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Indian Journal of Medical and Paediatric Oncology
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   1995| June  | Volume 16 | Issue 2  
    Online since May 30, 2009

 
 
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A twelve year study of multiple myeloma at the all india institute of medical sciences, new delhi, india.
P Gupta, V Kochupillai, S Singh, M Berry, L Kumar, KR Sundaram
June 1995, 16(2):108-114
A review of 146 cases records of multiple myeloma at the All India Institute of Medical Sciences, New Delhi, in India, from a period of 12 years revealed a predominance of this disease in younger individuals(mean age 52 years) of male gender(Male:Female ration 2.24:1). Significant anemia(Hb8.5g/dl) at presentation was seen in 40 percent and renal impairment in 37 percent patients. The response rate to a 4 drug combination (Vincristine, melphalan,cyclophosphamide and prenisolone:Group II) was better(73 percent) compared to a 2 drug combination including either cyclophosphamide or melphalann alon with prednisolone:Group I(43 percent:p less than 0.05). The median duration of response and median survival in Group II(12.5 and60 months respectively) however, were not significantly different from those in Group I(17 and 42.7 months respectively). These results support the presence of geographical variations in the clinical characteristics of multiple myeloma; treatment response and survival, however, are not different from those observed elsewhere.
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Sixteen years study of acute lymphoblastic leukemia in adults at all india institute of medical sciences(AIIMS), New delhi.
V Kochupillai, SP Kataria, VK Sharma, S Aggarwal, A Ranganathan, L Kumar, M Bhargava, KR Sundaram, R Singh, S Chander, Kochupillai Vinod
June 1995, 16(2):99-107
This report presents retrospective analysis of 215(median age 21 years; male 75 percent) adult ALL patients alt AIIMS from 1975 to 1991. Pre-treatment characteristics revealed higher proportion of T-ALL(51 percent) mediastinal mass(20 percent), CNS disease(12 percent) and high WBC count of more than 50,000/uul(37 percent). Consistent improvemtn in remission rate as well as 5 year survival over 2 decades coincided with modifications in therapy. With 2 drug induction, inconsisteent CNS prophylaxis and oral maintenance, remission rate of 52 percent and 5 year survival of 17 percent was observed (from 1975-1980). Addition of third drug to induction therapy increased remission rate to 57 percent and 5 year survival to 23 percent(statistically insignificant improvement). Consistent CNS prophylaxis, improvements in support therapy as well as addition of early intensification from 1989 onwards, resulted in remission rate of 90 percent and expected five year survival of 33 percent. Remission duration, however, has remained unchanged. Indian patients though younger in age may be at higher risk of relapse due to high leukemic burden at presentation. Innovative approaches to further improve their outcome are required.
[ABSTRACT]   Full text not available   
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Chemotherapy in ovarian cancer experience at railway cancer institute varanasi.
RC Joshi
June 1995, 16(2):133-135
Ovarian cancer is the third most common cancer among women. We have seen 53 patients with ovarian tumour over four years period. Thirty four(63 percent) patients had FIGO stage III and IV disease. Histopathology subtypes were: epithelial cancer in 89 percent and germ cell tumour of ovary in 11 percent of patients. 35 of 53 patients received cisplatin, cyclophosphamide and doxorubicin(CAP, n=12) or cisplatin and cyclophosphamide(CP,n=9)and cisplatin, bleomycin and vinblastine(PVB, n=2). Twenty three patients were evaluable for response. Twenty patients achieved significant response; complete 13(56 percent) and partial response in 7(30 percent) patients. Nausea/vomiting, alopecia were the main side effects due to chemotherapy. Currently, seven patients are alive, disease-free at a median follow up of 2 years(1-3 years). A longer follow up is required to see the impact of chemotherapy on overall and disease-free survival.
[ABSTRACT]   Full text not available   
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Chemotherapy in malignant germ cell tumors of ovary.
L Kumar, S Kumar, S Kriplani, A Kriplani, N Bhatia, G Kinara, R Dawar
June 1995, 16(2):81-88
Purpose: to evaluate the efficacy of cisplatin based combination chemotherapy in patients with germ cell tumors of ovary. Design: Prospoective, nonrandomized study with end points of tumor response, overall and disease-free survival. Setting: Single Institution based experience. Patients and Methods: Thirty three patients had received chemotherapy for recurrent disease. Histology subtypes were: dysgerminoma-13, immature teratoma-10, endodermal sinus tumor-6, mixed germ cell tumor-3 and choriocarcinoma in one patient. FIGO staging revealed:Stage 1-8,11-3, 111-17 and stage IV in 5 patients. 28 patients received 4 cycles of chemotherapy(PVB, n=19, BEP,n=9) and 5 patients with nonmeasurable disease received 3 cycles of BEP as adjuvant. Results: Overall, 27(82 percent) patients responded; complete(CR)-24(72.7 percent) and partial in 3 patients. Four patients had progressive disease. Two of four patients with recurrent disease achieved CR. The toxicity to PVB was moderate; one patient died due to PVB toxicity. Three patients with CR relapsed, 2 after 4 months and one after 16 months. Two of these 3 patients achieved second CR with alternate chemotherapy and one died of progressive disease. Nine patients were evaluated with second look laparotomy, n=7 or laparoscopy, n=2. The findings were negative in 7, mature teratoma in one and one patient had fibrrotic mass. 16 of 24 completer in 7, mature teratoma in one and one patient had fibrotic mass. 16 of 24 complete responders had preservation of contralateral ovary and uterus. Of these 13 had resumed normal menstruation. Functional ovarian cystt was seen in 4 patients. Three patients who attempted pregnancy, succeded in it; two delivered normal full term babies, another aborted after three months. The Kaplan and meter estimate of cumulative and disease-free survival at 78 months is 66.6 percent +9.1(SD) and 66.6 percent +8.5(SD) respectively. Currently,22 of 33 patients are alive and disease-free. 10 of 13 patientswith dysgerminoma are disease-free. Conclusions: Cisplatin based chemotherapy is effective in the treatment of germ cell tumors of ovary. It is suggested that 4 cycles of chemotherapy delivered over brief period may be adequate and treatment for longer period may not be necessary. The BEP combination is less toxic compared to PVB.
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Combination chemotherapy and radical radiotherapy in stage III b carcinoma of uterine cervix.
R Grover, S Chander, L Kumar, GK Rath, S Kumar, BM Biswal
June 1995, 16(2):127-132
Between May 1993 to May 1994 previously untreated eighty patients with carcinoma of uterine cervix stage III B were randomized to group A, treated by chemotherapy followed by radiotherapy and group B subjected to radiotherapy alone. Out of 40 patients in group A who received chemotherapy complete response(CR) was seen in 8 patients (20 percent) partial response(PR) in 23(57.5 percent) and 7 patients (17.5 percent) had no resonse, remaining 2 patients did not complete treatment. Following chemotherapy 38 patients completed RT as planned which resulted in CR in 26 patients (68.4 percent). Residual disease was present in 10 cases. While 2 patients had progressive disease at 6 weeks after completion of treatment. In the RT group B patients out of 39 evaluable patients 25(64 percent) achieved CR, 12 had residual disease and 2 progressed. Both the regimes were tolerated reasonably well. Patients receiving anterior chemotherapy had nausea, vomiting , pyrexia and alopecia as the more frequent side effects. Two of them developed VVF while on radiotherapy. In group B radiation related proctitis and cystitis were seen in one patient (2 percent).
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Carboplatin for relapsed and resistant acute myeloid leukemia.
PSRK Sastry, SS Kulkarni, M Basade, TK Saikia, R Gopal, CN Nair, PM Parikh, SH Advani
June 1995, 16(2):57-59
Eight patients of replased or resistant acute myeloid leukemia were treated with carboplatin in the dose of 1500 mg/m2 over five days. One patient had a complete response and two had partial response. The duration of response was 4-8 months. The toxicity associated with the treatment was significant but manageable and there were two early deaths. The overall response rate was 37.5 percent. We conclude that intravenous carboplatin in the dose used needs further evaluation in the treatment of acute myeloid leukemia.
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The treatment of advanced nonseminomatous germ cell tumors.
RM Gelfand, SC Gulati, MA Kabat, G Gandhi, S Rafi, R Glassman
June 1995, 16(2):52-56
The cure rate of nonseminomatous germ cell tumors has improved dramatically since the advent of platinum based chemotherapy. While the majority of patients are cured with first line treatment, the remaining relapsed or refractory patients represent a difficult to manage sub-group. The timing of autologous stem cell transplant (AuSCT) is a controversial issue. While AuSCT is accepted therapy after failure of salvage regimes, some have used this method of treatment at first relapse and even up front in patients with poor prognoses.
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Infections in neutropenic cancer patients.
V Kochupillai, L Kumar
June 1995, 16(2):115-120
Severe infections duue to gram negative bacilli, staphylococci, enterococci and candida species are common in cancer patients due to profound neutropenia during aggressive therapy. Altered gut flora because of frequent antibiotics administration, disruption of skin and mucous membranes by invasive devices and damage of epithelial surfaces by cytotoxic agents also contribute for the development of infections. Frequent hand washing or the use of gloves which must be changed after each examination as well as barrier techniques reduce hospital bsed infections. Flouroquinolones are required to prevent infections from patient's own endogenous microbial flora. Frequency and severity of bacterial and fungal infections despite preventive measures, however, necessitates empiric antibiotic combination therapy. Third generation cephalosporins in combination withh ureidopenicillin or aminoglycosides are recommended to combat gram negative bacterial infections. Vancomycin may be required to treat gram positive infections. Antifungals are added at 72 hours or subsequently if fever and/or general condition of patient deteriorates. For severe neutropenia of longer duration, such as that seen among bone marrow transplant recipients and among those undergoing aggressive chemotherapy for acute leukemia, prophylactic antifungal therapy in addition to antibacterial gut prophylaxis appears justified.
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Chemotherapy of lung cancer-experience from pgi, chandigarh.
Behera
June 1995, 16(2):121-126
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Acute pancreatitis following, etoposide therapy for testicular tumour.
A Prabha, P Prathiba, C Nityananda
June 1995, 16(2):66-67
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Chemotherapy of gastrointestinal malignancies.
PM Shah, T Raja, BJ Parikh, A Anand, SV Almel
June 1995, 16(2):93-98
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Adjuvant systemic therapy for breast cancer.
I Mittra
June 1995, 16(2):73-80
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Changing facets of radiotherapy in ovarian cancer.
S Chander, M Kumar
June 1995, 16(2):89-92
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Mitoxantrone and etoposide in relapsed acute leukemias.
SA Aziz, V Maitreyan, Aejaz Aziz Shiekh
June 1995, 16(2):60-65
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Amifositine(WR-2721).
T Raja
June 1995, 16(2):68-69
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