ABSTRACT
Background: Clear cell and mucinous types of epithelial ovarian cancers are relatively chemo resistant and have a poorer prognosis compared to other histologies. Aim of the study was to study the biochemical and histopathological response and surgical outcome of various histologies to standard platin based chemotherapy.Methods: All 42 cases of locally advanced carcinoma ovary who received several cycles of neoadjuvant chemotherapy (NACT) followed by, interval cytoreductive surgery (ICS) were included in this study. Serum CA125 levels before and after neoadjuvant chemotherapy, the ability to achieve optimal cytoreduction and the presence of residual tumour in the surgical specimen were the parameters measured. Continuous variables were compared by one-way ANOVA. Categorical variables were compared by the Pearson chi-square test. Significance was defined by p values less than 0.05. Survival analysis was done using Kaplan-Meier estimation.Results: There was a 95,84% reduction in serum CA125 levels for papillary serous carcinoma compared to clear cell and mucinous varieties, which had 81.2% and 78.5% reduction, respectively. More number of papillary serous tumours were able to achieve optimal cytoreduction (72%) compared to mucinous variety (25%). Residual tumour was present in 68% of serous papillary tumours compared to 87.5% in mucinous and 80% in clear cell histology.Conclusions: Our study concludes that mucinous and clear cell types of EOC are relatively chemo resistant compared to the serous subtype. We recommend more aggressive surgery especially for mucinous tumours. In the case of ovarian cancer, we observed that the mucinous and clear cell types of EOC are relatively chemoresistant compared to the serous subtype. From the results, we recommend the more aggressive strategy of surgery as a preliminary choice of treatment especially for mucinous tumours rather than chemotherapy in patients with EOC.
ABSTRACT
Introduction: Surgery is the standard treatment to achieve cancer control, but due to socioeconomic and other factors, most patientspresent with a locally advanced tumor leading to extensive resection of mucosa, muscle, bone, and skin. Reconstruction of thesedefects is essential not only in ensuring function and cosmesis but also in enabling the start and completion of adjuvant therapy on time.Aim: The study aims to analyze the various reconstruction methods used in the head-and-neck cancer surgery.Materials and Methods: Various cancers of the head and neck using various reconstruction options such as primary closure, localflaps, and regional flaps. Pre-operative radiotherapy, extent of defect, the type of reconstruction used, post-operative complications,and the functional outcome in the immediate post-operative period, 1 month after surgery, and at 6 months were recorded.Results: Of the 180 surgeries for head-and-neck cancers, primary closure was done in 79 cases. Other reconstruction optionsused were pedicled regional flaps – 75, local flaps – 11, and split skin grafting – 15. Of the 79 primary closures, 2 cases ofinfection, 2 cases of partial necrosis (neck skin and tongue), 8 cases of minor wound dehiscence, and 2 cases of fistulae of whichone was chylous were noted. Of the 50 pectoralis major myocutaneous (PMMC) flaps, 29 were for lining the oral/oropharyngealcavities, 6 were for cover the skin defects, and 15 were for both lining and cover.Conclusion: PMMC is the choice flap in high-volume centers with resource and time constraints where microsurgical expertiseis not available. They have proved effective in the absence of microvascular free flaps. Further improvement in our results canbe achieved if free flaps could be used in a choice few cases and effective mandibular reconstructions are to be used.