Browsing by Author "Sunil Choudhary"

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A comparative study of gemcitabine and cisplatin versus oral capecitabine alone in metastatic gallbladder cancer
(Wolters Kluwer Medknow Publications, 2022) Deepak Kumar; Neeraj Rastogi; Sushma Agarwal; Shagun Mishra; Shaleen Kumar; Punita Lal; Shalini Singh; Sunil Choudhary
Aims: There is no consensus for palliative chemotherapy regimen in metastatic gallbladder cancer. We did a retrospective study to compare the treatment outcome in patients of metastatic gallbladder cancer treated with either gemcitabine + cisplatin (regimen A) or oral capecitabine (regimen B) alone. Subjects and Methods: A total of 67 patients between January 2015 and September 15 treated with either regimen A or regimen B were retrospectively evaluated. Statistical analysis was done in June 2019. Kaplan-Meir and Log rank test were used to compare survival between two arms. Results: Out of 67 patients, 31/67 (46%) received regimen A, and 36/67 (54%) received regimen B. Male to female ratio was 1:3. About 42% patients in regimen A and 20% in regimen B required palliative stenting. Median number of chemotherapy cycles was 4 in both regimen A (range 1->6) and regimen B (range 1->6). Patients receiving 3 cycles and 6 cycles of chemotherapy in regimen A and regimen B was 68% and 31% versus 70% and 63%, respectively (P = 0.86). Response assessment as any response (complete response + partial response + disease was stable) after 3 cycles and 6 cycles was 71% and 57% (P = 0.20), 44% and 39% (P = 0.29), in regimen A and B, respectively. Median survival was 23 weeks (range 2-106 weeks) in regimen A and 15 weeks (range 4-83 weeks) in regimen B (P = 0.40). Conclusions: The present study shows gemcitabine and cisplatin has nonsignificant better survival compared to oral capecitabine. However, oral capecitabine is more convenient and easy to administer. Studies with larger sample size are needed to further establish the standard chemotherapy guidelines. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
A comparison between revised Manchester Point A and ICRU-89–recommended Point A definition absorbed-dose reporting using CT images in intracavitary brachytherapy for patients with cervical carcinoma
(Elsevier Inc., 2021) Ankur Mourya; Sunil Choudhary; Uday Pratap Shahi; Neeraj Sharma; Himani Gautam; Ganeshkumar Patel; Satyajit Pradhan; Lalit Mohan Aggarwal
Purpose: This study is a comparison between revised Manchester Point A and International Commission on Radiation Units and measurements (ICRU) 89 report–recommended Point A absorbed-dose reporting in intracavitary brachytherapy for patients with cervical carcinoma. Methods and Materials: The retrospective dosimetric study is based on the data of 32 patients with cervical carcinoma treated with high-dose-rate brachytherapy. Patients received 21 Gy in three fractions (7.0 Gy X three fractions) to Point A (Aflange, revised Manchester definition). All the patients were replanned with a new Point A (Aicru89) defined on CT images as per the American Brachytherapy Society/ICRU-89. The data collected were compared with the data obtained from Point A (Aflange). Results: When using the Aflange plan normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 820.79 ± 207.47 cGy, 654.66 ± 152.69 cGy, and 588.91 ± 136.35 cGy, respectively. Likewise, when using the ICRU-89 Point Aicru89 normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 869.30 ± 224.67 cGy, 693.24 ± 166.20 cGy, and 616.61 ± 150.32 cGy, respectively. For the rectum, Point Aflange normalization plans, the mean dose of 0.1 cc, 1 cc, and 2 cc volumes was 589.37 ± 163.26 cGy, 487.51 ± 126.03 cGy, and 442.70 ± 111.43 cGy, respectively. Likewise, using the Aicru89 plan, the mean 0.1 cc, 1 cc, and 2 cc rectum volume was 625.07 ± 171.31 cGy, 517.50 ± 131.05 cGy, 464.94 ± 121.81 cGy, respectively. The statistical mean difference of Total Reference Air Kerma rate, V100 (cc), bladder, rectum and sigmoid, was found significant. Conclusions: It has been found that the position of revised Manchester (Aflange) and ICRU-89 Point A does not match on CT images/radiograph, which resulted in variation in doses to the tumor, V100 (cc), organ at risk, and Total Reference Air Kerma. © 2021 American Brachytherapy Society
A comparison of six fractions per week chemoradiation versus five fractions per week of conventional chemoradiation in carcinoma cervix: A prospective controlled study
(Wolters Kluwer Medknow Publications, 2019) Deepak Kumar; Satyajit Pradhan; Sunil Choudhary; Lalit Aggarwal; Avipsa Das; Sovan Sarangdhar; Prashant Kaser; Satish Dewangan
Aims: The standard of care for carcinoma cervix stage IB2-IVA is five fractions per week of radiotherapy (RT) with concurrent cisplatin. We compared the standard treatment with six fractions per week of RT with concurrent Cisplatin to see whether the later had improved survival outcomes with comparable toxicities. Settings and Design: 46 patients of carcinoma cervix with stage IB2-IVAwere randomized into two arms. Materials and Methods: Study arm: 46 Gy/23 fractions/26 days, 6 fractions/week with injection CDDP 40 mg/m2 and Control arm: 46 Gy/23 fractions/31 days, 5 fractions/week with injection Cisplatin 40mg/m2. Patients in both the arms received LDR brachytherapy to a dose of 29 Gy at point A. Statistical Analysis Used: The primary end points were disease-free survival (DFS) and overall survival (OS). Compliance to treatment and treatment toxicities were the secondary end points. P value ≤0.05 were considered significant. Results: The study was carried out during June, 2014-April, 2015. Statistical analysis was done in May, 2019. Of 46 patients, 39 patients completed the treatment. The study and control arms had 17 and 22 patients, respectively. Median follow-up period is 45 months (range: 1-54 months). 3-year DFS rates and OS was 69.5% vs. 72.7% (P = 0.73) and 63% vs. 68% (P = 0.45) in study and in control arm, respectively. There was no significant difference in acute and late radiation toxicities between two arms. Conclusion: Chemoradiotherapy with six fractions per week seems feasible and equally efficacious in terms of survival outcomes and toxicity profile. Further prospective randomized controlled study is required to prove the merit of altered fractionation with concurrent cisplatin. © 2019 Journal of Cancer Research and Therapeutics - Published by Wolters Kluwer - Medknow.
A comparison of TG-43 and TG-186 dose calculation algorithms for treatment planning of intra-cavitary brachytherapy using tandem and ovoid applicator
(Termedia Publishing House Ltd., 2024) Syed Mohamed Shajid; Lalit Mohan Aggarwal; Ankur Mourya; Sunil Choudhary; V. Gogul Priean; Ankita Singh; Saji Oommen
Purpose: The present study evaluated the dosimetric impact and compared the dose variations between the advanced collapsed cone engine (Task Group 186) and Task Group 43 plans for cervical cancer using tandem and ovoid applicators. Material and methods: Thirty cervical cancer patients underwent iridium-192 (192Ir) high-dose-rate (HDR) intra-cavitary brachytherapy using tandem and ovoid applicator. Original treatment plans for all patients were created using TG-43 dose calculation formalism. Subsequently, these plans were re-calculated using ACE (TG-186) algorithm and were not re-optimized, so that dwell time and dwell positions were identical in both plans. High-risk clinical target volume and organs at risk were contoured in each dataset. Significant air gaps within region of interest and use of high density applicator materials were also considered. The assessment encompassed a point-based evaluation, extraction of dosimetric parameters from dose-volume histogram (DVH), and plan evaluation indices for each algorithm. Results: Compared with ACE (TG-186) plans, TG-43 plans predicted higher doses for point A, point B, D90, D100, V100, V150, V200, and V300for HR-CTV (p < 0.05). Similarly, TG-43 plans indicated higher doses for bladder point, rectum point, D0.1cm3, D10cm3, and D2cm3 for bladder, rectum, and sigmoid (p < 0.05). Additionally, overall plan quality score (PQS) was significantly greater in plans calculated with ACE (TG-186) formalism than in TG-43 plans (p < 0.05). In TG-186 (ACE) plans, gradient index (GI) was found to be lower than that in TG-43 plans (p < 0.05). Conclusions: TG-43 tends to overestimate doses compared with ACE (TG-186); nonetheless, both methods meet clinical standards. Material differences in the applicator are notable, and dose overestimations by TG-43 are within 5%. © 2024 Termedia Publishing House Ltd.. All rights reserved.
A dosimetric study to evaluate the inverse planning simulated annealing (IPSA) and hybrid inverse planning optimization (HIPO) algorithms in HDR brachytherapy of cervical cancer
(Wolters Kluwer Medknow Publications, 2025) V. Gogul Priean; Lalit Mohan Mohan Aggarwal; Ankur Mourya; Sunil Choudhary; Syed Mohamed Shajid; Abhijit Mandal; Ankita Singh
Purpose: To compare the effectiveness of the inverse planning simulated annealing (IPSA) and hybrid inverse planning optimization (HIPO) algorithms in interstitial HDR brachytherapy for treatment of cervical cancer. Methods and Materials: A dosimetric study was conducted on 46 cervical cancer patients who underwent multi catheter interstitial cervical HDR brachytherapy using the Martinez Universal Perineal Interstitial Template (MUPIT). Dosimetric parameters, plan evaluation indices, and mean treatment time were assessed for each algorithm. All the parameters were compared using statistical analysis. Results: With HIPO, significant improvements were observed in D90, D100, V100, and V200 (P < 0.05). Additionally, HIPO plans demonstrated lower doses to the bladder (B2cc) as compared to IPSA plans, whereas IPSA plans exhibited lower rectum (R2cc) and sigmoid (S2cc) doses, with statistical significance observed only for sigmoid doses. HIPO plans had better results in the plan evaluation indices such as CI, COIN, DHI, DNR, ODI, EI, NV100, GFB, GFR, GF, PQI1, PQI2, and PQS with statistical significance (P < 0.05) except for GFS. Moreover, HIPO plans had shorter mean treatment time compared to IPSA plans by 5.52 seconds, although this difference did not reach statistical significance. It was found that HIPO plans demonstrated superior dose-volumetric parameters for the high-risk clinical target volume (HR-CTV). Conclusions: In conclusion, HIPO emerged as the preferred algorithm for interstitial cervical HDR brachytherapy due to improved dose distribution in HR-CTV and plan quality as well. © 2025 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow.
A mathematical model to predict the different isodose volumes using TRAK value in HDR intracavitary brachytherapy for revised Manchester and ICRU-89 based Point A plans using computer tomography images
(Wolters Kluwer Medknow Publications, 2022) Ankur Mourya; Sunil Choudhary; Neeraj Sharma; Uday Pratap Shahi; Gaganpreet Singh; Satyajit Pradhan; Lalit Mohan Aggarwal
Purpose: To find out the simple relationship between Total Reference Air Kerma (TRAK) and various isodose volumes. Calculated isodose volumes were compared with experimental data for revised Manchester and International Commission on Radiation Units and measurements (ICRU)-89 Point A-based treatment plans. The accuracy of the formula was compared with the results of other relationships available in the literature. Materials and Methods: Dosimetric data from 62 intracavitary brachytherapy (ICBT) treatment plans of 31 patients with cervical cancer were studied. Each patient had treatment plans normalized to revised Manchester and ICRU-89 Points A (A flange and A icru89). For each treatment plan, TRAK values, V 350, V 700, V 1050, and V 1400 were obtained. The modeling curve was plotted between Isodose volume (V d) and the ratio of d/TRAK obtained from A flange plans to get a mathematical relation. The results of this formula were compared with the experimental data and outcomes of other formulas available in the literature. A paired-sample t-Test was performed to assess the statistical significance. Results: In the case of revised Manchester-based A flange normalization plans, the mean isodose volume of V 350, V 700, V 1050, and V 1400 were 285.98 ± 32.3 cm 3, 101.96 ± 10.63 cm 3, 52.71 ± 4.72 cm 3, and 31.44 ± 2.33 cm 3 respectively. Likewise, for ICRU-89 based A icru89 normalization plans, the mean isodose volumes of V 350, V 700, V 1050, and V 1400 were 304.11 ± 26.17 cm 3, 108.88 ± 8.29 cm 3, 56.62 ± 3.69 cm 3 and 34 ± 2.23 cm 3 respectively. The mean difference was significant. The Mathematical relationship developed was [INLINE:1]. No correlation was found between TRAK and D 0.1cm 3,D 2cm 3 for organs at risk. Conclusions: The developed formula calculated isodose volumes within the accuracy of ± 3% in ICBT plans. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
A prospective randomized comparison of simultaneous integrated boost with sequential boost intensity-modulated radiotherapy in locally advanced head and neck cancer
(Wolters Kluwer Medknow Publications, 2022) Nilesh Mani; Sushil K. Aggarwal; Ishan Kumar; Abhijit Mandal; Garima Jaiswal; Rakesh Ranjan; Anil K. Jaiswal; Neha Gupta; Ankita Singh; Ankur Mourya; Lalit M. Aggarwal; Sunil Choudhary
Purpose: A comparison of simultaneous integrated boost (SIB) with sequential boost (SEQ) using intensity-modulated radiotherapy along with concurrent cisplatin in locally advanced head and neck cancer (HNC) was made with regard to their survival outcomes and toxicity profile. Materials and Methods: A total of 34 patients were enrolled between October 2016 and March 2019. They were randomized into two arms, SIB and SEQB. All patients were treated with 6 MV photon beam on Linear Accelerator with weekly concurrent cisplatin at 35 mg/m 2. Overall survival (OS) and disease-free survival (DFS) were the primary end points and acute and late toxicities were the secondary end points. Results: The median follow-up period was 40.6 and 37.3 months for SIB and SEQB, respectively. At the end of 5 years, the median OS was 40.6 and 37.3 months (P = 0.947) and the median DFS was 35.1 and 37.3 months in the SIB and SEQB arms, respectively (P = 0.991).complete response at 3 months was 64.7% and 76.5% and partial response was 23.5% and 17.6%, whereas progressive disease was 11.8% and 5.9% in SIB and SEQB arms, respectively. Acute dermatitis, mucositis, dysphagia, and salivary gland toxicities were higher in the SIB arm compared to the SEQB arm. Conclusion: SIB and SEQ arms were comparable in terms of OS and DFS. However, the acute toxicities were higher in the SIB arm, although the difference was not significant, compared to the SEQB arm. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
A Prospective Study to Evaluate the Feasibility and Outcome of Completing Concurrent Chemo-radiation and Brachytherapy Within 4 Weeks Using Two Different Chemotherapy Regimens in Carcinoma Cervix
(Springer, 2018) Sovan Sarang Dhar; Uday Pratap Shahi; Tejbali Singh; Anupam Kumar Asthana; Satyajit Pradhan; Lalit Mohan Aggarwal; Sunil Choudhary; Abhijit Mandal; Deepak Kumar
Purpose: A prospective study was performed to assess the feasibility and outcome of completing concurrent chemo-radiotherapy (CCRT) in ≤ 4 weeks in cervical cancer patients using combination of paclitaxel and cisplatin as weekly regimen versus weekly cisplatin as concurrent chemotherapy. Methods: Forty patients of mostly locally advanced stage were prospectively allocated to receive either weekly cisplatin (40 mg/m2) [arm A] or weekly paclitaxel (50 mg/m2) and cisplatin (30 mg/m2) [arm B]. External Beam Radiotherapy [EBRT] in both arms given was 45 Gy/20 fractions/5 fractions per week (using conventional technique, Co60 teletherapy), intracavitary radiotherapy 30 Gy to point A (using LDR in a single setting) in between EBRT fractions, starting after completion of 10 fractions of EBRT. Results: Treatment of 65% of arm B and 70% of arm A patients could be completed by 4 weeks. At a median follow-up of 24 months, 85% patients in each arm had complete loco-regional control, on intention to treat analysis. Thirty-month survival in the respective arms were 69 and 72.2%. Grade 3 acute toxicity varied between 10 and 15% in both arms. Grade-5 acute haematological toxicity was found in one patient (5%) of each arm. Difference between the two arms was statistically not significant for response, survival or toxicity. Conclusion: Completing CCRT by 4 weeks is feasible with acceptable acute toxicity and encouraging outcome for carcinoma cervix. Concurrent weekly cisplatin + paclitaxel do not improve loco-regional control or survival as compared to weekly cisplatin alone at the cost of similar toxicity. Large sample study and long follow-up are needed to establish the same and identify late toxicities. © 2018, Association of Gynecologic Oncologists of India.
A radiobiological and dosimetrical comparison between simultaneous integrated and sequential boost intensity-modulated arc treatment of locally advanced head-and-neck cancer
(Wolters Kluwer Medknow Publications, 2020) Abhijit Mandal; Sunil Choudhary; Nilesh Mani; Sushil Aggarwal
Purpose: The study aimed to compare the radiobiological and dosimetric parameters between sequential boost (SEQB) and simultaneous integrated boost (SIB) treatment regimen using intensity-modulated arc therapy technique in locally advanced head-and-neck cancer (LAHNC) patients. Materials and Methods: A total of 24 previously untreated LAHNC patients were randomized into SIB (n= 11) and SEQB (n = 13) arms. The planning computed tomography data set was transferred to the treatment planning system. All the target volumes and organ at risk volumes were delineated. Single plan for SIB group and three plans (three phases) were generated for SEQB group of patients. Radiobiological and dosimetric parameters were compared. Results: The BED10(planned) value for high-risk (HR) planning target volume (PTV) was same in both groups, whereas for intermediate-risk (IR) PTV and low-risk (LR) PTV, the values were higher in SEQB arm than SIB arm. The V95values were 100% for all the target volumes in both arms of patients. The average D100value for gross target volume, HR PTV, and IR PTV was higher in SEQB arm than that in the SIB arm. The average D100value for LR PTV was higher in the SIB arm compared to that of the SEQB arm. The BED10(achieved) was calculated using D100values of target volumes. The difference of BED10(achieved) values between SEQB arm and SIB arm further increased than the BED10(planned) values for all target volumes. The maximum doses for spinal cord, spinal cord planning risk volume, and brain stem were within the tolerance dose in both groups of patients. The left and right parotid glands sparing was comparable in both groups of patients. Average integral dose was higher in the SIB group than SEQB group. The average total monitor unit per fraction was higher in the SEQB arm than that in the SIB arm. Conclusion: SIB regimen may be considered as more logical and efficient over SEQB regimen in the treatment of LAHNC with comparable radiobiological and dosimetric parameters. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
Addition of Etoricoxib During Concurrent Chemo-radiation of Cervical Cancer Patients Could Result in Faster Resolution of Gross Disease: A Prospective Single-Institution Study
(Springer, 2020) Sovan Sarang Dhar; Uday Pratap Shahi; Deepak Kumar; Ritusha Mishra; Prashant Kaser; Satish Dewangan; Abhijit Mandal; Sunil Choudhary; Lalit Mohan Aggarwal; Anupam Kumar Asthana; Satyajit Pradhan
Objective: A prospective study was conducted to assess the effect of adding COX-2 inhibitor Etoricoxib during concurrent chemo-radiotherapy schedule of cervical cancer patients on tumour response and acute toxicities. Materials and Methods: Forty patients of carcinoma cervix [mostly locally advanced] were treated using external beam radiotherapy (EBRT) [telecobalt, 45 Gy/20F/5F per week] concurrent with weekly cisplatin- or cisplatin + paclitaxel-based chemotherapy. Low-dose-rate (LDR) intracavitary brachytherapy (ICBT) 30 Gy to point A was delivered in between EBRT fractions in a single setting. Patients were prospectively allocated either to receive Etoricoxib 90 mg OD during the entire course of chemo-radiation [arm A] or not [arm B]. Weekly assessment with clinical evaluation and routine blood tests were done during the course of treatment, with pre-ICBT clinical evaluation taken into consideration for disease response comparison between arms. Results: When evaluated clinically before intracavitary brachytherapy procedure, the gross disease was found to have regressed more in the arm receiving Etoricoxib [p = 0.042]. Acute grade-3 toxicities ranged between 5 and 15% for patients who received Etoricoxib and 10–15% for those who did not. Difference in toxicities was not statistically significant. Conclusion: Addition of COX-2 inhibitor [Etoricoxib] during concurrent chemo-radiation results in a faster response of the primary disease in locally advanced cervical cancer patients, without a significant difference in acute toxicities. © 2019, Association of Gynecologic Oncologists of India.
An assessment of serum oxidative stress and antioxidant parameters in patients undergoing treatment for cervical cancer
(Elsevier Inc., 2021) Anju Shrivastava; Surendra Pratap Mishra; Satyajit Pradhan; Sunil Choudhary; Saurav Singla; Kulsoom Zahra; Lalit Mohan Aggarwal
Objectives: Oxidative stress and antioxidants are involved in all aspects of cervical cancer. The present study evaluated serum levels of oxidative stress and antioxidant biomarkers in cervical cancer patients and healthy controls. Moreover, the effect of Concurrent chemoradiotherapy (CCRT) on these biomarkers and their association with treatment outcome was investigated. Design: This study included ninety-seven cervical cancer patients and thirty controls. Three oxidative stress parameters (8-hydroxy-2-deoxyguanosine, Protein Carbonyl, and Malondialdehyde) and four antioxidant parameters (Superoxide Dismutase, Catalase, Glutathione Peroxidase, and Total Antioxidant Status) were measured. The analysis was conducted using repeated measures ANOVA for comparing among the phases (before, during, and follow-up) of treatment. The control group was compared using the Dunnet test. Logistic regression analysis was also conducted between oxidative stress and antioxidant parameters to study their association. Results: Significant rises in oxidative damage markers were observed in cervical cancer patients of all stages, compared to controls. There was a further increase in oxidative stress markers during CCRT among complete responders. However, among non-responders, the oxidative stress biomarkers like Protein Carbonyl and Malondialdehyde were unaltered during CCRT. Simultaneously, there was a significant decrease in antioxidant parameters in cervical cancer patients of all stages compared to controls. During CCRT, antioxidant levels continuously depleted among complete responders. Nevertheless, in non-responders, antioxidant parameters like Superoxide Dismutase and Total Antioxidant Status were consistent. The oxidative stress markers and antioxidant parameters normalized among complete responders at six months follow up. While in non-responders, the normalization of these parameters was not observed. Conclusion: Our results indicate that increased oxidative stress and diminished antioxidants among patients were associated with carcinoma cervix. Induced oxidative stress and decreased antioxidant parameters during CCRT among the complete responders show the treatment's efficacy. Oxidant-antioxidant profile merits investigation as markers of diagnosis, treatment response, survival, and recurrence in extensive prospective studies. © 2021 Elsevier Inc.
Artificial intelligence and machine learning disciplines with the potential to improve the nanotoxicology and nanomedicine fields: a comprehensive review
(Springer Science and Business Media Deutschland GmbH, 2023) Ajay Vikram Singh; Mansi Varma; Peter Laux; Sunil Choudhary; Ashok Kumar Datusalia; Neha Gupta; Andreas Luch; Anusha Gandhi; Pranav Kulkarni; Banashree Nath
The use of nanomaterials in medicine depends largely on nanotoxicological evaluation in order to ensure safe application on living organisms. Artificial intelligence (AI) and machine learning (MI) can be used to analyze and interpret large amounts of data in the field of toxicology, such as data from toxicological databases and high-content image-based screening data. Physiologically based pharmacokinetic (PBPK) models and nano-quantitative structure–activity relationship (QSAR) models can be used to predict the behavior and toxic effects of nanomaterials, respectively. PBPK and Nano-QSAR are prominent ML tool for harmful event analysis that is used to understand the mechanisms by which chemical compounds can cause toxic effects, while toxicogenomics is the study of the genetic basis of toxic responses in living organisms. Despite the potential of these methods, there are still many challenges and uncertainties that need to be addressed in the field. In this review, we provide an overview of artificial intelligence (AI) and machine learning (ML) techniques in nanomedicine and nanotoxicology to better understand the potential toxic effects of these materials at the nanoscale. © 2023, The Author(s).
Body Composition Analysis Techniques and Its Application in Oncology: A Review
(Taylor and Francis Ltd., 2024) Anil Kumar Maurya; Lalit Mohan Aggarwal; Sunil Choudhary
The oncology community has shown growing interest to understand how body composition measures can be utilized to improve cancer treatment and survivorship care for about 20 million individuals diagnosed with cancer annually. Recent observational studies demonstrate that muscle and adipose tissue distribution are risk factors for clinical outcomes such as postoperative complications, and worse overall survival. There is an emergent recognition that body mass index (BMI) is neither adequate to identify patients with adverse health outcomes due to poor muscle health or excess adiposity, nor does BMI accurately classify the distribution of adiposity. Abdominal CT is a most frequently imaging examination for a wide variety of clinical indications, but it is only used to diagnose the immediate problem. Additionally, each CT examination contains very robust data on body composition which generally goes unused in routine clinical practice. The field is eager to identify therapeutic interventions that modify body composition and reduce the incidence of poor clinical outcomes in this population. Large scale population based screening is feasible now by making all of these relevant biometric measures fully automated through the use of artificial intelligence algorithms, which provide rapid and objective assessment. © 2024 Taylor & Francis Group, LLC.
Carbon-based brilliance: a novel approach to renewable energy in radiotherapy centers
(Oxford University Press, 2024) Pitchaikannu Venkatraman; Lalit Mohan Aggarwal; Sunil Choudhary
The energy produced from other sources which does neither come from fossil fuels nor contribute in the production of any greenhouse effects that causes climate changes is called as ‘Alternative Energy’. Since our world’s primary energy sources such as coal, oil and natural gases are exploited to a greater extent, we are in an urge to switch to an alternative energy. Scattered radiation, a common byproduct in radiation therapy and diagnostic radiology, presents a unique opportunity in the realm of alternative energy. As a potential source of interference, scattered radiation can be repurposed to contribute to sustainable energy solutions. Addressing the issue of scattered radiation wastage and utilizing it for alternative energy, an activated carbon-based solar cell emerges as a solution. This solar cell, a conventional one in which cadmium Telluride is replaced by coconut shell based carbon material, has the potential in producing a significant amount of electrical energy by utilizing scattered radiation from radiotherapy and radiology machines. Furthermore, this activated carbon based-material undergoes thorough characterization into various teletherapy and radiology machines, and it can be seamlessly integrated into clinical practices. © The Author(s) 2024. Published by Oxford University Press. All rights reserved.
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.
Comparison of two hypofractionated radiotherapy schedules in locally advanced postmastectomy breast cancer patients
(Wolters Kluwer Medknow Publications, 2020) Sunil Choudhary; Neha Gupta; Shagun Misra; Narvada Narain Munnee; Amit Kumar; Rakesh Ranjan; Sovan Sarang Dhar; Deepak Kumar; Ankur Mourya; Lalit Mohan Aggarwal
Introduction: The role of hypofractionated radiotherapy (HFRT) in postmastectomy breast cancer patients is not well established. This study was done to establish the role of two different HFRT schedules in the treatment of chest wall and regional lymph nodes after mastectomy. Materials and Methods: Between 2012 and 2016, consecutively registered patients of locally advanced breast cancer patients having undergone mastectomy and adjuvant radiotherapy (RT) at a tertiary cancer center were analyzed. Locoregional recurrence (LRR) was the primary endpoint, whereas overall survival (OS), disease-free survival (DFS), and both acute and late adverse events were secondary endpoints. Results: A total of 34 patients who were treated with 39 Gy in 13 fractions over 2½ weeks and 35 patients who were treated with 40 Gy in 15 fractions over 3 weeks were identified. The median follow-up period was 47 months and 63.5 months in the 39 Gy and 40 Gy arms, respectively. LRR was seen in 11.8% and 8.6% of patients in the 39 Gy and 40 Gy arms, respectively. OS at 4 years was 66% and 71.5% in the 39 Gy and 40 Gy arms, respectively. The mean DFS for 39 Gy and 40 Gy arms was 43.6 months and 66.4 months, respectively (P = 0.822). Acute skin toxicity was similar in the two groups. Arm edema was significantly more in the 40 Gy arm. Conclusion: The two HFRT schedules are equivalent to each other in terms of survival outcomes. Arm edema is higher with 40 Gy arm as compared to 39 Gy arm. © 2020 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow.
Development and validation of an indigenous, radiobiological model‑based tumor control probability and normal tissue complication probability estimation software for routine plan evaluation in clinics
(Wolters Kluwer Medknow Publications, 2022) Ganeshkumar Patel; Abhijit Mandal; Avinav Bharati; Sunil Choudhary; Ritusha Mishra; Ankur Mourya
Purpose: Development and validation of a simple and convenient computational program in MATLAB environment for estimating the tumor control probability (TCP) and the normal tissue complication probability (NTCP), as a decision support system for routine plan evaluation. Materials and Methods: We developed an in‑house software using MATLAB 2016b (Mathworks) for estimating TCP and NTCP named as RBMODELV1. The program contains Niemierko free equivalent uniform dose (EUD) program code provided in authors research article. For rest of radiobiological (RB) models in the software separate coding is performed. The program accepts cumulative dose–volume histogram file in (.txt) format containing two columns dose and volume. A set of two RB parameters were prepared, default and user‑dependent in excel sheet named as RBDATA. We cross‑validated results of RBMODELV1 software with BioSuite software for Poisson’s TCP model and Lyman‑Kutcher‑Burman (LKB) model. A set of total 20 patient’s data of head and neck site took under study and respective TCP and NTCP calculated by all the RB models and compared. Results: This is the first study in which we tried to establish correlation between the mean doses (EUD) received by parallel structure (parotid gland and oral cavity) and predicted percentage of NTCP values. It is found that mean dose in the range of 35–40 Gy for parotid gland can result in more than 50% NTCP predicted by all four RB models. Similarly oral cavity receiving mean dose in the range of 53–58 Gy can results in more than 35% NTCP predicted by all the four models. There is <3% variation observed between TCP calculated by BioSuite and RBMODELV1 software and <4% variation observed between predicted NTCP for parotid gland and oral cavity OAR from LKB model by both the software. Conclusion: We created simple software RBMODELV1 which can be used as a research tool as well as decision support system. © 2021 Journal of Cancer Research and Therapeutics.
Diagnostic and prognostic application of Raman spectroscopy in carcinoma cervix: A biomolecular approach
(Elsevier B.V., 2021) Anju Shrivastava; Lalit Mohan Aggarwal; Chilakapati Murali Krishna; Satyajit Pradhan; Surendra Pratap Mishra; Sunil Choudhary; Chandan Bhai Patel; Saurav Singla; Ashish; Ranjan Kumar Singh
Blood serum samples from 63 cervical cancer patients and 30 controls were collected at three different phases of the treatment (i.e. before, during, and at follow up). The spectra of serum samples from control as well as patients were classified into different groups using principal component analysis (PCA) and linear discriminant analysis (LDA) based on different phases of treatment using R software. The spectra of blood serum samples have shown the distinct changes and differences compared with each other in the profile of various biochemical parameters. The sensitivity (92.5%) and specificity (85%) were observed maximum between control and cervical cancer patients (before treatment). Between different phases of treatment, the sensitivity and specificity were less but, all accuracies of detection and classification reached above 50%. This method can be considered as a screening method for detection and treatment monitoring. © 2020
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
Dose optimization comparison study of inverse planning simulated annealing [IPSA] and hybrid inverse planning optimization [HIPO] in interstitial brachytherapy of head and neck cancer
(Elsevier Inc., 2021) Bijay Kumar Barik; Sovan Sarang Dhar; Rumita Singh; Abhijit Mandal; Lalit Mohan Aggarwal; Uday Pratap Shahi; Sunil Choudhary
Purpose: This study was a retrospective dose optimization comparison of two commercially available inverse planning algorithms, the inverse planning simulated annealing (IPSA) and hybrid inverse planning optimization (HIPO) for head and neck cancer interstitial brachytherapy. Materials and Methods: Seven patients with head and neck cancer were selected (4 with tongue cancer, 2 with buccal mucosa cancer and 1 with carcinoma lip) who were previously treated with interstitial brachytherapy using a flexible nylon tube catheter and graphical optimization/geometric optimization technique. All seven patients were retrospectively re-planned using both IPSA as well as HIPO algorithms available in the Oncentra Brachytherapy Treatment Planning System (TPS) version V4.5.3.30. The dosimetric parameters [PTV-V100, V150, V200, D90; mandible-D2cc, parotid-D2cc, conformity index (CI), dose homogeneity index (HI), overdose volume index (ODI)] were chosen for evaluation in compliance with the objective function and organ at risk dose constraints. Results: Using the paired sample T test in chosen parameters (PTV-V100, V150, V200, D90; mandible-D2cc, CI, HI, ODI both the inverse planning algorithms), it was found that IPSA and HIPO were comparable. Conclusions: Even though both IPSA and HIPO are largely comparable in most of the dosimetric parameters for inverse planning in brachytherapy of head and neck cancers, differences in the algorithms can be exploited to improve certain parameters in specific situations such as D2cc parotid. © 2021