Abhilash Vasanth

Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India

To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality-4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.

The role of neoadjuvant chemotherapy in clinically advanced endometrial cancer: a real-world retrospective single-institutional study

Evidence on neoadjuvant chemotherapy in clinically advanced endometrial cancer is limited, with most of the data from high-income countries. To address this gap, we evaluated the treatment responses and survival outcomes in these patients at a tertiary cancer center in India. This retrospective study included patients with International Federation of Gynecology and Obstetrics 2009 stage III to IVB endometrial cancer treated at Gujarat Cancer Research Institute between January 1, 2017 and December 31, 2022. Patients deemed unfit for primary surgery and who received neoadjuvant chemotherapy were analyzed. Data collected included age, Eastern Cooperative Oncology Group performance status, tumor histology, CA125 levels, and chemotherapy regimens. Radiologic response to neoadjuvant chemotherapy was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1 criteria. Interval debulking surgery outcomes were categorized as optimal (residual tumor ≤1 cm) or sub-optimal. Post-operative therapies and survival outcomes were evaluated. The median overall survival was estimated using the Kaplan-Meier method. A total of 41 patients met inclusion criteria. The mean age was 55.6 years (standard deviation 12.1), and the majority (83%) had endometrioid histology. Most patients had stage III disease (78%). The primary reason for inoperability was parametrial invasion (46.3%). After neoadjuvant chemotherapy, 22 patients (53.7%) underwent interval debulking, 14 of these (63.6%) achieved optimal cytoreduction. Based on RECIST, complete response occurred in 6 patients (14.6%) and progressive disease in 10 (24.4%). Overall, 39% experienced recurrence. The 5-year overall survival rate was 58.2% (95% confidence interval 41.75% to 81.3%). Patients who underwent surgery had significantly better survival than those who received chemoradiotherapy (5-year overall survival 77.1% vs 26.1%) (95% confidence interval 58.90% to 100%, p = .014). Neoadjuvant chemotherapy, followed by interval debulking surgery, is a feasible and effective treatment approach with unresectable advanced-stage endometrial cancer. Although a small sample size, favorable survival outcomes are observed, particularly, in patients achieving optimal cytoreduction. Further prospective studies are needed to validate these findings and refine patient selection.