A K Bahadur

Maulana Azad Medical College, New Dilli, NCT, India

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Publications (23)14.56 Total impact

  • Radiotherapy and Oncology - RADIOTHER ONCOL. 01/2011; 99.
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    ABSTRACT: Colorectal cancer is rare in younger age group. Most cases occur in the second decade of life and are clinically aggressive. The prognosis of these patients is generally poor. This is a retrospective study in which data of Indian patients was compared to standard literature. Data on 32 young patients with colorectal cancer between ages of 10-25 years treated between January 2000 and December 2006 was reviewed. Clinical presentation, natural history and response to therapy were evaluated. Studied cases comprised 9.9% of the total number of colorectal cancer patients. The median age of presentation was 21.5 years. Four-fifths of the cases presented in late stage. Nodal involvement was seen in 38% cases and metastatic disease in 12% cases. The rectum was the most commonly involved site. A majority of the patients presented with pain (81%), altered bowel habits (72%) and bleeding per rectum (78%). Surgery was done in 16 cases; radiotherapy in 16 patients; while chemotherapy was used in 19 cases. Responses at completion of treatment were seen in 28% cases; while 1 year post treatment only 12% cases were alive and only 6% at 2 years. Colorectal cancer in younger age is rare and a high level of suspicion is necessary to diagnose it at an early and curable stage. Rectal bleeding therefore should not be ignored but evaluated further with at least a digital rectal examination and a sigmoidoscopy. Failure to do so results in late presentation with consequent dismal survival rates.
    Tropical gastroenterology: official journal of the Digestive Diseases Foundation 01/2011; 32(2):122-7.
  • Fuel and Energy Abstracts 11/2010; 78(3).
  • V Roy, D Saxena, M Agarwal, A K Bahadur, B Mishra
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    ABSTRACT: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.
    Indian Journal of Cancer 01/2010; 47(4):430-6. · 1.13 Impact Factor
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    ABSTRACT: We present the case of a 45-year-old female patient who harbored two synchronous primary malignant neoplasms-an anaplastic oligodendroglioma of the right frontal lobe and a squamous cell carcinoma of the tongue. Both neoplasms were in advanced stage and carried a dismal prognosis. To the best of our knowledge, this is the first documentation in the english literature of such a presentation. The purpose of this article is to alert clinicians to this possibility and to outline the management approach in a different manner in patients presenting with multiple primary neoplasms.
    Journal of cancer research and therapeutics 01/2010; 6(2):227-9. · 0.83 Impact Factor
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    ABSTRACT: Metastatic bone pain is acommonly encountered clinical condition seen in oncology clinical practice. About 50% of all cancer patients develop metastases in their lifetime and half of them develop skeletal metastases. Despite its importance, no specific therapeutic strategy, to prevent or treat this complication of cancer has been demonstrated. This study comparing two radiotherapy regimens was conducted at a cancer center in New Delhi, India. Patients with confirmed bone metastases were randomized into two treatment arms, Group A (single fraction) and Group B (multiple fractions). Patients were followed up for 12 weeks. Pain relief was the primary endpoint of the treatment. Other parameters were improvement in analgesic score, performance status, and acute side effects like nausea, vomiting, tiredness, and lassitude. Fifty patients were evaluated at the end of the study. Overall response rate was seen in 86% of cases, whereas complete response was seen in 36% of cases. The two treatment regimens were found to be comparable with respect to other endpoints. Hence, a single fraction treatment, which is more convenient and cost effective, is a more logical approach in the Indian scenario in selected cases.
    Indian Journal of Palliative Care. 01/2008;
  • International Journal of Radiation Oncology Biology Physics - INT J RADIAT ONCOL BIOL PHYS. 01/2008; 72(1).
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    ABSTRACT: Rectal bleeding secondary to radiation proctitis is the most dreaded complication of pelvic radiotherapy. Its management remains a perplexing problem despite the availability of multiple treatment modalities. Patients are usually managed on a “hit and miss” basis at most centers. Steroid, 5-aminosalicylic acid, short chain fatty acids and sucralfate enemas, hyperbaric oxygen therapy, and topical application of 4% formaldehyde all have been used with varying results. Surgical procedures such diversion colostomy or resection of involved segment have been proposed for refractory bleeding. Endoscopic methods are being increasingly adopted in the form of bipolar electrocoagulation, heat probe coagulation, photoablation, Nd:YAG laser and preferably argon plasma coagulation. The utility of conservative approaches remains far below desirable levels. Onset of hemorrhagic recurrence represents a major obstacle that leads to a need for repeated therapeutic sessions and sometimes invocation of radical techniques. This review discusses various treatment modalities and aims to identify their efficacy and limitations. A critical review was conducted of published reports regarding management of chronic hemorrhagic radiation proctitis (CHRP). Although there are few prospective randomized trials, enough evidence is available to conclude that argon plasma coagulation represents the current treatment of choice.
    Asia-Pacific Journal of Clinical Oncology 02/2007; 3(1):19 - 29. · 0.91 Impact Factor
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    Acta Cytologica - ACTA CYTOL. 01/2007; 51:102-106.
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    ABSTRACT: Osteosarcomas, despite their aggressive nature and propensity to metastasize, only rarely give rise to skin deposits. We report a case of a femoral osteosarcoma in which cutaneous scalp and neck metastases developed 3 years after treatment of the primary disease. Fine needle aspiration was pivotal in diagnosing the secondary disease. Only 8 instances of cutaneous metastases from an osteosarcoma have been previously reported. We recommend early investigation of such nodules with fine needle aspiration cytology and inclusion of multiagent chemotherapy as part of the treatment protocol in all patients with osteosarcoma.
    Acta cytologica 01/2007; 51(1):102-6. · 0.69 Impact Factor
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    ABSTRACT: Nine patients with a histologically proven diagnosis of chordoma seen at the Department of Radiation Oncology, Maulana Azad Medical College and Lok Nayak Hospital between January 1999 and December 2004 were retrospectively reviewed with respect to age, sex, presentation, location of tumour, treatment, response, recurrence, metastasis and follow up. Chordoma constituted 0.07% of total cancer cases registered over 6 years. Out of nine patients, eight were males and one was female with median age at time of diagnosis 52 years (range 34-68 years). All had sacrococcygeal lesions except one who had a spheno-occipital lesion. Seven patients had undergone either subtotal or gross total resection whereas only biopsy had been carried out in two of them. All patients received radiation therapy, seven in a postoperative setting and two for palliation. Follow-up period ranged from 2 to 50 months. Four patients died--the first after fourth fraction of radiation, second after 10 days of treatment, third of progressive lesion in sphenoidal region despite resection and radiation and fourth of local recurrence in the sacrococcyx. One patient developed distant metastases in the lungs and subcutaneous tissue over the scalp along with local recurrence; he is still alive. Two patients are locally free of disease whereas the other two were lost to follow up. The present analysis was undertaken to review our institutional experience with an aim to provide a practical approach to these tumours. In this report, these cases are discussed and the published works have been reviewed for the optimal management of patients with chordoma.
    Australasian Radiology 07/2006; 50(3):201-5. · 0.51 Impact Factor
  • Community Oncology 06/2006; 3(6):367–368.
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    ABSTRACT: Cytologic diagnosis of malignant fibrous histiocytoma can be problematic, as these neoplasms are known to mimic multiple other conditions. A fine needle aspirate from a 60-year-old woman was diagnosed at 2 institutions as medullary carcinoma of the breast. The patient received neo-adjuvant chemoradiotherapy before the tumor war excised. Gross pathologic examination and histomorphology on routine staining were compatible with the cytologic diagnosis. The accurate diagnosis of pleomorphic-storiform-type malignant fibrous histiocytoma was a surprise and was established with immunocytochemical stains. In retrospect, it was thought that clinical and radiologic overlap, creating a high index of suspicion for a breast neoplasm and compounding the cytologic appearance of a medullary carcinoma with spindle cell metaplasia and syncytial cells, was responsible for the error. This case highlights a potential cytodiagnostic pitfall and the importance of establishing a definitive tissue diagnosis in the face of equivocal cytologic findings.
    Acta cytologica 01/2006; 50(5):577-80. · 0.69 Impact Factor
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    ABSTRACT: Cystosarcoma phyllodes is a rare breast tumor with a low incidence of metastasis. Lymph node metastasis is even rarer. We report here a case of a 45-year-old woman who presented with a large lump in her left breast and involvement of multiple ipsilateral axillary lymph nodes. Clinical findings and cytologic examination (fine-needle aspiration) were suggestive of cystosarcoma phyllodes, for which she underwent a radical mastectomy. Postoperative histopathologic findings revealed cystosarcoma phyllodes with multiple lymph node metastases. Postoperative radiotherapy was given to the locoregional area.
    Community Oncology. 01/2006; 3(1).
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    ABSTRACT: Brachytherapy plays a major role in the treatment of patients with carcinoma of the cervix. However, routine intracavitary brachytherapy may not be feasible or adequate to treat locally advanced disease. The purpose of this prospective study was to assess treatment outcome for patients with locally advanced gynecological malignancies treated with interstitial brachytherapy using Martinez Universal Perineal Interstitial Template (MUPIT) and to study the acute and late sequelae after treatment by this technique. Thirty previously untreated patients with histologically confirmed carcinoma of the cervix (20 patients), vault (7 patients), and vagina (3 patients) were treated by a combination of external beam radiotherapy using megavoltage irradiation to the pelvis to a dose of 4000 to 5000 cGy followed by interstitial brachytherapy using MUPIT between June 2000 to August 2001 at Gujarat Cancer and Research Institute, Ahmedabad. Only those patients who were found unsuitable for conventional brachytherapy or in whom intracavitary radiotherapy was found to be unlikely to encompass the tumor volume were treated with interstitial template brachytherapy using MUPIT applicator and were enrolled for this study. Criteria for inclusion in this study were as follows: Hemoglobin--minimum 10 gm%; Performance Status--70% or more (Karnofsky Scale); Histopathological confirmation; FIGO Stage--IIb-IIIb (excluding frozen pelvis). Among the 30 patients studied, 4 lost to follow-up and they were excluded from the study. With a median follow up of 9 months, local control was achieved in (20/26) 76.92% patients. The local control was better for nonbulky tumors compared to bulky tumors irrespective of stage of disease. Local control rate was better in patients with good regression of disease after EBRT. The time gap between EBRT and implant also had an impact on the outcome. Interstitial template brachytherapy by MUPIT is a good alternative to deliver high-dose radiation in locally advanced gynecological malignancies where conventional brachytherapy application is either not feasible or unlikely to encompass tumor volume adequately. The locoregional control obtained is definitely better than external beam therapy alone and within the accepted range of complications. However, long-term follow-up is needed to comment on late morbidities.
    Gynecologic Oncology 11/2005; 99(1):169-75. · 3.93 Impact Factor
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    ABSTRACT: To quantitate radiation-associated cytologic abnormalities in oral cancer cells and analyze their relationships with radiation dose, clinical stage and histologic grade. Forty-three oral cancer patients receiving 2 Gy of fractionated radiotherapy per day were enrolled. Scrape smears were taken from the tumor surface before treatment and serially after 6-, 12-, 18- and 24-Gy fractions. Counts were done after Giemsa staining for the number of tumor cells; micronucleated, nuclear budded, binucleated and multinucleated tumor cells; cells with abnormal nuclear chromatin and membrane; cells with cytoplasmic granulation and vacuolization; and histiocytic giant cells. The variation in these counts with increasing radiation dose was assessed and compared with the histologic grade and clinical stage. Before therapy, counts for 7 of 10 cytologic abnormalities were significantly different between the 3 histologic grades (Kruskal-Wallis test). With increasing radiation dose, only micronucleation and nuclear budding remained significantly different within the grades. Most cytologic features were not significantly different in early and advanced clinical stage cancers before or after irradiation (Mann-Whitney U test). Cellular changes do not show a relationship with clinical stage either before or after irradiation. However, they demonstrate a partial pretherapy correlation with histology. This relationship diminishes progressively with increasing radiation dose. Since micronucleation and nuclear budding remain significantly different between histologic grades even after 24 Gy of irradiation, they may be utilized as clinically practicable alternatives to biopsy at this stage and may be useful in further studies on cytologic prognostication of irradiated oral cancer.
    Analytical and quantitative cytology and histology / the International Academy of Cytology [and] American Society of Cytology 05/2005; 27(2):111-7. · 0.60 Impact Factor
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    ABSTRACT: To study the Ki-67 labeling indices in surface scrape smears from patients with oral squamous cell carcinoma before and after 24 Gray radiotherapy. Forty three patients with histologically documented squamous cell carcinoma of the oral cavity were sampled by means of surface scrape smears prior to therapy and after receiving 24 Gray fractionated radiotherapy. These smears were stained for Ki-67 expression using the avidin biotin alkaline phosphatase technique. Ki-67 expression was seen in an extremely small number of cells. Only 10 tumors showed positive cells, and the labeling index in them varied from 0.1 % to 0.01 %. After 24 Gray irradiation, no case showed any Ki-67 positive cells. The overall yield of malignant cells in surface smears is low even prior to therapy and their number decreases further after irradiation. This, along with other factors including low concentration of proliferating cells on the surface of the lesion and obscuring inflammatory cells, anucleate squames, bacterial colonies and proteinaceous material could have accounted for the low labeling indices obtained. Radiation induced decline in proliferation has been described previously. The major conclusion, in balance, is that conventional oral scrape cytology may not be the optimal tool for immunocytochemical evaluation of proliferation in oral squamous cell cancer.
    Medicina oral, patologia oral y cirugia bucal 02/2005; 10 Suppl 1:E15-7. · 1.02 Impact Factor
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    ABSTRACT: Twenty-six patients of Cystosarcoma phyllodes, treated between July 1994 and July 2001, were analysed retrospectively. Median age at presentation was 38 years (range 13-61 years). Mean size of the lesion was 6 cm. There were 77% left-sided lesions and 23% right-sided lesions. Histologically, 58% lesions were benign, 11% borderline and 31% malignant lesions. All patients underwent definitive surgical procedure in the form of wide local excision or mastectomy. Four patients received postoperative radiotherapy. Median follow-up period was 35 months. Six patients showed recurrence, and four of these were malignant. Median disease-free survival period was 34 months.
    Australasian Radiology 01/2004; 47(4):434-7. · 0.51 Impact Factor
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    ABSTRACT: Primitive neuroectodermal tumors (PNETs) are malignant proliferations of small, undifferentiated neuroectodermal cells occurring mainly in children and share the same reciprocal translocation between chromosomes 11 and 22 and the same patterns of biochemical and oncogene expression as osseus and extraosseus Ewing's sarcoma. Some PNETs occur in the brain, while others (the peripheral PNETs) occur in sites outside the brain, such as in the extremities, pelvis and the chest wall. They mostly originate in the chest, pelvis and retroperitoneum; in rare cases, occurrence in the head and neck area has also been seen. We present a rare case of primitive neuroectodermal tumor arising in the prostate gland in a 25-year-old male. To the best of our knowledge, this is the first documentation of a primary peripheral primitive neuroectodermal tumor in the prostate gland of any patient from India and rarely reported in English literature.
    Indian Journal of Pathology and Microbiology 07/2003; 51(3):386-8. · 0.68 Impact Factor
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    ABSTRACT: We report a case of papillary adenocarcinoma of uterus which developed a recurrence over the scar of surgery. The patient initially underwent surgery followed by adjuvant chemoradiotherapy for her stage II disease. She was disease-free until 21 months when she developed a small mass over the lower site of incisional scar. Fine needle aspiration cytology from this swelling revealed metastatic papillary adenocarcinoma similar to previous histopathology. Treatment of the scar recurrence consisted of palliative radiation therapy and chemotherapy.
    International Journal of Gynecological Cancer 01/2003; 13(6):901-3. · 1.94 Impact Factor