-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: To prospectively evaluate and compare health-related quality-of-life (QOL) outcomes in patients with head-neck squamous cell carcinoma randomized to either intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) and assess serial longitudinal change in QOL over time. METHODS: QOL outcomes were assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN-35) at baseline (pre-treatment) and subsequently periodically on follow-up. Mean scores of individual domains/scales of 3D-CRT and IMRT were compared using 't' test at each time point; while longitudinal change in mean scores of both groups over time was evaluated by repeated measurement analysis of variance. RESULTS: Fifty eight of the 60 randomized patients who filled the QOL questionnaire at least at one time point were included in the analysis. Several general (emotional functioning, role functioning, social contact) as well as head and neck cancer-specific (dry mouth, opening mouth, sticky saliva, pain, senses) QOL domains were better preserved with IMRT compared to 3D-CRT at different time points. Importantly, none of the QOL domains were worse with IMRT at any time point. There was substantial deterioration in QOL scores immediate post-treatment (3-months) in both arms. However, QOL scores gradually but definitely improved over time for most domains. Global QOL, emotional/role functioning, nausea/vomiting, pain, swallowing, speech, social contact/eating, insomnia showed rapid recovery (<6months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6months). There were no significant differences in loco-regional or survival between the two arms. CONCLUSIONS: There is substantial deterioration in QOL after curative-intent head-neck irradiation that gradually improves over time. IMRT results in clinically meaningful and statistically better QOL scores for some domains compared to 3D-CRT at several time points with comparable disease outcomes that could support its widespread adoption in routine clinical practice.
Oral Oncology 04/2013; · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: We earlier observed altered expression of p53 and Bcl-xL in oral cancer cell lines/tissues and wanted to evaluate these proteins for prediction of radiotherapy response and outcome. METHODS: Thirty-nine paraffin-embedded, pretreatment oral cancer biopsies were analyzed for protein expression using immunohistochemistry and correlated with tumor response to radiotherapy and disease-free survival (DFS). RESULT: High p53 (p = .040) was observed in female versus male patients. Increased p53 intensity (p = .063) was observed in tobacco habitués (chewers ± smokers) versus patients with no habits. In univariate analysis, nodal positivity (p = .044) and favorable/complete tumor response (p = .002) exhibited a significant correlation with DFS, whereas tumor response emerged as an independent predictor of DFS in multivariate analysis. Significantly high Bcl-xL (p = .048) was observed in the unfavorable versus favorable responders. CONCLUSION: Our study suggests that Bcl-xL expression along with clinical parameters may be useful for identifying patients with oral cancer likely to draw maximum benefit from curative radiotherapy. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 09/2012; · 2.40 Impact Factor
-
Tejpal Gupta, Jaiprakash Agarwal,
Sandeep Jain,
Reena Phurailatpam,
Sadhana Kannan,
Sarbani Ghosh-Laskar,
Vedang Murthy,
Ashwini Budrukkar,
Ketayun Dinshaw,
Kumar Prabhash,
Pankaj Chaturvedi,
Anil D'Cruz
[show abstract]
[hide abstract]
ABSTRACT: To compare three-dimensional conformal radiotherapy (3D-CRT) with intensity modulated radiation therapy (IMRT) in curative-intent irradiation of head-neck squamous cell carcinoma (HNSCC).
Previously untreated patients with biopsy-proven squamous carcinoma of oropharynx, larynx, or hypopharynx (T1-3, N0-2b) were randomly assigned using computer-generated permuted-block design to either 3D-CRT or IMRT, with incidence of physician-rated Radiation Therapy Oncology Group (RTOG) grade 2 or worse acute salivary gland toxicity as primary end-point.
Between 2005 and 2008, 60 patients randomly allocated to either 3D-CRT (n=28 patients) or IMRT (n=32) were included and analyzed on an intention-to-treat basis. The proportion [95% confidence intervals (CI)] of patients with RTOG grade 2 or worse acute salivary gland toxicity was significantly lesser in the IMRT arm [19 of 32 patients (59%, 95%CI: 42-75%)] as compared to 3D-CRT [25 of 28 patients (89%, 95%CI: 72-97%; p=0.009)]. Late xerostomia and subcutaneous fibrosis were also significantly lesser with IMRT. There was significant recovery of salivary function over time in patients treated with IMRT (p-value for trend=0.0036). At 3-years, there were no significant differences in loco-regional control or survival between the two arms.
IMRT significantly reduces the incidence and severity of xerostomia compared to 3D-CRT in curative-intent irradiation of HNSCC.
Radiotherapy and Oncology 07/2012; 104(3):343-8. · 5.58 Impact Factor
-
Rahul Krishnatry,
Tejpal Gupta,
Vedang Murthy,
Sudhir Vasudevan Nair,
Deepa Nair,
Pankaj Chaturvedi,
A. K. Dcruz,
Kumar Prabhash,
Sarbani Laskar Ghosh,
Ashwini Narsingrao Budrukkar, Jaiprakash Agarwal
[show abstract]
[hide abstract]
ABSTRACT: Background: Loco-regional relapse is predominant pattern of failure in locally advanced head & neck squamous cell cancer (HNSCC). Distant metastasis (DM) is increasingly detected on follow-up. this study attempts to identify baseline patient, tumor & treatment characteristics which determine poor survival in radically treated HNSCC patients developing DM. Methods: Clinical outcome audit of HNSCC receiving radical treatment from 1990-2010 in a single HNCC radiotherapy (RT) clinic who developed DM, using electronic search of a prospectively maintained database. The Disease free survival (DFS) & overall survival (OS) were calculated using Kaplan Meier method. The Log rank test & Cox regression (p< 0.05 significant) were used for univariate & multivariate analysis respectively. Results: 104 HNC patients developed DM, baseline characteristics are shown in table 1. DM was detected at a median of 7(IQR 3-14) months from treatment completion & median survival after diagnosis of DM was 2.6 (0-6) months. The median DFS & OS were 19(13-26), 21.5(16-29) months respectively. On univariate analysis, factors affecting DFS & OS were advanced tumor and nodal stage, perinodal extension & treatment factors (surgery & RT gap >30 days). On multivariate analysis stage and PNE remained significant for DFS while only stage showed significance for OS. Conclusions: Locally advanced stage of presentation (stage IV, T4, N2+) is the most important baseline factor determining poor outcome in HNC patients developing DM. Trials for aggressive primary systemic treatment (chemotherapy, targeted agents) are needed.
Journal of Clinical Oncology 05/2012; 30(15_suppl):e16021. · 18.37 Impact Factor
-
Jaiprakash Agarwal,
Vijay Palwe,
Debnarayan Dutta,
Tejpal Gupta,
Sarbani Ghosh Laskar,
Ashwini Budrukkar,
Vedang Murthy,
Pankaj Chaturvedi,
Prathamesh Pai,
Devendra Chaukar,
Anil K. D’Cruz,
Suyash Kulkarni,
Aniruddha Kulkarni,
Gurmit Baccher,
Shyam Kishore Shrivastava
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive
(chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of
47 patients with locoregionally advanced (T1–4, N0–3) HNSCC treated with definitive CRT. Objective assessment of swallowing
function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was
done using penetration–aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration–aspiration,
pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present
on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%),
12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores
(3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n=34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and
6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients
after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT
poor subjective swallowing function (P=0.004), hypopharyngeal primary (P=0.05), and large tumor volume (P=0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This
study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive
(chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue
and aspiration domains being affected most significantly.
KeywordsChemoradiotherapy–Modified barium swallow–Penetration–aspiration scale–Swallowing function–Deglutition–Deglutition disorders
Dysphagia 04/2012; 26(4):399-406. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Locally advanced head and neck cancers are usually treated with concurrent chemoradiation. The residual nodes after chemoradiation in such patients are a common scenario, but the further investigation and treatment options in form of neck dissection are still not very clear. This review focuses on the current state of available evidence in literature for management of such patients and directs for the future development to fill the lacunae.
International Journal of Head Neck Surgery. 01/2012; 3(1-10.5005/jp-journals-10001-1083):15-21.
-
[show abstract]
[hide abstract]
ABSTRACT: Base tongue involvement is a rare presentation of lingual metastases from renal cell carcinoma. A 48-year-old gentleman was treated with open radical nephrectomy and adjuvant radiotherapy for Stage II Furhman grade I clear cell carcinoma of the left kidney at an outside hospital. He presented metachronously 5 years later with progressive dysphagia and change of voice. Clinicoradiological evaluation revealed a large exophytic mass in the oropharynx with epicenter in the right base of tongue. Metastatic workup revealed widespread dissemination to multiple organs and bone. In view of predominant symptom of dysphagia, base tongue metastasis was treated with protracted course of palliative radiotherapy to a dose of 50 Gy in conventional fractionation over 5 weeks. This resulted in excellent and durable response at the base tongue lesion (till the time of last follow-up). Radiation therapy is an acceptable palliative strategy for advanced lingual metastasis as it produces prompt relief of pain, bleeding, and dysphagia.
Indian Journal of Urology 10/2011; 27(4):550-2.
-
Sarbani Ghosh-Laskar,
Vedang Murthy,
Tabassum Wadasadawala, Jaiprakash Agarwal,
Ashwini Budrukkar,
Nikhilesh Patil,
Shubhada Kane,
Devendra Chaukar,
Prathamesh Pai,
Pankaj Chaturvedi,
Anil D'Cruz
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to identify the prognostic factors affecting the outcome in patients with mucoepidermoid carcinoma (MEC) of the parotid gland.
A total of 113 patients with MEC who were treated between 1993 and 2002 were analyzed.
At median follow-up of 49 months (range, 1-143 months), disease-free survival (DFS) at 5 and 10 years was 84.6 and 84.6%, 80.7% and 67.3%, and 52.5% and 35.0% for low-grade, intermediate-grade, and high-grade tumors, respectively. Five-year and 10-year overall survival was 96.8% for low-grade tumors; 94.1% and 82.4%, respectively, for intermediate-grade tumors; and 73.3% for high-grade tumors. High-grade tumors and lymph node cancer-positive neck tumors strongly predicted poor locoregional control and DFS, while close or positive cut margins showed a trend toward poorer outcomes.
Histologic grade is the most important factor affecting outcome in parotid MEC. Adjuvant radiotherapy is recommended for high-grade tumors and should be tailored according to the expected risk of recurrence for low-grade and intermediate-grade tumors.
Head & Neck 04/2011; 33(4):497-503. · 2.40 Impact Factor
-
Jaiprakash Agarwal,
Vijay Palwe,
Debnarayan Dutta,
Tejpal Gupta,
Sarbani Ghosh Laskar,
Ashwini Budrukkar,
Vedang Murthy,
Pankaj Chaturvedi,
Prathamesh Pai,
Devendra Chaukar,
Anil K D'Cruz,
Suyash Kulkarni,
Aniruddha Kulkarni,
Gurmit Baccher,
Shyam Kishore Shrivastava
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration-aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n = 34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P = 0.05), and large tumor volume (P = 0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.
Dysphagia 02/2011; 26(4):399-406. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sarcomatoid carcinomas are biphasic tumors proven to be monoclonal dedifferentiated forms of conventional squamous carcinomas. This study evaluates their clinicopathologic characteristics in head and neck mucosal sites and the problems in distinguishing them from other spindle cell tumors. A total of 103 cases with a confirmed diagnosis of sarcomatoid carcinoma accessioned in the pathology department of a tertiary referral cancer centre over a period of 7 years (2004-2010) were studied. An algorithm used for their diagnosis is presented. Ages of the patients were 22-90 years (median 53 years), and male:female ratio was 3.7:1. Site distribution was oral cavity (n = 65, 63.1%), larynx (18, 17.5%), oropharynx/hypopharynx (12, 10.7%), maxilla (6, 5.8%) and metastatic nodes (2, 1.9%). A large number of patients (95%) presented with a mass lesion of less than 1 year duration. Histopathologically, epithelial differentiation was evident on morphology in 48 (46.6%) cases, only on IHC in 34 (33%) cases, and in 21 (20.4%) no epithelial differentiation was seen. Typically, tumors were polypoidal (92, 89.3%) and ulcerated (95, 92.2%) with cells arranged predominantly in fascicles (59, 57.3%) or storiform pattern (17, 16.5%) amidst collagenous (50, 48.5%) or myxoid matrix (35, 34%). Anaplasia (2+/3+) and mitosis >10 per 10 HPF were noted in 96 (93.2%) cases. IHC was done in 82 cases; 55 (66.7%) showed positivity for epithelial markers with aberrant expression of mesenchymal markers in 43 (41.7%). Diagnosis of sarcomatoid squamous carcinoma is challenging because of overlapping histopathological features with other spindle cell tumors. Understanding their clinicopathologic characteristics facilitates their diagnosis and appropriate clinical management.
Head and Neck Pathology 12/2010; 4(4):265-75.
-
[show abstract]
[hide abstract]
ABSTRACT: At our laboratory, we recently observed cell cycle and apoptosis-related proteins Myeloid Cell Leukemia-1 (Mcl-1) and Proliferating Cell Nuclear Antigen (PCNA) to be altered in oral tumours/cell lines. The present study aimed to evaluate the above proteins for predicting response and outcome in oral cancer patients treated with definitive radiotherapy. Pre-treatment oral cancer biopsy samples from 39 patients were examined for Mcl-1 and PCNA proteins using immunohistochemistry and correlated with clinico-pathological variables using disease-free survival (DFS) as the primary endpoint. We observed high expression of Mcl-1 in older versus younger patients (p=0.013) and in tobacco chewers+/-alcohol versus smokers+/-alcohol (p=0.037); and PCNA in node-positive versus node-negative tumours (p=0.037). On univariate analysis, high PCNA (p=0.007), Mcl-1 (p=0.050), node positivity (p=0.040) and co-expression of PCNA and Mcl-1 (p=0.008), had a significant impact on DFS. On multivariate analysis, low PCNA/Mcl-1 (p=0.006) co-expressing tumours were associated with improved DFS. Thus our study suggests that in patients undergoing primary radiotherapy, PCNA could be of potential predictive value to identify patients with risk of nodal metastases and in combination with Mcl-1 may have potential prognostic value to differentiate patients with poor DFS. These markers may be used for future trial patients requiring radiotherapy for their treatment.
Oral Oncology 09/2010; 46(9):688-93. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To retrospectively review a long-term, single-institution experience of subjects with submandibular gland malignancies treated with definitive locoregional therapy with an aim to identify clinicopathologic variables that correlate with outcomes.
A comprehensive chart review of 47 patients presenting to the institute from 1993 to 2005 with a histologic diagnosis of submandibular salivary gland cancer was performed to extract demographic data, clinicopathological characteristics, and treatment details. Clinical and pathologic factors were correlated with locoregional control, distant metastases free survival, and disease-free survival using log-rank test and Cox proportional hazards model for univariate and multivariate analysis, respectively.
With a median follow-up of 29 months (interquartile range, 13 to 64 months), the actuarial 5-year locoregional control, distant metastasis-free survival, and disease-free survivals of the entire cohort were 80.5%, 86.1%, and 71.8%, respectively. Overall stage grouping (P = .008), perineural invasion (P = .04), and radiotherapy dose (P = .033) were significant predictors of locoregional control. Overall stage grouping (P = .014) and T stage (P = .05) also affected disease-free survival. Extraglandular involvement showed a trend toward poorer outcome.
Submandibular gland cancer is a rare disease with histologic diversity and variable clinical behavior. Overall stage grouping and perineural invasion remain the most significant predictors of outcome. Adequate doses of adjuvant radiotherapy improve locoregional control in high-risk patients.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 09/2010; 68(9):2104-10. · 1.58 Impact Factor
-
Jaiprakash Agarwal,
Debnarayan Dutta,
Vijay Palwe,
Tejpal Gupta,
Sarbani Laskar,
Ashwini Budrukkar,
Vedang Murthy,
Pankaj Chaturvedi,
Prathemesh Pai,
Devendra Chaukar,
A D′Cruz,
Suyesh Kulkarni,
Aniruddh Kulkarni,
Gurmit Baccher,
Shyam Shrivastava
[show abstract]
[hide abstract]
ABSTRACT: Aim : Prospective subjective evaluation of swallowing function and dietary pattern in locally advanced head and neck cancer patients treated with concomitant chemo-radiotherapy (CRT). Materials and Methods : Prospective evaluation of swallowing function with performance status scale for head and neck cancer patients (PSSHN) at pre-CRT, CRT completion and at subsequent follow-ups in adult with loco-regionally advanced head and neck squamous cell carcinoma (HNSCC) patients. Results : In 47 patients (40 male, seven females; mean age 53; 72% smoker 53%, oropharyngeal cancer), the mean total PSSHN score at pre-CRT was 258.5 and decreased to 225.2 and 219.2 at two and six months respectively. Understandability of speech, normalcy in diet and eating in public at pre-CRT and six months were 91.5 and 84.4; 80.4 and 63.1; 87.3 and 76.6 respectively. In univariate analysis, pre-CRT PSSHN scores were significantly lesser in patients with severe pre-CRT dysphagia (P = 0.001), hypopharyngeal cancer (P = 0.244) and advanced T-stage (T3/4) disease (P = 0.144). At CRT completion, there was significant reduction of PSSHN scores in patients with severe pre-CRT dysphagia (P = 0.008), post-CRT weight loss (>10%) and disease progression (P = 0.039). At two months and six months, 17 (57%) and 11 (73.5%) patients respectively showed change in dietary habit. Mean increase in meal time was 13% and 21% at two and six-month follow-up. Conclusions : HNSCC patients show deterioration in swallowing function after CRT with normalcy of diet in maximum and eating in public least affected. Pre-CRT severity of dysphagia, weight loss> 10% and disease progression have significant correlation with higher swallowing function deterioration after CRT.
Journal of Cancer Research and Therapeutics. 01/2010;
-
Rukmini B Govekar,
Anil K D'Cruz,
K Alok Pathak, Jaiprakash Agarwal,
Ketayun A Dinshaw,
Roshan F Chinoy,
Nikhil Gadewal,
Sadhana Kannan,
Ravi Sirdeshmukh,
Curam S Sundaram,
Siddhi A Malgundkar,
Shubhada V Kane,
Surekha M Zingde
[show abstract]
[hide abstract]
ABSTRACT: Tobacco-related oral cancer is the most common cancer among Indian males, gingivo-buccal complex (GBC) being the most affected subsite due to the habit of chewing tobacco. Proteins from the lysates of microdissected normal and transformed epithelium from clinically well-characterized tissue samples of the GBC were separated by two-dimensional gel electrophoresis to identify differentially expressed proteins. Eleven protein spots showed differential expression, which could withstand the stringency of statistical evaluation. The observations were confirmed with additional tissues. Nine of these differentiators were identified by MS as lactate dehydrogenase B, α-enolase, prohibitin, cathepsin D, apolipoprotein A-I, tumor protein translationally controlled-1, an SFN family protein, 14-3-3σ and tropomyosin. Cluster analysis indicated that these proteins, as a coexpressed set, could distinguish normal and transformed epithelium. Functionally, these differentiator molecules are relevant to the pathways and processes that have been previously implicated in oral carcinogenesis and could therefore be investigated further as a panel of markers for management of cancer of the GBC.
PROTEOMICS - CLINICAL APPLICATIONS 12/2009; 3(12):1451-62. · 1.81 Impact Factor
-
New England Journal of Medicine 04/2004; 350(10):1049-53; author reply 1049-53. · 53.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Linear Accelerator-based Intensity Modulated Radiation Therapy (IMRT), either as step-and shoot (SS) or in dynamic mode, is now considered routine in the definitive management of head and neck squamous cell carcinoma (HNSCC). Helical TomoTherapy (HT) is a new platform to deliver IMRT. This study aims to compare step-and-shoot Intensity Modulated Radiation Therapy (SS IMRT) with dynamic Helical TomoTherapy (HT) dosimetrically in patients with head and neck squamous cell carcinoma (HNSCC).
Twelve patients with HNSCC, previously treated with SS IMRT, were re-planned on HT using the same CT dataset. Plans were compared for target coverage and organs-at-risk (OARs) sparing. Sparing of parotids was assessed after stratifying for side (contralateral vs. ipsilateral) and site of disease (laryngopharynx vs. oropharynx). Normal tissue complication probabilities (NTCP) were also compared for the parotid glands.
All HT plans showed improvement in target coverage and homogeneity, and reduction in OAR doses as compared to SS IMRT plans. For PTV 66, the mean V 99 improved by 14.65% ( P = 0.02). Dose Homogeneity (D 10-90 ) was significantly better in the HT plans (mean 2.07Gy as compared to 4.5Gy in the SS IMRT plans, P = 0.02). HT resulted in an average reduction of mean parotid dose of 12.66Gy and 18.28Gy for the contralateral and ipsilateral glands ( P = 0.003) respectively. This translated into a 24.09% and 35.22% reduction in Normal Tissue Complication Probability (NTCP) for the contralateral and ipsilateral parotids respectively ( P < 0.01). Site of disease (laryngopharynx vs. oropharynx) did not have any significant impact on parotid sparing between SS IMRT and HT. The maximum dose to the spinal cord showed a mean reduction of 12.07Gy in HT plans ( P = 0.02).
Helical Tomotherapy achieved better target coverage with improved OAR sparing as compared to SS IMRT. The significant reduction in mean parotid doses translated into meaningful reduction in NTCP, with potential clinical implications in terms of reduction in Xerostomia and improved quality of life in patients with HNSCC.
Journal of cancer research and therapeutics 6(2):194-8. · 0.83 Impact Factor
-
Jaiprakash Agarwal,
Debnarayan Dutta,
Vijay Palwe,
Tejpal Gupta,
Sarbani Ghosh Laskar,
Ashwini Budrukkar,
Vedang Murthy,
Pankaj Chaturvedi,
Prathemesh Pai,
Devendra Chaukar,
A K D'Cruz,
Suyesh Kulkarni,
Aniruddh Kulkarni,
Gurmit Baccher,
Shyam Kishor Shrivastava
[show abstract]
[hide abstract]
ABSTRACT: Prospective subjective evaluation of swallowing function and dietary pattern in locally advanced head and neck cancer patients treated with concomitant chemo-radiotherapy (CRT).
Prospective evaluation of swallowing function with performance status scale for head and neck cancer patients (PSSHN) at pre-CRT, CRT completion and at subsequent follow-ups in adult with loco-regionally advanced head and neck squamous cell carcinoma (HNSCC) patients.
In 47 patients (40 male, seven females; mean age 53; 72% smoker 53%, oropharyngeal cancer), the mean total PSSHN score at pre-CRT was 258.5 and decreased to 225.2 and 219.2 at two and six months respectively. Understandability of speech, normalcy in diet and eating in public at pre-CRT and six months were 91.5 and 84.4; 80.4 and 63.1; 87.3 and 76.6 respectively. In univariate analysis, pre-CRT PSSHN scores were significantly lesser in patients with severe pre-CRT dysphagia (P = 0.001), hypopharyngeal cancer (P = 0.244) and advanced T-stage (T3/4) disease (P = 0.144). At CRT completion, there was significant reduction of PSSHN scores in patients with severe pre-CRT dysphagia (P = 0.008), post-CRT weight loss (>10%) and disease progression (P = 0.039). At two months and six months, 17 (57%) and 11 (73.5%) patients respectively showed change in dietary habit. Mean increase in meal time was 13% and 21% at two and six-month follow-up.
HNSCC patients show deterioration in swallowing function after CRT with normalcy of diet in maximum and eating in public least affected. Pre-CRT severity of dysphagia, weight loss> 10% and disease progression have significant correlation with higher swallowing function deterioration after CRT.
Journal of cancer research and therapeutics 6(1):15-21. · 0.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: An ongoing institutional randomized clinical trial comparing three-dimensional conformal radiotherapy (3D CRT) and intensity-modulated radiotherapy (IMRT) provided us an opportunity to document and compare the time-manpower burden with these high-precision techniques in head and neck cancers.
A cohort of 20 consecutive patients in the ongoing trial was studied. The radiotherapy planning and delivery process was divided into well-defined steps and allocated human resource based on prevalent departmental practice. Person-hours for each step were calculated.
Twelve patients underwent IMRT and eight patients had 3D CRT. The prerandomization steps (upto and including approval of contours) were common between the two arms, and expectedly, the time taken to complete each step was similar. The planning step was carried out postrandomization and the median times were similar for 3D CRT (312 min, 5.2 person-hours) and IMRT (325.6 min, 5.4 person-hours). The median treatment delivery time taken per fraction varied between the two arms, with 3D CRT taking 15.2 min (0.6 person-hours), while IMRT taking 27.8 min (0.9 person-hours) (P< 0.001). The total treatment time was also significantly longer in the IMRT arm (median 27.7 versus 17.8 person-hours, P< 0.001). The entire process of IMRT took 48.5 person-hours while 3D CRT took a median of 37.3 person-hours. The monitor units delivered per fraction and the actual "beam-on" time was also statistically longer with IMRT.
IMRT required more person-hours than 3D CRT, the main difference being in the time taken to deliver the step-and-shoot IMRT and the patient-specific quality assurance associated with IMRT.
Journal of cancer research and therapeutics 5(2):107-12. · 0.83 Impact Factor
