Browsing by Author "Ankita Pandey"

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Clinico.epidemiological profile and treatment outcome in adolescents and young patients of rectal cancer attending a tertiary cancer center
(Wolters Kluwer Medknow Publications, 2023) Ritusha Mishra; Ankita Pandey; Himanshu Mishra; Tej B. Singh; Abhijit Mandal; Anupam K. Asthana
Introduction: The incidence of colorectal cancer in young adults is on an increasing trend. It is observed that this subgroup of patients has an aggressive disease and carries a poorer prognosis compared to its older counterpart. This study aimed to analyze the incidence, treatment outcome, and prognostic factors in adolescents and young adults with rectal cancer attending a tertiary cancer center in North India. Materials and Methods: We retrospectively analyzed 50 patients of histologically proven rectal cancer, aged up to 30 years, treated at our center between 2015 and 2019. The clinical, demographic, and pathological parameters were studied in all these patients. Kaplan-Meier survival analysis was used to find out survival. Univariate analysis was performed to assess prognostic factors. Results: The incidence was 26.4% at our center with a median age of 28 years. Bleeding per rectum was the commonest complaint. Most of them had signet ring cell histology (26%). The median overall survival was 16 months. Survival was significantly better in patients having bleeding per rectum as an initial complaint (P = 0.009), absence of lymphovascular invasion (LVI) (P = 0.005), and perineural invasion (PNI) (P = 0.002), who received complete planned treatment compared to patients who could not receive either of the modality (P < 0.001). Patients who did not receive radiotherapy (RT) had the worst outcomes compared to those who received RT in any form. RT dose of 50.4 Gy was found to be superior as compared to other schedules. There was no significant difference in survival with gender, tumor stage, grade, type of surgery, or chemotherapy regimen. Conclusion: The majority of patients presented in an advanced stage. Therefore, bleeding per rectum should be properly and timely investigated in all these young patients. Early detection and complete treatment are paramount to improving the outcome. © 2023 Copyright:
Comparative analysis of simultaneous integrated boost and sequential boost radiotherapy in node-positive cervical cancer: dosimetric and radiobiological considerations
(Springer Science and Business Media Deutschland GmbH, 2024) Ritusha Mishra; Shreya Singh; Ganesh Patel; Abhijit Mandal; Himanshu Mishra; Ankita Pandey; Bajarang Bahadur; Pramod Kumar Singh; Shikha Sachan; Mallika Tewari
For locally advanced cervical cancer, the standard therapeutic approach involves concomitant chemoradiation therapy, supplemented by a brachytherapy boost. Moreover, an external beam radiotherapy (RT) boost should be considered for treating gross lymph node (LN) volumes. Two boost approaches exist with Volumetric Intensity Modulated Arc Therapy (VMAT): Sequential (SEQ) and Simultaneous Integrated Boost (SIB). This study undertakes a comprehensive dosimetric and radiobiological comparison between these two boost strategies. The study encompassed ten patients who underwent RT for cervical cancer with node-positive disease. Two sets of treatment plans were generated for each patient: SIB-VMAT and SEQ-VMAT. Dosimetric as well as radiobiological parameters including tumour control probability (TCP) and normal tissue complication probability (NTCP) were compared. Both techniques were analyzed for two different levels of LN involvement – only pelvic LNs and pelvic with para-aortic LNs. Statistical analysis was performed using SPSS software version 25.0. SIB-VMAT exhibited superior target coverage, yielding improved doses to the planning target volume (PTV) and gross tumour volume (GTV). Notably, SIB-VMAT plans displayed markedly superior dose conformity. While SEQ-VMAT displayed favorable organ sparing for femoral heads, SIB-VMAT appeared as the more efficient approach for mitigating bladder and bowel doses. TCP was significantly higher with SIB-VMAT, suggesting a higher likelihood of successful tumour control. Conversely, no statistically significant difference in NTCP was observed between the two techniques. This study’s findings underscore the advantages of SIB-VMAT over SEQ-VMAT in terms of improved target coverage, dose conformity, and tumour control probability. In particular, SIB-VMAT demonstrated potential benefits for cases involving para-aortic nodes. It is concluded that SIB-VMAT should be the preferred approach in all cases of locally advanced cervical cancer. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
Comparison of intravaginal and interstitial brachytherapy in cervical cancer after inadvertent hysterectomy: a retrospective study
(Nature Research, 2025) Sunil Choudhary; Ankita Pandey; Ankita Singh; Ankur Mourya; Neha Gupta; Syed Mohamed Shajid; Gogul Priean Venkatachalam; Sangita Rai; Sakshi Agarwal; P. Venkatraman; Lalit Mohan Mohan Aggarwal
The purpose of this study was to compare intravaginal brachytherapy (IVBT) with interstitial brachytherapy (ISBT) in patients presenting with residual or recurrent disease after inadvertent hysterectomy for cervical cancer. Records of consecutive patients with cervical cancer, registered in the Radiotherapy Outpatient Department (RTOPD) between March 2018 and March 2021, who had inadvertent hysterectomy followed by external beam radiotherapy (EBRT) and IVBT (n = 15) or ISBT (n = 15) were analyzed retrospectively. All the patients received a dose of 45–50 Gy/25 fractions in 5 weeks by EBRT with concurrent cisplatin. A dose of 6 Gy/fraction/week for two consecutive weeks was prescribed at 5 mm from the surface of the vaginal cylinder in the IVBT arm. Patients in the ISBT arm were treated with 6 Gy/fraction for four fractions over two days with Martinez Universal Perineal Interstitial Template (MUPIT). Overall survival (OS) and disease-free survival (DFS) were the primary endpoints. Acute and late toxicities were the secondary endpoints. Median follow-up (FU) was 24.3 months and 32.8 months in the IVBT and ISBT arms respectively. Most of the patients failed within 12–18 months after brachytherapy. The 3-year OS for IVBT and ISBT arms were 54% and 93% respectively (p = 0.011). The 3-year DFS for IVBT and ISBT arms were 42% and 93% respectively(p = 0.023). Both the arms had similar acute & late toxicities. ISBT had significantly better survival outcomes in terms of OS, and DFS with similar toxicity as compared to IVBT in patients with residual or recurrent disease after inadvertent hysterectomy for cervical cancer. © The Author(s) 2025.
Evaluation of survival outcome and prognostic factors for oral cavity cancer treated with volumetric arc therapy
(Springer Science and Business Media Deutschland GmbH, 2023) Himanshu Mishra; Shreya Singh; Ritusha Mishra; Ankita Pandey; Abhijit Mandal; Ekta Prakash; Ganeshkumar Patel; Manav Shah; Tej Bali Singh
Purpose: This study aimed to evaluate the survival outcomes and identify prognostic factors for patients with oral cavity cancer (OCC) who underwent adjuvant treatment with volumetric arc therapy (VMAT) using simultaneous integrated boost (SIB). Methods: Data was collected for post-operated patients of carcinoma of oral cavity who received adjuvant VMAT with SIB between June 2018 and December 2022. The data was entered and analyzed using SPSS software version 20.0. Survival rates were estimated using Kaplan Meier method. To determine survival difference between the groups, log rank test was used. Multivariate analyses were performed with Cox proportional hazard model and p value < 0.05 was considered as significant. Results: A total of 178 patients were included in the study. The median follow-up period was 26 months (range 3–56 months). The 3-year OS, DFS, and LRC rates were 78% (95% CI 77–79%), 76% (95% CI 74–77%), and 81% (95% CI 80–82%), respectively. Univariate analysis identified age ≥ 50 years, lymph node involvement, extracapsular extension (ECE), and N2–N3 disease as significant adverse prognostic factors for OS, DFS, and LRC. Multivariate analysis confirmed age ≥ 50 years and nodal involvement as independent predictors of worse OS, DFS, and LRC. Additionally, ECE independently affected OS and DFS. Conclusion: Adjuvant treatment with VMAT using SIBin patients with OCC is effective. Age and nodal involvement had significant impact on LRC, DFSand OS while ECE on DFSand OS. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Hiccups: An atypical side effect experienced during chemo-radiotherapy in carcinoma nasopharynx
(Wolters Kluwer Medknow Publications, 2023) Ankita Pandey; Himanshu Mishra; Pramod Kumar Singh; Ritusha Mishra
Nasopharyngeal carcinoma is an uncommon cancer but has a distinct racial and geographic distribution. Patient presents with constellation of signs and symptoms due to its vicinity to critical structures and are best treated by conformal concurrent chemo-radiotherapy. We present a case of 45-year-old male diagnosed with carcinoma nasopharynx, referred to us for radiotherapy after three cycles of neoadjuvant chemotherapy. As per the prevailing standard of care, patient was planned for radiotherapy by volumetric arc technique with concurrent cisplatin. Initial days of treatment were uneventful. After fourth week of treatment, patient developed persistent hiccup which was not relieved on conservative medications. Plan was re-evaluated and it revealed maximum dose of 54.6 Gy to the brainstem. Radiotherapy induced edema that could have stimulated vagus nerve leading to hiccups was suspected. Patient was started on injectable steroid and chlorpromazine. There was prompt recovery from the symptom within five days of conservative treatment. Copyright © 2023 Journal of Cancer Research and Therapeutics.
Survival outcome and prognostic factors post inadvertent hysterectomy in carcinoma cervix treated with salvage chemo-radiation
(Springer Science and Business Media Deutschland GmbH, 2023) Ritusha Mishra; Ankita Pandey; Himanshu Mishra; Shreya Singh; Pallavi Jain; Tej Bali Singh; Abhijit Mandal; Pramod Kumar Singh
Introduction: The standard of care for treating early invasive cervical cancer is radical hysterectomy or radiation alone while chemo-radiation is a definitive treatment for advanced disease. Occasionally, a simple hysterectomy is performed in the cancer cervix and these patients merit adjuvant treatment in view of the high chances of loco-regional recurrences. The aim of the study was to analyze the survival outcome of these patients treated with salvage chemo-radiotherapy and also to determine the prognostic factors affecting survival. Materials and methods: The medical records of all patients with cervical cancer post simple hysterectomy outside and who received salvage treatment in our department between 2014 and 2020 were retrieved. The data regarding clinical, treatment details and survival were analyzed. Results: A total of 198 patients were included. Median follow-up duration was 45.5 months. Gross disease and lymphadenopathy were seen in 60% and 28% patients, respectively. The 5-year progression-free survival(PFS) and overall survival(OS) was 75% and 76%, respectively. Concurrent chemotherapy alone or in combination with induction chemotherapy using three-drug regimens showed better survival compared to those treated by radiation alone. On multivariate analysis, factors found to be adversely affecting OS and PFS were lymph node (LN) size of more than 2 cm, non-squamous histology, overall treatment time(OTT) of more than 12 weeks and use of non three-drug chemotherapy regimen. Conclusion: Subtotal hysterectomy results in a higher incidence of local recurrence of disease. Factors that impair the outcome in this sub-group of patients are gross lymphadenopathy, non-squamous histology and prolong OTT. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
The crucial role of stability of intercalating agent for DNA binding studies in DMSO/water system
(Elsevier B.V., 2024) Krishanu Bandyopadhyay; Abhineet Verma; Ankita Pandey; Rajat Walia; Satyen Saha
In recent years, extensive research has been directed towards understanding the interactions between various zinc complexes with DNA, specifically delving into their intercalation and binding behaviors. The binding of zinc complexes to DNA is particularly intriguing due to their distinctive intercalating capabilities. This study unveils a remarkable phenomenon observed with a specific Zn complex, ([B-Zn-N3], where B is a Schiff base ligand), during DNA intercalation investigations in the popular DMSO-Water binary solvent mixture. An unanticipated observation revealed time-dependent changes in the UV–visible absorption spectroscopic studies, coupled with the existence of an isosbestic point. This observation questions the stability of the intercalating agent itself during the intercalation process. The emergence of a decomposed product during the intercalation study has been confirmed through various analytical techniques, including CHN analysis, MALDI mass, XPS, Raman spectroscopy, and Powder XRD. The change in the chemical species on intercalation is further substantiated by theoretical studies, adding depth to our understanding of the intricate dynamics at play during DNA intercalation with the [B-Zn-N3] complex in the DMSO-Water system. © 2024 Elsevier B.V.