Poster Presenting Department Designation Abstract Title...

Poster No.

Department Presenting

Author Designation Abstract Title Authors

SR-118 BRAIRCH, Surgical Oncology

Rashpal Thakur

Senior Resident

A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high volume centre.

Singh Rashpal , Dhamija Ekta , Deo SVS , Mathur S. , Thulkar S.


K Raghuram Senior Resident

Bilateral Breast Cancer –Incidence, clinical spectrum and Challenges in the Management

K Raghuram, Mishra Ashutosh, Gogia Ajay, Sharma DN, Shukla NK, Deo SVS


Mokkapati Praveen Royal

Senior Resident

A prospective Study to Evaluate Breast Anthropometry among Indian Breast Cancer Patients- Impact on Surgical Decision Making

Deo SVS, Mokkapati Royal Praveen, Thulkar Sanjay, Dhamija Ekta

SR-121 A & B

BRAIRCH, Surgical Oncology

Navin Kumar

M.ch SR

Abstract A: Awareness and Knowledge regarding Genetic aspects of Breast Cancer in LMIC – A prospective Questionnaire based Study. Abstract B:An Analysis of palliative Surgical procedures in patients with Gastro-Intestinal

Deo SVS, Kumar Navin

tract Cancers performed at a tertiary care center


Areendam Barua

Mch

Comparison of pre-operative short course radiotherapy verses long course chemo-radiotherapy in rectal cancer: surgical and oncologic outcomes

Barua Areendam , Khurse Bhushan Bharat, Kumar Sunil, Mohanti B.K., Pathy Sushmita, Thulkar Sanjay, Sharma Atul, Deo SVS.


Jyoutishman Saikia

Mch Student

Analysis of Critical complications following Upfront verses Re-do surgery for Thyroid Cancer.

Saikia Jyoutishman , Singh Seema, Bal C, Bhoriwal Sandeep , Deo SVS

SR-129 BRAIRCH, Medical Oncology

Akash Kumar

Senior Resident

Early discontinuation versus continuation of antimicrobial therapy in low risk pediatric cancer patients with febrile neutropenia, before recovery of counts: a randomized controlled trial (DALFEN study)

Kumar Akash, BiswasBivas , Chopra Anita, KapilArti, VishnubhatlaSreenivas, Bakhshi Sameer

SR-114 BRAIRCH, Lab Oncology

Rajni Anand Senior Resident

Rapid Identification of Key Copy Number Variations in Acute Lymphoblastic Leukaemia by Next GenerationSequencing based Multiplex Ligation-Dependent Probe Amplification

: Anand Rajni, Thakral Deepshi, Kaur Gurvinder, Savola Suvi, Benard-Slagter Anne, Kumar Lalit, Sharma Atul, Bakhshi Sameer, Seth Rachna, Kumar Indresh, Verma Pramod, Gupta Ritu

SR-116 A,B,C,D,E & F

BRAIRCH, Palliative Medicine

Rahul D Arora, Deptt. of Palliative Medicine

Senior Resident

Abstract A: A Survey on purview of palliative medicine services among the delegates of a national conference on supportive medicine

Rahul .D. Arora

SR-114

Title: Rapid Identification of Key Copy Number Variations in Acute Lymphoblastic

Leukaemia by Next GenerationSequencing based Multiplex Ligation-Dependent Probe

Amplification

Authors: Anand Rajni1, Thakral Deepshi1, Kaur Gurvinder1, Savola Suvi2, Benard-Slagter

Anne2, Kumar Lalit3, Sharma Atul3, Bakhshi Sameer3, Seth Rachna4, Kumar Indresh1, Verma

Pramod1&Gupta Ritu1

Affiliations:Laboratory Oncology Unit, Dr. BRA IRCH, All India Institute of Medical

Sciences1,Department of Tumor Diagnostics, MRC-Holland, Amsterdam,the Netherlands2,

Departments of Medical Oncology, Dr BRA IRCH3 & Pediatrics4, All India Institute of Medical

Sciences.

Presenting Author:

Name: Rajni Anand

Designation: Non-academic Senior Resident

Email:[email protected]

Corresponding Author:

Name: Prof.Ritu Gupta

Email: [email protected]

ABSTRACT

Introduction

Recurrent clonal genetic alterations are the hallmark of Acute Lymphoblastic Leukaemia (ALL). These

molecular aberrations govern the risk stratification in patients and are strong independent predictors of

response to treatment and clinical outcome.

Aims & Objectives

To evaluatenext-generation sequencing-based multiplex ligation-dependent probe amplification variant,

digital MLPA (dMLPA) for detection of submicroscopic Copy Number Variations (CNVs), which are

potentially missed by conventional and high-resolution technologies.

Materials and Methods

Patients:In this retrospective study, 154 consecutive samples of acute lymphoblastic leukemia patients

registered in the Medical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital and Pediatrics

outpatient departments (June 2017-November 2018) were included. The cases were diagnosed based

on morphology, cytochemistry and multicolor flow cytometry.

Treatment Regimen:The treatment protocol used for the pediatric patients was either Indian

Childhood Collaborative Leukemia (ICICLE) Group protocol or International Network for Cancer

Treatment and Research protocol (INCTR 02-04). Patientswho were positive for BCR-ABL

additionally received Imatinib.

Digital MLPA: Genomic DNA was isolated from either bone marrow or peripheral blood collected at the

time of diagnosis. For performing dMLPA, modified well-established MLPA protocol was combined with

Illumina next generation sequencing Miseq platform for amplicon quantification as described earlier

(Benard-Slagter A et al., 2017). Probes (>600) for detection of both B-ALL and T-ALL associated Copy

Number Variations (CNVs) were included in a single reaction and simultaneously performed copy

number analysis of 56 key target genes andkaryotyping. The PCR products were pooled and library was

quantifiedby Illumina MiSeqsequencer. Sixteen healthy control DNA samples were included in the first

validation run. Data analysis was performed by modified Coffalyser (MRC Holland). Statisticalanalysis

was done by STAT12.1 software and p values <0.05 were considered significant.

Results:In this study, of the 154 ALL cases, 73% were males, median age 6 years (2months-60years),

median TLC 16.9x 109/L (range 0.06-533.6) and median percent of leukemic blasts was 85%.These B-

ALL(n=127) and T-ALL(n=27) samples were analyzed for CNVs by dMLPA. We identified

intrachromosomalfusion genes SIL-TAL1 and NUP214-ABL1 in T-ALL and EBF1-PDGFRB in B-

ALL.Twenty-two cases of Hyperdiploidy were detected among B-ALL samples tested. Heterozygous

and homozygous gene deletions and intragenic deletions were detectedin putative driver genes

involved in cell cycle control and lineage differentiation in B-ALL (CDKN2A/B, CD200, BTLA, RAG2,

ETV6, IGHM, IKZF1,IGLL1, EPHA1, EZH2, JAK2, LEF1, MLLT3, MTAP, MYB, PAX5, BTG1, RB1,

TBL1XR1, VPREB1) and T-ALL (CDKN2A/B, EGR1, EBF1, LEF1, CASP8AP2, IKZF1, JAK2,PAX5,

MLLT3, NF1, PTEN, PTPN2, PHF6) subtypes. In addition, intragenic gains (IKZF3, ERG, MYB,

NOTCH1, NR3C2, PHF6, PTEN, P2RY8 and TP53) and intrachromosomal amplification of

chromosome 21 were observed, which were confirmed by conventional MLPA.

Conclusion:The number of genomic alterations analyzed by dMLPA was substantially higher (mean>5

CNVs/ sample) than that obtained with conventional MLPA.Furthermore, samples with > 25% of

neoplastic cells were reliably detected for the presence of sub-clonal alterations.Our results

demonstrateddMLPA as a robust and reliable alternative for rapid detection of CNVs with therapeutic

and prognostic implications in newly diagnosed ALL patients.

SR-116A

Abstract one

A Survey on purview of palliative medicine services among the delegates of a national

conference on supportive medicine

Type: Abstract

Category: Supportive care

Presenting

and

corresponding

Author:

Rahul .D. Arora; Dept. of Palliative Medicine, All India Institute of Medical

Sciences, New Delhi, IN

Background

The provision of personalized, symptom oriented, patient centered care at an early stage in

the patient’s trajectory of illness is the philosophy that underlies supportive care. There is

often an overlap in nature of supportive medicine services provided by a medical oncology

and palliative/supportive medicine team. A practical, cost effective and resource intensive

solution then lies in building a workforce of health care professionals from

palliative/supportive medicine who are well trained in supportive oncology.

Methods

A questionnaire based on clinical scenarios encountered in the integrated inpatient palliative

medicine unit was enclosed along with the delegate kit of the Indian association of

Palliative care 2018 conference.

Results

Interventional pain procedures (65.49 percent) and counseling regarding goals of care and

provision of palliative sedation (57.75 percent) were considered the main indications for an

inpatient palliative medicine unit admission. A majority (66.89 percent) agreed that the

duration of inpatient stay should be defined by the stage of the illness. 48.9 percent agreed

that pulse oximetry should be available for all inpatients. Acute kidney injury and

dyselectrolytemia were considered valid indications for an ICU admission. 36.9 percent felt

that use of non invasive ventilation strategies, antibiotic stewardship, management of sepsis

and dyselectrolytemia should be duties of a palliative medicine professional in the ICU.

48.3 percent, 65.31 percent and 50.34 percent of individuals reported that the timing of

intervention, healthcare professional involved and subset of patients involved were the

differences between supportive oncology and palliative medicine.

Purview of Early palliative medicine

1. Management of complex psychiatric symptoms 34.87 %

2. Management of chemotherapy related complications 40.79 %

3. Counselling regarding goals of care 80.92 %

4. Assessment of quality of life 73.68 %

5. Interventional pain management techniques 50.66 %

Conclusions

Inpatient admission is integral to sustain a cost effective model of delivery of supportive

medicine services, however a consensus on the guidelines which govern the establishment

and functioning of such a unit are lacking.

SR-116B

A Survey on acceptable nomenclature in addressing patient needs among the delegates of a

national conference on supportive medicine

Type: Abstract


Authors: Rahul .D. Arora; Dept. of Palliative Medicine, All India Institute of Medical


Background

The scope and ambit of services offered in an integrated inpatient palliative medicine unit

located in tertiary cancer centre is explored through various questions pertaining to multiple

domains encompassing clinical management of advanced cancer patients. The survey tests

the attitudes of the respondents while laying the foundation of building and sustaining a

novel model where Supportive cancer services, Pain management and Palliative medicine

interventions (including End of life care) are offered as part of a continuum.

Methods

The survey was carried out among the registered delegates of the annual national conference

of the Indian Association of Palliative Care.The survey questionnaire was part of the

delegate kit. Online responses were also invited through the portal “survey monkey”.

Results

48 percent (84/175) felt that Palliative medicine and supportive oncology are mutually

exclusive domains in patient management. 40 percent (71/175) agreed that the terms

Palliative medicine and Palliative care are different entities in patient management. 47

percent (96/203) agreed that the term Palliative medicine should be substituted by

Supportive medicine while only 22 percent (38/172) agreed that using the term Supportive

oncology would be justified in place of palliative medicine. 34 percent (59/169) felt that

substitution of the term Palliative medicine by Supportive oncology might remove the

stigma associated with the usage of the term "Palliation".

Conclusions

These results reflect the multiplicity of views which underlie existing divergent schools of

thought in this nascent subspeciality. An indigenous academic model based on the premise

of integration of supportive care and medical oncology which dispels the myth of pure

palliation as a segregated entity is the need of the hour. The services offered should also

reflect the understanding that recognition and management of supportive care needs of

cancer patients is of utmost important in making the model economically viable and socially

sustainable.

SR-116C

A survey on attitudes towards Euthanasia among delegates of a national conference on

supportive medicine

Type: Abstract


Authors: Rahul D. Arora; Dept. of Palliative Medicine, All India Institute of Medical


Background

There is a widespread belief that Euthanasia and good palliative medicine are mutually

exclusive. It is important to explore whether the philosophy of palliative medicine which

lays an emphasis on a good death also recognizes the individual’s right to seek death as a

means to end suffering.

Methods

A survey exploring the attitude and opinion of respondents on the extent of involvement of

Palliative/Supportive medicine professionals in the provision of Euthanasia was conducted

among the registered delegates of Indian association of Palliative Care conference 2018.

Results

55.66 percent (85/153) of the respondents agreed that the debate on Euthanasia was within

the purview of Palliative Medicine, while 52.71 percent (78/148) agreed that the provision

of Euthanasia was within End of Life care. 61.27 percent (87/152) of the respondents

believe that a set of multidisciplinary experts should be introduced to initiate the discussion

on Euthanasia in a terminally ill patient when the same is expressly demanded by the patient

or family members. A majority (37.68 percent - 52/138) disagreed with the use of the terms

Passive and Active euthanasia. A majority of the respondents (51.74 percent - 74/143) also

strongly disagreed with the use of the term physician assisted suicide. 42.46 percent

(62/146) of the individuals agreed that the right to a good death and Euthanasia were

mutually exclusive. 40.13 percent (61/152) agreed that they do not recognize the right to

Euthanasia.

Conclusions

The right to seek Euthanasia as a means of a respectable death is a debatable subject which

should be approached carefully keeping in mind the distinct sociopoliticocultural thread

which runs through the moral fiber of the society. The involvement of experts from multiple

subspecialities (as suggested by the highest court of law in India) while ignoring the pivotal

role of the palliative medicine professional in establishing a framework of guidelines

surrounding Euthanasia does not seem to be justified. The importance of having the law

firmly on their side should not be underestimated by Palliative/supportive medicine

professionals who are bound by duty to take the lead in the discourse surrounding end of

life care.

SR-116D

Salient features of an indigenous integrated inpatient model of delivery of supportive

medicine services - a narrative review

Type: Abstract


Authors: Rahul .D. Arora; Dept. of Palliative Medicine, All India Institute of Medical


Background

The multiplicity of existing models has the potential to act as a deterrant to the

development of an economically feasible and self sustaining model of delivery of

supportive medicine services. A uniformity in guidelines governing the delivery of

these services is the need of the hour.

Methods

The department recently submitted an application for recognition as an ESMO

Designated centre for Integrated oncology and Palliative Medicine. This paper tries to

highlight the features unique to this model and builds upon the argument that the

western model cannot be supplanted to the Indian setting.

Results

The following salient features were identified

The department encourages cancer directed therapy where feasible and prides itself as

being ahead of the times in proposing a model which incorporates various aspects of

disease directed therapy, supportive care and palliative care (including quality end of

life care provision) as a continuum.

A larger role for the palliative medicine professional with direct involvement in

critical areas of supportive oncology, procedures such as therapeutic paracentesis,

pigtail insertion and interventional pain management techniques is envisaged.

We have been able to cut down significantly on the time spent for the patient in

obtaining an expert liaison with specialists from other super-specialities.

A weekly clinico-radiological conference is held where important cases are discussed

with radiologists.

The fact that advanced cancer patients (who not recieving any cancer directed therapy)

are bieng treated alongside those receiving active anticancer treatment has also been

instrumental in creating an environment where there is no discrimination and stigma

attached to the term palliation.

Conclusions

This model of delivery of supportive medicine services can act as a benchmark on

which other regional centres can be modelled. The close involvement of professionals

from disciplines such as Anaesthesiology and Radiology could be one of the important

reasons in ensuring that this model has been successful in pushing the boundaries and

managing patient issues which were traditionally considered outside the scope and

ambit of Palliative medicine.

SR-116E

Existent academic patient care Palliative medicine models in India – a narrative

review

Background

The primary hospital based models of service delivery include the consultative model,

the integrated model and a model that combines the two.

Objective

This paper attempts to compare and contrast the two existing models of academic

palliative medicine, with an emphasis on their conceptualization, components and

means employed to achieving the goal of holistic patient management. An academic

patient care model for the purpose of this article includes a tertiary care teaching

hospital with dedicated round the clock palliative medicine services.

Methods

The paper is a distillation of the author’s experiences at these two places.

Results

There are two models of Academic palliative medicine services, the first one bieng a

consultative model at Tata memorial centre, Mumbai and the other an integrated

inpatient model nested within the Department of Onco-anaesthesiology at the All India

Institute of Medical Sciences, New Delhi. The first model capitalizes on the concept of

continuity of care which is integral to this discipline. The creation of a qualified

workforce capable of offering homecare services at the patient’s doorstep is

undoubtedly a feather in its cap. The respite model conceptualized as a euphemism for

inpatient liaison services is also an interesting experiment. The integrated model is the

first of its kind in the country to house a dedicated six bedded ward and has achieved a

certain degree of success in removing the psychosocial divide between patients

receiving curative cancer directed therapy and supportive management. This has been

made possible by interdisciplinary participation and close integration with multiple

specialities.

Conclusion

These models, which are closely intertwined with the cultural, religious and socio

political fibre of the society offer contrasting examples of delivering palliation to the

masses. A template needs to be developed for the provision of services to the entire

country. The omission of provision of dedicated community based palliative services

needs urgent redressal.

SR-116F

What does “Early” in Early Palliative Medicine really imply?

Background

Early palliative medicine has not been well defined. Multiple studies have failed to prove the

unequivocal beneficial effects of this premise. What are the components that can be added to

make this approach seem more feasible.

Objectives

This paper is a means to initiate a discussion on the urgent need to take a relook at the scope of

Early palliative medicine.

Methods

This paper is a distillation of the personal views of the author on the subject.

Results

As we go through multiple definitions of palliative medicine which have existed since the time

that this speciality came into existence and move towards the present we realize that there has

been an attempt to confine the scope of this speciality to a niche subgroup of advanced cancer

patients. Boundaries between supportive oncology and palliative medicine have often blurred.

The timing at which the patient is introduced to these services and the differences in the primary

providers (with supportive oncology bieng the domain of medical oncologists) is the thin line of

demarcation between the two.

Conclusion

Introduction of palliative medicine to the patients family at an earlier stage in the illness, active

involvement during the daily multispeciality oncology rounds, expanding its role to include

management of medical issues such as side effects of chemotherapy may make palliative

medicine more acceptable to the patient and his family. It might go a long way in making the

contributions of an expert acceptable at the later stage in the illness trajectory and negate the

apprehension associated with such a referral.

SR-118

TITLE:

A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high volume centre.

Authors: Singh Rashpal 1, Dhamija Ekta 2, Deo SVS 1, Mathur S. 3, Thulkar

S. 2

1-Department of Surgical Oncology,IRCH,AIIMS,New Delhi,2-Department of Radiodiagnosis,IRCH,AIIMS,New Delhi.,3-Department of Pathology,AIIIMS,New Delhi Presenting Author: Rashpal Singh Email: [email protected]

Corresponding Author : Prof.SVS Deo Email: [email protected] Abstract Body: Introduction: In breast cancer, axillary lymph node involvement directly impacts the patient

survival and prognosis.Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary

staging in early breast cancer.Currently,management options for axilla management are Axillary

Lymph Node Dissection(ALND) & SLNB in node positive & in node negative respectively. In

developing nation like India,where resource constraints,logistics issues and over burden health

institutes create difficulty in managing patients,our study address this issue by implementing

USG and USG-Fine Needle aspiration cytology(FNAC) in early breast cancer patients.

Aims & Objectives: (1)To evaluate the accuracy of focussed axillary ultrasound and ultrasound guided FNAC for

assessment of axillary lymph nodes in early breast cancer patients.

(2)To evaluate the accuracy of vascular pedicle based nodal mapping in axillary node

localisation during Axillary Lymph Node Dissection(ALND).

Materials & Methods: All early breast cancer patients were screened by ultrasound axilla to

categorise the nodes as suspicious or non suspicious.Suspicious nodes underwent USG & FNAC

using vascular pedicle based nodal mapping for node targeted on US-FNAC,if node found to be

positive, patient underwent ALND & negative node patients underwent SLNB.All non-

suspicious nodes patient underwent SLNB.Final histopathology was taken as gold standard. The

sensitivity, specificity, accuracy, positive predictive value and negative predictive value ,

accuacy and false negative rate calculated for USG & USG-FNAC.

mailto:[email protected]


Results: Total 100 patients included in which 58 were non- suspicious and 42 suspicious nodes

on USG. Among suspicious group, 24 were positive on USG-FNAC & 18 were negative.In non

suspicious SLNB done in all. False negative rate of USG & USG-FNAC was 38% and 17%

respectively. 24 % of total patients can be taken up for ALND without performing SLNB.

Sensitivity,specificity,positive predictive value,negative predictive value and accuracy of USG -

62%,75%,69%,68%,69% respectively. Sensitivity,specificity,positive predictive value,negative predictive value and accuracy of USG-

FNAC- 82%,100%,100%,72% & 88% respectively. Conclusion: Our study indicates the feasibility of USG & USG-FNAC in a high volume centre

with good accuracy of around 70-80%.Overall, 24 % of total patients can be taken up for ALND

without performing SLNB.This study can guide us to utilize ultrasound and ultrasound-guided

FNAC as a routine evaluation tool in the pre operative assessment of axillary lymph nodes in

early breast cancer.Our study showed good and acceptable result(75%) in isolating and retrieving

the targeted node by just following the Vascular pedicle based node mapping of axilla to locate

the suspicious node without using any tagging or marking of node from where FNAC was

performed. These results can be implemented as a practicing tool in a busy high volume,logistics

issue and resource constraint hospitals especially in developing nation.

SR-119

Bilateral Breast Cancer –Incidence, clinical spectrum and

Challenges in the Management .

K Raghuram1, Mishra Ashutosh1, Gogia Ajay2, Sharma DN3,

Shukla NK1, Deo SVS1

1.Department of Surgical Oncology DR BRA-IRCH, AIIMS, New Delhi

2. Department of Medical Oncology DR BRA- IRCH, AIIMS, New Delhi

3.Department of Radiation Oncology DR BRA- IRCH,AIIMS, New Delhi

Presenting Author: Dr. Raghuram K. Email : [email protected]

Corresponding Author: Dr. SVS Deo. Email: [email protected]

Background:- Bilateral Breast cancer (BBC) is a rare entity with incidence of 1-2% in reported

literature.There are conflicting and inadequate data regarding the incidence,behavior, molecular

subtypes, management policies and their outcomes. We present our experience of treating 87 BBC with

multimodality management.

Materials and Methods:- An audit of prospectively maintained computerized breast cancer database of

the department of surgical oncology, AIIMS, New Delhiwas performed . The medical records of patients

with histo-pathologically proven Bilateral Breast Cancer (synchronous or metachronous) were analyzed

to assess thecliincal profile, molecular sub-types, treatment patternsand outcomes.

Results: A total 87(2.68%) patients presented with BBC out of3235 breast cancer patients treated

between January 1996 and December 2016. Out of 87 BBC patients 67 had metachronous (MBBC) and

20 had synchronous breast cancer(SBBC).Family history of breast cancer was present in 13 patients

(15%).Similar Molecular types were found in 56 BBC patients (64%) while this pattern was relatively

higher in SBBC group (70%).Screen detected Contralateral breast cancer (CBC) was detected in 16

patients only and rest all presented with breast mass. Most contralateral breast cancer patients had

early stage breast cancer in comparison to the index side cancer (64% versus 36%). Among 20 SBBC



patients 3 had B/L BCS and 13 had B/L mastectomy where as in 67 MBBC group majority had B/L

mastectomy. All patients undergoing BCS and LABC were given postoperative radiotherapy.All patients

received adjuvant chemo and or hormonal therapy both for index and CBC based on the stage and

hormone receptor status.

Conclusion:- BBC is an uncommon clinical entity and with effective therapeutic interventions and

improving survival we are likely to see more BBC in future. Majority present with MBBC during follow-up

and positive family history is present in a small proportion of BBC patients. Treatment of BBC is

challenging including choice of surgery, issues of Bilateral breast irradiation and re-chemotherapy and

hormonal therapy decisions for MBBC. BBC patients require individualized treatment planning in a

multidisciplinary treatment setting .

SR-120

ABSTRACT FOR INSTITUTE DAY 2019

Title: “ A prospective Study to Evaluate Breast Anthropometry among Indian

Breast Cancer Patients- Impact on Surgical Decision Making”

Institute: Surgical Oncology, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi

AUTHORS:Deo SVS, Mokkapati Royal Praveen, ThulkarSanjay, DhamijaEkta

Presenting Author: Mokkapati Royal Praveen


Corresponding Author: Deo SVS


Abstract Body

Introduction:

Breast cancer in India is emerging as a major public health problem. During the last 2 decades There is a

paradigm shift in the approach to surgical management of breast cancer . Majority of breast cancer

patients are being offered Breast conservation surgery along with oncoplastic or reconstructive surgical

options to improve cosmetic and functional outcomes. Breast Anthropometry plays an important role in

surgical decision making and majority of surgical guidelines are based on anthropometric data of

western patients and may not be applicable for Indian patients. There is a need to evaluate and

standardize breast anthropometry among Indian patients and assess suitability of current surgical

guidelines.

Aims and Objectives:

1.To describe different aspects of breasts in Indian women with breast cancer

2. To compare with data from global population

3. Attempt to categorise breasts in Indian women

Materials and Methods:

The present study was a prospective observational pilot study of 231 consenting inpatients with

operable breast cancer recruited between January 2016 to October 2018. General and specific

anthropometry parameters were measured in terms of shape, volume, ptosis and nipple-areola complex

characteristics. Breast volume was calculated using formula devised by Qiao et al.

Results:

Majority (56.7%) belonged to the age group of 40-60 years with an average BMI of 25.3 kg/m2.Mean

breast volume was 515 ml with a range of 60ml to 2280ml. Breast ptosis (measured by Renault’s

classification) was seen in 81% of the study population and grade 3 ptosis was seen in 40% of the

participants. Mean areola diameter, nipple diameter and nipple projection were 4.47cm, 0.9cm and

0.7cm respectively.

Conclusion:

Results of the current study indicate Geometrical breast anthropometry is a simple, low cost, objective

measurement method of breast volume which can be performed routinely by clinicians. There is a wide

variation in Breast volume range and the mean breast volumes of Indian sample size is midway

between the breast volume of women from Far East and the West. Another striking finding is the high

incidence of ptosis (80%) among Indian breast cancer patients. Based on current data, the Indian breast

volume can be classified into three categories (Category I – <220ml, Category II – 220 to 730 ml and

Category III - >730ml) . This is one of the first studies evaluating breast anthropometry among Indian

breast cancer patients and the outcomes have potential to influence surgical decision making especially

breast conservation and reconstruction options.

SR-121A

Awareness and Knowledge regarding Genetic aspects of Breast

Cancer in LMIC – A prospective Questionnaire based Study

Deo SVS*, Kumar Navin

Department of Surgical oncology,BRA-IRCH, AIIMS, New Delhi

Introduction

Recent advances in understanding of Genetic factors and familial breast cancer has opened new

treatment pathways for risk reduction among breast cancer patients. However educational

background, awareness and knowledge of patients can impact decision making. This study was

conducted to evaluate the knowledge and awareness regarding genetic aspects of Breast cancer

patients in LMIC.

Aims and objectives

The purpose of our study is to evaluate knowledge and awareness of regarding breast cancer, its

genetic basis and attitude toward genetic testing, proposed intervention and its acceptance in

order to develop targeted educational and healthcare strategies.

Materials and Methods

It is a prospective interventional study performed with total sample size of 150 breast cancer

patients using a structured questionnaire and educational material regarding genetic factors.

Study Phases

1. Pre-intervention assessment- Questionnaire-based assessment of awareness and knowledge

haddone with prior informed consent.

2. Educational Intervention-Brief descriptive educational material about the breast cancer and

its risk factors, screening, treatment, genetic aspects and prophylactic interventions were

provided.

3. Post-Intervention assessment -After 5-7 days of educational intervention, patients were re-

assessed with same questionnaire.

Results

Pre-intervention

assessment (%) Post-Intervention

assessment (%) Difference (%)

Basic knowledge about

breast cancer

12.8 23.2 10.4

Knowledge about breast cancer screening

11.6 40.0 28.4

Basic knowledge about

breast cancer treatment

35 95.2 60.2

Awareness of hereditary

or familial breast cancer 13.6 73.6 60.0

Knowledge about BRCA

gene 2.4 15.0 12.6

Willingness for genetic

testing for self and family 32.0 75.2 43.2

Awareness of prophylactic

intervention in BRCA

positive patients

9.6 72.0 62.4

Willingness for

Prophylactic intervention

in BRCA positive patients

22.0 72.0 50.0

Conclusion:- Results of the current study indicate that there are significantly low levels of awareness among breast

cancer patients regarding genetic basis, genetic testing and risk reducing options in LMICS. However, a

short onetime educational interventions have shown to significantly improve these parameters among

breast cancer patients in LMICS. Hence patient education is of prime importance when dealing with

complex issues like genetic testing and risk reduction strategies.

SR-121B

An Analysis of palliative Surgical procedures in patients with Gastro-Intestinal tract Cancers performed at a tertiary care center Deo SVS*, Kumar Navin Dept.of surgical Oncology, BRA-IRCH, AIIMS, new Delhi.

Introduction Palliative surgery is an often neglected though an integral part of the management of advanced malignancies to improve the quality of life (QOL). This is reflected by the relative paucity of literature on palliative care surgeries. A significant proportion of G.I. cancer patients are suitable for surgical palliation only. We present an audit ofthe palliative surgical procedures performed in patients with gastro-intestinal tract malignancies.

Methods

All patients having a surgical procedure for a palliative indication between January, 2000 to 2016 for gastro-intestinal tract related malignancywere identified from a prospectively maintained database. A descriptive analysis of clinical spectrum, indication for surgery and profile of surgical procedures was performed.

Results

A total of 1522 patients of gastrointestinal malignancy had major surgery of whom 463 (30.4%) had surgery for palliation of symptoms. Colo-rectal carcinoma was the most common subset (40%) followed by esophagus (32.8%), gastric carcinoma (23.3%), anal cancer and small bowel carcinoma. Bowel obstruction (35%) was the most common symptoms for which a palliative procedure was performed followed by dysphagia (32.6%), gastric outlet obstruction, bleeding, fecal incontinence, intestinal perforation, recto-vaginal fistula .The procedures performed were feeding jejunostomy (37.3%), diversion ostomy (25.7%), gastrojejunostomy, small intestinal resection-anastomosis/bypass, hemicolectomy, feeding gastrostomy, gastrectomy, abdominoperineal resection (APR) and intra-thecal drug delivery pump implant. Surgical site infections, ostomy related complications, burst abdomen, bleeding, pneumonia were the common complications encountered after palliative care surgeries. 85.6% of patients had improvement in symptoms within 30 days after performance of palliative procedure.

Conclusion Surgical Palliation plays an important role in the management of G.I.Tract malignancies and approximately one third of patients with G.I tract cancer need palliative surgical procedures. Close collaboration with palliative care team and appropriate and judicious surgical intervention can lead to improvement in QOL of advanced G.I.Tract cancer patients.

SR-122

COMPARISON OF PRE-OPERATIVE SHORT COURSE

RADIOTHERAPY VERSES LONG COURSE CHEMO-RADIOTHERAPY

IN RECTAL CANCER: SURGICAL AND ONCOLOGIC OUTCOMES

Authors: Barua Areendam 1, Khurse Bhushan Bharat

1, Kumar Sunil

1, Mohanti B.K.

5, Pathy

Sushmita2, Thulkar Sanjay

3, Sharma Atul

4, Deo SVS

1.

1. Dept of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi

2. Dept of Radiation Oncology, BRA-IRCH, AIIMS, New Delhi

3. Dept of Oncoradiology, BRA-IRCH, AIIMS, New Delhi

4. Dept of Medical Oncology, BRA-IRCH, AIIMS, New Delhi

5. Dept of Radiation Oncology, Manipal Hospital, New Delhi

Presenting author: Dr. Areendam Barua, [email protected]

Corresponding author: Prof. SVS Deo, [email protected]

Introduction:

Radical resection is the mainstay of the treatment for rectal cancer and pelvic recurrence is one

of the most common types of failure. Pre-operative Radiotherapy has been shown to decrease

loco-regional recurrence and improve disease free survival in rectal cancer. Literature supports

usage of both short course radiotherapy (SRT) or long course chemo-radiotherapy (LCRT).Both

modalities have pros and cons.

Aims and objective:

Analysis of the surgical and oncologic outcomes of SRT vs LCRT for Rectal cancer.

Materials and Methods: A Retrospective analysis of prospectively maintained rectal cancer

computerized database was performed from 2000 to 2015 and all histopathologically proven

rectal cancers involving mid and lower third receiving preoperative radiotherapy were included

for analysis.



Results:A Total 208 out of 356 Rectal cancer patients received preoperative radiotherapy (

SRT=120 & CLRT =88). The median age at presentation was 56 year with male preponderance

at a ratio of 3:1. Lower one third was the most common location (50%) followed by bulky mid

rectal tumors. Majority of the patients had clinical stage II and III (33%&45%). Mean distance

from the anal verge was 4.5cm. The surgical and oncologic outcomes were as follows.

Table-1 showing Surgical & Oncologic outcomes for SRT and LCRT

Sl no Factors Short course

Radiotherapy

(n=120)

Long Course

Chemoradiotherapy

(n=88)

P value

1. Resectability 95(79%) 68(77%) 0.031

2. Sphincter salvage rate 32(33.68%) 25(39.05%) 0.06

3. Pathological Complete

response

6(5%) 5(7%) 0.74

4. Pathological Stage I 14(14%) 13(20%)

II 36(36%) 24(36.9%)

III 42(42%) 21(32.9%)

IV 2(2%) 2(3.08%)

5. Recurrence 20(21.7%) 13(19.1%) 0.20

Conclusion: Results of our study reveal a comparable resectability, sphincter salvage, path CR

and recurrence rates for SRT and LCRT. Overall Sphincter salvage rates were low and

unresectability rates were high due to a significant proportion of low and mid rectal tumors

presenting with advanced stage at presentation. SRT has logistic advantages in high volume and

resource constrained countries.

SR-123

Title: Analysis of Critical complications following Upfront verses Re-do

surgery for Thyroid Cancer.

Authors: Saikia Jyoutishman 1, Singh Seema1, Bal C2, Bhoriwal Sandeep 1,

Deo SVS1

1. Dept of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi

2. Dept of Nuclear medicine, AIIMS, New Delhi

Presenting Author:

Name: Jyoutishman Saikia


Corresponding author:

Name: Prof SVS Deo


Abstract Body:

Introduction: Thyroid cancer is the most common endocrine malignancy with a rapid world-wide

rise in incidence in the past few decades. Total thyroidectomy with or without neck dissection is the

mainstay of treatment with good long-term survival. Sub-optimal or incomplete surgical

interventions are common at community level practice. Re-do surgery for thyroid cancer carries a

higher risk of morbidity especially related to parathyroid and recurrent laryngeal nerve. We present

our experience of thyroid surgery related morbidity in upfront versus redo thyroid surgeries.

Aim & Objectives: To identify the critical morbidities following upfront and redo-surgery for

thyroid cancer at a tertiary care center and compare these morbidities between the two groups.

Methods: All the cases of biopsy proven differentiated thyroid cancer (DTC) undergoing surgery between 2009 to 2016 were analyzed from prospectively maintained computerized database. An analysis was performed for clinical spectrum, patterns of surgical intervention, and critical morbidities in patients undergoing upfront surgery (Group-1) and re-do surgery (Group-2). Results: A total 270 patients fulfilled inclusion criteria. Group-1 had 151 patients and group-2 119 patients. Median age at presentation was 40 years with female predominance. Among all histological variants of thyroid cancer, papillary carcinoma of thyroid was the commonest variant followed by follicular carcinoma thyroid. Majority of the patients had total thyroidectomy in both the groups: group-1 (92.7%) ; group -2 (81.5%) and almost two thirds of patients had neck dissection in both the groups. The details of critical morbidities are as follows -transient hypocalcaemia (3.31%), permanent hypocalcaemia (1.98 %) and RLN related vocal cord palsy (0.66%) in group-1 and 3.36%, 2.56%, 2.5% in group-2 respectively.

Conclusion: Surgical morbidity is one of the key determinants of outcome in surgical management of thyroid cancer and in general higher rates of parathyroid and recurrent laryngeal injuries were reported in patients undergoing redo surgeries. However results of the current study indicate the possibility of achieving comparable morbidity in redo cases in high volume centers with experienced surgeons.

SR-129 Title : Early discontinuation versus continuation of antimicrobial therapy in low risk pediatric cancer patients with febrile neutropenia, before recovery of counts: a randomized controlled trial (DALFEN study) Authors :Kumar Akash, BiswasBivas , Chopra Anita, KapilArti, VishnubhatlaSreenivas,

Bakhshi Sameer

Affiliation:

Presenting Author:

Name :DrAkash Kumar

Department of Medical Oncology, IRCH, AIIMS

Email : [email protected]

Corresponding Author:

Name : Prof Sameer Bakhshi

Department of Medical Oncology, IRCH, AIIMS

Email : [email protected]

ABSTRACT

Background: Stratifying pediatric cancer patients with febrile neutropenia into low and high risk

groups based on various clinical and laboratory parameters has assisted in de-escalation of

antimicrobials in clinics. There is lack of data for stopping antimicrobials in subjects with low

risk febrile neutropenia who become afebrile but continue to be neutropenic.

Method:

We conducted an open label,non-inferiority, randomized controlled phase 3 trial at tertiary

cancer centre in India. Patients aged 3-18years, presenting with low risk febrile neutropenia were

started on empirical intra-venous antibiotics, awaiting culture reports in outpatient setting.

Randomization was done when the patients became afebrile for atleast 24 hours; standard arm

consisted of oral antibiotics, while antibiotics were stopped in the experimental arm. Enrolled

patients were followed for re-appearance of fever and rate of re-admission, till the resolution of

neutropenia.

Result: From Jan 2017-Dec 2018, 75 patients were randomized: 38 to stoppage arm while 37

patients received oral antibiotics. Baseline characteristics were equally matched between two

arms. Success rates were 94.6% in the continuation arm versus 94.7% in the stoppage arm;

absolute risk difference was 0.1% (95% CI: -10.0% to +10.3%). Mean duration of neutrophil

recovery was 4.2 days and 3.9 days in stoppage and oral arm respectively (p=0.44). There was no

re-admission on failure in any arm.

Conclusion: Antimicrobial therapy in low risk afebrile neutropenic patients can be managed on

outpatient basis and can be stopped early. This approach can lead to significant cost and

manpower benefits as well as help decrease antimicrobial resistance.

(ClinicalTrials.gov, numberNCT03003273)

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