Rajiv Gandhi Cancer Institute and Research Center

Delhi, India

Rajiv Gandhi Cancer Institute and Research Center

Delhi, India
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Singh Nanda K.D.,SGT Dental College | Mehta A.,Rajiv Gandhi Cancer Institute and Research Center | Nanda J.,ITS Dental College
Journal of Oral Pathology and Medicine | Year: 2012

Background: Fine-needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. Material and methods: A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010 - a 5-year period. Histopathological follow-up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. Results: The male-to-female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non-neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. Conclusion: Fine-needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate. © 2011 John Wiley & Sons A/S.

Heidenreich A.,University of Cologne | Heidenreich A.,RWTH Aachen | Rawal S.K.,Rajiv Gandhi Cancer Institute and Research Center | Szkarlat K.,Koscierzyna Hospital | And 7 more authors.
Annals of Oncology | Year: 2013

Background: Intetumumab is a fully human mAb with antiangiogenic, antitumor properties which has shown potential therapeutic effect in castration-resistant prostate cancer (CRPC) patients. Patients and Methods: In a phase 2, randomized, double-blind, multicenter study, men with metastatic CRPC without prior systemic nonhormonal therapy were randomly assigned to 75-mg/m2 docetaxel (Taxotere) and 5-mg prednisone plus placebo (N = 65) or 10-mg/kg intetumumab (N = 66) q3w. Placebo patients with progressive disease (PD) could cross over to 10-mg/kg intetumumab alone or with docetaxel. The primary end-point was progression-free survival (PFS). The secondary end-points included tumor response (complete response + partial response, CR + PR), prostate-specific antigen (PSA) response, and overall survival (OS). Results: All efficacy end-points favored placebo over intetumumab, including PFS (median 11.0 versus 7.6 months, P = 0.014), tumor response (20% versus 16%, P = 0.795), PSA response (68% versus 47%, P = 0.018), OS (median 20.6 versus 17.2 months, P = 0.163). Common all-grade adverse events (AEs) with placebo and intetumumab were alopecia (43% versus 26%); diarrhea, leukopenia (both 34% versus 27%); neutropenia (35% versus 23%). Grade ≥3 leukopenia (28% versus 17%) and neutropenia (26% versus 18%) occurred more often with placebo than with intetumumab. Intetumumab serum concentrations increased with repeated dosing and did not reach steady-state. Greater decreases in N-telopeptide of type I collagen (NTx), C-telopeptide (CTx) and CTCs occurred with intetumumab than with placebo. Conclusion: The addition of intetumumab to docetaxel resulted in shorter PFS without additional toxicity among CRPC patients. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Gligorov J.,University Pierre and Marie Curie | Doval D.,Rajiv Gandhi Cancer Institute and Research Center | Bines J.,Instituto Nacional Of Cancer | Alba E.,Hospital Universitario Regional rgen Of La Victoria | And 8 more authors.
The Lancet Oncology | Year: 2014

Background: Longer duration of first-line chemotherapy for patients with metastatic breast cancer is associated with prolonged overall survival and improved progression-free survival. We investigated capecitabine added to maintenance bevacizumab after initial treatment with bevacizumab and docetaxel in this setting. Methods: We did this open-label randomised phase 3 trial at 54 hospitals in Brazil, China, Egypt, France, Hong Kong, India, Italy, Poland, Spain, and Turkey. We enrolled patients with HER2-negative measurable metastatic breast cancer; each received three to six cycles of first-line bevacizumab (15 mg/kg) and docetaxel (75-100 mg/m2) every 3 weeks. Progression-free patients were randomly assigned with an interactive voice-response system by block (size four) randomisation (1:1) to receive either bevacizumab and capecitabine or bevacizumab only (bevacizumab 15 mg/kg on day 1; capecitabine 1000 mg/m2 twice per day on days 1-14, every 3 weeks) until progression, stratified by oestrogen receptor status (positive vs negative), visceral metastases (present vs absent), response status (stable disease vs response vs non-measurable), and lactate dehydrogenase concentration (≤1.5 vs >1.5×upper limit of normal). Neither patients nor investigators were masked to allocation. The primary endpoint was progression-free survival (from randomisation) in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00929240. Findings: Between July 16, 2009, and March 7, 2011 (when enrolment was prematurely terminated), 284 patients received initial bevacizumab and docetaxel; 185 (65%) were randomly assigned (91 to bevacizumab and capecitabine versus 94 to bevacizumab only). Progression-free survival was significantly longer in the bevacizumab and capecitabine group than in the bevacizumab only group (median 11.9 months [95% CI 9.8-15.4] vs 4.3 months [3.9-6.8]; stratified hazard ratio 0.38 [95% CI 0.27-0.55]; two-sided log-rank p<0.0001), as was overall survival (median 39.0 months [95% CI 32.3-not reached] vs 23.7 months [18.5-31.7]; stratified HR 0.43 [95% CI 0.26-0.69]; two-sided log-rank p=0.0003). Results for time to progression were consistent with those for progression-free survival. 78 (86%) patients in the bevacizumab and capecitabine group and 72 (77%) in the bevacizumab only group had an objective response. Clinical benefit was recorded in 92 (98%) patients in the bevacizumab alone group and 90 (99%) in the bevacizumab and capecitabine group. Mean change from baseline in global health score did not differ significantly between groups. Grade 3 or worse adverse events during the maintenance phase were more common with bevacizumab and capecitabine than with bevacizumab only (45 [49%] of 91 patients vs 25 [27%] of 92 patients). The most common grade 3 or worse events were hand-foot syndrome (28 [31%] in the bevacizumab and capecitabine group vs none in the bevacizumab alone group), hypertension (eight [9%] vs three [3%]), and proteinuria (three [3%] vs four [4%]). Serious adverse events were reported by ten (11%) patients in the bevacizumab and capecitabine group and seven (8%) patients in the bevacizumab only group. Interpretation: Despite prematurely terminated accrual and the lack of information about post-progression treatment, both progression-free survival and overall survival were significantly improved with bevacizumab and capecitabine compared with bevacizumab alone as maintenance treatment. These results might inform future maintenance trials and current first-line treatment strategies for HER2-negative metastatic breast cancer. Funding: F Hoffmann-La Roche. © 2014 Elsevier Ltd.

Shah S.B.,Rajiv Gandhi Cancer Institute and Research Center | Hariharan U.,Delhi Government Health Services | Bhargava A.K.,Rajiv Gandhi Cancer Institute and Research Center
Trends in Anaesthesia and Critical Care | Year: 2016

The C MAC™ D blade videolaryngoscope is used for difficult airway management under vision. Difficulties with its use can arise at different junctures. We present a comprehensive summary of the common problems and their solutions for efficient trouble shooting during intubation with the C MAC D blade. © 2016 Elsevier Ltd.

Kapoor G.,Rajiv Gandhi Cancer Institute and Research Center | Sinha R.,Rajiv Gandhi Cancer Institute and Research Center | Naithani R.,Rajiv Gandhi Cancer Institute and Research Center | Chandgothia M.,Acton Biotech India Pvt Ltd
Leukemia Research | Year: 2010

The prevalence of thiopurine S-methyltransferase (TPMT) polymorphism and its association with clinical and hematological toxicities was retrospectively analyzed in 71 Indian children with acute lymphoblastic leukemia (ALL). Only heterozygous TPMT alleles were observed (10%, 7/71) with relative frequencies being 1/3C (4.2%), 1/2 (4.2%) and 1/3A (1.4%). The median 6-mercaptopurine dose administered during the maintenance therapy was 31% lower among patients with heterozygous TPMT alleles versus the rest (32.1mg/m2/day and 46.2mg/m2/day, p=0.005), though the myelosuppression and toxicities were similar in both the groups. Identification of TPMT genotype appears to be important in making the ALL treatment more effective and less toxic. © 2010 Elsevier Ltd.

Jain S.,Rajiv Gandhi Cancer Institute and Research Center | Kapoor G.,Rajiv Gandhi Cancer Institute and Research Center
Indian Journal of Orthopaedics | Year: 2010

Ewing's sarcoma constitutes three per cent of all pediatric malignancies. Ewing's sarcoma has generally been more responsive to chemotherapy than adult-type sarcomas, and chemotherapy is now recommended for all patients with this disease. It is essential to integrate local control measures in the form of surgery and/or radiotherapy at the appropriate time, along with chemotherapy to eradicate the disease. This approach has improved the survival substantially to the tune of 70% in localized disease, although outcome for metastatic disease remains dismal. Newer therapeutic approaches are required to improve outcome for metastatic and recurrent or refractory Ewing's sarcoma in organized co-operative group trials.

Shah S.B.,Rajiv Gandhi Cancer Institute and Research Center | Bhargava A.K.,Rajiv Gandhi Cancer Institute and Research Center
Sri Lankan Journal of Anaesthesiology | Year: 2014

Laryngeal papillomatosis is a rare throat infection which is potentially fatal without treatment as it leads to varying degrees of airway obstruction. CO2 LASER removal is the most common mode of treatment used. Anaesthesia for laser surgery entails two major complications, namely airway fires and difficult ventilation. The C-Mac D-blade is a valuable new addition to the anaesthetist's armamentarium to overcome critical events like sudden airway obstruction by laryngeal papillomas.

Khurana A.,Rajiv Gandhi Cancer Institute and Research Center | Jalpota Y.,Rajiv Gandhi Cancer Institute and Research Center
Indian Journal of Pathology and Microbiology | Year: 2010

Adenomyoepithelioma of the breast is a rare tumor. Malignant change arising in this lesion is infrequent and only a few cases have been reported. We discuss a case of a 56-year-old female presenting with a firm breast mass, which was interpreted as myoepithelial carcinoma arising in a background of adenomyoepithelioma, based on morphological and immunohistochemical studies. This case is being highlighted for its rarity and distinct morphological spectrum.

Kapoor G.,Rajiv Gandhi Cancer Institute and Research Center | Sinha R.,Rajiv Gandhi Cancer Institute and Research Center | Abedin S.,Rajiv Gandhi Cancer Institute and Research Center
Pediatric Blood and Cancer | Year: 2012

Background: Intensification of systemic chemotherapy with inclusion of high dose methotrexate (HDMTX) has helped omit cranial irradiation from standard risk acute lymphoblastic leukemia (ALL) protocols, thereby eliminating the adverse side effects associated with its use. Administration of HDMTX needs meticulous monitoring. Limitations in the availability of trained staff and adequate infrastructure often pose problems in the developing world. The aim of this study was (1) to treat childhood ALL with a protocol that would have reduced use of cranial irradiation and containing infusions of high-dose methotrexate HDMTX (5g/m 2) without compromising on survival, and (2) evaluate the experience with HDMTX in a tertiary care cancer centre in a developing country. Methods: A retrospective chart review was done of 41 consecutive children with a confirmed diagnosis of ALL who had received at least one cycle of HDMTX as part of their consolidation treatment with regard to the patient demographic profile, details of HDMTX infusion and leucovorin rescue, toxicity, additional hospitalization, delay in next cycle of chemotherapy and survival. Results: The clinically most significant toxicities observed were mucositis 39% (58/149) and fever 28% (42/149) together leading to additional hospital stay in 7% (11/149) cycles and neutropenia grade 3 or more in 24.8% (34/137) contributing to delay in next cycle of chemotherapy in 15% (23/149) cycles. Conclusion: With this strategy, it was possible to omit or reduce the dose of cranial irradiation while maintaining survival outcomes. The administration of HDMTX therapy was found to be feasible and safe with the precautions described. © 2012 Wiley Periodicals, Inc.

Khurana A.,Rajiv Gandhi Cancer Institute and Research Center | Mehta A.,Rajiv Gandhi Cancer Institute and Research Center | Sardana M.,Rajiv Gandhi Cancer Institute and Research Center
Indian Journal of Pathology and Microbiology | Year: 2011

We report a case of a 47-year-old female (posthysterectomy) with bleeding per vaginam. Imaging studies showed a large abdomino-pelvic mass diagnosed as extrauterine adenomyoma with uterus-like features. This pathological entity is extremely uncommon with only few case reports available in the reported literature. This case is being highlighted for its rarity and to discuss the possible theories for origin of this uncommon condition.

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