Pankaj Chaturvedi

Tata Memorial Centre, Mumbai, Maharashtra, India

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Publications (182)409.84 Total impact

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    ABSTRACT: Sinonasal tumors are chemotherapy responsive which frequently present in advanced stages making NACT a promising option for improving resection and local control in borderline resectable and locally advanced tumours. Here we reviewed the results of 25 such cases treated with NACT. Materials and Methods . Sinonasal tumor patients treated with NACT were selected for this analysis. These patients received NACT with platinum and etoposide for 2 cycles. Patients who responded and were amenable for gross total resection underwent surgical resection and adjuvant CTRT. Those who responded but were not amenable for resection received radical CTRT. Patients who progressed on NACT received either radical CTRT or palliative radiotherapy. Results . The median age of the cohort was 42 years (IQR 37–47 years). Grades 3-4 toxicity with NACT were seen in 19 patients (76%). The response rate to NACT was 80%. Post-NACT surgery was done in 12 (48%) patients and radical chemoradiation in 9 (36%) patients. The 2-year progression free survival and overall survival were 75% and 78.5%, respectively. Conclusion . NACT in sinonasal tumours has a response rate of 80%. The protocol of NACT followed by local treatment is associated with improvement in outcomes as compared to our historical cohort.
    Full-text · Article · Feb 2016 · International Journal of Surgical Oncology
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    ABSTRACT: Background: The purpose of this study was to explore urinary Epstein-Barr virus (EBV)-DNA as a potential biomarker in patients with nasopharyngeal carcinoma (NPC). Methods: EBV-DNA copies were estimated in plasma/urine of patients with NPC (n = 76) by real-time polymerase chain reaction (PCR) at baseline, during therapy, and at follow-up. Their correlation with EBV-RNA expression in tissues (n = 53) was used to assess sensitivity and specificity of plasma/urine EBV-DNA. Correlation of urine and plasma EBV-DNA with each other and with radiological response was evaluated. Results: This study demonstrated that urine EBV-DNA has high sensitivity (96%) at diagnosis and it correlates well with plasma EBV-DNA at baseline and after neoadjuvant chemotherapy. The EBV-DNA copies reduced significantly with therapy (plasma: p < .001; urine: p = .011). Patients with low EBV-DNA copies demonstrated improved survival (plasma: p = .023; urine: p = .083). Conclusion: Plasma EBV-DNA is a good prognostic marker, whereas further study on a larger cohort may help in developing urine EBV-DNA as a surrogate prognostic marker for patients with NPC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
    Full-text · Article · Dec 2015 · Head & Neck
  • Aditi Sahu · Atul Deshmukh · Arti R. Hole · Pankaj Chaturvedi · C. Murali Krishna
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    ABSTRACT: Oral cancers suffer from poor disease-free survival rates due to delayed diagnosis. Noninvasive, rapid, objective approaches as adjuncts to visual inspection can help in better management of oral cancers. Raman spectroscopy (RS) has shown potential in identification of oral premalignant and malignant conditions and also in the detection of early cancer changes like cancer-field-effects (CFE) at buccal mucosa subsite. Anatomic differences between different oral subsites have also been reported using RS. In this study, anatomical differences between subsites and their possible influence on healthy vs pathological classification were evaluated on 85 oral cancer and 72 healthy subjects. Spectra were acquired from buccal mucosa, lip and tongue in healthy, contralateral (internal healthy control), premalignant and cancer conditions using fiber-optic Raman spectrometer. Mean spectra indicate predominance of lipids in healthy buccal mucosa, contribution of both lipids and proteins in lip while major dominance of protein in tongue spectra. From healthy to tumor, changes in protein secondary-structure, DNA and heme-related features were observed. Principal component linear discriminant analysis (PC-LDA) followed by leave-one-out-cross-validation (LOOCV) was used for data analysis. Findings indicate buccal mucosa and tongue are distinct entities, while lip misclassifies with both these subsites. Additionally, the diagnostic algorithm for individual subsites gave improved classification efficiencies with respect to the pooled subsites model. However, as the pooled subsites model yielded 98% specificity and 100% sensitivity, this model may be more useful for preliminary screening applications. Large-scale validation studies are a pre-requisite before envisaging future clinical applications.
    No preview · Article · Nov 2015 · Journal of Innovative Optical Health Sciences
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    ABSTRACT: Serum Raman spectroscopy (RS) has previously shown potential in oral cancer diagnosis and recurrence prediction. To evaluate the potential of serum RS in oral cancer screening, premalignant and cancer-specific detection was explored in the present study using 328 subjects belonging to healthy controls, premalignant, disease controls, and oral cancer groups. Spectra were acquired using a Raman microprobe. Spectral findings suggest changes in amino acids, lipids, protein, DNA, and β-carotene across the groups. A patient-wise approach was employed for data analysis using principal component linear discriminant analysis. In the first step, the classification among premalignant, disease control (nonoral cancer), oral cancer, and normal samples was evaluated in binary classification models. Thereafter, two screening-friendly classification approaches were explored to further evaluate the clinical utility of serum RS: a single four-group model and normal versus abnormal followed by determining the type of abnormality model. Results demonstrate the feasibility of premalignant and specific cancer detection. The normal versus abnormal model yields better sensitivity and specificity rates of 64 and 80%; these rates are comparable to standard screening approaches. Prospectively, as the current screening procedure of visual inspection is useful mainly for high-risk populations, serum RS may serve as a useful adjunct for early and specific detection of oral precancers and cancer. © 2015 Society of Photo-Optical Instrumentation Engineers (SPIE).
    No preview · Article · Nov 2015 · Journal of Biomedical Optics
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    ABSTRACT: Among the reconstructive options available for buccal mucosa defects with an intact mandible, free flap with microvascular anastomosis is the best option. However, in the developing world, with poor resources, limited infrastructure, and high patient load, this cannot be offered to all patients. We report on the success of the masseter flap for reconstruction of such defects in carefully selected patients. Despite some known limitations, this flap is easy to learn and carries acceptable complications. The results of this flap may not be comparable to those of microvascular reconstructions, but they are better than those from other options such as skin graft, nasolabial flap, submental flap, etc., in terms of surgical time required, no donor site morbidity, and minimal aesthetic deformity.
    No preview · Article · Nov 2015 · Ear, nose, & throat journal
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    ABSTRACT: The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India. Early diagnosis is imperative in improving outcomes and preserving quality of life. High index of suspicion is to be maintained for leukoplakia (high risk site). Evaluation of a patient with newly diagnosed tongue cancer should include essential tests: Magnetic resonance imaging (MRI) is investigative modality of choice when indicated. Computed tomography (CT) scan is an option when MRI is unavailable. In early lesions when imaging is not warranted ultrasound may help guide management of the neck. Early stage cancers (stage I & II) require single modality treatment - either surgery or radiotherapy. Surgery is preferred. Adjuvant radiotherapy is indicated for T3/T4 cancers, presence of high risk features [lymphovascular emboli (LVE), perineural invasion (PNI), poorly differentiated, node +,close margins). Adjuvant chemoradiation (CTRT) is indicated for positive margins and extranodal disease. Locally advanced operable cancers (stage III & IVA) require combined multimodality treatment - surgery + adjuvant treatment. Adjuvant treatment is indicated in all and in the presence of high risk features as described above. Locally advanced inoperable cancers (stage IVB) are treated with palliative chemo-radiotherapy, chemotherapy, radiotherapy, or symptomatic treatment depending upon the performance status. Select cases may be considered for neoadjuvant chemotherapy followed by surgical salvage. Metastatic disease (stage IVC) should be treated with a goal for palliation. Chemotherapy may be offered to patients with good performance status. Local treatment in the form of radiotherapy may be added for palliation of symptoms. Intense follow-up every 3 months is required for initial 2 years as most recurrences occur in the first 24 months. After 2 nd year follow up is done at 4-6 months interval. At each follow up screening for local/ regional recurrence and second primary is done. Imaging is done only when indicated.
    Full-text · Article · Sep 2015 · Indian journal of medical and paediatric oncology
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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.
    No preview · Article · Aug 2015 · Annals of Surgical Oncology
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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.
    No preview · Article · Jul 2015 · Analytical methods
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    Saman Warnakulasuriya · Pankaj Chaturvedi · Prakash C Gupta

    Full-text · Article · Jul 2015 · Addiction
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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.
    No preview · Article · Jun 2015 · Journal of Maxillofacial and Oral Surgery
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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.).
    Full-text · Article · May 2015 · New England Journal of Medicine
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    VD Pai · D Nair · S Datta · P Chaturvedi

    Full-text · Article · Apr 2015
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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.
    Full-text · Article · Mar 2015 · Indian journal of medical and paediatric oncology
  • 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.
    No preview · Article · Feb 2015 · American Journal of Infection Control
  • Bikramjit Singh · Pooja Pal · Pankaj Chaturvedi · Tanuja Shet

    No preview · Article · Jan 2015
  • Poonam Joshi · Amit Joshi · Kumar Prabhash · Vanita Noronha · Pankaj Chaturvedi
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    ABSTRACT: Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT) in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were included in the study. These patients were studied in two groups. Group 1 included 153 patients who underwent surgery alone, and Group 2 included 52 patients who received 2-3 cycles of NACT followed by surgery. Results: The mean age of the population was 51 years in the Group 1 and 45 years in Group 2. The hospital stay and readmissions in postoperative period were similar in the two groups. In this study, the complication rate was 37.9% in the surgery patients and 30.8% in the NACT patients (P = 0.424). Conclusion: The postoperative complication rates in patients who received NACT followed by surgery were not significantly different from those who underwent surgery.
    No preview · Article · Jan 2015 · Indian journal of medical and paediatric oncology

  • No preview · Article · Jan 2015 · Indian Journal of Cancer
  • Poonam Joshi · Pankaj Chaturvedi · Jai Prakash Agarwal · Shubhada Kane

    No preview · Article · Jan 2015 · International Journal of Otolaryngology and Head & Neck Surgery
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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.
    Full-text · Article · Dec 2014 · Indian Journal of Cancer
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    S Arya · S Datta · P Chaturvedi

    Full-text · Article · Oct 2014 · Cancer imaging : the official publication of the International Cancer Imaging Society

Publication Stats

1k Citations
409.84 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
  • 2008
    • University of Manitoba
      • Department of Surgery
      Winnipeg, Manitoba, Canada