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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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Vaish R, Hawaldar R, Gupta S, Dandekar M, Shah S, Chaukar D, Pantvaidya G, Deshmukh A, Chaturvedi P, Pai P, Nair D, Nair S, Thakur M, Ghosh-Laskar S, Agarwal JP, D'Cruz AK. N0 neck trial: Does intensification of follow-up (Ultrasound + Physical Examination) influence outcomes in early-stage oral cancer? Eur J Cancer 2024; 204:114064. [PMID: 38705028 DOI: 10.1016/j.ejca.2024.114064] [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: 02/03/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
AIM OF THE STUDY We previously reported a survival benefit of elective neck dissection (END) over therapeutic neck dissection (TND) in patients with clinically node-negative early-stage oral cancer. We now report the results of the second question in the same study addressing the impact of adding neck ultrasound to physical examination during follow-up on outcomes. METHODS Patients with lateralized T1/T2 oral squamous cell carcinoma (SCC) were randomized to END or TND and to follow-up with physical-examination plus neck ultrasound (PE+US) versus physical-examination (PE). The primary endpoint was overall survival (OS). RESULTS Between January 2004 and June 2014, 596 patients were enrolled. This is an intention to treat analysis of 592 analysable patients, of whom 295 were allocated to PE+US and 297 to PE with a median follow-up of 77.47 months (interquartile range (IQR) 54.51-126.48). There was no significant difference (unadjusted hazard ratio [HR], 0.92, 95% CI, 0.71-1.20, p = 0.54) in 5-year OS between PE+US (70.8%, 95% CI, 65.51-76.09) and PE (67.3%, 95% CI, 61.81-72.79). Among 131 patients with neck node relapse as the first event, the median time to relapse detection was 4.85 (IQR 2.33-9.60) and 7.62 (IQR 3.22-9.86) months in PE+US and PE arms, respectively. The N stage in the PE+US arm was N1 33.8%, N2a 7.4%, N2b/c 44.1% and N3 14.7% while in PE was N1 28.6%, N2a 9.5%, N2b/c 39.7%, N3 20.6% and unknown 1.6%. CONCLUSION Adding neck ultrasound to physical examination during follow-up detects nodal relapses earlier but does not improve overall survival.
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Affiliation(s)
- Richa Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Snehal Shah
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Max Nanavati Hospital, Mumbai, India
| | | | - Anuja Deshmukh
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Prathamesh Pai
- Punyashlok Ahilyadevi Holkar, Head Neck Cancer Institute of India (HNCII), India
| | - Deepa Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Sudhir Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | | | - J P Agarwal
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Anil K D'Cruz
- Director Oncology-Apollo Group of Hospitals, Department of Oncology, Apollo Hospital, Navi Mumbai, India.
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Tibdewal A, Agrawal A, Bhogadi A, Mummudi N, Khatavkar G, Agarwal JP. Long Term Outcomes of Conventional Palliative Radiotherapy in Bone Metastases of Lung Cancer: A Prospective Study. Int J Radiat Oncol Biol Phys 2023; 117:e66-e67. [PMID: 37785955 DOI: 10.1016/j.ijrobp.2023.06.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Bone metastases (BM) are highly prevalent in metastatic lung cancer (LC) leading to consequential morbidity and a decline in quality of life. The identification of oncogenes mutation and introduction of targeted therapy has prolonged the survival and therefore evaluation of long-term pain response rates, durability and re-irradiation (Re-RT) with conventional radiotherapy (RT) is crucial, especially in LMIC where penetration of stereotactic body radiotherapy for BM is poor. MATERIALS/METHODS This prospective observational study included consecutive patients with histologically proven LC with radiologically confirmed BM. The primary objective was to evaluate the pain response rates in lung cancer patients with bone metastases treated with palliative RT. Palliative RT to BM was delivered using a conventional/conformal technique. The International Bone Metastases Consensus response criteria using Numeric Pain Rating Scale (NPRS) and Oral Morphine Equivalent Dose (OMED) was used to evaluate the pain response at 12, 24, and 52 weeks. Assuming the worst-case scenario, pain progression-free survival (PPFS) was calculated from the date of baseline assessment to the date of pain progression (PP) or death using Kaplan-Meier survival analysis. Known prognostic factors were evaluated using Cox regression analysis. RESULTS From June 2020 to August 2022, 250 patients of NSCLC (94%) were accrued. The majority were male (66%), smokers (35%), lytic lesions (75%) and in the axial skeleton (82%). The oncogenic mutation was seen in 123 (49%) patients. At baseline, the mean OMED was 20mg/day (SD-21), and the mean pain score was 6 (SD-2.3). The majority (66%) received an 8 Gy single fraction with only 3% treated with SBRT. In evaluable patients, the CR and PR rates at 12 (n-161) and 24 weeks (n-121) were 34%, 40%, and 44%, 35% respectively. The indeterminate response rate (IRR) at 3 and 6 months were 18% while the rate of PP was 6%. On multivariate analysis, negative oncogene mutation {HR-0.34 (CI 0.22- 0.50), p<0.0001} and soft tissue mass {HR-0.46 (CI 0.31- 0.68) p<0.0001} were significant prognostic factors for pain progression. Of 71 evaluable patients at 1 year, 56% had a complete response with an ORR of 87%. In patients with oncogene mutation, the CR rates at 12 (n-101), 24 (n-77), and 52 weeks were 40%, 47%, and 60% with an ORR of 86%. PP is observed in less than 4%. Pain response was significantly more durable than mutation negative (8 vs 3 months, p-0.003). Re-RT rate was overall 11% (n = 27) and 8.2% in oncogene mutation patients. Re-RT rate with single-fraction was 8% and 3% with fractionated RT. The median time to Re-RT was 9.7 weeks. The PPFS was 70% and 60% at 12 and 24 weeks, respectively. CONCLUSION This prospective study in an LC-specific population demonstrated excellent CR and PR rates with conventional RT. Durable pain relief with modest Re-RT rates with single fraction, particularly in oncogene mutation compels us to evaluate the role of SBRT for BM, especially in LMIC in a randomized setting.
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Affiliation(s)
- A Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - A Bhogadi
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - G Khatavkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Mahajan A, B G, Wadhwa S, Agarwal U, Baid U, Talbar S, Janu AK, Patil V, Noronha V, Mummudi N, Tibdewal A, Agarwal JP, Yadav S, Kumar Kaushal R, Puranik A, Purandare N, Prabhash K. Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer. Explor Target Antitumor Ther 2023; 4:657-668. [PMID: 37745691 PMCID: PMC10511818 DOI: 10.37349/etat.2023.00158] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 09/26/2023] Open
Abstract
Aim The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.
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Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Gurukrishna B
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shweta Wadhwa
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - JP Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Subash Yadav
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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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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Tiwari A, Mehrotra M, Hasan A, Agarwal J, Singh GK. "HBV liver decompensation: Antiviral therapy for all". J Gastroenterol Hepatol 2023; 38:833-834. [PMID: 36999212 DOI: 10.1111/jgh.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023]
Affiliation(s)
- A Tiwari
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - M Mehrotra
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - A Hasan
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - J Agarwal
- Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - G K Singh
- Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
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Mukherjee S, Gupta V, Panchal P, Mishra J, Nayak P, Agarwal J, Agravat H, Dewasi A, Dutta R, Desai A, Verma S, Swamy R, Mokariya P, Patel N, Patel T, Belsare S, Khirwadkar S, Gangradey R. Design and development of LN2 cooled cryopump for application in high heat flux test facility. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Ramanjinappa N, Agarwal J, Upveja K. 20P Physician perceptions to use of trastuzumab in HER2+ breast cancer in India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.028] [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: 12/07/2022] Open
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Mummudi N, Jiwnani S, Niyogi D, Srinivasan S, Ghosh-Laskar S, Tibdewal A, Rane P, Karimundackal G, Pramesh CS, Agarwal JP. Salvage radiotherapy for postoperative locoregional failure in esophageal cancer: a systematic review and meta-analysis. Dis Esophagus 2022; 35:6257764. [PMID: 33912933 DOI: 10.1093/dote/doab020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/02/2020] [Indexed: 12/11/2022]
Abstract
Locoregional recurrences following surgery for esophageal cancers represent a significant clinical problem with no standard recommendations for management. We conducted this systematic review and meta-analysis with the objective of studying safety and efficacy of salvage radiotherapy in this setting. All prospective and retrospective cohort studies, which studied patients who developed locoregional recurrence following initial radical surgery for esophageal cancer and subsequently received salvage radiation therapy (RT)/chemoradiation with all relevant information regarding survival outcome and toxicity available, were included. The quality of eligible individual studies was assessed using the Newcastle-Ottawa Scale score for risk of bias. R package MetaSurv was used to obtain a summary survival curve from survival probabilities and numbers of at-risk patients collected at various time points and to test the overall heterogeneity using the I2 statistic. Thirty studies (27 retrospective, 3 prospective) published from 1995 to 2020 with 1553 patients were included. The median interval between surgery and disease recurrence was 12.5 months. The median radiation dose used was 60 Gy and 57% received concurrent chemotherapy. The overall incidence of acute grade 3/4 mucositis and dermatitis were 8 and 4%, respectively; grade 3/4 acute pneumonitis was reported in 5%. The overall median follow-up of all studies included was 27 months. The 1-, 2- and 3-year overall survival (OS) probabilities were 67.9, 35.9 and 30.6%, respectively. Factors which predicted better survival on multivariate analysis were good PS, lower group stage, node negativity at index surgery, longer disease-free interval, nodal recurrence (as compared to anastomotic site recurrence), smaller disease volume, single site of recurrence, RT dose >50 Gy, conformal RT, use of concomitant chemotherapy and good radiological response after radiotherapy. Salvage radiotherapy with or without concomitant chemotherapy for locoregional recurrences after surgery for esophageal cancer is safe and effective. Modern radiotherapy techniques may improve outcomes and reduce treatment-related morbidity.
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Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Jiwnani
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Niyogi
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Srinivasan
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Rane
- Department of Bio-statistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Karimundackal
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Thoracic Surgery, 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
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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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Thirumalairaj R, Parikh PM, Agarwal A, Singh R, Krishnamurthy A, Desai SS, Maheshwari A, Mehta P, Ghafur A, Somashekhar SP, Iqbal A, Savant DN, Hussain SMA, Bhatt A, Wangdi T, Bajpai J, Ranade AA, Babu KG, Bapna A, Biswas G, Malhotra H, Krishna MV, Baral RP, Vashishtha R, Safi AJ, Agarwal S, Agarwal JP, Rathnam KK, Mohapatra PN, Kumar RV, Rajappa S, Limaye SA, Vora A, Reddy VAP, Parekh BB, Rath GK. South Asian Declaration-Consensus Guidelines for COVID-19 Vaccination in Cancer Patients. South Asian J Cancer 2021; 10:3-8. [PMID: 34430512 PMCID: PMC8378920 DOI: 10.1055/s-0041-1731909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.
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Affiliation(s)
- Raja Thirumalairaj
- Department of Medical Oncology, Apollo Cancer Center, Teynampet, Chennai, India
| | - Purvish M Parikh
- Department of Oncology, Integrated Academic Society of Clinical Oncology, Mumbai Oncocare Centers, Mumbai, Maharashtra, India
| | - Amit Agarwal
- Department of Medical Oncology, BLK Superspecilaity Hospital, Delhi, India
| | - Randeep Singh
- Department of Molecular Oncology Society, Narayana Health, Delhi, India
| | | | - Sharad S Desai
- Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
| | - Amita Maheshwari
- Divison of Gynecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Mehta
- Department of Medical Oncology/Hematoncology/BMT, Asian Institute of Medical Sciences, Faridabad, India
| | - Abdul Ghafur
- Department of Infectious Diseases, Apollo Cancer Institute, Chennai, India
| | - S P Somashekhar
- Department of Surgical Oncology, MHEPL, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Ahamed Iqbal
- Oncology and Radiotherapy Department, Teaching Hospital, Batticaloa, Sri Lanka
| | | | - Syed Md Akram Hussain
- Department of Radiotherapy, Square Oncology and Radiotherapy Centre, Dhaka, Bangladesh
| | - Amit Bhatt
- Department of Medical Oncology, Avinash Cancer Clinic, Pune, India
| | - Tashi Wangdi
- Oncology Department, JDWNR Hospital and KGUMS, Thimphu, Bhutan
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - K Govind Babu
- Department of Medical and Pediatric Oncology, St. Johns Medical College and Hospital, HCG Hospitals, Bangalore, India
| | - Ajay Bapna
- Department of Medical Oncology, BMCHRC, Jaipur, Rajasthan, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospital and Sum Hospital, Bhubaneswar, Odisha, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | - M Vamshi Krishna
- Department of Medical Oncology and Hematology, Institute of Oncology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Rajendra Prasad Baral
- Department of Medical Oncology, Norvic International Hospital and Om Hospital and Research Center, Kathmandu, Nepal
| | - Rajesh Vashishtha
- Department of Radiation Oncology, Max Super Speciality Hospital, Bathinda, Punjab, India
| | - Ahmad Javid Safi
- Afghanistan Cancer Foundation and Covid-19 Control Command Centre, Kabil, Afghanistan
| | - Sharmila Agarwal
- Department of Radiotherapy, Jaslok Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Krishna Kumar Rathnam
- Department of Medical Oncology, Meenakshi Mission Hospital and Research Centre, Madurai, India
| | - P N Mohapatra
- Department of Medical Oncology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Rajeev Vijay Kumar
- Department of Oncology, BGS Gleneagles Global Hospital, Bangalore, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Center, Hyderabad, India
| | - Sewanti Atul Limaye
- Department of Oncology and Oncology Research, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Amish Vora
- Department of Oncology, H.O.P.E. Oncology Cancer Clinic, PSRI Hospital, New Delhi, India
| | - Vijay A P Reddy
- Department of Radiation Oncology, Apollo Cancer Institute, Hyderabad, India
| | - Bhavesh B Parekh
- Department of Oncology, Shalby Cancer and Research Institute, Ahmedabad, Gujrat, India
| | - G K Rath
- National Cancer Center, Delhi, India
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Gangradey R, Mishra J, Mukherjee S, Nayak P, Panchal P, Agarwal J, Gupta V. Experimental Investigation of Thermal Properties of Materials Used to Develop Cryopump. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1904770] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Gangradey
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - J. Mishra
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - S. Mukherjee
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - P. Nayak
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - P. Panchal
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - J. Agarwal
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - V. Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
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Kumar A, Wadasadawala T, Laskar SG, Gondhowiardjo S, Agarwal JP. Mental Health Impact of COVID-19 in Radiation Oncology Health Care Workers of Asian Countries. Clin Oncol (R Coll Radiol) 2021; 33:e243-e244. [PMID: 33676823 PMCID: PMC7904513 DOI: 10.1016/j.clon.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Wadasadawala
- Department of Radiation 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
| | - S Gondhowiardjo
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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Anand AK, Agarwal JP, D'Cruz A, Dattatreya PS, Goswami C, Joshi A, Julka PK, Noronha V, Prabhash K, Rao RR, Kumar R, Toprani R, Saxena V. Evolving multidisciplinary treatment of squamous cell carcinoma of the head and neck in India ✰. Cancer Treat Res Commun 2020; 26:100269. [PMID: 33338859 DOI: 10.1016/j.ctarc.2020.100269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/10/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
In this article, we highlight the evolution of a multimodal approach in the overall management of squamous cell carcinoma of the head and neck (SCCHN) in India; present advances in technology (newer surgical techniques), novel medical and radiotherapy (RT) approaches; review their roles for an integrated approach for treating SCCHN and discuss the current role of immunotherapy in SCCHN. For locally advanced (LA) SCCHN, the multidisciplinary approach includes surgery followed by RT, with or without chemotherapy (CT) or concurrent chemoradiotherapy. Improved surgical techniques of reconstruction and voice-preservation are being implemented. Advanced forms of high-precision conformal techniques like intensity-modulated radiotherapy are used to deliver highly conformal doses to tumors, sparing the surrounding normal tissue. Compared with RT alone, novel CT regimens and targeted therapeutic agents have the potential to improve locoregional control and survival and reduce treatment-induced toxicities. Several clinical trials have demonstrated efficacy, safety, and quality of life benefits of adding cetuximab to RT regimens in LASCCHN. Studies have also suggested a cetuximab-related laryngeal preservation benefit. At progression, platinum-based CT combined with cetuximab (a monoclonal anti-epidermal growth factor receptor antibody) is the only validated option available as the first-line therapy. Thus, an integrated multidisciplinary approach plays a key role in maximizing patient outcomes, reduction in treatment related morbidities that consequently impact quality of life of survivors.
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Affiliation(s)
- A K Anand
- Max Super Speciality Hospital, Delhi, India.
| | | | - A D'Cruz
- Tata Memorial Hospital, Mumbai, India
| | | | - C Goswami
- Superspeciality Hospital, Kolkata, India
| | - A Joshi
- Memorial Hospital, Mumbai, India
| | - P K Julka
- Max Super Speciality Hospital, Delhi, India.
| | - V Noronha
- Tata Memorial Hospital, Mumbai, India
| | | | | | | | - R Toprani
- Healthcare Global Enterprises Cancer Centre, Ahmedabad, India
| | - V Saxena
- Medical Affairs, Merck Specialities Pvt Ltd, India.
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16
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Mummudi N, Ghosh-Laskar S, Tibdewal A, Agarwal JP. COVID-19 Pandemic and Nationwide Lockdown - Implications of the Double Trouble on Radiotherapy Practice in India. Clin Oncol (R Coll Radiol) 2020; 32:e219. [PMID: 32536557 PMCID: PMC7280101 DOI: 10.1016/j.clon.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Tibdewal
- 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
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17
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Panda S, Swamidas J, Chopra S, Mangaj A, Fogliata A, Kupelian P, Agarwal JP, Cozzi L. Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri. Radiat Oncol 2020; 15:22. [PMID: 32000832 PMCID: PMC6990476 DOI: 10.1186/s13014-020-1473-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT). Methods Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm3 for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm3. On the contrary, V15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm3 for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm3 for node-negative. Conclusion This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.
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Affiliation(s)
- S Panda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - J Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - A Mangaj
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Fogliata
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - P Kupelian
- Varian Medical Systems, Palo Alto, CA, USA.,Radiation Oncology Dept., University of California, Los Angeles, USA
| | - J P Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - L Cozzi
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Dept. of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
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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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19
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Mummudi N, Agarwal JP, Chatterjee S, Mallick I, Ghosh-Laskar S. Oral Cavity Cancer in the Indian Subcontinent - Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:520-528. [PMID: 31174947 DOI: 10.1016/j.clon.2019.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/08/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
Oral cavity cancer (OCC) poses a global challenge that plagues both the Orient and the Occident, accounting for an estimated 350 000 new cases and 177 000 deaths in 2018. OCC is a major public health problem in the Indian subcontinent, where it ranks among the top three cancer types in both incidence and mortality. Major risk factors are the use of tobacco, betel quid and alcohol consumption. OCC is a heterogeneous group of multiple histologies that affects multiple subsites. The oral cavity includes the lips, buccal mucosa, teeth, gingiva, anterior two-thirds of the tongue, floor of the mouth and hard palate. OCC is defined as cancer of lips, mouth and tongue as defined by the International Classification of Diseases coding scheme. The epidemiology, aetio-pathogenesis and treatment philosophy are similar within this group. Although salivary gland malignancies, sarcomas, mucosal melanomas and lymphomas can also arise within the oral cavity, this review will focus on squamous cell cancer, which is the predominant histology in OCC. We review and contrast data from developing and developed countries. We also highlight the unique regional challenges that countries in the East face; citing India as an example, we elaborate on the opportunities and scope for improvement in the management of OCC.
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Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
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Mahantshetty U, CH PN, Gurram L, Hawaldar R, Chopra S, Gupta S, Ghosh J, Bajpai J, Gulia S, Agarwal J. PO-0831 Effect of pre-treatment hematological indices on survival in cervical cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31251-4] [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: 10/26/2022]
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Moores N, Conway H, Donato D, Gociman B, Pannucci CJ, Agarwal J. Is release of the posterior lamella enough? A cadaveric exploration of posterior component separation techniques. Am J Surg 2018; 218:533-536. [PMID: 30591182 DOI: 10.1016/j.amjsurg.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/23/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND As posterior component separation techniques continue to gain popularity there is uncertainty regarding the degree of fascial advancement afforded by the various techniques. Our study seeks to compare the degree anterior rectus sheath translation seen in full transversus abdominus release compared to simple release of the posterior lamella of the rectus sheath. METHODS Ten hemi-abdomens in five fresh cadavers were dissected. One hemi-abdomen underwent external oblique release. The contralateral hemi-abdomen underwent retrorectus dissection and initial release of the internal lamella of the internal oblique, followed by full transversus abdominus release. A 4 kg weight was suspended from the fascia and excursion was measured after 1) external oblique separation, 2) posterior lamella of the internal oblique separation, and 3) transversus abdominis separation. RESULTS Average unilateral hemifascial translation after release of the external oblique provided an average unilateral hemi-fascial translation of 3.38 cm (+/- 0.69). Release of the posterior lamella of the internal oblique provided 3.98 cm (+/- 0.94). After transversus release the average translation increased to 4.31 cm (+/- 0.89). CONCLUSIONS In this cadaveric study, the majority (92%) of fascial advancement afforded by posterior component separation was achieved by an intermediate step in the transversus abdominus release operation: division of the posterior lamella of the internal oblique.
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Affiliation(s)
- N Moores
- University of Utah, Division of Plastic Surgery, 30N 1900 E, #3B400, Salt Lake City, UT, 84132, USA.
| | - H Conway
- Huntsman Cancer Institute, 2000 Circle of Hope dr, Rm 5524.12, Salt Lake City, UT, 84123, USA.
| | - D Donato
- University of Utah, Division of Plastic Surgery, 30N 1900 E, #3B400, Salt Lake City, UT, 84132, USA.
| | - B Gociman
- University of Utah, Division of Plastic Surgery, 30N 1900 E, #3B400, Salt Lake City, UT, 84132, USA.
| | - C J Pannucci
- University of Utah, Division of Plastic Surgery, 30N 1900 E, #3B400, Salt Lake City, UT, 84132, USA.
| | - J Agarwal
- University of Utah, Division of Plastic Surgery, 30N 1900 E, #3B400, Salt Lake City, UT, 84132, USA.
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Agarwal JP, Krishnatry R, Panda G, Pathak R, Vartak C, Kinhikar RA, James S, Khobrekar SV, Shrivastava SK, D'Cruz AK, Deshpande DD. An Audit for Radiotherapy Planning and Treatment Errors From a Low-Middle-Income Country Centre. Clin Oncol (R Coll Radiol) 2018; 31:e67-e74. [PMID: 30322681 DOI: 10.1016/j.clon.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/06/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
AIMS To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist. MATERIALS AND METHODS A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection. RESULTS In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes. CONCLUSION Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India.
| | - G Panda
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - C Vartak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R A Kinhikar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
| | - S James
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - S V Khobrekar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - A K D'Cruz
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - D D Deshpande
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
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Khare A, Agarwal J, Hariprasad R, Gupta S, Mehrotra R. Evaluation of Web Portal for Improving Cancer Awareness in General Population in India. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.78100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: With details on various cancers and recent advances in cancer prevention, a Web portal was developed to create awareness and value added education among Web-users in general population in villages, small towns and large cities of India. Aim: The Web portal aims at bringing awareness at the 3 levels of health related education program delivery success/efficacy triangle. The 1st level is cognitive learning of just being aware of cancer & basic knowledge. The 2nd level is a positive effect to be able to adopt life style changes that will lead to habit changes in diet, substance abuse and other life style habits and adherence to prescribed treatment. The 3rd level is actual behavioral change. Methods: A mixed methods study design incorporating etic-emic & qualitative research methodology and quantitative cross-sectional methods. We also used focused group discussions and in-depth interviews as part of qualitative study designs. Results: On the basis of data from the 100 participants, the Web portal was found to have improved attitudes toward accessing information related to cancer in participants. There was also an increase in the knowledge of the people, both general population and level 1 healthcare worker as compared with their previous knowledge about cancer. Also found was improvement in knowledge about the prevalent cancers, their screening procedures and general measures of prevention and treatment. Conclusion: On the basis of participants evaluated, we found that the Web portal may have a positive effect on cancer awareness of general population. Participants found the Web portal as a relevant tool to access information in the feedback. The comprehensive data which will be available after feedback from all participants, will help in understanding the nature of user´s response to Web based resources and its implications in improving lifestyle choices and promoting early screening & early detection of cancer.
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Krishnatry R, Bhatia J, Murthy V, Agarwal JP. Survey on Adaptive Radiotherapy Practice. Clin Oncol (R Coll Radiol) 2018; 30:819. [PMID: 30213704 DOI: 10.1016/j.clon.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Affiliation(s)
- R Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - J Bhatia
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
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Purandare NC, Pramesh CS, Agarwal JP, Agrawal A, Shah S, Prabhash K, Karimundackal G, Jiwnani S, Tandon S, Rangarajan V. Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Cancer 2018; 54:271-275. [PMID: 29199704 DOI: 10.4103/0019-509x.219563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
BACKGROUND Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a preferred imaging modality for the evaluation of solitary pulmonary nodule (SPN), particularly in the developed world. Since FDG can concentrate in infective/inflammatory lesions, the diagnostic utility of FDG-PET can be questioned, particularly in regions endemic for infectious decisions. AIM To evaluate the accuracy of FDG-PET/CT in evaluation of SPNs in a population endemic for infectious disease and to assess if regional variations have an impact on its effectiveness. MATERIALS AND METHODS All patients who underwent an FDG/PET-CT with a clinico-radiological diagnosis of SPN categorized as indeterminate were included. Based on a maximum standardized uptake values (SUVmax) cut-off of 2.5, lesions were classified as benign (<2.5) or malignant (>2.5) and compared with gold standard histopathology. The diagnostic accuracy of PET-CT to detect malignancy was calculated. On the basis of final histopathology, lesions were grouped as (a) malignant nodules (b) infective/granulomatous nodules with a specific diagnosis and (c) nonspecific inflammatory nodules. The SUVmaxbetween these groups was compared using nonparametric statistical tests. RESULTS A total of 191 patients (129 males, 62 females) with a median age of 64 years (range: 36-83) were included. Totally, 144 nodules (75.3%) were malignant and 47 were benign (24.7%). Adenocarcinoma (n = 84) was the most common malignancy. Tuberculosis (n = 16) and nonspecific infections (n = 24) were the two most common benign pathologies. There was a significant overlap in the metabolic uptake of malignant (median SUVmax-11.2, range: 3.3-34.6) and tuberculous nodules (median SUVmax-10.3, range: 2.7-22.5) with no statistically difference between their SUVmaxvalues (P = 0.43). The false-positive rate was 65.2% and the false-negative rate was 5.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for detecting malignancy were 94.4%, 34.7%, 81.9%, 66.6%, and 79.5%, respectively. CONCLUSIONS Though FDG-PET scans show a very high sensitivity for malignant nodules, it has a high false-positive rate and reduced specificity when characterizing SPNs in an infectious endemic region. Physicians must be aware of this limitation in the workup of lung nodules, and regional variations must be considered before further management decisions are taken.
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Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Chest Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
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Agarwal JP, Chakraborty S, Laskar SG, Mummudi N, Patil VM, Upasani M, Prabhash K, Noronha V, Joshi A, Purandare N, Tandon S, Arora J, Badhe R. Applying the QUARTZ Trial Results in Clinical Practice: Development of a Prognostic Model Predicting Poor Outcomes for Non-small Cell Lung Cancers with Brain Metastases. Clin Oncol (R Coll Radiol) 2018; 30:382-390. [PMID: 29499878 DOI: 10.1016/j.clon.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/21/2017] [Revised: 12/21/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023]
Abstract
AIMS The role of whole brain radiotherapy (WBRT) in patients with brain metastases from non-small cell lung cancers (NSCLC) has been questioned. However, no reliable criteria exist to identify patients who do not benefit from WBRT. The objective of the current study was to develop a prognostic model to identify such patients whose survival matches that of the Quality of Life after Treatment for Brain Metastases (QUARTZ) study. MATERIALS AND METHODS Outcome data of patients with NSCLC with brain metastases undergoing WBRT enrolled in a prospective observational study in a tertiary cancer centre were used to develop a prognostic model. Baseline clinico-radiological factors were used for development of the model. The model was internally validated and calibration accuracy was checked for prediction of 70 day mortality. The generated prognostic model was presented as a nomogram. RESULTS The median overall survival of 140 patients enrolled in the study was 166 days (95% confidence interval 108-242 days). The prognostic model identified gender, Karnofsky performance status and epidermal growth factor receptor activating mutation status as significant factors influencing overall survival. The model showed a modest discriminative ability with an optimism-corrected C-index of 0.64. However, model calibration error did reveal a moderate degree of calibration error. The high-risk subgroup identified by the model had a median overall survival of 67 days (95% confidence interval 56-101 days), which was similar to that observed in the QUARTZ trial. CONCLUSION This prognostic model derived from traditional clinico-radiological features had a modest ability to identify patients with poor prognosis who may not benefit from WBRT. However, the high-risk subgroup identified using this prognostic model had a survival similar to that observed for patients in the QUARTZ trial.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - M Upasani
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Purandare
- Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Parel, Mumbai, India
| | - J Arora
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - R Badhe
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
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Noronha V, Zanwar S, Joshi A, Patil VM, Mahajan A, Janu A, Agarwal JP, Bhargava P, Kapoor A, Prabhash K. Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm. Clin Oncol (R Coll Radiol) 2018; 30:23-29. [PMID: 29239731 DOI: 10.1016/j.clon.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/08/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Zanwar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - A Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - P Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
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Wagle PB, Jambhekar NA, Kumar R, Prabhash K, Pramesh CS, Desai SB, Noronha V, Karimundackal G, Shah A, Joshi A, Laskar SG, Jiwnani S, Pai T, Agarwal JP. A comparative analysis of immunohistochemistry and fluorescent in situ hybridization assay to detect anaplastic lymphoma kinase status in lung adenocarcinoma cases: A search for a testing algorithm. Indian J Cancer 2017; 54:148-154. [PMID: 29199679 DOI: 10.4103/ijc.ijc_202_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
INTRODUCTION Testing for echinoderm microtubule-associated protein-like 4 (EML4) anaplastic lymphoma kinase (ALK) translocation by fluorescence in situ hybridization (FISH) is well established whereas the Food and Drug Administration (FDA) ALK immunohistochemical (IHC) test is relatively new. AIMS AND OBJECTIVE The aim of this study is to compare FDA-approved ALK IHC test (D5F3 clone) with the standard ALK FISH test. MATERIALS AND METHODS A validation and a test arm with 100 and 200 cases of Formalin-Fixed, Paraffin-embedded blocks of lung adenocarcinoma, respectively, comprised the material. All cases had ALK IHC test on automated Ventana Benchmark XT IHC slide stainer using anti-ALK D5F3 rabbit monoclonal primary antibody; when positive tumor cells (any percentage) showed strong granular cytoplasmic staining. For the FISH test, Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.,) was used to detect ALK gene 2p23 rearrangements; when positive the red and green signals were split two signal diameter apart and/or isolated 3'red signal were detected in more than 15% tumor cells. The ALK FISH results were available in all 100 validation cases and 64-test arm cases which formed the basis of this analysis. RESULTS The ALK IHC test was positive in 16% cases; four discordant cases were ALK IHC positive but ALK FISH negative, but no case was ALK IHC negative and ALK FISH positive. There was 100% sensitivity, 90.5% specificity, and 93.75% accuracy. CONCLUSION A negative ALK IHC result obviates the need for a FISH test barring those with a strong clinical profile, and a positive ALK IHC result is sufficient basis for the initiation of treatment.
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Affiliation(s)
- P B Wagle
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N A Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S B Desai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Shah
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Pai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Mathew AS, Agarwal JP, Munshi A, Laskar SG, Pramesh CS, Karimundackal G, Jiwnani S, Prabhash K, Noronha V, Joshi A, Rangarajan V, Purandare NC, Jambhekar N, Tandon S, Mahajan A, Kumar R, Deodhar J. A prospective study of telephonic contact and subsequent physical follow-up of radically treated lung cancer patients. Indian J Cancer 2017; 54:241-252. [PMID: 29199699 DOI: 10.4103/0019-509x.219599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We tested the hypothesis that telephonic follow-up (FU) may offer a convenient and equivalent alternative to physical FU of radically treated lung cancer patients. DESIGN Prospective study carried out at a tertiary referral cancer care institute, Mumbai. MATERIALS AND METHODS Two hundred consecutive lung cancer patients treated with curative intent were followed up regularly with telephonic interviews paired with their routine physical FU visits. Patient satisfaction with the telephonic call and the physical visit, the anxiety level of the patient after meeting the physician and the economic burden of the visit to the patient were noted in a descriptive manner. Kappa statistics was used to assess concurrence between the telephonic and physical impression of disease status. RESULTS With a median FU duration of 21.5 months, the median satisfaction scores for telephonic and physical FU were 8 and 9, respectively. The prevalence and bias adjusted kappa (PABAK) score of the entire cohort of patients was 0.64 (95% confidence interval [CI] =0.58-0.70). Data analyzed up to first disease progression/relapse on FU had a PABAK score of 0.71 (95% CI = 0.64-0.77) indicating substantial agreement. Patients with disease controlled at the FU had a significant PABAK score of 0.88 (95% CI = 0.80-0.94) indicating excellent concurrence. On average, each patient spent Rs. 5117.10 on travel and Rs. 3079.06 on lodging per FU visit. CONCLUSION Telephonic FU is substantially accurate in assessing disease status until the first relapse. In a resource-constrained country like India, it is worthwhile to further explore the benefits of such an alternative strategy.
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Affiliation(s)
- A S Mathew
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Munshi
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N C Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Mahajan
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J Deodhar
- Department of Clinical Psychology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Mishra A, Datta S, Malik A, Garg A, Nair D, Nair S, Mair M, Bal M, Agarwal J, Chaturvedi P. Role of microscopic spread beyond gross disease as an adverse prognostic factor in oral squamous cell carcinoma. Eur J Surg Oncol 2017; 43:1503-1508. [DOI: 10.1016/j.ejso.2017.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/10/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022] Open
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Agarwal J, Hasan A, Mehrotra M. Hepatobiliary and Pancreatic: Hepatogastric fistula. J Gastroenterol Hepatol 2017. [PMID: 28639267 DOI: 10.1111/jgh.13794] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
| | - A Hasan
- Regency Health Care, Kanpur, India
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Gangradey R, Mishra J, Mukherjee S, Panchal P, Nayak P, Agarwal J, Saxena YC. SPINS-IND: Pellet injector for fuelling of magnetically confined fusion systems. Rev Sci Instrum 2017; 88:063503. [PMID: 28668001 DOI: 10.1063/1.4985639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Using a Gifford-McMahon cycle cryocooler based refrigeration system, a single barrel hydrogen pellet injection (SPINS-IND) system is indigenously developed at Institute for Plasma Research, India. The injector is based on a pipe gun concept, where a pellet formed in situ in the gun barrel is accelerated to high speed using high pressure light propellant gas. The pellet size is decided by considering the Greenwald density limit and its speed is decided by considering a neutral gas shielding model based scaling law. The pellet shape is cylindrical of dimension (1.6 mm ℓ × 1.8 mm φ). For pellet ejection and acceleration, a fast opening valve of short opening duration is installed at the breech of the barrel. A three-stage differential pumping system is used to restrict the flow of the propellant gas into the plasma vacuum vessel. Diagnostic systems such as light gate and fast imaging camera (240 000 frames/s) are employed to measure the pellet speed and size, respectively. A trigger circuit and a programmable logic controller based integrated control system developed on LabVIEW enables to control the pellet injector remotely. Using helium as a propellant gas, the pellet speed is varied in the range 650 m/s-800 m/s. The reliability of pellet formation and ejection is found to be more than 95%. This paper describes the details of SPINS-IND and its test results.
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Affiliation(s)
- R Gangradey
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - J Mishra
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - S Mukherjee
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - P Panchal
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - P Nayak
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - J Agarwal
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
| | - Y C Saxena
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382428, India
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Dandekar M, Trivedi R, Irawati N, Prabhash K, Gupta S, Agarwal JP, D'Cruz AK. Barriers in conducting clinical trials in oncology in the developing world: A cross-sectional survey of oncologists. Indian J Cancer 2017; 53:174-7. [PMID: 27146772 DOI: 10.4103/0019-509x.180865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
BACKGROUND Several obstacles impede oncologists from performing clinical trials in the developing world. This study aimed to identify these barriers in order of importance and suggest possible remedial measures. MATERIALS AND METHODS Design - cross-sectional survey. Two part questionnaire capturing experience of oncologists in practice and conducting trials (Part 1) and perceived barriers pertaining to investigator (training, time), patient (strict follow-up protocol), infrastructure (funds) and professional environment (encouragement from seniors) (Part 2) were administered to oncologists in two different settings: (1) Online portal (Survey Monkey) (2) In person during a national conference (Best of American Society of Clinical Oncology). Responses were captured on a Likert scale (1-5). RESULTS (436/3021) 14.04% responded. A total of 313 (71.8%) had experience in conducting trials, but these were mainly industry-sponsored or small nonpractice changing studies. Lack of patient follow-up was the most significant barrier (inter quartile range [IQR] 4-5) followed by inadequate training, time and funds (IQR 2-5) and lack of encouragement (IQR 2-4) in decreasing order of frequency. Lack of adequate training was a barrier across all specialties (113 [71.97%] radiation oncologists, 71 [60.68%] medical oncologists and 73 [71.56%] surgical oncologists). More than half of the respondents without experience in clinical trials worked in academic institutions (50.48%). They perceived time constraint as a barrier more than their counterparts into private practice (175/242 [72.31%] vs. 119/177 [66.47%] respectively). CONCLUSION Inability to maintain patient follow-up, lack of protected time and funds, inadequate training were the most significant barriers. Most of these can be addressed.
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Affiliation(s)
| | | | | | | | | | | | - A K D'Cruz
- Department of Head Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Agarwal JP, Hotwani C, Prabhash K, Munshi A, Misra S, Mathew A, Kalyani N, Noronha V, Laskar SG, Joshi A, Purandare N, Tandon S, Sharma V. Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource-limited population. Indian J Cancer 2017; 53:96-101. [PMID: 27146753 DOI: 10.4103/0019-509x.180810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
BACKGROUND Lung cancer most commonly presents in advanced stages in developing countries, where combined modality treatment using chemo-radiotherapy (CTRT) is the standard of care. MATERIALS AND METHODS A retrospective audit of patients of nonsmall cell lung cancer (NSCLC) treated at a single Institute from January 2008 to December 2012 was conducted. Various prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were studied by univariate and multivariate analysis. All patients were meticulously followed-up clinically and telephonic contacts. RESULTS Overall 171 patients of NSCLC were treated with definitive CTRT using concurrent chemotherapy in 66% patients and sequential therapy in 28% patients. The actuarial 2 years DFS was 17.5% and 2 years OS was 61.5%. Complete response to treatment resulted in significantly better DFS and OS. Definitive CTRT was very well-tolerated in these patients with good compliance. CONCLUSION Definitive CTRT, sequence being individualized depending on performance status and disease stage at presentation, is a feasible and effective treatment modality for locally advanced NSCLC patients in the developing world. Response to treatment is an important prognostic factor for treatment outcomes.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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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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Purandare NC, Pramesh CS, Karimundackal G, Jiwnani S, Agrawal A, Shah S, Agarwal JP, Prabhash K, Noronha V, Joshi A, Kumar R, Rangarajan V. Thymic epithelial tumors: Can fluorodeoxyglucose positron emission tomography help in predicting histologic type and stage? Indian J Cancer 2017; 53:270-273. [PMID: 28071625 DOI: 10.4103/0019-509x.197717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
OBJECTIVES To study the utility of fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting (1) the World Health Organization (WHO) histologic type and differentiating low-risk from high-risk types. (2) Tumor stage and differentiate early from advanced stage disease. MATERIALS AND METHODS Patients with thymic epithelial neoplasia who underwent a pretreatment FDG-PET study were included. Tumor maximum standardized uptake value (SUVmax) was correlated with the WHO histologic type and also with the Masaoka-Koga (MK) staging system. Patients with WHO Type A, AB, and B1 were classified as low risk and those with B2 and B3 as high risk. Thymic carcinomas belonged to Type C. Patients with MK Stage I and II disease were grouped as early stage and those with Stage III and IV as an advanced stage. Differences in SUVmax between the various groups were calculated. RESULTS The SUVmax of thymic carcinomas was significantly higher as compared to low-risk (P = 0.001) and high-risk groups (P = 0.007). The SUVmax of high-risk group was also significantly higher than the low-risk group (P = 0.002). SUVmax cutoff of 6.5 was able to differentiate thymic carcinomas from thymomas with 100% sensitivity and 87.2% specificity. The SUVmax in patients with advanced stage disease showed a higher trend compared to those with early stage, but the difference was not significant (P = 0.167). CONCLUSION PET can differentiate thymic carcinomas from rest of the thymoma subtypes by the virtue of their higher FDG uptake. It can also provide valuable information in differentiating high-risk from low-risk thymomas and in predicting disease stage.
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Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Agarwal JP, Hotwani C, Prabhash K, Munshi A, Joshi A, Misra S, Kumar D, Das S, Laskar SG. Palliative thoracic radiotherapy in advanced lung cancer: A single institution experience. Indian J Cancer 2017; 54:262-266. [DOI: 10.4103/0019-509x.219587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Fornasier S, Mottola S, Keller HU, Barucci MA, Davidsson B, Feller C, Deshapriya JDP, Sierks H, Barbieri C, Lamy PL, Rodrigo R, Koschny D, Rickman H, A’Hearn M, Agarwal J, Bertaux JL, Bertini I, Besse S, Cremonese G, Da Deppo V, Debei S, De Cecco M, Deller J, El-Maarry MR, Fulle M, Groussin O, Gutierrez PJ, Güttler C, Hofmann M, Hviid SF, Ip WH, Jorda L, Knollenberg J, Kovacs G, Kramm R, Kührt E, Küppers M, Lara ML, Lazzarin M, Moreno JJL, Marzari F, Massironi M, Naletto G, Oklay N, Pajola M, Pommerol A, Preusker F, Scholten F, Shi X, Thomas N, Toth I, Tubiana C, Vincent JB. Rosetta’s comet 67P/Churyumov-Gerasimenko sheds its dusty mantle to reveal its icy nature. Science 2016; 354:1566-1570. [DOI: 10.1126/science.aag2671] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/27/2016] [Indexed: 11/03/2022]
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Noronha V, Joshi A, Patil V, Dhumal S, Agarwal JP, Ghosh-Lashkar S, Prabhash K. Cisplatin based adjuvant chemoradiation following neoadjuvant chemotherapy and surgery in advanced oral cavity cancers: A deliverable regimen? Indian J Cancer 2016; 53:141-2. [PMID: 27146765 DOI: 10.4103/0019-509x.180861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Rathod S, Munshi A, Agarwal JP. Practice of stereotactic body radiotherapy in a developing country: Perception, aspiration, and limitation - A survey. Indian J Cancer 2016; 53:135-7. [PMID: 27146763 DOI: 10.4103/0019-509x.180864] [Citation(s) in RCA: 2] [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
BACKGROUND Stereotactic body radiotherapy (SBRT) is an effective and established modern technology now used more commonly. Radiation oncology personnel's (ROP) opinion toward SBRT in the developing countries like India is unknown. SUBJECTS AND METHODS A 30 question survey evaluating ROP's profile, technological details, and SBRT's perceptive were seeked. Tata Memorial Center - ROP's email database was used. RESULTS Survey questionnaire was emailed to 500 ROP's and 224 ROP's were contactable. Majority of the responders were from corporate hospitals and half of responders had experience of 5 or more years of experience in radiation oncology. SBRT was practiced by 70% of responders and the majority had adopted SBRT in 2010 or later. Quick turn around time, high dose delivery and competitive market forces were major factors to adopt SBRT. Lung was the most common site practiced followed by prostate, spine, and liver. All SBRT users were keen to increase SBRT in practice and the majority of non-responders were planning to adapt SBRT in the recent future. Almost half of SBRT users were willing to share data and expertise for training others. Lack of infrastructure was the prime reason for not practicing SBRT. ROP's perceived physics, radiobiology as the biggest challenge in SBRT. International collaboration may be helpful. CONCLUSION Use of SBRT is expected to increase in India. Limited experience with lack of infrastructure in public funded centers is a major limitation. Unmet need of infrastructure, training and guidelines is enormous and formulation of Indian SBRT consortium will help reforming at all levels.
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Affiliation(s)
| | | | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
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Laskar SG, Baijal G, Rangarajan V, Purandare N, Sengar M, Shah S, Gupta T, Budrukkar A, Murthy V, Pai PS, D'Cruz AK, Agarwal JP. Fluorodeoxyglucose-positron emission tomography in carcinoma nasopharynx: Can we predict outcomes and tailor therapy based on postradiotherapy fluorodeoxyglucose-positron emission tomography? Indian J Med Paediatr Oncol 2016; 37:47-52. [PMID: 27051158 PMCID: PMC4795376 DOI: 10.4103/0971-5851.177030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET-CT) is an emerging modality for staging and response evaluation in carcinoma nasopharynx. This study was conducted to evaluate the impact of PET-CT in assessing response and outcomes in carcinoma nasopharynx. MATERIALS AND METHODS Forty-five patients of nonmetastatic carcinoma nasopharynx who underwent PET-CT for response evaluation at 10-12 weeks posttherapy between 2004 and 2009 were evaluated. Patients were classified as responders (Group A) if there was a complete response on PET-CT or as nonresponders (Group B) if there was any uptake above the background activity. Data regarding demographics, treatment, and outcomes were collected from their records and compared across the Groups A and B. RESULTS The median age was 41 years. 42 out of 45 (93.3%) patients had WHO Grade 2B disease (undifferentiated squamous carcinoma). 24.4%, 31.1%, 15.6, and 28.8% patients were in American Joint Committee on Cancer Stage IIb, III, Iva, and IVb. All patients were treated with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy. Forty-five patients, 28 (62.2%) were classified as responders, whereas 17 (37.8%) were classified as nonresponders. There was no significant difference in the age, sex, WHO grade, and stage distribution between the groups. Compliance to treatment was comparable across both groups. The median follow-up was 25.3 months (759 days). The disease-free survival (DFS) of the group was 57.3% at 3 years. The DFS at 3 years was 87.3% and 19.7% for Group A and B, respectively (log-rank test, P < 0.001). Univariate and multivariate analysis revealed Groups to be the only significant factor predicting DFS (P value 0.002 and < 0.001, respectively). In Group B, the most common site of disease failure was distant (9, 53%). CONCLUSION PET-CT can be used to evaluate response and as a tool to identify patients at higher risk of distant failure. Further, this could be exploited to identify patients who may need treatment intensification. This needs to be validated prospectively.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gunjan Baijal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Nilendu Purandare
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A K D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Hopkins ZH, Frandsen J, Poruk KE, Agarwal J, Poppe MM. Abstract P3-12-08: Are different therapeutic approaches required after skin and nipple sparing mastectomies for locoregional control? A single institution's experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Nipple sparing (NSM) and skin sparing (SSM) mastectomies are gaining popularity. These procedures leave breast tissue at the skin/breast interface with the intent to better cosmesis. However, the impact of NSM versus SSM on risk of local recurrence in the remaining breast tissue is not well characterized, nor is the effect of post mastectomy radiotherapy (PMRT) in these patients.
Methods
A single institution retrospective study was conducted on women treated with NSM or SSM from 2005 to 2011 with follow up through 2015. Chest wall and chest wall or axillary recurrence were assessed. Factors associated with recurrence were examined. Kaplan Meier estimates and Cox proportional hazards models were used to analyze chest wall recurrence (CWR) and chest wall or axillary recurrence (CWAR), with CWAR as the primary outcome variable.
Results
This analysis identified 181 women who underwent a SSM (n=103, 58 (56%) with PMRT) or NSM (n=78, 35 (45%) with PMRT). Women undergoing SSM were older (56.0 ± 13.6 years, mean ± SD) than NSM (44.6 ± 11.3, p <0.0001) while follow-up times were similar (4.91 ± 0.43 and 5.43 ± 0.27 respectively, p = 0.15). Women undergoing PMRT were younger (49.2 ± 13.6 vs 53.1 ± 13.9 years, p = 0.008) but more likely to present with lymphovascular space invasion (LVSI)(42% vs 16%, p = 0.0003 by Chi-square), and were more likely to receive chemotherapy (83% vs 47%, p <0.0001). The majority of women (62%) in the group not receiving PMRT had stage I disease, and 79% were node negative. For those undergoing PMRT, 83% were stage II or III, and 69% were node positive (p <0.0001 for both differences). Despite the higher apparent risk of the PMRT group, the total number of chest wall or axillary recurrences was similar (8 in PMRT, 6 in no PMRT). Event-free survival for CWAR at 5 years was 92% for PMRT and 96% for no PMRT (p=0.42) and at 7.5 years, 85% and 84% respectively (p=0.42). In univariate Cox regression among all patients, age was the strongest predictor of CWAR (HR = 1.103 per year of age, 95% CI 1.053-1.154, p<0.0001). CWAR occurred in 2.6 % of NSM patients as compared with 11.8% of SSM patients (p=0.025 by Fisher's exact test). SSM versus NSM was associated with increased hazzard for CWAR with HR = 4.6 (95% CI 1.03-21, p=0.046) on univariate analysis. However, this apparent risk became non-significant (HR = 2.24, 95% CI 0.48 – 10.5) with adjustment for age. Other variables associated with CWAR on univariate analysis included receipt of chemotherapy (HR = 0.28, 0.09-0.86, p=0.027) and estrogen receptor positive status (HR = 0.34, 0.12-0.98, p=0.046) but these also became non-significant with adjustment for age. In multivariate Cox regression analysis, use of PMRT was associated with a non-significant higher risk of CWAR (HR = 1.45, 0.33-6.4, p=0.63 ) adjusting for age, LVSI, mastectomy type, stage, and ER status.
Conclusions
The risk of a chest wall or axillary recurrence for early stage breast cancer after a SSM or NSM appears to be low at five years. Radiation can likely be omitted in this group. Furthermore, despite presenting with more advanced disease, women who underwent PMRT experienced excellent locoregional control. Further research is needed on this topic.
Citation Format: Hopkins ZH, Frandsen J, Poruk KE, Agarwal J, Poppe MM. Are different therapeutic approaches required after skin and nipple sparing mastectomies for locoregional control? A single institution's experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-08.
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Affiliation(s)
- ZH Hopkins
- Huntsman Cancer Hospital, Salt Lake City, UT; Johns Hopkins Hosptial, Baltimore, MD; University of Utah Hospital, Salt Lake City, UT
| | - J Frandsen
- Huntsman Cancer Hospital, Salt Lake City, UT; Johns Hopkins Hosptial, Baltimore, MD; University of Utah Hospital, Salt Lake City, UT
| | - KE Poruk
- Huntsman Cancer Hospital, Salt Lake City, UT; Johns Hopkins Hosptial, Baltimore, MD; University of Utah Hospital, Salt Lake City, UT
| | - J Agarwal
- Huntsman Cancer Hospital, Salt Lake City, UT; Johns Hopkins Hosptial, Baltimore, MD; University of Utah Hospital, Salt Lake City, UT
| | - MM Poppe
- Huntsman Cancer Hospital, Salt Lake City, UT; Johns Hopkins Hosptial, Baltimore, MD; University of Utah Hospital, Salt Lake City, UT
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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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Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, Kohler HF, Ebrahimi A, Clark JR, Cernea CR, Brandao SJ, Kreppel M, Zöller J, Fliss MD, Bachar G, Shpitzer T, Bolzoni VA, Patel PR, Jonnalagadda S, Robbins KT, Iyer NG, Skanthakumar T, Shah JP, Patel SG, Gil Z. Prognostic Performance of Current Stage III Oral Cancer Patients After Curative Intent Resection: Evidence to Support a Revision of the American Joint Committee on Cancer Staging System. Ann Surg Oncol 2015; 22 Suppl 3:S985-91. [PMID: 26314876 DOI: 10.1245/s10434-015-4842-3] [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] [Received: 08/05/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). OBJECTIVE The aim of this study was to evaluate prognostic heterogeneity in the stage III category. METHODS AND PATIENTS An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011. RESULTS Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2). CONCLUSIONS The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
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Affiliation(s)
- M Amit
- The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel.,Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel
| | - T C Yen
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - C T Liao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | | | | | - A Ebrahimi
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia
| | - C R Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - S J Brandao
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - M Kreppel
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - J Zöller
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - M D Fliss
- Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - G Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - T Shpitzer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - V A Bolzoni
- Department of ENT, University of Brescia, Owensboro, Italy
| | - P R Patel
- University of Auckland, Auckland, New Zealand
| | - S Jonnalagadda
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - K T Robbins
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - N G Iyer
- Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore
| | - T Skanthakumar
- Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore
| | - J P Shah
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S G Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Z Gil
- The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel. .,Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel.
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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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Agarwal J. Correlation Between Poison Severity Asessment And Outcome In Organophosphate Poisoning In Tertiary Care Hospital. Value Health 2014; 17:A791. [PMID: 27202956 DOI: 10.1016/j.jval.2014.08.437] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Agarwal
- Manipal College of Pharmaceutical Sciences, Manipal, India
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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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Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, Arya S, Juvekar S, Chaturvedi P, Chaukar D, Pai P, Kane S, Patil A, Agarwal JP, Ghosh-Lashkar S, Dcruz A. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014; 50:1000-4. [PMID: 25130412 DOI: 10.1016/j.oraloncology.2014.07.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [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: 05/22/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012. PATIENTS AND METHODS All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS. RESULTS 721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p=0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59-25.21 months) and 8.16 months (95%, CI 7.57-8.76) in patients treated with non surgical treatment (p=0.0001). CONCLUSION In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients.
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Affiliation(s)
- V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - V Muddu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - S Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - S Arya
- Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - S Juvekar
- Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - P Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - D Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - S Kane
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - A Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Ghosh-Lashkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Dcruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
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Van Engelen M, Khodabandeh S, Akhavan T, Agarwal J, Gladanac B, Bellissimo N. Effect of sugars in solutions on subjective appetite and short-term food intake in 9- to 14-year-old normal weight boys. Eur J Clin Nutr 2014; 68:773-7. [DOI: 10.1038/ejcn.2014.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/16/2013] [Accepted: 01/21/2014] [Indexed: 11/09/2022]
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Kundu S, Mathew A, Munshi A, Prabhash K, Pramesh CS, Agarwal JP. Stereotactic body radiotherapy in early stage non-small cell lung cancer: first experience from an Indian Centre. Indian J Cancer 2014; 50:227-32. [PMID: 24061463 DOI: 10.4103/0019-509x.118739] [Citation(s) in RCA: 5] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent. AIMS AND OBJECTIVES We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT. MATERIALS AND METHODS Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits. RESULTS The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified. CONCLUSION SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.
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Affiliation(s)
- S Kundu
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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