Jagathnath Krishna K M

• PhD
• Professor (Associate) at Regional Cancer Centre Thiruvananthapuram

Several authors have considered the analysis of load-sharing parallel systems. The main characteoristics of such a two-component system is that after the failure of one component, the surviving component has to shoulder extra load, and hence, it is more likely to fail earlier than would be expected under the original model. In other cases, the fail...

Burkitt lymphoma (BL) is a challenging cancer to treat in resource‐limited settings. We retrospectively analysed 85 BL children ≤14 years, treated during 2007–2017. Median age was 6.5 (2–12) years. Group A, B and C disease was seen in 22%, 48% and 30% respectively. Advanced disease was seen in 78% (stage III 33, stage IV 25). Six children had stage...

To determine the proportion of children with acute lymphoblastic leukemia (ALL) with hypoglobulinemia during maintenance chemotherapy and to determine its association with severe febrile illnesses. Children with ALL receiving maintenance chemotherapy were prospectively recruited and serum immunoglobulin levels (IgG, IgM, IgA) were measured by turbi...

Surgical complications are graded using various systems, with the Clavien-Dindo classification (CDC) being the most widely used due to its simplicity and ease of replication. The Comprehensive Complication Index (CCI) was recently introduced to overcome the shortcomings of the CDC. This study aims to compare the Clavien-Dindo classification and the...

Background Well-defined pre-cancerous stages help early detection of uterine cervical cancer by Pap smear or human papillomavirus (HPV) analysis. HPV induces atypical squamous cells of undetermined significance (ASCUS) which can progress to higher grade lesions depending on persistence of infection with High-risk human papillomavirus (HrHPV). The H...

Objective: To assess the efficacy of Narrow band Imaging (NBI) in detecting laryngeal malignancies by statistical analysis. Methods: This prospective, observational study was conducted from 1st September 2022 to 31st December 2023. All patients above 18 years, who were scheduled to undergo nasopharyngolaryngoscopy with biopsy for laryngeal lesions,...

Objective Sputum cytology is recognized as a straightforward and noninvasive way to diagnose lung cancer, although its clinical utility has not yet been investigated. The objective of the study was to detect and classify cancerous cells in sputum by examining their expression of minichromosome maintenance proteins (MCM2 and MCM7). In addition, the...

Low-grade uterine endometrial stromal sarcoma (LG-ESS) is a rare tumour characterised by an overall good survival but showing indolent behaviour and a variable risk of recurrence. There is no clear consensus on the optimal management of these tumours and no prognostic or predictive factors have been established. With this study, we evaluated the cl...

Background Cyclin D1 is a protein that can enhance the proliferation of cancer cells and has been detected in various malignancies, including lung cancer. However, routine examinations for Cyclin D1 in lung cancer cases have not been conducted in Kerala. Aim This study sought to evaluate the links between cyclin D1 expression, clinicopathological...

Objectives The chemotherapy response score (CRS) has been described to assess the pathological response to chemotherapy in patients with high-grade serous tubal and ovarian carcinoma. The main aim of this study was to assess the prognostic significance of CRS in patients who underwent interval debulking surgery and attained complete cytoreduction....

Aim: This study explores the prognostic impact of FLT3-ITD, NPM1, and WT1 mutations both independently and in combination in Cytogenetically Normal Acute Myeloid Leukemia (CN-AML) patients as they exhibit varying clinical outcomes. Methods: 150 CN-AML patients were selected to assess the prevalence and prognostic significance of WT1 mutations in...

To find out whether additional interstitial component provides better dose distribution and less organ at risk (OAR) doses compared to treatment plan without needles for locally advanced carcinoma cervix cases with residual disease after chemoradiation. Nine patients with residual disease after chemoradiation for locally advanced cancer cervix were...

Breast cancer in young women (BCY) is associated with unfavourable tumour biology, worse pathological features, and poorer prognosis. There is limited data on the long-term survival outcomes in BCY patients who undergo breast conservation surgery (BCS). This study aims to determine the long-term survival outcome of BCY treated with BCS at our centr...

Multiple pre-operative risk assessment scores are available for risk stratification of cancer patients undergoing surgery. This is the first study comparing commonly used preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA PS) with fr...

The role of sentinel lymph node biopsy (SLNB) in locally advanced breast cancer (LABC) post-neoadjuvant chemotherapy (NACT) is debatable. We conducted a novel pilot study in which pre-NACT tattooing of breast lumps in LABC patients resulted in black tattoos being deposited in the axillary node. We hypothesized that this black node was the sentinel...

A notable finding is that Kerala's capital Thiruvananthapuram has shown an increasing trend in lung cancer (LC) incidence. Long-term exposure to air pollution is a significant environmental risk factor for LC. This study investigated the spatial association between LC and exposure to air pollutants in Thiruvananthapuram, using Spatial Lag Model (SL...

Background: Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of medium or large B lymphoid cells with a diffuse histopathologic growth pattern. Co-expression of MYC and BCL2 proteins in DLBCL by immunohistochemistry (IHC) is referred to as the double-expresser (DE) phenotype and is associated with inferior survival. Objectives of this study were...

The objective of the study was to assess the overall and disease free survival in patients with advanced (Stage III and IV) endometrial cancer who undergo cytoreductive surgery, and to assess the factors affecting recurrence in these patients. 80 patients with advanced endometrial cancer who were diagnosed and had undergone surgery in Regional Canc...

Longitudinal time-to-event analysis is a statistical method to analyze data where covariates are measured repeatedly. In survival studies, the risk for an event is estimated using Cox-proportional hazard model or extended Cox-model for exogenous time-dependent covariates. However, these models are inappropriate for endogenous time-dependent covaria...

Background The prevalence of TNBC in India is higher compared to western countries. There is a multitude of biomarkers associated with different clinical outcomes of TNBC with contradictory reports. Identification of a set of specific biomarkers from the very many number of proteins reported in the literature to predict prognosis of TNBC is an urge...

This study aims to evaluate the role of circulating cell-free DNA (cfDNA) levels in predicting optimal cytoreduction (OCR) during interval cytoreduction for advanced epithelial ovarian cancers. This prospective study included 24 patients of stage IIIC high-grade serous ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval...

Nisha Prasannan Breast cancer is the most common female cancer in India, with a significant number presenting as locally advanced breast cancer (LABC). Level III clearance is routinely performed in our institute in LABC following neoadjuvant chemotherapy (NACT). In our previous retrospective study, level III positivity rate was 15.5%. We aim to pro...

Aims To compare the accuracy of nidus delineation using magnetic resonance angiography (MRA) to digital subtraction angiography (DSA) and to evaluate setup accuracy of non-invasive frame SRS treatments. Settings and Design A prospective observational study of 16 patients who underwent non-invasive frame LINAC-based SRS for brain AVMs. Materials a...

Introduction Concurrent chemoradiation is the standard of care for women with locoregionally advanced cancer of the cervix. The disease and treatment can affect the quality of Life (QOL). The study aimed to determine the adverse events and quality of life of these patients. Methods A prospective longitudinal study was conducted at our institution...

Background Tumours on the scalp are diverse and often exhibit site- and histology-specific characteristics. Reconstructing the scalp after oncological resection has always been challenging because of its unique anatomy. Methodology A retrospective review of patients with malignant scalp tumour operated on at a single institution over 10 years was...

Esophagogastric junction (EGJ) carcinomas often require access to two compartments of the body for good margin and lymphadenectomy. Whether it is required to do so in all patients is debatable. We analyzed outcomes of patients who underwent surgeries for EGJ carcinomas in terms of margin status and survival. This is a retrospective analysis of a pr...

Background: Lack of druggable targets and complex expression heterogeneity of known targets is common among TNBC subtypes. An enhanced expression of galectin-3 in TNBCs has already been documented. We have observed a tumor progression-dependent galectin-3 expression in TNBCs compared to adjacent epithelium and non TNBCs. Objective: To unravel th...

Esthesioneuroblastoma (ENB) or olfactory neuroblastoma is a rare malignant neoplasm arising from the neural crest cells of the olfactory epithelium. The optimum treatment for this rare disease is still unclear. Most of the available literature on this rare head and neck tumour is limited to small retrospective series and single institutional report...

Anaplastic large-cell lymphoma (ALCL) constitutes 10-15% of non-Hodgkin lymphoma in children. With short-course chemotherapy, outcome has improved up-to 90% in developed-countries. There is limited-data on outcome of pediatric ALCL treated with ALCL99 protocol from low-middle income countries. Children ≤14 years, diagnosed with ALCL between 1st Jan...

Introduction Small cell lung cancer (SCLC) represents about 15% of all lung cancers. Extensive stage (ES) SCLC represents around 60% of diagnosed SCLC cancers. The median survival in untreated ES SCLC is 2 to 4 months and that of treated cases is 8 to 13 months. Aim and Objectives This retrospective analysis aims to find out the clinical outcome of...

The COVID-19 pandemic has created a remarkable challenge for the healthcare system. The delayed presentation, diagnosis, and treatment of head and neck cancer during the COVID-19 pandemic is expected to adversely affect outcomes. COVIDSurg collaborative group in 2020 concluded surgery ≥ 4 weeks after a positive COVID-19 swab result was associated w...

Background Radical chemoradiation is the standard of treatment for locally advanced squamous cell carcinoma of esophagus and for patients with operable disease, but who are medically unfit or unwilling for surgery. As the esophagus is a central organ, the planning target volume (PTV) is central, lies close to the spinal cord and heart, and is surro...

Introduction : Burkitt's lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma (NHL) having three distinct subtypes: endemic, sporadic, and immunodeficiency-associated BL. Sporadic BL accounts for only 1 to 2% of adult NHL. Objectives : The objective of this article was to study the clinical profile and treatment outcome of patients with...

Introduction: Oral cavity cancer with the masticator space involvement is considered as very advanced localised diseas e and staged as T4b in AJCC 8th edition. NCCN guidelines consider this as inoperable. This study intends to compare the different treatment modalities in T4b oral cavity cancer and their impact on survival. Patients and methods:...

Background Inadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribut...

The objective of this study is to assess the success of lymph nodal harvest, extent of nodal spread in pericolic and apical stations, and factors affecting nodal metastasis in freshly resected colon cancer specimens. Following surgery, the lymph nodes were dissected off the specimen in the presence of an onco-pathologist. Apical lymph nodes were st...

Introduction: Differentiated thyroid carcinoma usually has a good prognosis. Primary treatment is surgery, followed by radioactive iodine ablation based on risk stratification. The incidence of local and distant recurrence is 30%. Recurrence can be managed surgically or with multiple cycles of radioactive iodine ablation. There are multiple risk fa...

Objectives Excellent local control(>90%) and improved outcomes are reported with Image guided adaptive brachytherapy (IGABT) relative to traditional ‘Point A brachytherapy’. In majority of the developing world, even though Computed tomography (CT) has replaced X-rays for brachytherapy planning, dose prescription continues to be point based. In a mo...

Background This study aimed to evaluate loss of protective anti-hepatitis B (HBs) titers and seroconversion to hepatitis B vaccine (HBV) during chemotherapy in children with acute lymphoblastic leukemia (ALL). Methods Anti-HBs titers were done at diagnosis. Patients were divided into two groups. Group I (protective titers >10 mIU/ml) received sing...

PurposeTo analyze the feasibility of fertility-sparing surgery in patients who received neoadjuvant therapy for advanced malignant germ cell tumor of the ovary and to assess the menstrual and reproductive function in such patients. MethodsA retrospective study of 28 patients who underwent cytoreductive surgery following neoadjuvant chemotherapy for...

Background Post-operative sore throat, cough, and hoarseness of voice constitute the major pharyngolaryngeal morbidities following General anesthesia with an endotracheal tube since its introduction. Pharyngolaryngeal morbidity has been reported following the use of supraglottic airway devices as well, with less frequency and severity. Lidocaine je...

Introduction/Background Perioperative morbidity is an undesirable but critical issue for gynecologic cancer patients. It may cause delay in subsequent treatment and escalate the cost of postoperative management. Various studies have identified potential risk factors for postoperative morbidity in non-gynecologic surgery. The aim of this study was t...

Background: The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study...

Background and aims: The incremental shuttle walk test (ISWT) is a simple reproducible and non-invasive test for assessing cardiopulmonary function. The maximum oxygen consumption is less than 10 ml/kg/min for ISWT distance of less than 250 m. This study aimed to evaluate the effectiveness of ISWT in predicting morbidity and mortality in elective...

Introduction: Accurate surgical staging is an essential component in the management of carcinoma endometrium to assess the stage of disease and to tailor adjuvant treatment. Sentinel node technique was introduced as an alternative for extensive lymphadenectomy in early stages to avoid complications associated with lymphadenectomy. Aims and object...

Antitumor immune evasion is a hallmark for the development and progression of cancer. Tumor cells adopt various mechanisms to escape the host immune system recognition. One such mechanism is the over expression of programmed death ligand (PD-L1), a negative T cell regulatory molecule. Because PD-L1 overexpression causes resistance to chemotherapeut...

Breast cancer is the most common cancer in women globally(1). It is usually a disease of old age. The incidence of breast cancer in females younger than 40 years is as low as 0.5%. Disease in patients with age less than or equal to 40 years at diagnosis is usually considered a young breast cancer(2). Occurrence of more adverse pathological features...

Background Dexmedetomidine is a widely used alpha-2 adrenoreceptor agonist in perioperative patient care. Its postsynaptic activation of the receptors in the central nervous system is responsible for reduced neuronal firing with resultant sedation, anxiolysis, analgesia, hypotension and bradycardia leading to effective stress response attenuation s...

Introduction Breast cancer survivors are the largest group of female cancer survivors. Oncologic breast surgery can have a profound impact on a woman's body image and sense of self that can significantly affect their quality of life (QOL). The paucity of data about the effect of type of surgery on QOL of Indian breast cancer survivors has led to th...

Background The role of serum free light chain (FLC) as a prognostic biomarker in lymphoproliferative diseases is being increasingly studied. In this study we present the 5-year survival outcome for patients with aggressive B-cell non-Hodgkin's lymphoma (NHL) and their relation to FLC and other known prognostic markers. Materials and Methods This is...

Lakshmi Haridas K. 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 atte...

PurposeThe purpose of the study was to identify the clinicopathological factors associated with recurrence in patients who underwent primary surgical management for carcinoma endometrium stage I to IVA.Methods Retrospective analysis of data of 642 patients who underwent surgery with or without adjuvant therapy for carcinoma endometrium during the p...

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 ute...

Antitumor immune evasion is a hallmark for the development and progression of cancer. Tumor cells adopt various mechanisms to escape the host immune system recognition. One such mechanism is the over expression of programmed death ligand (PD-L1), a negative T cell regulatory molecule. Because PD-L1 overexpression causes resistance to chemotherapeut...

Introduction Surgery in older adults with cancer is complex due to multiple age related confounding factors. There are many scoring systems available for preoperative risk stratifications of older patients. Currently very few prospective studies comparing the various commonly used scales are available. This is the first study which compares the est...

Introduction: In locally advanced breast cancer, Neoadjuvant Chemotherapy (NACT) is the mainstay of treatment. NACT is also considered as a potentially helpful treatment option in earlystage HER2 positive and triple-negative breast cancer. Aim: To assess pathological Complete Response (pCR) in patients with breast cancer who received NACT and to ev...

Background The bispectoral index (BIS), a parameter derived from electroencephalogram, has been used to assess the depth of anesthesia. The objectives of this study were to evaluate the effect of BIS monitoring on sevoflurane consumption and recovery profile at the end of anesthesia. After obtaining Institutional Review Board approval and written i...

Abstract 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...

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...

Introduction/Background* Standard surgical treatment for carcinoma endometrium comprise hysterectomy with pelvic and para aortic node dissection followed by adjuvant treatment depending on final pathology report. Systematic lymphadenectomy in endometrial cancer still remains as a controversial topic. Methodology To assess pattern of lymph node met...

Introduction/Background* Malignant Germ cell tumours (MGCTs) are rare tumours that account for 2% - 3% of all ovarian cancers. Being highly chemosensitive, fertility sparing surgery whenever feasible with or without adjuvant chemotherapy, is the standard treatment approach in these patients. Upfront fertility sparing surgery may not be feasible in...

Introduction/Background* Epithelial ovarian cancer is a lethal gynaecological cancer with a 5 year survival of < 30% in advanced stages. Recently, NACT followed by surgery is being increasingly used to treat advanced tubo-ovarian high-grade serous carcinoma (HGSC) following the results of randomized trials that demonstrated non- inferior overall su...

Purpose: This retrospective analysis is aimed to report the single institution experience from an Asian country utilizing Intensity Modulated Radiotherapy (IMRT) based Chemo radiation in Anal Canal Squamous Cell Carcinoma (ASCC) with an emphasis on efcacy, toxicity and disease and treatment-related variables associated with outcomes. Study was con...

: Difficult tracheal intubation still contributes significantly to anaesthesia related morbidity and mortality. Poor visualisation of laryngeal structures and multiple attempts at intubation are the leading causes with the conventional laryngoscopes. Though the recently introduced video assisted devices have significantly improved the ease of intub...

Objectives: In time to event analysis, the risk for an event is usually estimated using Cox proportional hazards (CPH) model. But CPH model has the limitation of biased estimate due to unobserved hidden heterogeneity among the covariates, which can be tackled using frailty models. The best models were usually being identified using Akaike informati...

Objective To assess the survival outcome and morbidity pattern after interval cytoreduction surgery done for FIGO stage III and IV epithelial ovarian cancer, not amenable to primary cytoreduction.Methods This is a retrospective study of patients diagnosed with advanced-stage epithelial ovarian cancer who underwent interval cytoreduction from Januar...

Thyroid surgeries done under general anaesthesia use intravenous (iv) drugs as analgesics. A simple superficial cervical plexus block can reduce dose of iv analgesics and provide excellent analgesia. This study evaluated the analgesic efficacy of ultrasound guided Bilateral Superficial Cervical Plexus Block (BSCPB) in thyroidectomies and its opioid...

Introduction Multiple myeloma (MM) accounts for approximately 1% of all cancers and 10% of all hematologic malignancies. In our institution, we see around 200 patients with myeloma every year. We present our experience with multiple myeloma in the patients aged more than 60 years. Objectives This is a retrospective study of 300 newly diagnosed mult...

Background Cervical intraepithelial neoplasia (CIN) is the precursor lesion of cervical cancer. Untreated high-grade CIN significantly increases the risk of developing invasive cancer. Conization is the main treatment. Loop electrosurgical excision procedure (LEEP) is the most common conization method used. The study aims to assess the risk factors...

Objectives To assess the correlation between cervical smear, colposcopic findings and loop electrosurgical excision procedure (LEEP) histopathology and thereby assess the feasibility of performing LEEP bypassing cervical biopsy in selected cases.Methods This is a retrospective study of patients who underwent LEEP at our institution from 2014 to 201...

There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from Janu...

Background: Cervical cancer in India accounts for one-fifth of the global burden. Well-defined precancerous stages help early detection of the disease. Apart from human papillomavirus, the risk factors include age, education, occupation, early age at marriage and first delivery, abortions, and multiple sexual partners. Prevalence and risk factors...

Fine needle aspiration cytology (FNAC) reduces the number of unnecessary thyroid surgeries for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate treatment. This was a observational study done on cases presenting with clinical suspicion of thyroid malignancy which underwent ultrasonography followed by...

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...

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 histo...

Objective To review the treatment outcome in primary vaginal cancer patients who underwent definitive treatment at our institution. Methods 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...

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...

Prognostic factors for recurrence in Carcinoma Endometrium 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...