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Purohit S, Ahlawat P, Tandon S, Bellige AR, Gairola M. Myxofibrosarcoma of Head and Neck Region - A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1174-1177. [PMID: 38440645 PMCID: PMC10909039 DOI: 10.1007/s12070-023-04200-7] [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: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Myxofibrosarcoma (MFS) is a rare subtype of soft tissue sarcoma that usually occurs in the extremities of the body. Its location in the head and neck region is unique. Surgery is the primary treatment for all non-metastatic MFS. It has high rates of local recurrence and metastasis. Like other soft tissue sarcomas, the aim of adjuvant treatment is to decrease the chances of local recurrence or metastasis in MFS. Due to its rarity, there is a lack of data showing the benefit of adjuvant treatment in MFS of the head and neck region. We are presenting a case report and literature review on MFS in the head and neck.
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Affiliation(s)
- Sandeep Purohit
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Akash Raghavan Bellige
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
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Gupta M, Jajodia A, Ahlawat P, Gairola M, Agarwal M, Goyal S, Mehta P, Choudhury PS. Effectiveness of Head-and-Neck Molecular Imaging Reporting and Data System Criterion in Head-and-Neck Squamous Cell Carcinoma PostConcurrent Chemoradiotherapy. Indian J Nucl Med 2023; 38:334-339. [PMID: 38390552 PMCID: PMC10880860 DOI: 10.4103/ijnm.ijnm_23_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 02/24/2024] Open
Abstract
Purpose Postconcurrent chemoradiotherapy (CRT) response assessment has been challenging in locally advanced head-and-neck squamous cell carcinoma (LA-HNSCC) due to prevailing postradiation changes. Molecular response methods have been encouraging, although further clarifications and validations were needed. We tested the effectiveness of a proposed semi-quantitative molecular response criterion in these patients. Materials and Methods Two subspecialty-trained physicians evaluated 18F-fluorodeoxyglucose positron emission tomography/computed tomography of LA-HNSCC patients (n = 83) post 3 months CRT using a five points Head and Neck Molecular Imaging-Reporting and Data System (HAN-MI-RADS) criterion. Where available, histopathology examination with clinical and imaging interpretation was taken as a reference for the disease. A diagnostic accuracy comparison was done with the existing Hopkins score. Further effectiveness was analyzed with disease-free survival (DFI) and overall survival (OS). Results Metastasis was developed in 11/83 patients at 3 months of evaluation. Of 72 patients, 39, 2, and 31 patients had a complete response, equivocal response, and partial response as per HAN-MI-RADS. Per patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for predicting loco-regional disease up to 1 and 2 years was 93.3%, 92.5%, 90.3%, 94.9%, 92.9%, and 84.9%, 91.9%, 90.3%, 87.2%, and 88.6% respectively. One year and two years DFI for each HAN-MI-RADS score showed a statistically significant difference while it was not for OS. The receiver operating characteristic curve analysis showed significantly better outcome predictability of HAN-MI-RADS (area under the curve [AUC] 0.884) than Hopkins (AUC 0.699). Conclusions A five points HAN-MI-RADS criterion was found promising for response assessment with less equivocal results and statistically significant higher AUC than Hopkins for loco-regional recurrence prediction.
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Affiliation(s)
- Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ankush Jajodia
- Department of Radiology, Juravinski Hospital, McMaster University, Hamilton, Canada
| | - Parveen Ahlawat
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mudit Agarwal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parv Mehta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Ahlawat P, Bal A, Sharma S. PP01.62 Therapeutic Potential of Folate Conjugated Actinonin Encapsulated Human Serum Albumin Nanoformulation against Lung Adenocarcinoma Model. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.088] [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: 01/30/2023]
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Mitra S, Simson D, Khurana H, Tandon S, Ahlawat P, Bansal N, Barik S, Sethi J, Chufal K, Gairola M. Impact of Radiation Treatment Delay Due to COVID-19 Pandemic. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595463 DOI: 10.1016/j.ijrobp.2022.07.1410] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose/Objective(s) To study the effect of radiation treatment delay due to COVID-19 infection. Materials/Methods This study is a descriptive analysis. We studied all patients who were COVID-19 positive while undergoing radiation treatment. In addition, those COVID-19 positive patients before the start of radiation during their neoadjuvant treatment period or surgery were also analyzed. However, patients detected with COVID-19 infection after the radiation treatment course were excluded. The study period was from June 2020 to May 2021. A radiation treatment delay was defined as a delay in starting the treatment, a break in therapy during their scheduled radiation course, or treatment discontinuation. Patients who had a radiation treatment delay were followed-up till December 2021. Results Ninety-four patients who met the criteria were identified for the analysis. Seventy-seven of them had a mild infection, while 17 had a moderate or severe infection. Of the 94 patients identified, 83 patients had a treatment delay. The median treatment delay (MTD) was 18 (6 to 47) days and the median follow-up period was 13 months. In this cohort, 66 patients were treated with a curative intent, of which 51 are on follow-up {34 patients are disease-free (MTD – 18.5, 10 to 43), seven had either a residual disease or locoregional recurrence (MTD – 22, 10 to 32), seven had distant metastasis (MTD – 18, 15 to 47), and three patients died (MTD – 20, 8 to 27)}. Amongst the three patients who died, only one died of COVID-19 infection or sequel (Case Fatality Rate, CFR – 1.06%). Conclusion The CFR due to COVID-19 infection amongst those who underwent radiotherapy was low. At the same time, higher MTD might have been the reason for residual or locoregional recurrences. However, a longer follow-up is required to confirm this. Till then, it will remain debatable whether it was worth delaying radiotherapy for mild to moderate COVID-19 infection for a significant time to cause a potential cancer treatment failure.
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Mitra S, Simson DK, Khurana H, Tandon S, Ahlawat P, Bansal N, Barik S, Sethi JS, Chufal KS, Gairola M. Treatment Delay during Radiotherapy of Cancer Patients due to COVID-19 Pandemic. Asian Pac J Cancer Prev 2022; 23:2415-2420. [PMID: 35901349 DOI: 10.31557/apjcp.2022.23.7.2415] [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] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the impact of treatment delay caused by COVID-19 infection on patients scheduled for radiotherapy treatment. METHODS AND MATERIALS In this descriptive study, we analyzed all patients who were COVID-19 positive during the scheduled radiotherapy course, those who had an infection while on neoadjuvant treatment period, or during surgery before the start of radiation. The study period was from June 2020 to May 2021. A treatment delay was defined as a delay in starting the radiation treatment, a gap during their scheduled radiation treatment, or treatment discontinuation. All patients who had a treatment delay were followed-up till November 2021. RESULTS The median follow-up time of the study was 13 months. Ninety-four patients were selected for the study who met the inclusion criteria. Seventy-seven patients had a mild COVID-19 infection, while 17 had a moderate to severe illness. Of the entire cohort, 83 patients had a treatment delay. The median treatment delay (MTD) in days was 18 (6 to 47). Amongst those who had a treatment delay, 66 patients were treated with curative intent, of which 51 patients are on follow-up - 34 patients are disease-free (MTD - 18.5, 10 to 43), seven had either a residual disease or locoregional recurrence (MTD - 22, 10 to 32), seven had distant metastasis (MTD - 18, 15 to 47), and three patients died (MTD - 20, 8 to 27). Of three patients who died, only one died of COVID-19-related causes. CONCLUSIONS Even though the mortality due to COVID-19 infection among those who underwent radiotherapy was low, a treatment delay might have caused adverse treatment outcomes. Longer follow-up of these patients is required to further establish this. It will remain debatable whether it was worth delaying radiotherapy for mild to moderate COVID-19 infection for a significant time to cause a potential cancer treatment failure.
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Affiliation(s)
- Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - David K Simson
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Himanshi Khurana
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nitin Bansal
- Department of Infectious Diseases, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Soumitra Barik
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jaskaran Singh Sethi
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kundan Singh Chufal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Tandon S, Ahlawat P, Pasricha S, Purohit S, Simson DK, Dobriyal K, Umesh P, Mishra M, Kumar L, Karimi AM, M J, Gairola M. Depth of Invasion as an Independent Predictor of Survival in Patients of Stage
III
Squamous Cell Carcinoma of the Oral Tongue. Laryngoscope 2021; 132:1594-1599. [DOI: 10.1002/lary.29990] [Citation(s) in RCA: 1] [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] [Received: 08/21/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Sarthak Tandon
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Parveen Ahlawat
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Sunil Pasricha
- Department of Pathology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Sandeep Purohit
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - David K. Simson
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Kiran Dobriyal
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Preetha Umesh
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Manindra Mishra
- Division of Medical Physicis, Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Lalit Kumar
- Division of Medical Physicis, Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ahmad M. Karimi
- Department of Oncology University Hospital of Derby and Burton Derby England United Kingdom
| | - Jwala M
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Munish Gairola
- Department of Radiation Oncology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
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Tandon S, Gairola M, Ahlawat P, Purohit S, Umesh P, Krishnan A. Would Full-Dose Radiotherapy Benefit Patients With Synchronous Oligometastatic Head & Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ahlawat P, Singh T, Gairola M, Tandon S, Purohit S, Sachdeva N, Ismail Sharief M, Dobriyal K, Krishnan A. Inter-Correlations Between Various High-Risk Pathological Factors in Resected Buccal Mucosal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1137] [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: 11/16/2022]
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Ahlawat P, Tiwari S, Gairola M, Tandon S, Purohit S, Dobriyal K, Singh T, Krishnan A. PO-0950 Comparison between two-dose levels versus three-dose levels IMRT in head and neck cancers. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07401-6] [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: 12/01/2022]
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Umesh P, Tandon S, Gairola M, Ahlawat P, Purohit S, Dobriyal K. PO-0981 Wide histological spectrum of sinonasal malignancies and survival outcomes - An Institutional review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07432-6] [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: 10/20/2022]
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Sachdeva N, Ahlawat P, Gairola M, Tandon S, Purohit S, Sharief M, Dobriyal K, Singh T, Krishnan A. PO-0953 Impact of human papilloma virus on treatment outcomes in oropharyngeal cancer in India. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ahlawat P, Krishnan A, Gairola M, Tandon S, Purohit S, Sachdeva N, Sharief M, Dobriyal K, Singh T. PO-1028 Inter-correlations between various high-risk pathological factors in squamous cell carcinoma tongue. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sharief M, Ahlawat P, Gairola M, Erum T, Tandon S, Purohit S, Sachdeva N, Chufal K, Ahmad I, Chowdhary R, Antony V. PO-1865 Simultaneous integrated boost IMRT versus sequential IMRT in head and neck cancers. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ahlawat P, Gairola M, Purohit S, Tandon S, Sachdeva N, Sharief M, Singh T, Dobriyal K, Krishnan A. PO-0984 Impact of anterior commissure involvement in early glottic cancer treated with radical IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tandon S, Gairola M, Ahlawat P, Narang R, Varghese A, Sharma M. PO-129: Definitive radiotherapy in oligometastatic head and neck cancers responding to systemic therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30471-0] [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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Karimi AM, Gairola M, Ahlawat P, Tandon S, Pal M, Sachdeva N, Sharief MI, Dobriyal K. Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy - A prospective, analytical questionnaire-based study. Natl J Maxillofac Surg 2019; 10:134-140. [PMID: 31798246 PMCID: PMC6883888 DOI: 10.4103/njms.njms_92_18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Health-related quality of life (HRQoL) is a more specific area of QoL that deals with the evaluation and assessment of the impact of the disease and its treatment-related morbidities on a patient's physical, psychological, and social aspects. The aim of the present study was to assess the HRQoL of patients with head-and-neck cancer (HNCs) during and at 3 months after completion of radiotherapy (RT) by intensity-modulated RT. Materials and Methods This study was a prospective, longitudinal, observational, and self-completed questionnaire-based study that included 120 patients with HNC who underwent intensity-modulated RT. The questionnaire had adequate internal consistency. The questionnaires were given to each patient at the beginning of treatment (pretreatment), weekly visits during the course of RT (at the end of 1st, 2nd, 3rd, 4th, 5th, and 6th week), on the day of completion of RT, and then finally at 3 months after completion of RT. Thus, a total of successive nine time points were assessed. Results and Conclusions One hundred and eleven patients completed the questionnaires at all nine time points. HRQoL usually decreases during treatment and then increases to pretreatment levels by 3 months after treatment. The Quality of Life Questionnaire, Core Module and Quality of Life Questionnaire, Head and Neck Module were found to be both valid and reliable. There was a significant QoL reduction for the patients throughout treatment in relation to functions and symptoms in the treatment of HNC. However, all the functions and most of the symptoms returned to baseline at the 3-month follow-up.
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Affiliation(s)
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Manoj Pal
- Department of Medical Oncology, Millennium Cancer Center, Gurugram, Haryana, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Kiran Dobriyal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Sharma K, Ahlawat P, Gairola M, Tandon S, Sachdeva N, Sharief MI. Prognostic factors, failure patterns and survival analysis in patients with resectable oral squamous cell carcinoma of the tongue. Radiat Oncol J 2019; 37:73-81. [PMID: 31266288 PMCID: PMC6610009 DOI: 10.3857/roj.2018.00577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/27/2018] [Accepted: 05/27/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE There is sparse literature on treatment outcomes research on resectable oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to measure the treatment outcomes, explore the failure patterns, and identify the potential clinicopathological prognostic factors affecting treatment outcomes for resectable OTSCC. MATERIALS AND METHODS It is a retrospective analysis of 202 patients with resectable OTSCC who underwent upfront primary surgical resection followed by adjuvant radiotherapy with or without concurrent chemotherapy if indicated. RESULTS The median follow-up was 35.2 months (range, 1.2 to 99.9 months). The median duration of locoregional control (LRC) was 84.9 months (95% confidence interval, 67.3-102.4). The 3- and 5-year LRC rate was 68.5% and 58.3%, respectively. Multivariate analysis showed that increasing pT stage, increasing pN stage, and the presence of extracapsular extension (ECE) were significantly associated with poorer LRC. The median duration of overall survival (OS) was not reached at the time of analysis. The 3- and 5-year OS rate was 70.5% and 66.6%, respectively. Multivariate analysis showed that increasing pT stage and the presence of ECE were significantly associated with a poorer OS. CONCLUSION Locoregional failure remains the main cause of treatment failure in resectable OTSCC. There is scope to further improve prognosis considering modest LRC and OS. Pathological T-stage, N-stage, and ECE are strong prognostic factors. Further research is required to confirm whether adjuvant therapy adds to treatment outcomes in cases with lymphovascular invasion, perineural invasion, and depth of invasion, and help clinicians tailoring adjuvant therapy.
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Affiliation(s)
- Kanika Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Ahlawat P, Rawat S, Kakria A, Pal M, Chauhan D, Khurana R, Tandon S. Utilization and incorporation of tumor volume data in staging and prognostication of head and neck squamous cell carcinoma treated with definitive radiotherapy: A systematic review. Asian Journal of Oncology 2019. [DOI: 10.4103/2454-6798.165089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractHead and neck squamous cell cancers (HNSCC) are a group of heterogeneous tumors, evident by their diverse behavior and natural history. The largest diameter of tumor measured for T classification may not necessarily reflect the true tumor dimension. There is a need to take into account certain other feature(s) of these tumors other than the maximum single dimension which can reflect the true tumor burden more accurately. Tumor volume has been shown to be a useful and accurate tool burden because it is a measurement of tumor burden in all three dimensions. This review article has compiled and reviewed the literature published in past on impact of tumor volumes (TVs) on the prognosis of head and neck cancers. A comprehensive literature search was performed in PubMed for terms “clonogens,” “TV” or “primary TV (PTV)” or “nodal volume” or “total TV (TTV)” or “volumetric analysis of TV in head and neck” or “predicting response in head and neck cancer” “prognostic factors head and neck cancers” and “outcome in head and neck cancer.” We identified 33 studies which have commented on the impact of TV in HNSCC on treatment outcome, 9 of these had analyzed PTV, 11 studies had analyzed total nodal volume, and 14 studies have analyzed TTV. Besides these, we have dealt with laryngeal cancers separately with 9 studies. This review article is also aimed to enhance our knowledge further regarding how best a physician can incorporate TV data in staging and predicting response to radiotherapy.
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Affiliation(s)
- Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Manoj Pal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Deepika Chauhan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Ruparna Khurana
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Tandon S, Gairola M, Ahlawat P, Karimi AM, Tiwari S, Muttagi V, Sachdeva N, Sharief MI, Dobriyal K. Failure patterns of head and neck squamous cell carcinoma treated with radical radiotherapy by intensity modulated radiotherapy technique using focal volume and dosimetric method. Head Neck 2018; 41:1632-1637. [PMID: 30582238 DOI: 10.1002/hed.25586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/10/2018] [Accepted: 12/05/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Labeling locoregional failures in head and neck cancer (HNC) as "local" and "regional" becomes incomplete when treating with intensity modulated radiotherapy (IMRT). Target delineation and delivery errors, dose in-homogeneity complicate the assessment of failures. A combination of focal point and dosimetric method might attempt at simplifying failure analysis. METHODS One hundred eleven patients with locally advanced HNC treated with chemoradiation using IMRT were enrolled. Patients with documented failure had their recurrence volume assessed using focal point and dosimetric method. RESULTS With a median follow-up of 20 (range 0-39) months and median locoregional control (LRC) of 30 (range 24.8-34.5) months, the patients had a 3-year overall survival and LRC of 70.6% and 48.9%, respectively. Of 39 failures, there were 69.2%, 7.6%, 5.1%, 12.8%, and 5.1% type A, B, C, D, and E, respectively using the focal point and dosimetric method. CONCLUSION With the current classification, majority of the recurrences were high dose failures suggesting inherent radioresistance. While minority of failures were potentially preventable and needed modifying existing IMRT workflow.
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Affiliation(s)
- Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ahmad Masroor Karimi
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sandeep Tiwari
- Department of Radiation Oncology, Manipal Hospitals Dwarka, New Delhi, India
| | - Vinayakumar Muttagi
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kiran Dobriyal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Tandon S, Gairola M, Ahlawat P, Sharma K, Barik S, Sachdeva N, Pasricha S, Shenoy A. Sinonasal teratocarcinosarcoma treated with surgery followed by volumetric modulated radiotherapy: a case report with review of literature. Radiat Oncol J 2018; 36:341-347. [PMID: 30518169 PMCID: PMC6361250 DOI: 10.3857/roj.2018.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022] Open
Abstract
Surgical excision along with use of postoperative radiotherapy forms an integral management of sinonasal teratocarcinosarcoma (SNTCS). However, given the rarity of the tumor, no standardised guidelines, dose, technique and target delineation exist especially in the era of modern radiation delivery techniques. This is a case of 55-year-old male diagnosed as SNTCS treated with radical ethmoidectomy followed by volumetric modulated radiotherapy, showing good local control and acceptable toxicity profile.
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Affiliation(s)
- Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kanika Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Soumitra Barik
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Apeksha Shenoy
- Department of Radiology and Imaging, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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21
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Simson DK, Mitra S, Ahlawat P, Saxena U, Sharma MK, Rawat S, Singh H, Bansal B, Sripathi LK, Tanwar A. Prospective study of neoadjuvant chemoradiotherapy using intensity-modulated radiotherapy and 5 fluorouracil for locally advanced rectal cancer - toxicities and response assessment. Cancer Manag Res 2018; 10:519-526. [PMID: 29593430 PMCID: PMC5865559 DOI: 10.2147/cmar.s142076] [Citation(s) in RCA: 6] [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] [Indexed: 12/11/2022] Open
Abstract
Aims and objectives The past 2 decades witnessed the strengthening of evidence favoring the role of neoadjuvant chemoradiation (CHRT) in the treatment of locally advanced rectal cancer. The study aims to evaluate the response and acute toxicities to neoadjuvant CHRT using intensity-modulated radiotherapy (IMRT) in the treatment of rectal cancer. Predictive factors to achieve pathological complete response (pCR) were analyzed, as a secondary endpoint. Materials and methods All consecutive patients who underwent IMRT as part of neoadjuvant CHRT in the treatment of rectal cancer between August 2014 and December 2016 at a tertiary cancer care center were accrued for the study. The cohort underwent CHRT with IMRT technique at a dose of 50.4 Gy in 28 fractions concurrent with continuous infusion of 5 fluorouracil during the first and the last 4 days of CHRT. Surgery was performed 6 weeks later and the pathological response to CHRT was noted. Results Forty-three subjects were accrued for the study. Radiation dermatitis and diarrhea were the only observed grade ≥3 acute toxicities. Sphincter preservation rate (SPR) was 43.3%. pCR was observed in 32.6%. Univariate and multivariate logistic regression showed that carcinoembryonic antigen was the only independent predictive factor to achieve pCR. Conclusion IMRT as part of neoadjuvant CHRT in the treatment of locally advanced rectal cancer is well tolerated and gives comparable results with respect to earlier studies in terms of pathological response and SPR. Further randomized controlled studies are needed to firmly state that IMRT is superior to 3-dimensional conformal radiotherapy.
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Affiliation(s)
- David K Simson
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Upasna Saxena
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Kumar Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Harpreet Singh
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
| | - Babita Bansal
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
| | | | - Aditi Tanwar
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Sripathi LK, Ahlawat P, Simson DK, Khadanga CR, Kamarsu L, Surana SK, Arasu K, Singh H. Cardiac Dose Reduction with Deep-Inspiratory Breath Hold Technique of Radiotherapy for Left-Sided Breast Cancer. J Med Phys 2017; 42:123-127. [PMID: 28974856 PMCID: PMC5618457 DOI: 10.4103/jmp.jmp_139_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/17/2017] [Accepted: 06/20/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Different techniques of radiation therapy have been studied to reduce the cardiac dose in left breast cancer. AIM In this prospective dosimetric study, the doses to heart as well as other organs at risk (OAR) were compared between free-breathing (FB) and deep inspiratory breath hold (DIBH) techniques in intensity modulated radiotherapy (IMRT) and opposed-tangent three-dimensional radiotherapy (3DCRT) plans. MATERIALS AND METHODS Fifteen patients with left-sided breast cancer underwent computed tomography simulation and images were obtained in both FB and DIBH. Radiotherapy plans were generated with 3DCRT and IMRT techniques in FB and DIBH images in each patient. Target coverage, conformity index, homogeneity index, and mean dose to heart (Heart Dmean), left lung, left anterior descending artery (LAD) and right breast were compared between the four plans using the Wilcoxon signed rank test. RESULTS Target coverage was adequate with both 3DCRT and IMRT plans, but IMRT plans showed better conformity and homogeneity. A statistically significant dose reduction of all OARs was found with DIBH. 3DCRTDIBH decreased the Heart Dmean by 53.5% (7.1 vs. 3.3 Gy) and mean dose to LAD by 28% compared to 3DCRTFB. IMRT further lowered mean LAD dose by 18%. Heart Dmean was lower with 3DCRTDIBH over IMRTDIBH (3.3 vs. 10.2 Gy). Mean dose to the contralateral breast was also lower with 3DCRT over IMRT (0.32 vs. 3.35 Gy). Mean dose and the V20 of ipsilateral lung were lower with 3DCRTDIBH over IMRTDIBH (13.78 vs. 18.9 Gy) and (25.16 vs. 32.95%), respectively. CONCLUSIONS 3DCRTDIBH provided excellent dosimetric results in patients with left-sided breast cancer without the need for IMRT.
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Affiliation(s)
| | - Parveen Ahlawat
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
| | - David K Simson
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
| | - Chira Ranjan Khadanga
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shital Kumar Surana
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kavi Arasu
- Department of Radiation Oncology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Harpreet Singh
- Department of Radiation Oncology, Action Cancer Hospital, New Delhi, India
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Ahlawat P, Rawat S, Kakria A, Devnani B, Wahi IK, Simson DK. Reirradiation with IMRT for recurrent head and neck cancer: A single-institutional report on disease control, survival, and toxicity. Rep Pract Oncol Radiother 2017; 22:331-339. [PMID: 28663716 DOI: 10.1016/j.rpor.2017.05.001] [Citation(s) in RCA: 7] [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: 11/18/2016] [Revised: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 01/13/2023] Open
Abstract
AIM To study and explores the feasibility and efficacy of re-irradiation (Re-RT) for locally recurrent head and neck cancer (HNC) and second primary (SP) malignancies. BACKGROUND The most common form of treatment failure after radiotherapy (RT) for HNC is loco-regional recurrence (LRR), and around 20-50% of patients develop LRR. Re-irradiation (Re-RT) has been the primary standard of care in the last decade for unresectable locally recurrent/SP HNC. MATERIALS AND METHODS It was a retrospective analysis in which we reviewed the medical records of 51 consecutive patients who had received Re-RT to the head and neck region at our institute between 2006 and 2015. RESULTS Forty-eight patients were included for assessment of acute and late toxicities, response evaluation at 3 months post Re-RT, and analyses of locoregional control (LRC) and overall survival (OS). The median LRC was 11.2 months, and at 2 and 5 years the LRC rates were 41% and 21.2%, respectively. A multivariate analysis revealed two factors: initial surgical resection performed prior to Re-RT, and achievement of CR at 3 months after completion of Re-RT to be significantly associated with a better median LRC. The median OS was 28.2 months, and at 1, 2, and 5 years, OS were 71.1%, 55.9% and 18%, respectively. A multivariate analysis revealed initial surgical resection performed prior to Re-RT, and achievement of CR at 3 months post completion of Re-RT being only two factors significantly associated with a better median OS. Acute toxicity reports showed that no patients developed grade 5 toxicity, and 2 patients developed grade 4 acute toxicities. CONCLUSION Re-RT for the treatment of recurrent/SP head and neck tumors is feasible and effective, with acceptable toxicity. However, appropriate patient selection criteria are highly important in determining survival and treatment outcomes.
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Affiliation(s)
- Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi 110085, India
| | - Sheh Rawat
- Dharamshila Hospital and Research Centre, Vasundhara Enclave, New Delhi 110096, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi 110085, India
| | - Bharti Devnani
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Inderjit Kaur Wahi
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi 110085, India
| | - David K Simson
- Action Cancer Hospital, Paschim Vihar, New Delhi, 110063, India
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Rawat S, Ahlawat P, Kakria A, Kumar G, Rangaraju RR, Puri A, Pal M, Chauhan D, Devnani B, Chadha P. Comparison between weekly cisplatin-enhanced radiotherapy and cetuximab-enhanced radiotherapy in locally advanced head and neck cancer: first retrospective study in Asian population. Asia Pac J Clin Oncol 2016; 13:195-203. [PMID: 27813277 DOI: 10.1111/ajco.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/29/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022]
Abstract
AIM To present a direct comparison between chemotherapy-enhanced radiotherapy (CERT) and biotherapy-enhanced radiotherapy (BERT) in locally advanced head and neck cancer. METHODS It is a retrospective analysis of 53 patients with locally advanced head and neck cancer treated from August 2006 to December 2008. For CERT, patients received weekly cisplatin (40 mg/m2 ) and for BERT, a loading dose of 400 mg/m2 of cetuximab given one week prior to radiotherapy followed by 250 mg/m2 given weekly along with radiotherapy. Disease-free survival (DFS) and overall survival (OS) were computed with Kaplan-Meier curve with log-rank test for comparison between the two groups. Multivariate Cox proportional hazards regression analysis was performed to estimate the impact of known relevant prognostic factors on DFS and OS. RESULTS The median DFS was significantly better with CERT than BERT group (50.82 vs 11.66 months; P = 0.031). The 3 years DFS was significantly higher in CERT group than in BERT group (60.0% vs 14.3%; P = 0.022). The median OS was significantly better with CERT than BERT group (53.61 vs 32.55 months; P = 0.044). The 3 years OS was also significantly higher in CERT group than in BERT group (74.0% vs 42.1%; P = 0.032). There were no significant differences in acute toxicities of all grade and grade ≥3 between the two groups. The compliance to treatment and assisted feeding dependency for more than 6 months duration were also not significantly different. CONCLUSION CERT is associated with better outcome with no significantly increased acute toxicities compared to BERT.
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Affiliation(s)
- Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gaurav Kumar
- Department of Medical Oncology, Max Super Specialty Hospital, Shalimar Bagh, New Delhi, India
| | - Ranga Rao Rangaraju
- Department of Medical Oncology, Max Super Specialty Hospital, Shalimar Bagh, New Delhi, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Hospital, Mohali, Punjab, India
| | - Manoj Pal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Deepika Chauhan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bharti Devnani
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Pranav Chadha
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Maharashtra, India
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Simson DK, Mitra S, Ahlawat P, Sharma MK, Yadav G, Mishra MB. Dosimetric Comparison between Intensity Modulated Radiotherapy and 3 Dimensional Conformal Radiotherapy in the Treatment of Rectal Cancer. Asian Pac J Cancer Prev 2016; 17:4935-4937. [PMID: 28032499 PMCID: PMC5454699 DOI: 10.22034/apjcp.2016.17.11.4935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To compare dosimetric parameters of 3 dimensional conformal radiotherapy (3 DCRT) and intensity modulated radiotherapy (IMRT) in terms of target coverage and doses to organs at risk (OAR) in the management of rectal carcinoma. Methods: In this prospective study, conducted between August 2014 and March 2016, all patients underwent CT simulation along with a bladder protocol and target contouring according to the Radiation Therapy Oncology Group (RTOG) guidelines. Two plans were made for each patient (3 DCRT and IMRT) for comparison of target coverage and OAR. Result: A total of 43 patients were recruited into this study. While there were no significant differences in mean Planning Target Volume (PTV) D95% and mean PTV D98% between 3 DCRT and IMRT, mean PTV D2% and mean PTV D50% were significantly higher in 3 DCRT plans. Compared to IMRT, 3 DCRT resulted in significantly higher volumes of hot spots, lower volumes of cold spots, and higher doses to the entire OAR. Conclusion: This study demonstrated that IMRT achieves superior normal tissue avoidance (bladder and bowel) compared to 3 DCRT, with comparable target dose coverage.
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Affiliation(s)
- David K Simson
- Department of Radiation Oncology, Action Cancer Hospital, Paschim Vihar, Delhi, India.
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Gupta N, Pal M, Rawat S, Grewal MS, Garg H, Chauhan D, Ahlawat P, Tandon S, Khurana R, Pahuja AK, Mayank M, Devnani B. Radiation-induced dental caries, prevention and treatment - A systematic review. Natl J Maxillofac Surg 2016; 6:160-6. [PMID: 27390489 PMCID: PMC4922225 DOI: 10.4103/0975-5950.183870] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 11/20/2022] Open
Abstract
Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.
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Affiliation(s)
- Nishtha Gupta
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Manoj Pal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mandeep S Grewal
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Himani Garg
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Deepika Chauhan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ruparna Khurana
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali K Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mayur Mayank
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bharti Devnani
- Department of Radiation Oncology, SGPGI, Lucknow, Uttar Pradesh, India
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Kaur I, Rawat S, Ahlawat P, Kakria A, Gupta G, Saxena U, Mishra MB. Dosimetric impact of setup errors in head and neck cancer patients treated by image-guided radiotherapy. J Med Phys 2016; 41:144-8. [PMID: 27217627 PMCID: PMC4871004 DOI: 10.4103/0971-6203.181640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/25/2022] Open
Abstract
To assess and analyze the impact of setup uncertainties on target volume coverage and doses to organs at risk (OAR) in head and neck cancer (HNC) patients treated by image-guided radiotherapy (IGRT). Translational setup errors in 25 HNC patients were observed by kilovoltage cone beam computed tomography (kV CBCT). Two plans were generated. Plan one – the original plan which was the initially optimized and approved plan of the patient. All patients were treated according to their respective approved plans at a defined isocenter. Plan two – the plan sum which was the sum of all plans recalculated at a different isocenter according to setup errors in x, y, and z-direction. Plan sum was created to evaluate doses that would have been received by planning target volume (PTV) and OARs if setup errors were not corrected. These 2 plans were analyzed and compared in terms of target volume coverage and doses to OARs. A total 503 kV CBCT images were acquired for evaluation of setup errors in 25 HNC patients. The systematic (mean) and random errors (standard deviation) combined for 25 patients in x, y, and z directions were 0.15 cm, 0.21 cm, and 0.19 cm and 0.09 cm, 0.12 cm, and 0.09 cm, respectively. The study showed that there was a significant difference in PTV coverage between 2 plans. The doses to various OARs showed a nonsignificant increase in the plan sum. The correction of translational setup errors is essential for IGRT treatment in terms of delivery of planned optimal doses to target volume.
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Affiliation(s)
- Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gourav Gupta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Upasna Saxena
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manindra Bhushan Mishra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Rawat S, Srivastava H, Ahlawat P, Pal M, Gupta G, Chauhan D, Tandon S, Khurana R. Weekly versus Three-Weekly Cisplatin-based Concurrent Chemoradiotherapy as definitive treatment in Head and Neck Cancer- Where do we stand? Gulf J Oncolog 2016; 1:6-11. [PMID: 27250881] [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] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To compare toxicity, compliance, and early response of weekly and 3-weekly cisplatin administration concurrent with radiotherapy as definitive treatment in locally advanced squamous cell carcinoma head and neck. MATERIALS AND METHODS Patients with histologically proven stage III - IV B head and neck carcinoma presenting from June 2013 to March 2014 were randomly assigned to weekly (35 mg/m2, 6 cycles; arm A) and 3 weekly (100 mg/m2, 3 cycles; arm B) cisplatin with concurrent radiotherapy. RESULTS 60 patients were randomly assigned to treatment, 30 in each arm. Median follow-up was 8 months (range 4-13). There was no significant difference in grade 3 mucositis between the two arms (75.9% vs 70%, p = 0.20). Grade 3 neutropenia was more frequent in arm B (55.2% vs 26.7%, p = 0.01). Hypomagnesemia was the commonest electrolyte imbalance and it was significantly higher in arm B (60% vs 20%, p = 0.001). Completion rate of scheduled chemotherapy cycles was higher for patients receiving weekly regimen. Response at 3 months was similar for all the patients {Complete Response (66.7% vs 62.1%), p = 0.200}. Our data suggested that there is a reduced need of hospitalization and supportive care measures for patients receiving weekly cisplatin with RT (p = 0.05). CONCLUSIONS Weekly cisplatin 35 mg/m2 chemotherapy concurrent with radiotherapy is equally effective and less toxic in terms of neutropenia, hypomagnesemia and need for supportive measures than the conventional 3 weekly cisplatin 100 mg/m2 regimen.
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Affiliation(s)
- S Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - H Srivastava
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - P Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - M Pal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - G Gupta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - D Chauhan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - R Khurana
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Chauhan D, Rawat S, Sharma M, Ahlawat P, Pal M, Gupta G, Dewan A, Gupta M, Sharma S, Dodagoudar C, Pahuja A, Mitra S, Sharma S. Improving the accuracy of target volume delineation by combined use of computed tomography, magnetic resonance imaging and positron emission tomography in head and neck carcinomas. J Cancer Res Ther 2015; 11:746-51. [DOI: 10.4103/0973-1482.163679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kakria A, Rawat S, Bhutani R, Gupta G, Devnani B, Wahi IK, Ahlawat P. Retrospective analysis of treatment outcomes following reirradiation in locoregionally recurrent head and neck cancer patients: A single institutional study. Asia Pac J Clin Oncol 2014; 11:129-34. [PMID: 25132076 DOI: 10.1111/ajco.12261] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Abstract
AIM To present a retrospective analysis of treatment outcomes following reirradiation in locoregionally recurrent head and neck cancer patients at our institute. METHODS Thirty-one patients of head and neck cancer who presented with a locoregional recurrence from April 2007 to April 2012 underwent salvage reirradiation. Median dose of first-time radiation was 70 Gy. Median duration of gap between the first and second course of radiation was 45.6 months. The median dose of reirradiation was 60 Gy. Conformal radiotherapy technique in the form of intensity modulated radiotherapy was used in 60% (17) of patients. Fourteen patients received concurrent chemotherapy or immunotherapy. RESULTS After a median follow-up of 20.6 months, 12 patients were alive with no evidence of disease. The 3-year disease-free survival and overall survival were 28.7 and 48.5%, respectively. Acute and late toxicities were reported in 29 and 61% of patients, respectively. Severe grade 3 and 4 late complications were observed in nine patients but none of them led to mortality. CONCLUSION Reirradiation appears to be both feasible and well tolerated in patients treated with previous radiotherapy for recurrent and second primary head and neck cancer. Careful case selection for reirradiation based on patient's performance status and tumor characteristics is essential.
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Affiliation(s)
- Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Ahlawat P, Srinivas NR. Interspecies scaling of a camptothecin analogue: Human predictions for intravenous topotecan using animal data. Xenobiotica 2008; 38:1377-85. [DOI: 10.1080/00498250802488577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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