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Jones M, Rogers J, Kumar Shrimali R, Hamilton J, Athmanathan S, Jones B. Feasibility and safety of shortened hypofractionated high-dose palliative lung radiotherapy – A retrospective planning study. Phys Med 2023; 108:102559. [PMID: 37004334 DOI: 10.1016/j.ejmp.2023.102559] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/02/2023] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Assess the safety and feasibility of shortened hypofractionated high-dose palliative lung radiotherapy in a retrospective planning study. METHODS Fifteen late stage (III or IV) NSCLC lung radiotherapy patients previously treated with the standard palliative 36 Gy in 12 fractions (12F) schedule were non-randomly selected to achieve a representative distribution of tumour sizes, volumes, and location. Plans were produced using 30 Gy in 5 fractions (5F) and 6 fractions (6F) using a 6MV FFF co-planar VMAT technique. Plans were optimised to meet dose-constraints for planning target volumes (PTVs) and organs at risk (OARs) with established OAR constraints expressed as biological equivalent doses (BEDs). The potential safety was assessed using these BEDs and also with reductions of 10% (BED-10%) and 20% (BED-20%) to account for a reduction in tolerance doses from the effects of chemotherapy or surgery. RESULTS Mandatory BED constraints were met for all fifteen 5F and 6F plans; BED-10% constraints were met by all 6F plans and six 5F plans. BED-20% constraints were met by six 6F and three 5F respectively. CONCLUSION It is potentially safe and feasible to deliver high-dose palliative radiotherapy for late stage NSCLC using the 5F or 6F regimes described, when planned to comparable OAR BEDs as standard radical techniques. It appears toxicity from these regimes should be within acceptable limits provided the dose-constraints described are met. A Phase II study is required to fully assess safety and feasibility, the outcomes of which could reduce the number of patient hospital visits for radiotherapy, thereby benefiting patients and optimising resource utilisation.
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Shrikhande SV, Barreto S, Sirohi B, Bal M, Shrimali RK, Chacko RT, Chaudhari V, Bhatia V, Kulkarni S, Kaur T, Dhaliwal RS, Rath GK. Indian council of medical research consensus document for the management of pancreatic cancer. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_29_19] [Citation(s) in RCA: 3] [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] [Indexed: 12/17/2022] Open
Affiliation(s)
| | | | | | - Munita Bal
- Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Raj Kumar Shrimali
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju T Chacko
- Department of Medical Oncology, Division of Non-Communicable Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vikram Bhatia
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Tanvir Kaur
- Department of Gatroenterology, Indian Council of Medical Research, New Delhi, India
| | - R S Dhaliwal
- Department of Gatroenterology, Indian Council of Medical Research, New Delhi, India
| | - Goura Kishor Rath
- Department of Gatroenterology, Indian Council of Medical Research, New Delhi, India
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Sirohi B, Shrikhande SV, Gaikwad V, Patel A, Patkar S, Goel M, Bal M, Sharma A, Shrimali RK, Bhatia V, Kulkarni S, Srivastava DN, Kaur T, Dhaliwal RS, Rath GK. Indian Council of Medical Research consensus document on hepatocellular carcinoma. Indian J Med Res 2021; 152:468-474. [PMID: 33707388 PMCID: PMC8157895 DOI: 10.4103/ijmr.ijmr_404_20] [Citation(s) in RCA: 6] [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] [Indexed: 02/06/2023] Open
Abstract
This document aims to assist oncologists in making clinical decisions encountered while managing their patients with hepatocellular carcinoma (HCC), specific to Indian practice, based on consensus among experts. Most patients are staged by Barcelona Clinic Liver Cancer (BCLC) staging system which comprises patient performance status, Child-Pugh status, number and size of nodules, portal vein invasion and metastasis. Patients should receive multidisciplinary care. Surgical resection and transplant forms the mainstay of curative treatment. Ablative techniques are used for small tumours (<3 cm) in patients who are not candidates for surgical resection (Child B and C). Patients with advanced (HCC should be assessed on an individual basis to determine whether targeted therapy, interventional radiology procedures or best supportive care should be provided. In advanced HCC, immunotherapy, newer targeted therapies and modern radiation therapy have shown promising results. Patients should be offered regular surveillance after completion of curative resection or treatment of advanced disease.
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Affiliation(s)
- Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | - Shailesh V Shrikhande
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vinay Gaikwad
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Paras Hospital, Gurugram, Haryana, India
| | - Amol Patel
- Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
| | - Shraddha Patkar
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Vikram Bhatia
- Department of Gastroenterology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - R S Dhaliwal
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Shrimali RK, Saha A, Arun B, Prasath S, Nallathambi C, Bhoumik S, Mallick I, Achari RB, Chatterjee S. Setting up a lung stereotactic body radiotherapy service in a tertiary center in Eastern India: The process, quality assurance, and early experience. J Cancer Res Ther 2020; 16:888-899. [PMID: 32930136 DOI: 10.4103/jcrt.jcrt_427_18] [Citation(s) in RCA: 2] [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] [Indexed: 11/04/2022]
Abstract
Context Stereotactic body radiotherapy (SBRT) is increasingly being used for early-stage lung cancer and lung oligometastases. Aims To report our experience of setting up lung SBRT and early clinical outcomes. Settings and Design This was a retrospective, interventional, cohort study. Subjects and Methods Patients were identified from multidisciplinary tumor board meetings. They underwent four-dimensional computed tomography-based planning. The ROSEL trial protocol, the Radiation Therapy Oncology Group (RTOG) 0236, and the UK-Stereotactic Ablative Body Radiotherapy Consortium guidelines were used for target volume and organs-at-risks (OARs) delineation, dosimetry, and plan quality assessment. Each SBRT plan underwent patient-specific quality assurance (QA). Daily online image guidance using KVCT or MVCT was done to ensure accurate treatment delivery. Statistical Analysis Used Microsoft Excel 2010 was used for data analysis. Results Fifteen patients were treated to one or more lung tumors. One patient received helical tomotherapy in view of bilateral lung oligometastases at similar axial levels. All the remaining patients received volumetric modulated arc therapy (VMAT)-based treatment. The prescription dose varied from 40 to 60 Gy in 5-8 fractions with alternate-day treatment. The mean and median lung V20 was 5.24% and 5.16%, respectively (range, 1.66%-9.10%). The mean and median conformity indexes were 1.02 and 1.06, respectively (range, 0.70-1.18). After a median follow-up of 17 months, the locoregional control rate was 93.3%. Conclusions SBRT was implemented using careful evaluation of OAR dose constraints, dosimetric accuracy and plan quality, patient-specific QA, and online image guidance for accurate treatment delivery. It was safe and effective for early-stage nonsmall cell lung cancer and lung metastases. Prospective data were collected to audit our outcomes.
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Affiliation(s)
- Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India; Department of Clinical Oncology, Arden Cancer Centre, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Animesh Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India; Department of Clinical Oncology, St. James's University Hospital, Leeds LS97TF, UK
| | - Balakrishnan Arun
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sriram Prasath
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Chandran Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Suchandana Bhoumik
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rimpa Basu Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Shrimali RK, Khan YM. Peer-review and post-publication discourse: The challenges. Indian J Cancer 2019; 57:108-109. [PMID: 31736468 DOI: 10.4103/ijc.ijc_527_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Raj Kumar Shrimali
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yakhub Mohammed Khan
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Datta SS, Ghosal N, Daruvala R, Chakraborty S, Shrimali RK, van Zanten C, Parry J, Agrawal S, Atreya S, Sinha S, Chatterjee S, Gollins S. How do clinicians rate patient's performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology. Ecancermedicalscience 2019; 13:913. [PMID: 31123496 PMCID: PMC6467460 DOI: 10.3332/ecancer.2019.913] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
Background Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions. Methods The current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians (n = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis. Results Quantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities (p < 0.004) were rated to have better PS and women patients (p < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that ‘perceived socio-economic background of the patient’, ‘age of the patient’, ‘patient’s and family’s preferences’ and ‘past treatment response’ were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians. Conclusion There is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors.
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Affiliation(s)
- Soumitra S Datta
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India.,UCL EGA Institute for Women's Health, University College London, London WC1E 6BT, UK
| | - Niladri Ghosal
- Department of Clinical Oncology, North Wales Cancer Center, Rhyl LL18 5UJ, UK
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Santam Chakraborty
- Department of Radiation Oncology, Tata Medical Centre, Kolkata 700160, India
| | - Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Centre, Kolkata 700160, India
| | - Chantalle van Zanten
- Department of Economics and Business, University of Groningen, 9712 CP Groningen, Netherlands
| | - Joe Parry
- Newcastle University Business School, University of Newcastle, Newcastle upon Tyne NE1 7RU, UK
| | - Sanjit Agrawal
- Department of Surgical Oncology, Tata Medical Centre, Kolkata 700160, India
| | - Shrikant Atreya
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Subir Sinha
- Department of Biostatistics, Tata Medical Centre, Kolkata 700160, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Centre, Kolkata 700160, India
| | - Simon Gollins
- Department of Clinical Oncology, North Wales Cancer Center, Rhyl LL18 5UJ, UK
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Shrimali RK, Nallathambi C, Saha A, Das A, Prasath S, Mahata A, Arun B, Mallick I, Achari R, Dabkara D, Thambudorai R, Chatterjee S. Radical radiotherapy or chemoradiotherapy for inoperable, locally advanced, non-small cell lung cancer: Analysis of patient profile, treatment approaches, and outcomes for 213 patients at a tertiary cancer center. Indian J Cancer 2019; 55:125-133. [PMID: 30604722 DOI: 10.4103/ijc.ijc_469_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016. RESULTS RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment. CONCLUSION RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.
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Affiliation(s)
- Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Chandran Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Animesh Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Avipsa Das
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sriram Prasath
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Anurupa Mahata
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - B Arun
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Robin Thambudorai
- Department of Thoracic Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Shrimali RK, Chakraborty S, Prasath S, Arun B, Chatterjee S. Impact of modern radiotherapy techniques on survival outcomes for unselected patients with large volume non-small cell lung cancer. Br J Radiol 2018; 92:20180928. [PMID: 30457882 DOI: 10.1259/bjr.20180928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: Intensity modulated radiotherapy (IMRT) is used, where necessary, for bulky or complex-shaped, locally advanced, non-small cell lung cancer (NSCLC). We evaluate our real-world experience with radical radiotherapy including concurrent chemoradiation (CCRT), and analyse the impact of IMRT on survival outcomes in patients with larger volume disease. METHODS: All patients treated between May 2011 and December 2017 were included. Analyses were conducted for factors affecting survival, including large volume disease that was defined as planning target volume (PTV) > 500 cc. RESULTS: In 184 patients with large volume disease, the median overall survival was 19.2 months, compared to 22 months seen with the overall cohort of 251 patients who received radical radiotherapy. PTV and using CCRT were significant predictors for survival. IMRT was used in 93 (50.5%) of 184 patients with large PTV. The patients treated using IMRT had significantly larger disease volume (median PTV = 859 vs 716 cc; p-value = 0.009) and more advanced stage (proportion of Stage IIIB: 56 vs 29%; p-value = 0.003) compared to patients treated with three-dimensional conformal radiotherapy. Yet, the outcomes with IMRT were non-inferior to those treated with 3DCRT. CCRT was used in 103 (56%) patients with large volume disease and resulted in a significantly better median survival of 24.9 months. The proportional benefit from CCRT was also greater than in the overall cohort. CONCLUSION: Despite being used for larger volume and more advanced NSCLC, inverse-planned IMRT resulted in non-inferior survival. ADVANCES IN KNOWLEDGE: IMRT enables the safe use of curative CCRT for large-volume, locally-advanced NSCLC.
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Affiliation(s)
- Raj Kumar Shrimali
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - Santam Chakraborty
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - Sriram Prasath
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - B Arun
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
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Shrimali RK, Chakraborty S, Bhattacharyya T, Mallick I, Achari RB, Prasath S, Arun B, Mahata A, Vidhya Shree M, Vishnupriya E, Chatterjee S. Development and validation of a decision support tool to select IMRT as radiotherapy treatment planning modality for patients with locoregionally advanced non-small cell lung cancers (NSCLC). Br J Radiol 2018; 92:20180431. [PMID: 30387364 DOI: 10.1259/bjr.20180431] [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: 11/05/2022] Open
Abstract
OBJECTIVE: Radiation planning for locally-advanced non-small cell lung cancer (NSCLC) can be time-consuming and iterative. Many cases cannot be planned satisfactorily using multisegment three-dimensional conformal radiotherapy (3DCRT). We sought to develop and validate a predictive model which could estimate the probability that acceptable target volume coverage would need intensity modulated radiotherapy (IMRT). METHODS: Variables related to the planning target volume (PTV) and topography were identified heuristically. These included the PTV, it's craniocaudal extent, the ratio of PTV to total lung volume, distance of the centroid of the PTV from the spinal canal, and the extent PTV crossed the midline. Metrics were chosen such that they could be measured objectively, quickly and reproducibly. A logistic regression model was trained and validated on 202 patients with NSCLC. A group of patients who had both complex 3DCRT and IMRT planned was then used to derive the utility of the use of such a model in the clinic based on the time taken for planning such complex 3DCRT. RESULTS: Of the 202 patients, 93 received IMRT, as they had larger volumes crossing midline. The final model showed a good rank discrimination (Harrell's C-index 0.84) and low calibration error (mean absolute error of 0.014). Predictive accuracy in an external dataset was 92%. The final model was presented as a nomogram. Using this model, the dosimetrist can save a median planning time of 168 min per case. CONCLUSION: We developed and validated a data-driven, decision aid which can reproducibly determine the best planning technique for locally-advanced NSCLC. ADVANCES IN KNOWLEDGE: Our validated, data-driven decision aid can help the planner to determine the need for IMRT in locally advanced NSCLC saving significant planning time in the process.
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Affiliation(s)
- Raj Kumar Shrimali
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Santam Chakraborty
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Tapesh Bhattacharyya
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Indranil Mallick
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Rimpa Basu Achari
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Sriram Prasath
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - B Arun
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Anurupa Mahata
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - M Vidhya Shree
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - E Vishnupriya
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
| | - Sanjoy Chatterjee
- 1 Department of Radiation Oncology, Tata Medical Center , Rajarhat, Kolkata , India
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Chatterjee S, Chakraborty S, Moses A, Nallathambi C, Mahata A, Mandal S, Achari RB, Mallick I, Shrimali RK, Bhattacharyya T, Agrawal S, Ghosh J, Ahmed R. Resource requirements and reduction in cardiac mortality from deep inspiration breath hold (DIBH) radiation therapy for left sided breast cancer patients: A prospective service development analysis. Pract Radiat Oncol 2018; 8:382-387. [DOI: 10.1016/j.prro.2018.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Shrimali RK, Arunsingh M, Das A, Mallick I, Mahata A, Prasath S, Achari R, Chatterjee S. Continuous hyperfractionated accelerated radiotherapy using modern radiotherapy techniques for nonsmall cell lung cancer patients unsuitable for chemoradiation. Indian J Cancer 2018; 54:120-126. [PMID: 29199674 DOI: 10.4103/ijc.ijc_158_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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 The continuous hyperfractionated and accelerated radiotherapy (CHART) regimen of radiotherapy (RT) for nonsmall cell lung cancer is underused outside the UK. We present the first Indian experience of using CHART for patients, who were not suitable for chemotherapy or concurrent chemo-RT. METHODS We retrospectively reviewed the data of patients treated using CHART at our institution between January 2014 and December 2015. RESULTS Thirty-seven patients were treated using CHART. Planning methods and dosimetry parameters are described. Three-dimensional conformal RT was used for treatment planning and delivery in 23 patients and volumetric modulated arc RT was necessary for 14 patients. Patients in our series had a median age of 70 years (interquartile range 65.50-74.00) and 86.5% had Stage III disease. Median follow-up was short at 13.0 months. Actuarial rates of 1-year progression-free survival, 1-year overall survival (OS), and 2-year OS were 31.9%, 59.5%, and 28.5%, respectively. This treatment was well tolerated with manageable and some reversible acute esophageal toxicity (91.9% CONCLUSION: Our results indicate that CHART is feasible, safe, and well tolerated in Indian patients who are clinically found to be not suitable for either sequential or concurrent chemo- RT.
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Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Das
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Mahata
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - S Prasath
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Shrimali RK, Arunsingh M, Reddy GD, Mandal S, Arun B, Prasath S, Sinha S, Mallick I, Achari R, Chatterjee S. Actual gains in dosimetry and treatment delivery efficiency from volumetric modulated arc radiotherapy for inoperable, locally advanced lung cancer over five-field forward-planned intensity-modulated radiotherapy. Indian J Cancer 2018; 54:155-160. [PMID: 29199680 DOI: 10.4103/ijc.ijc_79_17] [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
AIMS Volumetric modulated arc radiotherapy (VMAT) is used for inoperable, locally advanced nonsmall cell lung cancer, where three-dimensional conformal radiotherapy (3D-CRT) cannot yield an acceptable plan. METHODS The planning and treatment data were prospectively collected on the first 18 patients treated using VMAT plans. We analyzed the actual dosimetric gain and impact on treatment, compared with complex multisegment 3D-CRT (five-field forward-planned intensity-modulated radiotherapy [IMRT]) that were generated for treatment. Proportion of planning target volume (PTV) receiving 95% dose (PTV-V95%) conformity index (CI), conformity number (CN), dose homogeneity index (DHI), monitor units (MUs), and treatment time were also analyzed. RESULTS The PTV coverage (PTV-V95%) was improved from a median of 91.41% for 5-F forward-IMRT to 98.25% for VMAT (P < 0.001). The CI improved with a mean of 1.12 for VMAT and 1.31 for 5-F forward-IMRT (P < 0.001). The mean DHI improved from 1.15 for forward-IMRT to 1.08 for VMAT (P < 0.001). The mean CN improved from 0.62 for forward-IMRT to 0.87 for VMAT (P < 0.001). No significant increase in the low-dose bath (V5, V10 and mean lung dose) to the lung was seen. Significantly higher number of MUs (P < 0.001) and shorter treatment delivery times (P = 0.03) were seen with VMAT. CONCLUSION VMAT resulted in improvement in target volume coverage, demonstrated by PTV-V95%, CI, CN, and DHI, without any increase in the low-dose bath to the lung. For conventional fractionation, VMAT requires more MUs (P < 0.001) but has a shorter treatment delivery time (P = 0.03) per fraction.
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Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - G D Reddy
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Mandal
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - B Arun
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Prasath
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Sinha
- Department of Medical Statistics, Tata Medical Centre, Kolkata, West Bengal, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
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Achari R, Arunsingh M, Badgami RK, Saha A, Chatterjee S, Shrimali RK, Mallick I, Arun B. High-dose Neural Stem Cell Radiation May Not Improve Survival in Glioblastoma. Clin Oncol (R Coll Radiol) 2017; 29:335-343. [PMID: 28188088 DOI: 10.1016/j.clon.2017.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 01/07/2023]
Abstract
AIMS To evaluate the effect of radiotherapy dose-volume parameters of neural stem cell (NSC) compartment on progression-free survival (PFS) and overall survival after post-resection chemoradiation in newly diagnosed glioblastoma. MATERIALS AND METHODS Sixty-one patients with unifocal glioblastoma were included. Ipsilateral (NSC_Ipsi), contralateral (NSC_Contra) and combined NSC (NSC_Combined) were contoured on radiotherapy planning computerised tomography datasets. NSC dose-volume parameters were correlated with PFS and overall survival. Serial magnetic resonance imaging scans were assessed to understand the frequency of pre- and post-treatment involvement of the NSC by contrast enhancing lesions (CELs). RESULTS Baseline involvement of NSC with CELs was seen in 67.2% and 95.9% had CELs and FLAIR abnormalities at progression. With a median follow-up of 14.1 months (interquartile range 9.4-20.6 months), median PFS and overall survival were 14.5 (95% confidence interval 11.6-17.5) and 16.2 (95% confidence interval 13.3-19.2) months, respectively. Poor Eastern Cooperative Oncology Group performance score, advanced recursive partitioning analysis class, unmethylated O6-methylguanine methyltransferase (MGMT) status, higher than median of mean NSC_Ipsi dose were associated with significantly inferior PFS and overall survival on univariate analysis. On multivariate analysis, unmethylated MGMT status, higher than median of mean doses to NSC_Ipsi and poor compliance to adjuvant temozolomide were independent predictors of inferior survival. CONCLUSIONS In this cohort, 67.2% of newly diagnosed glioblastoma patients had NSC involved with CELs at presentation and 95.9% at progression. This might be an imaging surrogate of the current notion of gliomagenesis and progression from NSC rests. A high radiation dose to NSC_Ipsi was significantly associated with inferior survival. This could be a function of larger tumours and planning target volumes in those with pre-treatment NSC involvement. Methylated MGMT and good compliance to adjuvant temozolomide were independent predictors of better survival. Until further evidence brings hope for glioblastoma, elective, partial NSC irradiation remains experimental.
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Affiliation(s)
- R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R K Badgami
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - A Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Medical Physics, Tata Medical Center, Kolkata, India
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Chatterjee S, Arunsingh M, Agrawal S, Dabkara D, Mahata A, Arun I, Shrimali RK, Achari R, Mallick I, Ahmed R. Outcomes Following a Moderately Hypofractionated Adjuvant Radiation (START B Type) Schedule for Breast Cancer in an Unscreened Non-Caucasian Population. Clin Oncol (R Coll Radiol) 2016; 28:e165-72. [PMID: 27369459 DOI: 10.1016/j.clon.2016.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/28/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/01/2023]
Abstract
AIMS Breast cancer is the most common cancer in women. Western data have confirmed hypofractionated radiation therapy to be safe and effective in the adjuvant radiation therapy of breast cancers. We report the disease-related outcomes in a non-Caucasian, unscreened population treated with hypofractionated radiation. MATERIALS AND METHODS Unselected case notes of patients presenting to a tertiary cancer centre between June 2011 and December 2013 were reviewed from the electronic hospital case records. Patients with a diagnosis of non-metastatic invasive non-sarcomatous breast cancer were identified. Demographic information, oestrogen receptor (ER), progesterone receptor (PR), HER2 status, pathological tumour, nodal stage at diagnosis and outcomes of treatment, including systemic therapies, surgery and hypofractionated radiation, were documented. Local recurrence rates, disease-free survival (DFS) and overall survival were calculated. RESULTS Overall 925 patents were identified, median age 53.0 years (interquartile range 45-61), 330 of whom had neoadjuvant chemotherapy. The median follow-up time was 22.6 months and 23.5 months for overall and neoadjuvant chemotherapy groups, respectively. ER, PR and HER2 status was available in 788 patients, 77.2% of whom were ER/PR positive, 14.7% had triple negative disease, while 9.5% were HER2 rich. Overall, 34.2% (113 patients) underwent breast conservation surgery; 744 (80.4%) patients were treated with systemic chemotherapy and 878 (94.9%) patients received adjuvant radiation therapy, of whom 407 (44.0%) received supraclavicular-fossa radiotherapy. Overall survival, DFS and locoregional recurrence-free survival (LRRFS) for the overall group were 93%, 86.9% and 97.1%, respectively. LRRFS in the breast conservation surgery versus mastectomy groups were 99% versus 95.5% (P=0.003), with more node-positive patients in the mastectomy group. Stage N0/1 had better LRRFS compared with N2/2 (99.1% versus 95.7%); 94.3% versus 82.3%; P=0.005, 0.000. Grade 3 (53.8%) tumours had worse overall survival compared with grade 1 or grade 2 disease (89.6% versus 100% and 96.4%; P<0.001) although the LRRFS was not significantly different between the groups (98.9% versus 97.8%; P=0.37). There was no difference in LRRFS based on molecular subtypes. CONCLUSION Local recurrence rates following hypofractionated radiation in our population were comparable with those reported by the START trialists and were found to be safe in the medium term for patients irrespective of breast conservation surgery/mastectomy or radiotherapy to the supraclavicular field. Molecular group frequencies were comparable with Western populations but did not affect LRRFS.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Agrawal
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
| | - D Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - A Mahata
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Arun
- Department of Pathology, Tata Medical Center, Kolkata, India
| | - R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Ahmed
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
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Shrimali RK, Mahata A, Reddy GD, Franks KN, Chatterjee S. Pitfalls and Challenges to Consider before Setting up a Lung Cancer Intensity-modulated Radiotherapy Service: A Review of the Reported Clinical Experience. Clin Oncol (R Coll Radiol) 2015; 28:185-97. [PMID: 26329504 DOI: 10.1016/j.clon.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/04/2014] [Revised: 05/27/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of non-small cell lung cancer (NSCLC), despite the absence of published randomised controlled trials. Planning studies and retrospective series have shown a decrease in known predictors of lung toxicity (V20 and mean lung dose) and the maximum spinal cord dose. Potential dosimetric advantages, accessibility of technology, a desire to escalate dose or a need to meet normal organ dose constraints are some of the factors recognised as supporting the use of IMRT. However, IMRT may not be appropriate for all patients being treated with radical radiotherapy. Unique problems with using IMRT for NSCLC include organ and tumour motion because of breathing and the potential toxicity from low doses of radiotherapy to larger amounts of lung tissue. Caution should be exercised as there is a paucity of prospective data regarding the efficacy and safety of IMRT in lung cancer when compared with three-dimensional conformal radiotherapy and IMRT data from other cancer sites should not be extrapolated. This review looks at the use of IMRT in NSCLC, addresses the challenges and highlights the potential benefits of using this complex radiotherapy technique.
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Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - A Mahata
- Medical Physics, Tata Medical Center, Kolkata, India
| | - G D Reddy
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - K N Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Gupta SK, Mallick I, Ray R, Shrimali RK, Achari R, Chatterjee S. Planning target volumes determine weight loss in highly conformal radiation therapy in head and neck cancers--a validation study. Clin Oncol (R Coll Radiol) 2014; 26:668. [PMID: 24908569 DOI: 10.1016/j.clon.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Affiliation(s)
- S K Gupta
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Ray
- Department of Clinical Nutrition, Tata Medical Center, Kolkata, India
| | - R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Correa PD, Shrimali RK, Han S, Rizwanullah M. Positron emission tomography with computed tomography (PET-CT) to evaluate the response of bone metastases to non-surgical treatment. BMJ Case Rep 2010; 2010:2010/may06_1/bcr1120092457. [PMID: 22736731 DOI: 10.1136/bcr.11.2009.2457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case of solitary bone metastasis from breast cancer, where MRI assessment of treatment response was inaccurate and whole-body fluorodeoxyglucose ((18)FDG) positron emission tomography with computed tomography (PET-CT) proved more reliable and objective, is presented.
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Affiliation(s)
- Peter Denzil Correa
- Beatson West of Scotland Cancer Centre, Clinical Oncology, Gartnavel General Hospital, Glasgow, UK
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18
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Shrimali RK, Correa PD, Reed NS. Dose-dense and dose-intense chemotherapy for small cell ovarian cancer: 2 cases and review of literature. Med Oncol 2010; 28:766-70. [PMID: 20361360 DOI: 10.1007/s12032-010-9509-0] [Citation(s) in RCA: 9] [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] [Received: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 11/24/2022]
Abstract
Small cell carcinomas of the ovary (SCCO) are rare and aggressive malignant neoplasms carrying a poor prognosis. Although multi-modality treatment including chemotherapy leads to a high initial response rate, the majority of these patients relapse quickly and die within 2 years of diagnosis. Because these tumours are rare, there is no consensus to support any particular approach to management. We present 2 cases and review the relevant literature to make a number of recommendations. The treatment of these unusual cases should to be individually discussed in a multi-disciplinary team and multi-modality treatment including surgery, chemotherapy and radiotherapy should be considered for patients with limited disease. Conservative, fertility-preserving surgery may be considered in younger women with early-stage disease. Induction chemotherapy with weekly dose-dense and dose-intense carboplatin and taxane is useful. Prophylactic cranial irradiation (PCI) may be considered in patients in remission after primary treatment with chemotherapy or surgery.
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Affiliation(s)
- Raj Kumar Shrimali
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK.
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Shrimali RK, Correa PD, Lee KC, Lai CNB, Kakumanu SA, Cowie F. Adjuvant radiotherapy with 50 Gy after limb-sparing surgery for soft-tissue sarcoma--West of Scotland experience. Clin Oncol (R Coll Radiol) 2010; 22:322-3. [PMID: 20303718 DOI: 10.1016/j.clon.2010.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 02/10/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
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Abstract
Patients are treated with palliative splenic irradiation (SI) to relieve pain, volume effects and the clinical consequences of hypersplenism. The case records of 19 patients treated with palliative SI at our centre, from April 2003 to November 2004, were reviewed. Twenty-two courses of SI were identified. The radiation doses delivered ranged from 150 to 800 cGy (median 450 cGy). The fraction sizes ranged from 25 to 100 cGy. Parallel-opposed anteroposterior-posteroanterior portals were the most common field arrangement. The target volume was reduced in 18 out of 22 courses. The percentage of field reduction ranged from 0 to 59.57% (mean 24.82%). Twelve of 14 courses were successful in achieving symptom palliation. Of the six patients who received SI for a combination of splenic symptoms and abnormal blood tests, five had symptomatic palliation but only one patient responded haematologically. Of two patients who were started on palliative SI for abnormal haematology alone, only one responded. In summary, 17 of 20 (85%) courses of SI initiated for symptom control resulted in effective palliation. Only two of eight (25%) courses of SI started for abnormal blood counts produced a desired response. To conclude, SI offers an effective and well-tolerated palliative treatment option.
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Affiliation(s)
- R K Shrimali
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
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De P, Shrimali RK, Subramonian S, Child DF. An unusual endocrine cause of hyponatraemia. Postgrad Med J 2002; 78:433, 437-8. [PMID: 12151668 PMCID: PMC1742424 DOI: 10.1136/pmj.78.921.433-a] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P De
- D F Child, Department of Medicine, Diabetes and Endocrinology, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK.
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Shrimali RK, Reddy KV. Integrins and disintegrins: the candidate molecular players in sperm-egg interaction. Indian J Exp Biol 2000; 38:415-24. [PMID: 11272403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Fertilization includes sperm-egg recognition, adhesion, binding, fusion and egg activation. Integrin (ITG) receptors which are adhesion molecules are expressed on mouse, hamster and human gametes and their potential ligands also have been identified. Role of ITGs during fertilization is supported by inhibition of sperm-egg adhesion and/or fusion by means of anti-ITG mAbs, Arg-Gly-Asp (RGD) or disintegrin-like peptides. This review includes the current understanding of the molecular mechanism that regulates sperm-egg interaction and implications of this knowledge for assessing the fertility potential of men and immunocontraceptive method.
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Affiliation(s)
- R K Shrimali
- Immunology Division, Institute for Research in Reproduction (ICMR), Parel, Mumbai 400 012, India
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