Sasidharan Balukrishna

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• MBBS, MD, DMRT, DNB
• Professor (Full) at Christian Medical College, Vellore

Purpose: Detecting circulating plasma tumor DNA (ptDNA) in patients with early-stage cancer has the potential to change how oncologists recommend systemic therapies for solid tumors after surgery. Droplet digital polymerase chain reaction (ddPCR) is a novel sensitive and specific platform for mutation detection. Experimental Design: In this prospec...

PurposeThe study aims to analyse patterns of recurrence following neoadjuvant treatment and surgery in carcinoma oesophagus with an intent to postulate optimal nodal radiation.MethodologyA retrospective review of patients who presented to our centre within a 5-year period (2014–2018), with recurrence following sequential neoadjuvant treatment and r...

ABSTRACT Background: Radiation induced proctitis is frequently encountered during the radiation therapy of cervical and prostate cancers that causes pain and occasionally with bleeding and may affect the continuity of radiation therapy. Aims and Objectives: The purpose of the study is to look at the benefit of administration of an oral prebiotic am...

Purpose: Pencil beam (PB) analytical algorithms have been the standard of care for proton therapy dose calculations. The introduction of Monte Carlo (MC) algorithms may provide more robust and accurate planning and can improve therapeutic benefit. We conducted a dosimetric analysis to quantify the differences between MC and PB algorithms in the cl...

Background: The treatment of locally advanced unresectable oral cavity cancers (OCC) is challenging, with limited consensus on optimal management and poor outcomes. Our clinical practice identified a subset of unresectable OCC patients who respond favourably to aggressive alternate treatment with chemotherapy and radiotherapy. We propose a systemat...

Thymic epithelial tumours (TETs) are rare and exhibit varied behaviour and prognosis based on their histological subtype, as classified by the World Health Organization (WHO). These subtypes are further categorized into low–risk and high–risk groups. Low– risk thymomas generally allow for complete surgical resection without adjuvant therapy, while...

Locally advanced head and neck squamous cell carcinoma (LAHNSCC) unresectable at presentation has a dismal survival when radical surgery or definitive chemoradiation is not possible. This ambispective cohort study evaluated the addition of low-dose nivolumab to induction chemotherapy (IC) in patients with locally advanced, unresectable or borderlin...

PURPOSE There is a lack of literature on treating stage III non–oncogene-driven non–small cell lung cancer (NSCLC) with low-dose immunotherapy in combination with chemotherapy for patients who are not candidates for local therapy up front. MATERIALS AND METHODS We performed an institutional retrospective analysis of patients with stage III non–onc...

A BSTRACT Introduction Surgical resection remains the primary treatment for all thyroid cancers. Traditionally, adjuvant therapy with external beam radiation therapy (EBRT) is considered in locally advanced cases, although its role remains undefined. This study aims to evaluate the tolerance, toxicity, and outcomes of EBRT in locally advanced thyr...

The oral tongue is a common location for squamous cell carcinoma (SCC) and behaves more aggressively. Lymph node yield(LNY) is a robust independent prognostic factor in oral SCC. In this study, we attempt to determine the prognostic significance of LNY per neck node level for oral tongue SCC. This retrospective observational study includes 302 pati...

Background Neoadjuvant chemoradiotherapy (NACRT) using the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) protocol has improved esophageal cancer outcomes. This study reports the real-world experience of the CROSS regimen for esophageal squamous cell carcinoma (ESCC) regarding its feasibility, safety, and predictors of t...

Background Surgery remains the only curative treatment for locally advanced oral cavity squamous cell carcinoma (OCSCC). For ‘Borderline resectable’ OCSCC, conversion to surgery has shown improved outcomes, but historical induction chemotherapy (IC) yields a mere 40% conversion rate. Addition of targeted agents like cetuximab has not yielded satis...

Objective(s) The treatment response to neoadjuvant chemoradiation (nCRT) differs largely in individuals treated for rectal cancer. In this study, we investigated the role of radiomics to predict the pathological response in locally advanced rectal cancers at different treatment time points: (1) before the start of any treatment using baseline T2-we...

Background The WHO 2021 introduced the term pituitary neuroendocrine tumours (PitNETs) for pituitary adenomas and incorporated transcription factors for subtyping, prompting the need for fresh diagnostic methods. Current biomarkers struggle to distinguish between high- and low-risk non-functioning PitNETs. We explored if radiomics can enhance preop...

Background: To determine if circulating tumor DNA (ct-DNA) dynamics of epidermal growth factor receptor (EGFR) mutation in plasma can identify a subset of patients with EGFR-mutant (EGFR- m) non-small cell lung cancer (NSCLC) with inferior survival outcomes, we analyzed and compared survival outcomes among patients with and without baseline presenc...

Background: Evidence on the role of induction systemic therapy is limited for stage III NSCLC patients who cannot undergo upfront local therapy due to locally extensive disease or baseline poor lung function. Methods: We analyzed 81 patients with Stage III Non-Oncogene driven NSCLC deemed ineligible for upfront local therapy by Thoracic MDT betw...

Background: In April 2021, during the peak of the second wave of the COVID-19 pandemic in India, hospitals overflowed with COVID-19 patients, and people hesitated to seek necessary care due to fear of contracting the disease. The UDHAVI helpline was set up by a tertiary care hospital in Vellore with the help of district administration, nongovernmen...

Featured Application The application of this work is in radiomics for medical imaging analysis. It addresses the question of how to establish if radiomic features are stable and reproducible. Abstract Radiomics involves the extraction of information from medical images that are not visible to the human eye. There is evidence that these features ca...

Radiomics involves the extraction of information from medical images not visible to the human eye. There is evidence these features can be used for treatment stratification and outcome prediction. However, there is much discussion about the reproducibility of results between different studies. This paper studies the reproducibility of CT texture fe...

Background and purpose Radiomics models trained with limited single institution data are often not reproducible and generalisable. We developed radiomics models that predict loco-regional recurrence within two years of radiotherapy with private and public datasets and their combinations, to simulate small and multi-institutional studies and study t...

Radiation recall pneumonitis (RRP) is a type of radiation induced lung injury that develops in a previously irradiated lung field and is triggered by administration of chemotherapeutic or immunomodulating agents. To our knowledge there is only one report of Osimertinib induced RRP. The predominant symptoms include dyspnea and cough which usually re...

Globally and in India, lung cancer is one of the leading malignancies in terms of incidence and mortality. Smoking and environmental pollution are the common risk factors for developing lung cancer. Traditionally, lung cancer is divided into small cell and nonsmall cell types, with nonsmall cell carcinomas including squamous cell carcinoma, adenoca...

Purpose/Objective(s) Delta radiomics which refers to longitudinal changes of radiomic features over time has shown the potential to predict treatment response. However, its role in predicting normal lung toxicity has not been studied extensively. This study evaluates the potential for CBCT based delta radiomics in predicting radiotherapy induced lu...

Background Patients undergoing chemoradiation and immune checkpoint inhibitor (ICI) therapy for locally advanced non-small cell lung cancer (NSCLC) experience pulmonary toxicity at higher rates than historical reports. Identifying biomarkers beyond conventional clinical factors and radiation dosimetry is especially relevant in the modern cancer imm...

Background: Neoadjuvant chemoradiotherapy (nCRT) has improved the resectability and survival of operable oesophageal squamous cell carcinoma (OSCC). We aimed to study if nCRT for OSCC makes minimally invasive oesophagectomy (MIO) technically more challenging and if the peri-operative and oncological outcomes are acceptable for MIO following nCRT. M...

Background: Patients undergoing chemoradiation and immune checkpoint inhibitor (ICI) therapy for locally advanced non-small cell lung cancer (LA-NSCLC) experience pulmonary toxicity at higher rates than historical reports. We investigated the role of novel functional lung radiomics, relative to functional lung dosimetry and clinical characteristics...

Purpose Pathological complete response correlates with better clinical outcomes in locally advanced esophageal cancer (LA-EC). However, there is lack of prognostic markers to identify patients in the current setting of neoadjuvant chemoradiotherapy (NACRT) followed by surgery. This study evaluates the utility of mid-treatment diffusion-weighted ima...

Introduction: We seek to examine the prognostic value of FDG-PET imaging during chemoradiation for unresectable non-small cell lung cancer (NSCLC) for survival and hypothesize tumor PET response is correlated with peripheral T-cell function. Methods: 45 patients with AJCCv7 stage IIB-IIIB NSCLC enrolled on a phase II trial and received platinum-do...

Context: Cancer Radiomics is an emerging field in medical imaging and refers to the process of converting routine radiological images that are typically qualitatively interpreted to quantifiable descriptions of the tumor phenotypes and when combined with statistical analytics can improve the accuracy of clinical outcome prediction models. However,...

Aim This study aimed to evaluate and compare simultaneous integrated boost-based volumetric modulated arc therapy (SIB-VMAT) of head-and-neck plans optimised using segmented and non-segmented intermediate-risk target volumes. Materials and methods CT data of 20 patients with locally advanced laryngeal cancer treated with radical chemoradiation wer...

Introduction: We hypothesized that FDG PET imaging during chemoradiation for unresectable non-small cell lung cancer (NSCLC) is prognostic for survival, and that tumor PET response is correlated with peripheral T-cell function. Methods: 45 patients with AJCCv7 stage IIB-IIIB NSCLC enrolled on the phase II FLARE-RT trial and received platinum-double...

Background: Salivary duct carcinoma (SDC) is an extremely rare and aggressive subtype of salivary gland cancer with high morbidity and mortality and poor response to treatment. The current options of treatment include radical surgery followed by radiotherapy (RT) with or without chemotherapy. The aim of this study was to analyse the patterns of rec...

In head-and-neck cancer (HNC), it is imperious to assess changes in health-related quality of life (HRQoL) for a comprehensive evaluation of patient needs and treatment outcomes. Currently, there is limited literature about HRQoL measures used in the Indian context. This lack of information may make it difficult for clinicians to understand their p...

Purpose There is limited clinical data on scanning-beam proton therapy (SPT) in treating locally-advanced lung cancer, as most published literature is with passive-scatter technology. There is increasing interest in whether the dosimetric advantages of SPT compared with photon therapy can translate into superior clinical outcomes. We present our ex...

Objective The effect of functional lung avoidance planning on radiation dose-dependent changes in regional lung perfusion is unknown. We characterized dose-perfusion response on longitudinal perfusion SPECT/CT in two cohorts of lung cancer patients treated with and without functional lung avoidance techniques. Methods The study included 28 primary...

Background To introduce a method to generate a ‘dose–volume histogram (DVH) band’ for plan evaluation of photon therapy and explore its various potentials. Materials and methods Intensity-modulated radiotherapy (IMRT) plans for head and neck cancer patients were analysed, retrospectively, for setup errors noted during treatment. From the maximum o...

This paper presents an improved GrowCut (IGC), a positron emission tomography-based segmen-tation algorithm, and tests its clinical applicability. Contrary to the traditional method that requires the user toprovide the initial seeds, the IGC algorithm starts with a threshold-based estimate of the tumor and a three-dimensional morphologically grown...

Introduction: Phyllodes Tumour (PT) of the breast is a relatively rare breast neoplasm (<1%) with diverse range of pathology and biological behaviour. Aim: To describe the clinical course of PT and to define the role of Radiotherapy (RT) in PT of the breast. Materials and methods: Retrospective analysis of hospital data of patients with PT pre...

Aim Indeterminate pulmonary nodules incidentally detected during radiological imaging completed for radiotherapy planning always creates dilemma for the oncologist. The purpose of this study is to evaluate the clinical significance of pulmonary nodules incidentally detected in patients undergoing locoregional radiotherapy for breast cancer and pres...

Does daily use of resistant starch in diet reduce the incidence and severity of acute bowel symptoms in pelvic radiotherapy? A randomized control trial Balukrishna Sasidharan, Viswanathan P.N, Prasanna Samuel, Ramadass Balamurugan, Pugazhendhi Srinivasan, B.S. Ramakrishna Christian Medical College Vellore Purpose: The purpose of the study is to...

Among various altered fractionation schedules, only hyper-fractionation has proven increased local control in head and neck cancers. MARCH (Metanalyses of Hyperfractionated or Accelerated radiotherapy in Head and neck cancer) concluded that hyper-fractionated radiotherapy in head and cancers had a survival benefit. This study attempts to combine th...

Purpose To quantify the effect of breathing motion on post-mastectomy radiotherapy with three-dimensional (3D) tangents and intensity-modulated radiotherapy (IMRT) Materials and methods Patients trained for breath-hold underwent routine free breathing (FB) computed tomography (CT) simulation for radiotherapy as well as additional CT scans with bre...

Glioblastoma Multiforme (GBM) is a high-grade brain tumour with the most dismal prognosis. There are very few reports on second malignancies occurring in GBM patients, as the survival has been short. Second malignancies have been reported after treatment of malignancies with radiation therapy and chemotherapy especially after 5 to 10 y of treatment...

Aim : Conformal radiotherapy and inverse planning generates plans with heterogenous dose distribution. There is a high dose-falloff around critical organs. The daily setup errors at treatment may lead to overlap of high dose areas on to critical organs. At plan evaluation the influence of setup errors on dose distribution is difficult to assess. He...

Background: Five year results of the UK Standardisation of Breast Radiotherapy (START) trials suggested that lower total doses of radiotherapy delivered in fewer, larger fractions are as safe and effective as the conventional standard regimen (50Gy in 25 fractions) for women after breast conservation surgery(BCS) for early breast cancer. The purpos...

Purpose: Intensity Modulated Radiation Therapy is a sophisticated technique of delivering radiation therapy with very high dose to tumour and sparing normal tissues. Patients with head and neck cancers undergoing radiation therapy with IMRT develop toxicities during their course of treatment like mucositis, radiation dermatitis etc as absolute spar...

Purpose:To quantify the effect of breathing motion on post mastectomy radiotherapy with standard wedged tangents and intensity modulated radiotherapy (IMRT) Materials and Methods:Ten patients with locally advanced breast cancer underwent routine free breathing (FB) CT simulation for post-mastectomy radiotherapy. Patients were trained using Jaegar’...

Purpose/Objective(s) To quantify the effect of breathing motion on post mastectomy radiation therapy with standard wedged tangents and intensity modulated radiation therapy (IMRT) and to see whether tidal volume can guide the selection of the technique. Materials/Methods Ten patients with locally advanced breast cancer underwent routine free brea...

Aim: The purpose of the survey was to understand the role of positron emission tomography (PET) in clinical radiotherapy practice among the radiation oncologists' in India. Settings and design: An online questionnaire was developed to survey the oncologists on their use of PET, viewing protocols, contouring techniques practiced, the barriers on...

Digital polymerase chain reaction is a new technology that enables detection and quantification of cancer DNA molecules from peripheral blood. Using this technique, we identified mutant PIK3CA DNA in circulating ptDNA (plasma tumor DNA) from a patient with concurrent early stage breast cancer and non-small cell lung cancer. The patient underwent su...

11019 Background: PIK3CA is mutated in up to 30% of breast cancers. Classically somatic mutations are identified by Sanger sequencing of the primary tumor specimen. However third generation droplet digital PCR technologies offer a novel platform for quantitative mutation detection with improved sensitivity. Methods: Thirty stage I-III breast cancer...

Alveolar Soft Part Sarcoma (ASPS) is a very rare type of soft tissue sarcoma. Its cell of origin is unclear. It usually presents in the second to fourth decade of life. The most common reported sites of ASPS are the lower extremities, the head and the neck. Because of the rarity of this disease, there is no standard treatment plan. Surgical excisio...

In areas like adaptive therapy, multi-phase radiotherapy, and single fraction palliative treatment or in the treatment of patients with metal implants where megavoltage(MV) CT could be considered as a treatment planning modality, the reduced contrast in the MV CT images could lead to limited accuracy in localization of the structures. This would af...

Purpose: In this work, the dosimetric parameters of Simultaneous Integrated Boost treatment with step?and?shoot IMRT were analysed.Method & Materials:Treatment plans of eight patients, who were treated for locally advanced head and neck squamous cell carcinoma, were included in the analysis. The homogeneity index for target volumes was estimated. T...

The prospective use for MV CT for patient treatment planning are for consecutive phase plans in 3D conformal and intensity modulated radiotherapy, patients with metal implants, adaptive radiation therapy and single fraction palliative treatment. This study is to validate the authors' previous work on MV cone beam CT (MV CBCT) images reconstructed w...