Browsing by Author "Choudhary, Sunil"
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Publication A comparative study of gemcitabine and cisplatin versus oral capecitabine alone in metastatic gallbladder cancer(Wolters Kluwer Medknow Publications, 2022) Kumar, Deepak; Rastogi, Neeraj; Agarwal, Sushma; Mishra, Shagun; Kumar, Shaleen; Lal, Punita; Singh, Shalini; Choudhary, SunilAims: 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.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 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) Mani, Nilesh; Aggarwal, Sushil K.; Kumar, Ishan; Mandal, Abhijit; Jaiswal, Garima; Ranjan, Rakesh; Jaiswal, Anil K.; Gupta, Neha; Singh, Ankita; Mourya, Ankur; Aggarwal, Lalit M.; Choudhary, SunilPurpose: 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.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 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) Singh, Ajay Vikram; Varma, Mansi; Laux, Peter; Choudhary, Sunil; Datusalia, Ashok Kumar; Gupta, Neha; Luch, Andreas; Gandhi, Anusha; Kulkarni, Pranav; Nath, BanashreeThe 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).Publication 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) Patel, Ganeshkumar; Mandal, Abhijit; Bharati, Avinav; Choudhary, Sunil; Mishra, Ritusha; Mourya, AnkurPurpose: 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.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 Dose at posterior-inferior border of symphysis point: A predictor for vaginal stricture in cervical cancer(Elsevier Inc., 2023) Singh, Ankita; Mani, Nilesh; Aggarwal, Lalit M.; Agarwal, Sumit; Mourya, Ankur; Verma, Ashish; Bagchi, Antara; Gupta, Neha; Choudhary, SunilPURPOSE: 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 SocietyPublication 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) Kumar Barik, Bijay; Sarang Dhar, Sovan; Singh, Rumita; Mandal, Abhijit; Mohan Aggarwal, Lalit; Pratap Shahi, Uday; Choudhary, SunilPurpose: 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. � 2021Publication Evaluating Ayurvedic mouthwash and soda-salt mouthwash for oral mucositis in head and neck cancer: A randomized controlled trial(Elsevier B.V., 2023) Saniya, C.K.; Rao, Mangalagowri V.; Patil, Rajkala; Choudhary, Sunil; Singh, Om Prakash; Dhiman, K.S.Background: Patients undergoing radiotherapy (RT) or concurrent chemo-radiation (CCRT) for head and neck squamous cell carcinoma (HNSCC) often suffer from side effects such as mucositis, xerostomia, pharyngitis, laryngitis, and pain, which are being managed symptomatically by alcohol-based mouthwashes. Objectives: To determine the effectiveness of Ayurvedic mouthwash �Draksha Guduchyadi Kashaya� in reducing the severity of oral side effects of chemo-radiation. Material and methods: This concurrent parallel randomized controlled study was conducted at Sir Sunderlal Hospital, BHU, on 70 HNSCC patients scheduled to undergo RT/CCRT. Patients who met the inclusion-exclusion criteria were enrolled, and 35 were randomly assigned to either the intervention group (Ayurveda) or the control group using a simple random technique (lottery method). Blinding was not implemented in this study. Patients in the intervention group (Ayurveda) were instructed to perform kavala with 50 ml of �Draksha Guduchyadi Kashaya� for 2 min, ten times daily, while the control group performed 2-min gargling with soda-salt mouthwash ten times daily. Results: Out of the 70 patients enrolled, data from 60 patients were analyzed, revealing statistically significant differences in the onset of mucositis (p = 0.049), pharyngitis (p = 0.034), laryngitis (p = 0.009) and intensity of variables such as mucositis (p = 0.000), xerostomia (p = 0.046), pharyngitis (p = 0.002), laryngitis (p = 0.035), and pain (p = 0.000). These findings indicate that Ayurvedic mouthwash may be beneficial in managing the oral side effects of chemo-radiation in HNSCC. Conclusion: This AYUSH financially supported trial (Reg No: CTRI/2020/04/024672) demonstrates promise as a safe and cost-effective alternative for managing oral complications of RT/CCRT, offering complementary treatment for comprehensive cancer care. � 2023 The AuthorsPublication Evolution of brachytherapy applicators for the treatment of cervical cancer(Wolters Kluwer Medknow Publications, 2021) Mourya, Ankur; Aggarwal, Lalit; Choudhary, SunilBrachytherapy applicators have come a long way since Danlos developed early intracavitary applicators to treat cervical cancer patients. Therefore, this review will help in the neoteric designs of intracavitary applicators. A detailed literature survey of the gynecological brachytherapy applicators from the era of preloading to conceptual intensity-modulated brachytherapy applicators has been carried out. Depending on the extent of the disease and patient anatomy, the selection of brachytherapy applicators plays a pivotal role in the treatment of cervical cancer. Furthermore, the selection of the applicators is also based on the imaging modalities to be used for applicator reconstruction and treatment planning. Dose acceleration in the target and reduction in nearby organs at risk can be optimized using an applicator having the capabilities of intensity-modulated brachytherapy. Now, three-dimensional printed applicators are used for patient-specific tailor-made treatment and they are fast replacing the old conventional applicators. Newer advancements in technology have greatly influenced the neoteric designs of intracavitary brachytherapy applicators. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication 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.Publication Letter to the editor on the research article �Total reference air kerma can accurately predict isodose surface volumes in cervix cancer brachytherapy. A multicenter study�(Elsevier Inc., 2021) Mourya, Ankur; Mohan Aggarwal, Lalit; Choudhary, Sunil[No abstract available]Publication Performance of NI-RADS on CECT Alone to Predict Recurrent Head and Neck Squamous Cell Carcinoma after Chemoradiotherapy: Added Value of RECIST 11.(Georg Thieme Verlag, 2022) Kumar, Ishan; Reza, Syed O.; Choudhary, Sunil; Shukla, Ram C.; Mani, Nilesh; Verma, AshishBackground � The Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting format for the categorization of the degree of suspicion for recurrent head and neck malignancies on positron emission tomography/computed tomography. Purpose � The purpose of our study was to analyze the efficacy of the NI-RADS rating scale and criteria for contrast-enhanced computed tomography (CECT) alone in predicting the local and regional recurrence of malignancies after chemoradiotherapy. Material and Methods � CECT of the patients with head and neck cancers receiving radiotherapy and concurrent chemotherapy as a primary treatment was obtained 3 months after the completion of radiotherapy and NI-RADS scoring was done using components of Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria. Their management was guided according to the recommendations based on their NI-RADS score. Results � Thirty patients with squamous cell carcinoma of the neck were included in this study. The positive or negative status of the recurrent disease was based on biopsy results or follow-up protocol as recommended in NI-RADS rating scale. Fifteen patients had path proven recurrence at the primary tumor site. For primary tumor site, disease persistence rates of 4% for NI-RADS 1, 24% for NI-RADS 2, and 80% for NI-RADS 3 scores were seen. Five patients had recurrent lymph nodal disease. For lymph nodal assessment, NI-RADS categories 1, 2, and 3 revealed nodal disease recurrence rates of 5.3, 25, and 66.7%, respectively. Conclusion � CECT alone may be used to assign the NI-RADS rating scale using RECIST 1.1 criteria to predict the presence or absence of recurrent tumor in patients with neck malignancies. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Role of Overall Treatment Time When Estimating TCP & NTCP of Head & Neck Radiotherapy Treatment Plans in Altered Fractionation(Mashhad University of Medical Sciences, 2023) Patel, Ganeshkumar; Mandal, Abhijit; Mishra, Ritusha; Choudhary, Sunil; Mishra, HimanshuIntroduction: The present study demonstrated role of overall treatment time when estimating tumor control probability (TCP) and normal tissue complication probability (NTCP) for moderately hypofractionated and accelerated fractionation schedules in head & neck treatment plans. Repopulation effect in the squamous cell carcinoma is an influencing factor that should be considered when evaluating TCP and NTCP in early responding tissue. This effect can be incorporated by the means of overall treatment time in days. Material and Methods: The proposed study separated in two parts. In the first case, we assumed four moderately hypofractionated schedules for demonstration, including conventional fractionation schedule (CFS) (70Gy/35 #), fractionation schedule 1 (66Gy/30#), fractionation schedule 2 (60Gy/24#) & fractionation schedule 3 (55Gy/20#). Four independent volumetric modulated arc treatment plans were generated at different fractionation schedules for 15 patient's data set and therefore led to a total of 60 treatment plans. The treatment plan created for CFS is the reference plan for comparison of calculated TCP & NTCP amongst the four plans. The rest three plans for each patient were created simply by changing the dose prescription for FS1, FS2 & FS3, the mean total dose and dose per fraction. In the second scenario, conventional fractionation schedule (66Gy/33# with five fractions per week) compared against accelerated fractionation schedule (66Gy/33# with six fractions per week). The cumulative dose volume histogram for all treatment plans were used for TCP/NTCP estimation by Niemierko EUD, Poisson model and LKB model. The TCP/NTCP calculated in two different way for tumor & oral mucosa of head & neck site. Contrary to the second case, the overall treatment time (OTT) in days not accounted in the first case. Results: It was statistically significant difference (p<0.05) obtained between calculated TCP/NTCP in both moderately hypofractionated and accelerated fractionation schedules. Conclusion: There is significant impact of OTT and it should be considered when evaluating TCP/NTCP for early responding tissue. � 2023.Publication The healing potential of Draksha-guduchyadi kavala in radiotherapy induced oral mucositis in non-metastatic squamous cell carcinoma of head and neck: A comparative case study(Elsevier B.V., 2022) C K, Saniya; Rao, Mangalagowri V.; Choudhary, Sunil; Singh, Om PrakashPatients undergoing Radiotherapy (RT) for Head and Neck carcinoma often suffer from side effects such as mucositis, xerostomia, pharyngitis, laryngitis and pain which are being managed symptomatically by mouthwashes of soda-salt, chlorhexidine or betadine. Among the side effects, oral mucositis is the most debilitating one. This comparative case study comprises of 4 patients undergoing RT. Here, 2 patients each are randomly allocated into two groups. One group received the existing prophylactic management i.e., Sodium bicarbonate-salt solution mouth wash and the other group received, Draksha-guduchyadi yoga for kavala (gargling). Both the sets of patients were asked to perform gargling, from the first day of radiation to 15 days thereafter. The effectiveness of both mouthwashes was compared for their healing potential on oral mucositis by RTOG grading. The reduction in mucositis was significant in the group which received Ayurvedic mouthwash compared to the other group. This study positively highlights the contribution of Ayurveda in cancer treatment especially in the field of quality of life. � 2021 The Authors
