Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India.

OBJECTIVE: To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). METHODS: Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. RESULTS: Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality-4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. CONCLUSION: NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.

Human papillomavirus: footprints in the population of western India.

OBJECTIVES: Cancer is a multi-factorial disease, with various intrinsic and environmental factors contributing to its occurrence. Human papillomavirus (HPV) has been associated with the occurrence of many cancers. India severely suffers from 3 HPV-associated cancers (cervical cancer, oral cancer, and oropharyngeal cancer). Hence, the present study aimed to evaluate the HPV burden in these 3 cancers among patients from the western region of India. METHODS: DNA was isolated from samples from 400 cervical cancer, 127 oral cancer, and 75 oropharyngeal cancer patients. Polymerase chain reaction was performed using degenerate primers for HPV infection. RESULTS: Overall, HPV infection was observed in 87% of cervical cancer cases, 12.5% of oral cancer cases, and 26.7% of oropharyngeal cancer cases when analyzed with a cumulative detection method using the MY 09/11, GP 5+/6+, and CP I/II primer sets. CONCLUSIONS: A significant prevalence of HPV infection was detected in all 3 cancers using the degenerate primer sets. This finding implies that testing for HPV infection using multiple primer sets is crucial for determining its actual prevalence in various malignancies.

Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis.

BACKGROUND AND AIMSBACKGROUND: Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19. METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics" with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis. RESULTS: There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1-4). CONCLUSIONS: Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients.

Female genital tract melanoma: Analysis from a regional cancer institute.

OBJECTIVE: Malignant melanoma of the genital tract comprises 3% of all melanomas afflicting females. They are characterized by poor prognosis with 5-year survival of 0-25% and high incidence for distant metastasis. This study was performed to assess various clinical features, treatment options, and thre management of genital melanomas. MATERIALS AND METHODS: This was a retrospective analysis where records of patients with genital melanomas between 2005 to 2018 were reviewed to obtain demographic and clinical information, including age of diagnosis, presenting symptoms, performance status, pathology reports, treatment, follow-up, and survival. RESULTS: Between 2005 and 2018, 31 women were analyzed. The median age was 53.5 (range: 28.5-85) years. Vaginal bleeding was the most common presenting symptom (80.6%), followed by discharge (29%), mass in the vagina/perineum (19.3%), pain (16.1%), and difficulty in micturition (9.6%). The most common site of origin was the vagina (67.7%), followed by that vulva (19.3%) and cervix (12.9%). Tumor diameter was more than 3 cm in 74.2% (23/31). Out of 31 patients, only 16 opted for treatment. Four patients underwent surgery, 10 received primary chemotherapy, and two needed palliative radiotherapy for heavy bleeding. The median survival in the treatment group was 5 (range: 2.5-28) months, almost similar to patients not receiving any treatment (5 months, range: 2-11). CONCLUSION: Genital melanoma are rare but aggressive tumors. Diagnosis is usually made with biopsy. No effective treatment strategy is yet available. However, surgery is the preferred first- line treatment, radiotherapy and chemotherapy have been used in adjuvant settings.

Prognostic value of lymph node ratio in surgically treated cases of vulvar cancer: a tertiary care centre experience.

OBJECTIVE: This study aimed to study the patterns of recurrence in surgically treated cases of vulvar cancer (VC) and determine the factors associated with recurrence, with a special emphasis on lymph node ratio (LNR). METHODS: This retrospective study examined VC patients primarily treated with surgery at our institute from January 2005 to December 2015. Demographic data, clinical characteristics, surgicohistopathological data, adjuvant treatment, follow up, and recurrence site and treatment were studied. RESULTS: Among the 111 cases treated, a recurrence rate of 18.9% was noted. Recurrence was most commonly local (61.9%). On univariate and multivariable analyses of clinicopathological parameters, an LNR >20 had the highest hazard ratio for recurrence. CONCLUSION: LNR may provide useful prognostic information in VC patients with positive inguinal lymph node status.

Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? - Our experience from a tertiary cancer institute.

AIM: The aim of the study is to evaluate percent fall in CA-125 levels after neoadjuvant chemotherapy (NAC) and preoperative CA-125 value to predict surgical and survival outcomes in women with advanced-stage epithelial ovarian cancer (EOC). METHODS: A retrospective review of 406 women receiving NAC for advanced-stage EOC from January 2012 to July 2015 was conducted. Data were collected for demography, radiographic profile, CA-125 levels before and after NAC, chemotherapy, and surgicopathological information. Percent fall in CA-125 was categorized into two groups: <95% (R < 95) and >95% (R > 95) fall from prechemotherapy to preoperative levels. Similarly, women were also categorized using preoperative CA-125 levels of <100 and >100 U/ml. A subset of women from January 2012 to December 2013 was followed to June 2015 for evidence of any recurrence to determine survival outcomes. RESULTS: About 56% women had R > 95 and 44% had R < 95. As compared to R < 95, R > 95 group was more likely to have complete cytoreduction (P = 0.00). Furthermore, women with R > 95 had significant better progression-free survival (PFS) as compared to women with R < 95 (P = 0.009) but no difference in overall survival (OS) (P = 0.28). Women with preoperative CA-125 <100 had significant higher number of complete cytoreduction (55% vs. 40%; P = 0.00) and were associated with both PFS (P = 0.007) and OS benefit (P = 0.02). CONCLUSION: Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.

Role of PET-CT Scan in Gynaeconcology.

THE PURPOSE OF THIS STUDY: This study was undertaken to evaluate the role of positron emission tomography-CT (PET-CT) in diagnosis and management of gynecological malignancies in primary and recurrent settings and also to investigate its role in inappropriately treated patients, for pretreatment evaluation (staging) to help in proper therapeutic management. METHOD: This is a retrospective study of 56 patients of gynecological malignancy registered in Gujarat Cancer Research Institute from June 2011 to December 2013. RESULTS: Out of 56 cases where PET was done, the results were as follows: carcinoma cervix-23, carcinoma ovary-20, carcinoma endometrium-9, carcinoma vulva-1, carcinoma vagina-2, and GTN-1. PET scan was negative in 37 % of patients where CT scan was suspicious, which changed the therapeutic modality and prevented further unnecessary interventions. In cases where clinical suspicion of recurrence was high based on rising tumor marker and CT scan was negative, subsequent PET-CT was able to pick up malignancy in 75 % cases. Eleven patients (25 %) with suspected recurrence with inconclusive CT scan and negative PET-CT scan were kept on follow-up, thus reducing further morbidity and cost. CONCLUSION: Addition of PET-CT, a noninvasive method to the oncologist's imaging armamentarium may ultimately improve both outcomes and costs by altering management strategies in primary and recurrent settings. The potential use of PET-CT appears promising in several decision-making steps in the management of patients with gynecological malignancy. It defines the extent of metastatic disease which enables the clinician to decide regarding salvageable surgical intervention or palliative measures.

High-risk gestational trophoblastic neoplasia at Gujarat Cancer and Research Institute: thirteen years of experience.

OBJECTIVE: To evaluate and analyze the results of chemotherapy (EMA-CO [etoposide, methotrexate, actinomycin D-cyclophosphamide, vincristine]) in high-risk gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 97 women with high-risk GTN were evaluated for a period of 13 years (1995-2008). All women received EMA-CO as a first-line chemotherapy. EMA-EP (etoposide, methotrexate, actinomycin and cisplatinum), PVB (cisplatin, vinblastine and bleomycin), and BEP (bleomycin, etoposide and cisplatin) were the chemotherapies used as second-line therapy in women who experienced resistance to primary chemotherapy. Intrathecal methotrexate was given in women with brain metastasis and also as prophylaxis in pulmonary metastasis. Eleven women had brain metastasis and received cranial radiotherapy. The most common toxicity was hematologic. . RESULTS: Of 97 women, 78 (80.4%) were evaluable and 19 (19.6%) were lost to follow-up with incomplete treatment. Of the 78 patients, 6 women developed resistance and had progression of disease. Seven women had died (5 due to disease, 2 due to chemotherapy toxicity). Overall 65 of the 78 (83.3%) women achieved remission. Of the 78 women, 66.7% (52/78) had complete remission with first-line chemotherapy, and an additional 16.6% (13/78) achieved remission with second-line chemotherapy, resulting in a total of 83.3% (65/78) attaining remission. A total of 46% (30/ 65) had follow-up of > 3 years, and 32.4% (21/65) had follow-up of 1-3 years. Three of 9 women with brain metastasis achieved remission. Sixty percent (39/65) resumed normal menstrual function (had remission for at least 2 years). Twelve women became pregnant since the completion of the chemotherapy, with 10 live births of healthy infants without any congenital abnormalities. CONCLUSION: High-risk GTNs are highly curable if properly treated, and patients can anticipate a normal future reproductive outcome. EMA-CO remains the preferred chemotherapy for management.

Granulosa cell tumor arising in an ovary with mature teratoma.

Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.