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PURPOSE There are limited data on management of cervical cancer in women living with HIV in the modern antiretroviral therapy era. The study aimed to evaluate outcomes and toxicities of these patients treated with radiotherapy. MATERIALS AND METHODS A retrospective analysis of HIV-positive cervical cancer patients treated with radiotherapy between 2011 and 2018 was conducted at a tertiary care center in India. RESULTS Eighty-two HIV-positive cervical cancer patients treated with radiotherapy were identified. Their median age was 45 years. Seventy-four (90%) patients received radiotherapy with curative-intent and eight patients received palliative radiotherapy. Median CD4 count at the start of treatment was 342 cells/mm3 (interquartile range: 241-531). Among patients planned for definitive radiotherapy, concurrent cisplatin was planned in 52 (70%) patients with a median of four chemotherapy cycles, and 81% (n = 60) patients received brachytherapy. Among patients who received brachytherapy, the median prescription dose was 80 Gy. Seventy-seven patients completed their prescribed treatment. At a median follow-up of 37 months, 3-year disease-free survival of patients planned with curative-intent was 54%. On multivariate analysis, treatment completion was associated with favorable disease-free survival. Grade III/IV acute gastrointestinal toxicity was seen in five (6.8%) patients, whereas 30% patients had grade III/IV acute hematologic toxicity. All these patients completed their planned radiotherapy with good supportive care. CONCLUSION Standard treatment of chemoradiation should be planned in women living with HIV with well-managed HIV presenting with locally advanced cervical cancer. Our study highlights the need for optimal management of these patients by a multidisciplinary team with intensive supportive care to ensure completion of planned treatment to achieve better outcomes.

IntroductionIn locally advanced cervical cancer, nodal, local and distant relapse continue to be significant patterns of relapse. Therefore, strategies to improve the efficacy of chemoradiation are desirable such as biological pathway modifiers and immunomodulating agents. This trial will investigate the impact of nelfinavir, a protease inhibitor that targets the protein kinase B (AKT) pathway on disease-free survival (DFS).Methods and analysisRadiosensitising effect of nelfinavir in locally advanced carcinoma of cervix is a single-centre, open-label, parallel-group, 1:1 randomised phase-III study. Patients aged over 18 years with a diagnosis of carcinoma cervix stage III are eligible for the study. After consenting, patients will undergo randomisation to chemoradiation and brachytherapy arm or nelfinavir with chemoradiation and brachytherapy arm. The primary aim of the study is to compare the difference in 3-year DFS between the two arms. Secondary aims are locoregional control, overall survival, toxicity and quality of life between the two arms. Pharmacokinetics of nelfinavir and its impact on tumour AKT, programmed cell death ligand 1, cluster of differentiation 4, cluster of differentiation 8 and natural killer 1.1 expression will be investigated. The overall sample size of 348 with 1 planned interim analysis achieves 80% power at a 0.05 significance level to detect a HR of 0.66 when the proportion surviving in the control arm is 0.65. The planned study duration is 8 years.Ethics and disseminationThe trial is approved by the Institutional Ethics Committee-I of Tata Memorial Hospital, Mumbai (reference number: IEC/0317/1543/001) and will be monitored by the data safety monitoring committee. The study results will be disseminated via peer-reviewed scientific journals, and conference presentations. Study participants will be accrued after obtaining written informed consent from them. The confidentiality and privacy of study participants will be maintained.Trial registration numberThe trial is registered with Clinical Trials Registry-India (CTRI/2017/08/009265) and ClinicalTrials.gov (NCT03256916).

Introduction: The most common form of cardiotoxicity in cancer treatment is anthracycline-related cardiomyopathy. Objective: To study the factors affecting response to heart failure (HF) therapy in patients with anthracycline- related cardiomyopathy (ARC). Methods: Patients with ARC were included in the study. ARC was defined as left ventricular ejection fraction (LVEF) < 50% in patients who had received anthracycline based chemotherapy. 2Decho was done at baseline and every 3 months after starting anti-heart failure treatment. The primary endpoint of the study was response to anti-heart failure treatment. The patients were considered as responders when LVEF increased at least 10 absolute points. The secondary endpoint was overall survival. Results: 177 patients with ARC were included in the study. The median cumulative dose of doxorubicin was 275 mg/m2. Median clinical follow up duration was 19 months (range 3–73 months). 55% were responders. 25 cumulative doxorubicin dose of more than 200 mg/m2 increased the likelihood of non-response (p = 0.008), by a factor of 3.07 (95% CI: 1.34–7.05). 25 patients expired. There was a significant difference in overall survival among responders as compared to non-responders (p value: 0.002, log rank test). Conclusions: In patients with ARC cumulative doxorubicin dose of more than 200 mg/m2 increased the likelihood of non-response to anti-heart failure treatment. Responders have a better overall survival compared to non-responders in patients with ARC.

Cisplatin has been used for over 40 years in various cancer chemotherapies. Toxicity induced by cisplatin-based therapeutic regimens include gastrointestinal toxicity, myelotoxicity, neurotoxicity, ototoxicity and nephrotoxicity. Cisplatin-based regimens have been associated with a wide range of cardiovascular complications. In this paper, we report 2 cases of cisplatin-induced cardiotoxicity. We present cases of 2 young patients who developed acute myocardial infarction during combination chemotherapy with bleomycin, etoposide and cisplatin. The first patient had acute anterior wall ST elevation myocardial infarction and the second one had acute myocardial infarction with peripheral arterial thromboembolism. Cisplatin use can result in cardiovascular events. Clinicians should be very cautious while managing patients on cisplatin-based che

45 year old male from Bihar, presented with carcinoma of left gingivobuccal sulcus (GBS). As part of his workup chest X-ray was done which showed multiple well defined slender shaped (“rice grain”) calcifications noted in subcutaneous tissue & along neck muscles, with their long axes oriented in the plane of the muscle fibers .This appearance is highly suggestive of cysticercosis. After asking the patient repeatedly later gives history of convulsions (since 15 years).He was non-vegetarian with frequent consumption of pork. CT scan done-showed multiple cystic lesions most of which were calcified inactive stage (Figure 1); few of the lesions show post contrast enhancement and active non calcified scolex in the vesicular stage. He was treated for neurocysticercosis after which he underwent treatment for malignancy with Surgery-mandible composite resection and neck dissection modified type II. Post-surgery received Radiotherapy. He is on regular follow up. Cysticercosis is a parasitic infection that results from ingestion of eggs from the adult tapeworm, Taenia solium (T. solium). These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult onset seizures in most low-income countries. A person gets cysticercosis by swallowing eggs found in the feces of a person who has an intestinal tapeworm. Cysts, called cysticerci, can develop in the muscles, the eyes, the brain, and or the spinal cord. Symptoms caused by the cysts depend on the location, size, number, and stage of the cysts. Cysts in the muscles, Generally do not cause symptoms May cause lumps under the skin, which can sometimes become tender. Cysts in the brain or spinal cord Cause the most serious form of the disease, called neurocysticercosis, cause seizures and/or headaches (these are more common).

e22102Background: Metabolic syndrome (MS) is a group of disorders related to insulin resistance, characterized clinically by central obesity, hyperglycemia, dyslipidemia and hypertension. There is ...

To study the cancer pattern among HIV positive cancer cases. The study group included patients registered in the HIV Cancer clinic at the Tata Memorial Hospital (TMH), Mumbai, which is the largest tertiary referral cancer center in India. We used the gender and age-specific proportions of each cancer site of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of various cancer sites among HIV positive cancer patients during the period 2001–2005. The observed number of site-specific cancer cases was divided by the expected number to obtain proportional incidence ratio (PIR). No case of Kaposi’s sarcoma was observed. Increased proportion of non- Hodgkin’s lymphoma (NHL) was observed (PIR in males = 17.1, 95%CI 13.33-21.84, females = 10.3, 95%CI 6.10-17.41).In males, PIR was increased for anal cancer (PIR = 10.3, 95%CI 4.30–24.83), Hodgkin’s disease, testicular cancer, colon cancer, and few head and neck cancer sites. Among females, the PIRs for cervical cancer (PIR = 4.1, 95%CI 2.90–5.75), vaginal cancer (PIR = 7.7, 95%CI 2.48–23.85), and anal cancer (PIR = 6.5, 95%CI 0.91–45.88) were increased. The absence of Kaposi’s sarcoma and increased PIRs for certain non –AIDS defining cancers among HIV infected cancer cases indicates a different spectrum of HIV associated malignancies in this region. The raised PIR for cervical cancer emphasizes the urgent need for screening programs for cervical cancer among HIV infected individuals in India.

e19012 Background: AIDS related non Hodgkin’s Lymphoma (ARL) remains a major cause of morbidity and mortality .There are limited prospective studies on ARLs in Indian population. We studied the clinical profile and outcome of patients with ARL . Methods: Consecutive patients diagnosed with ARL in the period February 2014-march 2016 who were treatment naïve were included in the study. Details of HIV and ARL, treatment details , complications and outcome were recorded. The primary objective was overall survival(OS), secondary objectives were response rates correlation of overall survival with CD4 count, IPI, duration of HIV, histopathology and stage of NHL. Survival was described with the Kaplan-Meier method, and effect of predictor variables was tested with the log-rank test. Results: 42 patients(28 males) with a median age 45.5 years were included in the study . The commonest types of NHL were DLBCL 22 (52.38 %) and plasmablastic lymphoma 14 (33.33%). HIV infection was detected at the time of lymphoma diagnosis in 21 (50%). The median CD4+ T cell count was 137 cells/mm3 . 32 (76.19%) had stage III/IV disease and and 35(83.3%) had extranodal involvement. IPI score was >2 in 20/40(50%). 30/42 patients received chemotherapy of these 21 received atleast 4 cycles. 19 patients received CVEP regimen , 8 REPOCH and 3 others . NNRTI plus 2 NRTI combination was the HAART regimen in 26/30(86.6%) patients. Grade 3-5 febrile neutropenia was seen in 17/30 (56.6%) . Response was assessed using PET-CT scan in 22 patients ,16 (72.7%) had complete response .16/30 patients expired , 8 of these were due to infections . Median survival was 10 months (0.0-20.4 months). The estimated 2 year overall survival is 43.6 % . Patients with early stage disease had better overall mean survival (p=0.01). Type of NHL, IPI, CD 4+ T cell count, HAART prior to NHL treatment did not affect overall survival . Conclusions: Patients of ARL present at a younger age ,with higher grade and advanced disease. Higher proportion of plasmablastic lymphomas were seen in our study as compared to western data. Though most patients achieve complete response the overall survival is low . Myelosuppression and associated infections continues to be a challenge in the management of ARL.

Metastatic involvement of the heart is a rare occurrence and remains undiagnosed until autopsy. In some instances, patients may have cardiac symptoms, leading to ante-mortem diagnosis. Although most primary cancers have been documented to metastasize to heart, the existing literature on cancers of upper aero-digestive tract is an exception, with only a few reports. We report four cases of upper aero-digestive tract cancers, three of which arise from oral cavity, one from lower esophagus, metastasising to the myocardium, detected on 18 F – Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) study , in the absence of related symptoms.

Background Infection with human immunodeficiency virus infection (HIV) is associated with an increased risk of Non Hodgkin’s lymphoma (NHL). There is limited data on the treatment and outcome of these lymphomas in India. We describe a retrospective study of 277 HIV infected patients with NHL at a tertiary referral cancer center in Mumbai. Material and methods All patients included in this study were registered at the HIV cancer clinic of the hospital during 2001-2010. All patients were diagnosed to have NHL by tissue biopsy and were confirmed by immunohistochemical tests. Patients were staged with the Ann Arbor staging system. Data of their demographic profiles, immune status, NHL stage, treatment received, response and outcomes were analyzed. We used the gender and age-specific proportion of NHL of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of NHL among HIV positive cancer patients during the period 2001-2010 (n=770) and the proportional incidence ratio (PIR) was calculated. Results There were 277 patients during the ten year study period. In males the PIR for NHL was 12.6 (95% CI 1.2-14.6) and in females it was 22.1 (95%CI 17.1-28.3) .Among the 277 patients there were 69 females (24.9%) and 208 males (75.1%). The median age of males was 38 years. In females the median age was 37 years.100 Patients (36.1%) were previously known to be HIV positive(range 6 mths-15 years).The CD4 count was less than 200 per cumm in 127/192 (66.14%) patients.76/277 (27.43% ) had current or past history of tuberculosis. 172/277 (62%) patients had extranodal involvement. 168/277 (60.64%) received cancer directed treatment . The data of the 168 patients who received treatment was analyzed. 91/134 (67.91%) had CD4 counts less than 200. 115/168 (68.45%) received antiretroviral therapy. 60% had extranodal involvement.72 (42.9%) had DLCL, 42 (25%) plasmablastic, 21(12.5%) Burkitt’s type and 31 (18.5%) others.90/168 (53.6%) had advanced disease at presentation. All patients were treated with chemotherapy. 54 patients also received RT. The response was evaluated in 96 patients. There was complete response in 46 (47.9%), partial in 15 (15.6%), stable in 6 (6.3%) and 29 (30.2%) patients had progressive disease. The median survival was 25.3 months (range 0-56 months). ART affected survival significantly; however age, sex, CD4 counts at presentation, histopathology, and presence of extranodal involvement and stage of disease did not affect the survival. Conclusions In our study the PIR for NHL was high in HIV-infected patients. The proportion of plasmablastic lymphomas is high. The use of antiretroviral therapy has impacted the overall survival.

PURPOSE OF REVIEW: India has the second largest number of HIV/AIDS patients in the world; however studies done in the area of HIV-related malignancies are few. With the availability of highly active antiretroviral therapy and treatment and prevention of opportunistic infections an increase in life expectancy of HIV-infected individuals and an increase in HIV-related malignancies is expected. The purpose of this review is to put forth the Indian scenario of HIV-related malignancies. RECENT FINDINGS: About 2.5 million Indians have HIV/AIDS. Non-Hodgkins lymphoma and cervical cancer were found to occur in a higher proportion among the HIV-infected individuals in India as compared with non-HIV-infected individuals. The incidence of AIDS-related primary central nervous system lymphoma is low in India. Kaposis sarcoma is rare in India. Amongst the non-AIDS defining cancers anal cancer testicular cancer Hodgkins disease colon cancer and certain head and neck cancer sites in men and vaginal cancers among women were found to occur more frequently. SUMMARY: With the availability of highly active antiretroviral therapy an increased mortality and morbidity due to neoplastic diseases is expected in the future. As India is a large country and geographically and culturally diverse large-scale studies need to be done linking the regional cancer centres with the AIDS centres across the country to evaluate the exact burden of HIV-related malignancies.

Methods An observational study was done of pediatric patients diagnosed with cancer and who were HIV-infected at the Tata Memorial Cancer Hospital, a tertiary referral cancer centre in Mumbai, India. The study period was 2001 to 2007. Data regarding demographic profiles, types of cancers, stage of cancer, treatment and outcome, immune status was analyzed. We used gender and age-specific proportions of pediatric cancer which were recorded in the Tata Hospital cancer registry in 2002 to estimate an expected number of pediatric cancers among HIV positive pediatric cancer patients during the 2001 to 2007. The proportional incidence ratio (PIR) was calculated.