International Journal of Radiation Oncology Biology Physics, 2005
Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patient... more Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix. Methods and Materials: Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions. Results: The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, diseasefree survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine. Conclusions: Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity.
In 2008, >85% of the 5,30,000 global new cervical cancer cases and about 88% of 275000 deaths occ... more In 2008, >85% of the 5,30,000 global new cervical cancer cases and about 88% of 275000 deaths occurred in resourceconstrained developing countries . Maternal, newborn, and child mortality, along with a broad array of vaccinepreventable and other communicable diseases, also remain urgent concerns in these less developed regions of the world [2]. Cervical cancer, although a chronic disease of sexually active women, is the product of infection, poor hygiene, poverty, high parity and malnutrition . Approximately 40 of more than 150 human papillomavirus (HPV) types identified can infect uterine cervix after (co-)transmission through sexual contact. HPV is a not only leading but also un-recognized sexually transmitted disease as vast majority of sexually active women and men have been infected with HPV at least once in their lifetime without any specific discern signs and symptoms and most of these infections clear spontaneously within few years time. However, persistent infections with one of approximately 14 carcinogenic (high-risk) HPV types are responsible for nearly all cases of cervical cancer. Most of these high-risk types are phylogenetically related to either HPV 16 (31, 33, 35, 52, and 58) or HPV 18 (39, 45, 59, and 68) [5].
International Journal of Radiation Oncology Biology Physics, 2005
Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patient... more Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix. Methods and Materials: Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions. Results: The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, diseasefree survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine. Conclusions: Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity.
In 2008, >85% of the 5,30,000 global new cervical cancer cases and about 88% of 275000 deaths occ... more In 2008, >85% of the 5,30,000 global new cervical cancer cases and about 88% of 275000 deaths occurred in resourceconstrained developing countries . Maternal, newborn, and child mortality, along with a broad array of vaccinepreventable and other communicable diseases, also remain urgent concerns in these less developed regions of the world [2]. Cervical cancer, although a chronic disease of sexually active women, is the product of infection, poor hygiene, poverty, high parity and malnutrition . Approximately 40 of more than 150 human papillomavirus (HPV) types identified can infect uterine cervix after (co-)transmission through sexual contact. HPV is a not only leading but also un-recognized sexually transmitted disease as vast majority of sexually active women and men have been infected with HPV at least once in their lifetime without any specific discern signs and symptoms and most of these infections clear spontaneously within few years time. However, persistent infections with one of approximately 14 carcinogenic (high-risk) HPV types are responsible for nearly all cases of cervical cancer. Most of these high-risk types are phylogenetically related to either HPV 16 (31, 33, 35, 52, and 58) or HPV 18 (39, 45, 59, and 68) [5].
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Papers by Ramaiah Kumar