Regional Cancer Center In India Research Articles

Clinicopathological Evaluation of Extragonadal Germ Cell Tumors - A Retrospective Study from a Regional Cancer Center in India

Introduction: Extragonadal germ cell tumors (EGGCTs) are tumors arising at extragonadal ana-tomical locations. The biological behavior and prognosis of these tumors differ from their gonadal counterparts. Our study aims to analyze their histological subtypes, the outcome, and the prognosis of these lesions at various age groups.Material and Methods: We carried out a retrospective analysis of all patients with EGGCTs diag-nosed from January 2017 to December 2019. Results: Our study included 61 cases of EGGCTs. These cases were divided into neonatal (birth to six months), prepubertal (more than six months to 12 years), and post-pubertal group (>12 years). The most frequently affected group was prepubertal (44.2%). The age ranged from birth to 45 years with a male-to-female ratio of 1:1.03. The frequently involved site was sacrococcyx (36%) followed by mediastinum (31.1%). The common histologic subtype was mature teratoma (39.3%), followed by yolk sac tumor (YST) (18%), mixed germ cell tumor (18%), immature teratoma (14.7%), and germinoma (9.8%). Four cases of teratoma had somatic malignancies. There were 48 stage I, 8 stage II, and 2 stage III tumors. Statistical analysis revealed a significant association of age group concerning primary site (p=0.004), histological type (p=0.002), and clinical stage (p=0.034). In a median follow-up of 30 months, an Overall Survival (OS) of 93.2% and Event Free Survival (EFS) of 90.4% were noted across all age groups. OS of 100% (neon tal), 96% (prepubertal) and 88.0% (post-pubertal) revealing a declining trend (p=0.324) with increasing age was noted. The important prognostic factors include histological subtype (mixed germ cell tumors and teratomas with somatic malignancies had reduced overall survival) and stage (I vs II and III) for OS and stage alone for EFS (P<0.0001). Conclusion: Our study highlights the clinicopathological characteristics, prognostic parameters, and the outcome of GCTs occurring at extragonadal sites and emphasizes the role of pathologists in the detailed reporting of these lesions.

Patterns of Male Breast Cancer over Three Decades: A Single Institutional Findings

Introduction: Male breast cancer (MBC) accounts for around 1% of all breast cancers. However, the incidence & patterns of MBC varies in different parts of the world. Due to the rarity of its occurrence, very few literature are available regarding its peculiarities.
 Material & Methods: A total of 119 patients of MBC were included in this retrospective analysis, who were registered in a single regional cancer center in India over 30 years period from 1991 to 2020. Data from all patients were collected to evaluate the spectrum and patterns of MBC concerning presentation, distribution, and clinicopathological characteristics.
 Results: Total of 119-patients of MBC were registered in this time. The median age of presentation was 59 years. The right to left ratio was 1.25:1, which indicated that both sides breast was equally affected. Most of the patients (68.1%) presented late in the disease course with locally advanced or metastatic lesions. The majority of breast lesion was central or retro-areolar in location and infiltrating ductal carcinoma histology was found in more than 90% of patients. Estrogen and progesterone receptor positivity was seen in 42.9% and 29.4% of patients, respectively. The most common metastatic site was bone.
 Conclusion: Our data regarding MBC patients matched closely with existing literature. However, it is seen MBC patients presented to oncologists in a locally advanced stages; either because of shyness or unaddressed health education. Emphasis should be given to prospective studies to gather more knowledge about the demography and pattern of this rare yet sprouting malignancy

Prognostic Implications of Concurrent Ductal Carcinoma In Situ in Invasive Breast Cancer: an Observational Nested Cohort Study from a Regional Cancer Center in India

Prognostic Implications of Concurrent Ductal Carcinoma In Situ in Invasive Breast Cancer: an Observational Nested Cohort Study from a Regional Cancer Center in India

Extranodal NK/T-cell lymphoma-nasal type: Experience from a regional cancer center in India

Introduction: Extranodal natural killer/T-cell lymphoma-nasal type (ENKTL-NT) is an aggressive rare non-Hodgkin's lymphoma (NHL) subtype. It presents with involvement of the nasal and upper aerodigestive region causing extensive destruction of these midline structures. It has a predilection for the Asian population. Most cases present in the early-stage disease. Treatment outcomes are usually poor, and no consensus for optimal treatment strategy exists. Patients and Methods: This is a retrospective analysis of ENKTL-NT, diagnosed in a regional cancer center in India during the period of 2013–2018. The demographic and clinical features, laboratory parameters, radiological, histopathological features, and treatment outcomes were studied. Patients were treated with SMILE or AspaMetDex regimes sandwiched with radiotherapy. Statistical analysis was performed using software “Epi Info” Version 7.2, (CDC, Atlanta, Georgia, USA). Results: Fourteen patients were diagnosed with ENKTL-NT during this period. Eight patients received SMILE, and six patients have received AspaMetDex as induction chemotherapy. Ten (71.42%) of 14 patients have achieved CR. At the median follow-up of 30 months (4–47 months), nine patients relapsed with median progression-free survival of 22 months. The median overall survival was not reached. There were two induction deaths, one in AspaMetDex and one in the SMILE group. All patients receiving SMILE experienced at least one episode of Grade 3/4 hematological toxicity. Patients receiving AspaMetDex did not have any Grade 3/4 hematological toxicity. Discussion: ENKTL-NT in India is not as common as reported in other Asian countries. Patients usually present at an earlier stage because of the peculiar site of affection. It has high response rates, but relapses are common. Most of the relapses occur within the first 2 years of follow-up. Conclusion: ENKTL-NT is rare aggressive NHL subtype with good response to L-asparaginase-based chemotherapy sandwiched with radiation therapy. SMILE is a more toxic regime than AspaMetDex but can be managed with proper supportive care.

Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India

BackgroundPatients with advanced cancer often experience poor health-related quality-of-life (HRQoL) due to cancer and treatment-related side-effects. With India’s palliative care landscape in its infancy, there is a concern that advanced cancer patients, especially individuals who are from disadvantaged populations experience poor HRQoL outcomes. We aim to assess HRQoL of advanced cancer patients in terms of general well-being (physical, functional, emotional, and social/family well-being), pain experiences, psychological state, and spiritual well-being, and determine the relationship between belonging to a disadvantaged group and HRQoL outcomes. We hypothesize that patients from disadvantaged or minority backgrounds, identified in this paper as financially distressed, female, lower years of education, lower social/family support, minority religions, and Non-General Castes, would be associated with worse HRQoL outcomes compared to those who are not from a disadvantaged group.MethodsWe administered a cross-sectional survey to 210 advanced cancer patients in a regional cancer center in India. The questionnaire included standardized instruments for general well-being (FACT-G), pain experiences (BPI), psychological state (HADS), spiritual well-being (FACT-SP); socio-economic and demographic characteristics.ResultsParticipants reported significantly lower general well-being (mean ± SD) (FACT-G = 62.4 ± 10.0) and spiritual well-being (FACT-SP = 32.7 ± 5.5) compared to a reference population of cancer patients in the U.S. Patients reported mild to moderate pain severity (3.2 ± 1.8) and interference (4.0 ± 1.6), normal anxiety (5.6 ± 3.1) and borderline depressive symptoms (9.7 ± 3.3). Higher financial difficulty scores predicted most of the HRQoL domains (p ≤ 0.01), and being from a minority religion predicted lower physical well-being (p ≤ 0.05) and higher pain severity (p ≤ 0.05). Married women reported lower social/family well-being (p ≤ 0.05). Pain severity and interference were significant predictors of most HRQoL domains.ConclusionsAdvanced cancer patients, especially those with lower financial well-being and belonging to minority religions, reported low physical, functional, emotional, social/family, and spiritual well-being, and borderline depressive symptoms. Future studies should be directed at developing effective interventions supporting vulnerable groups such as those with financial distress, and those belonging to minority religions.

HIV/AIDS-related lymphoma: perspective from a regional cancer center in India.

BackgroundIndia has the third largest population of people living with HIV/AIDS (PLHA). Lymphoma is the second most common malignancy among PLHA. However, data are lacking regarding HIV/AIDS-related lymphoma (ARL) in India. This study evaluated the epidemiology and clinical outcomes of ARL from a regional cancer center in India.MethodsThis retrospective analysis included cases of ARL between March 2011 and September 2017. Data were obtained from patient record files for the assessment of epidemiology and clinical outcomes. Statistical analysis was performed using GraphPad Prism 6. Comparisons of subtype-specific survivals were performed using log-rank tests.ResultsOf 1,226 lymphoma cases, 80 (6.5%) were ARL. Details were available for 70 patients. The median age at diagnosis was 40.5 (9–74) years with a male:female ratio of 2:1. AIDS-defining lymphomas (ADL) constituted 78.6% of cases, while 21.4% had non-AIDS defining lymphoma (NADL). The mean CD4 counts were 193.15±92.85 and 301.93±107.95 cells/µL, respectively (t-test; P=0.0002). Extranodal involvement was present in 55.7%, B symptoms were reported in 60%, and lactate dehydrogenase (LDH) was elevated in 64.3% of patients. The median overall survival times were 6 months for plasmablastic lymphoma (PBL), 23 months for diffuse large B-cell lymphoma (DLBCL), and was not reached for Hodgkin's lymphoma (log-rank test; P=0.0011). Other histological subtype cases were too few to draw meaningful survival outcomes.ConclusionARL is a heterogeneous disease. Histologic subtype is a major determinant of the clinical outcome. ADL has significantly lower CD4 counts than those of NADL. There is an urgent and unmet need for uniform management guidelines for improving outcomes in this under-represented patient population.

65P - Experience of prophylactic cranial irradiation in extensive stage small cell lung cancer at a regional cancer center in India

65P - Experience of prophylactic cranial irradiation in extensive stage small cell lung cancer at a regional cancer center in India

Time, Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India

Background: There is a geographical, socioeconomical and logistic diversity among the cancer patients who reach a regional cancer center. In a developing economy like that of India's, only a minority of patients have medical insurance. So in our setup a cancer patient is met with time, distance and financial challenges. These intangible factors theoretically are expected to influence the ultimate outcome of cancer treatment. Aim: To evaluate the prevailing demographic and economic variables of cancer patients visiting our RCC and to look for any correlation among each other. Methods: The demographic details of cancer patients registered at our RCC between August 2017- September 2017 were retrieved retrospectively. Distance traveled to get to the RCC and get a diagnosis of cancer, time taken for diagnosis and initiation of treatment, and the source of finances for treatment were collected. A correlation among these factors was attempted to be identified. Statistical correlation was identified using Student t-test. Results: Among 591 patients who were analyzed, the median age of patient was 55 years old. The median time taken for the patient to reach the RCC from permanent residence after the beginning of cancer related complaints was 3.19 months. The median distance traveled for the same was 131 km. The source of income was private employment for 223 patients and government employment for 164 patients and self-employment for 200 patients. Only 164 patients had some kind of structured health scheme to manage their health care expenses. Among these, 96 patients had private insurance/reimbursement and 64 patients had government reimbursement. 384 (64%) of patients presented with advanced and locally advanced stage disease while 114 (19%) patients presented to us with early stage disease. However a correlation between delay in presentation to the RCC, distance traveled to reach the RCC, source of income and advanced stage of disease couldn't not be established. Conclusion: Majority of patients visiting our RCC is from far off places and most of these patients pay for the cancer treatment themselves without any support from government or private insurances. All these factors may be responsible for late or advanced stage presentation of cancer patients.

Why Newly Diagnosed Cancer Patients Require Supportive Care? An Audit from a Regional Cancer Center in India.

Purpose:The present study was planned to record the distressing symptoms of newly diagnosed cancer patients and evaluate how the symptoms were addressed by the treating oncologists.Materials and Methods:All newly diagnosed cancer patients referred to the Department of Radiotherapy during May 2014 were asked to complete a questionnaire after taking their consent. The Edmonton symptom assessment scale-regular questionnaire was used to assess the frequency and intensity of distressing symptoms. The case records of these patients were then reviewed to compare the frequency and intensity documented by the treating physician. The difference in the two sets of symptoms documented was statistically analyzed by nonparametric tests using SPSS software version 16.Results:Eighty-nine patients participated in this study, of which only 19 could fill the questionnaire on their own. Anxiety was the most common symptom (97.8%) followed by depression (89.9%), tiredness (89.9%), and pain (86.5%). The treating physicians recorded pain in 83.1% whereas the other symptoms were either not documented or grossly underreported. Anxiety was documented in 3/87 patients, but depression was not documented in any. Tiredness was documented in 12/80 patients, and loss of appetite in 54/77 patients mentioning them in the questionnaire. Significant statistical correlation could be seen between the presence of pain, anxiety, depression, tiredness, and loss of appetite in the patients.Conclusion:The study reveals that the distressing symptoms experienced by newly diagnosed cancer patients are grossly underreported and inadequately addressed by treating oncologists. Sensitizing the oncologists and incorporating palliative care principles early in the management of cancer patients could improve their holistic care.

A prospective study to assess the efficacy and toxicity of 5-flurouracil and cisplatin versus taxane and cisplatin as induction chemotherapy in locally advanced head and neck squamous cell cancer in a regional cancer center in India

The aim of this study is to assess the efficacy and toxicity of 5-flurouracil (5-FU) and cisplatin (PF) versus taxane and cisplatin (TP) as induction chemotherapy in locally advanced head and neck squamous cell cancer. There were 50 patients in each arm, matched for age, performance state, site and stage of disease. PF arm (cisplatin - 100 mg/m2 D1, 5-FU - 1000 mg/m2 D1-D5) TP arm (docetaxel - 75 mg/m2 or paclitaxel - 175 mg/m2 on D1, cisplatin 75 mg/m2 on D2), received once in 3 weeks for 3 cycles. Patients without progressive disease underwent either surgery or chemoradiation. The primary end point was overall response rate (ORR) and secondary endpoint was toxicity. In a total of 100 patients in our study, 44 in PF and 47 in TP arm were evaluable. ORR was 86.6% in PF arm and 82.9% in TP arm (P = 0.71).There were more Grade 3 or 4 events of neutropenia, mucositis (P ≤ 0.05) and myelosuppression diarrhea, febrile neutropenia (P ≥ 0.05) in PF arm compared with TP arm. Post-chemotherapy hospital admissions due to toxicity were more frequent in PF arm (38.6% vs. 19%), dropout rate due to toxicity (9% vs. 0%) and deaths (6.8% vs. 2.1%) were more common in PF arm compared with TP arm. TP induction chemotherapy better tolerated than PF, which has similar efficacy, further multicenter randomized controlled studies; involving a large sample size is needed to confirm our data.

Do newly diagnosed cancer patients require palliative care? An audit at a regional cancer center in India.

65 Background: The present study was planned to record the distressing symptoms of newly diagnosed cancer patients and to evaluate how the symptoms were addressed by the treating oncologists. Methods: All newly diagnosed cancer patients referred to the department of Radiotherapy during the month of May 2014 were asked to fill a questionnaire after taking their consent. The ESAS-r questionnaire was used to assess the frequency and intensity of distressing symptoms. The case records of these patients were then reviewed to compare the frequency and intensity documented by the treating physician. The difference in the two sets of symptoms documented were statistically analysed by non-parametric tests using SPSS. Results: Eighty-nine patients participated in this study out of which only 19 could fill the questionnaire on their own. Anxiety was the commonest symptom (97.8%) followed by depression (89.9%), tiredness (89.9%) and pain (86.5%). The treating physicians recorded pain in 83.1% while the other symptoms were either not documented or grossly under reported. Anxiety was documented in 3/87 patients but depression was not documented in any. Tiredness was documented in 12/80 patients, loss of appetite in 54/77 patients mentioning them in the questionnaire. Significant statistical correlation could be seen between the presence of pain, anxiety, depression, tiredness and loss of appetite in the patients. Conclusions: The study reveals that the distressing symptoms experienced by newly diagnosed cancer patients are grossly under reported and inadequately addressed by treating oncologists. Sensitizing the oncologists and incorporating palliative care principles early in the management of cancer patients could improve their holistic care.

Incidence of hospitalization in patients receiving short course palliative cranial radiotherapy on outpatient basis in a limited resource setting – Experience from a regional cancer center in India

AimTo investigate incidence of toxicity and related hospitalization among patients treated at our institute by a short course of palliative cranial radiotherapy against a longer, widely established schedule. BackgroundShorter schedule palliative cranial radiotherapy is more convenient for patients and reduce waiting times. Although many studies have established safety of short schedules, the need for hospitalization due to acute treatment toxicity remains under-explored. Hospital admissions are an economic burden both for the patient and healthcare system in a limited resource setting. Delivery of treatment on an outpatient basis and within shorter times is preferred by patients, caregivers and healthcare staff. Materials and methodsThis was a prospective study on 68 patients treated with palliative whole brain radiotherapy between November 2010 and October 2012. One group received 20Gy in 5 fractions over 1 week and the other group, 30Gy in 10 fractions over 2 weeks. Treatment toxicity due to cranial radiotherapy was assessed as per RTOG acute and late toxicity criteria. Need for hospitalization owing to acute toxicity was also noted. Significant differences in the study parameters between the two groups were calculated by Fisher's t-test. ResultsRequirement for hospital stay due to acute toxicity was not significantly different between the two groups. Patients in both groups experienced similar toxicity both during and after treatment. ConclusionsThe shorter course entailed no significant increase in toxicity related admissions, suitable for limited resource settings where patient transport is difficult, there are financial constraints, and the healthcare system is overburdened.

Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment

The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.

Malignant melanoma: A retrospective series from a regional cancer center in India

To present our experience in treating malignant melanoma patients. All melanoma patients treated at the Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India, from 1995 to 2007 were studied retrospectively. The endpoints were loco-regional recurrence, distant recurrence, recurrence-free survival (RFS), and duration of follow-up (DOFU). RFS and DOFU were analyzed with respect to the factors like age, sex, tissue of origin, site of disease, number of nodes, lymphadenopathy, ulceration, stage, and operability to find out any association. Seventy-two patients were found evaluable with 40 males and 32 females (median age 46.5 years). Eye was the commonest primary site with visual disturbance as the commonest symptom. Overall, 87% of the lesions were single, with most of the nonocular lesions presenting in the advanced stage. During the disease course, regional lymphadenopathy and distant metastases were seen in 33% and 32% of cases, respectively. Highest incidence of lymphadenopathy was seen in skin lesions and in primaries from trunk and extremities. Of all treated patients, 47% achieved complete response, 18% partial response, and others had either stable or progressive disease. The median DOFU was 6.2 months. RFS was studied only in curatively treated cases with a median of 10 months. Operability at presentation was the only prognostic factor influencing DOFU. Malignant melanoma is an uncommon disease in India carrying a lot of morbidity due to late presentation. Its management is still not clear regarding the optimum use and schedule of treatment modalities. More prospective studies in the future are required to come to a definite conclusion.

Radiation delivery practices in nonmetastatic breast cancer at a regional cancer center in India

11578 Background: Radiation therapy (RT) forms an integral part of treatment of breast cancer, especially in locally advanced disease. Emerging knowledge of recurrence and morbidity patterns has helped modify the treatment parameters. Methods: We retrospectively reviewed the treatment records of 213 patients treated between 1998 and 2002 to study the RT delivery practices at our department. Patients were offered surgery, RT, anthracycline- or taxane-based chemotherapy and hormone therapy depending on stage and hormone receptor status. RT was either local (chest wall or whole breast) or locoregional (local, axilla and supraclavicular region). Results: Breast cancer patients with nonmetastatic disease (n=213, 211 females, 2 males) were evaluated. Median age was 48 years (range 22–83). Stage distribution was as follows: stage I- 3 (1.4%), stage II- 73 (34.3%), stage III- 106 (49.8%) and unknown in 31 (14.6%). Surgery was performed in 206 patients- 158 (76.7%) underwent modified radical mastectomy, 41 (19.9%)...

Cancer Patients’ Perception of the Quality of Communication Before and After the Implementation of a Communication Strategy in a Regional Cancer Center in India

Physician communication is one of the areas that cancer patients have expressed their lowest level of satisfaction. Very few studies have used patient-based outcomes in the Developing world. We conducted a survey of 400 consecutive patients attending our outpatient clinic (Step I). Survey results were used to make changes in the physical layout of the setting to increase privacy and to educate staff regarding practical techniques on communication (Step II). A second group of 400 patients were interviewed immediately after the implementation of the new communication strategy (Step III). Comparing Step I (n = 400) and Step III (n = 400) we observed a favorable response ("yes" v "no") with regard to overall satisfaction with communication in 52 patients (13%) versus 132 patients (33%; P = .0001), privacy in 21 patients (5%) versus 279 patients (70%; P = < .001), no interruptions in 170 patients (42%) versus 330 patients (82%; P = < .001), clear language in 57 patients (14%) versus 227 patients (57%; P = < .001), sufficient time in 88 patients (22%) versus 168 patients (42%; P = < .001), doubts cleared by the doctor in 105 patients (26%) versus 225 patients (56%; P = < .001). Patients older than 65 years and manual laborers were significantly more satisfied compared with younger patients and those patients with nonmanual occupations, during both Steps I and III. We conclude that cancer patients in Developing countries have many unmet needs regarding communication and that simple changes in the organization of clinics and oncologist education can result in major improvements in satisfaction with the quality of communication.

Perception of quality of physician communication by cancer patients before and after the implementation of a communication strategy in a regional cancer center in India

8088 Background: Physician communication is one of the areas where cancer patients express their lowest level of satisfaction. Very few studies have used patient based outcomes in the developing world. Methods: We conducted a survey of 400 consecutive patients attending our outpatient clinic [Phase I]. An 8-item questionnaire (Yes/No) was administered anonymously by a trained paramedical worker immediately after the clinic consult. The results were used to make changes in the physical layout of the setting by setting up curtains to form small private areas, to increase privacy, decrease interruptions by avoiding phone calls and to educate staff regarding practical techniques on communication skills [Phase II]. A second group of 400 patients were interviewed immediately after the implementation of the new communication strategy using the same 8-item questionnaire. 183 patients of these had participated in Phase I [Phase III].The largest improvements were seen in perception of improved privacy, less interruption, use of clear language, and clearing doubts. During Phase III improvement was not significantly different between new patients [n=217] and previously established patients [n=183]. Patients older than 65 and manual laborers were significantly more satisfied with communication both during Phase I [p=0.12 and 0.02] and during Phase III [p=0.01 and 0.008], respectively. Our results suggest that cancer patients in developing countries have significant unmet communication needs and that simple changes in physical layout and oncologists’ attitude towards better communication skills can have major impact on perception of communication. No significant financial relationships to disclose.

Pelvic exenteration: A perspective from a regional cancer center in India

Pelvic exenteration is an extensive surgical procedure performed for locally advanced cancers in the pelvis. The twenty-year experience with this procedure at the Cancer Institute has been analyzed for morbidity, failure pattern and survival. The case records of all the patients who had undergone pelvic exenteration between 1981 and 2000 at Cancer Institute (WIA), Chennai were retrieved from Tumor Registry and were analyzed. Forty-eight patients underwent Pelvic Exenteration from 1981 to 2000 at the institute. Twenty-nine of them had rectal cancer, 15 had cervical cancer, 3 had bladder cancer, and 1 had ovarian cancer. There were 43 women and 5 men with a median age of 45 years. The survival rates were calculated by Kaplan-Meier method using EGRET statistical software package. The operative mortality and postoperative morbidity were 10.42% and 62.50% respectively. The 5-year overall survival for the patients with Ca rectum and Ca cervix were 54.2% and 77.6% respectively. All 4 patients with Ca bladder or Ca ovary survived for more than 5 years. On multivariate analysis, nodal involvement and number of positive nodes emerged as significant prognostic factors for patients with Ca rectum. Although no factor reached statistical significance for patients with Ca cervix, those with adjacent organ invasion had a trend towards poorer survival. For carefully selected locally advanced cancer in the pelvis, pelvic exenteration may provide the opportunity of long-term survival.

Vulval dystrophy: an experience in a regional cancer center in India

Vulval dystrophy: an experience in a regional cancer center in India