Publications by authors named "Supreeta Arya"

59 Publications

Imaging and Management of Rectal Cancer.

Semin Ultrasound CT MR 2020 Apr 24;41(2):183-206. Epub 2020 Jan 24.

Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR.

High-resolution phased array external magnetic resonance imaging (MRI) is the first investigation of choice in rectal cancer for local staging, both in the primary and restaging situations. Use of MRI helps differentiate between those with good prognosis, which can be offered upfront surgery and the poor prognostic cases where treatment intensification is needed. MRI identified poor prognostic factors are threatened or involved mesorectal fascia, T3 tumors with >5 mm extramural spread, those with extramural vascular invasion, pelvic sidewall nodes and mucinous tumors. At restaging, use of MRI helps evaluate response and an MR tumor regression grading system is being evaluated. Complete response seen on clinical examination and endoscopy, needs confirmation on MRI using both T2-weighted and diffusion-weighted sequences to justify a "watch and wait" approach. In this subset of patients, MRI also plays a role in monitoring and detecting early regrowth. In those with partial response, MRI helps define surgical margins and can be used as a roadmap to decide between sphincter preserving surgeries and radical sphincter sacrificing surgeries; pelvic exenteration and pelvic sidewall lymph node dissection. Poor responders on MRI may benefit from adjuvant chemotherapy. Use of MRI thus helps in individualizing treatment in rectal cancer.
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http://dx.doi.org/10.1053/j.sult.2020.01.001DOI Listing
April 2020

Letter to Editor in response to "Imaging in oral cancers: A comprehensive review. Oral Oncology 2020, 21;104:104658. Mahajan A, Ahuja A, Sable N, Stambuk HE".

Authors:
Supreeta Arya

Oral Oncol 2020 10 28;109:104735. Epub 2020 Apr 28.

Ex-Professor, Radiodiagnosis, Tata Memorial Centre; Member, Expert Committee, National Cancer Grid, India. Electronic address:

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http://dx.doi.org/10.1016/j.oraloncology.2020.104735DOI Listing
October 2020

Addition of short course radiotherapy in newly diagnosed locally advanced rectal cancers with distant metastasis.

Asia Pac J Clin Oncol 2021 Apr 7;17(2):e70-e76. Epub 2020 Feb 7.

Departments of Surgical Oncology (Colorectal diseases), Tata Memorial Centre, Mumbai, India.

Aim: To study the outcomes of patients presenting with locally advanced rectal cancers with distant metastasis (mLARC), treated with short course radiotherapy (SCRT).

Method: Between May 2012 and August 2015, 70 patients diagnosed with mLARC, treated with SCRT (25 Gy/5#) and three to six cycles of CAPOX chemotherapy (CT), were assessed for surgical feasibility for the primary and metastatic sites.

Results: Sixty-five patients could complete the planned SCRT and three to six cycles of CT. Response rate and disease control rate for the primary was 68% and 97%, respectively. Radiologically, CRM became free in 44 (72%) patients out of 61 initially involved. Fifty-two (74%) were planned to receive treatment with a potentially curative intent and 18 (26%) with palliative intent. Of those treated with curative intent, 34 (65%) underwent primary tumor resection (PTR). Successful intervention for metastatic disease was done in 27 (52%) patients. At a median follow up of 43 months, the median overall survival (OS) for patients undergoing PTR was 36 months versus 12 months for those in which the tumor was still unresectable or had distant progression (P < .001). Of the operated patients, 56% were alive at the end of 3 years. The median pelvic recurrence free survival was 29 months. Symptom control in the form of pain and bleeding control was observed in 80%.

Conclusion: The addition of SCRT to CT in mLARC can downstage the primary tumor to undergo surgery, thereby, achieving better loco-regional control and survival. It achieves good palliation in patients unable to undergo surgery due to extensive primary or metastatic disease.
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http://dx.doi.org/10.1111/ajco.13305DOI Listing
April 2021

Evaluation of quantitative imaging parameters in head and neck squamous cell carcinoma.

Q J Nucl Med Mol Imaging 2019 Sep 5. Epub 2019 Sep 5.

Department of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, India.

Background: Functional imaging such as 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT), 18F-fluoro-misonidazole (F-MISO)-PET/CT, and diffusion-weighted magnetic resonance imaging (DW-MRI) can assess complex biological phenomena in tumors reflecting underlying disease biology. The aim of this prospective observational study was to correlate quantitative imaging parameters derived from pre-treatment biological imaging such as FDG-PET/CT, F-MISO-PET/CT, and DW-MRI with each other andì with clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with definitive radio(chemo)therapy.

Methods: Twenty patients with pharyngo-laryngeal cancers underwent pre-treatment biological imaging. Gross tumor volume (GTV) was delineated on axial planning CT (GTVCT). Quantitative FDG-PET/CT parameters included maximum, mean, minimum standardized uptake values (SUVmax-FDG, SUVmean-FDG, SUVmin-FDG); metabolic tumor volume (MTV); and total lesion glycolysis (TLG). F-MISO-PET/CT parameters included hypoxic tumor volume (HTV); maximum, mean, minimum SUV; and fractional hypoxic volume (FHV). Mean apparent diffusion coefficient (ADCmean) was derived from DW-MRI.

Results: There was moderately strong positive correlation (r=0.616, p=0.005) between GTVCT and MTV. HTV derived from F-MISO-PET/CT at 3-hours (HTV3hrs-F-MISO) showed strong positive correlation with GTVCT (r=0.753, p<0.0001) and MTV (r=0.796, p<0.0001) respectively. ADCmean showed strong positive correlations with SUVmean-5hrs-F-MISO (r=0.713, p=0.021) and SUVmin-5hrs-FMISO (r=0.731, p=0.016) respectively. A moderate negative correlation (r=-0.500, p=0.049) was observed between ADCmean and MTV. At a median follow up of 44 months, the 5-year Kaplan-Meier estimates of loco-regional control, disease-free survival, and overall survival were 53%, 43%, and 40% respectively. Larger volume of primary tumor (GTVCT>22cc and MTV>7.9cc) and increasing hypoxia (HTV3hr-F-MSO>4.9cc) were associated with worse outcomes.

Conclusions: Functional imaging represents an attractive and non-invasive modality to assess complex biological phenomena in solid tumors. Larger tumor volume and increasing hypoxia emerged as putative prognostic imaging biomarkers in HNSCC.
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http://dx.doi.org/10.23736/S1824-4785.19.03179-0DOI Listing
September 2019

Rectal cancer lexicon: consensus statement from the society of abdominal radiology rectal & anal cancer disease-focused panel.

Abdom Radiol (NY) 2019 11;44(11):3508-3517

Department of Radiology, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil.

Standardized terminology is critical to providing consistent reports to referring clinicians. This lexicon aims to provide a reference for terminology frequently used in rectal cancer and reflects the consensus of the Society of Abdominal Radiology Disease Focused Panel in Rectal cancer. This lexicon divided the terms into the following categories: primary tumor staging, nodal staging, treatment response, anal canal anatomy, general anatomy, and treatments.
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http://dx.doi.org/10.1007/s00261-019-02170-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824987PMC
November 2019

Dose escalated concurrent chemo-radiation in borderline resectable and locally advanced pancreatic cancers with tomotherapy based intensity modulated radiotherapy: a phase II study.

J Gastrointest Oncol 2019 Jun;10(3):474-482

Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.

Background: We report the response and outcomes of borderline resectable and locally advanced pancreatic cancer (BRPC & LAPC) patients treated with dose escalated neoadjuvant intensity modulated radiotherapy (IMRT).

Methods: Thirty newly diagnosed patients with BRPC (n=18) and LAPC (n=12) (NCCN criteria V 2.2.12) were accrued in this prospective study from 2008-2011. All patients received neoadjuvant chemoradiation (NACRT) using Helical Tomotherapy (dose of 57 Gy over 25 fractions to the gross tumor volume (GTV) and 45 Gy over 25 fractions to suspected microscopic extension) along with weekly gemcitabine.

Results: Fifteen patients (50%) had a partial response. A complete metabolic response (CMR) on PET was seen in 9 patients (30%). Among BRPC, 9 patients (50%) were surgically explored and 7 underwent R0 resection (39%). The median follow up of surviving patients was 85 [interquartile range (IQR): 64.5-85.8] months. The median progression free survival (PFS) was 13 months for BRPC and 8.8 months for LAPC. The median overall survival (OS) was 17.3 months for BRPC and 11.8 months for LAPC. Among patients undergoing R0 resection, the median PFS and OS was 27 and 35.5 months respectively.

Conclusions: Dose escalated radiotherapy with concurrent chemotherapy is feasible and can downsize some tumors resulting in surgery in about 39% of the BRPC.
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http://dx.doi.org/10.21037/jgo.2019.01.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534706PMC
June 2019

Can CRM Status on MRI Predict Survival in Rectal Cancers: Experience from the Indian Subcontinent.

Indian J Surg Oncol 2019 Jun 21;10(2):364-371. Epub 2019 Feb 21.

9Department of Gastro-intestinal surgery, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India.

To determine the role of MRI as a predictor of circumferential resection margin (CRM) involvement. To study the impact of CRM status on MRI on recurrence and survival, in correlation with pathology. Analysis of a prospective database was performed over a period of 1 year. All patients with adenocarcinoma of rectum were included in the study. The MRI at presentation for all patients irrespective of stage (MRIT), pre-NACTRT MRI (MRI) for patients with locally advanced tumours, and post-NACTRT MRI (MRI) of these patients were analysed separately. The status of CRM on MRI was compared to that on histopathology and as a predictor of recurrence and survival. Two hundred twenty-one patients were included with a median follow-up 30 months. Sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 50%, 65.46%, 5.63%, 96.95% and 64.85% for MRIT; 50%, 55.32%, 5.97%, 95.12% and 55.03% for MRI1; and 77.78%, 63.29%, 10.77%, 98.04% and 64.07% for MRI2, respectively. On multivariate analysis, pathological positive margin alone predicted a poor overall survival (OS) whereas involved CRM on pathology and MRIT predicted poorer disease-free survival (DFS) and local recurrence. Pre-treatment and post-treatment MRI scans have a moderate sensitivity, specificity and accuracy and a high negative predictive value to predict CRM status on pathology. Pathological CRM status is the only factor to impact OS, DFS and LR on multivariate analysis. CRM status on MRI at presentation (MRI) does impact DFS and local recurrence but not OS.
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http://dx.doi.org/10.1007/s13193-019-00894-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527632PMC
June 2019

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer.

Cancer 2019 09 31;125(18):3184-3197. Epub 2019 May 31.

Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.

Background: Because the addition of nimotuzumab to chemoradiation in patients with locally advanced head and neck cancer improved outcomes in a phase 2 study, the authors conducted a phase 3 study to confirm these findings.

Methods: This open-label, investigator-initiated, phase 3, randomized trial was conducted from 2012 to 2018. Adult patients with locally advanced head and neck cancer who were fit for radical chemoradiation were randomized 1:1 to receive either radical radiotherapy (66-70 grays) with concurrent weekly cisplatin (30 mg/m ) (CRT) or the same schedule of CRT with weekly nimotuzumab (200 mg) (NCRT).The primary endpoint was progression-free survival (PFS); key secondary endpoints were disease-free survival (DFS), duration of locoregional control (LRC), and overall survival (OS). An intent-to-treat analysis also was performed.

Results: In total, 536 patients were allocated equally to both treatment arms. The median follow-up was 39.13 months. The addition of nimotuzumab improved PFS (hazard ratio [HR], 0.69; 95% CI, 0.53-0.89; P = .004), LRC (HR, 0.67; 95% CI, 0.50-0.89; P = .006), and DFS (HR, 0.71; 95% CI, 0.55-0.92; P = .008) and had a trend toward improved OS (HR, 0.84; 95% CI, 0.65-1.08; P = .163). Grade 3 through 5 adverse events were similar between the 2 arms, except for a higher incidence of mucositis in the NCRT arm (66.7% vs 55.8%; P = .01).

Conclusions: The addition of nimotuzumab to concurrent weekly CRT improves PFS, LRC, and DFS. This combination provides a novel alternative therapeutic option to a 3-weekly schedule of 100 mg/m cisplatin in patients with locally advanced head and neck cancer who are treated with radical-intent CRT.
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http://dx.doi.org/10.1002/cncr.32179DOI Listing
September 2019

Systemic chemotherapy and short-course radiation in metastatic rectal cancers: A feasible paradigm in unresectable and potentially resectable cancers.

South Asian J Cancer 2019 Apr-Jun;8(2):92-97

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Background: The optimal use and sequencing of short-course radiotherapy (SCRT) in metastatic rectal cancers (mRCs) are not well established.

Materials And Methods: We retrospectively reviewed the records of mRC patients receiving SCRT followed by palliative chemotherapy between January 1, 2013, and December 31, 2016, in Tata Memorial Hospital. Patients were classified as having "potentially resectable" disease (local and metastatic) or "unresectable" disease at baseline based on prespecified criteria.

Results: A total of 105 consecutive patients were available for analysis. The median age of patients was 48 years (range: 16-62 years), and 57.1% were male patients. Signet ring histology was seen in 13.3% of patients. The most common site of metastases was liver limited (29.5%), nonloco-regional nodes (12.4%), and lung limited metastases (9.5%). Chemotherapeutic regimens administered were capecitabine-oxaliplatin (70.5%), modified 5 fluorouracil (5 FU)-leucovorin-irinotecan-oxaliplatin (10.5%), and modified 5 FU-leucovorin-irinotecan (8.6%). Targeted therapy accompanying chemotherapy was administered in 27.6% of patients. About 42.1% of patients with potentially resectable disease and 11.1% with the unresectable disease at baseline underwent curative-intent resection of the primary and address of metastatic sites. With a median follow-up 18.2 months, median overall survival (OS) was 15.7 months (95% confidence interval: 10.42-20.99). Patients classified as potentially resectable had a median OS of 32.62 months while patients initially classified as unresectable had a median OS of 13.04 months ( = 0.016). The presence of signet ring morphology predicted for inferior mOS ( = 0.021).

Conclusions: SCRT followed by systemic therapy in mRC is a feasible, efficacious paradigm for maximizing palliation, and achieving objective responses. The classification of patients based on resectability was predictive of actual resection rates as well as outcomes. Signet ring mRC show inferior outcomes in this cohort of patients.
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http://dx.doi.org/10.4103/sajc.sajc_174_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498721PMC
May 2019

Non-radiation occupational hazards and health issues faced by radiologists - A cross-sectional study of Indian radiologists.

Indian J Radiol Imaging 2019 Jan-Mar;29(1):61-66

Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Context: Radiologists as a group face unique occupational health hazards among which musculoskeletal injuries, chronic eye strain, and others are yet to receive adequate attention. Constant mental strain due to demanding turnaround times and work pressures may lead to burnout and depression. These combine to decrease overall work satisfaction and productivity.

Aims: To study the prevalence of various health issues faced by radiologists in India and to assess whether specific demographic and occupational factors are associated with an increased risk.

Settings And Design: Cross-sectional observational study conducted as a voluntary anonymous electronic survey.

Methods And Materials: A 36-item survey was sent to radiologists through email and social media. All respondents who completed survey were included in the study. Questions regarding workload, repetitive stress injuries, eye strain, burnout, and so on were asked.

Statistical Analysis Used: Chi-square test was used to test significance of correlation ( < 0.05).

Results: In all, 383 radiologists completed the survey. A high prevalence of repetitive stress injuries, chronic eye strain, depression, and burnout was found. Significant correlation was found between repetitive stress injuries and burnout. Pre-Conception and Pre-Natal Diagnostic Techniques Act (PCPNDT) related issues and work overload were the most common causes of high stress levels. Radiologists whose practices followed ergonomic design showed significantly less prevalence of neck pain.

Conclusion: Radiologists in India have a high prevalence of repetitive stress injuries, chronic eye strain, and burnout, along with unique mental stressors such as PCPNDT-related issues.
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http://dx.doi.org/10.4103/ijri.IJRI_403_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467047PMC
April 2019

Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017.

Abdom Radiol (NY) 2018 11;43(11):2893-2902

Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.

Purpose: To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma.

Methods: A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted.

Results: Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed.

Conclusion: These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.
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http://dx.doi.org/10.1007/s00261-018-1642-9DOI Listing
November 2018

Case of victims of modern imaging technology: Increased information noise concealing the diagnosis.

World J Radiol 2017 Dec;9(12):454-458

Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India.

We present a case of tubercular arthritis who underwent numerous unnecessary investigations what is known as "victims of modern imaging technology" or VOMIT. Today there is an exponential rise in the volume of the medical imaging, part of which is contributed by unnecessary and unjustified indications. We discuss about the untoward effects of the uninhibited and careless use of modern imaging modalities and possible ways to avoid. Skeletal manifestation of the tuberculosis is still common in the endemic countries like India. Although the final diagnosis of the skeletal tuberculosis like tubercular arthritis is made by bacteriological and histological studies, few demographic, clinical and radiological features might help making early diagnosis.
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http://dx.doi.org/10.4329/wjr.v9.i12.454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746649PMC
December 2017

Gnathic Osteosarcoma: Clinical, Radiologic, and Pathologic Review of Bone Beard Tumor.

J Glob Oncol 2017 12 28;3(6):823-827. Epub 2016 Oct 28.

All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.1200/JGO.2016.006494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735964PMC
December 2017

Results of a phase II randomized controlled clinical trial comparing efficacy of Cabazitaxel versus Docetaxel as second line or above therapy in recurrent head and neck cancer.

Oral Oncol 2017 12 5;75:54-60. Epub 2017 Nov 5.

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India. Electronic address:

Background: Cabazitaxel has shown activity in squamous cancer cell lines and in taxane resistant cell lines. Hence we planned a phase 2 study to evaluate the efficacy of cabazitaxel against Docetaxel in recurrent head and neck cancer, post first line treatment.

Methods: This was a phase 2, investigator initiated, randomized controlled trial of Docetaxel (75 mg/m) versus Cabazitaxel (20 mg/m), in patients with head and neck cancer with ECOG performance status 0-2 who have been exposed to at least one line of chemotherapy, involving a sample size of 92 (46 per group)(CTRI/2015/06/005848). Disease control rate at 6 weeks was assessed and compared using the chi-square test.

Results: The disease control rate at 6 weeks was better in the Docetaxel arm over the cabazitaxel arm (52.3% versus 13.6%, p = 0.017). The median progression free survival was 21 days (95% CI 5.28 to 36.72 days) in the cabazitaxel arm versus 61 days (95% CI 21.39 to 100.60 days) in the Docetaxel arm (HR-1.455, 95% CI 0.919-2.304, p = 0.100). The median overall survival was 115 days (95% CI 74.04 to 155.95 days) in the cabazitaxel arm versus 155 days (95% CI 148.6 to 161.40 days) in the Docetaxel arm (HR-1.464, 95% CI 0.849-2.523, p = 0.170).

Conclusion: Docetaxel had a superior disease control rate at 6 weeks compared to cabazitaxel.
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http://dx.doi.org/10.1016/j.oraloncology.2017.10.018DOI Listing
December 2017

Laparoscopic Versus Open Approach for Intersphincteric Resection-Results from a Tertiary Cancer Center in India.

Indian J Surg Oncol 2017 Dec 21;8(4):474-478. Epub 2017 Jun 21.

Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Mumbai, Maharashtra 400012 India.

The study aims to compare open intersphincteric resection (OISR) with laparoscopic intersphincteric resection (LISR) in terms of short-term oncological and clinical outcomes. This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent intersphincteric resection (ISR) at Tata Memorial Centre between 1st July 2013 and 30th November 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), distal resection margin involvement, and number of nodes harvested. Perioperative outcomes included blood loss, length of hospital stay and 30-day postoperative morbidity and mortality. Chi-square test was used to compare the results between the two groups. Thirty nine cases of OISR and 34 cases of LISR were included in the study. Median BMI was higher in LISR group; otherwise, the two groups were comparable in all aspects. There were no conversions in LISR group. CRM involvement was seen in four patients (10%) in the conventional group compared to none in the LISR group. Median hospital stay was comparable between the two groups. Laparoscopic ISR is safe and can be performed with low conversion rate in selected group of patients.
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http://dx.doi.org/10.1007/s13193-017-0672-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705509PMC
December 2017

Multicompartmental Trigeminal Schwannomas: Dumbbell Tumors Revisited.

J Glob Oncol 2016 Dec 27;2(6):431-435. Epub 2016 Jul 27.

All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India.

Multicompartmental trigeminal schwannomas (MTSs) are a rare and complex but treatable group of tumors. Herein, we describe the clinicoradiologic presentation of two patients with MTS. The two illustrated distinct case reports highlight the role of imaging and the outcome of two different types of MTS. The Discussion summarizes the literature to date, which will help the reader diagnose these tumors in a timely manner and manage them appropriately.
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http://dx.doi.org/10.1200/JGO.2016.006122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493256PMC
December 2016

Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management.

Semin Ultrasound CT MR 2017 Jun 26;38(3):231-268. Epub 2016 Nov 26.

Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India. Electronic address:

Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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http://dx.doi.org/10.1053/j.sult.2016.11.005DOI Listing
June 2017

A tertiary care experience with paclitaxel and cetuximab as palliative chemotherapy in platinum sensitive and nonsensitive in head and neck cancers.

South Asian J Cancer 2017 Jan-Mar;6(1):11-14

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Background: The combination of paclitaxel and cetuximab (PaCe) has led to an encouraging response rate in Phase 2 setting with limited toxicity. The aim of our study was to assess the efficacy of this regimen in our setting in platinum sensitive and nonsensitive patients.

Methods: This was a retrospective analysis of head and neck cancer patients treated with weekly PaCe as palliative chemotherapy between May 2010 and August 2014. The standard schedule of cetuximab along with 80 mg/m of weekly paclitaxel was administered till either disease progression or withdrawal of patient's consent. The toxicity and response were noted in accordance with CTCAE version 4.02 and RECIST version 1.1 criteria, respectively. The response rates between platinum sensitive and nonsensitive patients were compared by Chi-square test. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier survival method and log-rank test was used for comparison. Cox proportional hazard model was used for identification of factors affecting PFS and OS.

Results: One Hundred patients with a median age of 52 years (interquartile range: 46-56 years) were included. Forty-five patients (45%) were platinum insensitive, whereas 55 patients (55%) were platinum sensitive. In platinum insensitive patients and sensitive patients, the response rates were 38.5% and 22.2%, respectively ( = 0.104), whereas the symptomatic benefit in pain was seen in 89.5% and 71.7%, respectively ( = 0.044). The median PFS in platinum insensitive and sensitive patients were 150 and 152 days, respectively ( = 0.932), whereas the median OS was 256 days (95% confidence interval [95% CI]: 168.2-343.8 days) and 314 days (95% CI: 227.6-400.4 days), respectively ( = 0.23). Nineteen patients (19%) had grades 3-4 adverse events during chemotherapy.

Conclusion: Weekly paclitaxel combined with cetuximab has promising efficacy and good tolerability in the palliative setting in advanced head and neck cancer in both platinum sensitive and insensitive patients.
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http://dx.doi.org/10.4103/2278-330X.202558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379885PMC
April 2017

Additional chemotherapy and salvage surgery for poor response to chemoradiotherapy in rectal cancers.

Asia Pac J Clin Oncol 2017 Aug 17;13(4):322-328. Epub 2017 Mar 17.

Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.

Aim: A proportion of locally advanced rectal cancer patients who receive neoadjuvant chemoradiotherapy (NACRT) are still unresectable. This study was undertaken to assess the outcomes of giving additional chemotherapy to rectal cancer patients with unresectable disease after NACRT.

Methods: Patients with poor response to NACRT where mesorectal fascia was still involved on MRI and R0 resection was doubtful, received additional four cycles of chemotherapy with either CAPOX or FOLFIRINOX regimen, and the response was reevaluated with MRI and reassessed for surgical resection.

Results: Between June 2012 and December 2014, 50 patients received additional chemotherapy with CAPOX regime (19%, 38%) or FOLFIRINOX (31%, 62%) after CRT. Median number of chemotherapy cycles received was four (range 2-8 cycles). Overall 34 (68%) patients underwent exploration and 31 (62%) underwent R0 resection. The median time to surgery following chemoradiation was 5 months (range 3-18 months). Complete pathological response was seen in seven (22%) patients.

Conclusion: Patients with poor response to NACRT may be further downstaged using additional chemotherapy so as to achieve R0 resection in 62% of cases.
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http://dx.doi.org/10.1111/ajco.12660DOI Listing
August 2017

Neoadjuvant chemotherapy in geriatric head and neck cancers.

Head Neck 2017 05 1;39(5):886-892. Epub 2017 Mar 1.

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.

Background: The purpose of this study was to present our findings on the treatment completion rates and outcomes in geriatric patients with head and neck cancer treated with neoadjuvant chemotherapy followed by definitive therapy.

Methods: Geriatric patients with locally advanced head and neck cancer who received neoadjuvant chemotherapy were selected for this analysis. Overall survival (OS) and progression-free survival (PFS) were estimated.

Results: Forty-six of 49 patients completed neoadjuvant chemotherapy (93.9%). The compliance to local treatment was 73.3% and the median OS was 49.9 months (95% confidence interval [CI] = 22.0-77.8 months) in patients who received neoadjuvant chemotherapy for organ preservation (n = 15). In patients receiving neoadjuvant chemotherapy for technically unresectable disease, the corresponding figures were 82.06% and 9.0 months (95% CI = 5.9-12.1 months), respectively.

Conclusion: Individualized neoadjuvant chemotherapy protocols in geriatric patients have high compliance rates to treatment and the median OS in geriatric patients treated for organ preservation is similar to that of young patients. © 2017 Wiley Periodicals, Inc. Head Neck 39: 886-892, 2017.
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http://dx.doi.org/10.1002/hed.24694DOI Listing
May 2017

Dihydropyrimidine dehydrogenase mutation in neoadjuvant chemotherapy in head and neck cancers: Myth or reality?

South Asian J Cancer 2016 Oct-Dec;5(4):182-185

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Purpose: The docetaxel, 5-fluorouracil (5-FU), and cisplatin (TPF) regimen in India is associated with high percentages of Grade 3-4 toxicity. This analysis was planned to evaluate the incidence of dihydropyrimidine dehydrogenase (DPD) mutation in patients with severe gastrointestinal toxicity, to assess whether the mutation could be predicted by a set of clinical criteria and whether it has any impact on postneoadjuvant chemotherapy response.

Methods: All consecutive patients who received TPF regimen in head and neck cancers between January 2015 and April 2015 were selected. Patients who had predefined set of toxicities in Cycle 1 were selected for DPD mutation testing. Depending on the results, C2 doses were modified. Postcompletion of two cycles, patients underwent radiological response assessment. Descriptive statistics has been performed. The normally distributed continuous variables were compared by unpaired Student's -test, whereas variables which were not normally distributed by Wilcoxon sum rank test. For noncontinuous variables, comparison was performed by Fisher's exact test.

Results: Out of 34 patients, who received TPF, 12 were selected for DPD testing, and 11 (32.4%, 95% confidence interval [95% CI]: 19.1-49.3%) had DPD mutation. The predictive accuracy of the criteria for the tested DPD mutations was 81.3% (95% CI: 62.1-100%). Of the 11 DPD mutation positive patients, except for one patient, all others received the second cycle of TPF. The dose adjustments done in 5-FU were 50% dose reduction in 9 patients and no dose reduction in one patient. The response rate in DPD mutated patients was 27.3% (3/11) and that in DPD nonmutated/nontested was 39.1% (9/23) ( = 0.70).

Conclusion: In this small study, it seems that the incidence of DPD mutation is more common in Indian then it's in the Caucasian population. Clinical toxicity criteria can accurately predict for DPD mutation. Postdose adjustments of 5-FU from C2 onward, TPF can safely be delivered in the majority of patients with DPD heterozygous mutations without decrement in efficacy.
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http://dx.doi.org/10.4103/2278-330X.195338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5184753PMC
December 2016

Disseminated cysticercosis: role of whole body Magnetic Resonance Imaging.

Ann Parasitol 2016;62(2):149-51

Unlabelled: Cysticercercosis is a parasitic infection that is commonly seen in developing countries. Treatment of cysticercosis can precipitate an intense inflammatory response which may further worsen the symptoms. Whole body MRI is an upcoming tool for screening of diseases. It can be acquired in the same setting as a brain MRI in reasonable time without any additional hardware. We present a case wherein whole body MRI was used to evaluate disseminated cysticercosis. It can prove as useful screening tool to gauge the disease load and modify the treatment plan accordingly, especially in endemic areas.

Key Words: disseminated cysticercosis, whole body MRI.
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http://dx.doi.org/10.17420/ap6202.47DOI Listing
January 2017

Should (18)F FDG PET/CT Really Be Indicated in Routine Clinical Practice for Detecting Contralateral Neck Node Metastasis in Head and Neck Squamous Cell Carcinoma?

Radiology 2016 08;280(2):651-2

Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Tata Memorial Centre, Parel, Mumbai, India *

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http://dx.doi.org/10.1148/radiol.2016160051DOI Listing
August 2016

Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection?

J Gastrointest Oncol 2016 Jun;7(3):360-4

1 Specialist Registrar Oncosurgery, 2 Department of Radiation Oncology, 3 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India ; 4 Department of Radiodiagnosis, 5 Departmemt of GI Surgery, Tata Memorial Centre, Mumbai, India.

Background: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer. However, there is no clarity regarding the necessity for restaging scans to rule out systemic progression of disease post chemoradiation with existing literature being divided on the need for the same.

Methods: Data from a prospectively maintained database was retrospectively analysed. All locally advanced rectal cancers (node positive/T4/T3 with threatened or involved CRM) were included. Biopsy proof of adenocarcinoma and CT scan of abdomen and chest were mandatory. Grade of tumor and response to CTRT on restaging magnetic resonance imaging (MRI) were documented.

Results: Out of 119 patients subjected to CTRT, 72 underwent definitive total mesorectal excision while 13 patients progressed locoregionally on restaging MR pelvis and 15 other patients progressed systemically while the rest defaulted. Patients with poorly differentiated (PD) cancers were compared to those with well/moderately differentiated (WMD) tumors. PD tumors had a significantly higher rate of local progression (32.1% vs. 5.6% %, P=0.0011) and systemic progression (35.7% vs. 6.9%, P=0.0008) as compared to WMD tumors. Only one-third (9/28) of PD patients underwent TME while the rest progressed.

Conclusions: Selecting poorly differentiated tumors alone for restaging CECT abdomen and thorax will be a cost effective strategy as the rate of progression is very high. Also patients with PD tumors need to be consulted about the high probability of progression of disease.
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http://dx.doi.org/10.21037/jgo.2016.01.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880789PMC
June 2016

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center.

J Gastrointest Oncol 2016 Jun;7(3):354-9

1 Departmentof Surgical Oncology, 2 Departmentof Radiation Oncology, 3 Department of Digestive Diseases and Clinical Nutrition, 4 Departmentof Radio diagnosis, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.

Background: To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes.

Methods: This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ(2)-test was used to compare the results between the two groups.

Results: Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study. Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance.

Conclusions: ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient.
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http://dx.doi.org/10.21037/jgo.2015.11.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880788PMC
June 2016

Multivisceral resections for rectal cancers: short-term oncological and clinical outcomes from a tertiary-care center in India.

J Gastrointest Oncol 2016 Jun;7(3):345-53

1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.

Background: Locally advanced rectal cancers (LARCs) involve one or more of the adjacent organs in upto 10-20% patients. The cause of the adhesions may be inflammatory or neoplastic, and the exact causes cannot be determined pre- or intra-operatively. To achieve complete resection, partial or total mesorectal excision (TME) en bloc with the involved organs is essential. The primary objective of this study is to determine short-term oncological and clinical outcomes in these patients undergoing multivisceral resections (MVRs).

Methods: This is a retrospective review of a prospectively maintained database. Between 1 July 2013 and 31 May 2015, all patients undergoing MVRs for adenocarcinoma of the rectum were identified from this database. All patients who had en bloc resection of an adjacent organ or part of an adjacent organ were included. Those with unresectable metastatic disease after neoadjuvant therapy were excluded.

Results: Fifty-four patients were included in the study. Median age of the patients was 43 years. Mucinous histology was detected in 29.6% patients, and signet ring cell adenocarcinoma was found in 24.1% patients. Neoadjuvant therapy was given in 83.4% patients. R0 resection was achieved in 87% patients. Five-year overall survival (OS) was 70% for the entire cohort of population.

Conclusions: In Indian subcontinent, MVRs in young patients with high proportion of signet ring cell adenocarcinomas based on magnetic resonance imaging (MRI) of response assessment (MRI 2) is associated with similar circumferential resection margin (CRM) involvement and similar adjacent organ involvement as the western patients who are older and surgery is being planned on MRI 1 (baseline pelvis). However, longer follow-up is needed to confirm noninferiority of oncological outcomes.
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http://dx.doi.org/10.21037/jgo.2016.01.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880780PMC
June 2016

Multimodality Molecular Imaging (FDG-PET/CT, US Elastography, and DWI-MRI) as Complimentary Adjunct for Enhancing Diagnostic Confidence in Reported Intermediate Risk Category Thyroid Nodules on Bethesda Thyroid Cytopathology Reporting System.

World J Nucl Med 2016 May-Aug;15(2):130-3

Department of Radiology, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India.

The potential complimentary role of various molecular imaging modalities [fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), ultrasound (US)-elastography, and diffusion weighted imaging-magnetic resonance imaging (DWI-MRI)] in characterizing thyroid nodules, which have been designated as "intermediate risk category" on the Bethesda thyroid cytopathology reporting system (BTCRS), is illustrated in this communication. The clinical cases described (category III thyroid nodules on BTCRS) show the imaging features and the final diagnostic impressions rendered by the interpreting physicians with the modalities that have been independently compared in a tabular format at the end; of particular note is the high negative predictive value of these (specifically FDG-PET/CT), which could aid in enhancing the diagnostic confidence in the reported "intermediate risk category" thyroid nodules, a "gray zone" from the patient management viewpoint.
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http://dx.doi.org/10.4103/1450-1147.176883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809154PMC
May 2016

Technically unresectable recurrent oral cancers: Is NACT the answer?

Oral Oncol 2016 May 31;56:e12-4. Epub 2016 Mar 31.

Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India. Electronic address:

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http://dx.doi.org/10.1016/j.oraloncology.2016.03.015DOI Listing
May 2016

Neoadjuvant chemotherapy in technically unresectable carcinoma of external auditory canal.

Indian J Med Paediatr Oncol 2015 Jul-Sep;36(3):172-5

Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.

Background: Carcinoma of external auditory canal (EAC) is a very rare malignancy with surgical resection as the main modality of treatment. The outcomes with nonsurgical modalities are very dismal. We present a retrospective analysis of 4 patients evaluating the role of neoadjuvant chemotherapy in technically unresectable cancers.

Materials And Methods: This is a retrospective analysis of 4 patients from our institute from 2010 to 2014 with carcinoma EAC who were deemed unfit for surgery due to extensive disease involving occipital bone with soft tissue infiltration (n = 2), temporal dura (n = 1), left temporal lobe, and extensive soft tissue involvement (n = 1). All these patients received neoadjuvant chemotherapy with docetaxel, cisplatin and 5 fluorouracil (n = 3) and paclitaxel and cisplatin (n = 1).

Results: Response evaluation showed a partial response (PR) in 3 and stable disease (SD) in 1 patient by Response Evaluation Criteria in Solid Tumors criteria. All 3 patients who received 3 drug chemotherapy had PR while 1 patient who received 2 drug chemotherapy had SD. Two of these patients underwent surgery, and other 2 underwent definitive chemoradiation. One of 3 patients who achieved PR underwent surgical resection; the other 2 remained unresectable in view of the persistent intradural extension and infratemporal fossa involvement. One patient who had SD could undergo surgery in view of clearance of infraatemporal fossa. Recent follow-up shows that 3 out of these 4 patients are alive.

Conclusion: This indicates that there may be a role of induction chemotherapy in converting potentially unresectable tumors to resectable disease that could produce better outcomes in carcinoma EAC.
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http://dx.doi.org/10.4103/0971-5851.166734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743187PMC
February 2016

Indian Council of Medical Research consensus document for the management of tongue cancer.

Indian J Med Paediatr Oncol 2015 Jul-Sep;36(3):140-5

Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

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.
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http://dx.doi.org/10.4103/0971-5851.166712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743186PMC
February 2016