Vivek Kaushal - Academia.edu (original) (raw)
Papers by Vivek Kaushal
Current Practice in Medical Science Vol. 6
Emerging Trends in Disease and Health Research Vol. 9
Journal of Biology and Today`s World, 2019
We are presenting a 2-year male child with large abdominal mass extending from right inguino-scro... more We are presenting a 2-year male child with large abdominal mass extending from right inguino-scrotal region to suprapubic region of size 4.0 × 5.0 cm. Mass causing pressure effect over bilateral kidneys and ureters with bilateral dilated renal pelvis and extending into the right inguinal region and pelvis. Histopathologically and immunocytochemically patient was confirmed as rhabdomyosarcoma of the retroperitoneum. Patient treated with six cycles of infusion chemotherapy with 3- weekly VAC regimen and was having progressive disease because of the aggressive behaviour of the disease and further treated with second line chemotherapy. The present case is a very unusual and rare site of metastatic presentation of the Rhabdomyosarcoma.
Journal of Cancer Prevention & Current Research, 2018
Background and Aims: Head and neck cancer accounts for 4.8% of all cancers globally and 13.9% of ... more Background and Aims: Head and neck cancer accounts for 4.8% of all cancers globally and 13.9% of all cancers in India. 1 In Indian setting, more than 70% patients present in locally advanced stage and with poor general condition and are suitable candidates for palliative radiotherapy. The present prospective, randomized study was planned to comparatively evaluate the efficacy, tolerability and toxicity of two schedules of palliative radiotherapy in patients of locally advanced head & neck cancer (LAHNC). Methods: The present study was carried out on histopathological proven and inoperable 60-patients of LAHNC. Patients in group I received total external radiation dose of 40Gy, 4Gy/fraction, and 2fractions a week for 5weeks. Group II patients received 20Gy in 5fractions in 5days followed by 3week gap followed by 20Gy in 5fractions in 5days. The groups were compared in terms of local tumor control and adverse effects of radiation. Results: All patients were of stage IV and 83% had nodal involvement. At the end of treatment for local disease, complete response (CR) in group I was better than group II (13.2% vs 3.3%) and complete nodal response was seen in 17% patients in each group. Disease status at 6months of follow up was 27% vs 23% complete tumor response and 30% vs 24% complete nodal response in group I and II respectively. Overall no evidence of disease (NED) was seen in 13% in group I and 17% in group II. Grade 3 skin radiation reactions were only seen in 1-patient of group II, however, grade 3 mucosal radiation reactions were seen in 20% patients in group I and 7% in group II. Seven patients in group I required nasogastric feeding tube as compared to 3-patients in group II. Grade 3 subcutaneous toxicity was equally present in 3% in each group. Conclusions: In this study we observed that both the schedules of radiotherapy are equally effective in tumor control and have comparable toxicity profile. Hence, to decrease the patient load in tertiary care institutes, it is recommended to use fractionation schedule with two radiotherapy fractions per week.
International Journal of Scientific and Research Publications (IJSRP), 2021
Introduction: Primary brain tumors are uncommon tumors demonstrating characteristics histopatholo... more Introduction: Primary brain tumors are uncommon tumors demonstrating characteristics histopathological features. Variation of demographic profiles of these intracranial malignant tumors in different regions worldwide was there and understanding of these helps in prompt diagnosis and establish appropriate treatment strategy. Different nations have established their brain tumor registry. The current study also focusses on demographic profiles, treatment schedules and survival rates of patients with a brain tumor who attended in a tertiary care hospital in a northern state of India. Material and Methods: Records of primary brain tumor patients over a period of 5-years were reviewed retrospectively. These records were analyzed for incidence, demographic pattern, different treatment modalities and their response evaluation. Results: A total 168-patients of primary brain tumors were identified. The median age at presentation was 47-years and males slightly outnumbered females. Among all the tumors, frontal lobe involvement was most predominant and most common presentation was headache. Astrocytoma constituted the predominant histopathological types and glioblastoma forms the largest subtypes of astrocytic tumors. Majority of patients underwent surgery followed by adjuvant radiation therapy with concurrent oral temozolomide. Overall average survival was 23-months, with 17 patients had follow-up of more than 4-years. Clinically, the response at last follow-up was CR in 29% and PR in 41%. Conclusion: Despite the fact that primary brain tumors are rare in our country, noticeable state-wise variation in incidence, demographic profile and mortality has been noted. The histopathological pattern of primary brain tumors in our institution established astrocytic tumors as the major health burden and gross total resection followed by radiotherapy with or without concurrent temozolomide is standard of care. The present study had several limitations, including its retrospective design, which may introduce selection bias. Finally, it is recommended to develop nationwide proper atlas of the cancer patients so that exact geographical plotting of the patients can be done to establish the accuracy of the scattered data.
We report here a rare case of primary malignant melanoma of the female urethra. A 60-year-old fem... more We report here a rare case of primary malignant melanoma of the female urethra. A 60-year-old female presented at our hospital with a two month history of painful lump right inguinal region, dysuria, poor stream, gross hematuria, intermittent blood spots and a mass at the external urethral meatus. The physical examination revealed a soft, small, peanut-sized lesion through the urethral orifice. The mass was tan colored, non ulcerated, and protruded from the external urethral meatus. It was resected by wide local excision under spinal anesthesia. The histopathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen showed evidence of metastasis to liver. We discuss the clinicopathologic features and treatment of this tumor.
For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a maj... more For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a major worldwide risk to public health. Although it is still more prevalent in developing countries; there is a recent positive growth pattern in developed countries, more so 2000 onwards, as a consequences of higher prevalence of hepatitis C infection and increase in consumption of alcohol. Further appearance of extrahepatic metastasis makes it more vulnerable. New multimodality approaches are explored in literature for advanced metastatic disease which are unresectable. Although local therapy and liver transplant are carried out in a lots of case series, targeted therapies are still the standard of care in many centres especially for inoperable, metastatic cases. Here we present an atypical case of multifocal hepatocellular carcinoma with extrahepatic adrenal metastasis treated by oral targeted agent sorafenib only.
Clinical Infection and Immunity, 2020
International Journal of Innovative Science and Research Technology, 2020
Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and six... more Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and sixth most common cause of mortality constituting 5.3% cases worldwide in 2018. Most common presenting symptom is dysphagia which is seen in 80–90% of patients. Most patients present in locally advanced stage and because of extensive local disease palliative radiotherapy plays a significant role. Aim and objectivesAim of the study was to compare two palliative radiotherapy schedules- 30 Gy in 10 fractions over 2- weeks versus 20 Gy in 5 fractions over 1-week in locally advanced carcinoma esophagus. Objectives were to compare above schedules based upon symptomatic relief and tolerability by the patient. Material and methodsThe study was a randomized control study done from July 2017 - December 2018 on 60 previously untreated, histo-pathologically proven patients of squamous cell carcinoma esophagus (locally advanced) reporting in the Department of Radiation oncology, Pandit B. D. Sharma PGIM...
Journal of Cancer Research and Therapeutics, 2020
Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the s... more Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity.
World Journal of Oncology, 2018
Background: Bone is a common site of dissemination in advanced cancer accounting for one-third of... more Background: Bone is a common site of dissemination in advanced cancer accounting for one-third of all distant metastases. Various fractionation schedules of radiotherapy have been used for palliation of bone metastases. The aim of this study was to compare three schedules of external radiation therapy (8 Gy single session versus 20 Gy/5 fractions versus 30 Gy/10 fractions) for palliative management of bone metastases. Methods: In the present study, 60 patients of bone metastases from any primary site were enrolled and randomly divided into three groups of 20 patients each by draw of lots. These patients received palliative external beam radiation therapy to the involved site. Patients were given 8 Gy single session, 20 Gy/5 fractions/1 week and 30 Gy/10 fractions/2 weeks in groups I, II and III, respectively. Results: The percentage of patients with overall pain relief was 80% in group I, 75% in group II and 85% in group III (P = 0.7). The number of patients with complete pain relief was 4 (20%) in each group. Maximum patients got pain relief at 4 weeks post-radiotherapy. The number of patients with improved performance status was 4 (20%) in group II and 2 (10%) each in groups I and III (P = 0.5). Thirteen (65%) patients in each of the groups had decreased analgesic requirement at 2-month follow-up. Retreatment rate was more in the single fraction (20%) compared to only 5% in group II and none in the group III (P = 0.05). Conclusion: From the present study we conclude that 8 Gy single fraction is as effective as multifraction radiotherapy for the palliation of painful bone metastases. However, for a center like ours being the only Government Tertiary Cancer Care Centre in the State, general consensus drawn after this study, recommends external radiation therapy 20 Gy/5 fraction regimen to be an appropriate means of palliation of painful bone metastases.
Journal of Cancer Prevention & Current Research, 2018
Malignant nodular hidradenoma is very rare adnexal tumor with exceedingly low incidence of 0.001%... more Malignant nodular hidradenoma is very rare adnexal tumor with exceedingly low incidence of 0.001%. The biological behavior of the tumor is aggressive, with local recurrences reported in more than 50% of the surgically-treated cases. Treatment options are surgery and/or Radiotherapy. Till date there is no clear consensus on its treatment. We report a rare case of malignant nodular hidradenoma nose in an 80-years old male who responded miraculously to Radiotherapy.
Journal of Cancer Research and Immuno-Oncology, 2018
Background: The aim of the study was to evaluate and compare the efficacy, tolerability and toxic... more Background: The aim of the study was to evaluate and compare the efficacy, tolerability and toxicity of two palliative radiotherapy (RT) schedules in locally advanced head and neck carcinoma (LAHNC), i.e., Quad Shot schedule with chemotherapy and Quad Shot schedule alone. Methods: The patients were randomly divided into two groups of 30 each. Group I patients were planned for 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles. All these patients also received paclitaxel 60 mg/ m 2 intravenous. Group II patients received 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles alone. All these patients in Group I and II received total radiation dose of 44.4 Gy. Results: At the end of treatment, complete tumor response (CR) in Group I was better than Group II (40% vs. 36.7%). Disease status (tumor+node) at the end of treatment in terms of complete response was 36.7% vs. 0% (11/30 and 0/30) in Group I and II. Disease status at 6 months of follow up was noted as follows: complete tumor response in Group I and II was 23.3% (7/30) vs. 10% (3/30) (p=0.012). Complete nodal response was 35.7% (10/28) in Group I and 6.67% (02/30) in Group II (p= 0.538). Overall, no evidence of disease was observed in 16.7% (5/30) in Group I and 3.3% (1/30) in Group II respectively (p<0.001). Conclusion: This palliative schedule has been shown to provide good tumor response and palliation of symptoms. The toxicity profile remains low with the addition of paclitaxel. Further investigation is warranted in a larger trial. Palliation of symptoms resulted in improved quality of life for these group of patients
Journal of Cancer Prevention & Current Research, 2018
Background: Angio centric NK/T-cell lymphoma represents a rare malignant entity, characterized by... more Background: Angio centric NK/T-cell lymphoma represents a rare malignant entity, characterized by progressive and relentless destruction of the affected tissues. Typically, this type of lymphoma originates in the nasal cavity, the palate or midfacial region characterized by vascular invasion and unrelenting destruction of the midline structures of the palatine structures and nasal fossa causing severe pain. Epstein-Barr virus (EBV) infection has important pathogenetic role as it has been isolated in practically all cases of angiocentric NK/T-cell lymphoma. The prognosis of locally advanced cases remains very poor despite treatment. Case presentation: We are reporting a case of a 45year young female with an advanced angiocentric NK/T-cell lymphoma who had progression to deep necrotic ulcer in the midline of palate destroying palatal tissues thus creating an oronasal fistula complicated with secondary infection. Patient received standard CHOP regimen with high palliative external beam radiotherapy followed by metronomic chemotherapy with lenalidomide and have considerable regression of localized disease and got superb palliation. Conclusion: Combination of locoregional radiotherapy and CHOP chemotherapy are the mainstay of treatment till now. Prosthetic treatment of possible oronasal fistulas/defects can significantly improve the patient's quality of life. Present case highlights the important role of local radiotherapy and metronomic chemotherapy with lenalidomide for symptomatic improvement.
World Journal of Oncology, 2018
Background: Head and neck cancer (HNC) is the seventh most common type of cancer in the world and... more Background: Head and neck cancer (HNC) is the seventh most common type of cancer in the world and constitute 5% of the entire cancers worldwide. The global burden of HNC accounts for 650,000 new cases and 350,000 deaths worldwide every year and a major proportion of regional malignancies in India. More than 70% of squamous cell carcinoma of the head and neck are estimated to be avoidable by lifestyle changes, particularly by effective reduction of exposure to well-known risk factors such as tobacco smoking and alcohol drinking. Methods: A retrospective analysis of 12 years (2001-2012) of HNC patients attending RCC, PGIMS Rohtak was done. Total numbers of cancer patients seen were 26,295 and out of these 9,950 patients were of HNCs, which were retrospectively analyzed for their associated risk factors in different HNC subtypes. Most of the patients, i.e. 92.3%, were presented as locally advanced HNC (stages III and IV). Results: It has been observed that smoking and alcohol are the strongest independent risk factors responsible for increased risk of HNC and are further having synergetic correlations. Conclusion: The present study confirms the principal role of alcohol consumption and smoking in HNC carcinogenesis, as well as the differential associations with HNC subtypes, and a significant, positive, multiplicative interaction with different risk factors.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Due to rarity and inadequate reporting, Multiple Primary Malignant Tumours (MPMTs) sti... more BACKGROUND Due to rarity and inadequate reporting, Multiple Primary Malignant Tumours (MPMTs) still create a perplexing situation in our clinics. However, they are on an increasing trend as result of better investigative work up and treatment modalities leading to prolonged survival. Database maintenance is must to report them. We are hereby reporting a case series to add to the limited literature available and help define investigational and treatment strategy. MATERIALS AND METHODS Database of our institute from year 2012 to 2018 was searched for patients with MPMTs and they were categorized in metachronous and synchronous malignant tumours. We also studied the various parameters simultaneously, pertaining to their clinical presentation, work up, performance status, management and outcome. RESULTS 17 were found to have multiple malignancies out of 15,922 patients. In them 7-patients had synchronous primary malignancies and 10-patients have single primary malignancy at presentation and developed subsequent second malignancies over a period of 4-months to 11-years. Maximum number of first malignancies was of the head and neck region followed by breast. CONCLUSION Getting a MPMT diagnosed is a challenge for both patient and treating clinician. Prognosis should not be considered poor in such patients per se but early and meticulous work up and diagnosis is prerequisite for radical treatment. This case series will help in providing insight into the management of such patients, however a tailored approach based on the experience of clinician, patients' performance status and available resources is must.
Journal of Evidence Based Medicine and Healthcare, 2016
A rare case of trichilemmal carcinoma in a 40-year-young female is reported. She presented with a... more A rare case of trichilemmal carcinoma in a 40-year-young female is reported. She presented with a horny ulcerated lesion over anterior aspect of left arm. Strong history of exposure to sun, which is the main contributory factor for its aetiopathogenesis is present. Patient underwent wide surgical excision and diagnosis was established on histopathological examination with positive surgical margins. Hence adjuvant radical radiotherapy was administered. She is now on disease free followup for last 4 years.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Coexisting ovarian and breast carcinomas in a single patient are very rare with only i... more BACKGROUND Coexisting ovarian and breast carcinomas in a single patient are very rare with only infinitesimal cases reported in literature. The two cancers are either detected at the same time (synchronous) or one may follow the other after a period of time (metachronous). Although, breast and ovarian cancers are one of the commonest tumours in females, yet a coexisting primary involving both organs in a single patient is a rarity in medical literature prompting us to publish this article.
Current Practice in Medical Science Vol. 6
Emerging Trends in Disease and Health Research Vol. 9
Journal of Biology and Today`s World, 2019
We are presenting a 2-year male child with large abdominal mass extending from right inguino-scro... more We are presenting a 2-year male child with large abdominal mass extending from right inguino-scrotal region to suprapubic region of size 4.0 × 5.0 cm. Mass causing pressure effect over bilateral kidneys and ureters with bilateral dilated renal pelvis and extending into the right inguinal region and pelvis. Histopathologically and immunocytochemically patient was confirmed as rhabdomyosarcoma of the retroperitoneum. Patient treated with six cycles of infusion chemotherapy with 3- weekly VAC regimen and was having progressive disease because of the aggressive behaviour of the disease and further treated with second line chemotherapy. The present case is a very unusual and rare site of metastatic presentation of the Rhabdomyosarcoma.
Journal of Cancer Prevention & Current Research, 2018
Background and Aims: Head and neck cancer accounts for 4.8% of all cancers globally and 13.9% of ... more Background and Aims: Head and neck cancer accounts for 4.8% of all cancers globally and 13.9% of all cancers in India. 1 In Indian setting, more than 70% patients present in locally advanced stage and with poor general condition and are suitable candidates for palliative radiotherapy. The present prospective, randomized study was planned to comparatively evaluate the efficacy, tolerability and toxicity of two schedules of palliative radiotherapy in patients of locally advanced head & neck cancer (LAHNC). Methods: The present study was carried out on histopathological proven and inoperable 60-patients of LAHNC. Patients in group I received total external radiation dose of 40Gy, 4Gy/fraction, and 2fractions a week for 5weeks. Group II patients received 20Gy in 5fractions in 5days followed by 3week gap followed by 20Gy in 5fractions in 5days. The groups were compared in terms of local tumor control and adverse effects of radiation. Results: All patients were of stage IV and 83% had nodal involvement. At the end of treatment for local disease, complete response (CR) in group I was better than group II (13.2% vs 3.3%) and complete nodal response was seen in 17% patients in each group. Disease status at 6months of follow up was 27% vs 23% complete tumor response and 30% vs 24% complete nodal response in group I and II respectively. Overall no evidence of disease (NED) was seen in 13% in group I and 17% in group II. Grade 3 skin radiation reactions were only seen in 1-patient of group II, however, grade 3 mucosal radiation reactions were seen in 20% patients in group I and 7% in group II. Seven patients in group I required nasogastric feeding tube as compared to 3-patients in group II. Grade 3 subcutaneous toxicity was equally present in 3% in each group. Conclusions: In this study we observed that both the schedules of radiotherapy are equally effective in tumor control and have comparable toxicity profile. Hence, to decrease the patient load in tertiary care institutes, it is recommended to use fractionation schedule with two radiotherapy fractions per week.
International Journal of Scientific and Research Publications (IJSRP), 2021
Introduction: Primary brain tumors are uncommon tumors demonstrating characteristics histopatholo... more Introduction: Primary brain tumors are uncommon tumors demonstrating characteristics histopathological features. Variation of demographic profiles of these intracranial malignant tumors in different regions worldwide was there and understanding of these helps in prompt diagnosis and establish appropriate treatment strategy. Different nations have established their brain tumor registry. The current study also focusses on demographic profiles, treatment schedules and survival rates of patients with a brain tumor who attended in a tertiary care hospital in a northern state of India. Material and Methods: Records of primary brain tumor patients over a period of 5-years were reviewed retrospectively. These records were analyzed for incidence, demographic pattern, different treatment modalities and their response evaluation. Results: A total 168-patients of primary brain tumors were identified. The median age at presentation was 47-years and males slightly outnumbered females. Among all the tumors, frontal lobe involvement was most predominant and most common presentation was headache. Astrocytoma constituted the predominant histopathological types and glioblastoma forms the largest subtypes of astrocytic tumors. Majority of patients underwent surgery followed by adjuvant radiation therapy with concurrent oral temozolomide. Overall average survival was 23-months, with 17 patients had follow-up of more than 4-years. Clinically, the response at last follow-up was CR in 29% and PR in 41%. Conclusion: Despite the fact that primary brain tumors are rare in our country, noticeable state-wise variation in incidence, demographic profile and mortality has been noted. The histopathological pattern of primary brain tumors in our institution established astrocytic tumors as the major health burden and gross total resection followed by radiotherapy with or without concurrent temozolomide is standard of care. The present study had several limitations, including its retrospective design, which may introduce selection bias. Finally, it is recommended to develop nationwide proper atlas of the cancer patients so that exact geographical plotting of the patients can be done to establish the accuracy of the scattered data.
We report here a rare case of primary malignant melanoma of the female urethra. A 60-year-old fem... more We report here a rare case of primary malignant melanoma of the female urethra. A 60-year-old female presented at our hospital with a two month history of painful lump right inguinal region, dysuria, poor stream, gross hematuria, intermittent blood spots and a mass at the external urethral meatus. The physical examination revealed a soft, small, peanut-sized lesion through the urethral orifice. The mass was tan colored, non ulcerated, and protruded from the external urethral meatus. It was resected by wide local excision under spinal anesthesia. The histopathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen showed evidence of metastasis to liver. We discuss the clinicopathologic features and treatment of this tumor.
For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a maj... more For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a major worldwide risk to public health. Although it is still more prevalent in developing countries; there is a recent positive growth pattern in developed countries, more so 2000 onwards, as a consequences of higher prevalence of hepatitis C infection and increase in consumption of alcohol. Further appearance of extrahepatic metastasis makes it more vulnerable. New multimodality approaches are explored in literature for advanced metastatic disease which are unresectable. Although local therapy and liver transplant are carried out in a lots of case series, targeted therapies are still the standard of care in many centres especially for inoperable, metastatic cases. Here we present an atypical case of multifocal hepatocellular carcinoma with extrahepatic adrenal metastasis treated by oral targeted agent sorafenib only.
Clinical Infection and Immunity, 2020
International Journal of Innovative Science and Research Technology, 2020
Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and six... more Esophageal cancer is the seventh most common cancer constituting 3.2% of all cancer cases and sixth most common cause of mortality constituting 5.3% cases worldwide in 2018. Most common presenting symptom is dysphagia which is seen in 80–90% of patients. Most patients present in locally advanced stage and because of extensive local disease palliative radiotherapy plays a significant role. Aim and objectivesAim of the study was to compare two palliative radiotherapy schedules- 30 Gy in 10 fractions over 2- weeks versus 20 Gy in 5 fractions over 1-week in locally advanced carcinoma esophagus. Objectives were to compare above schedules based upon symptomatic relief and tolerability by the patient. Material and methodsThe study was a randomized control study done from July 2017 - December 2018 on 60 previously untreated, histo-pathologically proven patients of squamous cell carcinoma esophagus (locally advanced) reporting in the Department of Radiation oncology, Pandit B. D. Sharma PGIM...
Journal of Cancer Research and Therapeutics, 2020
Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the s... more Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity.
World Journal of Oncology, 2018
Background: Bone is a common site of dissemination in advanced cancer accounting for one-third of... more Background: Bone is a common site of dissemination in advanced cancer accounting for one-third of all distant metastases. Various fractionation schedules of radiotherapy have been used for palliation of bone metastases. The aim of this study was to compare three schedules of external radiation therapy (8 Gy single session versus 20 Gy/5 fractions versus 30 Gy/10 fractions) for palliative management of bone metastases. Methods: In the present study, 60 patients of bone metastases from any primary site were enrolled and randomly divided into three groups of 20 patients each by draw of lots. These patients received palliative external beam radiation therapy to the involved site. Patients were given 8 Gy single session, 20 Gy/5 fractions/1 week and 30 Gy/10 fractions/2 weeks in groups I, II and III, respectively. Results: The percentage of patients with overall pain relief was 80% in group I, 75% in group II and 85% in group III (P = 0.7). The number of patients with complete pain relief was 4 (20%) in each group. Maximum patients got pain relief at 4 weeks post-radiotherapy. The number of patients with improved performance status was 4 (20%) in group II and 2 (10%) each in groups I and III (P = 0.5). Thirteen (65%) patients in each of the groups had decreased analgesic requirement at 2-month follow-up. Retreatment rate was more in the single fraction (20%) compared to only 5% in group II and none in the group III (P = 0.05). Conclusion: From the present study we conclude that 8 Gy single fraction is as effective as multifraction radiotherapy for the palliation of painful bone metastases. However, for a center like ours being the only Government Tertiary Cancer Care Centre in the State, general consensus drawn after this study, recommends external radiation therapy 20 Gy/5 fraction regimen to be an appropriate means of palliation of painful bone metastases.
Journal of Cancer Prevention & Current Research, 2018
Malignant nodular hidradenoma is very rare adnexal tumor with exceedingly low incidence of 0.001%... more Malignant nodular hidradenoma is very rare adnexal tumor with exceedingly low incidence of 0.001%. The biological behavior of the tumor is aggressive, with local recurrences reported in more than 50% of the surgically-treated cases. Treatment options are surgery and/or Radiotherapy. Till date there is no clear consensus on its treatment. We report a rare case of malignant nodular hidradenoma nose in an 80-years old male who responded miraculously to Radiotherapy.
Journal of Cancer Research and Immuno-Oncology, 2018
Background: The aim of the study was to evaluate and compare the efficacy, tolerability and toxic... more Background: The aim of the study was to evaluate and compare the efficacy, tolerability and toxicity of two palliative radiotherapy (RT) schedules in locally advanced head and neck carcinoma (LAHNC), i.e., Quad Shot schedule with chemotherapy and Quad Shot schedule alone. Methods: The patients were randomly divided into two groups of 30 each. Group I patients were planned for 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles. All these patients also received paclitaxel 60 mg/ m 2 intravenous. Group II patients received 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles alone. All these patients in Group I and II received total radiation dose of 44.4 Gy. Results: At the end of treatment, complete tumor response (CR) in Group I was better than Group II (40% vs. 36.7%). Disease status (tumor+node) at the end of treatment in terms of complete response was 36.7% vs. 0% (11/30 and 0/30) in Group I and II. Disease status at 6 months of follow up was noted as follows: complete tumor response in Group I and II was 23.3% (7/30) vs. 10% (3/30) (p=0.012). Complete nodal response was 35.7% (10/28) in Group I and 6.67% (02/30) in Group II (p= 0.538). Overall, no evidence of disease was observed in 16.7% (5/30) in Group I and 3.3% (1/30) in Group II respectively (p<0.001). Conclusion: This palliative schedule has been shown to provide good tumor response and palliation of symptoms. The toxicity profile remains low with the addition of paclitaxel. Further investigation is warranted in a larger trial. Palliation of symptoms resulted in improved quality of life for these group of patients
Journal of Cancer Prevention & Current Research, 2018
Background: Angio centric NK/T-cell lymphoma represents a rare malignant entity, characterized by... more Background: Angio centric NK/T-cell lymphoma represents a rare malignant entity, characterized by progressive and relentless destruction of the affected tissues. Typically, this type of lymphoma originates in the nasal cavity, the palate or midfacial region characterized by vascular invasion and unrelenting destruction of the midline structures of the palatine structures and nasal fossa causing severe pain. Epstein-Barr virus (EBV) infection has important pathogenetic role as it has been isolated in practically all cases of angiocentric NK/T-cell lymphoma. The prognosis of locally advanced cases remains very poor despite treatment. Case presentation: We are reporting a case of a 45year young female with an advanced angiocentric NK/T-cell lymphoma who had progression to deep necrotic ulcer in the midline of palate destroying palatal tissues thus creating an oronasal fistula complicated with secondary infection. Patient received standard CHOP regimen with high palliative external beam radiotherapy followed by metronomic chemotherapy with lenalidomide and have considerable regression of localized disease and got superb palliation. Conclusion: Combination of locoregional radiotherapy and CHOP chemotherapy are the mainstay of treatment till now. Prosthetic treatment of possible oronasal fistulas/defects can significantly improve the patient's quality of life. Present case highlights the important role of local radiotherapy and metronomic chemotherapy with lenalidomide for symptomatic improvement.
World Journal of Oncology, 2018
Background: Head and neck cancer (HNC) is the seventh most common type of cancer in the world and... more Background: Head and neck cancer (HNC) is the seventh most common type of cancer in the world and constitute 5% of the entire cancers worldwide. The global burden of HNC accounts for 650,000 new cases and 350,000 deaths worldwide every year and a major proportion of regional malignancies in India. More than 70% of squamous cell carcinoma of the head and neck are estimated to be avoidable by lifestyle changes, particularly by effective reduction of exposure to well-known risk factors such as tobacco smoking and alcohol drinking. Methods: A retrospective analysis of 12 years (2001-2012) of HNC patients attending RCC, PGIMS Rohtak was done. Total numbers of cancer patients seen were 26,295 and out of these 9,950 patients were of HNCs, which were retrospectively analyzed for their associated risk factors in different HNC subtypes. Most of the patients, i.e. 92.3%, were presented as locally advanced HNC (stages III and IV). Results: It has been observed that smoking and alcohol are the strongest independent risk factors responsible for increased risk of HNC and are further having synergetic correlations. Conclusion: The present study confirms the principal role of alcohol consumption and smoking in HNC carcinogenesis, as well as the differential associations with HNC subtypes, and a significant, positive, multiplicative interaction with different risk factors.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Due to rarity and inadequate reporting, Multiple Primary Malignant Tumours (MPMTs) sti... more BACKGROUND Due to rarity and inadequate reporting, Multiple Primary Malignant Tumours (MPMTs) still create a perplexing situation in our clinics. However, they are on an increasing trend as result of better investigative work up and treatment modalities leading to prolonged survival. Database maintenance is must to report them. We are hereby reporting a case series to add to the limited literature available and help define investigational and treatment strategy. MATERIALS AND METHODS Database of our institute from year 2012 to 2018 was searched for patients with MPMTs and they were categorized in metachronous and synchronous malignant tumours. We also studied the various parameters simultaneously, pertaining to their clinical presentation, work up, performance status, management and outcome. RESULTS 17 were found to have multiple malignancies out of 15,922 patients. In them 7-patients had synchronous primary malignancies and 10-patients have single primary malignancy at presentation and developed subsequent second malignancies over a period of 4-months to 11-years. Maximum number of first malignancies was of the head and neck region followed by breast. CONCLUSION Getting a MPMT diagnosed is a challenge for both patient and treating clinician. Prognosis should not be considered poor in such patients per se but early and meticulous work up and diagnosis is prerequisite for radical treatment. This case series will help in providing insight into the management of such patients, however a tailored approach based on the experience of clinician, patients' performance status and available resources is must.
Journal of Evidence Based Medicine and Healthcare, 2016
A rare case of trichilemmal carcinoma in a 40-year-young female is reported. She presented with a... more A rare case of trichilemmal carcinoma in a 40-year-young female is reported. She presented with a horny ulcerated lesion over anterior aspect of left arm. Strong history of exposure to sun, which is the main contributory factor for its aetiopathogenesis is present. Patient underwent wide surgical excision and diagnosis was established on histopathological examination with positive surgical margins. Hence adjuvant radical radiotherapy was administered. She is now on disease free followup for last 4 years.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Coexisting ovarian and breast carcinomas in a single patient are very rare with only i... more BACKGROUND Coexisting ovarian and breast carcinomas in a single patient are very rare with only infinitesimal cases reported in literature. The two cancers are either detected at the same time (synchronous) or one may follow the other after a period of time (metachronous). Although, breast and ovarian cancers are one of the commonest tumours in females, yet a coexisting primary involving both organs in a single patient is a rarity in medical literature prompting us to publish this article.