Susan Mathews - Academia.edu (original) (raw)

Papers by Susan Mathews

South Asian Journal of Cancer

the different inclusion and exclusion criteria, we obtained 1156 patients, 733 CC patients and 42... more the different inclusion and exclusion criteria, we obtained 1156 patients, 733 CC patients and 423 non-CC patients. Subsequently, and after analyzing the first results, we decided to homogenize our database by means of a PMS analysis, by this way, we obtained a new balanced population of 374 patients (187 CC patients and 187 non-CC patients). Results In the general population, patients with CC present a 72% reduction in the risk of relapse compared to non-CC patients (HR: 0.28 95% CI (0.17-0.46) p = 0.000) and a 90% reduction in the risk of death (HR: 0.10 95% CI (0.03-0.33) p = 0.000), these differences may be due to the fact that both populations present differences. After homogenizing our population using the PMS, we obtained that the reduction in the risk of relapse was 65% for patients who have CC (HR: 0.35 CI 95% (0.16-0.75) p = 0.007) and 75% for the risk of death for the same cohort (HR: 0.25 95% CI (0.07-0.90) p = 0.033). Regarding the secondary objectives, we observed that the CC seems to have a protective effect in tumors between 2-4 cm (HR: 0.33 95% CI (0.11-0.99) p = 0.049). This same protective effect is observed in patients operated on by laparoscopy (HR: 0.35 95% CI (0.14-0.89) p = 0.028). Finally, the MIS patients who have CC do not present differences compared to those operated by the open approach, whether they are conized or non-conized (Log-Rank p = 0.439 and Log-Rank p = 0.346). Conclusion Patients undergoing CC have a significantly lower risk of relapse and death, this effect is more evident in those patients with 2-4 cm tumors or in those who are operated under MIS. Disclosures I have nothing to disclose.

Indian Journal of Gynecologic Oncology, 2021

Objective The objectives were to study the pattern of expression of PD-L1 in patients with carcin... more Objective The objectives were to study the pattern of expression of PD-L1 in patients with carcinoma cervix and find out any relation with the various patient- and disease-related factors like histology, FIGO stage, lymph node metastasis and response to treatment. Methods One hundred cervical cancer patients registered during 2018 who were suitable for radical treatment were identified. The paraffin-embedded, formalin-fixed cervical biopsy specimens of these patients were collected. Immunohistochemical staining for PD-L1 expression was performed on the cervical biopsy material. The test was considered positive if 50 per cent or more tumour cells or less than 50 per cent with intense staining were present. Results PD-L1 was positive in 25 of 99 (25.3%) cervical carcinoma samples. PD-L1 was positive in 18 of 81 (22%) squamous cell carcinomas, 7 of 16 (43.7%) adenocarcinomas and 0 out of 2 adenosquamous carcinomas. Twenty-nine per cent of patients with positive pelvic nodes expressed PD-L1 positivity. None of the patients with paraaortic node metastasis expressed PD-L1 positivity. No statistically significant associations were found between PD-LI positivity and menopausal status, haemoglobin level, histology, tumour size, FIGO stage, nodal involvement and response to treatment. Conclusions One out of four patients had evidence of PD-L1 positivity in their cervical cancer. No association was found between PD-L1 expression and various clinicopathological factors and response to treatment. But follow-up studies are needed to observe any effect on disease-free or overall survival. Validation of scoring of PD-L1 expression and uniform reporting is required.

Brachytherapy, May 1, 2015

optimized; they were normalized to point A. The purpose of this approach was to investigate if th... more optimized; they were normalized to point A. The purpose of this approach was to investigate if the shielding of the applicator results in a different protection rate using the optimized plans and plans normalized to point A. Results: The degradation of the CTV coverage was not noticed when the shielded applicator was used; the average change of the D90 was 0.19 % and 0.60 % for the optimized and point A normalized plans. The most affected organ with shielding in place was the rectum with an average decrease of D2 dose of 4.77 % for the optimized plans and 5.44 % for the plans normalized at point A. The effect of the shielding for one patient was noticeably low due to the unfavorable anatomy in respect to the position of the shields. When this patient was excluded from the analysis, the average decrease of D2 for the rectum was 7.45 % and 8.57 % in the first and second approach, respectively. The same level of protection was noticed for rectum D0.1 and D5, i.e. 7.21 % and 6.29 % for the optimized plan, and 9.31 % and 7.19 % for the point A normalized plans. The average alternation of the D2 for the bladder, sigmoid and bowel was not significant for the optimized plans. It was 0.36 %, 0.27 % and 0.51 % respectively. The similar values were noticed for the point A normalized plans, i.e. 0.18 %, 0.03 % and 1.19 %. Conclusion: The shielded applicators did not decrease the coverage of the CTVs. The D2 dose to the rectum was lower up to 8.4 % for the optimized plans and up to 9 % for the plans normalized to point A. It was noticed that the dose to the other OARs (bladder, sigmoid and bowel) was not significantly altered when the shielded applicators were used. However, the effect of the ovoids shielding was more pronounced in the plans normalized to point A rather than in the optimized plans. Since the level of the OARs protection is dependent on the patients' anatomy when the shielded applicators were used in the planning, it is required to extend the study with a larger patients' cohort for any additional conclusions.

Radiotherapy and Oncology, 2015

, 157 pts (median age 64 years-range 39-84) were enrolled. All pts underwent total abdominal hyst... more , 157 pts (median age 64 years-range 39-84) were enrolled. All pts underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy; patological stage (FIGO 2008) was I in 150 pts and II in 7 pts. Tumour grading was G1 in 49 pts, G2 in 98 and G3 in 10. All pts underwent high-dose-rate vaginal brachytherapy (total dose 21 Gy in three week-fractions), delivered with vaginal cylinder, with the reference isodose covering the proximal ½ of the vagina. The dose was specified at 5 mm distance from the cylinder surface. The Kaplan-Meier method estimated the probability of locoregional relapse free survival (LRFS), distant metastases-free survival (DMFS) and cancer-specific survival (CSS). Univariate analysis investigated the effect of age, grading, number of excised nodes and pathological stage on loco-regional relapse (LRR), metastases, and tumour-related death. Risk factors in univariate analysis were included in proportional hazard multivariate models. Vaginal toxicity was evaluated with the RTOG/EORTC scale and was correlated with the cylinder diameter (2.5, 3 or 3.5 cm). Results: LRFS occurred in 9/157 (5.8%) pts. Three pts (1.9%) developed liver metastases. At median follow-up of 83 months 144 pts (91.8%) are alive and disease free, 2 pts (1.2%) are alive with disease, 7 pts (4.5%) died from disease and 4 pts (2.5%) died from other causes. The 3-year probability of LRFS, DMFS and CSS was 94.

Annals of Oncology, Jun 1, 2022

Annals of Oncology, Nov 1, 2018

Background: Despite the known association between MMR loss and Lynch syndrome (LS), data on EC is... more Background: Despite the known association between MMR loss and Lynch syndrome (LS), data on EC is sparse; the degree of association is unknown as are the implications in term of prognosis and survival. Methods: Descriptive analysis of 396 tumour samples of patients (pts), treated between Jan 2012 to Jan 2018, MMR proteins were tested by immunohistochemistry. Median follow up time was 23.2 months. Tumours with loss of at least one protein were considered MMR(d). Patient characteristics were recorded from our electronic records. Survival was assessed by Kaplan Mayer and log-rank test. Results: 29% (114) tumours were deemed MMRd. Predominant histological subtype was endometrioid, high grade serous (HGS) including carcinosarcoma and clear cell. The most common somatic loss was MLH1-PMS2 (69%). 41% (47 pts) underwent germline testing for LS, 13pts (27.6%) were diagnosed with LS, association rate was PMS2 (100%), MSH6 (87.5%) and MSH2 MHS6 (40%). Our data suggest a non-significant differential survival between MMR proficient (p) and MMRd tumours (OS 116 months vs 82.9 months p0.756). Conclusions: Almost 30% of unselected EC pts have somatic loss MMR proteins; 27% of patients have a germline mutation that is more commonly associated with loss of PMS2, MSH6 and MSH2 MSH6, and endometrioid histology. Differences in survival between MMRp and MMRd tumours need to be further investigated.

International Journal of Research in Medical Sciences, Dec 28, 2020

Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary b... more Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary bladder patients treated with radical radiotherapy. Methods: A total of sixty patients with muscle invasive bladder cancer who were treated between 2011 and 2013 with bladder preservation protocol were identified. Thirty-two patients were stage T2 disease, rest were T3 and T4. Initial TURBT was reported complete in 24 of the total 60 patients. All patients received 60 to 64Gy to the whole bladder. Results: The follow-up range was 3 to 72 months. One year follow-up proportion was 78%. The median progression free survival was 40months. Early stage (T2) and advanced stage (T3 and T4) had progression free survival of 87.8% and 48.5% respectively at one year follow-up with a p value of 0.001. Thirty-six patients who had an incomplete Transurethral resection of bladder tumor (TURBT) initially had a statistically significant lower PFS compared to those patients who had a complete TURBT with a p value of 0.029. Twenty-nine patients were disease free with an intact bladder during the follow-up period providing a bladder preservation rate of 48%. Conclusions: A bladder-conserving protocol with radiotherapy provides encouraging results with nearly half of the patients able to retain a disease-free bladder. Proper patient selection with early stage disease and those with complete TURBT may further improve the bladder preservation rates.

Indian Journal of Gynecologic Oncology, Sep 28, 2020

Objective To review the treatment outcome in primary vaginal cancer patients who underwent defini... more Objective To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. Methods A total of 43 patients with histologically proven primary vaginal cancer, who were treated between January 2005 to December 2015, were identified. All were treated with definitive radiotherapy with or without concurrent chemotherapy. Radiotherapy was delivered as a combination of external beam radiotherapy and brachytherapy to a minimum dose of 60 Gy. Four patients were FIGO stage I, 13 were stage II, 23 stage III patients and three patients were stage IVA. Results The median age was 60 years (range 42-76). The median follow-up was 29 months with a range of 3 to 70 months. The different variables looked into like the histology, lower third of vagina involvement and prior hysterectomy did not show any difference in survival. Addition of concurrent chemotherapy was the only factor which showed a trend towards better survival with a p value of 0.09. Even in the subset of patients with prior hysterectomy, those who received definitive treatment with concurrent chemo-radiotherapy had a better two-year progression-free survival than those who received radiotherapy alone (57.4% Vs 10.5%). Conclusion A combination of EBRT and brachytherapy with concurrent chemotherapy is a reasonable option in the management of primary vaginal cancer. Further optimization of the dose and techniques of radiotherapy are warranted.

E-Posters, Dec 1, 2022

Methods Our study explored the simultaneous testing for multiple mutations targeted adenocarcinom... more Methods Our study explored the simultaneous testing for multiple mutations targeted adenocarcinoma in cervical cancer using the NGS. Cervical cancer initially treated at Tokai university hospital from 2010 to 2021 (50 specimens) was compared with the registered data in TCGA database (133 specimens). Results Following genome sequences were analyzed; BCAR4,

South Asian Journal of Cancer

Objective The study aimed to see the clinical outcome and to identify prognostic factors for surv... more Objective The study aimed to see the clinical outcome and to identify prognostic factors for survival in patients with carcinoma endometrium. Methods Patients registered at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, with carcinoma endometrium from January 2009 to December 2013 were identified from hospital registry. Data regarding patient demographics, tumor characteristics, treatment schedules, and follow-up were collected using a structured proforma. Survival estimates were generated using the Kaplan–Meier method. Univariate analysis was done using chi-square and Fisher's exact tests. Multivariate analysis using the Cox regression model was performed to determine the impact of prognostic factors on outcome. The statistical analysis was done using SPSS software version 11. Results The median follow-up of the 686 patients was 95 months (range 3–178 months).There were 432 stage 1 (63%), 100 stage II (14.6%), 108 stage III (15.7%), and 46 stage IV patients (6.7%). ...

ecancermedicalscience

Germ cell tumour of the testis is the most common cancer in young men in the western world. India... more Germ cell tumour of the testis is the most common cancer in young men in the western world. India has the lowest incidence globally, and hence Indian data are sparse. We report the outcomes of patients with nonseminomatous germ cell tumours of testis treated at a tertiary cancer centre in South India over a period of 10 years. Patients with a histopathological diagnosis of nonseminomatous germ cell tumours of the testis from 1 January 2006 to 31 December 2016 were included in the study. Patient demographics, tumour characteristics and treatment details were retrieved from case records. Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox regression model was used to analyse the prognostic factors. One hundred and nineteen patients with nonseminomatous germ cell tumours of the testis were included in the study. The median follow-up was 81 months. The estimated 4-year OS and progression-free survival were 87.1% and 84.5%, respectively. The fouryear OS for good, intermediate and poor-risk groups was 93.6%, 87.5% and 52.6%, respectively. The PFS at 4 years was 91.4%, 87.8% and 47.4% for good, intermediate and poor-risk groups, respectively. The presence of nonpulmonary visceral metastasis and biochemical response after chemotherapy were significant predictors for OS and PFS in multivariate cox proportional hazards regression. The survival figures are comparable to the rest of the world except in the poor prognostic risk group. The inferior survival noticed in this group of patients may be due to the lack of good salvage procedures. High-dose chemotherapy with stem-cell support may be considered more often for this group of patients.

Indian Journal of Gynecologic Oncology, 2021

The purpose of the study was to identify the clinicopathological factors associated with recurren... more The purpose of the study was to identify the clinicopathological factors associated with recurrence in patients who underwent primary surgical management for carcinoma endometrium stage I to IVA. Retrospective analysis of data of 642 patients who underwent surgery with or without adjuvant therapy for carcinoma endometrium during the period January 2009 to December 2013 was performed. The five-year disease-free survival (DFS) and locoregional relapse-free survival (LR-RFS) were calculated using the Kaplan–Meier method. Log-rank test, univariate cox regression analysis, and multivariate analysis were conducted to find out the significance of different factors on outcome. The five-year DFS of the study population was 82.1%, and LR-RFS was 93.2%. Age more than 60 yrs, high-grade tumor, advanced stage, deep myometrial invasion, cervical stromal invasion, and negative PR status were independent prognostic factors for disease-free survival for carcinoma endometrium in multivariate analysis. Locoregional relapse-free survival was affected by cervical stromal invasion, negative PR status, and the lack of adjuvant treatment. Traditional clinicopathological risk factors stage, grade, age, and lack of PR expression were predictive of recurrence and can guide us in deciding adjuvant treatment until newer molecular classifications are proved better.

Indian Journal of Gynecologic Oncology, 2020

Objective To review the treatment outcome in primary vaginal cancer patients who underwent defini... more Objective To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. Methods A total of 43 patients with histologically proven primary vaginal cancer, who were treated between January 2005 to December 2015, were identified. All were treated with definitive radiotherapy with or without concurrent chemotherapy. Radiotherapy was delivered as a combination of external beam radiotherapy and brachytherapy to a minimum dose of 60 Gy. Four patients were FIGO stage I, 13 were stage II, 23 stage III patients and three patients were stage IVA. Results The median age was 60 years (range 42-76). The median follow-up was 29 months with a range of 3 to 70 months. The different variables looked into like the histology, lower third of vagina involvement and prior hysterectomy did not show any difference in survival. Addition of concurrent chemotherapy was the only factor which showed a trend towards better survival with a p value of 0.09. Even in the subset of patients with prior hysterectomy, those who received definitive treatment with concurrent chemo-radiotherapy had a better two-year progression-free survival than those who received radiotherapy alone (57.4% Vs 10.5%). Conclusion A combination of EBRT and brachytherapy with concurrent chemotherapy is a reasonable option in the management of primary vaginal cancer. Further optimization of the dose and techniques of radiotherapy are warranted.

South Asian Journal of Cancer

the different inclusion and exclusion criteria, we obtained 1156 patients, 733 CC patients and 42... more the different inclusion and exclusion criteria, we obtained 1156 patients, 733 CC patients and 423 non-CC patients. Subsequently, and after analyzing the first results, we decided to homogenize our database by means of a PMS analysis, by this way, we obtained a new balanced population of 374 patients (187 CC patients and 187 non-CC patients). Results In the general population, patients with CC present a 72% reduction in the risk of relapse compared to non-CC patients (HR: 0.28 95% CI (0.17-0.46) p = 0.000) and a 90% reduction in the risk of death (HR: 0.10 95% CI (0.03-0.33) p = 0.000), these differences may be due to the fact that both populations present differences. After homogenizing our population using the PMS, we obtained that the reduction in the risk of relapse was 65% for patients who have CC (HR: 0.35 CI 95% (0.16-0.75) p = 0.007) and 75% for the risk of death for the same cohort (HR: 0.25 95% CI (0.07-0.90) p = 0.033). Regarding the secondary objectives, we observed that the CC seems to have a protective effect in tumors between 2-4 cm (HR: 0.33 95% CI (0.11-0.99) p = 0.049). This same protective effect is observed in patients operated on by laparoscopy (HR: 0.35 95% CI (0.14-0.89) p = 0.028). Finally, the MIS patients who have CC do not present differences compared to those operated by the open approach, whether they are conized or non-conized (Log-Rank p = 0.439 and Log-Rank p = 0.346). Conclusion Patients undergoing CC have a significantly lower risk of relapse and death, this effect is more evident in those patients with 2-4 cm tumors or in those who are operated under MIS. Disclosures I have nothing to disclose.

Indian Journal of Gynecologic Oncology, 2021

Objective The objectives were to study the pattern of expression of PD-L1 in patients with carcin... more Objective The objectives were to study the pattern of expression of PD-L1 in patients with carcinoma cervix and find out any relation with the various patient- and disease-related factors like histology, FIGO stage, lymph node metastasis and response to treatment. Methods One hundred cervical cancer patients registered during 2018 who were suitable for radical treatment were identified. The paraffin-embedded, formalin-fixed cervical biopsy specimens of these patients were collected. Immunohistochemical staining for PD-L1 expression was performed on the cervical biopsy material. The test was considered positive if 50 per cent or more tumour cells or less than 50 per cent with intense staining were present. Results PD-L1 was positive in 25 of 99 (25.3%) cervical carcinoma samples. PD-L1 was positive in 18 of 81 (22%) squamous cell carcinomas, 7 of 16 (43.7%) adenocarcinomas and 0 out of 2 adenosquamous carcinomas. Twenty-nine per cent of patients with positive pelvic nodes expressed PD-L1 positivity. None of the patients with paraaortic node metastasis expressed PD-L1 positivity. No statistically significant associations were found between PD-LI positivity and menopausal status, haemoglobin level, histology, tumour size, FIGO stage, nodal involvement and response to treatment. Conclusions One out of four patients had evidence of PD-L1 positivity in their cervical cancer. No association was found between PD-L1 expression and various clinicopathological factors and response to treatment. But follow-up studies are needed to observe any effect on disease-free or overall survival. Validation of scoring of PD-L1 expression and uniform reporting is required.

Brachytherapy, May 1, 2015

optimized; they were normalized to point A. The purpose of this approach was to investigate if th... more optimized; they were normalized to point A. The purpose of this approach was to investigate if the shielding of the applicator results in a different protection rate using the optimized plans and plans normalized to point A. Results: The degradation of the CTV coverage was not noticed when the shielded applicator was used; the average change of the D90 was 0.19 % and 0.60 % for the optimized and point A normalized plans. The most affected organ with shielding in place was the rectum with an average decrease of D2 dose of 4.77 % for the optimized plans and 5.44 % for the plans normalized at point A. The effect of the shielding for one patient was noticeably low due to the unfavorable anatomy in respect to the position of the shields. When this patient was excluded from the analysis, the average decrease of D2 for the rectum was 7.45 % and 8.57 % in the first and second approach, respectively. The same level of protection was noticed for rectum D0.1 and D5, i.e. 7.21 % and 6.29 % for the optimized plan, and 9.31 % and 7.19 % for the point A normalized plans. The average alternation of the D2 for the bladder, sigmoid and bowel was not significant for the optimized plans. It was 0.36 %, 0.27 % and 0.51 % respectively. The similar values were noticed for the point A normalized plans, i.e. 0.18 %, 0.03 % and 1.19 %. Conclusion: The shielded applicators did not decrease the coverage of the CTVs. The D2 dose to the rectum was lower up to 8.4 % for the optimized plans and up to 9 % for the plans normalized to point A. It was noticed that the dose to the other OARs (bladder, sigmoid and bowel) was not significantly altered when the shielded applicators were used. However, the effect of the ovoids shielding was more pronounced in the plans normalized to point A rather than in the optimized plans. Since the level of the OARs protection is dependent on the patients' anatomy when the shielded applicators were used in the planning, it is required to extend the study with a larger patients' cohort for any additional conclusions.

Radiotherapy and Oncology, 2015

, 157 pts (median age 64 years-range 39-84) were enrolled. All pts underwent total abdominal hyst... more , 157 pts (median age 64 years-range 39-84) were enrolled. All pts underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy; patological stage (FIGO 2008) was I in 150 pts and II in 7 pts. Tumour grading was G1 in 49 pts, G2 in 98 and G3 in 10. All pts underwent high-dose-rate vaginal brachytherapy (total dose 21 Gy in three week-fractions), delivered with vaginal cylinder, with the reference isodose covering the proximal ½ of the vagina. The dose was specified at 5 mm distance from the cylinder surface. The Kaplan-Meier method estimated the probability of locoregional relapse free survival (LRFS), distant metastases-free survival (DMFS) and cancer-specific survival (CSS). Univariate analysis investigated the effect of age, grading, number of excised nodes and pathological stage on loco-regional relapse (LRR), metastases, and tumour-related death. Risk factors in univariate analysis were included in proportional hazard multivariate models. Vaginal toxicity was evaluated with the RTOG/EORTC scale and was correlated with the cylinder diameter (2.5, 3 or 3.5 cm). Results: LRFS occurred in 9/157 (5.8%) pts. Three pts (1.9%) developed liver metastases. At median follow-up of 83 months 144 pts (91.8%) are alive and disease free, 2 pts (1.2%) are alive with disease, 7 pts (4.5%) died from disease and 4 pts (2.5%) died from other causes. The 3-year probability of LRFS, DMFS and CSS was 94.

Annals of Oncology, Jun 1, 2022

Annals of Oncology, Nov 1, 2018

Background: Despite the known association between MMR loss and Lynch syndrome (LS), data on EC is... more Background: Despite the known association between MMR loss and Lynch syndrome (LS), data on EC is sparse; the degree of association is unknown as are the implications in term of prognosis and survival. Methods: Descriptive analysis of 396 tumour samples of patients (pts), treated between Jan 2012 to Jan 2018, MMR proteins were tested by immunohistochemistry. Median follow up time was 23.2 months. Tumours with loss of at least one protein were considered MMR(d). Patient characteristics were recorded from our electronic records. Survival was assessed by Kaplan Mayer and log-rank test. Results: 29% (114) tumours were deemed MMRd. Predominant histological subtype was endometrioid, high grade serous (HGS) including carcinosarcoma and clear cell. The most common somatic loss was MLH1-PMS2 (69%). 41% (47 pts) underwent germline testing for LS, 13pts (27.6%) were diagnosed with LS, association rate was PMS2 (100%), MSH6 (87.5%) and MSH2 MHS6 (40%). Our data suggest a non-significant differential survival between MMR proficient (p) and MMRd tumours (OS 116 months vs 82.9 months p0.756). Conclusions: Almost 30% of unselected EC pts have somatic loss MMR proteins; 27% of patients have a germline mutation that is more commonly associated with loss of PMS2, MSH6 and MSH2 MSH6, and endometrioid histology. Differences in survival between MMRp and MMRd tumours need to be further investigated.

International Journal of Research in Medical Sciences, Dec 28, 2020

Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary b... more Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary bladder patients treated with radical radiotherapy. Methods: A total of sixty patients with muscle invasive bladder cancer who were treated between 2011 and 2013 with bladder preservation protocol were identified. Thirty-two patients were stage T2 disease, rest were T3 and T4. Initial TURBT was reported complete in 24 of the total 60 patients. All patients received 60 to 64Gy to the whole bladder. Results: The follow-up range was 3 to 72 months. One year follow-up proportion was 78%. The median progression free survival was 40months. Early stage (T2) and advanced stage (T3 and T4) had progression free survival of 87.8% and 48.5% respectively at one year follow-up with a p value of 0.001. Thirty-six patients who had an incomplete Transurethral resection of bladder tumor (TURBT) initially had a statistically significant lower PFS compared to those patients who had a complete TURBT with a p value of 0.029. Twenty-nine patients were disease free with an intact bladder during the follow-up period providing a bladder preservation rate of 48%. Conclusions: A bladder-conserving protocol with radiotherapy provides encouraging results with nearly half of the patients able to retain a disease-free bladder. Proper patient selection with early stage disease and those with complete TURBT may further improve the bladder preservation rates.

Indian Journal of Gynecologic Oncology, Sep 28, 2020

Objective To review the treatment outcome in primary vaginal cancer patients who underwent defini... more Objective To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. Methods A total of 43 patients with histologically proven primary vaginal cancer, who were treated between January 2005 to December 2015, were identified. All were treated with definitive radiotherapy with or without concurrent chemotherapy. Radiotherapy was delivered as a combination of external beam radiotherapy and brachytherapy to a minimum dose of 60 Gy. Four patients were FIGO stage I, 13 were stage II, 23 stage III patients and three patients were stage IVA. Results The median age was 60 years (range 42-76). The median follow-up was 29 months with a range of 3 to 70 months. The different variables looked into like the histology, lower third of vagina involvement and prior hysterectomy did not show any difference in survival. Addition of concurrent chemotherapy was the only factor which showed a trend towards better survival with a p value of 0.09. Even in the subset of patients with prior hysterectomy, those who received definitive treatment with concurrent chemo-radiotherapy had a better two-year progression-free survival than those who received radiotherapy alone (57.4% Vs 10.5%). Conclusion A combination of EBRT and brachytherapy with concurrent chemotherapy is a reasonable option in the management of primary vaginal cancer. Further optimization of the dose and techniques of radiotherapy are warranted.

E-Posters, Dec 1, 2022

Methods Our study explored the simultaneous testing for multiple mutations targeted adenocarcinom... more Methods Our study explored the simultaneous testing for multiple mutations targeted adenocarcinoma in cervical cancer using the NGS. Cervical cancer initially treated at Tokai university hospital from 2010 to 2021 (50 specimens) was compared with the registered data in TCGA database (133 specimens). Results Following genome sequences were analyzed; BCAR4,

South Asian Journal of Cancer

Objective The study aimed to see the clinical outcome and to identify prognostic factors for surv... more Objective The study aimed to see the clinical outcome and to identify prognostic factors for survival in patients with carcinoma endometrium. Methods Patients registered at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, with carcinoma endometrium from January 2009 to December 2013 were identified from hospital registry. Data regarding patient demographics, tumor characteristics, treatment schedules, and follow-up were collected using a structured proforma. Survival estimates were generated using the Kaplan–Meier method. Univariate analysis was done using chi-square and Fisher's exact tests. Multivariate analysis using the Cox regression model was performed to determine the impact of prognostic factors on outcome. The statistical analysis was done using SPSS software version 11. Results The median follow-up of the 686 patients was 95 months (range 3–178 months).There were 432 stage 1 (63%), 100 stage II (14.6%), 108 stage III (15.7%), and 46 stage IV patients (6.7%). ...

ecancermedicalscience

Germ cell tumour of the testis is the most common cancer in young men in the western world. India... more Germ cell tumour of the testis is the most common cancer in young men in the western world. India has the lowest incidence globally, and hence Indian data are sparse. We report the outcomes of patients with nonseminomatous germ cell tumours of testis treated at a tertiary cancer centre in South India over a period of 10 years. Patients with a histopathological diagnosis of nonseminomatous germ cell tumours of the testis from 1 January 2006 to 31 December 2016 were included in the study. Patient demographics, tumour characteristics and treatment details were retrieved from case records. Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox regression model was used to analyse the prognostic factors. One hundred and nineteen patients with nonseminomatous germ cell tumours of the testis were included in the study. The median follow-up was 81 months. The estimated 4-year OS and progression-free survival were 87.1% and 84.5%, respectively. The fouryear OS for good, intermediate and poor-risk groups was 93.6%, 87.5% and 52.6%, respectively. The PFS at 4 years was 91.4%, 87.8% and 47.4% for good, intermediate and poor-risk groups, respectively. The presence of nonpulmonary visceral metastasis and biochemical response after chemotherapy were significant predictors for OS and PFS in multivariate cox proportional hazards regression. The survival figures are comparable to the rest of the world except in the poor prognostic risk group. The inferior survival noticed in this group of patients may be due to the lack of good salvage procedures. High-dose chemotherapy with stem-cell support may be considered more often for this group of patients.

Indian Journal of Gynecologic Oncology, 2021

The purpose of the study was to identify the clinicopathological factors associated with recurren... more The purpose of the study was to identify the clinicopathological factors associated with recurrence in patients who underwent primary surgical management for carcinoma endometrium stage I to IVA. Retrospective analysis of data of 642 patients who underwent surgery with or without adjuvant therapy for carcinoma endometrium during the period January 2009 to December 2013 was performed. The five-year disease-free survival (DFS) and locoregional relapse-free survival (LR-RFS) were calculated using the Kaplan–Meier method. Log-rank test, univariate cox regression analysis, and multivariate analysis were conducted to find out the significance of different factors on outcome. The five-year DFS of the study population was 82.1%, and LR-RFS was 93.2%. Age more than 60 yrs, high-grade tumor, advanced stage, deep myometrial invasion, cervical stromal invasion, and negative PR status were independent prognostic factors for disease-free survival for carcinoma endometrium in multivariate analysis. Locoregional relapse-free survival was affected by cervical stromal invasion, negative PR status, and the lack of adjuvant treatment. Traditional clinicopathological risk factors stage, grade, age, and lack of PR expression were predictive of recurrence and can guide us in deciding adjuvant treatment until newer molecular classifications are proved better.

Indian Journal of Gynecologic Oncology, 2020

Objective To review the treatment outcome in primary vaginal cancer patients who underwent defini... more Objective To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. Methods A total of 43 patients with histologically proven primary vaginal cancer, who were treated between January 2005 to December 2015, were identified. All were treated with definitive radiotherapy with or without concurrent chemotherapy. Radiotherapy was delivered as a combination of external beam radiotherapy and brachytherapy to a minimum dose of 60 Gy. Four patients were FIGO stage I, 13 were stage II, 23 stage III patients and three patients were stage IVA. Results The median age was 60 years (range 42-76). The median follow-up was 29 months with a range of 3 to 70 months. The different variables looked into like the histology, lower third of vagina involvement and prior hysterectomy did not show any difference in survival. Addition of concurrent chemotherapy was the only factor which showed a trend towards better survival with a p value of 0.09. Even in the subset of patients with prior hysterectomy, those who received definitive treatment with concurrent chemo-radiotherapy had a better two-year progression-free survival than those who received radiotherapy alone (57.4% Vs 10.5%). Conclusion A combination of EBRT and brachytherapy with concurrent chemotherapy is a reasonable option in the management of primary vaginal cancer. Further optimization of the dose and techniques of radiotherapy are warranted.