ayush Garg - Academia.edu (original) (raw)

Papers by ayush Garg

Research paper thumbnail of Time to review the role of intraluminal brachytherapy for dose escalation after concurrent chemoradiation in cancer esophagus: A retrospective audit

Journal of Clinical Oncology, 2021

e16054 Background: Intraluminal brachytherapy (ILBT) for dose escalation after concurrent chemora... more e16054 Background: Intraluminal brachytherapy (ILBT) for dose escalation after concurrent chemoradiation (CRT) in cancer esophagus is not routinely practiced. This is particularly attributable to radiotherapy toxicity in terms of strictures and fistulas. Cancer esophagus has poor locoregional control and overall survival rates in comparison to head and neck cancers. Dose escalation may be an option to counteract the high failure rates. Methods: A retrospective analysis was conducted for esophageal cancer patients treated between 2008 to 2016 planned for radical CRT to a minimum dose of 59.4 Gy in 33 fractions along with concurrent cisplatin 35 mg/m2 and 5 FU 375 mg/m2 on weekly basis. Further, the patients who received dose escalation after external beam radiotherapy (EBRT) completion by ILBT to a dose of 6 Gy in a single fraction to the pre EBRT volume were also analysed. The patient, tumor, treatment characteristics along with response rates, survival outcomes, and toxicities were...

Research paper thumbnail of Does weekly versus daily low-dose of concurrent cisplatin have any effect on compliance and clinical outcomes in cases of locally advanced head and neck cancers?

Journal of Clinical Oncology, 2019

e17569 Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced s... more e17569 Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced squamous cell carcinomas of the head neck.Cisplatin at 35mg/m2(weekly) raise compliance & hospitalization. There are only few reports on efficacy and toxicity of low dose Cisplatin (6mg/m2). Hence the purpose of this study was to evaluate the compliance and clinical outcomes between two concurrent cisplatin chemotherapy regimens & to see long term effects. Methods: Total 50 patients were included in study from Nov 2015 to Mar 2017 with 25 in each group. Radiotherapy given 70Gy/35# in 7weeks & Cisplatin at 35mg/m2 weekly (Group I) and 6mg/m2 daily (Group II). Assessment of toxicity was done by RTOG scoring criteria. WHO Response criterion was used to assess clinical response. Median follow up was 6 months. Results: Group I(80%) and Group II(84%)patients completed Radiotherapy. In Group I 48% patients received less than 6 cycles and Group II 40% received ≤25 cycles chemotherapy. Median OTT ...

Research paper thumbnail of Cancer Cervix with Skin Metastasis-A Case Report with Review of Literature

SRMS Journal of Medical Science, 2016

Introduction: Carcinoma of the uterine cervix is seventh most common malignancy globally, however... more Introduction: Carcinoma of the uterine cervix is seventh most common malignancy globally, however, it is the most common neoplasm among rural In¬dian women. Skin metastases is rare even in the late stages of the disease, the reported inci-dence ranges from 0.1 to 2%.Frequent sites of cutaneous metastasis are abdominal wall, vulva and anterior chest wall. Case History: Fifty four years female of carcinoma cervix FIGO stage IIIB was radically treated with concurrent chemoradiation. On follow, after 10 months, she presented with multiple subcutaneous nodules in the right forearm and arm along with lung metastasis. Fine needle aspiration cytology from the nodular lesions was positive for squamous cell carcinoma. She was given chemotherapy but expired within eight months. Conclusion: Skin metastasis is considered as an ominous sign of widespread terminal disease with short survival.

Research paper thumbnail of Reducing planning target volume margins decreases dose to parotid glands in head and neck cancers - a dosimetric analysis

International Journal of Medical Research and Review, 2019

Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup ... more Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup and reproducibility is a challenge. This daily variability causes setup errors which accounts planning target volume margins. Reduced PTV margins have to be taken to decrease the dose to the parotid glands, without compromising on loco regional control rates. The present study is done to identify setup errors and see the feasibility to decrease the PTV margins by creating dummy radiotherapy plans in order to decrease dose to parotid glands. Material and Methods: 420 portal images were evaluated for setup errors in three dimensions (Antero Posterior, Left to Right and Superior to Inferior) which were performed in ten patients of oropharyngeal squamous cell carcinoma. All patients were treated in supine position using immobilization cast. After target volume delineation a PTV margin of 7 mm was given. Dosimetric parameters of PTV and organs at risk were assessed. PTV margins were calculated according to three methods proposed by Stroom, Van Herk and ICRU 62. Dummy radiotherapy plans were generated using new PTV margins and compared with 7mm PTV margins. The data was analyzed using 3-way ANNOVA test for statistical significance. Results: The optimum PTV margins were 4mm in LR and SI direction and 7mm in AP direction. The PTV parameters (V95, D95, Dmax, Dmean, HI and CI) had no significant difference among different radiotherapy plans with different PTV margins. There was a significant decrease in the dose to right parotid (39.12 Gy to 32.88Gy; p-0.04), left parotid (37.90 to 31.21Gy; p-0.03) and parotid combined (38.65 to 31.45 Gy; p-0.01) when 7mm PTV margins were reduced to 4mm PTV margins. The results of dummy radiotherapy plans using asymmetric PTV margins (LR-4mm, SI-4mm and AP-7mm) and symmetrical PTV margins (4mm in all directions) are compared with PTV margins (7mm in all directions), in terms of PTV and OAR dosimetric parameters. Conclusion: The decreased PTV margins of 4mm decreases the dose to the parotid significantly. The implementation of radiotherapy plans needs to be supplemented by daily IGRT.

Research paper thumbnail of Time to review the role of intraluminal brachytherapy for dose escalation after concurrent chemoradiation in cancer esophagus: A retrospective audit

Journal of Clinical Oncology, 2021

e16054 Background: Intraluminal brachytherapy (ILBT) for dose escalation after concurrent chemora... more e16054 Background: Intraluminal brachytherapy (ILBT) for dose escalation after concurrent chemoradiation (CRT) in cancer esophagus is not routinely practiced. This is particularly attributable to radiotherapy toxicity in terms of strictures and fistulas. Cancer esophagus has poor locoregional control and overall survival rates in comparison to head and neck cancers. Dose escalation may be an option to counteract the high failure rates. Methods: A retrospective analysis was conducted for esophageal cancer patients treated between 2008 to 2016 planned for radical CRT to a minimum dose of 59.4 Gy in 33 fractions along with concurrent cisplatin 35 mg/m2 and 5 FU 375 mg/m2 on weekly basis. Further, the patients who received dose escalation after external beam radiotherapy (EBRT) completion by ILBT to a dose of 6 Gy in a single fraction to the pre EBRT volume were also analysed. The patient, tumor, treatment characteristics along with response rates, survival outcomes, and toxicities were...

Research paper thumbnail of Does weekly versus daily low-dose of concurrent cisplatin have any effect on compliance and clinical outcomes in cases of locally advanced head and neck cancers?

Journal of Clinical Oncology, 2019

e17569 Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced s... more e17569 Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced squamous cell carcinomas of the head neck.Cisplatin at 35mg/m2(weekly) raise compliance & hospitalization. There are only few reports on efficacy and toxicity of low dose Cisplatin (6mg/m2). Hence the purpose of this study was to evaluate the compliance and clinical outcomes between two concurrent cisplatin chemotherapy regimens & to see long term effects. Methods: Total 50 patients were included in study from Nov 2015 to Mar 2017 with 25 in each group. Radiotherapy given 70Gy/35# in 7weeks & Cisplatin at 35mg/m2 weekly (Group I) and 6mg/m2 daily (Group II). Assessment of toxicity was done by RTOG scoring criteria. WHO Response criterion was used to assess clinical response. Median follow up was 6 months. Results: Group I(80%) and Group II(84%)patients completed Radiotherapy. In Group I 48% patients received less than 6 cycles and Group II 40% received ≤25 cycles chemotherapy. Median OTT ...

Research paper thumbnail of Cancer Cervix with Skin Metastasis-A Case Report with Review of Literature

SRMS Journal of Medical Science, 2016

Introduction: Carcinoma of the uterine cervix is seventh most common malignancy globally, however... more Introduction: Carcinoma of the uterine cervix is seventh most common malignancy globally, however, it is the most common neoplasm among rural In¬dian women. Skin metastases is rare even in the late stages of the disease, the reported inci-dence ranges from 0.1 to 2%.Frequent sites of cutaneous metastasis are abdominal wall, vulva and anterior chest wall. Case History: Fifty four years female of carcinoma cervix FIGO stage IIIB was radically treated with concurrent chemoradiation. On follow, after 10 months, she presented with multiple subcutaneous nodules in the right forearm and arm along with lung metastasis. Fine needle aspiration cytology from the nodular lesions was positive for squamous cell carcinoma. She was given chemotherapy but expired within eight months. Conclusion: Skin metastasis is considered as an ominous sign of widespread terminal disease with short survival.

Research paper thumbnail of Reducing planning target volume margins decreases dose to parotid glands in head and neck cancers - a dosimetric analysis

International Journal of Medical Research and Review, 2019

Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup ... more Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup and reproducibility is a challenge. This daily variability causes setup errors which accounts planning target volume margins. Reduced PTV margins have to be taken to decrease the dose to the parotid glands, without compromising on loco regional control rates. The present study is done to identify setup errors and see the feasibility to decrease the PTV margins by creating dummy radiotherapy plans in order to decrease dose to parotid glands. Material and Methods: 420 portal images were evaluated for setup errors in three dimensions (Antero Posterior, Left to Right and Superior to Inferior) which were performed in ten patients of oropharyngeal squamous cell carcinoma. All patients were treated in supine position using immobilization cast. After target volume delineation a PTV margin of 7 mm was given. Dosimetric parameters of PTV and organs at risk were assessed. PTV margins were calculated according to three methods proposed by Stroom, Van Herk and ICRU 62. Dummy radiotherapy plans were generated using new PTV margins and compared with 7mm PTV margins. The data was analyzed using 3-way ANNOVA test for statistical significance. Results: The optimum PTV margins were 4mm in LR and SI direction and 7mm in AP direction. The PTV parameters (V95, D95, Dmax, Dmean, HI and CI) had no significant difference among different radiotherapy plans with different PTV margins. There was a significant decrease in the dose to right parotid (39.12 Gy to 32.88Gy; p-0.04), left parotid (37.90 to 31.21Gy; p-0.03) and parotid combined (38.65 to 31.45 Gy; p-0.01) when 7mm PTV margins were reduced to 4mm PTV margins. The results of dummy radiotherapy plans using asymmetric PTV margins (LR-4mm, SI-4mm and AP-7mm) and symmetrical PTV margins (4mm in all directions) are compared with PTV margins (7mm in all directions), in terms of PTV and OAR dosimetric parameters. Conclusion: The decreased PTV margins of 4mm decreases the dose to the parotid significantly. The implementation of radiotherapy plans needs to be supplemented by daily IGRT.