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S Ayyagari

Publications and source records attributed to S Ayyagari.

At least 19 recordsLinked to original sources
PubMed1998

A non-randomized comparison of two radiotherapy protocols in inoperable squamous cell carcinoma of the oesophagus.

We report an audit of two different telebrachytherapy schedules in inoperable carcinoma of the oesophagus. Between October 1990 and December 1996, 108 patients with a Karnofsky performance status > or = 50 were selected from our database on the basis of intention to treat by telebrachytherapy. Teletherapy in the low dose group L (55 patients) consisted of 35 Gy in 15 fractions over 3 weeks, while that in the high dose group H (53 patients) consisted of 50 Gy in 25 fractions over 5 weeks. The choice of teletherapy dose was based on physician preference. The high dose rate intraluminal radiotherapy that followed 2 weeks later was identical in both groups and consisted of two applications of 6 Gy, a week apart. The pretreatment disease characteristics of the patients in both arms were similar. Relief of dysphagia was obtained in 49% of the patients in group L and in 75% of those in group H (chi2: P = 0.004). The median dysphagia-free interval was 0 and 7 months in groups L and H respectively (log-rank: P = 0.06), while the median overall survival was identical at 8 months (log-rank: P = 0.21) for both groups. The probability of survival at 1, 2 and 5 years was 34.8% versus 35.8%, 14.5% versus 13.9% and 0% versus 10% for groups L and H respectively. Morbidity in the form of ulcers, strictures and fistulae were observed in 9%, 7% and 5% of patients in group L compared with 8%, 8% and 13% in groups H respectively. This audit suggests that the protocol used in group H, when compared with group L, results in a greater proportion of patients being rendered dysphagia free, with a statistical trend towards a greater sustainment of dysphagia relief on follow-up.

Aged↗
PubMed1998

Partial transmission block for optimization of anterior supraclavicular-posterior axillary boost in the radiation therapy of carcinoma breast.

Radiation therapy of breast often involves an anterior supraclavicular-axillary (SC-AX) portal to irradiate the supraclavicular and axillary contents. However, the fall-off of the dose in this region leads to an inhomogeneity that could result either during the use of a single anterior SC-AX field or even with the concomitant use of a posterior axillary boost. An attempt has been made to circumvent this inhomogeneity by the use of a partial transmission block that could be placed in the anterior SC-AX portal corresponding to the posterior axillary boost field. The details of the quantum of partial transmission block to be used for different axillary separations and the reference depths of the dose prescription has been evaluated and presented.

Axilla↗
PubMed1998

The familial incidence of benign paroxysmal positional vertigo.

The goal of this investigation was to determine whether there is a familial tendency in the development of benign paroxysmal positional vertigo (BPPV). We hypothesized an increased frequency of BPPV among relatives of patients with the same diagnosis. BPPV is caused by dislodged otoconia from the utricular macula floating in the semicircular canals. At least half of BPPV cases are idiopathic and most pathological associations provide no clue as to the reason otoconia become dislodged. We have noted a number of BPPV patients with family histories of BPPV, suggesting a genetic predisposition to the condition. We surveyed 120 successive BPPV patients and 120 successive dizzy patients without BPPV regarding the frequency of dizziness and BPPV (diagnosed by a physician) among family members. Patients in our group with BPPV were 5 times as likely to have relatives with BPPV compared to the dizzy control group (chi2=5.95, DF=1, p=0.015). We have demonstrated that there is a familial tendency for the occurrence of BPPV. There is nothing in our data that would distinguish between a hereditary or environmental influence in the development of the disease, however.

Age Factors↗
PubMed1997

Midline shield for radiation therapy of carcinoma of the uterine cervix: should it be "midline" or "individualized".

This study attempts to evaluate the advantage of individualized midline shield (IMLS) constructed on the basis of uterine geometry and applicator position in terms of the dosimetric consequences to points A-right (AR) and left (AL) as compared to standard midline shield (SMLS) in radiation therapy of carcinoma cervix. Twenty consecutive patients of carcinoma cervix (Stage I, II and III) were treated by external beam radiotherapy (EBRT) (50 Gy/5 weeks/25 fractions) and high-dose rate intracavitary brachytherapy (24 Gy/4 weeks/4 fractions) prescribed at point A. At the completion of 40 Gy by EBRT (phase I), IMLS (5 cm wide) at isocenter was fabricated on the basis of uterine geometry as ascertained by a dummy intracavitary application. The remaining 10 Gy of EBRT was delivered using IMLS (phase II) to effectively minimize and optimize the dose to point A. The dose profiles of IMLS were compared against the corresponding dose profile of a 5 cm SMLS and were found to be dependent on the positional variation of AR and AL with respect to the midline. With IMLS, the dose to AR and AL for the 10 Gy of phase II varied between 21.7-38.87% (30.01 +/- 4.87) and 22.42-35.72% (28.12 +/- 3.79) respectively. However with SMLS, the AR and AL doses would have ranged from 22.03% to 77.26% (34.55 +/- 15.94) for AR and from 20.59% to 96.2% (46.93 +/- 28.15) for AL leading to considerable inhomogeneity. Thus, in protocols incorporating midline shield for radiotherapy of carcinoma cervix, IMLS in place of SMLS could be preferred for achieving a definitive and homogeneous dose to the points AR and AL.

Brachytherapy↗
PubMed1997

Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India.

OBJECTIVE: To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL: Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS: The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION: PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.

Adolescent↗
PubMed1997

Results of treatment in endometrial carcinoma: ten years experience.

From 1980 to 1989, 145 patients of histologically proven adenocarcinoma of the endometrium were seen and treated at the Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, Majority of the patients (84/145) presented with FIGO stage I disease. Relationship of myometrial invasion to grade was highly significant (p < 0.001). One hundred and seven patients were treated by surgery in combination with pre-operative or post-operative radiotherapy. The importance of various prognostic factors was assessed and grade of the tumour had statistically highly significant effect on survival (p < 0.005). Postoperative radiotherapy is recommended in patients with poor prognostic factors.

Combined Modality Therapy↗
PubMed1996

Spatial information on dose distribution using multisectional dose-volume histograms.

Dose-volume histograms are useful tools to summarize the information on the dose profiles resulting within a target volume. However, the spatial relationships of the hot and the cold spots are blunted in the dose-volume histograms. This study tries to circumvent this problem using multisectional dose-volume histograms and highlight the utility of these in the optimization of a radiation therapy plan.

Brachytherapy↗
PubMed1996

Feasibility of non-cisplatin-based induction chemotherapy and concurrent chemoradiotherapy in advanced head and neck cancer.

The purpose of the present study was to determine the safety and efficacy of induction chemotherapy followed by concomitant chemoradiotherapy. Thirty-eight patients were randomised to receive induction chemotherapy, consisting of cyclophosphamide and methotrexate followed by concomitant 5-fluorouracil and irradiation (study group) or irradiation alone (control group). There were non-significant differences in the initial tumor clearance rates in the two groups. Median disease-free survival (in complete responders) was 17 months (6-60+) vs 11 months (5-60+) (p = 0.407) and overall survival 11 months (1-60+) vs 14 months (2-60+) (p = 0.428) in the study and control groups respectively. Acute morbidity and deaths during intervention were higher in the study group (p = 0.007). This study suggests that induction along with concomitant chemoradiotherapy is too toxic for routine use and also fails to provide a survival benefit.

Adult↗
PubMed1995

Multisectional planning for external beam radiotherapy: a "poor person's" alternative to three-dimensional treatment planning.

Recent technical advances in the field of computers have led to the use of three-dimensional dose computation for optimizing a radiation therapy plan. However, in centers which lack such a state-of-the-art technology, one could explore the use of multisectional planning to obtain information about the dose profiles all along the target volume. This article highlights the utility of multisectional planning as an alternative to three-dimensional treatment planning systems for external beam radiation therapy.

Esophageal Neoplasms↗
PubMed1993

Myocardial ischemia after 5-fluorouracil chemotherapy.

A 40-year-old male patient with carcinoma of the tonsil was put on a 5-fluorouracil and cisplatinum regimen. On day 2 during 5-fluorouracil infusion, he had features of myocardial ischemia manifesting as angina and ST-elevation in ECG. These vasospastic ischemic changes subsided after nitroglycerine plus nifedipine therapy. Such vasospastic toxicity of 5-fluorouracil is rare and few such cases have been reported.

Adult↗
PubMed1993

Actinomycosis mimicking carcinoma of the maxillary sinus.

Human actinomycosis may pose a diagnostic problem at times and is often mistaken for a neoplasm. A thirty-five year old male was clinically diagnosed as a case of carcinoma of the right maxillary sinus on the basis of history, clinical presentation and radiologic findings. Tissue biopsy was negative for malignancy on three consecutive occasions. Microscopic examination showed bits of granulation tissue and fragments of filamentous structures. On microbiological examination, Actinomyces israelii was isolated and fungus culture was negative. Long term Penicillin treatment caused disappearance of all signs and symptoms. The report highlights the importance of bearing in mind the fact that certain rare, chronic, suppurative granulomatous infections, like actinomycosis, may mimic malignancy.

Actinomycosis, Cervicofacial↗
PubMed1992

Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.

Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.

Brachytherapy↗
PubMed1991

Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate.

In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.

Administration, Oral↗
PubMed1991

Giant cell tumour of the petrous bone.

Giant cell tumours (GCT) are rare in the skull bones. In the cranium the sphenoid bone is the most common site. The petrous bone is a very uncommon location for such tumours. The chance location of GCT at the base of the skull makes total surgery difficult and hazardous. A case of GCT of the petrous bone is presented. The clinical course in the patient and role of primary radiotherapy in GCT in such an unusual site is discussed.

Adult↗
PubMed1990

Damage to the anterior visual pathway and brain parenchyma following external pituitary irradiation.

Three cases of damage to the optic nerves and chiasma following pituitary irradiation with Co60 teletherapy are described. All of them presented with progressive visual impairment months following irradiation and simulated recurrence of the tumour. CT scan was also not helpful in differentiating radionecrosis from tumour recurrence. On exploration the optic nerves and chiasma appeared discoloured and scarred. One case, who also had diffuse radionecrosis of brain parenchyma, died. No satisfactory therapy is currently available for this grave complication but proper safeguards can prevent it.

Adult↗
PubMed1990

Histomorphological criteria for prognosis in breast cancer.

One hundred cases of carcinoma breast were analysed with regard to histological features and clinical follow-up. Bad prognostic factors included tumour size larger than 5cms; absent or minimal intraduct component in the tumour and absent or minimal periductal elastosis. Conversely significant intraduct component in the tumour and periductal elastosis were associated with better survival. Degree of lymph nodal involvement did not influence the outcome. One reason for this unexpected finding could be that patients with more than 3 lymph node involvement were given additional chemotherapy.

Breast Neoplasms↗
PubMed1989

Medulloblastoma in adults--clinical observations and results of treatment.

Ten cases of medulloblastomas, in patients above the age of 15 years, were treated during a 11 year period. These constituted 18 percent of all medulloblastomas and 1.2 percent of all primary brain tumours in adults during the same period. The majority of patients (80%) were between 16 and 25 years of age, and 80 percent were male. Half the patients presented within three months of the onset of symptoms. The usual clinical presentation was with features of raised intracranial pressure and cerebellar involvement. A lateral location of the tumour and its desmoplastic variant were common. Three patients survived more than five years. The desmoplastic variant and a gross total resection of the tumour favourably affected the prognosis. Posterior fossa recurrence was the chief cause of therapeutic failures. All the recurrences developed within three years of the initial diagnosis, and were fatal within six months of their detection.

Adolescent↗