Background Survival data for patients with advanced cholangiocarcinoma are very sparse in India. We performed this study to find the median overall survival of patients with advanced cholangiocarcinoma and to identify prognostic factors for survival. Methods This is a retrospective study of 30 patients with inoperable and metastatic cholangiocarcinoma treated with cisplatin and gemcitabine chemotherapy. Overall survival was estimated by the Kaplan–Meier method. Univariate and multivariate analyses were performed to determine the impact of age, gender, performance status, carbohydrate antigen (CA) 19.9, liver function test on survival. Data were analyzed using SPSS version 21. Results The mean age of the population was 47.5 years (± 14.5). The most common presenting complaint was jaundice followed by abdominal pain. Extrahepatic cholangiocarcinoma comprised of 86%. Median number of cycles was 4 and the response rate was 46.6% (partial response and stable disease) The median overall survival was 9 months (95% confidence interval = 6.0–11.8 months). The median survival of patients with Eastern Cooperative Oncology Group performance score < 2 and ≥2 were 15.6 and 4.2 months (p = 0.002), respectively. The median overall survival for patients with albumin > 3.0 g/dL was 12.1 and 4.5 months for < 3.0 g/dL (p = 0.039). Patients with CA 19.9 < 200 U/mL had a better overall survival (13.2 months) than those above 200 U/mL (5.6 months) (p = 0.001). In the multivariate analysis, performance status was found to be the only independent prognostic factor Conclusion Advanced cholangiocarcinoma has a poor prognosis. Performance status, serum albumin, and CA 19.9 were found to be prognostic.
Background: Metastatic osteosarcoma at presentation constitutes 10 to 20% of total osteosarcomas diagnosed. They have a very poor prognosis compared to non-metastatic subsets. This study was performed to find the response rate to first line cisplatin and adriamycin combination chemotherapy in upfront metastatic osteosarcoma patients and time to progression after first line chemotherapy. Secondary objective was to measure the overall survival (OS).Methods: Patients diagnosed with osteosarcoma at Madras Medical College were retrospectively identified from January 2013 to December 2017 (5 years). From these patients, those who had metastases at presentation were identified and analysed.Results: 71 patients were diagnosed with osteosarcoma during the 5 year period. Among them, 32 patients (45.1%) had metastatic disease at presentation. 25 patients were male (78.1%) and 7 were female (21.9%). Median age of the patients was 20.5 years. Two patients had type 2 diabetes mellitus; 20 patients had ECOG PS 2 (62.5%) and 12 had ECOG PS 1 (37.5%). Tibia and femur were the most common primary site (71.9%). 5 patients had resectable lung metastasis and underwent pulmonary metastasectomy and were excluded from analysis. Among the remaining 27 patients, 24 had multiple lung metastases (88.9%) and 3 had bone metastases (11.1%). All patients received 6 cycles of chemotherapy with adriamycin 25mg/m2 on d1-d3 and cisplatin 100mg/m2 on d1 repeated every 21 days, except 2 who progressed during chemotherapy. 15 patients (55.6%) had grade 1-2 vomiting. No one developed any acute cardiotoxicity and no treatment-related deaths occurred. At the end of 6 cycles, 20 patients (74.1%) had partial response, 5 patients (18.5%) had stable disease and 2 patients (7.4%) had progressive disease. Median time to progression was 12 months; 2-year OS was 77.8%.Conclusions: Metastatic osteosarcoma has a very poor prognosis overall. This platinum doublet is a reasonable option for these patients as most of them are young. A larger randomized controlled trial will be needed to understand response to different chemotherapy regimens in this metastatic subset.
Background: Lymphomas are the most common testicular malignancy in elderly male with DLBCL being most common subtype. Less common histological subtypes include Burkitt lymphoma and follicular lymphoma. Testicular DLBCL has poor treatment outcomes than nodal DLBCL due to high risk of relapse in opposite testes, CNS and other sites. Methods: From the database, patients diagnosed as testicular lymphoma over a period of five years from January 2013 to December 2017 at department of Madras Medical College, Chennai were retrieved and analysed. Results: 8 patients were found to have testicular lymphoma with all being DLBCL subtype. Median age of diagnosis was 61 years. 25% (n¼2) patients had B symptoms. 4 patients had stage IE, 2 patients had stage II and 2 patients had stage IV. LDH was elevated in stage IV patients. None developed contralateral testicular lymphoma. All patients underwent high inguinal orchidectomy of involved testis. 3 patients had removal of opposite testis after completion of whole treatment and 5 patients received radiotherapy of 30Gy to contralateral testes. All patients received R-CHOP once in 21 days for 6 cycles along with intrathecal methotrexate of 12.5mg except 1 patient receiving 4 cycles only due to poor PS. 2 patients had febrile neutropenia during chemotherapy and got recovered. 2.5 year DFS was 62.5%(n¼5) and 2.5 year OS was 75%(n¼6) with a median follow up period of 56 months. Conclusions: Due to rarity of this tumour standard treatment regimen remains unknown. R-CHOP gives treatment outcomes comparable to the literature. Legal entity responsible for the study: Sivasubramaniam.
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