samit purohit - Academia.edu (original) (raw)

Papers by samit purohit

Indian Journal of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology, 2014

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique r... more Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique radio imaging appearance. We describe this rare, mostly reversible condition in five cases undergoing similar treatment under preset protocol (MCP-841) for acute lymphoblastic leukemia (ALL) at our centre. Hypertension is a well-known adverse effect of high-dose corticosteroid therapy primarily mediated by its effects on the mineralocorticoid receptor especially in pediatric population and we hypothesize that this may be the etiology of PRES in two of these patients.

Indian Journal of Public Health Research and Development, 2012

Plasmablastic lymphoma (PBL) is a rare variant of a diffuse B-cell lymphoma that is most commonly... more Plasmablastic lymphoma (PBL) is a rare variant of a diffuse B-cell lymphoma that is most commonly found in the oral cavity affecting the mucosa, and so named for its blastoid morphology and immunophenotype. Oral PBL has been treated heterogeneously and well defined treatment guidelines are still lacking. It includes chemotherapy, radiotherapy, combination of both or local excision followed by radiation. Prognosis is usually poor regardless of the site of origin. The clinical course is very aggressive with most of the patients dying in the first year after diagnosis. Here we present a case who was treated with high grade lymphoma protocol, CODOX-M alternating with IVAC followed by radiotherapy & Patient showing a good clinical response.

Annals of Oncology, 2012

ABSTRACT Introduction GIST represents an uncommon form of malignancy and one of best paradigms of... more ABSTRACT Introduction GIST represents an uncommon form of malignancy and one of best paradigms of molecularly targeted therapy. While the natural history of GIST following treatment with imatinib mesylate is relatively well known from various series in western literature, rarely any series from developing world has been published in this regard. Methods Forty four GISTs cases diagnosed and treated with imatinib between 2003 and 2009 were retrieved from the Department of Medical Oncology database, KMIO, Bangalore. Their clinical, histopathological data and treatment outcome were analysed. Kaplan Meier survival analysis was done. Anatomic site, tumor size, mitotic activity and extent of resection were correlated with overall survival using the Log Rank test. Results Median age was 56 years (range 21-68 years) with a male : female ratio of 2:1.Stomach (52%) was the most commonly involved site followed by small intestine (36%). Twenty nine cases had disease localized to a single site and 15 cases were metastatic at presentation. Mean tumor size was 10.5 cm (range 4–18cm) and mitotic rate of 6 (range 4-9)/50 HPF. NIH 2002,” Fletchers” criteria was applied for non metastatic disease, none had very low risk, 1 case (3%) had low risk, 10 (34%) intermediate and 18 (65%) belonged to high risk. All cases underwent upfront surgery with R0 resection (84%), R1 (13%) and R2 resection in 3%cases followed by imatinib (400 mg/day) for duration of one year. Metastatic sites in descending frequency of involvement were liver (85%), peritoneum (13%), omentum (6%) and lungs (1%). None had lymph node or soft tissue involvement. In the adjuvant group, median follow-up was 42 months (m) (range 10-70 m).Estimated recurrence free survival (RFS) and overall survival (OS) at 42 m were 59.9 % and 80.6 % respectively. In metastatic group, median follow up was 28 months (range 2-54 m). The median progression free survival (PFS) and OS were 18m [95 %CI 8.65m – 27.34 m] and 28m [95 %CI 17.90 m-38.09 m] respectively. Estimated PFS and OS at 28 months were 38.7% and 46.7% respectively. Non gastric GIST, R2 resection, tumor size (> 10 cm) and mitotic rate>5 (per 50 HPF) were associated with negative impact on survival Conclusion Non gastric GISTs, R1, R2 resection, tumor size (> 10cm) and mitotic rate>5/50 HPF had a negative impact on survival. However, one limitation of our study is the small sample size. This obviates the need for larger prospective studies to determine the optimal duration of adjuvant therapy across various risk groups.

Indian journal of surgical oncology, 2012

Ecancermedicalscience, 2013

Primary non-Hodgkin's lymphoma of bone (PNHLB) accounts for less than 5% of all primary bone ... more Primary non-Hodgkin's lymphoma of bone (PNHLB) accounts for less than 5% of all primary bone tumours and less than 1% of all non-Hodgkin's lymphoma. Due to its rarity, only a few retrospective studies have been published describing the prognosis and its treatment. We report our experience of 20 cases of PNHLB with their clinicopathologic correlation that were treated at our centre over a period of ten years. There were 16 cases of the mono-ostotic subtype and four cases of poly-ostotic subtype. All of these had a histological diagnosis of diffuse large B-cell lymphoma. The age of presentation was fifth to sixth decade. The mono-ostotic subtype commonly presented with the involvement of femur or humerus, while the poly-ostotic subtype commonly had paraparesis due to vertebral involvement. Cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)-based chemotherapy was given to all patients, but definitive radiotherapy was used only in the mono-ostotic subtype. At median f...

Indian journal of surgical oncology, 2011

Soft tissue sarcomas (STS) comprise 1% of all cancers diagnosed worldwide with more than 40 diffe... more Soft tissue sarcomas (STS) comprise 1% of all cancers diagnosed worldwide with more than 40 different histological subtypes each with distinct underlying biology, natural history and response to treatment. Due to the differential chemosensitivity it is imperative to have a correct histological diagnosis for optimal treatment of these patients. Even though surgery remains the primary modality of treatment there is increasing specialization of chemotherapy with respect to histological subtype. In general there is no place for "one size fits all strategy". To correctly define the role of chemotherapy, an extensive search was carried out online and offline for all relevant articles concerning chemotherapy in soft tissue sarcoma. This review aims to discuss the evolution of chemotherapy, its present role in neoadjuvant, adjuvant, metastatic settings and exciting trends with the advent of targeted therapies.

Indian Journal of Surgical Oncology, 2013

L-Asparginase is a frequently used drug in hematological malignancies. Various side effects assoc... more L-Asparginase is a frequently used drug in hematological malignancies. Various side effects associated with its use include hypersensitivity, hyperglycemia, hypercoaguability and acute pancreatitis. We describe a rare complication of pancreatic pseudocyst in a 12 year old boy of Acute lymphoblastic leukemia (ALL) treated with MCP-841 protocol (during re-induction phase). Nearing the end of induction i.e. day 25, patient complained of a painful swelling in the epigastrium and left hypochondrium. Investigations revealed a pancreatic pseudocyst for which he underwent cystojejunostomy. Post surgical period was uneventful.

Hereditary Cancer in Clinical Practice, 2014

The association of neurofibromatosis type I with invasive male breast cancer is a rare clinical e... more The association of neurofibromatosis type I with invasive male breast cancer is a rare clinical entity with only one case in literature reported in 1953. Women with NF1 are at risk of developing breast cancer and men also may be at risk but there is scarce data on the risk and association of NF1 with male breast cancer due to its rarity. Established clinical trials in male breast cancer patients are lacking and the results are extrapolated from female breast cancer patients. The treatment of male breast cancer is followed as per the guidelines of premenopausal female breast cancer and tamoxifen is the hormone treatment in them. Mendes et al suggests that silencing of NF1 gene confers resistance to tamoxifen. Our conclusions are that since NF1 is mutated or deleted in one third of sporadic breast cancers, its role as a molecular driver for treatment has to be further explored.

Clinical Cancer Investigation Journal, 2014

Background: Gastrointestinal stromal tumors (GIST) represent an uncommon form of malignancy and o... more Background: Gastrointestinal stromal tumors (GIST) represent an uncommon form of malignancy and one of best paradigms of molecularly targeted therapy. While the natural history of GIST following treatment with imatinib mesylate is relatively well known from various series in western literature, rarely any series from India has been published in this regard. Materials and Methods: Forty-four GISTs cases diagnosed and treated with imatinib between 2005 and 2011 were retrieved from the Department of Medical Oncology database, KMIO, Bangalore. Their clinical, histopathological data, and treatment outcome were analyzed. Kaplan-Meier survival analysis was done. Anatomic site, tumor size, mitotic activity, and extent of resection were correlated with overall survival (OS) using the logrank test. Results: Median age was 56 years with a male: female ratio of 2:1. Stomach was the most common site involved. Twenty-nine patients had localized disease of which majority had high risk (65%) features, with a mean tumor size of 10.5 cm (range 4-18 cm) and mitotic rate of 6 (range 4-9)/50 high-power field (HPF). Fourteen patients had metastatic disease at presentation with liver being the most common site. In the adjuvant group, median follow-up was 42 months (m) (range 10-70 m). Estimated recurrence free survival (RFS) and OS at 42 m were 59.9 and 80.6%, respectively. In metastatic group, median follow-up was 28 m (range 2-54 m). The median progression free survival (PFS) and OS were 18 m (95% CI 8.65-27.34 m) and 28 m (95% CI 17.90-38.09 m), respectively. Estimated PFS and OS at 28 m were 38.7 and 46.7%, respectively. Conclusion: Patients with GIST still present with larger bulky tumor at diagnosis, this leads to slightly inferior survival in our scenario. Nongastric GISTs; R1 and R2 resection; and mitotic rate >5/50 HPF are the other a factors which have a negative impact on survival.

Objective: To evaluate the efficacy of imatinib in chronic myeloid leukemia patients with variant... more Objective: To evaluate the efficacy of imatinib in chronic myeloid leukemia patients with variant translocations. Methods: Forty eight chronic myeloid leukemia patients carrying variant translocations and treated with imatinib at our institute were considered for the study. Survival and response rates were evaluated. Results: The median follow up was 48 months(m). Forty three (89.58%) patients achieved complete hematologic response. Thirty one (64.58%) patients achieved complete cytogenetic response and 19(39.58%) achieved major molecular response anytime during their follow up period. Only 18.75% of the patients achieved complete cytogenetic response and major molecular response within the stipulated time frames. The estimated overall survival at 48 m median follow up was 81.2%.The progression free survival was also 81.2% and the event free survival was 79.1%.There was no significant survival difference between low vs intermediate and high risk sokal group. Conclusion: We report suboptimal responses to imatinib in chronic myeloid leukemia with variant translocations. Further studies with imatinib and the newer more active drugs dasatinib and nilotinib are justified.

Leukemia & Lymphoma, 2012

Chronic myeloid leukemia (CML) is a rare disease in children, accounting for 2-3% of leukemias in... more Chronic myeloid leukemia (CML) is a rare disease in children, accounting for 2-3% of leukemias in this age group. Few studies have reported on efficacy of imatinib in childhood CML. The purpose of this retrospective study was to determine the efficacy of imatinib in children. A total of 43 patients from age 7 years to 20 years with newly diagnosed CML received imatinib daily at 260 mg/m(2). Response rates, survival and toxicity were evaluated. The median follow-up was 43 months. All patients achieved a complete hematological response. Twenty-five (58.1%) patients achieved a complete cytogenetic response and 18 (41.9%) achieved a major molecular response at any time during their follow-up period. Both overall survival and progression-free survival at 43 months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; median follow-up were 100%. Event-free survival was 92.8%. Imatinib was well tolerated. We conclude that imatinib is effective in children and adolescents with CML.

Online Journal of Health & Allied Sciences, 2013

Endometrial cancer is a chemosensitive disease. Studies have established a clear benefit of chemo... more Endometrial cancer is a chemosensitive disease. Studies have established a clear benefit of chemotherapy in advanced stages and trials are ongoing to define its role in early stages as well. As more molecular pathways are being elucidated there is increasing role for targeted agents and future looks quite promising. We did an extensive search both online and offline for all the relevant articles including chemotherapy and targeted therapy for endometrial cancer.

Indian journal of surgical oncology, 2013

Head and neck cancers comprise a heterogenous group of cancers that require a multidisciplinary a... more Head and neck cancers comprise a heterogenous group of cancers that require a multidisciplinary approach. Last few decades have seen an increasing role of chemotherapy with intent of treatment shifting from palliation to cure. We performed a thorough search online and offline for all relevant articles of chemotherapy in head and neck cancer. Cancers of nasopharynx and salivary glands were excluded.