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Biomedical subjects

G K Rath

Publications and source records attributed to G K Rath.

At least 55 records · Page 3Linked to original sources
PubMed1998

Mitoxantrone, mitomycin-C, methotrexate combination chemotherapy with radiotherapy and/or surgery in stage III (T4B, NO-2, M0) breast cancer.

Results of primary surgery with or without locoregional radiotherapy (LRRT) are poor in stage III (T4b, NO-2, M0) breast cancer. Combination of mitoxantrone, mitomycin-c and methotrexate (MMM) has been reported to be as efficacious as doxorubicin based protocols with advantages of reduced nausea, vomiting, alopecia and cardiotoxicity. We tested MMM chemotherapy with LRRT and surgery in locally advanced breast cancer (LABC) with a view to assess response, survival, breast conservation, cost and toxicity. Fifty two previously untreated patients were given Mitoxantrone: 8 mg/m sq by infusion on days 1 and 21, Mitomycin-C: 8 mg/m sq by infusion on day 1 and Methotrexate: 35 mg/m sq i.v. on days 1 and 21. Cycles were repeated every 42 days. After 3 cycles LRRT was given if lump reduced to less than 2 cms. Otherwise patients were subjected to modified radical mastectomy (MRM) or radical mastectomy (RM). Following this 3 more cycles of chemotherapy were given. Patients with soft tissue, skin or heavy nodal involvement also received LRRT. Tamoxifen 20 mg daily was prescribed at the end of chemotherapy to postmenopausal patients. Complete/partial responses were seen in 5 and 26 patients, respectively after chemotherapy giving an overall response of 59.5%. Twenty four patients each had LRRT and MRM/RM. Responses could be significantly enhanced by LRRT/and or surgery. Nineteen out of 25 relapses were at distant sites. Breast conservation was achieved in 24/52 (46%) patients. Three year disease free and overall survival was 54% and 65%, respectively. There was 1 toxic death. Severe prolonged myelosuppresion was seen in those who also received LRRT. Mucositis, alopecia, nausea and vomiting were minor problems. Overall, combination was less expensive than doxorubicin based protocols.

Adult↗
PubMed1998

Simultaneous radiochemotherapy in the treatment of inoperable, locally advanced head and neck cancers.

The results of radiation therapy alone in locally advanced head and neck cancers are dismal with 5 year locoregional control rates not exceeding 15%. The addition of concomitant chemotherapy with cisplatin and more recently carboplatin has shown promising results. Twenty patients of inoperable stage III and IV oral or oropharyngeal cancers were treated with concomitant chemoradiation with carboplatin 300 mg/m2 i.v. on days 1, 21 and 42 of radiation therapy. Twelve (60%) patients had a complete remission. Thirteen patients were alive at a median follow up of 11 months. The treatment was well tolerated with only 2 patients requiring treatment interruptions for mucositis. Longer follow up would reveal any improvement in overall survival. The relative ease with which carboplatin/RT was administered suggests that other agents might be added as well.

Antineoplastic Agents↗
PubMed1998

Nucleolar organiser regions and morphologic subtypes of squamous cell carcinoma of cervix.

Nucleolar organiser regions (NOR) are chromosomal segments coding for ribosomal RNA. The number of nucleolar organiser regions correlates with cellular proliferation and has a diagnostic and prognostic value in neoplastic diseases. The aim of this study was to study the morphologic subtypes of squamous cell carcinoma of the uterine cervix in biopsy and hysterectomy specimens and to determine the AgNOR counts in these morphologic subtypes. One hundred and seventy-nine cases of squamous cell carcinoma of the uterine cervix were classified into three morphological subtypes namely large cell non keratinising squamous cell carcinoma (113), keratinising squamous cell carcinoma (64) and small cell carcinoma (2). A correlation of histologic typing on biopsy and hysterectomy specimens was done in 142 cases with a complete correlation in 90.5%. Fifty-eight of these tumours were stained with silver nitrate to demonstrate Nucleolar organiser regions (AgNORS). The mean AgNOR count was higher (3.66) in keratinising squamous cell carcinoma, which is known to have a worse prognosis as compared to 3.04 in large cell non keratinising carcinoma and (3.45) in the two cases of small cell carcinoma of the uterine cervix.

Adult↗
PubMed1997

Malignant melanoma presenting as bilateral breast masses.

Malignant melanoma presenting initially with disseminated disease is common. However, bilateral breast masses as the initial symptom of malignant melanoma are rare. One such case is detailed here, together with a review of literature.

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↗
PubMed1996

Improving cancer radiotherapy with 2-deoxy-D-glucose: phase I/II clinical trials on human cerebral gliomas.

PURPOSE: Evaluation of tolerance, toxicity, and feasibility of combining large fraction (5 Gy) radiotherapy with 2-deoxy-D-glucose (2DG), an inhibitor of glucose transport and glycolysis, which has been shown to differentially inhibit repair of radiation damage in cancer cells. METHODS AND MATERIALS: Twenty patients with supratentorial glioma (Grade 3/4), following surgery were treated with four weekly fractions of oral 2DG (200 mg/kg body weight) followed by whole brain irradiation (5 Gy). Two weeks later, supplement focal radiation to the tumor (14 Gy/7 fractions) was given. Routine clinical evaluation, x-ray computerized tomography (CT), and magnetic resonance (MR) imaging were carried out to study the acute and late radiation effects. RESULTS: All the 20 patients completed the treatment without any interruption. The vital parameters were within normal limits during the treatment. None reported headache during the treatment. Mild to moderate nausea and vomiting were observed during the days of combined therapy (2DG + RT) in 10 patients. No significant deterioration of the neurological status was observed during the treatment period. Seven patients were alive at 63, 43, 36, 28, 27, 19, and 18 months of follow-up. In these patients, the clinical and MR imaging studies did not reveal any late radiation effects. CONCLUSIONS: Feasibility of administering the treatment (2DG + 5 Gy) is demonstrated by the excellent tolerance observed in all 20 patients. Further, the clinical and MR studies also show the absence of any brain parenchymal damage.

Adult↗
PubMed1996

Male breast cancer: a retrospective study from a regional cancer center in northern India.

Over a 7-year period from 1987 to 1993, 41 male breast cancer patients were seen in the breast cancer clinic of the Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences (AIIMS). Their mean age was 54.2 years; and duration of symptoms ranged from 1 to 84 months with a mean of 15.1 months. Breast lump was the commonest presenting symptom. Fine needle aspiration cytology (FNAC) was the commonest diagnostic procedure. The TNM stage distribution was stage I, 5; stage II, 13; stage III, 17; and stage IV, 6. Radical mastectomy (25/36) was the commonest surgical procedure. Locoregional radiotherapy was given in 15 patients. Thirty patients received systemic adjuvant therapy (chemotherapy or tamoxifen, or a combination of the two). Local or distant recurrence occurred in 8 patients (8/31, 28.3%). Actuarial overall and disease-free survival was 100% and 80.1% at 2 years and 91.7% and 66.7% at 4 years, respectively. On univariate analysis, axillary lymph node status and age were found to affect disease-free survival significantly. Advanced stage of disease at presentation is common in Indian patients and will continue to influence treatment policies. Neoadjuvant chemotherapy needs to be evaluated for locally advanced tumors to improve outcome. Multicentric studies are necessary to define the relative roles of tamoxifen and chemotherapy for adjuvant treatment.

Adult↗
PubMed1996

Role of transabdominal pelvic ultrasound and computed tomography in the detection of bladder involvement in advanced cancer of the cervix.

The imaging data of 125 advanced cancer cervix patients attending the Institute Rotary Cancer Hospital between June 1992 and June 1994 was reviewed. The aim of the study was to assess the role of transabdominal pelvic ultrasound (TAPUS) and computed tomography (CT) in the detection of bladder involvement. TAPUS was performed in 65 patients (group I) and CT in 60 patients (group II). With respect to clinical stage, both groups were comparable. Cystoscopy was performed in all patients and the findings were taken as the gold standard for comparison of imaging data. The sensitivity, specificity and accuracy of TAPUS were 65, 94 and 75%, respectively, while those for CT were 80, 92 and 85%, respectively. Results of the present study reveal that the accuracy of TAPUS is comparable to the accuracy of other imaging modalities in the detection of bladder involvement in cervical cancer and that it should be used more frequently in developing countries that deal with a large number of cervical cancer patients in view of its easy availability, low cost and absence of exposure to radiation.

Adult↗
PubMed1996

Results of definitive radiotherapy in T1 and T2 glottic carcinoma: Institute of Rotary Cancer Hospital experience.

Early glottic carcinomas (T1 and T2) constitute only 2% of all laryngeal cancers in our data. Seventy patients were seen between 1985 and 1992. All patients were treated by cobalt-60 small field radiotherapy using a beam directed shell. The total dose delivered was 60-65 Gy in 31 patients and 66-70 Gy in 39 patients. The follow-up period ranged from 5 to 126 months, with a mean follow up of 37 months overall and 55 months in the surgical salvage group. Radiation therapy controlled disease in 71% (50 of 70) of patients overall; 75% with T1 and 67% with T2 lesions. Total laryngectomy as salvage surgery was performed in 70% (14 of 20) of patients whose disease recurred. Ultimate control including surgical salvage occurred in 64 (91%) of 70 patients in the present study. The actuarial 5 year survival was 83 and 80% in T1 and T2 tumours, respectively (statistically insignificant). This report supports the policy of definitive irradiation, reserving surgical salvage for radiation failures in early laryngeal cancers.

Adult↗
PubMed1996

Aggressive bone metastases in urachal carcinoma.

A 38-year-old female with urachal carcinoma showed extensive bone metastases 1 year after wide excision of the urachal tumor, including partial cystectomy. A combination of radiotherapy and systemic chemotherapy was offered. Local radiotherapy of 8 Gy as a single fraction or 10 Gy in two fractions was delivered to the painful regions of the skeletal system. Multiagent chemotherapy consisting of methotrexate, vinblastine, Adriamycin, and cisplatin was given for three cycles. The patient died 28 months after the initial presentation with progression of the disease to pelvis and skeletal sites. The problem of metastatic spread after initial resection should be considered in urachal carcinoma, and adjuvant chemoradiotherapy should improve the outcome in this rare neoplasm.

Adenocarcinoma↗
PubMed1996

Synchronous oesophageal carcinoma with non Hodgkin's lymphoma, problems with management.

A case of synchronous malignancy of oesophagus with Non Hodgkin's lymphoma is presented and the rarity of such an association is discussed. The inherent difficulties encountered were initial planning of therapy keeping in view of the general condition of the patient. The patient received three cycles (every 21 days) of CHOP regimen for Non Hodgkin's lymphoma and to maintain a static state of oesophageal cancer. The patient showed more than 75 percent response to NHL counterpart, and for carcinoma oesophagus counterpart short course high dose loco-regional radiation therapy was given and the tumor was found to be resectable.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Hemostatic radiotherapy in carcinoma of the uterine cervix.

OBJECTIVE: To evaluate the treatment of hemorrhagic carcinoma of the uterine cervix with hemostatic radiotherapy (external and intracavitary radiotherapy). METHOD: Twenty cases of refractory hemorrhagic carcinoma of the uterine cervix receiving hemostatic radiotherapy between April 1987 and May 1992 were analyzed. The age of the patients ranged between 30 and 60 years with a median of 42 years. RESULTS: The mean tumor volume was 130 mm3; all cases were classified as FIGO stage IIb (n = 8), IIIb (n = 11) or IVa (n = 1). Radiotherapy was carried out either by the external or intracavitary technique. The control of hemorrhage was 100% within 12-48 h after radiotherapy. However 85% of patients failed locally in the form of residual, recurrent pelvic or metastatic disease, within 24 months of follow-up. CONCLUSION: Hemorrhagic cervical cancer has a poor prognosis.

Adult↗
PubMed1995

Intrarectal formalin application, an effective treatment for grade III haemorrhagic radiation proctitis.

Haemorrhagic radiation proctitis (HRP) is infrequently seen amongst the patients who are either undergoing or have undergone radiotherapy to the pelvis. We treated 16 documented cases of HRP, who did not respond to conventional steroid retention enemas, with 4% formalin application. It was observed that the rectal bleeding was controlled completely in 81% cases in median follow up of 11 months (range 6-17 months) and diversion colostomy could be avoided in all the cases. The effectiveness of local formalin application in severe HRP is described in this article.

Administration, Rectal↗
PubMed1995

Germ cell tumours in uncorrected cryptorchid testis at Institute Rotary Cancer Hospital, New Delhi.

Twenty-four out of 164 (14%) adult patients with primary germ cell tumours of testis seen over the last 6 years at the Institute Rotary Cancer Hospital (IRCH) of the All India Institute of Medical Sciences (AIIMS), New Delhi, were found to have cryptorchidism. Only one patient had undergone correction. As a result the testes were intra-abdominal in the vast majority, and patients presented late. Twenty-two patients presented with stage IIb or more advanced disease. Twelve patients had seminoma and the others had mixed or non-seminomatous germ cell tumour (NSGCT), i.e. 50% each. The earlier patients were managed by initial resection followed by radiation and/or chemotherapy. As experience grew the seven patients who presented late were given initial chemotherapy followed by resection in those with residual tumours. The probability of overall survival was 0.65 at 36 months and, was not significantly different from survival in 114 patients with tumours of normally descended testis. Early orchipexy facilitates the detection, but whether it reduces the incidence of tumours is controversial. Uncorrected cryptorchidism is now rarely seen in the West, but in India and many other developing countries tumours of uncorrected cryptorchid testes continue to be seen.

Actuarial Analysis↗
PubMed1995

Carcinoma of the uterine cervix presenting as superior vena cava syndrome: report of three cases and a review of literature.

We present three cases of superior vena cava syndrome secondary to carcinoma of the uterine cervix which manifested 2 to 7 years after the initial diagnosis and primary therapy. In two of these patients, tissue diagnosis could be obtained. Two patients expired within two months of presentation despite timely radiotherapy, and one case died after six months of diagnosis.

Adult↗
PubMed1995

Incarcerated procidentia: a rare complication of carcinoma cervix.

A rare case of a huge carcinoma of the cervix leading to sudden uterovaginal prolapse and incarcerated procidentia, in a postmenopausal woman is presented. The woman presented as an emergency with severe distress. The problem was successfully managed by reducing the uterovaginal prolapse under deep sedation and starting radiotherapy as an emergency procedure at the same sitting. The role of immediate radiotherapy in the management of such an emergency situation is discussed.

Carcinoma, Squamous Cell↗