Jai Prakash Agarwal

Tata Memorial Centre, Mumbai, Maharashtra, India

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Publications (140)427.56 Total impact

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    ABSTRACT: To estimate dose-response relationship using dynamic quantitative (99m)Tc-pertechnate scintigraphy in head-neck cancer patients treated with parotid-sparing conformal radiotherapy. Dynamic quantitative pertechnate salivary scintigraphy was performed pre-treatment and subsequently periodically after definitive radiotherapy. Reduction in salivary function following radiotherapy was quantified by salivary excretion fraction (SEF) ratios. Dose-response curves were modeled using standardized methodology to calculate tolerance dose 50 (TD50) for parotid glands. Salivary gland function was significantly affected by radiotherapy with maximal decrease in SEF ratios at 3-months, with moderate functional recovery over time. There was significant inverse correlation between SEF ratios and mean parotid doses at 3-months (r = -0.589, p < 0.001); 12-months (r = -0.554, p < 0.001); 24-months (r = -0.371, p = 0.002); and 36-months (r = -0.350, p = 0.005) respectively. Using a post-treatment SEF ratio <45% as the scintigraphic criteria to define severe salivary toxicity, the estimated TD50 value with its 95% confidence interval (95%CI) for the parotid gland was 35.1Gy (23.6-42.6Gy), 41.3Gy (34.6-48.8Gy), 55.9Gy (47.4-70.0Gy) and 64.3Gy (55.8-70.0Gy) at 3, 12, 24, and 36-months respectively. There is consistent decline in parotid function even after conformal radiotherapy with moderate recovery over time. Dynamic quantitative pertechnate scintigraphy is a simple, reproducible, and minimally invasive test of major salivary gland function.
    Radiation Oncology 12/2015; 10(1):371. DOI:10.1186/s13014-015-0371-2 · 2.36 Impact Factor
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    ABSTRACT: Background Whether patients with early-stage oral cancers should be treated with elective neck dissection at the time of the primary surgery or with therapeutic neck dissection after nodal relapse has been a matter of debate. Methods In this prospective, randomized, controlled trial, we evaluated the effect on survival of elective node dissection (ipsilateral neck dissection at the time of the primary surgery) versus therapeutic node dissection (watchful waiting followed by neck dissection for nodal relapse) in patients with lateralized stage T1 or T2 oral squamous-cell carcinomas. Primary and secondary end points were overall survival and disease-free survival, respectively. Results Between 2004 and 2014, a total of 596 patients were enrolled. As prespecified by the data and safety monitoring committee, this report summarizes results for the first 500 patients (245 in the elective-surgery group and 255 in the therapeutic-surgery group), with a median follow-up of 39 months. There were 81 recurrences and 50 deaths in the elective-surgery group and 146 recurrences and 79 deaths in the therapeutic-surgery group. At 3 years, elective node dissection resulted in an improved rate of overall survival (80.0%; 95% confidence interval [CI], 74.1 to 85.8), as compared with therapeutic dissection (67.5%; 95% CI, 61.0 to 73.9), for a hazard ratio for death of 0.64 in the elective-surgery group (95% CI, 0.45 to 0.92; P=0.01 by the log-rank test). At that time, patients in the elective-surgery group also had a higher rate of disease-free survival than those in the therapeutic-surgery group (69.5% vs. 45.9%, P<0.001). Elective node dissection was superior in most subgroups without significant interactions. Rates of adverse events were 6.6% and 3.6% in the elective-surgery group and the therapeutic-surgery group, respectively. Conclusions Among patients with early-stage oral squamous-cell cancer, elective neck dissection resulted in higher rates of overall and disease-free survival than did therapeutic neck dissection. (Funded by the Tata Memorial Centre; ClinicalTrials.gov number, NCT00193765 .).
    New England Journal of Medicine 05/2015; DOI:10.1056/NEJMoa1506007 · 54.42 Impact Factor
  • Annals of Oncology 04/2015; 26(suppl 1):i23-i23. DOI:10.1093/annonc/mdv048.20 · 6.58 Impact Factor
  • Annals of Oncology 04/2015; 26(suppl 1):i46-i46. DOI:10.1093/annonc/mdv051.05 · 6.58 Impact Factor
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    ABSTRACT: Context: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. Aims and Objectives: To identify the factors that predict TDM in radically treated HNC patients. Settings and Design: Retrospective audit. Materials and Methods: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. Results: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. Conclusions: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed.
    Indian Journal of Cancer 12/2014; 51(3):231-235. DOI:10.4103/0019-509X.146734 · 1.13 Impact Factor
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    ABSTRACT: Background The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2–12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012. Patients and methods All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS. Results 721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p = 0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59–25.21 months) and 8.16 months (95%, CI 7.57–8.76) in patients treated with non surgical treatment (p = 0.0001). Conclusion In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients.
    Oral Oncology 10/2014; 50(10). DOI:10.1016/j.oraloncology.2014.07.015 · 3.03 Impact Factor
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    ABSTRACT: Background: We hypothesized that pathological N1 (pN1) and N2a (pN2a) nodal disease portend a similar prognosis in patients with oral cancer.Methods: An international multicenter study of 739 patients with oral cancer and pN1 or pN2a stage disease. Multivariable analyses were performed using Cox proportional hazard models to compare locoregional failure (LRF), disease-specific (DSS) and overall survival (OS). Institutional heterogeneity was assessed using two-stage random effects meta-analysis techniques.Results: Univariate analysis revealed no difference in LRF (p=0.184), DSS (p=0.761) or OS (p=0.475). Similar results were obtained in adjusted multivariable models and no evidence of institutional heterogeneity was demonstrated.Conclusion: The prognosis of pN2a and pN1 disease are similar in oral SCC suggesting these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy. However, these results may reflect more aggressive treatment of N2a disease hence we caution against using this data to de-intensify treatment. Head Neck, 2014
    Head & Neck 09/2014; DOI:10.1002/hed.23871 · 3.01 Impact Factor
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    ABSTRACT: Background:To report the results of a phase III, three arm, randomised trial comparing conventional radiotherapy (RT) to concurrent chemo-radiotherapy (CTRT) and accelerated radiotherapy (ART), in advanced head and neck Squamous Cell Carcinoma.Methods:One hundred and eighty six of planned 750 patients who were randomised to receive 1. RT (66-70Gy / 2 Gy fraction / 5 fractions weekly, 2. CTRT- weekly Cisplatin (30 mg/m2) with same RT dose, 3. ART alone- 66-70 Gy / 2 Gy fraction / 6 fractions weekly were available for analysis. The primary end point was loco-regional control (LRC) at 5 years.Results:The mean follow up was 54 months. Among the three arms, CTRT showed superior LRC (49%, p=0.049). RT had lower grade ≥ 3 mucositis and late toxicity.Conclusion:CTRT is associated with significantly better LRC as compared to RT and ART with higher but acceptable acute and late toxicities. Head Neck, 2014
    Head & Neck 09/2014; DOI:10.1002/hed.23865 · 3.01 Impact Factor
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    ABSTRACT: Malignant melanomas involving the mucosa are rare and aggressive lesions. Their rarity has made the formulation of staging and treatment protocols very difficult, as most of the available information comes from case reports and small case series. We conducted a retrospective study to analyze the behavior of melanomas of the oral mucosa in patients who were treated at Tata Memorial Hospital in Mumbai, a tertiary care referral center for malignancies and one of the largest cancer centers on the Indian subcontinent. During the 22-year period from January 1986 through December 2007, we found only 13 such cases, which had occurred in 8 men and 5 women, aged 26 to 70 years (mean: 37.5). All patients had been offered surgery with curative intent. Mucosal melanomas have exhibited a greater tendency for distant recurrence than for local treatment failure, which is why adjuvant radiation therapy has not been shown to confer any consistent benefit. In our study, only 3 of the 13 patients (23.1%) remained alive 2 years after diagnosis, despite aggressive treatment. Tumor staging, optimal treatment, and prognostic factors for oral mucosal melanoma are far from clear, and further research is needed. Despite the small number of patients in this study, it still represents one of the largest series of oral mucosal melanoma patients in India.
    Ear, nose, & throat journal 08/2014; 93(8):E4-E7. · 0.88 Impact Factor
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    ABSTRACT: The current American Joint Committee on Cancer (AJCC) staging system for oral cancer demonstrates wide prognostic variability within each primary tumor stage and provides suboptimal staging and prognostic information for some patients.
    07/2014; 140(12). DOI:10.1001/jamaoto.2014.1548
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    ABSTRACT: Squamous cell carcinoma of the oral cavity (OSCC) is a common malignant tumor worldwide.
    07/2014; 140(12). DOI:10.1001/jamaoto.2014.1539
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    ABSTRACT: A study was conducted to assess for prognostic heterogeneity within the N2b and N2c classifications for oral cancer based on the number of metastatic lymph nodes and to determine whether laterality of neck disease provides additional prognostic information. An international multicenter study of 3704 patients with oral cancer undergoing surgery with curative intent was performed. The endpoints of interest were disease-specific survival and overall survival. Model fit was assessed by the Akaike Information Criterion and comparison of models with and without the covariate of interest using a likelihood ratio test. The median number of metastatic lymph nodes was significantly higher in patients with N2c disease compared to those with N2b disease (P < .001). In multivariable analyses stratified by study center, the addition of the number of metastatic lymph nodes improved model fit beyond existing N classification. Next, the authors confirmed significant heterogeneity in prognosis based on the number of metastatic lymph nodes (≤ 2, 3-4, and ≥ 5) in patients with both N2b and N2c disease (P < .001). A proposed reclassification combining N2b and N2c disease based on the number of metastatic lymph nodes demonstrated significant improvement in prognostic accuracy compared with the American Joint Committee on Cancer staging system, and no improvement was noted with the addition of a covariate for contralateral or bilateral neck disease (P = .472). The prognosis of patients with oral cancer with N2b and N2c disease appears to be similar after adequate adjustment for the burden of lymph node metastases, irrespective of laterality. Based on this finding, the authors propose a modified lymph node staging system that requires external validation before implementation in clinical practice. Cancer 2014. © 2014 American Cancer Society.
    Cancer 07/2014; 120(13). DOI:10.1002/cncr.28686 · 4.90 Impact Factor
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    ABSTRACT: Certain tumor-related factors like thickness increases the risk of nodal metastasis and may affect survival in patients with oral tongue cancers. The objective of this study is to identify those tumor-related prognostic predictors that can potentially influence decision for adjuvant radiotherapy. A retrospective review of all patients with oral tongue cancers treated primarily by surgery at Tata Memorial Hospital between January 2007 and June 2010. The demographic and commonly reported histopathological features were analyzed for their influence on disease free and overall survival. Five hundred eighty-six patients were eligible for the study, of which 416 were males and 117 were females. Follow-up details were available for 498 (85%) patients with a median follow-up of 18 months and mean follow-up of 22 months. There were 302 patients who were alive and disease free at the last follow-up. This group had a mean follow-up of 27 months and median follow-up of 27.5 months. Disease recurrences during follow-up were observed in 184 (31%) patients. Sixty-one patients died subsequently. Perineural invasion significantly affected disease free survival (DFS). A tumor thickness of more than 11 mm significantly affected the overall survival (OS). Other than nodal metastasis, tumor-related factors like thickness and perineural invasion are adverse prognostic factors and can influence survival. These patients, especially in case of early stage cancers, may potentially benefit from postoperative adjuvant radiotherapy. 2b. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 06/2014; 109(7). DOI:10.1002/jso.23583 · 2.84 Impact Factor
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    ABSTRACT: Background Treatment intensification by using chemoradiotherapy (CRT) or altered fractionation radiotherapy (RT) improves outcomes in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).Methods Two comprehensive meta-analyses with similar control arms (conventionally fractionated RT) were compared indirectly.ResultsThe hazard ratio (HR) of death with 95% confidence interval (CI) for the overall comparison of altered fractionation RT with concomitant CRT was 1.13 (95% CI, 0.97-1.29; p = .07) suggesting no significant difference between both approaches. Compared to concomitant CRT, the HR for death was 1.01 (95% CI, 0.89-1.15; p = .82); 1.22 (95% CI, 0.94-1.59; p = .13); and 1.22 (95% CI, 1.07-1.39; p = .002) for hyperfractionated RT; accelerated RT without total dose reduction; and accelerated RT with total dose reduction, respectively.Conclusion Concomitant CRT and hyperfractionated RT are comparable to one another on indirect comparison in the radiotherapeutic management of locoregionally advanced HNSCC. Any form of acceleration (with or without total dose reduction) may not compensate fully for lack of chemotherapy. © 2014 Wiley Periodicals, Inc. Head Neck 37: 670-676, 2015
    Head & Neck 04/2014; 37(5). DOI:10.1002/hed.23661 · 3.01 Impact Factor
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    ABSTRACT: Objective: Advanced oral cancers are a challenge for treatment, as they require complex procedures for excision and reconstruction. Despite being occurring at a visible site and can be detected easily, many patients present in advanced stages with large tumors. Timely intervention is important in improving survival and quality of life in these patients. The aim of the present study was to find out the causes of delay in seeking specialist care in advanced oral cancer patients. Materials and Methods: A prospective questionnaire based study was done on 201 consecutive advanced oral squamous cancer patients who underwent surgery at our hospital. All patients had either cancer of gingivobuccal complex (GBC) or tongue and had tumors of size more than 4 cm (T3/T4) and were treatment naοve at presentation.
    Indian Journal of Cancer 04/2014; 51(2):95-97. DOI:10.4103/0019-509X.137934 · 1.13 Impact Factor
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    ABSTRACT: Background: Thymoma is the most common tumor of the anterior mediastinum. Surgery is mainstay of treatment, with adjuvant radiation recommended for invasive thymoma. Because of rarity, prospective randomized trials may not be feasible even in multicentric settings hence the best possible evidence can be large series. Till date Thymoma has not been studied in Indian settings. Materials and methods: All patients presenting to Thoracic disease management group at our Centre during 2006-2011 were screened. Sixty two patients' with histo-pathological confirmation of thymoma medical records could be retrieved and are presented in this study. Mosaoka staging and WHO classification was used. The clinical, therapeutic factors and follow up parameters were recorded and survival was calculated. Effects of prognostic factors were compared. Results: Sixty two patients were identified (36M, 26F; age 22-84, median 51.5 years) and majorities (57%) of thymoma were stage I-II. WHO pathological subtype B was most common 30 (49%). Mean tumor size was smaller in patients with myasthenia (5.3cm) than the entire group (7.6cm). Neoadjuvant therapy was offered to five unresectable stages III or IV a patient's with 40% resectability rates. Median overall survival was 60 months (Inter quartile-range 3-44 months) with overall survival rate (OS) at three year being 90%. Resectable tumors had better outcomes (94%) than non resectable (81%) at three years. Mosaoka Stage was the only significant (P = 0.03) prognostic factor on multivariate analysis. Conclusion: This is first thymoma series from India with large number of patients where staging is an important prognostic factor and surgery is the mainstay of therapy. In Indian context aggressive multimodality treatment should be offered to advanced stage patients and which yields good survival rates and comparable.
    Indian Journal of Cancer 04/2014; 51(2):109-112. DOI:10.4103/0019-509X.138144 · 1.13 Impact Factor
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    ABSTRACT: The judiciousness of the use of clozapine in patients with schizophrenia in clinical practice is brought to an even sharper focus when it has to be used in combination with other agents that cause myelosuppression, for example, chemotherapy and radiation treatment. There are a few references till date illustrating the combination of clozapine and chemotherapy and/or radiation therapy. To the best of our knowledge, such a case has not been reported from India. We report the case of a 39-year-old gentleman with a diagnosis of schizophrenia, remaining psychiatrically stable on clozapine, who underwent combination treatment of chemotherapy and radiotherapy for the treatment of cancer of the tongue in a tertiary care oncology centre in India.
    Indian Journal of Psychiatry 04/2014; 56(2):191-3. DOI:10.4103/0019-5545.130507
  • Indian Journal of Cancer 04/2014; 51(2):89-94. DOI:10.4103/0019-509X.137896 · 1.13 Impact Factor
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    ABSTRACT: Background: Various mouthwashes are used by specialists to reduce the side effects of anticancer therapies. At present, there is no gold standard available for the prevention and treatment of oral effects. In clinical practice, diversity exists in different treatment strategies used and their way of use. Aim: To get an understanding of various prescriptions given by various specialists treating cancer patients in Tertiary cancer hospital Materials and Methods: A questionnaire was formulated by two experts on the prescription and method of use of mouthwashes. Ethical committee approval was obtained. Survey questionnaire included : type of mouthwash prescribed, objective for use : primary objective behind its prescription, method of use, efficacy, adverse effects, awareness of evidence base. Data obtained was statistically analysed and results were obtained. Statistical Analysis: Data obtained was statistically analysed using SPSS software version 16.0 Results: Lot of variations exist in the type of mouthwashes prescribed, there way of use, duration and efficacy perceived by various practitioners. Conclusion: There is an urgent need of extensive research for the standardization of mouthwash prescriptions and clinical trials for the rationale of use of various mouthwashes. Evidence basis must be provided to the specialists for the better palliative care of the patients with oral mucositis. Also collaboration with a multidisciplinary team should be included in all phases of treatment for the better management of all the symptoms. Keywords: Oral Mucositis, Mouthwash, Mucositis Treatment, Mucositis Awareness.
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    ABSTRACT: Alopecia due to radiation has remained a widely accepted aspect of radiotherapy. We present an unexpected clinical scenario, where a patient with left lung stage IIIB nonsmall cell adenocarcinoma, treated with radiochemotherapy achieved a complete response and developed an obscure late effect in terms of paradoxical hypertrichosis in the radiation portals. The paper presents plausible hypothesis for this unusual phenomenon.
    Journal of cancer research and therapeutics 01/2014; 10(1):203-6. DOI:10.4103/0973-1482.131419 · 0.95 Impact Factor

Publication Stats

723 Citations
427.56 Total Impact Points

Institutions

  • 2001–2013
    • Tata Memorial Centre
      • Department of Radiation Oncology
      Mumbai, Maharashtra, India
  • 2011
    • Catholic University of the Sacred Heart
      • School of Ophthalmology
      Milano, Lombardy, Italy
  • 2009
    • Hospital Clínic de Barcelona
      Barcino, Catalonia, Spain
    • Maria Sklodowska Curie Memorial Cancer Centre
      Gleiwitz, Silesian Voivodeship, Poland