Jai Prakash Agarwal

Tata Memorial Centre, Mumbai, Mahārāshtra, India

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Publications (114)300.73 Total impact

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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 04/2014; · 5.20 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.
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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 03/2014; · 2.64 Impact Factor
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    ABSTRACT: Background: Treatment intensification by using chemo-radiotherapy (CT-RT) or altered fractionation radiotherapy (AF-RT) improves outcomes in loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). Methods: Two comprehensive meta-analyses with similar control arms (conventionally fractionated radiotherapy) were compared indirectly. Results: The hazard ratio (HR) of death with 95% confidence interval (CI) for the overall comparison of AF-RT with concomitant CT-RT was 1.13 (95%CI: 0.97-1.29, p=0.07) suggesting no significant difference between both approaches. Compared to concomitant CT-RT, the HR for death was 1.01 (95%CI: 0.89-1.15, p=0.82); 1.22 (95%CI: 0.94-1.59, p=0.13); and 1.22 (95%CI: 1.07-1.39, p=0.002) for hyperfractionated radiotherapy (HF-RT); accelerated radiotherapy (AX-RT) without total dose reduction; and AX-RT with total dose reduction respectively. Conclusion: Concomitant CT-RT and HF-RT are comparable to one another on indirect comparison in the radiotherapeutic management of loco-regionally advanced HNSCC. Any form of acceleration (with or without total dose reduction) may not compensate fully for lack of chemotherapy. Head Neck, 2014
    Head & Neck 03/2014; · 2.83 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.
    Unique Journal of Medical and Dental Sciences. 01/2014; 02(01):15-21.
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    ABSTRACT: Background. Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of NACT in improving the outcome in these patients. Methods. 41 patients with locally advanced technically unresectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The demographic profile, response and toxicity of chemotherapy, definitive treatment received, progression free survival (PFS), and overall survival (OS) were analyzed. Univariate and multivariate analysis were performed to determine factors associated with PFS and OS. Results. The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane, and 5 FU) in 7 (17.1%). There was no complete response seen in any of the patients, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. After induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%), and palliative chemotherapy in 3 (7.3%) patients. Overall, the median PFS was 10.0 months. The OS at 24 months and 36 months was 41% and 35%, respectively. Conclusion. In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity.
    Chemotherapy research and practice. 01/2014; 2014:487872.
  • South Asian journal of cancer. 10/2013; 2(4):197.
  • Journal of cancer research and therapeutics 10/2013; 9(4):761-762. · 0.83 Impact Factor
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    ABSTRACT: Seminoma is one of the most radio and chemo sensitive tumors. Aggressive variant of primary mediastinal seminoma (PMS) are rarely described in the literature. We here discuss an interesting case of young male (22 years) presenting with superior vena cava syndrome due to PMS that showed poor response to conventional platinum based chemotherapy and radiotherapy. Furthermore, with a short disease free interval (one year) relapsed at unusual sites of bone and soft-tissue deposits in check. This emphasizes the importance of identifying methods to pre-screen such aggressive variants for more effective treatment options.
    Indian journal of medical and paediatric oncology 10/2013; 34(4):309-12.
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    ABSTRACT: Background:Lymph node density (LND) has previously been reported to reliably predict recurrence risk and survival in oral cavity squamous cell carcinoma (OSCC). This multicenter international study was designed to validate the concept of LND in OSCC.Methods:The study included 4254 patients diagnosed as having OSCC. The median follow-up was 41 months. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control and distant metastasis rates were calculated using the Kaplan-Meier method. Lymph node density (number of positive lymph nodes/total number of excised lymph nodes) was subjected to multivariate analysis.Results:The OS was 49% for patients with LND0.07 compared with 35% for patients with LND>0.07 (P<0.001). Similarly, the DSS was 60% for patients with LND0.07 compared with 41% for those with LND>0.07 (P<0.001). Lymph node density reliably stratified patients according to their risk of failure within the individual N subgroups (P=0.03). A modified TNM staging system based on LND ratio was consistently superior to the traditional system in estimating survival measures.Conclusion:This multi-institutional study validates the reliability and applicability of LND as a predictor of outcomes in OSCC. Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed.British Journal of Cancer advance online publication, 24 September 2013; doi:10.1038/bjc.2013.570 www.bjcancer.com.
    British Journal of Cancer 09/2013; · 5.08 Impact Factor
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    ABSTRACT: An association between the survival of patients with oral cavity squamous cell carcinoma (OCSCC) and advancements in diagnosis and therapy has not been established. This was a retrospective, longitudinal, international, population-based study of 2738 patients who underwent resection of OCSCC during 2 different decades. Characteristics of patients from 7 international cancer centers who received treatment between 1990 and 2000 (group A; n = 735) were compared with patients who received treatment between 2001 and 2011 (group B; n = 2003). Patients in group B had more advanced tumors and tended to develop distant metastases more frequently than patients in group A (P = .005). More group B patients underwent selective neck dissection and received adjuvant radiotherapy (P < .001). Outcome analysis revealed a significant improvement in 5-year overall survival, from 59% for group A to 70% for group B (P < .001). There was also a significant improvement in disease-specific survival associated with operations performed before and after 2000 (from 69% to 81%, respectively; P < .001). Surgery after 2000, negative margins, adjuvant treatment, and early stage disease were independent predictors of a better outcome in multivariate analysis. The decade of treatment was an independent prognostic factor for cancer-specific mortality (hazard ratio, 0.42; 95% confidence interval, 0.3-0.6). The survival rate of patients with OCSCC improved significantly during the past 2 decades despite older age, more advanced disease stage, and a higher rate of distant metastases. The current results suggest that the prognosis for patients with OCSCC has improved over time, presumably because of advances in imaging and therapy. Cancer 2013. © 2013 American Cancer Society.
    Cancer 09/2013; · 5.20 Impact Factor
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    ABSTRACT: To evaluate the prognostic role of the lymph node ratio (LNR; ratio of total positive nodes to total dissected nodes) in oral squamous cell carcinoma (OSCC) as compared to pN staging with an aim to provide an optimal cut-off value. 1,408 OSCC previously untreated patients who underwent treatment (surgery + neck dissection + adjuvant treatment). LNR sensitivity with respect to survival was calculated using receiver operating characteristic (ROC) curves and Cox regression method. LNR and TNM staging variables were subjected to multivariate analysis. LNR (0.088) showed significant association with survival outcomes. For patients with LNR ≤0.088, the OS, DFS, local control, regional control and distant metastasis rates were 64%, 70%, and 89%; for LNR >0.088 it was 22%, 19%, and 52%, respectively (P < 0.001). On multivariate analysis LNR of 0.088 was seen to be an independent prognostic factor for 5-year regional control (p, hazard ratio [95% confidence interval]; 0.044, 2.016 (1.019-3.990), DFS, 0.032, 1.858 (1.054-3.276), and OS, 0.040, 1.195 (1.033-1.144). On multivariate analysis LNR categorization showed a statistically significant [0.032, 1.858, (1.054-3.276)] advantage over pN staging [0.527, 1.208 (1.054-3.276)] in predicting survival. LNR is a better prognostic marker than the current N staging of TNM classification. J. Surg. Oncol. 2013 9999:1-8. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 07/2013; · 2.64 Impact Factor
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    ABSTRACT: The main objective of this retrospective analysis was to understand the length of stay in hospital, the complication rates and the perioperative mortality after various forms of hypopharyngeal reconstructions. This is a retrospective analysis of hypopharyngeal cancer patients who underwent surgery at the Tata Memorial Hospital, during 2005–2010. Of the total 393 patients, 103 required some form of pharyngeal reconstruction. The mean age of this population was 56 with a male to female ratio of 4:1. The mean hospital stay for all patients was 22 days (mean: 22, median: 15) and 17 % were readmitted for various reasons in the first 30 days after the initial discharge from hospital. The overall perioperative mortality was 10 % (10/103) and majority of these patients (6/10) had GPU as part of treatment. Gastric pull up has a high morbidity especially in patients with low albumin levels and should be used judiciously when needed. A comprehensive analysis of clinical and radiological data is helpful for choosing an ideal reconstruction after hypopharyngeal cancer excision.
    Indian Journal of Otolaryngology and Head & Neck Surgery 07/2013; 65(1). · 0.05 Impact Factor
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    ABSTRACT: Carcinomas from either pulmonary or extrapulmonary sites can metastatise to supraclavicular lymph nodes (SCLN). Immunohistochemistry (IHC) is invaluable to comment on the possible primary site. However, the optimal number of antibodies to be tested is debatable. Seven antibodies were tested on 135 metastatic SCLN biopsies to propose a “best minimal” IHC panel to infer lung carcinoma, incorporating the principles of “evidence based medicine.” The 135 cases were divided into: Category I (110 cases) wherein, the primary was in the lung based on histological analysis [Ia, n = 14(12.7%)], cytological analysis [Ib, n = 43(39.1%)] or strong clinic-radiological evidence [Ic, n = 53(48.2%)], and Category II(25 cases) with a histologically proven extrapulmonary primary site. Categories Ia and Ib were together designated as “Control group” and category Ic was designated as “Test group”. The antibodies tested were CK7, CK 20, EMA, CEA, TTF-1, SPB and vimentin. Results of both individual and also panels of antibodies were statistically evaluated. The sensitivity and specificity of single antibodies for inferring a lung primary was: CK7(90%/56%), CK20(98%/40%), EMA(90.9%/4%), CEA(80.9%/36%), TTF-1(62.7%/100%), SPB(65.6%/100%) and vimentin(60.9%/60%). The highest sensitivity (85%) and specificity (100%) was seen with a four antibody panel: CK7, CK20, TTF-1 and SPB. This panel revealed the highest binomial probability (0.8), for diagnosing lung cancer. The results were validated using a “split sample method” and a high concordance was noted between control and test group. To conclude, such evidence based validated studies analyzing immunohistochemical results would be invaluable to guide the practice of surgical pathology in future.
    Annals of diagnostic pathology 01/2013;
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    ABSTRACT: The ability of the tumor cells to respond to radiotherapy depends upon their intrinsic radiosensitivity, which may be partly governed by molecules of the intrinsic cell death pathway. To identify the defects in this pathway in oral cancers, transcript expression analysis of the pathway members was done using the Ribonuclease protection assay in oral cell lines and tumors. The intrinsic apoptosis pathway was found to be deregulated in oral cell lines and majority of oral tumors with altered expression of Mcl-l, bclxl, survivin, p53 and p16 mRNA. To identify factors associated with radiosensitivity, differential gene expression profiles of radiation-treated versus untreated oral cell lines of differing radiosensitivities was carried out. To assess the predictive value of above altered molecules in radiotherapy outcome in oral cancer patients, pretreated biopsies from thirty nine oral cancer patients were examined for the expression of the apoptotic markers using immunohistochemistry and their expression was correlated with the clinico pathological parameters. High expression of Mcl-1 (p = 0.05) and PCNA (p = 0.007) was seen to be associated with poor disease free survival. High expression of Bcl-xL was associated with poor response to radiotherapy treatment. PCNA (p=0.04) and Mcl-1 (p=0.05) emerged as independent prognostic markers for predicting disease free survival in oral cancers treated with primary radiotherapy. A predominant overexpression of anti-apoptotic Mcl-1L over pro-apoptotic Mcl-1S isoform was observed in the oral cancer cell lines and oral tumors. An inverse correlation was observed between Mcl-1L expression and apoptosis induction in AW8507 cell line post-radiation treatment supporting its pro-survival role. A rapid and short induction of Mcl-1L versus sustained induction of Mcl-1L was observed in the relatively more radiosensitive FBM versus AW8507 respectively. siRNA treatment in combination with IR demonstrated significant induction of apoptosis. The colony formation assays demonstrated a synergistic effect Mcl-1 down regulation with IR. Our studies indicate that Mcl-1 expression influences survival and radiosensitivity of oral cancer cells. High expression of Mcl-1 was also observed in radioresistant sublines generated by fractionated ionizing radiation The sustained expression of Mcl-1L protein in the more radioresistant cell line indicates a possible role for Mcl-1L radioresistance and as a potential therapeutic target in oral cancers.
    Thirty eighth annual conference of Environmental Mutagen Society of India and National conference on current perspectives on environmental mutagenesis and human health, Bio-Medical Group, Bhabha Atomic Research Centre, Mumbai (India); 01/2013
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    ABSTRACT: The germ cell lines and kidney develop in close proximity in a similar embronic period. The extragonadal germ cell tumors and horseshoe kidney both are the result of abnormal migration of two germ line cells. Apart from origin, the combined incidence of mediastinal germ cell tumor with renal anomaly is a therapeutic challenge. This case review is an effort to address the various issues ranging from delima in origin to management and follow-up.
    Indian journal of medical and paediatric oncology 11/2012; 33(3-2012;33:179-81):179-81.
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    Rahul Krishnatry, Sarbani Ghosh-Laskar, Jai Prakash Agarwal
    Oral Oncology 09/2012; 48(11):e49-50. · 2.70 Impact Factor
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    ABSTRACT: BACKGROUND: Oral cancer is the most common cancer in Indian males and is the third most common cancer in Indian females. Tobacco, alcohol, areca nut, and human papillomavirus (HPV) are the common etiologic factors. Each of these agents follows a unique model of carcinogenesis that leads to a certain distinct presentation and behavior. For example, HPV is strongly associated with oropharyngeal cancers in younger age and is known to have a better outcome and specific histopathologic characteristics. A high incidence of oral submucous fibrosis (OSMF) is linked to areca nut (group 1 human carcinogen) chewing in the Indian subcontinent. METHODS: We prospectively studied 371 consecutive patients with proven squamous cell carcinoma of the oral cavity. Of these, 112 patients had oral cancer with OSMF and 259 had oral cancer without OSMF. All patients underwent standard management and their clinicopathologic findings were recorded. RESULTS: We found that patients of oral cancer with OSMF are younger males with better prognostic factors such as better grade of tumor differentiation, lesser incidence of nodal metastases, and extracapsular spread. This difference was maintained even after matching for stage. We also report that presence of OSMF is an independent factor influencing nodal metastases. CONCLUSIONS: Based on these findings we propose that oral cancers with OSMF constitute a clinicopathologically distinct disease. Since all patients with OSMF had chewed areca nut with or without smokeless tobacco, we believe that the differences in the 2 groups emanate from differential mechanisms of areca nut carcinogenesis. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 09/2012; · 2.83 Impact Factor
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    ABSTRACT: AIMS: To determine the influence of dose and fractionation on tumour characteristics, toxicity, disease control and survival outcomes in T1 glottic carcinoma. MATERIALS AND METHODS: Between 1975 and 2000, treatment charts of 652 patients with T1 glottic carcinoma who received curative radiation with four hypofractionated schedules (50 Gy/15 fractions [3.3 Gy/fraction] or 55 Gy/16 fractions [3.43 Gy/fraction] or 60 Gy/24 fractions or 62.5 Gy/25 fractions [2.5 Gy/fraction]) were analysed. The patients were divided into two groups based on fraction size <3 Gy and >3 Gy. Local control and overall survival were calculated. Patient- and tumour-related factors affecting local control were analysed using univariate and multivariate analysis. Factors affecting late toxicity were also analysed. RESULTS: The local control and overall survival at 10 years were 84 and 86.1%, respectively, for T1 glottic carcinoma. The response to radiation had a significant effect on local control with univariate analysis (P = 0.001). Other factors, such as beam energy, anterior commissure involvement and fractionation, did not affect local control. Persistent radiation oedema was seen in 123 patients (23.4%) and was significantly worse in patients who received radiation with a larger field size (>36 cm(2)) on a telecobalt machine (P < 0.001). CONCLUSIONS: Radical radiotherapy schedules incorporating a higher dose per fraction yield acceptable local control rates and late toxicity. Telecobalt therapy for early glottic cancer is a safe alternative to treatment with 6 MV photons on a linear accelerator in terms of local control and late toxicity as long as field sizes smaller than 36 cm(2) are used.
    Clinical Oncology 08/2012; · 2.86 Impact Factor
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    ABSTRACT: Stereotactic conformal radiotherapy is an established technique in treating cranial lesions and has made significant inroads in the treatment of extracranial sites as well. Early stage non-small cell lung cancer is one such site. This overview assesses the results that have been achieved with stereotactic conformal radiotherapy in non-small cell lung cancer so far and compares its efficacy with surgical and other non-surgical modalities.
    Clinical Oncology 05/2012; 24(8):556-68. · 2.86 Impact Factor