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Abstract
Introduction: Charlson comorbidity index (CCI) is a validated tool enabling clinicians for prediction of adverse events posttherapy. In this study, we planned to estimate the predictive value of age-adjusted CCI (ACCI) in assessing the perioperative complication in oncological patients undergoing major pelvic surgeries. Methods: This was a single arm, prospective, observational study, in which adult patients with pelvic malignancies undergoing pelvic surgeries were selected. The relationship between the ACCI and Grade 3–5 adverse events were tested using Fisher's test. Results: The rate of Grade 3–5 adverse event rate was 16.7% (11 patients, n = 66). Among the whole cohort, 11 patients (16.7%) had high score on ACCI. The rate of Grade 3–5 adverse events was higher in the cohort of patients with high ACCI score (45.5% vs. 10.9%, P = 0.014). The sensitivity, specificity and negative and positive predictive values were 45.5%, 89.1%, 89.1%, and 45.5%, respectively. Conclusion: ACCI can predict for postsurgical adverse events. It has a high negative predictive value for nonoccurrence of adverse events.
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Affiliation(s)
- Sampada B Dessai
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - R Fasal
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - J Dipin
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - D Adarsh
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
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Khalid N, Dessai SB, Anilkumar B, Dharmarajan A, Yadav P, Arvind S, Satheeshan B. Clinical Significance of Nodal Positivity Following Neoadjuvant Chemotherapy in Epithelial Ovarian Cancer. Indian J Gynecol Oncolog 2017. [DOI: 10.1007/s40944-017-0158-5] [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: 11/30/2022]
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Dessai SB, Adrash D, Geetha M, Arvind S, Bipin J, Nayanar S, Sachin K, Biji MS, Balasubramanian S. Pattern of care in operable endometrial cancer treated at a rural-based tertiary care cancer center. Indian J Cancer 2017; 53:416-419. [PMID: 28244473 DOI: 10.4103/0019-509x.200678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE An audit was planned to study the demographics, staging, treatment details, and outcomes of operable endometrial cancers. METHODOLOGY All operable endometrial cancers treated between January 2009 and October 2014 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. Descriptive statistics was performed. The time-to-event analysis was done by Kaplan-Meier method. Univariate and multivariate analyses were done for disease-free survival (DFS) and overall survival (OS). RESULTS There were 55 patients with a median age of 59 years (35-73 years). The Eastern Cooperative Oncology Group performance status was 1 in 52 patients (94.5%) and 2 in 3 patients (5.5%). Forty-nine patients (89.1%) had disease restricted to endometrium while 6 patients (10.9%) had cervical involvement. The surgery done was Type I hysterectomy in 49 patients (89.1%), Type II in 5 patients (9.1%), and Type III in 1 patient (1.8%). Pelvic lymph node dissection was done in all patients while para-aortic (infrahilar) dissection was done in 48 patients (87.3%). The pathological stages were Stage IA in 19 patients, Stage IB in 15 patients, Stage II in 4 patients, Stage IIIA in 3 patients, Stage IIIB in 2 patients, Stage IIIC1 in 5 patients, Stage IIIC2 in 4 patients, and Stage IV in 3 patients. Grade 1 tumors were seen in 23 patients, Grade 2 in 13 patients, and Grade 3 in 19 patients. The histology was endometrioid in 44 patients, serous in 6 patients, clear cell in 3 patients, and others in 2 patients. Adjuvant treatment was received by 40 patients. With a median follow-up of 2.5 years, the 3-year DFS and OS were 78% and 82%, respectively. Age >59 years, Stage III or greater, and Grade 3 tumors were independent prognostic factors adversely affecting both DFS and OS. CONCLUSION The outcomes in our study are comparable to that seen in Western literature. Elderly status, higher stage, and a poorly differentiated tumor are associated with poor outcomes.
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Affiliation(s)
- S B Dessai
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - D Adrash
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - M Geetha
- Department of Radiation Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - S Arvind
- Department of Clinical Laboratory Services and Translational Research, Division of Oncopathology, Malabar Cancer Center, Kannur, Kerala, India
| | - J Bipin
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - S Nayanar
- Department of Clinical Laboratory Services and Translational Research, Division of Oncopathology, Malabar Cancer Center, Kannur, Kerala, India
| | - K Sachin
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - M S Biji
- Department of Palliative Medicine, Malabar Cancer Center, Kannur, Kerala, India
| | - S Balasubramanian
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
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Dessai SB, Chakraborty S, Babu T, Nayanar S, Bhattacharjee A, Jones J, Balasubramanian S, Patil VM. Tolerance of weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin. Indian J Cancer 2017; 53:280-283. [PMID: 28071627 DOI: 10.4103/0019-509x.197742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to study the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. METHODS Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m2) and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (CTCAE version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. RESULT Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3-4 life-threatening complications were seen in two patients. The post NACT response rate was 100%. CONCLUSION Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.
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Affiliation(s)
- S B Dessai
- Department of Surgical Oncology, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Chakraborty
- Department of Radiation Oncology, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - Tvs Babu
- Department of Cancer Imaging, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Nayanar
- Department of Oncopathology and Translational Medicine, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - A Bhattacharjee
- Department of Division of Clinical Research and Biostatistics, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - J Jones
- Department of Radiation Oncology, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Balasubramanian
- Department of Surgical Oncology, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - V M Patil
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Center, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
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Dessai SB, Patil VM, Chakraborty S, Babu S, Bhattacharjee A, Nayanar S, Vikram S, Balasubramanian S. An audit of cytoreductive surgeries in ovarian cancer from a rural based cancer center. Indian J Cancer 2017; 53:284-287. [PMID: 28071628 DOI: 10.4103/0019-509x.197743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
BACKGROUND AND OBJECTIVE Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra-radical) done in such patients. METHODS This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease-related and treatment-related data were extracted. RESULTS Fifty-fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350-600) mL. The median time interval for surgery was 4.0 h (3-5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02-0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra-radical surgery as compared to those who underwent radical surgery. CONCLUSION Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra-radical surgery.
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Affiliation(s)
- S B Dessai
- Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - V M Patil
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - S Chakraborty
- Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - S Babu
- Department of Imageology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - A Bhattacharjee
- Department of Cancer Registry, Division of Clinical Research and Biostatistics, Malabar Cancer Centre, Thalassery, Kerala, India
| | - S Nayanar
- Department of Clinical Laboratory Services and Translational Research, Division of Oncopathology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - S Vikram
- Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - S Balasubramanian
- Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
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Dessai SB, Chakraborty S, Babu TVS, Nayanar S, Bhattacharjee A, Jones J, Balasubramanian S, Patil VM. Tolerance of weekly metronomic paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin. South Asian J Cancer 2016; 5:63-6. [PMID: 27275450 PMCID: PMC4873699 DOI: 10.4103/2278-330x.181629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/26/2022] Open
Abstract
OBJECTIVE There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to examine the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. METHODS Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m(2)) and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (Common Terminology Criteria for Adverse Events version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. RESULTS Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3-4 life-threatening complications were seen in two patients. The post NACT response rate was 100%. CONCLUSIONS Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.
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Affiliation(s)
- S B Dessai
- Department of Surgical Oncology, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Chakraborty
- Department of Radiation Oncology, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - T V S Babu
- Department of Cancer Imaging, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Nayanar
- Department of Oncopathology and Translational Medicine, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - A Bhattacharjee
- Division of Clinical Research and Biostatistics, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - J Jones
- Department of Radiation Oncology, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - S Balasubramanian
- Department of Surgical Oncology, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
| | - Vijay M Patil
- Clinical Hematology and Medical Oncology, Malabar Cancer Center, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala, India
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Dessai SB, Chakraborty S, Sajeev Kumar PB, Babu S, Muttath G, Nair C, Thiagarajan S, Sughosh B, Bhattacharjee A, Patil VM. Pilot study of single-day distress screening with the NCCN distress thermometer to evaluate the feasibility of routine distress screening in tertiary cancer center in rural India. Psychooncology 2014; 24:832-4. [PMID: 25534299 DOI: 10.1002/pon.3739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Sampada B Dessai
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - Santam Chakraborty
- Department of Radiation Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - P B Sajeev Kumar
- Tellicherry Co-operative Hospital, Department of Psychiatry, Kannur Medical College, Kannur, Kerala, India
| | - Sajith Babu
- Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - Geetha Muttath
- Department of Radiation Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | - Chandran Nair
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Center, Kannur, Kerala, India
| | | | - Biji Sughosh
- Department of Cancer Palliative Medicine, Malabar Cancer Center, Kannur, Kerala, India
| | - Atanu Bhattacharjee
- Division of Clinical research and Biostatistics, Malabar Cancer Center, Kannur, Kerala, India
| | - Vijay M Patil
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Center, Kannur, Kerala, India
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