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Introduction Testicular germ cell tumors are rare in India. Despite the advances in chemotherapy, poor-risk testicular nonseminomatous germ cell tumors (NSGCT) remain as a clinical challenge. Various prognostic factors have been described in this rare disease. The Indian data in this regard is scarce. Our study is the first attempt to assess the tumor marker decline with respect to treatment outcome in poor-risk NSGCT in Indian patients. Materials and Methods This retrospective study was done among newly diagnosed poor-risk NSGCT, treated at genitourinary clinic, at our tertiary cancer center during the period 2017 to 2019. The prognostic significance of tumor marker decline in them was correlated with 2-year progression-free survival (PFS) and 2-year overall survival (OS). Statistical Methods The association between two variables were assessed using chi-squared/Fischer's exact test. The PFS and OS were estimated using Kaplan–Meier method and the significance difference between survival curves was tested using log rank test. The risk for survival was estimated using cox regression analysis. A p-value of Results Out of 11 eligible patients, four (36%) had favorable tumor marker decline and seven (64%) had unfavorable decline. The 2-year PFS among favorable and unfavorable decline group were 66.7 and 42.9%, respectively (p-0.358), and the 2-year OS was 66.7 and 71.4%, respectively (p-0.974). Teratoma was not found to be a significant factor in our study. Tumors with only beta human chorionic gonadotropin (βHCG) elevation were observed to have good outcome. Postchemotherapy unresectable residual disease showed a significant trend toward inferior survival, the 2-year PFS was 38 versus 100% (p-0.188) and the 2-year OS was 62.5 versus 100% (p-0.334) in patients with and without unresectable residual disease, respectively. Conclusion Majority of our poor-risk NSGCT patients had unfavorable tumor marker decline and progressive events. However, the survival difference was not significant, given the small sample size. Tumors with only βHCG elevation were observed to have good outcome. Postchemotherapy unresectable residual disease showed a significant trend toward inferior survival.

Background: Inflammation has an important role in the initiation and progression of carcinoma cervix. The measurement of inflammatory biomarkers is a cost-effective method of identifying patients at high risk of recurrence after treatment. This study was done to identify the influence of pre-treatment inflammatory biomarkers on survival in patients treated with radical chemo-radiation or radiation. Methods: Patients with biopsy proven carcinoma cervix treated with Radiotherapy or Chemo-radiation from January 1st, 2016 to September 30th, 2017 were included. Pre-treatment complete blood counts, differential counts, serum albumin and C-reactive protein (CRP) were obtained. Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and CRP Albumin ratio (CAR) were calculated. The best cut off values for NLR, PLR, serum albumin, CRP and CAR were found out from receiver operating characteristic (ROC) curves. OS (Overall Survival) and DFS (Disease Free Survival) were estimated using Kaplan -Meier method. The prognostic value of inflammatory biomarkers on survival was assessed by cox regression model. Results: Sixty-three patients were included. The median follow up was 42.5 months. The best cut off values for NLR, PLR, albumin, CRP and CAR from the ROC curve were 2.36, 122.725, 3.95, 0.65 and 0.8 respectively. The three-year OS and DFS probability were 68.3% and 63.5% respectively. Patients with CAR >0.8 had 5.7 times more risk of death and 6.01 times risk of relapse or progression compared to patients with CAR ≤0.8. Conclusion: Patients with a CRP-Albumin ratio of more than 0.8 are at significant risk of relapse and death after chemoradiation or radiation.

The objectives were to study the pattern of expression of PD-L1 in patients with carcinoma cervix and find out any relation with the various patient- and disease-related factors like histology, FIGO stage, lymph node metastasis and response to treatment. One hundred cervical cancer patients registered during 2018 who were suitable for radical treatment were identified. The paraffin-embedded, formalin-fixed cervical biopsy specimens of these patients were collected. Immunohistochemical staining for PD-L1 expression was performed on the cervical biopsy material. The test was considered positive if 50 per cent or more tumour cells or less than 50 per cent with intense staining were present. PD-L1 was positive in 25 of 99 (25.3%) cervical carcinoma samples. PD-L1 was positive in 18 of 81 (22%) squamous cell carcinomas, 7 of 16 (43.7%) adenocarcinomas and 0 out of 2 adenosquamous carcinomas. Twenty-nine per cent of patients with positive pelvic nodes expressed PD-L1 positivity. None of the patients with paraaortic node metastasis expressed PD-L1 positivity. No statistically significant associations were found between PD-LI positivity and menopausal status, haemoglobin level, histology, tumour size, FIGO stage, nodal involvement and response to treatment. One out of four patients had evidence of PD-L1 positivity in their cervical cancer. No association was found between PD-L1 expression and various clinicopathological factors and response to treatment. But follow-up studies are needed to observe any effect on disease-free or overall survival. Validation of scoring of PD-L1 expression and uniform reporting is required.

Uterine sarcomas are heterogeneous group of tumours comprising 1% of gynaecological malignancies. There is lack of concences on optimal treatment of uterine sarcomas. This is because of lack of randomised controlled trials due to rarity of these tumours. Surgical management without spill remains the standard primary treatment. Most of the times uterine sarcomas are diagnosed postoperatively from histopathology report of either myomectomy or hysterectomy. This retrospective study analysed the clinico pathological characteristics, prognostic factors, treatment details and survival outcome of different types of uterine sarcomas.This is a retrospective analysis of 59 patients of uterine sarcomas. All patients underwent surgery. Adjuvant chemotherapy or radiation treatment were given according to histopathological report and FIGO stage. Patients were followed up every three months for first two years and then every six months. Disease free survival (DFS) and Overall survival (OS) were calculated.The data were summarized using descriptive statistics as mean, percent and range. Survival probabilities were estimated using Kaplan-Meier method and the significance of difference between the survival curves were calculate using log-rank test.Uterine sarcomas are rare and aggressive tumours of uterus. Majority of these tumours present in early stage. Surgery remains the main treatment modality. Role of adjuvant radiation treatment remains controversial. Tumour stage is the most important prognostic factor.

Introduction/Background Cervical cancer is the most prevalent cancer and the fifth most common cause of cancer death in Indian women. Clear cell carcinoma of the cervix (CCCC) is rare, accounting for only 4% of all adenocarcinomas. CCCC can occur sporadically or in association with in-utero diethylstilbestrol (DES) exposure. There are no clear-cut treatment recommendations for the management of CCCC. Early-stage disease is usually treated by surgery and more locally advanced stages by chemoradiation followed by brachytherapy. Methodology Aim: This study aimed to assess the survival outcomes and patterns of failure of patients with CCCC. Settings and Design: Retrospective study done at Regional Cancer Centre, Thiruvananthapuram, Kerala, India Material and Methods: Case records of all the patients with CCCC who were diagnosed and treated between 1995 and 2015 were reviewed for clinical, pathological and treatment characteristics. Statistical analysis: Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results The diagnosis of clear cell carcinoma of the cervix was confirmed in 15 patients. The median age was 53 years. 20% of the patients were in the International Federation of Gynaecology and Obstetrics (FIGO) stage I, 60% in stage II, 7% in Stage III and 13% in stage IVA. Stage IB and IVA patients were managed surgically, and adjuvant therapy decided based on the tumour pathology. Stage IIB and IIIB patients were treated with concurrent chemoradiation followed by brachytherapy. The median follow-up period was 47 months. The three-year DFS and OS were 13.3% and 13.3% respectively. Conclusion CCCC has a poor prognosis, stage for stage compared to other histologies. The FIGO stage, tumour size, lymphovascular space invasion and pelvic node status were factors that predicted the prognosis. Adjuvant radiotherapy or chemoradiotherapy have a limited role in the treatment of this rare cancer. Disclosures The authors have no potential conflict of interest to disclose.

Objective Incidence of endometrial cancer is on the rise in India. Although there have been significant advances in understanding of endometrial cancer biology, these factors are not yet included in routine management of patients. The aim of the study was to identify prognostic factors for risk stratification and offering judicious adjuvant therapy. Methods Retrospective analysis of data of patients with carcinoma endometrium registered at Regional Cancer Centre, Thiruvananthapuram from January 2009 to December 2013 was done. Various patient, tumor and treatment related factors were analyzed for its effect on recurrence. Survival estimates were generated using Kaplan –Meier method. Univariate analysis was done using Chi-square and Fisher’s exact tests and multivariate analysis was done using Cox regression model. The statistical analysis was done using SSPS software version 11. Results The median follow up of 642 patients was 95 months (range 3–178 months).There were 432 stage 1 (67%), 100 stage II ( 15.57%), 108 stage III (16.8%)and 2 stage IVa patients (0.3%). The five-year disease free survival (DFS) was 82.1%. Prognostic factors for DFS on multivariate analysis were age> 60 years, high grade tumor, advanced stage, deep myometrial invasion, cervical stromal invasion, and negative Progesterone Receptor (PR) status. Cervical stromal invasion, negative PR status, no adjuvant treatment were associated with pelvic failure. Conclusion The predictive and prognostic factors for Carcinoma endometrium is similar to those published in developed countries.

Traditional Manchester Point based brachytherapy continues to be popularly practiced even when CT imaging has replaced traditional X-rays for treatment planning. ICRU bladder and rectal Point doses are documented and monitored as predictive of Organs at Risk (OAR) doses. Aim To study the late effects of treatment and its correlation with dose volume parameters. Dosimetric correlation between volume doses and corresponding ICRU Rectum and Bladder point doses were studied. Materials and Methods 101 Cervical cancer patients treated during 2014 – 2016 with radio-chemo therapy and CT based Brachytherapy treatment planning were eligible. Bladder, rectum and sigmoid were retrospectively contoured on CT data sets and Dose volume histogram for doses to the most exposed portion of (D2cc) OARs were recorded and compared with corresponding ICRU Point doses. Patients were followed up till August 2019 and toxicity data collected prospectively using CTCAE V4.03. Correlation of toxicity with doses received was attempted. Results The overall incidence of bladder toxicity was 19.8% and rectal toxicity 30.7%. Grade 2 &3 toxicities were The threshold dose for bladder toxicity was D2cc- 89 Gy and 67 Gy for rectum. Grade 4 toxicity occurred with D 2cc - 83 Gy. There was no correlation between bladder D2cc and ICRU bladder point doses. Moderate correlation was seen between rectal D2cc and dose to point R (0.62) Conclusion Monitoring D2cc of OARs should be attempted on CT in an attempt to reduce morbidity even with traditional planning.

Germ cell tumour of the testis is the most common cancer in young men in the western world. India has the lowest incidence globally, and hence Indian data are sparse. We report the outcomes of patients with nonseminomatous germ cell tumours of testis treated at a tertiary cancer centre in South India over a period of 10 years. Patients with a histopathological diagnosis of nonseminomatous germ cell tumours of the testis from 1 January 2006 to 31 December 2016 were included in the study. Patient demographics, tumour characteristics and treatment details were retrieved from case records. Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox regression model was used to analyse the prognostic factors. One hundred and nineteen patients with nonseminomatous germ cell tumours of the testis were included in the study. The median follow-up was 81 months. The estimated 4-year OS and progression-free survival were 87.1% and 84.5%, respectively. The four-year OS for good, intermediate and poor-risk groups was 93.6%, 87.5% and 52.6%, respectively. The PFS at 4 years was 91.4%, 87.8% and 47.4% for good, intermediate and poor-risk groups, respectively. The presence of nonpulmonary visceral metastasis and biochemical response after chemotherapy were significant predictors for OS and PFS in multivariate cox proportional hazards regression. The survival figures are comparable to the rest of the world except in the poor prognostic risk group. The inferior survival noticed in this group of patients may be due to the lack of good salvage procedures. High-dose chemotherapy with stem-cell support may be considered more often for this group of patients.

To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. A total of 43 patients with histologically proven primary vaginal cancer, who were treated between January 2005 to December 2015, were identified. All were treated with definitive radiotherapy with or without concurrent chemotherapy. Radiotherapy was delivered as a combination of external beam radiotherapy and brachytherapy to a minimum dose of 60 Gy. Four patients were FIGO stage I, 13 were stage II, 23 stage III patients and three patients were stage IVA. The median age was 60 years (range 42–76). The median follow-up was 29 months with a range of 3 to 70 months. The different variables looked into like the histology, lower third of vagina involvement and prior hysterectomy did not show any difference in survival. Addition of concurrent chemotherapy was the only factor which showed a trend towards better survival with a p value of 0.09. Even in the subset of patients with prior hysterectomy, those who received definitive treatment with concurrent chemo-radiotherapy had a better two-year progression-free survival than those who received radiotherapy alone (57.4% Vs 10.5%). A combination of EBRT and brachytherapy with concurrent chemotherapy is a reasonable option in the management of primary vaginal cancer. Further optimization of the dose and techniques of radiotherapy are warranted.

Malignant peripheral nerve sheath tumour (MPNST) is a rare variety of sarcoma occurring in the uterine cervix. Only 16 cases have been reported in literature till date. There is no clear consensus on the treatment due to the rarity of the disease. This is primarily managed by surgery. Here, we present a case of MPNST of the cervix who was treated with preoperative radiotherapy followed by radical hysterectomy and bilateral salpingo-oophorectomy.

Introduction: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with aggressive behavior. Most of our knowledge about this rare tumor is based on retrospective case series. This study aimed at analyzing the clinicopathological features and outcomes of patients treated at a tertiary cancer center in India. Patients and Methods: We retrospectively reviewed the data of patients with ACC registered from January 2006 to December 2015. Results: Thirty-seven patients were included in the study, 20 males and 17 females. Median age was 49 (18–78) years. Hormonal overproduction was noticed in 27% of patients. Median tumor size was 10 cm (2–22). Seventeen patients had metastatic disease and 20 patients were localised at diagnosis. Median follow-up was 22 months and median overall survival (OS) was 23.46 months. OS at 2 years and 5 years was 46.1% and 21%, respectively. The median disease-free survival (DFS) was 20 months. DFS at 2 years and 5 years was 45% and 24%, respectively. Age, sex, tumor size, hormonal overproduction, tumor laterality, and stage of the disease did not influence survival. However, advanced stage was associated with higher risk for recurrence. (P = 0.03). Conclusion: ACC is a rare endocrine malignancy with very poor survival rates. Rate of recurrence is high even after complete surgery. Systemic treatment options are limited. Newer agents are needed to improve outcome.

ObjectivesCervical cancer is the second most common cancer in women in developing countries, including India. Recently, microRNAs (miRNAs) are gaining importance in cancer biology because of their involvement in various cellular processes. The present study aimed to profile miRNA expression pattern in cervical cancer, identify their target genes, and understand their role in carcinogenesis.MethodsHuman papillomavirus (HPV) infection statuses in samples were assessed by heminested polymerase chain reaction followed by direct DNA sequencing. Next-generation sequencing and miRNA microarray were used for miRNA profiling in cervical cancer cell lines and tissue samples, respectively. MicroRNA signature was validated by quantitative real-time PCR, and biological significance was elucidated using various in silico analyses.ResultsCervical cancer tissues samples were mostly infected by HPV type 16 (93%). MicroRNA profiling showed that the pattern of miRNA expression differed with respect to HPV positivity in cervical cancer cell lines. However, target and pathway analyses indicated identical involvement of these significantly deregulated miRNAs in HPV-positive cervical cancer cell lines irrespective of type of HPV infected. Microarray profiling identified a set of miRNAs that are differentially deregulated in cervical cancer tissue samples which were validated using quantitative real-time PCR. In silico analyses revealed that the signature miRNAs are mainly involved in PI3K-Akt and mTOR pathways.ConclusionsThe study identified that high-risk HPV induces similar carcinogenic mechanism irrespective of HPV type. The miRNA signature of cervical cancer and their target genes were also elucidated, thereby providing a better insight into the molecular mechanism underlying cervical cancer development.

Purpose: The study aims to estimate the differences in vaginal surface, bladder, and rectal doses when adjuvant intracavitary brachytherapy is carried out with ovoids or with vaginal cylinders, in postoperative carcinoma endometrium and to assess the difference in variability in organs at risk (OAR) doses and thereby the reproducibility of application in subsequent sittings. Materials and Methods: Fifteen patients each received vaginal brachytherapy with ovoid and cylindrical applicators. The dose received by 0.1 cc, 1.0 cc, 2.0 cc, 5.0 cc, and 10.0 cc volumes of the OAR, namely, bladder, and rectum were analyzed using independent t-test. Interfractional variation in dose to OAR was evaluated using a two-way repeated ANOVA test. The dose received by the upper 2 cm of vagina was assessed using volume receiving 100% (V100) and dose received by 100% (D100) for documenting dose distribution to the target volume. Results: The mean dose to rectum and bladder were significantly lesser with ovoids (P < 0.0001). This difference was seen in all volumes analyzed. V100 (99.05% vs. 67.7%, P < 0.0001) and D100 (95.70% vs. 53.08%, P < 0.0001) were significantly better with cylinders compared to ovoids. There was no statistically significant interfractional variation between sittings with either applicator. Conclusion: The two applicators studied have different dosimetric properties conferring specific advantages and disadvantages as far as dose to OARs and target is concerned. Both applicators provide good reproducibility. The choice of applicator would ultimately depend on the clinical outcomes of these dosimetric differences which need to be prospectively analyzed.

Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary bladder patients treated with radical radiotherapy.Methods: A total of sixty patients with muscle invasive bladder cancer who were treated between 2011 and 2013 with bladder preservation protocol were identified. Thirty-two patients were stage T2 disease, rest were T3 and T4. Initial TURBT was reported complete in 24 of the total 60 patients. All patients received 60 to 64Gy to the whole bladder.Results: The follow-up range was 3 to 72 months. One year follow-up proportion was 78%. The median progression free survival was 40months. Early stage (T2) and advanced stage (T3 and T4) had progression free survival of 87.8% and 48.5% respectively at one year follow-up with a p value of 0.001. Thirty-six patients who had an incomplete Transurethral resection of bladder tumor (TURBT) initially had a statistically significant lower PFS compared to those patients who had a complete TURBT with a p value of 0.029. Twenty-nine patients were disease free with an intact bladder during the follow-up period providing a bladder preservation rate of 48%.Conclusions: A bladder-conserving protocol with radiotherapy provides encouraging results with nearly half of the patients able to retain a disease-free bladder. Proper patient selection with early stage disease and those with complete TURBT may further improve the bladder preservation rates.

An assessment of transition of cancer in India during the past 30 years, according to changes in demographic and epidemiologic risk factors was undertaken.Cancer registry data (http://www.ncdirindia.org), (population coverage10%), was compared with transition in life-expectancy and prevalence on smoking, alcohol and obesity. We fitted linear regression to the natural logarithm of the estimated incidence rates of various cancer registries in India.Burden of cancer in India increased from 0.6 million in 1991 to 1.4 million in 2015. Among males, common cancers are lung (12.0%), mouth (11.4%), prostate (7.0%), and tongue (7.0%) and among females, they are breast (21.0%), cervix-uteri (12.1%), ovary (6.9%), and lung (4.9%) in 2012. Increased life-expectancy and population growth as well as increased use of alcohol and increased prevalence of overweight/obesity reflected an increase in all cancers in both genders except a reduction in infection-related cancers such as cervix-uteri and tobacco-related cancers such as pharynx (excludes nasopharynx) and oesophagus.Transition in demographics and epidemiologic risk factors, reflected an increase in all cancers in both genders except a reduction in a few cancers. The increasing incidence of cancer and its associated factors demands a planned approach to reduce its burden. The burden assessment needs to be strengthened by increasing the population coverage of cancer registries. Continued effort for tobacco prevention and public health efforts for reducing obesity and alcohol consumption are needed to reduce the cancer burden.

This paper presents a sampling-based method for path planning in robotic systems without known cost-to-go information. It uses trajectories generated from random search to heuristically learn the cost-to-go of regions within the configuration space. Gradually, the search is increasingly directed towards lower cost regions of the configuration space, thereby producing paths that converge towards the optimal path. The proposed framework builds on Rapidly-exploring Random Trees for random sampling-based search and Reinforcement Learning is used as the learning method. A series of experiments were performed to evaluate and demonstrate the performance of the proposed method.

Swyer syndrome or pure gonadal dysgenesis 46, XY is a medical condition associated with 46 XY karyotype and primary amenorrhea in a phenotypic female. In this syndrome, there is an abnormality in testicular differentiation. Patients with disorders in sexual differentiation have an increased risk for development of genital malignancies. A 14-year-old female admitted with abdominal pain was diagnosed to have Swyer syndrome and a pelvic tumor after clinical and laboratory investigations. She underwent surgery, and the histology report revealed a mixed germ cell tumor in a dysgenetic gonad. She recurred three months later and was successfully treated with chemotherapy and a second surgery to remove the differentiated teratoma. The early diagnosis of patients with Swyer syndrome is important because of the increased risk for the development of malignancy. Early surgical treatment is required. Recurrent and metastatic disease respond well to chemotherapy.

In this paper we consider the motion planning problem of humanoid with articulated-spine for object manipulation in double support phase. Complexity of motion planning increases due to higher degrees-of-freedom (DOF), redundancy arising due to articulated spine, inherent underactuation and stability constraint. Additionally, loop-closure constraints arise during double-support phase, and self-collision constraints exist independent of the task to be performed. These problems make motion planning of humanoids a challenging task. In this work, we address the above issues by proposing a sampling based approach for planning the motion of the humanoid. Our approach to the problem is based on RRT* which can generate asymptotically optimal paths. The proposed approach deals with the stability constraints by rejective sampling approach which divides random configurations generated into valid and invalid configurations. Additionally, the loop-closure constraints are tackled by separating the humanoid into two open-kinematic sub-chains, and then generating random configurations in one sub-chain whereas the remaining sub-chain uses inverse kinematics for closure. Efficacy of the proposed approach is demonstrated for whole-body motion planning of a 25-DOF humanoid in generating asymptotically optimal end-effector paths.

In space robots, coupling between the base and the arms causes the floating base to translate and rotate when the arms execute a maneuver, which is typically not seen in earth based robots. Since it is difficult to test developments in space robotics primarily due to the high cost and lack of access to robots in space, it is necessary to have physical systems that can mimic space conditions for experimental validation on earth. Among several options, the use of air bearings to build floating-base robots is one of the most effective. We describe the development of one such system that replicates zero gravity conditions for planar robots. Although similar systems exist elsewhere, the planar dual-arm space robot we have built is distinctive by being relatively lightweight, compact and modular. The setup can be used to test a wide range of experiments such as visual servoing, reactionless maneuvering and object grasping in space. In this paper, the approach taken during the development of both the hardware and software for the experimental setup are discussed. A few results obtained by numerical simulations as well as experimentation are also presented.

Langerhans cell histiocytosis is an interesting disorder with a variety of presentations and variable outcomes. This study evaluates response to treatment, recurrence, and survival in disseminated Langerhans cell histiocytosis treated at Regional Cancer Centre, Trivandrum, India from 1983 through 1994. Thirty-five patients with disseminated Langerhans cell histiocytosis were seen. Six had group A disease, 21 had group B disease, and eight had group C disease. In group A, five of six patients are disease free at a median follow-up of 48 months. Two had recurrence after initial treatment, which was salvaged. In group B, 13 of 15 patients had complete response after chemotherapy, nine of whom experienced recurrence later. Three of five patients who received irradiation alone experienced recurrence. One died of progressive disease. Two patients were lost to follow-up. Seventeen of 20 are alive with median follow-up of 67 months. In group C, one of eight patients are alive after multiple recurrences. Of the surviving patients, 29% had significant sequelae. In summary, group A and B patients do well with treatment, and most of the recurrences can be salvaged. A significant proportion of patients have sequelae. Newer aggressive protocols must be developed for treating group C patients. Measures to prevent sequelae must also be developed.

AIM: This study aims to identify clinical features, treatment outcomes, and prognostic factors for relapse and survival in patients with testicular seminoma. MATERIALS AND METHODS: Retrospective analysis of all patients with pure seminoma treated at our center during over a decade (January 2005–December 2014) was carried out. Patient demographics, tumor characteristics, and treatment details and pattern of recurrence were recorded in a structured format, and disease-free survival and overall survival were calculated. RESULTS: Sixty-three patients' case records were included in the analysis. Ten patients developed disease in the undescended testis. All patients underwent orchiectomy as the initial treatment procedure. Majority of the patients were Stage I (57.14%) followed by Stage II (39.6%). Among the patients with Stage I, 55.5% received adjuvant chemotherapy while 22.2% received adjuvant radiation and the rest opted for surveillance. The compliance for active surveillance was very poor. Among patients with Stage II disease, majority (80%) were treated with adjuvant chemotherapy and the rest with radiation. At a median follow-up of 49 months, there were four recurrences of which three were salvaged successfully, and one patient remained alive with disease. There were no disease-related deaths. CONCLUSIONS: Testicular seminoma remains to be relatively low and majority of them presented with Stage I disease and single agent carboplatin appeared to be the preferred adjuvant treatment. Advanced disease patients were treated with etoposide and cisplatin/bleomycin, etoposide and cisplatin chemotherapy and the clinical outcome is comparable with the Western literature.

Objectives. Host genetic factors may play a role in human papillomavirus (HPV)-associated tumorigenesis, although the issue continues to be a focus of much debate. Biotransformation is critical in carcinogenic activity of numerous environmental carcinogens. It is therefore possible that polymorphisms of genes producing functional changes in xenobiotic metabolizing enzymes may be susceptible factors in cervical carcinogenesis. This study looked into possible relationships among these factors. Methods. In this case–control study, we analyzed leukocyte DNA from a total of 312 subjects for germline polymorphisms of CYP1A1 (m1 and m2), GSTM1 and GSTT1 at various stages of the cervical tumor progression spectrum, using PCR and RFLP. Results. Both m1 and m2 polymorphisms of the CYP1A1 gene were more frequent among cases (36.1% for m1 and 38.1% for m2) compared to control subjects (18.2% and 17.6% respectively). The odds ratio of a subject with homozygous CYP1A1 m1 and m2 variant being a case was highest (m1 OR = 4.77 [95% CI = 1.28–17.77]; P = 0.02 and m2 OR = 5.48 [95% CI = 1.49–20.19]; P = 0.011) respectively. The distribution of m1 and m2 CYP1A1 genotypes was also studied as a function of age and in relation to the presence of HPV 16 infection. The risk due to CYP1A1 m1 genotype, when adjusted for HPV status, showed a significantly increased risk (OR = 3.58, 95% CI = 1.88–6.81; P = 0.0001). Similar results were observed in the case of CYP1A1 m2 variant and HPV 16. There was a significant over-representation of both m1 (25.9% vs. 13.9%) and m2 (27.9% vs. 13.3%) polymorphisms in older women (46 years or more). GSTM1 and GSTT1 deletions were also prominent among cases (53.7% and 16.3% respectively) compared to controls (32.7% and 9.7% respectively). A higher proportion of both GSTT1 and GSTM1 deletions were also detected in HPV-16-positive subjects. Conclusions. These results suggest that polymorphisms in the CYP1A1 , GSTM1 and GSTT1 genes may render women more susceptible to the development of cervical cancer. The association between this susceptibility and the presence of human papillomavirus infection further emphasizes the significance of the genetic polymorphisms.

Metachronous bilateral testicular germ cell tumors is a rare known problem. However, no report of metachronus bilateralism was identified in the PubMed database published from India so far, where testicular cancer is relatively rare. We report the cases of two gentlemen. One had stage 1 nonseminomatous germ cell tumor (NSGCT) at the age of 32 in 1990 and developed marker relapse on surveillance and had chemotherapy using cisplatin and etoposide for four cycles. He developed contralateral seminoma in the testis 13 years later. Another patient had left orchidectomy in 2003 for NSGCT, had adjuvant BEP for two cycles, and developed a contralateral testicular tumor 5 years later, which was also seminoma. As more patients with germ cell tumors are cured with chemotherapy, long-term problems become important. Contralateral testicular tumor is one of them. As it can be very late, many years of continued follow-up examination and patients' awareness are necessary.