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Vaish R, Hawaldar R, Gupta S, Dandekar M, Shah S, Chaukar D, Pantvaidya G, Deshmukh A, Chaturvedi P, Pai P, Nair D, Nair S, Thakur M, Ghosh-Laskar S, Agarwal JP, D'Cruz AK. N0 neck trial: Does intensification of follow-up (Ultrasound + Physical Examination) influence outcomes in early-stage oral cancer? Eur J Cancer 2024; 204:114064. [PMID: 38705028 DOI: 10.1016/j.ejca.2024.114064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
AIM OF THE STUDY We previously reported a survival benefit of elective neck dissection (END) over therapeutic neck dissection (TND) in patients with clinically node-negative early-stage oral cancer. We now report the results of the second question in the same study addressing the impact of adding neck ultrasound to physical examination during follow-up on outcomes. METHODS Patients with lateralized T1/T2 oral squamous cell carcinoma (SCC) were randomized to END or TND and to follow-up with physical-examination plus neck ultrasound (PE+US) versus physical-examination (PE). The primary endpoint was overall survival (OS). RESULTS Between January 2004 and June 2014, 596 patients were enrolled. This is an intention to treat analysis of 592 analysable patients, of whom 295 were allocated to PE+US and 297 to PE with a median follow-up of 77.47 months (interquartile range (IQR) 54.51-126.48). There was no significant difference (unadjusted hazard ratio [HR], 0.92, 95% CI, 0.71-1.20, p = 0.54) in 5-year OS between PE+US (70.8%, 95% CI, 65.51-76.09) and PE (67.3%, 95% CI, 61.81-72.79). Among 131 patients with neck node relapse as the first event, the median time to relapse detection was 4.85 (IQR 2.33-9.60) and 7.62 (IQR 3.22-9.86) months in PE+US and PE arms, respectively. The N stage in the PE+US arm was N1 33.8%, N2a 7.4%, N2b/c 44.1% and N3 14.7% while in PE was N1 28.6%, N2a 9.5%, N2b/c 39.7%, N3 20.6% and unknown 1.6%. CONCLUSION Adding neck ultrasound to physical examination during follow-up detects nodal relapses earlier but does not improve overall survival.
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Affiliation(s)
- Richa Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Snehal Shah
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Max Nanavati Hospital, Mumbai, India
| | | | - Anuja Deshmukh
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Prathamesh Pai
- Punyashlok Ahilyadevi Holkar, Head Neck Cancer Institute of India (HNCII), India
| | - Deepa Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Sudhir Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | | | - J P Agarwal
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Anil K D'Cruz
- Director Oncology-Apollo Group of Hospitals, Department of Oncology, Apollo Hospital, Navi Mumbai, India.
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Swain M, Budrukkar A, Murthy V, Pai P, Kanoja A, Ghosh-Laskar S, Deshmukh A, Pantvaidya G, Kannan S, Patil VM, Naronha V, Prabhash K, Sinha S, Kumar A, Gupta T, Agarwal J. Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:278-286. [PMID: 38365518 DOI: 10.1016/j.clon.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kanoja
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Clinical Research Secretariat Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Naronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Vaish R, Mahajan A, Sable N, Dusane R, Deshmukh A, Bal M, D’cruz AK. Role of computed tomography in the evaluation of regional metastasis in well-differentiated thyroid cancer. Front Radiol 2023; 3:1243000. [PMID: 38022790 PMCID: PMC10643764 DOI: 10.3389/fradi.2023.1243000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Abstract
Background Accurate neck staging is essential for performing appropriate surgery and avoiding undue morbidity in thyroid cancer. The modality of choice for evaluation is ultrasonography (US), which has limitations, particularly in the central compartment, that can be overcome by adding a computed tomography (CT). Methods A total of 314 nodal levels were analyzed in 43 patients with CT, and US; evaluations were done between January 2013 and November 2015. The images were reviewed by two radiologists independently who were blinded to histopathological outcomes. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of US, CT, and US + CT were calculated using histology as the gold standard. Results The overall sensitivity, specificity, PPV, and NPV for US, CT, and US + CT were 53.9%, 88.8%, 74.1%, and 76.4%; 81.2%, 68.0%, 60.1%, and 85.9%; and 84.6%, 66.0%, 59.6%, and 87.8%, respectively. The overall accuracy of the US was 75.80%, the CT scan was 72.93%, and the US + CT scan was 72.93%. For the lateral compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 56.6%, 91.4%, 77.1%, and 80.5%; 80.7%, 70.6%, 58.3%, and 87.8%; and 84.3%, 68.7%, 57.9%, and 89.6%, respectively. The accuracy of the US was 79.67%, the CT scan was 73.98%, and the US + CT scan was 73.98% for the lateral compartment. For the central compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 47.1%, 76.5%, 66.7%, and 59.1%; 82.4%, 55.9%, 65.1%, and 76.0%; and 85.3%, 52.9%, 64.4%, and 78.3%, respectively. The accuracy of the US was 61.76%, the CT scan was 69.12%, and the US + CT scan was 69.12% for the central compartment. Conclusions This study demonstrated that CT has higher sensitivity in detecting nodal metastasis; however, its role is complementary to US due to low specificity.
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Affiliation(s)
- Richa Vaish
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rohit Dusane
- Department of Statistics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. D’cruz
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Subramanian P, Deshmukh A, Kante K, Patil A, Pai T, Kaur R, Rane S, Shetty O, Ankathi SK, Mittal N. HRAS-mutated primary thyroid malignant melanoma or medullary thyroid carcinoma with melanocytic dedifferentiation? A singular case with an ontogeny-phylogeny quandary. Virchows Arch 2023; 483:421-429. [PMID: 37550582 DOI: 10.1007/s00428-023-03619-1] [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: 06/08/2023] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
Melanotic pigment in the thyroid is practically synonymous with chronic minocycline therapy and rare cases of melanotic medullary thyroid carcinoma. However, primary melanoma of the thyroid has not been reported yet. We report a rare case of a 25-year-old male with a locally aggressive thyroid mass and distant metastases at presentation. Radiologically, a 8.3×7.6-cm nodule was identified in the right thyroid lobe. Fine-needle aspiration cytology (FNAC) showed discohesive atypical plasmacytoid cells with prominent nucleoli and no cytoplasmic pigmentation. Serum calcitonin levels were normal. A trucut biopsy showed a malignant tumor with a similar cytomorphology, including marked nuclear pleomorphism. In addition, intracytoplasmic melanin was seen in <1% of cells. Tumor cells were immunonegative for AE1/AE3, TTF1, synaptophysin, and chromogranin while positive for SOX10, S100P, HMB45, and Melan A, confirming the diagnosis of malignant melanoma, without any detectable MTC component in the biopsy. An HRAS G13R mutation was detected on NGS, which, intriguingly, is a known mutation in MTC, and exceedingly rare in melanocytic lesions. No other clinically or radiologically apparent primary lesion was identified elsewhere in the patient. The unusual histology and hitherto unreported molecular findings make this case of primary thyroid melanocytic neoplasm worth reporting. Abstruse origin of melanoma cells in the thyroid gland with molecular signature suggestive of MTC in our case raises a nomenclature and management conundrum, prompting us to revisit the "ontogeny recapitulates phylogeny" theory.
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Affiliation(s)
- Priyadarsani Subramanian
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Homi Bhabha National Institute, Mumbai, India
- Department of Head and Neck Surgical oncology, Tata Memorial Center, Parel, Mumbai, 400012, India
| | - Katha Kante
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Ramandeep Kaur
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Omshree Shetty
- Homi Bhabha National Institute, Mumbai, India
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India
| | - Suman Kumar Ankathi
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, 400012, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Center, Mumbai, 400012, India.
- Homi Bhabha National Institute, Mumbai, India.
- Molecular pathology division, Department of Pathology, Tata Memorial Center, Mumbai, 400012, India.
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Thiagarajan S, Kantamani T, Sathe P, Shetty R, Deshmukh A, Chaukar D, Biswas S, Divatia JV, Srivastav S, Mathur P, Myatra SN. Impact of surgical site infection on unplanned hospital readmissions, initiation of adjuvant treatment following surgery, and disease-free survival on patients with upper aerodigestive tract squamous cell carcinoma. J Surg Oncol 2023; 128:692-700. [PMID: 37232552 DOI: 10.1002/jso.27356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Unplanned hospital readmission (UHR) is an important indicator of the quality of the healthcare system in place. It has various implications for the patients and the healthcare system at large. In this article, we have attempted to understand the various factors influencing UHR and the start of adjuvant treatment following cancer surgery. PATIENTS & METHODS In this study adult patients above 18 years of age with upper aerodigestive tract squamous cell carcinoma who underwent surgery at our center between July 2019 to December 2019 were included in the study. Various factors influencing UHR and delay in receiving adjuvant treatment were analyzed. RESULTS A total of 245 patients satisfied the inclusion criteria. Surgical site infection (SSI) was the factor that had the maximum influence on the UHR (p < 0.002, OR: 5.6, 95% CI: [1.911-16.4]) and delaying the start of adjuvant treatment (p = 0.008, OR: 3.786, 95% CI: [1.421-10.086]) on multivariate analysis. Surgery lasting for >4 h and patients who had received prior treatment tended to develop SSI postoperatively. The presence of SSI also seemed to have had a negative influence on disease-free survival (DFS) as well. CONCLUSIONS SSI is an important postoperative complication having major implications in terms of increased UHR and delays in starting adjuvant treatment which in turn is reflected as a poorer DFS among patients who develop SSI postoperatively.
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Affiliation(s)
- Shivakumar Thiagarajan
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Teja Kantamani
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pranav Sathe
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ratan Shetty
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuja Deshmukh
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Devendra Chaukar
- Department of Head & Neck Surgical Oncology, Max Nanavati Hospital, Mumbai, India
| | - Sanjay Biswas
- Department of Microbiology, Tata Memorial Hospital, Homi Bhabha ational Institute (HBNI), Mumbai, India
| | - Jigeeshu V Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sharad Srivastav
- Department of Laboratory Medicine, JPNA Trauma Center, AIIMS, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNA Trauma Center, AIIMS, New Delhi, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Ghosh Laskar S, Sinha S, Gupta M, Karmakar S, Nivedha J M, Kannan S, Budrukkar A, Swain M, Kumar A, Gupta T, Murthy V, Chaukar D, Pai P, Chaturvedi P, Pantvaidya G, Nair D, Nair S, Thiagarajan S, Deshmukh A, Noronha V, Patil V, Joshi A, Prabhash K, Agarwal JP. Prophylactic versus reactive feeding approach in patients undergoing adjuvant radiation therapy for oral cavity squamous cell carcinoma: A propensity score matched-pair analysis. Head Neck 2023; 45:1226-1236. [PMID: 36912016 DOI: 10.1002/hed.27336] [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: 09/02/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND To assess the efficacy of prophylactic versus reactive feeding strategy in oral cavity squamous cell carcinoma (OCSCC) patients receiving adjuvant radiation therapy (RT). METHODS This was a post hoc analysis of patients of OCSCC enrolled in a randomized trial comparing three adjuvant strategies. In this trial, till 2010, a prophylactic feeding approach was followed for all patients. Since January 2011, a reactive feeding approach was followed. RESULTS Two hundred and sixty-eight in each cohort (total n = 526) were eligible for analysis after propensity score matching. At 6 weeks post-RT completion, the median weight loss in the prophylactic versus reactive cohort was 5 versus 3 kg, p = 0.002. At all other time points until 1 year, the median weight loss was lesser in reactive than in the prophylactic cohort. CONCLUSIONS A reactive feeding tube approach should be preferred for OCSCC receiving adjuvant RT.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shreyasee Karmakar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Nivedha J
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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7
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Laskar SG, Chaukar D, Deshpande M, Chatterjee A, Sinha S, Chakraborty S, Agarwal JP, Gupta T, Budrukkar A, Murthy V, Pai P, Chaturvedi P, Pantvaidya G, Deshmukh A, Nair D, Nair S, Prabhash K, Swain M, Kumar A, Noronha V, Patil V, Joshi A, DCruz A. Oral cavity adjuvant therapy (OCAT) -a phase III, randomized controlled trial of surgery followed by conventional RT (5 fr/wk) versus concurrent CT-RT versus accelerated RT (6fr/wk) in locally advanced, resectable, squamous cell carcinoma of oral cavity. Eur J Cancer 2023; 181:179-187. [PMID: 36669426 DOI: 10.1016/j.ejca.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited data exists regarding the impact of intensification of adjuvant therapy in resected Oral Cavity Squamous Cell Carcinomas (OCSCC) with adverse prognostic features on histopathology. PATIENTS AND METHODS This was a three-arm phase III, randomised trial including patients with resected advanced OCSCC. Randomisation was done in a 1:1:1 ratio: Arm-A- standard adjuvant radiation therapy (RT) 60Gy/30 fractions over 6 weeks versus Arm-B-concurrent chemoradiation versus Arm-C-accelerated radiation therapy (6 d a week). The trial was powered to detect an absolute difference of 10% in 5-year Locoregional Control (LRC). RESULTS The trial was conducted between June 2005 and March 2013. Majority of the patients were males, had T3-T4 disease, had N2-N3 nodal status and had Extra-Capsular Extension (ECE) in nodes. The median follow-up was 95.9 months. There was no difference between the three arms (A versus B versus C) for 10-year locoregional control (LRC): 60.2% versus 61.4% versus 65.7%, p = 0.57; disease free survival (DFS): 37.4% versus 43.9% versus 39.6%, p = 0.40; or Overall Survival (OS): 39.7% versus 46.6% versus 40.4%, p = 0.40. There was no benefit of intensification with either modality in patients with any single adverse pathological factor. A benefit of intensification could be seen in patients with a combination of high-risk features: T3-T4 primary tumours with N2-N3 nodes along with ECE for DFS (Arm B versus Arm A HR) = 0.53, Arm C versus Arm A HR = 0.63) and OS (Arm B versus Arm A HR = 0.58, Arm C versus Arm A HR = 0.60). CONCLUSIONS All optimally resected OCSCC with adverse features did not benefit from intensification of adjuvant therapy. Only a cohort of patients with a combination of high-risk features are likely candidates for intensification. CLINICAL TRIAL REGISTRATION NCT00193843.
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Affiliation(s)
- Sarbani G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mandar Deshpande
- Department of Surgical Oncology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Jai P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anil DCruz
- Director Oncology Services and Head Neck Cancer Surgeon, Apollo Hospitals, Mumbai, India
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Swain M, Budrukkar A, Laskar SG, Sinha S, Kumar A, Pai P, Pantavaidya G, Deshmukh A, Patil V, Prabhash K, Naronha V, Agarwal J. Contralateral Nodal Relapse (CLNR) in Well Lateralized Oral Cavity Cancer Treated Ipsilaterally with Surgery and Adjuvant Radiotherapy with or without Concurrent Chemotherapy: A Retrospective Audit. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Victor V, Thakkar S, Patel H, Deshmukh A, Desimone C, Feitell SC, Blankstein R. A nationwide analysis of cardiac sarcoidosis and related in-hospital outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be.
Purpose
With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US).
Methods
We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses.
Results
A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993).
Conclusion
Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Victor
- Aultman Hospital , Canton , United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine , Rochester , United States of America
| | - H Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine , Chicago , United States of America
| | - A Deshmukh
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - C Desimone
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - S C Feitell
- Rochester General Hospital, Advanced Heart Failure and Transplant Cardiology , Rochester , United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Cardiology , Boston , United States of America
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Deshmukh A, Kesari P, Pahelkar N, Suryawanshi A, Rathore I, Mishra V, Dupuis J, Xiao H, Gustchina A, Abendroth J, Labaied M, Yada R, Wlodawer A, Edwards T, Lorimer D, Bhaumik P. Structural insights of plasmepsin X from Plasmodium falciparum uncovering a novel inactivation mechanism of zymogen. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Sainani S, Bhombe D, Rode K, Deshmukh A, Desai S. Plasma Therapy: An Effective Treatment for Infections from Microbes with Special Reference to Coronavirus Disease 2019. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Chaukar D, Prabash K, Rane P, Patil VM, Thiagarajan S, Ghosh-Laskar S, Sharma S, Pai PS, Chaturvedi P, Pantvaidya G, Deshmukh A, Nair D, Nair S, Vaish R, Noronha V, Patil A, Arya S, D'Cruz A. Prospective Phase II Open-Label Randomized Controlled Trial to Compare Mandibular Preservation in Upfront Surgery With Neoadjuvant Chemotherapy Followed by Surgery in Operable Oral Cavity Cancer. J Clin Oncol 2021; 40:272-281. [PMID: 34871101 DOI: 10.1200/jco.21.00179] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The objective of this study was to explore the potential role and safety of neoadjuvant chemotherapy (NACT) in tumor shrinkage and resultant mandibular preservation in oral cancers compared with conventional surgical treatment. METHODS This study was a single-center, randomized, phase II trial of treatment-naive histologically confirmed squamous cell carcinoma of the oral cavity with cT2-T4 and N0/N+, M0 (American Joint Committee on Cancer, seventh edition) stage, necessitating resection of the mandible for paramandibular disease in the absence of clinicoradiologic evidence of bone erosion. The patients were randomly assigned (1:1) to either upfront surgery (segmental resection) followed by adjuvant treatment (standard arm [SA]) or two cycles of NACT (docetaxel, cisplatin, and fluorouracil) at 3-week intervals (intervention arm [IA]), followed by surgery dictated by postchemotherapy disease extent. All patients in the IA received adjuvant chemoradiotherapy, and patients in the SA were treated as per final histopathology report. The primary end point was mandible preservation rate. The secondary end points were disease-free survival and treatment-related toxicity. RESULTS Sixty-eight patients were enrolled over 3 years and randomly assigned to either SA (34 patients) or IA (34 patients). The median follow-up was 3.6 years (interquartile range 0.95-7.05 years). Mandibular preservation was achieved in 16 of 34 patients (47% [95% CI, 31.49 to 63.24]) in the IA. The disease-free survival (P = .715, hazard ratio 0.911 [95% CI, 0.516 to 1.607]) and overall survival (P = .747, hazard ratio 0.899 [95% CI, 0.510 to 1.587]) were similar in both the arms. Complications were similar in both arms, but chemotherapy-induced toxicity was observed in the majority of patients (grade III: 14, 41.2%; grade IV: 11, 32.4%) in the IA. CONCLUSION NACT plays a potential role in mandibular preservation in oral cancers with acceptable toxicities and no compromise in survival. However, this needs to be validated in a larger phase III randomized trial.
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Affiliation(s)
- Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Kumar Prabash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Pawan Rane
- Head and Neck Surgical Oncologist, Healthway Hospital, Goa, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.,Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Shilpi Sharma
- Head and Neck Surgical Oncologist, Narayana Superspeciality Hospital, Gurugram, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Supreeta Arya
- Independent Practice Expert Opinion Teleradiology, Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Anil D'Cruz
- Department of Oncology, Apollo Hospital's, Navi, Mumbai, India
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Deshmukh A, Rao KN, Arora RD, Nagarkar NM, Singh A, Shetty OS. Correction to: Molecular Insights into Oral Malignancy. Indian J Surg Oncol 2021; 13:281. [DOI: 10.1007/s13193-021-01470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Deshmukh A, Rao KN, Arora RD, Nagarkar NM, Singh A, Shetty OS. Molecular Insights into Oral Malignancy. Indian J Surg Oncol 2021; 13:267-280. [DOI: 10.1007/s13193-021-01431-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
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D'Cruz AK, Dhar H, Vaish R, Hawaldar R, Gupta S, Pantvaidya G, Chaukar D, Chaturvedi P, Pai P, Deshmukh A, Kane S, Nair D, Nair SV, Ghosh-Laskar S, Agarwal J. Depth of invasion in early oral cancers- is it an independent prognostic factor? Eur J Surg Oncol 2021; 47:1940-1946. [PMID: 33814237 DOI: 10.1016/j.ejso.2021.03.243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/28/2021] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Depth of invasion (DOI) has been incorporated into oral cancer staging. Increasing DOI is known to be associated with an increased propensity to neck metastasis and adverse tumor factors and hence may not be an independent prognosticator but a surrogate for a biologically aggressive tumor. METHODS 570 patients, median follow up 79.01 months from a previously reported randomized trial (NCT00193765) designed to establish appropriate neck treatment [elective neck dissection (END) vs therapeutic neck dissection (TND)] in clinically node-negative early oral cancers were restaged (nT) according to AJCC TNM 8th edition. Overall survival (OS) was estimated for the entire cohort, END, and TND arms. Multivariate analysis performed for stratification and prognostic factors, and interaction term between revised T-stage and neck treatment, for tumours with DOI≤10mm. Presence of adverse factors was compared between nT3 (DOI>10 mm) and those with DOI≤10 mm. RESULTS Stage migration occurred in 44.38% of patients. 5-Year OS was nT1-79%, nT2-69.4% and nT3-53.8%, (p < 0.001). In TND arm 5-year OS was nT1-81.1% versus nT2-65%,p = 0.004, while that in END arm was nT1 -76.9% versus nT2 -73.7%,p = 0.73. There was a significant interaction between T stage and neck treatment (p = 0.03). T3 tumors (>10 mm) were associated with a higher proportion of adverse factors (occult nodal metastasis, p = 0.035; LVE/PNI, p = 0.001). CONCLUSION Elective neck treatment negates the prognostic impact of DOI for early oral cancers (T1/T2 DOI≤10 mm). T3 tumors with DOI>10 mm have a higher association with other adverse risk factors resulting in poorer outcomes in spite of elective neck dissection.
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Affiliation(s)
- Anil K D'Cruz
- Apollo Group of Hospitals, India; Dept. of Oncology, Apollo Hospital, Navi Mumbai, Pin code- 400614, Maharashtra, India.
| | - Harsh Dhar
- Dept. of Head and Neck Oncology, Narayana Superspeciality Hospitals, Howrah, Pin code-711103, West Bengal, India
| | - Richa Vaish
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Rohini Hawaldar
- Research Administration Council, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Research Administration Council, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Medical Oncology, ACTREC (Advanced Centre for Treatment, Research and Education in Cancer), Navi Mumbai, 410210, Maharashtra, India; Department of Medical Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Shubhada Kane
- SRL Diagnostics, Center of Excellence, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India; Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Sudhir Vasudevan Nair
- Department of Head and Neck Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India; Department of Head and Neck Oncology, Advanced Center for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, Maharashtra, 410210, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Pincode-400012, Maharashtra, India; Department of Radiation Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Pincode-400012, Maharashtra, India; Department of Radiation Oncology, Homi Bhabha National Institute, Mumbai, 400088, Maharashtra, India
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Laskar SG, Pai P, Sinha S, Budrukkar A, Nair D, Swain M, Mummudi N, Gupta T, Murthy V, Agarwal JP, Tiwari N, Thiagrajan S, Chaukar D, Chaturvedi P, Pantvaidya G, Deshmukh A, Nair S, Prabhash K, Joshi A, Noronha V, Patil V, Menon N, Patil A, Bal M, Mittal N, Rane S. Intensity-modulated radiation therapy for nasal cavity and paranasal sinus tumors: Experience from a single institute. Head Neck 2021; 43:2045-2057. [PMID: 33687114 DOI: 10.1002/hed.26669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/21/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To assess the efficacy of intensity-modulated radiation therapy (IMRT) for tumors of the nasal cavity and paranasal sinus (PNS) region. MATERIALS AND METHODS Two hundred fourteen patients with tumors of the nasal cavity and PNS region treated with curative intent IMRT between 2007 and 2019 were included in this retrospective analysis. RESULTS Fifty-one (24.1%) received definitive RT/CTRT and 163 (75.9%) received adjuvant RT. Most common histology was squamous cell carcinoma (26.1%) followed by adenoid cystic carcinoma (21.5%). The median follow-up was 43.5 months. The 5-year local control (LC), event-free survival (EFS), and overall survival (OS) for the entire cohort was 66.9%, 59%, and 73.9%, respectively. On univariate analysis treatment with nonsurgical modality, T classification and undifferentiated/poorly differentiated histology were associated with inferior 5-year LC, EFS, and OS. Four patients had late Grade 3/Grade 4 ocular toxicity. CONCLUSIONS IMRT should be the standard of care for tumors of PNS region across all histologies and treatment setting.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neelesh Tiwari
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shiva Thiagrajan
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Agrawal S, Gaikwad S, Patel R, Shinde L, Deshmukh A. Synthesis and Formulation Development of Phenytoin by Inclusion Complexation. Indian J Pharm Sci 2021. [DOI: 10.36468/pharmaceutical-sciences.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Arora S, P Patel H, Jani C, Thakkar S, Gonzalez J, Deshmukh A, Patel R, D'Hoit B. Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0441] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The effectiveness of catheter ablation as a management modality amongst patients with coexisting atrial flutter (AFL) and heart failure with reduced ejection fraction (HFrEF) is scarcely studied.
Methods
Appropriate ICD 10 codes were applied to the 2016 and 2017 National Readmission Database (NRD) to isolate patients having coexistent AFL and HFrEF including who had undergone an ablation. All-cause mortality at the end of 1 year was used as a primary outcome. Readmission due to AFL, heart failure (HF) and other causes were secondary outcomes. The hazard ratios were generated using Cox regression analysis while the time to event analysis was demonstrated with the Kaplan Meier curves.
Results
Out of a total of 9966 patients with AFL and HFrEF, 1980 (24.79%) patients underwent catheter ablation. The primary outcome, all-cause mortality (2.8% vs. 4.6%, HR: 0.610, 95% CI: 0.460–0.808, p=0.001) at the end of 1 year was significantly lower. Significant difference was also noted amongst two groups when it came to secondary outcomes such as readmissions due to AFL (1.6% vs. 6.3%, HR: 0.247, 95% CI: 0.173–0.354, p<0.001), HF (8.2% vs. 11.4%, HR: 0.693, 95% CI: 0.587–0.819, p<0.001) and other causes (29.4% vs. 37.1%, HR: 0.735, 95% CI: 0.673–0.804, p<0.001)
Conclusion
Ablative intervention amongst AFL patients with concomitant HFrEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to AFL, HF and other causes at the end of one year.
Outcomes of AFL and HFrEF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Arora
- Harrington Heart and Vascular institute/University Hospitals Cleveland Medical Center, Cardiovascular Diseases, Cleveland, United States of America
| | - H P Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine, Chicago, United States of America
| | - C Jani
- Mount Auburn Hospital, Internal Medicine, Cambridge, United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - J Gonzalez
- Miami Cardiac and Vascular Institute, Cardiovascular Disease, Miami, United States of America
| | - A Deshmukh
- Mayo Clinic, Cardiovascular Disease, Rochester, United States of America
| | - R Patel
- Louis A Weiss Memorial Hospital, Internal Medicine, chicago, United States of America
| | - B D'Hoit
- Harrington Heart and Vascular institute/University Hospitals Cleveland Medical Center, Cardiovascular Disease, Cleveland, United States of America
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Thakkar S, Jani C, P Patel H, Arora S, Patel R, Kumar A, Gonzalez J, Deshmukh A, Rao M. Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0440] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The availability of real-world data regarding the impact of the catheter ablation in patients with concomitant atrial flutter (AFL) and heart failure with preserved ejection fraction (HFpEF) is limited.
Methods
2016 and 2017 National Readmission Database (NRD) was subjected to appropriate ICD-10 codes to identify and extract patients having coexistent atrial flutter and heart failure with preserved ejection fraction including who had undergone ablation. At 1 year, all-cause mortality was utilized as the primary outcome while readmissions due to AFL, heart failure (HF) and any other causes were designated as secondary outcomes. Kaplan Meier curves were used for a time to event analysis. Cox proportional hazard regression was used to generate hazard ratios.
Results
Out of a total 6099 patients with AFL and HFpEF, 906 (14.85%) underwent catheter ablation. At 1 year all cause mortality (3%, vs. 4.4%, HR: 0.661, 95% CI: 0.444–0.985, p=0.042) and readmissions due to AFL (2.3% vs. 5.3%, HR: 0.424, 95% CI: 0.272–0.661, p<0.001) were significantly less among ablation group. Readmission due to HF (9.3% vs. 9.7%, HR: 0.938, 95% CI: 0.745–1.182, p=0.587) and other causes (37% vs.40.3%, HR: 0.926, 95% CI: 0.825–1.040, p=0.193) did not show any significant difference in outcomes at the end of 1 year.
Conclusion
The utilization of catheter ablation amongst AFL patients with concomitant HFpEF showed a significant reduction in all-cause mortality and readmission due to AFL. However, it did not show any significant changes in readmissions due to HF or other causes at the end of one year.
Outcomes of AFL and HFpEF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Thakkar
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - C Jani
- Mount Auburn Hospital, Internal Medicine, Cambridge, United States of America
| | - H P Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine, Chicago, United States of America
| | - S Arora
- University Hospitals Case Medical Center, Divison of cardiovascular, Cleveland, United States of America
| | - R Patel
- Louis A. Weiss Memorial Hospital, Internal medicine, Chicago, United States of America
| | - A Kumar
- St John's Medical College Hospital, Critical care, Bangalore, India
| | - J Gonzalez
- Baptist Health South Florida, Cardiovascular Diseases, Miami, United States of America
| | - A Deshmukh
- Mayo Clinic, Cardiovascular Disease, Rochester, United States of America
| | - M Rao
- Rochester General Hospital, Cardiovascular Diseases, Rochester, United States of America
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20
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Rao K, Deshmukh A, Pai P, Pantvaidya G. Advanced Thyroid Cancer Controversy and Consensus. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Karthik Rao
- Department of Surgical Oncology (Head and Neck), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Surgical Oncology (Head and Neck), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Surgical Oncology (Head and Neck), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Surgical Oncology (Head and Neck), Tata Memorial Hospital, Mumbai, Maharashtra, India
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21
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Ghosh-Laskar S, Pilar A, Johnny C, Prabhash K, Joshi A, Agarwal JP, Gupta T, Budrukkar A, Murthy V, Swain M, Noronha V, Patil VM, Pai P, Nair D, Chaukar DA, Thiagarajan S, Pantvaidya G, Deshmukh A, Chaturvedi P, Nair S, D'Cruz A. Clinical outcomes for nasopharyngeal cancer with intracranial extension after taxane-based induction chemotherapy and concurrent chemo-radiotherapy in the modern era. World J Otorhinolaryngol Head Neck Surg 2020; 6:25-33. [PMID: 32426700 PMCID: PMC7221210 DOI: 10.1016/j.wjorl.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the survival outcomes for a cohort of nasopharyngeal cancer with intracranial extension (ICE) treated with induction chemotherapy (ICT) followed by chemo-intensity-modulated radiotherapy (CTRT) at a tertiary cancer center. Methods We retrospectively analyzed 45 patients with histologically proven, non-metastatic NPC with ICE treated at our institute between October 2008 and October 2016. Patients were classified as minor ICE or major ICE, based on the extent of ICE. All the patients received 2–3 cycles of a taxane-based ICT regimen followed by CTRT. Radiotherapy was delivered with “risk-adapted” intensity-modulated radiotherapy (IMRT) technique in all patients. Results After a median follow up of 45 months (range: 8–113 months), the estimated 5-year DFS, LRFS, DMFS, and OS of the entire cohort was 58%, 82%, 67% and 74% respectively. On multivariate analysis, histological subtype was an independent predictor of LRFS, and age was an independent predictor of DFS. The extent of ICE showed only a trend towards worse DFS (P = 0.06). None of the factors significantly predicted for DMFS or OS. Gender, N-stage, and response to ICT did not significantly affect any of the outcomes. Grade 2 or worse subcutaneous fibrosis was seen in 22% of patients and grade 2 or worse xerostomia was seen in 24% of patients at last follow up. Thirty-three percent of the patients developed clinical hypothyroidism at last follow up. None of the patients experienced any neurological or vascular complications. Conclusions Taxane-based induction chemotherapy followed by chemo-intensity modulated radiotherapy resulted in excellent locoregional control and survival with acceptable toxicities in patients of nasopharyngeal cancer with intracranial extension. Distant metastasis continues to be the predominant problem in these patients.
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Affiliation(s)
- Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Avinash Pilar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Carlton Johnny
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Maruthi Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Deepa Nair
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Devendra Arvind Chaukar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shivakumar Thiagarajan
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gouri Pantvaidya
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudhir Nair
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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22
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Chaukar D, Pai PS, Chaturvedi P, Pantvaidya G, Deshmukh A, Nair D, Thiagarajan S, D'Cruz A, Prabash K, Noronha V, Patil VM, Laskar S. A prospective phase II open-label randomized controlled trial to compare mandibular preservation in upfront surgery to neoadjuvant chemotherapy followed by surgery in operable oral cavity cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6518 Background: The study objective was to evaluate the non-Inferiority of survival and ability to preserve mandible with the use of neoadjuvant chemotherapy (NACT) in locally advanced oral cancers compared to upfront surgery alone without compromising survival. Methods: This study was a randomized, single centre, non-inferiority trial. Eligibility criteria included treatment naïve histologically confirmed cancer of the oral cavity; cancers requiring segmental resection for paramandibular disease without clinicoradiological evidence of bone erosion, clinical T2, T3 and T4, any N, M0 as per TNM (AJCC) 7th edition, age at least 18 years; and written informed consent. The patients were randomly assigned (1:1) to receive either upfront surgery followed by adjuvant treatment (Standard arm-SA) or receive two cycles of three drugs NACT (Docetaxel, Cisplatin, 5-Flurouracil) at three weekly interval (Intervention arm-IA). Depending on the response after two cycles, the patient would either receive an additional third cycle or undergo surgery followed by adjuvant treatment as decided by the tumour board. The primary endpoint was mandible preservation rate at 30% in the experimental arm. The secondary end points being Loco regional control and treatment related toxicity. Results: Between September 2010 and April 2013, 68 patients were enrolled and randomized to SA (34 patients) and IA (34 patients) with a median follow-up of 3.6 years (IQR 0.95- 7.05 years). Majority of the patients were T4 (n = 40, 58.8%) In the IA 28 patients had partial response (n = 28,82.4%), with a mandible preservation (Marginal Mandibulectomy) rate of 48% (n = 16/34). There were no close or positive margins in the IA. All patients received adjuvant treatment. The number of recurrences was similar in both the arms. All patients in the IA developed toxicities with the majority developing Grade III-IV toxicities (Grade III: 14, 41.2%, Grade IV: 11, 32.4%) (p = 0.739). The disease free survival (DFS) (p = 0.715, HR 0.911[0.516-1.607]) and overall survival (OS) (p = 0.747, HR 0.899[0.510-1.587]) were similar in both the arms. Conclusions: NACT seems to be a feasible option for mandibular preservation with acceptable toxicities in a select group of patients without compromising survival. However this needs to be tested in a larger phase III randomized trial. Clinical trial information: CTRI/2015/11/006396 .
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Affiliation(s)
| | - P. S. Pai
- Tata Memorial Hospital, Mumbai, India
| | | | | | | | | | | | - Anil D'Cruz
- Department of Surgical Oncology, Head and Neck Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
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23
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Abstract
Primary cardiac neoplasms are extremely rare and are far outnumbered by metastases. These are difficult to diagnose and differentiate clinically due to lack of specific clinical manifestations. Technological advances have revolutionised cardiac imaging, with the cardiac magnetic resonance imaging (CMRI) showing promising results in the non-invasive evaluation of cardiac masses. Further, CMRI may envisage the malignant potential of a lesion based on its location, morphology, and signal characteristics, in addition to determining its impact on cardiac function. With the ever-increasing application of CMRI in the evaluation of neoplasms, comprehensive knowledge of their imaging characteristics becomes crucial.
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Affiliation(s)
- P Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Deshmukh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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24
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Thiagarajan S, Dhar H, Bhattacharjee A, Fatehi KS, Shah SB, Chaukar D, Nair D, Deshmukh A, Prabhash K, Joshi A, Patil V, Noronha V, Laskar SG, Cruz AKD. Patterns of failure and outcomes in cT4 Oral squamous cell carcinoma (OSCC) undergoing upfront surgery in comparison to Neo-Adjuvant Chemotherapy (NACT) followed by surgery: A Matched Pair analysis. Oral Oncol 2019; 100:104455. [PMID: 31739192 DOI: 10.1016/j.oraloncology.2019.104455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/08/2019] [Accepted: 10/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India.
| | - Harsh Dhar
- Consultant Head & Neck Surgeon, Narayana Hospital, Kolkata, India
| | - Atanu Bhattacharjee
- Department of Biostatistics, Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Khuzema Saifuddin Fatehi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Snehal Bhupesh Shah
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Maharashtra, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Tata Memorial Centre, Mumbai 400012, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Tata Memorial Centre, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Tata Memorial Centre, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Tata Memorial Centre, Mumbai 400012, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India
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Mehra N, Kapa S, Deshmukh A, Asirvatham S. P5703The anterior interventricular crux: anatomic basis for ablation below the left sinus of valsalva (LSOV) of varied ECG morphology PVCs. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0645] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Outflow tract premature ventricular complexes (PVCs) may be ablated at sites where the local electrogram is early. We describe ablation of PVCs of varying morphology at a cruciate structure extending from the inflection of the great cardiac vein to the junction of the distal RVOT and from the left ventricular (LV) inflow myocardium through the aortic mitral continuity (AMC) to the right coronary sinus of Valsalva centered below LSOV, termed the LV crux.
Purpose
Evaluate a novel target for ablation of PVCs with varied QRS morphologies.
Methods
A series of 51 patients undergoing ablation for PVCs between 2013–2018 was identified. In all cases, ICE-guided ablation occurred at the center of the LV crux.
Results
All patients had high PVC burden >20% (28±8%); EF<50% in 40/51 (78%). QRS morphology of PVCs is summarized in Table 1. 50% had prior ablation attempted at early sites. Mapping and ICE-guided ablation at the LV crux (Figure 1 A-B) revealed early activation with near-field ventricular or fascicular signal in 31 (61%), while others had early sites at extensions of the crux. PVCs were eliminated in 50/51 (98%) with continued suppression at 3-months. EF normalized in all 51.
Table 1. ECG charactaeristics ECG characteristics Number of patients (%) Inferior morphology 51/51 (100%) Lead I morphology Monophasic R 8/51 (16%) Rs 9/51 (18%) rS 34/51 (66%) Precordial transition Positive across precordium 40 (78%) V2 transition 7 (14%) V3 transition 4 (8%) Maximum deflection index <0.55 37 (73%) >0.55 14 (27%)
Figure 1. Mapping and ablation
Conclusions
A cruciate interventricular multidimensional crux centered below the LSOV is a site for successful ablation of varied PVC morphologies and should be considered for detailed mapping and ablation, particularly when multiple morphologies are present or prior ablation at early sites is unsuccessful. Ventricular myocardial architecture along with conduction system remnants may be the basis for this phenomenon.
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Affiliation(s)
- N Mehra
- Mayo Clinic, Rochester, United States of America
| | - S Kapa
- Mayo Clinic, Rochester, United States of America
| | - A Deshmukh
- Mayo Clinic, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Rochester, United States of America
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26
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Girkar F, Thiagarajan S, Malik A, Sawhney S, Deshmukh A, Chaukar D, D'Cruz A. Factors predisposing to the development of orocutaneous fistula following surgery for oral cancer: Experience from a tertiary cancer center. Head Neck 2019; 41:4121-4127. [PMID: 31497921 DOI: 10.1002/hed.25951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Orocutaneous fistula (OCF) is one of the frequently encountered postoperative complications following surgery for oral cancer, leading to prolonged hospital stay and delay in the initiation of adjuvant therapy. METHODS We included all patients with oral cancer operated between January 2016 to December 2017 and at risk to develop an OCF. We assessed the incidence of OCF, its management, and factors predisposing to its development. RESULTS Of 587 eligible patients, 9% developed OCF. On univariate and multivariate analysis, patients undergoing bilateral neck dissection or with surgical site infection (SSI) (P < .001) were at maximum risk. On univariate analysis, the incidence was higher following resections for tongue-floor of mouth sub site (P = .002), irrespective of the type of flap used for reconstruction. Majority (57%) required surgical intervention for management. CONCLUSION The presence of SSI and performing bilateral neck dissection posed the maximum risk for developing OCF in patients undergoing surgery for oral cancer.
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Affiliation(s)
- Farhana Girkar
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Akshat Malik
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shikhar Sawhney
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anuja Deshmukh
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Devendra Chaukar
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anil D'Cruz
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
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27
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Patil VM, Noronha V, Joshi A, Agarwal J, Ghosh-Laskar S, Budrukkar A, Murthy V, Gupta T, Mahimkar M, Juvekar S, Arya S, Mahajan A, Agarwal A, Purandare N, Rangarajan V, Balaji A, Chaudhari SV, Banavali S, Kannan S, Bhattacharjee A, D'Cruz AK, Chaturvedi P, Pai PS, Chaukar D, Pantvaidya G, Nair D, Nair S, Deshmukh A, Thiagarajan S, Mathrudev V, Manjrekar A, Dhumal S, Maske K, Bhelekar AS, Nawale K, Chandrasekharan A, Pande N, Goel A, Talreja V, Simha V, Srinivas S, Swami R, Vallathol DH, Dsouza H, Shrirangwar S, Turkar S, Abraham G, Thanky AH, Patel U, Pandey MK, Prabhash K. A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer. Cancer 2019; 125:3184-3197. [PMID: 31150120 DOI: 10.1002/cncr.32179] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/02/2019] [Accepted: 03/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Because the addition of nimotuzumab to chemoradiation in patients with locally advanced head and neck cancer improved outcomes in a phase 2 study, the authors conducted a phase 3 study to confirm these findings. METHODS This open-label, investigator-initiated, phase 3, randomized trial was conducted from 2012 to 2018. Adult patients with locally advanced head and neck cancer who were fit for radical chemoradiation were randomized 1:1 to receive either radical radiotherapy (66-70 grays) with concurrent weekly cisplatin (30 mg/m2 ) (CRT) or the same schedule of CRT with weekly nimotuzumab (200 mg) (NCRT).The primary endpoint was progression-free survival (PFS); key secondary endpoints were disease-free survival (DFS), duration of locoregional control (LRC), and overall survival (OS). An intent-to-treat analysis also was performed. RESULTS In total, 536 patients were allocated equally to both treatment arms. The median follow-up was 39.13 months. The addition of nimotuzumab improved PFS (hazard ratio [HR], 0.69; 95% CI, 0.53-0.89; P = .004), LRC (HR, 0.67; 95% CI, 0.50-0.89; P = .006), and DFS (HR, 0.71; 95% CI, 0.55-0.92; P = .008) and had a trend toward improved OS (HR, 0.84; 95% CI, 0.65-1.08; P = .163). Grade 3 through 5 adverse events were similar between the 2 arms, except for a higher incidence of mucositis in the NCRT arm (66.7% vs 55.8%; P = .01). CONCLUSIONS The addition of nimotuzumab to concurrent weekly CRT improves PFS, LRC, and DFS. This combination provides a novel alternative therapeutic option to a 3-weekly schedule of 100 mg/m2 cisplatin in patients with locally advanced head and neck cancer who are treated with radical-intent CRT.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Manoj Mahimkar
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | | | - Supreeta Arya
- Department of Radiology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Atanu Bhattacharjee
- Department of Epidemiology, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Anil K D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Aparna Manjrekar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kamesh Maske
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arti Sanjay Bhelekar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Alok Goel
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijai Simha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rohit Swami
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Dilip Harindran Vallathol
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Hollis Dsouza
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sameer Shrirangwar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Siddharth Turkar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Aditi Harsh Thanky
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Usha Patel
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Manish Kumar Pandey
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Dhar H, D'Cruz A, Vaish R, Hawaldar RW, Gupta S, Pantvaidya G, Chaukar D, Chaturvedi P, Pai PS, Deshmukh A, Kane S, Nair D, Nair SV, Laskar S, Agarwal J. Depth of invasion in early oral cancers: Is it an independent prognostic factor? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6058] [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: 11/20/2022] Open
Abstract
6058 Background: Depth of invasion (DOI) has been incorporated in the new AJCC TNM staging (8th edition) for oral cancers. We hypothesized that the negative effect of increasing DOI on outcomes was a result of an increased propensity to node metastasis and appropriate neck treatment would negate its detrimental effect on outcomes. Methods: Patients with T1/ T2 oral squamous cell carcinoma, clinically node negative, from a previously reported Randomized Controlled Trial (NCT 00193765) formed the cohort for this study. Patients were restaged according to the new staging system . Overall survival(OS) was estimated by the revised T stage for the entire cohort and separately for those who underwent END and those who did not (TND arm) using Kaplan Meier and log rank test . Multivariate analysis was performed using Cox proportional hazard model making adjustment for neck treatment, T stage, site, prognostic factors and the interaction between revised T stage and neck treatment. Results: Of the 596 patients 577 were evaluable, with a median follow up of 77.57 months. Initial pT staging was pT1, 389(67.4%); pT2, 181(31.4%); pT3, 7(1.2%) and was modified to pT1, 195(33.8%); pT2, 280(48.5%); pT3, 102(17.7%) on restaging . 288 patients underwent END and 289 did not (TND arm). For the entire cohort 5-year OS rates were 79.0% [95 %CI, 73.12-84.88] for pT1, 69.4% [95% CI, 63.91-74.89] for pT2 and 53.0% [95% CI, 43.2 -62.8] for pT3 with significant difference between the 3 groups (p < 0.001). In those without upfront neck treatment( TND ), OS difference was maintained between the pT1 and pT2 groups [81.1% (95%CI, 73.26-88.94) vs 65.0% (95%CI, 56.77-73.23)], p = 0.004. This difference was not apparent in the END arm ,pT1 -76.9% (95 %CI, 68.47-85.33) vs pT2 -73.7% (95%CI, 66.25-81.15), p = 0.73. T3 tumours had uniformly poor survival irrespective of neck treatment. On multivariate analysis of the revised pT1/T2 cohort (n = 475), pT stage, neck treatment and grade were independent prognostic factors impacting OS. There was a significant interaction between the T stage and neck treatment (p = 0.03). Conclusions: When DOI < 10 mm, END supplants the prognostic implication of depth with similar outcomes for T1 and T2 tumours (new AJCC staging). The exact role of DOI on outcomes warrants further research. Clinical trial information: NCT00193765.
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Affiliation(s)
| | - Anil D'Cruz
- Department of Surgical Oncology, Head and Neck Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
| | | | | | - Sudeep Gupta
- Department of Medical Oncology, Breast Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
| | | | | | | | - P. S. Pai
- Tata Memorial Hospital, Mumbai, India
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Redhwan A, Choudhury M, Al Harbi B, Kutbi A, Alfaresi M, AlJindan R, Balkhy H, Al Johani S, Ibrahim E, Deshmukh A, Ahmed M, AlJardani A, Al-Abri S, AlSalman J, Dashti A, Abdelrahman S, Shabban M, Aqel A, AlZoubi H, Sidjabat H, Walsh T, Paterson D, Zowawi H. A Snapshot about the Mobile Colistin Resistance (mcr) in The Middle East and North Africa Region. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Deshmukh A, Gangiti K, Pantvaidya G, Nair D, Basu S, Chaukar D, Pai P, Nair S, Hawaldar R, Dusane R, Chaturvedi P, D'Cruz A. Surgical outcomes of thyroid cancer patients in a tertiary cancer center in India. Indian J Cancer 2018; 55:23-32. [PMID: 30147089 DOI: 10.4103/ijc.ijc_528_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease. Aims This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients. Settings and Design Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India. Materials and Methods We analyzed 221 surgically treated patients in the year 2012. Statistical Analysis Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05. Results The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes. Conclusion Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management.
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Affiliation(s)
- Anuja Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kranthikumar Gangiti
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sandip Basu
- Department of Nuclear Medicine, Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rohini Hawaldar
- Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rohit Dusane
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Nair D, Singhvi H, Mair M, Qayyumi B, Deshmukh A, Pantvaidya G, Nair S, Chaturvedi P, Laskar SG, Prabhash K, DCruz A. Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India. Indian J Cancer 2018; 54:616-620. [PMID: 30082545 DOI: 10.4103/ijc.ijc_445_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes. AIM The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes. SETTINGS AND DESIGN This was a retrospective analysis of prospectively collected data in a tertiary cancer center. MATERIALS AND METHODS This study included 850 surgically treated oral cancer cases between January and December 2012. STATISTICAL ANALYSIS We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression. RESULTS The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula. CONCLUSION The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment.
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Affiliation(s)
- Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Hitesh Singhvi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Manish Mair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Burhanuddin Qayyumi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kumar Prabhash
- Medical Oncologist, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anil DCruz
- Director, Tata Memorial Centre, Mumbai, Maharashtra, India
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Hazarey V, Deshmukh A. Cancer-Free Drive in Rural India: Constituency Wise Initiatives by Member of Legislative Assembly. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.42500] [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: 11/20/2022] Open
Abstract
Background and context: Reducing the rate of cancer through awareness and prevention programs as well improvements in screening and treatment techniques is paramount. Citizen especially in rural India tend to neglect health due to routine chores of family life. The nonavailability of facilities worsen the issue. Tobacco habits leads to potentially malignant disorders and oral cancers. There is increasing trend of breast cancer, uterine and cervical cancers and also oral cancers. In India oral cancers are main cancers in males. Member of legislative assembly is public representative to represent state of Maharashtra. Cancer Free Constituency Drive was for creating awareness and screening for villagers. Katol is a rural constituency. There are 288 constituencies in Maharashtra state. Aim: 1) To create public awareness of all types of cancers. 2) To provide diagnosis and investigations and treatment to affected population. 3) Capacity building of young medical and dental professionals in cancer diagnosis and paramedical workers in screening all types of cancers. Strategy/Tactics: 72,056 house visits by 220 Asha workers and 129 nursing students and 30 dental interns to sensitize about 3,00,000 people through well designed brochure for all cancers. Self-Mouth mirror examination was designed for oral cancers and awareness against tobacco. The persons with complaints were told to visit camps on scheduled dates at 10 primary health centers. Program/Policy process: The mammography facilities and Papanicolaou test examination, dental examination in mobile vans and self-mouth mirror examination for oral cancers with trained professional carried out diagnosis in 10 primary health centers with the help of experts in medical and dental professionals. Suspeced cases were referred to tertiary referral medical hospitals. Outcomes: 5100 (males 2216 and females 2954) with complaints visited. Total 813 patients suspected to have cancers were examined by specialists from gynecology(84) general surgery (374) otorhinolaryngology (77) pediatrics (37) dermatology (19) and dentistry (131). 38 abnormal on mammography in 132 females, 55 abnormal reports from Pap smears in 472 females were evaluated, however no cancer detected in three months span. Twelve cases of oral cancers were detected and treated. Six breast cancers were detected and treated. Seven other cancers were reported by medicine and pediatric specialists. 150 cases of potentially malignant disorders were also identified. 90 had the oral submucous fibrosis (inability to open the mouth) caused due to areca quid chewing. The self-mouth mirror examination helped to create awareness against tobacco. What was learned: Awareness of cancer leading to early detection and treatment is possible in rural areas through “Cancer-Free Constituency”. The concept will help to pave the way for improved strategies and policies to better control occurrence and treatment of cancer and to address tobacco related health disparities across cancer care continuum.
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Affiliation(s)
- V. Hazarey
- No Tobacco Association, Nagpur, India
- Centre of Excellence for Oral Precancer and Cancer, Nagpur, India
| | - A. Deshmukh
- No Tobacco Association, Nagpur, India
- Legislative Assembly, Katol Nagpur, India
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Hegde S, Sadanand S, Bhagabaty S, Kataki A, Chanda S, Varma D, Deshmukh A, Phanse V. Community-Based Cancer Screening Program: The DESH (Detect Early Save Her, Him) Initiative of Piramal Swasthya. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.52900] [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: 11/20/2022] Open
Abstract
Background and context: Two-thirds of global cancer deaths are from less developed countries. Late stage presentation and inability to access care are observed to be higher in lower and middle-income countries resulting in avoidable deaths and disability. Kamrup district in Assam has the fourth highest incidence of cancers in India. Detect Early Save Her, Him (DESH) initiative by Piramal Swasthya in Kamrup district focuses on reducing late-stage diagnosis and mortality. Aim: To reduce the proportion of late-stage diagnosis and mortality from breast, cervical and oral cancers through a community based screening and referral program. Strategy: 1. Community level interventions to increase awareness, improve knowledge, alter attitudes and motivate and mobilize people to undergo screening. 2. Evidence based highly sensitive screening and referral through mobile cancer screening unit. 3. Partnering with a regional cancer care institute (Dr. B. Borooah Cancer Institute - BBCI) to ensure end to end care to the patients. Program: DESH initiative in partnership with BBCI was launched in November 2017. The Mobile Cancer Screening Unit (MCSU) is fully equipped with state-of-the-art cancer screening facilities including a mammography unit. It is staffed by trained medical doctor, two nurses, a radiographer, two community mobilization officers, a counselor, a driver and a helper. Apart from the driver and the helper, the entire staff is women. In consultation with community networks, a schedule is prepared to conduct awareness programs at the community level. Subsequently, the MCSU visits the village and the staff screen the adult population over the age of 30 years for the presence of oral, breast and cervical cancer. A vehicle ferries those who are screened positive, to BBCI for diagnostic tests. The program is also supported by a helpline, which provides tele-counseling for suspected cases of cancer. Outcomes: A total of 1750 beneficiaries have been screened for oral, breast and cervical cancers through 43 screening clinics in 18 villages of Kamrup district from November 2017 through March 2018. Of them, 57% were females. 57 beneficiaries (3.25%) were screen-positive. Majority were positive for oral cancers (n=50) followed by breast and cervical cancers. Out of the 15 beneficiaries who visited BBCI, 3 were confirmed to have oral cancer. What was learned: Rural community of Kamrup district has been very receptive of the screening program with 1750 people screened in a short duration of time. Many screen-positive patients have not yet to visited the hospital for diagnostic tests, due to their financial difficulties. With financial support from the government through a special scheme, the number of screen-positive patients reaching the hospital for diagnostic tests is expected to increase substantially. DESH initiative aims to screen 15,000 individuals in the next 12 months and the results will provide better insights about the scalability and impact of the program.
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Affiliation(s)
- S.K.B. Hegde
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | - S. Sadanand
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | | | - A.C. Kataki
- Dr. B Borooah Cancer Institute, Guwahati, India
| | - S. Chanda
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | - D. Varma
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | - A. Deshmukh
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | - V. Phanse
- Piramal Swasthya Management and Research Institute, Hyderabad, India
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Hazarey V, Deshmukh A. Self-Mouth Mirror Examination: A Boon to Tobacco-Related Potentially Malignant Lesions and Oral Cancer. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.39300] [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: 11/20/2022] Open
Abstract
Background and context: The tobacco related potentially malignant disorders and oral cancer occupies the major burden of diseases caused by smokeless and smoking tobacco in general in southeast Asia and in particular India. The major challenge is due to lack of awareness about ill effects of tobacco especially in rural India. Community awareness is adopted as a measure to reduce mortality and morbidity of oral cancer and also other cancers caused by tobacco. In developing countries like India, the problem is magnified because of low literacy levels and lack of logistics and IEC material. The qualified human resource especially professionals to assist is also another road block. Intervention is designed to create awareness about ill effects of tobacco through a simplified IEC pictorial brochure called Self-Mouth Mirror Examination (SELFMEE). Aim: To aware public about ill effects of tobacco and how to notice the disorders caused at early stages. Capacity building of dental and paramedical and nursing workers toward tobacco control. Strategy/Tactics: Young dental and medical professional and paramedical workers such as nursing students and ancillary workers were trained to educate public about self-mouth mirror examination. Thus spreading awareness against tobacco and promoting health by counseling and treatment of diseases diagnosed. Program/Policy process: Village constituency of a elected legislative member from rural India (katol) was considered to implement policy of SELFMEE. 75,000 homes coming under the ten primary health centers were surveyed nearly covering 200,000 population. The procedure was explained through visual demonstration of brochure. Sign and symptoms were explained and the sensitized populations was screened at primary health centers. Outcomes: 5100 citizens reported to have complaints which were examined by young dental and medical professionals mainly residents. 900 citizens were found to have oral diseases. Majority of the 800 showed the signs and symptoms of a potentially malignant disorder caused by smokeless tobacco and areca nut mixture (gutkha/kharra). Ten oral cancer cases were detected. Eight early cancers were treated at tertiary medical college centers. Two inoperable cases were given palliative treatment. The oral submucous fibrosis cases were advised tobacco and areca quid cessation. What was learned: Mouth mirror examination performed by self-helped tobacco users to observe the ill effects of tobacco habits by themselves thus becoming active partner in tobacco control. The self-motivation to quit habits is effective. Young dental and medical professions were trained in effective cancer control.
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Affiliation(s)
- V. Hazarey
- No Tobacco Association, Nagpur, India
- Center for Oral Precancer and Cancer, Nagpur, India
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Thiagarajan S, Fathehi K, Nair D, Deshmukh A, Pantvaidya G, Chaukar DA, D'Cruz AK. Surgical morbidities and outcomes of major salivary gland neoplasms treated at a tertiary cancer center. Indian J Cancer 2018; 55:33-36. [PMID: 30147090 DOI: 10.4103/ijc.ijc_466_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Objectives Salivary gland neoplasms are relatively uncommon. They have a wide variety of histopathological types with diverse biological behavior. It involves all the major and minor salivary glands in the head and neck. This article focuses on the various types of major salivary gland tumors treated at a tertiary cancer center along with their surgical morbidities and outcomes. Materials and Methods Data of all the salivary gland neoplasms operated in the head and neck services between January 2012 and December 2013 were retrieved from a prospectively collected database. The clinical, demographic data and types of surgeries along with the morbidities were collated from the database and the details regarding the follow-up were collected from the electronic medical record. Results Out of 235. cases registered, 107. patients were treated at our institute. The parotid gland was most commonly involved; majority were malignant lesions. Sixty-two patients were treatment naive at presentation. Majority presented with advanced disease. Superficial parotidectomy was the most common surgery performed and neck dissection was done in 27. patients. Facial nerve palsy was the most common complication following surgery. (16%). Sixty patients received adjuvant treatment. All patients on follow-up were alive at their last visit, with 10. patients having recurrence. Factors influencing the disease-free survival were extracapsular spread, tumor grade, and perineural invasion. Conclusion The postoperative morbidities and outcomes for major salivary gland neoplasms in our series were acceptable and comparable to the results available in the literature. Appropriate treatment of the salivary gland neoplasm will yield good outcomes with acceptable morbidity.
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Affiliation(s)
| | - Khuzema Fathehi
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Anil Keith D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
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Pantvaidya GH, Raina S, Mondal A, Deshmukh A, Nair D, Pai P, Chaturvedi P, D'Cruz A. Total laryngectomy: Surgical morbidity and outcomes - A case series. Indian J Cancer 2018; 54:621-625. [PMID: 30082546 DOI: 10.4103/ijc.ijc_463_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies. AIM The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center. SETTING AND DESIGN This was a retrospective review of a prospective database of TL patients operated during 2012-2013. MATERIALS AND METHODS Patient demographics and other data were captured from the database. Surgical complications were graded as per Clavien-Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan-Meier survival curves. RESULTS A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts. CONCLUSION TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation.
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Affiliation(s)
- Gouri H Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sheetal Raina
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Arindam Mondal
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Padmanabhan D, Kella D, Naksuk N, Isath A, Kapa S, Deshmukh A, Mulpuru S, Felmlee J, Dalzell C, Olson N, Jondal M, Asirvatham S, Watson R, Cha YM, Friedman P. P3698Correlation of lead length with procedural safety outcomes of magnetic resonance imaging in patients with legacy pacemakers and defibrillators. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Kella
- Mayo Clinic, Rochester, United States of America
| | - N Naksuk
- Mayo Clinic, Rochester, United States of America
| | - A Isath
- Mayo Clinic, Rochester, United States of America
| | - S Kapa
- Mayo Clinic, Rochester, United States of America
| | - A Deshmukh
- Mayo Clinic, Rochester, United States of America
| | - S Mulpuru
- Mayo Clinic, Rochester, United States of America
| | - J Felmlee
- Mayo Clinic, Rochester, United States of America
| | - C Dalzell
- Mayo Clinic, Rochester, United States of America
| | - N Olson
- Mayo Clinic, Rochester, United States of America
| | - M Jondal
- Mayo Clinic, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Rochester, United States of America
| | - R Watson
- Mayo Clinic, Rochester, United States of America
| | - Y.-M Cha
- Mayo Clinic, Rochester, United States of America
| | - P Friedman
- Mayo Clinic, Rochester, United States of America
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Pantvaidya G, Mishra A, Deshmukh A, Pai PS, D'Cruz A. Does the recurrent laryngeal nerve recover function after initial dysfunction in patients undergoing thyroidectomy? Laryngoscope Investig Otolaryngol 2018; 3:249-252. [PMID: 30062143 PMCID: PMC6057219 DOI: 10.1002/lio2.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/19/2018] [Accepted: 04/11/2018] [Indexed: 11/07/2022] Open
Abstract
Objective Total thyroidectomy with or without central compartment dissection is the treatment of choice for thyroid carcinoma. Extensive dissection along the recurrent laryngeal nerve (RLN) can lead to vocal cord fixity and hoarseness even without nerve sacrifice. Recovery rates after surgery for thyroid cancers have not been well documented. The aim of the study is to analyze the incidence of vocal cord palsy (VCP) and its recovery rates in patients operated for thyroid cancers. Methodology: We performed a retrospective study on prospectively collected data in 152 thyroidectomy patients with 254 RLNs at risk. All patients underwent a laryngoscopic examination to document vocal cord function in the immediate postoperative period and on subsequent follow-up. Incidence of VCP, recovery rates, univariate and multivariate analysis to identify risk factors for permanent VCP were calculated using binary logistic regression. Results In our study, 28% patients underwent redo surgeries and 74% patients had dissection of the central compartment. The immediate postoperative RLN palsy rate was 11.2%, with a palsy rate of 9% and 16.2% in the per primum and redo surgery cohorts. On follow-up, there was complete recovery of VCP in 66.7% of these nerves. The incidence of permanent RLN palsy was 3.9%. The mean time to recovery was 9.6 months. Conclusion Vocal cord dysfunction recovered in most patients in this high-risk cohort. There was a significant recovery even in the redo surgery group and a policy of watchful waiting is recommended in the absence of severe symptoms. Level of Evidence III.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Head and Neck Surgery Tata Memorial Hospital Mumbai India
| | - Aseem Mishra
- Department of Head and Neck Surgery Tata Memorial Hospital Mumbai India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery Tata Memorial Hospital Mumbai India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery Tata Memorial Hospital Mumbai India
| | - Anil D'Cruz
- Department of Head and Neck Surgery Tata Memorial Hospital Mumbai India
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Mair MD, Shetty R, Nair D, Mathur Y, Nair S, Deshmukh A, Thiagarajan S, Pantvaidya G, Lashkar S, Prabhash K, Chaukar D, Pai P, Cruz AD, Chaturvedi P. Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases. Oral Oncol 2018; 81:95-99. [PMID: 29884420 DOI: 10.1016/j.oraloncology.2018.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/10/2018] [Revised: 03/26/2018] [Accepted: 04/20/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Presence of extracapsular spread (ECS) significantly decreases survival in oral cancer patients. Considering its prognostic impact, we have studied the incidence and factors predicting ECS in clinically node negative early oral cancers. MATERIALS AND METHODS We performed a retrospective chart review of 354 treatment naïve clinically node negative early oral cancer patients operated between 2012 and 2014. Chi-square test and logistic regression were used for identifying predictors of ECS, while cox-regression test was used for survival analysis. RESULTS The incidence of occult nodal metastasis was 28.5% (101/354). Among them, ECS was seen in 15.3%(54/354) patients. The incidence of ECS in T1 and T2 lesion was 13.4% (21/157) and 16.8% (33/197), respectively. The overall incidence of ECS was 48% and 29% in lymph nodes smaller than 10 mm and 5 mm respectively. We found that tumor depth of invasion (>5 mm; p-0.027) and node (metastatic) size >15 mm (p-0.018) were significant predictors of ECS. p N2b disease was seen in 41/354 (11.6%) of which 31/354 (8.7%) had ECS, i.e. 75.6% of pN2b patients been ECS positive (p-0.000). The 3-year OS of patients without nodal metastasis, nodal metastasis without ECS and nodal metastasis with ECS was 88.4%, 66.9% and 59.2% (p-0.000) respectively. CONCLUSION A significant number of patients with metastatic nodal size less than 1 cm have ECS which suggests aggressive behavior of the primary tumor. Thus, elective neck dissection is the only way of detecting ECS in these patients which may warrant treatment intensification.
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Affiliation(s)
- Manish D Mair
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Rathan Shetty
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Yash Mathur
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sudhir Nair
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Anuja Deshmukh
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | | | - Gouri Pantvaidya
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | | | - Kumar Prabhash
- Medical Oncologist, Tata Memorial Hospital, Mumbai, India
| | - Devendra Chaukar
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Prathmesh Pai
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Anil D Cruz
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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Padmanabhan D, Kella DANESH, Tandon N, Deshmukh A, Mulpuru SIVA, Kapa SURAJ, Mehta RAMILA, Dalzell CONNIE, Olson NORA, Felmlee JOEL, Jondal MARYL, Asirvatham SAMUEL, Watson ROBERT, Cha YONGM, Friedman PAUL. 207Clinical utility of performing magnetic resonance imaging in patients with cardiac implantable electronic devices in situ. Europace 2018. [DOI: 10.1093/europace/euy015.056] [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: 11/14/2022] Open
Affiliation(s)
| | - DANESH Kella
- Mayo Clinic, Rochester, United States of America
| | - N Tandon
- Mayo Clinic, Rochester, United States of America
| | - A Deshmukh
- Mayo Clinic, Rochester, United States of America
| | - SIVA Mulpuru
- Mayo Clinic, Rochester, United States of America
| | - SURAJ Kapa
- Mayo Clinic, Rochester, United States of America
| | - RAMILA Mehta
- Mayo Clinic, Rochester, United States of America
| | | | - NORA Olson
- Mayo Clinic, Rochester, United States of America
| | - JOEL Felmlee
- Mayo Clinic, Rochester, United States of America
| | | | | | | | - YONG-M Cha
- Mayo Clinic, Rochester, United States of America
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Kella D, Gruner-Hegge N, Padmanabhan D, Mehta R, Hodge D, Meludini R, Rihal C, Mulpuru S, Deshmukh A, Ammash N, Greene E, Friedman P. P1218Incidence and Risk Factors for Renal Dysfunction after Direct Current Cardioversion of Atrial Fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.700] [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: 11/12/2022] Open
Affiliation(s)
- D Kella
- Mayo Clinic, Cardiology, Rochester, United States of America
| | | | - D Padmanabhan
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - R Mehta
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - D Hodge
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - R Meludini
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - C Rihal
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - S Mulpuru
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - A Deshmukh
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - N Ammash
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - E Greene
- Mayo Clinic, Cardiology, Rochester, United States of America
| | - P Friedman
- Mayo Clinic, Cardiology, Rochester, United States of America
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Bhatia S, Patel P, Bhatia S, Arora S, Deshmukh A. P808Utilization and safety profile of catheter ablation for non-ischemic ventricular tachycardia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deshmukh A, Deshmukh A, Patel N, Bhatia S, Badheka A, Vaidya V. P4615Trends and predictors of dysrhythmias in HIV positive population. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhatia S, Bhatia S, Patel P, Arora S, Deshmukh A. P209Quality of care outcomes among NSTEMI patients with chronic kidney disease undergoing PCI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boriani G, Deshmukh A, Brown ML, Koehler J, Friedman PA. P840Understanding the incidence of AF in single chamber ICD patients: a real world analysis. Europace 2017. [DOI: 10.1093/ehjci/eux151.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Kella D, Miyamoto K, Killu A, Hodge D, Deshmukh A, Kapa S, Munger T, Asirvatham S, Friedman P. P928The effect of right ventricular size and function on percutaneous pericardial access outcomes for electrophysiology procedure: A single center experience. Europace 2017. [DOI: 10.1093/ehjci/eux151.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pantvaidya G, Katna R, Deshmukh A, Nair D, D'Cruz A. Morbidity of central compartment clearance: Comparison of lesser versus complete clearance in patients with thyroid cancer. J Cancer Res Ther 2017; 13:102-106. [PMID: 28508841 DOI: 10.4103/0973-1482.199378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Extent of central compartment neck dissection (CCND) in thyroid cancers has been a debate because of associated morbidity. There have been attempts to reduce the extent of surgery in an attempt to decrease morbidity. PATIENTS AND METHODS We analyzed the morbidity of CCND from our prospectively maintained surgical morbidity database. CCND was divided into bilateral complete clearance (BCC) and less than complete clearance (LCC). LCC was performed for clinicoradiologically node negative patients. Rates of hypocalcemia and recurrent laryngeal nerve (RLN) palsy rates were compared for LCC versus BCC. We also classified procedures performed in the central neck according to the extent of dissection. RESULTS Of 153 evaluable patients, BCC was performed in 43.8% and LCC in 56.2%. Rate of postoperative hypocalcemia was 40.2% in BCC group versus 17.4% in LCC group. We had an overall RLN palsy rate of 7.4%. There was no significant difference in RLN palsy rates between the groups. CONCLUSION Lesser extent of dissection in central compartment reduces postoperative hypocalcemia but has no influence on RLN palsy rates.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rakesh Katna
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Anyanwu E, Bhatia A, Tehrani D, Deshmukh A, Rodgers D, Adatya S, Sarswat N, Kim G, Sayer G, Ota T, Jeevanandam V, Uriel N. The Accuracy of Physical Exam Compared to RHC in LVAD Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Deshmukh A, Bhatia A, Sarswat N, Adatya S, Kim G, Sayer G, Ozcan C, Ota T, Jeevanandam V, Uriel N. Left Atrial Appendage Occlusion Is Associated with Decreased Thromboembolic Events in LVAD Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pilar A, Laskar S, Rangarajan V, Purandare N, Budrukkar A, Gupta T, Murthy V, Pai P, Deshmukh A, Chaukar D, D'Cruz A, Agarwal J. Positron Emission Tomography/Computed Tomography Based Prognostication in Nasopharyngeal Cancers Treated With Definitive Chemoradiation Therapy: A Step Beyond TNM? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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