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Mallath M.K.,Tata Medical Center | Taylor D.G.,University College London | Badwe R.A.,Tata Memorial Center | Rath G.K.,All India Institute of Medical Sciences | And 20 more authors.
The Lancet Oncology | Year: 2014

Cancer can have profound social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1·2 billion. In age-adjusted terms this represents a combined male and female incidence of about a quarter of that recorded in western Europe. However, an estimated 600 000-700 000 deaths in India were caused by cancer in 2012. In age-standardised terms this figure is close to the mortality burden seen in high-income countries. Such figures are partly indicative of low rates of early-stage detection and poor treatment outcomes. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Social factors, especially inequalities, are major determinants of India's cancer burden, with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. In this first of three papers, we examine the complex epidemiology of cancer, the future burden, and the dominant sociopolitical themes relating to cancer in India. © 2014 Elsevier Ltd.


Elango K.J.,Mazumdar Shaw Cancer Center | Anandkrishnan N.,Head and Neck Institute | Suresh A.,Mazumdar Shaw Cancer Center | Iyer S.K.,Head and Neck Institute | And 3 more authors.
Oral Oncology | Year: 2011

Oral cancer is a potentially preventable disease due to its association with well-known risk factors and easy detectability. There is a significant deficiency in the awareness of oral cancer and its risk factors among the public. Raising public awareness could effectively contribute to achieving a significant reduction in the incidence of oral cancer. The objective of this study was to evaluate the effectiveness of mouth self-examination (MSE) in improving the awareness of oral cancer and its risk factors as well as test its feasibility as an oral cancer-screening tool. The study was carried out in a high-risk population of 57,704 from India, of which, 34,766 individuals who have met the eligibility criteria formed the study population. MSE brochures and trained health workers were employed for the purpose of health education and cancer screening. The present study compared their efficacy to detect oral lesions. Subjects with suspicious lesions were referred to the trained oral cancer specialist for confirmation. A questionnaire to assess the awareness of oral cancer and its risk factors was developed and validated. SPSS (v.11.0) was used for data analysis. The program identified 216 cases of potentially malignant lesions as well as three cases of oral cancer. The findings of MSE and health workers showed 72% concordance, while that of health workers and oral cancer specialist showed 100% concordance. MSE had a low sensitivity of 18%, while the specificity was 99.9%. Though the technique identified high-risk lesions such as red patches (66.7%) and non-healing ulcers (42.9%), the detection rate of white patches was low (12.7%). Overall awareness of oral cancer and its risk factors after introduction of MSE program was over 80%; but the compliance to seek treatment was poor (32%). Mouth self-examination may be used as an effective tool to improve the awareness of oral cancer and for the early detection of lesions. © 2011 Elsevier Ltd.


Rajapurkar M.,Amrita Institute of Medical science | Thankappan K.,Amrita Institute of Medical science | Sampathirao L.M.C.S.,Amrita Institute of Medical science | Kuriakose M.A.,Mazumdar Shaw Cancer Center | Iyer S.,Amrita Institute of Medical science
Head and Neck | Year: 2013

Background. The purpose of this study was to analyze the oncologic and functional outcomes of the preserved eye in malignant sinonasal tumors with orbital involvement. Methods. In a retrospective study of 19 consecutive patients who underwent craniofacial resection or maxillectomy with preservation of orbital contents and adjuvant radiotherapy, the oncological outcome in terms of local recurrence and survival was analyzed. The functional outcome in the preserved eye was analyzed for the cases that did not recur in the orbit. Results.Nineteen patients were analyzed for their oncologic and functional outcomes. Fifteen patients underwent immediate reconstruction of the orbital support. Eight patients had local recurrences; 11 patients were disease free at the end of the follow-up. Squamous cell carcinoma has a high propensity for local recurrences (ie, 5 of 8 local recurrences were squamous cell carcinoma). Sixteen patients, in whom a satisfactory orbital tumor clearance was obtained, remained recurrence free in the orbit. All the preserved eyes retained adequate function after adjuvant radiotherapy. Conclusions. Adequate local control with preserved visual function can be obtained with surgery and adjuvant radiation in appropriately selected malignant sinonasal tumors with orbital involvement. The preserved eye, if reconstructed appropriately, maintains good overall function with acceptable morbidity. © 2012 Wiley Periodicals, Inc.


Balasubramanian D.,Amrita Institute of Medical science | Thankappan K.,Amrita Institute of Medical science | Kuriakose M.A.,Mazumdar Shaw Cancer Center | Duraisamy S.,Amrita Institute of Medical science | And 4 more authors.
Microsurgery | Year: 2012

Extensive and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap. The indications of the simultaneous use of double free flaps can be broadly classified as: (a) large oro-mandibular bone and soft tissue defects (n = 13), (b) large oro-mandibular soft tissue defects (n = 4), (c) complex skull-base defects (n = 2), and (d) dynamic total tongue reconstruction (n = 2). Flap survival rate was 95%. Median follow-up period was 11 months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of flap combination for the appropriate indications is proposed. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. Copyright © 2012 Wiley Periodicals, Inc.


Dawood S.,Dubai Hospital | Sirohi B.,Mazumdar Shaw Cancer Center
Future Oncology | Year: 2015

Pertuzumab is a humanized monoclonal antibody targeting HER2 that is different from trastuzumab in that it binds to a different domain of HER2; hence, combining the two drugs leads to a more comprehensive blockade of the receptor. This is the first drug to receive fast-track approval from US FDA based on the pathologic complete response (as the primary end point) attained in patients treated with neoadjuvant chemotherapy for breast cancer. Pertuzumab is approved in first-line treatment in metastatic setting both by FDA and EMA in combination with trastuzumab and docetaxel. Combining two targeted therapies ('dual blockade') will certainly escalate treatment costs and it remains to be seen if this strategy will find its way in to the clinic for all patients. © 2015 Future Medicine Ltd.


Kekatpure V.D.,Mazumdar Shaw Cancer Center | Manjula B.V.,Mazumdar Shaw Cancer Center | Mathias S.,Mazumdar Shaw Cancer Center | Trivedi N.P.,Mazumdar Shaw Cancer Center | And 2 more authors.
Microsurgery | Year: 2013

Resection of advanced gingivo-buccal tumors results in a posterolateral mandibular and large soft tissue defect. Because of large soft tissue requirement, these defects are difficult to reconstruct using a single osteocutaneous flap. A double free flap reconstruction of such defects is recommended. However, double flap may not be feasible in certain situations. In this study, we objectively evaluated functional and cosmetic outcomes following single soft-tissue flap reconstruction in a group of patients where double flap reconstruction was not feasible. Patient and defect characteristics were obtained from charts. The speech and swallowing functions of patients were prospectively assessed by a dedicated therapist. The cosmetic outcome of reconstruction was evaluated by an independent observer. Fifty-six patients with large soft tissue and segmental posterolateral mandible defect, reconstructed with anterolateral thigh or pectoralis major flap from May 2009 till December 2010 were included. In this series, none of the flaps were lost; two patients with pectoralis major flap developed partial skin paddle loss. Most of the patients developed mandibular drift; however, majority of these patients had no postoperative trismus. All patients resumed regular or soft solid oral diet. The mean speech intelligibility was more than 70%. Majority of patients had satisfactory cosmetic outcome. The defects were classified into regions resected to develop a reconstruction algorithm for optimal reconstruction using a free or pedicle flap. In conclusion, patients with large oro-mandibular defect undergoing single soft tissue flap reconstruction have satisfactory functional and cosmetic outcome. © 2012 Wiley Periodicals, Inc.


Pipalia H.,Mazumdar Shaw Cancer Center
Journal of Craniofacial Surgery | Year: 2016

ABSTRACT: Three-dimensional virtual surgery programs are widely available for orthognathic surgery. The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, outcome measurement, and three-dimensional surgical simulation. Complex maxillofacial malformations continue to present challenges in analysis and correction beyond modern technology. Orthomorphic correction for mandibular dysmorphology refers to basal bone movement without any change in dental component. The purpose of this paper is to present a virtual surgery planning for surgeons to perform the orthomorphic surgery with precision and quantification. Moreover, it provides an essential educational tool for patients to foresee predicted surgical outcome. © 2016 by Mutaz B. Habal, MD.


Bhat V.,Mazumdar Shaw Cancer Center
Journal of Clinical Imaging Science | Year: 2014

This pictorial illustration demonstrates various aspects of arterial tortuosity syndrome (ATS) obtained predominantly from a multiple detector computed tomography (MDCT) examination of a patient. In addition, a comprehensive review of typical multi-modality imaging observations in patients with ATS is presented along with a description of a few imaging signs. Non-invasively obtained, conclusive information is required in patients with ATS in view of the fragile vascular structures involved. An amazing wealth of information can be obtained by reviewing the volumetric data sets of MDCT examination. In the context of incomplete clinical information or remote reading of radiographic examination with inadequate clinical details, ability to "image data mine" the hidden, unexplored information may be vastly useful. The role of MDCT as a single modality of evaluation in ATS is highlighted. © 2014 Bhat.


Kekatpure V.D.,Mazumdar Shaw Cancer Center | Trivedi N.P.,Mazumdar Shaw Cancer Center | Manjula B.V.,Mazumdar Shaw Cancer Center | Mathan Mohan A.,Mazumdar Shaw Cancer Center | And 2 more authors.
International Journal of Oral and Maxillofacial Surgery | Year: 2012

The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting. © 2011 International Association of Oral and Maxillofacial Surgeons.


Trivedi N.P.,Mazumdar Shaw Cancer Center | Kekatpure V.D.,Mazumdar Shaw Cancer Center | Trivedi N.N.,Mazumdar Shaw Cancer Center | Kuriakose M.A.,Mazumdar Shaw Cancer Center
Indian Journal of Cancer | Year: 2012

Background: In a large and diverse country like India, there is a wide variation in the availability of infrastructure and expertise to treat head-neck cancer patients. Lack of consistent adherence to evidence-based management is the biggest problem. Aims: There is an unmet need to evaluate the existing treatment practices to form the basis for development of effective and uniform treatment policies. Settings and Designs: Prospective case series. Materials and Methods: A group of previously treated, potentially curable patients presenting to our institution (from April 2009 to March 2011) were evaluated for appropriateness of initial treatment based on National Comprehensive Cancer Network or Tata Memorial Hospital guidelines. Data regarding treatment center, protocol and accuracy of delivered treatment and their eventual outcome were analyzed. Statistical Analysis: Descriptive. Results: Amongst 450 newly registered patients, 77(17%) were previously treated with curative intent and 69(89%) of them were inappropriately treated. Seventeen (25%) patients were treated in clinics while 12(17%) in cancer centers and 34(50%) in corporate hospitals. Fourteen (20%) patients received chemotherapy, 22(32%) received radiotherapy and 14(20%) underwent surgery while 19(28%) patients received multimodality treatment. Disease stage changed to more advanced stage in 40(58%) patients and curative intent treatment could be offered only to 33(48%) patients. Amongst 56 patients available for outcome review, 18(32%) patients were alive disease-free, 20(36%) had died and 18(32%) were alive with disease. Conclusion: Large numbers of potentially curable patients are inappropriately treated and their outcome is significantly affected. Many initiatives have been taken in the existing National Cancer Control Program but formulation of a uniform national treatment guideline should be prioritized.

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