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Tiwana MS, Ni LH, Saini S, Verma SK, Doddamani D, Jain N, Biswas M, Gupta M, Gupta M, Saini M, Chauhan N. Radiation therapy outcomes in muscle invasive urinary bladder cancer: A single institution experience. Indian J Cancer 2017; 53:143-6. [PMID: 27146766 DOI: 10.4103/0019-509x.180842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION To audit the survival outcomes and loco-regional control in muscle invasive urinary bladder cancer patients treated with external beam radiation therapy (RT). MATERIALS AND METHODS From November 2008 through December 2011, 50 consecutively diagnosed muscle invasive urinary bladder carcinoma (T2-4a N0-2, M0) patients were included in this retrospective study. All these patients received external beam RT to a median dose of 60 Gy (range 30-66 Gy), and were not suitable for radical surgery due to patients' preference or medical comorbidities. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to survival. RESULTS Completion trans-urethral resection of bladder tumor was done in 38 (76%) patients of the cohort and 47 (94%) had transitional cell carcinoma on histopathology. Clinical stage T2 was diagnosed in 40 (80%) patients. The median follow-up for the entire cohort was 14 ± 8.9 months (range 1-36 months). In conclusion, 24 patients (48%) were free of disease, 5 patients (10%) had residual disease, and 13 patients (26%) had died of disease. Two-year and 3 year overall survival of intact bladder for the entire cohort was 58% and 43.6%, respectively. Cox regression modeling strongly suggested clinical stage (P = 0.01) and RT dose (P = 0.001) as being predictors for overall survival. CONCLUSION RT shows reliable outcomes and excellent compliance in this advanced disease. Prescribing a higher RT dose could potentially correlate to better intact bladder control rates while maintaining good quality of life in selected patients.
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Affiliation(s)
| | - L H Ni
- Department of Radiation Oncology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
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Lee HN, Mahajan MK, Das S, Sachdeva J, Tiwana MS. Early hematological effects of chemo-radiation therapy in cancer patients and their pattern of recovery - A prospective single institution study. Gulf J Oncolog 2015; 1:43-51. [PMID: 25682452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 06/04/2023]
Abstract
UNLABELLED The purpose of this prospective study is to understand the early hematological effects of chemo-radiation therapy in cancer patients, their pattern of recovery and to ascertain their prognostic value. METHODS 255 diagnosed cancer patients planned for definitive treatment with radiation therapy alone or with chemotherapy were included in this two year prospective study. A complete blood count was done at baseline, weekly during the course of therapy and thereafter, monthly for a period of 6 months. For the purpose of grading clinical toxicity, the Common Toxicity Criteria, CTCAE v2.0 was used while RECIST criteria was used to define the tumor response rates. This study was statistically analyzed using SPSS software. RESULTS 255 patients were included in the study wherein head and neck cancers comprised the major patient population (28.6%) followed by cervix (18.8%) and breast (15.7%). Out of these, 37% in head-and-neck cancer subgroup, and 58.3% in cervix had anemia at start of treatment. 92.2% cases with chemoradiation developed anemia during treatment, while with radiation alone it was 95.5%. This was statistically significant in patients with cancer uterine cervix (p 〈 0.01). At the end of treatment 65% patients with normal hemoglobin had complete responses (CR), while 58.3% with mild anemia and 33.3% with moderate anemia had CR (p=0.1). CONCLUSIONS Severe anemia during treatment is a poor prognostic indicator and is usually a sign of advanced disease. Leucopenia and thrombocytopenia occur more commonly during chemoradiotherapy as against radiotherapy alone, but improves with supportive management.
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Affiliation(s)
- H N Lee
- Dept. of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab 141 008, India
| | - M K Mahajan
- Dept. of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab 141 008, India
| | - S Das
- Dept. of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab 141 008, India
| | - J Sachdeva
- Dept. of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab 141 008, India
| | - M S Tiwana
- Dept. of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab 141 008, India
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Tiwana MS, Wu J, Hay J, Wong F, Cheung W, Olson RA. 25 year survival outcomes for squamous cell carcinomas of the head and neck: population-based outcomes from a Canadian province. Oral Oncol 2014; 50:651-6. [PMID: 24731736 DOI: 10.1016/j.oraloncology.2014.03.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/17/2014] [Accepted: 03/23/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Long term outcomes of patients with head and neck cancer (HNC) are rarely reported, but of potential benefit to clinicians and researchers. Squamous cell carcinomas (SCC) of the head and neck represent a heterogeneous group of cancers. The purpose of this population based study is to describe primary site specific, long term outcomes of HNC. METHODS All patients from a Canadian province diagnosed between 1986 and 1990 with SCC of the oral cavity, pharynx, and larynx were identified. Chart review and patient data were abstracted through the provincial cancer registry database. Survival analysis was performed with Kaplan Meier methods, while differences in survival between groups were assessed with log-rank tests. Multivariable analysis was performed using Cox-regression. RESULTS 1657 patients were analyzed during the study period. Almost half (50.9%) of the cases were advanced stage (stage III IV) at presentation. Two, 5, 15 & 25year overall survival (OS) and HNC specific survival for all the patients were 64%, 46%, 21%, 11% and 74%, 63%, 53% & 49%, respectively. OS and HNC-specific mortality were statistically inferior among men, older age at diagnosis, advanced stages of disease, and was primary cancer site specific, with worse survival in oropharyngeal & hypopharyngeal sites, p<0.001. CONCLUSIONS Survival rates vary by primary HNC site, and the overall survival & HNC specific survival differ over this long follow up assessment. Head and neck cancer specific death is most common in the first five years, and is subsequently dominated by competing causes of mortality. These results are useful as a reference tool for clinicians, researchers, and trainees.
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Affiliation(s)
- M S Tiwana
- Radiation Oncology, BC Cancer Agency, Centre for the North, Prince George, British Columbia, Canada
| | - J Wu
- Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - J Hay
- Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - F Wong
- Radiation Oncology, BC Cancer Agency, Surrey, British Columbia, Canada
| | - W Cheung
- Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - R A Olson
- Radiation Oncology, BC Cancer Agency, Centre for the North, Prince George, British Columbia, Canada.
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Lee HN, Tiwana MS, Saini M, Verma SK, Saini M, Jain N, Gupta M, Chauhan N. Superior vena cava obstruction (SVCO) in patients with advanced non small cell lung cancer (NSCLC). Gulf J Oncolog 2014; 1:56-62. [PMID: 24610289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. MATERIAL AND METHODS From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates (MVA) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL). RESULTS Thirteen patients (72%) had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 (28%) progressed to SVCO after initiating treatment with chemotherapy. Twelve (68%) patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 (62%), while the median biologically equivalent dose delivered was 28 Gy. Six (33%) patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3±1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score (p=0.02), and partial response to chemotherapy (p= 0.001) have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients (p = 0.05) have a better OS. CONCLUSION RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients. KEYWORDS superior vena cava obstruction (SVCO), radiation therapy, chemotherapy, non small cell lung cancer (NSCLC), BED (biologically equivalent dose).
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Affiliation(s)
- H N Lee
- Lee Hsueh Ni, Assistant Professor, Radiation Oncology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India 248140. Office Tel. +91 135 2471127. Fax +91 135 2471190.
| | - M S Tiwana
- Surgical Oncology,STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - M Saini
- Radiodiagnosis, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - S K Verma
- Medical Oncology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - M Saini
- Radiodiagnosis, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - N Jain
- Surgical Oncology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - M Gupta
- Surgical Oncology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
| | - N Chauhan
- Pathology, STM Cancer Research Institute, Himalayan Institute Hospital Trust, Swami Ram Nagar, Jolly Grant, Dehradun, India
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Tiwana MS, Uppal B, Sachdeva J, Talole SD, Mahajan MK, Koshy G, Lee HN. Whole saliva physico-biochemical changes and quality of life in head and neck cancer patients following conventional radiation therapy: A prospective longitudinal study. Indian J Cancer 2011; 48:289-95. [DOI: 10.4103/0019-509x.84918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tiwana MS, Kakkar S, Shirazi N, Upadhya P, Nautiyal H. Role of adjuvant radiation therapy in unusually rare primary malignant osteoclast-like giant cell tumor of the kidney. Indian J Cancer 2011; 48:123-4. [DOI: 10.4103/0019-509x.76638] [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: 11/04/2022]
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Setia MS, Signh R, Rattan PJS, Tiwana MS. Distribution of trace elements in blood, plasma and erythrocytes during neonatal period in Buffalo calves (Bubalus bubalis). J Anim Physiol Anim Nutr (Berl) 1987. [DOI: 10.1111/j.1439-0396.1987.tb00160.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: 11/27/2022]
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Takkar OP, Chauhan FS, Tiwana MS, Singh M. Breeding behaviour of buffalo cows. Indian Vet J 1979; 56:168-72. [PMID: 478602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chauhan FS, Takkar OP, Tiwana MS. A note on incidence of gestational estrus in buffaloes and cattle. Indian Vet J 1976; 53:77-8. [PMID: 1026651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Acharya RM, Dhillon JS, Tiwana MS. Age at first egg and egg production--their inheritance and expected response to different methods of selection. Br Poult Sci 1969; 10:175-81. [PMID: 5813576 DOI: 10.1080/00071666908415756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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