11 research outputs found

    Advanced ovarian malignancy in pregnancy mimicking ovarian hyperstimulation syndrome: a case report

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    Advanced ovarian malignancy is a rare occurrence in pregnancy. Here we report a case of primary infertility presenting in early pregnancy following invitro fertilization with features of Ovarian hyperstimulation syndrome unresponsive to treatment. Further evaluation revealed advanced ovarian malignancy. She was treated with chemotherapy followed by staging surgery at the time of elective cesarean at 35 weeks gestation. This case outlines the difficulties in diagnosis of ovarian cancer during pregnancy

    Co-Creation of Breast Cancer Risk Communication Tools and an Assessment of Risk Factor Awareness: A Qualitative Study of Patients and the Public in India

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    The incidence of breast cancer (BC) is increasing worldwide, and India reported 179,790 cases in 2020. It is important to inform people of risk factors and methods for risk management through interactive risk communication techniques. Affordable, easy-to-understand transmedia tools for the communication of BC risk were co-created by a multidisciplinary team of doctors, clinical researchers, epidemiologists, health economists, digital designers, and public representatives. Qualitative in-depth interviews were conducted in regional languages to assess the views of patients, relatives, the public, and health professionals in India of these prototypes. There was low awareness of BC, with some understanding of age and hereditary risk factors but limited knowledge of reproductive factors amongst the general public, patients, and relatives. Participants favored storytelling techniques (animation and comic strips/infographics) to explain complex issues such as genetic risk and testing. Co-created BC risk communication transmedia tools should be used to support informed decision making

    A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

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    Objectives: The objective was to compare perioperative morbidity and mortality of patients with advanced epithelial ovarian cancer (EOC) treated with either of the two treatment approaches; neoadjuvant chemotherapy (NACT) followed by interval debulking versus upfront surgery. Design: Prospective comparative observational study. Participants: In total, 51 patients were included in the study. All patients with diagnosed advanced EOC (International Federation of Gynecology and Obstetrics IIIC and IV) presenting for the 1st time were included in the study. Interventions: Patients were either operated upfront (n = 19) if deemed operable or were subjected to NACT followed by interval debulking (n = 32). Primary and Secondary Outcomes: Intra- and postoperative morbidity and mortality were the primary outcome measures. Results: Patients with interval cytoreduction were noted to have significantly lesser operative time, blood loss, and extent of surgery. Their discharge time was also significantly earlier. However, they did not differ from the other group vis. a vis. postoperative complications or mortality. Conclusions: Neoadjuvant chemotherapy although has a positive impact on various intraoperative adverse events, fails to show any impact on immediate postoperative negative outcomes

    Retrospective Analysis of Factors Affecting Recurrence in Borderline Ovarian Tumors

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    Background Borderline ovarian tumors (BOTs) are an intermediate form of neoplasia, between benign and malignant. The aim of this retrospective analysis is to evaluate the clinicopathological characteristic profile of BOTs and to determine the predictors of recurrence in BOTs. Methods A retrospective review of all patients diagnosed, treated, and followed up for BOTs between 2010 and 2017 at Amrita Institute of Medical Sciences, Kerala, India, was conducted. Clinicopathological details and details of management, outcome, and survival were retrieved, and data were analyzed descriptively and for survival. Results A total of 103 patients were identified. During the median follow-up of 46.0 months, 15 (14.6%) patients developed recurrent disease, 6 (5.82%) had recurrence with progression to invasive carcinoma, and 9 had recurrent disease with borderline or benign histology. Mucinous tumors were found to have more recurrences than serous BOT (17.8 vs. 12.3%). Disease-related deaths (5/103 [4.9%]) were observed only in patients with progression to invasive carcinoma. Univariate analysis indicated that staging surgery was the most important prognostic factor that affected the disease-free survival ([DFS] 103 vs. 97 vs. 71 months, respectively, for complete staging vs. fertility-preserving staging vs. conservative surgery; p < 0.05). Conclusions Conservative surgery was associated with a higher risk of recurrence. Fertility-preserving staging surgery is an acceptable option in younger patients. The overall survival is not affected by the mode of surgery

    Pathological Complete Response in Locally Advanced Breast Cancer after Neoadjuvant Chemotherapy: Survival Outcome and Its Relevance as a Surrogate End Point

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    Background Pathological complete response (pCR) to neoadjuvant chemotherapy has emerged as a reliable surrogate marker for improved survival in breast cancer (BC), but its role as a surrogate end point is still controversial. Aims and Objectives The aim of the study is to investigate the clinical course of BC patients with pCR and to evaluate the relevance of pCR as a surrogate end point for survival. Materials and Methods This was a single-institution retrospective analysis done at Amrita Institute of Medical Sciences. Records of BC patients from 2004 to 2014 were analyzed. Disease-free survival (DFS) and overall survival (OS) were compared using the Kaplan–Meier method and log-rank test, respectively. pCR and survival association were evaluated using regression analysis (R 2). Results Of 224 patients included in the study pCR rate was 15.2%. The median duration of follow-up was 61 months (range: 3–151 months). DFS (73.4 vs. 46.1%, p = 0.032) and OS (82.5 vs. 56.4%, p = 0.022) of pCR cohort was significantly higher than non-pCR cohort. Recurrence rate was significantly lower in the pCR cohort at: All distant sites (p = 0.01 3), visceral sites (p = 0.007), both bone and visceral sites (p = 0.007), and nodal sites (p = 0.007). There was no difference in the bone-only recurrence (p = 0.3 15). Death rate was significantly lower in pCR cohort (p = 0.007). The R2 value for pCR as a surrogate for DFS and OS was 0.006 and 0.004, respectively. Conclusion pCR is a favorable prognostic factor associated with improved survival. However, there is no association between pCR and survival

    A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors

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    Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT

    Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

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