Indian Journal of Pathology and Microbiology, 2022
Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomar... more Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage. Design: Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis. Results: Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–...
Application of Gaming in New Media Marketing, 2019
The evolution of gaming in healthcare promotion evolved concurrently with the ascendance of compu... more The evolution of gaming in healthcare promotion evolved concurrently with the ascendance of computing technology, smart phones, facilitated by video-based 3D technology and virtual reality in the mid-eighties and nineties. Health and wellness in the twenty-first century is interlinked with the wealth of the nation and individuals and its traditional definition of physical, psychological, spiritual, social, and financial optima has seen new paradigms. The gaming technology has found groundbreaking applications in many diagnostic and therapeutic modalities to modulate the behavioral changes, simulation of virtual reality, and passage to recovery through neurologically engaging the cognitive functions with the stimuli produced. Physiological symptoms and life-threatening disorders which may caused be faced by viral inflictions (HIV, Hepatitis C, etc.) and type 2 diabetes could today be significantly managed by gaming technologies for psychosomatic management.
but it showed positive correlation with grain yield per plant. Similarly, days to 50 per cent flo... more but it showed positive correlation with grain yield per plant. Similarly, days to 50 per cent flowering had positive direct effect, but had negative association with grain yield per plant. The results of the present study indicated that an ideal bajra plant should have high spike yield per plant, spike length, spike thickness and 1000 grain weight since they expressed significant correlation with maximum direct effect on grain yield per plant.
International Journal of Radiation Oncology*Biology*Physics, 2021
PURPOSE/OBJECTIVE(S) The current standard of care for post operated patients of glioblastoma (PO-... more PURPOSE/OBJECTIVE(S) The current standard of care for post operated patients of glioblastoma (PO-GBM) is adjuvant radiotherapy with concurrent and adjuvant temozolomide (RT-TMZ). Accelerated tumor repopulation due to increased overall treatment time could be responsible for radio resistance and poorer outcomes. The role of hypofractionated adjuvant radiotherapy (HYPO-RT) has been evaluated in elderly patients but is unknown in other subsets of age group. We aim to evaluate prospectively the safety and tolerability of HYPO-RT with concurrent and adjuvant temozolomide in PO-GBM patients. MATERIALS/METHODS Between December 2019 to December 2020, we enrolled 15 PO-GBM patients in a prospective ethic approved institutional study (IEC No. 53/19). Computed- tomography based planning with aid of contrast enhanced pre-operative MRI fusion was done. All patient received HYPO-RT 60 Gray in 20 fractions at 3 Gy per fraction over 4 weeks with concurrent Temozolomide 75 mg/m2 with 3D-conformal radiotherapy technique. 45 Gray in 15 fractions were delivered in phase 1 followed by a phase 2 boost of 15 Gray in 5 fractions. Toxicity assessment was done according to common terminology criteria for adverse events 5.0. Memory impairment and cognitive dysfunction were assessed with mini mental status examination (MMSE). RESULTS All patients completed the full course of radiotherapy without any interruption with median radiotherapy treatment time of 4 weeks (4-5 weeks). Median age was 52 years (20-65), median Karnofsky performance score was 70 (range 70-90) with M: F ratio of 10:5. 4 (27%) and 11 (73%) patients were RTOG-RPA class IV and class V respectively. 5 (33%) patients underwent gross total resection, 9 (60%) underwent subtotal resection and 1 (7%) patient had biopsy only. IDH-wild type was reported in 4 patients. Median follow was 5 months (range 3-10 months). No patient reported grade 2 or higher hematological toxicity during RT. None of the patient showed grade 3 or 4 non-hematological toxicity. 11 (73%) patients have grade 1 and 4 (26%) patients had grade 2 cognitive dysfunction. Six (40%) patients had grade 1 and 2 (13%) had grade 2 headache. Only 1 (6.6%) patient showed depressed level of consciousness and there was no reported episode of seizure. 11 (73%) patients had grade 1 and 1 (6.6%) patient showed grade 2 memory impairment. At the time of last follow up; 8 patients have completed adjuvant TMZ, 4 patients are on adjuvant TMZ and 3 patients have died. CONCLUSION Adjuvant HYPO-RT with RT-TMZ is well tolerated in terms of acute toxicity and may be a good alternative to reduce overall treatment time and counteract tumor repopulation in PO- GBM. Further follow up of our study cohort will elucidate the clinical outcome of patients treated with this HYPO-RT approach.
International Journal of Radiation Oncology*Biology*Physics, 2021
PURPOSE/OBJECTIVE(S) The treatment of inoperable locally advanced oral cavity squamous cell carci... more PURPOSE/OBJECTIVE(S) The treatment of inoperable locally advanced oral cavity squamous cell carcinoma (OC-SCC) is challenging. In suitable patients, we prefer to treat them by definitive concurrent chemoradiotherapy (CTRT) with or without induction chemotherapy (IC). We intended to retrospectively evaluate the outcome of our cohort of inoperable OC-SCC treated with definitive CTRT. MATERIALS/METHODS Data of 71 patients (Jan 2017-Jan 2020) of histopathologically proven inoperable OC-SCC treated with definitive CTRT with weekly cisplatin 40 mg/m2 with or without IC were retrieved from departmental archives. Radiotherapy (RT) was delivered with 3-dimensional conformal plan (70 Gray at 2 Gray per fractions delivered 5 days a week in two phases). Toxicities were evaluated using acute morbidity scoring criteria of RTOG. Response was evaluated as per WHO criteria. Loco-regional failure (LRF) and Progression free survival (PFS) were estimated from date of registration using Kaplan Meier method. RESULTS Patient characteristics are summarized in Table 1. 48 patients (67.6%) received IC (Platinum+5 FU ± Taxane) q 3 weekly, median number of cycles was 3 (2-4). 64 (90%) patients received concurrent chemotherapy with median number of 5 cycles (4-6). Median RT dose was 70 Gray (50-70 Gray). Grade ≥ 3 skin toxicity, oral mucositis, dysphasia was noted in 7(9.9%), 11(15.5%) and 13 (18.3%) patients respectively. Median follow up duration was 15 months (3-52 months). Clinical response rate (CRR) at 1 month after completion of RT was 80%. Overall complete response, partial response, progressive disease and death at the time of last follow up were 37(52.1%), 21(29.6%), 11(15.5%), 2(2.8%) respectively. Age < 50 years was associated with poor outcome (odds ratio, 1.1; 95% CI 0.42-2.86). 3-month LRF rate was 32.4%. Median PFS was 11.4 months (5.3-32.4 months). CONCLUSION Inoperable patients of OC-SCC with good performance status treated with definitive CTRT with or without IC yielded complete response in approximately half of patients with acceptable toxicity profile. Loco-regional failure remains the predominant mode of failure. Future research including studies on biomarkers for better patient selection and treatment personalization is warranted.
Reconstruction following excision for tongue cancer carries important functional consequences. Is... more Reconstruction following excision for tongue cancer carries important functional consequences. Island nasolabial flap (NLF) is robust and oncologically safe and has a good functional outcome, identical to free flap reconstruction. We retrospectively analyzed the data of 11 tongue cancer patients operated between January 2019 and August 2019. Surgical resection and neck dissection followed by immediate reconstruction by island NLF were done. Post-operative functional outcome assessed using the University of Washington Quality of Life Questionnaire. Age of patients ranged between 39 and 70 years. All patients had either T2 or T3 tongue cancer. No incidence of flap necrosis noted in any patient. On an average, all were discharged between 3rd and 5th post-operative days. Cosmetic and functional outcomes were satisfactory in all patients. Island nasolabial has an excellent reach and can reach any part of the oral cavity, even to the contralateral side and base of the tongue. It has an excellent postoperative tongue function, almost equivalent to free flap. Hence, it should be considered locoregional flap of choice for tongue reconstruction.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamou... more Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamous cell cancer. There is paucity of literature regarding control rates in these cases. We intend to report the outcomes in terms of administered treatment and control rates. 28 patients of oral cavity verrucous carcinomas treated at our institute from March 2014 to December 2018 were reviewed retrospectively. Demographic profile, histopathological features and clinical outcomes were analyzed. Statistical analysis was performed with SPSS for Mac (version 23.0). Median age was 54 years (range 31-75) with M:F ratio of 25:3. Buccal mucosa was the most common site. All patients underwent surgical resection except one. Of these, 24 had neck dissection; 12 had supra-omohyoid neck dissection, eleven had modified neck dissection and one patient underwent radical neck dissection. Three patients had their histology upgraded to squamous cell carcinomas in the post-operative histopathology. The post-operative staging was as follows: 21% stage I and 35% stage II. One patient opted for non-surgical approach and received radical concurrent chemoradiotherapy. Median follow up was 12 months (range 6-36). Two patients had local failures and one had a regional failure. No distant metastasis was found. There was one death. 14-Months survival rate was 92%. Estimated 18 month loco-regional control rate was 92%. Curative surgical resection remains the cornerstone for VC of oral cavity. Any change of histopathology post-operatively to squamous cell carcinoma is a poor prognostic sign and needs appropriate adjuvant treatment.
planning (Figure 1c). The planning goal for these cases was a D90 to the CTV of least 90% prescri... more planning (Figure 1c). The planning goal for these cases was a D90 to the CTV of least 90% prescription (Figure 1b and 1d), while following GEC-ESTRO limitations on D2cc to bladder and rectum in all cases. There was no strict limitation on the vagina during this time period, however, the aim was a maximum vaginal surface dose of approximately 140Gy (EQD2). All patients had the upper vaginal mucosa drawn at the time of each implant in the same manner, which consisted of a 4mm expansion of the cylinder, with a length of 4cm, with a subtraction of the cap of the applicator to exclude the cervix or upper vaginal apex (Figure 1e). We recorded the D2cc and D1cc of the upper vagina for the current analysis, to establish baseline volumetric criteria. Results: A total of 20 unique plans were candidates for review among the 9 patients. MCVC diameters ranged from 2.5cm to 3.5cm. The BT prescription schema was 4.5Gy x 5 (n51); 5Gy x 5 (n53); 5.5Gy x 4 (n52); 5.5Gy x 5 (n51); 6.8Gy x 4 (n51) and 7Gy x 4 (n51). The average dose (range) delivered to D2cc and D1cc of vagina per BT fraction was 145% (99-206%) and 168% (120-231%) of the prescription, respectively. This resulted in an average absolute dose contribution (EQD2) from BT per patient of 75.2Gy and 99.4Gy to the vagina D2cc and D1cc, respectively. Among the patients treated in combination with EBRT, the average CTV D90 dose was 74.5Gy (range: 67.4-83.6Gy), with corresponding D2cc and D1cc of the upper vagina of 114.5Gy (range: 97.5-126Gy) and 137.7Gy (range: 108.5-165.3Gy), respectively. With a median follow-up of 16 months (range: 3-33), there were no local recurrences and no grade 3 or higher vaginal toxicity. Conclusions: Standardized recording of vaginal dose-volume parameters is feasible when using MCVC BT to treat gynecologic cancers involving the vagina. The average cumulative dose values in this cohort of 114.5Gy and 137.7Gy to the upper vaginal surface D2cc and D1cc, respectively, was associated with excellent clinical outcomes, and no grade 3 or higher vaginal toxicity. Validation in a larger cohort and further correlation with late toxicity is needed.
related deaths. During CCRT 4% of patients had grade 3/4 hematological while 7% non hematological... more related deaths. During CCRT 4% of patients had grade 3/4 hematological while 7% non hematological. With median follow-up of 21 months (Q1-Q3: 15-24 months) the 1 year progression free survival, distant disease survival and overall survival were 80%, 79% and 87% respectively.
γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its ex... more γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its expression has not been studied in cases with diagnostic low dose radiation exposure. Concerns have been raised about the after-effects of radiation in diagnostic procedures like Computed Tomography (CT) scan, Angiography etc especially when such scans are repeated within short span of time. The purpose of the present study was to assess immediate DNA damage after exposure to low level of ionizing radiation by the flow cytometric method of gamma-H2AX. Study sample includes total 60, cases and controls with two groups Group I-Normal controls (n = 15); Group II-Low dose, further divided in three groups: Group IIA-single CT scan (n = 15); Group IIB-Multiple CT scans (n = 15); and Group IIC-angiography single exposure (n = 15). For Low dose group blood was collected within 1 h after exposure in EDTA vaccutainers and immediately kept on ice. Lymphocytes were isolated and were fixed in 80% chill...
Conclusion: Renal angioplasty for RVHT due to FMD is technically successful, safe, and durable. M... more Conclusion: Renal angioplasty for RVHT due to FMD is technically successful, safe, and durable. Most patients have long-term clinical benefi t out to 10 years.
International Journal of Radiation Oncology*Biology*Physics, 2017
to the submandibular gland with hydrogel spacing was noted in the specimen with the smallest base... more to the submandibular gland with hydrogel spacing was noted in the specimen with the smallest baseline gland volume. Conclusion: Injection of biodegradable radiopaque hydrogel successfully displaces the contralateral submandibular gland, providing the opportunity for dosimetrically sparing the gland. This minimally invasive technique should be tested in a clinical trial for reduction of xerostomia.
Concurrent chemoradiation is presently the standard of care in locally advanced malignancy of the... more Concurrent chemoradiation is presently the standard of care in locally advanced malignancy of the cervix uteri. But accelerated radiotherapy regimes have not been investigated much. We conducted a randomized trial to compare the results of pure accelerated radiotherapy given as six fractions weekly to standard chemoradiotherapy in locally advanced carcinoma cervix patients. This was a prospective, phase III trial in which 106 patients of locally advanced (stage II and III) carcinoma cervix were randomized into two arms. The study arm (ART) received 50 Gy accelerated radiotherapy in 25 fractions, six fractions weekly; while control (CRT) arm was treated with concurrent chemoradiation 50 Gy in 25 fractions with weekly injection cisplatin. This was followed by intracavitary brachytherapy (ICBT; total dose of 85 Gy to point A) in both the arms. Fifty-one patients completed treatment in the ART arm and 50 patients in the CRT arm. In these patients, response to treatment, toxicity, and ov...
This report describes the case of a gentleman aged 59 years presenting with low-back pain, who ha... more This report describes the case of a gentleman aged 59 years presenting with low-back pain, who had underwent radical prostatectomy for prostate cancer 8 years ago. On evaluation, a slightly elevated serum alkaline-phosphatase level prompted a search for bone metastases. Although x-ray radiography and a bone scan were apparently normal, an MRI scan revealed the presence of metastatic marrow infiltration in the lumbar vertebrae. The patient subsequently was initiated on therapy with androgen-deprivation therapy and bisphosphonates, and currently enjoys symptom-free and progression-free survival. The images in this paper intend to impress upon the limitations of bone scan and x-ray radiography with regard to the detection of vertebral marrow infiltration in the absence of cortical bone invasion. In addition, a brief review of the pathophysiology of vertebral metastases arising from prostate cancer is included.
Indian Journal of Pathology and Microbiology, 2022
Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomar... more Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage. Design: Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis. Results: Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–...
Application of Gaming in New Media Marketing, 2019
The evolution of gaming in healthcare promotion evolved concurrently with the ascendance of compu... more The evolution of gaming in healthcare promotion evolved concurrently with the ascendance of computing technology, smart phones, facilitated by video-based 3D technology and virtual reality in the mid-eighties and nineties. Health and wellness in the twenty-first century is interlinked with the wealth of the nation and individuals and its traditional definition of physical, psychological, spiritual, social, and financial optima has seen new paradigms. The gaming technology has found groundbreaking applications in many diagnostic and therapeutic modalities to modulate the behavioral changes, simulation of virtual reality, and passage to recovery through neurologically engaging the cognitive functions with the stimuli produced. Physiological symptoms and life-threatening disorders which may caused be faced by viral inflictions (HIV, Hepatitis C, etc.) and type 2 diabetes could today be significantly managed by gaming technologies for psychosomatic management.
but it showed positive correlation with grain yield per plant. Similarly, days to 50 per cent flo... more but it showed positive correlation with grain yield per plant. Similarly, days to 50 per cent flowering had positive direct effect, but had negative association with grain yield per plant. The results of the present study indicated that an ideal bajra plant should have high spike yield per plant, spike length, spike thickness and 1000 grain weight since they expressed significant correlation with maximum direct effect on grain yield per plant.
International Journal of Radiation Oncology*Biology*Physics, 2021
PURPOSE/OBJECTIVE(S) The current standard of care for post operated patients of glioblastoma (PO-... more PURPOSE/OBJECTIVE(S) The current standard of care for post operated patients of glioblastoma (PO-GBM) is adjuvant radiotherapy with concurrent and adjuvant temozolomide (RT-TMZ). Accelerated tumor repopulation due to increased overall treatment time could be responsible for radio resistance and poorer outcomes. The role of hypofractionated adjuvant radiotherapy (HYPO-RT) has been evaluated in elderly patients but is unknown in other subsets of age group. We aim to evaluate prospectively the safety and tolerability of HYPO-RT with concurrent and adjuvant temozolomide in PO-GBM patients. MATERIALS/METHODS Between December 2019 to December 2020, we enrolled 15 PO-GBM patients in a prospective ethic approved institutional study (IEC No. 53/19). Computed- tomography based planning with aid of contrast enhanced pre-operative MRI fusion was done. All patient received HYPO-RT 60 Gray in 20 fractions at 3 Gy per fraction over 4 weeks with concurrent Temozolomide 75 mg/m2 with 3D-conformal radiotherapy technique. 45 Gray in 15 fractions were delivered in phase 1 followed by a phase 2 boost of 15 Gray in 5 fractions. Toxicity assessment was done according to common terminology criteria for adverse events 5.0. Memory impairment and cognitive dysfunction were assessed with mini mental status examination (MMSE). RESULTS All patients completed the full course of radiotherapy without any interruption with median radiotherapy treatment time of 4 weeks (4-5 weeks). Median age was 52 years (20-65), median Karnofsky performance score was 70 (range 70-90) with M: F ratio of 10:5. 4 (27%) and 11 (73%) patients were RTOG-RPA class IV and class V respectively. 5 (33%) patients underwent gross total resection, 9 (60%) underwent subtotal resection and 1 (7%) patient had biopsy only. IDH-wild type was reported in 4 patients. Median follow was 5 months (range 3-10 months). No patient reported grade 2 or higher hematological toxicity during RT. None of the patient showed grade 3 or 4 non-hematological toxicity. 11 (73%) patients have grade 1 and 4 (26%) patients had grade 2 cognitive dysfunction. Six (40%) patients had grade 1 and 2 (13%) had grade 2 headache. Only 1 (6.6%) patient showed depressed level of consciousness and there was no reported episode of seizure. 11 (73%) patients had grade 1 and 1 (6.6%) patient showed grade 2 memory impairment. At the time of last follow up; 8 patients have completed adjuvant TMZ, 4 patients are on adjuvant TMZ and 3 patients have died. CONCLUSION Adjuvant HYPO-RT with RT-TMZ is well tolerated in terms of acute toxicity and may be a good alternative to reduce overall treatment time and counteract tumor repopulation in PO- GBM. Further follow up of our study cohort will elucidate the clinical outcome of patients treated with this HYPO-RT approach.
International Journal of Radiation Oncology*Biology*Physics, 2021
PURPOSE/OBJECTIVE(S) The treatment of inoperable locally advanced oral cavity squamous cell carci... more PURPOSE/OBJECTIVE(S) The treatment of inoperable locally advanced oral cavity squamous cell carcinoma (OC-SCC) is challenging. In suitable patients, we prefer to treat them by definitive concurrent chemoradiotherapy (CTRT) with or without induction chemotherapy (IC). We intended to retrospectively evaluate the outcome of our cohort of inoperable OC-SCC treated with definitive CTRT. MATERIALS/METHODS Data of 71 patients (Jan 2017-Jan 2020) of histopathologically proven inoperable OC-SCC treated with definitive CTRT with weekly cisplatin 40 mg/m2 with or without IC were retrieved from departmental archives. Radiotherapy (RT) was delivered with 3-dimensional conformal plan (70 Gray at 2 Gray per fractions delivered 5 days a week in two phases). Toxicities were evaluated using acute morbidity scoring criteria of RTOG. Response was evaluated as per WHO criteria. Loco-regional failure (LRF) and Progression free survival (PFS) were estimated from date of registration using Kaplan Meier method. RESULTS Patient characteristics are summarized in Table 1. 48 patients (67.6%) received IC (Platinum+5 FU ± Taxane) q 3 weekly, median number of cycles was 3 (2-4). 64 (90%) patients received concurrent chemotherapy with median number of 5 cycles (4-6). Median RT dose was 70 Gray (50-70 Gray). Grade ≥ 3 skin toxicity, oral mucositis, dysphasia was noted in 7(9.9%), 11(15.5%) and 13 (18.3%) patients respectively. Median follow up duration was 15 months (3-52 months). Clinical response rate (CRR) at 1 month after completion of RT was 80%. Overall complete response, partial response, progressive disease and death at the time of last follow up were 37(52.1%), 21(29.6%), 11(15.5%), 2(2.8%) respectively. Age < 50 years was associated with poor outcome (odds ratio, 1.1; 95% CI 0.42-2.86). 3-month LRF rate was 32.4%. Median PFS was 11.4 months (5.3-32.4 months). CONCLUSION Inoperable patients of OC-SCC with good performance status treated with definitive CTRT with or without IC yielded complete response in approximately half of patients with acceptable toxicity profile. Loco-regional failure remains the predominant mode of failure. Future research including studies on biomarkers for better patient selection and treatment personalization is warranted.
Reconstruction following excision for tongue cancer carries important functional consequences. Is... more Reconstruction following excision for tongue cancer carries important functional consequences. Island nasolabial flap (NLF) is robust and oncologically safe and has a good functional outcome, identical to free flap reconstruction. We retrospectively analyzed the data of 11 tongue cancer patients operated between January 2019 and August 2019. Surgical resection and neck dissection followed by immediate reconstruction by island NLF were done. Post-operative functional outcome assessed using the University of Washington Quality of Life Questionnaire. Age of patients ranged between 39 and 70 years. All patients had either T2 or T3 tongue cancer. No incidence of flap necrosis noted in any patient. On an average, all were discharged between 3rd and 5th post-operative days. Cosmetic and functional outcomes were satisfactory in all patients. Island nasolabial has an excellent reach and can reach any part of the oral cavity, even to the contralateral side and base of the tongue. It has an excellent postoperative tongue function, almost equivalent to free flap. Hence, it should be considered locoregional flap of choice for tongue reconstruction.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamou... more Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamous cell cancer. There is paucity of literature regarding control rates in these cases. We intend to report the outcomes in terms of administered treatment and control rates. 28 patients of oral cavity verrucous carcinomas treated at our institute from March 2014 to December 2018 were reviewed retrospectively. Demographic profile, histopathological features and clinical outcomes were analyzed. Statistical analysis was performed with SPSS for Mac (version 23.0). Median age was 54 years (range 31-75) with M:F ratio of 25:3. Buccal mucosa was the most common site. All patients underwent surgical resection except one. Of these, 24 had neck dissection; 12 had supra-omohyoid neck dissection, eleven had modified neck dissection and one patient underwent radical neck dissection. Three patients had their histology upgraded to squamous cell carcinomas in the post-operative histopathology. The post-operative staging was as follows: 21% stage I and 35% stage II. One patient opted for non-surgical approach and received radical concurrent chemoradiotherapy. Median follow up was 12 months (range 6-36). Two patients had local failures and one had a regional failure. No distant metastasis was found. There was one death. 14-Months survival rate was 92%. Estimated 18 month loco-regional control rate was 92%. Curative surgical resection remains the cornerstone for VC of oral cavity. Any change of histopathology post-operatively to squamous cell carcinoma is a poor prognostic sign and needs appropriate adjuvant treatment.
planning (Figure 1c). The planning goal for these cases was a D90 to the CTV of least 90% prescri... more planning (Figure 1c). The planning goal for these cases was a D90 to the CTV of least 90% prescription (Figure 1b and 1d), while following GEC-ESTRO limitations on D2cc to bladder and rectum in all cases. There was no strict limitation on the vagina during this time period, however, the aim was a maximum vaginal surface dose of approximately 140Gy (EQD2). All patients had the upper vaginal mucosa drawn at the time of each implant in the same manner, which consisted of a 4mm expansion of the cylinder, with a length of 4cm, with a subtraction of the cap of the applicator to exclude the cervix or upper vaginal apex (Figure 1e). We recorded the D2cc and D1cc of the upper vagina for the current analysis, to establish baseline volumetric criteria. Results: A total of 20 unique plans were candidates for review among the 9 patients. MCVC diameters ranged from 2.5cm to 3.5cm. The BT prescription schema was 4.5Gy x 5 (n51); 5Gy x 5 (n53); 5.5Gy x 4 (n52); 5.5Gy x 5 (n51); 6.8Gy x 4 (n51) and 7Gy x 4 (n51). The average dose (range) delivered to D2cc and D1cc of vagina per BT fraction was 145% (99-206%) and 168% (120-231%) of the prescription, respectively. This resulted in an average absolute dose contribution (EQD2) from BT per patient of 75.2Gy and 99.4Gy to the vagina D2cc and D1cc, respectively. Among the patients treated in combination with EBRT, the average CTV D90 dose was 74.5Gy (range: 67.4-83.6Gy), with corresponding D2cc and D1cc of the upper vagina of 114.5Gy (range: 97.5-126Gy) and 137.7Gy (range: 108.5-165.3Gy), respectively. With a median follow-up of 16 months (range: 3-33), there were no local recurrences and no grade 3 or higher vaginal toxicity. Conclusions: Standardized recording of vaginal dose-volume parameters is feasible when using MCVC BT to treat gynecologic cancers involving the vagina. The average cumulative dose values in this cohort of 114.5Gy and 137.7Gy to the upper vaginal surface D2cc and D1cc, respectively, was associated with excellent clinical outcomes, and no grade 3 or higher vaginal toxicity. Validation in a larger cohort and further correlation with late toxicity is needed.
related deaths. During CCRT 4% of patients had grade 3/4 hematological while 7% non hematological... more related deaths. During CCRT 4% of patients had grade 3/4 hematological while 7% non hematological. With median follow-up of 21 months (Q1-Q3: 15-24 months) the 1 year progression free survival, distant disease survival and overall survival were 80%, 79% and 87% respectively.
γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its ex... more γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its expression has not been studied in cases with diagnostic low dose radiation exposure. Concerns have been raised about the after-effects of radiation in diagnostic procedures like Computed Tomography (CT) scan, Angiography etc especially when such scans are repeated within short span of time. The purpose of the present study was to assess immediate DNA damage after exposure to low level of ionizing radiation by the flow cytometric method of gamma-H2AX. Study sample includes total 60, cases and controls with two groups Group I-Normal controls (n = 15); Group II-Low dose, further divided in three groups: Group IIA-single CT scan (n = 15); Group IIB-Multiple CT scans (n = 15); and Group IIC-angiography single exposure (n = 15). For Low dose group blood was collected within 1 h after exposure in EDTA vaccutainers and immediately kept on ice. Lymphocytes were isolated and were fixed in 80% chill...
Conclusion: Renal angioplasty for RVHT due to FMD is technically successful, safe, and durable. M... more Conclusion: Renal angioplasty for RVHT due to FMD is technically successful, safe, and durable. Most patients have long-term clinical benefi t out to 10 years.
International Journal of Radiation Oncology*Biology*Physics, 2017
to the submandibular gland with hydrogel spacing was noted in the specimen with the smallest base... more to the submandibular gland with hydrogel spacing was noted in the specimen with the smallest baseline gland volume. Conclusion: Injection of biodegradable radiopaque hydrogel successfully displaces the contralateral submandibular gland, providing the opportunity for dosimetrically sparing the gland. This minimally invasive technique should be tested in a clinical trial for reduction of xerostomia.
Concurrent chemoradiation is presently the standard of care in locally advanced malignancy of the... more Concurrent chemoradiation is presently the standard of care in locally advanced malignancy of the cervix uteri. But accelerated radiotherapy regimes have not been investigated much. We conducted a randomized trial to compare the results of pure accelerated radiotherapy given as six fractions weekly to standard chemoradiotherapy in locally advanced carcinoma cervix patients. This was a prospective, phase III trial in which 106 patients of locally advanced (stage II and III) carcinoma cervix were randomized into two arms. The study arm (ART) received 50 Gy accelerated radiotherapy in 25 fractions, six fractions weekly; while control (CRT) arm was treated with concurrent chemoradiation 50 Gy in 25 fractions with weekly injection cisplatin. This was followed by intracavitary brachytherapy (ICBT; total dose of 85 Gy to point A) in both the arms. Fifty-one patients completed treatment in the ART arm and 50 patients in the CRT arm. In these patients, response to treatment, toxicity, and ov...
This report describes the case of a gentleman aged 59 years presenting with low-back pain, who ha... more This report describes the case of a gentleman aged 59 years presenting with low-back pain, who had underwent radical prostatectomy for prostate cancer 8 years ago. On evaluation, a slightly elevated serum alkaline-phosphatase level prompted a search for bone metastases. Although x-ray radiography and a bone scan were apparently normal, an MRI scan revealed the presence of metastatic marrow infiltration in the lumbar vertebrae. The patient subsequently was initiated on therapy with androgen-deprivation therapy and bisphosphonates, and currently enjoys symptom-free and progression-free survival. The images in this paper intend to impress upon the limitations of bone scan and x-ray radiography with regard to the detection of vertebral marrow infiltration in the absence of cortical bone invasion. In addition, a brief review of the pathophysiology of vertebral metastases arising from prostate cancer is included.
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Papers by Madhup Rastogi