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Growcott S, Renninson E, Rayner L, McKeon J, Ayre G, Comins C, Challapalli A, Owadally W, Beasley M, Hawley L, Hilman S, Strawson-Smith T, Bahl A. Commentary on the New National Institute for Health and Care Excellence Guideline for Metastatic Spinal Cord Compression. Clin Oncol (R Coll Radiol) 2024; 36:200-201. [PMID: 38216346 DOI: 10.1016/j.clon.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
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Kumar A, Acharya SK, Singh SP, Duseja A, Madan K, Shukla A, Arora A, Anand AC, Bahl A, Soin AS, Sirohi B, Dutta D, Jothimani D, Panda D, Saini G, Varghese J, Kumar K, Premkumar M, Panigrahi MK, Wadhawan M, Sahu MK, Rela M, Kalra N, Rao PN, Puri P, Bhangui P, Kar P, Shah SR, Baijal SS, Shalimar, Paul SB, Gamanagatti S, Gupta S, Taneja S, Saraswat VA, Chawla YK. 2023 Update of Indian National Association for Study of the Liver Consensus on Management of Intermediate and Advanced Hepatocellular Carcinoma: The Puri III Recommendations. J Clin Exp Hepatol 2024; 14:101269. [PMID: 38107186 PMCID: PMC10724697 DOI: 10.1016/j.jceh.2023.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 12/19/2023] Open
Abstract
Hepatocellular carcinoma (HCC) presents significant treatment challenges despite considerable advancements in its management. The Indian National Association for the Study of the Liver (INASL) first published its guidelines to aid healthcare professionals in the diagnosis and treatment of HCC in 2014. These guidelines were subsequently updated in 2019. However, INASL has recognized the need to revise its guidelines in 2023 due to recent rapid advancements in the diagnosis and management of HCC, particularly for intermediate and advanced stages. The aim is to provide healthcare professionals with evidence-based recommendations tailored to the Indian context. To accomplish this, a task force was formed, and a two-day round table discussion was held in Puri, Odisha. During this event, experts in their respective fields deliberated and finalized consensus statements to develop these updated guidelines. The 2023 INASL guidelines offer a comprehensive framework for the diagnosis, staging, and management of intermediate and advanced HCC in India. They represent a significant step forward in standardizing clinical practices nationwide, with the primary objective of ensuring that patients with HCC receive the best possible care based on the latest evidence. The guidelines cover various topics related to intermediate and advanced HCC, including biomarkers of aggressive behavior, staging, treatment options, and follow-up care.
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Gan R, Stokes S, Bahl A, Jose J. Modified transseptal approach in endoscopic transsphenoidal pituitary surgery. J Laryngol Otol 2023; 137:1409-1412. [PMID: 36799014 DOI: 10.1017/s0022215123000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages. METHODS This paper describes a modification, and discusses its pros and cons. RESULTS The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline. CONCLUSION Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.
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Biernacka KM, Barker R, Sewell A, Bahl A, Perks CM. A role for androgen receptor variant 7 in sensitivity to therapy: Involvement of IGFBP-2 and FOXA1. Transl Oncol 2023; 34:101698. [PMID: 37307644 PMCID: PMC10276180 DOI: 10.1016/j.tranon.2023.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Prostate cancer (PCa) is one of the leading causes of cancer-related deaths in men. Localised PCa can be treated effectively, but most patients relapse/progress to more aggressive disease. One possible mechanism underlying this progression is alternative splicing of the androgen receptor, with AR variant 7(ARV7) considered to play a major role. Using viability assays, we confirmed that ARV7-positive PCa cells were less sensitive to treatment with cabazitaxel and an anti-androgen-enzalutamide. Also, using live-holographic imaging, we showed that PCa cells with ARV7 exhibited an increased rate of cell division, proliferation, and motility, which could potentially contribute to a more aggressive phenotype. Furthermore, protein analysis demonstrated that ARV7 knock-down was associated with a decrease in insulin-like growth factor-2 (IGFBP-2) and forkhead box protein A1(FOXA1). This correlation was confirmed in-vivo using PCa tissue samples. Spearman rank correlation analysis showed significant positive associations between ARV7 and IGFBP-2 or FOXA1 in tissue from patients with PCa. This association was not present with the AR. These data suggest an interplay of FOXA1 and IGFBP-2 with ARV7-mediated acquisition of an aggressive prostate cancer phenotype.
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Bahl A, Qureshi B, Bravo C, Mahr C, Li S. Race and Incidence of Right Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Bahl A, Panda N, Bakshi J, Verma R, Oinam A, Mohindra S, Ghoshal S, Gupta R. 23P Treatment outcomes in nasal cavity and paranasal sinus tumors treated with postoperative volumetric modulated arc therapy. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Renninson E, Sonker P, Challapalli A, Hudson Z, Hilman S, Bahl A. Audit of Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma Treated in the Early Access Scheme. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Renninson E, Channell K, Ball J, Masson S, Challapalli A, Bahl A. Patient Experience and Impact of Rectal Spacers on Dosimetry and Acute Toxicity in Patients Undergoing Radical Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Johnson S, Pai E, Voroba A, Chen NW, Bahl A. 222 ED-ACT, Examining D-dimer and Empiric Anti-coagulation in COVID-19 Related Thrombosis. Ann Emerg Med 2022. [PMCID: PMC9519214 DOI: 10.1016/j.annemergmed.2022.08.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Challapalli A, Ratnayake G, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCusker C, Ford V, Ferrera A, Malik J, Boh Z, Jones E, T.R. Geldart, Nelmes S, Brown J, Bahl A. 1463P Patterns of care and outcomes of metastatic renal cell carcinoma (mRCC) patients (pts) with bone metastases (BM): A UK multicenter review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ratnayake G, Challapalli A, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCartney T, Jabbar R, Charnley N, Malik J, Abhi D, Chau C, Geldart T, Halstead A, Anuforom U, Bahl A. 1457P A UK multicentre retrospective review of metastatic renal cell carcinoma (mRCC) patients (pts) outcomes with brain metastases (BM) in the modern era. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bahl A, Rajappa S, Rawal S, Bakshi G, Murthy V, Patil K. A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone-releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix). Indian J Cancer 2022; 59:S160-S174. [PMID: 35343199 DOI: 10.4103/ijc.ijc_1415_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
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Krebs M, Lord S, Kenny L, Baird R, MacPherson I, Bahl A, Clack G, Ainscow E, Barrett A, Dickinson P, Fuchter M, Lehnert M, Ali S, Mcintosh S, Coombes R. 230MO First in human, modular study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced solid malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Howell S, Krebs M, Lord S, Kenny L, Bahl A, Clack G, Ainscow E, Arkenau HT, Mansi J, Palmieri C, Richards P, Jeselsohn R, Mitri Z, Gradishar W, Sardesai S, O'Shaughnessy J, Lehnert M, Ali S, McIntosh S, Coombes R. 265P Study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in combination with fulvestrant in patients with advanced hormone receptor positive HER2 negative breast cancer (HR+BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bahl A, Rajamanickam T, Isaacs R, Oberoi A. POS-560 HEMODIALYSIS CATHETER ASSOCIATED BLOODSTREAM INFECTIONS (CABSI) AT A TERTIARY CARE HOSPITAL IN NORTH INDIA: INCIDENCE,OUTCOME AND ANTIBIOGRAM OF THE ISOLATED ORGANISMS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Biswas I, Bahl A, Kumar B, Singh H, Thingnam S, Puri G. COVID-19 Infection in a 13-year-old Heart Transplant Recipient in Immediate Post Transplant Period - A Case Report. J Heart Lung Transplant 2021. [PMCID: PMC7979411 DOI: 10.1016/j.healun.2021.01.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Experience regarding course and outcome of Covid-19 infection in heart transplant recipients is limited. Case fatality rate of 25% of covid-19 infection in adult recipients of heart transplant and mild and self-limited disease in young heart transplant patients have been reported in small case series. We describe a case where a 13 year old patient contracted covid-19 infection on 7th post-operative day after undergoing heart transplant and was subsequently discharged from hospital uneventfully. Case Report A 13 year old boy, with dilated cardiomyopathy underwent orthotopic heart transplant surgery. In the immediate pre-operative period, the real-time polymerase chain reaction (RTPCR) of nasopharyngeal swabs of both the recipient and the brain-dead organ donor were negative for severe acute respiratory syndrome coronavirus type 2 (SARS CoV 2). The intraoperative and immediate postoperative periods were uneventful. The recipient got weaned off from mechanical ventilation on the 1st postoperative day and O2 support was weaned off on 4th postoperative day. He was put on immunosuppressive regimen consisting of mycophenolate mofetil, tacrolimus and prednisone. On 7th postoperative day, he complained of fever, sore throat and dry cough. Nasopharyngeal swab for RTPCR was sent. It reported positive for SARS CoV 2. He was shifted to isolation facility. He maintained more than 94% saturation on pulse oximetry in room air. Immunosuppressive regimen was continued. He was administered 5-day course of remdesivir. Inotropic support was weaned off on 10th postoperative day. On serial bedside echocardiography, the allograft function was found to be normal throughout. He was kept on prophylactic antimicrobial, antifungal and anti-cytomegaloviral therapy and on prophylactic dose of low molecular weight heparin. There was initial rise in neutrophil lymphocyte ratio (17), C reactive protein (58 mg/l), ferritin (871 ng/ml), D-dimer (1904 ng/ml), Troponin T (227 pg/ml) levels, which gradually came down to within normal limits. He was discharged on 38th postoperative day to a home isolation facility as his RTPCR for SARS CoV 2 was still positive, although he remained completely asymptomatic for the last 21 days. Summary The course of Covid-19 infection in the immediate post-transplant period of this young heart transplant recipient was largely uneventful.
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Ballari N, Rai B, Bahl A, Mittal BR, Ghoshal S. Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis. Tech Innov Patient Support Radiat Oncol 2021; 17:48-56. [PMID: 33748442 PMCID: PMC7970137 DOI: 10.1016/j.tipsro.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes. MATERIAL AND METHODS From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities. RESULTS Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest. CONCLUSION Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.
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Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
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Babu G, Bahl A, Bhattacharya GS, Bhowmik KT, Dattatraya PS, Ghadyalpatil N, Karandikar SM, Kulkarni P, Sridharan N, Parikh P, Prabhash K, Raja T, Rajasundaram S, Subramanian S, Talapatra K, Vaid A. Oncology Gold Standard ® practical consensus recommendations for the use of monoclonal antibodies in the management of squamous cell carcinoma of head and neck. South Asian J Cancer 2020; 6:154-160. [PMID: 29404293 PMCID: PMC5763625 DOI: 10.4103/sajc.sajc_181_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.
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Gullick G, Mohan V, Gibbs L, Comins C, Braybrooke J, Jenkins J, Bahl A, Caws C. Leptomeningeal Disease in Breast Cancer, Bristol Experience. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bahl A, Talwar V, Sirohi B, Mehta P, Arya D, Shrivastava G, Dahiya A, Pavithran K. Primary Tumor Location as a Prognostic and Predictive Marker in Metastatic Colorectal Cancer (mCRC). Front Oncol 2020; 10:964. [PMID: 32612957 PMCID: PMC7309590 DOI: 10.3389/fonc.2020.00964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/15/2020] [Indexed: 12/27/2022] Open
Abstract
Clinico-pathological differences between adenocarcinoma in the right and left colo-rectum play a role in determining the prognosis and response to treatment. Studies suggest that primary tumor location is more relevant as the disease progresses and reflects a possible difference in biology and response to therapy. This review aims to explore the clinico-pathological features of right and left colo-rectum and the impact of primary tumor location on prognosis of CRC as well as discuss the available clinical data on tumor sidedness in metastatic colorectal cancer. In so far as the clinical data of tumor sidedness is concerned, very few reviews have discussed the clinical implications of sidedness in heavily pre-treated metastatic colorectal cancer (second and subsequent lines of therapy in metastatic disease). This review aims to fill the current gap in this setting.
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Batra S, Jha SK, Bahl A, Chaturvedi H, Taneja S. Outcome of FOLFOX based chemotherapy in advanced pancreatobiliary cancers presenting with hyperbilirubinemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16605 Background: Treatment of pancreatobiliary cancer patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastasis or biliary obstruction is challenging. A significant number of patients at presentation are in advanced/ locally advanced stage thus severely limiting chemotherapy options. FOLFOX (5 FU, Leucovorin, Oxaliplatin) represents a feasible option considering the pharmacokinetics. Clinical data on the dosage and tolerability of chemotherapy is limited and no recommendations are available to treat such patients in upfront setting with persistent hyperbilirubinemia. This observational study was done to find out safety and efficacy of FOLFOX based chemotherapy in these patients. Methods: Patients with advanced pancreatobiliary cancers with hyperbilirubinemia were treated with mFOLFOX6 based chemotherapy. Patients were treated till progression or 6 months or death (whichever occurred ealy) and assessed for toxicity and survival. Results: Only 13 out of 40 patients were able to complete all 12 cycle of chemotherapy. 12 patients were able to receive 2nd line chemotherapy of physician choice and 2 patients were able to received 3rd line chemotherapy. Total bilirubin of patients at start of chemotherapy ranged from 3 to 39.4 mg/dl with a mean value of 9.17±6.67 mg/dl and a median value of 7.5 mg/dl. Median progression free survival (PFS) of mFOLFOX6 was 5.97 months whereas median overall survival (OS) was 8.2 months. 6 patients were able to receive only one cycle of chemotherapy. 2 patients were able to receive only 2 cycles of chemotherapy. 26 patients completed 6 cycles of chemotherapy. Objective response rate was 45% after 6 cycles of chemotherapy. Of these 26 patients response assessment revealed progressive disease in 7 patients. 2 patient had complete metabolic response of which one of them had locally advanced disease. On laparotomy of this patient there were an extensive peritoneal disease curative surgery was not feasible. One patient successfully underwent Whipple’s procedure after 6 cycles of chemotherapy followed by adjuvant radiotherapy. Conclusions: FOLFOX based chemotherapy is a feasible option and a hope for patients of advanced pancreatobiliary cancers presenting with hyperbilirubinemia with a tolerable toxicity profile and providing comparable PFS and OS to other chemotherapy drugs/ regimens used in non hyperbilirubinemic patients.
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Bahl A, Bhatia K, Choudhary P, Singhla S, Shrivastava G, Bal J, Anand AK, Chaturvedi H, Dua B. Palliative chemotherapy with or without cetuximab in recurrent or metastatic squamous cell carcinoma of the head and neck: Indian tertiary care retrospective analysis. Head Neck 2020; 42:955-962. [DOI: 10.1002/hed.26070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
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Immerzeel WW, Lutz AF, Andrade M, Bahl A, Biemans H, Bolch T, Hyde S, Brumby S, Davies BJ, Elmore AC, Emmer A, Feng M, Fernández A, Haritashya U, Kargel JS, Koppes M, Kraaijenbrink PDA, Kulkarni AV, Mayewski PA, Nepal S, Pacheco P, Painter TH, Pellicciotti F, Rajaram H, Rupper S, Sinisalo A, Shrestha AB, Viviroli D, Wada Y, Xiao C, Yao T, Baillie JEM. Importance and vulnerability of the world’s water towers. Nature 2019; 577:364-369. [DOI: 10.1038/s41586-019-1822-y] [Citation(s) in RCA: 477] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
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Price J, Hijazi M, Clavette-Lachapelle L, Bahl A. 346 Ultra Long Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasound-Guided Catheter Survival. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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