1
|
Jeys LM, Thorkildsen J, Kurisunkal V, Puri A, Ruggieri P, Houdek MT, Boyle RA, Ebeid W, Botello E, Morris GV, Laitinen MK, Abudu A, Ae K, Agarwal M, Ajit Singh V, Akiyama T, Albergo JI, Alexander J, Alpan B, Aoude A, Asavamongkolkul A, Aston W, Baad-Hansen T, Balach T, Benevenia J, Bergh P, Bernthal N, Binitie O, Boffano M, Bramer J, Branford White H, Brennan B, Cabrolier J, Calvo Haro JA, Campanacci DA, Cardoso R, Carey Smith R, Casales Fresnga N, Casanova JM, Ceballos O, Chan CM, Chung YG, Clara-Altamirano MA, Cribb G, Dadia S, Dammerer D, de Vaal M, Delgado Obando J, Deo S, Di Bella C, Donati DM, Endo M, Eralp L, Erol B, Evans S, Eward W, Fiorenza F, Freitas J, Funovics PT, Galli Serra M, Ghert M, Ghosh K, Gomez Mier LC, Gomez Vallejo J, Griffin A, Gulia A, Guzman M, Hardes J, Healey J, Hernandez A, Hesla A, Hongsaprabhas C, Hornicek F, Hosking K, Iwata S, Jagiello J, Johnson L, Johnston A, Joo MW, Jutte P, Kapanci B, Khan Z, Kobayashi H, Kollender Y, Koob S, Kotrych D, Le Nail LR, Legosz P, Lehner B, Leithner A, Lewis V, Lin P, Linares F, Lozano Calderon S, Mahendra A, Mahyudin F, Mascard E, Mattei JC, McCullough L, Medellin Rincon MR, Morgan-Jones R, Moriel Garcesco DJ, Mottard S, Nakayama R, Narhari P, O'Toole G, Vania O, Olivier A, Omar M, Ortiz-Cruz E, Ozger H, Ozkan K, Palmerini E, Papagelopoulos P, Parry M, Patton S, Petersen MM, Powell G, Puhaindran M, Raja A, Rajasekaran RB, Repsa L, Ropars M, Sambri A, Schubert T, Shehadeh A, Siegel G, Sommerville S, Spiguel A, Stevenson J, Sys G, Temple T, Traub F, Tsuchiya H, Valencia J, Van de Sande M, Vaz G, Velez Villa R, Vyrva O, Wafa H, Wan Faisham Numan WI, Wang E, Warnock D, Werier J, Wong KC, Norio Y, Zhaoming Y, Zainul Abidin S, Zamora T, Zumarraga JP, Abou-Nouar G, Gebert C, Randall RL. Controversies in orthopaedic oncology. Bone Joint J 2024; 106-B:425-429. [PMID: 38689572 DOI: 10.1302/0301-620x.106b5.bjj-2023-1381] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
Collapse
Affiliation(s)
- Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | | | - Ajay Puri
- Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Walid Ebeid
- Orthopedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Keisuke Ae
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Toru Akiyama
- Saitama Medical Center, JIchi Medical University, Saitama, Japan
| | - Jose I Albergo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | - Peter Bergh
- Sahlgren University Hospital, Gothenburg, Sweden
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Michele Boffano
- Orthopaedic Oncology Unit, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Jos Bramer
- Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | | | | | - Rodrigo Cardoso
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
| | | | - Nicolas Casales Fresnga
- National Orthopaedic and Trauma Institute Republic University Montevideo Montevideo, Montevideo, Uruguay
| | - Jose M Casanova
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Chung M Chan
- National University Hospital, Singapore, Singapore
| | - Yang-Guk Chung
- Seoul St. Mary's Hospital/The Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | - Levent Eralp
- Complex Extremity Reconstruction Unit, Acibadem Hospital Group, Istanbul, Turkey
| | - Bulent Erol
- Marmara University Orthopedics and Traumatology, Istanbul, Turkey
| | | | - Will Eward
- Duke University, Durham, North Carolina, USA
| | | | - Joao Freitas
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Marcos Galli Serra
- Hospital Universitario Austral / Orthopedic Oncology Unit Buenos, Aires, Argentina
| | | | | | | | | | | | - Ashish Gulia
- Homi Bhabha Cancer Hospital & Research Centre, Vishakhapatnam, India
| | | | | | - John Healey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Asle Hesla
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Keith Hosking
- Life Orthopaedic Hospital / Groote Schuur, Cape Town, South Africa
| | | | | | - Luke Johnson
- South Australian Bone & Soft Tissue Tumour Unit, Flinders Medical Centre, Adelaine, Australia
| | | | - Min Wook Joo
- The Catholic University of Korea, Seoul, South Korea
| | - Paul Jutte
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Zeeshan Khan
- Rehman Medical Institute and Medical College, Peshawar, Pakistan
| | | | | | | | - Daniel Kotrych
- Pomeranian Medical University of Szczecin, Szczecin, Poland
| | | | | | - Burkhard Lehner
- Orthopedic University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Peng Lin
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | | | | | | | | | | | | | | | | | | | - Sophie Mottard
- Maisonneuve Rosemont Hospital, Université de Montréal, Montreal, Canada
| | | | | | - Gary O'Toole
- St. Vincent's University Hospital Dublin, Dublin, Ireland
| | - Oliveira Vania
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | | | | | | | - Harzem Ozger
- Istanbul University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | - Sam Patton
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michael M Petersen
- Rigshospitalet/University of Copenhagen/Department of Orthopedics, Copenhagen, Denmark
| | | | | | | | | | | | | | - Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | - Ahmad Shehadeh
- Orthopaedic Unit, King Hussein Cancer Center, Amman, Jordan
| | - Geoffrey Siegel
- Michigan Medicine / University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Gwen Sys
- Ghent University Hospital, Ghent, Belgium
| | | | - Frank Traub
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | | | - Oleg Vyrva
- Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Hazem Wafa
- Leuven University Hospitals, Leuven, Belgium
| | | | - Edward Wang
- University of the Philippines Musculoskeletal Tumor Unit, Manila, Phillipines
| | | | | | - Kwok-Chuen Wong
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ye Zhaoming
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | - Tomas Zamora
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Zumarraga
- Hospital Metropolitano / Departamento de Ortopedia y Traumatología, Quito, Ecuador
| | | | | | - R L Randall
- University of California, Sacramento, California, USA
| |
Collapse
|
2
|
Budukh A, Dora T, Sancheti S, Singh V, Goel A, Bagal S, Kaur A, Manchanda I, Kaur G, Gulia A, Chaturvedi P, Badwe R. Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India. Int J Cancer 2024. [PMID: 38642029 DOI: 10.1002/ijc.34966] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.
Collapse
Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Tapas Dora
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sankalp Sancheti
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Vikram Singh
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Alok Goel
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Amandeep Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ishan Manchanda
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Gurwinder Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ashish Gulia
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rajendra Badwe
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| |
Collapse
|
3
|
Sancheti S, Goel AK, Singla A, Chauhan KS, Arora K, Chaudhary D, Dora T, Tahlan S, Kadam P, Joshi P, Sali A, Brar RS, Budukh A, Gulia A, Divatia JV, Badwe R. Deciphering the Patterns of Dual Primary Cases Registered at the Hospital-Based Cancer Registry: First Experience from Rural Cancer Center in North India. J Lab Physicians 2023; 15:524-532. [PMID: 37780887 PMCID: PMC10539055 DOI: 10.1055/s-0043-1768631] [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: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives The objective is to present the patterns of dual primary malignancies diagnosed at the Pathology Laboratory of Cancer Hospital with the support from hospital-based cancer registry (HBCR), Sangrur, Punjab, India for the years 2018 and 2019. Methods HBCR abstracts data from electronic medical records. Trained cancer registry staff abstracts cases in standard pro forma. Dual primary was coded as per the International Agency for Research on Cancer rule and was rechecked by the pathologist. Statistical Analysis Data about multiple primary was entered and documented in an Excel sheet. Time interval was calculated by subtracting the date of diagnosis for second primary and first primary. Results A total of 6,933 cases were registered, 45 cases are dual primary (26 females, 19 males) of which 64.4% are synchronous and 35.6% metachronous cases. Seventy-nine percent received cancer-directed treatment for synchronous and 87% for metachronous. The most common sites of the primary tumor were breast (33%), head and neck (22.2%), gynecological sites (11%), prostate (9%), esophagus (4%), and remaining other tumors (20.8%). Most common sites for second malignancies were gastrointestinal (GI) tract (31%), gynecological sites (18%), head and neck (16%), hematological malignancies (7%), soft tissue sarcoma (4%), breast (2%), and other sites (22%). Conclusion More than 70% of cases of primary tumors were in breast, head and neck, gynecological, and prostate. Of these, more than 60% of the second malignancy was found in the GI tract, gynecological, and head and neck sites. Around two-thirds of dual tumors are synchronous. Breast cancer cases have higher incidence of second malignancy. Regular follow-up is necessary to assess the survival of the second primary.
Collapse
Affiliation(s)
- Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Alok Kumar Goel
- Department of Medical Oncology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Anshul Singla
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Kuldeep Singh Chauhan
- Hospital-Based Cancer Registry, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Kiran Arora
- Hospital-Based Cancer Registry, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Debashish Chaudhary
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Tapas Dora
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Shweta Tahlan
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Prithviraj Kadam
- Division of Medical Records and Cancer Registries, Centre for Cancer Epidemiology, ACTREC, Navi Mumbai, Maharashtra, India
| | - Prachi Joshi
- Division of Medical Records and Cancer Registries, Centre for Cancer Epidemiology, ACTREC, Navi Mumbai, Maharashtra, India
| | - Akash Sali
- Department of Pathology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Rahatdeep Singh Brar
- Department of Radiodiagnosis, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Atul Budukh
- Division of Medical Records and Cancer Registries, Centre for Cancer Epidemiology, ACTREC, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Ashish Gulia
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia Critical Care and Pain Management, Homi Bhabha Cancer Hospital (Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| |
Collapse
|
4
|
Bansal N, Bansal Y, Singh C, Gulia A. Blood inventory management strategies to ensure adequacy of packed red blood cell stock. Transfus Clin Biol 2023; 30:455-456. [PMID: 37567361 DOI: 10.1016/j.tracli.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India.
| | - Yashik Bansal
- Department of Microbiology, ESIC Medical College and Hospital, Alwar, Rajasthan, India
| | - Charu Singh
- Department of Microbiology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Ashish Gulia
- Department of Orthopedic Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| |
Collapse
|
5
|
Somal PK, Sancheti S, Sharma A, Sali AP, Chaudhary D, Goel A, Dora TK, Brar R, Gulia A, Divatia J. A Clinicopathological Analysis of Molecular Subtypes of Breast Cancer using Immunohistochemical Surrogates: A 6-Year Institutional Experience from a Tertiary Cancer Center in North India. South Asian J Cancer 2023; 12:104-111. [PMID: 37969672 PMCID: PMC10635761 DOI: 10.1055/s-0043-1761942] [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] [Indexed: 03/11/2023] Open
Abstract
Puneet Kaur SomalObjective Classification of breast cancer into different molecular subtypes has important prognostic and therapeutic implications. The immunohistochemistry surrogate classification has been advocated for this purpose. The primary objective of the present study was to assess the prevalence of the different molecular subtypes of invasive breast carcinoma and study the clinicopathological parameters in a tertiary care cancer center in rural North India. Materials and Methods All female patients diagnosed with invasive breast cancer and registered between January 1, 2015, and December 31, 2020, were included. Patients with bilateral cancer, missing information on HER2/ER/PR receptor status, absence of reflex FISH testing after an equivocal score on Her 2 IHC were excluded. The tumors were classified into different molecular subtypes based on IHC expression as follows-luminal A-like (ER- and PR-positive, Her2-negative, Ki67 < 20%), luminal B-like Her2-negative (ER-positive, Her2-negative and any one of the following Ki67% ≥ 20% or PR-negative/low, luminal B-like Her2-positive (ER- and HER2-positive, any Ki67, any PR), Her2-positive (ER- and PR-negative, Her2-positive) and TNBC (ER, PR, Her2-negative). Chi square test was used to compare the clinicopathological parameters between these subtypes. Results A total of 1,625 cases were included. Luminal B-like subtype was the most common (41.72%). The proportion of each subtype was luminal A (15.69%), luminal B Her2-negative (23.93%), luminal B Her2-positive (17.78%), Her2-positive (15.26%), TNBC (27.32%). Majority of the tumors were Grade 3 (75.81%). Nodal metastases were present in 59%. On subanalysis of the luminal type tumors without Her2 expression (luminal A-like and luminal B-like (Her2-negative), luminal A-like tumors presented significantly with a lower grade ( p < 0.001) and more frequent node-negative disease in comparison to luminal B-like (Her2-negative) tumors. In comparison to other subtypes, TNBC tumors were more frequently seen in the premenopausal age group ( p < 0.001) and presented with node-negative disease ( p < 0.001). Conclusion This is one of the largest studies that enumerates the prevalence of various molecular subtypes of breast cancer in North India. Luminal B-like tumors were the most common followed by TNBC. TNBC tumors presented more commonly in premenopausal age group and with node negative disease in comparison to other subtypes.
Collapse
Affiliation(s)
- Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Aishwarya Sharma
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Akash Pramod Sali
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Debashish Chaudhary
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Alok Goel
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Tapas Kumar Dora
- Department of Radiotherapy, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Rahat Brar
- Department of Radio-diagnosis, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Ashish Gulia
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Jigeeshu Divatia
- Department of Anesthesiology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| |
Collapse
|
6
|
Bhargava P, Srinivas S, Shenoy R, Shah D, Gulia A, Prurthi M, Nayak P, Janu A, Chakrabarty N, Purandare N, Ramadwar M, Rekhi B, Panjwani P, Puri A, Bajpai J. 71P Does age impact outcomes of osteosarcoma? A single-center retrospective evaluation of the demographic profile and outcome of osteosarcoma in patients more than 40 years of age. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101108] [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: 04/05/2023] Open
|
7
|
Bansal N, Bansal Y, Singh C, Gulia A, Thakur K. Red cell alloimmunization in thalassaemia patients in India: Causes and mitigation strategies. Transfus Clin Biol 2023; 30:187-188. [PMID: 36806792 DOI: 10.1016/j.tracli.2023.02.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India.
| | - Yashik Bansal
- Department of Microbiology, ESIC Medical College and Hospital, Alwar, Rajasthan, India
| | - Charu Singh
- Department of Microbiology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Ashish Gulia
- Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Kusum Thakur
- Department of Transfusion Medicine, Shrimann Super Specialty Hospital, Jalandhar, Punjab, India
| |
Collapse
|
8
|
Shylasree TS, Kazi M, Jaiswal D, Singh P, Poddar P, Raj S, Gulia A, Puri A. Autologous Ovary Transplant in Pelvic Sarcoma: Two Case Reports and Review of Literature on Gonad Transplant. Indian J Gynecol Oncolog 2022. [DOI: 10.1007/s40944-022-00667-4] [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: 11/11/2022]
|
9
|
Bansal S, Sancheti S, Sali AP, Somal PK, Gulia A, Kapoor R. Immunohistochemistry on cell blocks for diagnosis of malignancy in abdomino-pelvic lesions and ascitic fluid cytology at a rural cancer center: A paradigm shift in cancer management. J Cancer Res Ther 2022; 18:S410-S419. [PMID: 36510996 DOI: 10.4103/jcrt.jcrt_1660_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cell block preparation is routine practice in cytopathology these days because of its pivotal role in increasing diagnostic yield and ancillary studies. In the present era of personalized medicine in oncology, ancillary techniques such as immunohistochemistry (IHC) and molecular analysis are gaining more importance. Methods A retrospective study was conducted in the Department of Pathology, over 6 months, which included 144 cases of Fine Needle Aspiration Cytology (FNAC) of abdominopelvic masses and 105 cases of ascitic fluids. Cell blocks and conventional smears were prepared simultaneously in all cases. IHC was applied on cell blocks and analyzed. Results IHC was performed on cell blocks in 76 cases of FNA and 53 cases of ascitic fluids. Based on IHC, liver lesions (50 cases) were categorized into metastatic carcinomas with a suggested primary site (45.0%), hepatocellular carcinoma (12.2%), neuroendocrine tumors (16.3%), and malignant melanoma (2%). Using MOC-31 and WT-1, ascitic fluid samples were categorized into benign and malignant. Forty-one out of 53 cases of fluids were diagnosed as metastatic adenocarcinomas with the ovary as the most common primary site. Conclusion A panel of IHC markers, though not specific alone when applied to cell blocks in a careful clinical and morphological context leads to a rapid and accurate diagnosis. This in turn obviates the need for biopsy in severely ill patients. An astute pathologist can provide accurate results with judicious use of IHC on cell blocks and may bring a sigh of relief for many cancer patients by averting the need for biopsy.
Collapse
Affiliation(s)
- Saloni Bansal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Akash Pramod Sali
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Ashish Gulia
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| | - Rakesh Kapoor
- Department of Radiotherapy, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India
| |
Collapse
|
10
|
Gulia A, Puri A, Kamath N, Thakur R, Laskar S, Bajpai J, Khanna N, Chinnaswamy G, Rekhi B. 436P Oncologic outcomes in patients with extraskeletal Ewing’s sarcoma (EES): A tertiary care centre experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.467] [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: 12/05/2022] Open
|
11
|
Chhabra P, Sancheti S, Sali AP, Somal PK, Sharma A, Brar RS, Gulia A, Kapoor R. Erratum: Approach to the Diagnosis of Hepatoid Adenocarcinoma, an Under-reported Entity: Case Series and Review of Literature. Asian Journal of Oncology 2022. [DOI: 10.1055/s-0042-1756342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Prerna Chhabra
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Akash Pramod Sali
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Aishwarya Sharma
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Rahat Singh Brar
- Department of Radio-diagnosis, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Rakesh Kapoor
- Department of Radiation-oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| |
Collapse
|
12
|
Kalra SK, Sancheti S, Somal PK, Sali AP, Sharma A, Goel A, Jain S, Dora TK, Gulia A, Divetia JV. Challenges Encountered and Pattern-Based Analysis of Bone Marrow Biopsy in Lymphomas: An Institutional Experience. J Lab Physicians 2022; 15:69-77. [PMID: 37064982 PMCID: PMC10104704 DOI: 10.1055/s-0042-1751318] [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: 10/15/2022] Open
Abstract
Abstract
Objective The evaluation of bone marrow (BM) status is an integral part of the initial workup of patients diagnosed with lymphoma as it plays an important role in staging and predicting prognosis in these patients. This article determines the incidence and pattern of BM involvement in lymphoma cases and distinguishes benign from malignant lymphoid aggregates in BM biopsies.
Materials and Methods The study group included 121 cases of Hodgkin and non-Hodgkin lymphomas for which BM biopsies were performed, fixed in acetic acid-zinc formalin solution, decalcified using 10% formic acid, and subjected to hematoxylin and eosin and immunohistochemistry.
Results The overall incidence of BM biopsy involvement in our study was 31.4% (37/118), including 34.7% (35/101) in cases of B cell lymphomas, 25% (2/8) in cases of T cell lymphomas, and no involvement in Hodgkin lymphoma. The predominant histological pattern of BM involvement was diffused (14/37; 37.8%), followed by interstitial (10/37; 27.1%). Five cases revealed benign nonparatrabecular lymphoid aggregates which could be confused with lymphomatous involvement, especially in low grade lymphomas.
Conclusion A careful examination of the BM biopsies along with clinical history, peripheral blood examination, flow cytometry, and immunohistochemistry will help in arriving at the correct diagnosis.
Collapse
Affiliation(s)
- Supreet Kaur Kalra
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Akash Pramod Sali
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Aishwarya Sharma
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Alok Goel
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Shivani Jain
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Tapas Kumar Dora
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Ashish Gulia
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Jigeeshu V. Divetia
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
- Department of Anaesthesiology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
| |
Collapse
|
13
|
Laskar S, Sinha S, Chatterjee A, Khanna N, Manjali JJ, Puri A, Gulia A, Nayak P, Vora T, Chinnaswamy G, Prasad M, Bajpai J, Juvekar S, Desai S, Janu A, Rangarajan V, Purandare N, Shah S, Rekhi B, Jambhekar N, Muckaden MA, Kurkure P. Radiation Therapy Dose Escalation in Unresectable Ewing Sarcoma: Final Results of a Phase 3 Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2022; 113:996-1002. [PMID: 35568246 DOI: 10.1016/j.ijrobp.2022.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Our aim was to assess the effect of radiation therapy (RT) dose escalation on outcomes in surgically unresectable Ewing sarcoma (ES)/primitive neuroectodermal tumor (PNET). METHODS AND MATERIALS Patients with nonmetastatic unresectable ES/PNET (excluding intracranial/chest wall) receiving vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide chemotherapy, planned for definitive RT, were accrued in this single-institution, open-label, phase 3 randomized controlled trial. Randomization was between standard dose RT (SDRT; 55.8 Gy/31 fractions/5 days a week) versus escalated dose RT (EDRT; 70.2 Gy/39 fractions/5 days a week) with a primary objective of improving local control (LC) by 17% (65%-82%). Secondary outcomes included disease-free survival (DFS), overall survival (OS), and functional outcomes by Musculoskeletal Tumor Society score. RESULTS Between April 2005 and December 2015, 95 patients (SDRT 47 and EDRT 48) with a median age of 17 years (interquartile range, 13-23 years) were accrued. The majority of patients were male (59%). Pelvis was the most common site of primary disease (n = 60; 63%). The median largest tumor dimension (9.7 cm) and the median maximum standardized uptake value (8.2) on pretreatment fluorodeoxyglucose positron emission tomography-computed tomography were similar. At a median follow-up of 67 months, the 5-year LC, DFS, and OS for the entire cohort was 62.4%, 41.3%, and 51.9%, respectively. The 5-year LC was significantly better in EDRT compared with SDRT (76.4% vs 49.4%; P = .02). The differences in DFS and OS at 5 years (for EDRT vs SDRT) did not achieve statistical significance (DFS 46.7% vs 31.8%; P = .22 and OS 58.8% vs 45.4%; P = .08). There was a higher incidence of Radiation Therapy Oncology Group grade >2 skin toxic effects (acute) in the EDRT arm (10.4% vs 2.1%; P = .08) with excellent functional outcomes (median Musculoskeletal Tumor Society score = 29) in both arms. CONCLUSIONS EDRT results in improved LC with good functional outcomes without a significant increase in toxic effects. Radiation dose escalation should be considered for surgically unresectable nonmetastatic ES/PNET.
Collapse
Affiliation(s)
- Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jifmi Jose Manjali
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Puri
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashish Gulia
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prakash Nayak
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Department of Pediatric 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
| | - Shashikant Juvekar
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Subhash Desai
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sneha Shah
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Jambhekar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Mary Ann Muckaden
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purna Kurkure
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
14
|
Gulia A, Prajapati A, Gupta S, Exner U, Puri A. Rotationplasty after failed limb salvage: an alternative to amputation. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03333-9. [PMID: 35864216 DOI: 10.1007/s00590-022-03333-9] [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] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Limb salvage procedures for musculoskeletal tumors have inherent complications. Though most complications can be managed with retention of the reconstructions, occasionally salvaging these reconstructions is not possible. We evaluated the outcomes of patients undergoing rotationplasty after multiple failed revisions of limb salvage surgery and document the success rate of this "salvage" technique and the subsequent functional outcome of these patients. METHOD Between January 1, 1999, and December 31, 2018, 14 patients (12 male and 2 female) with a median age of 24 years (11-51 years) underwent rotationplasty after multiple failed revisions of limb salvage surgery. Indication for rotationplasty was infection (10 patients), failed megaprosthesis (2 patients), unstable biological reconstruction (1 patient) and local recurrence (1 patient). The mean number of surgeries done before the patient underwent rotationplasty was 5 (range 2-7). RESULTS One patient developed a vascular complication (venous congestion) immediately after rotationplasty and underwent an early amputation. The remaining 13 patients had no surgical complications. Mean Musculo Skeletal Tumor Society score in 13 evaluable patients was 26 (23-30). CONCLUSION Our study demonstrates the utility of rotationplasty as a "salvage" procedure after multiple failed lower limb salvage surgeries. It offers good success rates, low rates of complications and good functional outcomes in carefully selected cases.
Collapse
Affiliation(s)
- Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Ashwin Prajapati
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srinath Gupta
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ulrich Exner
- FMH Orthopädische Chirurgie Und Traumatologie, Orthopaedie Zentrum Zuerich Ozz, 8038, Zurich, Germany
| | - Ajay Puri
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
15
|
Chhabra P, Sancheti S, Sali AP, Somal PK, Sharma A, Brar RS, Gulia A, Kapoor R. Approach to the Diagnosis of Hepatoid Adenocarcinoma, an Under-reported Entity: Case Series and Review of Literature. Asian Journal of Oncology 2022. [DOI: 10.1055/s-0042-1748629] [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: 02/07/2023] Open
Abstract
AbstractHepatoid adenocarcinoma is a rare type of extra-hepatic adenocarcinoma which exhibits morphological, functional, and immunohistochemical features of hepatocellular carcinoma, hence correct diagnosis poses a challenge. The most frequent site of this tumor is stomach and rarely occurs in ovaries, lung, gallbladder, pancreas, uterus, and other sites. We present four cases of hepatoid adenocarcinoma of our hospital at rare sites like lungs and gallbladder along with literature review and a simplified approach to diagnosis. In absence of adequate immunohistochemistry or radiological findings often this entity is missed or misdiagnosed as metastatic hepatocellular carcinoma. We have analyzed these hepatoid adenocarcinoma cases in terms of various clinical, serological, histo-morphological, and immunohistochemical parameters, and propose a systematic approach to correctly diagnose this entity.
Collapse
Affiliation(s)
- Prerna Chhabra
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Akash Pramod Sali
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Aishwarya Sharma
- Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Rahat Singh Brar
- Department of Radio-diagnosis, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| | - Rakesh Kapoor
- Department of Radiation-oncology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, (A Unit of Tata Memorial Centre), India
| |
Collapse
|
16
|
Bakshi S, Rana M, Gulia A, Puri A, Harsha TSS, Tiwari S, Gotur A. "Prevalence of chronic pain following resection of pelvic bone tumours: A single centre prospective observational survey". Br J Pain 2022; 16:263-269. [PMID: 35646344 PMCID: PMC9136992 DOI: 10.1177/20494637211047143] [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] [Indexed: 09/17/2023] Open
Abstract
Background Hemipelvectomy is a major surgery most often performed for pelvic malignancy. These complex surgeries often involve dissection around major neurovascular bundle and resection of tumour being bone along with involved tissues. This may result in short and long term morbidities. There is very little literature about incidence of chronic pain after pelvic resections. We conducted a prospective study at a tertiary cancer hospital to assess the prevalence of chronic pain post hemipelvectomy. Method This is a single centre prospective observational study conducted over 30 months. Pain scores were recorded using Brief pain inventory (BPI) and pain detect questionnaire. The quality of life was assessed using musculoskeletal tumour society (MSTS) score. Intra-operative details like extent of surgical resection, nerves spared, details of intra-operative and post-operative analgesia were retrieved from the patient files. Data were analysed using SPSS 21 version. Results Neuropathic pain post hemipelvectomy was uncommon. The prevalence of mild to moderate somatic pain was around 30%. Functional limitation was minimal as assessed by BPI and MSTS score. A high incidence of numbness was seen to persist in and around the area of surgical incision (50%). Conclusion This is first study to report the incidence of chronic pain post hemipelvectomy done for pelvic tumour resections. Despite the extensive nature of resection involved, there is a low prevalence of neuropathic pain in this population. However, incidence of persistent somatic pain is high and there is a need for further studies for evaluating the causality.
Collapse
Affiliation(s)
- Sumitra Bakshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Meenal Rana
- Department of Cardiothoracic Anaesthesia, Glenfield Hospital, Leicester, UK
| | - Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institure (HBNI), Mumbai, India
| | - Ajay Puri
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institure (HBNI), Mumbai, India
| | - Tadala SS Harsha
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institure (HBNI), Mumbai, India
| | - Shashank Tiwari
- Department of Anesthesia and Critical Care, Institute of Medical Sciences, BHU, Varanasi, India
| | - Aparna Gotur
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
17
|
Kaur R, Ramadwar M, Gulia A, Pruthi M, Rekhi B, Panjwani PK, Puri A, Nayak P, Bajpai J, Janu A. Primary Alveolar Soft Part Sarcoma of Bone. Arch Pathol Lab Med 2022; 146:1514-1522. [PMID: 35438716 DOI: 10.5858/arpa.2021-0217-oa] [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] [Accepted: 11/11/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Alveolar soft part sarcoma is a rare soft tissue tumor involving mainly deep soft tissue of the lower extremities. Primary bone involvement is extremely rare. OBJECTIVE.— To discuss histopathologic and immunohistochemical features of alveolar soft part sarcoma along with challenges in diagnosis and management in the context of primary bone origin. DESIGN.— Our study constituted 8 patients. Data were collected from the Tata Memorial Hospital, Mumbai, India, during a 10-year period. RESULTS.— Five patients in our study were female and 3 were male. Their ages ranged from 13 to 56 years. Primary bone involvement was seen in the humerus, tibia, fibula, radius, calcaneus, and rib. Radiologic impression was that of a primary malignant bone tumor in all patients. Conventional histopathologic features were seen in 7 of 8 patients. Positive immunohistochemical expression for TFE3 was demonstrated in 6 patients. All patients had distant metastasis either at presentation or later in the course of the disease. Surgical excision of the primary tumor and adjuvant chemotherapy formed the basis of treatment. Four patients succumbed to disease and 2 were alive with disease. CONCLUSIONS.— Rare occurrences of primary bone alveolar soft part sarcoma posed a diagnostic challenge in the form of differential diagnoses of metastatic tumors resembling it either morphologically or immunohistochemically. The combined application of clinical and radiologic features along with characteristic histomorphology and immunohistochemistry helps to arrive at a definite diagnosis of alveolar soft part sarcoma. Aggressive behavior of this tumor and its refractoriness to conventional chemotherapy were evident from our series.
Collapse
Affiliation(s)
- Ramandeep Kaur
- From the Department of Pathology (Kaur, Ramadwar, Rekhi, Panjwani), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- From the Department of Pathology (Kaur, Ramadwar, Rekhi, Panjwani), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ashish Gulia
- The Department of Orthopaedic Oncology (Gulia, Pruthi, Puri, Nayak), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Manish Pruthi
- The Department of Orthopaedic Oncology (Gulia, Pruthi, Puri, Nayak), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- From the Department of Pathology (Kaur, Ramadwar, Rekhi, Panjwani), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Poonam K Panjwani
- From the Department of Pathology (Kaur, Ramadwar, Rekhi, Panjwani), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ajay Puri
- The Department of Orthopaedic Oncology (Gulia, Pruthi, Puri, Nayak), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Prakash Nayak
- The Department of Orthopaedic Oncology (Gulia, Pruthi, Puri, Nayak), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- The Department of Medical Oncology (Bajpai), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Amit Janu
- The Department of Radiodiagnosis (Janu), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
18
|
Tandon S, Khanna N, Chivate R, Dey S, Gulia A, Narula G, Shah S, Rane S, Banavali S, Laskar S. Solitary Bone Plasmacytoma of Humerus Presenting as a Nonhealing Fracture in a Child: A Rare Entity. J Pediatr Hematol Oncol 2022; 44:e233-e236. [PMID: 34654755 DOI: 10.1097/mph.0000000000002332] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
Solitary bone plasmacytoma is an extremely rare entity and is characterized by localized proliferation of monoclonal plasma cells. Plasmacytomas are extremely rare in the pediatric population. The median age at diagnosis is usually the fifth or sixth decade, with axial skeleton being more commonly involved than appendicular. We hereby, report the case of a 13-year-old boy with solitary bone plasmacytoma of the right humerus. Though extremely rare in the pediatric age group, plasmacytomas may be considered as one of the remote differentials in children presenting with solitary bone tumors.
Collapse
Affiliation(s)
- Sneha Tandon
- Division of Paediatric Oncology, The Royal London Hospital, Barts Health NHS Trust, London
| | | | | | | | | | | | | | - Swapnil Rane
- Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | | |
Collapse
|
19
|
Gulia A, Puri A, Gupta S, Vora T, Laskar S. Functional and Oncological Outcomes of Multidisciplinary Management of Ewing's Sarcoma of Clavicle: A Single-Center Experience. South Asian J Cancer 2021; 10:138-143. [PMID: 34934757 PMCID: PMC8683259 DOI: 10.1055/s-0041-1731901] [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: 10/25/2022] Open
Abstract
Objectives Ewing's sarcoma is best treated using a multidisciplinary approach. We discuss the functional and oncological outcomes of clavicular Ewing's sarcoma which has been sparsely reported in literature. Materials and Methods We retrospectively evaluated patients who underwent resections for Ewing's sarcoma of clavicle from January 2002 to December 2017. The study end points were locoregional recurrence free survival (LRFS), disease-free survival (DFS), and overall survival (OS) at 3 and 5 years, and functional outcomes measured by Musculoskeletal Tumor Society (MSTS) scores. Statistical Analysis The LRFS, DFS, and OS were calculated and analyzed using the Kaplan-Meier method and log-rank test. Results Data of 21 patients (male: 12, female: 9) was analyzed with a mean age [range] of 15.3 [6-40] years. Total clavicle excision was done in 62% (13 of 21) while 38% ( n = 8) had partial resections. Radiotherapy was administered in 15 patients (71.5%). At a median follow-up of 42 months (range: 7-198), data of 20 patients was available for follow-up. Ten patients died (due to disease: nine, other reasons: One), eight are disease free and alive, one had metastasectomy on recurrence and is disease free and, one patient is alive with disease and on palliative chemotherapy. The LRFS, DFS, and OS were 95, 59, 65% and 95, 47, 59% at 3 and 5 years, respectively. The functional evaluation done for nine patients who are free of disease showed a mean MSTS score of 29 (range: 27-30; total clavicle excision: 28.5, partial clavicle excision: 29.5). Conclusion Patients with Ewing's sarcoma of the clavicle who underwent resection without reconstruction have acceptable local control rates and excellent functional outcomes.
Collapse
Affiliation(s)
- Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Srinath Gupta
- Department of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Medical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| |
Collapse
|
20
|
Prajapati A, Gupta S, Nayak P, Gulia A, Puri A. The effect of COVID-19: Adopted changes and their impact on management of musculoskeletal oncology care at a tertiary referral centre. J Clin Orthop Trauma 2021; 23:101651. [PMID: 34703161 PMCID: PMC8531238 DOI: 10.1016/j.jcot.2021.101651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has disrupted access to healthcare. Delay in diagnosis and onset of care increases cancer related mortality. We aim to analyse its impact on patient profile, hospital visits, morbidity in surgically treated patients and process outcomes. METHODS We analysed an ambi-directional cohort from 16th March to June 30, 2020 (Pandemic cohort, PC) as compared to 2019 (Pre-pandemic cohort, PPC). We measured, new patient registrations, proportion of 'within state' patients vs 'rest of India', median time to treatment decision, proportion of patients seeking 'second opinions', modality of initial treatment (surgery/radiotherapy/chemotherapy), 30-day post-operative morbidity/mortality and conversion of inpatient-to 'teleconsult' in the PC. RESULTS Between the 2 cohorts, new registrations declined from 235 to 69 (70% reduction). The percentage of 'within state' patients increased from 41.7% to 53.6% (11.9% increase). There was a decline in second opinion consults from 25% to 16%. The median time to decision-making decreased to 16 days in PC vs 20 days in PPC (20% reduction). Surgery was the first line of treatment in 40% as compared to 34% in the PPC with a mean time to surgery of 24 days in PC compared to 36 days in PPC (33% reduction). 66 surgeries were performed in the PC compared to 132 in the PPC. Thirty day post operative morbidity needing readmission remained similar (18% PC, vs 17% PPC). Perioperative intensive care remained similar in both cohorts. Teleconsultation was deemed medically safe in 92.8% (439/473 patients). CONCLUSIONS The COVID 19 pandemic has substantially reduced access and onset to cancer care. Post operative morbidity and mortality did not seem to worsen with triage. Teleconsultation is an effective tool in optimizing follow up strategy.
Collapse
Affiliation(s)
- Ashwin Prajapati
- Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srinath Gupta
- Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prakash Nayak
- Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashish Gulia
- Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Puri
- Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
21
|
Laskar S, Kakoti S, Khanna N, Manjali JJ, Mangaj A, Puri A, Gulia A, Nayak P, Pai P, Nair D, Qureshi S, Chinnaswamy G, Bajpai J, Prabhash K, Rekhi B, Ramadwar M, Jambhekar N, Janu A, Juvekar S, Purandare N, Rangarajan V. Outcomes of osteosarcoma, chondrosarcoma and chordoma treated with image guided-intensity modulated radiation therapy. Radiother Oncol 2021; 164:216-222. [PMID: 34597737 DOI: 10.1016/j.radonc.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/21/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND & PURPOSE To evaluate the efficacy and toxicity of dose-escalated image guided-intensity modulated radiation therapy (IG-IMRT) in osteosarcoma (OGS), chondrosarcoma (CS) and chordoma (CH) of head and neck (H&N) and pelvis. METHODS AND MATERIALS In this prospective non-randomized study, 65 patients of H&N or pelvic OGS (24), CS (7) and CH (34) mandating definitive or post-operative radiotherapy from May 2013 to December 2018 were included. Radiotherapy doses in definitive setting were 72.0 Gy for CH and 70.2 Gy for OGS and CS; while in post-operative setting it was 66.6 Gy and 64.8 Gy respectively (at 1.8 Gy per fraction). RESULTS Planned doses of radiotherapy could be completed in 61 (93.8%) patients; with grade III or higher acute and late toxicities of 3% and 0% respectively. With a median follow-up of 52 (range 6-92) months, the five-year actuarial local control (LC) rates were 66% in OGS, 38.1% in CS and 75.9% in CH; while cause-specific survival (CSS) rates were 54.7%, 64.3% and 92.2% respectively. There was no statistically significant difference in outcomes for patients receiving definitive and post-operative radiotherapy. Locally controlled disease at first follow-up after radiotherapy was associated with improved CSS and OS in CS (p = 0.014) and CH (p < 0.001). Radiotherapy resulted in significant and sustained improvement in Musculoskeletal tumour society (MSTS) score and reduction in pain score. Salvage re-irradiation was feasible in local progression after radiotherapy, with good outcomes and tolerability. CONCLUSION Dose-escalated IG-IMRT results in good LC & functional improvement with minimal toxicity in OGS, CS and CH.
Collapse
Affiliation(s)
- Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Sangeeta Kakoti
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jifmi Jose Manjali
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Akshay Mangaj
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Puri
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashish Gulia
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prakash Nayak
- Department of Orthopedic Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sajid Qureshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Girish Chinnaswamy
- Department of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nirmala Jambhekar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sashikant Juvekar
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
22
|
Gulia A, Kurisunkal V, Puri A, Nayak P, Rekhi B. Clear Cell Chondrosarcoma—Oncological Outcomes in an Asian Cohort. Indian J Surg Oncol 2021; 13:282-287. [DOI: 10.1007/s13193-021-01450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
|
23
|
Abstract
The purpose of this study was to report the incidence of giant cell tumour of the hand bones in an Asian population, document treatment options and report outcomes of treatment. Of 698 giant cell tumours of bone that underwent surgery between January 2011 and December 2020 at our institute, only 22 (3%) were in the hand. Fourteen occurred in the metacarpals, eight in the phalanges. Fifteen were primary tumours and seven had recurrent disease. Twenty lesions had an associated soft tissue component. Two patients treated for primary disease and one who had been treated for recurrence had local recurrence. Recurrence occurred in two of nine patients treated with curettage, one of three with resection and none of five with ray or digit amputation. Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control.Level of evidence: IV.
Collapse
Affiliation(s)
- Ajay Puri
- Surgical Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, India
| | - Rohit Rajalbandi
- Orthopaedic Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, India
| | - Ashish Gulia
- Orthopaedic Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
24
|
Kulkarni SS, Shetty NS, Polnaya AM, Janu A, Kumar S, Puri A, Gulia A, Rangarajan V. CT-guided radiofrequency ablation in osteoid osteoma: Result from a tertiary cancer centre in India. Indian J Radiol Imaging 2021; 27:318-323. [PMID: 29089682 PMCID: PMC5644327 DOI: 10.4103/ijri.ijri_30_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/04/2022] Open
Abstract
AIMS The aim of this study is to evaluate the clinical efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma. MATERIALS AND METHODS This is a retrospective analysis of prospectively maintained data of 43 symptomatic osteoid osteoma patients who were treated by radiofrequency ablation (RFA). Forty out of 43 patients were naive cases and underwent primary treatment for osteoid osteoma with RFA, whereas 3 patients included in the study underwent RFA for local recurrence after having undergone surgical treatment. Diagnosis was based on clinical and characteristic imaging findings, and biopsy was done for cases with atypical presentation. Pre and post procedure Visual Analog Score (VAS) was documented in all cases. Monopolar RFA system was used in all patients, and the electrode was placed within the lesion nidus under CT guidance coaxially through 11G introducer needle. Ablation was performed at 90° C for 5 min. RESULTS Technical success rate of intranidal placement of electrode was 100%. The primary clinical success in our study was 97.7% (42 of 43), and the secondary clinical success was 100%. Pre and postprocedure VAS score in our study group was 7.8 and 0.4, respectively. Mean follow-up period in our study was 48 months (Range: 4-129 months). One patient had recurrence of pain 4 years after treatment and was treated successfully by a second session. Minor complications were seen in 3 patients with two cases of RF pad burns and one case of skin burn at the treatment site, and these were managed conservatively. No patients developed temporary/permanent neurological deficits, and no procedure-related mortality was seen in our study. CONCLUSION CT-guided percutaneous RFA is a simple, safe, minimally invasive, and highly effective treatment option for osteoid osteoma with good long-term pain control and potentially low disease recurrence.
Collapse
Affiliation(s)
- Suyash S Kulkarni
- Interventional Radiology Unit, Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nitin S Shetty
- Interventional Radiology Unit, Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashwin M Polnaya
- Interventional Radiology Unit, Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amit Janu
- Interventional Radiology Unit, Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Suresh Kumar
- Interventional Radiology Unit, Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
25
|
Abstract
Desmoid fibromatosis is a locally aggressive tumor with an unpredictable clinical course. Surgery was once the mainstay of treatment, but the treatment protocol has been constantly evolving and currently active surveillance is the front-line approach. There have been significant insights into the molecular biology with the addition of mutational analysis of CTNNB1 adding to prognostic information. We present a review of the literature with current practice guidelines, also including novel therapeutic targets and ongoing clinical trials, to unravel the next step in the management of sporadic desmoid fibromatosis.
Collapse
Affiliation(s)
- Saneya Pandrowala
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
| | - Robin L Jones
- Department of Medicine, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sanjay Gupta
- Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, Scotland, UK
| | - Ashish Gulia
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
| |
Collapse
|
26
|
Gulia A, Pruthi M, Gupta S, Nadkarni S. Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions. J Clin Orthop Trauma 2021; 20:101496. [PMID: 34350096 PMCID: PMC8319519 DOI: 10.1016/j.jcot.2021.101496] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
Most malignant bone tumors are treated with surgical excision, adhering to oncologic principles, followed by reconstruction to preserve form and function whenever feasible. Primary bone tumors around the elbow are rare accounting for <1% of all skeletal tumors. They pose a reconstructive challenge, due to the complex interplay between the osseous & capsulo-ligamentous structures which is essential for elbow stability and function. Tumors affecting the proximal ulna are rare and reconstruction of the defects following these tumors is extremely challenging. Various reconstruction options like arthrodesis, autogenous bone grafts, allografts, re-implantation of sterilized tumor bone, pseudoarthrosis, and endoprosthesis have been tried with variable success. However, due to lack of standardization and the rarity of the site, surgeons are often in a dilemma to choose the correct option. This can lead to suboptimal functional outcomes and long-term failures. In this article, we reviewed the published literature on proximal ulnar tumors and noted the pros and cons of various reconstructive procedures. We have also attempted to formulate reconstruction recommendations based on the level of resection of proximal ulna.
Collapse
Affiliation(s)
- Ashish Gulia
- Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
- Corresponding author. Dept of Surgical Oncology, 93, Main building, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Manish Pruthi
- Assistant Professor, Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srinath Gupta
- Fellow, Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shravan Nadkarni
- Assistant Professor (adhoc), Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
27
|
Affiliation(s)
- Purvish Parikh
- Chief Advisor, Mumbai Oncocare Clinics, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Sashank Joshi
- Department of Medical Oncology, Joshi Clinic, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| |
Collapse
|
28
|
Abstract
The COVID-19 pandemic has hampered health-care delivery, with non-emergent consultations and surgical procedures being brought to a standstill. However, a delay in comprehensive cancer care may result in disease progression and poorer outcomes. Surgical oncology residents often form the front line responders for cancer patients, but now also have to function outside of their specialty to serve in COVID-19 units. With the uncertainty and unpredictability of this pandemic, surgical oncology residents find themselves at a crossroads. The need to keep abreast with COVID-19 treatment guidelines and recommendations comes at the expense of their surgical training. There is also a rising concern about personal safety, wellness, psychosocial well-being, and burnout. We highlight various elements concerning residents and suggest strategies that may be undertaken to allay anxiety and fatigue and facilitate surgical education.
Collapse
Affiliation(s)
- Kaival K. Gundavda
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| |
Collapse
|
29
|
Affiliation(s)
- Shashank R Joshi
- Joshi Clinic, Lilavati Hospital, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Rahul Pandit
- Director, Critical Care, Fortis, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Purvish Parikh
- Chief Advisor, Mumbai Oncocare Clinics, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Ashish Gulia
- Professor, Orthopedic Oncology, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| |
Collapse
|
30
|
Dhiliwal SR, Gulia A, Salins N. Adaptations to palliative home care in India in a COVID pandemic: An experiential narrative. IJMS 2021. [PMCID: PMC8219018 DOI: 10.25259/ijms_13_2021] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
India is in the midst of a fierce pandemic with a rapid surge of cases and the health-care system in a quandary. Care of patients with life-limiting illness needing palliative care has been compromised due to limitations in palliative care access and a paradigm shift in the hospital toward care of COVID. Therefore, it is imperative to augment the home-based services so that patients continue to remain at home with their care needs met so that their access to hospitals is restricted for acute and complex needs. To overcome practical aspects of home-based care service delivery, several adaptations were needed. An urban standalone home-based palliative care service provider made adaptations to personal protection, personal protection equipment, and team self-care that facilitated an effective service delivery and satisfaction.
Collapse
Affiliation(s)
| | - Ashish Gulia
- Department of Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| |
Collapse
|
31
|
Gulia A, Prajapati A, Gupta S, Puri A. Operative technique of distal radius resection and wrist fusion with iliac crest bone graft. J Clin Orthop Trauma 2021; 19:17-20. [PMID: 34046295 PMCID: PMC8144336 DOI: 10.1016/j.jcot.2021.04.034] [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: 02/08/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant lesions of distal radius and appropriately selected cases of benign aggressive lesions (giant cell tumor) of distal radius require resection for limb salvage. Post resection, reconstruction of that defect can be accomplished by either arthrodesis or arthroplasty both having their own pros and cons. In cases undergoing arthrodesis as modality of reconstruction, small defects (≤6 cm) can be reconstructed using autologous iliac crest bone graft which results in good cosmetic appearance and functional outcome. We have described in detail, the preoperative planning, surgical steps and rehabilitation of wrist fusion with iliac crest bone grafting post distal radius resection.
Collapse
Affiliation(s)
- Ashish Gulia
- Corresponding author. Bone and Soft Tissue Services, Department of Surgical Oncology, 93, Main building, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | | | | | | |
Collapse
|
32
|
Gulia A, Arora RS, Panda PK, Raja A, Tiwari A, Bakhshi S, Salins N, Goel V, Janu A. Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review. Indian J Orthop 2021; 55:1-13. [PMID: 32836361 PMCID: PMC7261215 DOI: 10.1007/s43465-020-00143-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
With the novel coronavirus disease (COVID-19) being declared a global pandemic by the World Health Organization, the Indian healthcare sector is at the forefront to deliver optimal care. Patients with cancer especially are at serious risk for increased chances of morbidity and mortality due to their immunocompromised state. Currently there is a paucity of definitive guidelines for the management of sarcomas during the pandemic in a resource-constrained and diverse population setting like India. Health care professionals from various specialties involved in the management of sarcomas have collaborated to discuss various aspects of evidence-based sarcoma management during the COVID-19 pandemic. This article provides structured recommendations for HCP to adapt to the situation, optimize treatment protocols with judicious use of all resources while providing evidence-based treatment for sarcoma patients.
Collapse
Affiliation(s)
- Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institure (HBNI), Mumbai, India
| | | | - Pankaj Kumar Panda
- Department of Clinical Research, Apollo Proton Cancer Centre, Chennai, India
| | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Akshay Tiwari
- Musculoskeletal Oncology, Max Institute of Cancer Care, Saket, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, MAHE, Manipal, India
| | - Vineeta Goel
- Radiation Oncology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Hospital, and Homi Bhabha National Institure (HBNI), Mumbai, India
| |
Collapse
|
33
|
Gulia A, Puri A, Gupta S, Kurisunkal V. 'Umbrella construct' - an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours. Shoulder Elbow 2021; 13:188-194. [PMID: 33897850 PMCID: PMC8039762 DOI: 10.1177/1758573219895988] [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: 08/28/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/15/2022]
Abstract
AIM Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique 'Umbrella construct' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. METHODS Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14-36 years). The maximum longitudinal extent of disease was 9 cm (range 5-9 cm). RESULTS The median follow-up was 54 months (range 34-122 months). The mean allograft incorporation time was 7 months (5-8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23-29). CONCLUSIONS Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.
Collapse
Affiliation(s)
- Ashish Gulia
- Ashish Gulia, Tata Memorial Hospital, Main building
OPD - 93, Dr Ernst Borges Road, Parel, Mumbai 400012, India.
| | | | | | | |
Collapse
|
34
|
Kulkarni SS, Shetty NS, Gala KB, Shariq M, Gulia A, Polnaya AM, Shetty NG, Janu AK, Choudhari A, Puri A. Percutaneous Radiofrequency Ablation of Appendicular Skeleton Chondroblastoma-an Experience from a Tertiary Care Cancer Center. J Vasc Interv Radiol 2021; 32:504-509. [PMID: 33612370 DOI: 10.1016/j.jvir.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate safety and long-term efficacy of radiofrequency (RF) ablation in treatment of chondroblastoma. MATERIALS AND METHODS This retrospective analysis comprised 27 consecutive patients with histopathologically proven chondroblastoma treated by RF ablation. The tumors were located in the proximal humerus (n = 6), proximal tibia (n = 8), proximal femur (n = 6), distal femur (n = 5), acromion process (n = 1), and lunate (n = 1). In 19 patients (70.3%), the tumor was in the weight-bearing area of the bone. Clinical response was assessed by comparing pain scores and functional assessment by Musculoskeletal Tumor Society (MSTS) score before and after ablation. Patients were followed for a minimum of 1 year to rule out complications and recurrence. RESULTS Technical success rate was 100%. Mean pain score before the procedure was 7.34 (range, 7-9); all patients experienced a reduction in pain, with 25 (92.6%) patients reporting complete pain relief at 6 weeks. Mean MSTS score before the procedure was 15.4, whereas mean MSTS score at 6 weeks after the procedure was 28.6, suggesting significant functional improvement (P < .0001). Two patients developed osteonecrosis and collapse of the treated bone. There were no recurrences. CONCLUSIONS Percutaneous RF ablation is a safe and effective option for treating chondroblastoma of the appendicular skeleton.
Collapse
Affiliation(s)
- Suyash S Kulkarni
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Nitin Sudhakar Shetty
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India.
| | - Kunal B Gala
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Mohd Shariq
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Ashish Gulia
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India; Orthopedic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel East, Parel, Mumbai, Maharashtra 400012, India
| | - Ashwin M Polnaya
- Department of Radio-Diagnosis and Imaging, A.J. Institute of Medical Science and Research Centre, Mangalore, Karnataka, India
| | - Neeraj G Shetty
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Amit Kumar Janu
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Amitkumar Choudhari
- Interventional Radiology, Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India
| | - Ajay Puri
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra 400094, India; Orthopedic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel East, Parel, Mumbai, Maharashtra 400012, India
| |
Collapse
|
35
|
Abstract
Extraskeletal osteosarcoma is a very infrequently diagnosed soft-tissue sarcoma subtype which has identical histological features to bone osteosarcoma. However, its demographics, presentation, radiology and treatment strategy differ from those of osteosarcoma. Its diagnosis can be at times challenging due to radiological and pathological mimics which have more common incidence. A multimodality approach is essential for optimizing the outcomes in extraskeletal osteosarcoma. Although there are certain caveats on inclusion of adjuvant therapies (radiotherapy and chemotherapy), in all cases surgical resection with wide local margins is considered the gold standard for adequate local control. The outcome in advanced disease remains dismal and there is a huge unmet need for prospective studies addressing the optimal treatment strategy. In this article, we review the evidence available for the management of extraskeletal osteosarcoma.
Collapse
Affiliation(s)
- Abhay K Kattepur
- Department of Surgical Oncology, Sri Devaraj Urs Medical College, Tamaka, Kolar 563101, Karnataka, India
| | - Ashish Gulia
- Department of Surgical Oncology, Bone & Soft Tissue Services, Tata Memorial Hospital & Homi Bhabha National Institute (HBNI), Dr Ernst Borges Marg, Parel, Mumbai, 400012, India
| | - Robin L Jones
- Royal Marsden Hospital, NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, 110029, India
| |
Collapse
|
36
|
Smrke A, Anderson PM, Gulia A, Gennatas S, Huang PH, Jones RL. Future Directions in the Treatment of Osteosarcoma. Cells 2021; 10:172. [PMID: 33467756 PMCID: PMC7829872 DOI: 10.3390/cells10010172] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
Osteosarcoma is the most common primary bone sarcoma and is often diagnosed in the 2nd-3rd decades of life. Response to the aggressive and highly toxic neoadjuvant methotrexate-doxorubicin-cisplatin (MAP) chemotherapy schedule is strongly predictive of outcome. Outcomes for patients with osteosarcoma have not significantly changed for over thirty years. There is a need for more effective treatment for patients with high risk features but also reduced treatment-related toxicity for all patients. Predictive biomarkers are needed to help inform clinicians to de-escalate or add therapy, including immune therapies, and to contribute to future clinical trial designs. Here, we review a variety of approaches to improve outcomes and quality of life for patients with osteosarcoma with a focus on incorporating toxicity reduction, immune therapy and molecular analysis to provide the most effective and least toxic osteosarcoma therapy.
Collapse
Affiliation(s)
- Alannah Smrke
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (A.S.); (S.G.)
| | - Peter M. Anderson
- Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic R3 Main Campus, 9500 Euclid Avenue, Cleveland, OH 44195, USA;
| | - Ashish Gulia
- Orthopedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai 400012, India;
| | - Spyridon Gennatas
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (A.S.); (S.G.)
| | - Paul H. Huang
- The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK;
| | - Robin L. Jones
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (A.S.); (S.G.)
- The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK;
| |
Collapse
|
37
|
Rekhi B, Gulia A. "Rosette forming" Primary high-grade B-cell lymphoma, presenting as a scapular mass, masquerading Ewing sarcoma: A rare case with diagnostic implications. INDIAN J PATHOL MICR 2021; 64:617-619. [PMID: 34341293 DOI: 10.4103/ijpm.ijpm_468_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, HBNI University, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Surgical Oncology (Bone and Soft Tissues), Tata Memorial Hospital, Parel, HBNI University, Mumbai, Maharashtra, India
| |
Collapse
|
38
|
Affiliation(s)
- Purvish Parikh
- Department of Precision Oncology and Research, Shalby Hospital, Mumbai, Maharashtra, India,
| | - Manit K. Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India,
| | - Pankaj Kumar Panda
- Department of Clinical Research, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India,
| | - Ashish Gulia
- Bone and Soft Tissue, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| |
Collapse
|
39
|
Rao V, Priyanka MS, Lakshmi A, Faheema AGJ, Thomas A, Medappa K, Subhash A, Arakeri G, Shariff A, Vijendra V, Amith R, Kannan S, Gulia A, Shivalingappa SS, Merode GGFV, Shariff A, Masood S. Predicting COVID-19 pneumonia severity on chest X-ray with convolutional neural network: A retrospective study. IJMS 2020. [PMCID: PMC8219001 DOI: 10.25259/ijms_349_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Radiological lung changes in COVID-19 infections present a noteworthy avenue to develop chest X-ray (CXR) -based testing models to support existing rapid detection techniques. The purpose of this study is to evaluate the accuracy of artificial intelligence (AI) -based screening model employing deep convolutional neural network for lung involvement. Material and Methods: An AI-based screening model was developed with state-of-the-art neural networks using Indian data sets from COVID-19 positive patients by authors of CAIR, DRDO, in collaboration with the other authors. Our dataset was comprised of 1324 COVID-19, 1108 Normal, and 1344 Pneumonia CXR images. Transfer learning was carried out on Indian dataset using popular deep neural networks, which includes DenseNet, ResNet50, and ResNet18 network architectures to classify CXRs into three categories. The model was retrospectively used to test CXRs from reverse transcriptase-polymerase chain reaction (RT-PCR) proven COVID-19 patients to test positive predictive value and accuracy. Results: A total of 460 RT-PCR positive hospitalized patients CXRs in various stages of disease involvement were retrospectively analyzed. There were 248 males (53.92%) and 212 females (46.08%) in the cohort, with a mean age of 50.1 years (range 12–89 years). The commonly observed alterations included lung consolidations, ground-glass opacities, and reticular–nodular opacities. Bilateral involvement was more common compared to unilateral involvement. Of the 460 CXRs analyzed, the model reported 445 CXRs as COVID -19 with an accuracy of 96.73%. Conclusion: Our model, based on a two-level classification decision fusion and output information computation, makes it a robust, accurate and reproducible tool. Based on the initial promising results, our application can be used for mass screening.
Collapse
Affiliation(s)
- Vishal Rao
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, India
| | - M. S. Priyanka
- Centre for Artificial Intelligence and Robotics, Bengaluru, Karnataka, India
| | - A. Lakshmi
- Department of Research, COVID Consultative Group, Bengaluru, Karnataka, India
| | - A. G. J. Faheema
- Centre for Artificial Intelligence and Robotics, Bengaluru, Karnataka, India
| | - Alex Thomas
- Association of Healthcare Providers - AHPI (India), Indian Medical Association, New Delhi, India
| | | | - Anand Subhash
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, India
| | - Adnan Shariff
- Data Science and AI, Ankh Lifecare, Bengaluru, Karnataka, India,
| | - Vybhav Vijendra
- Department of Respiratory Medicine, Vydehi Institute of Medical Sciences, Bengaluru, Karnataka, India,
| | - R. Amith
- Department of Radiology, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India,
| | - Swetha Kannan
- Department of Immunology, School of Biological Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom,
| | - Ashish Gulia
- Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - G. G. Frits van Merode
- Logistics and Operations Management of Health Care, Maastricht University Medical Centre, Maastricht, Limburg, Netherlands,
| | - Asrar Shariff
- Department of Paediatrics, Bhagwan Mahaveer Jain Hospital, Karnataka, India,
| | - S. Masood
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, India
- Association of Healthcare Providers - AHPI (India), Indian Medical Association, New Delhi, India
| |
Collapse
|
40
|
Abstract
The milder form of infection and higher rates of recovery witnessed among COVID-19 patients in India is indicative of the potential intervention of other “unconventional” biological mechanisms. The recently established similarity between beta-coronavirus strains in animals and humans led us to hypothesize that previous contact with infected dogs or cattle could shield humans from the circulating SARS-CoV-2 virus. We further believe that our hypothesis, if confirmed by further studies, could be used as a potential vaccine strategy.
Collapse
Affiliation(s)
- Vishal Rao
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, Bengaluru, Karnataka, India,
| | - Swetha Kannan
- Department of Immunology, School of Biological Sciences, University of Edinburgh, Scotland, United Kingdom,
| | - Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery, Navodaya Dental College, Raichur, Karnataka, India,
| | - Anand Subhash
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, Bengaluru, Karnataka, India,
| | - H. V. Batra
- Shankarnaraya Lifesciences, Bengaluru, Karnataka, India,
| | - Jitendra Kumar
- Bangalore Bio-Innovation Center, Bengaluru, Karnataka, India,
| | - Ashish Gulia
- Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India,
| |
Collapse
|
41
|
Rao V, Gulia A. Convalescent plasma therapy in COVID-19: Does it merit a deeper probe? IJMS 2020. [PMCID: PMC8218999 DOI: 10.25259/ijms_491_2020] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vishal Rao
- Department of Head and Neck Surgical Oncology, HCG Cancer Hospital, Bengaluru, Karnataka, India,
| | - Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Parel, Mumbai, Maharashtra, India,
| |
Collapse
|
42
|
Abstract
INTRODUCTION We retrospectively analyzed a consecutive group of patients operated for bone tumors of extremity and pelvis who received only perioperative antibiotics (Group A) against a similar group that had additional 1 g topical vancomycin sprinkled in the wound before closure (Group B). The aim was to determine if the addition of topical vancomycin decreases the incidence of deep surgical site infection (SSI). MATERIALS AND METHODS A total of 221 patients operated between January 2011 and December 2011 were analyzed in Group A and 254 patients operated between April 2012 and March 2013 were analyzed in Group B. Any patient who required operative intervention for wound discharge was considered to be infected. All patients had a 1 year follow-up to determine the incidence of SSI. RESULTS The overall rate of SSI was 7% (31 of 475 patients). Seventeen (8%) of Group A patients had SSI as against 14 (6 %) of Group B patients (P = 0.337). A subgroup analysis of endoprosthetic reconstructions, internal fixation implants (plates/intramedullary nails), extracorporeal radiation treated bones and strut allografts showed no difference between the two groups of patients. CONCLUSION Our data suggest that the addition of topical vancomycin before wound closure in patients operated for bone tumors does not decrease the incidence of SSI. Further investigation of this technique using a case-controlled methodology with an increase in the dose of vancomycin may be warranted.
Collapse
Affiliation(s)
- Suman Byregowda
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
43
|
Abstract
Background: Primary bone sarcomas mainly metastasize through haematogenous route and rarely through lymph nodes due to paucity of lymphatic channels in the bone (1). Nodal spread in chondrosarcoma is extremely rare and there are two reported cases in literature including one previously published by our institute (3, 5). Aims and Objectives: We present a series of chondrosarcoma cases (primary tumour located in the scapula, proximal femur, proximal humerus and pelvis), presenting with lymph node metastasis, treated at our institute. We assessed the oncological outcome of these cases and the impact of nodal metastasis on survival. Materials and Methods: Between January 2006 and December 2015, 243 patients of extremity and pelvic chondrosarcoma were operated at our institute. These cases were retrieved from a prospectively maintained database. Four (1.6%) of these patients developed lymph node metastasis. Clinical and radiological details of these cases were retrieved from electronic medical records and case files. Histopathology of the primary chondrosarcoma lesion and nodal metastasis was reconfirmed by a pathologist specializing in sarcomas. Conclusion: Lymph node metastasis though extremely rare in primary osseous chondrosarcoma, definitely affects their survival adversely. The rarity of the occurrence of lymph node metastasis in primary osseous tumors, especially chondrosarcoma highlights the need for multi institutional studies to pool knowledge and evaluate the prognostic significance and etiopathogenesis of lymph node metastasis in primary bone chondrosarcoma.
Collapse
Affiliation(s)
- Vineet Kurisunkal
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Ajay Puri
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India
| |
Collapse
|
44
|
Thaker S, Azzopardi C, Gulia A, Botchu R. Exploring Correlation between Extent of Tumour Necrosis on MRI And Histological Grade of Soft Tissue Sarcoma. An Initial Experience. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.04.2020.11] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Thaker
- Department of Diagnostic Imaging, Kettering General Hospital, Kettering UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Gulia
- Department of Orthopaedic Oncology, Tata Memorial Centre, Mumbai, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
45
|
Parambil BC, Vora T, Sankaran H, Prasad M, Bakshi A, Puri A, Gulia A, Qureshi S, Laskar S, Khanna N, Shah S, Ramadwar M, Kembhavi S, Chinnaswamy G, Banavali S. Outcomes with nondose-dense chemotherapy for Ewing sarcoma: A practical approach for the developing world. Pediatr Blood Cancer 2020; 67:e28604. [PMID: 32706522 DOI: 10.1002/pbc.28604] [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: 11/16/2019] [Revised: 06/17/2020] [Accepted: 07/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The current multidisciplinary approach in the treatment of Ewing sarcoma has improved cure rates, with contemporary dose-dense chemotherapy attaining 5-year event-free survival (EFS) of 73% in localized cases. Dose-intense and dose-dense chemotherapy is difficult in the majority of resource-limited settings with limited access to optimal supportive care. We report on patients with Ewing sarcoma treated on EFT-2001, a nondose-dense chemotherapy protocol. PROCEDURE A retrospective analysis was conducted of patients (<15 years) with Ewing sarcoma treated with curative intent during January 2013-June 2017 with an institutional ethics committee-approved nondose-dense protocol (EFT-2001). Local therapy was planned after 9-12 weeks of chemotherapy with metastatic sites addressed with radiotherapy. The study assessed outcomes and prognostic factors. RESULTS We analysed 200 patients with M:F ratio of 1.27:1 and metastases in 41 patients (20.5%). At a median follow up of 41.5 months (range 4.5-81.8 months), respective 3-year EFS and overall survival (OS) of the whole cohort is 65.3% (95% confidence interval [CI]: 58.1-71.7%) and 79.3% (95% CI: 72.8-84.5%); for localized and metastatic cohort, 70.9% (95% CI: 62.9-77.5%) and 82.8% (95% CI: 75.7-89.0%); and for metastatic cohort, 42.8% (95% CI: 28.0-58.6%) and 65.3% (95% CI: 47.7-78.3%). Presence of residual disease (morphologic/metabolic) on positron emission tomography-computed tomography scan done 3 months post definitive radiotherapy (hazard ratio [HR] 7.92 [95% CI: 3.46-18.14]) and delay in any form of local control >4 months (HR 3.42 [95% CI: 1.32-8.89]) affected outcomes. Nonrelapse mortality during treatment was 6.5%, mainly due to cardiomyopathy (3.0%) and bacterial sepsis (1.5%). Cardiotoxicity was seen in 11.5% of patients. CONCLUSIONS Nondose-dense chemotherapy provides good outcomes with manageable toxicities in a multidisciplinary treatment approach, while reducing cumulative drug exposures in the developing world where dose-intense or dose-dense chemotherapy could potentially increase toxicity, and hence seems a feasible approach in resource-limited settings. Presence of any residual disease post definitive radiotherapy or delay in local control portends poor outcome.
Collapse
Affiliation(s)
- Badira Cheriyalinkal Parambil
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Hari Sankaran
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Asish Bakshi
- Department of Medical Oncology, Dr L.H. Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| |
Collapse
|
46
|
Gulia A, Kurisunkal V, Puri A, Purandare N, Gupta S, Rangarajan Drm V. Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma? Clin Orthop Relat Res 2020; 478:2480-2484. [PMID: 32567825 PMCID: PMC7594919 DOI: 10.1097/corr.0000000000001357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/21/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Staging of a bone sarcoma before initiating treatment helps orthopaedic oncologists determine the intent of treatment and predicting the prognosis. As per National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, there are no exclusive recommendations for chondrosarcoma staging. They are staged similar to other bone sarcomas even though skeletal metastases are extremely rare in chondrosarcomas. QUESTIONS/PURPOSES We asked: (1) What proportion of patients with a chondrosarcoma present with detectable only skeletal metastasis? (2) What proportion of patients with chondrosarcoma present with skeletal metastasis with or without concurrent pulmonary metastases? METHODS Between January 2006 to December 2017, 480 patients with histology-proven chondrosarcomas of the extremity, including clavicle, scapula, spine, and pelvis, presented to our institute. Fifty-three patients were excluded due to incomplete details about their staging. The remaining 427 were retrospectively analyzed and included in this study. Their clinical, radiological, and histopathological details were retrieved from patient files and electronic medical records. Of the 427 patients included, 53 had Grade 1 chondrosarcoma, 330 had Grade 2 chondrosarcoma, and 41 had Grade 3 chondrosarcoma. Grade was not available in three patients. All patients were staged with a thoracic CT scan and bone scan or a whole body fluorodeoxyglucose positron-emission tomography/CT (FDG PET/CT). Patients with a suspected or documented metastasis were reviewed again by an experienced radiologist and a nuclear medicine expert for the purpose of this study. A total of 8% (35 of 427) of patients with chondrosarcoma had isolated lung metastases at the time of initial staging. These included 9% (31 of 330) of patients with Grade 2 chondrosarcomas and 10% (4 of 41) of patients with Grade 3 chondrosarcomas. No patient with a Grade 1 chondrosarcoma had detectable lung metastases. The primary study endpoint was the number of patients who had a diagnosis of skeletal or skeletal and lung metastases as identified by the staging modalities. RESULTS Three patients with Grade 2 chondrosarcoma had only skeletal metastasis. No patients with Grade 1 or Grade 3 chondrosarcoma had detectable bone metastases. Combined lung and bone metastases were seen in only two patients with Grade 2 chondrosarcoma. CONCLUSIONS Our study found that the incidence of bony metastasis in conventional chondrosarcomas is extremely low. Considering the present results, we believe skeletal scanning may be overused in current staging algorithms. We do not have survival outcomes to know if detecting these few patients with skeletal lesions at initial presentation would be important in the absence of symptoms, but our data suggest that omitting skeletal imaging from the staging work-up of conventional chondrosarcomas should be considered. It may be reserved for patients with documented pulmonary metastases. LEVEL OF EVIDENCE Level IV, diagnostic study.
Collapse
Affiliation(s)
- Ashish Gulia
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vineet Kurisunkal
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Ajay Puri
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Srinath Gupta
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Venkatesh Rangarajan Drm
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| |
Collapse
|
47
|
Puri A, Gupta SM, Gulia A, Shetty N, Laskar S. Giant cell tumors of the sacrum: is non-operative treatment effective? Eur Spine J 2020; 30:2881-2886. [PMID: 33106943 DOI: 10.1007/s00586-020-06650-x] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Giant cell tumors of sacrum in which surgery could endanger important neural components were treated with short term denosumab, angioembolisation and radiotherapy in different combinations to provide a non-operative function preserving treatment option. METHODS Between April 2013 and April 2017, 13 sacral GCTs [proximal extent of disease-S1 (10), S2 (2) and S3 (1)] were treated. Age ranged from 20 to 50 years. One patient had loss of bladder control at presentation. Treatment protocol included short term denosumab, angioembolisation and radiotherapy in different combinations. Patients were evaluated every 10-12 weeks. If disease ceased to progress no further treatment was advised. In case of progress, patient was advised additional denosumab and/or angioembolisation and/or radiotherapy till disease stopped progressing. RESULTS 10 patients have non-progressive disease and are asymptomatic, 2 have non-progressive disease with occasional pain, 1 patient died. Follow-up duration (since final non-progression of disease) ranged from 15 to 54 months (mean 31 months). Total number of angio embolisation sessions ranged from 0 to 12 (mean = 4), total number of denosumab doses ranged from 5 to 16 (mean = 9). Five patients did not receive any radiotherapy, 5 received 50.4 Gy and one patient each received 50.4 + 30 + 12 Gy, 50.4 + 30 Gy and 50.4 + 12 Gy. The patient with loss of bladder control at presentation recovered. There were no other long-term complications. CONCLUSION This study offers a non-surgical management option that provides good mid-term local control while preserving neurological function in these complex lesions.
Collapse
Affiliation(s)
- Ajay Puri
- Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
| | - Srinath M Gupta
- Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ashish Gulia
- Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Nitin Shetty
- Interventional Radiology, Tata Memorial Centre, HBNI, Mumbai, India
| | | |
Collapse
|
48
|
Pyone K, Khanna NR, Sasidharan A, Chinnaswamy G, Vora T, Bajpai J, Ramadwar M, Rekhi B, Janu A, Purandhare N, Nayak P, Gulia A, Puri A, Laskar S. Clinical outcomes of Ewings sarcoma patients with limited metastasis treated by curative intent. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.020] [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: 11/28/2022] Open
|
49
|
Rekhi B, Shetty O, Vora T, Gulia A, Bajpai J, Laskar S. Clinicopathologic, immunohistochemical, molecular cytogenetic profile with treatment and outcomes of 34 cases of Ewing sarcoma with epithelial differentiation, including 6 cases with "Adamantinoma-like" features, diagnosed at a single institution, India. Ann Diagn Pathol 2020; 49:151625. [PMID: 32932018 DOI: 10.1016/j.anndiagpath.2020.151625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/20/2020] [Revised: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 12/29/2022]
Abstract
To analyze clinicopathological features, including treatment profile of 34 cases of Ewing sarcomas with epithelial differentiation, including 6 cases with adamantinoma-like features. EWSR1 gene rearrangement was tested by fluorescence in-situ hybridization. Thirty-four tumors occurred in 19 males and 15 females (M:F = 1.26:1), with age ranging from 7 to 61 years (average = 24.2); in extremities (17), pelvis (5), paraspinal region (6), head and neck region (3), abdomen (2) and lung (1). Prior to molecular testing, 20/34(58.8%) cases were unequivocally diagnosed as Ewing sarcomas. Histopathologically, the most commonly observed pattern was nesting-type, comprising malignant round cells, including adamantinoma-like features, seen in 6 tumors. Immunohistochemically, tumor cells were diffusely positive (cytoplasmic membranous staining) for CD99/MIC2 (34/34), Fli1 (30/30); focally for synaptophysin (4/16) (25%); variably positive for AE1/AE3(31/32)(96.8%), including diffuse immunoexpression in 4 cases; EMA(6/8) and p40(3/8). All 34 (100%) tumors, tested for EWSR1 rearrangement, displayed positive results. According to the treatment details (available in 24/34 cases, 70.5%), most patients (13/24)(54.1%) were treated with surgical resection and a specific chemotherapy(CT) regimen (neoadjuvant or adjuvant settings), including 7 patients, who received adjuvant radiotherapy. During follow-up (16 cases, 47%), 5 patients developed recurrences and 8 developed metastasis, including a single, who developed recurrence. Finally, 10 patients were alive-with-disease (2-22 months); 6 free-of-disease (5-36 months). This constitutes one of the largest documentation of these rare tumors from our subcontinent, which are diagnostically challenging; require molecular confirmation and associated with treatment implications.
Collapse
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India; Division of Molecular Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India.
| | - Omshree Shetty
- Division of Molecular Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Tushar Vora
- Department of Medical Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Ashish Gulia
- Department of Surgical Oncology (Bone and Soft Tissues), Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| |
Collapse
|
50
|
Shrikhande SV, Pai PS, Bhandare MS, Bakshi G, Chaukar DA, Chaturvedi P, Goel M, Gulia A, Qureshi SS, Maheshwari A, Moiyadi A, Nair S, Nair NS, Karimundackal G, Saklani AP, Shankhadhar VK, Parmar V, Divatia JV, Cs P, Puri A, Badwe RA. Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre: Implications for Cancer Care Policy. Ann Surg 2020; 272:e249-e252. [PMID: 32520743 PMCID: PMC7299113 DOI: 10.1097/sla.0000000000004116] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overburdened systems and concerns of adverse outcomes have resulted in deferred cancer surgeries with devastating consequences. In this COVID pandemic, the decision to continue elective cancer surgeries, and their subsequent outcomes, are sparsely reported from hotspots. METHODS A prospective database of the Department of Surgical Oncology was analysed from March 23rd to April 30th, 2020. FINDINGS Four hundred ninety-four elective surgeries were performed (377 untested and 117 tested for Covid 19 before surgery). Median age was 48 years with 13% (n = 64) above the age of 60 years. Sixty-eight percent patients were American Society of Anaesthesiology (ASA) grade I. As per surgical complexity grading, 71 (14·4%) cases were lower grade (I-III) and 423 (85.6%) were higher grade complex surgeries (IV - VI).Clavien-Dindo ≥ grade III complications were 5.6% (n = 28) and there were no postoperative deaths. Patients >60 years documented 9.3% major complications compared to 5.2% in <60 years (P = 0.169). The median hospital stay was 1 to 9 days across specialties.Postoperatively, 26 patients were tested for COVID 19 and 6 tested positive. They all had higher grade surgeries but none required escalated or intensive care treatment related to COVID infection. INTERPRETATION A combination of scientific and administrative rationale contributed to favorable outcomes after major elective cancer surgeries. These results support the continuation of elective major cancer surgery in regions with Covid 19 trends similar to India.
Collapse
Affiliation(s)
- Shailesh V Shrikhande
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Prathmesh S Pai
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Manish S Bhandare
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Ganesh Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Devendra A Chaukar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Sajid S Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Sudhir Nair
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Nita S Nair
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - George Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Avanish P Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Vinay K Shankhadhar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Vani Parmar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Pramesh Cs
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India
| |
Collapse
|