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The global increase in cancer burden is a challenge for countries with scarce resources. Amongst all the malignancies, gynaecological cancer still continues to have a high incidence and prevalence leading to significant morbidity and mortality. While a multipronged strategy of decreasing the gynaecological cancer burden is a global priority, one of the key strategies to decrease the morbidity and mortality is to train gynaecological oncology specialists. Most of the developed nations have an established gynaecologic oncology training programme in the form of a well-designed curriculum and skill training. However, in developing countries where the actual disease burden of these cancers is highest, such focused training programmes have only started emerging and evolving over the past two decades. While it is a positive step to initiate such training programmes in a country like India, there are still gaps in the uniformity of curriculum and training. Also, exposure to modern practices in gynaecologic oncology surgery, chemotherapy and technology in radiation oncology, especially brachytherapy, is still insufficient in many centres. This review discusses some of the challenges and opportunities in the still evolving programmes for training gynaecologic oncologists in India.

Aim: To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India. Materials and methods: The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis. Results: The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively. Conclusion: The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.

In this retrospective analysis of 36 patients with recurrent ovarian cancer (ROC) treated with platinum pemetrexed doublet ± bevacizumab, the median age was 54.5 years (47-60) and 33 (91.7%) had serous histology. The overall response rate [ORR = complete (CR)+partial (PR) response] was 83.3%. At a median follow-up of 16 months, the median PFS was 13.8 months (95% CI: 10.849-20.580) and median OS 30.6 months, (95% CI: 21.46 months-NR). The incidence of Grade 3/4 anemia, thrombocytopenia, neutropenia and non-hematological toxicity was 19.4%, 3.9%, 16.6%, and 8.3%. Platinum pemetrexed chemotherapy in ROC is safe and effective treatment option.

Aim:To analyse the presentation, treatment strategies and outcomes of neuroendocrine carcinoma of cervix treated with multi-modality approach at our institute.Materials and methods:The data of patients diagnosed to have cervical cancer between October 2004 and November 2018 were retrieved, and 14 patients of neuroendocrine carcinoma cervix who received treatment in our institution were identified. The patients were analysed based on demographic characteristics, disease stage, pathological characteristics, treatment and follow-up. The median overall survival and disease-free survival were calculated.Results:Median follow-up period was 8 months (range 1–52 months). Six patients died within 4 months of completion of treatment due to disease progression. Median overall survival was 12 months and median disease-free interval was 5·5 months. Four of the patients who underwent combined modality treatment consisting of neoadjuvant chemotherapy, concurrent chemoradiation therapy and brachytherapy are still on regular follow-up and are disease-free.Conclusion:Neuroendocrine carcinoma of the cervix is a rare but aggressive histological subtype. Combined modality approach with judicious use of systemic chemotherapy along with surgery and radiation therapy is essential for optimal outcomes.

Chemoradiation is the standard of care in locally advanced carcinoma of the anal canal. However, the irregular surface and elective inguinal treatment poses a challenge for radiation planning and treatment with associated significant toxicity. In this retrospective study, we analysed the outcome of patients treated with intensity-modulated radiation therapy (IMRT) at our centre from 2012 to 2019. Records of patients treated with IMRT at our centre from 2012 to 2019 were reviewed. Patients with non-squamous histology and previous irradiation were excluded. Thus, 25 patients were found suitable for the study. Twenty-five patients with squamous cell carcinoma of the anal canal were treated at our centre from 2012 to 2019 using IMRT based chemoradiation. RTOG guidelines were followed for contouring and Varian Eclipse version 13(Palo Alto, California) was used for planning. Clinical response could be assessed in 20 patients and dosimetric data of all patients was available for review. The target volumes coverage goals as per ICRU 83 were achieved in all patients. The organ at risk constraints for bladder and femoral heads as per LATE-QUANTEC were achieved in most patients; however, the constraints for the rectum, testis and bowel bag were not achieved in the majority of the patients. The median duration of treatment break was 7 days. Mitomycin C and 5–FU or capecitabine were given concurrently with radiation. Eighteen patients (72%) received 2 cycles of chemotherapy, three (12%) received 1 cycle of chemotherapy while 4(16%) patients did not receive any chemotherapy. Median follow-up was 7.5 months. At median follow-up, 15(75%) patients were disease-free and asymptomatic, 2(10%) had residual disease and 3(15%) had progressive disease. Toxicity was assessed using CTCAE Version 5.0. Grade III skin toxicity was reported in 9(36%) of the patients and Grade III gastrointestinal toxicity was reported in 1 (4%) of the patients, no other grades III–IV toxicity was reported. Overall, the disease control was comparable to previous 3D-CRT studies but with much less toxicity. IMRT-based chemoradiation should be the standard of care in locally advanced carcinoma of the anal canal.

To analyse the patterns of para-aortic nodal recurrence in carcinoma cervix and the outcomes with various treatment options at our institution. The data of patients diagnosed to have cervical cancer between January 2012 and December 2017 were retrieved from the electronic medical records. Those with para-aortic recurrence following definitive treatment for cervical cancer were identified and were classified as isolated para-aortic nodal recurrence, para-aortic and pelvic recurrences, and para-aortic and distant metastases. Analysis was done based on demographic characteristics, disease stage at diagnosis, pathological characteristics, treatment modality, and follow-up. There were 18 isolated para-aortic recurrences (41%), 17 para-aortic with distant metastasis (39%), and 9 para-aortic with pelvic metastasis (20%). The median time to recurrence from diagnosis for isolated para-aortic recurrences, para-aortic with pelvic recurrences, and para-aortic with distant metastasis was 26 months, 14 months, and 12.5 months, respectively. The median survival of the entire cohort of patients was 36 months. The median survival of isolated para-aortic recurrence, para-aortic with pelvic recurrence, and para-aortic with distant metastasis was 45 months, 16 months, and 10 months, respectively (p = 0.001). The median survival was 45 months for those who received combined modality treatment with chemotherapy followed by RT, followed by 30 months for those who received RT alone, and 11 months for those who received chemo alone. For patients who received best supportive care alone, it was 7 months (p = 0.055). Isolated para-aortic recurrences present late and have a relatively favourable prognosis when treated with a combined modality approach. At recurrence, definitive para-aortic radiation therapy combined with chemotherapy had the best outcome. High-risk approach with prophylactic lower para-aortic radiation for high volume primary and pelvic nodal disease needs to be studied for further improvement in outcomes.

Kimura’s disease (KD) is a rare, chronic inflammatory disorder of unknown aetiology, which commonly affects men of the Asian race. Here, we present a case capsule of a 39- year-old man with KD of the left cheek, managed initially by surgery alone. He developed local recurrence after 6 months and was treated with steroids and isotretinoin. Eventually, steroids were discontinued due to toxicity and the lesion progressively increased in size. The patient was successfully treated using intensity-modulated radiotherapy with simultaneous integrated boost as a primary modality with minimal adverse effects. The patient has good local control and cosmetic outcome with no radiation-related toxicity at a follow-up period of 28 months.

Introduction: As much as the number of oral cancer patients is a heavy burden to the health care system in India, so much is the economic burden to the patient and the relatives, especially in India where most do not have any financial cover for their medical expenditure. Objectives: To find out the approximate cost of treatment of oral cancer through various modalities, and calculate the proportion of direct and indirect expenses, and then identify the factors which would increase the indirect expenses so as to come up with recommendations which will reduce the indirect cost thereby reducing the financial burden to the patient.Methods: A retrospective observational study was done in a tertiary care center for cancer treatment and the direct cost (medical expense), indirect cost (non-medical expense) incurred by the patients, their economic status and source of fund for payment of the expenses were obtained. Results: The proportion of indirect cost was about 38.72% of the total cost for patients who underwent a single modality treatment with surgery, around 34.73% for a combination treatment with surgery and RT (Radiotherapy), about 79.63% for treatment with conventional Radiotherapy without surgery and about 49.61% for treatment with IMRT (Intensity Modulated Radio Therapy) without surgery. Availability of financial aid or cover is abysmally poor. The rate of discontinuance of treatment is also very high according to this study.Conclusion: The proportion of the indirect cost is very high and the total expenditure can be reduced by approximately 30% by following measures discussed in this article.