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Bakshi G, Tongaonkar H, Addla S, Menon S, Pradhan A, Kumar A, Bapat A, Gore A, Joshi A, Raja A, Bradoo A, Ramesh A, Kumar A, Agrawal A, Ambekar A, Joshi A, Singh A, Singh BP, Dabkara D, Khadakban D, Gautam G, Prakash G, Pahwa HS, Goel HK, Kulkarni J, Mishra JJ, Patel K, Pal M, Chibber PJ, Tiwari P, Naik R, Raghunath SK, Krishnatry R, Shimpi R, Sharma R, Taran R, Trivedi S, Nabar S, Surekha S, Kumar S, Sawaimoon SK, Raina S, Narasimha S, Advani S, Ghouse SM, Muddu VK, Maniar V, Venkat V, Murthy V. Expert survey on management of prostate cancer in India: Real-world insights into practice patterns. Indian J Cancer 2022; 59:S19-S45. [PMID: 35343189 DOI: 10.4103/ijc.ijc_1145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web-based survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ≥90% and ≥75% agreement, respectively. Sixty-two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high-level evidence.
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Affiliation(s)
- Ganesh Bakshi
- Department of Uro-Oncology, P D Hinduja National Hospital, Mumbai, India
| | - Hemant Tongaonkar
- Director of Surgical Oncology and Uro-Oncology, Max Nanavati Hospital, Mumbai, India
| | - Sanjai Addla
- Department of Uro-Oncology, Apollo Hospital, Hyderabad, India
| | - Santosh Menon
- Department of Uro-Onco Pathology, Tata Memorial Hospital & HBNI, Mumbai, India
| | - Aditya Pradhan
- Department of Uro-Oncology, BL Kapoor Hospital, Delhi, India
| | - Abhay Kumar
- Department of Uro-Oncology, Narayana Health, Kolkata, India
| | - Abhijit Bapat
- Department of Urology, Bapat Urology Hospital, Mumbai, India
| | - Adwaita Gore
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anand Raja
- Department of Uro-Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Anil Bradoo
- Department of Urology, Excel Urology Centre, Mumbai, India
| | - Anita Ramesh
- Department of Medical Oncology, Apollo Hospital, Chennai, India
| | - Anup Kumar
- Department of Urology, Safdarjung Hospital, Delhi, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Ashish Joshi
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | | | - Deepak Dabkara
- Department of Medical Oncology, Tata Memorial Centre, Kolkata, India
| | - Dhiraj Khadakban
- Department of Surgical Oncology, Oncolife Hospital, Satara, India
| | - Gagan Gautam
- Department of Uro-Oncology, Max Healthcare, Delhi, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | | | | | | | - Kaushal Patel
- Department of Medical Oncology, Tristar Hospital, Surat, India
| | - Mahendra Pal
- Department of Uro-Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Priya Tiwari
- Department of Medical Oncology, Artemis Hospital, Delhi, India
| | - Radheshyam Naik
- Department of Medical Oncology, HCG Hospital, Bangalore, India
| | - S K Raghunath
- Department of Uro-Oncology, HCG Hospital, Bangalore, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Rakesh Sharma
- Department of Uro-Oncology, Indo-American Hospital, Hyderabad, India
| | - Rakesh Taran
- Department of Medical Oncology, CHL Hospital, Indore, India
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Science, Varanasi, India
| | - Sanjay Nabar
- Department of Urology, Nanavati Hospital, Mumbai, India
| | | | - Satish Kumar
- Department of Surgical Oncology, Mohan's Medicity Hospital, Madurai, India
| | | | | | | | - Suresh Advani
- Department of Medical Oncology, SL Raheja Hospital, Mumbai, India
| | | | | | - Vashishth Maniar
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Vivek Venkat
- Department of Urology, Nanavati Hospital, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
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Khadakban D, Kudpaje A, Thankappan K, Jayaprasad K, Gorasia T, Vidhyadharan S, Mathew J, Sharma M, Iyer S. Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction. Craniomaxillofac Trauma Reconstr 2015; 9:40-5. [PMID: 26889347 DOI: 10.1055/s-0035-1558455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/22/2015] [Indexed: 10/23/2022] Open
Abstract
Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal.
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Affiliation(s)
- Dhiraj Khadakban
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Akshay Kudpaje
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Kiran Jayaprasad
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Tejal Gorasia
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Jimmy Mathew
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Mohit Sharma
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Rajanbabu A, Kuriakose S, Ahmad SZ, Khadakban T, Khadakban D, Venkatesan R, Vijaykumar DK. Evolution of surgery in advanced epithelial ovarian cancer in a dedicated gynaecologic oncology unit-seven year audit from a tertiary care centre in a developing country. Ecancermedicalscience 2014; 8:422. [PMID: 24834117 PMCID: PMC3998656 DOI: 10.3332/ecancer.2014.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Indexed: 11/06/2022] Open
Abstract
AIMS To audit our performance as a dedicated gynaecologic oncology unit and to analyse how it has evolved over the years.To retrospectively evaluate the outcome of advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval surgery versus upfront surgery. METHODS AND RESULTS One hundred and ninety-eight patients with advanced epithelial ovarian cancer (EOC) who were treated from 2004 to 2010 were analysed. Eighty-two patients (41.4%) underwent primary surgery and 116 (58.6%) received NACT. Overall, an optimal debulking rate of 81% was achieved with 70% for primary surgery and 88% following NACT. The optimal cytoreduction rate has improved from 55% in 2004 to 97% in 2010. In primary surgery, the optimal debulking rate increased from 42.8% in 2004 to 93% in 2010, whereas in NACT group the optimal cytoreduction rate increased from 60% to 100% by 2010. On the basis of the surgical complexity scoring system it was found that surgeries with intermediate complexity score had progressively increased over the years. There was a mean follow-up of 21 months ranging from 6 to 70 months. The progression-free survival and overall survival (OS) in patients undergoing primary surgery were 23 and 40 months, respectively, while it was 22 and 40 months in patients who received NACT. However, patients who had suboptimal debulking, irrespective of primary treatment, had significantly worse OS (26 versus 47 months) compared with those who had optimal debulking. CONCLUSIONS As a dedicated gynaecologic oncology unit there has been an increase in the optimal cytoreduction rates. The number of complex surgeries, as denoted by the category of intermediate complexity score, has increased. Patients with advanced EOC treated with NACT followed by interval debulking have comparable survival to the patients undergoing primary surgery. Optimal cytoreduction irrespective of primary modality of treatment gives better survival.
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Affiliation(s)
- Anupama Rajanbabu
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Santhosh Kuriakose
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Sheikh Zahoor Ahmad
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Tejal Khadakban
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Dhiraj Khadakban
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - R Venkatesan
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - D K Vijaykumar
- Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India
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Khadakban D, Gorasia-Khadakban T, Vijaykumar DK, Pavithran K, Anupama R. Factors associated with better survival after surgery in metastatic breast cancer patients. Indian J Surg Oncol 2012; 4:52-8. [PMID: 24426700 DOI: 10.1007/s13193-012-0204-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022] Open
Abstract
Women with Metastatic Breast Cancer (MBC) and an intact primary have long been treated with systemic therapy alone. Local therapy is not considered unless for palliative reasons. However, several studies have suggested local treatment in the form of Surgery for the primary improves overall survival in certain groups of MBC patients. We evaluated the factors influencing the outcome in this group of patients. In a retrospective review of our prospective database, we identified the patients who presented with MBC and underwent surgery for primary tumour (2004-2009). Patients' surgical details and clinicopathological factors were reviewed. The overall survival of the MBC patients who underwent surgery was evaluated and compared depending on the various clinicopathological factors. Out of 196 patients with MBC, 48 underwent surgery of the primary tumor during their treatment course. Median overall survival was better in patients with young age (<=40 years), Estrogen receptor(ER) positive tumors (31.4 months vs 21.2 months), single metastatic site vs multiple metastatic sites (43.4 months vs 26.69 months). We also found that patients with low level of suspicion for metastases fared better than those with high level of suspicion (43.4 months vs 20.9 months). Our data analysis suggested that for MBC patients who undergo surgery, survival is significantly worse in patients with pathological T4 lesions and there is a trend towards better survival in younger patients and in those who have ER positive tumour, Her2neu negative tumour, single site of metastases and patients with low level of metastatic suspicion. However these factors need to be evaluated in a randomized trial comparing with patients who have not undergone surgery.
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Affiliation(s)
- Dhiraj Khadakban
- Department of Surgical oncology, Tower 3-0, Hospital building, Amrita Institute of Medical Sciences, AIMS lane, Ponekkara, Kochi, Kerala 682041 India
| | - Tejal Gorasia-Khadakban
- Department of Surgical oncology, Tower 3-0, Hospital building, Amrita Institute of Medical Sciences, AIMS lane, Ponekkara, Kochi, Kerala 682041 India
| | - D K Vijaykumar
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, AIMS lane, Ponekkara, Kochi, Kerala 682041 India
| | - K Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, AIMS lane, Ponekkara, Kochi, Kerala 682041 India
| | - R Anupama
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, AIMS lane, Ponekkara, Kochi, Kerala 682041 India
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