In the unprecedented times of Corona Pandemic (CP), each individual is facing uncertainty and stress. Presence of cancer during these times compounds the troubles. The changing scenario of consultation and treatment during pandemic, logistic issues, dwindling finances and fear are making a negative impact on the mental health of cancer patients. In a qualitative analysis conducted in a tertiary oncology hospital from 1st June to 6th July on the recently diagnosed or under treatment cancer patients. The face to face interview was conducted using a semi structured questionnaire specific to Cancer amid CP, General Anxiety Disorder Item Scale 7 and Physical Health Questionnaire 9 (PHQ-9). There were total 294 patients, mean age around 51 years with a male female ratio of 3:2, 40% were suffering from head and neck malignancy. There was a delay initiating cancer treatment in 22.4% of patients and three fourths of them attributed it to CP. Almost 80% of patients perceived that pandemic has adversely affected their treatment and 50% thought they would have had a better chance of cure. Half of our cohort stated that due to social distancing and usage of masks, there is a communication gap between them and the doctors. They also felt that now, with decreased nonverbal communication; they felt lack of empathy. 14.9% patients were more concerned about corona pandemic as compared to malignancy. This study is about the challenges and perspective of cancer patients during the CP. It indicates a need for more systematic and patient friendly approach by the regulatory authorities, hospital management and staff. Timely intervention of those under stress is recommended more frequently during CP.

Distant metastasis from Head and Neck Squamous Cell Carcinomas (HNSCC) is uncommon, Cavernous Sinus (CS) metastasis being very rare. Infrequent presentation and misdiagnosis makes it a difficult entity to identify and treat. Hereby, Authors present a rare case of 47 year old male of CS metastasis from postoperative carcinoma of buccal mucosa. The patient was a histopathologically proven case of poorly differentiated Squamous Cell Carcinoma (SCC) of left buccal mucosa for which he underwent definitive surgery. During adjuvant Radiotherapy (RT) he developed severe headache, diplopia and ptosis. 18Fluorodeoxy-Glucose-Positron Emission Tomography-Computed Tomography (18FDG PET-CT) revealed an FDG avid lesion in left CS suggestive of CS metastasis. In view of local recurrence and CS metastasis palliative RT was given. Patient responded well to palliative RT but succumbed to the disease within months. CS metastasis has poor prognosis with limited treatment options which include palliative RT, either External Beam Radiotherapy (EBRT) or radiosurgery to CS. Chemotherapy for disseminated disease has limited benefits due to lesser penetration of the blood brain barrier.

Purpose/Objective(s): Concurrent chemoradiation (CRT) with high dose cisplatin or cetuximab in case of contra-indication to cisplatin is the standard of care non-surgical approach for patients (pts) with locally advanced head and neck squamous cell carcinoma (LA HNSCC). Older age is a contra-indication to cisplatin and survival in older pts might not improve with cetuximab. The development of new treatment options for elderly pts with LA HNSCC is therefore urgently needed. NBTXR3, hafnium oxide nanoparticles that enhance the efficacy of radiotherapy (RT) by locally increasing the deposited dose, may benefit this patient population. In this phase I clinical trial we aimed to evaluate the feasibility and safety of intratumoral (IT) NBTXR3 injection prior to RT in elderly pts with LA HNSCC. Materials/Methods: Patients with stage III-IV LA HNSCC of the oropharynx or oral cavity ineligible for platinum-based CRT received a single IT injection of NBTXR3 into a selected primary tumor followed by intensity modulated RT (IMRT; 70 Gy/35 fractions/7 weeks) [NCT01946867]. The study used a 3+3 dose escalation design to test NBTXR3 dose levels of 5, 10, 15, and 22% of baseline tumor volume, followed by a dose expansion at the Recommended Phase 2 Dose (RP2D). Primary endpoints included RP2D determination, and early dose limiting toxicities (DLT). NBTXR3 intratumoral bioavailability and anti-tumor activity (RECIST 1.1) were also evaluated. Results: Enrollment at all dose levels has been completed: 5% (3 pts), 10% (3 pts), 15% (5 pts), and 22% (8 pts). There were no observed early DLT or SAE related to NBTXR3 or injection. Median follow-up from NBTXR3 administration is currently 7.6 months. One Grade 1 AE related to NBTXR3 at the 22% dose level and 4 Grade 1-2 AEs related to the injection at the 15% and 22% dose levels were observed. IMRTrelated toxicity was as expected. NBTXR3 was well dispersed throughout the tumor and not in surrounding healthy tissues, as assessed by CT-scan. The RP2D was determined to be 22%. Preliminary efficacy was evaluated in pts who received the intended dose of NBTXR3 and RT. Among 13 evaluable pts at doses !10%, 9 pts (69%) achieved a complete response (2 unconfirmed) of the injected tumor and 5 pts (38%) achieved an overall complete response. Preliminary safety and efficacy data of the dose expansion cohort at the RP2D will also be presented. Conclusion: NBTXR3 was well tolerated at all tested doses and when activated by RT demonstrated promising preliminary anti-tumor activity. Recruitment in the dose expansion cohort is ongoing. These results highlight the potential of NBTXR3 activated by RT as a novel treatment option for elderly pts with LA HNSCC and address an unmet medical need.

Madam d The diagnosis of cancer leads to many psychological problems e denial, self-pity, guilt, change in interpersonal relationships, loss of job, self-image, fear of lifelong morbidity, fear of death, managing logistics of treatment and prolonged follow-up. The suffering of cancer patients has further increased due to the ongoing coronavirus pandemic [1,2]. Considering the pervasive and diverse effect the coronavirus pandemic is having on cancer patients [3], we carried out a systematic qualitative analysis of newly diagnosed and under-treatment patients between 1 June 2020 and 6 July 2020. It was a cross-sectional, descriptive and hospital-based study conducted at a tertiary care oncology super specialty hospital in western India. In total, 294 patients were interviewed.Among our subjects, cancer diagnosis and treatment were delayed in 25.17% and 61.90%, respectively, due to the ongoing coronavirus pandemic. Despite the huge psychological impact cancer has, 15% of our patients were more worried about coronavirus infection and 63.2% of patients thought they would have a better chance of cure if it were not for the coronavirus pandemic. Significant levels (moderate to severe) of anxiety and depression were noticed in 28.91% and 26.50% of patients, respectively, which could be attributed to worsening of instrumental and/or emotional support in nearly 59% during the coronavirus pandemic. Another noteworthy observation was that 35% of the patients were dissatisfied with the distancing between them and the doctors. In a study, half of neuro-oncology patients preferred the face-to-face consultations rather than telephone clinics [4].Without compromising the outcomes, we may have to regularly treat COVID-19-positive cancer patients as there seems to be no relief from the pandemic in the near future [5]. With coronavirus infection looming all over, the psychological issues of cancer patients have exacerbated. It is important to reassure them that it is safe and essential to seek medical advice with due precautions. It is imperative to address the mental health of cancer patients to mitigate their anxiety and depression as they fight against two devils e cancer and coronavirus.

Background: Chest wall primitive neuroectodermal tumor (PNET) is a rare tumor necessitating a prompt diagnosis. Unfortunately, the diagnosis of this tumor can be extremely challenging and misdiagnosis is at times unavoidable. Case Report: Here we present one such rare case of chest wall PNET. Patient initially had complaints of pain and lump in the right breast. Contrast enhanced computed tomography (CECT) of thorax showed large mass with both intra-thoracic and extra-thoracic extension. Trucut biopsy from lump was suggestive of PNET on histopathology and immunohistochemistry. Later patient was treated with induction chemotherapy with alternating VAC/IE followed by right chest wall resection. Post-operative histopathology was suggestive of complete pathological response. 18 FDG PET-CT done subsequently was suggestive of complete metabolic response. Conclusion: Chest wall PNETs may mimic as breast lump, posing diagnostic dilemma. Multimodality treatment may yield excellent outcome as in our case.