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Biomedical subjects

B K Mohanti

Publications and source records attributed to B K Mohanti.

At least 19 recordsLinked to original sources
PubMed2006

Analysis of 2167 head and neck cancer patients' management, treatment compliance and outcomes from a regional cancer centre, Delhi, India.

Head and neck cancer care was analysed in 2167 unselected patients for management compliance and outcome. Median age was 55 years, with a male to female ratio of 5.5ratio1. Major sites were oropharynx (32.4 per cent), larynx (19.8 per cent), oral (16.6 per cent) and hypopharynx (12.9 per cent). Stage-wise distribution was I-II=8.9 per cent, III=20.6 per cent and IV=60.3 per cent and unstaged=10.2 per cent. Squamous cell carcinoma was the dominant histology for 90.9 per cent. Clinic-based cancer-directed treatment decisions were made for 1905 patients: curative intent in 53 per cent, palliative in 35 per cent and for the remaining 262 (12 per cent) supportive care. Overall, 1209 (56 per cent) patients complied with the prescribed treatments; 62 per cent, 54 per cent, and 35 per cent of curative, palliative and supportive care intent groups, respectively. Modalities were radiotherapy alone (64.6 per cent), combined surgery with irradiation (17.6 per cent), and chemoradiotherapy (11.2 per cent). Median follow-up periods were 17.5 and three months in curative and palliative groups respectively. Overall, 712 (33 per cent) cases received curative therapy, with three-year disease-specific survival of 49 per cent. Patient compliance was a major obstacle. The comparison of this series with the USA, Canada and Norway showed wide disparities in stage of presentation and survival.

Adolescent↗
PubMed2006

A case of Hodgkin's disease presenting with recurrent laryngeal nerve palsy and tracheoesophageal fistula.

Malignancy is the most common cause of tracheoesophageal fistulas. The malignancies commonly implicated in the development of tracheoesophageal fistulas are primary bronchial or esophageal carcinomas. Hodgkins disease rarely leads to such a fistula. We report a case of Hodgkin's disease with a tracheoesophageal fistula as well as a left recurrent nerve palsy at presentation. This presentation has no precedent in literature. The patient was treated with systemic chemotherapy and involved field radiotherapy. On follow up 1 year after the completion of treatment, he was clinically and radiologically disease free.

Adult↗
PubMed2004

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy.

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.

Adult↗
PubMed2003

Multiple extranodal sites at presentation in non-Hodgkin's lymphoma.

About one-third of NHL patients present lymphomas at extranodal sites. Involvement of multiple noncontiguous extranodal sites at presentation without lymph node involvement is unknown. Herein we present two such cases. The first patient had sinonasal tract and urinary bladder NHL at presentation, while the other patient presented with bilateral adrenal involvement in addition to sinonasal tract NHL. Clinical presentation and pathophysiology are discussed, and a brief review of literature is included.

Adrenal Gland Neoplasms↗
PubMed2003

Disregulated expression of the Th2 cytokine gene in patients with intraoral squamous cell carcinoma.

It has been seen that advanced stage oral squamous cell carcinoma is associated with impaired T-cell function and higher antibody response. In order to find out if such immune disregulation is associated with alteration of T-helper (Th) type CD4+ T-cell phenotype leading to altered cytokine production, we studied the Th-like cytokine profile in 35 oral squamous cell carcinoma patients and 21 normal controls. Concomitant expression of both Th1 and Th2 cytokine genes was studied by reverse transcription and Polymerase Chain Reaction (PCR) based amplification (RT-PCR) of mRNA extracted from freshly isolated peripheral blood mononuclear cells (PBMC) using specific primers for Interferon (IFN)-gamma, Interleukin (IL)-2, IL-4 and IL-10. Almost 63% of oral cancer patients showed polarization of a Th-like cytokine response as compared to 33% of the normal controls while 66.6% of normal controls showed a predominantly non-polarized Th0 response. Expression of IFN-gamma and IL-2 genes was more commonly seen in the early stage of the disease (p < 0.02) whereas majority of advanced stage tumours was associated with enhanced expression of IL-4 and IL-10 but not IFN-gamma and IL-2 genes. Patients with lymphnode metastases and poorly differentiated tumours expressed IL-4 and IL-10 more frequently with concomitant suppression of IFN-gamma and IL-2 genes. It seems therefore, that the development of oral squamous cell carcinoma leads to polarization of cytokine gene expression that is skewed towards the Th1-like response in the early stage. However, increasing tumour load and lymphnode invasion suppresses Th1 cytokine genes, thus skewing it toward a Th2-like cytokine response.

Adult↗
PubMed2002

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx.

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).

Adult↗
PubMed2001

Attitudes and treatment outcome of breast conservation therapy for stage I & II breast cancer using peroperative iridium-192 implant boost to the tumour bed.

Breast conservation therapy for early breast cancer is an established but grossly under-utilized treatment option in India for various reasons. Breast conservation therapy was offered to 200 suitable breast cancer patients between June 1993 and June 1998. Fifty-one patients (25%) opted for breast conservation and the remaining preferred mastectomy. In patients agreeing to conservation therapy, surgery was performed first along with peroperative implantation of iridium-192 to deliver a boost. Whole breast irradiation of 45 Gy was delivered 3-4 weeks after the boost. Cosmesis was assessed at the end of 6 months from completion of therapy. The main reason for refusal of breast conservation therapy was fear of recurrence in the remaining breast (60%). There were no locoregional failures in our study at a median follow up of 42 months; one patient experienced a systemic relapse. Cosmesis was good to excellent in 80% of patients. Breast conservation therapy using peroperative iridium-192 implant provides excellent locoregional disease control and cosmesis. The results of our study indicate that patient preference for mastectomy is an important reason for the under-utilization of breast conservation therapy in India.

Adult↗
PubMed2001

Interstitial brachytherapy with or without external beam irradiation in head and neck cancer: Institute Rotary Cancer Hospital experience.

Iridium-192 interstitial brachytherapy is practiced infrequently in developing countries, even where head and neck cancer is a major neoplasm and the technique could provide good results. This report from India is presented as an audit to validate the benefit of brachytherapy. One hundred and six head and neck cancer patients were treated by interstitial brachytherapy alone (n = 29) or combined with external irradiation (n = 77). The oral cavity and the oropharynx together constituted 82% of the sites of implanted tumours; 75% were T(1-2)N0 status. Brachytherapy was carried out using afterloaded plastic catheters and the Paris dose prescription system was followed. External cobalt-60 beam portals covered the primary and the neck. The median duration of follow-up was 22 months. The median dose of brachytherapy used alone was 60 Gy. With combined treatment, the median external radiotherapy and brachytherapy doses were 50 Gy and 25 Gy respectively. The median brachytherapy dose rate was 0.5 Gy/h. Primary and nodal recurrences were recorded in 41/106 (38.7%) and 18/106 (17.0%) patients at median intervals of 15 and 13 months respectively. Implant site failure was more common after combined treatment than with brachytherapy alone (42.8% versus 27.5%), but it did not reach statistical significance in this analysis (P = 0.15). Kaplan-Meier actuarial 5-year estimates showed 52% and 87% disease-free and overall survivals. Iridium-192 interstitial implants in suitably selected head and neck cancer patients can improve the radiotherapeutic results, with the promise of organ conservation in 50%. In India, the practice should be established in more radiotherapy centres and could be utilized in 10,000-25,000 head and neck cancer patients annually.

Adult↗
PubMed2001

Management of retinoblastoma with radiation.

OBJECTIVE: To evaluate the role of radiation therapy in the management of retinoblastoma. DESIGN: Retrospective analysis. METHOD: From January 1993 to March 1994, one hundred and eleven children (150 eyes) of retinoblastoma were referred for radiotherapy. The diagnosis was based on clinical examination and ocular ultrasonogram for both the eyes. The radiation treatment policy involved 40 Gy in 20 fractions over 4 weeks delivered with sedation for children under 1 year of age, 36 Gy in 9 fractions over 3 weeks under ketamine anesthesia for 1-4 years of age and for >4 years of age, a dose of 50 Gy in 25 fractions over 5 weeks. The initial tumor regression was evaluated by A and B mode ultrasonography and/or CT scan. RESULTS: The age distribution ranged from two months to six years (median - 20 months). Bilaterality was observed in 39 out of 111 cases (35%). The male to female ratio was 1.8:1. Eighty two of the 111 children were treated by definitive external beam radiation to one or both eyes. Fifteen cases received adjuvant radiotherapy after enucleation, and 14 had extensive disease for which palliative radiotherapy was offered. We observed a complete response in 54% of cases, partial response in 32%, and none in 14% of cases. Forty per cent (40%) eye survival was documented at the end of 28 months. The complication rate encountered was about 15%. CONCLUSION: Radiotherapy is an effective modality of treatment in significant number of patients with retinoblastoma. However, it requires appropriate fractionation, precise colimation and careful immobilization with general anesthesia.

Child↗
PubMed2000

Clinically staged T3N0M0 laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy.

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective analysis of the survival results of 119 cases of clinically staged T3N0 cancer larynx treated over a 14-year period at a single centre with either of the above two modalities has been undertaken. The selection of the treatment modality for an individual patient was decided jointly by the patient and the clinicians at a combined cancer clinic. The combined surgery plus radiotherapy treatment group was comprised of a relatively greater number of transglottic tumours while the curative radiotherapy group had a higher proportion of glottic tumours. Actuarial four-year disease-free survival rates were significantly better with combined treatment (79.3 per cent) than with radical radiotherapy and surgical salvage (65.3 per cent)--p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximately half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery for failure) for unselected clinically staged T3N0 cancer larynx, does not provide for comparable cure rates or for satisfactory laryngeal preservation.

Combined Modality Therapy↗
PubMed1999

Temporal assessment of quality of life of head and neck cancer patients receiving radical radiotherapy.

The study was undertaken to evaluate physical, psychological and functional aspects in quality of life (QoL) assessment prospectively in biopsy-proven head and neck cancer patients receiving radical radiotherapy. Fifty male patients were assessed using Karnofsky's Performance Status (KPS), Beck's Depression Inventory (BDI) and the Functional Living Index-Cancer (FLIC). Patient questionnaires were completed before radiotherapy, during 3-4 weeks of radiotherapy and 3 months after radiotherapy. Before the start of radiotherapy, KPS was 91 +/- 10.26, FLIC was 129.98 +/- 33.41 and BDI was 7.10 +/- 4.57. This indicated good performance and functional status with lower depression. In weeks 3-4 of radiotherapy, KPS (71.00 +/- 20.12) and FLIC (81.34 +/- 45.23) decreased, while BDI (16.56 +/- 9.01) increased, indicating impairment in QoL. Three months after radiotherapy, KPS (78.37 +/- 23.0), FLIC (119.51 +/- 43.62) and BDI (9.02 +/- 7.81) improved but were not restored to pre-treatment levels. When patients were scheduled for radical radiotherapy, maximum deterioration in QoL was seen in weeks 3-4. This is the time when maximum supportive care and psychologic counselling is required.

Activities of Daily Living↗
PubMed1999

Radiation therapy in skeletal metastases.

From June 1993 to September 1995, 132 case files of patients who received palliative radiotherapy (RT) for skeletal metastases were reviewed. Majority of the patients (75/132) was in the age range of 41-60 years. Common sites of metastases were the vertebrae (86 patients) and the pelvic bones (40 patients). The major primary tumors encountered were as follows: multiple myeloma (30), breast cancer (25) and prostate cancer (20). Pain was the commonest symptom of presentation. Doses of palliative RT ranged from 8-40 Gy in different fractionation schedules. Ninety-four patients showed more than 50% symptomatic response, 26 had no response and 12 were lost to follow up immediately after the treatment. Single fraction treatments resulted in almost similar responses compared to various multiple fraction treatments. To conclude, short course radiation therapy regimes are optimum in our local circumstances where RT resources are limited and patients have to travel long distances to attend hospital.

Adolescent↗
PubMed1998

Leptomeningeal carcinomatosis from carcinoma of the palatine tonsil.

Distant metastases from carcinoma of the palatine tonsil are very uncommon. We encountered a case of a carcinoma involving the tonsillar region that resulted in subarachnoid mestastases following local radical radiotherapy. Metastases were diagnosed following magnetic resonance imaging and spinal fluid cytology. The patient succumbed to the disease after a rapid downhill course, 1 month following diagnosis of the secondary deposit. The present paper describes the rare site of distant metastasis and reviews the relevant literature.

Carcinoma, Squamous Cell↗
PubMed1998

Radiotherapy in locally advanced cancer of the cervix.

Radical radiotherapy is considered as the treatment of choice in locally advanced cancer cervix. In late stages radiotherapy produce optimum palliation and to some extent cure. Three hundred cases of cancer cervix (stage I-IV) comprising stage-I (7), stage-II (144), stage-III (145) and stage IV (4) were evaluated and treated with radiotherapy between April 1990 to July 1994. FIGO stage IB, IIA and IIB (early), were treated with predominant intracavitary radiotherapy (34 Gy X 2 fractions; within one week) followed by external pelvic radiotherapy to a dose of 36 Gy in 18 fractions; treating 200 cGy per fraction, 5 days a week. The late stage (stage-IIB, IIIA and IIIB, IVA) of disease were managed with initial external radiotherapy to a dose of 50 Gy, followed by a single intracavitary dose of 30 Gy to point-A. The median follow up was 33 months (range 12-72 months). The tumor volume less than 100 cc were associated with better survival than volume more than 100 cc (p < 0.05). The five year actuarial survival was 83%, 68% and 58% respectively in FIGO stage I-III disease. There were 0.33% and 2.6% late grade-III bladder and rectal complications. Our experience shows effectiveness of radiotherapy in the management of locally advanced cancer of the cervix.

Adult↗
PubMed1997

Iridium-192 interstitial brachytherapy in carcinoma of the tongue. The importance of various tumor and physical parameters.

A detailed analysis of host-tumor factors and interstitial physical factors influencing the disease-free control in carcinoma of the tongue was carried out. Twenty-eight cases of carcinoma of the tongue T1-3, NO-1, MO were treated radically with combined external irradiation and 192Iridium interstitial brachytherapy (one patient received brachytherapy only). The teletherapy dose ranged from 44 Gy to 56 Gy (average 48 Gy), the brachytherapy dose ranged from 16 Gy to 55 Gy (average 22 Gy). The interstitial practice involved loop technique in all the cases. Dose distribution analysis to assess factors influencing local control included indices of dose rate, source activity, inter-planar distance, and discontinuity in the prescribed isodose in other planes when compared to mid-plane. Two-year actuarial disease-free survival (DFS) was 46% with primary treatment and 63% when salvage treatment was also included. DFS was significantly poorer when the interplanar distance at mid-plane exceeded 10 mm (p < 0.05). Similarly, tumor control was poorer (p < 0.008) when there was discontinuity in the prescribed isodose in 1 or 2 planes (1 cm superior and inferior to mid-plane). Interplanar distance of around 10 mm, prescribed isodose continuity in all three planes and limiting the dose maximum within a factor of 2 will optimize the results of interstitial implants.

Adult↗