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Swamidas J, Pradhan S, Chopra S, Panda S, Gupta Y, Sood S, Mohanty S, Jain J, Joshi K, Ph R, Gurram L, Mahantshetty U, Prakash Agarwal J. Development and clinical validation of Knowledge-based planning for Volumetric Modulated Arc Therapy of cervical cancer including pelvic and para aortic fields. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:61-67. [PMID: 34258410 PMCID: PMC8254199 DOI: 10.1016/j.phro.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
A knowledge-based planning model was configured for VMAT of cervical cancer. Knowledge-based plans were comparable, and for some OARs, outperformed clinical plans. Improved organ sparing was observed, when individual patient geometry was considered.
Background and Purpose Knowledge-based planning (KBP) is based on a model to estimate dose-volume histograms, configured using a library of historical treatment plans to efficiently create high quality plans. The aim was to report configuration and validation of KBP for Volumetric Modulated Arc Therapy of cervical cancer. Materials and methods A KBP model was configured from the institutional database (n = 125), including lymph node positive (n = 60) and negative (n = 65) patients. KBP Predicted plans were compared with Clinical Plans (CP) and Re-plans (Predicted plan as a base-plan) to validate the model. Model quality was quantified using coefficient of determination R2, mean square error (MSE), standard two-tailed paired t-test and Wilcoxon signed rank test. Results Estimation capability of the model was good for the bowel bag (MSE = 0.001, R2 = 0.84), modest for the bladder (MSE = 0.008) and poor for the rectum (MSE = 0.02 R2 = 0.78). KBP resulted in comparable target coverage, superior organ sparing as compared to CP. Re-plans outperformed CP for the bladder, V30 (66 ± 11% vs 74 ± 11%, p < .001), V40 (48 ± 14% vs 52 ± 14%, p < .001), however sparing was modest for the bowel bag V30 (413 ± 191cm3 vs 445 ± 208cm3, p = .037) V40 (199 ± 105cm3 vs 218 ± 127cm3, p = .031). All plans were comparable for rectum, while KBP resulted in significant sparing for spinal cord, kidneys and femoral heads. Conclusion KBP yielded comparable and for some organs superior performance compared to CP resulting in conformal and homogeneous target coverage. Improved organ sparing was observed when individual patient geometry was considered.
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Affiliation(s)
- Jamema Swamidas
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Sangram Pradhan
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Subhajit Panda
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Yashna Gupta
- Department of Radiotherapy, All India Institute of Medical Sciences, Rishikesh, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Sahil Sood
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Samarpita Mohanty
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Jeevanshu Jain
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Kishore Joshi
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Reena Ph
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Lavanya Gurram
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Umesh Mahantshetty
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Vishakapatnam, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - Jai Prakash Agarwal
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.,Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
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Rocha TAH, Thomaz EBAF, da Silva NC, de Sousa Queiroz RC, de Souza MR, Barbosa ACQ, Thumé E, Rocha JVM, Alvares V, de Almeida DG, Vissoci JRN, Staton CA, Facchini LA. Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer. BMC Cancer 2017; 17:706. [PMID: 29084516 PMCID: PMC5661925 DOI: 10.1186/s12885-017-3700-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. Methods An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). Results The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014). Conclusions In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths. Electronic supplementary material The online version of this article (10.1186/s12885-017-3700-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Federal University of Minas Gerais, School of Economics, Center of post-graduate and Research in Administration, Belo Horizonte, Minas Gerais, Brazil. .,Business Administration Department - Observatory of human resources for health, Universidade Federal de Minas Gerais, Antonio Carlos, avenue, 6627, Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | | - Allan Claudius Queiroz Barbosa
- Faculty of Economics, Department of Administrative Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Elaine Thumé
- Faculty of Nursing, Department of Collective Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Viviane Alvares
- National School of Public Health, Nova University of Lisbon, Lisboa, Portugal
| | | | - João Ricardo Nickenig Vissoci
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Catherine Ann Staton
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Luiz Augusto Facchini
- Faculty of Medicine, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol 2016; 37:278-285. [PMID: 28144096 PMCID: PMC5234166 DOI: 10.4103/0971-5851.195751] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings. MATERIALS AND METHODS MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as "cervical cancer", "screening", "early detection", "cervical cytology" and "visual inspection", and their corresponding MeSH terms in combination with Boolean operators "OR, AND." Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study. RESULTS In India, cervical cancer contributes to approximately 6-29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively. CONCLUSIONS In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.
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Affiliation(s)
- Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ganesh Balasubramaniam
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Janaki KL, Kannan NS, Palaniappan M, Nandi P. Profile of Breast Diseases in Post Pubertal Women Assessed By Clinical Breast Examination - A Community Based Study in Rural Pondicherry. J Clin Diagn Res 2016; 10:PC07-11. [PMID: 27042516 DOI: 10.7860/jcdr/2016/17264.7276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/07/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Breast diseases in women, whether benign or malignant, are very commonly encountered. Benign diseases are under reported and cancer is one of the leading causes of mortality in women. This study was undertaken with an aim to study the profile of various breast disease in the community. MATERIALS AND METHODS In this observational study all the post pubertal women residing in the selected village (n=1000) were included. The study was done from September 2013 to August 2015. A thorough history taking was done with the help of a predesigned proforma followed by a clinical breast examination and further investigation at our hospital if necessary. RESULTS It was found in this study that mastalgia, both cyclical and non-cyclical as well as lumps were a common finding in the general population. Significant proportions of women were found to be in the peri-menopausal age group. Median age of menarche was 13 years; menopause was 45 years. The average age at first childbirth was 21 years with 1 year being the median duration of breast-feeding. A total of 128 women (1 in 8) had positive symptomatology with 94 (1 in 11) of them having a breast disease on examination. One was diagnosed with breast cancer. The prevalence of cyclical mastalgia was 1 in 11, non-cyclical mastalgia 1 in 34, fibroadenosis 1 in 23 and fibroadenoma 1 in 100. The awareness regarding risk factors and the availability of screening program was very poor. The average age of presentation of mastalgia was 34 years; fibroadenosis was 35 years and fibroadenoma 29 years. None of the women interacted with or had consulted a practitioner regarding mastalgia as it was not perceived to be a sign of malignancy and did not cause any significant discomfort. CONCLUSION It was thus concluded from this study that benign breast diseases are a common occurrence in the general population. Breast cancer continues to be diagnosed only at later stages owing to lack of awareness and inadequately structured screening program. The concept of self-breast examination seems to be poorly understood. CBE is more fruitful with subsequent radiological and histopathological investigation, if warranted.
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Affiliation(s)
- Kavasseri L Janaki
- Resident, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Narayanasamy Subbaraju Kannan
- Associate Professor, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - M Palaniappan
- Professor, Department of General Surgery, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
| | - Partha Nandi
- Professor, Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth , Pillaiyarkuppam, Pondicherry, India
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