Pankaj Chaturvedi

Tata Memorial Centre, Mumbai, Maharashtra, India

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Publications (173)399.23 Total impact

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    ABSTRACT: The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). The aim of this study was to evaluate prognostic heterogeneity in the stage III category. An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011. Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2). The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
    Annals of Surgical Oncology 08/2015; DOI:10.1245/s10434-015-4842-3 · 3.93 Impact Factor
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    ABSTRACT: For oral cancers, screening and monitoring of high-risk populations can aid in early diagnosis and improve overall outcomes. Of the new methods, approaches based on exfoliative cytology are more practical for mass screening and monitoring of high-risk populations. Raman spectroscopy and exfoliative cytology for cervical cancers has shown promise in differentiating normal and abnormal samples. In this study, feasibility of Raman oral exfoliative cytology along with cytopathology for oral cancer diagnosis was evaluated on 70 specimens. Exfoliated cells were obtained from 15 healthy volunteers (HV), 15 healthy tobacco users (HT), and 20 contralateral or disease control (DC) and 20 tumor (T) sites of oral-cancer patients. Pap staining was carried out post Raman spectral acquisition. Spectral findings demonstrate that with increase in severity of pathology from HV to T, higher DNA and changes in secondary structure of proteins were encountered. Owing to heterogeneity in cellular samples, two different approaches- point-spectra and patient-wise were evaluated for data analysis. PCA and PC-LDA using both approaches indicate that HV and HT are distinct from cancer groups DC and T. Misclassifications were also observed between HT and DC. These findings also correlate with cytopathological findings. Less misclassifications and higher classification efficiency was observed for patient-wise approach. Large-scale validation study needs to be undertaken for evaluating utility of Raman oral exfoliative cytology for screening of oral cancers using patient-wise approach.
    Analytical methods 07/2015; 7:7548 - 7559. DOI:10.1039/C5AY00954E · 1.82 Impact Factor
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    Saman Warnakulasuriya · Pankaj Chaturvedi · Prakash C Gupta
    Addiction 07/2015; 110(9). DOI:10.1111/add.13006 · 4.74 Impact Factor
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    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; number, NCT00193765.).
    New England Journal of Medicine 05/2015; 373(6). DOI:10.1056/NEJMoa1506007 · 55.87 Impact Factor
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    VD Pai · D Nair · S Datta · P Chaturvedi
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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 03/2015; 36(1). DOI:10.4103/0971-5851.151771
  • Akshat Malik · Swagnik Chakrabarty · Sudhir Nair · Deepa Nair · Pankaj 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 · 2.21 Impact Factor
  • Poonam Joshi · Pankaj Chaturvedi · Jai Prakash Agarwal · Shubhada Kane
    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 · 0.80 Impact Factor
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    S Arya · S Datta · P Chaturvedi
    Cancer imaging : the official publication of the International Cancer Imaging Society 10/2014; 14(Suppl 1):S10-S10. DOI:10.1186/1470-7330-14-S1-S10 · 2.07 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 · 3.61 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 oral squamous cell carcinoma (SCC) patients with pN1 or pN2a stage disease was conducted. Multivariable analyses were performed using Cox proportional hazard models to compare locoregional failure, disease-specific survival (DSS), and overall survival (OS). Institutional heterogeneity was assessed using 2-stage random effects meta-analysis techniques. Results: Univariate analysis revealed no difference in locoregional failure (p = .184), DSS (p = .761), or OS (p = .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 is 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 these data to deintensify treatment. © 2014 Wiley Periodicals, Inc. Head Neck, 2015.
    Head & Neck 09/2014; DOI:10.1002/hed.23871 · 2.64 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 · 4.45 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 · 2.64 Impact Factor
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    ABSTRACT: Aim: 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. Method: Prospective, observational study comparing ultrasound (US), contrast enhanced computed tomography (CECT) and positron emission tomography-computed tomography (PET-CT). Level wise assessment of neck nodes with each imaging modality was performed and compared with final histopathology. Results: Eighty-five necks were evaluated in 70 patients. Sensitivity, specificity and accuracy of the three modalities were 78.9, 68.75 and 73.25% for US, 73.6, 85.4 and 80.2% for CECT, and 81.5, 54.1 and 66.2% for PET-CT, respectively. CECT performed better than US and PET-CT scan particularly in levels IB and II (accuracy of 81.4 and 88.3% for CECT, 73.25 and 79.1% for US, and 68.6 and 68.6% for PET-CT scan, respectively). Concordance with histology was best with CECT (κ = 0.615) followed by US (κ = 0.461) and PET-CT (κ = 0.337). Conclusion: The quest for the most accurate imaging modality in clinically node-negative necks continues. US alone is inadequate. While PET-CT may not be a specific imaging modality in detecting occult cervical nodal metastasis in endemic regions of chronic granulomatous diseases, the performance of PET CECT in this setting remains to be evaluated. CECT scan, routinely used in imaging for primary disease, is fairly accurate in detecting nodal metastasis. However, in early oral cancers that are generally treated without any imaging for the primary tumor, management of the neck will largely depend on clinical judgment.
    Asia-Pacific Journal of Clinical Oncology 08/2014; DOI:10.1111/ajco.12255 · 1.54 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. · 1.00 Impact Factor
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    ABSTRACT: Importance 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.Objective To determine if a modified staging system for oral cancer that integrates depth of invasion (DOI) into the T categories improves prognostic performance compared with the current AJCC T staging.Design, Setting, and Participants Retrospective analysis of 3149 patients with oral squamous cell carcinoma treated with curative intent at 11 comprehensive cancer centers worldwide between 1990 and 2011 with surgery ± adjuvant therapy, with a median follow-up of 40 months.Main Outcomes and Measures We assessed the impact of DOI on disease-specific and overall survival in multivariable Cox proportional hazard models and investigated for institutional heterogeneity using 2-stage random effects meta-analyses. Candidate staging systems were developed after identification of optimal DOI cutpoints within each AJCC T category using the Akaike information criterion (AIC) and likelihood ratio tests. Staging systems were evaluated using the Harrel concordance index (C-index), AIC, and visual inspection for stratification into distinct prognostic categories, with internal validation using bootstrapping techniques.Results The mean and median DOI were 12.9 mm and 10.0 mm, respectively. On multivariable analysis, DOI was a significantly associated with disease-specific survival (P < .001), demonstrated no institutional prognostic heterogeneity (I2 = 6.3%; P = .38), and resulted in improved model fit compared with T category alone (lower AIC, P < .001). Optimal cutpoints of 5 mm in T1 and 10 mm in T2-4 category disease were used to develop a modified T staging system that was preferred to the AJCC system on the basis of lower AIC, visual inspection of Kaplan-Meier curves, and significant improvement in bootstrapped C-index.Conclusions and Relevance We propose an improved oral cancer T staging system based on incorporation of DOI that should be considered in future versions of the AJCC staging system after external validation.
    JAMA Otolaryngology - Head and Neck Surgery 07/2014; 140(12). DOI:10.1001/jamaoto.2014.1548 · 1.79 Impact Factor
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    ABSTRACT: Importance Squamous cell carcinoma of the oral cavity (OSCC) is a common malignant tumor worldwide.Objective To determine if regional failure in patients with OSCC and pathologically negative neck nodes (pN–) is due to an incomplete sampling procedure during surgery.Design, Setting, and Participants We retrospectively reviewed the medical records of 2258 patients from 11 cancer centers worldwide who underwent neck dissection for OSCC (1990-2011) and who were pN−. Of those, 345 had clinical evidence of nodal metastases (cN+) on radiologic workup. The neck specimens were available for reanalysis in 193 patients. Survival rates were calculated using the Kaplan-Meier graphs and analyzed by multivariable analysis.Main Outcomes and Measures Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).Results Resectioning and analysis of the neck dissection specimens in the cN+/pN− subgroup revealed false-negative results in 29 (15%) of 193 patients. The negative predictive value of the initial pathologic examination was 85%. The 5-year OS and DSS in the cN−/pN− group were 77.6% and 87.2%, respectively. The 5-year OS and DSS of the cN+/pN− group were 62.6% and 78.5%, respectively (P < .001). In multivariable analysis, cN+ classification was significantly associated with poor OS (hazard ratio [HR], 1.7; 95% CI, 1.1-3.8; P = .03) and poor DSS (HR, 1.46; 95% CI, 1.1-4.1; P = .04). A cN+ classification was associated with lower DFS (66.3% vs 76.2%; P = .05) and lower regional recurrence–free survival (68.6% vs 78.8%; P = .02) but not with local (P = .20) or distant recurrence (P = .80).Conclusions and Relevance Pathologic staging underestimates the incidence of nodal metastases in cN+ disease. After correction for pathologically missed nodal metastases, radiologic evidence of neck nodes is an independent predictor of outcome, suggesting that traditional sampling during surgery might miss metastases, and this fact might explain the origin of treatment failure in these patients.
    JAMA Otolaryngology - Head and Neck Surgery 07/2014; 140(12). DOI:10.1001/jamaoto.2014.1539 · 1.79 Impact Factor
  • Akshat Malik · Poonam Joshi · Harsh Thanky · Pankaj Chaturvedi
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    ABSTRACT: Parapharyngeal space is a potential space in the neck in the form of an inverted pyramid and can be divided into pre- and post-styloid compartment. Salivary gland tumors commonly arise from the pre-styloid compartment and neurogenic tumors and paragangliomas from the post-styloid compartment. These tumors can have a highly variable presentation due to their location which often also makes it difficult to get a confirmed pre-operative diagnosis due to their inaccessibility. In such cases, diagnosis is often radiological. We present two cases of parapharyngeal space masses, where, in spite of thorough pre-operative workup, final diagnosis turned out to be a surprise.
    Indian Journal of Surgery 07/2014; DOI:10.1007/s12262-014-1146-y · 0.26 Impact Factor

Publication Stats

751 Citations
399.23 Total Impact Points


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