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Banerjee S, Sarkar S, Mahantshetty U, Shishak S, Kaliyaperumal V, Bisht SS, Gupta D, Narang K, Mayank M, Srinivasan V, Anand V, Patro KC, Prasad RR, Kataria T. Current status and future readiness of Indian radiation oncologists to embrace prostate high-dose-rate brachytherapy: An Indian Brachytherapy Society survey. J Contemp Brachytherapy 2023; 15:391-398. [PMID: 38230402 PMCID: PMC10789157 DOI: 10.5114/jcb.2023.134168] [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] [Received: 10/30/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose This survey aimed to understand the practice pattern and attitude of Indian doctors towards prostate brachytherapy. Material and methods A 21-point questionnaire was designed in Google form and sent to radiation oncologists practicing in India, using texts, mails, and social media. Responses were collated, and descriptive statistical analysis was performed. Results A total of 212 radiation oncologists from 136 centers responded to the survey questionnaire, with majority (66%) being post-specialty training > 6 years. We found that about 44.3% (n = 94) of respondents do not practice interstitial brachytherapy for any site, and majority (83.3%, n = 175) do not practice high-dose-rate (HDR) prostate brachytherapy. Only 2.8% (n = 6) of doctors preferred boost by brachytherapy compared with 38.1% (n = 80) of respondents, who favored stereotactic body radiation therapy (SBRT) boost. When asked about the indication of HDR prostate brachytherapy in Indian setting, 32.5% (n = 67) of respondents favored monotherapy, 46.1% (n = 95) of oncologists thought boost as a good indication, and 21.4% (n = 44) preferred re-irradiation/salvage setting. The most cited reason for prostate brachytherapy not being popularly practiced in India was lack of training (84.8%, n = 179). It was also noted that out of 80 respondents who practiced SBRT for prostate boost, 37 would prefer HDR brachytherapy boost if given adequate training and facilities. Conclusions The present survey provided insight on practice of prostate brachytherapy in India. It is evident that majority of radiation oncologists do not practice HDR prostate brachytherapy due to lack of training and infrastructure. Indian physicians are willing to learn and start prostate brachytherapy procedures if dedicated training and workshops are organized.
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Affiliation(s)
- Susovan Banerjee
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Soumya Sarkar
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhaba Cancer Hospital and Research Centre, Tata Memorial Centre, Vizag, India
| | - Sorun Shishak
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | | | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Mayur Mayank
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - V Srinivasan
- Department of Radiation Oncology, MIOT International Hospital, Chennai, India
| | - Vivek Anand
- Department of Radiation Oncology, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Kanhu Charan Patro
- Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital, Vizag, India
| | - Rajiv Ranjan Prasad
- Division of Radiation Oncology, Jay Prabha Medanta Super Specialty Hospital, Kankarbagh, Patrakar Nagar, Patna, Bihar, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
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Bisht SS, Gupta D, Banerjee S, Kataria T. Re: Kumar A, Yadav S, Krishnappa RS, Gautam G, Raghavan N, Bakshi G, et al. The Urological Society of India guidelines for the evaluation and management of prostate cancer (executive summary). Indian J Urol 2022;38:252-7. Indian J Urol 2023; 39:249-251. [PMID: 37575166 PMCID: PMC10419779 DOI: 10.4103/iju.iju_103_23] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
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Gupta D, Gajraj P, Goyal S, Bisht SS, Kataria T, Venkatesan K, Banerjee S, Narang K, Bhatter P. Diagrammatic Approach to Delineate Phrenic Nerve in Central Lung Tumors. Pract Radiat Oncol 2023; 13:e134-e138. [PMID: 35977668 DOI: 10.1016/j.prro.2022.08.002] [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] [Received: 06/23/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
Incremental use of high-dose radiation therapy (RT) with SABR in thoracic tumors has led to identification of many unusual toxicities (chest wall pain, rib fractures, vascular perforation, brachial plexopathy) and consequently additional organs at risk (OARs; chest wall, ribs, bronchial wall, carotid artery, brachial plexus). Phrenic nerve is another structure that may be affected at any point during its long course from origin until end, although symptomatic toxicities have been reported rarely in the setting of reirradiation, large-volume irradiation such as mantle field, or SABR. We undertook a prospective study to describe the delineation of phrenic nerve course on RT planning computed tomography scan as an OAR. An anonymized RT planning computed tomography scan of neck and thorax (1.5-mm slice thickness, intravenous contrast) was used for the study. Radiology textbooks and publications were reviewed, and the course was delineated with the help of 2 radiologists and 6 radiation oncologists well versed with thoracic radiologic anatomy. A step-by-step description in the form of a pictorial essay is given. The adjacent structures including cervical vertebrae, cervical and mediastinal vessels, lungs, heart, and so on were identified, and the course of phrenic nerve on either side is described in relation to these structures. Delineation of the phrenic nerve as an OAR is challenging but feasible. We recommend routine delineation of the phrenic nerve as an OAR during thoracic RT. Although specific dose constraints are not known yet, unnecessary dose to the same during RT planning should be minimized.
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Affiliation(s)
- Deepak Gupta
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
| | | | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Tejinder Kataria
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | | | - Susovan Banerjee
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Pallav Bhatter
- Radiology, Medanta-The Medicity, Gurgaon, Haryana, India
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Kaliyaperumal V, Banerjee S, Kataria T, Abraham SK, Kamaraj D, Tamilselvan S, Gupta D, Bisht SS, Narang K, Shishak S. Commissioning and Dosimetric Results of an Indigenously Developed Intra-Vaginal Template for Interstitial Plus Intracavitary High dose Rate Image-Guided Brachytherapy of Advanced Cervix Cancer. J Med Phys 2022; 47:322-330. [PMID: 36908497 PMCID: PMC9997539 DOI: 10.4103/jmp.jmp_50_22] [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: 06/10/2022] [Revised: 09/23/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023] Open
Abstract
Aim The goal of this study is to discuss the commissioning and dosimetric parameters achieved during the clinical implementation of an indigenously developed intracavitary (IC) plus interstitial (IS) template for high dose rate (HDR) image-guided brachytherapy (IGBT) in cancer (Ca) cervix. We want to discuss our achieved values of cumulative equi-effective doses (EQD2) for high-risk clinical target volume (HRCTV) and organ at risk (OAR) and compare it with available published results. Materials and Methods Medanta anterior oblique/lateral oblique template has a total of 19 needles including the central tandem. For commissioning the template with needles, the indigenously made acrylic phantom was used. Oblique and straight needles were placed inside the acrylic phantom and a computed tomography (CT) scan was performed. Sixteen patients were treated in HDR IGBT using this template after external-beam radiotherapy. The IGBT plans were evaluated based on EQD2 of target coverage i.e., dose received by 98% (D98%_HRCTV), 90% (D90%_HRCTV), and 50% (D50%_HRCTV) volume of HRCTV, and dose received by 2 cc (D2cc) and 0.1 cc (D0.1cc) of OAR using linear quadratic (LQ) radiobiological model. Results The autoradiographic in radiochromic film shows that the distance between the needle tip and the middle of the source position is 6 mm. The mean D98%_HRCTV and D90%_HRCTV was 76.8 Gy (range: 70-87.7 Gy, P < 0.01) and 84.49 Gy (range: 76.6-96.7 Gy, P < 0.01), respectively. Mean EQD2 of D2cc of the bladder, rectum, and sigmoid was 85.6 Gy (range: 77.5-99.6 Gy, P < 0.03), 74.3 Gy (range: 70.9-76.7 Gy, P < 0.05), and 58.3 Gy (range: 50.6-67.9 Gy, P = 0.01), respectively. The mean total reference air kerma at a 1 m distance is 0.489cGy (range: 0.391-0.681cGy). Conclusions The indigenously developed template could attain satisfactory standards in terms of set parameters for commissioning and acceptable dose volume relations in our clinical use for treating the advanced Ca cervix patients who need IC + IS type of HDR IGBT. The comparative analysis with contemporary applicators was acceptable.
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Affiliation(s)
- Venkatesan Kaliyaperumal
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Susan K Abraham
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Dayanithi Kamaraj
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Singaravelu Tamilselvan
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Sorun Shishak
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
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Gupta D, Kaliyaperumal V, Bisht SS, Kataria T, Banerjee S, Goyal S, Narang K, Goel G, Mahajan A, Narang K, Dubey S. Nidus delineation and dosimetric comparison in arteriovenous malformation in stereotactic radiosurgery by using MRI and 3DCT angiography. J Radiosurg SBRT 2022; 8:201-209. [PMID: 36861001 PMCID: PMC9970736] [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] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/05/2022] [Indexed: 03/03/2023]
Abstract
Purpose/Objectives Accurate delineation of target is key to any successful radiosurgery. C-arm Dyna CT/ 3DCT angiography (3DCTA) has the potential of improving the accuracy of nidus delineation in intracranial arteriovenous malformations (AVM) due to high temporo-spatial resolution of vessel architecture. Here, we present a comparison of nidus delineation and dosimetric parameters between digital 3DCTA and MRI. Materials/Methods Ten consecutive patients treated for intracranial AVMs were included in this study. All patients underwent MRI/MRA, and 3DCTA and all images were co-registered. AVM were delineated using 3DCTA (GTV3DCTA) and contrast enhanced MRI/MRA (GTVMRI). Hausdorff distance (HD) matrices and dice similarity coefficient (DSC) matrices were analysed. Stereotactic radiosurgery plans were developed for both the volumes for all patients and statistical analysis were performed with T-test. Results Mean volumes of GTV3DCTA and GTVMRI were 1.771 cc (SD 1.794cc, range 0.124-4.191cc) and 2.183cc (SD 2.16cc, range 0.221-6.133cc), respectively. Significant deviation (p=0.018) was found when taking GTVMRI as a primary and comparing it to GTV3DCTA (MD=0.723cc±0.816cc). Similar result was observed with GTV3DCTA as primary and GTVMRI as secondary (MD=0.188cc, SD=0.193cc, p=0.024). Maximum HD was in the range of 1.71 to 7.44mm (mean=4.27mm, SD=1.56). For GTV3DCTA based plans, significant deviation was found between GTVMRI and GTV3DCTA in dose coverage and the mean difference was 22.17% (SD 16.73). In GTVMRI based plans, the mean CIRTOG deteriorated from 1.33 to 2.18 for GTVMRI and GTV3DCTA, respectively. Significant deviation was found in CIRTOG (0.005) and mean deviation was 0.86(SD=0.72) when comparing GTVMRI and GTV3DCTA. Highly significant (p=0.002) deviation was found in CIPaddick between GTVMRI and GTV3DCTA for GTVMRI based plans with mean difference of 0.26(SD=0.4, for GTVMRI=0.3, GTV3DCTA=0.46). Conclusion Nidus volume was significantly altered with the use of 3DCTA compared to that of MRA/MRI images. Multimodality imaging is crucial for accurate target delineation, and successful radiosurgical obliteration of nidus.
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Affiliation(s)
- Deepak Gupta
- Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | | | | | - Tejinder Kataria
- Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh UT, India
| | - Kushal Narang
- Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Gaurav Goel
- Division of Neuroradiology and Neurointervention, Institute of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Anshu Mahajan
- Division of Neuroradiology and Neurointervention, Institute of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Karanjit Narang
- Neurosurgery, Institute of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sudhir Dubey
- Neurosurgery, Institute of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana, India
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Shishak S, Bisht SS, Gupta D, Kaliyaperumal V, Gupta R, Banerjee S, Kataria T. Mannitol prior to radiosurgery reduces peritumoral edema and tumor volume of brain metastasis from lung primary. J Radiosurg SBRT 2022; 8:67-69. [PMID: 35387410 PMCID: PMC8930058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Sorun Shishak
- Division of Radiation Oncology, Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta The Medicity, Gurgaon 122001, Haryana, India
| | | | - Rajiv Gupta
- Department of Radiology and Imaging, Medanta The Medicity, Gurgaon, 122001, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta The Medicity, Gurgaon 122001, Haryana, India
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Sahu SP, Reddy PD, Banerjee S, Gupta D, Singh Bisht S, Amar A, Kataria T. Stereotactic body radiation therapy treatment by deep inspiratory breath hold in a patient with permanent tracheostomy - Technical solution and clinical implementation - A case report. J Radiosurg SBRT 2022; 8:155-157. [PMID: 36275128 PMCID: PMC9489074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 01/03/2023]
Affiliation(s)
| | - Panomali Dayakar Reddy
- Division of General Anaesthesia and Critical Care, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Amarendra Amar
- Department of Medical Oncology, Jai Prabha Medanta Hospital - Patna, Bihar, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta – The Medicity, Gurgaon, Haryana, India
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Kataria T, Naga P, Banerjee S, Gupta D, Narang K, Tayal M, Bisht SS. CyberKnife Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Gynecological Cancers. South Asian J Cancer 2021; 10:107-111. [PMID: 34568224 PMCID: PMC8460339 DOI: 10.1055/s-0041-1731576] [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: 10/26/2022] Open
Abstract
Purpose Use of stereotactic ablative radiotherapy (SABR) in the treatment of recurrent or metastatic lesions from a primary gynecologic cancer is a relatively new concept. The present study aims to assess the safety, efficacy, and possible toxicity profile of CyberKnife SABR, recurrent or metastatic disease. Materials/Methods CyberKnife VSI-based SABR was offered to 20 oligometastatic/recurrent gynecological cancer patients between 2013 and 2019. Patient, tumor, and treatment characteristics including radiotherapy details, clinical outcome in terms of local control rates, and toxicities are reported in this study. Results Twenty-five recurrent or oligometastatic lesions for 20 primary gynecologic cancer patients including cervical ( n = 8), ovarian ( n = 6), endometrial ( n = 5), and vulvar ( n = 1) cancers were analyzed. Of these, 4 (16%) were intracranial lesions and remaining 21 (84%) were extracranial, consisting of 14 (67%) extrapelvic and 7 (33%) pelvic lesions. The median SABR dose delivered was 60 Gy biologically effective dose (range 42-133 Gy) in an average of four fractions (range 1-6). The mean follow-up was 18 (range 2-70) months. Local tumor control was achieved in 82% of patients. There was no grade ≥ 3 toxicity recorded. Conclusion Our study results suggest that CyberKnife SABR is an effective treatment modality with no major morbidity in patients with recurrent or oligometastatic gynecological cancers.
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Affiliation(s)
- Tejinder Kataria
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Pushpa Naga
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Manoj Tayal
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
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Kaliyaperumal V, Abraham S, Veni M, Banerjee S, Tamilselvan S, Gupta D, Dayanithi K, Manigandan D, Mishra S, Bisht SS, Kataria T. Dosimetric Comparison of Robotic and Linear Accelerator Multi-Leaf Collimator-Based Stereotactic Radiosurgery for Arteriovenous Malformation. J Med Phys 2021; 46:16-25. [PMID: 34267485 PMCID: PMC8240906 DOI: 10.4103/jmp.jmp_79_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the dosimetric comparison of different collimators which are used in robotic radiosurgery (cyberknife-CK) and linear accelerator (LINAC) for stereotactic radiosurgery (SRS) in arteriovenous malformation (AVM). Materials and Methods: Twenty-five AVM patients were planned in CK using FIXED cone, IRIS collimator, and multi-leaf collimator (MLC) based in LINAC. Dosimetric comparison was performed using Paddick conformity index (CIPaddick) and International Commission on Radiation Units and measurements (ICRU) homogeneity index (HIICRU), gradient score (GS), normal brain dose received by 10cc (D10cc) and critical structure (brain stem, optic chiasma, optic nerves) doses. Paired sample t-test was used for statistical analysis. Results: Mean treatment volume was 3.16cc (standard deviation ± 4.91cc). No significant deviation (P =0.45, 0.237 for FIXED vs. IRIS and FIXED vs. MLC, respectively) was found in target coverage. For CIPaddick, the mean difference (MD) between FIXED- and MLC-based plans was 0.16(P = 0.001); For HIICRU, difference between FIXED and IRIS was insignificant (0.5, P = 0.823); but, when FIXED versus MLC, the deviation was 7.99% (P = 0.002). In FIXED- and MLC-based plans, significant difference was found in GS70 and GS40 (P < 0.041 and 0.005, respectively). MD between FIXED- and MLC-based plans for normal brain for 5Gy, 10Gy, 12Gy, and 20Gy were 36.08cc (P = 0.009), 7.12cc (P = 0.000), 5.84cc (P = 0.000) and 1.56cc (P = 0.000), respectively. AVM volume <0.7cc should be treated with CK FIXED and >0.7cc were treated by using FIXED or IRIS collimators. AVM volume > 1.4cc can be treated by either LINAC MLC-based SRS or CK. Conclusion: Our study shows CK collimator (IRIS and FIXED) could be able to treat brain AVMs in any size. Linac MLC-based SRS has some limitations in terms of conformity and low-dose spillage, and advantages like reduced treatment time and MU.
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Affiliation(s)
- Venkatesan Kaliyaperumal
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Susan Abraham
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Maragatha Veni
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - S Tamilselvan
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - K Dayanithi
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - D Manigandan
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Saumyaranjan Mishra
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India
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Banerjee S, Goyal S, Mishra S, Gupta D, Bisht SS, K V, Narang K, Kataria T. Artificial intelligence in brachytherapy: a summary of recent developments. Br J Radiol 2021; 94:20200842. [PMID: 33914614 DOI: 10.1259/bjr.20200842] [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
Artificial intelligence (AI) applications, in the form of machine learning and deep learning, are being incorporated into practice in various aspects of medicine, including radiation oncology. Ample evidence from recent publications explores its utility and future use in external beam radiotherapy. However, the discussion on its role in brachytherapy is sparse. This article summarizes available current literature and discusses potential uses of AI in brachytherapy, including future directions. AI has been applied for brachytherapy procedures during almost all steps, starting from decision-making till treatment completion. AI use has led to improvement in efficiency and accuracy by reducing the human errors and saving time in certain aspects. Apart from direct use in brachytherapy, AI also contributes to contemporary advancements in radiology and associated sciences that can affect brachytherapy decisions and treatment. There is a renewal of interest in brachytherapy as a technique in recent years, contributed largely by the understanding that contemporary advances such as intensity modulated radiotherapy and stereotactic external beam radiotherapy cannot match the geometric gains and conformality of brachytherapy, and the integrated efforts of international brachytherapy societies to promote brachytherapy training and awareness. Use of AI technologies may consolidate it further by reducing human effort and time. Prospective validation over larger studies and incorporation of AI technologies for a larger patient population would help improve the efficiency and acceptance of brachytherapy. The enthusiasm favoring AI needs to be balanced against the short duration and quantum of experience with AI in limited patient subsets, need for constant learning and re-learning to train the AI algorithms, and the inevitability of humans having to take responsibility for the correctness and safety of treatments.
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Affiliation(s)
- Susovan Banerjee
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shikha Goyal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saumyaranjan Mishra
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Venketesan K
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
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Kataria T, Bisht SS, Gupta D, Abhishek A, Basu T, Narang K, Goyal S, Shukla P, Bansal M, Grewal H, Ahlawat K, Banarjee S, Tayal M. Quantification of coronary artery motion and internal risk volume from ECG gated radiotherapy planning scans. Radiother Oncol 2016; 121:59-63. [PMID: 27641783 DOI: 10.1016/j.radonc.2016.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 05/01/2016] [Revised: 07/30/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Radiotherapy for carcinoma of breast and thoracic structures involves inadvertent radiation to heart and coronary arteries (CA). Coronary artery stenosis in high radiation dose segments has been documented. Cardiac and respiratory motion induced displacement of CA and internal risk volume (IRV) margin remains inadequately quantified. MATERIAL AND METHODS Twenty cases of carcinoma breast, lung and lung metastasis were enrolled in this study. ECG gated intravenous contrast enhanced computed tomography (CECT) scans were performed in inspiratory breath hold (IBH) and expiratory breath hold (EBH). The images were segregated into inspiratory systole (IS), inspiratory diastole (ID), expiratory systole (ES) and expiratory diastole (ED) sets. Left anterior descending (LAD), limited segment of LAD close to chest wall (short LAD), right coronary artery (RCA), Left circumflex artery (LCX) and left ventricle (LV) were delineated in all four sets. Mean displacements in systole versus diastole and inspiration versus expiration were calculated in three co-ordinates [anterio-posterior (Z), left-right (X) and cranio-caudal (Y)]. RESULTS Mean of displacement (mm) between systole and diastole (IS versus ID; and ES versus ED) in X, Y, Z co-ordinates were: LAD 3.0(±1.6), 2.8(±1.5), 3.6(±2.0); Short-LAD 3.0(±1.1), 0.8(±0.4), 2.4(±0.6); LV 2.4(±1.6), 1.7(±1), 5.0(±1.5); LCX 4.9(±1.6), 2.9(±1.3), 5.1(±1.9); RCA 6.6(±2.2), 3.6(±2.1), 5.9(±2.2). Mean displacement between inspiration and expiration (IS versus ES; and ID versus ED) in X, Y, Z axes were: LAD 3.3(±1.5), 8.0(±3.4), 3.8(±1.8); Short-LAD 2.7(±1), 12.2(±4.4), 3.3(±1.5); LV 2.9(±1.4), 9.8(±3.3), 4.7(±1.9); LCX 2.9(±.8), 9.7(±3.2), 6.2(±2.5); RCA 2.6(±1.3), 7.6(±2.5), 3.8(±1.7). CONCLUSION Radial (RM), cranio-caudal margin (CC) of 7mm, 4mm in breath-hold radiotherapy whereas RM, CC of 7mm, 13mm respectively in free breath radiotherapy will cover the range of motions of CA, LV and can be recommended as IRV for these structures.
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Affiliation(s)
| | | | - Deepak Gupta
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
| | - Ashu Abhishek
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
| | - Trinanjan Basu
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
| | - Kushal Narang
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
| | - Shikha Goyal
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
| | - Pragya Shukla
- Clinical Oncology, Delhi State Cancer Institute, India
| | | | | | | | | | - Manoj Tayal
- Radiation Oncology, Medanta - The Medicity, Gurgaon, India
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Kataria T, Gupta D, Bisht SS, Goyal S, Basu T, Srivastava A, Abhishek A, HB G, Sharma K, Kumar V. Chemoradiation in elderly patients with head and neck cancers: a single institution experience. Am J Otolaryngol 2015; 36:117-21. [PMID: 25442075 DOI: 10.1016/j.amjoto.2014.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
Abstract
AIMS To evaluate the efficacy and toxicity of concurrent chemoradiation in patients with head and neck cancers aged 65 and older. MATERIALS AND METHODS Thirty-two elderly patients were treated with radical chemoradiation. Twenty-six (81.3%) out of thirty-two patients had stage III-IV disease. Twenty-nine (90.6%) patients received concurrent weekly cisplatin or carboplatin, 3 (9.4%) patients received concurrent cetuximab or nimotuzumab. Total dose of radiotherapy ranged from 66Gy to 70Gy. RESULTS Twenty-nine patients (90.6%) completed at least 5cycles of concurrent chemotherapy. Twenty-four (77.6%) patients achieved complete response. Fourteen (45.2%) patients experienced grade 3 mucositis. None of our patients developed grade 3 or above hematological toxicity. Loco-regional control and overall survival at 2year were 71.6% and 88.9%, respectively. CONCLUSIONS Chemoradiation in elderly patients with high precision radiotherapy is a feasible option.
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Gupta D, Shukla P, Bisht SS, Pant MC, Bhatt ML, Gupta S, Negi M. A prospective comparision of sequential chemoradiation vs concurrent chemoradiation in locally advanced oropharyngeal carcinomas. Cancer Biol Ther 2014; 8:213-7. [DOI: 10.4161/cbt.8.3.7484] [Citation(s) in RCA: 7] [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] [Indexed: 11/19/2022] Open
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Kataria T, Gupta D, Bisht SS, Karthikeyan N, Goyal S, Pushpan L, Abhishek A, Govardhan HB, Kumar V, Sharma K, Jain S, Basu T, Srivastava A. Adaptive radiotherapy in lung cancer: dosimetric benefits and clinical outcome. Br J Radiol 2014; 87:20130643. [PMID: 24628269 DOI: 10.1259/bjr.20130643] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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 Anatomical changes during radiotherapy (RT) might introduce discrepancies between planned and delivered doses. This study evaluates the need for adaptive treatment in lung cancer RT. METHODS 15 patients with non-small-cell lung cancer, undergoing radical RT with or without concurrent chemotherapy, consecutively underwent planning CT scans at baseline and after 44-46 Gy. Target volumes were delineated on both scans. Phase I delivered 44-46 Gy to the initial planning target volume (PTV). Two Phase II plans for 16-20 Gy were developed on initial and mid-treatment scans, the treatment being delivered with the mid-treatment plan. The second CT structure set was fused with the initial scan data set using dose wash. Volumetric and dosimetric changes in target volumes and critical structures were assessed. RESULTS There was significant reduction in primary gross tumour volume (34.00%; p = 0.02) and PTV (34.70%; p < 0.01) in the second scan. In Plan 2, delivering the same dose to the initial PTV would have resulted in a significantly higher dose to the lung PTV (V20, 52.18%; V5, 21.76%; mean, 23.93%), contralateral lung (mean, 29.43%), heart (V10, 81.47%; V5, 56.62%; mean, 35.21%) and spinal cord (maximum dose, 37.53%). CONCLUSION Treatment replanning can account for anatomical changes during RT and thereby enable better normal tissue sparing, while allowing radical target doses with the possibility of maximizing local control. ADVANCES IN KNOWLEDGE This study supports the sparse dosimetric data regarding the quantitative tumour volume reduction, re-emphasizing the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control, and adds to the existing body of literature.
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Affiliation(s)
- T Kataria
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
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Abstract
Consumer’s perception of health care quality and his satisfaction is being identified as an important issue in health care industry. Studies addressing patients’ perceptions of quality are available but there is paucity of data regarding the perception of health care providers (service-providers) towards their own services. This study was undertaken to compare the satisfaction level between the patients and health care providers from a radiation oncology department. A common 16-item questionnaire was served to 40 patients and 40 staff members. The responses were statistically evaluated to assess the satisfaction level among the two groups and the scores were compared to assess the agreement between two groups. Overall, satisfaction level of both groups regarding quality of services ranged from ‘good’ to ‘excellent’. A high level of agreement was observed between the two groups. The physician’s ability to give explanation to patients, helping attitude of the staff and the staff’s concern for patient safety were the most satisfying features of the department while inconvenience during scheduling of appointments, billing and registration process, status of the changing rooms and inter-department coordination were the least satisfying features. A high level of satisfaction may be achieved from the consumers if service providers are trained to assess the needs and expectations of consumers and to critically evaluate themselves. The service-providers’ perception regarding their own services may serve as a preliminary indicator of overall quality. Future studies in different settings with more number of patients may further explore our results.
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Kataria T, Gupta D, Karrthick KP, Bisht SS, Goyal S, Abhishek A, Govardhan HB, Sharma K, Pareek P, Gupta A. Frame-based radiosurgery: Is it relevant in the era of IGRT? Neurol India 2013; 61:277-81. [PMID: 23860148 DOI: 10.4103/0028-3886.115068] [Citation(s) in RCA: 8] [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
PURPOSE To assess the setup errors and intrafraction motion in patients treated with frame-based and frameless stereotactic radiosurgery (SRS). MATERIALS AND METHODS Ten patients treated with frame-based and six patients treated with frameless radiosurgery were prospectively enrolled in the study. Leksell frame was used for frame-based and a customized uniframe orfit cast for frameless techniques. Cone beam computed tomography (CBCT) scans were taken immediately before and after each treatment to evaluate the positional accuracy and corrections applied with the use of hexapod couch for both groups. RESULTS The mean translational shifts with frame-based SRS were 1.00 ± 0.30 mm in the lateral direction (X), 0.20 ± 1.20 mm in craniocaudal direction (Y) and -0.10 ± 0.31 mm in the anteroposterior direction (Z). The rotational shifts for frame-based treatments were as follows: roll 0.32 ± 0.70, pitch 0.44 ± 0.66 and yaw 0.20 ± 0.4. For frameless SRS, translational shifts were -0.40 ± 0.90, 1.10 ± 1.10, and 0.50 ± 1.30 mm in X, Y, and Z directions, respectively, and rotational shifts were -0.11 ± 0.78, 0.20 ± 0.44, and 0.29 ± 0.35 in roll, pitch, and yaw, respectively. Intrafraction shifts with frame-based SRS were: X = 0.60 ± 1.80 mm, Y = 0.20 ± 0.60 mm, and Z = 0.00 ± 0.05 mm; and rotational shifts were: roll 0.01 ± 0.27, pitch 0.06 ± 0.15, and yaw 0.01 ± 0.09. For frameless SRS, these were: X = 0.11 ± 0.20 mm, Y = 0.20 ± 0.40 mm, and Z = 0.20 ± 0.20 mm and rotational shifts were: roll 0.09 ± 0.23, pitch 0.00 ± 0.12, and yaw 0.00 ± 0.09. CONCLUSIONS In our experience, set up accuracy of frameless SRS is as good as frame-based SRS. With availability of verification methods such as CBCT and hexapod couch, an accurate and precise treatment delivery is feasible with frameless techniques.
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Affiliation(s)
- Tejinder Kataria
- Division of Radiation Oncology, Medanta Cancer Institute, Gurgaon, Haryana, India.
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Kataria T, Bisht SS, Gupta D, Goyal S, Jassal K, Abhishek A, Sharma K, Pareek P, Kumar V, Jain S, Tayal M, Karthikeyan N. Incidental radiation to axilla in early breast cancer treated with intensity modulated tangents and comparison with conventional and 3D conformal tangents. Breast 2013; 22:1125-9. [PMID: 24012148 DOI: 10.1016/j.breast.2013.07.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 01/10/2013] [Revised: 04/30/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To analyze incidental radiation doses to minimally dissected axilla with Intensity modulated radiotherapy (IMRT), 3D conformal radiotherapy (3DCRT) and standard tangents (ST). METHODS & MATERIALS We prospectively evaluated incidental radiation to axilla in fifty cases of early breast cancer treated with breast conservation surgery with sentinel node biopsy alone followed by whole breast irradiation with IMRT. Three plans were devised for each CT dataset, comprising ST, 3DCRT and IMRT tangents. Doses to axillary nodal levels I, II and III were evaluated for mean dose, V95, V90, V80 and V50. Comparisons were made using ANOVA. RESULTS The mean doses delivered to axilla by the three techniques (IMRT, 3DCRT, ST) were: 78% (range 67-90, SD ± 5.2%), 80% (63-95, ±7.5%) and 87% (73-98, ±4.8%) for level I (IMRT vs ST; p = 0.037); 70% (46-89, ±12.4%), 72% (34-93, ±15.5%) and 65% (29-87, ±11.8%) for level II; and 51% (28-76, ±11.1%), 53% (19-86, ±13.7%) and 41% (6-72, ±10.6%) for level III, respectively. V90 values (volume receiving 90% of dose) for the three techniques were 49% (43-53, ±2.7%), 57% (51-65, ±3.1%) and 73% (65-80, ±3.4%) for level I (IMRT vs. ST; p = 0.029); 35% (26-42, ±4.7%), 41% (33-50, ±4.2%) and 25% (17-36, ±4.5%) for level II (IMRT vs ST; p = 0.068); and 15% (9-22, ±3.4%), 16% (10-24, ±3.7%) and 8 (5-12, ±3.1%) for level III (IMRT vs ST; p = 0.039), respectively. CONCLUSION Axillary levels I and II (lower axilla) receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than ST technique.
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Affiliation(s)
- Tejinder Kataria
- Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India.
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Kumar N, Varshney S, Saxena RK, Kumar R, Bisht SS. Retained foreign body in sino-orbital region. Indian J Otolaryngol Head Neck Surg 2012; 58:194-5. [PMID: 23120285 DOI: 10.1007/bf03050788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
It is rare to find foreign bodies in nose and paranasal sinuses. The further rarity is to encounter impacted foreign body in this region and route of entry being through the orbit. We are here by presenting a case, where a metallic foreign body was retained for duration of 4 months in sino - orbital region.
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Affiliation(s)
- Navneet Kumar
- Department of E.N.T., Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, 248140 Dehradun (Uttaranchal)
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Gupta D, Shukla P, Bisht SS, Bhatt MLB, Pant MC, Srivastava K. Deep vein and artery thrombosis associated with cetuximab-based chemoradiotherapy. Indian J Pharmacol 2011; 43:478-80. [PMID: 21845013 PMCID: PMC3153721 DOI: 10.4103/0253-7613.83135] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 02/26/2011] [Accepted: 04/25/2011] [Indexed: 11/06/2022] Open
Abstract
Molecular targeted agents have lower hematological toxicity. However, specific side-effects such as allergic rashes, skin reactions and high cost limit their use. We report a case of 35-year-old male patient with carcinoma of left tonsil treated with concurrent cetuximab and radiotherapy. After four weeks of treatment, the patient developed sudden onset of pain in the left calf region radiating to the left foot. Doppler study of the left lower limb revealed complete thrombosis of superficial femoral, popliteal and proximal tibial arteries and veins and no flow in anterior tibial artery and lower posterior tibial artery. Emergency embolectomy was done. After 48 h of observation, no improvement was noted. A repeat Doppler examination showed similar finding. Ultimately a left lower limb amputation was done. We report simultaneous arterio-venous thrombosis associated with cetuximab-based chemoradiotherapy. Oncologists should be aware of this possible complication to undertake early intervention.
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Affiliation(s)
- Deepak Gupta
- Department of Radiotherapy, CSMMU, Lucknow, Uttar Pradesh, India
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Shukla P, Gupta D, Bisht SS, Pant MC, Bhatt ML, Srivastava K, Negi MPS. Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis. Indian J Med Paediatr Oncol 2010; 30:124-30. [PMID: 20838553 PMCID: PMC2930299 DOI: 10.4103/0971-5851.65334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
Introduction: Metastatic carcinoma in the lymph nodes of the neck from an unknown primary is relatively rare, accounting for about 3% of all head and neck cancers. Management of secondary neck of undetermined primary is controversial. Materials and Methods: The case records of all the patients treated in the Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, from Oct 1999 to Sep 2004, were studied and the patients with secondary neck without a known primary tumor were analyzed in detail to elucidate the outcome of various treatment modalities in various stages of the disease. One hundred and forty patients were found to be eligible for this analysis. Initial treatment could be divided into two categories: concurrent chemoradiation (n=76) and radiotherapy alone (n=64). Results: The patients who had received radiotherapy alone (53.1%) had lesser complete response as compared to those who had received chemoradiotherapy (68.4%). The overall survival duration in patients of the radiotherapy treatment group ranged from 5 to 60 months, with an average (±SD) of 31.06 ± 21.01 months, while in the chemoradiotherapy treatment group it ranged from 6 to 60 months, with an average (±SD) of 39.42 ± 21.33 months. Both hematological and nonhematological toxicities, although higher in the chemoradiotherapy group, showed statistically insignificant differences. Conclusion: To the best of our knowledge, this is the only study evaluating the role of concurrent chemoradiation in cases of secondary neck with primary unknown. The improved response rates along with an increased survival (both disease free and overall) show the superiority of chemoradiotherapy in the management of such cases.
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Affiliation(s)
- Pragya Shukla
- Department of Radiation Oncology, TATA Memorial Cancer Hospital, Mumbai, India
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Kataria T, Bisht SS, Mitra S, Abhishek A, Potharaju S, Chakarvarty D. Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy. Rare Tumors 2010; 2:e21. [PMID: 21139824 PMCID: PMC2994506 DOI: 10.4081/rt.2010.e21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 02/25/2009] [Accepted: 02/26/2010] [Indexed: 11/26/2022] Open
Abstract
Paragangliomas are rare tumors and very few cases of malignant vagal paraganglioma with synchronous carotid body paraganglioma have been reported. We report a case of a 20-year old male who presented with slow growing bilateral neck masses of eight years duration. He had symptoms of dysphagia to solids, occasional mouth breathing and hoarseness of voice. Fine needle aspiration cytology (FNAC) performed where he lived showed a sinus histiocytosis and he was administered anti-tubercular treatment for six months without any improvement in his symptoms. His physical examination revealed pulsatile, soft to firm, non-tender swellings over the anterolateral neck confined to the upper-mid jugulo-diagastric region on both sides. Direct laryngoscopy examination revealed a bulge on the posterior pharyngeal wall and another over the right lateral pharyngeal wall. Magnetic resonance imaging (MRI), 99mTc-labeled octreotide scan and angiography diagnosed the swellings as carotid body paraganglioma, stage III on the right side with left-sided vagal malignant paraganglioma. Surgery was ruled out as a high morbidity with additional risk to life was expected due to the highly vascular nature of the tumor. The patient was treated with radiation therapy by image guided radiation to a dose of 5040cGy in 28 fractions. At a follow-up at 16 months, the tumors have regressed bilaterally and the patient can take solids with ease.
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Affiliation(s)
- Tejinder Kataria
- Dept of Radiation Oncology, Medanta, The Medicity, Gurgaon, India
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Shukla P, Gupta D, Bisht SS, Pant MC, Bhatt ML, Gupta R, Srivastava K, Gupta S, Dhawan A, Mishra D, Negi MPS. Circadian variation in radiation-induced intestinal mucositis in patients with cervical carcinoma. Cancer 2010; 116:2031-5. [PMID: 20162717 DOI: 10.1002/cncr.24867] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mucositis, a radiotherapy-associated toxicity, is an important factor determining morbidity and treatment compliance. Gastrointestinal mucositis in patients undergoing radiotherapy may also depend on time of administration of radiation in addition to several other factors. The presence of any correlation between the severity of acute gastrointestinal mucositis in cervical carcinoma patients and the time of irradiation was prospectively evaluated. METHODS A total of 229 patients with cervical carcinoma were randomized to morning (8:00-10:00 AM) and evening (6:00-8:00 PM) arms. The incidence of mucositis in the 2 arms was assessed and reported in terms of various grades of diarrhea. RESULTS Overall (grade I-IV) as well as higher grade (III and IV) diarrhea was found to be significantly increased in the morning arm as compared with the evening arm (overall: 87.39 % vs 68.18 %, P < .01; higher grade: 14.29% vs 5.45%, P < .05). Other radiation-induced toxicity was also higher in the morning arm, but its occurrence in the 2 arms did not differ significantly (13.45% vs 12.73%, P > .05). After completion of treatment, patients' response to radiation in the 2 arms was similar (P > .05). CONCLUSIONS The significant difference in the incidence of higher grade diarrhea between the morning and evening arms is indirect evidence of the influence of circadian rhythm on the intestinal mucosa of the human intestine. This knowledge may facilitate treating patients with decreased toxicity to the intestinal mucosa.
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Affiliation(s)
- Pragya Shukla
- Department of Radiotherapy, Chatrapati Sahuji Maharaj Medical University, Lucknow, India
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Goyal M, Shukla P, Gupta D, Bisht SS, Dhawan A, Gupta S, Pant MC, Verma NS. Oral mucositis in morning vs. evening irradiated patients: a randomised prospective study. Int J Radiat Biol 2009; 85:504-9. [PMID: 19412843 DOI: 10.1080/09553000902883802] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients of head and neck cancer undergoing radiotherapy develop oral mucositis. The severity of mucositis may also depend on the time of administration of radiation apart from patient-related factors. The most radiosensitive phase of the cell cycle (G2-M) occurs in the late afternoon and evening in human oral mucosa; therefore, it is more vulnerable to radiation injury in the evening. The present study evaluated prospectively the severity of acute oral mucositis in head and neck carcinoma patients irradiated in the morning (08:00-11:00 h) versus late afternoon/evening (15:00-18:00 h). METHOD A total of 212 patients of head and neck carcinoma were randomised to morning (08:00-11:00 h) and evening (15:00-18:00 h) groups. The grades of oral mucosa ulceration were compared in the two groups. RESULTS The grades of mucositis were marginally higher in the evening-irradiated group than in the morning-irradiated group 38% vs. 26% (p = 0.08). CONCLUSION The observed incidence of grade III/IV mucositis in morning vs. evening irradiated patients may be because of the existence of circadian rhythm in the cell cycle of normal mucosa. This knowledge may provide a possibility of treating the patients with decreased toxicity to oral mucosa.
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Affiliation(s)
- Manish Goyal
- Department of Physiology, King George's Medical University, Lucknow, India
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Gupta D, Shukla P, Bisht SS, Aggarwal A, Dhawan A, Pant MC, Bhatt ML, Gupta R, Srivastava K, Gupta S, Srivastava M. Comparitive study of efficacy, tolerability of four field box technique vs. two field anterior posterior technique in locally advanced carcinoma cervix--a prospective analysis. Cancer Biol Ther 2009; 8:759-64. [PMID: 19270510 DOI: 10.4161/cbt.8.9.8129] [Citation(s) in RCA: 2] [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: 11/19/2022] Open
Abstract
PURPOSE The pelvic failure rate decreases with increase in the radiation dose but the complications increase. The four field pelvic technique has a theoretical advantage of providing a higher tumor dose with less dose to the surrounding normal tissue thus reducing the complications. RESULT Eighty-three patients completed treatment, 42 in Arm A and 41 in Arm B. The complete response achieved in the two groups was 85.75% and 87.8% (p = 0.67). Skin reactions were more in Arm B (p < 0.05). Grade II GIT symptoms were more common in both the groups (p = 0.75). Grade I GUT toxicity was the most common toxicity in both the arms (p = 0.38). The most common hematological toxicity in the two arms was of grade II (p = 0.78). MATERIAL AND METHOD After satisfying the eligibility criteria histo-pathologically proven locally advanced carcinoma cancer cervix patients were randomized to four (Arm A) or two (Arm B) field techniques. CONCLUSIONS Both two and four field box techniques are equally effective and feasible as statistically insignificant difference in the response rate and acute toxicities was observed in the two arms.
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Affiliation(s)
- Deepak Gupta
- Department of Radiotherapy, Chatrapati Sahuji Maharaj Medical University, Lucknow, India.
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Rai V, Khatoon S, Bisht SS, Mehrotra S. Effect of cadmium on growth, ultramorphology of leaf and secondary metabolites of Phyllanthus amarus Schum. and Thonn. Chemosphere 2005; 61:1644-50. [PMID: 15992855 DOI: 10.1016/j.chemosphere.2005.04.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 03/22/2005] [Accepted: 04/11/2005] [Indexed: 05/03/2023]
Abstract
The pollution is increasing in the environment by different kinds of human activities, which results in the accumulation of heavy metals including cadmium in the soil and water and it causes different types of problems to living beings. As the plants are utilized by human being as food and medicine, therefore, it is mandatory to see the effect of metals on plants. In this context, efforts have been made to observe the effect of different concentration of Cadmium (Cd) on Phyllanthus amarus Schum. and Thonn., because Cd is the widespread metal and the plants response to low and high level of exposure is a complex phenomenon. P. amarus is mostly grown as weed in agricultural and waste lands. It is a reputed plant used in Indian indigenous systems of medicine with hepatoprotective, diuretic, stomachic properties and is recently being used for the treatment of hepatitis B. The study revealed that Cd causes significant decrease in fresh and dry weight, length of root and shoot, protein, chlorophyll, carotenoids and sugar and increase in starch content. It is interesting to note that the therapeutically active compounds-phyllanthin and hypophyllanthin, enhanced at certain levels of Cd due to abiotic stress. Besides, the ultramorpholical changes were also observed in stomatal opening and wax deposition on both the surfaces of leaves.
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Affiliation(s)
- Vartika Rai
- Pharmacognosy and Ethnopharmacology Division, National Botanical Research Institute, Rana Pratap Marg, Lucknow 226001, Uttar Pradesh, India.
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Gomber S, Bisht SS. Resurgence of epidemic dropsy. Indian Pediatr 1997; 34:953. [PMID: 9567567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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