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Bhandare MS, Gundavda KK, Yelamanchi R, Chopde A, Batra S, Kolhe M, Ramaswamy A, Ostwal V, Deodhar K, Chaudhari V, Shrikhande SV. Impact of pCR after neoadjuvant chemotherapy and radical D2 dissection in locally advanced gastric cancers: Analysis of 1001 cases. Eur J Surg Oncol 2024; 50:108343. [PMID: 38640606 DOI: 10.1016/j.ejso.2024.108343] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Advances in perioperative chemotherapy have improved outcomes in patients with gastric cancers (GC). This strategy leads to tumour downstaging and may result in a pathologic complete response (pCR). The study aimed to evaluate the predictors of pCR and determine the impact of pCR on long-term survival. METHODS At the Department of Gastrointestinal and HPB Oncology at the Tata Memorial Centre, Mumbai, 1001 consecutive patients with locally advanced GCs undergoing radical resection following neoadjuvant chemotherapy from January 2005 to June 2022 were included. RESULTS At a median follow-up of 61 months, the median OS was 53 months with a 5-year OS of 46.8 %. Ninety-five patients (9.49 %) realized pCR. Non-signet and well-differentiated histology were associated with pCR. pCR was significantly associated with improved OS, 5-year OS 79.2 % vs 43.2 % (HR 0.30, p < 0.001). On multivariable analysis, the realization of pCR and completion of adjuvant chemotherapy had superior OS. Whereas, signet-ring histology, linitis-like tumours, and high lymph node ratio had adverse outcomes. CONCLUSION Tumour grade and signet-ring histology predict achievement of pCR in locally advanced GCs after neoadjuvant chemotherapy. Patients with pCR have significantly improved survival. Future neoadjuvant strategies should focus on enhancing pCR rates to improve overall outcomes.
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Affiliation(s)
- Manish S Bhandare
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Kaival K Gundavda
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Raghav Yelamanchi
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Amit Chopde
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Swati Batra
- Department of Surgical Oncology, Armed Forces Medical Services (Army Hospital, Research and Referral), Delhi, India.
| | - Manjushree Kolhe
- Department of Statistics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Vikram Chaudhari
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Shailesh V Shrikhande
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Mahantshetty U, Kashid SR, Mulye G, Gurram L, Engineer R, Chopra S, Ghosh J, Gulia S, Gupta S, Ghadi Y, A D, Kohle S, Kadam S, Menon S, Deodhar K, Maheshwari A, Ts S, Lewis S, Kalyani N, Shrivastava SK. Reirradiation with advanced brachytherapy techniques in recurrent GYN cancers. Brachytherapy 2023; 22:753-760. [PMID: 37716821 DOI: 10.1016/j.brachy.2023.07.004] [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] [Received: 03/25/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To evaluate clinical outcomes of recurrent gynaecological cancers treated with reirradiation (reRT) using advanced brachytherapy (BT) technique. METHODS AND MATERIALS Seventy-six women who underwent reRT with BT for gynaecological cancers at our institute between January 2000 and December 2019 were analysed to determine patient, disease and treatment characteristics and clinical outcomes. Descriptive analysis was used for demographics, and the Kaplan Meir method was used for survival analysis. RESULTS Median age at recurrence was 55 years (Range: 35-73). Forty-three patients had recurrent cervical cancer with intact uterus, and 33 had recurrent vault/vaginal cancers post adjuvant RT. Eight patients received EBRT prior to BT (Range: 30-50Gy). Twenty-two patients (28.9%) received salvage chemotherapy before consideration of brachytherapy. Brachytherapy application was done using MUPIT in 38, Vienna applicator in 20, Syed Neblett in 8, central vaginal cylinder in 3, multicatheter intravaginal applicator in 2, tandem-ovoids in 4 and Houdek applicator in 1 patient. Median cumulative EQD2 for all courses of radiation was 108 Gy (IQR 92-123 Gy). At median follow up of 39 months, local control (LC), progression-free survival (PFS) and Overall survival (OS) at 2-years was 60%, 56.3%, and 72.9 respectively. Patients who had recurrences beyond 2 years had significantly better OS compared to early recurrences. Patients who received BT doses >40 Gy had a higher LC and PFS. Grade 3 to 4 late rectal toxicity was seen in 10 (13%), bladder toxicity in 6 (8%) and vaginal fibrosis in 24 (31%) patients. CONCLUSION The use of advanced BT approach in reirradiation setting is a feasible and safe option in treatment of post-treatment recurrent cervical, endometrial, and vaginal cancers.
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Affiliation(s)
- Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Visakhapatnam, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sheetal R Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gargee Mulye
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Yogesh Ghadi
- Department of Radiation Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dheera A
- Department of Radiation Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Satish Kohle
- Department of Radiation Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudarshan Kadam
- Department of Radiation Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shylasree Ts
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104
| | - Nikhil Kalyani
- Department of Radiation Oncology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - S K Shrivastava
- Department of Radiation Oncology, HCG ICS Khubchandani Cancer Centre, Mumbai, Maharashtra, India
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Jain AK, Sundaram S, Tyagi U, Kale A, Patkar S, Patil P, Deodhar K, Ramadwar M, Yadav S, Chaudhari V, Shrikhande S, Mehta S. IgG4-related disorders of the gastrointestinal tract: Experience from a tertiary care centre with systematic review of Indian literature. Indian J Gastroenterol 2023:10.1007/s12664-023-01437-6. [PMID: 37823986 DOI: 10.1007/s12664-023-01437-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION IgG4-related disease (IgG4-RD) is a rare disease entity in India. We aimed at studying the clinical profile of IgG4-RD of gastrointestinal tract (GIT) from our centre, while systematically reviewing data from India. METHODS Retrospective review of IgG4-RD of GIT was done using electronic medical records between January 2013 and July 2022. Literature search was done for studies of IgG4-RD of the GIT reported from India from 2000 till January 2023. Case series, case reports of IgG4-RD of GIT and case reports describing GIT with multi-organ involvement were included in the review. Primary outcome measure was response to treatment. Secondary outcome measure was relapse after remission. RESULTS Thirty-one patients were included with 71% (22/31) having autoimmune pancreatitis. The diagnosis was achieved on surgical specimen in 35% (11/31) patients. Steroid was given to 64% (20/31) patients with remission achieved in 70% (14/20) patients. Four patients exhibitted response to prolonged course of steroids with maintenance azathioprine. Relapse was seen in four (20%) patients who achieved remission. Of 731 articles screened, 48 studies (four case series and 44 case reports) were included in the literature review. Of 95 patients described, steroids were given to 65.2% (62/95), while surgery was done in 33.6% (32/95). Remission was seen in 96.6% (85/88) with relapse occurring in 11.4% (10/88) patients on follow-up. CONCLUSION One-third patients of IgG4-RD of GIT are diagnosed after surgery. Response to steroids is good with relapse occurring in up to 12% patients.
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Affiliation(s)
- Aadish Kumar Jain
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India.
| | - Unique Tyagi
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Aditya Kale
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Vikram Chaudhari
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Shailesh Shrikhande
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012, India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400 012, India
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Pathuthara S, Dighe S, Uke M, Prabhudesai N, Deodhar K, Desai SB. Conventional versus Liquid-based Cytology: "Man versus Machine". J Cytol 2023; 40:169-176. [PMID: 38058665 PMCID: PMC10697311 DOI: 10.4103/joc.joc_54_23] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/08/2023] [Accepted: 08/17/2023] [Indexed: 12/08/2023] Open
Abstract
Background Liquid-based cytology (LBC) can improve adequacy, monolayer quality with a clean background compared to conventional smears (CS). Aims and Objectives The objective was to compare the quality and diagnostic yield of CS and LBC in routine cytological investigations. Materials and Methods This retrospective study consisted of 306 samples (255 gynecological, 39 nongynecological, and 12 fine needle aspiration cytology [FNAC]) during a 2-year period (2019-2020). From each patient, two samples were collected in the same manner in the same sitting and processed by CS and LBC (ThinPrep® 2000, Hologic Inc.). Both CS and LBC were compared for adequacy, quality, representativeness, inflammation, hemorrhage, necrosis, preservation, reactive changes, organisms, atypia/dysplasia/malignancy, and preparation/screening time. Statistical analysis was performed. Results No statistically significant difference was noted for adequacy, representativeness, reactive changes, preservation, and atypia/dysplasia/malignancy. CS was better in cellularity and diagnosis of inflammation and organisms, whereas LBC had a clean background and the difference was statistically significant (P = 0.0005). Conclusions CS was equivalent to LBC in adequacy, representativeness, reactive changes, and atypia/dysplasia/malignancy. Adequacy comparable to LBC can be achieved in CS by careful sample collection, processing, and screening by trained cytotechnologists. CS was better in detecting organisms and inflammation than LBC. The advantages of LBC were monolayer smear, clean background, and lesser screening time, but the demerit was higher cost and longer processing time. Therefore, LBC is best suited to those laboratories having high sample inadequacy rates, lack of competent cytotechnologists, and no financial constraints. Either man or machine, appropriate and adequate sample collection by trained personnel forms the cornerstone for ensuring adequacy in both CS and LBC.
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Affiliation(s)
- Saleem Pathuthara
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Swati Dighe
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Maya Uke
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neelam Prabhudesai
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sangeeta B. Desai
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Dhende S, Pathuthara S, Prabhudesai N, Shinde D, Karnik N, Deodhar K. Heat Induced Processing of Cellblocks with Significant Reduction in Overall Turn Around Time. J Cytol 2023; 40:126-132. [PMID: 37745803 PMCID: PMC10516157 DOI: 10.4103/joc.joc_34_23] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/14/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Cellblock (CB) with immunohistochemistry (IHC) is practically indispensable in the diagnostic workup of serous effusions; however, CB requires a minimum of 15-20 h for routine histopathological processing. A reduction in processing time can expedite a faster diagnosis. Aim This study was undertaken to evaluate the utility of the heat-induced CB (HICB) technique. Material and Methods Two sets of agar-embedded CBs were processed from 50 effusion samples. CBs were further processed by conventional and rapid methods. Conventional CBs (CCB) were processed in a histoprocessor, whereas rapid CB was processed in a heated water bath with an agitation facility. For HICB processing, dehydration and clearing were performed at 50°C followed by paraffin wax impregnation at 65°C temperature. From both CBs, sections of 5 um thickness were cut and stained with hematoxylin and eosin (H and E). Cell morphology, cost, and time were compared between the two methods. The feasibility of IHC was attempted in a few cases. Results HICB was completed within 4.30 h compared with CCB. Diagnoses on both CBs were concordant in all the cases. Incomplete dehydration was noted in six (12%) cases, but the diagnosis was not compromised. No additional cost was involved in HICB. On IHC, both HICB and CCB exhibited equivalent expression. Conclusions HICB is a rapid, innovative, simple, and cost-effective technique and expedites faster diagnosis. It does not require any advanced equipment.
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Affiliation(s)
- Suhas Dhende
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saleem Pathuthara
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neelam Prabhudesai
- Department of Cytopathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dipak Shinde
- Department of Surgical Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nupur Karnik
- Department of Surgical Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Surgical Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Gupta V, Chopde A, Patkar S, Deodhar K, Goel M. Oxaliplatin-Induced Sinusoidal Obstruction Syndrome Masquerading as Colorectal Liver Metastasis: A Case Report. J Gastrointest Cancer 2023; 54:682-686. [PMID: 35666356 DOI: 10.1007/s12029-022-00835-x] [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] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Oxaliplatin-based chemotherapy is commonly used in adjuvant treatment of colon cancer as well as in neoadjuvant setting in patients with liver metastases. However oxaliplatin can cause damage to non-tumor bearing liver which presents as sinusoidal obstructive syndrome (SOS). These changes are difficult to differentiate from metastasis clinic-radiologically and manifests as sinusoidal dilatation, peliosis and nodular regenerative hyperplasia. CASE The present study reports the case of a patient with oxaliplatin-induced SOS which mimicked colo-rectal liver metastasis on follow up imaging studies after receiving neoadjuvant oxaliplatin based chemotherapy. After multidisciplinary discussion, patient was planned for simultaneous resection of rectal primary and right hepatectomy for metastasis. Final histopathology revealed no tumour in liver but the liver lesions seen radiologically were actually changes of oxaliplatin induced focal SOS and mimicked metastatic nodules. CONCLUSION In patients with colo-rectal cancer having received oxaliplatin-based chemotherapy, SOS may be considered as one of the causes of newly developed liver lesions, and should be subjected to additional radio-pathologic evaluation to prevent overtreatment and avoiding potentially morbid surgeries.
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Affiliation(s)
- Vipul Gupta
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
| | - Amit Chopde
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India.
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
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Patkar S, Gundavda K, Chaudhari V, Yadav S, Deodhar K, Ramadwar M, Goel M. Utility and limitations of intraoperative frozen section diagnosis to determine optimal surgical strategy in suspected gallbladder malignancy. HPB (Oxford) 2023; 25:330-338. [PMID: 36586775 DOI: 10.1016/j.hpb.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/03/2022] [Accepted: 12/09/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preoperative diagnosis of gallbladder cancer (GBC) remains a challenge. Unwarranted extensive surgery for benign disease and undertreatment for GBC pose challenges. We aimed to analyze the utility, diagnostic accuracy, and limitations of intraoperative frozen section (FS), for primary diagnosis of suspected gallbladder malignancy. METHODS Patients with suspected GBC underwent a cystic-plate cholecystectomy and FS for primary diagnosis. The procedure was considered adequate if FS suggested a benign pathology. A radical cholecystectomy was performed if FS favoured GBC, or in patients with high intra-operative suspicion of malignancy. All FS records were compared with final histopathology. RESULTS FS guided the surgical strategy in 491 of 575 resections (85.4%). FS had a sensitivity of 88.3%, specificity of 99.6%, a positive predictive value of 99.4% and a negative predictive value of 92.7%. The diagnostic accuracy of FS was 95.1%. With routine use of intraoperative FS, only 10 out of 491 patients (2%) required a revised surgical strategy. CONCLUSIONS For radiologically suspected GBC it is prudent to confirm the histological diagnosis by use of intraoperative FS before undertaking radical resections. This study emphasizes the safety and accuracy of FS as an adjunct for directing optimal surgical strategy in suspected GBC.
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Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Kaival Gundavda
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Vikram Chaudhari
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Popat PB, Maheshwari A, Manchanda S, Renganathan R, Sen S, Dhamija E, Thakur M, Deodhar K, Chopra S, Kanteti APK, Ghosh J, Shah S, Sable N, Baheti A, Chauhan S, Gala K, Kulkarni S. Imaging Recommendations for Diagnosis, Staging, and Management of Cervical Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractCervical cancer is the fourth most common cancer in women globally and the second most common cancer in Indian women, more common in lower socioeconomic strata. Improvement in survival and decrease in morbidity reflect the earlier detection with screening and imaging, as well as multifactorial multimodality therapy integrating surgery, and concurrent chemoradiation therapy providing superior therapeutic benefits. Imaging plays a vital role in assessing the extent of disease and staging of cervical cancer. The appropriateness criteria of a modality are different from its availability based on infrastructure, medical facilities, and resource status. Although in an ideal situation, magnetic resonance imaging (MRI) would be of greatest value in locoregional assessment of extent of disease and fluorodeoxyglucose positron emission tomography-computed tomography for distant staging; often, an ultrasonography, chest radiograph, and bone scans are utilized, with contrast-enhanced computed tomography representing a fair superior diagnostic accuracy, and can be reported as per the RECIST 1.1 criteria. MRI is also of good utility in the assessment of residual disease, predicting response and detecting small volume recurrence. MRI offers the highest diagnostic accuracy in determining parametrial invasion and hence surgical planning; so also, MRI-guided radiation planning helps in more accurate graded radiation dose planning in radiation therapy. Stage and therapy-based surveillance imaging should be encouraged and recommended.
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Affiliation(s)
- Palak Bhavesh Popat
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Division of Gynaecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rupa Renganathan
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Centre, Kolkata, West Bengal, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, IRCH, AIIMS, New Delhi, India
| | - Meenakshi Thakur
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aditya Pavan Kumar Kanteti
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay Baheti
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Radiology, H. N. Reliance Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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9
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Dey S, Anne S, Rath S, Nandhana R, Gulia S, Menon S, Rekhi B, Tandon S, Sable N, Baheti A, Popat P, Lavanya G. N, Jadhav S, Chopra S, Shylasree T, Deodhar K, Maheshwari A, Ghosh J, Gupta S. 67P Survival and reproductive outcomes of patients with malignant ovarian germ cell tumors, a retrospective analysis from a tertiary care center in India. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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10
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Gundavda K, Chaudhari V, Patkar S, Deodhar K, Ramadwar M, Goel M, Patel S. Use of intraoperative frozen section for primary diagnosis to determine optimum surgical strategy in suspected gallbladder malignancy. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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11
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Tembhurne AK, Maheshwari A, Warke H, Chaudhari H, Kerkar SC, Deodhar K, Rekhi B, Mania-Pramanik J. Killer cell immunoglobulin-like receptor (KIR) gene contents: Are they associated with cervical cancer? J Med Virol 2023; 95:e27873. [PMID: 35593263 DOI: 10.1002/jmv.27873] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
Killer cell immunoglobulin-like receptors (KIRs) are required for natural killer cell function against virus-infected cells or tumor cells. KIR gene content polymorphisms in Indian women with cervical cancer (CaCx) remain unexplored. Hence, we analyzed the frequencies of KIR genes, KIR haplotypes, and Bx subsets to draw their association with CaCx. The polymerase chain reaction-sequence-specific primer method was used for KIR genotyping in three groups of women: healthy controls (n = 114), women with human papillomavirus (HPV) infection (n = 70), and women with CaCx (n = 120). The results showed that the frequency of KIR2DS5 was significantly higher in women with CaCx compared to women with HPV infection (p = 0.02) and healthy controls (p = 0.01). Whereas the frequency of KIR2DL5B was significantly higher in healthy controls than in women with HPV infection (p = 0.02). The total number of activating KIR genes was higher in women with CaCx than in healthy controls (p = 0.006), indicating their positive association with CaCx. Moreover, the C4T4 subset was higher in women with CaCx than in women with HPV infection, though not significant. In conclusion, our findings highlight KIR2DS5, the C4T4 subset, and activating KIR genes are susceptible factors or positively associated with CaCx. Besides KIR2DL5B, this study also reported for the first time significantly high frequency of KIR2DL1 in healthy controls, indicating its possible protective association against CaCx. Further, significantly high frequency of KIR2DL3 observed in HPV-infected women might be also a promising biomarker for viral infections. Thus, the study confirms the association of KIR genes with cervical cancer in women with HPV infection.
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Affiliation(s)
- Alok K Tembhurne
- ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | | | - Himangi Warke
- Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
| | - Hemangi Chaudhari
- Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
| | - Shilpa C Kerkar
- ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
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12
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Budukh A, Maheshwari A, Bagal S, Singh A, Deodhar K, Panse N, Palyekar V, Dikshit R, Badwe R. Factors influencing women to participate in cervical cancer screening by providing menstrual pads: A population-based study from rural areas of Maharashtra state, India. Indian J Cancer 2022; 59:462-468. [PMID: 34380839 DOI: 10.4103/ijc.ijc_910_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0-1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0-2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0-14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1-1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4-2.5). Conclusion Factors including health worker availability, using mobile phones for communication and high education level facilitate women's participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit.
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Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpit Singh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nandkumar Panse
- Rural Cancer Registry, Nargis Dutt Memorial Cancer Hospital, Barshi, Maharashtra, India
| | - Vrushali Palyekar
- Department of Clinical Research, National Institute for Research and Reproductive Health, Mumbai, Maharashtra, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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13
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Suthar RR, Agrawal A, Deodhar K, Purandare N, Shah S, Puranik A, Choudhury S, Rangarajan V. Unusual Presentation of Helicobacter pylori Infection as PSMA-Avid Gastric Mass. Clin Nucl Med 2022; 47:e607-e608. [PMID: 35384885 DOI: 10.1097/rlu.0000000000004215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT 68 Ga-PSMA PET/CT is one of the most common imaging uses for prostate cancer imaging. Although initially thought to be specific for prostate cancer, there are many evidences that are coming of its concentration in many other neoplastic and nonneoplastic pathologies. Helicobacter pylori is the most common bacteria causing gastric inflammation and usually presents with gastroduodenal ulcer. Here we present one unusual case of benign gastric mass formation caused by H. pylori infection with PSMA concentration.
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Affiliation(s)
- Ritesh Ramesh Suthar
- From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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14
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Sengar M, Pramesh CS, Mehndiratta A, Shah S, Munshi A, Vijaykumar DK, Puri A, Mathew B, Arora RS, Kumari T P, Deodhar K, Menon S, Epari S, Shetty O, Cluzeau F. Ensuring quality in contextualised cancer management guidelines for resource-constraint settings: using a systematic approach. BMJ Glob Health 2022; 7:bmjgh-2022-009584. [PMID: 35985695 PMCID: PMC9396157 DOI: 10.1136/bmjgh-2022-009584] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022] Open
Abstract
To address the wide variation in access to cancer care in India requires strengthening of infrastructure, trained oncology workforce, and minimisation of out-of-pocket expenditures. However, even with major investments, it is unlikely to achieve the same level of infrastructure and expertise across the country. Therefore, a resource stratified approach driven by evidence-based and contextualised clinical guidelines is the need of the hour. The National Cancer Grid has been at the forefront of delivery of standardised cancer care through several of its initiatives, including the resource-stratified guidelines. Development of new guidelines is resource and time intensive, which may not be feasible and can delay the implementation. Adaptation of the existing standard guidelines using the transparent and well-documented methodology with involvement of all stakeholders can be one of the most reasonable pathways. However, the adaptation should be done keeping in mind the context, resource availability, budget impact, investment needed for implementation and acceptability by clinicians, patients, policymakers, and other stakeholders. The present paper provides the framework for systematically developing guidelines through adaptation and contextualisation. The process can be used for other health conditions in resource-constraint settings.
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Affiliation(s)
- Manju Sengar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Tata Memorial Centre, Mumbai, India .,Homi Bhabha National Institute, Mumbai, India
| | | | - Sudeep Shah
- P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - D K Vijaykumar
- Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Ajay Puri
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Beela Mathew
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Ramandeep Singh Arora
- Max Institute of Cancer Care, Max Super Speciality Hospital, New Delhi, New Delhi, India
| | - Priya Kumari T
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kedar Deodhar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sridhar Epari
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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15
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Chakravarti P, Maheshwari A, Tahlan S, Kadam P, Bagal S, Gore S, Panse N, Deodhar K, Chaturvedi P, Dikshit R, Budukh A. Diagnostic accuracy of menstrual blood for human papillomavirus detection in cervical cancer screening: a systematic review. Ecancermedicalscience 2022; 16:1427. [PMID: 36158979 PMCID: PMC9458266 DOI: 10.3332/ecancer.2022.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Priyal Chakravarti
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- https://orcid.org/0000-0003-2163-796X
| | - Amita Maheshwari
- Tata Memorial Hospital (TMH), Dr. E Borges Road, Parel, Mumbai 400012, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400094, India
- https://orcid.org/0000-0001-7655-1608
| | - Shweta Tahlan
- Homi Bhabha Cancer Hospital, Sangrur 148001, Punjab, India
- https://orcid.org/0000-0003-1655-684X
| | - Prithviraj Kadam
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- https://orcid.org/0000-0001-6241-9518
| | - Sonali Bagal
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- https://orcid.org/0000-0002-2510-1751
| | - Suvarna Gore
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- https://orcid.org/0000-0002-2866-5480
| | - Nandkumar Panse
- Rural Cancer Registry, Nargis Dutt Memorial Cancer Hospital, Barshi 413401, Maharashtra, India
- https://orcid.org/0000-0001-6043-3789
| | - Kedar Deodhar
- Tata Memorial Hospital (TMH), Dr. E Borges Road, Parel, Mumbai 400012, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400094, India
- https://orcid.org/0000-0002-6338-8191
| | - Pankaj Chaturvedi
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400094, India
- https://orcid.org/0000-0002-3520-1342
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400094, India
- https://orcid.org/0000-0003-4830-0486
| | - Atul Budukh
- Centre for Cancer Epidemiology (CCE), Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400094, India
- https://orcid.org/0000-0001-6723-802X
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16
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Chopra S, Goda JS, Mittal P, Mulani J, Pant S, Pai V, Kannan S, Deodhar K, Krishnamurthy MN, Menon S, Charnalia M, Shah S, Rangarajan V, Gota V, Naidu L, Sawant S, Thakkar P, Popat P, Ghosh J, Rath S, Gulia S, Engineer R, Mahantshetty U, Gupta S. Concurrent chemoradiation and brachytherapy alone or in combination with nelfinavir in locally advanced cervical cancer (NELCER): study protocol for a phase III trial. BMJ Open 2022; 12:e055765. [PMID: 35387819 PMCID: PMC8987785 DOI: 10.1136/bmjopen-2021-055765] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In locally advanced cervical cancer, nodal, local and distant relapse continue to be significant patterns of relapse. Therefore, strategies to improve the efficacy of chemoradiation are desirable such as biological pathway modifiers and immunomodulating agents. This trial will investigate the impact of nelfinavir, a protease inhibitor that targets the protein kinase B (AKT) pathway on disease-free survival (DFS). METHODS AND ANALYSIS Radiosensitising effect of nelfinavir in locally advanced carcinoma of cervix is a single-centre, open-label, parallel-group, 1:1 randomised phase-III study. Patients aged over 18 years with a diagnosis of carcinoma cervix stage III are eligible for the study. After consenting, patients will undergo randomisation to chemoradiation and brachytherapy arm or nelfinavir with chemoradiation and brachytherapy arm. The primary aim of the study is to compare the difference in 3-year DFS between the two arms. Secondary aims are locoregional control, overall survival, toxicity and quality of life between the two arms. Pharmacokinetics of nelfinavir and its impact on tumour AKT, programmed cell death ligand 1, cluster of differentiation 4, cluster of differentiation 8 and natural killer 1.1 expression will be investigated. The overall sample size of 348 with 1 planned interim analysis achieves 80% power at a 0.05 significance level to detect a HR of 0.66 when the proportion surviving in the control arm is 0.65. The planned study duration is 8 years. ETHICS AND DISSEMINATION The trial is approved by the Institutional Ethics Committee-I of Tata Memorial Hospital, Mumbai (reference number: IEC/0317/1543/001) and will be monitored by the data safety monitoring committee. The study results will be disseminated via peer-reviewed scientific journals, and conference presentations. Study participants will be accrued after obtaining written informed consent from them. The confidentiality and privacy of study participants will be maintained. TRIAL REGISTRATION NUMBER The trial is registered with Clinical Trials Registry-India (CTRI/2017/08/009265) and ClinicalTrials.gov (NCT03256916).
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaahid Mulani
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sidharth Pant
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Venkatesh Pai
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Department of Biostatistics, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mayuri Charnalia
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Bio-Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Bio-Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, India
| | - Lavanya Naidu
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sheela Sawant
- Department of General Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Praffula Thakkar
- Department of General Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, India
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17
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Gurram L, Mohanty S, Chopra S, Grover S, Engineer R, Gupta S, Ghosh J, Gulia S, Sawant S, Daddi A, Deodhar K, Menon S, Rekhi B, Shylasree TS, Maheshwari A, Mahantshetty U. Outcomes of Cervical Cancer in HIV-Positive Women Treated With Radiotherapy at a Tertiary Care Center in India. JCO Glob Oncol 2022; 8:e2100312. [PMID: 35324255 PMCID: PMC9071252 DOI: 10.1200/go.21.00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
There are limited data on management of cervical cancer in women living with HIV in the modern antiretroviral therapy era. The study aimed to evaluate outcomes and toxicities of these patients treated with radiotherapy.
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Affiliation(s)
- Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Samarpita Mohanty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Advanced Centre for Training, Research Education in Cancer, Navi Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sheela Sawant
- Department of Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuprita Daddi
- Department of Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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18
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Mundada AD, Deodhar K, Ramadwar M, Bal M, Kumar R. Hepatic epithelioid hemangioendothelioma: A clinocopathological correlation. INDIAN J PATHOL MICR 2022; 65:133-136. [PMID: 35074978 DOI: 10.4103/ijpm.ijpm_350_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Primary hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor with an incidence of <0.1 per 100,000. The clinical course is variable with variable outcomes. Due to its rarity, treatment protocols, prognostic and predictive factors are not well established underscoring the need for such a study. Pathologists' awareness of this entity, a meticulous morphologic examination coupled with immunohistochemistry can aid in accurate diagnosis.
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Affiliation(s)
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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19
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Wagh P, Kulkarni P, Kerkar S, Tongaonkar H, Chaudhari H, Warke H, Deodhar K, Rekhi B, Mania-Pramanik J. Polymorphism of interleukin-6 -174 G/C (rs1800795) & the corresponding interleukin-6 level as a prognostic marker of cervical cancer. Indian J Med Res 2021; 154:391-398. [PMID: 34854425 PMCID: PMC9131768 DOI: 10.4103/ijmr.ijmr_1111_19] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background & objectives: Aetiology of cervical cancer (CaCx) is multifactorial. Besides human papillomavirus (HPV) infection, many immunogenetic factors are involved in this complex process. The present study was carried out to investigate one such factor, interleukin-6 (IL-6), a central pro-inflammatory cytokine and a polymorphism at its promoter region -174 G/C (rs1800795) with CaCx. Methods: HPV-infected women with or without CaCx were enrolled in group I and II, respectively. Another group of uninfected healthy women was also included as group III for comparison. Polymorphism in IL-6-174 G/C and IL-6 levels were analyzed by sequence-specific primer PCR (PCR-SSP) and ELISA, respectively. Results: Groups I (n=111) and II (n=87) had significantly higher frequency of IL-6-174 GG genotype [odds ratios (OR)=3.9; P<0.001 and OR=3.2; P<0.001, respectively] as compared to group III (n=163). Furthermore, individuals with GG or GC genotypes had high IL-6 levels than those with CC genotypes. IL-6 levels were significantly (P<0.001) elevated in group I. This was also significantly high in untreated cases as compared to treated (P<0.05) ones. IL-6 levels of treated group were comparable with groups II and III. Interpretation & conclusions: Our results suggested a possible association of IL-6-174 GG with CaCx, which was also associated with high IL-6 levels. Decreased levels of IL-6 following treatment indicate its possible prognostic use in CaCx cases.
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Affiliation(s)
- Priyanka Wagh
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Priyanka Kulkarni
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Hemant Tongaonkar
- Department of Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hemangi Chaudhari
- Department of Obstetrics & Gynaecology, King Edward Memorial Hospital & Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Himangi Warke
- Department of Obstetrics & Gynaecology, King Edward Memorial Hospital & Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Maheshwari A, Gupta S, Rai S, Rekhi B, Kelkar R, Shylasree TS, Menon S, Deodhar K, Thakur M, Das U, Gupta S, Tandon S. Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer. South Asian J Cancer 2021; 10:102-106. [PMID: 34604126 PMCID: PMC8483894 DOI: 10.1055/s-0041-1736030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 10/25/2022] Open
Abstract
Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15-79 years) were identified. Of these 112 (93.3%; 95% CI 88.9-97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6-61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38-18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9-97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7-99.4%). Ascitic fluid Ziel-Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3-12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6-20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.
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Affiliation(s)
- Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Deptartment of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shweta Rai
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rohini Kelkar
- Deptartment of Microbiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Deptartment of Radiodiagnosis, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ushasree Das
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Stuti Gupta
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandeep Tandon
- Department of Medicine, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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21
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Chopra S, Gupta S, Kannan S, Dora T, Engineer R, Mangaj A, Maheshwari A, Shylasree TS, Ghosh J, Paul SN, Phurailatpam R, Charnalia M, Alone M, Swamidas J, Mahantshetty U, Deodhar K, Kerkar R, Shrivastava SK. Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial. J Clin Oncol 2021; 39:3682-3692. [PMID: 34506246 DOI: 10.1200/jco.20.02530] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Postoperative Adjuvant Radiation in Cervical Cancer (PARCER), a phase III randomized trial, compared late toxicity after image-guided intensity-modulated radiotherapy (IG-IMRT) with three-dimensional conformal radiation therapy (3D-CRT) in women with cervical cancer undergoing postoperative radiation. METHODS Patients were randomly assigned to receive either IG-IMRT or 3D-CRT after stratification for the type of hysterectomy and use of concurrent chemotherapy. The primary end point was 3-year grade ≥ 2 late GI toxicity assessed using Common Toxicity Criteria for Adverse Events v 3.0 and estimated using time-to-event, intention-to-treat analysis, with a study level type I error of 0.05 and a nominal α of .047 after accounting for one interim analysis. Secondary end points included acute toxicity, health-related quality of life, and pelvic relapse-free, disease-free, and overall survival. RESULTS Between 2011 and 2019, 300 patients were randomly assigned (IG-IMRT 151 and 3D-CRT 149). At a median follow-up of 46 (interquartile range 20-72) months, the 3-year cumulative incidence of grade ≥ 2 late GI toxicity in the IG-IMRT and 3D-CRT arms were 21.1% versus 42.4% (hazard ratio [HR] 0.46; 95% CI, 0.29 to 0.73; P < .001). The cumulative incidence of grade ≥ 2 any late toxicity was 28.1% versus 48.9% (HR 0.50; 95% CI, 0.33 to 0.76; P < .001), respectively. Patients reported reduced diarrhea (P = .04), improved appetite (P = .008), and lesser bowel symptoms (P = .002) with IG-IMRT. However, no difference was observed in the time by treatment interaction. The 3-year pelvic relapse-free survival and disease-free survival in the IG-IMRT versus the 3D-CRT arm were 81.8% versus 84% (HR 1.17; 95% CI, 0.68 to 1.99; P = .55) and 76.9% versus 81.2% (HR 1.03; 95% CI, 0.62 to 1.71; P = .89), respectively. CONCLUSION IG-IMRT results in reduced toxicity with no difference in disease outcomes.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Epidemiology and Clinical Trials Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Tapas Dora
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Tata Memorial Centre, Sangrur, Punjab, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Akshay Mangaj
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - T Surappa Shylasree
- Department of Gynecologic Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Siji N Paul
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Reena Phurailatpam
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Mayuri Charnalia
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Mitali Alone
- Clinical Research Secretariat, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Jamema Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Rajendra Kerkar
- Department of Gynecologic Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Shyam K Shrivastava
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
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Gulia S, Ghosh J, Bajpai J, Rath S, Maheshwari A, Shylasree TS, Deodhar K, Thakur M, Gupta S. Pazopanib and Oral Cyclophosphamide in Women With Platinum-Resistant or -Refractory Epithelial Ovarian Cancer. JCO Glob Oncol 2021; 6:542-547. [PMID: 32228315 PMCID: PMC7113132 DOI: 10.1200/jgo.19.00331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Women with recurrent, multiply-treated epithelial ovarian cancer (EOC) have unfavorable prognosis with limited treatment options after failure of platinum-based regimens. We report here a retrospective analysis of women with recurrent, platinum-resistant EOC treated with an oral regimen of pazopanib and cyclophosphamide. PATIENTS AND METHODS Women with recurrent platinum-resistant or -refractory EOC were treated with pazopanib (600 mg orally daily in 2 divided doses, 400 and 200 mg) and cyclophosphamide (50 mg orally daily for 21 days every 28 days) until disease progression or unacceptable toxicity. RESULTS Twenty patients (17 with platinum-resistant and 3 with platinum-refractory disease) were treated between April 2014 and April 2018. Patients had a median age of 52 years (range, 40-60 years) and median of 4 previous lines of chemotherapy (range, 2-8 previous lines), including 3 patients with progressive disease on bevacizumab. Patients received a median of 6 cycles (range, 2-48 cycles) of pazopanib and cyclophosphamide, with best responses of partial response in 9 patients (45%, including 1 of 3 patients treated previously with bevacizumab), stable disease in 6 patients (30%), and disease progression in 5 patients (25%). The median progression-free survival time was 5.5 months, and median overall survival was 9.5 months. Common adverse events (grade 3 or 4) were fatigue (25%), diarrhea (15%), hand-foot syndrome (10%), mucositis (10%), transaminitis (5%), and hypertension (5%). Dose reduction as a result of toxicity was required in 14 patients (70%), and no patient stopped treatment as a result of toxicity. CONCLUSION Pazopanib plus oral cyclophosphamide is a well-tolerated regimen with clinically relevant benefit in patients with platinum-resistant or -refractory EOC.
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Affiliation(s)
- Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T S Shylasree
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Meenakshi Thakur
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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23
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Yadav S, Agarwal A, Mokal S, Menon S, Rekhi B, Deodhar K. Serous endometrial intraepithelial carcinoma: A clinico-pathological study of 48 cases and its association with endometrial polyps - A tertiary care oncology centre experience. Eur J Obstet Gynecol Reprod Biol 2021; 264:168-172. [PMID: 34304025 DOI: 10.1016/j.ejogrb.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/14/2021] [Revised: 06/19/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endometrial serous carcinoma (ESC) is an aggressive neoplasm wherein the recent studies have shown that it arises from its putative precursor namely the serous endometrial intraepithelial carcinoma (SEIC). SEIC usually arises in inactive/ atrophic endometrium but surprisingly is frequently associated endometrial polyps (EPs). The aim of this study was to assess the incidence of SEIC with or without invasion, its clinical behaviour and association with endometrial polyp. MATERIALS AND METHODS After Institutional review board approval, a total of 205 samples (belonging to 120 patients); diagnosed as ESC from January 2009 to December 2015 were retrieved and reviewed for presence of in situ carcinoma and also for associated endometrial polyp. RESULTS The mean age at diagnosis was 62.40 years with postmenopausal bleeding being the most common presenting symptom. The incidence of SEIC with or without invasive tumor was 40% (48/120). Of these 48 cases; 25 cases were associated with in-situ carcinoma arising in the EPs which amounted to 52% of the total cases. The overall three year survival and disease free survival in SEIC with or without invasion were 1.9% and 0.25%, indicating the aggressive nature of the disease. CONCLUSION SEIC is a difficult histopathological diagnosis and one should carefully look for these lesion, especially in the EPs which are frequently associated with them. Extensive sampling of the EP will be helpful to pick up in-situ carcinoma arising in EP. SEIC is an aggressive disease on its own with a propensity to develop distant metastasis even in the absence of myometrial invasion and hence should be treated with optimum surgical staging and if indicated aggressive adjuvant treatment protocols.
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Affiliation(s)
- Subhash Yadav
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Arti Agarwal
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, Maharashtra, India.
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24
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Chopra S, Dora T, Gupta S, Kannan S, Engineer R, Menachery S, Phurailatpam R, Mahantshetty U, Swamidas J, Ghosh J, Maheshwari A, TS S, Kerkar R, Deodhar K, Popat P, Shrivastava S. Phase III Randomized Trial of Postoperative Adjuvant Conventional Radiation (3DCRT) versus Image Guided Intensity Modulated Radiotherapy (IG-IMRT) in Cervical Cancer (PARCER): Final Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2069] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raut A, Chopra S, Mittal P, Patil G, Mahantshetty U, Gurram L, Swamidas J, Ghosh J, Gulia S, Popat P, Deodhar K, Maheshwari A, Gupta S. FIGO Classification 2018: Validation Study in Patients With Locally Advanced Cervix Cancer Treated With Chemoradiation. Int J Radiat Oncol Biol Phys 2020; 108:1248-1256. [PMID: 32681859 DOI: 10.1016/j.ijrobp.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE In 2018, the International Federation of Gynecology and Obstetrics (FIGO) proposed a new staging for cervical cancer. The present study was designed to reclassify patients with locally advanced cervix cancer and perform a comparative evaluation with FIGO 2009. METHODS AND MATERIALS Patients with locally advanced cervical cancer (stage IB2-IVA) who had baseline cross-sectional imaging and received (chemo-) radiation and brachytherapy were included. Survival outcomes were analyzed according to FIGO 2009. Patients were then reclassified according to FIGO 2018, and TNM classification outcomes were analyzed. FIGO stage and known prognostic factors were included in univariate analysis, and multivariate analysis was performed to investigate the prognostic value of clinical stage. RESULTS Six hundred thirty-two patients were included. Overall, 185 (29.3%) patients had pelvic adenopathy, and 51 (8.2%) had positive paraortic nodes. At a median follow-up of 33 months, 116 (18.3%) patients had recurrence. Three-year disease-free survival (DFS) according to FIGO 2009 for stage IB, IIA, IIB, IIIA, IIIB, and IVA was 86%, 91%, 76%, 57%, 65%, and 61%, respectively. The 3-year DFS after restaging according to FIGO 2018 for stage IB, IIA, IIB, IIIA, IIIB, IIIC1, IIIC2, and IVA was 100%, 93%, 84%, 53%, 77%, 74%, 61%, and 61%, respectively. Patients with clinically significant lymphadenopathy had inferior outcomes compared with node-negative patients (62.9% vs 77.8%; P = .002). Patients with ≥3 paraortic nodes had poorer DFS than patients with <3 paraortic lymphadenopathy (13.6% vs 56.3%; P = .001). Furthermore, patients with primary tumor volume >30 cm3 had worse 3-year DFS than those with primary tumor volume ≤30 cm3 (67.4% vs 78.5%; P = .002). CONCLUSIONS FIGO 2018 modification is associated with heterogenous outcomes in node-positive patients that are affected by primary tumor and nodal volume. We propose a modification to the existing TNM staging system to allow more robust classification of outcomes.
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Affiliation(s)
- Atul Raut
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre For Treatment and Education in cancer, Tata Memorial Centre (ACTREC), Parel, Homi Bhabha National Institute, Mumbai, India.
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Gayatri Patil
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Jamema Swamidas
- Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Parel, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Mumbai, India
| | - Palak Popat
- Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Mumbai, India
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Jearth V, Patil P, Patkar S, Goel M, Mehta S, Deodhar K, Rao V. Immunoglobulin G4-related cholecystitis mimicking a locally advanced gallbladder cancer-a case report and review of literature. Clin J Gastroenterol 2020; 13:806-811. [PMID: 32596793 DOI: 10.1007/s12328-020-01168-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Immunoglobulin G4 (IgG4)-related disease is a multi-organ immune-mediated condition that can mimic many inflammatory, malignant, and infectious disorders. Isolated IgG4-related cholecystitis without systemic manifestation is extremely rare. We report a rare case of IgG4-related disease with its clinical, radiological and histopathological findings involving only the gallbladder which presented initially as unresectable locally advanced gallbladder cancer on imaging but was diagnosed as IgG4-related cholecystitis preoperatively depending upon serum IgG4 levels and immunohistochemistry. Patient was successfully treated with steroids followed by simple cholecystectomy in view of symptomatic gallstones. Preoperative diagnosis is challenging for IgG4-related cholecystitis in view of mass like appearance of the lesion with surrounding invasion on imaging so most of the cases are reported postoperatively. Knowledge of this disease as differential for malignancy can save patients from extensive resections in view of its steroid responsive nature. Xanthogranulomatous cholecystitis mimicking gallbladder cancer can coexist with this disease.
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Affiliation(s)
- Vaneet Jearth
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India.
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
| | - Shraddha Patkar
- Division of Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
| | - Mahesh Goel
- Division of Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
| | - Vidya Rao
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India
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Gulia S, Srikanth A, Adsul DK, Mahantshetty U, Ghosh J, Maheshwari A, Rath S, TS S, Chopra S, Menon S, Deodhar K, Rekhi B, Popat P, Gupta S. Treatment and outcome of patients with uterine carcinosarcoma: Data from developing world. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18102 Background: To evaluate the clinicopathological factors, outcome and prognostics factors of uterine carcinosarcoma. Methods: All patients of uterine carcinosarcoma treated between January 2013 and December 2018 were identified and their clinical, laboratory and imaging details were retrieved from electronic medical record. Details of the treatment received, toxicity profile and outcome were recorded and analyzed. Patients (including stage I) were considered for four cycles of chemotherapy (Paclitaxel +Carboplatin) followed by radiation (EBRT to pelvis with vaginal brachytherapy). Survival analysis was done using the Kaplan–Meier method and compared between treatment groups using the Log-rank test. Results: Of 81 cases, 48 % presented with early stage disease (FIGOI-II) and 52 % with late stage (FIGO III-IV) disease. Median age was 58 years (30-80 years). Most women (83%) were postmenopausal and 80% of them presented with postmenopausal bleeding. Six patients developed carcinosarcoma on adjuvant tamoxifen (given for breast cancer) after a median drug intake of 8 years. In early stage, 10% patients received only surgical treatment; 46% received both chemotherapy (CT) and radiation therapy (RT) while 33 % received RT alone. In advanced stage, 31% received only CT, 14 % received only RT and 33% received both CT and RT after surgery. About 8% of patients had myelosuppression(grade I/II), 10 % had peripheral neuropathy (grade I/II) and 11% had electrolyte imbalance. At a median follow up of 2 years (1- 80 months), median DFS and OS in early stage group was 28.5 months and 31.0 months while in advanced stage group it was 13.0 months and 15.0 months respectively. Distant metastasis (omentum, peritoneum and lung being the common site) were seen in 30% of patients while local relapse was seen in 5 % cases. On univariate analysis stage of disease and receipt of adjuvant therapy were the factors found to be significantly associated with improved OS (p < 0.001) and adjuvant RT alone was associated with improved DFS (p < 0.023). Conclusions: Adjuvant treatment (chemotherapy and or radiation therapy) is associated with improved overall survival in uterine carcinosarcoma, irrespective of stage at presentation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Santosh Menon
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre (TMC), Mumbai, India
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Verma A, Menon S, Rekhi B, Pai T, Maheshwari A, Ghosh J, Gupta S, Deodhar K. Utility of YWHAE fluorescent in-situ hybridisation in mesenchymal tumors of uterus- An initial experience from tertiary oncology centre in India. Indian J Cancer 2020; 56:335-340. [PMID: 31607703 DOI: 10.4103/ijc.ijc_722_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Endometrial stromal sarcoma (ESS) is a common uterine mesenchymal malignancy. According to World Health Organisation (WHO) 2014 classification, ESSs are further subdivided into low-grade ESS (LGESS) and high-grade ESS (HGESS). HGESS is defined by the presence of YWHAE gene rearrangement and has a poorer prognosis compared to LGESS. METHODS Twenty-four cases comprising of 16 endometrial stromal sarcoma and 8 lesions mimicking ESS were retrieved from the archives of the Department of Pathology and subjected to fluorescent in situ hybridization (FISH) analysis for YWHAE gene rearrangement. Immunohistochemistry for CD10, ER, PR, Cyclin D1, SMA, H-Caldesmon, Desmin, Ki-67, and Pan Cytokeratin was performed. RESULTS Two cases with histological features similar to HGESS were positive for YWHAE gene rearrangement while 1 was indeterminate. No cases of LGESS and histological mimics of ESS were positive for this rearrangement. CONCLUSIONS HGESSs are defined by the presence of YWHAE rearrangement. These tumors present at higher stage and have poorer prognosis. They may not respond to hormonal therapy and may be treated with chemotherapy. Cyclin D1 though not specific remains a sensitive tool to triage endometrial stromal sarcomas for this FISH study.
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Affiliation(s)
- Anuj Verma
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Sasidharan A, Mahantshetty UM, Gurram L, Chopra S, Engineer R, Maheshwari A, Gupta S, Deodhar K, Rangarajan V, Thakur M, Shrivastava SK. Patterns of First Relapse and Outcome in Patients with Locally Advanced Cervical Cancer After Radiochemotherapy: A Single Institutional Experience. Indian J Gynecol Oncolog 2019. [DOI: 10.1007/s40944-019-0345-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shylasree TS, Kattepur AK, Gupta M, Ghosh J, Maheshwari A, Bajpai J, Hawaldar R, Gulia S, Deodhar K, Popat P, Gupta S, Kerkar RA. Compliance to treatment guidelines and survival in women undergoing interval debulking surgery for advanced epithelial ovarian cancer. Cancer Rep (Hoboken) 2019; 3:e1217. [PMID: 32671995 DOI: 10.1002/cnr2.1217] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND One of the primary treatment strategies for advanced epithelial ovarian cancers includes neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy. Compliance to treatment is important to possibly improve outcomes. AIM To audit treatment compliance and its effect on overall survival (OS) and disease free survival (DFS) in women undergoing IDS. METHODS AND RESULTS Women diagnosed with advanced epithelial ovarian cancer undergoing IDS were included. Details of compliance to chemotherapy and surgery as per standard guidelines were assessed, and correlation with survival was studied. Reasons for protocol deviation at various levels were documented and analysed. A total of 182 patients were included. The total number of deviations was 134 with deviation at any level being 89 (48.9%) and at all levels 5%. Both patient- and treatment-related factors contributed towards deviation. Deviation or noncompliance towards treatment resulted in a significantly reduced 5-year OS (34.4% vs 58.2%; P = .001) compared with compliant patients, which retained its significance on multivariate analysis (P = .024) as well. CONCLUSION Deviation from treatment guidelines resulted in a significantly lower 5-year OS compared with those who remained treatment compliant. Both patient- and treatment-related factors contributed towards noncompliance and hence towards lower survival.
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Affiliation(s)
| | - Abhay K Kattepur
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Monisha Gupta
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amita Maheshwari
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rohini Hawaldar
- Department of Clinical Research Methodology and Biostatistics, Tata Memorial Hospital, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Palak Popat
- Department of Radio-diagnosis, Tata Memorial Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rajendra A Kerkar
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
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Wagh P, Kulkarni P, Kerkar S, Tongaonkar H, Deodhar K, Rekhi B, Salvi V, Chaudhari H, Warke H, Mania-Pramanik J. Types of human papillomavirus observed in hospital-based population. Indian J Med Microbiol 2019; 37:557-562. [PMID: 32436880 DOI: 10.4103/ijmm.ijmm_19_451] [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: 11/04/2022]
Abstract
Background and Objectives Human papillomavirus (HPV) is the causative agent of cervical cancer, a major cause of cancer mortality in Indian women. The current study was undertaken to add information to the existing data on HPV type distribution in Indians, in an attempt to document HPV types for future vaccination programme, if any. Materials and Methods HPV infection was screened in 223 cervical cancer cases and 2408 healthy women without cancer and cervical intraepithelial neoplasia (control). HPV was typed using polymerase chain reaction, Southern hybridisation using specific probes and HPV GenoArray (Hybribio) test. Results HPV DNA was found in 92.8% of cases and 7.3% of controls. Of the 383 HPV-infected women, 30.0% had single infection; 50.9% had multiple infections (two or more types) and 19.1% were infected with HPV types other than HPV-16, -18, -6 and -11. Besides HPV-16, HPV-51 and HPV-33 were also seen as single infection in cases. In cases, HPV-18 or its homologous HPV-45 was always present as co-infection with HPV-16 or with other high-risk type. Binary logistic regression (backward) analysis highlighted significant association of age, parity and socioeconomic status with HPV infection. The present study highlighted the presence of multiple HPV infection (186 of 207, 89.9%) along with HPV-16 in women with cervical cancer. In control, 27.3% were co-infected with other sexually transmitted infections, while Chlamydia trachomatis infection was seen in 13% of cases. Conclusions The study highlighted the type of HPV infection seen among the hospital-based population. For better screening, HPV tests available in the market should include all the types seen in the population.
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Affiliation(s)
- Priyanka Wagh
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Priyanka Kulkarni
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Hemant Tongaonkar
- Department of Urologic and Gynecologic Oncology, Hinduja Hospital, Mahim; Department of Urology and Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinita Salvi
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Hemangi Chaudhari
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Himangi Warke
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Abstract
Tailgut cysts are rare congenital lesions presenting as retrorectal space masses. They can occur in all age groups. Patients often present with ill-defined nonspecific symptoms and the diagnosis if often delayed. Malignancy arising in a tailgut cyst is an even rarer and unique occurrence. A precise diagnosis can be made only after complete excision and histopathological examination of the retrorectal space mass. We describe here a case of a 63-year-old male presenting with chronic constipation, who was diagnosed with a well-differentiated neuroendocrine tumor (Grade I) arising in a tailgut cyst after surgical excision.
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Affiliation(s)
- Angad Singh
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Swapnil Karnik
- Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Bhushan Khedkar
- Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sanjay Deshmukh
- Department of Surgical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Budukh A, Maheshwari A, Palayekar V, Bagal S, Purwar P, Deodhar K, Dikshit R, Badwe R. Prevalence and nonsexual transmission of human papilloma virus (HPV) in the adolescence girls from rural area of Maharashtra state, India. Indian J Cancer 2019; 55:336-339. [PMID: 30829266 DOI: 10.4103/ijc.ijc_188_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To find out the prevalence of human papilloma virus (HPV) in adolescent girls and to access the nonsexual transmission of HPV from their mother by using the same old cloth used by their mother. METHOD Menstrual pads were collected from the women of age group years to find out the presence of HPV and whether it can be used as a cervical cancer screening tool. The results of the said study have been published in the European Journal of Cancer Prevention. During this study, menstrual pads of the daughters of participating women were collected to see the nonsexual transmission of HPV. After conducting the health education and obtaining the informed consent, we interviewed 57 mothers (age group 30-50, married, sexually active) and daughters [age group 12-18, unmarried (not exposed to sex)] from the rural area of Pune district of Maharashtra state, India. The menstrual pads were collected and transported to Mumbai for polymerase chain reaction (PCR) testing. HPV testing was carried out by PCR. RESULTS Out of 57, 28 (49%) daughters and 23 (40.4%) mothers provided menstrual pad. Out of 23 mothers, one was HPV positive [4.3%: 95% confidence interval (CI) 0.2-23.0] and out of 28 girls, 3 (10.7%: 95% CI 2.0-33.0) were HPV positive. The daughter, whose mother was HPV positive, had negative result for HPV. CONCLUSION The HPV prevalence in adolescence girls was 10.7%. There may be other nonsexual medium that might have caused HPV in adolescence girls, which needs further research.
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Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vrushali Palayekar
- National Institute for Research and Reproductive Health, Mumbai, Maharashtra, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pallavi Purwar
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajendra Badwe
- Centre for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Joshi S, Muwonge R, Kulkarni V, Deodhar K, Mandolkar M, Lucas E, Sankaranarayanan R. Incidence of cervical intraepithelial neoplasia in women infected with human immunodeficiency virus (HIV) with no evidence of disease at baseline: Results of a prospective cohort study with up to 6.4 years of follow-up from India. Int J Cancer 2019; 144:1082-1091. [PMID: 30132840 DOI: 10.1002/ijc.31826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 11/12/2022]
Abstract
We report the incidence of cervical intraepithelial neoplasia (CIN) among HIV-infected women who did not have any colposcopic or histopathological evidence of CIN at baseline. Of the 1,023 women without any CIN at baseline, 855 (83.6%) have been followed up to a maximum of 6.4 years contributing 2,875 person years of observation (PYO). Among these 855 women, 54 cases of any CIN were observed resulting in incidence rate of any CIN of 1.9 per 100 PYO. The median time for follow-up for women with any CIN was 3.0 (IQR 1.6-3.7) years. The cumulative incidence rate per 100 PYO of CIN 2 or worse lesion in women with HPV-18 infection at baseline was 13.3% (95% CI 5.1-26.8); in women with HPV-16 infection was 10.8% (95% CI 4.4-20.9); in women with HPV-31 infection was 4.2% (95% CI 0.9-11.7); and in women with other high-risk HPV infections was 5.4% (95% CI 2.6-9.7). HPV-18 infection at baseline contributed highest frequency of incident CIN 2 or worse lesions followed by HPV-16 infection; however, other high-risk HPV types were also responsible for substantial number of incident CIN. The elevated risk of CIN2+ disease in the study cohort was non-significant in women with CD4 count <200, possibly because of the small number of cases. Our results emphasize the need for regular cervical cancer screening of HIV-infected women and urgent implementation of cervical cancer screening services in HIV programs in India and other low and middle-income countries.
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Affiliation(s)
- Smita Joshi
- Department of Preventive Oncology, Prayas and HCJMRI, Pune, India
| | - Richard Muwonge
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | | | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France
- Research Triangle Institute International-India, Commercial Tower, New Delhi, India
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Wagh P, Kulkarni P, Kerkar S, Warke H, Chaudhari H, Deodhar K, Rekhi B, Tongaonkar H, Mania-Pramanik J. Polymorphisms in cytotoxic T-lymphocyte associated antigen 4 gene does not affect scytotoxic T-lymphocyte associated antigen 4 levels in human papillomavirus-infected women with or without cervical cancer. Indian J Med Microbiol 2018; 36:207-210. [PMID: 30084412 DOI: 10.4103/ijmm.ijmm_17_220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Cervical cancer (CaCx) is the second most common cancer in Indian women. Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) + 49 AA polymorphism is known to be associated with CaCx. Current attempt is to use immunotherapy for the treatment of metastatic melanoma and metastatic castration-resistant prostate cancer, i.e., blocking of CTLA-4 using a fully human monoclonal CTLA-4 antibody to disrupt its inhibitory signal. This allows the CTLs to destroy the cancer cells. There is no information available on the soluble level of CTLA-4 on which the immunotherapy is targeted. This is specifically in Indian population including cases with CaCx. Objective The aim of this study is to evaluate the levels of soluble CTLA-4 (sCTLA-4) in human papillomavirus (HPV)-infected women with or without CaCx and their association with the polymorphism at CTLA-4 + 49 A/G and CTLA-4 -318 C/T genotypes. Materials and Methods This is an exploratory case-control study involving two groups of HPV-infected women, the cases were with invasive CaCx and the control group was women with the healthy cervix. sCTLA-4 levels were measured using ELISA in 92 CaCx cases and 57 HPV-positive women with the healthy cervix. Results Both cases and controls have similar sCTLA-4 levels. Comparison of CTLA-4 + 49A/G and -318 C/T genotypes with sCTLA-4 levels among cases and control also did not show any statistically significant difference. Conclusion The present study suggests sCTLA-4 levels are not affected by a polymorphism at + 49 A>G CTLA-4. Hence, levels of CTLA-4 are similar in both CaCx cases and control group.
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Affiliation(s)
- Priyanka Wagh
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Priyanka Kulkarni
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India; Department of Urology, University of California, San Francisco, California, USA
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Himangi Warke
- Department of Gynecology and Obstetrics, Seth G. S. Medical College, KEM Hospital, Mumbai, Maharashtra, India
| | - Hemangi Chaudhari
- Department of Gynecology and Obstetrics, Seth G. S. Medical College, KEM Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hemant Tongaonkar
- Department Urology and Gynecologic Oncology, Tata Memorial Hospital; Department of Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Rekhi B, Deodhar K, Gulia S, Bajpai J. Cover Image. Cytopathology 2018. [DOI: 10.1111/cyt.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chopra S, Gupta M, Mathew A, Mahantshetty U, Engineer R, Lavanya G, Gupta S, Ghosh J, Thakur M, Deodhar K, Menon S, Rekhi B, Bajpai J, Gulia S, Maheshwari A, Kerkar R, Shylasree TS, Shrivastava SK. Locally advanced cervical cancer: A study of 5-year outcomes. Indian J Cancer 2018; 55:45-49. [PMID: 30147092 DOI: 10.4103/ijc.ijc_428_17] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Cervical cancer is the second most common cancer among Indian women. This present retrospective study was conducted to report patient outcomes with locally advanced cervical cancer treated in the year 2010. Materials and Methods Case records of cervical cancer patients registered from January 1, 2010, to December 31, 2010 were retrieved. A total of 1200 patients were registered, of which 583 received either definitive or adjuvant radiotherapy (RT). Of these, 345 patients who received complete treatment at our hospital were included for outcome analysis. Descriptive statistics were used to summarize patient- and treatment-related variables, and Kaplan-Meier analysis was performed for survival analysis. Results The median age was 56 years (range: 33-90). Squamous carcinoma was the most common histology (91.4%) and the majority were FIGO Stage III (45.4%). Median follow-up of the cohort was 44 months (1-85 months). The 5-year disease-free survival (DFS) across stages was 50%. Most important predictor of DFS was FIGO staging (Stage II vs. Stage III: 62% vs. 45%) and use of concurrent chemoradiotherapy (CTRT) l (RT vs. CTRT: 32% vs. 57%, respectively). Patients aged >70 years had a significantly poor DFS at 5 years; however, did not have any effect on survival. Grade 3 or more late toxicity was seen in only 5% of the patients. Conclusion Five-year DFS of 62% and 45% of Stage II and III patients treated under routine care represents comparable stage-matched results to the rest of the world, respectively.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashwathy Mathew
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Lavanya
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rajendra Kerkar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Maheshwari A, Kumar N, Gupta S, Rekhi B, Shylasree TS, Dusane R, Bajpai J, Ghosh J, Gulia S, Deodhar K, Menon S, Popat P, Sable N, Thakur M, Kerkar R. Outcomes of advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Indian J Cancer 2018; 55:50-54. [PMID: 30147093 DOI: 10.4103/ijc.ijc_468_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Ovarian cancer is the fourth most common cancer in Indian women. Majority of these are epithelial ovarian cancers (EOCs), most of which present in advanced stage. Women with poor performance status and/or those unlikely to achieve optimal debulking at upfront surgery, benefit from neoadjuvant chemotherapy (NACT) followed by interval cytoreduction, with lesser surgical morbidity and equal survival rates as compared to primary cytoreduction. Methodology This was a retrospective analysis of patients with advanced ovarian cancer, treated with NACT followed by interval debulking surgery at Tata Memorial Hospital from January 2014 to December 2014. Results Epithelial cancers constituted 84.4% (n = 406) of all cases of ovarian malignancies. Of these, overwhelming majority (84.3%, n = 342) were in the advanced stage. Sixty percent of all EOC patients received NACT. The mean baseline serum CA-125 level in women treated with NACT was 4294.7 U/ml (range, 11-151,200 U/ml). The median number of NACT cycles (paclitaxel + carboplatin) was 3. Optimal cytoreduction was achieved in 81.5% cases. The rates of Grade 3 or 4 intraoperative and postoperative complications were 4% each. The median postoperative stay was 5 days and the median time between surgery and adjuvant chemotherapy was 20 days. The median progression-free survival (PFS) was 15.15 months (95% confidence interval [CI]: 12.95-17.34), and the median overall survival (OS) was 34.73 months. Multivariate analysis revealed that optimal cytoreduction (hazard ratio [HR] = 2.04 [95% CI: 1.15-3.62]; P = 0.015) and number of NACT cycles (3 vs. >3; HR = 1.51 [95% CI: 1.06-2.16]; P = 0.022) were significantly associated with PFS, and optimal cytoreduction (HR = 3.21 [95% CI: 1.53-6.73]; P = 0.002) and ECOG status (0-1 vs. ≥2; HR = 2.64 [95% CI: 1.25-5.55]; P = 0.011) with OS. Conclusions High rates of optimal cytoreduction were achieved at interval cytoreductive surgery after NACT, with acceptable surgical morbidity, early start of adjuvant chemotherapy, and survival outcomes comparable to international standards.
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Affiliation(s)
- Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Neha Kumar
- Department of Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rohit Dusane
- Department of Biostatistics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajendra Kerkar
- Department of Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Bal M, Rane S, Talole S, Ramadwar M, Deodhar K, Patil P, Goel M, Shrikhande SV. Correction to: Tumour origin and R1 rates in pancreatic resections: towards consilience in pathology reporting. Virchows Arch 2018; 473:659. [PMID: 30284030 DOI: 10.1007/s00428-018-2465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors regret that one of the author's given name was missing and a typographical error was present in Reference 26 of the above article. These are presented correctly in this article.
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Affiliation(s)
- Munita Bal
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India.
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Sanjay Talole
- Department of Epidemiology and Statistics, Tata Memorial Centre, Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Prachi Patil
- Department of Digestive Diseases and Nutrition, Tata Memorial Centre, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
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40
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Chopra S, Deodhar K, Pai V, Pant S, Rathod N, Goda JS, Sudhalkar N, Pandey P, Waghmare S, Engineer R, Mahantshetty U, Ghosh J, Gupta S, Shrivastava S. Cancer Stem Cells, CD44, and Outcomes Following Chemoradiation in Locally Advanced Cervical Cancer: Results From a Prospective Study. Int J Radiat Oncol Biol Phys 2018; 103:161-168. [PMID: 30213750 DOI: 10.1016/j.ijrobp.2018.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/20/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Although cancer stem cells (CSCs) have been reported across solid tumors, there is a dearth of data regarding CSC and its impact on outcomes of cervical cancer. METHODS AND MATERIALS From October 2013 to December 2015, patients with squamous cancer of the cervix (stage IB2-IVA) were included. Pretreatment and posttreatment biopsy was obtained and immunohistochemistry was performed for SOX-2, OCT-4, Nanog, CD44, and Podoplanin. All patients received concurrent radiation and brachytherapy to an equivalent dose of 80 to 84 Gy to point A with concurrent weekly cisplatin. Correlation of CSC expression was performed with known prognostic factors. The effect of stem cell expression on disease outcomes was tested within multivariate analysis. RESULTS One hundred fifty patients were included. The median dose to point A was 83 Gy (46-89 Gy) and a median of 4 cycles (range, 0-6 cycles) of chemotherapy was administered. At baseline, moderate to strong immunohistochemical expression of SOX-2, OCT-4, Nanog, CD44, and Podoplanin was observed in 12.8%, 4.8%, 24.4%, 15.5%, and 1.3% of patients, respectively. At median follow-up of 30 months (range, 3-51 months), locoregional and distant relapse was observed in 12.2% and 23.1% of patients, of whom 4.7% had both local and distant relapse. The 3-year disease-free survival rate was 87%. On multivariate analysis, moderate to high CSC expression and CD44 low status (hazard ratio [HR] = 8.8; 95% confidence interval [CI], 1.0-77.2; P < .04) independently predicted for locoregional relapse-free survival. International Federation of Gynecology and Obstetrics stage (HR = 2.6; 95% CI, 1.3-5.4; P = .004) and presence of residual tumor after external radiation (HR = 3.5; 95% CI, 1.8-6.5; P = .0001) predicted for a detriment in disease-free survival. CONCLUSIONS The presence of stem cell proteins and loss of CD44 independently predicts for reduced locoregional control in locally advanced cervical cancer. Further investigation into the interaction of stem cell and CD44 biology is warranted.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Venkatesh Pai
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sidharth Pant
- Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nidul Rathod
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayant S Goda
- Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Niyati Sudhalkar
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Puloma Pandey
- Clinical Biology Laboratory, Department of Radiation Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sanjeev Waghmare
- Stem Cell Biology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Medical Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Medical Oncology, Advanced Centre for Treatment, Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shyam Shrivastava
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Bal M, Rane S, Talole S, Ramadwar M, Deodhar K, Patil P, Goel M, Shrikhande S. Tumour origin and R1 rates in pancreatic resections: towards consilience in pathology reporting. Virchows Arch 2018; 473:293-303. [PMID: 30091124 DOI: 10.1007/s00428-018-2429-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/07/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 12/17/2022]
Abstract
To evaluate differences in the R1 rates of ampullary (AC), pancreatic (PC), and distal bile duct (DBD) cancers in pancreatoduodenectomies (PD) using standardised pathology assessment. Data of PD (2010-2011) analysed in accordance with the Royal College of Pathologists (UK) protocol, were retrieved. Clinicopathologic features, including frequency, topography, and mode of margin involvement in AC (n = 87), PC (n = 18), and DBD (n = 5) cancers were evaluated. The R1 rate was 7%, 67%, and 20% in the AC, PC, and DBD cancers (p < 0.001). Within the PC cohort, R1 rate was heterogeneous (chemo-naïve, 77%; post-neoadjuvant, 40%). Commonest involved margins were as follows: posterior in overall PD (35%), AC (43%), overall PC (33%), and post-neoadjuvant PC (100%); superior mesenteric artery margin in chemo-naïve PC (38%) and common bile duct margin in DBD (100%) cancers. In AC, majority (66%) of R1 were signet ring cell type. Indirect margin involvement due to tumour within lymph node, perineural sheath or lymphovascular space was observed in 26% cases, and altered R1 rate in AC, PC, and DBD cohorts by 1%, 12%, and 0%, respectively. Although not statistically significant, patients with R1 had lower disease-free survival than those with R0 (mean, 25.4 months versus 44.4 months). Tumour origin impacts R1 data in PD necessitating its accurate classification by pathologists. Indirect involvement, histology, and neoadjuvant therapy influence the R1 rate, albeit in a minority of cases. Generating cogent R1 data based on standardised pathology reporting is the foremost need of the hour.
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Affiliation(s)
- Munita Bal
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India.
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Sanjay Talole
- Department of Epidemiology and Statistics, Tata Memorial Centre, Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, 400012, India
| | - Prachi Patil
- Department of Digestive Diseases and Nutrition, Tata Memorial Centre, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
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Chopra SJ, Mathew A, Maheshwari A, Bhatla N, Singh S, Rai B, Surappa ST, Ghosh J, Sharma D, Bhaumik J, Biswas M, Deodhar K, Popat P, Giri S, Mahantshetty U, Tongaonkar H, Billimaga R, Engineer R, Grover S, Pedicayil A, Bajpai J, Rekhi B, Alihari A, Babu G, Thangrajan R, Menon S, Shah S, Palled S, Kulkarni Y, Gulia S, Naidu L, Thakur M, Rangrajan V, Kerkar R, Gupta S, Shrivastava SK. National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer. J Glob Oncol 2018; 4:1-15. [PMID: 30085891 PMCID: PMC6223405 DOI: 10.1200/jgo.17.00152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Standard guidelines for the management of early and locally advanced cervical cancer are available from various academic consortiums nationally and internationally. However, implementing standard-of-care treatment poses unique challenges within low- and middle-income countries, such as India, where diverse clinical care practices may exist. The National Cancer Grid, a consortium of 108 institutions in India, aims to homogenize care for patients with cervical cancer by achieving consensus on not only imaging and management, but also in addressing potential solutions to prevalent challenges that affect the homogenous implementation of standard-of-care treatment. These guidelines therefore represent a consensus statement of the National Cancer Grid gynecologic cancer expert group and will assist in homogenization of the therapeutic management of patients with cervical cancer in India.
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Affiliation(s)
- Supriya J. Chopra
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Ashwathy Mathew
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Amita Maheshwari
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Neerja Bhatla
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shalini Singh
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Bhawana Rai
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shylasree T. Surappa
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jaya Ghosh
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Dayanand Sharma
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jaydip Bhaumik
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Manash Biswas
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Kedar Deodhar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Palak Popat
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sushil Giri
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Umesh Mahantshetty
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Hemant Tongaonkar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Ramesh Billimaga
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Reena Engineer
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Surbhi Grover
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Abraham Pedicayil
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jyoti Bajpai
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Bharat Rekhi
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Aruna Alihari
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Govind Babu
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Rajkumar Thangrajan
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Santosh Menon
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sneha Shah
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sidhanna Palled
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Yogesh Kulkarni
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Seema Gulia
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Lavanya Naidu
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Meenakshi Thakur
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Venkatesh Rangrajan
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Rajendra Kerkar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sudeep Gupta
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shyam K. Shrivastava
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
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Rekhi B, Deodhar K, Gulia S, Bajpai J. Raspberry bodies and hyaline globules with positive napsin A immunoexpression are useful features in diagnosing clear cell carcinoma of the female genital tract in cytology samples. Cytopathology 2018; 29:600-602. [PMID: 29956857 DOI: 10.1111/cyt.12607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
| | - Kedar Deodhar
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Sastri Chopra S, Deodhar K, Goda J, Pai V, Pant S, Rathod N, Waghmare S, Mahantshetty U, Engineer R, Ghosh J, Gupta S, Shrivastava S. PO-0806: Cervical cancer stem cells and response to chemo-radiation in locally advanced cervical cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mahantshetty U, Teni T, Naga P, Hotwani C, Umesh S, Kannan S, Hande V, Pawar S, Engineer R, Chopra S, Deodhar K, Maheshwari A, Gurram L, Gupta S, Shrivastava SK. Impact of HPV 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy - A prospective observational study. Gynecol Oncol 2018; 148:299-304. [DOI: 10.1016/j.ygyno.2017.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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Maheshwari A, Ranade R, Kerkar R, Shylasree T, Deodhar K, Rekhi B, Menon S, Gupta S. Preoperative MRI versus intra-operative frozen section in surgical management of clinically early endometrial cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pai T, Nair N, Pantvaidya G, Deodhar K, Shet T. Metastatic nasopharyngeal carcinoma presenting as an isolated breast mass: A diagnostic pitfall and a review of literature. INDIAN J PATHOL MICR 2017; 60:119-121. [PMID: 28195109 DOI: 10.4103/0377-4929.200058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Metastases to breast are much rarer than primary breast tumors. We now present a case of 45-year-old female, who presented with an isolated breast mass. A positron emission tomography-computed tomography (PET-CT) done revealed hypermetabolic right breast nodules, soft tissue deposits, and multiple nodal involvement. The biopsy from the breast and axillary lymph node showed dense lymphoid infiltrate and was interpreted initially as granulomatous inflammation. However, the lumps were hard and suspicious for primary breast cancer, so an immunohistochemistry for cytokeratin was performed which highlighted the epithelial cell clusters masked within the inflammatory infiltrate and the diagnosis of undifferentiated carcinoma, lymphoepithelioma-like was made. After the diagnosis was made, it was realized that the patient had been treated earlier for a nasopharyngeal carcinoma (NPC). The in situ hybridization (ISH) test for Epstein-Barr virus-encoded RNA ISH was positive in the tumor cells, and hence, a diagnosis of metastatic NPC was finally made. The patient subsequently developed extensive nodal, skeletal, and soft tissue metastatic disease but was alive till September 2015. Although extremely rare, metastatic NPC can occur in the breast and the above case highlights that it mimics an inflammatory lesion. This case highlights the importance of the multidisciplinary approach for appropriate tumor diagnosis and patient management.
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Affiliation(s)
- Trupti Pai
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gauri Pantvaidya
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Shaikh R, Prabitha VG, Dora TK, Chopra S, Maheshwari A, Deodhar K, Rekhi B, Sukumar N, Krishna CM, Subhash N. A comparative evaluation of diffuse reflectance and Raman spectroscopy in the detection of cervical cancer. J Biophotonics 2017; 10:242-252. [PMID: 26929106 DOI: 10.1002/jbio.201500248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 05/09/2023]
Abstract
Optical spectroscopic techniques show improved diagnostic accuracy for non-invasive detection of cervical cancers. In this study, sensitivity and specificity of two in vivo modalities, i.e diffuse reflectance spectroscopy (DRS) and Raman spectroscopy (RS), were compared by utilizing spectra recorded from the same sites (67 tumor (T), 22 normal cervix (C), and 57 normal vagina (V)). Data was analysed using principal component - linear discriminant analysis (PC-LDA), and validated using leave-one-out-cross-validation (LOOCV). Sensitivity, specificity, positive predictive value and negative predictive value for classification between normal (N) and tumor (T) sites were 91%, 96%, 95% and 93%, respectively for RS and 85%, 95%, 93% and 88%, respectively for DRS. Even though DRS revealed slightly lower diagnostic accuracies, owing to its lower cost and portability, it was found to be more suited for cervical cancer screening in low resource settings. On the other hand, RS based devices could be ideal for screening patients with centralised facilities in developing countries.
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Affiliation(s)
- Rubina Shaikh
- Chilakapati Laboratory, ACTREC, Kharghar, Navi Mumbai, 410210, India
| | - Vasumathi G Prabitha
- Biophotonics Laboratory, National Centre for Earth Science Studies, Akkulam, Thiruvananthapuram, 695 031, Kerala, India
| | - Tapas Kumar Dora
- Tata Memorial Center, Radiation Oncology, ACTREC, Kharghar, Navi Mumbai, 410210, India
| | - Supriya Chopra
- Tata Memorial Center, Radiation Oncology, ACTREC, Kharghar, Navi Mumbai, 410210, India
| | - Amita Maheshwari
- Tata Memorial Hospital, Gynecology Oncology, Parel, Mumbai, 400012, India
| | - Kedar Deodhar
- Tata Memorial Hospital, Surgical Pathology, Cytopathology, Parel, Mumbai, 400012, India
| | - Bharat Rekhi
- Tata Memorial Hospital, Surgical Pathology, Cytopathology, Parel, Mumbai, 400012, India
| | - Nita Sukumar
- Biophotonics Laboratory, National Centre for Earth Science Studies, Akkulam, Thiruvananthapuram, 695 031, Kerala, India
| | - C Murali Krishna
- Chilakapati Laboratory, ACTREC, Kharghar, Navi Mumbai, 410210, India
| | - Narayanan Subhash
- Sascan Meditech Pvt Ltd, Centre for Innovation in Medical Electronics, BMS College of Engineering, Basavanagudi, Bangalore, 560019, India
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Kaur S, Kerkar RA, Maheshwari A, Shylasree TS, Gupta S, Deodhar K. Clinical characteristics with patterns of relapse and survival analysis of ovarian clear cell carcinoma. Indian J Cancer 2017; 53:288-291. [PMID: 28071629 DOI: 10.4103/0019-509x.197719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- S Kaur
- Depatment of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - R A Kerkar
- Depatment of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Maheshwari
- Depatment of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - T S Shylasree
- Depatment of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Gupta
- Depatment of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - K Deodhar
- Depatment of Pathology, Tata Memorial Hospital, Mumbai, India
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Bal M, Verma A, Ramadwar M, Deodhar K, Patil P, Goel M. Clinicopathologic characteristics of Wnt/β-catenin-deregulated hepatocellular carcinoma. Indian J Cancer 2017; 54:634-639. [DOI: 10.4103/ijc.ijc_655_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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