Browsing by Author "Sumit Agarwal"

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Accelerated hypofractionated chemoradiation for locally advanced head and neck cancer during COVID 19 pandemic: A tertiary care experience
(Wolters Kluwer Medknow Publications, 2024) Sumit Agarwal; Isha Jaiswal; Uday P. Shahi; Abhijit Mandal; Lalit M. Aggarwal; Ankita Singh; Anil Jaiswal; Nandlal Yadawa
Purpose: To assess the role of Accelerated Hypofractionated Chemoradiation for Locally Advanced Head & Neck squamous cell cancer (HNSCC) during COVID 19 pandemic. Materials and Methods: Previously untreated 20 patients with locally advanced HNSCC (Oral cavity/oropharynx/larynx/hypopharynx) were treated with definitive hypofractionated radiotherapy of 60Gy in 25 fractions with concurrent cisplatin @35 mg/m2 once weekly for 5 weeks from March 2020 to November 2021. The patients were treated on 6MV LINAC with Volumetric modulated arc therapy (VMAT) by the Sequential boost technique and concurrent chemotherapy @35 mg/m2. All the patients received 48Gy in 20 fractions to low-risk volume (CTV LR) in Phase I followed by 12Gy in 5 fractions boost to High-risk volume (CTV HR) in Phase II. The organs at risk (OARs) were contoured and appropriate constraints were given considering the hypofractionated regimen. Results: Out of 20 patients, most of the patients were Stage IV (15;75%) & stage III 20%, out of which (55%) 11 were of the oral cavity, (40%) 8 were of the oropharynx, and (5%) 1 of larynx. All patients were treated with 60Gy/25#/5 weeks with the majority of the patients (17;85%) completing their treatment in less than 45 days. The Median follow-up was of 214 days. The locoregional control at 6 Months was 55%. Maximum acute toxicity was grade 3 mucositis which was observed in 18 (90%) patients. Ryle’s tube feeding was needed in 11 (55%) patient. Out of 20 patients, 5 patients did not receive concurrent chemotherapy, and 8 (40%) patients received all 5 cycles of chemotherapy. 7, 35% of the patients could not complete all 5 cycles of concurrent chemotherapy due to grade 3 mucositis. Conclusion: During a pandemic crisis with limited manpower & technical resources accelerated hypofractionated radiotherapy with concurrent chemotherapy can be considered a feasible therapeutic option for HNSCC which can significantly reduce the overall Treatment Time (OTT) with comparable local control and manageable toxicities. © 2023 Journal of Cancer Research and Therapeutics.
Dose at posterior-inferior border of symphysis point: A predictor for vaginal stricture in cervical cancer
(Elsevier Inc., 2023) Ankita Singh; Nilesh Mani; Lalit M. Aggarwal; Sumit Agarwal; Ankur Mourya; Ashish Verma; Antara Bagchi; Neha Gupta; Sunil Choudhary
PURPOSE: To study the effect of various dose-volume parameters on the severity of vaginal stricture (VS) and the correlation of the latter with the posterior-inferior border of symphysis (PIBS) points in locally advanced cervical cancer patients treated with concurrent chemoradiation and brachytherapy. METHODS AND MATERIALS: A prospective study was done on 45 histologically proven locally advanced cervical cancer patients between January 2020 and March 2021. All of them were treated with concurrent chemoradiation with 6 MV photon linear accelerator to a dose of 45 Gy/25 fractions in 5 weeks. Twenty-three patients were treated with intracavitary brachytherapy with a dose of 7 Gy/fraction/week for three fractions. Twenty-two patients were treated with interstitial brachytherapy, with 6 Gy/fraction for four fractions, each fraction 6 h apart. Grading of VS was done as per Common Terminology Criteria for Adverse Events version 5. RESULTS: The median followup was 21.5 months. About 37.8% of patients had VS with a median duration of 8.0 months (4.0–12 months). About 22.2% had Grade 1, 6.7% had Grade 2, and 8.9% had Grade 3 toxicity. Doses at PIBS and PIBS−2 points had no correlation with vaginal toxicity, however, the dose at PIBS+2 was significantly associated with VS (p = 0.004). The treated length of the vagina at the time of brachytherapy (p = 0.001), initial tumor volume (p = 0.009), and vaginal involvement after completion of external beam radiotherapy (EBRT) (p = 0.01) were also statistically significant with the development of VS of Grade 2 or more. CONCLUSIONS: Dose at PIBS + 2, treated length of the vagina with brachytherapy, initial tumor volume, and post-EBRT vaginal involvement are strong predictors for the severity of VS. © 2023 American Brachytherapy Society
Molecular shifts in breast cancer following neoadjuvant chemotherapy: a prospective study and review of literature
(Taylor and Francis Ltd., 2025) Avinash Chandra Singh; Kalyan K. Pandey; Sumit Agarwal; Ankita Singh; P. Venkatraman
Background: Standard clinical guidelines recommend evaluating Estrogen & progesterone Receptor (ER, PR), Human epidermal growth factor receptor-2 (HER-2), and Ki-67 in breast cancer biopsy samples. This study investigates the changes in molecular subtype following neoadjuvant chemotherapy (NACT) in breast cancer patients. Methods: Patients aged 18 to 65 years who underwent core needle biopsy before NACT and received at least four chemotherapy cycles were included in the study. Patients with inflammatory breast cancer, de novo metastatic or bilateral breast cancer, pregnancy, lactation, prior endocrine/radiation therapy, or achieved pathological complete response (pCR) were excluded. Molecular profiles (ER, PR, HER-2, Ki-67) were analyzed pre- and post-NACT. Results: The study involved 100 breast cancer patients with a median age of 51.78 years. 47% of patients underwent breast-conserving surgery (BCS), while 53% underwent modified radical mastectomy (MRM). Seventy-six percent of patients had tumors larger than 5 cm, and 72% presented with axillary lymph node metastasis. Initially, 90% and 89% of patients were ER, and PR positive, respectively, which decreased to 81% and 75% post-surgery. Ki67 expression showed a significant reduction following chemotherapy. Larger tumors and lymph node-positivity had significant changes in molecular subtypes. Conclusion: The study revealed significant alterations in ER, PR, HER-2, and Ki-67 levels post-NACT, prompting reassessment for tailored therapy. © 2025 Informa UK Limited, trading as Taylor & Francis Group.