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Anand P. V, Mishra S, Patra C, Gnanasoundari J, Sinha P, Mishra AK, Rajeev R, Desigan N, Velavendan P, Venkatesan K, Ananthasivan K. Development of a three-stage, cross-current air sparged mixer-settler for the purification of degraded PUREX solvent. SEP SCI TECHNOL 2023. [DOI: 10.1080/01496395.2023.2189542] [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: 03/22/2023]
Affiliation(s)
| | | | | | - J. Gnanasoundari
- Process Radiochemistry and Reprocessing Research & Development Division, Indira Gandhi Centre for Atomic Research, Kalpakkam, India
| | | | | | | | | | | | - K.A. Venkatesan
- Process Radiochemistry and Reprocessing Research & Development Division, Indira Gandhi Centre for Atomic Research, Kalpakkam, India
| | - K. Ananthasivan
- Process Radiochemistry and Reprocessing Research & Development Division, Indira Gandhi Centre for Atomic Research, Kalpakkam, India
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Vishnu Anand P, Mishra S, Gnanasoundari J, Rajeev R, Desigan N, Velavendan P, Venkatesan K, Ananthasivan K. Wiped film evaporator with a roller wiper and an internally mounted condenser for the recovery of TBP and n-DD from degraded PUREX solvent. Chem Eng Res Des 2023. [DOI: 10.1016/j.cherd.2023.02.027] [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: 02/22/2023]
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Panda SK, Mishra VK, Vishnu Anand P, Rajeev R, Venkatesan K, Ananthasivan K. Investigating sedimentation process in the plutonium reconversion using Eulerian Two-Fluid simulations and experimental verification. Nuclear Engineering and Design 2022. [DOI: 10.1016/j.nucengdes.2022.111955] [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: 10/31/2022]
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Augustine E, Desigan N, Rajeev R, Pandey NK, Joshi JB. Kinetics of dissolution of simulated (U–Ce) MOX fuel pellet in nitric acid. J Radioanal Nucl Chem 2022. [DOI: 10.1007/s10967-022-08582-w] [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: 10/17/2022]
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Chrabaszcz S, Rajeev R, Witmer HDD, Dhiman A, Klooster B, Gamblin TC, Banerjee A, Johnston FM, Turaga KK. A Systematic Review of Conversion to Resectability in Unresectable Metastatic Colorectal Cancer Chemotherapy Trials. Am J Clin Oncol 2022; 45:366-372. [PMID: 35838247 DOI: 10.1097/coc.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Metastasectomy in patients with metastatic colorectal cancer (mCRC) confers a significant survival benefit. We hypothesized that conversion to resectability (C2R) correlates with superior overall survival (OS) in patients with unresectable mCRC. METHODS A prospectively registered systematic review (PROSPERO CRD42015024104) of randomized clinical trials published after 2003 was conducted. Exposure of interest was C2R with a primary outcome of OS. Clinical trials were classified based on difference in C2R between study arms (<2%, 2% to 2.9%, ≥3%). Generalized estimating equations were used to measure associations while adjusting for multiple observations from the same trial. RESULTS Of 2902 studies reviewed, 30 satisfied selection criteria (n=13,618 patients). Median C2R was 7.3% (interquartile range [IQR]: 5% to 12.9%), with maximum C2R in the FOLFOX/FOLFIRI+cetuximab arm (28.6%). The median difference in C2R between 2 arms of the same study was 2.3% (IQR: 1.3% to 3.4%) with a maximum difference of 15.4% seen in FOLFOX/FOLFIRI+cetuximab versus FOLFOX/FOLFIRI. Median OS for the entire patient cohort was 20.7 months (IQR: 18.9 to 22.7 mo), with a between group difference of 1.3 months (IQR: -1.2 to 3.6 mo). The median survival difference between the 2 study arms with <2% C2R difference was 0.8 months versus 1.6 months with ≥3% C2R rates . Increasing C2R had an incremental dose-effect response on OS ( P =0.021), and higher response rates correlated with C2R rates ( P =0.003). CONCLUSIONS C2R occurs infrequently and variably in clinical trials enrolling patients with unresectable mCRC. Prioritization of chemotherapeutic agents that enhance C2R might improve OS of patients.
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Affiliation(s)
| | - Rahul Rajeev
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | | | - Ankit Dhiman
- Department of Surgery, University of Chicago, Chicago, IL
| | | | | | | | | | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL
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P VA, Mishra S, Rajeev R, Desigan N, Venkatesan K, Ananthasivan K. Hydrolysis of tri-butyl phosphate in n-dodecane using sodium hydroxide: Factors affecting the hydrolysis process. Progress in Nuclear Energy 2022. [DOI: 10.1016/j.pnucene.2022.104247] [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: 10/18/2022]
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Panda SK, Aashranth B, Vishnu Anand P, Rajeev R, Venkatesan KA, Ananthasivan K. Comparative and inter-conversion analysis of dry and wet methods of particle size distribution using a test case of batch sedimentation. Braz J Chem Eng 2022. [DOI: 10.1007/s43153-022-00244-4] [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: 11/24/2022]
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Dahdaleh FS, Sherman SK, Witmer HD, Dhiman A, Rajeev R, Poli EC, Johnston FM, Turaga KK. Potential evidence of peritoneal recurrence in Stage-II colon cancer from the control arm of CALGB9581. Am J Surg 2022; 224:459-464. [DOI: 10.1016/j.amjsurg.2022.01.017] [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] [Received: 10/04/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/01/2022]
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Murali R, Ganesh S, Desigan N, Augustine E, Rajeev R, Pandey N. Kinetics of simultaneous stripping of U(VI) and nitric acid from tri-n-butyl phosphate. Progress in Nuclear Energy 2021. [DOI: 10.1016/j.pnucene.2021.103678] [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: 11/30/2022]
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Das L, Kumari TK, Renuka K, Rajeev R, Raju N. Microanatomy of Left Internal Thoracic Artery and Left Anterior Descending Artery: A Comparative Study. Natl J Clin Anat 2021. [DOI: 10.4103/njca.njca_30_20] [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: 11/04/2022] Open
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Das A, Sil A, Jaiswal S, Rajeev R, Thole A, Jafferany M, Ali SN. A Study to Evaluate Depression and Perceived Stress Among Frontline Indian Doctors Combating the COVID-19 Pandemic. Prim Care Companion CNS Disord 2020; 22. [PMID: 33031651 DOI: 10.4088/pcc.20m02716] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
Objective Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, health care workers of multiple disciplines have been designated as frontline doctors. This unforeseen situation has led to psychological problems among these health care workers. The objective of this study was to evaluate the mental health status of pan-Indian frontline doctors combating the COVID-19 pandemic. Methods A cross-sectional, observational study was conducted among frontline doctors of tertiary care hospitals in India (East: Kolkata, West Bengal; North: New Delhi; West: Nagpur, Maharashtra; and South: Thiruvananthapuram, Kerala) from May 23, 2020, to June 6, 2020. Doctors involved in clinical services in outpatient departments, designated COVID-19 wards, screening blocks, fever clinics, and intensive care units completed an online questionnaire. The 9-item Patient Health Questionnaire and the Perceived Stress Scale were used to assess depression and perceived stress. Results The results of 422 responses revealed a 63.5% and 45% prevalence of symptoms of depression and stress, respectively, among frontline COVID-19 doctors. Postgraduate trainees constituted the majority (45.5%) of the respondents. Moderately severe and severe depression was noted in 14.2% and 3.8% of the doctors, respectively. Moderate and severe stress was noted in 37.4% and 7.6% of participants, respectively. Multivariate regression analysis showed working ≥ 6 hours/day (adjusted odds ratio: 3.5; 95% CI, 1.9-6.3; P < .0001) to be a significant risk factor for moderate or severe perceived stress, while single relationship status (adjusted odds ratio: 2.9; 95% CI, 1.5-5.9; P = .002) and working ≥ 6 hours/day (adjusted odds ratio: 10.3; 95% CI, 4.3-24.6; P < .0001) significantly contributed to the development of moderate, moderately severe, or severe depression. Conclusions The pandemic has taken a serious toll on the physical and mental health of doctors, as evident from our study. Regular screening of medical personnel involved in the diagnosis and treatment of patients with COVID-19 should be conducted to evaluate for stress, anxiety, and depression.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, West Bengal, India 700004. .,Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Saurabh Jaiswal
- Department of Dermatology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Rahul Rajeev
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Akhilesh Thole
- Department of Dermatology, ABVIMS, Dr Ram Manohar Lohia Hospital, Delhi, India
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Syed Naiyer Ali
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Heera R, Rajeev R. Curbing COVID-19: Kerala model. J Oral Maxillofac Pathol 2020; 24:222-226. [PMID: 33456228 PMCID: PMC7802861 DOI: 10.4103/jomfp.jomfp_285_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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Heera
- Department of Oral Pathology and Microbiology, GDC, Thiruvananthapuram, Kerala, India
| | - R Rajeev
- Department of Oral Pathology and Microbiology, GDC, Thiruvananthapuram, Kerala, India
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Sil A, Das A, Jaiswal S, Jafferany M, Thole A, Rajeev R, Ali SN. Mental health assessment of frontline COVID-19 dermatologists: A Pan-Indian multicentric cross-sectional study. Dermatol Ther 2020; 33:e13884. [PMID: 32567207 PMCID: PMC7361073 DOI: 10.1111/dth.13884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Abheek Sil
- Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Saurabh Jaiswal
- Department of Dermatology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Akhilesh Thole
- Department of Dermatology, ABVIMS, Dr. Ram Manohar Lohia Hospital, Delhi, India
| | - Rahul Rajeev
- DM Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Syed Naiyer Ali
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Balakrishnan R, Soumyamol P, Vijayalakshmi K, Alen Varghese L, Rajeev R, Manu S, Sekkar V. Kinetic analysis of urethane formation between castor oil-based ester polyol and 4,4’-diphenyl methane diisocyanate. Chem Ind 2020. [DOI: 10.1080/00194506.2020.1760947] [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: 10/24/2022]
Affiliation(s)
| | - P.B. Soumyamol
- Analytical Spectroscopy and Ceramics Group, Vikram Sarabhai Space Centre, Trivandrum, India
| | - K.P. Vijayalakshmi
- Analytical Spectroscopy and Ceramics Group, Vikram Sarabhai Space Centre, Trivandrum, India
| | - Lity Alen Varghese
- Department of Chemical Engineering, National Institute of Technology, Calicut, India
| | - R. Rajeev
- Analytical Spectroscopy and Ceramics Group, Vikram Sarabhai Space Centre, Trivandrum, India
| | - S.K. Manu
- Chemical Systems Group, Vikram Sarabhai Space Centre, Trivandrum, India
| | - V. Sekkar
- Retd Scientist, Vikram Sarabhai Space Centre, Trivandrum, India
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Sherman SK, Lange JJ, Dahdaleh FS, Rajeev R, Gamblin TC, Polite BN, Turaga KK. Cost-effectiveness of Maintenance Capecitabine and Bevacizumab for Metastatic Colorectal Cancer. JAMA Oncol 2019; 5:236-242. [PMID: 30489611 DOI: 10.1001/jamaoncol.2018.5070] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unregulated drug prices increase cancer therapy costs. After induction chemotherapy, patients with metastatic colon cancer can receive maintenance capecitabine and bevacizumab therapy based on improved progression-free survival, but whether this treatment's cost justifies its benefits has not been evaluated in the United States. Objective This study sought to determine the influence of capecitabine and bevacizumab drug prices on cost-effectiveness from a Medicare payer's perspective. Design, Setting, and Participants The incremental cost-effectiveness of capecitabine and bevacizumab maintenance therapy was determined with a Markov model using a quality-of-life penalty based on outcomes data from the CAIRO phase 3 randomized clinical trial (RCT), which included 558 adults in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. The outcomes were modeled using Markov chains to account for patients who had treatment complications or cancer progression. Transition probabilities between patient states were determined, and each state's costs were determined using US Medicare data on payments for capecitabine and bevacizumab treatment. Deterministic and probabilistic sensitivity analyses identified factors affecting cost-effectiveness. Main Outcomes and Measures Life-years gained were adjusted using CAIRO3 RCT quality-of-life data to determine quality-adjusted life-years (QALYs). The primary end point was the incremental cost-effectiveness ratio, representing incremental costs per QALY gained using a capecitabine and bevacizumab maintenance regimen compared with observation alone. Results Markov model estimated survival and complication outcomes closely matched those reported in the CAIRO3 RCT, which included 558 adults (n = 197 women, n = 361 men; median age, 64 and 63 years for patients in the observation and maintenance therapy groups, respectively) in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. Incremental costs for a 3-week maintenance chemotherapy cycle were $6601 per patient. After 29 model iterations corresponding to 60 months of follow-up, mean per-patient costs were $105 239 for maintenance therapy and $21.10 for observation. Mean QALYs accrued were 1.34 for maintenance therapy and 1.20 for observation. The incremental cost-effectiveness ratio favored maintenance treatment, at an incremental cost of $725 601 per QALY. The unadjusted ratio was $438 394 per life-year. Sensitivity analyses revealed that cost-effectiveness varied with changes in drug costs. To achieve an incremental cost-effectiveness ratio of less than $59 039 (median US household income) per unadjusted life-year would require capecitabine and bevacizumab drug costs to be reduced from $6173 (current cost) to $452 per 3-week chemotherapy cycle. Conclusions and Relevance Antineoplastic therapy is expensive for payers and society. The price of capecitabine and bevacizumab maintenance therapy would need to be reduced by 93% to make it cost-effective, a finding useful for policy decision making and payment negotiations.
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Affiliation(s)
- Scott K Sherman
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Joel J Lange
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Fadi S Dahdaleh
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Rahul Rajeev
- Department of Surgery, University of Texas Rio Grande Valley, Edinburg
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, Illinois
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Rajeev R, Samath JA, Karthikeyan NK. An Intelligent Recurrent Neural Network with Long Short-Term Memory (LSTM) BASED Batch Normalization for Medical Image Denoising. J Med Syst 2019; 43:234. [DOI: 10.1007/s10916-019-1371-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
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Radhakrishnan JS, Raj DC, Rajeev R, Jagannathan K, Indira SG. Physicochemical and Pharmacological Evaluation of Silaasaththu Parpam for Highlighting its Anti-urolithiasic Property. CTM 2019. [DOI: 10.2174/2215083804666181023094029] [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: 11/22/2022]
Affiliation(s)
- Jisha S. Radhakrishnan
- PG & Research Department of Chemistry, Sree Narayana College, Chempazhanthy, Thiruvananthapuram- 695587, Kerala, India
| | - David C. Raj
- Central Animal Facility (CAF), SASTRA Deemed University, Tirumalaisamudrum, Thanjavur-613 402, Tamilnadu, India
| | - R. Rajeev
- Analytical and Spectroscopy Division, Vikram Sarabhai Space Centre, Thumba, Thiruvananthapuram-695022, Kerala, India
| | - K. Jagannathan
- Department of Maruthuvam (General Medicine), Santhigiri Siddha Medical College & Hospital, Santhigiri, Thiruvananthapuram- 695 589, Kerala, India
| | - Shibi G. Indira
- PG & Research Department of Chemistry, Sree Narayana College, Chempazhanthy, Thiruvananthapuram- 695587, Kerala, India
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Heera R, Chandran R, Padmakumar SK, Rajeev R. Age estimation using impacted mandibular third molar teeth in Kerala population. Egypt J Forensic Sci 2018. [DOI: 10.1186/s41935-018-0073-7] [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: 11/10/2022] Open
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Vishnu Anand P, Rajeev R, Velavendan P, Pandey N, Kamachi Mudali U. Modeling and simulation of diluent recovery unit in PUREX solvent regeneration system. Progress in Nuclear Energy 2018. [DOI: 10.1016/j.pnucene.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Iatrogenic injury and/or damage to the parotid salivary gland during transparotid approach for open reduction and internal fixation of mandibular condyle fracture is a rare event. Accumulation of saliva in the gland leads to formation of a sialocele. Huge sialocele often seeks drain through the most dependent area through an extraoral wound, whereas in the absence of extraoral fistula, saliva can be redirected intraorally using a stent. A case of mangement of sialocele caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. The various conservative methods and surgical management for this condition are discussed.
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Affiliation(s)
- R Rajeev
- Department of Oral and Maxillofacial Surgery, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - S Sajesh
- Department of Oral and Maxillofacial Surgery, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - Mathew Jose
- Department of Oral and Maxillofacial Surgery, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - N Dhineksh Kumar
- Department of Oral and Maxillofacial Surgery, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
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Lange J, Rajeev R, Gamblin TC, Turaga K. Cost effectiveness of maintenance bevacizumab in patients with metastatic colorectal cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.718] [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
718 Background: Observation alone after initial treatment of unresectable metastatic colorectal cancer is often anxiety provoking for physician and patient alike. The CAIRO 3 trial suggested the efficacy of maintenance capecitabine and bevacizumab in improving overall survival for such patients. We hypothesized that the cost effectiveness for maintenance capecitabine and bevacizumab would be worse than accepted population thresholds. Methods: Data from the CAIRO-3 trial was used to populate a semi-markov model, in which patients transitioned between different disease and complication based states. Transition probabilities were extratcted from the trial. Costs were determined from a thirs payer persective from the Medicare part B ASP drug pricing file. Utility was converted from the global quality of life scale. Incremental cost effectiveness ratios were calculated. Results: Cost of the maintenance arm after 10 cycles was $108,848 with a gain in 14.93 quality adjusted life months, while the quality adjusted life months gained at no cost in the observation arm was 13.67. This yielded an ICER of $1,036,648/QALY. Two way sensitivity analyses demonstrated dominance of observation across a wide range of parameters unless the cost per cycle was < $6250. Conclusions: Maintenance capecitabine and bevacizumab is not cost effective and is higher than the willingness to pay threshold for any developed nation. Reducing drug pricing is the only way to financially support the argument for this treatment strategy.
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Affiliation(s)
- Joel Lange
- Medical College of Wisconsin, Milwaukee, WI
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22
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Poli E, Sekigami Y, Rajeev R, Gamblin TC, Turaga K. Effect of extended postoperative recovery on long-term oncological outcomes. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.765] [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
765 Background: Curative cancer surgery remains the cornerstone of treatment of localized malignancies. Extended post operative recovery (eLOS) is associated with debility and immunosuppression. We hypothesized that eLOS is associated with worse long term oncological outcome. Methods: The NCDB participant user file from 2004-13 was utilized to identify patients with localized gastrointestinal malignancies undergoing curative cancer resections. Quartiles (Qx) of length of stay (LOS) were calculated based on histology and site specific indicators. Survival modeling was performed using cox-proportional hazards and conditional models were created. Alpha of 0.05 was set for statistical significance. Results: Of 1,616,215 patients in the cohort, 577,860 patients were included who met inclusion criteria. Majority of patients were ≥65 years (56%) with a predominance of colon cancer (70%). The median length of stay (LOS) varied from 5 days (partial hepatectomy) to 10 days (esophagectomy). After adjusting for age, gender, stage, and site of disease, increasing length of stay was significantly associated with worse oncological survival with a dose response effect (Q1 HR 1.0, Q2 1.12 (1.10-1.14) p<0.001, Q3 1.42 (1.41-1.44) p<0.001 and Q4 1.82(1.80-1.85), p<0.001). Conditional overall survival for patients who survived 3, 6 and 12 months after surgery, was worse with eLOS (p<0.001). Conclusions: Longer than expected length of stay after an index curative cancer operation leads to worse overall oncological outcomes. This effect persists even after excluding patients who suffer delayed post-operative mortality within 12 months after the operation. More research needs to be done to determine if this outcome is related to perioperative immunosuppression.
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Rajeev R, Giri B, Choudhary LP, Kumar R. Surgery for benign prostatic hyperplasia: Profile of patients in a tertiary care institution. Natl Med J India 2017; 30:7-10. [PMID: 28730999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Medical therapy is widely used for managing benign prostatic hyperplasia (BPH) and has made an impact on the profile of patients who ultimately undergo surgery. This changing profile may impact outcomes of surgery and associated complications. To assess the impact of medical management, we evaluated the profile of patients who had surgery for BPH at our institution. METHODS A retrospective chart-review was performed of patient demographics, indications for surgery, preoperative comorbid conditions and postoperative course in patients who underwent surgery for BPH over a 5-year period. The data were analysed for demographic trends in comparison with historical cohorts. RESULTS A total of 327 patients underwent surgery for BPH between 2008 and 2012. Their mean age was 66.4 years, the mean prostate gland weight was 59.2 g and the mean duration of symptoms was 35.3 months; 34% had a prostate gland weight of >60 g; 1 59 (48.6%) patients had an absolute indication for surgery; 139 (42.5%) of these were catheterized and 6.1% of patients presented with azotaemia or upper tract changes without urinary retention. CONCLUSIONS In comparison with historical cohorts, more patients are undergoing surgery for absolute indications including retention of urine and hydroureteronephrosis. However, the patients are younger, they have fewer comorbid conditions and have a similar rate of complications after the procedure.
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Affiliation(s)
- Rahul Rajeev
- Department of Surgery, Medical School of Wisconsin, Wisconsin, USA
| | - Bhuwan Giri
- Department of Surgery, University of Minnesota, Minnesota, USA
| | - Lok Prakash Choudhary
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Rajeev R, Turaga KK. Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis. Cancer Control 2016; 23:36-46. [PMID: 27009455 DOI: 10.1177/107327481602300107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malignant peritoneal disease can lead to significant debility due to bowel obstructions, ascites, and cancer cachexia. Moreover, inadequate imaging techniques can lead to the suboptimal detection of disease, and the poor vascularity of tumors can lead to a poor response to systemic chemotherapy. However, combination cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising novel treatment for patients with this disease. METHODS The medical literature focusing on diagnostic updates and the management of peritoneal disease was reviewed. The application principles of HIPEC for use in peritoneal disease were also summarized. RESULTS Improvements in imaging and the application of laparoscopic techniques have significantly increased the rate of diagnosis of early peritoneal disease with consequently less morbid cytoreductive procedures. Appropriate patient selection based on prognostic scores along with complete cytoreduction can identify a cohort of patients likely to derive durable benefit from this combination treatment. CONCLUSIONS Advances in diagnostic and therapeutic techniques, including surgical cytoreductive techniques, have demonstrated significant survival gains in patients with peritoneal disease. Although HIPEC can be used for the management of various types of histologies, further development of high-level evidence is necessary to advance the field.
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Affiliation(s)
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Abstract
Solitary fibrous tumor (SFT) is a ubiquitous rare mesenchymal neoplasm. Pleura is the favored site of origin and is rare in the oral cavity. SFT occurs across a wide histopathologic spectrum. Fibrous form characterized by hyalinized, thick-walled vessels with opened lumina and strong CD34 reactivity constitute one end and on the other end, a cellular form representing the conventional hemangiopericytoma, with branched, thin-walled vessels and focal or negative CD34 reactivity characterize the spectrum. A case of oral SFT in a 30-year-old female patient with its clinical, histopathological and immunohistochemical features is being presented here.
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Affiliation(s)
- R Heera
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
| | - M Renu Chandran
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
| | - S K Padmakumar
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
| | - R Rajeev
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
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Lee SY, Goh BKP, Sadot E, Rajeev R, Balachandran VP, Gönen M, Kingham TP, Allen PJ, D'Angelica MI, Jarnagin WR, Coit D, Wong WK, Ong HS, Chung AYF, DeMatteo RP. Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor. Ann Surg Oncol 2016; 24:202-210. [PMID: 27624583 DOI: 10.1245/s10434-016-5565-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The surgical management of duodenal gastrointestinal stromal tumors (DGIST) is poorly characterized. Limited resection may be technically feasible and oncologically safe, but anatomic considerations may compromise the resection margins due to the proximity of critical structures, thereby necessitating more extensive resections such as pancreaticoduodenectomy. METHODS Patients undergoing surgery for DGIST at two institutions from 1994 to 2014 were identified. Clinicopathologic and survival data were analyzed to compare outcomes in patients treated with limited or radical resection. RESULTS Sixty patients underwent surgery for DGIST. Pancreaticoduodenectomy was performed in 38 % while the rest underwent limited resections. The most common type of limited resection was wedge resection and primary closure (49 %) followed by segmental resection with an end-to-end or side-to-side duodenojejunostomy (27 %). The pancreaticoduodenectomy group tended to have larger tumors with the majority located in D2/3 (87 %) and at the mesenteric border (91 %). The pancreaticoduodenectomy group also had significantly greater intraoperative blood loss, longer operative time, longer hospital stay, and higher 90-day morbidity and readmission rates. The 5-year relapse-free survival, recurrence-free survival, and overall survival for the pancreaticoduodenectomy versus limited resection were 81 versus 56 % (p = 0.05), 64 versus 53 % (p = 0.5), and 76 versus 72 % (p = 0.6), respectively. A surgical algorithm based on the location and size of the tumor is proposed. CONCLUSIONS Limited resection of DGIST is safe, but may be associated with lower 5-year relapse-free survival. Pancreaticoduodenectomy is recommended for selected patients with DGIST when an R0 resection cannot be performed without removing the ampulla or part of the pancreas.
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Affiliation(s)
- Ser Yee Lee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Eran Sadot
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahul Rajeev
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wai Keong Wong
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hock Soo Ong
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Abstract
Context: A study on odontogenic cysts and tumors. Aims: The aim of this study is to determine the frequency of odontogenic cysts and tumors and their distribution according to age, gender, site and histopathologic types of those reported over a period of 1998–2012 in a Tertiary Health Care Center at South Kerala. Settings and Design: The archives of Department of Oral Pathology and Microbiology, were retrospectively analyzed. Subjects and Methods: Archival records were reviewed and all the cases of odontogenic cysts and tumors were retrieved from 1998 to 2012. Statistical Analysis Used: Descriptive statistical analysis was performed using the computer software, Statistical Package for Social Sciences (SPSS) IBM SPSS Software version 16. Results: Of 7117 oral biopsies, 4.29% were odontogenic tumors. Ameloblastoma was the most common odontogenic tumor comprising 50.2% of cases, followed by keratocystic odontogenic tumor (24.3%). These tumors showed a male predilection (1.19: 1). Odontogenic tumors occurred in a mean age of 33.7 ± 16.8 years. Mandible was the most common jaw affected (76.07%). Odontogenic cysts constituted 12.25% of all oral biopsies. Radicular cyst comprised 75.11% of odontogenic cysts followed by dentigerous cyst (17.2%). Conclusions: This study showed similar as well as contradictory results compared to other studies, probably due to geographical and ethnic variations which is yet to be corroborated.
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Affiliation(s)
- P V Deepthi
- Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - V T Beena
- Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - S K Padmakumar
- Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - R Rajeev
- Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - R Sivakumar
- Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, Kerala, India
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Jayakrishnan TT, Sekigami Y, Rajeev R, Gamblin TC, Turaga KK. Morbidity of curative cancer surgery and suicide risk. Psychooncology 2016; 26:1792-1798. [PMID: 27421798 DOI: 10.1002/pon.4221] [Citation(s) in RCA: 8] [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: 12/08/2015] [Revised: 06/07/2016] [Accepted: 07/10/2016] [Indexed: 11/08/2022]
Abstract
IMPORTANCE Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied. OBJECTIVE To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. DESIGN Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review. SETTING General US population. PARTICIPANTS Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries. MAIN OUTCOMES AND MEASURES Death by suicide or self-inflicted injury. RESULTS Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% confidence interval, CI, 14.54-18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82-31.86) and age >65 years (IR, 22.54; 95% CI, 18.84-26.76). When stratified by 30-day overall postoperative morbidity, a significantly higher incidence of suicide was found for high-morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide-specific survival (hazards ratio, 1.02; 95% CI, 1.00-1.03, P = .01) in prognosis-adjusted models. CONCLUSIONS In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow-up period for these patients.
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Affiliation(s)
- Thejus T Jayakrishnan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yurie Sekigami
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Klooster B, Rajeev R, Chrabaszcz S, Charlson J, Miura J, Bedi M, Gamblin TC, Johnston F, Turaga KK. Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)? J Surg Oncol 2016; 113:823-7. [PMID: 27060344 DOI: 10.1002/jso.24232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/06/2016] [Accepted: 03/11/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long-term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS). METHODS National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short-term survival. RESULTS Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P < 0.001). Of 272 patients with available survival, 24% (n = 64) survived ≥5 years with 64% alive at follow-up. LTS was most often seen in younger patients (<65 years) with well-differentiated liposarcoma. Chemotherapy appeared to improve survival in the first 3 postoperative years, but paradoxical effects were seen in LTS (Hazards Ratio [HR] 0.69, 95%CI: 0.50-0.95, P = 0.024) in first 3 years versus (HR 2.15, 95%CI: 1.21-3.81, P = 0.009). CONCLUSION Long-term survival is possible for a subset of patients after an R2 resection for RPS, especially with favorable histology characteristics. Benefits of chemotherapy in margin positive settings need to be investigated. J. Surg. Oncol. 2016;113:823-827. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Brittany Klooster
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Chrabaszcz
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Charlson
- Section of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Miura
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Fabian Johnston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
Isolated hepatic perfusion uses the unique vascular supply of hepatic malignancies to deliver cytotoxic chemotherapy. The procedure involves vascular isolation of the liver and delivery of chemotherapy via the hepatic artery and extraction from retrohepatic vena cava. Benefits of hepatic perfusion have been observed in hepatic metastases of ocular melanoma and colorectal cancer and primary hepatocellular carcinoma. Percutaneous and prophylactic perfusions are avenues of ongoing research.
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Affiliation(s)
- Rahul Rajeev
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Cheng H, Miura JT, Lalehzari M, Rajeev R, Donahue AE, Bedi M, Gamblin TC, Turaga KK, Johnston FM. Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review. J Surg Oncol 2016; 113:628-34. [PMID: 26990903 DOI: 10.1002/jso.24221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The multi-modal treatment of retroperitoneal sarcoma has seen increased use of neoadjuvant radiation. However, its effect on local recurrence and survival remain controversial. We aimed to synthesize and evaluate the literature. METHODS The review was conducted according the recommendation of the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) group with pre-specified inclusion and exclusion criteria. RESULTS Of 8,701 citations collected, 15 articles reported on 464 patients. The median age was 56 years (45-64). The predominant histological subtypes were liposarcoma (51.54%) and leiomyosarcoma (23.26%). Tumor differentiation composed of 37.1% well-, 12.8% moderate-, 46.0% poorly-, and 4.1% undifferentiated. Most studies featured external beam radiation therapy (EBRT) treatment regimen with some who included patients treated with IMRT instead. Median follow-up averaged 41.4 months (19-106 months). Median 5-year OS, PFS, and LRR rates were 58%, 71.5%, and 25%. Using the NCI CTCAE, toxicities from Grade 1 (Mild) through Grade 5 (death) were experienced by 18.8%, 10.2%, 16.3%, 0.7%, and 1.6% of patients. CONCLUSIONS NART is a safe to use for RPS, but its effect toward survival and local control remains unclear. Without randomized control trials, common reporting criteria for pro- and retrospective studies are needed to allow comparison between studies. J. Surg. Oncol. 2016;113:628-634. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hao Cheng
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John T Miura
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mona Lalehzari
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy E Donahue
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nadeem H, Jayakrishnan TT, Rajeev R, Johnston FM, Gamblin TC, Turaga KK. Cost Differential of Chemotherapy for Solid Tumors. J Oncol Pract 2016; 12:e299-307, 251. [PMID: 26860586 DOI: 10.1200/jop.2015.006700] [Citation(s) in RCA: 6] [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
PURPOSE A significant portion of national cancer expenditure is attributed to chemotherapy.Although the National Comprehensive Cancer Network has generated recommendations for the treatment of various solid tumors, the outlined chemotherapeutic strategies lack information about the cost differential for increasing effectiveness. METHODS Chemotherapy regimens (curative [adjuvant/neoadjuvant] and metastatic therapy) and dosages outlined in the 2013 National Comprehensive Cancer Network guidelines were acquired for four common cancers: bladder, breast, colon, and lung. Baseline drug and treatment costs (in US dollars)were calculated for the average US adult male on the basis of the payment allowance in the 2013 Medicare Part B average sales price (ASP) drug pricing files. Costs were extrapolated for a treatment period of 6 months. RESULTS Of the 62 regimens included, the 6-month mean cost of chemotherapy was $26,989 ± $29,971, and the median cost was $9,611 (interquartile range, $6,305-$39,383). The mean cost of metastatic cancer therapy regimens (n = 32) was $35,315 ± 32,962 compared with $18,107 ± 23,873 for curative therapy (P = .02). Of the 13 regimens with biologics used, the mean costs were $77,278 versus $13,646 for 49 regimens that did not use biologics (P<.001). The cost differential between extremes of costs for regimens with presumed similar efficacy was $90,843 ($79,165 for curative therapy and $90,210 for metastatic cancer therapy). The highest cost differential was noted in breast cancer regimens at $71,041 for metastatic cancer therapy and $63,926 for curative therapy. CONCLUSION A significant cost differential exists between chemotherapeutic regimens for the most common solid tumors. Incorporation of costs and incremental effectiveness in current guidelines may encourage socially responsible practice patterns.
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Sekigami Y, Rajeev R, Johnston F, Clark Gamblin T, Turaga KK. Conditional Survival as a Patient Centered Metric for Patients with Appendiceal Adenocarcinoma. Ann Surg Oncol 2016; 23:2295-301. [DOI: 10.1245/s10434-016-5105-7] [Citation(s) in RCA: 3] [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] [Received: 05/28/2015] [Indexed: 11/18/2022]
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Chrabaszcz S, Rajeev R, Klooster B, Chinn A, Gamblin TC, Johnston FM, George B, Banerjee A, Turaga K. Conversion to resectability in unresectable metastatic colorectal cancer chemotherapy (mCRC) trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.641] [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
641 Background: Patients with mCRC undergoing surgical metastasectomy have been shown to derive significant survival benefit with a potential for cure. We hypothesized that conversion to resectability (c2r) is correlated with increased overall survival in patients with unresectable mCRC. Methods: Prospectively registered systematic review (PROSPERO CRD42015024104) was utilized to identify randomized clinical trials published after 2003. Exposure of interest was c2r from unresectable disease, while the outcome was overall survival (OS). Clinical trials were classified into three groups based on difference in c2r between the two study groups ( < 2, 2-2.9, ≥ 3 %). Generalized estimating equations(GEE) were used to measure associations while adjusting for multiple observations from the same trial. The Cochrane risk of bias tool was used to evaluate the methodological quality. Results: Out of 2,902 studies reviewed, 30 satisfied selection criteria (n = 13,618 patients). All studies had two arms only (100%). Median c2r was 7.3% (Interquartile Range 5%-12.9%), with maximum c2r in FOLFOX/FOLFIRI+ cetuximab arm (28.6%). The median difference in c2r between two arms of the same study was 2.3% (IQR 1.3 – 3.4%) and the maximum difference was 15.4% seen in FOLFOX/FOLFIRI+ cetuximab vs. FOLFOX/FOLFIRI (Ye, 2013). Median OS for the entire cohort of patients was 20.7 months (IQR 18.9 – 22.7 months), with a between group difference of 1.3 (IQR -1.2 – 3.6 months). The maximum survival benefit between two study arms was 9.9 months. Median survival difference between the two study arms with a minimal c2r difference ( < 2%) was 0.8 months, as compared to 1.6 months with higher c2r ( ≥ 3%). Incremental dose effect response was noted with an increasing c2r leading to improved overall survival in regression models (p = 0.021, r2= 0.16). Higher response rates also correlated with higher c2r rates (p = 0.003, r2= 0.25). Conclusions: Conversion to resectability is positively correlated with an improvement in survival in trials examining therapies for unresectable mCRC. Patient level data examining the contribution of metastasectomy to the overall survival benefit of systemic chemotherapy needs to be further examined.
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Affiliation(s)
| | | | | | | | | | | | - Ben George
- Medical College of Wisconsin, Milwaukee, WI
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Hammad AY, Younan G, Rajeev R, Berger NG, Turaga K, Johnston FM, Christians KK, Gamblin TC. Radiotherapy for intrahepatic cholangiocarcinoma: An analysis of the National Cancer Database. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.379] [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
379 Background: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when a positive resection margin exists. The present study sought to examine the impact of radiotherapy following liver resection. Methods: Patients with early stage ICC, who underwent surgical resection, were identified from the National Cancer Database (1998-2011). Patients were stratified by resection margin status and receipt of RT. Survival was analyzed by Kaplan-Meier method and a multivariate regression model was used to identify predictors of survival. Results: A total of 2,182 patients were identified. R0 status was obtained in 1,624 patients (74.4%). RT was delivered to 405 patients (R0=209, R1/R2=196). In the R1/R2 group, 196 patients received RT vs. 362 R1/R2 patients that did not receive RT. Survival for R0 vs. R1/R2 was 32m vs. 16.5m (p<0.001). RT appeared to trend toward improving survival for R1/R2 patients, though this was not significant (20.4m vs. 14.5m, p=0.191). In a multivariate model accounting for age, sex, comorbidities, disease stage and resection margins, RT was not a predictor of survival. Negative predictors of survival included age>65years (Hazards Ratio [HR]: 1.20 (95%CI: 1.04-1.39), p=0.013), and positive resection margins (HR: 1.95 (95%CI: 1.65-2.30), p<0.001). Female sex was the only positive predictor of survival identified (HR: 0.76 (95%CI: 0.65 -0.88), p<0.001). Conclusions: Surgical resection with negative margins provides the best outcome for patients with ICC. Radiotherapy does not appear to significantly impact survival in patients with positive resection margins.
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Rajeev R, Johnston FM, Gamblin TC, Turaga K. Chasing the proverbial unicorn of relative value units (RVU) and block time. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.660] [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
660 Background: Competitive market forces on healthcare have led to increasing demands on work effort of academic surgical oncologists. This has to be balanced against resource constraints of limited operating room space and block time availability. We hypothesized that current work RVU (wRVU) requirements pose an unrealistic expectation of practicing surgical oncologists. Methods: University HealthSystem Consortium (UHC) median wRVUs were utilized to determine the effort expected of a surgical oncologist. Surgical oncology subspecialties were divided into breast, colorectal, melanoma, sarcoma, liver and pancreas. Representative procedures from each specialty were determined using Healthcare Common Procedure Coding System and median wRVUs were obtained per procedure including a single consultation cost without incorporating modifiers and adjustments for multiple procedures. A work year was assumed to include 48 weeks of work time to account for CME, and vacation. Night and weekend call was excluded from the analysis. Results: The median UHC wRVU for a surgical oncologist is 7800 wRVU, which corresponds to a theoretical reimbursement of $383,387-493,459 in a pure Medicare population. In order to meet the work RVU requirements, the number of annual major procedures performed varied from 124-1625 procedures (breast 365-701, colorectal 192- 324, melanoma 677-1625, sarcoma 234-334, liver 124-571, pancreas 139-264). The number of major procedures performed per day varied from 3 procedures/day for a 4 day block time to 12 procedures/day for a single day block time. Conclusions: Current wRVU expectations and block time schedules need to be better aligned to account for increasing demands on surgical oncologists. Society driven surveys as recently conducted by ASBS might be effective ways to truly understand workforce demands in the nation.
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Rajeev R, Klooster B, Turaga KK. Impact of surgical volume of centers on post-operative outcomes from cytoreductive surgery and hyperthermic intra-peritoneal chemoperfusion. J Gastrointest Oncol 2016; 7:122-8. [PMID: 26941990 PMCID: PMC4754306 DOI: 10.3978/j.issn.2078-6891.2015.099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/17/2015] [Indexed: 12/21/2022] Open
Abstract
Complex surgical operations performed at centers of high volume have improved outcomes due to improved surgical proficiency, and betters systems of care including avoidance of errors. Cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemoperfusion (HIPEC), which has been shown to be an oncologically effective strategy for peritoneal carcinomatosis (PC), is one such procedure with significant morbidity and mortality. The learning curve to reach technical proficiency in CRS + HIPEC is about 140-220 cases for a center. Focus on improving surgical proficiency through training, improving systems of care through partnerships and reporting mechanisms for quality could reduce the time to proficiency.
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Affiliation(s)
- Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brittany Klooster
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Rajeev R, Berger NG, Hammad AY, Miura JT, Johnston FM, Gamblin TC, Turaga K. Conditional probability of survival in gallbladder carcinoma as a prognostic tool for long term survivors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.455] [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
455 Background: Gallbladder carcinoma (GBC) often presents in an advanced stage and despite radical resection and nodal harvest, prognosis remains poor. Conventional survival statistics do not account for time elapsed from diagnosis and may not carry relevant prognostic information for long term survivors. This study sought to estimate the conditional probability of survival (CS) in patients of GBC. Methods: Patients with GBC were identified from the Surveillance, Epidemiology and End Results (SEER) database (1988-2012). Overall probability of survival (OS) was estimated using Kaplan-Meier method. Cumulative incidence method was employed to calculate CS. Results: Of 15,046 GBC patients identified, Stage IV disease was the most common presentation (n = 5625). Surgical intervention was reported in 9,720(65%) patients with cholecystectomies (n = 8254) outnumbering radical resections (n = 1116). 3-year OS for all stages was 18% and conditional probability of surviving additional 3 years (CS3) at 1, 2 and 3 years from diagnosis was 42%, 57% and 66% respectively. Stage III and IV disease had 3-year OS rates of 19% and 3% respectively while CS3 increased progressively with each year survived(33% and 17% at 1 year, 51% and 34% at 2 years, 60% and 56% at 3 years). Conclusions: Conditional probability of survival is favorable in patients surviving one year from diagnosis and shows an increasing trend with time. Improvements in survival are more substantial in patients with adverse initial prognosis. Conditional survival provides valuable information on prognosis to patients after curative surgery and can be the basis of follow-up guidelines.
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Zacharias AJ, Jayakrishnan TT, Rajeev R, Rilling WS, Thomas JP, George B, Johnston FM, Gamblin TC, Turaga KK. Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. PLoS One 2015; 10:e0139940. [PMID: 26448327 PMCID: PMC4598149 DOI: 10.1371/journal.pone.0139940] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/19/2015] [Indexed: 12/23/2022] Open
Abstract
Background Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data is available on the comparative effectiveness of these options. We hypothesized that outcomes in terms of survival and toxicity were equivalent across the three strategies. Methods A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013003861) that utilized studies from PubMed (2003–2013). Primary outcome was median overall survival (OS). Secondary outcomes were treatment toxicity, tumor response, and conversion of the tumor to resectable. Additional covariates included prior or concurrent systemic therapy. Results Of 491 studies screened, 90 were selected for analyses—52 (n = 3,000 patients) HAI, 24 (n = 1,268) RE, 14 (n = 1,038) TACE. The median OS (95% CI) for patients receiving HAT in the first-line were RE 29.4 vs. HAI 21.4 vs. TACE 15.2 months (p = 0.97, 0.69 respectively). For patients failing at least one line of prior systemic therapy, the survival outcomes were TACE 21.3 (20.6–22.4) months vs. HAI 13.2 (12.2–14.2) months vs. RE 10.7 (9.5–12.0). Grade 3–4 toxicity for HAT alone was 40% in the HAI group, 19% in the RE group, and 18% in the TACE groups, which was increased with the addition of systemic chemotherapy. Level 1 evidence was available in 5 studies for HAI, 2 studies for RE and 1 for TACE. Conclusion HAI, RE, and TACE are equally effective in patients with unresectable CRLM with marginal differences in survival.
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Affiliation(s)
- Anthony J. Zacharias
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Thejus T. Jayakrishnan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - William S. Rilling
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - James P. Thomas
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ben George
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - T. Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kiran K. Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
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Rajeev R, Patel M, Jayakrishnan TT, Johnston FM, Bedi M, Charlson J, Turaga KK. Retroperitoneal solitary fibrous tumor: surgery as first line therapy. Clin Sarcoma Res 2015; 5:19. [PMID: 26322223 PMCID: PMC4551387 DOI: 10.1186/s13569-015-0034-y] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solitary fibrous tumors (SFT) of the retroperitoneum are rare spindle cell neoplasms, with a paucity of data on treatment outcomes. We hypothesized that surgical excision offered acceptable outcomes in SFTs. METHODS The National Cancer Database (NCDB) was used to identify patients with SFT from 2004 to 2011. Primary outcome measures were 30 day mortality and overall survival. Descriptive analyses were performed. Furthermore, a systematic review of published literature was conducted after creating a pre-specified search strategy. RESULTS Of 51 patients in the NCDB, 58.8 % (n = 30) were males, with a median age 60 years (IQR 49-72 years). Median tumor size was 16 cm (IQR 11-21 cm). Surgical resection was performed in 92.2 % (n = 47) with 63.8 % (n = 30) having a margin negative resection. Peri-operative mortality was 2.1 % (n = 1). Of survival outcomes available for 18 patients, the median OS was 51.1 months. From the systematic review, we identified 8 studies, with 24 patients. Median age and tumor size was similar to the NCDB [47.5 years (IQR 39-66.5 years), 12 cm (IQR 7-17 cm)]. Majority [91.7 % (n = 22)] underwent surgical excision alone while one received adjuvant chemotherapy and none received radiation. After median follow up of 54 months (IQR 28-144 months), 79.2 % (n = 19) were alive without disease. Three patients (12.5 %) died of disease, one was alive with disease and one was lost to follow up. Recurrence was reported in 16.7 % (n = 4) of patients. CONCLUSION Complete surgical excision is a viable treatment modality for retroperitoneal SFT leading to long term survival. Low recurrence rates would argue against the need for routine adjuvant radiation or chemotherapy.
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Affiliation(s)
- Rahul Rajeev
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Mohit Patel
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Thejus T. Jayakrishnan
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Fabian M. Johnston
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Meena Bedi
- />Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226 USA
| | - John Charlson
- />Section of Hematology and Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Kiran K. Turaga
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
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Ammajan RR, Joseph R, Rajeev R, Choudhary K, Vidhyadharan K. Assessment of periodontal changes in patients undergoing radiotherapy for head and neck malignancy: a hospital-based study. J Cancer Res Ther 2014; 9:630-7. [PMID: 24518708 DOI: 10.4103/0973-1482.126461] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surgical resection, radio and chemotherapy, either used singly or in combination, are the three most common modalities used in head and neck cancer treatment. These modalities are effective in eradicating the tumor; they also negatively impact the normal head and neck structures surrounding the tumor. Direct damage to the oral structures (soft and hard tissue) frequently occurs from radio and chemotherapy, and indirect damage may also arise from systemic toxicity. MATERIALS AND METHODS This prospective study was designed to analyze the effect of radiotherapy on periodontal parameters in oncology patients prior to irradiation in the head and neck area, compared with 6 months following treatment. The statistical analysis was done using SPSS. RESULTS The study sample consisted of total 29 patients of head and neck malignancy (M = 17, F = 12), of mean age 45.66 years. Only 22% of patients had various habits (smoking, tobacco chewing, and alcohol consumption) and majority (27.59% patients) had tongue malignancy. All periodontal parameters - oral hygiene index Siller (OHIS), clinical attachment level (CAL), gingival recession (GR), except probing pocket depth (PPD) - were significantly increased after radiotherapy. When comparison was made between doses and fractions, only in mandible statistically significant difference were observed in GR. CONCLUSION Although there was no significant change in PPD, there was increased GR, CAL, and plaque index associated with radiotherapy. In this study, 61.5% cases of mandibular teeth and 34.4% cases of maxillary teeth showed attachment loss greater than 0.2 mm. So, all patients with head and neck malignancy should undergo an oral examination before the initiation of cancer therapy with adequate prophylaxis.
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Dalui M, Kundu M, Trivikram TM, Rajeev R, Ray K, Krishnamurthy M. Bacterial cells enhance laser driven ion acceleration. Sci Rep 2014; 4:6002. [PMID: 25102948 PMCID: PMC4126001 DOI: 10.1038/srep06002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022] Open
Abstract
Intense laser produced plasmas generate hot electrons which in turn leads to ion acceleration. Ability to generate faster ions or hotter electrons using the same laser parameters is one of the main outstanding paradigms in the intense laser-plasma physics. Here, we present a simple, albeit, unconventional target that succeeds in generating 700 keV carbon ions where conventional targets for the same laser parameters generate at most 40 keV. A few layers of micron sized bacteria coating on a polished surface increases the laser energy coupling and generates a hotter plasma which is more effective for the ion acceleration compared to the conventional polished targets. Particle-in-cell simulations show that micro-particle coated target are much more effective in ion acceleration as seen in the experiment. We envisage that the accelerated, high-energy carbon ions can be used as a source for multiple applications.
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Affiliation(s)
- Malay Dalui
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - M. Kundu
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - T. Madhu Trivikram
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - R. Rajeev
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - Krishanu Ray
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - M. Krishnamurthy
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Colaba, Mumbai 400 005, India
- TIFR Centre for Interdisciplinary Sciences, 21 Brundavan Colony, Narsingi, Hyderabad 500075, India
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Abstract
Sialoblastoma is a rare congenital tumour of the salivary glands arising mainly from the parotid gland. It is usually diagnosed at birth or shortly thereafter with a significant variability in histological appearance and clinical course. In extensive search of PubMed indexed journals, we got 46 cases of "sialobalstoma/embryoma/congenital basal adenoma", with one case was of German literature and three additional cases of adult sialobalstoma. This article has extensively reviewed the clinical, histopathological and immunohistochemical features, Magnetic resonance imaging (MRI) and Computerized Tomography (CT) findings, treatment and prognosis.
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Abstract
Oral cancer is the most common cancer diagnosed in Indian men and is the leading cause of cancer deaths. It is considered as a multistep and multifactorial disease. Besides accumulation of genetic mutations, numerous other carcinogens are involved. In this category, viral and chemical carcinogens are well studied and documented. However, in the oral cavity, the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites, and certain oral bacterial species have been linked with malignancies, but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways, and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer such as pancreatic and gastrointestinal cancer. This review presents possible carcinogenesis pathway involved in bacterial carcinogenesis, commonly implicated bacteria in oral carcinogenesis, and their role in cancer therapeutics as well.
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Affiliation(s)
- R Rajeev
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
| | - Kanaram Choudhary
- Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, Kerala, India
| | | | - Neha Gandhi
- Oral Pathology and Microbiology, Government Dental College, Ahmedabad, Gujarat, India
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Choudhary K, Rajeev R. Pindborg′s tumor: Report of a case with 6 years of follow-up. Clin Cancer Investig J 2014. [DOI: 10.4103/2278-0513.130219] [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: 11/04/2022]
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46
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Rajeev R, Beena VT, Indu G, Choudhary K, Devu A. Fibrolipoma of floor of the mouth of 20 years of duration. Clin Cancer Investig J 2014. [DOI: 10.4103/2278-0513.138058] [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: 11/04/2022]
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Krishnan SR, Gopal R, Rajeev R, Jha J, Sharma V, Mudrich M, Moshammer R, Krishnamurthy M. Photoionization of clusters in intense few-cycle near infrared femtosecond pulses. Phys Chem Chem Phys 2014; 16:8721-30. [DOI: 10.1039/c3cp55380a] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this article we present a perspective on the current state of the art in the photoionization of atomic clusters in few-cycle near-infrared laser pulses.
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Affiliation(s)
- S. R. Krishnan
- Tata Institute of Fundamental Research (Hyderabad)
- Hyderabad 50075, India
| | - R. Gopal
- Tata Institute of Fundamental Research (Hyderabad)
- Hyderabad 50075, India
| | - R. Rajeev
- Tata Institute of Fundamental Research
- Mumbai 400001, India
| | - J. Jha
- Tata Institute of Fundamental Research
- Mumbai 400001, India
| | - V. Sharma
- Indian Institute of Technology – Hyderabad
- Hyderabad 502205, India
| | - M. Mudrich
- Physikalisches Institut, Universität Freiburg
- 79104 Freiburg, Germany
| | - R. Moshammer
- Max-Planck-Institut für Kernphysik
- D-69117 Heidelberg, Germany
| | - M. Krishnamurthy
- Tata Institute of Fundamental Research (Hyderabad)
- Hyderabad 50075, India
- Tata Institute of Fundamental Research
- Mumbai 400001, India
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Trivikram TM, Rajeev R, Rishad KPM, Jha J, Krishnamurthy M. Anomalous ion charge distribution from cluster nanoplasmas. Phys Rev Lett 2013; 111:143401. [PMID: 24138236 DOI: 10.1103/physrevlett.111.143401] [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] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Indexed: 06/02/2023]
Abstract
In nearly all the intense laser experiments with nanoclusters, the key observation has been that immense ionization drives highly charged ions to highest energies while low charge ions, if any, have lower kinetic energies. We show experimental measurements that are contrary to this established notion. The active role of outer-ionized electrons in a multicluster interaction is shown to effectively reduce high charge ions to low charge states with no loss of momentum. The role of Rydberg excited clusters, intrinsic in dense cluster ensembles, is identified and a quantitative analysis is shown to comprehensively explain the anomalous charge distribution and ion energies observed in experiments.
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Affiliation(s)
- T Madhu Trivikram
- Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai-400005, India
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Abstract
Since the discovery of acquired immuno deficiency syndrome (AIDS) in late1980s, the spread of human immunodeficiency virus (HIV) has reached pandemic proportions, representing a global developmental and public health threat. Finding of a safe, globally effective and affordable HIV vaccine offers the best hope for the future control of the disease pandemic. Significant progress has been made over the past years in the areas of basic virology, immunology, and pathogenesis of HIV/AIDS and the development of anti-retroviral drugs. However, the search for an HIV vaccine faces formidable scientific challenges related to the high genetic variability of the virus, the lack of immune correlates of protection, limitations with the existing animal models and logistical problems associated with the conduct of multiple clinical trials. Most of the vaccine approaches developed so far aim at inducing cell-mediated immune responses. Multiple vaccine concepts and vaccination strategies have been tested, including DNA vaccines, subunit vaccines, live vectored recombinant vaccines, various prime-boost vaccine combinations and vaccine based on broadly neutralizing human anti-HIV Antibody 2G12. This article reviews the state of the art in HIV vaccine research, summarizes the results obtained so far and discusses the challenges to be met in the development of a successful HIV vaccine.
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Affiliation(s)
- Vt Beena
- Department of Oral and Maxillofacial Pathology, Government Dental College, Trivandrum, Kerala, India
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50
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Abstract
Metastatic lesions to the oral region are uncommon and account for approximately 1% of all malignant oral tumors. In 25% of the cases, oral metastases are found to be the first sign of the metastatic spread; and in 23% of the cases, it is the first indication of an undiscovered malignancy at a distant site. Metastases to oral soft tissues are even less frequent than jaw bones. Because of its rarity, the clinical presentation of a metastatic lesion in the oral cavity can be deceiving, leading to a misdiagnosis of a benign process; therefore, in any case where the clinical presentation is unusual, especially in patients with a known malignant disease, a biopsy is mandatory. Here, we are presenting a rare case of multiple secondary tumors in the attached gingiva in an otherwise apparently healthy patient with no other symptoms of the primary tumor. It subsequently led to the diagnosis of Pancoast tumor (bronchoalveolar carcinoma) metastasizing simultaneously to multiple sites in the oral cavity and bilateral adrenal glands.
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Affiliation(s)
- Vt Beena
- Department of Oral and Maxillofacial Pathology, Government Dental College, Trivandrum, India
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