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Pattanaik J, Bhasker S, Biswas A, R AV, Sharma A, Pramanik R, Kumar R, Sanyal S, Samala SK, Ghosh V, Sushant S, Pandey S, Tanwar MS, Praveen DVS, Mandal S. Patient-Reported Outcomes Evaluating the Impact of Hypo-Fractionated Palliative Quadshot Radiotherapy and Concurrent CDDP Treatment on Health-Related Quality of Life in Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2023; 117:S122. [PMID: 37784316 DOI: 10.1016/j.ijrobp.2023.06.461] [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) In locally advanced squamous cell carcinoma of the head and neck (LAHNSCC), the main goal of treatment remains survival while improving quality of life (QOL). In recent decades, there has been a paradigm shift in the measurement of clinical outcomes in patients diagnosed with cancer, focusing on the patient perspective by incorporating patient-reported outcomes (PROs). The primary objective of this study was to evaluate the improvement in quality of life with the use of cyclic hypo-fractionated palliative QUAD SHOT radiotherapy (RT) with concurrent cisplatin (CDDP) in previously untreated patients with incurable LAHNSCC. MATERIALS/METHODS In this prospective interventional phase- II study, 60 patients with locally advanced squamous cell carcinoma of the head and neck, majority stage IVB, ECOG PS ≤ 3, were treated with QUAD SHOT RT (14 Gy/4 fractions/2 days - BD with 6-hour interval and concurrent CDDP at 6 mg/m2. This treatment was repeated at 4-week intervals for 2 additional cycles if tumor progression did not occur. Serial changes in HR -QoL were assessed using EORTC QLQ C-30 and H&N-35) at 4 different time points. Statistical methods such as the Wilcoxon signed-rank test and Friedman test were used to compare QoL values at different time points with Bonferroni correction for multiple comparisons to control for type I errors. RESULTS The median global health score (GHS) at baseline was 41.667, with an initial increase in score at 4 weeks (50.00) and at 8 weeks (54.167) that did not continue at 12 weeks (41.667). Symptoms related to toxicities (speech, social contact, sticky saliva, dry mouth, senses in H&N 35) were lower after 4 weeks. Application of the Friedman test for four time points revealed significant improvement in role function at 4 weeks, which remained constant at 8 weeks but was not sustained at 12 weeks. Comparison of HN-35 symptom scores between the four time points showed improvement in symptoms such as pain, swallowing, and mouth opening at 4 and 8 weeks. The mean QLQ C30 summary score for these patients improved at four weeks but did not remain constant at 8 and 12 weeks. CONCLUSION Our study showed significant improvement in quality-of-life parameters and reduction in symptom burden at 4 and 8 weeks due to disease control and symptom palliation by QUADSHOT CTRT, while quality-of-life scores worsened and symptom scores were not maintained at 12 weeks due to disease progression and occurrence of acute toxicities. This phase II study may serve as the basis for designing a phase III randomized control trial to compare quality of life changes with QUADSHOT CTRT and other palliative CTRT regimens.
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Affiliation(s)
- J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S Bhasker
- All India Institute of Medical Sciences, New Delhi, India
| | - A Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | - A V R
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- DM Medical Oncology, AIIMS New Delhi, Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - V Ghosh
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
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Bhasker S, Pattanaik J, Biswas A, R AV, Sharma A, Pramanik R, Sanyal S, Praveen DVS, Kumar R, Sushant S, Ghosh V, Mandal S, Samala SK, Tanwar MS, Pandey S. Hypo-Fractionated Palliative QUADSHOT Radiotherapy and Concurrent CDDP in Patients with LAHNSCC: Toxicities and Clinical Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e567. [PMID: 37785734 DOI: 10.1016/j.ijrobp.2023.06.1893] [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) Shorter palliative hypo-fractionated radiotherapy regimens given concurrently with chemotherapy, preferably cisplatin (radiosensitizer), increase response rates with acceptable toxicity, leading to better compliance of patients with locally advanced squamous cell carcinoma of the head and neck (LAHNSCC) in whom late toxicities due to chemoradiotherapy are less relevant. This single institution prospective interventional phase II study was conducted with the goal of achieving high rates of locoregional control with acceptable treatment-related toxicity. MATERIALS/METHODS In this prospective interventional phase- II study, 60 patients with LAHNSCC (treatment naive), the majority in stage IVB and ECOG PS ≤ 3, were treated with QUAD SHOT RT using the conventional 2D technique (14Gy in 4 fractions on 2 consecutive days twice daily with a 6-hour interval between the two fractions) and concurrent cisplatin (CDDP) at a dose of 6 mg/m2. This treatment was repeated at 4-week intervals for 2 additional cycles if tumor progression did not occur. The Kaplan-Meier method was used to determine survival probability for progression-free survival (PFS) and overall survival (OS). Descriptive statistics with number and percentage were used for each toxicity and tumor response at different time points. A P value of less than 0.05 was considered significant. RESULTS In our study, all patients received at least one cycle of QUADSHOT chemoradiotherapy (CTRT), while 35 and 18 patients received the 2nd and 3rd QUADSHOT CTRT, respectively. Of the patients who completed the first cycle of QUADSHOT CTRT, 27 (45%) patients had a partial response (PR) and 22 (36.7%) had stable disease (SD). Of the patients who completed the second cycle QUADSHOT CTRT, 77.2% had SD, while 11.4% had PR and 11.4% had PD. After the 3rd QUADSHOT CTRT, 72.2% had SD, while 11.1% had PR and 16.7% had PD. The overall response rate (SD +PR) in our study was 81%, 88.6%, and 83% after the 1st, 2nd, and 3rd QUADSHOT CTRT, respectively. After the 3rd QUADSHOT CTRT, no patient showed grade 4 toxicity. Most patients had grade I/ II toxicities e.g., skin (grade I -83%), mucositis (grade II -50%), salivary gland toxicity (grade II -50%), grade I laryngitis (83.3%). Grade- III oral mucositis and pharyngitis were seen in 27% and 6.7% of patients, respectively. Median OS and PFS were 7.9 months and 6.2 months, respectively. CONCLUSION Concurrent chemotherapy acts as a radiosensitizer and provides a synergistic effect when coupled with hypo-fractionated radiation, resulting in more effective control of locoregional disease in locally advanced head and neck tumors with acceptable toxicities. This study is hypothesis-generating and may serve as a basis for developing optimal CTRT regimens for patients with LAHNSCC who are not suitable for curative treatment.
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Affiliation(s)
- S Bhasker
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - A Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | - A V R
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- DM Medical Oncology, AIIMS New Delhi, Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - V Ghosh
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
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Gogi R, Sharma A, Sharma A, Mohanti BK, Pramanik R, Bhasker S, Biswas A, Thakar A, Singh AC, Sikka K, Kumar R, Thulkar S, Bahadur S. Real World Presentation and Treatment Outcomes with a Predominant Induction Chemotherapy Based Approach in Nasopharyngeal Carcinoma: A Sixteen Year Report from a Teaching Hospital in India. Cancer Invest 2023; 41:155-163. [PMID: 36305837 DOI: 10.1080/07357907.2022.2141771] [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] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Nasopharyngeal carcinoma (NPC) is a rare malignancy in India except in north-eastern states. We present our institutional experience of 16 years highlighting management, outcomes, responses and toxicities. MATERIALS AND METHODS NPC patients registered at our center during the period of 2000-2015. The primary objective of the study was to assess the overall survival (OS). Secondary outcome included determinations of response rates, progression free survival (PFS) and to assess treatment-related toxicity (CTCAE v4.0). Institute ethics committee approval was obtained prior to initiation of this study. RESULTS Data was retrieved from complete records of 222 patients out of 390 registered during study period. There were 163 males (73.4%) and 59 females (26.6%) with a male to female ratio of 2.8:1. The median age was 35 years (range 6-73). Only 5.6% (n = 12) presented in early-stage disease (stage I and II) while 89.6% (n = 199) were advanced stage (stage III, IVA, IVB). Five patients (2.2%) presented as metastatic disease. Majority of patients were treated with induction chemotherapy followed by concurrent chemoradiation (CCRT) {76.1%, n = 169}. Relapses were documented in 10.4% patients. 5% patients had loco-regional relapse while distant metastases were seen in 4% patients. The 3-year PFS and OS rates are 60.9% and 68.4%, respectively. Achieving a CR predicted superior OS on multivariate analysis. CONCLUSIONS NPC is a rare malignancy and majority presented with advanced stages. This data outlines our experience and outcomes with a predominantly induction chemotherapy followed by definitive CCRT based approach.
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Affiliation(s)
- Ramana Gogi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Sharma
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - B K Mohanti
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Chirom Singh
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Bahadur
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Kanodia R, Kumar R, Biswas A, Bhasker S. 251P Is QUAD SHOT palliative cyclical hypo-fractionated radiotherapy in advanced head and neck cancer the way to go? An alternative regimen in low resource countries. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.064] [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: 12/05/2022] Open
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Sarangi J, Kakkar A, Roy D, Mishra D, Thakar A, Deo SVS, Sharma A, Bhasker S. Metastases to the Parotid Gland: Study from a Tertiary Care Centre. Head Neck Pathol 2022; 16:1034-1042. [PMID: 35576094 PMCID: PMC9729487 DOI: 10.1007/s12105-022-01458-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/16/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Metastases account for 6-25% of parotid tumors, often presenting dilemmas in their diagnosis. METHODS Parotid metastases diagnosed on histology/cytology were retrieved. MUC2, MUC5AC, androgen receptor immunohistochemistry was performed in select cases. RESULTS Fifty-one samples were identified from 42 patients, including 14 aspirates, 7 biopsies and 30 parotidectomies. Previous history was available in 17 cases, 13 parotidectomies accompanied excision of the primary, and relevant clinical data was unavailable for 12 patients. Majority (81%) had head and neck primaries; eye and ocular adnexa were the commonest subsite (52.4%), and sebaceous carcinoma the commonest histology (33%). When history was unavailable, most metastases were initially diagnosed as poorly differentiated carcinoma/malignant tumor, or mucoepidermoid carcinoma on cytology. CONCLUSIONS Intraparotid metastases encompass a wide spectrum, often mimicking primary salivary gland neoplasms, particularly on limited samples. Metastases should be considered when histological/cytological features are unusual; detailed clinical information and ancillary techniques aid in arriving at an accurate diagnosis.
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Affiliation(s)
- Jayati Sarangi
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Diya Roy
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepika Mishra
- Division of Oral Pathology and Microbiology, Centre of Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Alok Thakar
- Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Suryanarayan V S Deo
- Department of Surgical Oncology, BRA Institute Rotary Cancer Hospital and National Cancer Institute, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Sharma
- Department of Medical Oncology, BRA Institute Rotary Cancer Hospital and National Cancer Institute, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Suman Bhasker
- Department of Radiation Oncology, BRA Institute Rotary Cancer Hospital and National Cancer Institute, All India Institute of Medical Sciences, New Delhi, 110029, India
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Sakthivel P, Thakar A, Fernández-Fernández MM, Panda S, Sikka K, Amit Singh C, Kumar R, Kakkar A, Sharma A, Bhasker S. TransOral UltraSonic surgery (TOUSS) for oral cavity, oropharyngeal and supraglottic malignancy: A prospective study of feasibility, safety, margins, functional and survival outcomes. Oral Oncol 2021; 124:105643. [PMID: 34902808 DOI: 10.1016/j.oraloncology.2021.105643] [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: 10/23/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION/BACKGROUND With the advent of TransOral Robotic Surgery (TORS) the ease of transoral procedures has been dramatically improved. TORS is already established for its feasibility, functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx. This study reports on preliminary results with TransOral UltraSonic Surgery (TOUSS) for oncologic resections of oral cavity, oropharyngeal and supraglottic malignancies. MATERIALS AND METHODS Eighteen patients with malignancies of oral cavity, oropharynx and supraglottis underwent TOUSS with simultaneous neck dissection and adjuvant therapy as indicated, from January 2018 to April 2019. Essential equipment included the FK-retractor (Gyrus Medical, Tuttilngen, Germany) for TransOral exposure, the Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes, and 35 cm long ultrasonic harmonic scalpel (Thunderbeat). Parameters evaluated include tumor staging, mouth opening, TOUSS setup time, TOUSS primary removal time, surgical margins, blood transfusions, tracheostomy, postoperative complications, enteral feeding and resumption of oral diet, duration of hospital stay, and survival outcomes. RESULTS Eighteen patients underwent complete TransOral UltraSonic Surgery (TOUSS), with simultaneous unilateral or bilateral neck dissection. No procedure was abandoned intraoperatively due to difficulty in extirpation of the tumor. Margins were negative for ten patients (55.6%), close in five (27.8%), and positive in three patients (16.7%). Average TOUSS set-up time was 22.5 min (range, 10-30 min) and average TOUSS primary tumor removal time was 35.3 min (range, 15-60 min). Patients started tolerating oral feeds even in the second post op day (mean 6 days), and transitioning to complete oral feeds with removal of the nasogastric tube was achieved in all (mean, 16 days). The average hospital stay was 7.4 days (range 2-16 days). Secondary hemorrhage occurred in two cases and required an emergency tracheostomy and ligation of lingual artery. Minor cervicopharyngeal fistula occurred in four cases and settled in all with conservative non-surgical treatment. Overall survival at 3 years was 70.5%, and disease-specific survival was 94.4%. CONCLUSION TransOral UltraSonic Surgery (TOUSS) is a safe and sound alternative method of endoscopic surgical treatment of oral cavity, oropharynx and supraglottic neoplasms. Advantages of this technique include faster resection time, intraoperative assistance from Narrow Band Imaging, easy affordability compared to TORS, and excellent functional outcomes.
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Affiliation(s)
- Pirabu Sakthivel
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Mario M Fernández-Fernández
- Department of Otolaryngology Head & Neck Surgery, MD, Anderson International, c/Arturo Soria 270, 28033 Madrid, Spain.
| | - Smriti Panda
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India.
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Panda S, Kumar R, Chandran C A, Thakar A, Sharma SC, Bhasker S, Sharma A. Impact of skin invasion on long-term survival outcomes in gingivobuccal complex carcinoma. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:205-211. [PMID: 34294218 DOI: 10.1016/j.otoeng.2020.04.007] [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: 12/24/2019] [Accepted: 04/09/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Gingivo-buccal complex cancers (GBCC) have an aggressive clinical course in the presence of skin and bone involvement. OBJECTIVE This study intends to analyze the clinico-pathological factors affecting local control and survival outcomes in GBCC. METHODS This is a retrospective study conducted on 125 GBCC cases from January 2011 to April 2016. RESULT Univariate analysis revealed lymphovascular invasion (LVI) and skin involvement as predictors of poor overall survival (OS) and disease- free survival (DFS). Multivariate analysis showed skin involvement and LVI to be independent prognostic factors towards poor OS. Corresponding results in case of DFS showed skin involvement to be the single most important prognostic factor. With a median follow up of 24 months, the median survival of patients with skin involvement, skin and mandible invasion and isolated mandible invasion, respectively, were 18 months, 12 months and 22 months. CONCLUSION GBCC with skin involvement portends poor outcome in terms of survival. In the presence of skin invasion, treatment entails liberal soft tissue and bone margin followed by adjuvant treatment.
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Affiliation(s)
- Smriti Panda
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashwin Chandran C
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Panda S, Kumar R, Chandran C A, Thakar A, Sharma SC, Bhasker S, Sharma A. Impact of skin invasion on long-term survival outcomes in gingivobuccal complex carcinoma. Acta Otorrinolaringológica Española 2021. [DOI: 10.1016/j.otorri.2020.04.006] [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: 11/25/2022]
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Thakar A, Panda S, Kakkar A, Singh V, Singh CA, Sharma A, Bhasker S, Krishnamurthy P, Sharma SC. A matched pair analysis of oncological outcomes in human papillomavirus-negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation. Head Neck 2021; 43:2896-2906. [PMID: 34050557 DOI: 10.1002/hed.26771] [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: 12/10/2020] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). METHODS Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk-stratified adjuvant treatment) and Arm II (nonsurgical treatment - radiation/chemoradiation) in HPV(-) OPSCC. RESULTS Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease-free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5-year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4-year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04). CONCLUSIONS TOS +/- adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I-III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.
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Affiliation(s)
- Alok Thakar
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Panda
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Padmavathi Krishnamurthy
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sultania M, Deo SVS, Shukla NK, Sharma A, Sahoo R, Bhasker S. Low Cost, Low Dose, Oral, Neoadjuvant Chemotherapy Protocol in Locally Advanced Borderline Oral Cancers-Feasibility Study. Indian J Surg Oncol 2021; 12:67-72. [PMID: 33814834 DOI: 10.1007/s13193-020-01247-8] [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] [Received: 05/09/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
A vast majority of oral cancer patients in developing countries present in an advanced stage with borderline resectable/inoperable stage to busy resource-constrained tertiary cancer centers. Conventional chemotherapy protocols are associated with issues like toxicity, tolerance, cost, and compliance. The present study was conducted to assess the feasibility of low-cost home-based chemotherapy options. Single-arm feasibility study was done in borderline resectable/inoperable oral cancer patients. Home-based oral neoadjuvant chemotherapy consisting of oral methotrexate 15 mg/m2 once a week and oral celecoxib 200 mg twice daily for 8 weeks was used. RECIST Criteria 1.1 was used to assess response to therapy. The study included 60 patients. The mean age was 51.98 years with male predominance (80%). Fifty-five patients adhered to the treatment; the compliance rate is 91.60%. Affordability (Rs 700 per month) and tolerance to therapy was 100%, and no grade III or IV toxicity was seen. Overall, 18 patients had stable disease (32.73%), partial response was seen in 15 patients (27.27%), and the disease progressed in 22 patients (40%). At the end of 8 weeks, 26 (43.3%) patients were deemed resectable. Neoadjuvant low cost, home-based metronomic chemotherapy using oral methotrexate and celecoxib seems to be a viable option in managing advanced oral cancer in resource-constrained setups.
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Affiliation(s)
- Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751003 India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - R Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Sharma A, Mohanti B, Thakar A, Bhasker S, Sikka K, Singh A, Pramanik R, Kumar R, Biswas A, Deo S, Thulkar S, Bahadur S. 959P Analysis of concurrent chemo-radiation using weekly cisplatin in locally advanced SCCHN: Identification of prognostic factors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1074] [Citation(s) in RCA: 1] [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: 10/23/2022] Open
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Panda S, Thakar A, Sharma SC, Sikka K, Sharma A, Bhasker S, Mohan VK, Sharma MC. Trans-oral robotic surgery for mandibulotomy sparing in posteriorly positioned oral tongue cancers. Clin Otolaryngol 2020; 45:827-831. [PMID: 32446276 DOI: 10.1111/coa.13587] [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: 07/06/2019] [Revised: 12/18/2019] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Smriti Panda
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Virender K Mohan
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Kumar R, Biswas R, Mathur S, Bhasker S, Damle N, Bal CS, Dhamija E. A Report of a Rare Case of Hurthle Cell Carcinoma of Thyroid with Metachronous Renal Metastasis. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_147_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractRenal metastasis from Hurthle cell thyroid carcinoma is an extremely rare phenomenon which when present usually indicates widely disseminated disease. Herein, we present a case of Hurthle cell carcinoma of thyroid in a 58-year-old gentle lady, with metachronous renal metastasis which happens to be the fourth reported case in English literature.
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Affiliation(s)
- Ritesh Kumar
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rituparna Biswas
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - CS Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
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Kumar RV, Bhasker S. Obesity in patients with carcinoma cervix increases the risk of adverse events. Rep Pract Oncol Radiother 2020; 25:212-216. [DOI: 10.1016/j.rpor.2019.12.024] [Citation(s) in RCA: 1] [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] [Received: 02/02/2019] [Revised: 08/17/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022] Open
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Panda S, Kumar R, Konkimalla A, Thakar A, Singh CA, Sikka K, Sharma SC, Kakkar A, Bhasker S. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol 2019; 10:608-613. [PMID: 31857751 DOI: 10.1007/s13193-019-00935-4] [Citation(s) in RCA: 5] [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: 02/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
Thyroidectomy conventionally accompanies total laryngectomy. This study intends to analyze the incidence and factors leading to thyroid gland involvement in carcinoma larynx and hypopharynx. Retrospective chart review from March 2011 to December 2016 of all patients who had undergone total laryngectomy at our institute. A total of 125 patients entered into the analysis. Subsites involved were glottis (n = 32), supraglottis (n = 28), transglottis (n = 52), pyriform sinus (n = 12), and subglottis (n = 1). TNM distribution according to AJCC 7th edition is as follows: T2 (n = 1), T3 (n = 34), T4 (n = 90); N0 (n = 97), N1 (n = 13), N2a (n = 5), N2b (n = 5), N2c (n = 4), and N3 (n = 1). Total thyroidectomy was performed in 16 patients, near total thyroidectomy in 5, and hemithyroidectomy in 104. Histopathologically thyroid gland involvement was seen in 11/125 (8.8%). The overall incidence of hypothyroidism was 48% (hemithyroidectomy, 43/104; total thyroidectomy, 16/16; near total thyroidectomy, 1/5). The incidence of permanent hypoparathyroidism was 12.8% (total thyroidectomy, 11; hemithyroidectomy, 5). On multivariate analysis (Cox proportional hazards model), extralaryngeal spread into level 6 (HR = 5.5, p = .006, C.I = 1-18.8) and extracapsular extension (HR = 9.3, p = 0.02, C.I = 1.29-67.5) were statistically significant predictors for thyroid gland involvement. Survival analysis of patients with thyroid gland involvement (n = 11) revealed 5-year overall survival (OS) of 100% and 5-year disease-free survival (DFS) of 59.3% compared with patients without thyroid gland involvement, 71% and 51.7%, respectively (median follow-up, 30 months). Thyroid gland involvement did not show a statistically significant effect on OS/DFS on multivariate analysis. In view of the endocrine abnormalities and lack of survival benefit seen, thyroidectomy should be performed judiciously during total laryngectomy.
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Affiliation(s)
- Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Rajeev Kumar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Abhilash Konkimalla
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Chirom Amit Singh
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Kapil Sikka
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Aanchal Kakkar
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- 3Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
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Kanodia R, Kumar R, Bhasker S, Biswas A, Verma H, Chander S. PO-149 Impact of Palliative Quad Shot RT on psychosocial outcomes in locally advanced HNC in MLIC’s. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30315-9] [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: 11/29/2022]
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Adhikari N, Biswas A, Gogia A, Sahoo R, Garg A, Nehra A, Sharma MC, Bhasker S, Singh M, Vishnubhatla S, Chawla R, Joshi G, Kumar L, Chander S. A phase II trial of response adapted whole brain radiotherapy after high dose methotrexate based chemotherapy in patients with newly diagnosed primary central nervous system lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Narayan Adhikari
- All India Institute of Medical Sciences (India), New Delhi, India
| | | | - Ajay Gogia
- Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Suman Bhasker
- All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Rohan Chawla
- All India Institute of Medical Sciences, New Delhi, India
| | - Garima Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- All India Institute of Medical Sciences, Delhi, India
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Adhikari N, Biswas A, Gogia A, Sahoo RK, Garg A, Nehra A, Sharma MC, Bhasker S, Singh M, Sreenivas V, Chawla R, Joshi G, Kumar L, Chander S. A prospective phase II trial of response adapted whole brain radiotherapy after high dose methotrexate based chemotherapy in patients with newly diagnosed primary central nervous system lymphoma-analysis of acute toxicity profile and early clinical outcome. J Neurooncol 2018; 139:153-166. [PMID: 29633112 DOI: 10.1007/s11060-018-2856-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/31/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The treatment of primary CNS lymphoma (PCNSL) comprises high dose methotrexate (HDMTX) based chemotherapy followed by whole brain radiotherapy (WBRT), the major drawback of which is long term neurotoxicity. We intended to assess the feasibility of response adapted WBRT in PCNSL in the Indian setting. METHODS We screened 32 patients and enrolled 22 eligible patients with PCNSL from 2015 to 2017 in a prospective phase II trial. The patients underwent five 2-weekly cycles of induction chemotherapy with rituximab, methotrexate, vincristine, procarbazine. Patients with complete response(CR) to induction chemotherapy were given reduced dose WBRT 23.4 Gy/13 fractions/2.5 weeks while those with partial response (PR), stable or progressive disease (SD or PD) were given standard dose WBRT 45 Gy/25 fractions/5 weeks. Thereafter two cycles of consolidation chemotherapy with cytarabine were given. The primary endpoints of the study were assessment of response rate (RR) and progression free survival (PFS). The secondary endpoints of the study were assessment of overall survival (OS), toxicity profile of treatment and serial changes in quality of life and neuropsychological parameters. RESULTS Out of 19 patients who completed HDMTX based chemotherapy, 10 (52.63%) patients achieved CR, 8 (42.11%) patients had PR and 1 patient had PD. After a median follow-up period of 11.25 months, the estimated median OS was 19 months. The actuarial rates of PFS and OS were respectively 94.1 and 68.2% at 1 year and 50.2 and 48.5% at 2 years. Three patients in reduced dose WBRT arm had recurrence and two of them died of progressive disease, whereas there was no recurrence or disease related death in standard dose WBRT arm. On univariate analysis of PFS, age ≤ 50 years and use of standard dose WBRT (45 Gy) led to significantly improved outcome (p value 0.03 and 0.02 respectively). CONCLUSION In patients with PCNSL, reduced dose WBRT after CR to HDMTX based chemotherapy may lead to suboptimal clinical outcome due to higher risk of recurrence, progression and early death. Trial Registration No CTRI/2015/10/006268.
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Affiliation(s)
- Narayan Adhikari
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Department of Clinical Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rohan Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Joshi
- Department of Clinical Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Chander
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Kumar RV, Bhasker S. A peek into epidemiology, screening, management of breast cancer in developing countries: Experience from two regional cancer centers in India. Breast J 2017; 24:422-423. [PMID: 29205685 DOI: 10.1111/tbj.12965] [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] [Received: 01/26/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
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Mohanti BK, Thakar A, Kaur J, Bahadur S, Malik M, Gandhi AK, Bhasker S, Sharma A. Postoperative radiotherapy dose requirement in standard combined-modality practice for head and neck squamous cell carcinoma: Analysis of salient surgical and radiotherapy parameters in 2 cohorts. Head Neck 2017; 39:1788-1796. [PMID: 28586138 DOI: 10.1002/hed.24836] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC). METHODS Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used. RESULTS Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age ≤ 50 years (P = .041); ≥ 4 positive nodes (P = .029); and overall treatment time (OTT) ≥ 100 days (P = .042). CONCLUSION Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs.
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Affiliation(s)
- Bidhu K Mohanti
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Alok Thakar
- Department of Ear, Nose, and Throat, and Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Jaspreet Kaur
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sudhir Bahadur
- Department of Ear, Nose, and Throat, and Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Monica Malik
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ajeet K Gandhi
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sahai P, Mohanti BK, Sharma A, Thakar A, Bhasker S, Kakkar A, Sharma MC, Upadhyay AD. Clinical outcome and morbidity in pediatric patients with nasopharyngeal cancer treated with chemoradiotherapy. Pediatr Blood Cancer 2017; 64:259-266. [PMID: 27681956 DOI: 10.1002/pbc.26240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the outcome and treatment-related morbidity in pediatric patients with nasopharyngeal carcinoma (NPC) treated with chemoradiotherapy. METHODS We did a retrospective review of 41 pediatric patients diagnosed with NPC between 2000 and 2013. The majority of the patients were treated with neoadjuvant chemotherapy followed by concurrent chemoradiation with the dose of 70 Gy in 35 fractions. Eight patients were treated with intensity-modulated radiation therapy, while the remaining with three-dimensional conformal radiation therapy or two-dimensional simulation technique. RESULTS The median age of the patients was 14 years (range 6-20 years). Most of the patients had locoregionally advanced disease (stage III/IVA/IVB). The histology of all the cases was undifferentiated carcinoma. Immunohistochemistry for the Epstein-Barr virus-Latent membrane protein 1 was positive in nine of the 13 tested cases. The median follow-up for all and the surviving patients was 26.6 months (range 2-140.8) and 51.2 months, respectively. The 3-year overall survival (OS) and event-free survival (EFS) rates were estimated at 83.7% (95% confidence interval [CI]: 64.8-93%) and 55.8% (95%CI: 38.7-69.8%), respectively. Distant metastases were the predominant pattern of failure. Treatment response showed an independent association with OS. T classification (T1/T2 vs. T3/T4) was significantly associated with EFS. Xerostomia, hypothyroidism, dental caries, neck fibrosis, trismus, and dysphagia were the common late effects in survivors. Radiation myelitis was observed in one patient. CONCLUSIONS Treatment with neoadjuvant chemotherapy followed by concurrent chemoradiation provides good survival outcomes in pediatric NPC. The quality of life of the survivors is a pertinent area that necessitates consideration.
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Affiliation(s)
- Puja Sahai
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Sultania M, Deo S, Shukla N, Sharma A, Sahu R, Bhasker S. Neoadjuvant metronomic chemotherapy in locally advanced head and neck cancers – feasibility study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30429-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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Chaudhari P, Kaur J, Nalwa A, Suri V, Panda A, Bhasker S, Chander S. Epithelial Myoepithelial Carcinoma of Parotid Gland. Indian J Otolaryngol Head Neck Surg 2016; 71:62-65. [PMID: 31741932 DOI: 10.1007/s12070-016-1025-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/12/2015] [Accepted: 10/03/2016] [Indexed: 11/28/2022] Open
Abstract
Epithelial myoepithelial carcinoma (EMC) is a rare biphasic tumor of salivary glands with low malignant potential. Although known to occur in submandibular gland and minor salivary glands, its most common location is parotid. Clinical and radiological findings often mimic a benign tumor. Because of rarity of EMC a standard treatment guideline is not yet known. Surgical resection is the most widely used approach. Although it is a low grade tumor, local recurrence rates of 23-50 % have been reported with 25 % chance of distant metastasis. Patients with histo-pathologic markers of aggressive disease should be considered for adjuvant radiotherapy. We report a case of epithelial myoepithelial carcinoma of parotid in a 40 year male that was treated with surgery followed by post-operative radiotherapy.
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Affiliation(s)
- Pritee Chaudhari
- 1Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Jaspreet Kaur
- 1Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Aasma Nalwa
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Vaishali Suri
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ananya Panda
- 3Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Suman Bhasker
- 1Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Subhash Chander
- 1Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
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Shukla NK, Deo SVS, Jakhetiya A, Nml M, Sreenivas V, Thulkar S, Bhasker S, Sharma A. Clinical Spectrum, Treatment and Relapse Patterns in 353 Patients with Squamous Cell Carcinoma of the Alveobuccal Complex Treated with a Curative Intent: A Retrospective Study. J Maxillofac Oral Surg 2016; 17:24-31. [PMID: 29382990 DOI: 10.1007/s12663-016-0970-y] [Citation(s) in RCA: 4] [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: 06/20/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022] Open
Abstract
Aims and Objectives Oral cancer is one of the most common cancers in Indian subcontinent with alveobuccal complex as most common cancer sub site. Cancers of Alveobuccal complex provides maximum challenge and management guidelines are not clear. The aim of the present study is to provide comprehensive demographic, clinical and treatment outcome data of alveobuccal squamous cell carcinoma (SCC) patients treated at a tertiary care cancer center in North India. Materials and Methods An analysis of prospectively maintained database in department of surgical oncology at Dr BRA-IRCH, AIIMS, Delhi, India was performed. All alveobuccal cancer patients who had undergone surgery from 1995 to 2010 were included for analysis. Results A total of 353 patients were included for analysis. Mean age was 49.75 years (SD ±12.04) with male and female ratio of 4:1. Composite resection without mandible was done in 25 % patients and 75 % underwent mandibular resection. Neck dissection was performed in 347 patients. Nodal deposits were identified in 124 (35.73 %) neck dissection specimens. Margin negative resection was performed in 89.5 % cases. After a median follow up of 30 months, 87 (24.64 %) patients developed disease relapse and 25 (7.08 %) patients developed second primaries. Overall 5-year disease free survival (DFS) was 57.65 % and 5 year overall survival (OS) was 59.86 %. Conclusion Among Indian oral cancer patients alveobuccal complex is most common sub site. Majority presents in locally advanced stage and reasonably good outcomes can be achieved with quality control surgery and judicious use of radiotherapy.
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Affiliation(s)
- Nootan Kumar Shukla
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - S V Suryanarayana Deo
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Ashish Jakhetiya
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Manjunath Nml
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Vishnubhatla Sreenivas
- 2Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Sanjay Thulkar
- 3Department of Radio Diagnosis, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Suman Bhasker
- 4Department of Radiation Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Atul Sharma
- 5Department of Medical Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
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Sahai P, Baghmar S, Nath D, Arora S, Bhasker S, Gogia A, Sikka K, Kumar R, Chander S. Extrapulmonary Small Cell Carcinoma - a Case Series of Oropharyngeal and Esophageal Primary Sites Treated with Chemo-Radiotherapy. Asian Pac J Cancer Prev 2016; 16:7025-9. [PMID: 26514485 DOI: 10.7314/apjcp.2015.16.16.7025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The optimal sequence and extent of multimodality therapy remains to be defined for extrapulmonary small cell carcinoma because of its rarity. The purpose of our study was to assess the response to neoadjuvant chemotherapy followed by chemoradiation/radiation in patients with extrapulmonary small cell carcinoma. MATERIALS AND METHODS Four consecutively diagnosed patients were included in this study. The primary tumor site was oropharynx in three patients and esophagus in one. The patients with the limited disease were treated with chemotherapy followed by concurrent chemoradiation (n=2) or radiotherapy (n=1). The patient with the extensive disease with the primary site in vallecula was treated with chemotherapy and palliative radiotherapy to the metastatic site. RESULTS The median follow-up was 22.5 months (range, 8-24 months). Three patients with the limited disease (base of tongue, n=2; esophagus, n=1) were in complete remission. The patient with the extensive disease died of loco-regional tumor progression at 8 months from the time of diagnosis. CONCLUSIONS The combination of chemotherapy and radiotherapy is the preferred therapeutic approach for patients with extrapulmonary small cell carcinoma. Induction chemotherapy followed by concurrent chemoradiation or radiation provides a good loco-regional control in patients with limited disease.
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Affiliation(s)
- Puja Sahai
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India E-mail :
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Giridhar P, Mallick S, Bhasker S, Pathy S, Mohanti BK, Biswas A, Sharma A. Head and neck extra nodal NHL (HNENL)--Treatment Outcome and Pattern of failure--A Single Institution Experience. Asian Pac J Cancer Prev 2016; 16:6267-72. [PMID: 26434827 DOI: 10.7314/apjcp.2015.16.15.6267] [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: 11/10/2022] Open
Abstract
BACKGROUND Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. MATERIALS AND METHODS We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. RESULTS We retrieved data of 75 consecutive patients HNENL. Median age was 47 years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55 patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24 received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21 patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37 cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI-68.6-95.35) and 88% (95%CI-60.82-92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. CONCLUSIONS Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.
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Affiliation(s)
- Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi E-mail :
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Melgandi W, Benson R, Hakin A, Bhasker S. Porocarcinoma scalp with high risk features treated with surgery and adjuvant radiotherapy: A case report and review of literature. J Egypt Natl Canc Inst 2016; 28:195-8. [PMID: 27302529 DOI: 10.1016/j.jnci.2016.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Abstract
Eccrine porocarcinoma is a rare malignant sweat gland tumor arising from the intra dermal part of the gland and accounts for only 0.005% of all epithelial cutaneous tumors. Commonly involved site includes extremities and face. Scalp is a rare site for porocarcinoma with less than 20 reported cases so far. Wide local excision with clear margins remains the treatment of choice. Review of literature revealed a local recurrence rate of 37.5% and a nodal involvement risk of 20%. Porocarcinoma of the scalp is peculiar in that the primary tumor may be large at presentation, making surgery with adequate margins difficult. Adjuvant radiotherapy must be considered in a case to case basis due to the high local recurrence rates compared to other sites of porocarcinoma and should be given to all patients with close margins and extra capsular extension.
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Affiliation(s)
- Wineeta Melgandi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rony Benson
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Abdul Hakin
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
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Gandhi AK, Roy S, Biswas A, Bhasker S, Sharma A, Thakar A, Mohanti BK. Adenoid cystic carcinoma of head and neck: A single institutional analysis of 66 patients treated with multi-modality approach. Indian J Med Paediatr Oncol 2016; 36:166-71. [PMID: 26855525 PMCID: PMC4743188 DOI: 10.4103/0971-5851.166729] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Adenoid cystic carcinoma (ACC) accounts for 1% of all head and neck (HN) cancers. Materials and Methods: Demographic, clinical, treatment, and survival details of 66 patients were collected (1995-2011) and analyzed. Disease-free survival (DFS) was estimated by Kaplan-Meier method. Results: Primary disease sites were sinonasal (n = 27), salivary gland (n = 30), and others (n = 9). Median follow-up was 23 months (range: 12-211 months). Estimated DFS at 2- and 5-year were 75% and 67.2%, respectively. On univariate analysis, intra-cranial extension (ICE) (hazard ratio [HR]: 3.59, P = 0.0071), lymph node involvement (HR: 4.05, P = 0.0065), treatment modality (others vs. surgery plus adjuvant radiotherapy, HR: 2.39, P = 0.0286) and T stage (T3/4 vs. T1/2, HR: 3.27, P = 0.007) had significant impact on DFS. Lymph node involvement (P = 0.038) and ICE (P = 0.038) continued to have significant impact on DFS on multivariate analysis. Conclusion: Surgery followed by adjuvant radiotherapy remains the treatment of choice for HN ACC. Lymph node involvement and ICE confer poor prognosis.
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Affiliation(s)
- Ajeet Kumar Gandhi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumyajit Roy
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Oto-rhino-laryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Gandhi AK, Roy S, Biswas A, Raza MW, Saxena T, Bhasker S, Sharma A, Thakar A, Mohanti BK. Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience. Auris Nasus Larynx 2016; 43:45-9. [DOI: 10.1016/j.anl.2015.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/13/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
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Gupta A, Kumar R, Sahu V, Agnihotri V, Singh AP, Bhasker S, Dey S. NFκB-p50 as a blood based protein marker for early diagnosis and prognosis of head and neck squamous cell carcinoma. Biochem Biophys Res Commun 2015; 467:248-53. [DOI: 10.1016/j.bbrc.2015.09.181] [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] [Received: 08/26/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
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Kumar A, Sharma A, Mohanti BK, Thakar A, Shukla NK, Thulkar SP, Sikka K, Bhasker S, Singh CA, Vishnubhatla S. A phase 2 randomized study to compare short course palliative radiotherapy with short course concurrent palliative chemotherapy plus radiotherapy in advanced and unresectable head and neck cancer. Radiother Oncol 2015; 117:145-51. [DOI: 10.1016/j.radonc.2015.07.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
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Kumar RV, Bhasker S. Health-care related supportive-care factors may be responsible for poorer survival of cancer patients in developing countries. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Bhanuprasad V, Mallick S, Bhasker S, Mohanti BK. Pediatric head and neck squamous cell carcinoma: Report of 12 cases and illustrated review of literature. Int J Pediatr Otorhinolaryngol 2015; 79:1279-82. [PMID: 26072014 DOI: 10.1016/j.ijporl.2015.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Head and neck carcinoma is a very rare entity in pediatric age group. We here present the demography, treatment and outcome of 12 pediatric patients. METHODOLOGY We retrieved the treatment charts of pediatric patients with a diagnosis of head and neck squamous cell carcinoma (PHNSCC). We also retrieved the published literature of pediatric HNSCC to present the treatment modalities being delivered across institutes. RESULTS We found 12 patients registered with a diagnosis of squamous cell carcinoma. Median age of the entire cohort was 17 years (Range: 8-20). Gender predilection was skewed in favor of male (male:female ratio-11:1). Oral tongue 3(25%) was the commonest sub site followed by soft palate 2(17%) gingiva 2 (17%), supra glottis larynx 2(17%) and one each of hard palate, buccal mucosa, floor of mouth (8.25% each). The most commonly employed modality of treatment was surgery in 6(50%). Radiation was used in seven cases: 7(Adjuvant-4, Radical-3). Two patients received radical chemo-radiation. Neo-adjuvant chemotherapy was used in two cases. Median follow up duration was 2 years (Range: 6 months to 8 years). One patient recurred 6 months post completion of radical chemo-radiation. The patient with recurrent disease had soft palate primary and had isolated local recurrence. The patient was salvaged with surgery and was disease free at the last follow up. At the last follow up all patients were surviving without disease. CONCLUSION The treatment and survival are not much different in pediatric patients compared to adult counterpart. However, in the absence of molecular profiling it is difficult to assess the cause of development of SCC in pediatric patients. A detailed study of underlying molecular pathway will further guide the future treatment.
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Affiliation(s)
- V Bhanuprasad
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Venkatesulu B, Mallick S, George A, Bhasker S. Small cell carcinoma of the lung in a treated case of Myoepithelial carcinoma of the tongue--report of a rare case with illustrated review of the literature. J Egypt Natl Canc Inst 2015; 28:45-8. [PMID: 26117146 DOI: 10.1016/j.jnci.2015.06.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/05/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022] Open
Abstract
Myoepithelial carcinoma has rarely been reported in the oral cavity and oropharynx. We found only 6 cases of myoepithelioma of the tongue reported till date. Two cases had a benign myoepithelioma; four had epithelial-Myoepithelial carcinoma. The present case had malignant myoepithelioma, a distinct entity from other histologies.
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Affiliation(s)
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Archana George
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Kaur J, Goyal S, Muzumder S, Bhasker S, Mohanti BK, Rath GK. Outcome of surgery and post-operative radiotherapy for major salivary gland carcinoma: ten year experience from a single institute. Asian Pac J Cancer Prev 2015; 15:8259-63. [PMID: 25339015 DOI: 10.7314/apjcp.2014.15.19.8259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS To determine the clinical characteristics, pathological features, local and distant failure patterns in patients with carcinoma of major salivary glands treated with surgery and postoperative radiotherapy (PORT). MATERIALS AND METHODS We retrospectively reviewed 106 cases of major salivary gland tumor seen at our centre (1998-2008). Sixty five cases of major salivary gland carcinoma were selected for analysis (exclusions: benign, palliative, non-carcinomas). The patient population treated by surgery and PORT was divided into two groups: 1) Patients who underwent surgery and immediate PORT (Primary PORT); 2) Patients with recurrent carcinoma who underwent at least two surgeries and received PORT in the immediate post-operative period of the last performed surgery (Recurrent PORT). Recurrence free survival (RFS) was assessed using the Kaplan-Meier method. RESULTS Median age was 35 years with a male: female ratio of 1.3:1. The majority of cancers were located in the parotid gland (86.2%) and the most common histology was mucoepidermoid carcinoma (43%). Thirty nine cases (60%) were primary while 26 (40%) were recurrent. Optimal surgery was performed in 59/65 patients (90.8%). 43 patients (66.2%) underwent neck dissection, of which 14 (32.5%) had nodal metastasis. Overall, 61 (93.8%) patients complied with the prescribed radiotherapy. Median dose of PORT was 60 Gy. Median follow-up was 13.1 months (range 2-70). Relapse free survival was 50.4% at 60 months. Some 12 cases (18.5%) recurred with a median time to recurrence of 16.9 months. CONCLUSIONS Surgery and PORT is an effective treatment for major salivary gland carcinoma with over 90% compliance and <20% recurrence. Early treatment with postoperative radiotherapy may increase the survival rate in major salivary gland carcinoma patients.
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Affiliation(s)
- Jaspreet Kaur
- All India Institute of Medical Sciences, New Delhi, India E-mail :
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Giridhar P, Mallick S, Laviraj MA, Bhasker S. Esthesioneuroblastoma with large intracranial extension treated with Induction chemotherapy, de-bulking surgery and image guided intensity modulated radiotherapy. Eur Arch Otorhinolaryngol 2015; 273:1323-5. [PMID: 26041440 DOI: 10.1007/s00405-015-3672-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Esthesioneuroblastoma is a rare tumour of the sino-nasal tract. One-third cases present with intracranial extension. However, treatment options are limited for such cases. METHODOLOGY We herein report a case with large intracranial extension treated with Induction chemotherapy, de-bulking surgery, and image guided intensity modulated radiotherapy. RESULTS The patient was treated with IGIMRT technique to a dose of 64 Gy in 32 fractions. Cone bean CT verification was done twice a week to eliminate set up error. The patient achieved complete resolution of the disease and was disease free 6 months after completion of treatment. CONCLUSION IGIMRT even after a de-bulking surgery may help to achieve long-term disease control for patients with large intracranial extension with minimal morbidity.
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Affiliation(s)
- Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - M A Laviraj
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Mallick S, Benson R, Bhasker S, Mohanti B. Conformal radiotherapy for locally advanced juvenile nasopharyngeal angio-fibroma. J Cancer Res Ther 2015; 11:73-7. [DOI: 10.4103/0973-1482.150349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Giridhar P, Mallick S, Laviraj MA, Bhasker S. Adenoid cystic carcinoma sphenoid sinus with intracranial extension treated by radical radiotherapy: a rare case. Eur Arch Otorhinolaryngol 2014; 272:1037-1040. [PMID: 25503101 DOI: 10.1007/s00405-014-3441-4] [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: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - M A Laviraj
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Kumar RV, Bhasker S. SM-09 * BED-SIDE HIGH-GRADE GLIOMA PROGNOSTICATION CONCENTRIC PANEL CALCULATOR TO DETERMINE RECURSIVE PARTITIONING ANALYSIS (RPA) CLASSES. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou277.8] [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: 11/13/2022] Open
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Venkatesulu BP, Mallick S, Ventrapati P, Roshan V, Bhasker S, Rath GK. Pattern of microbial organisms in radiation induced mucositis and dermatitis in head and neck squamous cell carcinoma (HNSCC) treated with radiation (RT)/chemo radiation (CTRT). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.31_suppl.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
210 Background: Mucositis and dermatitis complicated by bacterial and fungal infections are common in patients undergoing RT/CTRT. We intended to assess spectrum of microbial organisms in skin and oral swabs, rationality of antibiotics/anti-fungal (AB/F), toxicities, hospitalization and treatment delays. Methods: This was a prospective, single arm observational study conducted in a tertiary care hospital. 25 patients undergoing RT or CTRT from January 2014 to June 2014 were included. Patients were subjected to skin-wound and oral swab gram stain, potassium hydroxide mount, bacterial and fungal culture with sensitivity. Results: Median age was 54 years (30-69). Male: female ratio 1.5:1. Primary site: tongue 5 (20%), palate 5 (20%), tonsil, pyriform-sinus 4 (16%) each, buccal-mucosa, alveolus 2 (8%) each, EAC, nasopharynx, RMT one each (12%). 24 2D (96%) and 1 (4%) 3D planning. Feeding tube required for one (4%). 16 received concurrent cisplatin (40mg/m2 weekly), median 3 cycles. At median dose 48 (16-68 Gy) patients were referred for toxicities. Grade III,IV dermatitis were in 5(20%), 1(4%) respectively.Grade III,IV mucositis was 5(20%), 0(0%) respectively. Median laboratory parameters: hemoglobin 10.5, TLC 6350, albumin3.6 and globulin 2.8. Spectrum of organisms isolated is tabulated below. In GPC, specific isolate was Methicillin sensitive staphylococcus aureus 2, beta hemolytic streptococcus one. Four required i.v antibiotics. 3 received i.v ciprofloxacin 200mg BD and i.v metronidazole 500mg TDS, one required i.v cefoperazone-sulbactam 2 gm BD (7 days); rest 21 had adequate relief with topical antibiotics (metronidazole TDS) or antifungal (clotrimazole mouth paint TDS) alone for 7 days. Median duration of hospital stay was 10 days (2-16). Treatment interruption was in 6 ranging 6-10 days. Conclusions: Topical AB/F with adequate hydration can provide adequate symptom relief and avoid treatment interruption for mucositis and dermatitis. [Table: see text]
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Affiliation(s)
| | | | | | - Vikas Roshan
- All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- All India Institute of Medical Sciences, New Delhi, India
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Kaur J, Roy S, Mallick SR, Mathur S, Sharma A, Bhasker S, Mohanti BK. Squamous cell carcinoma of larynx in an 8-year-old child: successful management with chemo-radiation. Pediatr Blood Cancer 2014; 61:1481-3. [PMID: 24453121 DOI: 10.1002/pbc.24952] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/30/2013] [Indexed: 11/09/2022]
Abstract
Incidence of laryngeal squamous cell cancer (SCC) in childhood is rare, more so in children below 10 years of age. Due to the rarity of the disease and nonspecific symptoms diagnosis often gets delayed. Treatment is challenging and demands expert multi-modality care. We describe the clinico-pathologic findings and management of laryngeal cancer with chemo-radiation in an 8-year-old male. After 18 months of completion of treatment the child is in complete remission clinically and radiologically. This report aims at increasing awareness of head and neck SCC in paediatric population and also underscores the importance of multi-modality care in managing such cases.
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Affiliation(s)
- Jaspreet Kaur
- Department of Radiation Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Kumar RV, Bhasker S. Optimizing cervical cancer care in resource-constrained developing countries by tailoring community prevention and clinical management protocol. J Cancer Policy 2014. [DOI: 10.1016/j.jcpo.2013.11.002] [Citation(s) in RCA: 4] [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: 10/25/2022]
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Mohanti BK, Sahai P, Thakar A, Sikka K, Bhasker S, Sharma A, Sharma S, Bahadur S. Institutional Experience of Interstitial Brachytherapy for Head and Neck Cancer with a Comparison of High- and Low Dose Rate Practice. Asian Pac J Cancer Prev 2014; 15:813-8. [DOI: 10.7314/apjcp.2014.15.2.813] [Citation(s) in RCA: 4] [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: 11/10/2022] Open
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Kumar RV, Bhasker S. Potential opportunities to reduce cervical cancer by addressing risk factors other than HPV. J Gynecol Oncol 2013; 24:295-7. [PMID: 24167663 PMCID: PMC3805908 DOI: 10.3802/jgo.2013.24.4.295] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022] Open
Abstract
Cervical cancer is the most common cancer in developing world and 80% of global burden is reported from these nations. Human papillomavirus along with poverty, illiteracy/lower education level and standards, multi-parity, tobacco, malnutrition and poor genital hygiene may act synergistically to cause cervical cancer. Risk factor of cervical cancer may in itself be the reason for non-viability of cervical cancer vaccine program in this part of the world. Interventions to address these risk factors in addition to vaccination of girls before their sexual debut may hold promises of reducing the morbidity and mortality of female genital cancers.
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Affiliation(s)
- Ramaiah Vinay Kumar
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bangalore, India
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Bhasker S, Kumar V. AOSP2 INITIAL IMAGING WORK-UP AND VARIATIONS IN NEWLY DIAGNOSED BREAST CANCER PATIENTS. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70017-0] [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: 11/26/2022]
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Bajpai V, Bhasker S, Saraya A. Of the Relationship between Population and Development: Need to Stop Vilifying the People. Journal of Health Management 2012. [DOI: 10.1177/0972063412457516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The world population recently touched seven billion and as expected, there was an outpouring of concern over how burgeoning population was the biggest stumbling block for our development. There is a well-entrenched notion in the popular perception of the laity and the policy establishment that it is burgeoning population that is the biggest hindrance in the development of the country. This perception has often led to vilification of the people who are the biggest victims of the lack of development. Consequently, there has been an imposition of a population policy that concentrates only on population stabilization through family planning measures. The article builds its argument by tracing the history and ideological roots of the conventional thinking on population policy. It further relies on data regarding historical trends in population growth to establish the close relationship between development phases in human civilization and its population dynamics. Data on the relationship between population growth and availability of resources are also examined. Population policies around much of the world have privileged fertility control measures over the overall socio-economic development. The frustration engendered by such an approach has led to greater adoption of overt and covert coercion to limit population sizes. The article emphasizes the need for a more nuanced population policy. There is a need to broaden the concept of unmet need from that of a narrow techno-centric approach to include the developmental needs of the people.
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Affiliation(s)
- Vikas Bajpai
- Vikas Bajpai, Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi
| | - Suman Bhasker
- Suman Bhasker, Additional Professor, Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi
| | - Anoop Saraya
- Anoop Saraya, Professor, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi
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Singh K, Kumar V, Bhasker S, Mohanti BK. Carcinoma cervix with metastasis to the orbit: a case report and review of literature. J Cancer Res Ther 2012; 7:357-8. [PMID: 22044825 DOI: 10.4103/0973-1482.87010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mullapally S, Mohanti B, Laviraj M, Thulkar S, Subramani V, Sharma A, Bhasker S, Pandey R, Thakkar A, Rath G. PO-0730 IMAGE GUIDED ADAPTIVE RADIOTHERAPY (IGART) OF HEAD AND NECK CANCER: VOLUMETRIC AND CLINICAL EVIDENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71063-0] [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: 10/28/2022]
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