Carcinoma cervix is the second most common gynaecological cancer among women in India, with high prevalence in rural regions. Accurate staging is imperative for providing appropriate treatment. This study aims to analyse the concordance among clinical examination, examination under anaesthesia, and CECT in evaluating the clinical components of the staging. Materials and Methods: Carcinoma cervix patients with clinical examination staging upto stage lll, admitted in government royapettah hospital, department of surgical oncology between November 2017 and October 2019 were subjected to examination under spinal anaesthesia. CECT taken for all patients. Results regarding tumour size, fornix and parametrium involvement were tabulated and analysed. Results: Tumour size: In 21.2% (17/80) of patients who had bulky disease in EUA, CECT has reported tumour size as <4cm. Based on tumour size 5/81(6.2%) patients were down-staged by EUA in comparison with clinical examination. In 5% of patients (4/80) EUA upstaged tumour size in comparison with clinical examination. Fornix: Clinical examination failed to identify fornix involvement in 8 out of the 83 patients who had fornix involvement in EUA (9.6%). Parametrium: Out of 67 cases who had parametrium involvement in EUA, clinical examination failed to identify it in 5. (7.4%). In 28.3% of patients (19/67) who had parametrium involvement in EUA, there was no parametrium involvement in CECT. Among the 71 patients with parametrium involvement, 4 patients were identified only in CECT (5.6%). Out of 16 patients who had parametrium involvement upto side wall in EUA, CECT had no HUN or lateral pelvic wall in 11 patients(68.5%). Clinical examination failed to identify parametrium involvement upto side wall in 11/16 patients stage lllB according to EUA (68%). Conclusion: In significant number of patients CECT did not identify parametrium involvement, and it had very low sensitivity for identifying disease upto side wall. There is a non-significant under staging of tumour size in CECT in comparison to EUA. Clinical examination has low sensitivity for identifying parametrium involvement and its extent in comparison to EUA. There is no significant difference.
Induction chemotherapy yields significant response in locally advanced squamous cell carcinoma of oral cavity. Pre-treatment biomarkers can help to predict response to chemotherapy. The neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) are cost-effective and simple parameters that can predict response to chemotherapy. This study aims to find the correlation between NLR, PLR and response to induction chemotherapy in oral cavity malignancies. Materials and Methods: Details of 32 patients with locally advanced squamous cell carcinoma of oral cavity who received induction chemotherapy from Jan 2017-March 2019 were collected and the following were recorded. Pre-treatment total leukocyte count, neutrophil, lymphocyte and platelet counts. Post induction chemotherapy, reduction in size of tumour. Patients were categorised into complete, partial and non-responders.The mean NLR and PLR, and the significance in variation of NLR and PLR between the three groups was calculated and the statistical significance analysed. Results: The mean NLR is significantly low in both partial (2.62) and complete response groups (2.4) compared to the patients with static response (5.6). The mean PLR is also low in responders (124) when compared to the static group (180), but it is not statistically significant. With a cut-off value of 3.95 for NLR and 153 for PLR, response could be predicted with high positive predictive value. When both the ratios are combined the predictive value is further increased as shown in this study. Conclusion: Pre-treatment NLR and PLR are reliable biomarkers of the systemic immunologic phenotype of the cancer patients. They predict the response to chemotherapy in patients with oral cavity malignancy.
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