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OBJECTIVE: To measure the bias in absolute cancer survival estimates in the absence of active follow-up of cancer patients in developing countries. METHODS: Included in the study were all incident cases of the 10 most common cancers and corresponding subtypes plus all tobacco-related cancers not ranked among the top 10 that were registered in the population-based cancer registry in Chennai, India, during 1990-1999 and followed through 2001. Registered incident cases were first matched with those in the all-cause mortality database from the vital statistics division of the Corporation of Chennai. Unmatched incident cancer cases were then actively followed up to determine their survival status. Absolute survival was estimated by using an actuarial method and applying different assumptions regarding the survival status (alive/dead) of cases under passive and active follow-up. FINDINGS: Before active follow-up, matches between cases ranged from 20% to 66%, depending on the site of the primary tumour. Active follow-up of unmatched incident cases revealed that 15% to 43% had died by the end of the follow-up period, while the survival status of 4% to 38% remained unknown. Before active follow-up of cancer patients, 5-year absolute survival was estimated to be between 22% and 47% higher, than when conventional actuarial assumption methods were applied to cases that were lost to follow-up. The smallest survival estimates were obtained when cases lost to follow-up were excluded from the analysis. CONCLUSION: Under the conditions that prevail in India and other developing countries, active follow-up of cancer patients yields the most reliable estimates of cancer survival rates. Passive case follow-up alone or applying standard methods to estimate survival is likely to result in an upward bias. [ABSTRACT FROM AUTHOR]

Purpose: There are sparse data on the outcome of patients with locally advanced breast cancer (LABC). This report is on the prognostic factors and long-term outcome from Cancer Institute, Chennai., Methods: This is an analysis of untreated patients with LABC (stages IIIA-C) who were treated from January 2006 to December 2013., Results: Of the 4,577 patients with breast cancer who were treated, 2,137 patients (47%) with LABC were included for analysis. The median follow-up was 75 months (range, 1-170 months), and 2.3% (n = 49) were lost to follow-up at 5 years. The initial treatment was neoadjuvant concurrent chemoradiation (NACR) (77%), neoadjuvant chemotherapy (15%), or others (8%). Patients with triple-negative breast cancer had a pathologic complete response (PCR) of 41%. The 10-year overall survival was for stage IIIA (65.1%), stage IIIB (41.2%), and stage IIIC (26.7%). Recurrence of cancer was observed in 27% of patients (local 13% and distant 87%). Multivariate analysis showed that patients with a tumor size > 10 cm (hazard ratio [HR], 2.19; 95% CI, 1.62 to 2.98; P = .001), hormone receptor negativity (HR, 1.45; 95% CI, 1.22 to 1.72; P = .001), treatment modality (neoadjuvant chemotherapy, HR, 0.56; 95% CI, 0.43 to 0.73; P = .001), lack of PCR (HR, 2.36; 95% CI, 1.85 to 3.02; P = .001), and the presence of lymphovascular invasion (HR, 1.97; 95% CI, 1.60 to 2.44; P = .001) had decreased overall survival., Conclusion: NACR was feasible in inoperable LABC and gave satisfactory long-term survival. PCR was significantly higher in patients with triple-negative breast cancer. The tumor size > 10 cm was significantly associated with inferior survival. However, this report acknowledges the limitations inherent in experience of management of LABC from a single center.

Background: Globally, retinoblastoma is the most common primary intraocular malignancy occurring in children. This paper documents the recent incidence rates of retinoblastoma by age and sex groups from the Population Based Cancer Registries (PBCRs) of Bangalore, Mumbai, Chennai, Delhi and Kolkata using the data from the National Cancer Registry Programme., Materials and Methods: Relative proportions, sex ratio, method of diagnosis, and incidence rates (crude and age standardized) for each PBCR and pooled rates of the five PBCRs were calculated for the years 2005/06 to 2009/10. Standard errors and 95% confidence limits of ASIRs by sex group in each PBCR were calculated using the Poisson distribution. Standardised rate ratios of ASIR by sex group and rate ratios at risk were also calculated., Results: The maximum retinoblastoma cases were in the 0-4 age group, accounting for 78% (females) and 81% (males) of pooled cases from five PBCRs. The pooled crude incidence rate in the 0-14 age group was 3.5 and the pooled ASIR was 4.4 per million. The pooled ASIR in the 0-4, 5-9 and 10-14 age group were 9.6, 2.0 and 0.1 respectively. The M/F ratio in Chennai (1.9) and Bangalore PBCRs (2.0) was much higher than the other PBCRs. Among the PBCRs, the highest incidence rate in 0-4 age group was found in males in Chennai (21.7 per million), and females in Kolkata (18.9 per million). There was a distinct variation in incidence rates in the PBCRs in different geographic regions of India.

Background: This paper investigates cancer trends in Chennai and predicts the future cancer burden in Chennai and Tamil Nadu state, India, using data on 89 357 incident cancers from the Chennai registry during 1982-2006, published incidence rates from the Dindigul Ambilikkai Cancer Registry during 2003-06 and population statistics during 1982-2016., Methods: Age-specific incidence rates were modelled as a function of age, period and birth cohort using the NORDPRED software to predict future cancer incidence rates and numbers of cancer cases for the period 2007-11 and 2012-16 in Chennai. Predictions for Tamil Nadu state were computed using a weighted average of the predicted incidence rates of the Chennai registry and current rates in Dindigul district. RESULTS; In Chennai, the total cancer burden is predicted to increase by 32% by 2012-16 compared with 2002-06, with 19% due to changes in cancer risk and a further 13% due to the impact of demographic changes. The incidence of cervical cancer is projected to drop by 46% in 2015 compared with current levels, while a 100% increase in future thyroid cancer incidence is predicted. Among men, a 21% decline in the incidence of oesophageal cancer by 2016 contrasts with the 42% predicted increase in prostate cancer. The annual cancer burden predicted for 2012-16 is 6100 for Chennai, translating to 55 000 new cases per year statewide (in Tamil Nadu). Breast cancer would dislodge cervical cancer as the top-ranking cancer in the state, while lung, stomach and large bowel cancers would surpass cervical cancer in ranking in Chennai by 2016., Conclusion: In order to tackle the predicted increases in cancer burden in Tamil Nadu, concerted efforts are required to assess and plan the infrastructure for cancer control and care, and ensure sufficient allocation of resources., (Copyright 2011, NMJI.)

The Madras metropolitan tumour registry was established in 1981, and registration of incident cancer cases is entirely done by active method. Data on survival for 20 cancer sites or types registered during 1990-1999 are reported. Follow-up has been carried out predominantly by active methods with a median follow-up time ranging between 2-28 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 45-100%; death certificates only (DCOs) comprised 0-5%; 68-95% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 83-96%. The 5-year age-standardized relative survival rates for common cancers were cervix (60%), breast (47%), stomach (8%), oesophagus (9%), lung (6%) and mouth (36%). The 5-year relative survival by age group portrayed either an inverse relationship or fluctuated. A majority of cases were diagnosed with regional spread of disease, and survival decreased with increasing extent of disease. The absolute difference in 5-year relative survival of most cancers diagnosed in 1984-1989 and1990-1999 ranged between 2-3%, with lesser survival in the latest period in most instances.

Background: Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions., Methods: Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined., Findings: For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services., Interpretation: The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources., Funding: Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA)., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: To conduct a retrospective analysis of disease free survival (DFS) of locally advanced cervical cancer (LACC) in relation to evolution of treatment and related factors., Methods: A total of 3,892 cases of LACC treated at the Cancer Institute (WIA), Chennai, India, during 1990-1999 were analyzed. Management of LACC including concurrent chemo-radiation (CCRT) has evolved through trials conducted at the institute. DFS and risk of second cancer were elicited using actuarial and Kaplan-Meier methods, respectively., Results: A majority belonged to stage III (54%) and complete follow-up at 5-years was 90%. DFS at 5, 10 and 15-years were 58%, 49% and 42% for stage IIB and 43%, 35% and 31% for stage III, respectively. External beam radiotherapy (EBRT) alone as treatment modality reported the poorest 5-year DFS (37%). Addition of chemotherapy to EBRT resulted in marginal increase in survival (41%) but inclusion of brachytherapy to EBRT enhanced survival (58%) significantly (p<0.001). CCRT with brachytherapy as a planned component resulted in the best DFS (69%), irrespective of disease stage. In a carefully selected group of patients who were suitable for salvage surgery, the long-term DFS was 71%, 63% and 63% at 5, 10 and 15 years, respectively, for stages IIB and III together. Complete response was achieved in 67% and 15% of them recurred. Remote metastasis occurred in 13%. The cumulative risk of developing any second cancer was 0.5% at 5 years, 1.9% at 10 years and 2.8% at 15 years of follow up., Conclusion: Our data indicates satisfactory treatment outcome even in advanced disease and with the present state of knowledge, the recommended standard treatment for LACC is careful pre-treatment evaluation followed by CCRT which includes brachytherapy.

Background: Cancer pattern data are rare and survival data are none from rural districts of India., Methods: The Dindigul Ambilikkai Cancer Registry (DACR) covering rural population of 2 millions in Dindigul district, Tamil Nadu state, South India, registered 4516 incident cancers during 2003-2006 by active case finding from 102 data sources for studying incidence pattern, of which, 1045 incident cancers registered in 2003 were followed up for estimating survival. House visits were undertaken annually for each registered case for data completion. Cancer pattern was described using average annual incidence rates and survival experience was expressed by computing observed survival by actuarial method and age-standardized relative survival (ASRS)., Results: The average annual age-standardized rate per 100,000 of all cancers together was higher among women (62.6) than men (51.9) in DACR. The most common cancers among men were stomach (5.6), mouth (4.2) and esophagus (3.7). Cervical cancer (22.1) was ranked at the top among women followed by breast (10.9) and ovary (3.3). DACR incidence rates were lesser by at least two folds and 5-year survival were on par or lower than Chennai metropolitan registry for most cancers. Five-year age-standardized relative survival (%) in DACR was as follows: all cancers (29%), larynx (48), mouth (42), breast/tongue (38) and cervix (37)., Conclusion: Cancer incidence was significantly lower, cancer patterns were markedly different and population-based cancer survival was lower in rural areas than urban areas thus providing valuable leads in estimating realistic cancer burden and instituting cancer control programs in India.

Background: Population-based studies describing the association between education and cancer incidence has not yet been reported from India., Methods: Information on the educational attainment of 4417 cancer cases aged 14 years and above, diagnosed during 2003-2006 in Dindigul district, Tamil Nadu, India, was obtained from the Dindigul Ambilikkai Cancer Registry, which registers invasive cancer cases by active methods from 102 data sources. Population distribution by 5-year age groups and for four educational levels namely no education, education 12 years, was obtained from census data. Standardized rate ratios based on age-standardized rates were calculated to study cancer risks for different educational levels., Results: Men and women with no education had higher overall cancer incidence rates compared to the educated population. The risk of cervix, mouth, esophagus, stomach and lung cancers were inversely associated with higher levels of education whereas a high incidence of breast cancer was observed with increasing educational levels. The standardized rate ratio of cervical cancer 0.32 (95% CI: 0.19-0.52) and of breast cancer was 6.08 (95% CI: 1.81-20.48) for women with more than 12 years of education compared to those with no education. There was paucity of cases in the highest education level for most cancers., Conclusion: With more and more women in rural India becoming educated, one could foresee breast cancer becoming more frequent even in rural areas of India in future.

Childhood cancers (age at diagnosis: 0-14 years) comprise a variety of malignancies, with incidence varying worldwide by age, sex, ethnicity and geography, that provide insights into cancer etiology. A total of 1,334 childhood cancers registered in population-based cancer registry, Chennai, India, during 1990-2001 and categorized by International Classification of Childhood Cancer norms formed the study material. Cases included for survival analysis were 1,274 (95.5%). Absolute survival was calculated by actuarial method. Cox proportional hazard model was used to elicit the prognostic factors for survival. The age-standardized rates for all childhood cancers together were 127 per million boys and 88 per million girls. A decreasing trend in incidence rates with increasing 5-year age groups was observed in both sexes. The top 5 childhood cancers were the same among boys and girls: leukemias, lymphomas, central nervous system neoplasms, retinoblastomas and renal tumors. The highest 5-year absolute survival was observed in Hodgkin's disease (65%) followed by Wilm's tumor (64%), retinoblastomas (48%), non-Hodgkin's lymphomas (47%), osteosarcomas (44%), acute lymphoid leukemia and astrocytoma (39%). Multifactorial analysis of age at diagnosis and sex showed no differences in the risk of dying for all childhood cancers. Completeness of treatment and type of hospital combination emerged as a prognostic factor for survival for all childhood cancers together (p < 0.001), acute lymphoid leukemia (p < 0.001) and non-Hodgkin's lymphoma (p = 0.04). A Childhood Cancer Registry with high-resolution data collection is advocated for in-depth analysis of variation in incidence and survival., ((c) 2008 Wiley-Liss, Inc.)

Adrenal cortical carcinomas are rare neoplasms and the definitive diagnostic criteria are distant metastasis and / or local invasion. Due to advances in imaging techniques, adrenal cortical neoplasms are discovered earlier and are smaller, increasing the need for more accurate diagnosis and pathologic indicators of prognosis. A twelve year retrospective clinicopathologic analysis of 15 histopathologically proven cases of adrenocortical carcinomas was done. Clinical details including radiologic findings, endocrine manifestations and gross finding were analysed. Hematoxylin and eosin stained slides were reviewed. Emphasis was on application of Weiss criteria. All fifteen tumors fulfilled Weiss criteria of malignancy, ie. all 15 possessed 3 or more of these criteria of malignancy. Functional tumors showed a greater representation of mixed cell type. It was concluded that Weiss criteria is easy to apply and that a combined evaluation of clinical features, size, weight and microscopic appearance seems necessary for the diagnosis of adrenocortical carcinomas.

Oral, pharyngeal and esophageal cancers are 3 of the 5 most common cancer sites in Indian men. To assess the effect of different patterns of smoking, chewing and alcohol drinking in the development of the above 3 neoplasms and to determine the interaction among these habits, we conducted a case-control study in Chennai and Trivandrum, South India. The cases included 1,563 oral, 636 pharyngeal and 566 esophageal male cancer patients who were compared with 1,711 male disease controls from the 2 centers as well as 1,927 male healthy hospital visitors from Chennai. We observed a significant dose-response relationship for duration and amount of consumption of the 3 habits with the development of the 3 neoplasms. Tobacco chewing emerged as the strongest risk factor for oral cancer, with the highest odds ratio (OR) for chewing products containing tobacco of 5.05 [95% confidence internal (CI) 4.26-5.97]. The strongest risk factor for pharyngeal and esophageal cancers was tobacco smoking, with ORs of 4.00 (95% CI 3.07-5.22) and 2.83 (95% CI 2.18-3.66) in current smokers, respectively. An independent increase in risk was observed for each habit in the absence of the other 2. For example, the OR of oral cancers for alcohol drinking in never smokers and never chewers was 2.56 (95% CI 1.42-4.64) and that of esophageal cancers was 3.41 (95% CI 1.46-7.99). Furthermore, significant decreases in risks for all 3 cancer sites were observed in subjects who quit smoking even among those who had quit smoking 2-4 years before the interview., (Copyright 2003 Wiley-Liss, Inc.)

Cancer of the breast is the second most common cancer seen among Indian women. This study describes the use of DHPLC for mutation analysis for BRCA1, BRCA2 and CHEK2 (1100delC) in 22 patients with a family history of breast and/or ovarian cancer and early onset breast cancer (<35 years of age). Three of the 22 patients were found to have a non-sense mutation or a deletion, resulting in a premature stop codon, potentially leading to a truncated protein. Two of these were in BRCA1 (one was a novel 5 base deletion) and one in the BRCA2 gene. No patient was found in our series to have the CHEK2 (1100delC) mutation. DNA from a healthy blood donor and all but one of the 22 patients, demonstrated polymorphisms in BRCA1 and/or BRCA2 genes. This is the first study from South India, on BRCA1, BRCA2 & CHEK2 (1100 del C) mutations in patients with a family history of breast and/or ovarian cancer and early onset breast/ovarian cancer, using the sensitive DHPLC approach.

Cancer registration in the population based cancer registry (PBCR), Chennai, India, is carried out by active methods. It undertakes re-screening of cases in government hospitals and Cancer Institute (WIA), trace back death certificate notifications and collect information on all the deaths, irrespective of the stated cause on the death certificate, occurring in the registry area routinely to reduce the under-registration of incident cancer cases and associated mortality. The completeness of registration during 1982-95 was assessed by conducting an independent survey in randomly selected areas in Chennai. The total number of households covered in the survey was 7737 and were collected which constituted 1% of the Chennai city population. The response rate to the survey was 96%. A total of 42,502 incident cancer cases were registered in Chennai PBCR during 1982-95. The total number of cancer cases that were already registered in PBCR from the survey area during 1982-95 was 208. Out of 208 cases, 91 (44%) were identified in the survey; the families of the remaining 117 had migrated out of the surveyed area. Two new cancer cases hitherto unregistered in the PBCR during 1982-95 were identified from the survey. Based on the survey, it is estimated that the completeness of cancer registration in Chennai PBCR is 96%, which is comparable to those of other registries in the world.

A total of 4304 cervical cancer cases registered during 1982-89 in Chennai registry, India, were analyzed. Relative survival at 1, 3 and 5 years were 90%, 72% and 60% respectively. Age at diagnosis and extent of disease emerged as statistically significant prognostic factors (p<0.001). Five-fold higher risk of death was seen among those above 64 years vs. <45 years and those with distant metastasis vs. localized disease at diagnosis. Cancer control programs focusing on health education would motivate women to attend hospital at an early stage of disease for better survival.

Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. The estimated new cancer cervix cases per year is 500,000 of which 79% occur in the developing countries. Cancer cervix occupies either the top rank or second among cancers in women in the developing countries, whereas in the affluent countries cancer cervix does not even find a place in the top 5 leading cancers in women. The truncated rate (TR) in the age group 35-64 years in Chennai, India, is even higher (99.1/100,000; 1982-95) than rate reported from Cali, Colombia (77.4/100,000, 1987-91). The cervical cancer burden in India alone is estimated as 100,000 in 2001 AD. The differential pattern of cervical cancer and the wide variation in incidence are possibly related to environmental differences. Aetiologic association and possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Sexual hygiene, use of barrier contraceptives and ritual circumcision can undoubtedly reduce cervical cancer incidence. Education, cervical cancer screening of high risk groups and improvement in socio-economic status can reduce cervical cancer morbidity and mortality significantly.

Two-hundred and six breast cancer cases were histologically confirmed breast cancer diagnoses at the Cancer Institute in Chennai (Madras), India. One-hundred and fifty hospital controls were patients who had cancer at any site other than breast and gynecological organs, and 61 healthy controls were persons accompanying patients in the Cancer Institute. Serum levels of carotenoids such as beta-carotene, lycopene, cryptoxanthin, and zeaxanthin & lutein were determined by HPLC. Serum levels of total carotenes and total carotenoids including beta-carotene, which reflects food intake of colored vegetables and fruits and has a protective role for certain sites of cancer, were significantly lower among breast cancer cases and hospital controls compared to healthy controls, especially in post-menopausal women. Serum carotenoid levels appeared to change with menopausal status. Serum beta-carotene levels tended to be lower among breast cancer cases than among hospital controls in premenopausal women. Serum xanthophyll levels were significantly lower among breast cancer cases than among healthy controls in post-menopausal women, but not in premenopausal women. Serum levels of retinol and alpha-tocopherol among breast cancer cases were not significantly different from those in post-menopausal healthy controls, but were higher than those in hospital controls. Serum estrone levels were significantly higher among breast cancer cases than among healthy controls, but serum levels of estradiol and estriol were not. In conclusion, Indian women with cancer of breast or of other sites might have low intake of green-yellow vegetables rich in fiber and carotenoids such as beta-carotene and zeaxanthin & lutein.

Patients receiving chemotherapy for acute leukemia were prospectively followed up to determine the frequency, nature and outcome, of episodes of infection during a 6 or 12 month period at each of the participating centres. A total of 605 cycles of chemotherapy were surveyed. Of these, 490 cycles were received by patients with acute lymphoblastic leukemia (ALL) and 115 by patients with acute non-lymphoblastic leukemia (ANLL). 241 episodes of infection were recorded during the survey: 179 among ALL patients and 62 among patients of ANLL. Infections were more common during chemotherapy for ANLL than for ALL, occurring in 54% (62/115) and 36% (179/490) of chemotherapeutic cycle respectively. A favorable response to empiric antibacterial agents was seen in 39% (23/59) of episodes in ANLL patients and 77% (134/174) of episodes among ALL patients. Infection presented as fever of unidentified origin in an overwhelming majority (63%) of episodes. Gastroenteritis and pneumonia occurred with a frequency of 11% and 10% while the frequency of all other diagnoses was 3% or less. Overall, E coli and Candida were the most frequently isolated organisms while Staphylococcus aureus and Group A Streptococci were the most frequent isolates from blood and throat swabs, respectively. A high degree of resistance to commonly used antimicrobial agents was seen among the most frequently isolated organisms. About 75% of episodes of infection which did not respond to antibacterial agents responded to empiric systemic antifungal therapy; although fungi were mycologically isolated in only a quarter of these instances. Oropharyngeal candidiasis occurred in association with 3% of chemotherapeutic cycles.

Uterine cervical cancer is the most common malignancy among females in developing countries, including India. The success of cervical cancer screening programs in North America and Western Europe has been the result of centralized cervical-cytology screening. This is not possible in the villages (n = 17,000) of Tamilnadu where 58 percent of females in rural areas are illiterate, health infrastructure is mediocre, and cervical cytology is unknown. The present study was undertaken to examine if the village health nurse (VHN) could be trained quickly to identify a cervical abnormality by visual inspection so that we could 'down stage' the cancer to earlier stages, more amenable to treatment. VHNs also would be trained to take an adequate Pap smear. A total of 101 VHNs were trained in batches and returned to their villages. Within two years, 6,459 eligible women in the study area were screened. The agreement between the gynecologists and the VHNs in identifying cancer among those with abnormal cervix was 95 percent, and 80 percent of the Pap smears taken by VHNs were adequate by WHO criteria, making the feasibility study highly successful.

The utility of data collected on patients will be rendered insignificant without adequate follow-up information. Efficient methods should be used to follow cases in order to get vital status information in Hospital(HBCR) and Population Based Cancer Registries (PBCR). Based on our experience we have evolved methods to follow cancer cases and this has been discussed in this paper. Active follow up of cases has enhanced follow-up rate from 50% to more than 85% at HBCR and "death in period" from 19% to 41% during the period 1982 to 1991 in PBCR. Active follow-up is mandatory for the cases registered at HBCR. In addition to collecting data from VSD on cancer deaths, active follow-up is desirable to get maximum death information on cases registered at PBCR in a developing environment. Computerization of follow-up data is necessary in order to further improve the efficiency of the follow-up system.

At the Cancer Institute, Madras, India, we have performed immunophenotyping in 125 untreated cases of acute lymphoblastic leukaemia using a panel of 16 monoclonal antibodies and the avidin-biotin immunoperoxidase technique in a haematology autoanalyser (Technicon Hi system). Our results demonstrate a marked difference in the phenotypic pattern of ALL compared to Western countries, the predominant finding being a relative excess of T-ALL and a paucity of C-ALL cases. Age distribution of C-ALL reveals a peak at 2-6 years in paediatric ALL cases.

Background: Problems of initial empirical antibiotic therapy in febrile neutropenia are further complicated by other factors such as cost and the pattern of infective organisms in a particular institution. We, therefore, conducted a randomized study comparing the efficacy of two sets of antibiotics which differed in their spectrum of action, availability and price., Methods: Sixty episodes of febrile neutropenia in 40 patients who were not on any prophylactic antibiotics were randomized into one of two arms--cefotaxime and gentamicin or ciprofloxacin and gentamicin. Depending upon the response by 72 hours, they were crossed over to the other arm or continued with the same combination. Empirical antifungal therapy was added in those who did not become afebrile., Results: Infection was documented either clinically, bacteriologically or radiologically in 42% of the febrile episodes. The commonest organism isolated was Klebsiella and the commonest organism producing bacteraemia was the Staphylococcus. The temperature was reduced to normal without cross-over in 53% of the febrile episodes with cefotaxime and gentamicin and in 60% with ciprofloxacin and gentamicin (p > 0.05). After cross-over the temperature came down in 30% of the episodes with cefotaxime and gentamicin (initial combination) and 40% with ciprofloxacin and gentamicin (initial combination; p > 0.05). The overall response rate without empirical antifungal therapy was 83% in the patients on cefotaxime and gentamicin (initial combination; p > 0.05). While both the arms of the study had a 100% response rate, there was no significant difference between the efficacy of the antibiotic combinations. The ciprofloxacin-gentamicin combination is one-third as expensive as cefotaxime-gentamicin and is more readily available., Conclusion: We recommend the use of ciprofloxacin and gentamicin as the initial drug combination and cefotaxime and gentamicin only when the former is not effective.

A total of 4,995 cervical and 311 penile cancer cases were registered in the Madras Population-Based Cancer Registry at the Cancer Institute (WIA), Madras, India, in 1982-1990. The parameters analyzed were age at the time of diagnosis, educational level, marital status, and religion. Peak incidence of carcinoma of the cervix was seen in the age group 55-59 years. The incidence of penile cancer increased consistently with age. Among cervical cancer patients, the incidence was significantly higher among illiterates and among those who had an education for 12 years or less than among those with over 12 years of education. The incidence of cervical cancer was low among Muslim women compared to Hindu and Christian women, and penile cancer was not seen at all among Muslim men. Our results re-emphasize the importance of circumcision in the reduction of the risk of both cervical and penile cancers.

Twelve patients with high grade osteosarcomas of the extremities were treated with two cycles of induction chemotherapy using adriamycin and cis-platinum and sandwich radiation between the two cycles (4000 rads). Ten patients underwent amputation or disarticulation, two patients had wide excision followed by endoprosthesis. The specimen was assessed for grade of necrosis. The Disease Free Survival at a minimum follow-up period of 26 months and median follow-up period of 35.5%. All the five patients who developed distant metastases had shown only a grade I necrosis in the tumour.

Chronic granulocytic leukaemia (CGL) is the commonest leukaemia among adults in India. Case records of 183 CGL patients diagnosed between 1975 and 1985 were reviewed. The median age at diagnosis was 40.5 years. Most patients presented with weakness, fullness in the left upper abdomen and fever. Splenomegaly and hepatomegaly were present in 90% and 48% respectively. Patients were treated with oral, intermittent busulphan with monitoring of total leucocyte count. Overall, 87 patients expired, including 63 (72%) due to blast crisis. The median survival was 33 months from diagnosis and 44 months from the onset of symptoms.

Bone involvement in Chronic Granulocytic Leukemia (CGL) is rare. We describe here five such patients who presented with severe localized bone pain with involvement of femur neck, skull, tibia-upper end and spine. Lesions were osteolytic in three of them. Blast crisis was present in four of them. Survival was poor in all except one who presented in chronic phase. Bone involvement in CGL carries a poor prognosis.

Five hundred and fifty two bone marrow (BM) specimens (497 aspirates, 55 biopsies) from 518 patients with nonhaematological malignancies were examined to determine the frequency of metastatic deposits. BM involvement was highest in neuroblastoma (9/14), prostate cancer (2/4), retinoblastoma (3/7), Ewing's sarcoma (14/47), rhabdomyosarcoma (5/20) and small cell carcinoma of lung (3/18). BM aspiration smears were adequate in paediatric tumours (neuroblastoma, retinoblastoma, rhabdomyosarcoma) while BM biopsies were most useful in patients with Ewing's sarcoma, prostate cancer and small cell lung cancer. We conclude that BM is an easy investigation in the diagnosis and staging of nonhaematological cancers.

Oral squamous cell carcinoma is the commonest male (29%) and the second commonest female (18%) malignancy in South India. At first attendance 93% of the tumours are stage T3 or T4. They are essentially locoregional, remote metastases being rare (0.75%). Radiotherapy alone yields a poor survival (19% 5 year NED). Radiopotentiation by chemical sensitizers and cytotoxic drugs has been attempted since 1960, the best results being obtained by a combination of irradiation and bleomycin. There was, however, persistent failure in about 40% of cases. The present three-armed trial attempted to improve the results of radiotherapy and bleomycin by the addition of hyperthermia. A total of 101 T3 and T4 buccal squamous cancers were entered in the trial over a period of nearly three years. Entry closed in August 1987 and the last case was evaluated in October 1987, hence only response data are available. Hyperthermia did not confer any benefit.