Krishnangshu Bhanja Choudhury

Demographic and clinical profile of patients with brain metastases: A retrospective study.

Context: Brain metastases are the most common type of intracranial neoplasm, with the total number outnumbering primary brain tumors by a ratio of 10:1 and occur in about 25% of cancer patients. However, controversies exist regarding demographic and clinical profile of brain metastases. Aims: The purpose of this study was to analyze retrospectively the demographic and clinical profile of patients with brain metastases. Settings and Design: Retrospective, single institutional study. Materials and Methods: A retrospective study of 72 patients with brain metastasis was carried out from November 2010 to October 2012. The data pertaining to these patients was entered in a standardized case record form. These include History; clinical examination and other investigations including computed tomography/magnetic resonance imaging scan of the brain. Statistical Analysis: A statistical analysis was performed on the data collected using the MedCalc version 11. Results: Brain metastases were more common in male and occur in 6th decade of life mostly. There was no relationship of occupation or socio-economic status with the incidence of brain metastases. Carcinoma lung was the most common primary giving rise to brain metastases followed by breast. Adenocarcinoma accounts for most common histology of the primary that give rise to metastases. Multiple metastases were more common than the single group. Supratentorial lesions were more common than infratentorial lesions. Among them, parietal lobe was the most common site of involvement. Conclusions: The present study highlights that the incidence of brain metastasis is common in elderly population and mostly due to primary lung. Adenocarcinoma was the most common histology of primary. Majority of lesions has been observed at parietal lobe.

Gemcitabine-induced radiation recall phenomenon in a post-operative and post-radiotherapy case of peri-ampullary carcinoma during adjuvant chemotherapy

Radiation recall phenomenon is an inflammatory process occurring at sites of previous radiation subsequent to administration of pharmacologic agents. The most common chemotherapeutic agents implicated with radiation recall phenomenon are anthracyclines and taxanes. Skin is the most common site for radiation recall. About 63% of the radiation recall events are reported to manifest as dermatitis. This finding differs from radiation recall due to Gemcitabine, in which approximately 70% cases manifested as inflammation of internal organs or tissues and 30% manifested as dermatitis. Here, we report a case of post-operative peri-ampullary carcinoma who developed radiation recall dermatitis during adjuvant chemotherapy with inj. Gemcitabine and inj. Carboplatin after concurrent chemoradiation with capecitabine.

Feasibility of organ preservation in muscle-invasive transitional cell carcinoma bladder: A single institutional approach

Background: Trimodality treatment initial transurethral resection of the bladder tumor [TURBT] followed by concurrent chemotherapy and radiation and organ preservation have been gradually replacing the radical cystectomy in muscle-invasive transitional cell carcinoma (TCC) of bladder. Aims: The aims of this study is to determine the clinical effectiveness, safety and protocol completion rate of trimodality treatment in muscle-invasive TCC of the bladder. Settings and Design: Prospective randomized and open-labeled study. Subjects and Methods: Patients with TCC of bladder, American Joint Committee on Cancer tumor node metastasis (TNM) Bladder Cancer Staging (2002) T2-3, N0, M0. Were underwent TURBT followed by three cycles of neoadjuvant chemotherapy with methotrexate, vinblastine, adriamycin, and cisplatin regimen. The patients were then randomized to receive either concurrent cisplatin 75 mg/m 2 in week 1 and 4 (arm-A) or no cisplatin (arm-B) along with external beam radiation therapy (EBRT) 45 Gy, in 25 fractions over 5 weeks. 4 weeks after completion of the initial phase of treatment, all patients were re-evaluated with TURBT. Those with complete remission (CR) received additional 15 Gy of EBRT in 8 fractions, while patients with residual disease were recommended for immediate radical cystectomy. All the patients of arm-B received boost dose of 15 Gy of EBRT. Statistical Analysis Used: The major statistical endpoints of this study were the CR rate at 8 weeks post-concurrent chemoradiotherapy (CCRT) and only radiotherapy. Statistical significance was accepted at the P < 0.05 (two-sided) level. Statistical analysis was performed entirely using the Statistical Package for the Social Sciences for Windows, version 17 (SPSS Inc., Chicago, IL, U.S.A.). Results: 8 weeks after completion of treatment 13/16 (81%) patients were in CR in CCRT arm (arm-A) compare to 6/15 (40%) patients receiving radiation only (arm-B). Conclusions: Patients, after TURBT receiving CCRT, had a better chance of organ preservation (81%) than those receiving radiation only.

Fractionated beam radiotherapy is a special case of continuous beam radiotherapy when irradiation time is small.

Fractionated beam radiotherapy, in other terms, external beam radiotherapy (EBRT) and continuous beam radiotherapy or Brachytherapy are two modes of radiotherapy techniques. Although in many ways, they appear to be different, radiobiologically, with the help of mathematics, it can be proved that the biological effective dose (BED) of EBRT is similar to BED of Brachytherapy, when irradiation time is small. Here an attempt is made to correlate these two predominant modes of radiotherapy techniques.

Radical treatment of locally advanced head and neck cancer with concurrent chemo radiation-cisplatin versus carboplatin: A randomized comparative phase III trial

Context: Concurrent chemoradiation with cisplatin is a standard approach for definitive management of locally advanced head and neck squamous cell carcinoma (LAHNSCC). Carboplatin, though a platinum group of drug, is generally well-tolerated compared to cisplatin. Aim: The aim is whether carboplatin can be a substitute of cisplatin with equivalent response and with less toxicity profile. Settings and Design: Single institutional prospective randomized phase III study. Materials and Methods: Between January 2011 and August 2012, 100 patients LAHNSCC with normal comorbidities were included. The patients in Arm A received injection carboplatin (AUC 6) 3 weeks along with external beam radiotherapy (EBRT) dose 66-70 Gy in conventional fractionation and Arm B received injection cisplatin (100 mg/m 2 ) 3 weeks with same EBRT schedule. Detailed clinical examination along with biopsy for residual or recurrent disease, CT scan of head and neck were done to assess the response, toxicities, and disease-free survival (DFS) in follow-up. Statistical Analysis Used: SPSS version 17 used for statistical calculation. For categorical variables, Chi-Square and Fisher Exact tests were used. For continuous variables, independent samples t test were used with 95% CI. Kaplan-Meier survival analysis was used for comparing the DFS. Results: Overall response rate (CR + PR) were 76.9% in Arm A and 63.6% in Arm B ( P = 0.06, non-significant). Statistically significant acute skin ( P = 0.003), mucosa ( P = 0.003), and upper GI ( P = Conclusions: It can be concluded that carboplatin is non-inferior in response with statistically significant less toxicities when compared with cisplatin.

A comparison of outcomes with 'Christie Regimen' and pure accelerated radiotherapy versus conventional radiation in locally advanced squamous cell carcinoma of head and neck: A randomized controlled study

Context and Aim: Radiotherapy is alternative to concurrent chemoradiation or surgery for locally advanced squamous cell carcinoma of head and neck (LAHNSCC) due to comorbid conditions. The aim of this study was to compare efficacy and toxicity among hypofractionated, pure accelerated and conventional radiotherapy schedules. Settings and Design: Interventional randomized controlled study. Materials and Methods: Between May 2008 and May 2012, 132 LAHNSCC patients, AJCC stages III to IVB, creatinine clearance <60 ml/min, age more than 50 years, comorbidities like uncontrolled diabetes, cardiac disease, ECOG 3 and 4, or combination of these were randomized into three arms: Arm A, Christie Regimen, 50 Gray (Gy) in 16 fractions, 3.125 Gy per fraction over 3 weeks; Arm B, 66 Gy in 33 fractions in 6 fractions per week in 5.5 weeks; and Arm C, 66 Gy in 33 fractions, 5 fractions per week, in 6.5 weeks. The endpoints of the study were overall response (ORR = complete response + partial response), diseasefree survival (DFS), toxicities, and overall survival (OS). Statistical Analysis Used: All statistical tests were done using ANOVA. OS and DFS were calculated using KaplanMeier analysis. Result: ORRs were comparable in all arms, P value = 0.401. DFS were in favor of altered radiation, P value = 0.034. Acute Grade 3 cutaneous toxicity (P value = 0.018) and mucositis (P value = 0.011) were high with altered fractionation. Chronic grade 2 and 3 toxicities were higher in altered fractionations. Conclusion: There was no difference in the ORR between three arms but DFS was in favor of altered fractionation arms with manageable toxicity. Both altered fractionation had short overall treatment time which is radiobiologically superior and is beneficial for centers like ours where the patient load is much higher than the facility available.