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Iyer P, Krishnamurthy A, Velusamy S, Sundersingh S, Rajaram S, Balasubramanian A, Radhakrishnan V. Effect of Neoadjuvant Concurrent Chemoradiation on Operability and Survival in Locally Advanced Inoperable Breast Cancer. Int J Radiat Oncol Biol Phys 2024; 119:163-171. [PMID: 38036271 DOI: 10.1016/j.ijrobp.2023.11.042] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Inoperable locally advanced breast cancers (LABCs) are treated with neoadjuvant chemotherapy. We studied the use of neoadjuvant concurrent chemoradiation (NACCRT) in patients with inoperable LABC. METHODS AND MATERIALS From May 2017 to December 2021, the study recruited patients with stage III inoperable LABC. Treatment included 4 cycles of doxorubicin and cyclophosphamide and 4 cycles of paclitaxel, along with concurrent radiation therapy to a total dose of 46 Gy. Thereafter, all patients were evaluated for surgery, and additional treatments were given based on receptor status. The effects of NACCRT on pathologic complete response (pCR), operability, and survival were analyzed. RESULTS The study involved 202 female patients with a median age of 52 years. Of these, 23.7% had IIIA, 65.3% had IIIB, and 10.8% had IIIC disease. Hormone receptor-positive disease was observed in 44.6% of patients, triple-negative breast cancer was observed in 24.8% of patients, and Human epidermal growth factor receptor 2 (HER2)-positive disease was observed in 30.7% of patients. Modified radical mastectomy (MRM) was performed in 88.1% of patients, 8.5% of patients remained inoperable, and 3.4% of patients declined surgery. Among the patients who underwent MRM, 36.5% of patients had a pCR. Patients who were operable and underwent MRM had complete resections and had negative margins. pCR was observed in 16% with hormone receptor-positive disease, in 45.6% with triple-negative breast cancer, and in 60.7% with HER2-positive disease. Grade 3 skin reactions were observed in 19.3% of patients. Postoperative wound morbidity requiring hospitalization was observed in 10.6% of patients. After a median follow-up of 42 months, the 4-year event-free survival and overall survival rates were 63.4% and 71.5%, respectively. HER2-positive patients who achieved a pCR had significantly improved event-free survival and overall survival. CONCLUSIONS Our study shows that using NACCRT can improve operability and survival outcomes in patients with inoperable LABC.
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Affiliation(s)
- Priya Iyer
- Departments of Radiation Oncology, Cancer Institute (W.I.A.), Chennai, India.
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Iyer P, Ganesharajah S, Krishnamurthy A, Velusamy S, Sundersingh S, Balasubramanian A, Radhakrishnan V. Impact of Neoadjuvant Concurrent Chemoradiation (NACCRT) on Operability and Survival in Locally Advanced Inoperable Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S6-S7. [PMID: 37784535 DOI: 10.1016/j.ijrobp.2023.06.214] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Inoperable locally advanced breast cancers (LABC) are treated with neoadjuvant chemotherapy (NACT). However, many patients remain inoperable after NACT due to an inadequate response. We, therefore, investigated the role of neoadjuvant concurrent chemoradiation (NACCRT) in this setting. MATERIALS/METHODS Patients with inoperable Stage III LABC were prospectively recruited in the study between May 2017 and December 2021. NACT consisted of 4 cycles of q3weekly Adriamycin (60 mg/m2) and Cyclophosphamide (600mg/m2), and 4 cycles of q3weekly Paclitaxel (175 mg/m2). Concurrent radiotherapy with 6 MV X-rays was given using a 3D conformal technique to a total dose of 46 Gy (2 Gy/fraction, 5 days/week) to the involved breast, axilla, supraclavicular fossa, and internal mammary chain (upper 3 intercostal spaces) along with the first two cycles of paclitaxel. A 0.5 cm bolus was used to boost the skin till the appearance of hyperpigmentation. All patients were assessed for surgery after the completion of the planned neoadjuvant treatment. Adjuvant treatments were given based on the receptor status. The impact of neoadjuvant CTRT on the pathological complete response (pCR), operability, and survival was analyzed. Event-free survival (EFS) and Overall Survival (OS) were analyzed using the Kaplan-Meier method. RESULTS The study enrolled 202 female patients with a median age of 52 years, with 23.7% having IIIA, 65.3% IIIB, and 10.8% having IIIC disease. Hormone-receptor (HR) positive disease was observed in 90/202 (44.6%) patients, triple-negative (TNBC) in 50/202 (24.8%) and Her2/neu positive in 62/202 (30.7%) patients. Modified radical mastectomy was performed in 88.1% of patients, with 8.5% remaining inoperable and 3.4% declining surgery due to clinical complete response (cCR). Among the patients who underwent MRM, 65/178 (32.2%) patients had a pCR. pCR was observed in 13/81 (16%) with HR-positive disease, 21/46 (45.6%) with TNBC, and 31/51 (60.7%) patients with Her2/neu-positive disease. Grade 3 skin reactions were observed in 39/202 (19.3%). Postoperative wound morbidity requiring hospitalization was observed in 19/178 (10.6%) patients. The median follow-up was 42 months, with 4-year EFS and OS of 63.8% and 71.5%, respectively. Six out of 7 patients who were in cCR and declined surgery are alive and remain in cCR. On subgroup analysis of Her 2 positive patients, pCR was significantly associated with improved EFS and OS (89.8% vs 33.3%, p = 0.001 and 89.1% vs 44.4%, p = 0.001 respectively). CONCLUSION Our study demonstrates the feasibility and efficacy of NACCRT in improving operability, pCR rates and survival outcomes in patients with inoperable LABC. The results suggest that NACCRT can be considered for use in clinical practice with careful patient selection. These findings contribute to the ongoing efforts to optimize treatment for this patient population and warrant further investigation in larger, randomized trials.
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Affiliation(s)
- P Iyer
- Cancer Institute (W.I.A), Chennai, India
| | | | | | - S Velusamy
- Cancer Institute (W.I.A), Chennai, India
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Spartacus R, Selvarajan G, Perumal Kalaiyarasi J, Velusamy S, Prakash U, Radhakrishnan V. 70P Prognostic factors and outcome in ovarian adult granulosa-cell tumours: A retrospective real-world data. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100850] [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: 02/27/2023] Open
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Selvarajan G, Radhakrishnan V, Jayachandran PK, Subramaniam Murali C, Velusamy S, Krishnamurthy A, Iyer P, Ananthi B, Ganesarajah S, Sagar TG. Forecasting factors and outcomes in hawkish inflammatory breast carcinoma - A single center data exploration. Cancer Treat Res Commun 2022; 32:100599. [PMID: 35792427 DOI: 10.1016/j.ctarc.2022.100599] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Inflammatory breast carcinoma (IBC) is an aggressive clinical syndrome of invasive breast carcinoma. There is paucity of data regarding the outcomes in IBC. OBJECTIVES Analyses of OS and Event-free survival (EFS) in nonmetastatic and metastatic IBC and to find prognostic factors influencing them. METHODOLOGY In this single center, retrospective study the data of patients fulfilling the clinical criteria of IBC were retrieved from 2016 to 2021. The impact of prognostic factors on OS and EFS were analysed by log rank test (univariate analysis). The OS and EFS were depicted as Kaplan Meier survival curves. RESULTS There were 22 patients with IBC. Median follow-up was 17 months. The median OS was significantly better in non-metastatic(M0) compared to metastatic IBC (25 months vs 6 months) with 3year OS rate of 50% vs 0% respectively. The post-menopausal status, grade 2 histology and trimodality treatment showed better outcome while N3 stage at diagnosis had worse outcome in M0 group. The lesser HR expression, lesser pCR rates, higher N3 proportion, liver metastasis and multiple metastatic site involvement contributed to the worse outcome observed in this study. CONCLUSION The aggressive clinicopathological features of IBC in the present study resulted in less favourable outcome compared to literature review. Improved outcome with trimodality highlights the emergent need for additional targeted therapy to improve pCR and operability.
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Affiliation(s)
- Gangothri Selvarajan
- Department of Medical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India.
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | | | | | - Sridevi Velusamy
- Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | - Priya Iyer
- Department of Radiation Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | - Balasubramanian Ananthi
- Department of Radiation Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | - Selvaluxmy Ganesarajah
- Department of Radiation Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
| | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, 600036, India
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Selvarajan G, Dhanushkodi M, Radhakrishnan V, Kalaiyarasi JP, Murali CS, Ananthi B, Iyer P, Krishnamurthy A, Velusamy S, Ganesarajah S, Sagar TG. The continuing conundrum in oligometastatic breast carcinoma: A real-world data. Breast 2022; 63:140-148. [PMID: 35395472 PMCID: PMC8991292 DOI: 10.1016/j.breast.2022.03.010] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED The optimal management in Oligometastatic (OM) breast carcinoma is not defined. OBJECTIVES To identify the prognostic factors influencing OM and the effect of Locoregional treatment (LRT) on survival in OM. METHODOLOGY Patients with ≤5 metastases and each with ≤ 5 cm size were defined as OM. Data of OM were extracted from the Institute Registry between 2012 and 2018. The impact of prognostic factors on survival was analysed by univariate and multivariate Cox regression. The Kaplan Meier survival curves were used to plot PFS and OS. RESULTS There were 170 patients with OM. The median follow-up was 61 months. Median OS was 43.3 months. The median OS was 74 months in OMD vs 22.7 months in Oligorecurrent disease (ORD) with 5year OS rate of 55.3% vs 16.5% respectively. In the multivariate analyses of OMD both Ki67 ≤ 50% and hormone therapy (HT) showed significant favourable survival outcome. While premenopausal status and HT showed significant survival benefits in ORD. The worse survival outcome in ORD could be because of their aggressive biology and deficit in LRT compared to literature review. The prognostic factors were swayed by the uneven distribution of HR status, grade and Ki67. CONCLUSION The survival of OM was influenced by OMD, Ki67 ≤ 50%, premenopausal status and HT. The lesser survival rates of OM in the long term suggest the need for curative LRT to metastatic sites and primary tumor. The potential role of HT and targeted therapy with or without LRT need to be assessed in future randomised trials.
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Affiliation(s)
- Gangothri Selvarajan
- Department of Medical Oncology,Cancer Institute (WIA), Chennai, Tamil Nadu, India.
| | | | | | | | | | | | - Priya Iyer
- Department of Radiation Oncology,Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology,Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Sridevi Velusamy
- Department of Surgical Oncology,Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | - Tenali Gnana Sagar
- Department of Medical Oncology,Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Vaikundaraja IM, Dhanushkodi M, Radhakrishnan V, Kalaiarasi JP, Mehra N, Selvarajan G, Rajan AK, Kesana SS, Ananthi B, Iyer P, Rao M, Krishnamurthy A, Velusamy S, Ranganathan R, Sagar TG. Real-World Outcome of Platinum-Based Chemotherapy in Advanced Breast Cancer (ABC): A Retrospective Study from a Tertiary Cancer Center in India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1735597] [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: 10/19/2022] Open
Abstract
Abstract
Introduction There is a paucity of data on platinum-based chemotherapy in advanced breast cancer (ABC) from developing countries like India.
Objectives The objectives were to analyze the efficacy and safety of platinum-based chemotherapy in patients with ABC.
Materials and Methods This was a retrospective study of 35 patients with ABC who were treated with platinum-based chemotherapy (gemcitabine and carboplatin, [GC]) in a tertiary cancer center in India from August 2015 to November 2019. The inclusion criteria were patients with ABC, who had received palliative chemotherapy with GC. The exclusion criteria were patients who had received less than two cycles of GC and patients who received platinum-based chemotherapy for neuroendocrine carcinoma of the breast.
Results The median age was 45 years (range: 28–68 years). All patients were female (97%) except one male (3%). The histology was ductal carcinoma (77%), mixed (17%), and others (6%). Out of the 12 patients tested for breast cancer (BRCA) gene mutation, six patients had a BRCA mutation. Patients with metastatic and locally progressive disease were 91 and 9%, respectively. The median number of prior lines of systemic therapy for metastatic disease was 1 (range: 0–5). The median number of sites of metastasis was 2 (range: 0–5). Patients with visceral crises were 23%. The median number of cycles of GC chemotherapy received was 6 (range: 2–6). A dose reduction in chemotherapy was done in 74%. The responses among 34 evaluable patients were complete response (11%), partial response (24%), stable disease (41%), and progressive disease (24%). Grade 3 or more hematological and nonhematological toxicities were observed in 69 and 9%, respectively. The median progression-free survival and overall survival were 6 and 8 months, respectively. The 1-year progression-free survival and overall survival were 19 and 34%, respectively. Multivariate analysis showed that patients who had received more than 3 cycles had a better outcome.
Conclusion GC was an active and well-tolerated regimen in ABC regardless of the receptor status. Further prospective randomized studies are warranted to assess the optimal regimen in patients with triple-negative breast cancer.
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Affiliation(s)
| | | | | | | | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Gangothri Selvarajan
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arun Kumar Rajan
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Siva Sree Kesana
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | - Priya Iyer
- Department of Radiation Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Manjula Rao
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Sridevi Velusamy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Rama Ranganathan
- Department of Epidemiology & Biostatistics, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Muthiah Vaikundaraja I, Dhanushkodi M, Radhakrishnan V, Peumal Kalaiyarasi J, Selvarajan G, Kesana SS, SM C, Iyer P, Ananthi B, Krishnamurthy A, Velusamy S, Gnana Sagar T. Outcome of Breast Cancer Patients with COVID-19 Infection: A Report from a Tertiary Cancer Center in India. Arch Breast Cancer 2021. [DOI: 10.32768/abc.202184291-296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome.
Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated.
Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis.
Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival, this may be due to Trastuzumab uncovered insurance till 10 years ago in our country. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. But this study showed that triple negative BC had better survival.
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Periyasamy A, Gopisetty G, Subramanium MJ, Velusamy S, Rajkumar T. Identification and validation of differential plasma proteins levels in epithelial ovarian cancer. J Proteomics 2020; 226:103893. [DOI: 10.1016/j.jprot.2020.103893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 01/09/2023]
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Gnanaguru V, Dhanushkodi M, Radhakrishnan V, Kalaiarasi JP, Mehra N, Joshi A, Rajan AK, Selvarajan G, Karunakaran P, Ananthi B, Iyer P, Senguttuvan G, Rao M, Priya M, Krishnamurthy A, Velusamy S, Raj H, Ranganathan R, Sundersingh S, Kumar K, Ganesarajah S, Ganesan TS, Sagar TG. Letrozole and Palbociclib in Advanced Breast Cancer: Outcome from Cancer Institute, Chennai. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_156_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background: Cyclin-dependent kinase 4/6 inhibitor addition to hormonal therapy has shown to improve the survival of hormone receptor (HR)-positive, HER2-negative advanced breast cancer (ABC). Methods: We retrospectively analyzed untreated patients with HR-positive, HER2-negative ABC, who received letrozole and palbociclib at the Cancer Institute, Chennai, from October 2017 to January 2019. Results: A total of 24 patients were included in this study. The median progression-free survival (PFS) was 18 months, and the median overall survival (OS) had not reached. The 1-year PFS and OS were 73.7% and 89.2%, respectively. The common toxicities were neutropenia and fatigue but none of the patients had febrile neutropenia. Conclusion: Letrozole-Palbociclib is effective with manageable toxicity as the first-line treatment for HR-positive, HER2-negative ABC.
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Affiliation(s)
- Vijay Gnanaguru
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | | | | | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Archit Joshi
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arun Kumar Rajan
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Gangothri Selvarajan
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Parathan Karunakaran
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | - Priya Iyer
- Department of Radiation Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Geetha Senguttuvan
- Department of Radiation Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Manjula Rao
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Madhu Priya
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Sridevi Velusamy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Hemanth Raj
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Rama Ranganathan
- Department of Epidemiology Biostatistics and Tumor Registry, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Shirley Sundersingh
- Department of Oncopathology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Krishna Kumar
- Department of Nuclear Medicine, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | - Trivadi S Ganesan
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Frost HR, Davies MR, Velusamy S, Delforge V, Erhart A, Darboe S, Steer A, Walker MJ, Beall B, Botteaux A, Smeesters PR. Updated emm-typing protocol for Streptococcus pyogenes. Clin Microbiol Infect 2020; 26:946.e5-946.e8. [PMID: 32120034 DOI: 10.1016/j.cmi.2020.02.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES PCR-based typing of the emm gene Streptococcus pyogenes often results in the amplification of multiple bands. This has resulted in the misclassification of strains into types based on non-emm gene sequences. We aimed to improve the specificity of the emm typing PCR reaction using a primer called CDC3, the sequence for which has been previously used to identify emm genes in silico. METHODS The proposed primer CDC3 was validated in silico from a global database of 1688 GAS genomes and in vitro with 32 isolates. PCR reactions were performed on genomic DNA from each isolate, using the published CDC1 forward primer with the CDC2 reverse primer or the new CDC3 reverse primer. The products were examined by gel electrophoresis, and representative PCR products were sequenced. RESULTS In 1688 S. pyogenes genomes, the previous CDC2 reverse primer annealed in silico in 1671 emm genes and also in 2109 non emm genes in close proximity, whereas the new CDC3 primer annealed in 1669 emm genes only. The remaining 19 genes without a CDC3 binding site were chimeric emm genes. The PCR pair CDC1+CDC3 produced a single band at appropriate molecular weight in all 32 isolates tested, while the CDC1+CDC2 pair produced more than one band in 13 of 32 isolates (40%). CONCLUSIONS The new CDC3 primer is more specific for emm genes than the previous CDC2 primer and represents a simple solution to reduce the potential for mistyping S. pyogenes strains.
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Affiliation(s)
- H R Frost
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - M R Davies
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - S Velusamy
- National Centre for Immunization and Respiratory Diseases, Centres for Disease Control and Prevention, Atlanta, GA, USA
| | - V Delforge
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - A Erhart
- Medical Research Council The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - S Darboe
- Medical Research Council The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - A Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M J Walker
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Australia
| | - B Beall
- National Centre for Immunization and Respiratory Diseases, Centres for Disease Control and Prevention, Atlanta, GA, USA
| | - A Botteaux
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - P R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Academic Children's Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
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Dhanushkodi M, Vaikundaraja I, Radhakrishnan V, Kalaiarasi J, Mehra N, Rajan A, Selvarajan G, Kesana S, Ananthi B, Iyer P, Senguttuvan G, Rao M, Krishnamurthy A, Velusamy S, Raj H, Ranganathan R, Sundersingh S, Ganesarajah S, Ganesan T, Sagar T. Fulvestrant in hormone-positive advanced breast cancer: Real-world outcome. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_53_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Sethjiwala T, Dhanushkodi M, Radhakrishnan V, Kalaiarasi JP, Mehra N, Joshi A, Rajan AK, Selvarajan G, Ananthi B, Iyer P, Senguttuvan G, Srilatha B, Krishnamurthy A, Velusamy S, Ganesarajah S, Ganesan TS, Sagar TG. Eribulin in Recurrent/Metastatic Breast Cancer (MBC). Indian J Gynecol Oncolog 2019. [DOI: 10.1007/s40944-019-0301-6] [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: 12/09/2022]
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Velusamy S, Bharathi SS, Krishnakumar B. Partial encephalocraniocutaneous lipomatosis syndrome. J Pediatr Neurosci 2017; 12:102-104. [PMID: 28553398 PMCID: PMC5437771 DOI: 10.4103/jpn.jpn_130_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Encephalocranial lipomatosis is a rare disorder that characteristically involves ectomesodermal tissues such as skin, eye, and the central nervous system. Here, we report a 3-year-old girl presented with developmental delay, seizures, limbal dermoid, and weakness of right lower limb. Imaging revealed hemiatrophy, arachnoid cyst, and polymicrogyria. The constellation of clinical finding and imaging leads to the diagnosis.
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14
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Venkitaraman B, Velusamy S, Chandrashekar A, R. S. 1914 Breast conservation surgery: A 7 years single institutional analysis of treatment outcome. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30863-2] [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: 10/22/2022]
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15
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Sundararajan M, Bhat K, Velusamy S, Babu N, Janaki M, Sasibhooshanan S, Das PM. Characterization of Ilmenite from Kerala Coastline, India:Implications in the Production of Synthetic Rutile. ACTA ACUST UNITED AC 2009. [DOI: 10.4236/jmmce.2009.86038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Nessim GT, Ofori-Kumba FK, Hanson R, Velusamy S. Early diagnosis of traumatic rupture of the right hemidiaphragm. Ann R Coll Surg Engl 2000; 82:101-2. [PMID: 10743426 PMCID: PMC2503523] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
A case of traumatic rupture of the right hemidiaphragm, which was diagnosed early on the basis of clinical and radiographic suspicions, is discussed.
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Affiliation(s)
- G T Nessim
- Department of Surgery, Longford/Westmeath General Hospital, Ireland
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17
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Affiliation(s)
- A Ramsanahie
- Longford/Westmeath General Hospital, Mullingar, Co., Westmeath
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18
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Mary ER, Velusamy S, Meena U, Lobithas L. Primary school health education: a practical project for a small hospital community health department. Trop Doct 1989; 19:50-1. [PMID: 2734834 DOI: 10.1177/004947558901900202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A pilot project in a rural district of Tamil Nadu, India in which health is taught as a subject in primary schools by hospital-based staff is described.
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