Publications by authors named "Surya Ravichandran"

6 Publications

  • Page 1 of 1

The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma.

Surg Oncol 2020 Dec 2;35:533-539. Epub 2020 Nov 2.

Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address:

Background: This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma.

Methods: A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed.

Results: Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively.

Conclusions: These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease.
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http://dx.doi.org/10.1016/j.suronc.2020.10.018DOI Listing
December 2020

Higher BMI, But Not Sarcopenia, Is Associated With Pembrolizumab-related Toxicity in Patients With Advanced Melanoma.

Anticancer Res 2020 Sep;40(9):5245-5254

Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A.

Background/aim: To determine whether BMI and sarcopenia were related to treatment-limiting toxicity or efficacy of pembrolizumab treatment in melanoma patients.

Patients And Methods: Medical records for melanoma patients undergoing pembrolizumab treatment at Duke University from January 2014 to September 2018 were reviewed. Pre-treatment measurements such as BMI were collected. Pre-treatment CT imaging was used to determine psoas muscle index (PMI). Patients in the lowest sex-specific tertile of PMI were sarcopenic. Logistic regression measured associations with treatment toxicity and response. Kaplan-Meier analysis assessed progression-free survival (PFS) and overall survival (OS).

Results: Among 156 patients, the overall objective response rate was 46.2% and 29 patients (18.6%) experienced treatment-limiting toxicity. Sarcopenia was not significantly associated with toxicity, response, or survival. However, obese patients (BMI >30) experienced higher rates of toxicity (p=0.0007).

Conclusion: Sarcopenia did not appear to predict clinically relevant outcomes. Obesity, however, represents a readily available predictor of pembrolizumab toxicity.
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http://dx.doi.org/10.21873/anticanres.14528DOI Listing
September 2020

Retreatment with talimogene laherparepvec for advanced melanoma.

Immunotherapy 2020 Nov 25;12(16):1167-1172. Epub 2020 Aug 25.

Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.

Talimogene laherparepvec (T-VEC) is a genetically modified oncolytic herpesvirus approved for the treatment of unresectable, locoregionally advanced and recurrent melanoma. There is little relevant literature in the context of retreatment with T-VEC. We reviewed four patients aged 71-87 years old with stage IIIB-IV melanoma at treatment who were rechallenged with T-VEC after experiencing recurrence of locoregional disease or prior treatment-limiting toxicity. Cessation of initial treatment was due to one of the following reasons: severe adverse event (one case), mixed response (one case) or complete response (two cases). Three males and one female underwent T-VEC retreatment with a mean of 5.5 injection cycles. Three patients experienced a complete response to retreatment, while one experienced disease progression. Intralesional T-VEC may be effective and well-tolerated in patients who have completed prior T-VEC therapy.
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http://dx.doi.org/10.2217/imt-2020-0029DOI Listing
November 2020

Diagnostic delay for head and neck cancer in South India: A Mixed-methods Study.

Asian Pac J Cancer Prev 2020 Jun 1;21(6):1673-1678. Epub 2020 Jun 1.

Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background: Early diagnosis is an important aspect of quality of cancer care.Analysis of the diagnostic delays and the reasons for delay helps to plan strategies to improve cancer care.

Objectives: To determine the primary, secondary, and total diagnostic delay of patients diagnosed with head and neck cancer and to explore the reasons for the delay from the patient perspective.

Methods: Explanatory mixed method design was used. Two hundred persons with a confirmed diagnosis of head and neck cancer attending the ENT (ear, nose, throat) cancer clinic in a teaching hospital before the initiation of treatment were included in the study. The median delay and the association of the delay with the various factors were analyzed. Sixteen one-to-one interviews of patients were done to identify the reasons for the delays from the patient perspective.

Results: Median primary, secondary, and total diagnostic delays were 30 days, 30 days, and 73 days, respectively. Statistically, primary delay was found significantly longer among ever users of smokeless tobacco and significantly longer secondary delay was found among those with age less than 60 years. The reasons for the delay were grouped in the categories (i) Symptom appraisal delay due to low perceived seriousness and (ii) health-seeking behavior delay.

Conclusions: The diagnostic delay was considerable. Measures to enhance symptom appraisal by improving health literacy, opportunistic screening, and strengthening the referral system would decrease diagnostic delay.
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http://dx.doi.org/10.31557/APJCP.2020.21.6.1673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568875PMC
June 2020

Apremilast for the off-label treatment of lichenoid and interface dermatoses.

J Am Acad Dermatol 2020 Nov 1;83(5):1489-1491. Epub 2020 Jun 1.

Department of Dermatology, Duke University Medical Center, Durham, North Carolina. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.05.112DOI Listing
November 2020

Validity and Reliability of Tamil translated University of Washington Quality of Life Questionnaire for Head and Neck Cancers.

Asian Pac J Cancer Prev 2019 Dec 1;20(12):3649-3654. Epub 2019 Dec 1.

Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom.

Background: Quality of life is an important outcome measure used both in research and patient care across all cultural healthcare settings.

Objective: This study is aimed to evaluate the validity and reliability of interviewer-administered Tamil translated University of Washington Quality of Life Questionnaire (Version 4) in a setting with low literacy.

Methods: The study was done in a tertiary care teaching institute in Puducherry, South India. The translation was done by using 'forward-backward translation method.' A hundred subjects diagnosed with head and neck cancer (HNC) were interviewed before the initiation of treatment. The Tamil version of University of Washington Quality of Life Questionnaire (UWQOL) questionnaire was validated using the Tamil version of the World Health Organization Quality of Life-Brief questionnaire (WHOQOL-BREF) version. Inter-rater reliability and test-retest reliability was also assessed. Item-total correlation and Cronbach alpha were calculated for assessing validity and internal consistency respectively.

Results: In the Tamil version of UWQOL, social-emotional subscale was more affected than physical subscale. The domains such as mood, anxiety, and pain were most affected. The subscale scores were significantly different between those with early and late cancer. Tamil version of UWQOL showed moderate correlation with WHOQOL-BREF. The Tamil version of UWQOL had good test-retest and inter-rater agreement. Item-total correlation for the subscales was >0.80. The internal consistency of the Tamil Questionnaire was acceptable with Cronbach Alpha of 0.69.

Conclusion: The Tamil version of UWQOL questionnaire is a short, valid and reliable for HNC patients of low literacy.
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http://dx.doi.org/10.31557/APJCP.2019.20.12.3649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173376PMC
December 2019