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Swain M, Budrukkar A, Murthy V, Pai P, Kanoja A, Ghosh-Laskar S, Deshmukh A, Pantvaidya G, Kannan S, Patil VM, Naronha V, Prabhash K, Sinha S, Kumar A, Gupta T, Agarwal J. Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:278-286. [PMID: 38365518 DOI: 10.1016/j.clon.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kanoja
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Clinical Research Secretariat Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Naronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Rembielak A, Budrukkar A, Kron T. Function Preservation with Brachytherapy: Reviving the Art. Clin Oncol (R Coll Radiol) 2023; 35:485-488. [PMID: 37394265 DOI: 10.1016/j.clon.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Affiliation(s)
- A Rembielak
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
| | | | - T Kron
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
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Sood S, Sinha S, Balaji A, Mundhe SR, Mummudi N, Budrukkar A, Swain M, Prabash K, Noronha V, Joshi A, Patil V, Laskar SG. Non-surgical organ preservation in laryngeal and hypopharyngeal cancers: an audit from the clinic. J Laryngol Otol 2023; 137:448-454. [PMID: 35678378 DOI: 10.1017/s002221512200113x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increasing concern regarding efficacy of organ preservation protocol in laryngeal and hypopharyngeal cancers. METHOD This study retrospectively assessed disease-related and functional outcomes of 191 patients with non-metastatic laryngeal or hypopharyngeal squamous cell carcinoma treated with curative intent (radiotherapy with or without chemotherapy). RESULTS Seventy-six patients (39.8 per cent) had a primary cancer in the larynx, and 115 patients (60.2 per cent) had a primary cancer in the hypopharynx. The median follow up was 39 months. The 3-year time to progression, overall survival, local control and laryngectomy free survival was 56.2 per cent, 76.3 per cent, 73.2 per cent and 67.2 per cent, respectively. At the time of analysis, 83 patients (43.5 per cent) were alive and disease free at their last follow up and did not require tube feeding or tracheostomy. The laryngo-oesophageal dysfunction-free survival was 61 per cent at 3 years. CONCLUSION Organ conservation protocols remain the standard of treatment in appropriately selected patients with laryngeal and hypopharyngeal cancers.
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Affiliation(s)
- S Sood
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Balaji
- Department of Speech and Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S R Mundhe
- Department of Radiation Oncology, Krupamayi Cancer Hospital, Aurangabad, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Budrukkar A, Guinot JL, Tagliaferri L, Bussu F, García-Consuegra A, Kovacs G. Function Preservation in Head and Neck Cancers. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00044-4. [PMID: 36849321 DOI: 10.1016/j.clon.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
The treatment of head and neck cancers can have a significant impact on function and appearance, which results in impairment of quality of life. Various long-term sequelae of treatment include speech and swallowing difficulty, oral incompetence, trismus, xerostomia, dental caries and osteoradionecrosis. Management has evolved from single modality treatment of either surgery or radiation to multimodality treatment to attain acceptable functional outcomes. Brachytherapy, also known as interventional radiotherapy, with its ability to deliver high doses centrally to the target, has been shown to improve local control rates. Due to the rapid fall-off of the dose of brachytherapy there is better organ at risk sparing as compared with that of external beam radiotherapy. In the head and neck region, brachytherapy has been practiced in various sites, including the oral cavity, oropharynx, nasopharynx, nasal vestibule and paranasal sinuses. Additionally, brachytherapy has also been considered for reirradiation as a salvage. Brachytherapy can also be considered as a perioperative technique together with surgery. Close multidisciplinary cooperation is required for a successful brachytherapy programme. In oral cavity cancers, depending on the location of the tumour, brachytherapy has been shown to preserve oral competence, maintain tongue mobility, maintain speech, swallowing and the hard palate. Brachytherapy in oropharyngeal cancers has been shown to reduce xerostomia and also reduce dysphagia and aspiration post-radiation therapy. For the nasopharynx, paranasal sinus and nasal vestibule, brachytherapy preserves the respiratory function of the mucosa. Despite such an incomparable impact on function and organ preservation, brachytherapy is an underutilised technique for head and neck cancers. There is a strong need to improve brachytherapy utilisation in head and neck cancers.
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Affiliation(s)
- A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.
| | - J L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain
| | - L Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - F Bussu
- Otorinolaringology Division, Azienda Ospedaliero Universitaria, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, Università degli studi di Sassari, Sassari, Italy
| | | | - G Kovacs
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
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Swain M, Budrukkar A, Laskar SG, Sinha S, Kumar A, Pai P, Pantavaidya G, Deshmukh A, Patil V, Prabhash K, Naronha V, Agarwal J. Contralateral Nodal Relapse (CLNR) in Well Lateralized Oral Cavity Cancer Treated Ipsilaterally with Surgery and Adjuvant Radiotherapy with or without Concurrent Chemotherapy: A Retrospective Audit. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Budrukkar A, Jansari J, Swain M, Ghosh S, Sinha S, Kumar A, Agarwal J, Upreti R, Kale S. Patterns of Failure in Sinonasal Cancers after Curative Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Ghosh Laskar S, Kannan S, Kale S, Upereti R, Gawli S, Pai P, Pantvaidya G, Gupta T, Agarwal J. OC-0100 IMRT vs IMRT and brachytherapy for early oropharyngeal cancers (Brachytrial) : A randomized trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Agarwal J, Sinha S, Lewis Salins S, Pandey S, Deodhar J, Salins N, Ghosh Laskar S, Budrukkar A, Gupta T, Murthy V, Swain M, Nair S, Chaturvedi P. OC-0592 Impact of palliative care referral on distress in patients undergoing RT for HNSCC: Randomized Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Laskar SG, Sinha S, Singh M, Mummudi N, Mittal R, Gavarraju A, Budrukkar A, Swain M, Agarwal JP, Gupta T, Murthy V, Mokal S, Patil V, Noronha V, Joshi A, Menon N, Prabhash K. Post-cricoid and Upper Oesophagus Cancers Treated with Organ Preservation Using Intensity-modulated Image-guided Radiotherapy: a Phase II Prospective Study of Outcomes, Toxicity and Quality of Life. Clin Oncol (R Coll Radiol) 2021; 34:220-229. [PMID: 34872822 DOI: 10.1016/j.clon.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
AIMS To prospectively examine the outcomes, toxicity and quality of life (QoL) of patients with post-cricoid and upper oesophagus (PCUE) cancers treated with an organ-preservation approach of (chemo)-radiotherapy using intensity-modulated image-guided radiotherapy (IM-IGRT). MATERIALS AND METHODS This phase II prospective study was conducted at a tertiary cancer centre from February 2017 to January 2020. Forty patients with squamous cell carcinoma of PCUE of stage T1-3, N0-2, M0 were accrued. Gross exolaryngeal extension/dysfunctional larynx were major exclusion criteria. Patients received 63-66 Gy in once-daily fractions using volumetric modulated arc therapy with daily IGRT. Outcome measures included disease-related outcomes, patterns of failure, Radiation Therapy Oncology Group toxicities, feeding tube dependency and QoL. RESULTS The median follow-up was 22 months. Twenty-six (87.5%) patients had locoregionally advanced disease and 34 (85%) patients received (chemo)-radiotherapy. A complete response was observed in 26 (65%) patients. The 2-year locoregional control, event-free survival and cause-specific survival were 59.6%, 40.2% and 44.8%, respectively. The volume of primary tumour (GTVPvol) exceeding 28 cm3 had inferior overall survival (P = 0.005) on univariate analysis. Multivariable analysis showed GTVPvol and positron emission tomography-computed tomography maximum standardised uptake value to be independently predictive for event-free and overall survival. A feeding tube requirement at presentation was seen in 11 (27.5%) patients, whereas long-term feeding tube dependency at 6 months was seen in 10 (37%) patients. For QoL, a statistical improvement in pain, appetite loss and swallowing was observed over time. CONCLUSION Although the outcomes of PCUE cancers remain dismal, the use of state of the art diagnostic modalities, careful case selection and modern radiotherapy techniques improved outcomes as compared with before in this exclusive analysis of PCUE cancers.
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Affiliation(s)
- S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Mittal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Gavarraju
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Noronha V, Patil V, Joshi A, Menon N, Agarwal J, Laskar S, Budrukkar A, Murthy V, Gupta T, Prabhash K. DOES AGE MATTER FOR RADICAL CHEMORADIATION IN HEAD AND NECK CANCER: A POST-HOC ANALYSIS OF A RANDOMIZED STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bhargava P, Shenoy R, Rathnasamy N, Gulia S, Bajpai J, Ghosh J, Rath S, Budrukkar A, Shet T, Patil A, Nair N, Popat P, Wadasadawala T, Sarin R, Kannan S, Badwe R, Gupta S. Clinical profile and outcome of HER2 positive breast cancer patients with brain metastases treated with HER2 targeted therapy: Real-world experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prabhash K, Patil V, Noronha V, Joshi A, Bhattacharjee A, Mathrudev V, Bhelekar A, Nawale K, Agarwal J, Ghosh-Laskar S, Budrukkar A, Mahajan A, Agarwal A, Purandare N, Chaturvedi P, Pai P, Chaukar D. Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV-negative oropharyngeal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sinha S, Ghosh Laskar S, Agarwal J, Juvekar S, Mahajan A, Chakraborty S, Gupta T, Budrukkar A, Murthy V. EP-1153: Impact of pre-treatment imaging on outcomes of organ conservation in laryngopharyngeal cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Telkhade T, Wadasadawala T, Upereti R, Sarin R, Jalali R, Badwe R, Parmar V, Gupta S, Budrukkar A. OC-0569: Comparison of clinical outcome of APBI by interstitial brachytherapy as per ESTRO & ASTRO guidelines. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murthy V, Kumar DP, Budrukkar A, Gupta T, Ghosh-Laskar S, Agarwal J. Twice-weekly palliative radiotherapy for locally very advanced head and neck cancers. Indian J Cancer 2017; 53:138-41. [PMID: 27146764 DOI: 10.4103/0019-509x.180847] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of the following study is to evaluate the efficacy of a twice-weekly hypofractionated palliative radiotherapy schedule in locally very advanced head and neck cancers. MATERIALS AND METHODS Patients with locally very advanced, head and neck cancers were prospectively evaluated after twice-weekly palliative radiotherapy regimen of 32 Gy in 8 fractions. Median age was 55.5 years and the predominant primary site was oral cavity (46%). Majority (70.6%) had Stage IV B disease. Disease related distressing symptoms such as pain, bleeding, skin fungation, respiratory symptoms due to tumor burden, were prospectively assessed before the start of treatment, at conclusion and at 6-12 weeks of completion of treatment. RESULTS A total of 126 patients were enrolled in the study. Ninety three (73.8%) patients who completed the planned treatment of 32 Gy in 8 fractions were included in the symptom analysis. Overall response rates were 42% at primary disease and 55% at nodal disease. At conclusion of radiotherapy 76.3% of the patients reported improvement in pain scores (P = 0.001) and 42.8% patients reported improvement in anxiety and depression levels (P = 0.001). At first follow-up after 6-12 weeks significant improvement in pain scores (P = 0.001) and anxiety/depression levels (P = 0.001) persisted. The median survival of the patients was 5.5 months. Acute grade III mucositis was seen in one patient (1.2%) while none had grade III skin reactions. CONCLUSION The proposed radiotherapy regimen is effective for sustained symptom palliation with low acute toxicity in locally very advanced head and neck cancers. It delivers a moderately high dose while being logistically simpler for the patient.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, ACTREC and Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
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Murthy V, Swain M, Teni T, Pawar S, Kalkar P, Patil A, Chande A, Ghonge S, Laskar SG, Gupta T, Budrukkar A, Agrawal J. Human papillomavirus/p16 positive head and neck cancer in India: Prevalence, clinical impact, and influence of tobacco use. Indian J Cancer 2017; 53:387-393. [PMID: 28244466 DOI: 10.4103/0019-509x.200668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Limited data are available on the prevalence and prognostic significance of human papillomavirus (HPV) in squamous cell carcinoma of head and neck (SCCHN) in the Indian population. AIM The present study aimed to determine the prevalence of HPV and p16 in an Indian cohort of SCCHN and assess their correlation and influence of tobacco use on patient outcomes. MATERIALS AND METHODS The p16 and HPV status of 170 patients of SCCHN treated with curative chemoradiotherapy was determined using immunohistochemistry and polymerase chain reaction, respectively, and further correlated with their demographic characteristics. In addition, genotyping of HPV-positive samples was performed. Survival outcomes were analyzed and compared for both p16 positive (p16 +ve) and p16 negative (p16 -ve) population. The influence of tobacco use on outcomes was assessed. RESULTS p16 expression was observed in 20% (34/170) cases whereas HPV positivity was detected in 39.4% (67/170) of SCCHN patients with HPV16 being the most common (91%) subtype. About 73.5% patients were p16 +ve among the tobacco users in this cohort (83.5%). Interestingly, p16 positivity was significantly associated with nonusers of tobacco (P = 0.02) and younger females (P = 0.06). The p16 +ve and p16 -ve groups did not exhibit a significant difference in the 5-year cause-specific survival (CSS) (79% vs. 72.2%), disease-free survival (DFS) (78.3% vs. 68.3%, P = 0.5), and locoregional control (LRC) (82.2% vs. 71.5%, P = 0.4). However, the outcome analyses in tobacco nonusers revealed a definite large improvement in CSS (P = 0.08) and a trend toward improvement in DFS (P = 0.15) and LRC (P = 0.11) in the p16 +ve versus the p16 -ve groups. CONCLUSION The low prevalence of p16 positivity (20%) and dual HPV and p16 positivity (38.8%) in the studied Indian cohort indicates the low utility of p16 as a surrogate for HPV in the background of high tobacco burden. The outcomes are largely improved in a small subset of SCCHN cases comprising p16 +ve tobacco nonusers.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Teni
- Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - S Pawar
- Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - P Kalkar
- Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - A Patil
- Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - A Chande
- Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - S Ghonge
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Wadasadawala T, Nair N, Lewis S, Budrukkar A, Parmar V, Gupta S, Ghosh J, Shet T, Badwe R, Sarin R. Clinical Profile and Outcome of Various Stages of Breast Cancer Treated at a Tertiary Cancer Centre. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lewis S, Wadasadawala T, Budrukkar A, Chakraborty S, Gupta S, Parmar V, Jalali R, Sarin R. Assessment of Patient Satisfaction of Outpatient Care in the Multidisciplinary Breast Clinic. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sarin R, Wadasadawala T, Kannan S, Gudi S, Rishi A, Budrukkar A, Parmar V, Shet T, Desai S, Gupta S, Badwe R. Predicting loco-regional recurrence risk in T1, T2 breast cancer with 1–3 positive axillary nodes postmastectomy: Development of a predictive nomogram. Indian J Cancer 2017; 54:352-357. [DOI: 10.4103/ijc.ijc_178_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pilar A, Laskar S, Rangarajan V, Purandare N, Budrukkar A, Gupta T, Murthy V, Pai P, Deshmukh A, Chaukar D, D'Cruz A, Agarwal J. Positron Emission Tomography/Computed Tomography Based Prognostication in Nasopharyngeal Cancers Treated With Definitive Chemoradiation Therapy: A Step Beyond TNM? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laskar SG, Gurram L, Gupta T, Budrukkar A, Murthy V, Agarwal JP. Outcomes in nasopharyngeal carcinoma: Results from a nonendemic cohort. Indian J Cancer 2016; 53:493-498. [DOI: 10.4103/0019-509x.204762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Budrukkar A, Dasgupta A, Pandit P, Laskar S, Murthy V, Swamidas J, Upereti R, Gupta T, Agarwal J. OC-0038: Clinical outcomes with high dose rate surface mould brachytherapy in head and neck cancers. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tagliaferri L, Kovács G, Budrukkar A, Autorino R, Gatta R, Dinapoli N, Lanzotti V, Miccichè F, Gambacorta M, Damiani A, Bussu F, Paludetti G, Valentini V. PO-1030: COBRA ontology: a proposal for a standardized data collection (SDC) for H&N patients treated with brachytherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghosh Laskar S, Pilar A, Purandare N, Rangarajan V, Budrukkar A, Gupta T, Murthy V. PO-120: Clinical impact of metabolic and anatomic imaging in nasopharyngeal carcinoma treated with chemo-radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34880-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rathod S, Gupta T, Laskar S, Murthy V, Budrukkar A, Agarwal J. High-Precision Conformal Radiation Therapy in Head-Neck Cancers: Longitudinal Changes in Quality-of-Life and Temporal Time-Trends. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yathiraj P, Ghosh-Laskar S, Datta D, Rangarajan V, Purandare N, Gupta T, Budrukkar A, Murthy V, Kannan S, Agarwal J. Randomized Controlled Trial to Compare 3-Dimensional Conformal Radiation Therapy (3DCRT) to Intensity Modulated Radiation Therapy (IMRT) in Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pandit P, Murthy V, Agarwal J, Ghosh Laskar S, Choudhari S, Ghadi Y, Gupta T, Budrukkar A. PO-1014: Clinical outcome of patients with early stage head neck cancer treated with 3D CT based radical HDR brachytherapy. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krishnatry R, Gupta T, Murthy V, Ghosh-Laskar S, Budrukkar A, Chaturvedi P, Nair S, Nair D, Kumar P, Joshi A, Agarwal JP. Factors predicting 'time to distant metastasis' in radically treated head and neck cancer. Indian J Cancer 2014; 51:231-235. [PMID: 25494111 DOI: 10.4103/0019-509x.146734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. Aims and Objectives: To identify the factors that predict TDM in radically treated HNC patients. Settings and Design: Retrospective audit. Materials and Methods: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. Results: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. Conclusions: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India
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Laskar SG, Baijal G, Murthy V, Chilukuri S, Budrukkar A, Gupta T, Agarwal JP. Hypofractionated radiotherapy for T1N0M0 glottic cancer: retrospective analysis of two different cohorts of dose-fractionation schedules from a single institution. Clin Oncol (R Coll Radiol) 2012; 24:e180-6. [PMID: 22862908 DOI: 10.1016/j.clon.2012.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 04/10/2012] [Accepted: 05/03/2012] [Indexed: 11/26/2022]
Abstract
AIMS To determine the influence of dose and fractionation on tumour characteristics, toxicity, disease control and survival outcomes in T1 glottic carcinoma. MATERIALS AND METHODS Between 1975 and 2000, treatment charts of 652 patients with T1 glottic carcinoma who received curative radiation with four hypofractionated schedules (50 Gy/15 fractions [3.3 Gy/fraction] or 55 Gy/16 fractions [3.43 Gy/fraction] or 60 Gy/24 fractions or 62.5 Gy/25 fractions [2.5 Gy/fraction]) were analysed. The patients were divided into two groups based on fraction size <3 Gy and >3 Gy. Local control and overall survival were calculated. Patient- and tumour-related factors affecting local control were analysed using univariate and multivariate analysis. Factors affecting late toxicity were also analysed. RESULTS The local control and overall survival at 10 years were 84 and 86.1%, respectively, for T1 glottic carcinoma. The response to radiation had a significant effect on local control with univariate analysis (P = 0.001). Other factors, such as beam energy, anterior commissure involvement and fractionation, did not affect local control. Persistent radiation oedema was seen in 123 patients (23.4%) and was significantly worse in patients who received radiation with a larger field size (>36 cm(2)) on a telecobalt machine (P < 0.001). CONCLUSIONS Radical radiotherapy schedules incorporating a higher dose per fraction yield acceptable local control rates and late toxicity. Telecobalt therapy for early glottic cancer is a safe alternative to treatment with 6 MV photons on a linear accelerator in terms of local control and late toxicity as long as field sizes smaller than 36 cm(2) are used.
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Affiliation(s)
- S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
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Nair D, Pai P, Prabhash K, Moiyadi A, Pal P, Noronha V, Shetty P, Agarwal J, Budrukkar A. Response Evaluation of Neoadjuvant Chemotherapy in Patients with Epithelial Malignancies of the Paranasal Sinus. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Murthy V, Narang K, Agarwal J, Ghosh-Laskar S, Gupta T, Budrukkar A. PD-0442 HYPOTHYROIDISM AFTER HEAD AND NECK 3DCRT AND IMRT: PROSPECTIVE DATA FROM TWO RANDOMIZED TRIALS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Budrukkar A, Sarin R, Jalali R, Munshi A, Badwe R, Seth T, Parmar V, Deshpande D. 5125 POSTER Five Year Clinical Outcome in 109 Women With Clinically Palpable Tumours (1-3 cm) Treated With Accelerated Partial Breast Irradiation Using Interstitial Brachytherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71567-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Ghosh-Laskar S, Chaukar D, Agarwal J, Gupta T, Budrukkar A, Murthy V. O81. Comparison of early quality of life (QOL) in patients with squamous cell carcinoma of the head and neck (HNSCC) treated with 3-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiotherapy (IMRT). Oral Oncol 2011. [DOI: 10.1016/j.oraloncology.2011.06.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Agarwal JP, Kalyani N, Laskar SG, Kumar P, Pai P, D′cruz AK, Gupta T, Budrukkar A, Murthy V, Narohna V, Chaturvedi P. Cetuximab with radiotherapy in patients with loco-regionally advanced squamous cell carcinoma of head and neck unsuitable or ineligible for concurrent platinum-based chemo-radiotherapy: Ready for routine clinical practice? Indian J Cancer 2011; 48:148-53. [DOI: 10.4103/0019-509x.82872] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma PK, Jamema SV, Kaushik K, Budrukkar A, Jalali R, Deshpande DD, Tambe CM, Sarin R, Munshi A. Electron arc therapy for bilateral chest wall irradiation: treatment planning and dosimetric study. Clin Oncol (R Coll Radiol) 2010; 23:216-22. [PMID: 21185700 DOI: 10.1016/j.clon.2010.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/13/2010] [Accepted: 09/10/2010] [Indexed: 10/18/2022]
Abstract
AIMS The treatment of patients with synchronous bilateral breast cancer is a challenge. We present a report of dosimetric data of patients with bilateral chest walls as the target treated with electron arc therapy. MATERIALS AND METHODS Ten consecutive patients who had undergone electron arc therapy to the bilateral chest wall for breast cancer were analysed. After positioning and immobilisation, patients underwent computed tomography scans from the neck to the upper abdomen. Electron arc plans were generated using the PLATO RTS (V1.8.2 Nucletron) treatment planning system. Electron energy was chosen depending upon the depth and thickness of the planning target volume (PTV). For all patients, the arc angle ranged between 80 and 280° (start angle 80°, stop angle 280°). The homogeneity index, coverage index and doses to organs at risk were evaluated. The patient-specific output factor and thermoluminescence dosimetry (TLD) measurements were carried out for all patients. The total planned dose to the PTV was 50Gy/25 fractions/5 weeks. RESULTS The mean PTV (± standard deviation) was 568.9 (±116)cm(3). The mean PTV coverage was 89 (±5.8)% of the prescribed dose. For the right lung, the mean values of D(1) and D(10) were 46 (±7.6) and 30 (±9)Gy, respectively. For the left lung, the mean values of D(1) and D(10) were 45 (±7) and 27 (±8)Gy, respectively. For the heart, the mean values of D(1), D(5) and D(10) were 21 (±15), 13.5 (±12) and 9 (±9)Gy, respectively. The mean values of TLD at various pre-specified locations on the chest wall surface were 1.84, 1.82, 1.82, 1.89 and 1.78Gy, respectively CONCLUSION The electron arc technique for treating the bilateral chest wall is a feasible and pragmatic technique. This technique has the twin advantages of adequate coverage of the target volume and sparing of adjacent normal structures. However, compared with other techniques, it needs a firm quality assurance protocol for dosimetry and treatment delivery.
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Affiliation(s)
- P K Sharma
- Department of Medical Physics & Radiation Safety, International Oncology Centre, Fortis Hospital, Noida, India
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Trivedi S, Ghosh Laskar S, Agarwal J, Gupta T, Budrukkar A, Murthy V, Chaukar D, Chaturvedi P, Pai P, D'Cruz A. Need for Prophylactic Contralateral Neck Irradiation in all Locally Advanced Oral Cavity Squamous Cell Carcinomas? Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghosh S, Agarwal J, Budrukkar A, Gupta T, Murthy V, Pai P, D'Cruz A, Bahl G. Esthesioneuroblastoma: Prognostic Factors and Outcomes in a Developing Country. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wadasadawala T, Pandey A, Agarwal JP, Jalali R, Laskar SG, Chowdhary S, Budrukkar A, Sarin R, Deshpande D, Munshi A. Radiation therapy with implanted cardiac pacemaker devices: a clinical and dosimetric analysis of patients and proposed precautions. Clin Oncol (R Coll Radiol) 2010; 23:79-85. [PMID: 21041071 DOI: 10.1016/j.clon.2010.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
Abstract
AIMS To report the radiation planning dosimetric aspects and clinical outcomes of patients with implanted cardiac pacemakers. MATERIALS AND METHODS Between 2005 and 2009, eight patients with in situ cardiac pacemakers of varied primary site were treated at our hospital. All patients underwent computed tomography-based treatment planning. The target volumes, organs at risk and pacemaker device were all contoured. A treatment plan optimally covering the target area and maximally sparing the pacemaker was generated. All patients were evaluated at baseline, during radiotherapy and after radiotherapy conclusion by a cardiologist as well as pacemaker company personnel. RESULTS The median age at presentation was 67 (range 53-77) years. There were three men with head and neck primaries, two men with lung primaries and three women with breast primaries. The prescribed dose ranged from 45 to 70 Gy in 25-35 fractions with a daily dose of 1.8-2.0 Gy. Four patients had the pacemaker implanted on the same side as the radiotherapy target. The dose ranges for the minimum, mean and maximum doses to the pacemaker were 0.06-2.0, 0.07-20.6 and 0.14-60.0 Gy, respectively. Radiation therapy was safely delivered in all patients without any untoward effects. At 5 months of median follow-up, all patients were well with no malfunction of the pacemaker. CONCLUSION A series of eight patients with in situ pacemakers treated with radiotherapy is reported. Radiotherapy can be safely delivered in patients with implanted cardiac pacemakers. However, it mandates a cautious approach in planning and treatment delivery to ensure the least possible dose to the pacemaker. Close liaison with the cardiologist and a pacemaker clinic before, during and after the course of treatment is essential to ensure patient safety.
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Affiliation(s)
- T Wadasadawala
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
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Murthy V, Agarwal JP, Laskar SG, Gupta T, Budrukkar A, Pai P, Chaturvedi P, Chaukar D, D′Cruz A. Analysis of prognostic factors in 1180 patients with oral cavity primary cancer treated with definitive or adjuvant radiotherapy. J Cancer Res Ther 2010; 6:282-9. [DOI: 10.4103/0973-1482.73360] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma P, Munshi A, Budrukkar A, Jamema S, Tambe C, Jalali R, Sarin R, Deshpande D, Shrivastava S. Electron Arc Therapy for Bilateral Chest Wall Irradiation: Treatment Planning and Dosimetric Study. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chopra S, Gupta T, Agarwal J, (Ghosh) Laskar S, Budrukkar A, Murthy V, D'Cruz A. Postoperative Adjuvant Radiotherapy for Hypopharyngeal Cancers: Outcome Analysis of 159 Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wadasadawala T, Budrukkar A, Chopra S, Badwe R, Hawaldar R, Parmar V, Jalali R, Sarin R. Quality of life after accelerated partial breast irradiation in early breast cancer: matched pair analysis with protracted whole breast radiotherapy. Clin Oncol (R Coll Radiol) 2009; 21:668-75. [PMID: 19734028 DOI: 10.1016/j.clon.2009.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/28/2022]
Abstract
AIMS To compare the quality of life of women with early breast cancer treated with either accelerated partial breast irradiation (APBI) or whole breast radiotherapy (WBRT). MATERIALS AND METHODS After matching for the American Brachytherapy Society criteria, the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the breast cancer-specific BR23 modules were given to 48 women (23 APBI and 25 WBRT) who attended the radiotherapy clinic between May 2006 and December 2006 at Tata Memorial Hospital. RESULTS The median follow-up of patients in both groups was 3 years. The reliability and validity of the English and translated versions of the questionnaires were tested by Cronbach alpha (0.67-0.96) and Pearson's correlation for scale-scale correlation statistic (0.013-0.505). The scores for social functioning and financial difficulties in QLQ-C30 showed a trend towards a better outcome in the APBI group (P=0.025 and 0.019, respectively) and body image in BR23 was significantly better in the APBI group as compared with the WBRT group (P=0.005). When the analysis was restricted to women receiving chemotherapy in order to eliminate the confounding effect of the heterogeneous use of chemotherapy in the WBRT group, the difference in social functioning was not significant. However, financial difficulties and body image showed a trend towards a worse outcome in the WBRT group. CONCLUSION Favourable long-term results of APBI in terms of superior body image perception and lesser financial difficulties compared with WBRT need to be confirmed in larger prospective studies investigating the effect of APBI on quality of life and health economics in different ethnic groups and health care set-ups.
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Affiliation(s)
- T Wadasadawala
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
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Budrukkar A, Mallick I, Bhalavat R, Chendil V, Agarwal J, Laskar SG, Murthy V. 8538 Xerostomia and dysphagia related quality of life in patients treated with interstitial brachytherapy boost for head neck cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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de Palma EV, Clivio A, Nicolini G, Cozzi AF, Ghosh-Laskar S, Agarwal J, Upreti R, Budrukkar A, Murthy V, Deshpande D, Shrivastava S, Dinshaw K, Cozzi L. RAPIDARC COMPARED TO IMRT FOR H&N CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Munshi A, Kakkar S, Bhutani R, Jalali R, Budrukkar A, Dinshaw K. Factors Influencing Cosmetic Outcome in Breast Conservation. Clin Oncol (R Coll Radiol) 2009; 21:285-93. [DOI: 10.1016/j.clon.2009.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/07/2009] [Accepted: 02/04/2009] [Indexed: 11/30/2022]
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Munshi A, Trivedi S, Budrukkar A, Jalali R. 0120 A weekly fractionated radiotherapy regimen for brain metastases in breast cancer patients with poor performance status. Breast 2009. [DOI: 10.1016/s0960-9776(09)70161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mohindra P, Laskar SG, Agarwal JP, Sengar M, Vyas S, Pai VR, Budrukkar A, Pai P, D’Cruz A, Dinshaw KA. Ifosfamide based chemotherapy in nasopharyngeal cancer: Evaluation of its role as neo-adjuvant chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Munshi A, Srinivas C, Jalali R, Budrukkar A, Sarin R, Dinshaw K. Results of a novel weekly fractionation regimen for brain metastasis in patients with carcinoma breast. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sharma S, Budrukkar A, Upreti R, Munshi A, Jalali R, Deshpande D. Dosimetric Comparison of Conventional Radiograph- and Three-dimensional Computed Tomography-based Planning using Dose Volume Indices for Partial Breast Intraoperative Implants. Clin Oncol (R Coll Radiol) 2008; 20:46-52. [DOI: 10.1016/j.clon.2007.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/08/2007] [Accepted: 09/18/2007] [Indexed: 11/25/2022]
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