Showing papers by "Neerja Bhatla published in 2011"

Asia Oceania Guidelines for the Implementation of Programs for Cervical Cancer Prevention and Control

Abstract: This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed.

Clinical outcome of patients with uterine sarcomas

Abstract: Purpose: The aim of our retrospective analysis was to study and report the clinical outcome of patients with uterine sarcoma (US) treated at our center; and to share our experience with literature. Materials and Methods: We retrieved the information regarding the patient's demography, clinico-pathological details, treatment given, survival, and complications of all the US patients treated at our center between the years 2000-2008. The three-year overall survival (OS) was determined with respect to various prognostic factors like age, stage of disease, histopathological type, adjuvant RT etc. Results: A total of 50 case records were retrieved for this retrospective analysis. Age ranged from 24 to 75 years with a median of 50 years. Carcinosarcoma was the commonest histopathological type (23/50 patients). FIGO stage distribution was: stage I, 27; stage II, 7; stage III, 12; stage IV, 2; and unknown stage, two patients. Forty-eight patients underwent surgery; 31 received postoperative radiation therapy (PORT) and 16 received chemotherapy therapy. Median follow-up period was 34 months (range 2-69 months). The three-year OS for the entire group of patients was 42%. Stage of the disease, histopathological type, and use of PORT were found significant prognostic factors for survival. Conclusion: Although limited by small sample size and retrospective nature, ours is the only study on US being reported from India. Our results have demonstrated FIGO stage of the disease, histopathology and use of PORT to be the significant prognostic factor for survival. Use of chemotherapy in future trials is warranted.

Postoperative radiotherapy following inadvertent simple hysterectomy versus radical hysterectomy for cervical carcinoma.

Abstract: Purpose: For cervical carcinoma, postoperative radiation therapy (PORT) following radical hysterectomy (RH) is indicated for certain adverse pathological factors. Simple hysterectomy (SH) is considered inadequate treatment for invasive cervical carcinoma and PORT is required for all such cases. Clinical outcome of patients receiving PORT following SH and RH may be different. The aim of our retrospective study is to compare the results of PORT following inadvertent SH or RH in cervical carcinoma. Materials and Methods: During year s2003-2005, we treated 83 patients with cervical carcinoma with PORT following either SH (Group SH, 33 patients) or RH (Group RH, 50 patients). All patients were treated with pelvic external beam radiation therapy (EBRT) followed by intravaginal brachytherapy (IVBT). The endpoints of the study were local control, recurrence free survival (RFS) and delayed complications. Results: Median follow period up was 34 months (range 2-75 months). Local control rate observed in Gp SH and RH was 70% and 88% respectively with a p value of <0.05. Cumulative 5-year overall survival (OS) for combined group was 62%. Group RH patients had significantly better 5-year RFS than Group SH patients (72% and 49% respectively; p value 0.04). The frequency of Grade III-IV toxicity (bladder, rectum, and bowel) in Group SH versus Group RH was 6% vs 8% respectively (p value 0.1). The pedal lymph edema was higher in Group RH patients (10% vs 3%, p value <0.05). Conclusion: PORT provides greater clinical benefit in patients who had undergone RH than SH for early stage invasive cervical carcinoma.

Invasive carcinoma of cervix during pregnancy--a case report and review of literature.

Abstract: Carcinoma of cervix is the commonest malignancy seen in Indian women in all age groups and therefore commonly seen in pregnancy. However, most of the cases remain in early stage and the occurrence of invasive cervical carcinoma is relatively uncommon in pregnant women. There is always a therapeutic dilemma faced by the gynaecologic oncologist and the maternal foetal specialist regarding management of pregnancy with cervical malignancy. A 30 years old, multiparous woman diagnosed to have squamous cell carcinoma of the cervix FIGO stage IB1 in the early second trimester was treated by radical hysterectomy followed by radiotherapy is being reported. The various therapeutic options and prognosis are discussed.