Pankaj Chaturvedi

Tata Memorial Centre, Mumbai, Maharashtra, India

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Publications (169)378.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Oral cancer is the most common type of cancer occurring in India and it is equally important to assess morbidities after treatment for optimal utilization of resources. Utilizing PSS HN we try to identify the patient population who are severely impaired and need aggressive rehabilitation. Method and Material The PSSHN questionnaire was administered by the treating physician to 100 consecutive oral cancer patients who completed their index treatment at least 6 months prior to accrual. Functional morbidities with score ≤50 were considered as significant. Results Prevalence of functional deficit of eating in public; deficit of understandability of speech and deficit of normalcy of diet were 28, 13 and 38 % respectively. Conclusion Type of resection either segmental mandibulectomy or major glossectomy, had most significant impact on concerned functional deficits and surgeries involving these defects should be carefully planned to involve free flap reconstruction and proper postoperative rehabilitation.
    Journal of Maxillofacial and Oral Surgery 06/2015; DOI:10.1007/s12663-015-0805-2
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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
  • VD Pai, D Nair, S Datta, P Chaturvedi
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    ABSTRACT: Necrotizing fasciitis is a severe polybacterial infection characterized by necrosis of the fascia and adjacent soft tissues with rapid expansion of the infection along the fascial planes. It is a rare and potentially fatal entity in the head and neck region. We present 2 patients with head and neck cancers who developed necrotizing fasciitis during the postoperative period. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Infection Control 02/2015; 43(4). DOI:10.1016/j.ajic.2015.01.010 · 2.33 Impact Factor
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    ABSTRACT: With the advent of nicotine replacement therapy, the consumption of the nicotine is on the rise. Nicotine is considered to be a safer alternative of tobacco. The IARC monograph has not included nicotine as a carcinogen. However there are various studies which show otherwise. We undertook this review to specifically evaluate the effects of nicotine on the various organ systems. A computer aided search of the Medline and PubMed database was done using a combination of the keywords. All the animal and human studies investigating only the role of nicotine were included. Nicotine poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is decreased immune response and it also poses ill impacts on the reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents. The use of nicotine needs regulation. The sale of nicotine should be under supervision of trained medical personnel.
    Indian journal of medical and paediatric oncology 01/2015; 36(1). DOI:10.4103/0971-5851.151771
  • International Journal of Otolaryngology and Head & Neck Surgery 01/2015; 6:14-16. DOI:10.5005/jp-journals-10001-1210
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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: We report a pilot study carried out to evaluate the applicability of in vivo Raman spectroscopy for differential diagnosis of malignant and potentially malignant lesions of human oral cavity in a clinical setting. The study involved 28 healthy volunteers and 171 patients having various lesions of oral cavity. The Raman spectra, measured from multiple sites of normal oral mucosa and of lesions belonging to three histopathological categories, viz. oral squamous cell carcinoma (OSCC), oral submucous fibrosis (OSMF) and leukoplakia (OLK), were subjected to a probability based multivariate statistical algorithm capable of direct multi-class classification. With respect to histology as the gold standard, the diagnostic algorithm was found to provide an accuracy of 85%, 89%, 85% and 82% in classifying the oral tissue spectra into the four tissue categories based on leave-one-subject-out cross validation. When employed for binary classification, the algorithm resulted in a sensitivity and specificity of 94% in discriminating normal from the rest of the abnormal spectra of OSCC, OSMF and OLK tissue sites pooled together. (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim).
    Journal of Biophotonics 09/2014; 7(9). DOI:10.1002/jbio.201300030 · 3.86 Impact Factor
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    ABSTRACT: Background The purpose of this study was to report the results of a phase III, 3-arm, randomized trial comparing conventional radiotherapy (RT) to concurrent chemoradiotherapy (CRT) and accelerated RT in advanced head and neck squamous cell carcinoma (HNSCC).Methods One hundred eighty-six of 750 planned patients were randomized to receive one of the following treatment plans: RT (66-70 Gy/2 Gy fraction/5 fractions weekly; CRT of weekly cisplatin (30 mg/m2) with the same RT dose; or accelerated RT alone of 66 to 70 Gy/2 Gy fraction/6 fractions weekly were available for analysis. The primary endpoint was locoregional control at 5 years.ResultsThe mean follow-up was 54 months. Among the 3 arms, CRT showed superior locoregional control (49%; p = .049). RT had lower grade ≥3 mucositis and late toxicity.ConclusionCRT is associated with significantly better locoregional control as compared to RT and accelerated RT with higher but acceptable acute and late toxicities. © 2014 Wiley Periodicals, Inc. Head Neck, 2014
    Head & Neck 09/2014; DOI:10.1002/hed.23865 · 3.01 Impact Factor
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    ABSTRACT: To determine the most accurate noninvasive imaging modality for occult metastasis in clinically node-negative necks in oral squamous cell carcinoma from a granulomatous disease endemic region.
    Asia-Pacific Journal of Clinical Oncology 08/2014; DOI:10.1111/ajco.12255 · 1.06 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
  • Poonam Joshi, Sudhir Nair, Deepa Nair, Pankaj Chaturvedi
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    ABSTRACT: Background and Aims: To report the incidence of occult papillary carcinoma of thyroid in a tertiary care center in India in post-laryngectomy specimen of carcinoma of hypopharynx. Settings and Design: Retrospective analysis. Materials and Methods: This is a retrospective analysis of incidentally detected papillary carcinoma of thyroid in 358 patients of carcinoma of hypopharynx treated with total/near total laryngectomy at our tertiary care institute from 2005 to 2011. Statistical Analysis Used: Statistical analysis was performed using the software Statistical Package for the Social Sciences 20.0 (IBM, NY, USA). Percentages were calculated. Results: Thyroid cancer was seen in 7/358 patients with incidence of 2%. Five patients had tumor localized to thyroid gland only. One patient had nodal metastasis with thyroid cancer and one had only metastatic cervical node with normal thyroid gland on final histopathology. Three of these patients (3/7) had a recurrence of carcinoma of hypopharynx within 1 year duration. Conclusions: The incidence of occult papillary carcinoma of thyroid varies from 0.25% to 7% in the Indian literature.
  • S Datta, P Chaturvedi, A Mishra, P Pawar
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    ABSTRACT: In India, about 60% of tobacco users use smokeless tobacco (ST) alone. Head and neck squamous cell carcinoma is one of the most common cancers in India. International Agency for Research on Cancer (IARC) monograph (Vol 89) found a significant association between ST use and oral cancer. However, only a few articles from India were included in this monograph. To overcome this lacuna, we have reviewed the articles published from India investigating the association between ST use and malignant and premalignant diseases of head and neck region. Data collection has been performed by computer-aided search of the MedLine and PubMed databases using different combinations of the key words. For malignant lesions, only cohort and case control studies were considered for review. For premalignant lesions and dental diseases other than case control studies, some cross-sectional studies have also been reviewed. Studies found a significant association between ST use and cancer of the oral cavity. The association was stronger for the buccal mucosa compared to tongue and for females compared to males. Significant association noted between cancer of the hypopharynx and oropharynx with ST use but no definitive association noted for cancer of the larynx and nasopharynx. Some dental disease and oral premalignant conditions were also associated with ST use. Indian studies suggest ST use is strongly associated with cancer of the oral cavity, oropharynx and hypopharynx.
    Indian Journal of Cancer 07/2014; 51(3):200-208. DOI:10.4103/0019-509X.146713 · 1.13 Impact Factor
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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 This study aimed to compare sentinel node biopsy (SNB) and Ultrasonography(US) guided fine needle aspiration cytology (USgFNAC) for preoperative evaluation of the N0 neck in T1-T2 oral cavity squamous cell carcinoma (OCSCC).MethodologyConsecutive 51 patients with T1-T2 N0 OCSCC were included. Pre-operative US was performed in all patients. USgFNAC was performed in patients where US was reported as indeterminate or positive. SNB was done in all patients followed by elective neck dissection (END). Histopathology of END was considered as gold standard for all statistical analysis.ResultsThe incidence of occult metastasis was 26.4%. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 100%, 100% and 90.2% for SNB and 14.3%, 100%, 100% and 76.5% for USgFNAC.ConclusionUSgFNAC lacked sufficient accuracy to detect occult metastases. SNB is a reliable method to detect occult metastasis which has potential to replace END. Head Neck, 2014
    Head & Neck 05/2014; DOI:10.1002/hed.23787 · 3.01 Impact Factor

Publication Stats

651 Citations
378.31 Total Impact Points

Institutions

  • 2003–2015
    • Tata Memorial Centre
      • • Department of Radiation Oncology
      • • Pathology
      Mumbai, Maharashtra, India
  • 2013
    • Tallahassee Memorial HealthCare
      Tallahassee, Florida, United States
  • 2011
    • Advanced Centre for Treatment, Research and Education in Cancer
      Mumbai, Maharashtra, India
  • 2010
    • Kidwai Memorial Institute of Oncology
      • Department of Head and Neck Surgery
      Bengalore, State of Karnataka, India
    • Raja Ramanna Centre for Advanced Technology
      Indaur, Madhya Pradesh, India
  • 2008
    • University of Manitoba
      • Department of Surgery
      Winnipeg, Manitoba, Canada