<p>We are reporting an uncommon case of second primary chondrosarcoma of the maxilla in a 52-year-old male patient. Patient had first been diagnosed in 2004 with chondrosarcoma of the right maxilla. He had undergone right partial maxillectomy for the same. Since 2016 he had started noticing a swelling over the left side of the maxilla. Repeated biopsies from the growth showed no evidence of any malignancy. Hence, he was kept on routine follow up. However, in 2018, during follow up the growth had increased in size - hard swelling present in remnant post partial maxillectomy cavity, non-tender -and a punch biopsy was taken, revealing a well differentiated chondrosarcoma. A diagnosis of second primary chondrosarcoma of the maxilla was made based on Warren and Gates criteria. A brief discussion on the radiologic and histologic presentation of the tumor and the treatment modalities of this unusual tumor is discussed.</p>

Background: Trastuzumab is now the standard of care in patients with Her-2 positive breast cancer. Despite its availability, high cost of treatment of trastuzumab makes it out of reach for many patients. This study analyses access to trastuzumab and identified potential barriers to its use in a large tertiary care hospital in northern India.Methods: This is a cross- sectional study of all the Her-2 positive breast cancer patients diagnosed and treated in our institute in 2018. These patients were investigated to look into various socio-economic factors for acceptance or non-acceptance of trastuzumab by using a predesigned questionnaire. Chi square test or Fishers exact test was applied.Results: Out of 310 diagnosed cases of carcinoma breast 52 (16%) patients were Her-2 positive. The majority of the trastuzumab recipients belonged to upper/middle socioeconomic status as compared to the non-recipient group (75% vs. 34.4%, P=0.004). Most of the receiver were well-educated (75% vs. 28.2%, P= 0.0009) and belonged to the high-income strata (55% vs. 37.5%, P= 0.22). It was found that the treatment of maximum (84.6%) Her-2 positive patients were met by out- of- pocket expenditure (OOPE) and 71.9% of the patients cited financial issues as the main cause of not taking the drug.Conclusions: The patient’s socioeconomic class and their education level significantly influenced the usage of the drug. Improving patient education as well as the implementation of the government health scheme can improve the availability and usage of this drug.

Background: Extranodal extension (ENE) has been included as a factor for the staging of head-and-neck cancer (HNC) considering its prognostic value. Aim: The present study aimed to find out the percentage of patients with HNC getting upstaged because of ENE and their treatment outcome. Patients and Methods: A retrospective analysis of all patients with HNC registered in the Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India, between January 2018 and January 2019. American Joint Committee on Cancer (AJCC) criteria were used for defining clinical and radiological ENE. The site, subsite, stage and presence of ENE were documented. The clinical outcome of all these patients was collected and analysed. Results: A total of 562 patients were registered with HNC. Among them 45 patients were identified to have ENE (8%). The majority of the cases were oral cavity (44.4%) and oropharyngeal tumours (26.8%). Thirty-three patients had clinically documented ENE and 11 were radiological and one patient had pathological ENE. Among those who got upstaged to N3b disease due to ENE, 29 patients (64.4%) had N2 disease as per the 7th edition AJCC. When stage grouping was considered, 28 patients (62.2%) who got upstaged had stage Isovaleric acidaemia (IVA) disease as per the AJCC 7th Edition. Twelve patients were treated with radical intent and 16 received palliative treatment and rest did not complete the treatment or defaulted. Overall, the outcomes of these patients remained poor. Conclusion: A significant proportion of HNC patients got upstaged when ENE was included in the staging. Patients with ENE had a poor prognosis irrespective of the treatment modality.

Introduction Breast cancer is the most common malignancy in women worldwide and is a prototype of global cancer disparity. While breast cancer mortality is decreasing in developed countries, it continues to increase in low- and middle-income countries. Trastuzumab in combination with chemotherapy is the standard of care and essential drug for patients with Her2 positive breast cancer. Despite the availability of biosimilar, it is still out of reach for many patients in India for various reasons such as lack of drug funding or because of high treatment costs. This study examines access to trastuzumab and identified potential barriers to its use in a large tertiary care hospital in an underserved and resource-restricted hilly region of Northern India (Uttrakhand). Material and methods In a cross-sectional study all patients diagnosed with Her2 positive breast cancer who underwent treatment in our institute from January -December 2018 were included. All relevant details like age, stage, treatment details, receptor status (ER/PR/ Her2) were recorded. All Her2 positive patient who had 3+ score on immunohistochemistry (IHC) were considered positive. These patients were investigated to look into various factors for acceptance or non -acceptance of trastuzumab like socio-economic status, funding of treatment, education status and reasons for non-usage of the drug. Patients were categorized into high, middle and lower socioeconomic status by using an appropriate scale. The data were analyzed by using SPSS Version 20.0 and Open epi software. Chi-square test of significance was applied to test the association between variables. Results 310 patients of carcinoma breast were included in study, out of which 68 patients were Her2 positive (22%). Of these 68 patients, 24 (35%) received trastuzumab. Most trastuzumab recipients belong to upper and middle socioeconomic status as compared to the lower class (83.3% vs 16.7%, p=0.001). The treatment of maximum (91.7%) users were met by out of pocket expenditure whereas only two patients were beneficiary of government health schemes. Most of the trastuzumab user patients were well educated (above high school level) compared to those who did not take the drug (83% vs 36%, p= 0.0001). Among 44(65%) patients who did not receive the drug, the majority had education level below high school (63% vs 36%) despite high income (54% vs 37%). 26 (59%) patients reported the financial issue as the main cause of not taking trastuzumab whereas the remaining 18 (41%) patients cited the reason that they were not offered this drug by treating physician probably assuming that patient will not be able to afford this treatment. Except for two patients, all trastuzumab nonrecipient patients were also financing their treatment themselves. These two non-user patient with financial support from the government denied the use of trastuzumab due to personal reasons. Conclusions The majority of Her2 positive patients were unable to receive trastuzumab treatment due to financial constraints, non-availability of health insurance and poor government support for treatment. Patient’s socioeconomic class, monthly income & their education level significantly influenced the usage of the drug. Treating oncologist should also overcome their personal biases about the socio-economic status of patients and should offer the drug wherever indicated as this was the second most common reason for non-usage of the drug. Improvement in education standard raises the socioeconomic status as well as disease awareness among the patient which would make them vigilant and receptive to life-saving beneficial but costly treatment like trastuzumab. Tremendous efforts are required for cost reduction, patient education as well as the implementation of the government health scheme to bridge this gap. Citation Format: Rajesh Pasricha, Pragya Singh, Ajas Ibrahim, Laxman Pandey, Ajeet Singh Bhadoria, Sweety Gupta, Deepa Joseph, Manoj Gupta, Bina Ravi. Socio-economic factors affecting trastuzumab usage in breast cancer patients belonging to hilly regions of north India [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-08.