Abstract ID: 169
Author ID: 182
Presenter Name: Ishita Chugh
Affiliation: Department of Surgical Oncology, RGCIRC, New Delhi, India
Abstract Title: An Unusual Case of Synchronous Malignancies—Laryngeal Squamous Cell Carcinoma and Papillary Thyroid Carcinoma with Concomitant Laryngeal Metastasis in Thyroid: A Rare Case Report
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To understand the prognostic role of isolated thyroid metastasis in locally advanced laryngeal SCC.
Methodology: Observations—case report.
Results: Isolated thyroid metastasis in locally advanced laryngeal cancer may not be a predictor of early recurrence (especially within 6 months).
Discussion: Isolated thyroid metastasis in locally advanced laryngeal cancer may not be a predictor of early recurrence (especially within 6 months).
Conclusions: Isolated thyroid metastasis in locally advanced laryngeal cancer may not be a predictor of early recurrence (especially within 6 months).
Abstract ID: 168
Author ID: 181
Presenter Name: Bashid V
Affiliation: Department of Head and Neck Surgery, AIIMS, New Delhi, India
Abstract Title: Deciphering Bilateral Neck Dissection in Carcinoma Larynx: Disentangling Myths
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To ascertain the relevance of bilateral neck dissection in treating carcinoma larynx patients, to assess the subsite correlation and to identify the level of lymph node to be addressed while performing neck dissection.
Methodology: A retrospective observational study was conducted at a tertiary cancer care centre over a four-year period (2020–2023). The study population included the patients of laryngeal carcinoma who had undergone primary curative surgery (total laryngectomy with bilateral neck dissection).
Results: A total of 121 patients were enrolled in the study period between 2020 and 2023. The mean population consisted of 95.86% males and 4.13% females. Of these, 36.36% (n = 44) of the patients had clinical nodal positivity. Out of the patients with clinical nodal positivity, 84% (N = 37/44) had involvement of level II LN, 15.90% (N = 7/44) had involvement of level III LN and 2.2% (N = 1/44) had involvement of level IV LN. Also, 13.6% (n = 6/44) patients belonged to clinical N2c category. Among the cN+ patients, ipsilateral nodal metastasis was detected in histopathology in 65.90% (N = 29/44) of the patients and contralateral neck metastasis was present in 31.81% (N = 16/44), of which 14 had N3b nodal involvement. Among the clinical nodal positive patients (n = 44), 34% (n = 15/44) had clinical extranodal extension. Among the pathological node positive patients (n = 50), 48% (n = 24/50) had pathological extranodal extension. Among the clinical node positive patients without ENE (n = 9), 20.4% (9/44) were found to have pathological extranodal extension.
Discussion: The rate of ipsilateral lymph node metastasis was noted to be 72.72% in the patients who underwent bilateral neck dissection for carcinoma larynx. Patients who had transglottic carcinoma were found to have maximum rate of ipsilateral as well as contralateral pathological nodal positivity. The study necessitates the need of ipsilateral neck dissection of levels II, III and IV in all laryngeal carcinoma. Contralateral neck dissection of levels II, III and IV can be considered in transglottic and hypopharyngeal malignancies due to the high incidence of contralateral involvement.
Conclusions: Contralateral neck dissection should be considered in advanced stage transglottic and hypopharyngeal malignancies. Levels IIa, III and IV should be considered when addressing the contralateral neck. Level IIb need not be addressed in cases of laryngeal malignancies.
Abstract ID: 166
Author ID: 174
Presenter Name: Mohd. Akber Lone
Affiliation: Department of ENT and Head and Neck Surgery, GMC Jammu, Jammu and Kashmir, India
Abstract Title: T-cell Non-Hodgkin’s Lymphoma in Case of Goiter
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: To present a rare case of goiter with T-cell non-Hodgkin’s lymphoma.
Methodology: A 32-year old female presented in ENT with swelling over the anterior of the neck, which was approximately 8 cm × 10 cm. The swelling was moving with deglutition and was showing no signs of local inflammation, and the patient had no history of fever, sweating or rapid weight loss in the recent past.
Results: The patient was treated with surgery followed by chemotherapy with CHOP regime (six cycles with three-week interval) and L-thyroxin substitutions.
Discussion: Non-Hodgkin’s lymphoma is divided into two main categories, namely, B-cells and T-cells. Out of these two types, T-cell lymphocytes present only 2% cases of non-Hodgkin’s lymphoma.
NHL can appear in the sinuses, skin, liver, lungs and lymph nodes. But rarely, non-Hodgkin’s lymphoma affects the thyroid gland. The diagnosis may be difficult due to the absence of clinical and biological signs. But histopathological study confirms the diagnosis and helps to determine the grades of malignancy.
Conclusions: Non-Hodgkin’s lymphoma primarily affecting the thyroid enlarged gland is very rare. Patients with NHL are advised to be treated with chemotherapy after the surgical procedure.
Abstract ID: 164
Author ID: 178
Presenter Name: Tapas Kumar Sahu
Affiliation: Department of Radiology, RGCIRC, New Delhi, India
Abstract Title: Perineural Spread (PNS) in Head and Neck Cancers: Radiologic Footprints on Various Imaging Modalities
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: To understand the anatomy, pathophysiology and clinical presentation of perineural spread in head and neck cancers.
To review imaging features of perineural spread on various imaging modalities such as CT, MRI and 18F-FDG PET/CT. To emphasize the value of recognizing perineural spread on imaging for proper clinical management.
Methodology: Perineural spread (PNS) refers to tumor dissemination along the nerves, which can be distant from the original primary tumor site.
Perineural spread is now considered an independent prognostic indicator during tumor staging, as per the latest edition of the TNM classification of malignant tumors.
Results: Key imaging features of PNS can be divided into primary and secondary features. Primary features include neural enlargement/enhancement, foraminal enlargement and/or destruction, obliteration of foraminal fat planes, and secondary feature include denervation edema/atrophy, among others. We utilized the zonal classification for large nerve perineural involvement, which divides PNS into peripheral (Zone 1), central/skull base (Zone 2) and cisternal (Zone 3).
Discussion: Perineural spread is an important adverse prognostic indicator in the staging of head and neck malignancies, which influences the planning of the surgical approach and treatment regimen. Imaging plays a critical role in the assessment and delineation of perineural tumor spread. A comprehensive knowledge of the pertinent anatomy of the cranial nerves and the typical imaging features of perineural tumor spread are therefore essential in the imaging of head and neck oncology.
Conclusions: Contrast enhanced MRI is the best tool to detect PNS, which has a major influence on the type of treatment patients receive, which generally carries a worse prognosis. Instead of surgery, chemotherapy or radiotherapy is usually provided. Pain management comes into play in the case of symptomatic patients. Therefore, thorough knowledge of cranial nerve anatomy and key imaging features of PNS is essential for correct diagnosis and adequate management of patients with head and neck malignancies.
Abstract ID: 163
Author ID: 177
Presenter Name: Jitin Goyal
Affiliation: Department of Radiology, RGCIRC, New Delhi, India
Abstract Title: Neck Imaging Reporting and Data System (NIRADS): A Pictorial Depiction in Oral Cavity Squamous Cell Carcinomas on PET-CT and MR Imaging
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: To distinguish loco-regional tumor recurrence from post-treatment benign findings in the postsurgical and radiation status in head and neck cancer on PET-CT and MR imaging using NIRADS.
Methodology: Surgery with or without a combination of chemoradiation is the mainstay of management of head and neck (HN) cancers depending on the stage of the disease. Imaging interpretation becomes challenging to distinguish loco-regional recurrence from post-treatment.
Results: Neck Imaging Reporting and Data System (NIRADS) lexicon was initially designed for surveillance of treated patients of head and neck cancers using contrast-enhanced CT (CECT) with or without PET. However, newer studies with additive role of DWI and T2W signal intensity on MR imaging enhance diagnostic and predictive values of NIRADS lexicon. On post-treatment (8–12 weeks) imaging evaluation on PET-CT/MRI, the status of the disease at the primary site and regional nodes can be simplified into four categories that drive management: negative (1), low suspicion (2), high suspicion (3) and definite recurrence (4). If prior imaging is lacking to place the patient in one of these categories, then the study is designated as “incomplete.” Lexicon of NIRADS-1 shows non-mass-like distortion of soft tissues, NIRADS-2 lesions are divided into mucosal (2A) versus deep (2B) abnormalities, NIRADS-3 primary site can either be a submucosal or a deep lesion, and NIRADS-4 is a biopsy-proven residual or recurrent disease.
Discussion: In postsurgical subjects for cancers occurring in the oral cavity, plastic reconstruction with flaps and post-treatment trismus further impedes clinical examination. Recurrent cancer and the scar fibrosis resulting from post-radiation treatment changes will enhance on post-contrast images. With superimposed anatomical changes induced in postsurgical settings, resulting in artifacts on diffusion sequences, the interpretation of valid tumoral restriction becomes challenging.
Conclusions: NIRADS is a simple, practical imaging surveillance template used to guide the appropriate imaging interpretation, follow-up, and next clinical management steps.
Abstract ID: 162
Author ID: 73
Presenter Name: Dhrubajyoti Biswas
Affiliation: Department of Onco-Anesthesia, RGCIRC, New Delhi, India
Abstract Title: Emergency Tracheostomy in Anaplastic Carcinoma Thyroid: A Case Series
Abstract Topic: Onco-Anesthesia
Aims/Objectives of the Study: NA
Methodology: NA
Results: NA
Discussion: ATC is an aggressive disease. Airway-related problems may be caused by extrinsic pressure on the trachea. Paralysis of one cord with impending paralysis of the other side, bilateral vocal cord paralysis or tracheal invasion by the tumor or bleeding inside the trachea most often leads to acute airway distress. Fiberoptic intubation in the operating room is done to secure the airway and then a later tracheostomy is advised.
Conclusions: Fiberoptic intubation helps to buy valuable time for tracheostomy under emergent conditions by securing the airway.
Abstract ID: 161
Author ID: 176
Presenter Name: Akshay Trimukhe
Affiliation: Kerala Department of Pathology, Malabar Cancer Centre, Thalassery, Kannur District, Kerala, India
Abstract Title: Unearthing a Rare Encounter: Malignant Spindle Cell Tumor in the Maxilla—An Extensive Case Report, Diagnostic Expedition, and Literature Review
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: Head and neck sarcomas (HNS) represent a subset of biologically aggressive neoplasms known for their rapid proliferation, metastatic potential, and propensity for recurrence. Despite their rarity, constituting less than 1% of adult and 20% of pediatric malignancies, they present significant clinical challenges. The pathogenesis of HNS involves dysregulation of proto-oncogenes and tumor suppressor genes. Herein, we present a case of a rare malignant spindle cell neoplasm arising in the maxilla.
Methodology: A 43-year-old female presented with a growth on the left upper jaw persisting for the past month. Clinically, the tumor measured 6 × 5 cm, displaying proliferative characteristics over the left Upper Alveolus, extending from the 1st Premolar to the Maxillary Tuberosity, positioned 0.5 cm from the Midline, and involving the Upper Gingival Buccal Sulcus (GBS) without tooth mobility. An incisional biopsy revealed a malignant spindle cell population with a disorganized arrangement and slender collagen fibers. Immunohistochemical analysis demonstrated negativity for cytokeratin and p63, with diffuse positivity for vimentin, suggesting a sarcomatous nature. Wide local excision with inferior partial maxillectomy and infratemporal fossa clearance was performed, followed by reconstruction using titanium mesh and radial artery free flap, along with a tracheostomy.
Results: Macroscopic examination revealed a multilobulated, sessile tumor with a smooth reddish-white surface. Microscopically, the histopathological features were similar to the incisional biopsy. Further immunohistochemical analysis, including panels for cytokeratin (CK), p63, vimentin, CD31, CD34, S100, SMA, desmin, myogenin, MyoD1, ALK1, and beta-catenin markers, ruled out various differential diagnoses, with a Ki-67 index indicating a low proliferative rate (10–15%). Following an exhaustive review of immunohistochemical markers and literature, a final diagnosis of low-grade myofibroblastic sarcoma (Grade I, FNCLCC) was established.
Discussion: LMSG is recognized as a distinct entity by the World Health Organization. It is characterized as a mesenchymal neoplasm with rare metastatic potential, often displaying fibromatosis-like characteristics, primarily found in the head and neck region. Only six cases have been documented in the literature thus far in maxilla. Microscopically, LMSG typically presents with fascicles or broad sheets of spindle cells, sometimes exhibiting focal herringbone or storiform patterns. Immunohistochemically, LMSG demonstrates a myofibroblastic phenotype with variable expression of SMA, desmin, calponin, and CD34. H-caldesmon expression is occasionally observed in certain cases. Surgical resection with clear margins is the mainstay of treatment for LMSG, with some cases receiving adjuvant chemotherapy. Local recurrences are frequent, although metastatic spread to the lung, soft tissue, and bone occurs infrequently and typically after a prolonged interval.
Conclusions: Based on clinicopathological features, low-grade myofibroblastic sarcoma (LGMS) of the oral cavity has been observed in both pediatric and adult populations. Recurrences are frequently noted in maxillary lesions. However, definitive conclusions regarding outcomes necessitate long-term follow-up information.
Abstract ID: 160
Author ID: 175
Presenter Name: Isha Singla
Affiliation: Department of Oral and Maxillofacial Surgery, SGT, Gurugram, Haryana, India
Abstract Title: Free vs Local Flap in Head and Neck Reconstruction
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To compare the outcomes and efficacy of free flaps versus local flaps in head and neck reconstruction.
Methodology: In the present poster, I will be explaining 4–5 cases in which variables such as flap success rates, postoperative complications, donor site morbidity, aesthetic outcomes and long-term functional outcomes are assessed to provide a holistic understanding.
Results: Local flap offers more advantage over free flap such as increased success rates, minimal postoperative complications, less donor site morbidity, better aesthetic outcomes and long-term functional outcomes.
Discussion: Head and neck reconstruction following surgical resections poses a unique challenge due to the complex anatomy and functional demands of this region. Both free flaps and local flaps exhibit advantages and limitations, necessitating careful consideration of patient-specific factors and surgical goals.
Conclusions: The comparative analysis of free flaps versus local flaps in head and neck reconstruction reveals distinct advantages and limitations for each technique. The choice between local and free flaps should be guided by careful consideration of patient-specific factors, the extent of the defect and the surgeon’s expertise.
Abstract ID: 158
Presenter Name: Mohd. Akber lone
Affiliation: Department of ENT and Head and Neck Surgery, GMC Jammu
Abstract Title: Effect of Chemotherapy and Radiation in Head and Neck Cancer on Esophagus
Aims/Objective of the Study: To review the effect of chemotherapy and radiation in head and neck cancer on esophagus.
Methodology History Taking: Complaint of difficulty in swallowing–solids, liquids or both. Coughing, choking or throat clearing before, during or after swallowing. Pain in swallowing. Complaint of food sticking in throat while swallowing. Weight loss due to swallowing problem. Eating Tool Assessment Questionnaire.
Examination: General physical examination, Complete ENT examination of nasal cavity, oral cavity, oropharynx, larynx and hypopharynx.
Examination of neck including neck nodes and chest. Cranial nerve examination.
Investigations:
Laboratory Tests:
CBC
Routine Urine RFT
LFT
Lipid Profile TFT
ESR
ABO and RH grouping
Radiological: X-ray soft tissue neck-AP and lat view X-ray chest-PA view Ba swallow study (as and when required) CT scan/ MRI (as and when required) Upper gastrointestinal (GI) endoscopy (Fibreoptic esophagoscopy)
Result: The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy. (Farwell DG et al. 2010). Those treated with chemoradiation had higher experiencing dysphagia whereas patients treated with any combined therapy more commonly experienced stricture. Abnormality of pharyngeal constriction and/or aberrant upper esophageal sphincter observed. (Wu CH et al. 2000). Radiation therapy patients experienced dysphagia lasting more than 90 days after therapy (Chen AM et al. (2010)).
Discussion: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type worldwide, accounting for more than 550,000 cases and 380,000 deaths annually. Different modalities treatment is required viz, Radiotherapy, Chemotherapy and Surgery or combination of these depending upon the stage, extend and nature of the disease. Potential mechanisms to reduce this include (a) contouring the esophagus as a dose-limiting structure; (b) early flexible examination post-treatment, with early intervention with dilation; (c) improved therapy for mucositis. (Lawson JD et al.2008) Radiation-induced injury involves DNA damage that activates stress-induced signalling pathways and pro-inflammatory cytokines leading to cell death by various mechanisms (Dholaria B et al., 2015). The esophagus is vulnerable particularly to radiation injury due to its continuous mucosal cell turnover. Mucosal inflammation and basal epithelial thinning can progress to denudation and ulceration (Chowhan NM, 1990). RT induces hyperactivation through hydroxyl radicals of transforming growth factor-b1 (TGF-b1) which plays a role in collagen deposition and degradation. This leads to fibrosis and the resulting abnormal motility of deglutition muscles, impaired pharyngeal contraction and laryngeal elevation responsible for dysphagia, aspiration and stenosis (Nguyen NP et al., 2004).
Conclusions: Esophageal pathology is extremely common in patients treated for head and neck cancer (HCNCA). A significant proportion of patients exhibit symptoms of esophageal toxicity after radiation therapy for HCNCA. The spectrum of injury ranges from acute self-limited esophagitis to life-threatening esophageal perforation Special emphasis should be put on gastroesophageal reflux screening and treatment before, during and after the therapy.
Abstract ID: 157
Author ID: 170
Presenter Name: Yasir Abbas Khan
Affiliation: Department of ENT, GMC and Associated Hospitals Baramulla, Jammu and Kashmir, India
Abstract Title: Recurrent Laryngeal Papillomatosis
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: Recurrent Respiratory Papillomatosis is a disease in which benign timors called papillomas grow in the air passages. This study describes the unusual presentation of papillomas in a 58-year-old male as a single fungating central mass above the tracheostomy site up to the hyoid bone.
Methodology: A 58-year-old normotensive, non-diabetic, euthyroid male presented with swelling above the tracheostomy site since one month associated with pain and discomfort, which was aggravated by swallowing. The patient had a previous history of growth of bilateral vocal cords.
Results: Repeated surgical debridement of the lesion followed by radiotherapy was done due to refusal of the patient for total laryngectomy.
Discussion: Recurrent respiratory papillomatosis (RRP) is a disease in which benign tumors called papillomas grow in the air passage. Although the tumors can grow anywhere in the respiratory tract, they most commonly grow in the larynx, a condition called laryngeal papillomatosis. The papillomas may vary in size and grow very quickly. They often grow back after they have been removed.
What causes RRP: It is caused by two types of human papilloma virus—HPV 6 and HPV 11. Most people who encounter HPV never develop a related illness. However, in a small number of people exposed to the HPV 6 or 11 virus, respiratory tract papillomas and genital warts can form. The virus is thought to spread through sexual contact or when a mother with genital warts passes the HPV 6 or 11 virus to her baby during childbirth.
Who is affected by RRP: It may occur in adults (adultonset RRP) as well as in infants and small children (juvenile-onset RRP) who may have contracted the virus during childbirth. The RRP Foundation estimates that there are roughly 1.8 cases per 1,00,000 individuals in India. According to the Centers for Disease Control and Prevention (CDC), estimates of the incidence for juvenile-onset RRP are imprecise but range from two or fewer cases per 100,000 children under age 18.
Conclusions: There is no curative therapy for RRP. The goals of therapy should be to relieve airway obstruction, improve voice quality, and facilitate remission by surgical debulking by microdebridement, angiolytic laser, cryotherapy or carbon dioxide laser.
Abstract ID: 155
Author ID: 17
Presenter Name: Eshwar Thota
Affiliation: Department of Oral and Maxillofacial Surgery, SVSIDS, Mahabubnagar, Telangana, India
Abstract Title: Unveiling Primary Intraosseous Carcinoma: A Deep Dive into Diagnostic and Therapeutic Strategies
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To investigate the clinico-pathologic features of primary intraosseous squamous cell carcinoma (PIOSCC) and comprehensively improve the understanding of this disease.
Methodology: We retrospectively investigated five cases of PIOSCC at SVSMCH, Mahabubnagar. We also conducted a systematic review of studies on PIOSCC by using online databases from their inception until February 2022.
Results: In our series of five cases, all lesions were located in the mandible. During the follow-up period, one patient died, loco-regional reoccurrence was seen in two patients and no patient developed metastasis. Based on our literature survey, we selected 111 articles reporting 260 cases. The incidence of PIOSCC ranges from 1% to 2% of all oral cancers. Because of the rarity of PIOSCC, most available studies are case reports. PIOSCC has a male predilection and more commonly affects patients in their fifth to seventh decade of life. The mandible is significantly more involved than the maxilla. The two-year survival rate ranges from 60% to 70%, while the five-year survival rate ranges from 30% to 40%.
Discussion: Given the lack of specific clinical and radiographic features, PIOSCC should be included in the differential diagnosis of intraosseous lesions of the jaws. Specific staging and therapeutic protocols should be elaborated for PIOSCC to improve the prognosis of the tumour. Furthermore, future studies with adequate sample sizes are necessary to investigate possible correlations between clinical and radiographic aspects and morphological parameters and tumour behaviour.
Conclusions: The prognosis of patients with PIOSCC is poor, with high rates of regional lymph node metastases, recurrence and mortality.
Abstract ID: 152
Author ID: 164
Presenter Name: Parmar Simran
Affiliation: Department of ENT, Pramukhswami Medical College, Karmsad, Gujarat, India
Abstract Title: Unusual Cases of Head and Neck: Our Institutional Experience
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To study unusual cases of head and neck—our institutional experience.
Methodology: A 19-year-old female patient presented to ENT OPD with complaint of right-side neck swelling since three months.
Right side carotid body tumor excision was performed with right common carotid artery to internal carotid artery with PTFE graft.
Results: CT USG and FNAC can aid the diagnosis, but histopathological examination is the gold standard for the treatment.
Discussion: Although paraganglioma is a rare entity, it is crucial to differentiate from its mimickers, as this can change the treatment and prognosis of such cases.
Conclusions: Although paraganglioma is a rare entity, it is crucial to differentiate from its mimickers, as this can change the treatment and prognosis of such cases.
Abstract ID: 147
Author ID: 152
Presenter Name: Sweta Singh
Affiliation: Department of Dental Sciences, ESIC Dental College and Hospital, Rohini, New Delhi, India
Abstract Title: Functional Rehabilitation of Mandible Reconstructed with Free Fibula Graft
Abstract Topic: Quality of Life
Aims/Objectives of the Study: To emphasize the importance of functional rehabilitation in reconstructed mandible with free fibula bone graft.
Methodology: A 31-year-old female presented with a complaint of inability to chew food since five years. On history taking, the patient revealed of previous surgeries on the right side of the lower jaw, following which she lost multiple teeth, which led to functional disability.
Results: Functional rehabilitation with implants was planned for reconstructed mandible with free fibula bone graft. Based on the radiograph and the amount of bone present, placement of three endosseous implants was done in the region of the premolar and the first and second molar teeth in the right lower jaw. After six months of healing and osseointegration, dental crowns were delivered. Post the rehabilitation with implants, the patient was able to chew food satisfactorily. This improved the level of nourishment, and the quality of life of the patient was improved. At one-year follow-up, no complication in terms of loosening of teeth, dislodgement of crown or implant structure, and no recurrence were seen. The patient is satisfied with the restored functional abilities of teeth and jaw altogether.
Discussion: Resection of the mandible is necessary in some aggressive benign and malignant lesions. This affects the function and aesthetics of the patient. This makes it necessary to reconstruct the mandible and provide dental rehabilitation to improve the chewing efficiency of the patient. Free fibula bone graft provides a framework for the reconstruction of mandible and dental rehabilitation. The authors have managed to functionally rehabilitate a case of reconstructed mandible with free fibula bone graft.
Conclusions: It is of paramount importance to restore both aesthetics and function in cases of jaw pathologies involving the resection of a segment or the whole jaw. Rehabilitation with dental implants restores functions such as chewing and eating food satisfactorily. This improves the quality of life of patients and overall wellbeing altogether.
Abstract ID: 145
Author ID: 157
Presenter Name: Manali Gaudani
Affiliation: Shree Krishna Hospital, Pramukh Swami Medical College, Bhaikaka University, Anand, Gujarat, India
Abstract Title: Unusual Cases of Thyroid Malignancy at Our Centre
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To establish standardized diagnostic and management protocols for unusual thyroid malignancies to ensure consistent and evidence-based patient care.
Methodology: Clinical assessment biopsy and pathological evaluation imaging studies molecular testing.
Results: Medullary thyroid carcinoma (MTC) is a rare type of thyroid cancer that arises from the parafollicular cells (C cells) of the thyroid gland. It can occur sporadically or as part of multiple endocrine neoplasia type 2 (MEN 2) syndrome. MTC produces calcitonin and may present with symptoms related to excess calcitonin production, such as flushing, diarrhoea and abdominal pain.
Anaplastic thyroid carcinoma (ATC) is a highly aggressive form of thyroid cancer that accounts for only a small percentage of cases. It often presents as a rapidly growing mass in the neck, with symptoms such as difficulty swallowing, breathing difficulties and hoarseness. ATC is associated with a very poor prognosis due to its aggressive nature and resistance to treatment.
Primary thyroid lymphoma is rare and usually presents as a rapidly enlarging thyroid mass. It may be associated with symptoms such as pain, dysphagia (difficulty swallowing) and dyspnoea (difficulty breathing).
While thyroid cancer is relatively rare in children, it can occur often in the form of papillary thyroid carcinoma. Children with thyroid cancer may present with symptoms similar to adults, such as a thyroid nodule or neck swelling.
Follicular thyroid carcinoma is less common than papillary thyroid carcinoma but tends to be more aggressive. It may invade blood vessels and spread to distant organs, particularly the lungs and bones.
Hürthle cell carcinoma, also known as oxyphilic cell carcinoma, is a subtype of follicular thyroid carcinoma. It is characterized by the presence of Hürthle cells, which are large, granular cells with eosinophilic cytoplasm. Hürthle cell carcinoma tends to be more aggressive than other types of thyroid cancer and may be resistant to radioactive iodine therapy
Discussion: Uncommon histological variants such as medullary carcinoma, anaplastic carcinoma and thyroid lymphoma pose diagnostic challenges due to their resemblance to benign thyroid nodules or other thyroid disorders. Moreover, metastatic thyroid malignancies masquerading as primary thyroid neoplasms further complicate diagnosis and necessitate meticulous histopathological examination and immunohistochemical analysis.
This abstract also discusses the role of advanced imaging techniques, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) in delineating the extent of disease and guiding surgical intervention.
Conclusions: This review highlights the myriad presentations of thyroid malignancy beyond the conventional spectrum, emphasizing the importance of a multidisciplinary approach involving endocrinologists, radiologists, pathologists and surgeons in the accurate diagnosis and optimal management of these challenging cases. A nuanced understanding of rare presentations of thyroid malignancy is imperative to enhance diagnostic precision, improve prognostication and optimize patient outcomes.
Abstract ID: 143
Author ID: 158
Presenter Name: Devender
Affiliation: Department of Radiation Oncology, JLN Medical College, Agra, Uttar Pradesh, India
Abstract Title: Risk Factors Associated with Residual Disease After Radiotherapy in Head and Neck Squamous Cell Carcinoma
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To assess the risk factors associated with residual disease following radiotherapy (RT) in patients with head and neck squamous cell carcinoma (HNSCC).
Methodology: We analysed HNSCC patients treated with RT between January 2021 and December 2022. Of the 77 patients treated with RT, 47 were non-operated cases receiving primary RT using 2D techniques with or without weekly cisplatin. Among them, 28 completed the treatment.
Results: Of the 28 patients analysed, 9 (32.14%) had residual disease at three months post-RT. Higher rates of residual disease were observed in patients younger than 40 years (40%) compared to those older than 40 years (30.43%). Oropharyngeal cancers (44.44%) exhibited higher rates of residual disease compared to laryngeal (33.33%), hypopharyngeal (33.33%) and oral cavity cancers (20%). T3 and T4 tumours had significantly higher rates of residual disease (42.85%) compared to T1 or T2 tumours (20%). Lymph node positive cases had a higher rate of residual disease (43.75%) compared to lymph node negative patients (16.67%). Poorly differentiated cancers (55.55%) showed higher rates of residual disease compared to moderately differentiated (40%) or well-differentiated cancers (0%). Treatment completion duration of >9 months was associated with a higher rate of residual disease (41.67%) compared to <9 months (25%). Gender and addiction were not significantly associated with tumour response.
Discussion: The findings of this study shed light on several important considerations regarding the response to radiotherapy (RT) in patients with head and neck squamous cell carcinoma (HNSCC). Age, treatment completion duration, tumour subsite, T-staging, nodal status and histopathological grade were identified as predictors of treatment outcomes to radiotherapy, while gender and addictions were not associated with the risk of residual disease.
Conclusions: These findings underscore the importance of personalized treatment strategies to optimize outcomes for HNSCC patients undergoing radiotherapy. Further research is warranted to explore novel therapeutic approaches for these high-risk patient groups.
Abstract ID: 141
Author ID: 156
Presenter Name: Gitanjali Ajit Deshpande
Affiliation: Department of Radiology, RGCIRC, New Delhi, India
Abstract Title: Oropharyngeal Defect Reconstruction Using Locoregional Options After Transoral Robotic Surgery (TORS)
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To assess the feasibility of various locoregional reconstructive options for primary reconstruction of the post-TORS oropharyngeal defects to prevent fistula formation in oropharyngeal cancer.
Methodology: This is a retrospective analysis of patients who underwent TORS with concomitant neck dissection for oropharyngeal cancer at a tertiary care centre in India, from February 2018 till January 2022. Descriptive statistics were employed.
Results: 11 patients underwent TORS with concomitant neck dissection, of which eight (73%) were male. Reconstruction was done for surgical defects with mandibular bone exposure post-posterior intraoral marginal mandibulectomy, resection margin reaching till or incorporating glossotonsillar sulcus, breach of floor of mouth (FOM) and retropharyngeal internal carotid artery cover. The various reconstructive locoregional options included pectoralis major muscle only flap (PMMF), pectoralis major myocutaneous (PMMC) flap, modified SPAF (submental platysmal adipomyofacial flap), supraclavicular flap, sternal head of sternocleidomastoid (SCM) muscle, digastric muscle, inferior belly of omohyoid muscle as well as a combination of two flaps. PMMF was used in two patients (18.2%), PMMC flap in one patient (9.1%), modified SPAF in three patients (27.3%) and modified SPAF with sternal head of SCM muscle in one patient (9.1%). Modified SPAF (used primarily to cover the intraoral marginal mandibulectomy defect) with supraclavicular flap combination was used in another patient (9.1%). Three patients (27.3%) did not need any oropharyngeal defect reconstruction but needed additional FOM buttressing. Five patients underwent adjuvant radiation and chemotherapy (RTCT), four needed adjuvant radiation therapy (RT) whereas two patients were
kept on observation. 10 patients (90.9%) had no orocutaneous fistula (OCF) postoperatively. OCF was seen only in one patient (09.09%), which was managed with minor repositioning of sternal head of SCM muscle flap under local anaesthesia followed by conservative chin strap application for one week. Flap uptake was good in all patients with no major flap loss and acceptable functional outcomes.
Discussion: Oropharyngeal defect reconstruction has been studied since a long time, but very few studies have focused on TORS defects. De Almeida et al. classified TORS defects and suggested the need for reconstruction. Most of the local flap reconstructions for post-TORS defect have been done to prevent velopharyngeal insufficiency by reconstructing the soft palate and to cover internal carotid artery or exposed mandible in order to prevent delay in radiation therapy initiation. Reconstruction options to prevent OCF are seldom studied. Genden et al. published outcomes of 25 patients who underwent musculomucosal advancement flap pharyngoplasty for TORS defect and none had OCF.
Conclusions: Various reliable locoregional options are available for primary reconstruction of oropharyngeal defects, which can secondarily be used to buttress the FOM, thus decreasing the fistula rates in patients undergoing TORS with concomitant neck dissection. Locoregional reconstructive options are not only economically viable for the patients in developing world countries but also translate into less operative time and shorter duration of hospital stay.
Abstract ID: 140
Author ID: 155
Presenter Name: Isha Maheshwari
Affiliation: Department of OMFS, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
Abstract Title: Functio Laesa: Undesirable Post-surgical Outcome in Mandibular Cancer Resection
Abstract Topic: Quality of Life
Aims/Objectives of the Study: To evaluate the functio laesa as an undesirable outcome in cases of mandibulectomy in oral cancer surgical management.
Methodology: Patients surgically treated in a tertiary care centre with mandibulectomy (hemi/segmental) and neck dissection in cases of oral carcinoma were evaluated based on changes in their quality of life (QoL) post-operative follow-up.
Results: Observed patients experienced difficulty in speech, swallowing, proprioception and social eating, which overall affected their QoL.
Discussion: Oral cancer and its treatment is itself a terrifying term affecting patients physically, mentally, psychologically and socially. Its management includes complete resection of tumour with cervical nodal clearance, which affects the QoL of the cancer survivor. Post-surgical defect of mandibulectomy leads to an undesirable outcome including functio laesa for an entire lifetime. This mandates screening for physical and psychological dysfunction that can promote multidisciplinary intervention by delineating specific difficulties following oral cancer resection. Mandible resection impedes the range of motion of the mandible in lateral and protrusive movement along with impairment of occlusion and reduced proprioception. Also, uncoordinated masticatory movements may result in dental or soft tissue trauma.
Conclusions: Functional impairment can decrease one’s QoL drastically, which any cancer survivor goes through. Any restoration and rehabilitation of defect post-surgery may facilitate survival but remains a void in terms of aesthetics, function and QoL for the patients.
Abstract ID: 139
Author ID: 153
Presenter Name: Sunil Kumar Gulia
Affiliation: Department of Head and Neck Oncology, Saptarishi Cancer Centre, Jabalpur, Madhya Pradesh, India
Abstract Title: Cancer’s Magnetic Pull for Younger Women
Abstract Topic: Quality of Life
Aims/Objectives of the Study: To bring light over increasing incidences of oral cancer among younger females and to evaluate the poor prognosis among younger females as compared to their male counterparts suffering from oral squamous cell carcinoma at Saptarishi Cancer Centre, Jabalpur.
Methodology: A retrospective study was carried out for 245 patients suffering from oral squamous cell carcinoma who reported at the Department of Head and Neck Oncology, Saptarishi Cancer Centre, Jabalpur. Clinical data was collected from the medical records after all the ethical considerations and clearance from the respective authority.
Results: Among all the surveyed participants, a significant difference was found in the case of females who were less than 25 years of age. A significant variation in females more than 35 years of age was also recorded.
Discussion: Not much literature is available on the subject, calculating the increasing incidences of cancer among younger females. However, little literature is available, which paved the way to calculate the increasing incidences and poor prognosis among younger females.
According to an article published in PubMed by Yi Chieh Lee and Chi-Kuang Young (otolaryngologists, Taiwan) in the year 2021, women share the same major risk factors, such as the use of cigarettes and alcohol, as men, which facilitated the core behind our study of increasing cases among younger females.
Another study conducted by Nan-Chin Lin and Jui-Tin Hsu in the year 2020 found that oral squamous cell carcinoma was prominent among older females; however, contrary to this, our study has found significant increase in the case among younger females suggestive of changing trends and further poor prognosis.
Conclusions: Changing tobacco and smoking habits among younger females bring forth increasing incidences of oral squamous cell carcinoma in younger females as compared to younger males, which is becoming the major concern for poor prognosis among the affected group.
Abstract ID: 138
Presenter Name: Vaishnavi Vasant Kulkarni
Affiliation: Department of Radiation Oncology, MNJ Institute of Oncology & RCC, Osmania Medical College, Hyderabad
Abstract Title: Sinonasal Teratocarcinosarcoma (SNTCS): A Rare Case Report
Aims/Objective of the Study: To emphasis on the need for multimodality treatment approach in a case of SNTCS.
Methodology: We report a case of 48 years old female with complaints of right sided nasal block, recurrent nasal bleeding and generalised headache for 15–20 days duration in 2020. She was primarily evaluated by an ENT surgeon and was detected to have a sino nasal mass. Radiological assessment revealed evidence of ill-defined heterogeneously enhancing soft tissue density mass lesion measuring
6.6 × 4.5 × 4.0 cm in the right nasal cavity, extending to the right maxillary sinus, right ethmoidal and right frontal sinus, posteriorly till posterior choanae, anteriorly infiltrating the skin over the tip of the nose and medially displacing the nasal septum with suspicious infiltration of left inferior turbinate.
Debulking surgery was performed, HPE and IHC confirmed it to be Sinonasal teratocarcinosarcoma (SNTCS). For the post-operative residual disease, radiotherapy was given to a total dose of 60 Gy in 30 fractions, delivered using conformal technique –VMAT. Post radiotherapy evaluation showed a residual mass, for which adjuvant chemotherapy as a part of multimodality treatment was given with Cisplatin and Etoposide for a total of six cycles. Patient tolerated the treatment well.
Result: Patient was reviewed clinically and radiologically for every 3–4 months and had complete response. The patient is on regular follow-up and is disease free now. Last follow up was done in November 2023.
Discussion: SNTCS is a very rare tumour with only 150 cases reported in the literature. As it has multiple components like carcinomatous, sarcomatous alongside immature epithelial, neuroepithelial, mesenchymal cells; it poses a diagnostic challenge.
It has male preponderance (7:1) and common in the fourth to fifth decades of life.
There are no consensus guidelines available for treatment in view of its rarity. With trimodality treatment - surgery, radiation and chemotherapy, 3-year recurrence free survival is around 60% Vs 15–18% when compared to surgery alone. Overall survival of patients still remains unsatisfactory.
Conclusion: This case report emphasizes the need for accurate diagnosis which depends entirely on histopathological examination and immunohistochemistry and multimodality treatment which can potentially lead to improve outcomes for the patient.
Abstract ID: 134
Author ID: 149
Presenter Name: Shilpa Pati
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Invasive Rhino-cerebral Mucormycosis in Carcinoma Base of Tongue Patient: A Rare Case Report
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To present what appears to be the inaugural case of IM in a patient with a solid malignancy affecting the head and neck. This case emphasizes the necessity of further exploration into the occurrence and clinical implications of mucormycosis in individuals with solid organ malignancies, shedding light on a potential area of concern in this patient population.
Methodology: A 24-year-old medical student of North-East Indian ethnicity, presented with complaints of painful swelling on the left side of the neck and difficulty in swallowing for two months. He was advised IGRT and Q3W cisplatin (100 mg/m2).
Results: Nil.
Discussion: Invasive mucormycosis (IM) is a life-threatening fungal infection linked mainly to uncontrolled diabetes and haematological malignancies. While haematological malignancies and organ transplants show a clear association with IM, solid organ malignancies represent only 0.01% of cases. Cancer treatments, especially cytotoxic chemotherapy, increase susceptibility to opportunistic infections. Diagnosis involves immunohistopathological evaluation, culture confirmation, and PCR for non-invasive detection. Treatment includes aggressive surgical debridement and systemic antifungal therapy, primarily Amphotericin B, with a standard dosage of 5 mg/kg daily for 3–6 weeks. Despite its rarity in solid organ malignancies, vigilance and swift intervention are crucial for managing this life-threatening infection.
Conclusions: The existing body of evidence suggesting the incidence of mucormycosis in the context of solid malignancies, such as head and neck cancers, lacks clear evidence and the imperative for further investigation, and research into the pathophysiology and preventive strategies is evident. Enhancing the diagnostic capabilities can expedite therapeutic interventions and ultimately improve patient outcomes. This case underscores the importance of recognizing mucormycosis in a non-traditional patient population and the need for early diagnosis and prompt management.
Abstract ID: 129
Author ID: 118
Presenter Name: Shaifali Mahajan
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Tumour Depth in Early Tongue Squamous Cell Carcinoma:ASurvival Tool forAdjuvant Radiotherapy?
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: Oral squamous cell carcinomas (OSCC) are the second most common cancer in India, and oral tongue squamous cell carcinoma forms the most common subsite with the worst prognosis. The significance of depth of invasion (DOI) in the management of oral squamous cancers has been abundantly emphasized in scientific literature. The probability of local and nodal metastasis and its relation with increasing DOI were primarily evaluated in these studies. The importance of DOI in predicting treatment is still a point of concern for most treating oncologists. The role of elective neck dissection using DOI as a cut-off has been established, but its importance in deciding post-operative radiotherapy (PORT) continues to be a clinical dilemma. This study aims to assess the role of PORT with a DOI cut-off of millimeters in terms of survival.
Methodology: The institutional database was reviewed from January 2014 to December 2021. Patients diagnosed with OTSCC (and restaged as per AJCC 2018) with pT1,2 and pN0 were selected. Patients with incomplete data and with DOI > 10 mm were excluded. Baseline disease and treatment characteristics were collected and divided into two cohorts using a DOI cut-off of ≤ 5 mm (Cohort 1) vs > 5 mm (Cohort 2).
Results: Two hundred and fifty patients were identified. The median follow-up for the entire study population was 37 months (range 8–138 months). The median follow-up for DOI ≤ 5mm vs > 5 mm was 38 (range 8–124) and 37 (range 9–138) months, respectively. The baseline characteristics were similar between the groups. However, there was a significantly higher percentage of perineural invasion (PNI) in the patients in cohort 2. The median overall survival (OS) in cohort 1 was not reached. In cohort 2, the median OS for patients not receiving PORT was 48 (39.47–56.53) months in comparison to those receiving PORT where median survival was not reached, p = .03. The median locoregional control (LRC) in cohort 1 not receiving PORT was 88 (35.67–140.34) months in comparison to those receiving PORT where median survival was not reached, p = .46. The median LRC in cohort 2 not receiving PORT was 37 (20.57–53.43) months in comparison to those receiving PORT where median survival was not reached, p < .001.
Discussion: The multivariable model suggested that the use of PORT and higher margin clearance significantly improves LRC and OS in patients with DOI > 5 mm, whereas these factors had no impact on cohorts of patients with DOI ≤ 5mm.
Conclusions: Despite a significantly higher distribution of PNI in patients with DOI > 5 mm, the use of PORT significantly improved OS and LRC in this retrospective analysis. The Cox proportional hazard model also suggested that the use of PORT in patients with DOI > 5 mm increases survival endpoints irrespective of PNI and LVI positivity.
Abstract ID: 128
Author ID: 143
Presenter Name: Charli Roy
Affiliation: Department of Pathology, AIIMS, New Delhi, India
Abstract Title: NUT Carcinoma of the Buccal Mucosa: First Documented Case
Abstract Topic: Onco-pathology
Aims/Objectives of the Study: To report the first case of NUT carcinoma of the buccal mucosa.
Methodology: An 18-year-old male sought medical attention for a progressively enlarging right cheek swelling, which had manifested insidiously over a span of five months. He underwent excision of the swelling in a community health centre, and it was reported as an undifferentiated tumor on histological examination.
Results: Histopathological examination of the excised tumor revealed an undifferentiated carcinoma infiltrating the entire thickness of the cheek, ulcerating the buccal mucosa and extending to the subcutaneous plane of the skin. Large areas of necrosis were present. The tumor was composed of sheets of medium-sized undifferentiated cells with scant to moderate amounts of clear to pale eosinophilic cytoplasm and vesicular nuclei. Occasional foci of abrupt squamous differentiation with fetal-type and keratinized squamous cells were identified. Mitoses were frequent. The tumor cells were diffusely immunopositive for pancytokeratin, p63 and p40 and showed speckled nuclear staining with NUT protein. CD99 and NKX2.2 were negative. Multiple foci of lymphatic and perineural invasion were present. Level I cervical lymph nodes showed metastatic tumor with extranodal extension.
Discussion: NUT carcinoma is an aggressive epithelial malignancy defined by chromosomal rearrangements of the NUT midline carcinoma family member 1 (NUTM1) gene. Initially referred to as “NUT midline carcinoma,” these tumors are typically seen in midline locations of the head and neck and the mediastinum. However, they are increasingly being reported in non-midline structures including major salivary glands and pancreas. We report the first case of NUT carcinoma of the buccal mucosa.
Conclusions: This case highlights the necessity for a high index of suspicion for NUT carcinoma even at hitherto undescribed mucosal sites to avoid underdiagnosis as poorly differentiated squamous cell carcinoma, as NUT carcinoma needs more aggressive management.
Abstract ID: 127
Author ID: 142
Presenter Name: Mansi Mishra
Affiliation: Department of Dental Sciences, I.T.S Dental College, Muradnagar, Ghaziabad, Uttar Pradesh, India
Abstract Title: Diagnostic Dilemma of Oral Squamous Cell Carcinoma as Osseous Pathosis: A Case Report
Abstract Topic: Onco-pathology
Aims/Objectives of the Study: Some lesions may show identical clinical and radiographic appearance creating a diagnostic dilemma. In such scenarios, histopathological assessment may prove helpful; therefore, a clinic–pathological correlation may be necessary for accurate diagnosis. Hence, here we would like to present two cases that showed similar radiographic picture, but one turned out to be an epithelial malignancy while the other proved to be an osseous pathosis.
Methodology: the histopathological examination.
Results: The histopathological diagnosis of this case matched its clinical and radiological findings with a final diagnosis of osteomyelitis.
Discussion: The first case is of a 43-year-old man who reported to the Department of Oral and Maxillofacial Pathology, with an ulceroproliferative lesion in the left buccal mucosa extending from the mid-occlusal plane of maxillary teeth to the lower vestibular region. The superior aspect of the lesion was erythematous, whereas the inferior-most part had white keratotic tissue with a sinus tract. The lesion was soft to firm in consistency, tender with ill-defined and indurated borders. On radiographic examination, the panoramic view exhibited evident destruction of the bone with classical moth-eaten appearance. Although the clinical and radiological evaluation suggested a provisional diagnosis of osteomyelitis, the histopathological examination confirmed moderately differentiated oral squamous cell carcinoma. Similarly, a 48-year-old man reported with deviation of the mandible toward the right side of the face with reduced mouth opening (less than 37 mm). Intra-oral clinical examination revealed the presence of necrotic bone formation with slough in the right posterior region. Radiological assessment of computed beam tomography revealed an extensive osteolytic destruction with ill-defined borders and permeative/invasive margins in the mandibular posterior tooth region.
Conclusions: Henceforth, we would like to emphasize the diverse morphological appearance of any lesion and how clinic–pathological correlation is a mainstay in reaching conclusive diagnosis.
Abstract ID: 126
Author ID: 145
Presenter Name: Charu Priya
Affiliation: Department of Dental Sciences, ITS Dental College, Muradnagar, Ghaziabad, Uttar Pradesh
Abstract Title: Histomorphological and Molecular Risk Assessment in Advanced Stage of Oral Cancer
Abstract Topic: Onco-pathology
Aims/Objectives of the Study: The assessment of cancer and fatality is complex owing to its diverse genetics, etiology, and response to therapy. Despite recent advances in the diagnosis and treatment, its five-year survival rate remains at 60%. In this case report, a 48-year-old male patient reported with the chief complaint of pain and swelling in the lower left back tooth region since two months. The intraoral clinical examination revealed a reddish-pink non-healing ulceroproliferative growth on the left buccal mucosa. So the present poster comment on the prognostic significance, local recurrence and overall survival probability in the case of OSCC.
Methodology: Histopathological evaluation with H&E stain and immunohistochemical analysis with STAT3, beta-catenin, p53, Ki67, SOX2, VEGF, and GLUT-1.
Results: Increased depth of invasion
Discussion: We evaluated the depth of invasion and subjected the tissue to a panel of immunohistochemical markers such as STAT3, beta-catenin, p53, Ki67, SOX2, VEGF, and GLUT-1 for prognostic significance. A proposed risk assessment by Brandwein Gensler 2005 was done for the case to comment on local recurrence and overall survival probability.
Conclusions: A multitude of parameters were evaluated for determining the prognosis of the patient so that suitable management can be planned to reduce the patient morbidity and mortality rates.
Abstract ID: 124
Author ID: 140
Presenter Name: Deep Patel
Affiliation: Department of ENT and Head and Neck Surgery, Shree Krishna Hospital, Anand, Gujarat, India
Abstract Title: Unveiling the Uncommon: A Singular Encounter with Rhabdomyosarcoma—A Case Report
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To provide a detailed analysis of a specific patient’s experience, diagnosis, treatment and outcome and to report a rhabdomyosarcoma affecting the right posterior triangle region of an adult female, with diagnosis being achieved with an intra-operative biopsy followed by immunohistochromatography.
Methodology: A 29-year-old woman sought care at Shree Krishna Hospital’s ENT OPD, reporting a mass at the right side back of the neck since 7–8 months. Examination disclosed a hard, non-mobile bossellated mass 7 × 5 × 3 cm. The USG showed a well defined hypoechoic lesion with internal vascularity suggestive of a benign neural tumour, whilw FNAC gave possibility of chronic granulomatous inflammation.
Results: A biopsy from the excised mass revealed malignant round cell tumour favouring embryonal rhabdomyosarcoma. The immunohistochromatography reports gave an impression of malignant round cell tumor. PET SCAN showed multiple avid soft tissue density parenchymal nodules of varying sizes involving bilateral lung fields.
Discussion: Unveiling the complexities of neck masses, this case defies typical demographic trends, manifesting in an adult female with distant metastasis. Diagnosis was challenging due to various investigation modalities giving different differential diagnosis; the final diagnosis was achieved through biopsy and immunohistochromatography. Typically associated with teens, our case highlights a unique profile. Despite advanced disease and distant metastasis, the patient, undergoing surgery and chemotherapy, demonstrated survival, emphasizing the enigma surrounding optimal management in this rare malignancy.
Conclusions: Head and neck surgeon must comprehend the varied types of neck masses underscoring the importance of vigilance due to their nonspecific nature. Early diagnosis, facilitated by comprehensive evaluation and imaging like CT, FNAC, Biopsy, as well immunohistochromatography is pivotal. Prompt treatment planning, guided by precise diagnosis, markedly improves patient outcomes and survival rates.
Abstract ID: 123
Author ID: 141
Presenter Name: Komal Mehta
Affiliation: Department of Research, RGCIRC, New Delhi, India
Abstract Title: Living Cell Repository at RGCIRC: Propelling Precision Medicine in Head and Neck Cancer Research
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: Preclinical evaluation of potential anticancer drugs has historically relied on immortalized cell lines, lacking key features of human tumors. There is a pressing demand for alternative cell culture models that retain patient-specific traits for studying tumor biology and precision medicine. Addressing this need, we at RGCIRC Biorepository, Department of Research, have pioneered the development of patient-derived tumor live cell preparations. These preparations closely mimic the primary tumor’s pathological and molecular features, serving as prototypes for functional studies and personalized oncology. Our transition from a traditional clinical tissue repository to a living cell biobank is guided by objectives aimed at advancing research capabilities in the field.
To isolate and analyze dissociated tumor cells (DTCs) from diverse H&N tumor sites including upper and lower alveolus, buccal mucosa, tongue, gingivobuccal sulcus (GBS), and maxilla or mandible regions.
To compare cellular heterogeneity and yields across various sites, which is crucial for downstream single-cell (SC) analysis and organoid/spheroid preparations.
To develop a robust quality assessment tool to enhance acceptance by the pharmaceutical industry and academic researchers.
Methodology: DTC isolation from H&N tissue involved an enzyme-based method. Surgical excess tumor chunks (500–1000 mg) were acquired from surgical resection specimens received in the histopathology department at RGCIRC. Tumor chunks were transferred to the research lab.
Results: Cell counts were obtained after dissociation from various H&N sites (n = 30), comprising buccal mucosa (n = 10), alveolus (n = 5), tongue (n = 11), and GBS (n = 4). Variability in cell counts was obtained across these sites. Notably, the presence of calcification and fibrosis posed significant challenges during digestion, with their composition varying within sites. Digestion parameters, including time and enzyme concentration, were adjusted based on tissue type. Adequate tissue sampling was essential in regions with such tissue characteristics to obtain good cell yields for downstream applications. Multiple preanalytical and post-analytical parameters were monitored to ensure high-quality preparations, such as cold ischemia time, freeze–thaw cycles, amount of start-up tissue, and final storage temperature.
Discussion: Research in cancer biology has taken a paradigm shift to single-cell genomics. A tripartite combination of clinically annotated FFPE, fresh frozen, and patient-derived living cells can act as powerful tools to reveal transcriptome networks and study disease mechanisms. Drug responses at the cellular level aid in identifying biomarkers to predict the prognosis of HNSCC.
Conclusions: Based on our three-year experience, we showcase that next-generation biobanking is much more complex than traditional biospecimen collection, as it requires complex resources, infrastructure, and expertise. DTCs are a primary step in developing PDC models and can also support newer high-throughput technologies such as microfluidics and organ-on-a-chip. DTCs represent heterogeneous populations of tumor cells and associated stromal and immune cells, which can be potential targets for personalized medicine.
Abstract ID: 122
Author ID: 104
Presenter Name: Arunima Bhaduri
Affiliation: Department of Biomedical Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Abstract Title: Advancing Head and Neck Cancer Research Through A Comprehensive Biobanking Initiative at RGCIRC, New Delhi
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: Head and neck cancers (HNC) are one of the most common cancers in the world. Oral cancers are the most common site and also represent around 11% of all cancers in India. Extensive research is ongoing in the arena of biomarker discovery, and biobanks play a pivotal role by providing researchers with a vast array of clinically annotated biological samples, thus bridging the gap between clinical and translational research. Biobank at RGCIRC is one such ambitious and crucial initiative with the following objectives:
To collect and store various types of biosamples such as tissue samples, blood, saliva, FFPE blocks, dissociated tumor cells, and viable tissue from patients diagnosed with head and neck cancers.
To integrate demographic, clinical, pathological, and molecular data with the cryopreserved samples and to upscale to meet the living cell biobanking and digital pathology demands.
To ensure visibility and availability of the sample inventory to both academic and commercial researchers in India and abroad for translational research.
Methodology: The biobank donors included presurgical HNC patients above the age of 18 years reporting to surgical oncology OPD. The collection period is between 2018 and 2023. In this hospital-based biobank, we adhere to the stringent ISBER, ICMR Guidelines, and IARC WHO.
Results: Over six years, 1,205 HNC patient donors were consented. Over 12,500 biosample aliquots have been cryopreserved, of which 28% had paired plasma and tumor tissues and in 54% of samples, only plasma samples were stored. The other biosample types included saliva (n = 10), dissociated tumor cells (DTC) (n = 30), and peripheral blood mononuclear cells (PBMC) (n = 32), digital images, tumor-educated platelets (n = 70) and about 2 lakh FFPE blocks. Our disbursal rate of biosamples is about 34% with an acceptability rate of 92–95%. These have been utilized for molecular studies, validation assays, and drug discoveries by various institutes such as IGIB, IIT-Ropar, IIIT-D, RCB, Amity Institute nationally, University of California, Oxford Biotherapeutics, Cureline, USA, and Children’s Cancer Center, Australia.
Discussion: RGCIRC biorepository has successfully cryopreserved more than a thousand patient samples of HNC adhering to the best lab practices ensuring their sustainability for research. The successful utilization of tumor tissues, plasma, saliva, DTCs, and PBMCs by various academic centers and commercial hubs for “-omics” discoveries serves as evidence that the samples were well preserved and fit for purpose.
Conclusions: Biobanks are pivotal in modern biomedical research, and the extensive resources of the RGCIRC biobank are poised to accelerate oral cancer research, potentially leading to advancements in early detection methods, targeted treatments, and improved patient survival rates.
Abstract ID: 120
Author ID: 127
Presenter Name: Sonam Khokhar
Affiliation: Foundation of Head and Neck Oncology, Neeti Clinics Pvt Ltd, Nagpur, Maharashtra, India; Oral and Maxillofacial Surgery Department, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh; King George’s Medical University, Lucknow, Uttar Pradesh, India
Abstract Title: Crush Imprint Cytology Changing the Surgical Fate of Indeterminate Thyroid Nodules
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study:
To study the utility of crush imprint cytology (CIC) of central compartment nodes to diagnose thyroid cancer, especially in indeterminate nodules.
To study the utility of CIC in deciding the extent of central neck dissection in thyroid cancers.
To study the utility of CIC in deciding the extent of lateral neck dissection in thyroid cancers.
Methodology: This is a retrospective analysis of a prospectively maintained database. Inclusion criteria were treatment naïve patients undergoing thyroid surgery at a single centre with a single team of surgeons and cytopathologists.
Results: 92 thyroid surgeries were performed during the study period (January–December 2023). Of these, 30 patients had indeterminate nodules. Central compartment nodes were identified in 18 out of these 30 patients during surgery. Crush imprint confirmed the presence of metastatic disease in 6 of these patients, thus confirming a diagnosis of thyroid cancer, and total thyroidectomy with appropriate central compartment neck dissection was performed in these. The extent of central compartment nodal dissection was also guided by crush imprint cytology, requiring the surgery to be upstaged in 8/25 (32%) and downstaged in 17/25 (68%). Similarly, it was also very useful in guiding the extent of lateral nodal dissection, upstaging surgery in 1/8 (12.5%) and downstaging in 7/8 (87.5%) patients, respectively. On comparison with histopathology, sensitivity and specificity of crush imprint cytology were 97.6% and 98.1%, respectively.
Discussion: Crush imprint cytology is an excellent intraoperative pathology technique with high sensitivity and specificity. The availability, cost, turnaround time and logistics are favourable to frozen section. All our cytology interpretation frozen section examinations and histopathology were conducted by the same set of expert pathologists to avoid inter-observer bias.
Conclusions: Crush imprint cytology is an excellent intraoperative pathology technique. We found its utility for diagnosing carcinoma in indeterminate nodules and guiding the extent of central and lateral compartment nodal dissection. In view of its easy availability, low cost and fast turn-around time, we recommend all centres practicing thyroid surgery to have this technique in their armamentarium.
Abstract ID: 119
Author ID: 138
Presenter Name: Titiksha Jain
Affiliation: Department of Dental Sciences, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
Abstract Title: Early Detection: Early Intervention
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: To compare the various diagnostic modalities for early detection of oral cancer with a focus on nobel laser capture micro-dissection (LCM) technique for its use in detection of the oral cancer timely, aimed at early intervention, in turn giving the patient better quality of life.
Methodology: Various diagnostic techniques ranging from clinical examination, vital staining, and imaging techniques to various types of biopsies were compared. The technique superior in terms of sensitivity and specificity was analyzed.
Results: Biopsy is considered as the gold standard for detection of oral cancer. LCM is a powerful technique that enables oncology researchers to compare molecular profiles of tumor tissues to surrounding non-tumor cells.
Discussion: Deciphering the cellular and molecular interactions that drive diseases within the tissue microenvironment holds promise for discovering drug targets of the future. In order to recapitulate the in vivo interactions through molecular analysis, one must be able to analyze specific cell populations within the context of their heterogeneous tissue micro-ecology. LCM is a method to procure subpopulations of tissue cells under direct microscopic visualization. LCM technology can harvest the cells of interest directly or can isolate specific cells by cutting away unwanted cells to give histologically pure enriched cell populations. This in turn will result in accurate diagnosis of the lesion and thus early and prompt intervention.
Conclusions: LCM is a precise, contact-free technique that helps minimize contamination, uncovering answers that might otherwise be missed using a non-targeted sample due to the small size or homogenized nature of the sample. Emerging advanced commercialized techniques need encouragement by professionals for integration in clinical diagnostic practices.
Abstract ID: 118
Author ID: 139
Presenter Name: Shanvi Kumari
Affiliation: Department of Dental Sciences, I.T.S. Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
Abstract Title: Prognostic Significance of GLUT-1 and Immune Phenotyping in Oral Squamous Cell Carcinoma in Prediction of Early Relapse
Abstract Topic: Onco-pathology
Aims/Objectives of the Study:
To assess the immunoexpression of GLUT-1 and correlation of immune phenotyping in OSCC in predicting early relapse.
To analyse immunoexpression of GLUT-1 in OSCC cases.
To study the immune phenotype (tumour‐infiltrating lymphocytes) of OSCC cases.
To correlate hypoxia biomarker GLUT-1 with independent prognostic indicators in study groups.
Methodology: The study sample will comprise:
Group 1: 20 cases of OSCC.
Group 2: 5 samples of normal oral mucosa (control).
1) Immunohistochemical quantification of GLUT-1 using an Anti-GLUT-1 antibody.
2) Immune phenotyping based on:
Results: Expected outcome: High expression of GLUT-1 will be observed in all OSCC cases and could be associated with a poor prognosis. Hypoxia and angiogenesis will have a definite role in development and progression of oral carcinogenesis. The immune desert phenotype will be the least prevalent among OSCC cases and might serve as an independent prognostic indicator. We will predict the prognosis of the case using the regression analysis based on the parameters assessed.
Discussion: Dysregulation of the hypoxia-aerobic system has been postulated in various malignancies. GLUT-1, overexpressed in cancer cells, follows the glycolytic pathway and acts as a source of energy for cancer cells. Therefore, understanding this mechanism is important for improving prognostic tools and targeted therapies. Correspondingly, given the importance of tumour-infiltrating lymphocytes (TILs) in the development of cancers, the prognostic significance of the immune phenotype in OSCC needs to be investigated. Additionally, increased levels of TILs are associated with favourable prognosis.
Conclusions: Events linked to hypoxia appear to play a significant role in the development of oral carcinogenesis. Similarly, TILs could serve as an integrated parameter within the current staging system and aid in selecting appropriate therapeutic strategies. The algorithm of hypoxia, angiogenesis and prognostic indicators can be used to describe and predict the biological tumour behaviour of OSCC.
Abstract ID: 117
Author ID: 119
Presenter Name: Shraddhanjali Satapathy
Affiliation: Department of Oncopathology, All India Institute of Medical Sciences, New Delhi, India
Abstract Title: TRPS1 (Transcriptional Repressor GATA Binding 1) Is a Sensitive Marker for Salivary Gland Neoplasms but Lacks Specificity
Abstract Topic: Onco-pathology
Aims/Objectives of the Study: To investigate TRPS1 and SOX10 immunoexpression in various SGNs and non-SG carcinomas, head and neck paragangliomas (HNPGLs) and mucosal melanomas (HNMMs).
Methodology: TRPS1 immunoreactivity score (IRS) was determined as negative, or low, intermediate, or high positive. SOX10 was reported as negative or positive.
Results: 148 SGNs, 5 breast carcinomas, 105 non-breast non-SG carcinomas including 33 squamous cell carcinomas (HNSCC), 6 HNPGLs and 6 HNMMs were assessed for TRPS1. All 23 benign SGNs showed TRPS1 positivity, with the majority having high positive IRS (17 cases; 74%). Among 125 SG carcinomas, 115 (92%) were TRPS1 positive, with high positive IRS in 94 (75%), intermediate positive in 15 (12%) and low positive in 6 (5%). Among non-breast non-SG carcinomas, HNSCC, lung, thyroid, kidney and ovarian carcinomas showed frequent TRPS1 staining. Nearly half of HNSCC had high (11/18; 33%) or intermediate positive (4/18; 12%) IRS. Mean IRS in SG carcinomas was significantly higher than that of non-breast non-SG carcinomas (p < .001). None of the TRPS1-positive non-breast non-SG carcinomas expressed SOX10.
Discussion: Salivary gland carcinomas (SGCs) are locally aggressive neoplasms; regional and distant metastases occur in up to 30% of cases. SGCs are of diverse histological types, some of which have sensitive and specific immunohistochemical markers that aid in their diagnosis. However, there is no pan-SGC immunohistochemical stain to aid in the identification of a salivary gland primarily in the investigation of metastatic carcinomas from unknown primary sites. TRPS1 protein regulates the TGFβ1-mediated epithelial-to-mesenchymal transition during embryonic development as well as the expression of genes implicated in the cell cycle by down-regulating the transcriptional activity of GATA factors and cycle-related genes. Recently, TRPS1 has been identified as a sensitive and specific immunomarker for breast cancer; additionally, occasional reports of TRPS1 immunopositivity in breast ADCC and in SGC have been published. The primary focus of the current study was to find a reliable pan-SG marker across the various types of SGNs. In our study, TRPS 1 expression was seen in 94% of all SGNs, irrespective of its benign or malignant nature. There were no benign cases that were immunonegative, making TRPS1 a single most reliable immunohistochemical marker covering all types of benign salivary gland neoplasms, irrespective of the cell of origin, and our findings were in concordance with various studies performed. On further evaluation of TRPS1 among other carcinomas, invasive breast carcinomas, irrespective of its hormonal status, was diffusely immunopositive for TRPS1. Apart from breast cancer, lung adenocarcinomas, ovarian carcinomas, papillary carcinoma of the kidneys and high-grade urothelial carcinomas also showed TRPS1 positivity. Hence, this study shows TRPS1 has good sensitivity for salivary gland tumour; however, it cannot be used as the sole marker for diagnosis.
Conclusions: TRPS1 is positive in most benign and malignant SGNs. Its expression in several non-breast non-SG carcinomas indicates that it lacks specificity for breast and SG carcinomas, even if considering only high positive IRS. Addition of SOX10 can increase discriminatory utility of TRPS1.
Abstract ID: 112
Author ID: 133
Presenter Name: Naveen Saini
Affiliation: Department of Surgical Oncology, State Cancer Institute, Guwahati, Assam, India
Abstract Title: Assessment of Functional Outcomes After Oral Commissure Defect Reconstruction Using Orbicularis Sling
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To assess the competence of oral stoma after reconstruction using orbicularis oris sling (digastric/tensor fascia lata).
Methodology: Data was collected prospectively from patients of carcinoma oral cavity involving oral commissure, operated at the State Cancer Institute, Guwahati. Patients who underwent reconstruction using orbicularis oris sling along with flap and those in whom only flap was used were chosen. Data was collected from patient records and during follow-up visits at 1 month and 3 months postoperatively by physical examination using standard grading system.
Results: There were 14 patients in each group, with a mean age of 61.5 years in the sling with flap group and 61.8 years in the flap-only group. The most common location is the angle of mouth, and the most common stage is t4a in both the groups. A nasolabial flap was used in 12 patients, and 2 patients underwent pectoralis major myocutaneous (PMMC) flap in the sling and flap group, whereas 8 patients underwent PMMC flap reconstruction and 6 nasolabial flap reconstruction in the flap-only group. A significant improvement was seen in drooling frequency and severity with p values (unpaired Student’s t test) of 0.016 and 0.076, respectively. There was no statistically significant difference in oral stoma size in the groups with a p value of .223.
Discussion: This comparative study shows significant decrease in drooling severity and frequency in patients when orbicularis oris sling is used for reconstruction along with flaps. No difference is seen in the size of the stoma between both the groups. Although the number of patients studied was less and groups were heterogenous in terms of flaps used, this study points towards the usefulness of orbicularis oris sling in reconstruction.
Conclusions: This comparative study shows a significant decrease in drooling severity and frequency in patients when the orbicularis oris sling is used for reconstruction along with flaps. No difference is seen in the size of the stoma between both groups. Although the number of patients studied is less and groups are heterogeneous in terms of flaps used, this study points towards the usefulness of orbicularis oris sling in reconstruction.
Abstract ID: 111
Author ID: 57
Presenter Name: Ambika Rana
Affiliation: Department of ENT & HNS, SMGS Hospital, Jammu, India
Abstract Title: Study of the Stage of Presentation and the Evaluation of Causes of Late Presentation of Patients with Head and Neck Cancer in a Tertiary Care Hospital in Jammu Region
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study:
To study the stage at which patients with head and neck (H&N) cancer present in our set-up.
To evaluate the reasons for delayed presentation (i.e., in advanced stages) to the hospital.
Methodology: This is a retrospective observational study on patients who are histologically proven cases of head and neck cancers, and the study was conducted between February 2022 and February 2024 at the Department of ENT & HNS (at SMGS Hospital, Jammu).
Results: A total of 400 cases were analysed with 375 males and 25 females with the male:female ratio of 15:1, and among them, nearly >95% were found to have squamous cell carcinoma and in the majority, the stage of presentation was stage 2 and beyond with maximum incidence in the age group of 40–60. With regard to the first actions taken by the patients after awareness of signs and symptoms, 65% patients consulted a physician first, 30% ignored the symptoms and took no action and 5% started a self-treatment regimen. In older patients, the delayed presentation was due to their dependency on others, and among younger patients, the delayed presentation was because of lack of awareness about the signs and symptoms. Lower socio-economic status is also related to more patient delay.
Discussion: In general, squamous cell carcinoma is the most common histological variant (>90%). In the current study, the male:female ratio was 15:1. In this study, oral cancer was found to be the most common H&N cancer followed by laryngeal cancers because of increased incidence of tobacco chewing (>60%) and smoking. In this study, the maximum number of H&N cancer patients presented in the age group of 40–60, with more incidence in men than in women. A majority of patients presented in stage 2 and beyond (>70%). The prime reason for late presentation was lack of awareness about the signs and symptoms of H&N cancers in more than 60% patients.
Conclusions: The highest priority for cancer control should be given to the burden of H&N cancers in India. Emphasis should be on preventing the onset and detecting the disease at an early stage. Implementing cancer control activities has to be prioritised, making optimal use of limited resources to deliver the utmost benefit to the largest number of people. While many H&N cancers are difficult to manage, but being highly preventable, the emphasis should be on preventing the onset and detecting the disease at an early stage. The total time from a patient’s signs and symptoms to doctor visits is comparably high in H&N cancer patients. Increased population awareness programmes emphasising the preventable factors associated with the cancer and change in lifestyle will decrease morbidity and mortality associated with late stage presentation.
Abstract ID: 109
Author ID: 118
Presenter Name: Shaifali Mahajan
Affiliation: Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Abstract Title: IMRT Versus 2D RT in Early Glottic Cancer: Retrospective Comparison of Survival Outcomes
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: The use of two-dimensional radiotherapy (2D RT) with parallel opposing fields has been the standard technique for early glottic cancer (EGC). However, there is a controversy about using intensity modulated radiotherapy (IMRT) in this site because of a paucity of sensitive organs at risk to be spare. Another concern with IMRT is believed to be probability of marginal miss, which may lead to treatment failure. The aim of this study was to compare oncological outcomes and patterns of failure between 2D RT and IMRT for EGC.
Methodology: It was a retrospective analysis of 284 patients with newly diagnosed EGC (clinical T1 or T2 with/without nodal involvement) treated between 2010 and 2017 with radical radiotherapy. T1 tumours were given 66 Gy in 33 fractions, and T2 tumours were given 70 G.
Results: The two groups were comparable, except with regard to alcohol consumption and RT dose. The median follow-ups in 2D RT and IMRT groups were 54.6 months (range 4.7–124.3) and 48.5 months (range 3.7–115.4), respectively. The median LRC was not achieved with IMRT technique at the time of analysis. The median LRC in 2D RT was 109 months (95% confidence interval [CI]: 59.601–158.486). There was a trend towards improvement in median LRC in IMRT technique (p = .063). The median OS was not achieved with 2D RT. Median OS in IMRT technique was 94 months (95% CI: 82.409–106.04). There was no difference in median OS between the two techniques (p = .301). The 5- and 10-year LRC was significantly higher in IMRT than in the 2D technique (69.7% vs 57.9%, p = .039; 69.7% vs 55.3%, p = .012, respectively). The 5- and 10-year OS was also significantly higher in IMRT than in the 2D technique (81.8% vs 67.1%, p = .005; 75.8% vs 64.5%, p = .039, respectively). There were 70%, 0% and 30% local, regional alone and loco-regional recurrence in IMRT, and 85.7%, 2.9% and 11.4% local, regional alone and loco-regional recurrence in the 2D RT technique (p = .034).
Discussion: The median OS was not achieved with 2D RT. The 5- and 10-year LRC was significantly higher in IMRT than in the 2D technique. The 5- and 10-year OS was also significantly higher in IMRT than in the 2D technique.
Conclusions: IMRT provides better 5- and 10-year LRC and OS than 2D RT. The predominant pattern of failure continues to be local in both techniques, although higher in 2D RT than in IMRT. IMRT may be considered even for EGC routinely.
Abstract ID: 106
Author ID: 130
Presenter Name: Akash R. Bellige
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Failure Patterns in Bucco-alveolar Complex Carcinoma Patients Post-surgery and Radiotherapy: An Analysis of Treatment Volumes Using Dosimetry
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To correlate the role of bilateral neck irradiation in cases of squamous cell carcinoma of the bucco-alveolar complex (BAC-SCC) with patterns of failure in the neck.
Methodology: 600 patients with BAC-SCC treated with surgery followed by radiotherapy and pathological N0-2b during the period 2015–2022 were enrolled. Patients were grouped on the basis of whether radiotherapy was delivered unilaterally or bilaterally.
Results: Median OS was not reached for the cohort. 38.4% patients received ipsilateral RT, whereas 61.6% received bilateral RT. 32% had locoregional recurrences, of which 5% received ipsilateral radiotherapy and 26% received bilateral radiotherapy.
Discussion: The most common failure patterns were found to be equally distributed along the anterior flap margins and in the regional neck nodes. It was found that both extracapsular extension and pathological nodal staging were predictors for bilateral neck irradiation.
Conclusions: This study reports results of an eight-year single-institution experience in bucco-alveolar complex carcinoma treatment focussing on finding relapse patterns. Innate radioresistance of the tumor and extraneous disease were the most common patterns of failure noted.
Abstract ID: 102
Author ID: 99
Presenter Name: Saroj Kumari
Affiliation: Department of Dental Sciences, ESIC Dental College and Hospital, Rohini, New Delhi, India
Abstract Title: Maxillectomy Defect Reconstruction: Comparative Analysis of Buccal Fat Pad Flap, Temporalis Muscle Flap, and Anterolateral Thigh Free Flap
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: Maxillectomy defects pose significant challenges in oral and maxillofacial surgery, requiring meticulous reconstruction to restore form and function. This study aims to assess the efficacy of buccal fat pad (BFP), temporalis muscle (TM), and anterolateral thigh (ALT) flaps in reconstructing maxillectomy defects. The objective is to compare the advantages and limitations of these reconstruction techniques, taking into account factors such as defect size, location, patient characteristics, and desired outcomes.
Methodology: A retrospective review of 20 patients who underwent maxillectomy defect reconstruction with BFP, TM, or ALT flaps was conducted. Patient demographics, defect size, flap type, surgical technique, and postoperative outcomes were recorded.
Results: BFP flaps were used in seven patients, TM flaps in nine patients, and ALT flaps in four patients. Functional outcomes were comparable among all flap types, with no significant differences in speech, swallowing, or mastication. Complication rates were low, with no major complications reported. Aesthetic results were satisfactory, with no significant differences among flap types.
Discussion: The choice of flap depends on the size and location of the defect, as well as the patient’s overall health and aesthetic goals. The buccal fat pad flap, known for its versatility and proximity to the defect site, offers a simple and reliable option for small to moderate defects. In contrast, the temporalis muscle flap provides robust vascularization and bulk for larger defects but may involve more complex surgical procedures. The anterolateral thigh flap is a versatile option for extensive defects but may require microsurgical expertise. The low complication rates and satisfactory aesthetic results suggest that all three flap types are safe and effective for maxillectomy defect reconstruction.
Conclusions: Buccal fat pad, temporalis muscle, and anterolateral thigh flaps are all deemed safe and effective choices for maxillectomy defect reconstruction. The selection of a specific flap type should be guided by considerations such as defect characteristics (size, location), patient characteristics, and desired outcomes. Clinicians should consider the advantages and limitations of each flap type when selecting the most appropriate technique for maxillectomy defect reconstruction.
Abstract ID: 101
Author ID: 118
Presenter Name: Shaifali Mahajan
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Is It Bad to Be Young? Comparing Disease Outcomes Between Younger and Older Patients with Carcinoma Oral Tongue
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To compare the clinicopathological profile and disease-related outcomes (loco-regional control (LRC) and overall survival (OS)) between younger (40 years or lesser) and older cohorts (over 40 years) with resectable oral tongue squamous cell cancer (OTSCC) patients who underwent combined modality treatment (surgery followed by adjuvant radiotherapy ± concurrent chemotherapy).
Methodology: A retrospective comparative study at a tertiary oncology centre in India comprising 650 primary OTSCC patients over the duration 2008–2022. This study included patients with local/locoregional disease who underwent combined modality treatment.
Results: Of the total 650 patients, 461 (70.9%) were in the older cohort and 189 (29.1%) in the younger cohort at diagnosis. General patient characteristics were balanced in the two cohorts. Factors found to be statistically significantly different between the two groups were gender, co-morbidities, smoking, smokeless tobacco and alcohol consumption. Median follow-up for the younger and older cohort was 22.9 and 23.7 months, respectively. Based on univariate and multivariate analysis, tumour grade, tumour margins, perineural invasion (PNI), pNodal stage and extracapsular extension (ECE) were statistically significant for LRC. Tobacco smoking, tumour grade, tumour margins, PNI, pN stage and ECE were statistically significant for OS.
Discussion: In terms of patient and disease-related characteristics, a significant difference between the younger and older groups of patients was observed for gender, smokeless tobacco consumption, tobacco smoking, alcohol consumption and the presence of co-morbidities. Higher tumour grade, involved tumour margins, presence of PNI, higher pN stage and ECE were associated with an overall worse LRC, whereas tobacco smoking and higher tumour grade, involved tumour margins, PNI, higher pN stage and ECE were significant for poorer OS. The current study suggests no difference in LRC or OS in younger versus older patients with OTSCC at the end of three or five years. It is suggested that age is not an independent predictor of outcome for these patients.
Conclusions: There is no rationale for the use of a different management approach or treatment intensification for the younger patients.
Abstract ID: 99
Author ID: 126
Presenter Name: Manish Verma, Amit Kumar, Rajeev Kumar, Alok Thakar and Kapil
Affiliation: Department of Surgical Oncology, AIIMS, New Delhi, India
Abstract Title: Surgical Outcomes in Geriatric Head Neck Cancer Patients in Indian Population: A Singlecenter Study
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To study the surgical outcomes in geriatric head neck cancer patients and to identify the clinical factors which are related with poor outcomes.
Methodology: The retrospective data was collected for the last two years. All patients aged 60 years and above, who were diagnosed with head neck cancer and were operated, were included in the study. Patient demographic data and clinical and surgical details were collected.
Results: A total of 110 patients’ data were collected from 2020 to 2023. The median age in our cohort was 66. Out of 110, 48 patients had postoperative complications. Out of 48 patients, 17 had medical complications. The total number of patients with surgical complications classified as ≥3A/3B were 39. Out of 110 patients, 70 patients belonged to ASA II category. 68.2% patients belonged to ACE 27 mild category, and 11.8% patients belonged to ACE 27 moderate severe category. 59.1% underwent the use of flap for reconstruction. Multivariate regression analysis was performed for patients with major surgical complications. On univariate analysis, the use of flap (7.11 (2.49–25.73), p = .001) and moderate ACE 27 score (6.86 (1.24–55.56), p = .039) are predictors of major surgical complications. On multivariate analysis, flap usage (13.18 (2.98–88.01), p = .002) and T4B (26.29 (1.36–1127.99), p = .047). Patients with ASA III have an OR 7.33 (0.74–103.09, p = .104) of developing complications, and those with ACE 27 have an OR of 12.19 (1.02–233.33, p = .064), but this was not clinically significant in our cohort of patients.
Discussion: Small et al. conducted a retrospective review of 305 patients to find an association between ASA classification and surgical outcomes, but similar to our study, no statistical significance was found. In Garza et al.’s retrospective review of 582 patients with moderate ACE 27, severe category is associated with medical complications, but not with surgical outcomes. However, in our cohort, moderate ACE 27 categories carry an OR of 6.86 for developing surgical complications.
Conclusions: ACE 27 tool can be used to risk stratify patients undergoing major surgical resections in head neck cancer patients.
Abstract ID: 96
Author ID: 125
Presenter Name: Maulik Panasara
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: NUT Carcinoma of Oropharynx: A Case Report and Review of Literature
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: NUT carcinoma is a rare and aggressive subtype of squamous carcinoma that arises from midline supradiaphragmatic structures, frequently from the head neck region and lung. NUT carcinoma is genetically driven by a chromosomal rearrangement of the NUT gene. Head neck NUT carcinoma treatment consists of multimodal approach with systemic chemotherapy, surgery and radiation therapy. BET inhibitors and histone deacetylase inhibitors have emerged as promising targeted agents.
Methodology: We report a rare case of oropharyngeal NUT carcinoma along with review of the published literature on NUT carcinoma of the head neck region.
Results: A 61-year-old male presented with complaints of dysphagia and lump on the right side of the neck since two months. On examination, there was a firm lymph node mass in the right side of the neck involving levels II and III. Fibrotic laryngoscopy showed an ulcerative growth rightr tonsil involving the right base of the tongue, right lateral pharyngeal wall, and right epiglottis. Biopsy from the neck node was suggestive of undifferentiated carcinoma. Immunohistochemistry analysis showed the tumor cells were immunoreactive for NUT (diffuse intense nuclear), P40, CK5/6, and CD 99 and immunonegative for synapto-physin and chromogranin with Ki 67 80%. PET CT scan showed a lesion with SUV 6.8 involving right oropharynx and epiglottis, a 4 × 4 cm nodal mass SUV 21 at the right cervical levels II and III. He was treated with three cycles of neoadjuvant chemotherapy with carboplatin and etoposide. After neoadjuvant chemotherapy, there was partial response at the primary oropharynx lesion with stable nodal mass. He was planned and started on radical radiotherapy to a dose of 70 Gy in 35 fractions over seven weeks. Presently, he is undergoing radiotherapy treatment.
Discussion: Head neck NUT carcinoma is extremely rare and has a poor prognosis. Hellquist et al. in 2017 published a case series of seven cases of laryngeal NUT carcinoma with overall survival from 3 to 11 months.
Conclusions: The present case report explores the diagnosis, clinical and pathological characteristics, prognosis and treatment of NUT carcinoma of the head neck region.
Abstract ID: 95
Author ID: 122
Presenter Name: Vibhor Patodi
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: VMAT Dosimetric Comparison Between HALCYON and Clinac iX for Locally Advanced Pharyngeal Cancer
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: Halcyon linear-accelerator (LINAC) uses flattening-filter-free (FFF) mode beams (800 MU/min) and is configured with an alternative design for a dual-layer multi-leaf collimator (MLC). The aim of the current study was to compare dosimetric performance, plan quality, treatment delivery efficiency of pharyngeal cancer between Halcyon 1.0 and Clinac iX LINAC.
Methodology: 35 patients with locally advanced pharyngeal cancer treated between March 2021 and March 2022 with radical radiotherapy to a dose of 70 Gy in 35 fractions were evaluated. Volumetric modulated arc therapy (VMAT) plans were created on both Halcyon and Clinac iX LINAC.
Results: There was significantly better Homogeneity Index (HI), Conformity Index (CI), integral dose, monitoring units (MU) and treatment delivery time with Halcyon plan than Clinac iX plan. Target coverage and doses to OARs were comparable between the two plans.
Discussion: Halcyon plans are superior than Clinac iX plans for locally advanced pharyngeal cancer with regard to parameters such as HI, CI, integral dose, MU and treatment delivery time, but not with target coverage and doses to OARs.
Conclusions: These results assured that Halcyon plans are suitable for pharyngeal cancer.
Abstract ID: 94
Author ID: 99
Presenter Name: Saroj Kumari
Affiliation: Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, New Delhi, India
Abstract Title: Functional and Anatomic Reconstruction of Maxillectomy Defects: A Case Report Utilizing Anterolateral Thigh (ALT) Free Flap
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: Maxillectomy defects pose significant challenges in achieving functional and esthetic reconstruction, necessitating innovative approaches for optimal outcomes. This case report aims to illustrate the feasibility and efficacy of utilizing the anterolateral thigh (ALT) free flap for the functional and anatomic reconstruction of class II maxillectomy defect resulting from squamous cell carcinoma. Specific objectives include evaluating the technical modifications employed for nasal separation and palatal support and assessing functional outcomes, including speech, swallowing, and nasal regurgitation.
Methodology: Patient Selection: A 58-year-old male with squamous cell carcinoma of the palate underwent comprehensive pre-operative evaluations and tumor board discussion.
Surgical Procedure: Bilateral Weber Ferguson incision provided access to perform subtotal maxillectomy.
Results: Surgical outcome—Subtotal maxillectomy was successfully performed with negative margins. The ALT flap, divided into oral and nasal components, facilitated palatal and nasal separation. Functional outcome—The patient exhibited no significant postoperative complications. Naso-pharyngeal airways were maintained for two weeks, ensuring proper nasal healing. At the one-month follow-up, the patient comfortably resumed soft oral diet without nasal regurgitation, and speech was satisfactory. Long-term follow-up—Six months postoperatively, fiberoptic laryngoscopy revealed patent nasal airway, and at 11 months, the patient presented with metabolically active lung lesions, leading to chemotherapy recommendations.
Discussion: The study emphasizes the advantages of the ALT flap over traditional methods for maxillectomy reconstruction, emphasizing its versatility, minimal donor site morbidity, and potential for multi-dimensional reconstruction. An exploration of the rationale and outcomes of selective deepithelization emphasizes its role in enhancing functional and anatomic reconstruction. The benefits include proper nasal healing and prevention of nasal regurgitation. The study limitations include the single-case nature and the need for further research.
Conclusions: The utilization of the ALT free flap for the reconstruction of class II maxillectomy defects demonstrates promising results in terms of both functional and anatomic outcomes. Technical modifications, particularly de-epithelization for nasal separation, contribute to successful rehabilitation. While this case highlights the potential of the ALT flap, larger studies are warranted to establish its universal applicability and assess long-term outcomes.
Abstract ID: 93
Author ID: 124
Presenter Name: Meenakshi Jha
Affiliation: Department of Research, Dharamsheela Cancer Hospital & Research Centre, New Delhi, India
Abstract Title: Analysis of Epigenetic Status of FHIT and p14 Genes in Oral Cancer
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study:
To check the promoter hypermethylation status of FHIT and p14 genes in oral squamous cell carcinoma (OSCC) patients.
To statistically correlate the promoter hypermethylation of these genes with the risk of OSCC.
Methodology: Samples (blood) were collected from Dharamsheela Cancer Hospital & Research Centre, New Delhi, with due ethical clearance, and the DNA was extracted from the obtained blood samples. The DNA isolated from blood samples was used to carry out bisulfite modification.
Results: Hypermethylation of FHIT was observed in 55% of OSCC patients. Statistically significant difference in methylation of FHIT (p value < .05) between patients and controls was observed. The methylation of FHIT showed a significant risk of developing OSCC in patients. Hypermethylation of p14ARF was observed in 12.5% of OSCC patients. Any significant difference in methylation of p14ARF (p value > .05) between patients and controls was not observed. The methylation of p14ARF showed no risk of developing OSCC in patients.
Discussion: Statistically significant relation in association with FHIT methylation was observed in tobacco chewers, smokers and alcohol consumers (p value < .05). A statistically significant increase in the risk of OSCC was observed in the case of all of these categories. This proves that FHIT hypermethylation is a significant step in OSCC patients. Statistically significant relation in association with p14ARF methylation was not observed in tobacco chewers, smokers and alcohol consumers (p value > .05). No significant increase in the risk of OSCC was observed in all of these cases.
Conclusions: FHIT hypermethylation is a significant step in OSCC patients, and it can possibly be used as a diagnostic biomarker in OSCC patients. Based upon the present study, p14 could not be used as a diagnostic biomarker in OSCC patients. This study needs to be carried out on a large scale as the sample size in the present study was small to draw any complete statistical conclusion.
Abstract ID: 92
Author ID: 123
Presenter Name: Suchita Chowdhury
Affiliation: Department of Surgical Oncology, RGCIRC, New Delhi, India
Abstract Title: Follicular Carcinoma Thyroid: Unusual Presentations
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To show that follicular carcinoma thyroid is the second most common thyroid malignancy after papillary carcinoma thyroid and constitutes 10–20% of all thyroid malignancies. It spreads hematogeneously, and distant metastasis is reported in 11–20% of the patients. Sometimes, symptoms due to metastasis may be the only presenting feature.
Methodology: We report two cases of follicular carcinoma thyroid, both of whom presented with unusual symptoms and were found to have a thyroid pathology on further detailed evaluation. The first patient presented with paraesthesia of the right lower limb and was found to
Results: Both the cases were evaluated with imaging studies and biopsy with IHC. After establishing the diagnosis of follicular carcinoma, both the cases underwent surgery followed by radioiodine ablation therapy.
Discussion: Hematogeneous spread of follicular thyroid cancer is common with metastasis to lung, bone and other solid organs. Unusual presentations as discussed above are rare. Surgical resection followed by radioiodine ablation is the standard treatment.
Conclusions: High index of suspicion and histopathological diagnosis with IHC aid is necessary to diagnose cases with such unusual presentations.
Abstract ID: 90
Author ID: 120
Presenter Name: Azhar Mohammed Ansari
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Impact of Presence of Perineural Invasion as Prognostic Factor in Oral Tongue Cancer
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To compare the patients and disease-related characteristics and disease outcome between patients with lymphovascular invasion (LVI) and without LVI in a large cohort of patients with OTC subsite. Endpoints for the study were locoregional control (LRC) and overall survival (OS).
Methodology: This was a retrospective study. Inclusion criteria were: Patients with localized and resected OTC who underwent upfront surgical resection and whose complete histopathological data were available between 2009 and December 2020. Exclusion criteria were: E
Results: The medical records of 625 patients were studied. There were 187 (29.9%) patients with LVI and 438 (70.1%) patients without LVI. The median follow-up for patients with LVI and without LVI was 22.1 and 31.9 months, respectively. The median duration of LRC had not reached in either cohort till the time of analysis. The three-year LRC rate in patients with LVI and without LVI was 74.9% and 64.6%, respectively (p = .019). The five-year LRC rate in patients with LVI and without LVI was 64.9% and 61.6%, respectively (p = .106). The median duration of OS in patients with LVI and without LVI was 33.6 and 83.5 months, respectively (p ≤ .001). The three-year OS rate in patients with LVI and without LVI was 49.8% and 67.1%, respectively (p < .001). The five-year OS rate in patients with LVI and without LVI was 44.1% and 58.5%, respectively (p < .001).
Discussion: A significant number of patients with OTC have LVI. The presence of LVI is a poor prognostic factor for OTC in this large cohort. The presence of LVI may have an impact on the therapeutic decision-making algorithm. Patients with the presence of LVI should be treated aggressively with adjuvant therapy after primary surgical resection. Further research should focus on the impact of adjuvant therapy in patients with LVI as the sole pathological risk factor.
Conclusions: Lymphovascular invasion is a poor prognostic factor in OTC.
Abstract ID: 88
Author ID: 116
Presenter Name: Shivani Malik
Affiliation: Department of Radiation Oncology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
Abstract Title: A Comparative Study of Three Palliative Radiotherapy Schedules in Locally Advanced Head and Neck Squamous Cell Cancer
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To evaluate and compare efficacy, tolerability, toxicity and QOL of three palliative radiotherapy schedules in incurable LAHNSCC.
Methodology: A total of 60 patients were randomized equally in 3 arms; Arm A [14.8 Gy/4 fractions @ 3.7 Gy /#, 2 fractions per day (6 h apart) for 2 consecutive days × 3 sessions at 3 weekly intervals]; Arm B [50 Gy/16 # /3.1 weeks @ 3.125 Gy /# @5#/week]; Arm C [20 Gy / 5 # @ 4Gy/# @5# /week X 2 sessions at 3weekly interval]. All the patients were assessed pre RT and at 1 month post RT.
Results: The baseline parameters were comparable in all three arms. In arm A, 15 patients; in arm B, 14; in arm C, 12 completed the intended treatment. The drop-out rate was 25%, 30% and 40%, respectively. Defaulters were excluded from the study. Mean ± standard deviation scores of individual domains of QOL (before and after radiation) were calculated. For pain pre-RT, these were 82 ± 29.1, 90.78 ± 26.6 and 85.25 ± 28.9, and one month post-RT, these were 14.5 ± 11.7, 13.5 ± 24.6 and 28 ± 21.9 in Arms A, B and C, respectively. Statistically significant improvement was observed in QOL. Scores of pain, appearance, activity, recreation, mood, anxiety, speech, swallowing and chewing in all the arms with partial tumour response in all arms. Arm B had complete nodal response in all patients, with Grade 3 mucositis in two patients.
Discussion: To the best of our knowledge, this is the second open-label, prospective, randomized interventional study comparing three palliative RT schedules for the management of LAHNSCC. RT with or without chemotherapy remains the mainstay of treatment. Because of advanced stage at the time of presentation, the local failure rates were as high as 50–70%, despite improvement in treatment strategies. Since the study included poor socio-economic status, comprising patients who could not afford costly palliative treatments, it might have confounded the results of QOL. As this study is an interim analysis and has a low sample size, this data needs to be confirmed on a larger multicentre trial with a larger subgroup of patients and a longer time scale of follow-up.
Conclusions: All QOL parameters were improved statistically in all the three arms. However, Christie arm had more symptomatic response for severe pain, swallowing, mood and anxiety, along with better loco-regional control and manageable toxicity. Although Quad shot is nowadays preferred for palliation of LAHNSCC for good LRC and QOL in less time, as per our study, Christie schedule can also be considered for adequate palliation.
Abstract ID: 85
Author ID: 10
Presenter Name: Garima Rawat
Affiliation: Dharamshila Narayana Superspecialty Hospital, New Delhi, India
Abstract Title: Head and Neck Myoepithelial Carcinoma: A Clinicopathologic Series
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: Myoepithelial carcinoma (MC) is a rare malignant salivary neoplasm exclusively composed of neoplastic myoepithelial cells with infiltrative growth. These tumors can arise de novo or from pre-existing pleomorphic adenoma. The parotid is the most common site among major salivary glands, followed by the minor salivary glands of the palate and nasal cavity.
Methodology: We conducted a retrospective analysis of six patients diagnosed with MC of the head and neck between 2020 and 2023. The primary treatment modalities comprised surgery, followed by post-operative radiotherapy or adjuvant chemotherapy.
Results: Our patient cohort consisted of five females and one male, of which three cases exhibited involvement of the parotid gland, while others affected the palate, sub-mandibular gland, and nasal cavity. Surgical intervention followed by adjuvant radiotherapy was the primary treatment approach for most patients, although one individual received neoadjuvant chemotherapy. The majority of cases were de novo occurrences, while two cases originated from a pre-existing benign pleomorphic adenoma. One of the cases presented with the second primary malignancy—squamous cell carcinoma of the buco-alveolar region. Each case underwent comprehensive histopathological evaluation supplemented by immunohistochemical analysis.
Discussion: Myoepithelial carcinomas exhibit a wide spectrum of cytomorphologic features and diverse clinical outcomes. Due to their morphologic heterogeneity, they are commonly mistaken for benign tumors such as pleomorphic adenoma and may be under-diagnosed. In this series, we underscore the significance of precise histopathological diagnosis, employing multidisciplinary treatment modalities, and meticulously planned surgical interventions aimed at achieving R0 resection, complemented by adjuvant radiotherapy.
Conclusions: Myoepithelial carcinoma in the head and neck is a rare entity, with approximately one-third of patients experiencing metastatic and progressive disease.
Abstract ID: 84
Author ID: 113
Presenter Name: Harsh Vyas
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Impact of Presence of Perineural Invasion as Prognostic Factor in Oral Tongue Cancer
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To compare the patients and disease-related characteristics and disease outcome between patients with PNI and without PNI in a large cohort of patients with OTC subsite. Endpoints for the study were locoregional control (LRC) and overall survival (OS).
Methodology: This was a retrospective study. Inclusion criteria were: Patients with localized and resected OTC who underwent upfront surgical resection and whose complete histopathological data were available between 2009 and December 2020. Exclusion criteria were: E
Results: There were 300 patients with PNI and 332 without PNI. There is large disparity in high-risk pathological features between patients with and without PNI. The five-year LRC of patients with and without PNI were 55.4% and 67.1%, respectively (p = .012). The five-year OS of patients with PNI and without PNI were 41.3% and 65.6%, respectively (p < .001). Multivariate analysis showed that only male sex, low resection margins, PNI, and ENE were significantly associated with poor LRC and that a high pN stage, tumor grade, high DOI, low resection margin, PNI, and ENE were significantly associated with poor OS.
Discussion: Studies have reported that PNI is associated with a pathologically advanced nodal stage, higher DOI, higher pattern of invasion, presence of ENE and LVI, and higher incidence of positive margins. These studies were conducted on a mixed population, including various subsites of head and neck cancer and in a small number of patients. The current study has extensively evaluated the association in a large cohort of patients with cancer only at the oral tongue subsite; it has highlighted a large disparity between patients with and without PNI with regard to high-risk pathological features. PNI is associated with high pT and pN stages, poor differentiation grades, close/positive resection margin, high DOI, LVI, and ENE positivity. This study validates locoregional failure as the predominant pattern of failure in patients with OTC. Prognostic factors for poor outcomes were age, sex, tumor grade, pT stage, pN stage, DOI, close/positive resection margin, LVI, PNI, and ENE. The LRC and OS were significantly better in patients without PNI than in those with PNI.
Conclusions: The incidence of PNI is very high in OTC. There is large disparity between patients with and without PNI with regard to high-risk pathological features. The LRC and OS were significantly better in patients without PNI than in those with PNI.
Abstract ID: 83
Author ID: 111
Presenter Name: Apoorva Nayak
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Surface Mould Brachytherapy of the Scalp in a Case of Squamous Cell Carcinoma—A Case Report
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To report on the treatment of squamous cell carcinoma (SCC) of the scalp with surface mould brachytherapy on an elderly frail patient at our institution.
Methodology: A 77-year-old female, a case of squamous cell carcinoma of the scalp, cT3N0M0 with a well-defined, plaque-like, superficial lesion, measuring 6 × 7 cm, in the right parietal region, was evaluated for feasibility of mould brachytherapy. The shape and superf.
Results: Radiotherapy was well tolerated by the patient with grade I dermatitis, which developed after the treatment completion. She has been on regular follow-up since then and has shown complete response on follow-up imaging.
Discussion: Surface mould brachytherapy is an effective treatment modality for localized skin cancers, including those affecting the scalp. This technique involves placing a customized mold directly onto the skin surface to deliver targeted radiation therapy to the tumor while minimizing damage to the surrounding healthy tissues. The mold ensures precise delivery of radiation to the treatment area, making it particularly suitable for irregularly shaped or curved regions like the scalp. Several studies have demonstrated the efficacy and safety of surface mould brachytherapy for scalp lesions. A study by Bradford et al. (2016) evaluated the outcomes of 101 patients with scalp lesions treated with high-dose-rate brachytherapy using customized molds. The results showed excellent local control rates with minimal toxicity, indicating the feasibility and effectiveness of this approach.
Moreover, a review by Bhatnagar and colleagues (2019) summarized various studies on surface mould brachytherapy for non-melanoma skin cancers, including those on the scalp. The review highlighted favourable outcomes in terms of tumor control and cosmetic results, emphasizing the importance of patient selection and mold customization for optimal outcomes.
Additionally, advancements in technology, such as three-dimensional (3D) printing, have enhanced the precision and customization of molds, further improving treatment outcomes and patient comfort. Studies exploring the use of 3D-printed molds in surface mould brachytherapy have reported promising results, with increased conformity to the treatment area and reduced radiation exposure to adjacent healthy tissues.
Conclusions: Surface mould brachytherapy is a feasible option in the case of squamous cell carcinoma of the scalp. Long-term follow-up and further clinical studies are required to implement this in routine clinical practice.
Abstract ID: 79
Author ID: 107
Presenter Name: Preetha Umesh
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Search for the Ideal Palliative Fractionation Regimen in HNC: A Single Institutional Experience
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: Head and neck cancers (HNC) comprise approximately 30% of total cancer burden in the Indian subcontinent, out of which a significantly large population is ineligible for definite treatment due to advanced nature of the disease at the time of presentation. Owing to large heterogeneity in HNC with respect to different subsites, modes of presentation, histologies and patterns of lymphatic dissemination, there is a lack of universal consensus on what should be considered as the ideal palliative fractionation regimen. This study reports a single institutional experience with treating palliative HNC patients with different fractionation schedules in order to evaluate their differences in progression free survival (PFS), overall survival (OS) and the level of symptomatic relief achieved by these fractionation schedules, which have been classified based on their EQD2 (equivalent dose in 2 Gy fractions).
Methodology: Between January 2019 and April 2023, 105 patients of HNC who were treated with palliative radiotherapy were included in this study. Use of chemotherapy in neoadjuvant, concurrent and adjuvant settings was allowed. Appropriate fractionation schedule of pall.
Results: For the purpose of survival analysis, the Mantel– Cox test was applied. The median PFS for Group A (EQD2 < 37.5Gy) was seven months (range: 5.2–8.7 months) and that for Group B (EQD2 > 42.2 Gy) was 15 months (range: 9.9– 20.0 months) with a significant p value of .045. The median OS for Group A was six months (range: 4.0–7.9 months) and for Group B was 13 months (range: 10.1–15.8 months) with a significant p value of .001. Regarding symptomatic improvement (till the point of progression), 80% of patients in Group B reported greater than 50% symptomatic relief from baseline, whereas only 48.6% of patients belonging to Group A reported this improvement. This degree of marked improvement shown by radiation schedules with EQD2 > 42.4 Gy was found to be statistically significant on chi square test with a p value of .002.
Discussion: In sync with our own results, past studies have also shown improved results with higher dose delivered per fraction for palliative purposes.
Conclusions: This study showed that fractionation regimens that deliver higher EQD2 show more promising results when it comes to providing sustained and significant improvement in symptoms caused by advanced stage of disease in HNC. Although short, hypo-fractionated regimens are convenient to administer when seen from a logistical point of view, they fall short in terms of the degree of response at the local site and poorer PFS as compared to their counterpart regimens delivering comparatively higher dose.
Abstract ID: 78
Author ID: 107
Presenter Name: Preetha Umesh
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Wide Histological Spectrum of Sinonasal Malignancies and Survival Outcomes: An Institutional Review
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: With recent advancements in our diagnostic capabilities, the range of histologies observed in sinonasal malignancies have increased manifolds. Elaborate immunohistochemistry and detailed microscopic examination have diversified our diagnosis, which were initially labelled as ‘poorly differentiated malignancy’. This review aims at understanding the different histologies observed over the past decade, their treatments and survival outcomes.
Methodology: The institutional database was reviewed from January 2010 to December 2020; 258 patients with sinonasal malignancy were identified. Sixty-two patients defaulted to treatment after their initial diagnosis. Analysis was calculated for 196 patients for whom d
Results: The majority of patients were male (65.8%), with tumours primarily located in the maxillary sinus (34.7%) and the nasal cavity (41.3%). Most of the patients presented with obstructive symptoms (34.2%), subsequent epistaxis (27%) and mass effect (27.5%). The analysis reinforced the incidence of multiple histologies in the paranasal location. Squamous cell carcinoma (SqCC) (39.8%) was the most common histology followed by small cell carcinoma (SCC) (15.3%) and adenoid cystic carcinoma (ACC) (11.2%). The median OS for SqCC and ACC was not reached. The median OS for SCC was 24.0 ± 3.9 (range: 16.3–31.6) months. The median LRFS for SqCC and adenocarcinoma was 52.0 ± 12.5 (range: 27.3–76.6) months and 50.0 ± 19.3 (range: 12.0–87.9) months, respectively. Tumours located in the maxillary sinus did fairly better with median OS and LRFS, 135.0 ± 49.7 (range: 37.3–232.6) months and 73.0 ± 13.3 (range: 46.7–99.2) months, respectively. Patients who had surgery incorporated in their treatment protocol did better (median OS 66.0 ± 14.5 (range: 37.5–94.4) months versus 46.1 ± 12.7 (range: 16.0–65.9) months).
Discussion: Surgery as a single modality of treatment has generally been associated with poor outcomes in terms of OS. Amendola et al. in a study of 39 patients treated with curative intent with surgery or radical RT found no statistical difference in OS five years after treatment with a survival rate of 31% and 35% for surgery alone and RT alone, respectively. Other studies have showed improved results with combined modality treatment, especially for maxillary sinus tumours. In a study on 61 patients by St Piere and Baker, 16% patients underwent surgery alone, 53% underwent definitive radiation and 31% received combined modality therapy (CMT). There was a trend for improved survival among patients who received a combination of both surgery and adjuvant radiation. Paulino et al. studied maxillary sinus tumours, where 23% patients were treated with definitive radiation alone and 77% with surgery followed by adjuvant radiation. Local control and disease-specific survival rates were both significantly improved in the combined modality arm at five years. Our study also showed no statistical association between nodal relapse and histology.
Conclusions: Paranasal sinus tumours are a heterogeneous group of histological tumours. Due to variable histology, no single treatment algorithm has been validated. Surgery is the mainstay of therapy for these patients, but a combination of radiation and chemotherapy improves end-point outcomes in advanced cases.
Abstract ID: 74
Author ID: 102
Presenter Name: Kratika Bhatia
Affiliation: Department of Radiation Oncology, RGCIRC, New Delhi, India
Abstract Title: Assessing Baseline Haemoglobin as an Independent Marker of Survival in Head and Neck Squamous Cell Carcinoma: An Institutional Review from a Tertiary Cancer Centre
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: Anaemia impedes treatment in 30% of cancer patients. Hypoxia affects tumour radio-sensitivity, while oxygen is crucial for preventing repair. Head and neck cancers, often hypoxic, provide an ideal setting to study hypoxia’s impact. This review evaluates how baseline haemoglobin (Hb) influences overall survival and relapse-free survival in radiotherapy-treated patients.
Methodology: The institutional database was reviewed from 2020 to 2022 for head and neck cancer patients undergoing definitive radiotherapy with or without chemotherapy. Of the 100 patients meeting inclusion criteria and providing complete data, baseline haemoglobin le
Results: Baseline and treatment characteristics were comparable between the two groups, except for clinical nodal staging, smoking and gender. The entire cohort had a median follow-up of 49 (range: 1–104) months. In arm A, the median OS was 70 months, while it was not reached in arm B (p = .044). Median RFS was 7 (95% CI 3.92–10.08) months and 50 (95% CI 6.36–93.64) months, respectively (p = .001). Logistic regression indicated that for each unit reduction in Hb, the odds of survival decreased by a factor of 0.231 (odds ratio 0.794; CI = 0.680–0.926; p = .003). Univariate analysis identified T staging, N staging, tobacco usage, smoking and Hb groups as significant predictors for RFS. However, only Hb group and N staging emerged as significant predictors for OS.
Discussion: This study explored the critical haemoglobin (Hb) threshold, revealing a significant impact on overall survival and progression-free survival (PFS) at 12.7 g/dL. Aligned with recent reviews and key trials, it underscores low Hb as an independent prognostic factor associated with inferior loco regional control in head and neck cancer. The optimal cutoff for anemia remains debated, ranging from 9 to 14.5 g/dL in previous studies, while international guidelines propose an Hb threshold of 12–13 g/dL. This study establishes a crucial threshold at 12.7 g/dL, refining our comprehension of Hb levels and survival outcomes in head and neck cancer patients during chemo radiation.
Conclusions: Low baseline Hb (less than 12.7 g/dl) is a poor prognostic marker for overall survival and relapse-free survival in HNC patients treated with definitive RT with or without chemotherapy. This easily accessible marker of systemic inflammation can guide clinical decisions on survival and recurrence, suggesting that addressing low hemoglobin is a cost-effective strategy for enhancing local control in HNC patients.
Abstract ID: 71
Author ID: 100
Presenter Name: Harsh Goel
Affiliation: Department of Research, All India Institute of Medical Sciences, New Delhi, India
Abstract Title: Genetic Alteration, RNA Expression, and DNA Methylation Profiling of LATS1 Gene in Head-Neck Squamous Cell Carcinoma
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: Oral squamous cell carcinoma (OSCC) is the sixth most prevalent type of oral neoplasm induced due to a wide range of genetic and epigenetic alterations. Large tumor suppressor gene (LATS1) is a tumor suppressor gene that suppresses tumor outgrowth by regulating cell proliferation, cell growth, and apoptosis. Therefore, in this study, we aim to investigate the expression, promoter methylation, and mutation status of LATS1 gene in head-neck squamous cell carcinoma (HNSC) and further distinguish its prognostic significance.
Methodology: We analyzed the expression, methylation, and mutation status of LATS1 genes from publicly available HNSC-TCGA (n = 523) dataset using cBioPortal. GEPIA2 was utilized to filter out the positively and negatively correlated genes with LATS1.
Results: Higher expression and lower methylation of LATS1 gene were observed in HNSC cases as compared with normal samples (p < .05). Our data revealed that 19 out of 50 patients (38.0%) were found to be methylated for LATS1 gene in HNSC patients. In mutation analysis, LATS1 gene was mutated in 29 out of 523 cases, in which approximately 6% H227Q, R767L, P192S, S1023C, D837H, and P375S missense mutations were commonly seen. RBM16, SHPRH, ASXL2, REST, and TAOK1 genes were positively correlated, while TIAF1, USMG5, ZNHIT2, UQCRQ, and ATPIF1 genes were negatively correlated genes with LATS1 expression in HNSC. WWNTR, YAP1, AMOT, SAV1, STK4, NF2, WTIP, and MOB1B were the most common genes involved with LATS1 PPI enrichment (p < .05). On gene ontology (GO) analysis, these PPI genes were enriched in cell differentiation regulation, hemopoiesis in biological process, protein serine/threonine kinase activity in molecular function, and Hippo signaling pathway in KEGG pathway analysis. Moreover, higher expression and lower methylation levels of LATS1 gene were found to be statistically significantly associated with patients consuming alcohol, chewing tobacco, and having a smoking history frequently (p value < .005). Poor overall survival was observed in HNSC patients having higher LATS1 expression as compared with patients having lower LATS1 gene expression (p = .21). Higher LATS1 gene expression was positively associated with tumor purity, B-cell, CD8+ T cell, CD4+ T cell, macrophage, neutrophils, and dendritic cells’ immune infiltration level in HNSC with (p < .001).
Discussion: Early estimation of LATS1 hypermethylation might allow the identification of subgroups of patients with poor diagnosis, who might require a diverse therapeutic strategy.
Conclusions: Higher expression of LATS1 gene in HNSC is correlated with poor prognosis. LATS1 gene plays a significant role in the diagnosis of cancer and may be a useful diagnostic biomarker.
Abstract ID: 69
Author ID: 26
Presenter Name: Madhav Kumar
Affiliation: Department of Biotechnology, Sharda University, Greater Noida, Uttar Pradesh, India
Abstract Title: Natural Compounds Nanoparticles for Diagnosis and Therapy in Head and Neck Cancer
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: To investigate the potential of natural compound nanoparticles (NCNPs) for both diagnostic and therapeutic applications in head and neck cancer Specifically, the objectives include synthesizing NCNPs, evaluating their efficacy in cancer cell targeting, assessing their diagnostic capabilities, and examining their therapeutic effects on head and neck cancer cells.
Methodology: NCNPs will be synthesized using biocompatible natural compounds known for their anticancer properties. The nanoparticles’ physicochemical properties, such as size, morphology, and surface charge, will be characterized using advanced analytical techniques.
Results: In vitro studies had revealed efficient cellular uptake and specific targeting of head and neck cancer cells by NCNPs. Furthermore, NCNPs exhibit diagnostic capabilities, allowing for precise imaging of cancer cells. In terms of therapy, NCNPs demonstrate significant cytotoxic effects, induction of apoptosis, and inhibition of cancer cell proliferation, indicating their potential as effective therapeutic agents for head and neck cancer.
Discussion: The findings suggest that NCNPs hold promise as versatile platforms for both diagnosis and therapy in head and neck cancer. Their ability to selectively target cancer cells while sparing normal tissues underscores their potential for minimizing off-target effects associated with conventional therapies. Additionally, the diagnostic capabilities of NCNPs offer opportunities for early detection and monitoring of disease progression. The multifunctional nature of NCNPs opens avenues for personalized and targeted treatment strategies in head and neck cancer.
Conclusions: This study demonstrates the feasibility and effectiveness of using natural compound nanoparticles for the diagnosis and therapy of head and neck cancer. These findings highlight the potential of NCNPs as valuable tools in the fight against this challenging disease, paving the way for further exploration and development of nanoparticle-based approaches in cancer management.
Abstract ID: 68
Author ID: 98
Presenter Name: Paramjeet Kaur
Affiliation: Department of Radiation Oncology, Pt BDS PGIMS, Rohtak, Haryana, India
Abstract Title: The Evaluate a Role of Pre-treatment Plasma Fibrinogen Biomarker as Prognostic Impact in Patients with Locally Advanced Head and Neck Carcinoma
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To determine the prognostic significance of pretreatment plasma fibrinogen in patients with locally advanced head and neck carcinoma in terms of pathologic grades, clinical stages, treatment response and disease-free survival.
Methodology: A total of 90 patients with locally advanced head and neck cancer during 2021–2023 were evaluated in this prospective randomized study. Histopathologically proven cases of squamous cell carcinoma of head and neck cancer with known value of pretreatment plasma fibrinogen tre.
Results: Most of the patients with high pretreatment plasma fibrinogen were elderly male, higher AJCC stage (73% vs 67%), high nodal disease (83% vs 70%), higher stages of presentation, poorly differentiated histology and poor disease-free survival (80.33% vs 65.67%) in comparison to low pretreatment plasma fibrinogen. No significant acute skin, mucosal or late skin toxicity was noted in both groups.
Discussion: The study showed the role of pretreatment plasma fibrinogen as a prognostic indicator in patients with head and neck cancer. The results are in accordance with similar studies reported by Selzer et al., Holzinger et al., Espeli et al. and Tsan et al.
Conclusions: Higher ranges of pretreatment plasma fibrinogen may present with higher stages and poor survival; hence, they might be considered as a negative prognostic factor in patients with locally advanced head and neck cancer.
Abstract ID: 66
Author ID: 97
Presenter Name: Rishabh Sachdeva
Affiliation: Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
Abstract Title: Predictors of Prognosis and Overall Survival in Pediatric Mucoepidermoid Carcinoma of Salivary Glands: A Systematic Review
Abstract Topic: Onco-pathology
Aims/Objectives of the Study: To assess the impact of different clinicopathological parameters on the prognosis and survival of mucoepidermoid carcinoma of salivary glands in the pediatric population.
Methodology: This systematic review was conducted according to the recommendations of PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) statement. Articles were searched from the following databases: Medline (by PubMed), Web of Science, and Scopus.
Results: A total of 1,813 articles were obtained; 41 were retrieved for full text screening and 21 articles were selected. Studies with similar methodologies and outcomes were categorized together. The following data were extracted: authors, design, methodology, outcome, statistical data, and conclusion. The results were pooled, and statistical mean values were obtained. A structured narrative synthesis of findings from all studies was prepared. The average risk of bias was low. Univariate and multivariate analyses showed the association of clinicopathological profile with survival and recurrence.
Discussion: Mucoepidermoid carcinoma is the most common salivary gland malignancy in children. Prognostic factors that were associated with poor survival outcomes were histological grade, TNM staging, and regional and distant metastasis. The predictors of prognosis and overall survival are therefore essential for proper treatment planning and post-treatment quality of life.
Conclusions: Clinicopathological parameters can be considered as valuable prognostic predictors of mucoepidermoid carcinoma of salivary glands in pediatric population.
Abstract ID: 65
Author ID: 95
Presenter Name: Sonalee Shah
Affiliation: Department of Dental Sciences, Government Dental College, Raipur, Chhattisgarh, India
Abstract Title: E-cadherin: An Orchestrating Biomolecule of OSCC
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: To compare and correlate soluble E-cadherin expression in the saliva of OSCC patients, OPMD patients and controls.
Methodology: 5 ml of unstimulated saliva was collected in a pre-marked sterile collection tube from 18 controls, 18 OPMDs and 18 OSCC patients. Samples were centrifuged at 3,000 rpm for 10 min at room temperature immediately, and the supernatants were stored at −20 °C.
Results:
The sE-cadherin of controls: Minimum 119.34 ng/ml; maximum 5,253.4 ng/ml
The sE-cadherin of OPMD patients: Minimum 198.10 ng/ml; maximum 7,882.6 ng/ml
The sE-cadherin of OSCC patients: Minimum 2,119.7 ng/ml; maximum 7,820.9 ng/ml
The difference between each group is statistically significant using both one-way Anova test and Turkey post hoc test for both absorbance and ng/mml values.
Discussion: The difference between all groups is statistically significant. We can infer that the knowledge about the value range of each group will help us to monitor at-risk groups and also probably adjudge the OSCC patients in the context of TNM staging and HP grading. Although our sample size was small, we could interpret and identify a probable range of disease-free group, questionable group, suspicious group and carcinoma group. In oral carcinoma and OPMD patients, E-cadherin’s immediate availability in soluble form is more likely to be in saliva. Our results prove our point that it can serve as a vital key in OSCC diagnostics.
Conclusions: An evaluation of the type of OPMD and its correlation with site and habit in a larger sample can give further insights into the efficacy of the estimation of this parameter for the diagnosis of cases most likely to undergo malignant transformation. A larger sample with simultaneous correlation with TNM staging and HP grading will give further insights into the usefulness of the estimation of this parameter in the saliva of OSCC patients.
Abstract ID: 63
Author ID: 92
Presenter Name: Hemant Nemade
Affiliation: Head and Neck Oncology Division, Department of Surgical Oncology, Basavtarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana
Abstract Title: Lost the Tongue, but not the Taste of Life: Long-term QOL Outcomes in Total Glossectomy Survivors
Abstract Topic: Quality of Life
Aims/Objectives of the Study: To evaluate the long-term QOL outcomes (both objective and subjective) of patients after total glossectomy.
Methodology: This was a cross-sectional study.
Results: 25 survivors were evaluated.
EORTC QLQ 30: higher global health status (M = 80), but issues in pain (M = 25), swallowing (M = 16) and speech (M = 22).
HN35 identified concerns in social eating and single-item problems.
Speech outcomes: 80% with moderate to severe intelligibility impairment.
Swallowing outcomes: None of them are tube dependent.
Special food preparation in 84%, aspiration in 24% and pharyngeal residue in 72%.
PROMs: mean SHI score of 32.5, with 68% experiencing speech and ability impairment.
Discussion: Global health status is high (80%).
Specific concerns: challenges in speech and swallowing.
Need for tailored support.
Conclusions: In spite of specific challenges, survivors have decent global health status. The findings underscore the complex challenges faced by survivors, emphasizing the importance of personalized treatment approaches and ongoing supportive care.
Abstract ID: 61
Author ID: 59
Presenter Name: Laboni Sarkar
Affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
Abstract Title: Clinical Characteristics, Outcomes and Decision-making in Older Indian Adults with Head and Neck Cancers Planned for Chemoradiation
Abstract Topic: Medical Oncology
Aims/Objectives of the Study: Radical treatment in older patients with head and neck squamous cell carcinomas (HNSCC) is complicated by several factors such as comorbidities, multiple concomitant medications, frailty and compliance issues. We aimed to evaluate the demographic, clinical, treatment characteristics and outcomes of patients with HNSCC planned for chemoradiation enrolled in our geriatric clinic and the role of the geriatric assessment in treatment decision-making.
Methodology: Patients aged over 60 years with locally advanced HNSCC planned for chemoradiation who were referred to the geriatric clinic in Tata Memorial Hospital, Mumbai, from June 2018 to June 2023 were identified from the clinic database.
Results: Between June 2018 and June 2023, 164 patients with HNSCC planned for chemoradiation after multimodality joint clinic discussion underwent geriatric assessment at our clinic. On geriatric assessment, 36/148 (24.3%) patients were vulnerable in the domain of function and falls, 41/84 (48.8%) in comorbidities, 88/148 (55.4%) in nutrition, 35.148 (23.6%) in psychological, 6/87 (6.9%) in cognition, 25 (11.8%) in polypharmacy and 8 (5.4%) in social domains. 28 (18.9%) patients were fit, with no vulnerabilities on GA, and 76 (51.4%) were frail, with two or more vulnerabilities. The median Cancer Aging and Research Group (CARG) risk score was 6 (IQR, 4–7), corresponding to a 44% predicted risk of grade 3 or higher toxicities from a combination chemotherapy regimen.
35 (21.3%) patients underwent radiotherapy alone after being deemed unfit for concurrent chemotherapy, 12 (7.3%) patients defaulted after initial evaluation and 117 (71.3%) patients ultimately received CTRT. Decision on chemotherapy regimen was made after awaiting geriatric clinic assessment in 99 (84.6%) patients. Among them, the tentative chemotherapy regimen was changed as per results of GA in 13 (13.1%) patients. Regimens used were cisplatin 40 mg/m2 weekly (37, 31.6%), docetaxel (31, 26.5%), nimotuzumab (17, 14.5%), cisplatin 100 mg/m2 thrice weekly (11, 6.7%), cisplatin with nimotuzumab (7, 5.9%), carboplatin alone (6, 5.1%) and cetuximab (2, 1.7%). 47 (40.2%) patients developed grade 3 or 4 toxicity, most commonly mucositis (44.1%), neutropenia (32.3%) and dysphagia (30.9%). Median progression-free survival (PFS) was 21.0 months, (95% CI: 15.5– 26.5 months), and median overall survival (OS) was 31 months (95% CI: 4.0–57.9 months). On Cox regression analysis, factors significantly associated with poorer PFS were vulnerabilities in the domain of nutrition (HR 1.6, CI 1.1–2.1, p = .003), higher CARG score (HR 1.8, CI 1.6–2.0, p = .029), abnormal G8 score (HR 1.4, CI 1.2–1.7, p = .013) and frailty (HR 1.8, CI 1.5–2.2, p = .001), and for poorer OS, there were higher CARG score (HR 1.3, CI 1.1–1.6, p = .04) and frailty (HR 1.3, CI 1.1–1.7, p = .025).
Discussion: 71.3% patients who planned to receive CTRT in the multidisciplinary clinic ultimately went on to receive concurrent chemotherapy after evaluation in the geriatric clinic. Vulnerability in the domain of nutrition, frailty, high CARG score and abnormal G8 score adversely impacted survival.
Conclusions: Geriatric assessment aids decision making in older patients with locally advanced head and neck cancers warranting chemoradiation. Vulnerabilities in geriatric domains have survival implications, and identification may help improve outcomes.
Abstract ID: 59
Author ID: 51
Presenter Name: Abhishek Arya
Affiliation: Department of ENT, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
Abstract Title: A Case Report on Juvenile Nasopharyngeal Angiofibroma
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To report a case of juvenile nasopharyngeal angiofibroma (JNA) in a 16-year-old male.
Methodology: A detailed history was taken, examination and investigations were performed, and surgery was carried out on the basis of diagnosis in Amaltas Institute of Medical Sciences, Dewas.
Results: A 16-year-old male with c/o bilateral nasal obstruction and intermittent headache was relieved by analgesics and on and off spontaneous epistaxis from the right nostril for three months. Mouth breathing was more during sleep. There was no external facial deformity. Oro-dental examination was normal. Vitals were stable. A white pale mass was seen arising from the left sphenopalatine foramen and extending to the floor of the nose inferiorly on endoscopy. CT revealed large isodense mass 6 (AP)5 (CC) × 36 (T). In post-contrast study, strong heterogenous enhancement was seen. Features were suggestive of JNA. Extension of mass in the left nasal cavity, oropharynx, left ethmoidal and sphenoidal sinus was seen. The patient underwent preoperative embolization and endoscopic removal of the mass under general anaesthesia 24 hours later. Histological findings were suggestive of nasopharyngeal tissue consistent with nasopharyngeal angiofibroma diagnosis.
Discussion: Adhikari et al. discussed that JNA occurs in males, 5–25 years old, and presents with nasal blockade and epistaxis; it is characterized by local invasiveness. The tumor may extensively involve the nasal cavity and paranasal sinuses and sometimes invade the skull base, as stated by Sánchez-Romero et al. As per Acharya et al., coronal CT provides good hard tissue imaging to show the invasion of cancellous bone of the sphenoid and in staging of tumour, peri-tumour anatomy and extension. Mair et al. stated that surgery is the mainstay of management.
Conclusions: JNA should be included in the differential diagnosis of an adolescent male presenting with nasal obstruction and epistaxis. Timely diagnosis greatly reduces surgical difficulty and possible complications.
Abstract ID: 54
Author ID: 71
Presenter Name: Monish Balaji S.
Affiliation: Medical Oncology, Government Kilpauk Medical College, Chennai, India
Abstract Title: Sarcomatoid Carcinoma of Buccal Mucosa: A Rare Case Report
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: To report a rare case of sarcomatoid carcinoma of the buccal mucosa treated in our institution.
Methodology: The patient’s details were obtained by detailed history taking and clinical examination as well as from case records of the patient.
Results: A 45-year-old male presented with a non-healing ulcer over the inner aspect of the left cheek for eight months. He was a known case of systemic hypertension and coronary artery disease complicated by heart failure. Examination revealed ulceroproliferative growth involving left buccal mucosa with no palpable lymphadenopathy. Biopsy findings directed towards either undifferentiated carcinoma or sarcoma. Immunohistochemistry testing led to a conclusion in favour of sarcomatoid carcinoma. Imaging showed soft tissue thickening involving the buccal aspect of left oral cavity opposite the left upper molar tooth. He was thus diagnosed as having sarcomatoid carcinoma of the oral cavity subsite left buccal mucosa cT3N0M0. In view of ejection fraction of 31% with severe left ventricular dysfunction on echocardiogram, he was deemed medically inoperable and was referred to the Medical Oncology Department for further management. He was treated with radiation therapy to the primary and neck nodes to a dose of 70 Gy/35#/2 Gy/# with five cycles of weekly intravenous 5-fluorouracil 500 mg and vincristine 2 mg in view of his cardiac status. Posttreatment, he was found to have progressive residual disease. He was deemed medically inoperable for salvage surgery, and thus, a plan of palliative systemic therapy was taken. He was started on palliative chemotherapy with oral methotrexate and celecoxib with erlotinib.
Discussion: Sarcomatoid carcinomas of the head and neck are a rare variant of squamous cell carcinoma, which evolve from conventional squamous cell carcinoma with dedifferentiation associated with sarcomatoid transformation. Their diagnosis can be challenging due to overlap with other spindle cell tumours in morphology and immunohistochemistry. However, an accurate diagnosis is of great importance as both management and prognosis vary. These have a conventional epithelial squamous and a sarcomatous spindle cell component on histopathology. Our patient’s age was 45, which is close to the fifth to seventh decade, where maximum incidence has been described. Our patient was male, which is in line with prior studies that describe a male preponderance. Tobacco and alcohol use play causative roles in the development of sarcomatoid carcinoma, and these were present in our patient as well. Our patient exhibited progressive disease that appeared to be refractory to the treatment given. This has again been described previously in literature.
Conclusions: Diagnosis of sarcomatoid carcinomas in the head and neck region is challenging due to overlapping histopathological features with other spindle cell tumours. Accurate understanding of their clinical, histopathological and immunohistochemical features with a systematic approach is crucial for correct diagnosis and treatment. In this patient, in addition to the dilemmas in diagnosis, treatment was rendered challenging due to the presence of significant comorbidity in the form of coronary artery disease with heart failure.
Abstract ID: 52
Presenter Name: Arun EJ
Affiliation: Department of ENT and Head and Neck Surgery, AIIMS, New Delhi, India
Abstract Title: Rhabdomyosarcoma of Temporal Bone: Into the Confirmation
Aims/Objective of the Study: Rhabdomyosarcoma (RMS) is a primitive form of soft tissue sarcoma, originating from primitive mesenchymal cells, primarily found in paediatric patients displaying a skeletal muscle phenotype . Typically diagnosed in children under six years old, the exact causes and risk factors of this malignancy remain largely elusive. While most cases are sporadic, certain instances are linked to familial syndromes. The diagnosis is often delayed and easily misdiagnosed as aural polyp. We have presented a rare case of RMS of left EAC.
Methodology: A 5-year-old boy who presented with complaints of alleged foreign body insertion in his left ear 10 days back which was apparently removed by self, but presented with complaints of recurrent left ear bleed, earache and intermittent fever.The mother also complaints of left sided headache and facial swelling in the child for the same duration. On examination, after clearing of the external ear blood clots, a friable looking polyp was found in his left EAC, which was bleeding on touch. He had incidental left eye squint to medial aspect, which raised suspicion further. Further clinical and endoscopic evaluation revealed left facial nerve palsy, left vocal cord palsy with other cranial nerve palsies.
Result: An HRCT temporal bone, CE-MRI head and neck and a WB-PET CT scan was done which all pointed to a large petrous apex neoplasm. A Left post-aural approach biopsy through trans-mastoid route was taken under GA and the histopathology came out to be Embryonal Rhabdomyosarcoma. The patient was referred to pediatric oncology where he was classified as a parameningeal RMS and is being planned for chemotherapy with VAC(Vincristine, Actinomycin D and cyclophosphamide) regimen with local radiotherapy.
Discussion: There has been no single large study featuring the condition and majority of the case reports published for rhabdomyosarcoma with middle ear as the location presented with palsy of 7th cranial nerve with either associated otalgia/ otorrhoea. One of the case described by Viswanatha et al had 6th cranial nerve palsy additionally where as the one by Salunke et al had hearing loss as additional presenting feature. The study candidate in our description have quite advanced disease diagnosed through a special trans-mastoid approach diagnostic algorithm
Conclusion: We have described the diagnosis of a rare case with myriad of symptoms on presentation and imaging findings to manage a challenging case in head and neck disease spectrum.
Abstract ID: 49
Author ID: 56
Presenter Name: Jaspreet Kaur
Affiliation: Department of Oral and Maxillofacial Surgery, Mohali, Punjab, India
Abstract Title: Navigating Sinonasal Carcinoma: A Case Study and Insight into Rare Neoplasm
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To present the case of a 61-year-old female who complained of pain, paresthesia, and ulceration on her left palate, which was suspected to be mucormycosis, but on investigations, it came out to be the sinonasal carcinoma.
Methodology: A 61-year-old woman with no history of chronic disease came to our department with the chief complaint of pain and paresthesia on the left cheek since seven months. The patient had been observing exfoliation of teeth since six months. =
Results: Left maxillary sinus is a site for presentation, and the patient underwent surgery and further investigations to rule out where it was metastasized, and the patient is undergoing further treatment.
Discussion: Malignancies of the sinonasal tract are rare. They account for less than 10% of head and neck cancers, with an annual incidence of 0.5– 1.0 per 100,000 people in the United States. The nasal cavity is by far the most common site for neoplasia of epithelial origin arising in this region, followed by the maxillary antrum and ethmoid air cells. Tumors of the frontal and sphenoid sinuses are exceedingly rare. However, the exact site of origin of many advanced tumors is often difficult to ascertain because of the anatomic contiguity of the paranasal sinuses and because a significant number of tumors may involve more than one site at the time of initial diagnosis. More than 80% of neoplasms arising in this region are of epithelial origin, and the remainder arise from the bone cartilage and soft tissues. Approximately 25% of all sinonasal tumors are benign. Benign epithelial neoplasms include squamous papillomas, inverted papillomas, adenomas, and other rare lesions. Squamous cell carcinoma is the most common malignant tumor, followed by carcinomas of minor salivary gland origin (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), melanoma, and esthesioneuroblastomas. Although they are rare, a wide variety of mesenchymal tumors can arise in the sinonasal cavity, including benign lesions such as osteoma, ossifying fibroma, fibromyxoma, and angiofibroma; malignant lesions such as chondrosarcoma and osteogenic sarcoma; and, less commonly, soft-tissue sarcomas. As with the remainder of the upper aerodigestive tract, smoking is a predisposing factor for the development of sinonasal squamous cell carcinomas. Moreover, squamous cell carcinomas may also develop from preexisting inverting papillomas in up to 10% of cases. Other etiologic factors for sinonasal malignant tumors include exposure to wood dust, nickel, and possibly chemicals used in leather processing, although the precise carcinogens have not yet been identified.
Conclusions: Further research is required as we have reported only one case here.
Abstract ID: 48
Author ID: 81
Presenter Name: Sunayana Misra
Affiliation: Department of Pathology, Surgical Pathology Division, Sir Ganga Ram Hospital, New Delhi, India
Abstract Title: Re-evaluation of Follicular Thyroid Lesions Based on WHO 2022 Criteria with Emphasis of Grey-zone Lesions
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study:
To reclassify thyroid nodules (TN) with follicular-patterned morphology according to WHO 2022 criteria, emphasizing on grey-zone lesions.
To differentiate the invasive encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) from infiltrative FVPTCs on histo-morphology with the aid of BRAFV600E immunohistochemistry (IHC).
To study the utility of CD56, HBME-1 and CK19 IHCs in distinguishing benign (and borderline) from malignant follicular-patterned TNs.
Methodology: Archives of histopathology department were searched for all thyroid specimens received from January 2020 to December 2023. Only those cases with dominant nodule(s) having predominant follicular-patterned histology were included. Demographic details, radiolog
Results: 79 cases met the inclusion criteria (age range: 16– 74 years; male–female ratio: 1: 3). On stringent review, a change in diagnosis due to interpretative errors was done in 11 cases, most commonly the follicular adenoma (FA) and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) categories. Reclassification of the lesions according to WHO 2022 criteria was done in four cases (FVPTC to IEFVPTC, widely invasive). FND (42%), NIFTP (12.6%) and FTC (15.2%) were the most commonly encountered benign, borderline and malignant entities. BRAFV600E IHC was positive in the two cases of infiltrative FVPTC, while it was negative in all nine IEFVPTCs. Diffuse, strong HBME1 expression was noted in a majority of malignant nodules (61%), while CD56 (30%) was more expressed in benign lesions (70%). CK19 was positive in lesions exhibiting nuclear PTC features (86%).
Discussion: Morphologic pattern recognition of TNs reflects specific molecular alterations categorizing these lesions. Molecular studies for BRAF and RAS mutations are required to distinguish morphologically overlapping cases. IHC for BRAFV600E and N-RAS may be employed as surrogate markers for molecular alterations in a limited resource setting. Thorough examination of the tumour capsule and careful search for nuclear features of PTC is imperative for accurate categorization of well-demarcated/encapsulated lesions. CD56 and HBME-1 in a panel may aid in distinguishing benign from malignant TNs.
Conclusions: Using WHO 2022 criteria, we were able to reclassify follicular-patterned thyroid lesions with greater confidence. The distinction between benign and borderline versus malignant lesions require understanding of diagnostic criteria, meticulous grossing as well as thorough evaluation of the histological findings. Use of IHC panel in adjunct to histology aids in categorizing histologically challenging cases.
Abstract ID: 47
Author ID: 69
Presenter Name: Archita Sood
Affiliation: Department of ENT and Head and Neck Surgery, GMC Jammu, Jammu and Kashmir, India
Abstract Title: Hemangiopericytoma of the Nasal Cavity
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To discuss a case hemangiopericytoma of the nasal cavity.
Methodology: This is a prospective case study of a 65-year-old male, who presented to our hospital with complaints of recurrent epistaxis. A/R showed a reddish mass obliterating the bilateral nasal cavity.
Results: CECT PNS revealed enhancing soft tissue lesion involving B/L nasal cavity, with the mass extending into the LEFT maxillary sinus through the medial wall. The patient underwent a diagnostic nasal endoscopy, from which biopsy was taken. Biopsy reported it as hemangiopericytoma of the nasal cavity. The patient initially refused for surgery in view of high risk of bleeding and underwent 25 cycles of radiotherapy. However, due to failure of radiotherapy, the patient finally underwent a successful transnasal excision for the same.
Discussion: Hemangiopericytoma is a rare tumour of the pericytes of the blood vessels usually affecting lower limbs, lungs, pleura, meninges, and pelvis. Hemangiopericytoma of the nasal cavity is very rare and can be easily misdiagnosed as some other soft tissue tumour.
Diagnosis is primarily based on histopathological studies, mostly showing the presence of vessel branching. Trans-endoscopic resection is the treatment of choice in cases where the tumour is localized to the nasal cavity, as indicated by CECT. Relevance of adjuvant radiotherapy is usually limited to prevent the risk of local recurrence.
Conclusions: It is usually the malignant type of HPC that requires wide local excision and has a high recurrence rate, but due to the indolent nature of the disease, all tumours should be treated as malignant type even when the suspicion is low.
Abstract ID: 46
Author ID: 40
Presenter Name: Gazala Shamim
Affiliation: Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India
Abstract Title: A Clinicopathological and Epidemiological Study of Oral Squamous Cell Carcinoma in a Tertiary Care Hospital
Abstract Topic: Diagnostics (Onco-pathology, Radiology)
Aims/Objectives of the Study: Squamous cell carcinoma is a well-known malignant tumor accounting for more than 90% of the oral cancers. These tumors have a multifactorial etiology with tobacco and alcohol consumption being the most determinant etiological factors.
Methodology: A retrospective study of 80 oral squamous cell carcinoma patients between January 2023 and January 2024 was carried out in the Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu. Clinical data were recorded.
Results: The prevalence of oral squamous cell carcinoma was significantly higher in males than in females. The most common site for oral squamous cell carcinoma was the tongue, and the most common histological subtype was conventional squamous cell carcinoma. Well-differentiated tumors comprise the largest number.
Discussion: The study assessed the clinicopathological and epidemiological characteristics of oral squamous cell carcinoma. Males comprised a majority of the sample with an M:F ratio of 4.3:1. This is consistent with certain European studies that reported a male dominance in patients with oral squamous cell carcinoma. As for age, most patients were more than 45 years old. The most common site of primary tumor in the current study was the tongue, followed by buccal mucosa, floor of the mouth, retromolar area, and lips.
Conclusions: In India, oral squamous cell carcinoma is on the rise with significant morbidity and mortality. Tobacco and alcohol use are the primary risk factors for oral cancer. Another significant risk factor for tobacco use is the smokeless variety, particularly for women. It is imperative to launch extensive educational efforts targeting tobacco usage, duration of tobacco exposure, and related variables in order to lower the incidence rates of oral cancer.
Abstract ID: 43
Author ID: 60
Presenter Name: Vaishnavi Vasant Kulkarni
Affiliation: Department of Radiation Oncology, MNJ Institute of Oncology and RCC, Osmania Medical College, Hyderabad, Telangana, India
Abstract Title: Squamous Cell Carcinoma of the External Auditory Canal in Previously Treated Case of Adenoid Cystic Carcinoma of Parotid Gland: A Rare Case Report
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To highlight the challenges in the diagnosis and management of primary SCC of the external auditory canal.
Methodology: A sixty-year-old female with a past history of adenoid cystic carcinoma of right parotid gland post superficial parotidectomy and post adjuvant radiotherapy in 2004; now with complaints of right ear discharge and earache of 6 months duration, on further detailed and systematic evaluation, revealed a mass lesion in the EAC with intra-temporal fossa extension which was confirmed to be SCC on biopsy.
Patient underwent surgical resection followed by adjuvant EBRT with VMAT technique to a total dose of 66Gy in 33 fractions; 2 Gy per fraction, 5 fractions in a week.
Results: The patient tolerated radiotherapy well and is planned for response evaluation.
Discussion: SCC of EAC are rare tumours. These are usually misdiagnosed in the early stages as benign disease owing to the similarity of symptoms, and due to the complex anatomical location and their invasive nature, advanced diseases have poor prognosis.
Due to the rarity of the disease, current guidelines are based largely on literature; thus, the level of evidence in the management is weak and hence requires a multimodality approach.
Conclusions: This case report emphasizes the need for a high index of suspicion and multidisciplinary approaches, which can lead to early diagnosis and potentially improve outcomes for the patient.
Abstract ID: 40
Author ID: 72
Presenter Name: Niharika Oza
Affiliation: Department of ENT at Dr. M. K. Shah Medical College & Research Centre, Ahmedabad, Gujarat, India
Abstract Title: Our Experience in Nasolabial Flap Reconstruction in Oral Cavity Cancer
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To study various types of defects for which the flap can be used and its associated complications.
Methodology: This was a prospective observational study done over a period of 1.5 years from January 2022 to June 2023 at the Department of ENT at Dr M. K. Shah Medical College and Research Centre, Ahmedabad. A total of 20 patients were included in this study.
Results: The cosmetic and functional results were good in all patients. Out of 20 patients, 1 patient had flap failure. No patient had trismus, wound infection or nodes failure.
Discussion: Nowadays, there is a general consensus about this flap viability that it exceeds 90%. The reason for high survival rate of nasolabial flap is good vascular supply. It is good for small and intermediate intraoral defects. The blood supply is mainly attributed to facial artery and blood vessels in the subdermal layer. Inferiorly based flap is most commonly used. Flap survival also depends on early recognition of ischemia or necrosis.
Conclusions: Small or medium-sized intraoral defects can often be accomplished with the nasolabial flap. The rich vascular supply contributes to the success of this reconstructive technique, allowing for efficient single-stage closure.
Abstract ID: 39
Author ID: 72
Presenter Name: Meshwa Pankajkumar Oza
Affiliation: Department of ENT, Dr M K Shah Medical College & Research Centre, Ahmedabad, Gujarat, India
Abstract Title: A Case Study of Surgical Management of Mandibular Ossifying Fibroma
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To obtain knowledge about clinical features, radiological findings and surgical findings in a patient with ossifying fibroma of mandible.
Methodology: We managed an 11-year-old female patient having swelling over the lower side of the left cheek. On further examination, it was found to be ossifying fibrous lesion of ramus and body of mandible. The lesion in our case was an isolated one.
Results: For large mandibular ossifying fibroma, surgical treatment is essential for removal of the disease as well as for improving the aesthetics of the patient.
Discussion: Osteomas are benign, slow-growing, well-defined osteogenic lesions developing from mature bone. They are characterized by the proliferation of compact or cancellous bone. Osteomas are most commonly found in the skull and facial bones. The etiology of osteomas remains unknown. Trauma, inflammatory or infectious processes are the causes commonly cited in the literature. Some authors consider such lesions as true neoplasms, while others classify them as developmental anomalies. Osteomas are usually asymptomatic, and they are detected during routine radiographic examinations, unless they become large enough to cause facial asymmetry or functional impairment.
Conclusions: Mandibular osteomas are rare, radio opaque bony lesions, which may rarely show malignant transformation. If not treated surgically, follow-up every six months is advisable.
Abstract ID: 38
Author ID: 63
Presenter Name: Rajasree S. R.
Affiliation: NMCH AMU, Aligarh, Uttar Pradesh, India
Abstract Title: To Determine the Survival Benefit of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy (CRT) Compared to Concurrent Chemoradiotherapy (CRT) Alone in Head and Neck Carcinoma (HNC) Patients Undergoing Curative Treatment: Clinical Audit at a Tertia
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: To compare five-year disease-free survival and overall survival in head and neck squamous cell carcinoma patients who had undergone induction chemotherapy followed by concurrent radiotherapy (CRT) versus those who underwent concurrent chemoradiotherapy alone.
4. To compare the response of induction chemotherapy followed by CRT to that of definitive CRT alone.
Methodology: We retrospectively evaluated 400 patients’ records. Patients were divided into two arms—those who received definitive CRT (Arm A; 212 patients) and those who received ICT followed by CRT (Arm B; 188 patients). Patients in Arm A received concurrent CRT with
Results: In Arm A, 49.2% of the patients achieved complete treatment response, while in Arm B, it was 44.8%. Partial treatment response in Arm B was 38.46% versus 49.2% in Arm A after initial assessment. The five-year overall survival in Arm A was 36% versus 23% in Arm B, with p value being significant (<.001), whereas the five-year disease-free survival was 31.1% in Arm A and 15.2% in Arm B (p value <.001).
Discussion: Definitive CRT was superior in terms of five-year overall survival and disease-free survival. So induction chemotherapy should be used judiciously in HNC patients before CRT. Inferior results may be due to increase of overall time of treatment, tumour repopulation or chemo-related toxicities, etc. More prospective studies should be done on this topic.
Conclusions: According to this study, definitive CRT was superior in terms of five-year overall survival and disease-free survival. More prospective studies should be done on this topic.
Abstract ID: 33
Author ID: 68
Presenter Name: Tejansh Sharma
Affiliation: Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
Abstract Title: Retrospective Study of Carcinoma Oral Tongue Patients Treated at Tertiary Care Cancer Centre
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study: The present study describes the patient’s clinical profile and treatment outcomes of carcinoma oral tongue (anterior–lateral) patients treated at a tertiary care cancer centre in India.
Methodology: A retrospective study of cases of carcinoma tongue patients treated with radical surgery, followed by adjuvant chemo-radiotherapy at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, from 2015 to 2016 was carried out.
Results: The mean age of the patients was 48 years. Males and females constituted 74.5% and 25.5% of the cases, respectively. 33.3% and 29.4% patients presented with stage II and I, respectively. Neoadjuvant chemotherapy was given in 5.8% cases. Wide excision with neck dissection was done in all cases. MND and SOHND were done in 70.5% and 21.5% cases, respectively. Bilateral neck dissection was done in 5.8% cases. Mean pT size was 2.5 cm (range 1– 5 cm), mean DOI was 9 mm (range 3–20 mm), LVI was seen in 15.7% cases, PNI was seen in 27.4% cases, cut margins were positive in 2% cases and mean closest cut margin was 2 mm (range 1–3 mm). Most patients had pN0 neck 58.8% followed by pN1 23.5%. Concurrent chemotherapy was given in 58.8% cases. Indication of concurrent chemotherapy was cut margin positive cases, PNE positive cases and other high-risk features in HPR. Radiotherapy doses were 56–66 Gy in 27–33 fractions over 6–7 weeks. 51% patients completed radiotherapy without any gap/break. 49% patients had mean 3.56 days’ gap during radiotherapy. 33.3% patients were treated with rapid arc technique and 23.5% patients with 3-DCRT technique. The mean number of concurrent cisplatin weekly chemotherapy cycles was 5. 19.6% and 11.7% patients had severe xerostomia and subcutaneous fibrosis toxicity. The median follow-up period was 44 months (range 1 month to 108 months). Loco-regional recurrence rate was 25.5%. 4% patients developed distant metastasis. Five-year disease-free and overall survival was 77.1% and 95.8%, respectively.
Discussion: In their study, Ronika Devi Ukrani et al. found disease-free survival of 59.2% at five years and overall survival of 60.7% at five years. In another study done by Kanika Sharma et al., it was found that five-year OS was 66.6% and LRC was 58.3%.
Conclusions: The result of our study parallels that of the various published retrospective reviews. Radiotherapy as an adjuvant treatment is effective for oral tongue cancer patients with acceptable toxicities. Most failures were infield failures. Further clinical studies are necessary to improve the outcomes of patients with high-risk features.
Abstract ID: 32
Author ID: 48
Presenter Name: Arun E. J.
Affiliation: Department of ENT and Head and Neck Surgery, AIIMS, New Delhi, India
Abstract Title: Comparison of Suction Versus Microdissection Method for Harvesting Supporting Cell from Inner Ear
Abstract Topic: Basic/ Translational Research
Aims/Objectives of the Study: Deafness is a large burden of morbidity; around 466 million people worldwide have disabling hearing loss and nearly 34 million of these are children. Supporting cells in the cochlea, including Hensen’s cells, Deiters’ cells, inner and outer pillar cells, Claudius cells and inner supporting cells, have been reported to have some self-regenerating capacity in studies done on avian inner ear cells. We propose a novel method to isolate the human inner ear tissue for extracting supporting cells from inner ear, the suction method through round window in comparison to the microdissection method.
Methodology: This study was done at AIIMS, New Delhi, from January 2022 to December 2023 at the Department of Otorhinolaryngology, Head and Neck Surgery in collaboration with the Department of Biochemistry and Forensic Medicine. The sample was collected from five cadavers.
Results: The mean number of cells extracted by the microdissection method was 92,986.33 (21,059.6 SD) and median was 81,595 (75,289–120,945 min–max). The mean number of cells extracted by the micro-suction method was 6,925.5 (4,219.547 SD) and the median was 6,768 (754 min–12,463 max). The p value obtained was .0022, which was found to be statistically significant.
Discussion: A few studies have been discussed related to cell extraction, but ours is a novel study in human inner ear cadavers.
Conclusions: The dissection method of supporting cell isolation from human inner ear cadavers was found to be a superior method than the micro-suction method. However, more studies are required to establish definitive evidence.
Abstract ID: 29
Author ID: 65
Presenter Name: Monika
Affiliation: Centre of Excellence in Virology and Immunology, Sharda University, Greater Noida, Uttar Pradesh, India
Abstract Title: Correlative Study on Late Proteins of Epstein–Barr Virus (EBV) with Prospective Oral Carcinoma: Development of Determinants and Predictor of Virus-induced Carcinoma.
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: Oral cancer is the sixth most common type of cancer worldwide leading to death. It is considered to be one of the subclasses of head and neck malignancy. One of the prominent causative agents of oral cancer are viruses, which account for 15–20% cancers all over the world. The Epstein–Barr virus, which belongs to the Gamma herpes virus family, has been reported to reside for a lifetime in the oral cavity and can be transmitted through the saliva to another person. The present study was done to investigate the association of the Epstein–Barr virus proteins with oral cancer.
Methodology: We have undertaken molecular studies to look for the expression of the major capsid protein (MCP) encoded by BCLF1 in saliva samples of patients. The primers for the BCLF1 gene were designed in silico and then synthesized commercially by M/S Eurofins.
Results: Of the 50 patients studied, 47 were male and 3 were female. The gel images showed the presence of BCLF1 gene in 11 (22%) out of the 50 patients.
Discussion: The Epstein–Barr virus consists of early and late proteins. While early proteins are responsible for entry and survival inside the host, the late protein genes are responsible for the formation of viral structures such as capsid, glycoproteins and viral antigens. The late viral structural protein gene includes BCLF1, BDLF1, BOFR1, BFRF3, BVRF2, BdRF1, BBRF1 and BVRF1. Late gene expression has been reported to cause oral carcinoma; however, the experimental evidence to prove this are yet to be generated. Available literature suggests that the expression of BCLF1 genes supports the evidence of the role of EBV late protein activity in carcinogenesis for developing possible prediction of prospective oral cancer. The present study undertaken on this aspect indicated the confirmatory role of BCLF1 gene presence in the progression of oral cancer.
Conclusions: The presence of this late gene, that is, BCLF1, indicates the activation of virus and its possibility of targeting the p53 gene, the tumor suppressor gene, to cause cancer of the oral region.
Abstract ID: 28
Author ID: 62
Presenter Name: Priyanka Iyengar
Affiliation: Department of Radiation Oncology, Bhagwaan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
Abstract Title: Prospective Randomized Trial to Assess the Effect of Megestrol Acetate on Weight Loss During Concurrent Chemo-radiotherapy in Patients with Locally Advanced Carcinoma Oropharynx, Larynx and Hypopharynx
Abstract Topic: Radiation Oncology
Aims/Objectives of the Study:
To study the role and efficacy of megestrol acetate (MA) in limiting weight loss during concurrent chemo-radiotherapy in patients with locally advanced carcinoma oropharynx, larynx and hypopharynx.
To compare radiotherapy-induced toxicity in the form of oral mucosi.
Methodology: This is a prospective randomized control trial with the primary objective to compare the weight loss between the study group (MA) and control the group (without MA).
Results: A total of 60 patients were enrolled in the study. The mean age of all subjects was 55.12 ± 8.98 years, with the male:female ratio of 9:1. The mean weight of subjects declined in both groups; however, no significant difference was noted at any follow-up. No significant difference was seen in weekly weight change among both groups. No significant difference was seen in the frequency of grade 3 mucositis or dysphagia or dermatitis in both groups. No significant difference was seen in the albumin level in both groups. No significant difference was seen in change in BMI or MUAC in both groups.
Discussion: MA may act as both a progestational agent and an anti-inflammatory/glucocorticoid agent. It down-regulates IL-6 production also. The evidence about the supportive effect of MA as an appetite stimulant in head neck cancer patients during chemotherapy and radiotherapy is not clear. A randomized trial is required to establish the role of MA in head neck cancer patients during chemo-radiotherapy. In a randomized study by Farmer et al., the authors found that MA significantly reduces weight loss in lung and head and neck cancer patients during chemo-radiotherapy. In a randomized trial by McQuellon et al., the authors found that patients in the MA group had a mean weight loss over 12 weeks of 2.7 pounds, whereas the placebo group had a mean weight loss of 10.6 pounds during radiotherapy of head neck cancer and thorax. The authors concluded that MA used pro-phylactically is useful as an appetite stimulant. It can help patients maintain weight over the course of curative radiotherapy of the head and neck or lung and can improve specific aspects of QOL.
Conclusions: In our study, MA has shown no effect in weight gain in head and neck cancer patients. Overall, no significant toxicity was seen in patients who took MA.
Abstract ID: 27
Author ID: 4
Presenter Name: Radhika Bakshi
Affiliation: Department of ENT and HNS, SMGS, GMC, Jammu, Jammu and Kashmir, India
Abstract Title: Clinicopathological and Radiological Correlation of Cervical Lymph Node Metastasis in Head and Neck Malignancies—A Prospective Analysis
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To compare the diagnostic accuracy of clinical palpation and computed tomography scan of the cervical lymph nodes with cytology for the evaluation of lymph node metastasis.
Methodology: Sixty consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy at the Department of ENT & HNS at SMGS, GMC Jammu. Every patient was subjected to clinical examination for cervical lymph node metastasis.
Results: It was observed that clinical examination was least sensitive (82.9%) when compared with ultrasonography (97.8%) and computed tomography (93%). Computed tomography was found to be most specific (84.6%) when compared to clinical examination (69.2%) or ultrasonography (70%).
Discussion: The appropriate diagnosis of the presence of metastatic node is very important for the management of head and neck cancer. The possibility of early detection and treatment of head and neck cancer shows great potential for improving the quality of life for these cancer patients and a better prognosis. On comparing the results of the three diagnostic modalities—clinical examination, ultrasound and computerized tomography—we found that both ultrasound and computerized tomography were better than clinical examination for the assessment of cervical lymph node metastasis.
Conclusions: It is concluded that out of three diagnostic modalities used in this study, ultrasound had the highest sensitivity, which was followed by computed tomography. Clinical examination alone appeared inaccurate and inadequate method for the diagnosis of metastatic neck node. It is concluded that in the evaluation of cervical metastasis, clinical examination must be supplemented with ultrasound and computed tomography.
Abstract ID: 24
Author ID: 58
Presenter Name: Deepanshi Gahlaut
Affiliation: Department of ENT, GMC, Jammu, Jammu and Kashmir, India
Abstract Title: Hurthle Cell Adenoma of Thyroid and Recurrent Ameloblastoma of Mandible
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To study a case of Hurthle cell adenoma of thyroid and recurrent ameloblastoma of mandible.
Methodology: This was a prospective study. Ameloblastoma is an aggressive tumor mainly in the oral and maxillofacial region formed from odontogenic epithelium with a fibrous stroma devoid of ectomesenchyme. The global incidence was 0.5 cases/million/year but local recurre.
Results: Hemi-mandiblectomy of the right side of the mandible done and reconstruction plate with TMJ condylar head fixed. Right hemithyroidectomy of the patient was done, and the dissected thyroid tissue was sent for HPE. The patient recovered uneventfully and was kept on regular follow-up.
Discussion: Though the recurrence of ameloblastoma is rare but it can still be possible. The main treatment modalities for ameloblastoma treatment include conservative surgical enucleation, radical surgery, bone curettage, electrocautery, radiation therapy or a combination of radiation and surgery. Preoperative diagnosis of Hurthle cell neoplasm is often difficult due to the atypical performance of various imaging examinations. The misdiagnosis rate of Hurthle cell neoplasm of the thyroid is high because it is easily confused with nodular goiter and other thyroid tumors. They also tend to undergo spontaneous necrosis or show extensive degenerative necrosis following fine-needle aspiration biopsy.
Conclusions: Early diagnosis and surgical resection with negative margins is the preferred approach for the treatment of ameloblastoma. Drugs against proto-oncogenes are also developing as modern alternatives to surgery. Histopathology remains the gold standard for the diagnosis of Hurthle cell tumors. Surgery (lobectomy for adenoma and complete thyroidectomy for carcinoma) still remains the preferred treatment.
Abstract ID: 21
Author ID: 53
Presenter Name: Varsha Rathi
Affiliation: Department of ENT and Head and Neck Surgery, MGMMC and MYH, Indore, Madhya Pradesh, India
Abstract Title: Comparative Study of Histopathologically Proven Supraglottic Squamous Cell Carcinoma for Primary Surgery vs Primary Radiotherapy
Abstract Topic: Basic/Translational Research
Aims/Objectives of the Study: To compare outcomes of primary treatment as surgery or radiotherapy, in proven cases of supraglottic squamous cell carcinoma.
Methodology: 50 cases of histopathologically proven supraglottic squamous cell carcinoma were selected. The patients were divided into Group A (who underwent primary surgical treatment) and Group B (who underwent primary radiotherapy) randomly.
Results: In Group A, patients showed high initial control rate, while this was gradual in Group B. At the end of two weeks, the mean fundamental frequency significantly increased in Group A, while this was gradual in Group B with less increase of mean fundamental frequency at the end of three months. The maximum phonation time and mean harmonic noise ratio increased post-operatively in Group A, while in Group B this increase was gradual.
Discussion: In this study, Group A underwent primary debulking microlaryngeal surgery, while Group B underwent 25 cycles of radiotherapy. After the completion of the treatment, the patients were followed postoperatively at an interval of two weeks, one month and three months, using videostroboscopy. Also a one-year follow-up was done for any recurrence. At the time of follow-up, the groups were compared on the basis of any residual growth. In Group A, patients showed high initial control rate, while this was gradual in Group B. At the end of two weeks, the mean fundamental frequency significantly increased in Group A, while this was gradual in Group B with less increase of mean fundamental frequency at the end of three months. The maximum phonation time and mean harmonic noise ratio increased postoperatively in Group A, while in Group B, this increase was gradual.
Conclusions: Based on our data and the literature, early supraglottic carcinomas may be treated successfully with supraglottic debulking surgeries or radiotherapy. Supraglottic debulking surgeries probably produce a higher initial local control rate, but, based on anatomic and coexisting medical constraints, it is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy. If further compared debulking surgeries if followed with radiotherapy have a higher success rate, when compared with those who underwent surgery or radiotherapy alone.
Abstract ID: 20
Presenter Name: Varsha Rathi
Affiliation: Department of ENT and Head and Neck Surgery, MGMMC and MYH, Indore
Abstract Title: Management of a Rare Case of Myofibroblastic Tumor
Aims/Objective of the Study: The present study was undertaken for the management of a smooth growth over left lateral border of tongue.
Methodology: A 45-year-old man was referred to our OPD with a painless, pediculated large mass on the left side of the tongue. The lesion grew rapidly within 3 months. Oral examination revealed an approximately 5*5 cm, firm, pediculated mass on the left side of the tongue. There was no regional lymphadenopathy, rest of physical examination was reported to be normal. There was no significant past history. The patient used to have tobacco, one pocket per day since 5 years and smoking weed since 10 years.
Result: Complete laser excision of the growth using diode laser.
Discussion: There are cases of IMT that clinically and radiologically may simulate malignant tumors, but the bland histologic appearance of proliferating spindle cell and plasma cell rich inflammatory background is characteristic. The neoplastic behavior is reflected by some cytogenetic and immunofluorescence aberrations, especially chromosome 2p23 involving the Anaplastic Lymphoma Tyrosine Kinase (ALK) receptor and its fusion with clathrin heavy chains. Cytogenetic and molecular studies point to the possibility that some subsets of IMTs are in fact true monoclonal neoplasms and are also invasive and locally recurrent.
Conclusion: H and E-stained section showed non-encapsulated mass composed of connective tissue stroma with diffuse and focal infiltration of lymphocytes, plasma cells and histiocytes. Focal areas of inflammatory cells were seen gathered around blood vessels and forming germinal centers. Spindle-shaped cells were seen interspersed in the connective tissue.
Abstract ID: 17
Author ID: 43
Presenter Name: Tanha Zarin Naaz
Affiliation: Department of ENT, Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra, India
Abstract Title: Prevalence of Carcinoma of Tongue in Tertiary Care Hospital
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: To evaluate the association of risk factors with tongue cancers.
Methodology: All patients who reported at the ENT department diagnosed with carcinoma of the tongue at Pravara Medical College were included in the study. The patients either came to department directly or were referred from other departments and other hospitals.
Results: A total 10 patients were treated at the Department of ENT, Pravara Medical College and Hospital, from December 2022 to December 2023. The following observations were made. Among the total 10 cases of tongue cancer, the maximum number of cases occurred in fourth to sixth decades of life accounting for 60% of the cases. Of these, males pre-dominate and constituted 70% of cases. The male:female ratio was 3:1.
Discussion: Regarding the site of cancer, 80% cases had cancer in oral (anterior) tongue and 20% cases were found to have lesion in the posterior tongue. 70% of the cases were T3 and T4 lesions.
Conclusions: Association of smoking and alcohol is 40%; tobacco chewing 50%; and pan masala 10%.
Abstract ID: 16
Author ID: 45
Presenter Name: Rohan Jacob Verghese
Affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
Abstract Title: Impact of Neo-adjuvant Chemotherapy in Borderline Resectable Oral Cancers: An Analysis of Long-term Outcomes
Abstract Topic: Medical Oncology
Aims/Objectives of the Study: To analyse the outcomes at 10 years in patients who underwent neo-adjuvant chemotherapy (NACT) for borderline resectable oral cavity squamous cell carcinomas (OCSCC).
Methodology: This was a retrospective analysis of a prospectively collected dataset of borderline resectable OCSCC patients who received NACT. Adult patients with an eastern co-operative oncology group (ECOG) performance status (PS) 0–2 who were deemed as borderline r
Results: 3,266 patients were analysed. Buccal mucosa (54.7%) was the most common sub-site, followed by tongue (30.4%) and alveolus (7.9%). Oedema reaching up to zygoma (42.2%) was the most common indication for NACT followed by the involvement of hyoid bone (22.6%) and high infra-temporal fossa (ITF) involvement (11.5%). The most common NACT was docetaxel-cisplatin (DC1) (50.2%) followed by docetaxel-cisplatin-5-fluorouracil (DCF1) (29.0%) and paclitaxel-carboplatin (PC) (13.3%). Three hundred sixty-one (11.1%) patients could not complete the planned NACT cycles. Nine hundred twenty-nine (28.4%) patients underwent surgery followed by adjuvant CTRT (26.7%) or adjuvant RT (1.3%); 13.1% underwent definitive CTRT, 35.8% received palliative chemotherapy, while 11.7% defaulted for definitive treatment. 29.3% of patients who received two drug regimens underwent surgery as compared to 37.1% of those who received more than two drugs. Seventy-six (8.2%) patients attained pathologically complete response, 871 (93.8%) achieved negative margins, while 338 (36.4%) had extra-nodal extension. Patients who received a two-drug regimen had a median OS of 7.5 months (95% CI: 7.1–7.97 months), while those who received more than two drugs had a median OS of 13.2 months (95% CI: 12–14.4 months). The 10-year OS for regimens with more than two drugs was 21% (95% CI: 17.4%–24.9%) vs 5.14% (95% CI: 3.28%–7.6%) for two-drug regimens (p < .001). The patients who underwent surgery had a 10-year OS of 21.8% vs 4.1% in those who did not (p < .001).
Discussion: Patients who received two-drug NACT regimens had a significantly lower median OS and 10-year OS compared to those who received more than two drugs. Less than one-third of patients underwent surgery after completing NACT. A higher proportion of patients who received more than two drug regimens underwent surgery as compared to those who received two-drug regimens. Overall survival at 10 years was significantly higher in patients who underwent surgery as compared to those who did not.
Conclusions: NACT with regimens containing more than two drugs significantly improved overall survival at 10 years as compared to two-drug regimens in borderline resectable OCSCC.
Abstract ID: 10
Author ID: 22
Presenter Name: Atul Kumar Gupta
Affiliation: Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
Abstract Title: Induction Chemotherapy: Hope or Hype in Head and Neck Cancer—An Audit from Institute of National Importance in Western Rajasthan
Abstract Topic: Medical Oncology
Aims/Objectives of the Study: To study the impact of induction chemotherapy on survival in patients with head and neck cancer.
Methodology: The records of head and neck cancer patients who received definitive/adjuvant radiotherapy in our department from 2018 to 2020 were compiled, and various factors associated with the outcome were assessed.
Results: A total 130 patients with proper records were taken into consideration. The mean age of presentation was 52 years (95% CI ranging from 50.07 to 54.87 years), males were predominant, 85 patients (65%) had oral cavity, 15 (10%) had pharyngeal subsites, 20 (15%) had laryngeal subsites, 15 (11%) presented with stage I, 20 (15%) presented with stage II, 19 (14%) presented with stage III, 74 (56%) presented with stage IVA and 2 (2%) presented with stage IVB. Out of 130 patients, 36 (28%) received induction chemotherapy, out of which 25 received doublet chemotherapy while 11 received triplet chemotherapy. In surgically resectable oral cavity tumours, 12 patients received neo-adjuvant chemotherapy, out of which 10 (83%) received for downstaging while 2 (17%) received due to logistic issues.
Survival analysis of the patients with operable oral cavity cancer who received NACT or who underwent upfront surgery was done using Kaplan–Meier analysis, and median OS was found to be 25 months in the NACT arm vs 14.9 months in the non-NACT arm (p = .01).
In all operable patients who received NACT vs who underwent upfront surgery, median OS was found to be 25 months in the NACT arm vs 19.8 months in the non-NACT arm (p = .08).
In pharyngeal tumours that got treated with radical RT alone or CTRT, median OS in the RT-alone arm was found to be 13 months, 14 months in the CTRT arm, while 17 months in the NACT f/b CTRT arm (p = .07).
In patients receiving definitive RT/CTRT, median OS was found to be 14.01 months in the NACT arm vs 14.6 months in the non-NACT arm (p = .11).
Overall, in all HNC subsites, the median OS was found to be 17 months in the NACT arm vs 20 months in the non-NACT arm (p = .76).
Discussion: NA
Conclusions: In a country like India, where head and neck cancers are quite common and mostly present in a locally advanced stage, induction chemotherapy seems to be a valid option helping in downstaging of the disease and filling the gap between patient presentation and its definitive management by either surgery or definitive radiotherapy with good tolerability in good PS patients. However, its effect on survival outcome is still debatable, which needs to be confirmed in further large-scale trials; NACT can be offered to patients with locally advanced disease with quite favorable outcomes.
Abstract ID: 9
Author ID: 33
Presenter Name: Ruchir Tandon
Affiliation: Department of Medical Oncology, GSL Medical College and Trust Hospital, Rajamahendravaram, Andhra Pradesh, India
Abstract Title: A Rare Presentation of TENIS Syndrome
Abstract Topic: Medical Oncology
Aims/Objectives of the Study: To report a rare case of papillary carcinoma thyroid.
Methodology: C-N, a 34-year-old hypertensive male on telmisartan and hydrochlorothiazide presented on 21 June 2022 with the complaint of swelling in the right side of the neck for 10 days. He had a history of regular tobacco and snuff usage since last 10 years, with no family history of malignancy (BMI = 44.4, BSA = 2.16/m).
Results: It was labelled as a case of truncated expression of NIS (TENIS) that met the criteria of elevated thyroglobulin with negative iodine scan, and the patient was started on tab lenvatinib 24 mg OD since 6 November 2023 and has completed three cycles, and the current thyroglobulin level is 0.72 ng/ml. The patient is now asymptomatic and has also lost weight.
Discussion: Thyroid carcinoma is the most common endocrine tumour (90%), and carcinoma is its most common subtype (70–80%) in iodine-replete populations. It has an M:F ratio of 3:1 and has a peak age incidence of 30–50 years. Papillary thyroid carcinoma typically spreads to locoregional lymph nodes and to the lungs.
After total thyroidectomy and radioactive iodine ablation, the patient was monitored with whole-body iodine scans and serum thyroglobulin levels. Thyroglobulin is a sensitive tumour marker. Up to 55% of patients may have elevation of thyroglobulin in the presence of a negative I-131 whole-body scan. This condition has been termed the TENIS syndrome. There are several possible aetiologies, such as
Dedifferentiation of the carcinoma
Stunning of radioiodine (RAI) uptake by functional thyroid tissue
Loss of function (LOF) mutation of the sodium iodide symporter
Small dose of radioiodine used for the diagnostic scan
Iodine ingestion/administration blocking the RAI uptake
Absence of immunoreactive cytoplasmic thyroglobulin and thyroxine or tumour size below gamma camera resolution
F-18 FDG PET/CT imaging, with a sensitivity of 85–94% and a specificity of 90–95%, has been declared by a consensus as the most suitable modality for detecting tumour spread and recurrence in such instances.
Conclusions: Post-total thyroidectomy and lymph node clearance, serum thyroglobulin is an established tumour marker for monitoring. Negative whole-body RAI scan with persistently elevated thyroglobulin levels is of importance. F-18 FDG PET/CT is efficacious in TENIS syndrome. TKI are approved for TENIS. Tolerance of high-dose lenvatinib requires close monitoring.
Abstract ID: 5
Author ID: 34
Presenter Name: Ekta Yadav
Affiliation: Department of ENT (Otorhinolaryngology), Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh, India
Abstract Title: Squamous Cell Carcinoma (SCC) of Buccal Mucosa and its Surgical Management
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: About 90% cases of head and neck cancer (cancer of the mouth, nasal cavity, nasopharynx, throat and associated structures) are due to SCC. Carcinoma of buccal mucosa presents in stages with deep infiltration to the adjacent structures. Surgery is the treatment of choice.
Methodology: A 43-year-old male presented with complaint of ulcerative growth over the left side of the face (cheek). On examination, a fungating mass, hard in consistency, irregular margins, bleeding on touch, having foul-smelling discharge involving buccal mucosa, was noted. Histopathology was suggested.
Results: The patient received total parenteral nutrition during the post op period along with blood transfusion in the form of PRBC, FFP. Regular dressings and tracheostomy care were done. The patient was discharged on the 10th post op day with Ryle’s and tracheostomy tube in situ. No other surgical complication was noticed on follow-up. The flap was taken up by the recipient site, adequate and mucosalization was attained, which was noted on subsequent follow-up.
Discussion: Squamous cell carcinoma of buccal mucosa is a common malignant tumor in the Indian population. Risk factors include betel quid chewing and tobacco and alcohol consumption. It grows and penetrates through adjacent anatomical structures. Surgery or radiotherapy as a single modality is currently considered a suitable method for the treatment of early-stage buccal squamous cell carcinoma, whereas postoperative radiation combined with surgical excision is recommended for advanced tumor. The concept of neoadjuvant chemotherapy is the newest treatment modality in which research studies are being undertaken to see its efficacy in the prognosis and the recurrence of the lesion in the postoperative phase.
Conclusions: Buccal mucosa squamous cell carcinoma is an aggressive malignant tumor. History, examination and imaging may suggest squamous cell carcinoma, but biopsy for histopathology establishes the diagnosis. Resecting sufficient margins from lesion favors local control as it reduces the rate of local recurrence. Since the site has a high cosmetic value, consideration of reconstruction has become an obligatory step during surgery.
Abstract ID: 3
Author ID: 20
Presenter Name: K. Hema Geeta
Affiliation: SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
Abstract Title: Navigating the Strategies of Treatment for the Management of Oral Submucous Fibrosis
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: Oral submucous fibrosis is an insidious, chronic disease affecting any part of the oral cavity. The symptoms of OSMF include dry mouth, pain, taste disorders, restricted tongue mobility, trismus and dysphagia. The main risk factor is areca nut chewing. OSMF is one of the most prevalent premalignant conditions in India, which is easy to diagnose but difficult to manage. The treatment of patients suffering from OSMF depends on the degree of clinical involvement. The management modality varies from most non-invasive method to the most invasive method, depending on the stage and site of the disease. By navigating through the complexities, this article aims to contribute a deeper understanding of the strategies involved in the treatment of this condition.
Methodology: Patients were treated with various treatment modalities depending on the clinical staging using either non-surgical or surgical strategies.
Results: Significant improvement was noted in interincisal distance, cheek flexibility, and VAS in patients who were surgically treated when compared to non-invasive modalities.
Discussion: The various treatment modalities range from non-invasive to invasive. The non-invasive modalities are physical treatment, drug, HBO therapy, etc. Physical treatment attempts to influence the remodeling of tissue by using movement. The invasive treatment modalities ranging from the use of interpositional grafts in areas of band excision have been the most populous methods The grafts used have been divided into local flaps and distant flaps. Local flaps imply donor sites in the head and neck region transposed to the oral cavity by pedicle attachments. Distant flaps include free flaps with AV anastomoses from donor sites in the arm and thigh.
Conclusions: The management of OSMF is a complex and multifaceted challenge. While controversies persist, it is essential to approach the condition with a holistic perspective that considers both clinical and patient-centered outcomes.
Abstract ID: 1
Author ID: 17
Presenter Name: Eshwar Thota
Affiliation: Department of Oral and Maxillofacial Surgery, SVSIDS, Mahabubnagar, Telangana, India
Abstract Title: Squamous Cell Carcinoma Mimicking Osteomyelitis of Jaw: A Diagnostic Dilemma and Our Experience
Abstract Topic: Surgical Oncology
Aims/Objectives of the Study: Osteomyelitis is inflammation of the osteoarticular apparatus and medullary canal caused by bacterial infection and colonization, progressive destruction of the tissue. Osteomyelitis is the presence of exposed bone because of destruction, which fails to heal. This malignant transformation is a change in the clinical, radiological, bacteriological, and histological symptomatology of chronic osteomyelitis. The physio-pathological mechanism of cancerization is unknown.
Methodology: A series of four cases that were reported to the Department of Oral and Maxillofacial Surgery, SVS Institute of Dental Sciences, Telangana, are being presented. Patients reported to us with the chief complaint of swelling and pain in the lower back tooth.
Results: After performing an incisional biopsy, histopathologically they were reported as well-differentiated SCC.
Discussion: The conversion of chronic osteomyelitis of jaws to oral SCC is not reported, and the question remains unanswered if it was an infection of the mandible that progressed into a malignancy, or if it was an oral SCC, which is superimposed by secondary infection.
Conclusions: An incisional biopsy is essential for appropriate diagnosis and treatment of these suspicious lesions.
