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Article ; Online: Demographic and clinical profile of 1106 adult soft tissue sarcoma patients: A single institutional prospective database experience from India.

Sharma, Jyoti / Deo, Surya V S / Kumar, Sunil / Bhoriwal, Sandeep / Kar, Madhabananda / Barwad, Adarsh W / Thulkar, Sanjay / Bakhshi, Sameer / Sharma, D N

Asia-Pacific journal of clinical oncology

2024

Abstract: Background: Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low-middle-income countries. This is our ... ...

Abstract	Background: Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low-middle-income countries. This is our experience managing adult sarcomas in the tertiary cancer center of North India. Materials and methods: This is a retrospective analysis of the structured sarcoma database of patients treated in the surgical oncology department between 1992 and 2020. The descriptive analysis includes demography, site distribution, diagnosis, histopathology variations, prior surgical interventions, and stage. Results: A total of 1106 soft tissue sarcoma patients were treated in three decades. Age distribution was 13%, 43%, 31%, and 11% in <20, 21-40, and 41-60 and >60 years, respectively. The male-to-female ratio was 1.73. The anatomical distribution was 17%, 42%, 23%, 7%, 7%, and 3% in upper extremity, lower extremity, trunk, retroperitoneum, head and neck, and viscera, respectively. Overall, 49% of patients had undergone prior suboptimal surgeries at community hospitals. Common histology subtypes were synovial sarcoma (18%), undifferentiated pleomorphic sarcoma (UPS) (13%), dermatofibrosarcoma protuberans (12%), and liposarcoma (9%). A pathological discordance of 13% was identified between the initial and the final histologies. Overall, 61% of tumors were high-grade. Memorial Sloan Kettering Stages II and III were present in 33% and 35% of patients, respectively. Conclusions: This is one of the largest single institutional experiences of STS from the Asian population. Mostly young adults were affected with male preponderance. The lower extremity and trunk were common subsites. Frequent histologies were synovial sarcoma and UPS. A high rate of suboptimal surgical intervention at the community level and pathological discordance was noted. This study highlights the need to establish prospective structured databases for capturing quality information related to rare malignancies and providing insights for future research.
Language	English
Publishing date	2024-02-21
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2187409-8
ISSN	1743-7563 ; 1743-7555
ISSN (online)	1743-7563
ISSN	1743-7555
DOI	10.1111/ajco.14050
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Article ; Online: Nodal metastasis of cervix carcinoma- As a probable cause of bone erosion.

Sethi, Sonal / Ramalingam, Vidyasagar / Yadav, Mukesh / Thulkar, Sanjay

Journal of cancer research and therapeutics

2020 Volume 15, Issue 6, Page(s) 1260–1264

Abstract: Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases ... ...

Abstract	Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and design: Retrospective study. Materials and methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix.
MeSH term(s)	Biopsy ; Bone Neoplasms/diagnosis ; Bone Neoplasms/secondary ; Combined Modality Therapy/psychology ; Female ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Neoplasm Invasiveness ; Pelvis/pathology ; Recurrence ; Tomography, X-Ray Computed ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnostic imaging ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Neoplasms/therapy
Language	English
Publishing date	2020-01-03
Publishing country	India
Document type	Journal Article
ZDB-ID	2187633-2
ISSN	1998-4138 ; 0973-1482
ISSN (online)	1998-4138
ISSN	0973-1482
DOI	10.4103/jcrt.JCRT_374_18
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Article ; Online: Treatment outcomes in patients with Ewing sarcoma of the spine in a resource-challenged setting: 17-year experience from a single center in India.

Sasi, Archana / Chitikela, Sindhura / Ganguly, Shuvadeep / Biswas, Bivas / Pushpam, Deepam / Kumar, Akash / Khan, Shah Alam / Kumar, Venkatesan Sampath / Kale, Shashank Sharad / Biswas, Ahitagni / Barwad, Adarsh / Mridha, Asit Ranjan / Thulkar, Sanjay / Bakhshi, Sameer

Pediatric hematology and oncology

2024 Volume 41, Issue 3, Page(s) 211–223

Abstract: Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged ... ...

Abstract	Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged setting. We conducted a retrospective analysis of patients with spinal ES registered at a tertiary care oncology center between 2003-2019. Clinical patient data was retrieved from hospital records. Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS). A cohort of 85 patients was analyzed including 38 (45%) patients with metastatic disease. The median age was 15 years with 73% being male. Local therapy was administered in 62 (72.9%) patients with surgery alone in 8 (9.4%), radiotherapy alone in 36 (42.4%) and both in 18 (21.2%) patients. A higher proportion of males received local therapy than females (80.3% versus 59.1%;
MeSH term(s)	Humans ; Male ; Female ; Child ; Adolescent ; Sarcoma, Ewing/drug therapy ; Retrospective Studies ; Hypoalbuminemia ; Prognosis ; Treatment Outcome ; Bone Neoplasms/drug therapy
Language	English
Publishing date	2024-01-08
Publishing country	England
Document type	Journal Article
ZDB-ID	632914-7
ISSN	1521-0669 ; 0888-0018
ISSN (online)	1521-0669
ISSN	0888-0018
DOI	10.1080/08880018.2023.2296949
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Article ; Online: ASO Author Reflections: Malignant Chest Wall Tumors: Chasing the Challenges.

Sharma, Jyoti / Deo, S V S / Kumar, Sunil / Bhoriwal, Sandeep / Kumar, Naveen / Saikia, Jyoutishman / Bhatnagar, Sushma / Mishra, Seema / Bharti, Sachidanand / Thulkar, Sanjay / Sharma, D N / Bakhshi, Sameer

Annals of surgical oncology

2024 Volume 31, Issue 4, Page(s) 2793

MeSH term(s)	Humans ; Thoracic Wall ; Neuroendocrine Tumors ; Thoracic Neoplasms/therapy
Language	English
Publishing date	2024-01-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-14882-6
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Article: Ultrasonographic assessment of airway.

Jain, Kinshuki / Yadav, Mukesh / Gupta, Nishkarsh / Thulkar, Sanjay / Bhatnagar, Sushma

Journal of anaesthesiology, clinical pharmacology

2020 Volume 36, Issue 1, Page(s) 5–12

Abstract: Ultrasound is gaining increasing popularity among anesthesiologists as it is readily available and provides real-time imaging for various procedures. It is considered as a "visual stethoscope" of the anesthesiologist. After establishing its use in ... ...

Abstract	Ultrasound is gaining increasing popularity among anesthesiologists as it is readily available and provides real-time imaging for various procedures. It is considered as a "visual stethoscope" of the anesthesiologist. After establishing its use in regional blocks and central venous catheter insertion, it is now finding increasing use in anticipation of difficult airway and securing and maintaining it. It has challenged the classical approach of clinical assessment of airway and allows more dynamic bedside assessment. This article attempts to briefly outline the role of ultrasound and its applications for airway management in patients.
Language	English
Publishing date	2020-02-18
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	1401760-x
ISSN	0970-9185
ISSN	0970-9185
DOI	10.4103/joacp.JOACP_319_18
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Article: Oncologic and reproductive outcomes of borderline ovarian tumors in Indian population.

Kumari, Sarita / Kumar, Sunesh / Bhatla, Neerja / Mathur, Sandeep / Thulkar, Sanjay / Kumar, Lalit

Gynecologic oncology reports

2021 Volume 36, Page(s) 100756

Abstract: Borderline ovarian tumor (BOT) is characterized by atypical epithelial proliferation without stromal invasion and majority are diagnosed at early stages and in women of reproductive age group. A retrospective review of medical records of patients ... ...

Abstract	Borderline ovarian tumor (BOT) is characterized by atypical epithelial proliferation without stromal invasion and majority are diagnosed at early stages and in women of reproductive age group. A retrospective review of medical records of patients diagnosed with BOT and on regular follow up at All India Institute of Medical Sciences New Delhi, during a five-year study period from March 2014 to March 2019 was performed. Surgical treatment was classified as radical, fertility sparing surgery (FSS) or cystectomy. Surgical staging was defined as complete, partial or unstaged. Median age of seventy-five women was 32 years. Follow up period ranged from 22 to 61 months (median 36 m). Radical surgery was done in 34 (45.3%), FSS in 32 (42.6%) and cystectomy in 9 (12.0%) women. Complete surgical staging was performed in 22 (29.3%), partial staging in 23 (30.6%) and 30 (40%) were unstaged. During the follow up period, 98.7% patients were alive and 90.7% were free of recurrence. Median time to recurrence was 35 months. Recurrence rate was 33.3% in cystectomy vs 6.2% in oophorectomy (p = 0.03). All seven recurrences were in unstaged (six) or partially staged patient (one). Six recurrences in ovary were salvaged by surgery and recurrent disease was of borderline histology. Spontaneous conception and live birth rate was 42.1%. FSS is a safe procedure and should be considered in a young patient with early stage disease and desirous of future fertility. Spontaneous conception and live birth rates after fertility sparing surgery in patients with BOT are modest.
Language	English
Publishing date	2021-03-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2021.100756
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Article ; Online: Modified Protocol of Nivolumab in Relapsed/Refractory Hodgkin Lymphoma: A Brief Communication of Real World Data.

Pathak, Neha / Pramanik, Raja / Bakhshi, Sameer / Kumar, Akash / Sharma, Mehar C / Shamim, Shamim A / Kumar, Sudhir / Thulkar, Sanjay / Sharma, Atul

Journal of immunotherapy (Hagerstown, Md. : 1997)

2022 Volume 45, Issue 5, Page(s) 239–242

Abstract: Immune check point inhibitors such as nivolumab are changing the treatment paradigm of relapsed/refractory Hodgkin lymphoma (r/rHL). Data from single arm studies have shown nivolumab to be an effective and safe therapy. Real world data from resource ... ...

Abstract	Immune check point inhibitors such as nivolumab are changing the treatment paradigm of relapsed/refractory Hodgkin lymphoma (r/rHL). Data from single arm studies have shown nivolumab to be an effective and safe therapy. Real world data from resource constrained settings are limited. Our study is a retrospective single center analysis of nivolumab in r/rHL from India. Data regarding baseline and pretreatment characteristics were collected for 20 patients treated with nivolumab from January 2016 to March 2021. Of 20, 15 patients received nivolumab in modified protocol, because of financial limitations. Postnivolumab therapy, the overall response rate was 90%, with 40% in complete remission. The median progression free survival was 13.1 month (95% confidence interval 8.33 mo, not reached) and median overall survival not reached, at a follow up of 24.3 months. No patients discontinued nivolumab because of side effects. Univariate and multivariate analysis showed no effect of dose reduction or increased duration of administration. Most common adverse effect seen was autoimmune hypothyroidism. Possible delayed immune-related side effects were seen in 3 out 5 patients in peritransplant period, in those who received nivolumab as salvage regimen before autologous stem cell transplant. In conclusion, nivolumab shows comparable efficacy and safety even with compromised dosing and schedule of administration of the drug in real world setting.
MeSH term(s)	Communication ; Drug-Related Side Effects and Adverse Reactions/drug therapy ; Hodgkin Disease/drug therapy ; Humans ; Immunoconjugates/therapeutic use ; Nivolumab/adverse effects ; Retrospective Studies
Chemical Substances	Immunoconjugates ; Nivolumab (31YO63LBSN)
Language	English
Publishing date	2022-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1064067-8
ISSN	1537-4513 ; 1053-8550 ; 1524-9557
ISSN (online)	1537-4513
ISSN	1053-8550 ; 1524-9557
DOI	10.1097/CJI.0000000000000411
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Article: Robotic ultrasound: An initial feasibility study.

Chandrashekhara, Sheragaru Hanumanthappa / Rangarajan, Krithika / Agrawal, Ayushi / Thulkar, Sanjay / Gamanagatti, Shivanand / Raina, Deepak / Saha, Subir Kumar / Arora, Chetan

World journal of methodology

2022 Volume 12, Issue 4, Page(s) 274–284

Abstract: Background: Performing ultrasound during the current pandemic time is quite challenging. To reduce the chances of cross-infection and keep healthcare workers safe, a robotic ultrasound system was developed, which can be controlled remotely. It will also ...

Abstract	Background: Performing ultrasound during the current pandemic time is quite challenging. To reduce the chances of cross-infection and keep healthcare workers safe, a robotic ultrasound system was developed, which can be controlled remotely. It will also pave way for broadening the reach of ultrasound in remote distant rural areas as well. Aim: To assess the feasibility of a robotic system in performing abdominal ultrasound and compare it with the conventional ultrasound system. Methods: A total of 21 healthy volunteers were recruited. Ultrasound was performed in two settings, using the robotic arm and conventional hand-held procedure. Images acquired were analyzed by separate radiologists. Results: Our study showed that the robotic arm model was feasible, and the results varied based on the organ imaged. The liver images showed no significant difference. For other organs, the need for repeat imaging was higher in the robotic arm, which could be attributed to the radiologist's learning curve and ability to control the haptic device. The doctor and volunteer surveys also showed significant comfort with acceptance of the technology and they expressed their desire to use it in the future. Conclusion: This study shows that robotic ultrasound is feasible and is the need of the hour during the pandemic.
Language	English
Publishing date	2022-07-20
Publishing country	United States
Document type	Journal Article
ISSN	2222-0682
ISSN	2222-0682
DOI	10.5662/wjm.v12.i4.274
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Article: Patterns of Multimodality Management of Gastric Cancer-Single Institutional Experience of 372 Cases From a Tertiary Care Center in North India.

Kumar, Sunil / Kumar, Naveen / Deo, Suryanarayana / Bhoriwal, Sandeep / Mandal, Amitabha / Sharma, Atul / Pathy, Sushmita / Das, Prasenjit / Thulkar, Sanjay / Bhatnagar, Sushma

Frontiers in oncology

2022 Volume 12, Page(s) 877493

Abstract: Introduction: Worldwide gastric cancer is the 5th most commonly diagnosed cancer and the leading cause of gastrointestinal cancer-related deaths. Alone surgery provides long-term survival improvements in 20% of the patients with local advanced gastric ... ...

Abstract	Introduction: Worldwide gastric cancer is the 5th most commonly diagnosed cancer and the leading cause of gastrointestinal cancer-related deaths. Alone surgery provides long-term survival improvements in 20% of the patients with local advanced gastric cancer. The results can be improved considering multimodal management including chemotherapy and radiotherapy. However, in low middle-income countries like India, multimodal management is challenging. Herein, we evaluated the experience of multimodal management of gastric cancer and the long-term outcome. Methods: Retrospective analysis of the data of 372 patients was done from a prospectively maintained computerized database from 1994 to 2021. Records were analyzed for demographic details, treatment patterns, recurrences, and long-term outcomes (DFS and OS). Statistical analysis was done with the package SPSS version 26 (IBM Corp, Chicago, Illinois, USA). Results: This study included 372 patients. The mean age of the patients was 54.07. A total of 307 patients (82.5%) were operated upfront, 45 (12%) received NACT, and 20 (5.5%) underwent the palliative procedure. A total of 53.2% underwent curative resection. R0 resection rate was achieved in 95% of patients. A total of 72.58% of patients required adjuvant treatment, and the majority of the patients underwent chemoradiotherapy. The most common site of metastasis was the liver. Median follow-up was 50.16 months. The 3-year disease-free survival and overall survival were 36.28% and 67.8%, and the 5-year disease-free survival and overall survival were 30.15% and 37.7%, respectively. Conclusion: Our study suggested that multimodal management is required in locally advanced gastric cancer to achieve good long-term outcomes. The treatment sequence can be tailored based on the available resources.
Language	English
Publishing date	2022-05-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.877493
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Article ; Online: Central nervous system metastasis from epithelial ovarian cancer- predictors of outcome.

Jayraj, Aarthi S / Kumar, Sunesh / Bhatla, Neerja / Malik, Prabhat Singh / Mathur, Sandeep / Rangarajan, Krithika / Vanamail, Perumal / Thulkar, Sanjay / Kumar, Lalit

Current problems in cancer

2022 Volume 47, Issue 1, Page(s) 100918

Abstract: Management of central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) is an unmet need. We analyzed data on 41 such patients to evaluate predictors of outcome. Between January, 2010 and December 2020, among 1028 patients with EOC ... ...

Abstract	Management of central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) is an unmet need. We analyzed data on 41 such patients to evaluate predictors of outcome. Between January, 2010 and December 2020, among 1028 patients with EOC treated at our institute 41 (3.98%) developed CNS metastasis. Median age of patients was 48 years, ranging from 22 to 75 years. Primary outcome measure was progression free survival (PFS). Overall survival (OS), and analysis of prognostic factors were secondary outcome measures. An intention to treat analysis was done. We also performed review the literature (n=2253) as regards to clinicopathological and radiological features, treatment received, survival outcomes and prognostic factors. Median time from diagnosis of EOC to CNS metastasis was 27 months (range: 0 to 101 months). 33(80.5%) patients had FIGO stage III-IV at baseline and serous carcinoma (75.6%) was common pathology subtype. Thirteen (31.7%) patients had isolated CNS metastasis and 28 (68.3%) had intra-abdominal disease in addition. Nineteen (46.3%) patients achieved complete response post treatment with surgery, radiation and chemotherapy. Median PFS and OS from the time of CNS metastasis is 12 (range:1 to 51) months and 33 (range: 1 to 71) months, respectively. Absence of extracranial disease and lower serum CA-125 at diagnosis of CNS metastasis were predictive of superior PFS and OS on multivariate analysis. CNS metastasis is a late event in EOC, post multiple lines of treatment. Patients with disease limited to brain and treated with surgical resection and chemoradiation have best outcome.
MeSH term(s)	Humans ; Female ; Middle Aged ; Carcinoma, Ovarian Epithelial ; Ovarian Neoplasms/pathology ; Prognosis ; Central Nervous System Neoplasms/therapy ; Neoplasm Staging ; Brain
Language	English
Publishing date	2022-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	441816-5
ISSN	1535-6345 ; 0147-0272
ISSN (online)	1535-6345
ISSN	0147-0272
DOI	10.1016/j.currproblcancer.2022.100918
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