Background: Carcinoma penis is a rare neoplasm, and the literature is scarce on long-term survival and its predictors. The aim of the study was to determine the clinical profile and management patterns, identify predictors of survival, and the impact of education and rural/urban dwelling on survival. Methods: Patients with a histological diagnosis of carcinoma penis from January 2015 to December 2019 were included in the study. Demographics, clinical profile, education status, primary residence address, and outcomes were obtained from the case records. Distance from the treatment centre was obtained from the postal code. The primary objectives were to assess relapse-free survival (RFS) and overall survival (OS). The secondary objectives were to identify the predictors of RFS and OS and to determine the clinical profile and treatment patterns in patients with carcinoma penis in India. Time-to-event was calculated by Kaplan–Meir analysis and survival was compared by the log-rank test. Univariate and multivariable Cox regression analyses were used to find independent predictors of relapse and mortality. Logistic regression analyses to examine the associations of rural residence, education status, and distance from the treatment centre with the relapse adjusting for measured confounding variables. Results: Case records of 102 patients treated during the above period were retrieved. The median age was 55.5 (interquartile range [IQR] 42–65 years). Ulcero-proliferative growth (65%), pain (57%), and dysuria (36%) were the most common presenting features. Clinical examination or imaging revealed inguinal lymphadenopathy in 70.6% of patients, however, only 42% of these lesions were pathologically involved. A total of 58.8% of patients were from rural areas, 46.9% had no formal education, and 50.9% had a primary residence ≥100 km from the hospital. Patients with lower education and rural households had higher TNM stages and nodal involvement. Median RFS and OS were 57.6 months (15.8 months to not reached) and 83.9 months (32.5 months to not reached), respectively. On univariate analysis tumor stage, involvement of lymph nodes, T stage, performance status, and albumin was predictive for relapse and survival. However, on multivariate analysis, the stage remained the only predictor of RFS and nodal involvement, and metastatic disease was a predictor of OS. Education status, rural habitation, and distance from the treatment centre were not predictors for relapse or survival. Conclusions: Patients with carcinoma have locally advanced disease at presentation. Rural dwellings and lower education were associated with the advanced stage but did not have a significant bearing on the survival outcomes. The stage at diagnosis and nodal involvement is the most important predictor of RFS and OS.

In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controv...

The current treatment for advanced epithelial ovarian cancer (EOC) is complete cytoreductive surgery (CRS) followed by adjuvant chemotherapy. Although many patients respond well to this treatment, many will relapse and die from peritoneal carcinomatosis. Adding Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to the standard treatment has been shown to improve survival by reducing cancer recurrence in the abdomen, with acceptable side effects. This article summarizes the current evidence and our long experience with CRS and HIPEC at different stages of ovarian cancer treatment: at upfront CRS, at interval CRS, at secondary CRS, and as palliative setting. Our study cohort includes 400 EOC patients who underwent CRS only and CRS with HIPEC in upfront, interval, and secondary setting. Cisplatin 75mg/m2 for 60 min was used in all settings. For a median follow-up of 80 months, the DFS in CRS with HIPEC and CRS only were 34.3 months vs 22.7 months in the upfront group (p < 0.001), 18.9 months vs 13.3 months in the interval group, (p 0.04) and 14.7 months vs 11.9 months in secondary group, (p 0.13). The median OS in the CRS with HIPEC vs CRS only group was 72.1 months vs 43.3 months in the upfront setting, (p-value 0.034) and 54.2 months vs 44.7 months in the interval setting (p-value 0.44). At 5 years, 49% in the upfront setting and 28% in the interval setting were alive in the CRS with HIPEC arm. There was no difference in Clavien Dindo Grade 3 & 4 postoperative complications among both the groups except for days of hospital stay (p-value 0.016). Cytoreductive surgery (CRS) with HIPEC presently play a promising treatment strategy for advanced ovarian cancer, potentially enhancing outcomes compared to conventional therapies in all settings. Thus, adding HIPEC to complete cytoreductive surgery has improved outcomes in all required settings of advanced EOC especially in upfront setting.