOI:10.4103/CRST.CRST_242_20  
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Combinations will lead the way in immunotherapy for bladder cancer p. 603
Rahul Ravind
DOI:10.4103/CRST.CRST_257_20  
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LETTERS TO EDITOR Top

Palliative oral triple metronomic chemotherapy in a patient with head-and-neck cancer during the COVID-19 pandemic in India: A case report p. 608
Sachin Babanrao Dhumal, Vanita Noronha, Akhil Rajendra Kurup, Vijay Patil, Amit Joshi, Nandini Menon, Kumar Prabhash
DOI:10.4103/CRST.CRST_220_20  
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COVID-19 pandemic: Another nail in the coffin of the “dying art” of the physical examination p. 610
Thirunavukkarasu Arun Babu, Vijayan Sharmila
DOI:10.4103/CRST.CRST_274_20  
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Challenges in the diagnosis and treatment of gynecological cancers during the COVID-19 pandemic p. 611
Vijayan Sharmila, Thirunavukkarasu Arun Babu
DOI:10.4103/CRST.CRST_273_20  
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Primary intraosseous leiomyosarcoma of the clavicle secondary to radiation therapy p. 612
Arvind Krishnamurthy, Abhijit Das, Ramasubba Reddy, Manikandan Dhanushkodi
DOI:10.4103/CRST.CRST_54_20  
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Clofarabine-based conditioning for T-cell replete haploidentical hematopoietic stem cell transplant for relapsed/refractory acute leukemia using peripheral blood stem cell grafts and post-transplantation cyclophosphamide p. 614
Prashant Mehta, Rahul Arora
DOI:10.4103/CRST.CRST_27_20  
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Cardiac metastasis from squamous cell carcinoma of the buccal mucosa: A case report and review of the literature p. 617
Joydeep Ghosh, Jayanta Das, Sandip Ganguly, Bivas Biswas, Deepak Dabkara
DOI:10.4103/CRST.CRST_62_20  
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Leptomeningeal metastasis in lung cancer: Not always a gloomy picture p. 619
Archisman Basu, Meheli Chatterjee, Joydeep Ghosh, Sandip Ganguly, Bivas Biswas, Deepak Dabkara
DOI:10.4103/CRST.CRST_151_20  
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Mining artificial intelligence in oncology: Tata Memorial Hospital journey p. 622
Mohnish Bothra, Abhishek Mahajan
DOI:10.4103/CRST.CRST_59_20  
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Extramedullary hematopoiesis: Detection of common and rare sites of involvement using18F-fluorodeoxyglucose and18F-fluorothymidine positron emission tomography–computed tomography scan p. 624
Melvika Pereira, Nilendu Purandare, Ameya D Puranik, Sneha Shah, Archi Agrawal, Venkatesh Rangarajan
DOI:10.4103/CRST.CRST_56_20  
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Rectal cancer with breast metastasis: A case report with review of literature p. 627
Sandip Ganguly, Sheena Alphones, Priya Ghosh, Divyas Midha, Joydeep Ghosh, Bivas Biswas
DOI:10.4103/CRST.CRST_102_20  
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Blastic plasmacytoid dendritic cell neoplasm of the thigh: A case report and narrative review of literature p. 630
Tanmoy Kumar Mandal, Somnath Roy, Shalini Singh, Bhagat Singh Lali, Zachariah Chowdhury, Lingaraj Nayak
DOI:10.4103/CRST.CRST_202_20  
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Tranexamic acid-induced acute renal failure in a pediatric patient with acute myeloid leukemia: A cautionary note p. 634
Nikita Mehra, Venkatraman Radhakrishnan
DOI:10.4103/CRST.CRST_158_20  
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Role of aerobic exercise in mitigating cancer treatment-induced cardiovascular toxicity p. 636
Chidiebere Emmanuel Okechukwu
DOI:10.4103/CRST.CRST_233_20  
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Outcome of chronic lymphocytic leukemia with deletion 17p p. 638
Ajay Gogia, Lalit Kumar, Atul Sharma, Ritu Gupta, Lata Rani
DOI:10.4103/CRST.CRST_215_20  
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Cancer stigma: Are we asking the right questions? p. 640
Soumya Swaroop Sahoo, Udit Kumar Panda, Pragyan Paramita Parija
DOI:10.4103/CRST.CRST_225_20  
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Acute leukemia treatment in low- and middle-income countries: Is it time for tailored therapy? p. 642
Sneha Tandon
DOI:10.4103/CRST.CRST_238_20  
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Navigating the financial impasse in acute myeloid leukemia: Prednisolone, etoposide, and 6-mercaptopurine metronomic chemotherapy p. 644
Vishal Jayakar
DOI:10.4103/CRST.CRST_227_20  
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Challenges in managing acute leukemia in India p. 645
Tapan Saikia
DOI:10.4103/CRST.CRST_226_20  
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Management of acute leukemias: New tools validated by old treatments p. 647
Aditi Jain, Sumeet P Mirgh
DOI:10.4103/CRST.CRST_240_20  
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Author's reply to Saikia, Jayakar, Tandon, and Jain et al. p. 648
Avinash Pandey
DOI:10.4103/CRST.CRST_253_20  
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Does induction chemotherapy advance the multimodal treatment of locally advanced esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation? p. 650
Merrill S Kies
DOI:10.4103/CRST.CRST_236_20  
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Changing treatment paradigms in advanced sinonasal neuroendocrine cancers p. 651
Rakesh Katna, Nikhil Kalyani, Bharat Bhosale
DOI:10.4103/CRST.CRST_229_20  
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Authors' reply to Kies and Katna et al. p. 653
Vijay M Patil, Vanita Noronha, Amit Joshi, Sachin Dhumal, Nandini Menon, Kumar Prabhash
DOI:10.4103/CRST.CRST_235_20  
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Adrenocortical carcinoma: Challenges and opportunities p. 654
Abhishek Tripathi, Neeraj Agarwal
DOI:10.4103/CRST.CRST_244_20  
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Treatment of adrenocortical carcinoma – Present and future p. 655
Saba Samad Memon, Anurag R Lila, Tushar R Bandgar
DOI:10.4103/CRST.CRST_223_20  
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Author's reply to Tripathi et al. and Memon et al. p. 656
Akhil Kapoor, Vanita Noronha, Anup Toshniwal, Santosh Menon, Amit Joshi, Vijay M Patil, Nandini Menon, Gagan Prakash, Vedang Murthy, Rahul Krishnatry, Ganesh Bakshi, Mahendra Pal, Palak Popat, Nilesh Sable, Kumar Prabhash
DOI:10.4103/CRST.CRST_260_20  
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Paving the way for a bright future for geriatric oncology in India p. 658
Ravindran Kanesvaran, Anupama Roy Chowdhury
DOI:10.4103/CRST.CRST_224_20  
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Next steps for geriatric oncology in India p. 659
Amish D Vora
DOI:10.4103/CRST.CRST_231_20  
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Author's reply to Kanesvaran et al. and Vora p. 660
Vanita Noronha, Anant Ramaswamy, Kumar Prabhash
DOI:10.4103/CRST.CRST_268_20  
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Fulvestrant in the fight against ER-positive advanced breast cancer; lone soldier or an important partner? p. 662
Ashish Singh
DOI:10.4103/CRST.CRST_249_20  
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Fulvestrant: Do not forget the history and opportunities for cost saving from real-world data p. 663
Amol Patel, MS Shivashankara
DOI:10.4103/CRST.CRST_256_20  
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Author's reply to Singh and Patel et al. p. 664
Manikandan Dhanushkodi, Indhuja Muthiah Vaikundaraja, Rama Ranganathan
DOI:10.4103/CRST.CRST_261_20  
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The pregnant physician: The elephant in the room p. 665
Vidisha Tuljapurkar, Deepa Nair
DOI:10.4103/CRST.CRST_232_20  
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Author's reply to Tuljapurkar et al. p. 666
Mounika Boppana
DOI:10.4103/CRST.CRST_241_20  
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Social lockdown and ecological intervention for the prevention of the community spread of COVID-19 p. 667
Biswaranjan Paital, Kabita Das, Tapas Ranjan Behera
DOI:10.4103/CRST.CRST_222_20  
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