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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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2
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Agarwal JP, Krishnatry R, Panda G, Pathak R, Vartak C, Kinhikar RA, James S, Khobrekar SV, Shrivastava SK, D'Cruz AK, Deshpande DD. An Audit for Radiotherapy Planning and Treatment Errors From a Low-Middle-Income Country Centre. Clin Oncol (R Coll Radiol) 2018; 31:e67-e74. [PMID: 30322681 DOI: 10.1016/j.clon.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
AIMS To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist. MATERIALS AND METHODS A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection. RESULTS In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes. CONCLUSION Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India.
| | - G Panda
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - C Vartak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R A Kinhikar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
| | - S James
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - S V Khobrekar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - A K D'Cruz
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - D D Deshpande
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
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Dandekar M, Trivedi R, Irawati N, Prabhash K, Gupta S, Agarwal JP, D'Cruz AK. Barriers in conducting clinical trials in oncology in the developing world: A cross-sectional survey of oncologists. Indian J Cancer 2017; 53:174-7. [PMID: 27146772 DOI: 10.4103/0019-509x.180865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Several obstacles impede oncologists from performing clinical trials in the developing world. This study aimed to identify these barriers in order of importance and suggest possible remedial measures. MATERIALS AND METHODS Design - cross-sectional survey. Two part questionnaire capturing experience of oncologists in practice and conducting trials (Part 1) and perceived barriers pertaining to investigator (training, time), patient (strict follow-up protocol), infrastructure (funds) and professional environment (encouragement from seniors) (Part 2) were administered to oncologists in two different settings: (1) Online portal (Survey Monkey) (2) In person during a national conference (Best of American Society of Clinical Oncology). Responses were captured on a Likert scale (1-5). RESULTS (436/3021) 14.04% responded. A total of 313 (71.8%) had experience in conducting trials, but these were mainly industry-sponsored or small nonpractice changing studies. Lack of patient follow-up was the most significant barrier (inter quartile range [IQR] 4-5) followed by inadequate training, time and funds (IQR 2-5) and lack of encouragement (IQR 2-4) in decreasing order of frequency. Lack of adequate training was a barrier across all specialties (113 [71.97%] radiation oncologists, 71 [60.68%] medical oncologists and 73 [71.56%] surgical oncologists). More than half of the respondents without experience in clinical trials worked in academic institutions (50.48%). They perceived time constraint as a barrier more than their counterparts into private practice (175/242 [72.31%] vs. 119/177 [66.47%] respectively). CONCLUSION Inability to maintain patient follow-up, lack of protected time and funds, inadequate training were the most significant barriers. Most of these can be addressed.
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Affiliation(s)
| | | | | | | | | | | | - A K D'Cruz
- Department of Head Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Laskar SG, Baijal G, Rangarajan V, Purandare N, Sengar M, Shah S, Gupta T, Budrukkar A, Murthy V, Pai PS, D'Cruz AK, Agarwal JP. Fluorodeoxyglucose-positron emission tomography in carcinoma nasopharynx: Can we predict outcomes and tailor therapy based on postradiotherapy fluorodeoxyglucose-positron emission tomography? Indian J Med Paediatr Oncol 2016; 37:47-52. [PMID: 27051158 PMCID: PMC4795376 DOI: 10.4103/0971-5851.177030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET-CT) is an emerging modality for staging and response evaluation in carcinoma nasopharynx. This study was conducted to evaluate the impact of PET-CT in assessing response and outcomes in carcinoma nasopharynx. MATERIALS AND METHODS Forty-five patients of nonmetastatic carcinoma nasopharynx who underwent PET-CT for response evaluation at 10-12 weeks posttherapy between 2004 and 2009 were evaluated. Patients were classified as responders (Group A) if there was a complete response on PET-CT or as nonresponders (Group B) if there was any uptake above the background activity. Data regarding demographics, treatment, and outcomes were collected from their records and compared across the Groups A and B. RESULTS The median age was 41 years. 42 out of 45 (93.3%) patients had WHO Grade 2B disease (undifferentiated squamous carcinoma). 24.4%, 31.1%, 15.6, and 28.8% patients were in American Joint Committee on Cancer Stage IIb, III, Iva, and IVb. All patients were treated with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy. Forty-five patients, 28 (62.2%) were classified as responders, whereas 17 (37.8%) were classified as nonresponders. There was no significant difference in the age, sex, WHO grade, and stage distribution between the groups. Compliance to treatment was comparable across both groups. The median follow-up was 25.3 months (759 days). The disease-free survival (DFS) of the group was 57.3% at 3 years. The DFS at 3 years was 87.3% and 19.7% for Group A and B, respectively (log-rank test, P < 0.001). Univariate and multivariate analysis revealed Groups to be the only significant factor predicting DFS (P value 0.002 and < 0.001, respectively). In Group B, the most common site of disease failure was distant (9, 53%). CONCLUSION PET-CT can be used to evaluate response and as a tool to identify patients at higher risk of distant failure. Further, this could be exploited to identify patients who may need treatment intensification. This needs to be validated prospectively.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gunjan Baijal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Nilendu Purandare
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A K D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Sawant SS, Vaidya MM, Chaukar DA, Alam H, Dmello C, Gangadaran P, Kannan S, Kane S, Dange PP, Dey N, Ranganathan K, D'Cruz AK. Clinical significance of aberrant vimentin expression in oral premalignant lesions and carcinomas. Oral Dis 2013; 20:453-65. [DOI: 10.1111/odi.12151] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 05/10/2013] [Accepted: 06/04/2013] [Indexed: 12/25/2022]
Affiliation(s)
- SS Sawant
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - MM Vaidya
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - DA Chaukar
- Oral Surgery, Head and Neck Unit Tata Memorial Hospital (TMH) Parel Mumbai India
| | - H Alam
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - C Dmello
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - P Gangadaran
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - S Kannan
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - S Kane
- Pathology Department Tata Memorial Hospital (TMH) Parel Mumbai India
| | - PP Dange
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - N Dey
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar Navi Mumbai India
| | - K Ranganathan
- Department of Oral and Maxillofacial Pathology Ragas Dental College and Hospital Chennai India
| | - AK D'Cruz
- Oral Surgery, Head and Neck Unit Tata Memorial Hospital (TMH) Parel Mumbai India
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Abstract
AIM This retrospective study was done to evaluate the impact of cut margins on disease-free survival in patients with previously untreated oral squamous cell cancers. MATERIALS AND METHODS Records of 306 cases were reviewed for clinical details and status of margins at resection. The independent influence of margins on recurrence was analyzed. The impact of frozen section analysis on achieving free margins was also examined. RESULTS 190 (62.1%) patients had negative margins of resection (≥ 5 mm), 102 (33.3%) patients had close margins (1-5 mm), while 14 (4.6%) patients had positive margins (≤ 1 mm). The median follow-up for the entire cohort was 26.5 months. There were 79 (25.8%) recurrences, of which, 46 (58.2%) were local, 9 (11.3%) were locoregional, 16 (20.2%) were regional, and 8 (10.1%) were distant metastasis. 42 (22.2%) cases with negative margins developed a recurrence as compared to 31 (30.4%) cases with close margins and 6 (42.8%) cases with positive margins (P value 0.01). Average time to recurrence in case of negative margins was 34.8 months, for close margins was 33.9 months, while in those with positive margins was 10.18 months (P value 0.002). Close and positive margins were found to be significantly associated with increased local recurrence (P values 0.01 and 0.03, respectively) and with overall recurrence (P values 0.003 and 0.003, respectively). Frozen section was seen to influence margins in 20.4% cases. CONCLUSION Margins are an important predictor of disease control. The surgeon must aim for adequate margins at initial resection.
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Affiliation(s)
- S R Priya
- Head and Neck Services, Tata Memorial Hospital, Mumbai, India.
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7
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Vaidya AD, Pantvaidya GH, Metgudmath R, Kane SV, D'Cruz AK. Minor salivary gland tumors of the oral cavity: a case series with review of literature. J Cancer Res Ther 2012; 8 Suppl 1:S111-5. [PMID: 22322728 DOI: 10.4103/0973-1482.92224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Minor salivary gland tumors (MSGTs) are unusual, accounting for only 15-20% of all salivary gland tumors. The commonest site of MSGTs of the head and neck is oral cavity. AIMS To describe our experience with MSGTs of oral cavity seen over a period of one decade and elucidate their prognostic factors. MATERIALS AND METHODS Over a period of 10 years, from 1991 to 2000, all MSGTs of oral cavity were analyzed. All demographic, treatment and survival data were recorded. Kaplan-Meier curves were used to find the survival. Multivariate analysis was performed using Cox regression. RESULTS We treated 104 patients with curative intent. The commonest site was hard palate, accounting for 54.8% of all sites. The commonest histology was adenoid cystic carcinoma (45.2%). There were 17 (16.34%) pleomorphic adenoma cases, while the remaining 87 (83.66%) were minor salivary gland malignancies. Treatment was surgical in 91.3% of patients. Adjuvant radiotherapy was administered in 38.5% of patients. The median follow-up was 50 months. Recurrences were seen in 22 (25.3%) of the 87 malignant cases. Using Kaplan-Meier analysis, the expected 10-year overall and disease-free survivals were 75.2 and 65.8%, respectively. Survivals were better in non-adenoid cystic tumors (non-ACC). On multivariate analysis, T status, tumor grade and adjuvant therapy were independent prognostic factors for disease-free survival. CONCLUSIONS MSGTs of oral cavity have good overall survival despite recurrences. T stage, adjuvant radiotherapy and grade are independent prognostic factors for disease-free survival. Adenoid cystic tumors have worse outlook than non-ACC.
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Affiliation(s)
- A D Vaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
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8
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Deshmukh AD, Katna R, Patil A, Chaukar DA, Basu S, D'Cruz AK. Ectopic thyroid masquerading as submandibular tumour: a case report. Ann R Coll Surg Engl 2011; 93:e77-80. [PMID: 21929891 DOI: 10.1308/147870811x590324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An ectopic thyroid gland may be present in any location along the path of migration from the foramen caecum to the mediastinum. The most common locations for an ectopic thyroid are the lingual thyroid followed by median cervical cysts. An ectopic thyroid in the submandibular region is extremely rare. We present the case of a 44-year-old patient with ectopic thyroid tissue in submandibular space and a review of the literature related to it.
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9
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Pantvaidya GH, Agarwal JP, Deshpande MS, Rangarajan V, Singh V, Kakade A, D'Cruz AK. PET-CT in recurrent head neck cancers: a study to evaluate impact on patient management. J Surg Oncol 2009; 100:401-3. [PMID: 19235784 DOI: 10.1002/jso.21257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES PET-CT has shown promise in the management of head neck cancers. However, there have been only few studies evaluating its impact on management of patients with recurrent cancers in the presence of available clinicoradiologic methods of assessment. We conducted this study to assess the same in patients with suspected recurrent head and neck cancer. METHODS Case histories were presented to two oncologists, who were blinded to PET-CT reports. Treatment plans were made by these oncologists based on clinical findings and other conventional imaging. These plans were then compared to the actual treatment received by patients after PET-CT. Any change was recorded as "change in management." RESULTS Forty-nine patients with suspected recurrent head and neck cancer were evaluated in the study. Overall, there was a 38.7% change in management because of the addition of PET-CT to conventional methods of assessment. Eight patients (16.3%) had a major change in therapy while in 11 patients (22.4%), diagnostic procedures like endoscopies, biopsies and examination under anesthesia were avoided. CONCLUSION In our study, PET-CT had a significant impact on the management of patients with suspected recurrent head neck cancer.
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Affiliation(s)
- G H Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
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Walvekar RR, Kane SV, Nadkarni MS, Bagwan IN, Chaukar DA, D'Cruz AK. Chronic arsenic poisoning: a global health issue -- a report of multiple primary cancers. J Cutan Pathol 2007; 34:203-6. [PMID: 17244035 DOI: 10.1111/j.1600-0560.2006.00596.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic arsenic (As) poisoning is a worldwide public health problem. Effects of prolonged exposure to high levels of As in drinking water have been observed and documented in various epidemiological studies from all over the world. The non-malignant cutaneous effects of chronic exposure to inorganic As are well known. A case presenting with multiple cutaneous cancers as well as an internal lung primary in a patient exposed to toxic levels of As in the drinking water is discussed along with a review of literature.
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Affiliation(s)
- R R Walvekar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Parel, Mumbai, India
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Pathak KA, Juvekar AS, Radhakrishnan DK, Deshpande MS, Pai VR, Chaturvedi P, Pai PS, Chaukar DA, D'Cruz AK, Parikh PM. In vitro chemosensitivity profile of oral squamous cell cancer and its correlation with clinical response to chemotherapy. Indian J Cancer 2007; 44:142-6. [DOI: 10.4103/0019-509x.39376] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Chaukar DA, Pai A, D'Cruz AK. A technique to identify and preserve the spinal accessory nerve during neck dissection. J Laryngol Otol 2006; 120:494-6. [PMID: 16772057 DOI: 10.1017/s0022215106000879] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2005] [Indexed: 11/06/2022]
Abstract
Introduction: Preservation of the spinal accessory nerve during neck dissection should be the rule rather than the exception. Despite the presence of many described techniques to locate the nerve, a tedious dissection is often required; as a consequence, it remains vulnerable to damage.Method: We describe a novel method, not previously reported, based on identifying a constant vein which crosses the nerve. This aids in the nerve's early identification.Conclusion: Our method enables the surgeon to locate the nerve precisely and to avoid damage to it, thereby maximizing post-operative function.
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Affiliation(s)
- D A Chaukar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
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13
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Chaturvedi P, Pai PS, Pathak KA, Chaukar DA, Deshpande MS, D'Cruz AK. Simultaneous reconstruction of large skin and mucosal defect following head and neck surgery with a single skin paddle pectoralis major myocutaneous flap. J Laryngol Otol 2006; 119:303-5. [PMID: 15949086 DOI: 10.1258/0022215054020511] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pectoralis major myocutaneous (PMMC) flap is commonly used for head and neck reconstruction especially in impoverished nations. PMMC is a sturdy pedicled flap with relatively fewer complications, the learning curve is short and no specialized training in microvascular surgery is needed in order to use this flap. In a defect that requires a large skin and mucosal lining the authors routinely use either a bi-paddle PMMC or a combination of PMMC (for the mucosal lining) and a delto-pectoral flap (for the skin defect). It is indisputable that free tissue transfer is a better way of reconstruction for the majority of most such defects. Unfortunately, not all patients can be offered this form of reconstruction due to the cost, time, expertise and infrastructural constraints in high volume centres such as ours. Bi-paddling of PMMC is hazardous in obese males and most female patients. In such patients the skin defect is reconstructed usually by the delto-pectoral (DP) flap but this, for obvious reasons, is less welcomed by the patients. The authors suggest a technique wherein mucosal lining is created by the myofascial lining (inner surface) of the flap and the skin defect is reconstructed by the skin paddle of the single paddle PMMC. It should be considered wherever a DP flap is unacceptable, or bi-paddling or free tissue transfer is not possible.
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Affiliation(s)
- P Chaturvedi
- Head and Neck Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
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14
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Chaukar DA, Das AK, Deshpande MS, Pai PS, Pathak KA, Chaturvedi P, Kakade AC, Hawaldar RW, D'Cruz AK. Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-H&N 35 in Indian patients. Indian J Cancer 2005; 42:178-84. [PMID: 16391435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIMS To present the first cross-culture validation of the European organization for research and treatment of cancer (EORTC) quality of life questionnaires, the EORTC-QLQ-C30, and the QLQ-H&N 35 in India. SETTINGS AND DESIGN These questionnaires were translated into two vernacular languages and pilot test was done on 15 patients. Two hundred head and neck cancer patients completed the QLQ-C30 and the QLQ-H&N 35 at two time points during their treatment. Psychometric evaluation of the structure, reliability, and validity of the questionnaire was undertaken. RESULTS The data supports the reliability of the scales. Validity was tested by item-scale, scale--scale correlation and by performing known group comparisons. The results demonstrated that the items correlated with their respective scale and no significant correlation was found between scales. The questionnaire was responsive to change over a period of time. SUMMARY This data suggests that the EORTC QLO-C30 and the QLQ-H&N 35 are reliable and valid questionnaires when applied to a sample of head and neck cancer patients in India.
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Affiliation(s)
- D A Chaukar
- TATA Memorial Hospital, Parel, Mumbai, India.
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15
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Pai VR, Mazumdar AT, Deshmukh CD, Bakshi AV, Parikh DM, Parikh PM, Mistry RC, Pathak KA, D'Cruz AK. Two- vs three-drug combination chemotherapy in advanced or recurrent head and neck cancer: a single institution experience of 361 patients. Med Oncol 2004; 21:305-8. [PMID: 15579913 DOI: 10.1385/mo:21:4:305] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2003] [Revised: 09/03/2003] [Accepted: 09/03/2003] [Indexed: 11/11/2022]
Abstract
Head and neck squamous cancer is a major concern in India. The proportion of advanced cases is significantly high, and these patients have dismal survival prospects despite aggressive therapy. Often surgical resection and/or radiotherapy are not feasible in these patients. Hence, we decided to explore the option of neoadjuvant chemotherapy using effective agents like ifosfamide and paclitaxel in combination with cisplatin in these patients. A total of 361 patients were evaluable at the end of study. Of these, 207 had received ifosfamide and cisplatin and 154 had received taxanes (paclitaxel or docetaxel) in addition to ifosfamide and cisplatin. The ifosfamide-cisplatin group had an overall response rate of 66.67% (CR, 16.42%; PR, 50.24%) and the median duration of response was 5.5 mo; whereas the group in which taxanes were added, showed an overall response rate of 73.37% (CR, 7.79%; PR, 65.58%) with a median duration of response of 10 mo. The toxicity in both the groups was acceptable and there was no mortality. We conclude that taxane-based combinations have a significant activity in advanced head and neck squamous cancer and warrant further studies.
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Affiliation(s)
- V R Pai
- Department of Medical and Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India.
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Pai VR, Kulkarni PS, Mazumdar AT, Biswas G, Parikh PM, Pathak KA, D'Cruz AK. Ifosfamide based neoadjuvant chemotherapy in locoregionally advanced head & neck squamous cell carcinoma (HNSCC): A retrospective analysis of 718 cases. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5550] [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: 11/20/2022] Open
Affiliation(s)
- V. R. Pai
- Tata Memorial Hospital, Mumbai, India
| | | | | | - G. Biswas
- Tata Memorial Hospital, Mumbai, India
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Abstract
Buccal-gingival (BG) cancers are an integral part of oral cancers but are biologically distinct, particularly with regard to the propensity and pattern of neck metastases. This study was undertaken to examine the adequacy of limited neck dissection in the management of these tumors. Between 1980 and 1989, 527 T3/4 BG cancers were treated surgically at Tata Memorial Hospital, Bombay. These cases were reviewed retrospectively. Among these, 178 underwent radical neck dissection (RND), 166 supradigastric dissection (SD) and 183 supraomohyoid dissection (SOHD) after confirming the negativity of levels II and III for nodal disease on frozen section. The overall incidence of histological node positivity was 42.5% (224/527). Level I was the most frequent site of metastases, with a skip rate of only 9%. The incidence of pure regional failure (primary controlled) was 3% with RND (67/178), 12% with SD (11/95) and 5% with SOHD (7/141) in patients with N0 necks. In the N+ category the regional failure was 18% with RND (20/111), 34% with SD (24/71) and 19% with SOHD (8/42). These findings show that a limited (SD) dissection is grossly inadequate in the management of T3/4 BG cancers, whereas an SOHD when neck levels II and III are confirmed negative on frozen section yields results comparable to RND for both N0 and N+ necks.
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Affiliation(s)
- S A Pradhan
- Department of Surgery (Head and Neck Surgery), Tata Memorial Hospital, Parel, Bombay, India
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Abstract
Eleven cases of synovial sarcoma of the head and neck are analyzed. Patients presented with a mass either in the parapharynx, pharyngeal wall, or nape of the neck. The tumors ranged in size from 3 to 8 cm. Microscopically, the classic biphasic pattern was seen in 10 tumors. Immunohistochemistry and electron microscopy were useful in the diagnosis of the single monophasic variant of synovial sarcoma. Radical surgery was the mainstay of treatment with post-operative radiotherapy for residual disease. Five patients were dead of disease while 6 were alive for periods varying from 9 months to 15 years. The purpose of this presentation is to accrue data on this sarcoma at a rare site, and to highlight the histopathological differential diagnosis, which includes both carcinomas and sarcomas. Treatment decisions would be affected by the histology report.
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Affiliation(s)
- S Pai
- Department of Pathology, Tata Memorial Hospital, Bombay, India
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Kapasi AA, Mandrekar PS, D'Cruz AK, Vyas JJ, Sheth NA. De novo biosynthesis and localization of immunoreactive inhibin (10.7 kDa) in normal human stomach. Cell Biol Int Rep 1992; 16:859-69. [PMID: 1423656 DOI: 10.1016/s0309-1651(06)80166-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have previously reported the occurrence of inhibin-like peptide in gastric juice of normal men. In the present investigation, normal gastric mucosa was shown to synthesize inhibin, in vitro, as measured by 3H-leucine incorporation (Maximum at 18 h). Furthermore, the immunohistochemical localization studies demonstrated its presence in the acid secreting parietal cells and basal region of foveolar epithelium of gastric mucosa. Surprisingly, the protein secreting zymogen cells remained unstained.
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Affiliation(s)
- A A Kapasi
- Endocrinology Unit, Tata Memorial Centre, Parel, Bombay, India
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Abstract
Thirty-eight patients with node positive squamous cell carcinoma of the esophagus were entered into a pilot clinical study using postoperative adjuvant chemotherapy (cisplatinum 100 mg/m2 and methotrexate 150 mg/m2 x 4 cycles) with an intent of improving cure rates and overall survival. Patient compliance was excellent and toxicity minimal. At 24 months of follow-up 22 patients (58%) were disease free, while 14 patients (37%) have relapsed and 2 were lost to follow-up. A highly significant correlation was noted between the number of nodes involved, the grade of the tumour, and the response to chemotherapy. Patients with poorly differentiated tumours and those with more than 4 nodes involved were more likely to develop recurrent disease (P less than 0.01 and P less than 0.005). We conclude that postoperative chemotherapy following resection for carcinoma of the esophagus is well tolerated with minimal side effects. It may also have an impact on improving disease free and overall survival.
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Affiliation(s)
- S Sharma
- Department of Thoracic Surgery, Tata Memorial Hospital, Bombay, India
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D'Cruz AK, Vyas JJ. Tracheoesophageal fistula--foreign body induced. Am J Gastroenterol 1991; 86:528-9. [PMID: 2012060] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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