bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study evaluating preoperative (clinical, imaging) and intraoperative predictors of suboptimal debulking in advanced epithelial ovarian cancer
Authors: Rajanbabu Anupama , Bagul Kiran ,   Venkatesan
Published: February 2021

Introduction: In advanced epithelial ovarian cancer, there is a survival benefit for patients who achieve optimalcytoreduction. Suboptimallycytoreduced patients are at risk of the increased morbidity of a surgery without associated survival benefit. Predicting which patients can undergo optimal cytoreduction represents a critical decision-making point. Present study analyses the predictors, pre operative (clinical and radiologic) and intraoperative of suboptimal debulking.
Methods: This was a prospective observational study conducted at Amrita Institute of Medical Sciences from March 2013 to May 2015. All the patients with clinically (physical examination, laboratory and imaging results) diagnosed Stage IIIc epithelial ovarian, fallopian tube, or primary peritoneal carcinoma (PPC) who were planed for primary debulking surgery were included. The demographic data and details of tumor markers, radiological investigations including CT scan, intra operative findings and histopathologic details were collected. Statistical analysis was done using SPSS v20.0.
Results: 36 patients fit the inclusion criteria. Gross ascites wasthe clinical parameter found to be associated with suboptimal debulking. CT scan had low sensitivity (35-53%) in diagnosing small bowel mesenteric and porta hepatis disease and high sensitivity in diagnosing diffuse peritoneal thickening, omental disease, diaphragmatic and nodal disease. On univariate analysis diffuse peritoneal thickening and small bowel serosa and mesenteric disease were significantly consistent with sub optimal debulking.
Conclusion: Finding out disease at the sites which are associated with suboptimal debulking (diffuse peritoneal thickening, smallbowel mesenteric and serosal disease) pre operatively or at the beginning of surgery can predict optimal debulking and can help avoid un necessary surgery.
Modified posterior pelvic exenteration and rectosigmoid anastomosis for advance epithelial ovarian cancer: A safe cytoreductive procedure
Authors: Bora Rashmi Rekha 
Published: February 2021

Introduction: Surgery plays an important role in the management of advanced stage ovarian cancer and is complex involving surgical procedures including peritonectomy, splenectomy, diaphragmatic stripping, retroperitoneal lymph node dissection and bowel resection including resection of recto-sigmoid.
Objective: To assess the safety and efficacy of the patients undergoing modified posterior pelvic exenteration and rectosigmoid anastomosis achieving in optimal cytoreduction.
Methods: Between June 2011 and June 2014 a total of 100 patients underwent surgical cytoreduction for advanced epithelial ovarian cancer of which 20 patients had undergone modified posterior pelvic exenteration with rectosigmoid anastomosis. The present study includes a retrospective analysis of these 20 patients. Rectosigmoid anastomosis was done using circular stapler in these patients. All patients had a PS score of 1 or 2.
Results: The median age of patients was 50 years. The optimal status of no macroscopic residual disease was achieved in all patients. Modified posterior pelvic exenteration with rectosigmoid anastomosis was carried out to achieve optimal status of surgical cytoreduction in 20 patients out of which fifteen patients had primary surgical cytoreduction, three patients had interval surgical cytoreduction surgery after receiving three cycles of neoadjuvant chemotherapy with paclitaxel & carboplatin while two patients had this procedure as a part of secondary surgical cytoreduction. The most common histology was papillary serous carcinoma. Average blood loss was 500 ml. Mean operative time was 6 hours. There were no intra operative complications. Bowel movements returned to normal in 3 to 5 days. The median length of hospital stay was 7 days. The median time to start postoperative chemotherapy was 32 days. There was no major morbidity and mortality.
Conclusion: Modified posterior pelvic exenteration with rectosigmoid anastomosis should be performed when indicated as a part of cytoreduction. In our experience this is a safe and effective procedure to achieve optimal status in advanced ovarian cancer.
Multiple recurrence of granulosa cell tumor of the ovary: A case report and literature review
Authors: Chandra Varkha , Jain Sandhya , Goel Neerja , Gupta Bindia , Rajaram Shalini 
Published: February 2021

Introduction: Granulosa cell tumors comprise approximately 5% of all ovarian malignancy and account for 70% of malignant sex cord stromal tumors. Granulosa cell tumors have been diagnosed from infancy, the peak incidence being perimenopausal age. The potential of malignancy of these tumors is low, recurrences are often late and found in 10-33% of cases.
Case Report: A 32-year-old P1L1 presented with large abdominal mass for which she underwent staging laparotomy with debulking surgery. She was a known case of granulosa cell tumor in the past and had undergone three laparotomies, along with chemotherapy. At the age of 13 years, she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. She underwent surgical staging and removal of left sided adnexal mass, after which she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy, patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. At that time, she received 6 cycles of chemotherapy and the mass regressed. Meanwhile she got married and had one child. After four year in 2010 she again presented with lump abdomen and she underwent surgical staging, total abdominal hysterectomy with right salphingo ophorectomy along with removal of mass. After five year in 2015 she again presented with lump abdomen; there was a large pelvic mass which was removed and patient referred for chemotherapy.
Discussion: GCTS which a rare malignant tumors of ovary tend to be associated with late recurrences. Although most recurrences occurs within 10 years after initial diagnosis, there are occasional reports of recurrences after10 years. We experienced the rare case of a patient who relapsed multiple times over 20 years, despite surgical and targeted treatment. In conclusion the long history of granulosa cell tumor highlights the importance of extended follow up of the patient.
Role of IL-6 and VEGF in epithelial ovarian cancer
Authors: Dalal Venus 
Published: February 2021

Introduction: Over the last two decades there is a trend toward increasing incidence of ovarian cancer cases. CA-125 and some other tumor markers are known to have prognostic importance. Some cytokines have also been studied for their role in prognosis; IL-6 and VEGF are among them. It is hypothesized that these cytokines might affect the clinical progression of patients with ovarian cancer.
Aim and Objectives: To measure and correlate the effect of levels of IL-6 and VEGF in ascitic fluid on presentation, treatment response and outcome in patients with epithelial carcinoma ovary and to determine whether levels of IL-6 significantly correlate with progression-free survival.
Materials and Methods: Thirty patients with epithelial ovarian carcinoma and 15 patients who were undergoing hysterectomy for benign condition were recruited. Once patients found fit for study, they were taken up for primary debulking surgery. Ascitic fluid was collected and sent for measuring IL 6 and VEGF levels. Peritoneal washings taken from patients posted for total abdominal hysterectomy for benign pathology was used as control to achieve the values of IL-6 and VEGF in the study population. Patients were followed up for 1 year after surgery with ultrasound abdomen and pelvis and serum CA 125 levels.
Results: Median value of IL-6 in ascetic fluid was 8563.18 pg/ml in EOC cases and 17 pg/ml in benign pathology group and of VEGF was 6090.35 pg/ml and 34.01 pg/ml, which were found to be significantly higher in cases compared to control group (p = 0.0001). Levels of VEGF was significantly higher in patients with positive ascitic fluid cytology (p = 0.009) and ascitic fluid volume >1L (p = 0.021). Correlation of VEGF and IL6 levels with other prognostic was not statistically significant. Levels of IL-6 and VEGF in ascitic fluid did not correlate statistically with survival time or with recurrence (p = 0.651).
Conclusion: Levels of VEGF in ascitic fluid were found to correlate with ascitic fluid cytology and volume but not with FIGO stage, histological grade, histological type, tumor size, residual tumor, CA 125 levels, chemotherapy response, presentation and with overall outcome and survival time. None of the above mentioned prognostic factors were found to correlate with levels of IL-6 in ascitic fluid.
Clinicopathological review of epithelial ovarian tumors in young females and reproductive and survival outcome: Ten years expierence from a tertiary center
Authors: Lata Kusum , Agarwal Nutan , Bhatla Neerja , Kriplani Alka 
Published: February 2021

Objective: To find out the prevalence of epithelial ovarian tumors in young females and correlation with reproductive and survival outcome.
Design: Retrospective study.
Setting: Tertiary referral hospital.
Methods: A retrospective analysis of females from 9-35 year of age group treated for ovarian tumors between January 2003 to July 2013 was performed. Variables studied included age, presenting symptoms, imaging, tumor markers, surgical findings, type of surgery, histopathology reports and follow-up.
Main Outcome Measures: Histopathological variant, FIGO stage, reproductive and survival outcome.
Results: A total of 155 patients were found to have ovarian tumors. Mean age at time of diagnosis was 24.9 ± 1.8 years (range 9-35). Clinical presentation in majority of the cases was abdominal pain in 68 (43.8%), ascites in 13 (8.3%) mass in abdomen in 25 (16%), followed by irregular menstrual cycles in 15 (9.6%), infertility in 18 (11.6%) 12 (7.7%) were found to be incidental on ultrasound examination while 4 women were found to have virilising symptoms. There were 76 (49.1%) cases of epithelial ovarian tumors, 6 (0.03%) of borderline tumors and 30 (19.3%) were of malignant ovarian tumors while 40 (25.8%) were benign. Stage IA (N = 80), Stage I 8 (n = 2), Stage III (N = 6) and Stage IV (N = 12). Females were further subdivided into three age groups 9-15 years, 15-25 years and 25 to 35 years for determining outcome of epitheliail tumors. Reproductive and survival outcome were studied in each stage.
Conclusions: Limited data exists about the histological type distribution, surgical treatment and overall survival of epithelial ovarian tumors in women aged below 35 years. Young patients have higher overall progression-free survival and a better clinical outcome than older patients. Any women presenting with pain and nonspecific symptoms should be investigated and evaluated properly.
Study of efficacy and safety of adjuvant intraperitoneal chemotherapy in carcinoma ovary
Authors: Goel Varun , Singh Sajjan , Talwar Vineet , Goyal Pankaj , Upadhyay Amitabh ,   Prashant
Published: February 2021

Background: The benefit of administering chemotherapy directly into the peritoneal cavity is supported by preclinical, clinical and pharmacokinetic data. In view of paucity of data from the Indian subcontinent, we decided to study the response and tolerability of intraperitoneal (I/P) chemotherapy in carcinoma ovary in Indian population.
Methods: In this observational study, from March 2013 to June 2015, the efficacy and tolerability of adjuvant I/P chemotherapy in optimally cytoreduced stage III epithelial ovarian cancer patients were assessed. Treatment consisted of 135 mg/m2 of i.v. paclitaxel over a 3-hours period on day 1 followed by AUC 5 carboplatin i.v. on day 2 and 60 mg/m2 of i.p. paclitaxel on day 8 every 3 weekly for six cycles.
Results: Total 50 patients were enrolled. The median age of patients was 53 yrs (32 yrs – 67 yrs). Out of a total of 240 I/P cycles, 225 cycles (93%) were completed. 30 patients (75%) received all the 6 cycles by IP route, 6 patients completed 5, 3 patients completed 4 cycles and 1 completed 3 I/P cycles. 4 Out of 30 patients who completed all 6 cycles of I/P chemotherapy, had one or more adjustment including delay while in 3 patients (7.5%) dose had to be reduced. after median follow up of 14 months, 8 patients (12.5%) had local or systemic recurrence, 2 patients (5%) had progression during treatment and died due to disease. median progression free survival not reached yet. One patients had vaginal leak. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. 6 patients had severe abdominal pain and cramp (grade 3) after infusion of saline. Hematologic toxicity was evaluated in all patients and in all cycles. Grade 3 or 4 Leucopenia was experienced by 25 patients (50%) but Febrile Neutropenia occurred in only 5 (10%) patients. Grade 3 or 4 anemia occurred in 17 (42.5%) and grade 3 or 4 thrombocytopenia was experienced by 6 patients (15%). Renal complication present in 3 patients (7.5%) and transient transfusion reaction developed in 5 patients. mucositis present in 21 patients.
Conclusions: Adjuvant I/P chemotherapy in optimally cytoreduced epithelial ovarian cancer is active and well tolerated in Indian patients.
To assess the role of addition of bevacizumab therapy to carboplatin and paclitaxel as frontline treatment of epithelial ovarian cancer
Authors: Vatsa Richa , Kumar Sunesh , Kumar Lalit 
Published: February 2021

Introduction: Efforts are going on for development of new drugs for epithelial ovarian cancer (EOC). We assessed safety profile of bevacizumab, a VEGF receptor blocking antibody in treatment of EOC.
Methods: We assigned women with EOC to carboplatin (area under curve, 5 or 6) and paclitaxel (175 mg/square meter of body-surface area), given every 3 weeks for 6 cycles, or to this regimen plus bevacizumab (15 mg/kilogram body weight), given concurrently every 3 weeks for 5 or 6 cycles and continued for 30 additional cycles. Primary outcome measures was safety profile of bevacizumab and secondary outcome was to see progression free survival (PFS).
Results: Out of 30 patients, 10 were in Bevacizuma arm (Arm A) and 20 in conventional chemotherapy arm (Arm B). Haematological toxicity, GI perforation and proteinuria was similar in both. Other toxicities e.g. bleeding complication (p = 0.002) and hypertension (p = 0.04) was more in Arm A. PFS was similar in both arms; 24 months in Arm A and 22 months in Arm B (p = 0.565). 4 (40%) patients in arm A discontinued treatment, two (20%) because of disease progression after PFS of 9 and 6 months, two because of development of toxicity considered to be due to bevacizumab; of which one developed jejenal perforation and disease progression after PFS of 6 months and 1 because of development of persistent proteinuria of grade 3 after 18 months.
Conclusion: Bevacizumab therapy does not improve PFS in EOC but increases toxicity spectrum of chemotherapy.
Two interesting cases of granulosa cell tumor: A case report
Authors: Savita Pannu , Harsha Khullar 
Published: February 2021

Introduction: Granulosa cell tumor (GCT) is an ovarian malignancy that arise from granulosa cells of the ovary. This tumour is a type of the sex cord-gonadal stromal tumour. GCT have good prognosis in comparison with other epithelial tumors.
Methodology: Two cases of granulosa cell tumors were diagnosed in sir Ganga ram hospital, Rajender Nagar, New Delhi in December 2015 and January 2016. The patient’s age, clinical manifestations, radiological and histopathological findings were evaluated. One was in perimenopausal age group and other case was in postmenopausal age group. The clinical manifestations were menorrhagia and abdominal pain. Ultrasonographically, in one case focal hypoechoic zone showing peripheral hypervascularity with possibility of old hemorrhage follicular cyst was seen and in other case of granulosa cell tumors was both solid and cystic areas were seen. Histologically, variety of patterns like diffuse, trabecular, nodular, sheets, nests and fascicular patterns with nuclear grooving in ovarian tissue. In addition endometrial findings were suggestive of simple hyperplasia without atypia. Treatment modalility used was surgery i.e. Total hysterectomy and bilateral salpingo-oophorectomy in both cases.
Conclusion: Granulosa cell tumor of the ovary is a rare ovarian malignancy. Endometrial pathology to rule out endometrial carcinoma specially when postmenopausal bleeding is concomitant finding is advised. Radical surgery is usually not required.
Neoadjuvant chemotherapy in epithelial ovarian cancer: Largest single institute experience
Authors: Kumar Siva 
Published: February 2021

Purpose: Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) is an alternative treatment option, compared to the current standard of care primary debulking surgery for treating advanced epithelial ovarian cancer (EOC). We present our institute experience of neoadjuvant chemotherapy strategy in the management of EOC which is one of the largest single institute experience.
Methods: This is a retrospective analysis of patients with epithelial ovarian cancer who were treated in our institute between 2000 and 2006. Patient with advanced disease by clinical and imaging were treated with 3 cycles of neoadjuvant chemotherapy and then taken up for interval debulking surgery (IDS) who had static or partial or complete response to chemotherapy. The remaining chemotherapy is delivered after the surgery. Patient who had limited disease had primary debulking surgery and then adjuvant chemotherapy according to institute protocol. Outcomes in terms of disease free and overall survival were analysed.
Results: This retrospective analysis included 59 patients with limited disease who had primary debulking surgery and 283 patients with advanced disease who received neoadjuvant chemotherapy. The median age was 50 years and majority are in the 50-59 years age group. Age more than 60 years represent 14.5%. Postmenopausal women were55.3 % and premenopausal women were 44.7 %. Multiparity is higher 70.2% than the uniparity 16.4% ornulliparity 11.7%. Abdomen distension 42% and pain 25 % are the most common symptoms. Advanced stage was the most common presentation 71% with stage III-56.1% and stage IV-14.9%. Among the neoadjuvant chemotherapy group 126/283(44.5%) had optimal cytoreduction, 44/283 (15.5%) had suboptimal cytoreduction and 113/283 (40%) not suitable for IDS. The 5 year disease free and overall survival was 30.8% and 41.5% in the NACT group with advanced disease and 58.5% and 75.8% in the primary cytoreduction group who had limited diseaserespectively. The 5 years overall survival among the IDS group with optimal cytoreduction was 57.1% and 11.7% for the suboptimal cytoreduction group. The 5 years survival was not affected by the number of neoadjuvant chemotherapy cycles delivered before surgery in the IDS group. Patient who received paclitaxol + carboplatin as first line chemotherapy had better survival than carboplatin alone or cyclophosphamide + cisplatin.
Conclusion: NACT as an alternative option to primary debulking surgery in operable EOC is still debatable. But for patient with high disease burden where optimal cytoreduction is not possible NACT strategy is a valid option. Recent randomised controlled trials from Europe had shown the noninferiority of neoadjuvant chemotherapy followed by IDS when compared to the primary debulking surgery in operable advanced EOC.
Malignant ovarian germ cell tumors in children: A single centre experience
Authors: Soni Priyanka , Mishra Shalini , Jain Sandeep , Kapoor Gauri 
Published: February 2021

Background: Germ-cell tumors (GCT) are the commonest ovarian neoplasm in the first two decades of life.
Aim: To study the profile of ovarian GCT in children and their outcome.
Methods: Retrospective study of all cases of malignant ovarian GCT in the pediatric age (up to 18 years) was done from January 2002 to December 2015. The medical records of all admitted cases during this period were reviewed and the data was analysed with respect to age at diagnosis, clinical presentation, tumor markers, surgical stage, tumor histology, therapy, clinical course, and outcome.
Results: Girls with malignant ovarian GCT were seen at our institute during the study period. Out of these 25 underwent treatment. Mean age at presentation was 11.7 years (range: 3-18 years). Abdominal pain was the commonest presentation. Twelve (47.3%) had right sided disease, 11 (42%) had left sided disease and 2 had bilateral disease. Twelve cases (57.8%) were diagnosed as stage I disease, 5 (10.5%) as stage II, 7 (26.3%) as stage III and 1 (5.2%) as stage IV. Elevated AFP >1000 was found in 9 (47.3%), elevated B-HCG (>50) in 7 (42%) and elevated LDH (>1000) in 7 (36.8%) patients at presentation. Twenty (73.6%) patients underwent surgery prior to chemotherapy out of which 4 (21%) patients presented after undergoing surgery at other centre. Fourteen (57.8%) patients received 4 cycles of BEP based chemotherapy, 6 (21%) received 3 cycles, 2 (10.5%) received 2 cycles and 1 patient did not receive any chemotherapy as it was mature teratoma. The most common histology was dysgerminoma in 8 (42%) patients followed by mixed germ cell tumor in 4 (21%), teratoma in 3 (15.7%), embryonal carcinoma in 2 (10.5%) and yolk sac tumor and mature teratoma in 1 patient each. Four (21%) patients had relapse on contralateral side which was salvaged. 1 patient presented with relapse who underwent only surgery outside, 1 patient had ovarian torsion. Median follow up is 27months. The event free survival rate was 78.9%.
Conclusion: This study confirms an excellent outcome for girls with ovarian germ cell tumor. Patients with advanced surgical stage relapsed frequently. The mainstay of treatment is fertility preserving surgery and cisplatin-based chemotherapy.