Suresh P.,Command Hospital Southern Command |
Batra U.,Rajiv Gandhi Cancer Institute |
Doval D.C.,Rajiv Gandhi Cancer Institute
Indian Journal of Medical and Paediatric Oncology | Year: 2013
Background: Triple negative breast cancer (TNBC) is a recent concept and the burning topic of research today. Various studies have been reported in western literature on TNBCs or the similar group of basal like cancers, all highlighting the poor prognostic features of this molecular subtype in comparison to the other types of breast cancers. However extensive data from India is lacking. The aim of this study was to analyze the epidemiological and clinical profile of TNBcs at our institute. Materials and Methods: Data on 171 patients of TNBCs registered at this hospital between 2005 and 2008 and followed up until December 2010 was collected and reviewed for epidemiological and clinical features. Results: The median age at presentation was 49 years (22-75 years). Sixty eight patients (40%) had lump in the breast of less than 1 month duration. Fourteen (8%) were nulliparous and 10 (7%) patients had crossed the age of 30 years at first full-term pregnancy, 89 (52%) were pre or peri-menopausal at presentation. Only 8 (5%) patients had a family history of breast or ovarian cancer. One hundred and six (62%) patients were stage II, 26 (15%) stage III, 21 (12%) stage I and 18 (10%) stage IV at presentation. One hundred and twenty eight patients (75%) had early breast cancer eligible for surgery at presentation, 25 (15%) were locally advanced and received neoadjuvant chemotherapy (NACT) and 18 (10%) were found to be metastatic. Modified radical mastectomy was the preferred surgical option by most patients (76%) who underwent upfront surgery in our study. The pathological overall response rates (complete and partial response) after NACT was 75% with complete response rate of 25% and there were no relapses in the complete responders. The median follow-up was 30 months (9-70 months). One hundred and twenty two patients (71%) were alive at last follow-up, 34 (22%) had relapsed, 18 (11%) had died due to progressive disease. Thirty one patients (18%) were lost to follow-up. Most of the relapses were systemic and rarely preceded by local relapses. Conclusions: TNBCs are aggressive cancers with high rates of systemic relapses within the first 3 years of presentation. Longer follow-up of these patients is required for more mature data on these cancers.
Dhamija M.,Rajiv Gandhi Cancer Institute |
Kapoor G.,National Institute of Medical Statistics |
Juneja A.,National Institute of Medical Statistics
Journal of Pediatric Hematology/Oncology | Year: 2014
Background: Drug administration is a multiprofessional process. The high toxicity and low therapeutic index of chemotherapy drugs make medication errors a significant problem, resulting in excessive patient morbidity and cost. Objective: An audit of the delivery of infusional chemotherapy among pediatric inpatients was planned, with the objective of improving practice and minimizing errors.Method: An observational study was conducted between January and August 2012. Patients were followed up from their premedication until the completion of postchemotherapy hydration and/or rescue drugs. Errors were recorded and classified by error type, cause, severity, unit location, medication involved, and harm caused.Results: A total of 205 observations were made and 23(13.6%) errors recorded, of which 6 were intercepted. No life-threatening adverse drug event was recorded. The most important risk factor predisposing to errors was admission to nonpediatric ward (P=0.004). Documentation errors and incorrect infusion time were the 2 most common errors, whereas the most frequent error node was administration error. Appropriate steps were taken to prevent their reoccurrence.Conclusions: This study helped provide important information about the rate and epidemiology of medication errors, emphasizing on the role of audit in enabling development of appropriate errorreducing strategies, particularly in the context of quality assurance in hospitals. Copyright © 2013 by Lippincott Williams & Wilkins.
Mehta S.B.,Philips |
Mehta S.B.,Delhi Technological University |
Chaudhury S.,Indian Institute of Technology Delhi |
Bhattacharyya A.,Delhi Technological University |
Jena A.,Rajiv Gandhi Cancer Institute
Applied Soft Computing Journal | Year: 2010
This paper proposes a soft-computing based diagnostic tool for analyzing (white matter changes) demyelination due to radiation therapy given to brain tumor cases. The tool exploits the pattern of changes in gray level distribution using a temporal sequence of magnetic resonance (MR) images. Appearance of white matter changes due to demyelination varies from patient to patient. Further, there exists inherent impreciseness in the white matter change patterns. These characteristics make use of fuzzy features well suited for describing image based temporal patterns. Correlation between these temporal patterns and actual onset of demyelination can be captured by fuzzy rules because of the inherent uncertainty associated with changes in gray level pattern in the image and occurrence of the disease. The tool is based on hybrid approach of two popular approaches of genetic algorithm based machine learning (GBML) techniques namely Michigan and Pittsburgh approach. The genetic algorithm (GA) based machine learning tool generates an optimized rule set to indicate positive (P), negative (N) or doubtful (D) cases of demyelination. © 2009 Elsevier B.V. All rights reserved.
Desai C.,Vedanta Institute of Medical science |
Mehta A.,Rajiv Gandhi Cancer Institute |
Mishra D.,SFJ Pharmaceuticals Group
Lung India | Year: 2014
Introduction: Personalized medicine has facilitated improved management of non-small cell lung cancer (NSCLC) patients by identifying predictive and prognostic biomarkers for enhanced efficiency of detection and efficacy of treatment. This systematic review and survey assessed the patterns of biomarker usage, molecular testing techniques to diagnose patients with NSCLC in India and testing techniques recommended by cancer societies. Materials and Methods: Studies were retrieved from Embase, PubMed, and Cochrane databases for the last 12 years, using relevant search strategies as per the Cochrane methodology for systematic reviews. Outcomes of interest were biomarkers for NSCLC, patterns of biomarker testing, diagnostic methods, guidelines and cost of biomarker testing. Results: In all, 499 studies were identified for screening and 17 primary publications were included in the review. Epidermal growth factor receptor (EGFR) expression and epithelial markers (particularly cytokeratins (CK)) were the most commonly reported biomarkers (7/17) and immunohistochemical (IHC) staining was the most common technique for detection of biomarkers. The frequency of EGFR mutations was higher among women than men. Significantly elevated levels of CK-18 were observed in patients with squamous cell carcinoma and of CK-19 in patients with adenocarcinoma, squamous cell carcinoma, and NSCLC (P < 0.001). Prognostic or predictive role of cytokines and angiogenic markers as well as DNA expression were evaluated. The survey also showed that IHC was the most common technique for detection of biomarkers. Conclusions: This systematic review and survey provides valuable information on biomarker usage in the Indian population, and highlights the need for initiatives required for future biomarker testing in India.
Taneja S.,Rajiv Gandhi Cancer Institute |
Jena A.,Rajiv Gandhi Cancer Institute |
Zaidi S.M.S.,The Surgical Center |
Khurana A.,Rajiv Gandhi Cancer Institute
Indian Journal of Radiology and Imaging | Year: 2012
Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well.
Rahman K.,Rajiv Gandhi Cancer Institute |
George S.,Rajiv Gandhi Cancer Institute |
Tewari A.,Rajiv Gandhi Cancer Institute |
Mehta A.,Rajiv Gandhi Cancer Institute
Cytometry Part B - Clinical Cytometry | Year: 2013
Mixed phenotypic acute leukemia (MPAL) is a rare disorder with an incidence of less than 2% of all acute leukemia using the recent 2008 WHO criteria. Common subtypes encountered are the B/myeloid and T/myeloid; B/T or trilineage MPAL being an exception. We discuss here a case of 20-year-male patient who presented with pallor and generalised lymphadenopathy. Peripheral blood smear examination showed presence of 61% blasts of lymphoid morphology. Immunophenotyping by multicolor flow cytometry showed two distinct populations of blasts with T and B phenotype respectively. He was diagnosed as MPAL with two distinct blast lineages. Conventional karyotyping done on bone marrow sample showed t(9;22)(q34;q11)(Ph +). Induction was started using ALL based protocol. The patient is on follow up with post induction marrow being in morphological remission. Copyright © 2013 International Clinical Cytometry Society.
Gandhi J.S.,Rajiv Gandhi Cancer Institute |
Mehta A.,Rajiv Gandhi Cancer Institute |
Sharma A.,Rajiv Gandhi Cancer Institute |
Kamboj M.,Rajiv Gandhi Cancer Institute
Journal of Cancer Research and Therapeutics | Year: 2010
Primary classical Hodgkin lymphomas of the gastrointestinal tract are rare lymphoproliferative neoplasms as against other well established mucosa-associated lymphoid tissue (MALT) lymphomas. The primary nature of these cases is established based on chest radiograph, computed axial tomography, positron emission tomography, peripheral blood and bone marrow biopsy examination. Here, we report a 79-year-old male patient, who presented to the emergency department with complaints of abdominal discomfort on right side and low grade fever. An ultrasonogram was performed which suggested of an intestinal perforation. An emergency laporotomy was done with resection of the ileal segment. The histomorphology of the resected ileal segment revealed features of classical Hodgkin lymphoma which were confirmed by immunohistochemistry. Epstein Barr virus encoded RNA (EBER) via in-situ hybridization was positive and provided substantial evidence of EBV etiology.
Ram D.,Rajiv Gandhi Cancer Institute |
Selvakumar V.P.P.,Rajiv Gandhi Cancer Institute
Journal of Clinical and Diagnostic Research | Year: 2016
Breast hamartomas are benign lesions composed of variety of normal breast components arranged in disorganized manner. These are rare and classified as adenolipoma, fibrolipoma, adenofibrolipoma, etc. Clinically these present as painless well-circumscribed, mobile lumps of breast. Incidence and etiology remain obscure due to its rarity. These have been described in women in their 40’s or 50’s. Mammographically they appear non homogenous mass with circumscribed fatty masses. Histologically they appear as circumscribed masses with variable amount of fat, fibrous and glandular tissue. Here we are presenting adenolipoma in 29-year-old woman with review of literature. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Shah S.B.,Rajiv Gandhi Cancer Institute |
Chowdhury I.,Rajiv Gandhi Cancer Institute |
Bhargava A.K.,Rajiv Gandhi Cancer Institute |
Sabbharwal B.,Rajiv Gandhi Cancer Institute
Journal of Anaesthesiology Clinical Pharmacology | Year: 2015
Background and Aims: This study aimed to compare the hemodynamic responses during induction and intubation between propofol and etomidate using entropy guided hypnosis. Material and Methods: Sixty ASA I & II patients in the age group 20-60 yrs, scheduled for modified radical mastectomy were randomly allocated in two groups based on induction agent Etomidate or Propofol. Both groups received intravenous midazolam 0.03 mg kg -1 and fentanyl 2 μg kg -1 as premedication. After induction with the desired agent titrated to entropy 40, vecuronium 0.1 mg kg -1 was administered for neuromuscular blockade. Heart rate, systolic, diastolic and mean arterial pressures, response entropy [RE] and state entropy [SE] were recorded at baseline, induction and upto three minutes post intubation. Data was subject to statistical analysis SPSS (version 12.0) the paired and the unpaired Student's T-tests for equality of means. Results: Etomidate provided hemodynamic stability without the requirement of any rescue drug in 96.6% patients whereas rescue drug ephedrine was required in 36.6% patients in propofol group. Reduced induction doses 0.15mg kg -1 for etomidate and 0.98 mg kg -1 for propofol, sufficed to give an adequate anaesthetic depth based on entropy. Conclusion: Etomidate provides more hemodynamic stability than propofol during induction and intubation. Reduced induction doses of etomidate and propofol titrated to entropy translated into increased hemodynamic stability for both drugs and sufficed to give an adequate anaesthetic depth.
Jena A.,Rajiv Gandhi Cancer Institute |
Mehta S.B.,Rajiv Gandhi Cancer Institute |
Taneja S.,Rajiv Gandhi Cancer Institute
Journal of Magnetic Resonance Imaging | Year: 2013
Purpose: To assess the effects of reduced scan time in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of breast for the evaluation of pharmacokinetic parameters (Ktrans, ve, and kep). Materials and Methods: High temporal resolution DCE-MRI was performed for calculation of pharmacokinetic parameters (Ktrans, ve, and kep) at different timepoints using an in-house developed computation scheme adopting the standard model (SM). Results: The receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) of 0.994 for Ktrans at 90 seconds and 0.987 for Ktrans at 60 seconds with a significant decrease in the AUC for Ktrans at 30 seconds (0.669). While ve showed a consistently higher AUC (>0.9) at timepoints ≥40 seconds, the AUC for kep showed a consistent decline with reduced acquisition times. Conclusion: Reducing the acquisition time for the Ktrans and v e measurement up to 60 seconds yields reasonable accuracy for both and can be incorporated in the routine DCE-MRI protocol for evaluation of enhancing breast lesions. © 2013 Wiley Periodicals, Inc.