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Joseph K, Al Habsi Z, Abraham A, Elangovan A, Ghosh S, Pham T, Shreekumar D, Ramji Z, Paulson K, Tankel K, Usmani N, Severin D, Schiller D, Wong C, Mulder K, Karachiwala H, Doll C, King K, Nijjar T. A population-based analysis of the impact of 1 vs. 2 doses of mitomycin on patterns of failure of anal cancer patients treated with concurrent chemoradiotherapy. Radiother Oncol 2024; 196:110219. [PMID: 38479443 DOI: 10.1016/j.radonc.2024.110219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE We report the impact of 1 vs. 2 doses of mitomycin-C (MMC) based chemoradiation (CRT) on patterns of treatment failure and long-term patient outcomes in anal squamous cell carcinoma (ASCC) and the predictors for locoregional failure (LRF) and distant metastasis (DM). METHODS In this population-based study, we identified all patients with anal cancer in our province treated radically with radiation and concurrent 5-Fluorouracil (5FU) and 1 vs. 2 doses of MMC between the years 2000-2019. The primary outcomes analyzed were locoregional recurrence (LRR), disease free survival (DFS), ASCC cancer-specific survival (ASCC-CSS) and overall survival (OS). RESULTS 451 patients were identified. 272 (60%) patients received 1 cycle of MMC (MMC1) and 179 (40%) received 2 cycles (MMC2) as part of the CRT regimen. The median follow-up was 57 (36-252) and 97 (38-239) months for MMC1 and MMC2, respectively. Cox Regression analysis showed stage IIIb and IIIc were associated with worse locoregional recurrence free survival (RFS) (HR=2.851, p=<0.001) and distant RFS (HR=3.391, p=<0.001). Similarly, stage IIIb and IIIc patients had poorer DFS (HR 3.439, p=<0.001), ASCC-SS (HR 3.729, p=<0.001) and OS (2.230, p=<0.001). The use of MMC2 showed a positive impact on improved ASCC-SS (HR 0.569, p=0.029) and distant RFS (HR 0.555, p=0.040) in patients with stage IIIb and IIIc. CONCLUSIONS Our analysis showed that 1 vs. 2 cycles of MMC along with 5FU and radiation is associated with comparable treatment outcomes in general. However, in patients with stage IIIb and IIIc cancer, 2 doses of MMC were associated with improved ASCC-SS and distant DFS.
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Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada.
| | - Zainab Al Habsi
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Aswin Abraham
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada.
| | - Arun Elangovan
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
| | - TruongMinh Pham
- Cancer Research & Analytics, Alberta health services, Edmonton, Alberta, Canada
| | | | | | - Kim Paulson
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Diane Severin
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
| | - Dan Schiller
- Department of Surgical Oncology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Clarence Wong
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen Mulder
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Hatim Karachiwala
- Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Corinne Doll
- Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Karen King
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, 11560 University Ave, Edmonton AB T6G 1Z2, Alberta, Canada
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Elangovan A, Wachowicz K, Riauka T, Ghosh S, Yun J, Abraham A, Waheed A, Daly H, Warkentin HK, Severin DM, Joseph KJ. Significance of Radiomics in Predicting Local Control for Patients with Malignant Liver Tumors Treated Using Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e465. [PMID: 37785484 DOI: 10.1016/j.ijrobp.2023.06.1666] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We routinely deliver Stereotactic Body Radiotherapy (SBRT) in malignant liver tumors using planning computed tomography (CT) and Magnetic Resonance Images (MRI) to aid target definition. In this study, we extracted radiomic features from the MR images to predict local control (LC) post-SBRT. MATERIALS/METHODS We retrospectively analyzed patients with either hepatocellular cancers (HCCs) or liver metastases (Mets) treated with SBRT between Aug 2014 and Aug 2020. All patients had CT simulation followed by 1.5 Tesla planning MRI in treatment position. Contrast enhanced T1 VIBE and T2 Haste MR sequences were registered with planning CT for target definition. Radiomic features were extracted from Gross Tumor Volumes (GTV) masked out of 60 seconds post contrast T1 VIBE MR images using the Radiomics calculator tool RaCaT. The output included 480 (408 textural, 50 intensity and 22 morphological) features for each target. Principal Component Analysis of the outputs obtained from all the targets yielded 20 radiomic feature clusters after computational prioritization. These clusters were correlated to LC outcomes at various time points post-SBRT. LC was defined as non-progressive disease. Accuracy of predictions was measured by area under (AUC) receiver operating characteristic curve. Cox regression analysis was done to find univariate and multivariate clinical [HCCs vs. Mets, single vs. multiple lesions, previous local therapy (yes vs. no), GTV volume (≤40 vs. >40 cc)], radiomic and dosimetric predictors (continuous) of LC. RESULTS In total, 97 patients received SBRT to 122 lesions. The median dose prescribed was 45 Gy (range, 30-50 Gy). Median age was 69 years (interquartile range, IQR 61-73 yrs.). 59 patients had HCCs and 38 had Mets. 24 lesions had prior ablative therapy. 75 patients had one target, and 22 had multiple targets. Median GTV was 43.5 cc (IQR 23.4-78.6 cc). Median follow up was 16.6 months (IQR 9.7-27.2 mths). Median LC was 13.6 months (IQR 8.0-23.5 mths). On univariate analysis, histology (HCCs vs. Mets; Hazard ratio (HR) 2.9, 95% CI 1.4-6.4; p < 0.006), radiomic clusters (p < 0.006) and the max., mean, and min. doses to GTV and Planning Target Volumes correlated with improved LC (all p-values < 0.05). On multivariate analysis, histology (HCCs vs. Mets; HR 4.4, 95% CI 1.6-12.3; p = 0.004), radiomic clusters (p = 0.034) and prescription dose (p = 0.048) were significant covariates. Specifically, the 20 radiomic clusters were predictive of LC, and the accuracy of predictions showed promise with AUC values of 0.74, 0.80, and 0.81 at 12, 24, and 36 months post-SBRT, respectively. AUC values for LC in HCCs vs. Mets at 12, 24, and 36 months were 0.83, 0.77, and 0.70, and 0.66, 0.77, and 0.88, respectively. CONCLUSION MR-based radiomics predict LC post-SBRT in patients with malignant liver tumors. Further research focused on independent validation of the model is required to explore its clinical use.
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Affiliation(s)
- A Elangovan
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - K Wachowicz
- Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - T Riauka
- Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - S Ghosh
- Cross Cancer Institute, Edmonton, AB, Canada
| | - J Yun
- Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - A Abraham
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - A Waheed
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - H Daly
- Alberta Health Services, Edmonton, AB, Canada
| | | | - D M Severin
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - K J Joseph
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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Joseph K, Balushi MA, Ghosh S, Stenson T, Abraham A, Elangovan A, Warkentin H, Paulson K, Tankel K, Usmani N, Severin D, Schiller D, Wong C, Mulder K, Doll C, King K, Nijjar T. Long-Term Patient-Reported Quality of Life of Anal Cancer Survivors Treated With Intensity Modulated Radiation Therapy and Concurrent Chemotherapy: Results From a Prospective Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:434-445. [PMID: 37148982 DOI: 10.1016/j.ijrobp.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Intensity modulated radiation therapy (IMRT) has confirmed its superiority in improving acute treatment-related toxicities in anal cancer, without compromising tumor control. However, the effect of IMRT on long-term quality of life (QOL) is poorly documented. The study prospectively evaluated the long-term patient-reported QOL after IMRT-based chemoradiation in anal cancer. METHODS AND MATERIALS Fifty-eight patients treated with IMRT and concurrent 5 fluorouracil/mitomycin-C were enrolled in the study. A prespecified secondary endpoint was prospective evaluation of long-term QOL. Fifty-four patients underwent QOL evaluation at baseline, after treatment, and during follow-up until 60 months, with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales. The QOL scores at baseline and posttreatment periods were compared. RESULTS For QLQ-C30, at 60 months, the mean scores of global health status, all functional scales, and all symptoms except diarrhea had improved, indicating normalization of QOL. Clinically and statistically significant improvements in the global health status (15.4; P = .003), role functioning (19.3; P = .0017), emotional functioning (18.9; P = .008), and social functioning (29.8; P ≤ .001) were observed. Diarrhea persisted as a concern over the years (P = .172). For European Organization for Research and Treatment of Cancer QLQ-CR29, rectal pain (-38.6; P = .001), mucous or blood discharge per rectum (-22.8; P = .005), and perianal soreness (-37.3; P ≤ .001) were improved both clinically and statistically. Clinically significant fecal leakage was reported by 16% of patients (5.6; P = .421). Volumes receiving 45 and 54 Gy were independent predictors for fecal incontinence. Clinically and statistically significant urinary incontinence occurred in 21% of patients (17.5; P = .014). Deterioration of dyspareunia was clinically significant (26.7; P = .099) at 60 months. CONCLUSIONS Compared with historical data, IMRT is associated with reduced long-term effects on QOL. The majority of patients treated with IMRT experienced clinically significant recovery of function and improvement in QOL over 5 years after completion of treatment. Specific toxicities such as chronic diarrhea, fecal incontinence, and urinary and sexual dysfunction were primarily responsible for deterioration of the long-term QOL. Future research aimed at reducing such toxicities is needed to further improve long-term QOL in anal cancer.
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Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
| | - Mustafa Al Balushi
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Trevor Stenson
- Alberta Cancer Clinical Trials, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Aswin Abraham
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Arun Elangovan
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Heather Warkentin
- Alberta Cancer Clinical Trials, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Kim Paulson
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Diane Severin
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Dan Schiller
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Clarence Wong
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada; Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen Mulder
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Corinne Doll
- Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Karen King
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
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Sangeetha T, Sahana R, Mounica P, Elangovan A, Shanmugam R, Arivazhagan G. H – Bond interactions in water multimers and water multimers – Pyridine complexes: Natural bond orbital and reduced density gradient isosurface analyses. J Mol Liq 2023. [DOI: 10.1016/j.molliq.2023.121524] [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: 02/26/2023]
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Sai Sarath K, Murali G, Elangovan A, Kalaivanan D. Case Series on Personalized Pediatric Posterior Zirconia Crowns. IJPedoR 2022. [DOI: 10.56501/intjpedorehab.v7i2.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pediatric dentists must comprehend children's aesthetic perception because kids are increasingly aware of their own and other children's appearance. Many aesthetic restorations are available on the market, including open-faced stainless-steel crowns, pre-veneered stainless-steel crowns, strip crowns, and polycarbonate crowns, but each has its own drawbacks. Prefabricated zirconia crowns are a new trend among pediatric dentists for restoring carious, damaged, and malformed primary molars and anteriors. Customized zirconia crowns, on the other hand, may be able to overcome the limitations of prefabricated crowns in certain situations, particularly molars, resulting in excellent aesthetics and longevity. Our case series illustrates the use and performance of personalized zirconia crowns in a variety of challenging clinical circumstances.
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Ghoshal S, Dracham CB, Sundaram A, Kumar R, Bal A, Das A, Bahl A, Verma RK, Elangovan A. Prognostic Value of HPV Infection Assessed by p16 Immunohistochemistry and the Influence of Tobacco Usage in Oropharyngeal Cancers: Real World Scenario. Indian J Otolaryngol Head Neck Surg 2022; 74:5823-5831. [PMID: 36742604 PMCID: PMC9895501 DOI: 10.1007/s12070-021-02427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
To find if an association could be established between Human Papilloma Virus (HPV) infection and oropharyngeal cancers (OPCs) in a group of patients known to be regular users of tobacco, and to determine the impact of HPV status on clinical outcomes.Case records of 212 patients with AJCC-7 (The American Joint Committee on Cancer 7th edition) stages II-IVB non metastatic squamous cell carcinoma of the oropharynx treated using radical radiotherapy with or without chemotherapy during the years 2015-2018 were retrieved. Formalin-fixed, paraffin-embedded blocks from oropharyngeal biopsies were available for 177 patients and were evaluated for p16 expression by immunohistochemical (IHC) staining. More than 50% nuclear staining with or without cytoplasmic staining was considered HPV+ . The association between tobacco use and HPV, as well as the influence of HPV status on survival outcomes were assessed. p16 expression was found to be positive in 23(13%) patients. Significant association was found between chewable tobacco usage and HPV positivity (p = 0.051). The median follow up was 20.5 months (range: 3-80). 5-year Overall Survival was 43.4% and 29.8% (p = 0.044) in HPV+ and HPV- patients, respectively. Local control was significantly better in HPV+ patients (38.6% vs. 25.3%, p = 0.049). There was also a trend towards improved Disease-free Survival in HPV+ patients (31 months vs. 15 months, p = 0.078). Though less in prevalence among the Indian population, improved outcomes in HPV+ OPC patients and widely available IHC HPV assays signifies the routine implementation of p16 testing in day-to-day clinical practice.
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Affiliation(s)
- Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chinna Babu Dracham
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Archana Sundaram
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Kumar
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashim Das
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Bahl
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Roshan Kumar Verma
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sangeetha T, Sahana R, Mounica P, Elangovan A, Shanmugam R, Arivazhagan G. Atoms in molecules theory, electrostatic potential surface and frontier molecular orbital analyses on water multimers and pyridine – water hydrogen bonded complexes. COMPUT THEOR CHEM 2022. [DOI: 10.1016/j.comptc.2022.113960] [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: 11/30/2022]
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Rajmohan G, Shanmugam R, Elangovan A, Sankaranarayanan R, Ravindran G, Dineshkumar P, Arivazhagan G. Synthesize, characterization and topological properties of new hydrazone derivatives. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2021.132028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Chandran S, Elangovan A, Vijayakumar S, Kumar KSS. Intraoral malignant glomus tumor. J Oral Maxillofac Pathol 2022; 26:259-262. [PMID: 35968168 PMCID: PMC9364626 DOI: 10.4103/jomfp.jomfp_444_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
Glomus tumors are uncommon, benign solitary tumors derived from the glomus apparatus. We report here a case of a malignant glomus tumor in an 8-year-old child presenting as a multilocular ill-defined radiolucency of the mandible. The lesion microscopically showed sheets of round basophilic cells with high nuclear-cytoplasmic ratio, indistinct cell boundaries, nuclear hyperchromatism and nuclear pleomorphism. Immunohistochemically, the tumor was positive for vimentin and smooth muscle actin.
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Affiliation(s)
- Satheesh Chandran
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Arun Elangovan
- Department of Pediatric Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Saranya Vijayakumar
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College and Hospital, Chennai, Tamil Nadu, India
| | - K. Sai Sarath Kumar
- Department of Pediatric and Preventive Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India,Address for correspondence: Dr. K. Sai Sarath Kumar, Department of Pediatric and Preventive Dentistry, Sathyabama Dental College and Hospital, 26/51, Sundar Moorthy Vinayagar Koil Street, Triplicane, Chennai - 600 005, Tamil Nadu, India. E-mail:
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Dineshkumar P, Sahana R, Shanmugam R, Elangovan A, Sankaranarayanan R, Kumbharkhane A, Joshi Y, Arivazhagan G. Heteromolecular H –bond interaction forces and dielectric parameters: Time domain reflectometry studies. Chem Phys Lett 2022. [DOI: 10.1016/j.cplett.2021.139272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Raju R, Kezia Angelin J, Karthikeyan AS, Kumar D, Kumar R R, Sahai N, Ramanujam K, Murhekar M, Elangovan A, Samuel P, John J, Kang G. Healthcare Utilization Survey in the Hybrid Model of the Surveillance for Enteric Fever in India (SEFI) Study: Processes, Monitoring, Results, and Challenges. J Infect Dis 2021; 224:S529-S539. [PMID: 35238353 PMCID: PMC8914874 DOI: 10.1093/infdis/jiab371] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Lack of reliable data in India drove the “Surveillance of Enteric Fever in India” (SEFI) concept. Hybrid surveillance, combining facility-based surveillance for the crude incidence, and a community-based healthcare utilization survey (HCUS) to calculate the factor needed to arrive at the adjusted incidence, was used in 6 sites. The HCUS aimed to determine the percentage of utilization of study facilities by the catchment population for hospitalizations due to febrile illness. Methods Population proportional to size sampling and systematic random sampling, in 2 stages, were used to survey 5000 households per site. Healthcare utilization was assessed. Results Febrile illness accounted for 20% of admissions among 137 990 individuals from 30 308 households. Only 9.6%–38.3% of those admitted with febrile illness sought care in the study hospitals. The rate of rural utilization of the private sector for hospitalization was 67.6%. The rate of hospitalization for febrile illness, per 1000 population, ranged from 2.6 in Manali to 9.6 in Anantapur; for 25.8% of the deaths associated with febrile illness, no facility was used before death. Conclusions One in 5 hospitalizations were associated with fever. Rural utilization of the private sector for hospitalization due to febrile illness was more than that of the public sector. Healthcare utilization patterns for hospital admissions due to febrile illness varied across sites. A meticulously performed HCUS is pivotal for accurate incidence estimation in a hybrid surveillance. Clinical Trials Registration ISRCTN72938224.
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Affiliation(s)
- Reshma Raju
- Department of Paediatrics, Christian Medical College Vellore, Vellore, India
| | - J Kezia Angelin
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Arun S Karthikeyan
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Dilesh Kumar
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Ranjith Kumar R
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Nikhil Sahai
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Karthikeyan Ramanujam
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Manoj Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - A Elangovan
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Prasanna Samuel
- Department of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Jacob John
- Department of Community Health, Christian Medical College Vellore, Vellore, India
| | - Gagandeep Kang
- Department of Paediatrics, Christian Medical College Vellore, Vellore, India
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Dracham CB, Kumar N, Kumar S, Elangovan A, Yadav BS, Mavuduru RS, Lal A, Gupta PK, Kapoor R. A phase II study of neoadjuvant chemotherapy followed by organ preservation in patients with muscle-invasive bladder cancer. Asian J Urol 2021; 9:318-328. [PMID: 36035340 PMCID: PMC9399551 DOI: 10.1016/j.ajur.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 09/04/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Conservative approaches in muscle-invasive bladder cancer (MIBC) have been evolved to avoid aggressive surgery, but are limited to elderly, frail, and patients medically unfit for surgery. Our study aimed to assess the response rate of neoadjuvant chemotherapy (NACT) before radiotherapy (RT) in MIBC patients. Methods Forty patients with urothelial carcinoma of stage T2–T4a, N0, M0 were enrolled between November 2013 and November 2015, and treated with three cycles of NACT with gemcitabine-cisplatin. Post-NACT response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Patients who achieved complete response (CR) and partial response (PR) >50% were treated with radical RT, and those who had PR <50%, stable disease (SD), and progressive disease (PD) underwent radical cystectomy (RC). Survival analysis was done with Kaplan-Meier method and point-to-time events were analyzed with Cox-proportional hazards regression model. Results After NACT, 35 (87.5%) patients achieved either PR >50% or CR, and were treated with RT. Five (12.5%) patients who had PR <50%, SD, or PD underwent RC. All patients who received radiation showed CR after 6 weeks. Median follow-up was 43 months (range: 10–66 months) and median overall survival (OS) was not reached. Three-year OS, local control, and disease-free survival were 70.1%, 60.9%, 50.6%, respectively, and 50% of patients preserved their functioning bladder. Three-year OS rate was 88.9% in patients who achieved CR to NACT, 73.1% in patients with PR ≥50% and 40% in patients with PR <50%. Conclusion NACT followed by RT provides a high probability of local response with bladder preservation in CR patients. Appropriate use of this treatment regimen in carefully selected patients may omit the need for morbid surgery.
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Kumar N, Elangovan A, Madan R, Dracham C, Khosla D, Tripathi M, Gupta K, Kapoor R. Impact of Immunohistochemical profiling of Glioblastoma multiforme on clinical outcomes: Real-world scenario in resource limited setting. Clin Neurol Neurosurg 2021; 207:106726. [PMID: 34116459 DOI: 10.1016/j.clineuro.2021.106726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Intuition into the molecular pathways of glioblastoma multiforme (GBM) has changed the diagnostic, prognostic, and therapeutic approaches. We investigated the influence of various clinical and molecular prognostic factors on survival outcomes in radically treated GBM patients. METHODS Medical records of 160 GBM patients treated between January-2012 and December-2018 with surgery followed by post-operative external beam radiotherapy (EBRT) with/without temozolomide (TMZ) were reviewed. Immunohistochemical (IHC) assays were performed for IDH1mutation, ATRX loss, TP53 overexpression and Ki-67% index. Apart from disease and treatment-related factors' influence on clinical outcomes, the impact of IHC markers in prognostication was analyzed using appropriate statistical tests. RESULTS The median overall survival (OS) was 14 months. EBRT with concurrent TMZ was given to 60% of patients and 42.5% completed the standard Stupp-protocol. Significant improvements in OS was observed in patients aged ≤ 50years (2-year OS: 22.1% vs. 12.5%, p = 0.001), those who underwent gross total resection (2-year OS: 21.8% vs. 12.8%, p = 0.002), received concurrent TMZ (21.9% vs. 12.5%, p = 0.005), completed the entire Stupp-protocol (2-year OS: 23.4% vs. 6.5%, p = 0.000), and with Ki-67 index <20% (2-year OS: 23.3% vs. 11.6%, p = 0.015). On multivariate analysis, IDH1 mutation, ATRX loss, TP53 expression, and Ki-67 ≤ 20% were significant prognosticators of outcomes. CONCLUSION GBM patients treated with concurrent chemoradiation and those who completed the full Stupp-protocol experienced better survival outcomes. Molecular biology significantly impacts clinical outcomes and plays a key deterministic role in newer management strategies.
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Affiliation(s)
- Narendra Kumar
- Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India.
| | - Arun Elangovan
- Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India.
| | - Renu Madan
- Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India.
| | | | - Divya Khosla
- Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India.
| | | | - Kirti Gupta
- Department of Pathology, PGIMER, Chandigarh, India.
| | - Rakesh Kapoor
- Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India.
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Dracham C, Khosla D, Kapoor R, Dey T, Periasamy K, Elangovan A, Madan R, Goyal S, Kumar N. Expanding role of radiotherapy in adenoid cystic carcinoma of the tracheobronchial tree: a new horizon. Tumori 2021; 108:347-356. [PMID: 33977780 DOI: 10.1177/03008916211012461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Primary adenoid cystic carcinomas (ACCs) of central trachea-bronchi system are rare and heterogeneous tumors. Definitive radiotherapy (RT) is the recommended treatment in surgically unresectable or incomplete resection or in the presence of severe comorbidities. OBJECTIVE To evaluate the clinical features and outcomes of patients with ACC of trachea-bronchi treated with radiotherapy. METHODS Retrospective medical records review was done in all patients with histologically confirmed ACC of trachea-bronchi between January 2010 and December 2019. Patient disease and treatment characteristics and toxicity data were analyzed. Overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were computed using Kaplan-Meier method (log-rank test). RESULTS Nineteen patients (10 women and 9 men) were included in this analysis with median age of 40 years (range, 14-70). Of these patients, 63.2% (n = 12) presented in stage IV disease. Twelve and three patients received definitive (median dose 67.8 Gy) and adjuvant (median dose 50 Gy) RT, respectively. The median follow-up was 42.5 months (range, 4-120); 15 patients were alive and 4 were dead at that time. Local recurrence or progression was observed in 52.6% and distant metastasis found in 47.3% of patients. The 5-year OS, LRFS, and DMFS for all patients were 81.2%, 52.8%, and 39.6%, respectively. Baseline lymph node involvement showed significant impact on OS (56.3% vs 100%, p = 0.011). Among patients receiving definitive RT, patients with higher RT dose (⩾66 Gy) had significantly better survival outcomes (5-year LRFS: 75% vs 16.7%, p = 0.013). CONCLUSION Definitive RT is an exemplary treatment for unresectable disease. Higher dose is recommended to improve long-term outcomes.
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Affiliation(s)
- ChinnaBabu Dracham
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Treshita Dey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sahu D, Kumar P, Chandra N, Rajan S, Shukla DK, Venkatesh S, Nair S, Kumar A, Singh J, Reddy S, Godbole S, Elangovan A, Saha MK, Rai S, Lakshmi PVM, Gambhir T, Ammassari S, Joshi D, Das A, Bakshi P, Chakraborty S, Palkar A, Singh SK, Reddy DCS, Kant S, Pandey A, Vardhana Rao MV. Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India. Indian J Med Res 2021; 151:562-570. [PMID: 32719229 PMCID: PMC7602920 DOI: 10.4103/ijmr.ijmr_1619_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.
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Affiliation(s)
- Damodar Sahu
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Pradeep Kumar
- Division of Strategic lnformation - Surveillance and Epidemiology, National AIDS Control Organisation, Ministry of Health & Family Welfare, Government of India, Chennai, Tamil Nadu, India
| | - Nalini Chandra
- Joint United Nations Programme on HIV/AIDS, New Delhi, India
| | - Shobini Rajan
- Division of Strategic lnformation - Surveillance and Epidemiology, National AIDS Control Organisation, Ministry of Health & Family Welfare, Government of India, Chennai, Tamil Nadu, India
| | - D K Shukla
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - S Venkatesh
- Principal Advisor to Board of Governors, Medical Council of India, New Delhi, India
| | - Saritha Nair
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Anil Kumar
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Jitenkumar Singh
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Srikanth Reddy
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Sheela Godbole
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - A Elangovan
- Computing and Information Sciences, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - M K Saha
- Department of Virology, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, Chennai, Tamil Nadu, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - T Gambhir
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | | | | | - Amitabh Das
- Odisha State AIDS Control Society, Bhubaneswar, Odisha, India
| | - Poonam Bakshi
- Chandigarh State AIDS Control Society, Chandigarh, India
| | | | - Amol Palkar
- Mumbai District AIDS Control Society, Maharashtra, India
| | - S K Singh
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - D C S Reddy
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, Chennai, Tamil Nadu, India
| | - Arvind Pandey
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
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Kannan P, Karthick N, Sangeetha T, Shanmugam R, Elangovan A, Arivazhagan G. FTIR studies and DFT calculations on the associative nature of methyl cellosolve in binary solutions with acetonitrile. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2020.129572] [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: 10/23/2022]
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Joshua V, Sylvia Grace J, Godwin Emmanuel J, Satish S, Elangovan A. Spatial mapping of COVID-19 for Indian states using Principal Component Analysis. Clin Epidemiol Glob Health 2021; 10:100690. [PMID: 33521388 PMCID: PMC7834364 DOI: 10.1016/j.cegh.2020.100690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vasna Joshua
- ICMR-National Institute of Epidemiology, Chennai, 600077, India
| | | | | | - S Satish
- ICMR-National Institute of Epidemiology, Chennai, 600077, India
| | - A Elangovan
- ICMR-National Institute of Epidemiology, Chennai, 600077, India
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18
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Kumar N, Madan R, Dracham CB, Khosla D, Das N, Dey T, Elangovan A, Tripathi M, Gupta K, Ahuja CK, Kapoor R. Multimodality treatment for Central Nervous System Germ Cell Tumors: Disease spectrum and management strategies - A tertiary care center experience from India. Clin Neurol Neurosurg 2021; 202:106481. [PMID: 33508649 DOI: 10.1016/j.clineuro.2021.106481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Intracranial germ cell tumors (GCTs) are relatively rare neoplasms, representing 2-3 % of paediatric brain tumors in Western countries and 8-15 % in East Asia. Here, we discuss the clinical features and treatment outcomes in patients with central nervous system (CNS) GCTs treated at our institute. METHODS Medical records of all primary CNS GCT patients were retrieved retrospectively from 2007 to 2019. Demographic, clinical, treatment and follow up details were entered in a predesigned proforma. Overall survival (OS) and progression-free survival was computed using Kaplan-Meier method and Log-Rank test. Effect of various prognostic factors on survival outcomes was assessed by univariate and multivariate analysis. RESULTS A total of 28 CNS GCT patients were included in this analysis. Median age at presentation was 17 years (range, 7-45 years) with a male to female ratio of 1.8:1. Pineal region was the commonest location, encountered in 15 patients (53.6 %). Pure germinoma was the most frequent histology observed, seen in 19 patients (67.9 %). Male gender and germinoma histology were highly associated with pineal location (p = 0.043 and p = 0.052, respectively). Fourteen patients underwent surgical intervention and nine patients underwent biopsy for diagnostic purpose or to relieve the obstructive symptoms. Only 23 patients (82.1 %) received chemotherapy. However, all patients received radiotherapy (Craniospinal irradiation/whole brain radiotherapy/whole ventricular radiotherapy/ or local radiotherapy). After a median follow-up of 53 months (range, 7-150), 23 patients (82.1 %) were alive. OS was significantly affected by histology (89 % in germinoma vs. 60 % in non-germinomatous, p = 0.054) and location (93 % in pineal region vs. 64.2 % in other location, p = 0.042). Age, gender and surgery did not have any impact on the survival outcomes. CONCLUSION CNS GCTs are relatively rare and heterogeneous neoplasms commonly seen in pineal and suprasellar locations. A combination of chemotherapy and radiotherapy had shown excellent outcomes.
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Affiliation(s)
- Narendra Kumar
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Renu Madan
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Chinna Babu Dracham
- Department of Radiation Oncology, Queen's NRI Hospital, Visakhapatnam, India.
| | - Divya Khosla
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Namrata Das
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Treshita Dey
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
| | - Arun Elangovan
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada.
| | | | - Kirti Gupta
- Department of Pathology, PGIMER, Chandigarh, India.
| | | | - Rakesh Kapoor
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India.
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Kumar MS, Aravinth V, Chenchugopal M, Elangovan A, Thomas A, Aishwarya V, Jerisha GR. Assessing the Attitude of Parents Towards Various Behaviour Management Techniques Used during Paediatric Dental Treatment: A Cross-sectional Study. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/49797.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Every child who enters the dental clinic is different. Some of them are anxious, some are scared, some are angry, and some are confused. Rarely, children exhibit a positive behaviour, most of them being uncooperative. The child’s behaviour in turn influences the efficiency and outcome of the dental treatment. Aim: To assess parents or caregivers’ acceptance of various Behaviour Management Techniques (BMT) through direct observation and feedback received. materials and methods: A cross-sectional study was planned to assess the most preferred BMT. The study was conducted from November 1st, 2018 to October 31st, 2019 for a period of one year. Parents of children between the ages of four to nine years were included in the study using non random convenience sampling with 675 participants. Every parent was given an explanation about the study and briefed about nine major BMTs in regional language. Audiovisual aid for each technique in their own mother tongue was displayed via a projector and sound systems and parents were asked to watch it. Later they were given a Visual Analog Scale (VAS) of 10 mm length with markings, printed on a sheet of paper to assess the preference for each technique. Collected data was entered in an excel sheet and analysis was done using median test. Results: The results showed that 32.4% i.e., the highest percentage of people opted for Tell Show Do (TSD), indicating that TSD is the best BMT. Professional status of parent showed a significant impact on BMT selection. Conclusion: This study reveals that amongst all the behaviour management methods, ‘Tell-Show-Do’ was the most accepted BMT by the parents and the professional background of the parent has a statistically significant role in the selection of BMT.
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20
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Kumar N, Madan R, Dracham CB, Chandran V, Elangovan A, Khosla D, Yadav BS, Kapoor R. Primary mediastinal germ cell tumors: Survival outcomes and prognostic factors - 10 years experience from a tertiary care institute. Rare Tumors 2020; 12:2036361320972220. [PMID: 33282160 PMCID: PMC7682202 DOI: 10.1177/2036361320972220] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Primary Mediastinal Germ Cell Tumor (PMGCT) is a rare and heterogeneous entity. These tumors are typically diagnosed in young adults and carry a poor prognosis. We conducted this study to evaluate the role of radiotherapy on treatment outcomes and prognostic factors in PMGCT that may allow a more adapted treatment strategy to improve survival. Case records of patients who presented with PMGCT over a period of 10-years from January-2009 to December-2019 were retrospectively evaluated. Survival analyses were calculated using Kaplan-Meier (Log-rank) method. Poor prognostic factors for survival were evaluated with Multivariate analysis using Cox-regression method. A total of 46-patients data was analyzed, the majority of the patients were males (95.7%) with a median age of 25-years (range, 17–62). Non-seminomatous histology was predominant (60.9%). Sixteen-patients (34.7%) presented with complications at their initial presentation. Majority of the patients were treated with multimodality approach using chemotherapy, surgery, and/or radiotherapy. At a median follow-up of 40.8 months, the 1, 3, and 5-year overall survival (OS) was 69.6%, 52.2%, and 44.7% respectively. Patients who received radiotherapy in first-line treatment showed significant improvement in 5-year OS (72% vs 30%, p = 0.004) and disease-free survival (70% vs 24%, p = 0.007) in comparison with patients who did not receive. Multivariate analysis revealed that radiotherapy, chemotherapy, surgery, and complications at presentation were independent prognostic factors for OS. PMGCTs are aggressive neoplasms especially in patients presenting with disease-related complications. Dual modality management (radiotherapy as local therapy along with chemotherapy) had shown improvement in survival.
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Affiliation(s)
| | | | - Chinna Babu Dracham
- Chinna Babu Dracham, Radiotherapy, Senior resident, Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Room no: 4, Radiotherapy office, Sector-12, Chandigarh 160012, India.
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Elangovan A, Husain S, McGeahy P, Roumeliotis M, Wu CHD, Wolfe N, Meyer T, Watt E, Martell K, Thind K. Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility. Brachytherapy 2020; 20:58-65. [PMID: 33008763 DOI: 10.1016/j.brachy.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR). METHODS AND MATERIALS A total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound-based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores. RESULTS We found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3-11), which increased to 12 (7-17) at 4 weeks and 9 (5-14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion. CONCLUSIONS Single-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.
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Affiliation(s)
- Arun Elangovan
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
| | - Siraj Husain
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Philip McGeahy
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Michael Roumeliotis
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Che Hsuan David Wu
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | | | - Tyler Meyer
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Elizabeth Watt
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Kundan Thind
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
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Abstract
Primary broad ligament carcinoma is a very rare occurrence with 28 reported cases worldwide, to date. The epidemiology, treatment strategy and prognosis are still uncertain because of the scarcity of cases. Currently, all broad ligament carcinomas are managed similar to epithelial ovarian cancer. We report the case of a 43-year-old female with a prolonged complaint of abdominal pain and intermittent urinary retention, requiring frequent catheterization. She was diagnosed with obstructive right hydroureteronephrosis. The abdominal Contrast Enhanced Computed Tomography (CECT) revealed a well-defined heterogeneous lesion of 2.1х3х3.2cm size in the right lateral and posterior wall of the cervix. An ultrasound (USG)-guided Fine Needle Aspiration Cytology (FNAC) of the mass was done and it was suspected to be malignant. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, pelvic lymph-nodal sampling, and peritoneal washing. Histological examination depicted an endometrioid adenocarcinoma of the broad ligament. She received adjuvant chemotherapy, followed by hormonal therapy. It has been five years since her surgery, and she is now alive and disease free.
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Affiliation(s)
- Arun Elangovan
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Radiotherapy & Oncology. Chandigarh, India
| | - Chinna Babu Dracham
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Radiotherapy & Oncology. Chandigarh, India
| | | | - Ariba Zaidi
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Pathology. Chandigarh, India
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Elangovan A, Martell K, Quon H, Wu CHD, Thind K, Husain S. 89: Does The Timing of High Dose Rate Brachytherapy Boost in Relation to External Beam Radiation Impact Acute Toxicities in Patients Receiving Combined Modality Radiotherapy for Prostate Cancer? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30981-6] [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: 11/28/2022]
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Elangovan A, Martell K, Quon H, Angyalfi S, David Wu CH, Meyer T, Husain S. 21: Comparison of Acute Toxicities in Patients with Prostate Cancer Treated with High Dose Rate Versus Low Dose Rate Brachytherapy Boost. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30913-0] [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: 10/23/2022]
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Bahl A, Panda NK, Elangovan A, Bakshi J, Verma R, Mohindra S, Gupta R, Oinam AS, Kaur S, Vashishta RK, Ghoshal S. Evaluation of Multimodality Management of Adenoid Cystic Carcinoma of the Head and Neck. Indian J Otolaryngol Head Neck Surg 2019; 71:628-632. [PMID: 31742032 DOI: 10.1007/s12070-018-1442-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/07/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022] Open
Abstract
Adenoid cystic carcinoma is a relatively rare tumour arising from salivary glands of head and neck region. Surgery and radiotherapy form standard treatment modalities in the management of this tumor. In this analysis we present results of multimodality treatment in our cohort of patient. This retrospective analysis evaluated results of treatment in forty patients diagnosed with adenoid cystic carcinoma of the head and neck. Evaluation was done to identify prognostic factors affecting the disease free survival. A median disease free survival of 34 ± 2.42 (Median ± SE) versus 10 ± 5.45 months was seen in patients undergoing surgery followed by post operative radiotherapy versus radiotherapy alone (P = 0.01). A radiotherapy dose more than 60 Gy was associated with a better disease free survival compared with patients receiving less than 60 Gy (P = 0.01). Positive surgical margins and perineural invasion were associated with a poor treatment outcome (P = 0.02) Patients with c-kit positive status showed a poor local control rate (P = 0.05).
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Affiliation(s)
- Amit Bahl
- 1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Kumar Panda
- 2Departments of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Elangovan
- 1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- 2Departments of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Verma
- 2Departments of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyawati Mohindra
- 2Departments of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rijuneeta Gupta
- 2Departments of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Singh Oinam
- 1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Satinder Kaur
- 1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Vashishta
- 3Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- 1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kaur G, Gupta P, Elangovan A, Kapoor R, Jain V, Rajwanshi A. Bilateral adnexal masses in a perimenopausal female. Cytopathology 2019; 31:68-70. [PMID: 31231891 DOI: 10.1111/cyt.12746] [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] [Received: 03/22/2019] [Revised: 04/06/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Gurwinder Kaur
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Dracham CB, Gupta S, Das CK, Elangovan A. Platinum sensitive carcinoma of ovary relapsed as pericardial effusion with cardiac tamponade. BMJ Case Rep 2019; 12:12/3/e228268. [PMID: 30904894 DOI: 10.1136/bcr-2018-228268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association-IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.
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Affiliation(s)
- Chinna Babu Dracham
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shipra Gupta
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Krushna Das
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Elangovan
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bahl A, Elangovan A, Oinam A, Kumar R, Mittal B, Verma R, Panda N, Ghoshal S. PO-080 Radiotherapy versus concurrent chemo radiotherapy in cancers of unknown primary of Head and Neck. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Miriyala R, Rai B, Ballari NR, Oinam AS, Elangovan A, Singla V, Singh T, Ghoshal S. Prospective Study to Quantify Expansion Volumes Around the Involved Pelvic Lymph Nodes to Plan Simultaneous Integrated Boost in Patients With Cervical Cancer Undergoing Pelvic Intensity Modulated Radiation Therapy. Pract Radiat Oncol 2019; 9:e394-e399. [PMID: 30802616 DOI: 10.1016/j.prro.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/06/2019] [Accepted: 02/14/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aimed to calculate the expansion margins around enlarged pelvic lymph nodes to encompass internal motion and setup errors during intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer. METHODS AND MATERIALS Four-dimensional computed tomography scans were obtained for 19 patients with cervical cancer, and 32 fluorodeoxyglucose-avid pelvic lymph nodes were delineated in different respiratory phases to calculate respiratory displacement. Setup variations during daily treatments were estimated from on-board imaging. Descriptive statistics were used to quantify the expansion margins using Mc Kenzie and Van Herk formulas separately. An analysis of variance was used to analyze the volumetric impact of the margins. RESULTS Based on the McKenzie formula, an internal margin (internal target volume) of 3 mm and setup margin (planning target volume) of 5 mm was required to adequately encompass respiratory and setup uncertainties, respectively. Although the use of the Van Herk formula necessitated a single 6 mm expansion margin for all uncertainties, which resulted in a significant reduction in boost volume, inherent limitations in our methodology might pose a higher risk of target miss with such smaller margins. CONCLUSIONS An isotropic expansion margin of 3 mm for the internal target volume and 5 mm for the planning target volume is necessary for enlarged pelvic lymph nodes while planning intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer.
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Affiliation(s)
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India.
| | | | - Arun Singh Oinam
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Veenu Singla
- Department of Radiology, PGIMER, Chandigarh, India
| | - Tulika Singh
- Department of Radiology, PGIMER, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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Mazumder K, Elangovan A, Rai B, Suri V, Jain V, Kalra J, Ghoshal S. Conventional radiotherapy and intensity-modulated radiotherapy in carcinoma vulva: An experience from a tertiary medical center of India. South Asian J Cancer 2019; 8:41-43. [PMID: 30766852 PMCID: PMC6348779 DOI: 10.4103/sajc.sajc_66_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease. Aims The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution. Subjects and Methods This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated. Statistical Analysis Used Kaplan-Meier survival analysis and Chi-square test were used for statistical analysis. Results Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy - 2, radical vulvectomy - 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity (P = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up. Conclusions Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks.
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Affiliation(s)
- Koustav Mazumder
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Gynecology and obstetrics, Postgraduate Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Gynecology and obstetrics, Postgraduate Medical Education and Research, Chandigarh, India
| | - Jaswinder Kalra
- Department of Gynecology and obstetrics, Postgraduate Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
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Dracham CB, Mahajan R, Rai B, Elangovan A, Bhattacharya T, Ghoshal S. Toxicity and clinical outcomes with definitive three-dimensional conformal radiotherapy (3DCRT) and concurrent cisplatin chemotherapy in locally advanced cervical carcinoma. Jpn J Clin Oncol 2019; 49:146-152. [PMID: 30452664 DOI: 10.1093/jjco/hyy164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/26/2018] [Indexed: 11/13/2022] Open
Abstract
Objective(s) This study aimed to retrospectively evaluate the toxicity and clinical outcomes in patients of locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) and concurrent chemotherapy. Material and methods Two hundred and ten newly diagnosed patients of locally advanced cervical cancer of FIGO 2009 Stage II-III treated with 3DCRT (46 Gy/23 fractions/4½ weeks) and weekly concurrent Cisplatin (40 mg/m2), from January 2013 to 2015 were analyzed. A planning computed tomography was performed and contouring was done according to published guidelines. External radiotherapy was followed by Intracavitary brachytherapy delivered to a dose of 9 Gy HDR in 2-fractions, given one week apart. The endpoints were treatment related toxicities and clinical outcomes. Local control (LC), overall survival (OS) and disease free survival (DFS) were evaluated and toxicities were documented using the common terminology criteria for adverse events (v3.0) (CTCAE). Results The median follow up time was 37 (range, 19-54) months. The 3 year OS, DFS and LC were 84.2%, 80.6% and 81% respectively. Grade ≥3 acute skin, upper and lower gastrointestinal (GI) and genitourinary (GU) toxicity was observed in 3 (1.4%), 11 (5.2%), 12 (5.7%) and 0 (0%) patients, respectively. Grade ≤2 hematological toxicity was observed in 154 (73.3%) patients. Grade ≥3 late GI and GU toxicity was seen in 9 (4.2%) patients and 2 (0.9%) patients, respectively. Conclusion 3DCRT with concurrent chemotherapy results in good loco-regional control with acceptable normal tissue toxicity. In the background of indeterminate evidence regarding routine practice of intensity modulated radiotherapy in carcinoma of the cervix, 3DCRT may be considered as the treatment of choice.
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Affiliation(s)
| | - Rohit Mahajan
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh
| | - Bhavana Rai
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh
| | - Arun Elangovan
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh
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Bahl A, Elangovan A, Dracham CB, Kaur S, Oinam AS, Trivedi G, Verma R, Panda NK, Ghoshal S. Analysis of volumetric and dosimetric changes in mid treatment CT scan in carcinoma nasopharynx: implications for adaptive radiotherapy. J Exp Ther Oncol 2019; 13:33-39. [PMID: 30658024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/25/2018] [Accepted: 07/01/2018] [Indexed: 06/09/2023]
Abstract
Carcinoma of nasopharynx is a radiosensitive tumor and therapeutic response during radiation treatment can result in dosimetric variations in the delivered dose to the tumor and critical organs. This study was done to evaluate the volumetric and dosimetric changes seen in tumor tissue and organs at risk in a mid treatment planning scan and its implications for adaptive replanning. Twenty patients of locally advanced carcinoma nasopharynx were evaluated. All patients were started on treatment with a baseline treatment plan on SIB-VMAT. To evaluate volumetric and dosimetric changes during treatment, a mid treatment CT scan (MTS) was taken at the 17th fraction of treatment and compared with the baseline planning CT scan (BS). Adaptive treatment plans were generated on the MTS and further treatment was continued on the adaptive plans. The mean weight loss observed at the 17th fraction of treatment was 3.4 ± 2.6 kg(Mean±S.D). The mean neck diameter at C2 level was 14.19±1.02 and 13.29 ± 1.14 cm in the BS and MTS respectively (p=0.001). The GTV 70 volume showed a 29.16% volume loss. The mean doses received by the right and left parotids were 25.45±0.98 and 24.64±3.8 Gy in the baseline treatment plan and 33.21±11.29 (p=0.054) and 31.76±8.44 Gy respectively in the MTS (p=0.016) The mean weight loss showed a statistically significant correlation with increase in the right parotid(p=0.043) and left parotid doses(p=0.024). Weight loss during treatment combined with volume changes in target tissues mandate routine adaptive replanning while treating carcinoma nasopharynx.
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Affiliation(s)
- Amit Bahl
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Arun Elangovan
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Chinna Babu Dracham
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Satinder Kaur
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Arun Singh Oinam
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Gaurav Trivedi
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Roshan Verma
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Naresh K Panda
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
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Elangovan A, Bahl A, Patel F, Dracham C, Rai B, Trivedi G. Is bone marrow sparing intensity modulated radiotherapy better than 3-dimensional conformal radiotherapy in reducing haematological toxicities during pelvic irradiation in locally advanced carcinoma cervix?: A prospective study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.010] [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: 11/14/2022] Open
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Sundaram A, Elangovan A, Rajwanshi A, Srinivasan R, Kapoor R. Proximal-type epithelioid sarcoma of the vulva: Cytopathological diagnosis of a rare neoplasm. Cytopathology 2018; 29:471-473. [PMID: 29683530 DOI: 10.1111/cyt.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Sundaram
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rajwanshi
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kannan P, Karthick N, Mahendraprabu A, Shanmugam R, Elangovan A, Arivazhagan G. Corrigendum to “Red/blue shifting hydrogen bonds in acetonitrile - Dimethyl sulphoxide solutions: FTIR and theoretical studies” [J. Mol. Struct. 1139 (2017) 196–201]. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2017.08.045] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bahl A, Oinam AS, Kaur S, Verma R, Elangovan A, Bhandari S, Bakshi J, Panda N, Ghoshal S. Correction: Evaluation of Acute Toxicity and Early Clinical Outcome in Head and Neck Cancers Treated With Conventional Radiotherapy and Simultaneous Integrated Boost Arc Radiotherapy. World J Oncol 2017; 8:174. [PMID: 29149224 PMCID: PMC5687898 DOI: 10.14740/wjon1049wc1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Amit Bahl
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Arun S Oinam
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Satinder Kaur
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Roshan Verma
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Arun Elangovan
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sudhir Bhandari
- Department of Oral Health Sciences, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Jaimanti Bakshi
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Naresh Panda
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Bahl A, Oinam AS, Kaur S, Verma R, Elangovan A, Bhandari S, Bakshi J, Panda N, Ghoshal S. Evaluation of Acute Toxicity and Early Clinical Outcome in Head and Neck Cancers Treated With Conventional Radiotherapy and Simultaneous Integrated Boost Arc Radiotherapy. World J Oncol 2017; 8:117-121. [PMID: 29147446 PMCID: PMC5650008 DOI: 10.14740/wjon1049w] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022] Open
Abstract
Background Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques. Methods Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/m2 weekly or 100 mg/m2 thrice weekly. Results The incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073). Conclusion SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers.
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Affiliation(s)
- Amit Bahl
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Arun S Oinam
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Satinder Kaur
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Roshan Verma
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Arun Elangovan
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sudhir Bhandari
- Department of Oral Health Sciences, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Jaimanti Bakshi
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Naresh Panda
- Department of Otolaryngology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Bahl A, Elangovan A, Kaur S, Verman R, Oinam AS, Ghoshal S, Panda NK. Pre-Treatment Nutritional Status and Radiotherapy Outcome in Patients with Locally Advanced Head and Neck Cancers. Gulf J Oncolog 2017; 1:61-63. [PMID: 29019332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
AIM Poor oral intake and associated nutritional depletion can affect treatment outcome in locally advanced head and neck cancers. The aim of this study was to evaluate the pre radiotherapy nutritional status as a predictor for response to radiotherapy treatment. PATIENTS AND METHODS Fifty patients of locally advanced head and neck cancers undergoing radical chemoradiotherapy were evaluated in this prospective analysis. Patients were treated with definitive radiotherapy to a total dose of 60-70 Gy along with concurrent chemotherapy with injection Cisplatin 100mg/m2 delivered three weekly. The patients were evaluated for pre-treatment nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. The PG-SGA evaluation was completed just before starting radiotherapy treatment and scores correlated to treatment outcome. RESULTS Forty-seven male and three female patients were evaluated in this analysis. The median PG-SGA score was 8 with a range from 2-14.Grade 3-4 mucositis was seen in seven patients (21.8%) with PGSGA <9 compared to 55.5% in those with PG-SGA score = 9 (p=0.01). At the time of evaluation a complete response was seen in 16 patients (32%) with a PG-SGA score <9 compared to 4 patients (8%) with a PGSGA =9 (p=0.05). The median survival was 16±2.8months (Median ±S. Error) and 17±2.9 months in those with PG-SGA <9 and =9 respectively (p=0.49, log rank). CONCLUSION PG-SGA nutritional score <9 is associated with a better local control and acute toxicity profile in radically treated head and neck cancer patients.
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Affiliation(s)
- Amit Bahl
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Satinder Kaur
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Rosahn Verman
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Arun Singh Oinam
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
| | - Naresh K Panda
- Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India
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Chenchugopal M, Mungara J, Venumbaka NR, Elangovan A, Vijayakumar P, Rajendran S. In vivo Evaluation of 4% Articaine and 2% Lignocaine Intraligamentary Injection Administered with Single Tooth Anesthesia-Wand. Contemp Clin Dent 2017; 8:315-320. [PMID: 28839421 PMCID: PMC5551340 DOI: 10.4103/ccd.ccd_882_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The available literature confirms the effectiveness of intraligamentary injections equal to nerve blocks and articaine equal to lignocaine with better depth of penetration for single tooth pulpectomy procedures with less postoperative soft tissue trauma. An advancement in the field of local anesthesia delivery is the Single Tooth Anesthesia-Wand (STA-Wand) which is relatively pain-free and offers comfort to the child. Aims: This study aims to evaluate and compare the anesthetic effectiveness and postoperative complications of 4% articaine and 2% lignocaine intraligamentary injection administered as single tooth anesthesia using a computer-controlled local anesthetic delivery system, the STA-Wand. Settings and Design: Using a randomized, split-mouth, cross-over study design, twenty children aged 4–10 years who required bilateral mandibular pulpectomies were administered intraligamentary injections with 4% articaine and 2% lidocaine in two appointments using STA-Wand. Pain, anxiety, and cooperation levels were scored by an operator and an observer at four phases of treatment using Wong-Baker Faces Pain Rating Scale and Two-6 point Co-operation Anxiety Rating Scale. Results were tabulated and analyzed. Statistical Analysis: Mann–Whitney U-test, paired t-test, and Student's t-test. Results: Both the local anesthetic agents were equally effective with no significant difference (P > 0.05) throughout rest of the treatment procedure compared to injection phase in minimizing pain, anxiety, and gaining the cooperation levels of children whereas during injection phase, 4% articaine showed superior effectiveness in minimizing pain compared to 2% lignocaine (P = 0.054). Conclusion: Both the local anesthetic agents delivered using STA-Wand is clinically acceptable, effective, and safe for usage in children.
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Affiliation(s)
- Madhan Chenchugopal
- Department of Pedodontics and Preventive Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Jayanthi Mungara
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Nilaya Reddy Venumbaka
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Arun Elangovan
- Department of Pedodontics and Preventive Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Poornima Vijayakumar
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sakthivel Rajendran
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
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Kannan P, Karthick N, Mahendraprabu A, Shanmugam R, Elangovan A, Arivazhagan G. Red/blue shifting hydrogen bonds in acetonitrile-dimethyl sulphoxide solutions: FTIR and theoretical studies. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2017.03.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karthick NK, Kumbharkhane AC, Joshi YS, Mahendraprabu A, Shanmugam R, Elangovan A, Arivazhagan G. Molecular interactions in ethyl acetate-chlorobenzene binary solution: Dielectric, spectroscopic studies and quantum chemical calculations. Spectrochim Acta A Mol Biomol Spectrosc 2017; 178:218-224. [PMID: 28199926 DOI: 10.1016/j.saa.2017.01.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 01/13/2017] [Accepted: 01/27/2017] [Indexed: 06/06/2023]
Abstract
Dielectric studies using Time Domain Reflectometry method has been carried out on the binary solution of Ethyl acetate (EA) with Chlorobenzene (CBZ) over the entire composition range. Spectroscopic (FTIR and 13C NMR) signatures of neat EA, CBZ and their equimolar binary solution have also been recorded. The results of the spectroscopic studies favour the presence of (CBZ) CH⋯OC (EA), (EA) methylene CH⋯π electrons (CBZ) and (EA) methyl CH⋯Cl (CBZ) contacts which have been validated using quantum chemical calculations. Dimerization of CBZ has been identified. Presence of β-clusters has been identified in all the solutions. Although EA and CBZ molecules have nearly equal molar volumes, CBZ molecules experience larger hindrance for the rotation than EA molecules. Very small excess dielectric constant (εE) values may be correlated with weak heteromolecular forces and/or closed heteromolecular association.
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Affiliation(s)
- N K Karthick
- Department of Physics, Thiagarajar College, Madurai-09, Tamil Nadu, India
| | - A C Kumbharkhane
- School of Physical Sciences, Swami Ramanand Teerth Marathwada University, Nanded 431606, Maharashtra, India
| | - Y S Joshi
- Lal Bahadur Shastri Mahavidyalaya, Dharmabad Dist., Nanded, Maharashtra, India
| | - A Mahendraprabu
- Department of Physics, Thiagarajar College, Madurai-09, Tamil Nadu, India
| | - R Shanmugam
- Department of Chemistry, Thiagarajar College, Madurai-09, Tamilnadu, India
| | - A Elangovan
- Department of Chemistry, Thiagarajar College, Madurai-09, Tamilnadu, India
| | - G Arivazhagan
- Department of Physics, Thiagarajar College, Madurai-09, Tamil Nadu, India.
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Perumal S, Muthumanickam S, Elangovan A, Karthik R, kannan RS, Mothilal KK. Bauhinia tomentosa Leaves Extract as Green Corrosion Inhibitor for Mild Steel in 1M HCl Medium. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40735-017-0072-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karthik R, Govindasamy M, Chen SM, Chen TW, Vinoth kumar J, Elangovan A, Muthuraj V, Yu MC. A facile graphene oxide based sensor for electrochemical detection of prostate anti-cancer (anti-testosterone) drug flutamide in biological samples. RSC Adv 2017. [DOI: 10.1039/c6ra28792a] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An electrochemical sensor based on graphene oxide modified glassy carbon electrode for the determination of anti-cancer drug flutamide.
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Affiliation(s)
- R. Karthik
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Mani Govindasamy
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Shen-Ming Chen
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Tse-Wei Chen
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - J. Vinoth kumar
- Department of Chemistry
- VHNSN College
- Virudhunagar – 626001
- India
| | - A. Elangovan
- Department of Chemistry
- Thiagarajar College
- Madurai – 625009
- India
| | - V. Muthuraj
- Department of Chemistry
- VHNSN College
- Virudhunagar – 626001
- India
| | - Ming-Chin Yu
- Department of Surgery
- Chang Gung Memorial Hospital at Linkou
- Taoyuan
- Taiwan
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Chenchugopal M, Venumbaka NR, Vijayakumar P, Selvaraju G, Rajendran S, Elangovan A. Shade selection of primary maxillary anterior teeth in children using Vitapan classical shade guide. Indian J Dent Res 2016; 27:657-660. [PMID: 28169266 DOI: 10.4103/0970-9290.199596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The purpose of this study was to determine the closest matching shade for primary maxillary anterior teeth from the most widely used Vitapan classical shade guide available for permanent teeth. MATERIALS AND METHODS A total of 313 children aged between 3 and 5 years were evaluated. Vitapan classical shade guide was used to determine the shade of six primary maxillary anterior teeth. Scores obtained were noted down in a scoring sheet and values were tabulated. Data collected were tabulated and statistically analyzed using Pearson Chi-square test. RESULTS A1 was found to be the closest matching shade for primary maxillary anterior teeth. D3 was found to be the least prevalent shade for primary maxillary anterior teeth. There was no statistical significant difference in the shades among teeth of same quadrant (p > 0.05) and also between teeth of right and left quadrants (p > 0.05), respectively. CONCLUSION A1 shade of Vitapan classical shade guide is the most prevalent shade for primary maxillary anterior teeth and can be satisfactorily reproduced to all primary maxillary anterior teeth in general.
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Affiliation(s)
- Madhan Chenchugopal
- Department of Pedodontics and Preventive Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Nilaya Reddy Venumbaka
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Poornima Vijayakumar
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Girija Selvaraju
- Department of Pedodontics and Preventive Dentistry, Asan Memorial Dental College and Hospital, Kancheepuram, Tamil Nadu, India
| | - Sakthivel Rajendran
- Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Arun Elangovan
- Department of Pedodontics and Preventive Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
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Ghoshal S, Miriyala R, Elangovan A, Rai B. Why Newly Diagnosed Cancer Patients Require Supportive Care? An Audit from a Regional Cancer Center in India. Indian J Palliat Care 2016; 22:326-30. [PMID: 27559263 PMCID: PMC4973495 DOI: 10.4103/0973-1075.185049] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The present study was planned to record the distressing symptoms of newly diagnosed cancer patients and evaluate how the symptoms were addressed by the treating oncologists. Materials and Methods: All newly diagnosed cancer patients referred to the Department of Radiotherapy during May 2014 were asked to complete a questionnaire after taking their consent. The Edmonton symptom assessment scale-regular questionnaire was used to assess the frequency and intensity of distressing symptoms. The case records of these patients were then reviewed to compare the frequency and intensity documented by the treating physician. The difference in the two sets of symptoms documented was statistically analyzed by nonparametric tests using SPSS software version 16. Results: Eighty-nine patients participated in this study, of which only 19 could fill the questionnaire on their own. Anxiety was the most common symptom (97.8%) followed by depression (89.9%), tiredness (89.9%), and pain (86.5%). The treating physicians recorded pain in 83.1% whereas the other symptoms were either not documented or grossly underreported. Anxiety was documented in 3/87 patients, but depression was not documented in any. Tiredness was documented in 12/80 patients, and loss of appetite in 54/77 patients mentioning them in the questionnaire. Significant statistical correlation could be seen between the presence of pain, anxiety, depression, tiredness, and loss of appetite in the patients. Conclusion: The study reveals that the distressing symptoms experienced by newly diagnosed cancer patients are grossly underreported and inadequately addressed by treating oncologists. Sensitizing the oncologists and incorporating palliative care principles early in the management of cancer patients could improve their holistic care.
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Affiliation(s)
| | | | | | - Bhavana Rai
- Department of Radiotherapy, PGIMER, Chandigarh, India
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Karthik R, Govindasamy M, Chen SM, Mani V, Lou BS, Devasenathipathy R, Hou YS, Elangovan A. Green synthesized gold nanoparticles decorated graphene oxide for sensitive determination of chloramphenicol in milk, powdered milk, honey and eye drops. J Colloid Interface Sci 2016; 475:46-56. [DOI: 10.1016/j.jcis.2016.04.044] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
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49
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Karthik R, Hou YS, Chen SM, Elangovan A, Ganesan M, Muthukrishnan P. Eco-friendly synthesis of Ag-NPs using Cerasus serrulata plant extract – Its catalytic, electrochemical reduction of 4-NPh and antibacterial activity. J IND ENG CHEM 2016. [DOI: 10.1016/j.jiec.2016.03.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Karthik R, Chen SM, Elangovan A, Muthukrishnan P, Shanmugam R, Lou BS. Phyto mediated biogenic synthesis of gold nanoparticles using Cerasus serrulata and its utility in detecting hydrazine, microbial activity and DFT studies. J Colloid Interface Sci 2016; 468:163-175. [DOI: 10.1016/j.jcis.2016.01.046] [Citation(s) in RCA: 30] [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: 12/17/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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