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  Citation statistics : Table of Contents
   2009| April-June  | Volume 5 | Issue 2  
    Online since June 16, 2009

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Role of human papilloma virus in the oral carcinogenesis: An Indian perspective
Noureen M Chocolatewala, Pankaj Chaturvedi
April-June 2009, 5(2):71-77
DOI:10.4103/0973-1482.52788  PMID:19542661
Oral squamous cell carcinoma (OSCC) is one of the most common cancers in the Indian subcontinent. Although tobacco and alcohol are the main etiologic factors for nearly three-fourth of these cancers, no definite etiologic factor can be identified in one-fourth of the cases. There is growing evidence that human papilloma virus (HPV) may act as a cocarcinogen, along with tobacco, in the causation of oral cancers. The role of HPV in the etiology of anogenital cancers has been firmly established, and infection with this virus has also been shown to have prognostic significance. However, there is no clear evidence to support its involvement in oral carcinogenesis. We searched the PubMed database for all literature published from 1985 to 2008 and performed a systemic review in order to understand the relationship of HPV with oral cancers and its prevalence in various sub-sites in the oral cavity. Association of HPV is strongest for oropharyngeal cancers, especially cancers of the tonsils, followed by those of the base of tongue. High-risk HPV-16 is the predominant type; it commonly affects the younger age-groups, with males appearing to have a predisposition for infection with this strain. Its prevalence increases from normal to dysplasia and finally to cancer. HPV prevalence has been reported to be twice as high in premalignant lesions as in normal mucosa and is nearly five times higher in OSCC. The overall prevalence of HPV in OSCC ranges between 20-50%. OSCCs associated with HPV have been found to have better outcomes, being more responsive to radiotherapy and showing higher survival rates. In view of the association of HPV with OSCC, it should be worthwhile to conduct further experimental studies to elucidate its role in oral carcinogenesis.
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Time trial: A prospective comparative study of the time-resource burden for three-dimensional conformal radiotherapy and intensity-modulated radiotherapy in head and neck cancers
Vedang Murthy, Tejpal Gupta, Avinash Kadam, Sarbani Ghosh-Laskar, Ashwini Budrukkar, Reenadevi Phurailatpam, Rajeshri Pai, Jaiprakash Agarwal
April-June 2009, 5(2):107-112
DOI:10.4103/0973-1482.52800  PMID:19542666
Introduction: An ongoing institutional randomized clinical trial comparing three-dimensional conformal radiotherapy (3D CRT) and intensity-modulated radiotherapy (IMRT) provided us an opportunity to document and compare the time-manpower burden with these high-precision techniques in head and neck cancers. Materials and Methods: A cohort of 20 consecutive patients in the ongoing trial was studied. The radiotherapy planning and delivery process was divided into well-defined steps and allocated human resource based on prevalent departmental practice. Person-hours for each step were calculated. Results: Twelve patients underwent IMRT and eight patients had 3D CRT. The prerandomization steps (upto and including approval of contours) were common between the two arms, and expectedly, the time taken to complete each step was similar. The planning step was carried out postrandomization and the median times were similar for 3D CRT (312 min, 5.2 person-hours) and IMRT (325.6 min, 5.4 person-hours). The median treatment delivery time taken per fraction varied between the two arms, with 3D CRT taking 15.2 min (0.6 person-hours), while IMRT taking 27.8 min (0.9 person-hours) (P<0.001). The total treatment time was also significantly longer in the IMRT arm (median 27.7 versus 17.8 person-hours, P<0.001). The entire process of IMRT took 48.5 person-hours while 3D CRT took a median of 37.3 person-hours. The monitor units delivered per fraction and the actual "beam-on" time was also statistically longer with IMRT. Conclusions: IMRT required more person-hours than 3D CRT, the main difference being in the time taken to deliver the step-and-shoot IMRT and the patient-specific quality assurance associated with IMRT.
  18 4,830 439
Accelerated partial-breast irradiation vs conventional whole-breast radiotherapy in early breast cancer: A case-control study of disease control, cosmesis, and complications
Tabassum Wadasadawala, Rajiv Sarin, Ashwini Budrukkar, Rakesh Jalali, Anusheel Munshi, Rajendra Badwe
April-June 2009, 5(2):93-101
DOI:10.4103/0973-1482.52794  PMID:19542664
Context: Accelerated partial-breast irradiation (APBI) using various approaches is being increasingly employed for selected women with early breast cancer (EBC). Aims: To conduct a case-control study comparing disease control, cosmesis, and complications in patients with EBC undergoing APBI using multicatheter interstitial brachytherapy vs those receiving conventional whole breast radiotherapy (WBRT). Settings and Design: Women with EBC fulfilling the American Brachytherapy Society (ABS) criteria were selected as 'cases' if treated with APBI or as 'controls' if offered WBRT during the period from May 2000 to December 2004. Materials and Methods: APBI patients were treated with high-dose-rate brachytherapy (HDR) to a dose of 34 Gy/10#/6-8 days. WBRT was delivered to the whole breast to a dose of 45 Gy/25# followed by tumor bed boost, either with electrons (15 Gy/6#) or interstitial brachytherapy (HDR 10 Gy/1#). Results: At the median follow-up of 43.05 months in APBI and 51.08 months in WBRT there was no difference in overall survival (OS), disease-free survival (DFS), late arm edema, and symptomatic fat necrosis between the two groups. However, APBI resulted in increase in mild breast fibrosis at the tumor bed. Telangiectasias were observed in three patients of the APBI group. The cosmetic outcome was significantly better in the APBI group as compared to the WBRT group (P = 0.003). Conclusions: This study revealed equivalent locoregional and distant disease control in the two groups. APBI offered better overall cosmetic outcome, though at the cost of a slight increase in mild breast fibrosis and telangiectasias.
  16 7,203 841
Sister Mary Joseph nodule as the presenting sign of disseminated prostate carcinoma
Prabal Deb, Radhey Shyam Rai, Rahul Rai, Ekawali Gupta, Yogesh Chander
April-June 2009, 5(2):127-129
DOI:10.4103/0973-1482.52793  PMID:19542671
Sister Mary Joseph's nodule is referred to as metastasis of visceral malignancy to the umbilicus. Most common primaries are in the gastrointestinal or genital tract, while other locations are rare. We recently encountered a 76-year-old male who was referred to the surgery clinic with an erythematous nodule in the umbilicus measuring 6 cm in diameter with complaints of painless profuse hematuria. History revealed severe obstructive voiding symptoms of 2-year duration, along with significant loss of weight and difficulty in walking. A detailed examination showed hard nodular hepatomegaly, along with grade IV prostatomegaly. Serum prostate-specific antigen was 3069 ng/ml. A pelvic radiograph displayed multiple osteolytic lesions, while ultrasonography showed multiple iso- and hypoechoic lesions in both lobes of the liver, suggestive of metastasis. Histopathology of a Tru-cut biopsy of the prostate confirmed an adenocarcinoma (Gleason score 9) with umbilical metastasis. The patient was on regular follow-up and died 3 months later.
  12 8,955 519
Brain metastasis from esophageal carcinoma
Rashi Agrawal, Prity Shukla, Vikas Shukla, Arvind Chauhan
April-June 2009, 5(2):137-139
DOI:10.4103/0973-1482.52785  PMID:19542674
Esophageal carcinoma rarely metastasizes to brain. In our center, among 504 cases of esophageal cancer registered for treatment during a 15-year (1990-2005) period, brain metastasis from esophageal carcinoma was detected in only 1 case. An unusual case of esophageal carcinoma that presented with brain metastasis is reported here.
  10 12,219 488
Small cell carcinoma of the urinary bladder: A case report and review of the literature
Nabil Ismaili, Samia Ghanem, Nawfel Mellas, Said Afqir, Meriem Taleb, Meryem Amrani, Lamia Gamra, Hassan Errihani
April-June 2009, 5(2):133-136
DOI:10.4103/0973-1482.52790  PMID:19542673
Small cell carcinoma of the bladder (SCCB) is extremely rare. In this paper, we present a case of metastatic SCCB managed by chemotherapy and we would provide a brief review of the epidemiology, clinical features, diagnosis, pathologic features, staging, treatment, and prognosis of SCCB. A 52-year-old man was admitted with signs and symptoms suggestive of a bladder cancer. Computed tomography of the pelvis and abdomen showed a large tumor at the right bladder wall, measuring 10 cm in diameter, and a multinodular liver disease. Diagnosis of small cell carcinoma was established from the histological study of the transurethral resection of the bladder tumor. The patient received 12 cycles of platinum-based chemotherapy with a good partial response of bladder tumor and liver metastasis. The patient is still alive, 18 months after diagnosis.
  8 9,824 707
Dural sinus vein thrombosis in a patient with colon cancer treated with FOLFIRI/bevacizumab
Alaattin Ozen, Irfan Cicin, Atakan Sezer, Sernaz Uzunoglu, Mert Saynak, Hakan Genchellac, Hakan Karagol
April-June 2009, 5(2):130-132
DOI:10.4103/0973-1482.52791  PMID:19542672
The adverse effects of regimes in cancer treatment have forced us to change to new targeted therapy options. Understanding these side effects, which can lead to discontinuation of the new therapy strategies, will allow the clinical management of these side effects and result in continuing therapies with effective medications. Bevacizumab, which is an IgG1 antibody against vascular endothelial growth factor, has side effects such as proteinuria, hypertension, venous and arterial thromboembolic events, and hemorrhage. This is the first reported case of dural sinus vein thrombosis, during the treatment with bevacizumab.
  6 5,223 426
Resource-sparing and cost-effective strategies in current management of breast cancer
Anusheel Munshi
April-June 2009, 5(2):116-120
DOI:10.4103/0973-1482.52797  PMID:19542668
Breast cancer is the leading cause of death in women throughout the world. There have been significant advances in the practice of breast oncology over the past few years. However, most of these advances have an associated price tag or are resource intensive. The present article discusses means to achieve cost-effectiveness in the treatment of breast cancer, while retaining the benefits of the modern anticancer approaches.
  4 3,943 443
Normal tissue complication probability: Does simultaneous integrated boost intensity-modulated radiotherapy score over other techniques in treatment of prostate adenocarcinoma
KS Jothy Basu, Amit Bahl, V Subramani, DN Sharma, GK Rath, PK Julka
April-June 2009, 5(2):78-84
DOI:10.4103/0973-1482.52789  PMID:19542662
Aim: The main objective of this study was to analyze the radiobiological effect of different treatment strategies on high-risk prostate adenocarcinoma. Materials and Methods: Ten cases of high-risk prostate adenocarcinoma were selected for this dosimetric study. Four different treatment strategies used for treating prostate cancer were compared. Conventional four-field box technique covering prostate and nodal volumes followed by three-field conformal boost (3D + 3DCRT), four-field box technique followed by intensity-modulated radiotherapy (IMRT) boost (3D + IMRT), IMRT followed by IMRT boost (IMRT + IMRT), and simultaneous integrated boost IMRT (SIBIMRT) were compared in terms of tumor control probability (TCP) and normal tissue complication probability (NTCP). The dose prescription except for SIBIMRT was 45 Gy in 25 fractions for the prostate and nodal volumes in the initial phase and 27 Gy in 15 fractions for the prostate in the boost phase. For SIBIMRT, equivalent doses were calculated using biologically equivalent dose assuming the α/β ratio of 1.5 Gy with a dose prescription of 60.75 Gy for the gross tumor volume (GTV) and 45 Gy for the clinical target volume in 25 fractions. IMRT plans were made with 15-MV equispaced seven coplanar fields. NTCP was calculated using the Lyman-Kutcher-Burman (LKB) model. Results: An NTCP of 10.7 0.99%, 8.36 0.66%, 6.72 0.85%, and 1.45 0.11% for the bladder and 14.9 0.99%, 14.04 0.66%, 11.38 0.85%, 5.12 0.11% for the rectum was seen with 3D + 3DCRT, 3D + IMRT, IMRT + IMRT, and SIBIMRT respectively. Conclusions: SIBIMRT had the least NTCP over all other strategies with a reduced treatment time (3 weeks less). It should be the technique of choice for dose escalation in prostate carcinoma.
  4 5,276 654
Diffuse large B-cell lymphoma of the uterine cervix: A rare case managed novelly
Gunjan Baijal, BM Vadiraja, Donald J Fernandes, MS Vidyasagar
April-June 2009, 5(2):140-142
DOI:10.4103/0973-1482.52784  PMID:19542675
Non-Hodgkin's lymphoma (NHL) of the uterine cervix is exceedingly rare. The management of the disease is not standardized. A 44-year-old lady presented with a history of bleeding pervaginum and a foul-smelling discharge of 2 months' duration. A 7 x 7 growth was seen in the cervix. A biopsy revealed it to be a CD20-positive diffuse large B-cell (DLBCL)-type NHL. She was diagnosed as stage IE after staging work-up, and managed with three courses of rituximab, cyclophosphamide, vincristine, adriamycin, and prednisolone followed by external beam radiotherapy (46 Gy in 23 fractions) by 3D conformal technique. She attained a complete response, and has been in remission for 1 year 3 months.
  3 7,507 557
Results of combined modality treatment for nasopharyngeal cancer
Ramachandran Venkitaraman, S Ganapathy Ramanan, A Vasanthan, Tenali Gnana Sagar
April-June 2009, 5(2):102-106
DOI:10.4103/0973-1482.52798  PMID:19542665
Context: Radiotherapy is the cornerstone of treatment in nasopharyngeal cancer (NPC); the addition of chemotherapy has shown improved results. Aims: To compare the results of concurrent chemoradiation with that of radiotherapy alone in NPC. Materials and Methods: One hundred and ninety consecutive NPC patients, without distant metastasis, who reported to the institute from January 1992 to December 2001, received external-beam radiation to 66 Gy in 33 fractions. Seventy-five of these patients received concurrent chemotherapy with cisplatin and 5-fluorouracil (5-FU) for four cycles. We compared the results of treatment in these two groups. Results: The 5-year disease-free survival rates were 40% and 60%, respectively, for patients who had radiotherapy alone and those who had chemoradiation (P = 0.002), while the median survival was 45 months and 60 months, respectively (P = 0.0028). Conclusion: A significant improvement in local control and survival was observed by the addition of concurrent chemotherapy with cisplatin and 5-FU to radical radiation in this nonrandomized study on patients with NPC.
  3 5,024 515
A simple technique for cranio-spinal irradiation in pediatric patients
R Prabhakar, KP Haresh, A Munshi, PS Sridhar, V Subramani, PK Julka, GK Rath
April-June 2009, 5(2):113-115
DOI:10.4103/0973-1482.52799  PMID:19542667
Purpose: Field matching poses challenges in craniospinal irradiation (CSI) as it leads either to underdosage or overdosage in the junctional area. A simple technique for CSI in pediatric patients is proposed. Materials and Methods: Computed tomography scans were performed in the prone position. Two lateral cranial fields and a direct posterior spinal field were planned with a common central axis. Half-beam-blocked cranial fields with zero collimator rotation were used for treating the cranium. A half-beam-blocked field defined with jaws was used to treat the spinal column at an extended source-to-surface distance. Before treating the patient, matching of the cranial and spinal field junction along the central axis was verified with an extended dose range film. Results and Conclusion: The technique described is simple and easy to implement and can be applied to pediatric patients undergoing CSI. This method has the potential to reduce daily setup time and setup errors. This technique is ideally suitable for patients with spinal fields less than 30 cm.
  2 9,963 748
Is electroglottography-based videostroboscopic assessment of post-laryngectomy prosthetic speech useful?
Rehan A Kazi, Arvind Singh, Ramachandran Venkitaraman, Suhail I Sayed, P Rhys-Evans, Kevin J Harrington
April-June 2009, 5(2):85-92
DOI:10.4103/0973-1482.52792  PMID:19542663
Objectives: To use an electroglottography (EGG)-based videostroboscopy tool to assess the anatomical and morphologic characteristics of the pharyngoesophageal (PE) segment in tracheoesophageal (TO) speakers. Study d0 esign: Cross-sectional cohort study. Subjects: Fifty-two post-laryngectomy patients with no recurrence and using prosthetic (Blom-Singer) speech. Intervention: An electroglottography (EGG)-based videostroboscopy tool EGG-based rigid videostroboscopy as well as perceptual evaluation. Outcome m0 easures: Stroboscopic protocol included nine subjective/visual parameters to evaluate the neoglottis and study correlation of the G (GRBAS scale) and the overall voice quality (OVQ) with the treatment variables. Results: Of the 52 laryngectomees, videostroboscopic recordings were possible in 46 patients (36 males and 10 females) with a mean age of 63.4 10.5 (SD) an electroglottography (EGG)-based videostroboscopy tool years. All used the Blom-Singer valve and the median time since Total Laryngectomy was 2 years. The neoglottis was assessable in 26 patients. We were able to strobe only 9 patients. There was excellent correlation between G and OVQ (Spearman rho > 0.9). Statistically significant correlation was found between G1 and saliva (P = 0.03) and between good OVQ and saliva (P = 0.02); similarly, there was significant correlation between G1 and LVV (P = 0.05) and between good OVQ and LVV (P = 0.03). Conclusions: This study is the first to examine the use of an EGG-based stroboscopy instrument to evaluate TO speech. Our observations suggest that from the standpoint of functional voice, saliva and the LVV had statistically significant effect in determining voice quality.
  1 4,673 350
Head and Neck Surgery
Pankaj Chaturvedi
April-June 2009, 5(2):143-143
  - 4,095 1,085
Rhinology and Facial Plastic Surgery
Pankaj Chaturvedi
April-June 2009, 5(2):143-144
  - 1,813 292
The great debate: Stroboscopy vs high- speed imaging for assessment of alaryngeal phonation
R Kazi, P Rhys-Evans, CM Nutting, KJ Harrington
April-June 2009, 5(2):121-123
DOI:10.4103/0973-1482.52796  PMID:19542669
Assessment of total laryngectomy patients has always been problematic and controversial. This is particularly so when one wants to assess and characterize the mucosal wave using the existing modalities of assessment. Videostroboscopy is generally regarded as an easily available and clinically relevant technique for adequately assessing this important parameter. However, it has its limitations, especially in laryngectomees. Recently, high-speed imaging has been recommended as the ideal tool for studying the physiology and mucosal parameters in this set of patients. In this brief article we examine this debate on the 'best' modality for assessment of the total laryngectomy patient.
  - 4,112 345
Cylindric cell carcinoma of the base of the tongue: A rare variant of squamous cell carcinoma
Milind Kumar, Amit Bahl, DN Sharma, Ruchi Sharma, Ruchika Gupta, Shamim Ahmed, PK Julka, GK Rath
April-June 2009, 5(2):124-126
DOI:10.4103/0973-1482.52795  PMID:19542670
Cylindric cell carcinomas (transitional cell carcinomas) are a rare and distinct histopathological entity presenting in the head and neck region. They have been known by myriads of nomenclature like cylindric carcinomas, nonkeratinizing sinonasal carcinoma, papillary carcinoma, cylindrical or columnar cell carcinoma, intermediate cell carcinoma, Schneiderian carcinoma, and Ringertz carcinoma. They are considered a variant of nonkeratinizing squamous cell carcinoma. Cylindric carcinomas are usually described in the sinus and nasal cavity and rarely said to involve nasopharynx and larynx. Only passing references have been made for its presentation in oropharynx including tonsils and the base of the tongue. We report here a rare case of transitional cell carcinoma presenting in the base of the tongue. There are no separate treatment recommendations in the literature, and the management is on the lines of treatment of squamous cell carcinoma. We report here a case of cylindric cell carcinoma presenting in the base of the tongue. The patient was staged as having cT2 N3 M0 (Stage IV B) disease. The patient received palliative radiotherapy of 20 Gy in five fractions followed by chemotherapy with injection paclitaxel and carboplatin. A partial response to treatment was achieved at the time of writing this report.
  - 3,878 386
Gaining from gaming
Nagraj G Huilgol, Nachiket N Huilgol
April-June 2009, 5(2):67-68
DOI:10.4103/0973-1482.52786  PMID:19542659
  - 4,730 545
Phase 1 trials in oncology in India: The clear case for innovation
Sunil Sharma
April-June 2009, 5(2):69-70
DOI:10.4103/0973-1482.52787  PMID:19542660
  - 3,956 551