Journal of Current Oncology and Medical Sciences

Impact of induction chemotherapy on resectability of borderline resectable/unresectable oral cavity carcinomas

2025-10-06T02:02:49-04:00

Introduction: To assess the impact of neoadjuvant chemotherapy (NACT) on achieving surgical resectability in patients with borderline resectable or unresectable T4a oral cavity squamous cell carcinoma (OCSCC).

Materials and methods: Patients with borderline resectable or unresectable T4a OCSCC enrolled between October 2023 and June 2025 received three to four cycles of NACT. Post-treatment, patients were assessed for response and resectability using clinical and radiological criteria.

Results: A total of 102 patients received NACT; 65.7% were male (n = 67) and 34.3% were female (n = 35). The median age was 47 years (range: 28–72). All patients received either two-weekly or three-weekly TPF regimens. Tobacco use and combined alcohol–tobacco habits were the most common (44.1% each), followed by tobacco with betel nut (4.9%), betel nut alone (2.9%), and no habits (3.9%). The buccal mucosa was the most frequent primary site (41.1%), followed by the tongue (35.2%). Other sites included the retromolar trigone (8.9%), upper alveolus (6.8%), and gingivobuccal sulcus (6.8%). Most patients presented with cT4aN1 disease (30.3%).The two-weekly TPF regimen was more commonly used (58.8%) than the three-weekly regimen (41.1%). Toxicity was manageable, with 36.3% of patients experiencing no adverse effects. The most frequent response was partial response (39.2%), followed by progressive disease and unevaluable responses (23.5% each), stable disease (8.8%), and complete response (4.9%). Surgery was considered feasible in 33 patients (32.3%), and 25 (24.5%) ultimately underwent surgery. Patients who underwent surgery demonstrated a significantly improved median overall survival (17.4 months) compared with those managed non-surgically (10.2 months; log-rank p = 0.001).

Conclusion: NACT is well tolerated and has an acceptable toxicity profile, enabling conversion to resectability in nearly one-third of patients with borderline resectable or unresectable T4a OCSCC. Surgical intervention significantly improves overall survival, underscoring the potential role of NACT in appropriately selected patients.

An in silico comparative docking analysis of breast cancer drugs and natural compounds targeting DLAT and ATOX1 proteins

2025-10-08T10:59:35-04:00

Introduction: Breast cancer is common among women, influenced by genetic and environmental factors. Proteins DLAT and ATOX1 contribute to disease. DLAT is part of the pyruvate dehydrogenase complex, involved in metabolism, while ATOX1 regulates copper. Chemotherapy drugs like Epirubicin, Xeloda, and Gemcitabine prevent cancer growth. Natural compounds such as Formononetin and Curcumin also show anticancer potential. Formononetin induces apoptosis and inhibits invasion, while Curcumin has antioxidant and anti-inflammatory effects against cancer.

Materials and methods: In this study, we used molecular docking to explore how these drugs and natural compounds interact with the DLAT and ATOX1 proteins. We obtained the protein structures from the PDB database and the drug structures from PubChem, and docking was performed using Pyrx software version 0.8 to evaluate binding affinities.

Results: The results showed that all the drugs and plant compounds had a good ability to bind to both proteins, but the binding to DLAT was stronger. Among the drugs, Xeloda performed the best with a binding affinity of -7.5 kcal/mol, and among the plant compounds, Formononetin showed the highest effectiveness with a binding affinity of -8.3 kcal/mol.

Conclusion: Natural compounds such as formononetin and curcumin may offer insights into potential interactions with proteins involved in breast cancer, but further studies are needed to confirm their effectiveness.

Quantifying benefit of deep inspiration breath hold technique in reducing cardiac avoidance area (CAA) and liver doses for right-sided breast cancer patients

2025-09-02T03:43:45-04:00

Introduction: The present study aimed to observe the difference in dosimetry between Deep inspiration breath hold (DIBH) and Free breathing (FB) in patients who received right-sided breast radiotherapy with Intensity-Modulated Radiotherapy (IMRT), focusing on the cardiac avoidance area (CAA) and liver doses.

Materials and methods: This retrospective study analyzed twenty-one right-sided breast cancer patients from 2018 to 2023 at our centre. Tangential multiple-field IMRT plans were generated using two scan datasets with identical field arrangements. Dose-volume histograms (DVH) were analyzed to compare dose to target volume and organs at risk. The mean and standard deviation represent continuous variables. Pairwise, Wilcoxon signed rank tests with two tails were used to compare the groups. The Statistical Package for the Social Sciences (SPSS) version 21 was used for all statistical calculations.

Results: The study found that PTV coverage was similar for both FB and DIBH. Most patients are stage II (52.4%) with invasive ductal carcinoma histology. Over half had undergone mastectomy. The primary endpoint of CAA exposure and liver doses was significantly lower in DIBH than in FB. The maximum dose to the CAA was 5.23 (0.00-11.09) with DIBH compared to 6.35 (2.89-14.32) with FB (p=0.05). The mean dose of the liver was 2.27 (0.45-6.38) with DIBH compared to 3.91 (0.95-10.36) with FB (p =0.001); similar trends were observed across other liver volumes. The mean dose to the right lung was 6.38 (1.88-12.94) with DIBH compared to 6.92 (1.66-16.09) with FB (p=0.018); similar trends were observed across other lung volumes. The mean dose to right coronary artery and contralateral breast was less with DIBH, but not statistically significant.

Conclusion: DIBH for right-sided breast irradiation effectively reduces CAA and liver exposure while maintaining target volume coverage. However, larger studies are needed to determine clinical benefits.

Psychometric properties of the Persian avoidance-endurance questionnaire in Iranian patients with chronic non-specific low back pain: a cross-sectional

2026-01-04T05:53:42-05:00

Introduction: The Avoidance-Endurance Questionnaire (AEQ) is a suitable instrument for assessing pain-related endurance and avoidance responses in individuals with chronic non-specific low back pain (CNSLBP). The aim of this study was to assess of factor structure and psychometric properties of Persian version of AEQ.

Materials and Methods: The groups that were recruited in this psychometric study were 120 individuals who had history of CNSLBP of more than three months. First, the Persian AEQ factorial structure has been investigated on the basis of the Exploratory Factor Analysis (EFA) with the Principal Axis Factoring and Promax oblique rotation method. An analysis of the usefulness of the extracted model was then performed through a confirmatory factor analysis (CFA) that included bootstrapping procedures and modification indices. Moreover, test-retest reliability and internal consistency were tested to realize the stability and reliability of the factors identified.

Results: The EFA demonstrated two factors in the emotional domain, three in the cognitive domain and four and three in the behavioral domain when it is mild and severe pain, respectively. The Kaiser-Meyer-Olkin (KMO) values were between 0.76 and 0.85; Bartlett Test of Sphericity was significant (p < 0.001) which proved that the data is sufficient to conduct factor analysis. The CFA also justified the extracted structure, it was shown that the model fit indices are in the range of poor to acceptable Root Mean Square Error of Approximation (RMSEA) = 0.05-0.10, Comparative Fit Index (CFI) = 0.88-0.98, and χ²/df = 1.36-2.45. Internal consistency scores varied between 0.66 and 0.91, whereas the Intraclass Correlation Coefficient varied between 0.42 and 0.83, which is satisfactory inter-dimensional reliability.

Conclusion: The AEQ Persian version eventually exhibited a nine-factor structure whose models of fit were in the range of poor to acceptable. In addition, the results connected to internal consistency, test-retest indicate the adequate psychometric characteristics and clinical validity of this version.

Unusual extrahepatic sites of hepatocellular metastases: case series

2025-12-05T03:20:30-05:00

Introduction: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related mortality. Patients typically present with symptoms related to the primary hepatic tumor, while extrahepatic metastases are generally associated with advanced disease and poor prognosis. Rarely, HCC may initially manifest through symptoms arising from metastatic involvement before the primary hepatic lesion is identified.

Case Presentation: We report two cases of hepatocellular carcinoma that initially presented with symptoms attributable to extrahepatic metastases to the rare sites. Both cases had normal AFP levels and were CT negative, with HCC detected only on MRI of the abdomen.

Case 1: A 63-year-old male presenting with epistaxis and a destructive maxillary sinus mass, which on histopathology and immunohistochemistry was diagnosed as metastatic HCC. Subsequent MRI of the liver revealed a small LI-RADS 5 lesion that was occult on CT.

Case 2: A 60-year-old chronic alcoholic male presenting with gastrointestinal bleeding due to a duodenal mass. Biopsy confirmed metastatic HCC, and subsequent MRI demonstrated two hepatic lesions categorized as LI-RADS 5 and LI-RADS 4, which were not definitively detected on initial CT imaging.

Discussion: Extrahepatic metastases from HCC most commonly involve the lungs, lymph nodes, and bones, while involvement of unusual sites such as the maxillary sinus and duodenum is exceedingly rare. Presentation with metastatic disease prior to identification of the primary tumor may delay diagnosis and management. These cases highlight the limitations of CT in detecting small or infiltrative hepatic lesions and emphasize the superior sensitivity of MRI in lesion characterization. Immunohistochemical markers such as HepPar-1 and arginase play a crucial role in establishing the diagnosis of metastatic HCC, particularly when serum alpha-fetoprotein levels are normal or only mildly elevated.

Conclusion: Hepatocellular carcinoma may rarely present with symptoms related to extrahepatic metastases before the primary hepatic lesion becomes clinically or radiologically apparent. A high index of suspicion, combined with comprehensive imaging using MRI and appropriate immunohistochemical analysis, is essential for early diagnosis. Recognition of such atypical presentations can prevent diagnostic delay and facilitate timely initiation of appropriate therapy.

Mullerian adenosarcoma of the uterus in a premenopausal woman: case report and literature review

2025-10-21T07:00:59-04:00

Introduction: Müllerian adenosarcoma is a rare biphasic uterine tumor, typically low-grade but with a worse prognosis when associated with sarcomatous overgrowth, deep myometrial invasion, or lymphovascular space invasion (LVSI). Despite being first described in 1974, reported cases remain limited.

Case Presentation: A 40-year-old premenopausal woman presented with abnormal uterine bleeding. Pelvic MRI showed a bulky uterus with a possible polypoidal growth or endometrial carcinoma. Endometrial biopsy suggested simple cystic hyperplasia. She underwent hysterectomy, and histopathology confirmed uterine adenosarcoma.

Discussion: Although rare, uterine adenosarcoma should be considered in patients with abnormal uterine bleeding and uterine masses. Its biphasic morphology and potential for sarcomatous overgrowth make diagnosis and prognosis difficult. Hysterectomy with bilateral salpingo-oophorectomy remains the standard treatment. The patient’s loss to follow-up after 24 weeks highlights the need for long-term monitoring.

Conclusion: Uterine adenosarcoma, though uncommon, must be included in the differential diagnosis of uterine growths. Early diagnosis and surgical management are vital, and further research on prognostic markers and adjuvant therapies is warranted.

Subcutaneous tuberculous abscess presenting as chest wall swelling: a case report

2025-12-14T10:12:33-05:00

Introduction: A subcutaneous tuberculosis abscess is typically characterized by one or more, slow-growing, fluctuant, cold nodules or lumps under the skin, often on the limbs or trunk, which can rupture to form draining ulcers with caseous material, particularly in malnourished or immunocompromised individuals, sometimes with constitutional symptoms such as fever but often without prominent signs such as cough. Tuberculous aetiology should always be considered whenever we encounter such isolated or even multiple soft tissue swellings, irrespective of their immunological status.

Case Presentation: A 16-year-old male presented with a gradually enlarging, dull-aching soft tissue swelling on his chest wall for the past four months along with low-grade fever. Ultrasonography of the swelling showed ill-defined, heterogenous hypoechoic collection in the subcutaneous plane of left paramedian anterior chest wall, superficial to pectoralis major muscle. This finding corroborated with the HRCT thorax report. FNAC of the swelling was done and ZN staining of the aspirate revealed acid-fast bacilli. Nucleic acid amplification test (NAAT) confirmed rifampicin sensitive Mycobacterium tuberculosis. The patient had complete resolution following a 6-month course of anti-tubercular chemotherapy in accordance with 2024 NTEP guideline (India) along with surgical drainage of the abscess.

Discussion: Clinical, microbiological, and radiological findings must be combined and corroborated to confirm a case of subcutaneous tuberculous abscess. Surgical drainage and debridement of the abscess along with administration of anti-tubercular drugs is required for a complete resolution of such cases.

Conclusion: In high prevalence areas, especially in the Indian subcontinent, tuberculosis should always be a differential diagnosis in any soft tissue swelling unless diagnosed otherwise.