Browsing by Author "Aggarwal, Lalit Mohan"
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Publication 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) Mourya, Ankur; Choudhary, Sunil; Shahi, Uday Pratap; Sharma, Neeraj; Gautam, Himani; Patel, Ganeshkumar; Pradhan, Satyajit; Aggarwal, Lalit MohanPurpose: 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 SocietyPublication 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) Mourya, Ankur; Choudhary, Sunil; Sharma, Neeraj; Shahi, Uday Pratap; Singh, Gaganpreet; Pradhan, Satyajit; Aggarwal, Lalit MohanPurpose: 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.Publication An assessment of serum oxidative stress and antioxidant parameters in patients undergoing treatment for cervical cancer(Elsevier Inc., 2021) Shrivastava, Anju; Mishra, Surendra Pratap; Pradhan, Satyajit; Choudhary, Sunil; Singla, Saurav; Zahra, Kulsoom; Aggarwal, Lalit MohanObjectives: 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.Publication Diagnostic and prognostic application of Raman spectroscopy in carcinoma cervix: A biomolecular approach(Elsevier B.V., 2021) Shrivastava, Anju; Aggarwal, Lalit Mohan; Murali Krishna, Chilakapati; Pradhan, Satyajit; Mishra, Surendra Pratap; Choudhary, Sunil; Patel, Chandan Bhai; Singla, Saurav; Ashish; Singh, Ranjan KumarBlood 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. � 2020Publication Feasibility of using polytetrafluoroethylene flexible implant tube for interstitial brachytherapy patients(Elsevier Inc., 2022) Mourya, Ankur; Aggarwal, Lalit Mohan; Choudhary, Sunil; Shahi, Uday Pratap; Sharma, Neeraj; Prakash, Rajiv; Mishra, RitushaPURPOSE: To design the different Polytetrafluoroethylene (PTFE) based flexible implant tubes using an in-house developed device and to evaluate them for High dose rate (HDR) interstitial brachytherapy using computer tomography images. METHODS AND MATERIALS: PTFE hollow tube having a 2 mm (6 French) outer diameter (OD) and 1.4 mm inner diameter (ID) was used to design in-house single and/or double leader flexible catheters for interstitial brachytherapy implant. An in-house Plastic Wire Drawing Plate (PWDP) machine was developed. Customization of PTFE hollow flexible implant tube (FIT) was done through PWDP. Different percentages of BaSO4 (5%, 10%, & 15%) were added to Nylon 6 to make radiopaque button. Various quality assurance tests were performed with the PTFE tubes implanted in the brinjal (phantom) before using them on the patients. That is, coupling of brachytherapy machine transfer tube with flexible PTFE Tubes, CT scan artifacts, tube kinks, breast template, and free-hand compatibility. RESULTS: With the help of the PWDP machine, plastic wires of different lengths were made for single leader and double leader tubes. The different plastic leader ends of 1 cm to 50 cm lengths having 1 mm diameter were created. The radiopaque button of Nylon 6 in circular shape having 1 cm diameter and 0.5 cm thick was created. Developed radiopaque buttons were visible on CT scan images as well as on radiograph images. CONCLUSIONS: PTFE tubes of the desired length can be made depending upon the size of the brachytherapy implant and are inexpensive than commercially available flexible implant tubes. � 2022 American Brachytherapy SocietyPublication Influence of adjuvant therapy on pattern of failure and survival in curatively resected gallbladder carcinoma(Wolters Kluwer Medknow Publications, 2021) Choudhary, Sunil; Gupta, Neha; Verma, Chandra Prakash; Das, Avipsa; Aggarwal, Lalit Mohan; Tewari, Mallika; Mandal, Abhijit; Asthana, Anupam KumarPurpose: The study was done to evaluate the role of adjuvant therapy in curatively resected Stage II and III gallbladder carcinoma (GBC). Materials and Methods: This was a retrospective analysis of patients of GBC registered between 2008 and 2017 in outpatient department of a tertiary cancer hospital in India. Patients who had any of the following adjuvant treatment after radical surgery: (a) external beam radiotherapy (RT) alone, (b) chemotherapy (CT) alone, and (c) RT with CT (CRT) were considered for the study. Results: A total of fifty patients could meet the selection criteria. It was seen that seven patients were treated with RT, 20 with CT, and 23 with CRT. Median follow-up for patients who were alive was 26.7 months. Nineteen patients had locoregional failure while eight had distant failure. Patients treated with CRT had a significantly better mean overall survival compared to those treated with RT or CT (44.0 months, 12.5 months, and 15.1 months, respectively; P = 0.003). Similarly, mean disease-free survival was superior in CRT arm compared to RT and CT arms (43.6 months, 9.6 months, and 12.4 months, respectively; P = 0.002). Conclusions: Adjuvant CRT had better survival outcome compared to patients treated with either RT or CT with Stage II and III disease after curative cholecystectomy. � 2020 Journal of Cancer Research and Therapeutics.
