Indian Journal of Cancer
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   2016| April-June  | Volume 53 | Issue 2  
    Online since January 6, 2017

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Knowledge, attitude and practice about breast cancer and breast self-examination among women seeking out-patient care in a teaching hospital in central India
Rao Siddharth, D Gupta, R Narang, P Singh
April-June 2016, 53(2):226-229
DOI:10.4103/0019-509X.197710  PMID:28071615
Background: Breast cancer (BC) continues to be a major cause of morbidity and mortality throughout the world. Early detection of BC and early treatment increases the chance of survival. According to Breast Health Global Initiative guidelines for low and middle income countries, diagnosing BCs early by promoting breast self-awareness; clinical breast examination (CBE) and resource adapted mammographic screening will reduce BC mortality. There is a paucity of data on the knowledge and awareness of BC and self-breast examination in India. We designed this hospital based cross sectional descriptive study to evaluate the current status of knowledge, awareness and practices related to BC and breast self-examination in the female rural population attending a teaching hospital. Materials and Methods: We did a random sampling to identify and enroll 360 women and their female relatives. We excluded a participant from the study if she had already undergone a screening mammography or had had a BC. The data was collected by a self-administered questionnaire in vernacular language. Results: Our study population included 360 women with a mean age of 45.81 (±10.9) years. Only 5 (1.38%) females had a family history of BC. A whopping 81% of women did not have any knowledge about BC. All the women thought that CBE by doctors was the only way for screening BC. Conclusions: We concluded that with the results of this study, it is imperative to increase awareness about BC and its detection methods in the community through health education campaigns. We should have major policy changes to increase future screening programs and health education programs which would have an overall positive impact on reducing the disease burden.
  10,645 677 6
The ban on smokeless tobacco products is systematically violated in Chennai, India
E Vidhubala, C Pisinger, B Basumallik, DS Prabhakar
April-June 2016, 53(2):325-330
DOI:10.4103/0019-509X.197722  PMID:28071639
Background: India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India. Methods: In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for “gutkha” and “pan masala,” one of each product available. Details of each product were reviewed based on the information printed on the sachets. Results: Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be “tobacco” by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed. Conclusion: The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution.
  10,205 222 2
Epidemiological data and case load spectrum of patients presenting to bone and soft tissue disease management group at a tertiary cancer center
A Gulia, A Puri, S Chorge, PK Panda
April-June 2016, 53(2):333-338
DOI:10.4103/0019-509X.197734  PMID:28071641
Introduction and Background: This study was conducted to know the spectrum and number of bone and soft tissue (BST) tumors presenting to our institute. We needed to assess the gap between the number of patients seen and infrastructure available, and based on this information, help formulate guidelines for optimum utilization of resources and to provide best possible evidence-based cancer care. Settings And Designs: This is a prospective observational study (epidemiological). Materials and Methods: This study included all new patients seen in BST-disease management group (DMG) in the year 2010. An audit form was devised to capture all the relevant information. A comparison of our data with other national and international studies was also done. Results: Out of total 31,951 new patients registered at our institute, 2007 patients availed BST-DMG services. Sixty percent were bone tumors and 36% were soft tissue tumors. In bone tumor, 66% were malignant, 15% were benign, and 19% were non-neoplastic. Osteosarcoma (43%) was the most common malignant tumor followed by primitive neuroectodermal tumor/Ewing's (27%) and chondrosarcoma (11%). Giant cell tumor was the most common benign bone tumor. Eighty-one percent of all soft tissue lesions were malignant, of which 75% were of mesenchymal origin and 25% were of cutaneous origin. Conclusion: This is an attempt to document the epidemiology of musculoskeletal tumors presenting to our institution while guiding the institute to frame and implement disease-specific protocols and generate further research questions. Continued data collection and follow-up can provide valuable information on long-term survival and treatment-related toxicities. This data (within limitations) may be extrapolated to national level to identify the need for infrastructure and human resources.
  5,251 304 5
Importance of nutrition in pediatric oncology
R Bhoite
April-June 2016, 53(2):211-212
DOI:10.4103/0019-509X.197738  PMID:28071610
  4,808 475 -
Squamous cell carcinoma of the oral cavity and oropharynx in patients aged 18–45 years: A case–control study to evaluate the risk factors with emphasis on stress, diet, oral hygiene, and family history
KP Dholam, GC Chouksey
April-June 2016, 53(2):244-251
DOI:10.4103/0019-509X.197725  PMID:28071620
Background: Increasing incidence of squamous cell carcinoma (SCC) of the oral cavity and oropharynx is reported in young adults. However, there is a paucity regarding etiology and risk factors. Aim: To evaluate the exposure potential carcinogenic factors among a sample aged 45 years and younger, diagnosed with SCC of the oral cavity and oropharynx. Methodology: Eighty-five case samples aged 18–45 years, diagnosed with SCC of the oral cavity and oropharynx were compared with 85 controls who had never had cancer, matched for age and sex. This study was conducted by questionnaire-based interviews. Questionnaire contained items about exposure to the following risk factors: Caries prevalence, oral hygiene status, dental trauma, dental visit, stress, family history of cancer, environmental exposure to potential carcinogens, diet, body mass index (BMI), habits such as smoking, tobacco chewing, betel quid/pan, or supari. Statistical Analysis: Odds ratios (ORs) of oral and pharyngeal cancer and the corresponding 95% confidence intervals were estimated using multiple logistic regression models. P< 0.05 was considered statistically significant. Results: Elevated OR was seen in young adults who had poor oral hygiene, stress, dental trauma, low BMI, family history of cancer, exposure to environmental carcinogens, and habit of placement of quid for 11–20 years. Conclusions: An increased risk of oral and pharyngeal cancer was seen in cases who had poor oral hygiene, stress, dental trauma, low BMI, family history of cancer, exposure to environmental carcinogens, and habit of placement of quid.
  4,361 464 3
Role of frozen section in the intra-operative margin assessment during breast conserving surgery
KR Anila, K Chandramohan, A Mathews, T Somanathan, K Jayasree
April-June 2016, 53(2):235-238
DOI:10.4103/0019-509X.197732  PMID:28071617
Background: Breast conserving surgery (BCS) is increasingly done for early breast cancers in many countries since it has been demonstrated by randomized trials that survival rates after BCS followed by adjuvant therapy are equivalent to those obtained after mastectomy. Frozen section analyses (FSA) is a technique used for intra-operative assessment of margin status in BCS. The aim of this study was to assess the concordance of margin status assessment by FSA and permanent sections and to assess correlation with local recurrence. Materials and Methods: A total of 162 patients underwent BCS for in situ or invasive carcinoma with FSA of margins during the year 2008 at our center. The inclusion criteria in this study were patients with intact tumor at the time of surgery. After application of the inclusion criteria, 60 patients could be included in this study. Results: After frozen section, 20 patients had an initial negative margin. 40 subjects underwent additional excisions at the time of initial surgery because of close or positive margins. Of these 40 patients, in 32 patients a negative margin could be achieved with re-excisions. Pathological analyses of frozen section showed concordance to permanent sections in all cases. At a median follow-up of 40 months, there were no local recurrences. Conclusion: Intra-operative FSA allows resection of suspicious margins at the time of primary conservative surgery and results in low rates of local recurrence and second surgeries. There is good concordance between results of FSA and the final paraffin section in assessing margin status.
  4,437 327 2
Primary gastrointestinal lymphomas in children: An experience of 12 years from a tertiary care center of North India
SK Qadri, A Shah, NH Hamdani, KM Baba
April-June 2016, 53(2):300-303
DOI:10.4103/0019-509X.197718  PMID:28071632
Background and Aim: Lymphomas are among the dominant solid tumors in children and primary gastrointestinal lymphomas (PGILs), although rare, are the most common extranodal lymphomas and the most common malignancies affecting the gastrointestinal tract in children. This study was undertaken to analyze childhood PGIL with reference to clinical presentation, anatomic distribution, histopathologic, and immunohistochemical (IHC) characteristics. Materials and Methods: In this 12 year combined retrospective and prospective descriptive study, all the cases of PGIL in children were selected according to Dawson's criteria. Results: A total of 11 cases were found which included 9 boys and 2 girls (male:female - 4.5:1) ranging in age from 1 to 14 years (mean 6.6 years). Abdominal pain (81.8%) and intestinal obstruction (63.6%) were the most common presenting features. Grossly, most of the lesions were ulcero-infiltrative (72.7%) and involved the terminal part of the ileum (36.4%) and ileocecal region (27.3%) most commonly. Histopathologically and IHC, all the cases were high-grade lymphomas of diffuse large B-cell type except for one case of mucosa-associated lymphoid tissue lymphoma. No case of Burkitt's lymphoma was found. Conclusion: PGILs are an important cause of morbidity and mortality in children worldwide with considerable variation in their clinicopathological features and treatment modalities. Only some studies are available in literature for comparison. Further studies are required to define the genetic and molecular basis of the different histopathological pattern found in our setting.
  4,396 226 1
Prognostic factors and 5-year survival of patients with carcinoma penis: Tertiary health center study
AA Shah, HA Shah, GN Panjwani, BB Pandey, N Shah
April-June 2016, 53(2):309-312
DOI:10.4103/0019-509X.197729  PMID:28071635
Context: To identify prognostic factors in carcinoma penis with its impact on survival. Aims: To find out the relation of various prognostic factors of carcinoma penis with the various outcomes. Settings and Design: Retrospective cohort study. Subjects and Methods: Each patient diagnosed as having carcinoma of penis by incision biopsy and operated from January 2004 to May 2009 at the institute was included in the study (n = 117). Data were collected and analyzed. Statistical Analysis Used: The Chi-square (χ2) test was used to test for the significance of association between the independent (predictor) and dependent (outcome) variables. Multivariate logistic regression analysis was used to determine predictor variables that predicted the outcome. Five year disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Results: Of the total 117 patients studied, 30 patients died within 5 years (median = 25 months). Recurrences (local or systemic) were seen in 23 patients (median = 14 months). Five-year DFS was 80.34% and OS was 72.22%. Kaplan–Meier analysis showed that well to moderately differentiated grade, lymph node negative disease and low stage have higher survivals than poorly differentiated grade, lymph node positive disease and higher stage, respectively. Multiple logistic regression analysis revealed that inguinal lymph node positivity and grade were significantly associated with local or systemic recurrence. Conclusions: Penile cancer patients with advanced disease had poor survival. Tumor grade and inguinal lymph node metastasis are factors affecting DFS. Lymphadenectomy remains an integral part of the management of patients with penile cancer.
  3,983 199 4
Ovarian tumors in children: 10-year experience from a tertiary care center in South India
B Rajeswari, M Nair, A Ninan, K Parukuttyamma
April-June 2016, 53(2):292-295
DOI:10.4103/0019-509X.197726  PMID:28071630
Background: Ovarian tumors are uncommon in childhood and constitute around 1% of childhood malignancies. Two thirds of pediatric ovarian tumors are germ cell tumors. Epithelial ovarian tumors and stromal tumors are less frequent. We share our experience in childhood ovarian cancers, analyzing a series of cases with respect to the clinical profile, treatment and survival. Methods: All newly diagnosed ovarian tumors in children up to 14 years of age, registered in our Pediatric Oncology Division between January 2000 and December 2009 were retrospectively reviewed. Observations: There were 47 patients with newly diagnosed ovarian tumors. The mean age at presentation was 10.0 ± 3.4 years. The most common symptoms at presentation were acute abdominal pain (48.9%) and abdominal mass (40.4%). Precocious puberty was uncommon (6.3%). Histology was germ cell tumors in 44 cases and nongerm cell tumors in three cases. The benign teratomas (mature and immature grade 1 and 2; n=9) underwent complete surgical resection alone; none had recurrence on follow up. Of the remaining 35 GCTs, 31 patients were given chemotherapy and 4 refused treatment.26 out of the 31 patients completed chemotherapy with BEP (bleomycin, etoposide, cisplatin) regimen with acceptable toxicities. 5 children i.e.; (19.2%) developed recurrence. At a median follow up of 80 months, 10 year disease free survival was 80.8 ± 7.7% and 10 year overall survival was 92.7 ± 4.9%. Conclusion: Germ cell tumors are the most common ovarian malignancy in children. With surgery and chemotherapy using BEP, good outcome can be expected in these patients.
  3,756 320 4
Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: A longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire
KP Dholam, GC Chouksey, J Dugad
April-June 2016, 53(2):256-260
DOI:10.4103/0019-509X.197716  PMID:28071622
Background: Prosthodontic rehabilitation helps to improve the oral health-related quality of life (OHRQOL). The Liverpool Oral Rehabilitation Questionnaire (LORQ) and Oral Health Impact Profile (OHIP) are specific tools that measure OHRQOL. Objective: The primary objective of this study was to assess the impact of oral rehabilitation on patients' OHRQOL following treatment for cancer of oral cavity using LORQ version 3 (LORQv3) and OHIP-14 questionnaire. Secondary objectives were to identify issues specific to oral rehabilitation, patients compliance to prosthetic rehabilitation, the effect of radiation treatment on prosthetic rehabilitation, to achieve meaningful differences over a time before & after prosthetic intervention, to carryout and document specific patient-deprived problem. Methodology: Seventy-five oral cancer patients were studied. Patients were asked to rate their experience of dental problems before fabrication of prosthesis and after 1 year using LORQv3 and OHIP-14. The responses were compared on Likert scale. Results: Patients reported with extreme problems before rehabilitation. After 1 year of prosthetic rehabilitation, there was improvement noticed in all the domain of LORQv3 and OHIP-14. Complete compliance to the use of prosthetic appliances for 1 year study period was noted. In response to the question no. 40 (LORQv3), only 15 patients who belonged to the obturator group, brought to notice the problems which were not addressed in the LORQv3 questionnaire. Conclusion: The study showed that the oral cancer patients coped well and adapted to near normal oral status after prosthetic rehabilitation. This contributed to the improved overall health-related quality of life.
  3,775 261 9
Place of birth and risk of gallbladder cancer in India
SS Mhatre, RT Nagrani, A Budukh, S Chiplunkar, R Badwe, P Patil, M Laversanne, P Rajaraman, F Bray, R Dikshit
April-June 2016, 53(2):304-308
DOI:10.4103/0019-509X.197723  PMID:28071634
Context: Within India, the incidence of gallbladder cancer (GBC) is characterized by marked geographical variation; however, the reasons for these differences are unclear. AIMS: To evaluate the role of place of birth, length of residence, and effect of migration from high- to low-risk region on GBC development. Settings and Design: Population-based cancer registries (PBCRs); case–control study. Subjects and Methods: Data of PBCRs were used to demonstrate geographical variation in GBC incidence rates. A case–control study data examined the role of birth place, residence length, and effect of migration in etiology of GBC. Statistical Analysis: Rate ratios for different PBCRs were estimated using Chennai Cancer Registry as the reference population. Odds ratios (ORs) for developing GBC in a high-risk region compared to a low-risk region and associated 95% confidence interval (CI) were estimated through unconditional logistic regression models using case–control study. Results: GBC shows marked variation in incidence with risk highest in Northeast regions and lowest in South India. OR of 4.82 (95% CI: 3.87–5.99) was observed for developing GBC for individuals born in a high-risk region compared to those born in a low-risk region after adjusting for confounders. A dose–response relationship with increased risk with increased length of residence in a high-risk region was observed (OR lifetime 5.58 [95% CI: 4.42–7.05]; Ptrend ≤ 0.001). The risk persisted even if study participant migrated from high- to low-risk region (OR = 1.36; 95% CI: 1.02–1.82). Conclusions: The present study signifies the importance of place of birth, length of stay, and effect of migration from high- to low-risk region in the development of GBC. The data indicate role of environmental and genetic factors in etiology of disease.
  3,691 315 14
Clinical characteristics with patterns of relapse and survival analysis of ovarian clear cell carcinoma
S Kaur, RA Kerkar, A Maheshwari, TS Shylasree, S Gupta, K Deodhar
April-June 2016, 53(2):288-291
DOI:10.4103/0019-509X.197719  PMID:28071629
Aims: To analyze clinical characteristics, patterns of relapse, and treatment outcomes of clearcell carcinoma of the ovary (CCO). Materials and Methods: Case files of 51 patients diagnosed with CCO between 2003 and 2010 were reviewed. Results: The median age at diagnosis was 48 years (27-64 years). Fifty percent presented with nonspecific gastrointestinal symptoms. The median serum Ca125 was 74 IU/ml (6-1567 U/ml). Optimal cytoreduction was achieved in 32 (62.7%) patients. Of the 51 patients in this series, 34 (66.6%) had Stage I disease; Stage Ia in 12 (23.6%), Stage Ib in 1(1.9%), and Stage Ic in 21 (41.1%). Thirteen (25.6%) presented with Stage III and 4 (7.8%) with Stage IV. No patient had Stage II disease. All patients received 4-6 cycles of platinum-based combination chemotherapy. There were 18 relapses (35.2%), with disease-free intervals <6 months in 9, 6-12 months in 4, and >12 months in 5, respectively. Of them 33.3% had a recurrent pelvic mass. The median survival after relapse was 14 months. There were 13 deaths, 11 due to disease progression, 1 due to chemo toxicity, and 1 unrelated to disease. At a median follow up of 28 months, disease-free survival (DFS) and overall survival (OS) of patients with Stage I-Stage II (early) disease was 64% and 80%, respectively. In patients with advanced disease, that is, Stages III and IV, DFS and OS were 35% and 38%, respectively. Conclusion: CCO generally presents at an early stage but has a high propensity for relapse. Patients with early-stage disease have a relatively good prognosis as compared with those with advanced-stage disease.
  3,253 259 4
Comparison of two different radiation fractionation schedules with concurrent chemotherapy in head and neck malignancy
MS Alam, R Perween, SA Siddiqui
April-June 2016, 53(2):265-269
DOI:10.4103/0019-509X.197740  PMID:28071624
Introduction: The worldwide incidence of head and neck malignancy exceeds half a million cases annually. In radiotherapy (RT), conventional fractionation comprises giving five fractions per week from Monday to Friday. Accelerated RT includes administration of six fractions per week is being advocated. It gives better locoregional control and the median overall treatment time is 39 days as compared to 46 days in conventional group. Our study involved comparison of conventional versus accelerated RT with concurrent chemotherapy, in evaluation of local control and toxicity in the two arms. Materials and Methods: Sixty patients of locally advanced squamous cell carcinoma head and neck region were studied. All the patients received cisplatin (30 mg/m2) weekly during the therapy. The patients received RT dose of 70 Gray (Gy) in 35 fractions (#). The patients were randomly assorted into two groups: Group 1 - Study group (n = 30) - Six fractions RT per week (Monday–Saturday). Group 2 - Control group (n = 30) - Five fractions RT per week (Monday–Friday). During and after the treatment, locoregional control, acute and late radiation toxicity were assessed. Results and Observation: There was no significant difference between the two schedules regarding locoregional control rate. The Grade 3 or higher acute toxicities were significantly higher in the accelerated arm although there was no significant difference in late toxicities between the two arms. Conclusion: Accelerated fractionation regimen was not more efficacious than conventional fractionation in the treatment of previously untreated head and neck carcinoma.
  3,074 189 1
Smokeless tobacco use and perceptions of risk among students in Mumbai municipal schools
ML Rose, D Chadha, TD Bhutia
April-June 2016, 53(2):322-324
DOI:10.4103/0019-509X.197720  PMID:28071638
Introduction: Nearly 15% of youth in India use tobacco. However, few studies have explored the use, knowledge, and attitudes of smokeless tobacco use among youth. AIM: To determine the patterns of use as well as knowledge and perceptions of smokeless tobacco among youth in Mumbai attending municipal schools. Materials and Methods: A cross-sectional survey was performed among 1053 students in the 8th and 9th grades in 16 municipal schools in Mumbai to determine the knowledge and perceptions about smokeless tobacco products as well as the patterns of use. Results and Conclusions: Ever use of smokeless tobacco was reported by 47 (4.7%) students in the survey. Twenty-nine (2.9%) students reported ever using smoked tobacco. Students were more likely to identify cigarettes and bidis as tobacco products compared to smokeless tobacco products such as gutkha, mishri, and khaini. Betel nut products were used by 178 (17.9%) students. The high rate of smokeless tobacco and betel nut use coupled with low levels of knowledge about their contents and harms suggests that tobacco control programs targeting youth should ensure that these products are adequately explained and understood by students.
  3,062 192 2
Adrenocortical carcinoma in children and adults: Two decades experience in a single institution
M Sabaretnam, A Mishra, G Agarwal, A Agarwal, AK Verma, SK Mishra
April-June 2016, 53(2):317-321
DOI:10.4103/0019-509X.197737  PMID:28071637
Context: Adrenocortical carcinoma (ACC) occurring in children and adults show distinct characteristics. However, due to rarity of the disease no large series addressing this issue has been published. Aims: The aim of this study was to study clinico-pathologic profile and outcome of ACC in children and adults. Settings and Design: Tertiary referral center. Retrospective study (January 1990-June 2011). Subjects and Methods: Forty-five patients with ACC were included; 16children (aged < 18 years) and 29 adults. Clinical details, hormonal profile, operation records, pathology reports and follow-up findings were noted and compared. Survival analysis was performed using Kaplan-Meier method. Log rank test and Cox regressionan alysis were performed. Results: Mean age was 8 ± 5.7 (M: F = 1:2.1) in children and 44.4 ± 15 years (M: F = 1:1.1) in adult groups. Prevalence of functioning tumors was significantly high in children (87.5 vs. 31% P = 0.001), while prevalence of incidentalomas was high in adults (6.3 vs. 51.7% P = 0.05). Tumor stage distribution at presentation, mean diameter (10.9 vs. 13.7 cm), and weight (392.9 vs. 892.9 g) didn't differ significantly in two groups. Adults had better albeit non-significant 5 year overall survival (OS) than children (0 vs. 13%). On univariate analysis stage of disease (P = 0.008), surgical intervention (P = 0.004), Weiss score (P = 0.04) and hormonal secretion (P = 0.04) were significantly associated with OS in adults but not in children. No factor was found significant on multivariate analysis. Conclusions: Except for high prevalence of functioning tumors in children, clinico-pathologic attributes and outcome of ACC in the two groups didn't differ significantly.
  2,854 273 3
Tolerance of weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin
SB Dessai, S Chakraborty, TVS Babu, S Nayanar, A Bhattacharjee, J Jones, S Balasubramanian, VM Patil
April-June 2016, 53(2):280-283
DOI:10.4103/0019-509X.197742  PMID:28071627
Objective: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to study the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. Methods: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m2) and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (CTCAE version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. Result: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3–4 life-threatening complications were seen in two patients. The post NACT response rate was 100%. Conclusion: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.
  2,862 225 1
Clinical and pathologic response following taxane based neoadjuvant chemotherapy in locally advanced breast cancer patients in a tertiary care centre in India
Masillamany Sivasanker, SC Sistla, S Ali Manwar, S Vivekanandam
April-June 2016, 53(2):220-225
DOI:10.4103/0019-509X.197715  PMID:28071613
Background: Neoadjuvant chemotherapy has become the standard recommendation in the management of patients with locally advanced breast cancer. At present anthracycline based regimen such as CAF (cyclophosphamide, adriamycin and 5-FU) is widely used in clinical practice. The introduction of taxanes has revolutionized this field because of superior results. Aims and Objectives: This study is designed to compare the efficacy of paclitaxel plus doxorubicin regimen and CAF (cyclophosphamide, doxorubicin and 5-fluorouracil) regimen as neoadjuvant treatment of locally advanced breast cancer and to compare their toxicity profiles and also to correlate the hormonal receptor status in predicting response to the NACT. Materials and Methods: In this prospective study, 101 patients with newly diagnosed locally advanced breast cancer were randomized to receive either CAF or Paclitaxel/adriamycin as NACT for three cycles. The response was assessed objectively using CT scans and applying RECIST criteria. The patients were monitored for hematologic, cardiac and other minor toxicities. Results: There was a significantly increased complete and objective response seen in the AP group when compared to CAF group (24% and 58% in the AP group versus 7.8% and 39.2% in the CAF group, P value 0.0313 for complete response). The pCR rate was also significantly higher in the AP group compared to CAF group. (20.93% versus 4.34%, P value 0.0237). There was no significant difference between the groups with respect to cardiotoxicity and hematotoxicity. Patients with ER negative tumors have responded well to neoadjuvant chemotherapy better than ER positive patients. (Objective response 62.8% vs. 40%, P - 0.0473). Conclusions: Based on these results, taxane based regimen such as Paclitaxel/adriamycin can be recommended as a first line neoadjuvant regimen in patients with locally advanced breast cancer.
  2,720 296 3
Clinico-pathological factors affecting lymph node yield in Indian patients with locally advanced squamous cell carcinoma of mandibular Gingivo-Buccal sulcus
SS Muttagi, BR Patil, AS Godhi, DK Arora, SR Hallikerimath, AD Kale
April-June 2016, 53(2):239-243
DOI:10.4103/0019-509X.197724  PMID:28071618
Aim: Lymph node yield (LNY) is a valid marker of prognosis in oral cancer. Precise estimation of LNY in Indian patients with T3/T4 gingivobuccal sulcus squamous cell carcinoma (GBS-SCC) has not been well documented. Hence, the primary objective of the study was to determine the LNY in patients with T3/T4 SCC of mandibular GBS, and the secondary objective was to study the association of LNY with clinicopathological factors such as tumor thickness, histological differentiation, number of positive nodes, and extracapsular spread (ECS). Materials and Methods: Study patients comprised biopsy proven T3/T4 SCC of mandibular GBS that underwent unilateral surgery (composite or bite composite resection with level I to level V-neck dissection and pectoralis major flap reconstruction) at our center between January 2012 and October 2014. Grossing of surgical specimens was done as per the guidelines established by the Royal College of Pathologists (December 2009). The data were analyzed using SPSS software (22nd version) and Chi-square test. Results: The surgical specimens of 106 patients yielded 2329 lymph nodes with the mean LNY of 21.97 ± 5.57. Higher mean LNY of over 21 was significantly associated with ECS, number of positive nodes, delay in surgery over 15 days, skin involvement by the tumor, and presence of oral potentially malignant disorders. Conclusion: With the single surgeon, pathologist and same surgical procedure, the mean LNY in Indian patients with T3/T4 SCC of mandibular GBS is 21.97 ± 5.57. Although clinicopathological factors affect the estimation of LNY, further studies are needed to validate the findings of this study.
  2,699 239 8
Development and validation of a questionnaire to measure preferences and expectations of patients undergoing palliative chemotherapy: EXPECT questionnaire
VM Patil, S Chakraborty, TK Jithin, S Dessai, TP Sajith Babu, V Raghavan, M Geetha, T Shiva Kumar, MS Biji, A Bhattacharjee, C Nair
April-June 2016, 53(2):339-344
DOI:10.4103/0019-509X.197735  PMID:28071643
Objective: The objective was to design and validate the questionnaire for capturing palliative chemotherapy-related preferences and expectations. Design: Single arm, unicentric, prospective observational study. Methods: EXPECT questionnaire was designed to capture preferences and expectations of patients undergoing palliative chemotherapy. This questionnaire underwent a linguistic validation and then was tested in patients. Ten patients are undergoing chemotherapy for solid tumors who fulfilled the inclusion and exclusion criteria self-administered the EXPECT questionnaire in regional language. After filling this questionnaire, they self-administered quick questionnaire-10 (QQ-10). SPSS version 16 (IBM New York) was used for analysis. Completion rate of EXPECT questionnaire was calculated. The feasibility, face validity, utility and time taken for completion of EXPECT questionnaire was also assessed. Results: The completion rate of this questionnaire was 100%. All patients completed questionnaire within 5 min. The QQ-10 tool confirmed the feasibility, face validity and utility of the questionnaire. Conclusion: EXPECT questionnaire was validated in the regional language, and it's an effective tool for capturing patient's preferences and expectation from chemotherapy.
  2,675 184 2
Presenting features, treatment patterns and outcomes of patients with breast cancer in Pakistan: Experience at a university hospital
S Kumar, AJ Shaikh, YA Rashid, N Masood, ATV Mohammed, UZ Malik, G Haider, N Niamutullah, S Khan
April-June 2016, 53(2):230-234
DOI:10.4103/0019-509X.197728  PMID:28071616
Background: Breast cancer is the most common cancer in Pakistani women. We report the presenting features, treatment patterns and survival of breast cancer from a University Hospital in Southern Pakistan and compare the data with international population based studies. Materials and Methods: Medical records of patients diagnosed to have breast cancer between January 1999 and November 2008 were reviewed retrospectively. Results: A total of 845 patients were identified. Median age of diagnosis was 48 years (range 18-92). Clinical stage was as follows: Stage I 9.9%; Stage II 48.5%; Stage III 26.2%; Stage IV 13.8%; data not available 1.5%. Approximately, half (51.6%) were estrogen receptor (ER) positive and 17.5% over-expressed Her2/neu. Nearly 23% patients received neo-adjuvant chemotherapy while 68.9% received adjuvant chemotherapy. Anthracycline based treatment was the most common treatment until 2003 while later on, patients also received taxanes and trastuzumab based therapy. Age, stage, tumor size, lymph node status, tumor grade, ER status, treatment with hormonal therapy and radiation were the major predictive factors for overall survival (OS). We report an impressive 5 year OS of 75%, stage specific survival was 100%, 88% and 58% for Stages I, II and III respectively. Conclusion: The majority of patients present at a younger age and with locally advanced disease. However, short term follow-up reveals that the outcomes are comparable with the published literature from developed countries. Long-term follow-up and inclusion of data from population-based registries are required for accurate comparison.
  2,647 205 -
Microsomal epoxide hydrolase gene polymorphisms and susceptibility to prostate cancer: A systematic review
DSL Srivastava
April-June 2016, 53(2):213-215
DOI:10.4103/0019-509X.197739  PMID:28071611
Microsomal epoxide hydrolase (mEH) is a crucial biotransformation enzyme that has capability to metabolize a large number of structurally divergent, highly reactive epoxides, and numerous environmentally exposed carcinogens. It catalyzes the conversion of xenobiotic epoxide compounds into more polar diol metabolites and may play important part of the enzymatic defense against adverse effects of foreign compounds. Most commonly, two functional polymorphisms affecting mEH enzyme activity have been identified: One in exon 3 and other in exon 4 of the mEH gene, which results in His113Tyr and Arg139His amino acid substitutions, respectively. Recent reports have shown that polymorphisms in mEH gene loci may an important risk factor for susceptibility of prostate cancers (PCs), worldwide, but inconsistent finding were also be illustrated. To the best of our knowledge, globally, there is no any systematic review has been published related to mEH gene polymorphisms and PC risk. Thus, in the current review, we have discussed the association between mEH gene polymorphisms, gene–environmental interaction, and PC risk.
  2,552 287 2
Innovation in chemotherapy administration process
A Aziz
April-June 2016, 53(2):331-332
DOI:10.4103/0019-509X.197733  PMID:28071640
Introduction: This project was started after patient's complaints of increased cost burden on patients with increase stay of patient in hospital for chemotherapy administration for 3–4 days, how to decrease this hospital stay and financial burden and how can we improve services to decrease hospital stay and expedite the process of chemotherapy administration. Methods: A total of 100 patients' confidential files reviewed from February 12, 2013 to May 15, 2013, patients, who were admitted for chemotherapy administration only in inpatient area and all services timings, were reviewed and documented on sheet named as delays chemotherapy sheet, nine processes timings checked against their benchmarks. Results: All services process timings analyzed and compared with their benchmarks, results of all services timings are nearly close to benchmark except lab test results of patients who were admitted without labs test for chemotherapy administration delays seen in collecting blood sample and sending this sample to the laboratory, significant delay is seen in chemotherapy order entry by physician if patient is admitted after 4 p.m. for chemotherapy administration. Delays also identified in administration of chemotherapy. Conclusion: After identifying the reasons of delays in chemotherapy administration, improvement and innovation in chemotherapy administration process done which not only decrease hospital stay, but also decrease the cost of chemotherapy administration.
  2,596 170 1
Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first-line chemotherapy from a tertiary cancer center in India
A Joshi, S Zanwar, N Shetty, V Patil, V Noronha, G Bakshi, G Prakash, S Menon, K Prabhash
April-June 2016, 53(2):313-316
DOI:10.4103/0019-509X.197741  PMID:28071636
Introduction: Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. This study aims to elaborate on the epidemiology of testicular GCTs and response to standard first-line chemotherapy (CT). Methods: GCTs treated at our center from January 2013 to June 2014 were retrospectively analyzed. Patients underwent orchidectomy either outside or at our hospital. Based on stage and risk group, standard CT (bleomycin, etoposide, and cisplatin/etoposide and cisplatin/carboplatin AUC7) and radiotherapy were given as appropriate. Response was calculated based on the Response Evaluation Criteria in Solid Tumors. Statistical analysis was performed using SPSS 18 software. Results: Fifty nonseminomatous germ cell tumor (NSGCT) and 36 of SGCT cases were studied. 30%, 46%, and 64% of NSGCT and 11%, 28%, and 22% of SGCT had N2, N3, and M1 diseases, respectively. The mean nodal size was 7 cm (1.5–19) in NSGCT and 5.5 cm (1.3–11) in SGCT. As per the International Germ Cell Cancer Collaborative Group classification, in patients with metastatic disease, 9% of NSGCT were good, 53% were intermediate, and 38% were poor risk whereas 75% of SGCT were good and 25% were intermediate risk. Following CT among NSGCT, 5% and 71% had radiologic complete response (CR) and partial response (PR), respectively. Among SGCT, 46% and 38% had radiologic CR and PR, respectively. 22%, 53%, and 13% of NSGCT and 12%, 24%, and 20% of SGCT developed febrile neutropenia, Grade 3 or 4 hematological and nonhematological toxicities, respectively, after standard chemotherapy. Conclusions: GCTs in India present with high nodal and high-risk diseases wherein the standard first-line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance.
  2,535 202 2
Expression of Raf kinase inhibitor protein in human hepatoma tissues by two-dimensional gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight methods
DA Tsao, YF Shiau, CS Tseng, HR Chang
April-June 2016, 53(2):216-219
DOI:10.4103/0019-509X.197730  PMID:28071612
Purpose: Hepatocellular carcinoma (HCC) is the most common malignant liver tumor. To reduce the mortality and improve the effectiveness of therapy, it is important to search for changes in tumor-specific biomarkers whose function may involve in disease progression and which may be useful as potential therapeutic targets. Materials and Mehtods: In this study, we use two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to observe proteome alterations of 12 tissue pairs isolated from HCC patients: Normal and tumorous tissue. Comparing the tissue types with each other, 40 protein spots corresponding to fifteen differentially expressed between normal and cancer part of HCC patients. Results: Raf kinase inhibitor protein (RKIP), an inhibitor of Raf-mediated activation of mitogen-activated protein kinase/extracellular signal-regulated kinase, may play an important role in cancer metastasis and cell proliferation and migration of human hepatoma cells. RKIP may be considered as a marker for HCC, because its expression level changes considerably in HCC compared with normal tissue. In addition, we used the methods of Western blotting and real time-polymerase chain reaction to analysis the protein expression and gene expression of RKIP. The result showed RKIP protein and gene expression in tumor part liver tissues of HCC patient is lower than peritumorous non-neoplastic liver tissue of the corresponding HCC samples. Conclusion: These results strongly suggest that RKIP may be considered to be a marker for HCC and RKIP are down-regulated in liver cancer cell.
  2,333 234 -
Thymic epithelial tumors: Can fluorodeoxyglucose positron emission tomography help in predicting histologic type and stage?
NC Purandare, CS Pramesh, G Karimundackal, S Jiwnani, A Agrawal, S Shah, JP Agarwal, K Prabhash, V Noronha, A Joshi, R Kumar, V Rangarajan
April-June 2016, 53(2):270-273
DOI:10.4103/0019-509X.197717  PMID:28071625
Objectives: To study the utility of fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting (1) the World Health Organization (WHO) histologic type and differentiating low-risk from high-risk types. (2) Tumor stage and differentiate early from advanced stage disease. Materials and Methods: Patients with thymic epithelial neoplasia who underwent a pretreatment FDG-PET study were included. Tumor maximum standardized uptake value (SUVmax) was correlated with the WHO histologic type and also with the Masaoka-Koga (MK) staging system. Patients with WHO Type A, AB, and B1 were classified as low risk and those with B2 and B3 as high risk. Thymic carcinomas belonged to Type C. Patients with MK Stage I and II disease were grouped as early stage and those with Stage III and IV as an advanced stage. Differences in SUVmax between the various groups were calculated. Results: The SUVmax of thymic carcinomas was significantly higher as compared to low-risk (P = 0.001) and high-risk groups (P = 0.007). The SUVmax of high-risk group was also significantly higher than the low-risk group (P = 0.002). SUVmax cutoff of 6.5 was able to differentiate thymic carcinomas from thymomas with 100% sensitivity and 87.2% specificity. The SUVmax in patients with advanced stage disease showed a higher trend compared to those with early stage, but the difference was not significant (P = 0.167). Conclusion: PET can differentiate thymic carcinomas from rest of the thymoma subtypes by the virtue of their higher FDG uptake. It can also provide valuable information in differentiating high-risk from low-risk thymomas and in predicting disease stage.
  2,344 172 -
Differentiated thyroid cancer in Iran – initial observations, histological features, management of the disease, and tumor recurrence: A review of 1689 cases
M Moslehi, Z Shahi, S Badihian, P Jalalpour, M Sedghian, G Motamedi, G Tavakol
April-June 2016, 53(2):261-264
DOI:10.4103/0019-509X.197727  PMID:28071623
Aim: The main objective of this study was to define some histopathological aspects of differentiated thyroid cancer (DTC), describe the disease management, and evaluate potential predicting factors for tumor recurrence in Iran. Materials and Methods: Medical records of 1689 patients of DTC treated over a 15-year period at a referral hospital located in the central region of Iran were reviewed retrospectively. Results: The female/male ratio was 3.78. The mean size of tumors was 23.35 mm. Most patients had papillary thyroid cancer (PTC) followed by follicular thyroid cancer (FTC) (83% and 5.5%, respectively). Lymph node involvement was seen in 27.6% of patients, and 3.6% of them had distant metastasis. Tumor recurrence was reported in 36.4% of patients. Higher stages of cancer, presence of lymph node involvement, presence of distant metastasis, larger tumor size, history of goiter, and higher doses of 131-Iodine at the first admission were associated with more chance of recurrence (P < 0.05). Comparing features of PTC and FTC, we found a more invasive behavior in FTC patients, including more capsular and near tissue invasion, higher stages of cancer, more frequent distant metastasis, and larger tumor size. Conclusion: This study provides useful information on characteristics of DTC, its management, and some prognostic factors. Our findings suggest that higher stages of cancer at diagnosis, presence of lymph node involvement, presence of distant metastasis, larger tumor size, history of goiter, and higher doses of 131-iodine administered at the first admission are associated with more chance of tumor recurrence. Furthermore, we found that FTC follows a more aggressive behavior and recommends clinicians to handle FTC patients more cautiously.
  2,312 155 2
Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria
AA Adoga, OA Silas, JP Yaro, ET Okwori, AA Iduh, CJ Mgbachi
April-June 2016, 53(2):252-255
DOI:10.4103/0019-509X.197713  PMID:28071621
Background: The efficacy of screening for oral, head and neck cancers (HNCs) in adequately identifying high-risk groups is controversial. Objectives: This study aims to review our experience with a free oral, HNC-screening program to determine the sociodemographic characteristics of the participants and the effectiveness of this program to improve future programs. Materials and Methods: A prospective cross-sectional survey of participants in a free oral, HNC screening exercise was performed in the years 2009, 2012, and 2013. Results: In the years of screening, 135 participants presented aged between 21 and 83 years (mean = 47.0; ±15.6) with a male to female ratio of 1.2:1. 32.6% consumed alcohol, and 17.8% were smokers. Smoking (P = 0.04) and alcohol use (P = 0.05) were associated with higher rates of suspicious malignant symptoms. There was no statistical correlation between symptom prevalence and the number of participants requiring immediate consultation for oral, HNC (r = 0.47), and those referred for routine follow-up (r = 0.34). Premalignant and malignant lesions were diagnosed in 5 males aged 44–72 years. 83.7% found the screening program beneficial in increasing their awareness of the disease. Conclusions: This hospital-based screening demonstrates improved awareness among people about oral, HNCs, and survival outcomes on a small scale. A community-based screening with health education to target a larger high-risk population is recommended to encourage individuals to modify high-risk factors and improve outcomes.
  2,183 190 -
Inadvertent intramuscular administration of vincristine in two pediatric patients with uneventful outcomes
V Radhakrishnan, A Murali, S Mishra
April-June 2016, 53(2):303-303
DOI:10.4103/0019-509X.197731  PMID:28071633
  2,185 113 2
Profile of pancreatic tumors at a tertiary care center
P Nandan, M Nirupama, JR Kini, S Gopal, KK Sahu, S Rai
April-June 2016, 53(2):296-299
DOI:10.4103/0019-509X.197714  PMID:28071631
Background: Pancreas, a relatively inaccessible organ, poses diagnostic difficulties with overlapping presentation among benign and malignant tumors. In the present study, pancreatic aspirates obtained by computed tomography (CT) guided procedures were used for cytodiagnosis. Our study aims at correlating clinical, cytological, biochemical, and histopathological results in obtaining a final diagnosis. Methodology: A retrospective study of 2 years was done which included 32 cases of pancreatic tumors at a tertiary care center. Patient data were retrieved and analyzed. Results: Twenty-seven of the 32 (84.37%) cases were malignant tumors. Age distribution in malignant tumors was predominantly seen in the fourth to eighth decade, whereas in benign, it ranged in the second to third decade. Thirteen out of the 32 (40.62%) cases reported were females, with male:female ratio of 1.46:1. The most common presenting symptom was abdominal pain followed by jaundice and vomiting. Three of the 32 cases had visceral metastasis at the time of diagnosis. CT-guided aspirates in most cases yielded diagnostic material. Cytological and histopathological results concurred except for three cases. Cancer Antigen 19-9 was worked up for 14 of 27 malignant cases, 11 of which showed grossly elevated values (700–7000), and three cases showed mildly elevated values (100–300). Three of the four benign cases worked up for CA 19-9 showed normal values. Conclusions: Among the mass forming lesions in pancreas, malignancy was more common compared to benign tumors. A multidisciplinary approach in the assessment and diagnosis of pancreatic tumors yields accurate results in spite of the limitations faced in obtaining adequate samples by needle aspirates.
  2,131 159 -
Prognostic factors in postoperative radiotherapy in salivary gland carcinoma: A single institution experience from Turkey
M Kandaz, G Soydemir, Z Bahat, E Canyılmaz, A Yöney
April-June 2016, 53(2):274-279
DOI:10.4103/0019-509X.197721  PMID:28071626
Background: We reviewed clinical characteristics, treatment outcomes, local and distant failure and prognostic factors in patients with salivary gland carcinoma treated with surgery and postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 75 patients with salivary gland cancer. 69 (%92) patients had cancer of the parotid gland, 3 (%4) patients had cancer of the submandibular gland and 3 (%4) patients had cancer of the minor salivary gland. 4 patients underwent postoperative chemoradiotherapy and 71 patients underwent postoperative radiotherapy. Median radiotherapy dose was 60Gy (range, 30Gy to 69Gy). Results: Median age was 59.6±17.9 (13-88) and the female/male ratio was 1/1.7. Median follow-up 52 months (2-228 months). The mean overall survival 69.2±8 (95%confidence interval[CI], 53.4-85.1) months. The 1-,3-,5- and 10- year overall survival rates were 79.8%, 53.2%, 37.4% and 22.8% respectively. The mean disease free survival 79.7±10 (95%CI, 60.1-99.3) months. The 1-,3-,5- and 10- year disaese free survival rates were 72.8%, 51.9%, 44.1% and 30.4% respectively. On multivariate analysis, the OS was significantly better for the female sex (hazard ratio[HR]:3,0;95%CI:1.5-5.6;P=0.001), absence of lymph node involvement ([HR]:3,0;95%CI:1.7-5.3;P=0.0001), lower tumor grade ([HR]:25,7;95%CI:3.3-199.3;P=0.002), negativity of the surgical margin ([HR]:2,3;95%CI:1.3-4.2;P=0.005), absence of lymphovasculer invasion ([HR]:2,6;95%CI:1.5-4.6;P=0.001), absence of extracapsuler extension ([HR]:6,5;95%CI:2.2-19.1;P=0.001), absence of perineural invasion ([HR]:4,8;95%CI:2.6-8.7;P=0.0001) and ≤60Gy radiotherapy dose ([HR]:3,1;95%CI:1.7-5.5;P=0.0001). They observed local recurrens in17 (23%) patients and distant metastasis in 33 (44%) patients. Conclusions: Employing existing standards of postoperative radiotherapy is a possible treatment that was found to be effective mainly in patients with salivary gland carcinomas.
  1,995 156 2
An audit of cytoreductive surgeries in ovarian cancer from a rural based cancer center
SB Dessai, VM Patil, S Chakraborty, S Babu, A Bhattacharjee, S Nayanar, S Vikram, S Balasubramanian
April-June 2016, 53(2):284-287
DOI:10.4103/0019-509X.197743  PMID:28071628
Background and Objective: Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra-radical) done in such patients. Methods: This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease-related and treatment-related data were extracted. Results: Fifty-fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350–600) mL. The median time interval for surgery was 4.0 h (3–5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02–0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra-radical surgery as compared to those who underwent radical surgery. Conclusion: Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra-radical surgery.
  1,981 146 1
A “Guided” technique for insertion of lumbar cerebrospinal fluid drains
SG Bakshi, NB Praveen, V Patil
April-June 2016, 53(2):338-338
DOI:10.4103/0019-509X.197736  PMID:28071642
  1,957 142 1
In silico analysis to predict lack of carcinogenicity of Zika virus
B Joob, V Wiwanitkit
April-June 2016, 53(2):225-225
DOI:10.4103/0019-509X.197711  PMID:28071614
  1,836 190 -
Role of regional catheters for postoperative analgesia following reconstructive surgeries for breast cancer
SG Bakshi, S Pokhale, S Sharma
April-June 2016, 53(2):243-243
DOI:10.4103/0019-509X.197712  PMID:28071619
  1,716 164 1
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