Pub Date : 2023-01-01DOI: 10.4103/crst.crst_276_23
K Devaraja
The latest issue of Cancer Research, Statistics and Treatment contained an interesting article by Michaelraj et al., an epidemiological study on risk factors of head-and-neck squamous cell carcinoma (HNSCC) in south India.[1] I would like to discuss some of the crucial findings of this study and their implications in developing risk stratification models and beyond. This study cross-sectionally analyzed the epidemiological profile of 150 consecutive patients with primary treatment-naïve HNSCC recruited over three years at a tertiary care hospital in Tamil Nadu.[1] As seen in most of the other regions of India, the most common primary site of HNSCC was the oral cavity (40.7%) in this cohort.[2] There were three times more men than women among the diagnosed cases, and only just about a quarter of the study cohort had no exposure to smoking, tobacco chewing, or alcohol (27.3%). Although there existed a significant variability among the men and women regarding the distribution of these risk factors, as per Table 4 in the paper,[1] more than half the men with HNSCC had exposure to multiple risk factors. Furthermore, 66.7% of the overall cohort had exposure to at least one tobacco product. These observations of Michaelraj et al.[1] align with the existing consensus, as they suggest a possible etiopathological role of these known carcinogenic elements, particularly tobacco, the exposure to which is significantly higher among men than women.[3] In Table 5,[1] the authors analyzed the proportional distribution of risk factors in different age groups and found it statistically significant by two-way ANOVA. This table also showed that 91.8% (100/109) of patients with HNSCC exposed to a known risk factor(s) were aged between 41 and 70 years, and only a few patients in the exposed group were outside this range. Additionally, the distribution of all these risk factors (including various combinations of these factors) was seen to peak around the sixth decade of life. Lastly, the patients in the sixth decade of life or older had a higher degree of exposure to multiple risk factors than those in the fifth decade or younger, who had either one risk factor or no exposure at all. All these findings suggest that the putative role of tobacco and alcohol in the carcinogenesis of HNSCC seems to be more relevant in older adults, in their fourth, fifth, and sixth decades of life than in the younger population, a notion that has also been supported by other recent studies.[4] While the relative risk attributable to these known carcinogens is not always predictable, it is understandable that the risk increases with an increase in the duration and severity of exposure to these factors.[5] By these observations, the elderly male with a long-standing use of tobacco, with or without alcohol, would seem to have a higher risk of developing HNSCC, which includes oral cancer. Accordingly, these groups of people, if targeted, would be more likely to benefit from screening programs a
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Pub Date : 2023-01-01DOI: 10.4103/crst.crst_247_23
M. Dilan Davis
While deciding whether to pursue a doctorate of medicine (DM) in Medical Oncology, I talked to numerous people. Most had limited knowledge, some mentioned the potential for significant earnings, others spoke of the emotional toll caused due to the nature of the field, and there were discussions about interdepartmental interference. However, one conversation that particularly stands out is the one I had with a close friend of mine from the United States of America (USA). Dr. DJ Shah left India after completing his Bachelor of Medicine, Bachelor of Surgery (MBBS), to pursue a residency in Internal Medicine in the USA. After finishing his residency, he planned to specialize in Pulmonary Medicine and Critical Care. He explained that he chose critical care because many of the patients he saw were acutely ill. They would either recover and not return, or their condition would deteriorate, and they would pass away. In the latter scenario, an emotional attachment might not be as strong, considering most patients in the intensive care unit (ICU) are intubated, hindering verbal communication, a critical element in forming deep connections. Conversely, he pointed out that oncology presents a different dynamic. Patients you would meet would most likely not be acutely sick, but in a state of shock due to a serious diagnosis. In this field, you would console them, treat them, and accompany them on their journey. Over time, they may be cured or gradually move toward the end of their life. In the latter situation, the experience could be emotionally taxing, both for the family and the treating oncologist, as a personal connection would have been forged during the long journey. He shared a story of a friend at MD Anderson Cancer Center, renowned for cancer treatment in the USA. This friend often struggled with the realization that even at a world-class hospital with exceptional resources, there were cases where treatment fell short, and all that could be done was inform the patient that their time was limited. Despite various perspectives, I ultimately chose to pursue oncology for my DM course. The initial transition was challenging, and I was adapting to a new hospital, environment, and a diverse set of patients. However, I gradually acclimated and found my place. After a month at the Tata Memorial Hospital (TMH, Parel, Mumbai, India), I received the unexpected news that my next two months would be spent at the Advanced Center for Treatment, Research and Education in Cancer (ACTREC) in Kharghar (Navi Mumbai), approximately 35 km from TMH. This facility had a distinct atmosphere, located away from the city’s hustle, offering patients with cancer a serene campus with green spaces and the peace they deserved. They had a building named “Asha Niwas,” which was home to patients with cancer and their families who came for treatment from all over India. During my exploration, I stumbled upon an inauguration stone bearing a name I was familiar with. The name was found in
在决定是否攻读肿瘤医学博士学位(DM)的过程中，我和很多人谈过。大多数人的知识有限，一些人提到了大量收入的潜力，另一些人则谈到了由于该领域的性质而造成的情感损失，还有关于部门间干预的讨论。然而，我和一位来自美国的好朋友的谈话尤其引人注目。Dr. DJ Shah在完成外科医学学士学位(MBBS)后离开印度，前往美国攻读内科住院医师。实习结束后，他计划专攻肺部医学和重症监护。他解释说，他选择重症监护是因为他看到的许多病人都病得很重。他们要么康复而不再回来，要么病情恶化而死去。在后一种情况下，情感依恋可能没有那么强烈，因为大多数重症监护室(ICU)的患者都是插管的，这阻碍了语言交流，而语言交流是形成深度联系的关键因素。相反，他指出肿瘤学呈现出不同的动态。你遇到的病人很可能不是重病，而是由于严重的诊断而处于休克状态。在这个领域，你会安慰他们，对待他们，陪伴他们的旅程。随着时间的推移，他们可能会被治愈或逐渐走向生命的尽头。在后一种情况下，对于家庭和治疗肿瘤的医生来说，这种经历可能是一种情感上的负担，因为在漫长的旅程中，人与人之间的联系是建立起来的。他分享了一个朋友在MD安德森癌症中心的故事，该中心在美国以癌症治疗而闻名。这位朋友经常挣扎于这样一种认识:即使在拥有特殊资源的世界级医院，也会有治疗不足的情况，而所能做的就是告诉病人他们的时间有限。尽管有各种各样的观点，我最终还是选择了肿瘤学作为我的糖尿病课程。最初的过渡是充满挑战的，我要适应新医院、新环境和各种各样的病人。然而，我逐渐适应了环境，找到了自己的位置。在塔塔纪念医院(TMH，帕雷尔，印度孟买)呆了一个月后，我得到了一个意想不到的消息，我接下来的两个月将在哈尔哈尔市(新孟买)的癌症治疗、研究和教育高级中心(ACTREC)度过，距离塔塔纪念医院大约35公里。这个设施有一个独特的氛围，远离城市的喧嚣，为癌症患者提供了一个宁静的校园，有绿色的空间和他们应得的宁静。他们有一座名为“Asha Niwas”的建筑，这里是来自印度各地的癌症患者和他们的家人的家。在探索过程中，我偶然发现了一块就职石，上面有一个我熟悉的名字。在我从医学博士毕业后的许多次火车旅行中，我读过的所有书中都有这个名字:苏达•穆尔蒂(Sudha Murthy)，印孚瑟斯基金会(Infosys Foundation)主席。这是一个让我兴奋的时刻，我忍不住拍了一张照片。几天过去了，我开始适应新的工作环境。许多病人在那里寻求治疗。起初，所有的面孔都是新的，但最终，许多人变得熟悉了。在这些面孔中，有一张很显眼——一个二十多岁的年轻人陪着他的母亲。我第一次注意到他是在门诊部(OPD)的房间里听到他说泰米尔语，那里最常用的语言是印地语、马拉地语和英语。他们正在用泰米尔语和我们的泰米尔顾问之一安布医生交谈。虽然我没有直接接触过他们，但随着时间的推移，他们的面孔变得熟悉了。时间流逝，在我的一次夜班中，这些熟悉的人带着担忧的表情来到了事故现场。我称呼她为沙昆塔拉(化名)，评估了她的状况。她是一名患有转移性乳腺癌的患者，接受了多种治疗。她出现了高烧，实验室检查显示有中性粒细胞减少症。癌症患者发热性中性粒细胞减少需要及时治疗;否则，他们的病情会迅速恶化。我用英语和印地语解释了情况，让她住进我的病房。在这个过程中，我发现他们说的是马拉雅拉姆语，我的母语，而不是我以为的泰米尔语。然而，我选择不立即透露我的出身。在接下来的几个星期里，沙昆塔拉的病情有所好转，她的发热性中性粒细胞减少症也消失了。查房时，她问我是不是马来亚人。这让我很惊讶，因为我的口音是多年来在说印地语的中央邦和古吉拉特邦养成的。她解释说，我用“La”来称呼她，让她知道了，因为印地语中没有这种特殊的“La”音，而我念她名字的方式只有马来亚人才会有。 这种共同的语言纽带加深了我们之间的联系。我还想知道我们的大脑能够学习多少种语言，因为沙昆塔拉对马拉雅拉姆语、泰米尔语、印地语和英语都很熟悉。她来自帕拉卡德，在著名的高知医院接受了治疗，在多种治疗取得进展后，她转向孟买的TMH。就像许多医生对待自己珍爱的病人一样，我记住了她的细节，甚至是她的病人医院识别码(ID)。她从发热性中性粒细胞减少症中康复后，愉快地出院了。临走前，他们问我要手机号码，我解释说，如果我正忙着处理眼前的病人，可能无法一直接听电话。随着时间的流逝，他们又回到了门诊，为她进行癌症治疗。他们愉快的举止引人注目。每当我们相遇时，就会简短地聊几句。在ACTREC工作两个月后，我回到了帕雷尔TMH的繁华氛围中，恢复了日常工作。一天晚上8点左右，我在查房时接到了一个电话。沙昆塔拉的儿子打电话来了，甚至在接电话之前，我就感觉到有些不对劲。他的声音被泪水压得喘不过气来，起初让人听不懂他在说什么。最后，他告诉我，他的母亲又住院了，这次她病得很重，医生说她的病情很严重。他恳求我和治疗他的医生谈谈，探索任何可能的途径。我的朋友纳赫医生正在监督她的治疗。我立即与他联系，寻求信息。他透露肺转移是问题所在，称她的病情很严峻。从x光片上看，她的肺几乎全被转移瘤覆盖了。他不抱太大希望。我面临着一项艰巨的任务，那就是把这个信息转达给沙昆塔拉的儿子。我倾听他们的担忧，试图安慰他们，并尽可能诚实地解释情况。接下来的两天，我在TMH忙得不可开交。沙昆塔拉一直萦绕在我的脑海里，于是我决定打电话给纳奇医生了解最新情况。由于联系不上他，我就用我记住的病人ID查看了电子病历。输入她的病人号，我发现她已经在那天早上去世了。我不知道该说什么好。悲伤、失望和无助压倒了我。我翻开自己最喜欢的一首诗——朗费罗的《生命赞美诗》，就像我在悲伤时经常做的那样:“你本是尘土，也要归于尘土;这话不是指灵魂。”活在当下，心在内心，上帝在头顶。两天后，当我走在医院附近的街上时，我决定给她的家人发个信息。我发了一条短信，对迟到的消息表示深切的哀悼和遗憾。我转达说，他们竭尽全力帮助她与疾病作斗争。在这艰难的时刻，我为他们的力量祈祷。她的儿子以感激之情回应，感谢我的信息以及我在她住院期间提供的照顾。随着时间的流逝，他们的联系方式被保存了下来，我偶尔会注意到她儿子在WhatsApp上的状态。毫无疑问，他们幸福的小家庭受到了她去世的深刻影响，留下了言语无法填补的空白。当我回顾这段旅程时，我意识到医学不仅仅是治疗疾病;它是关于在人们最脆弱的时刻与他们建立联系。前进的道路充满了挑战和回报，充满了更多的故事要讲，更多的人要牵，更多的人要影响。那么，让我们起来干吧，勇敢地面对任何命运;不断成就，不断追求，学会劳动和等待。——《生命赞美诗》朗费罗财政支持和赞助无。利益冲突没有利益冲突。
{"title":"Footprints on the sands of time","authors":"M. Dilan Davis","doi":"10.4103/crst.crst_247_23","DOIUrl":"https://doi.org/10.4103/crst.crst_247_23","url":null,"abstract":"While deciding whether to pursue a doctorate of medicine (DM) in Medical Oncology, I talked to numerous people. Most had limited knowledge, some mentioned the potential for significant earnings, others spoke of the emotional toll caused due to the nature of the field, and there were discussions about interdepartmental interference. However, one conversation that particularly stands out is the one I had with a close friend of mine from the United States of America (USA). Dr. DJ Shah left India after completing his Bachelor of Medicine, Bachelor of Surgery (MBBS), to pursue a residency in Internal Medicine in the USA. After finishing his residency, he planned to specialize in Pulmonary Medicine and Critical Care. He explained that he chose critical care because many of the patients he saw were acutely ill. They would either recover and not return, or their condition would deteriorate, and they would pass away. In the latter scenario, an emotional attachment might not be as strong, considering most patients in the intensive care unit (ICU) are intubated, hindering verbal communication, a critical element in forming deep connections. Conversely, he pointed out that oncology presents a different dynamic. Patients you would meet would most likely not be acutely sick, but in a state of shock due to a serious diagnosis. In this field, you would console them, treat them, and accompany them on their journey. Over time, they may be cured or gradually move toward the end of their life. In the latter situation, the experience could be emotionally taxing, both for the family and the treating oncologist, as a personal connection would have been forged during the long journey. He shared a story of a friend at MD Anderson Cancer Center, renowned for cancer treatment in the USA. This friend often struggled with the realization that even at a world-class hospital with exceptional resources, there were cases where treatment fell short, and all that could be done was inform the patient that their time was limited. Despite various perspectives, I ultimately chose to pursue oncology for my DM course. The initial transition was challenging, and I was adapting to a new hospital, environment, and a diverse set of patients. However, I gradually acclimated and found my place. After a month at the Tata Memorial Hospital (TMH, Parel, Mumbai, India), I received the unexpected news that my next two months would be spent at the Advanced Center for Treatment, Research and Education in Cancer (ACTREC) in Kharghar (Navi Mumbai), approximately 35 km from TMH. This facility had a distinct atmosphere, located away from the city’s hustle, offering patients with cancer a serene campus with green spaces and the peace they deserved. They had a building named “Asha Niwas,” which was home to patients with cancer and their families who came for treatment from all over India. During my exploration, I stumbled upon an inauguration stone bearing a name I was familiar with. The name was found in","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135698960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_278_23
Minu J. Michaelraj, Sivasamy Ramasamy, Fenwick A. E. Rodriguez
We thank Jobanputra,[1] Chauhan and Trivedi,[2] and Devaraja[3] for showing interest in our manuscript, published in the previous issue of the Cancer, Research, Statistics and Treatment journal.[4] The prime objective of our study was to unravel the genetics of head-and-neck squamous cell carcinoma (HNSCC) with special emphasis on the human papillomavirus (HPV). Demographic analysis was performed meticulously as a part of our primary study. As our research was mainly focused on the HPV status of the patient samples, we included only crucial and extensively reported risk factors in our questionnaire (tobacco consumption, smoking, and alcohol). HPV status was identified from the collected patients’ tissue samples in our laboratory as the HPV status of the patients was not available in the medical records. Thus, obtaining information on the HPV status from the patient’s general report would be more informative and would have enabled a wider analysis. HPV testing was performed on all the tissue samples collected, and it was not restricted to a particular subset of cancers, such as oropharyngeal cancers. The results obtained delineated HPV positivity in the oropharyngeal region. Though the sample collection was performed from a single center, we had multiple patients from diverse regions of western Tamil Nadu (Coimbatore, Erode, Salem, Tirupur, Nilgiris, and Dharmapuri). Certain ethical constraints, a limited number of patients reporting to the hospital due to the COVID-19 pandemic, and the unwillingness of the patients to participate in the study were the reasons for not including a larger sample size from diverse centers across Tamil Nadu. Measures are being taken to collect samples from other hospitals and tertiary centers to conduct a large cohort study. In conclusion, we will take the readers’ comments into consideration in the work being continued in our laboratory. Financial support and sponsorship This study was supported by Rashtriya Uchchatar Shiksha Abhiyan (RUSA) under the Bharathiar Cancer and Theranostics Research Center (BCTRC) Scheme. Conflicts of interest There are no conflicts of interest.
{"title":"Authors’ reply to Jobanputra, Chauhan and Trivedi, and Devaraja","authors":"Minu J. Michaelraj, Sivasamy Ramasamy, Fenwick A. E. Rodriguez","doi":"10.4103/crst.crst_278_23","DOIUrl":"https://doi.org/10.4103/crst.crst_278_23","url":null,"abstract":"We thank Jobanputra,[1] Chauhan and Trivedi,[2] and Devaraja[3] for showing interest in our manuscript, published in the previous issue of the Cancer, Research, Statistics and Treatment journal.[4] The prime objective of our study was to unravel the genetics of head-and-neck squamous cell carcinoma (HNSCC) with special emphasis on the human papillomavirus (HPV). Demographic analysis was performed meticulously as a part of our primary study. As our research was mainly focused on the HPV status of the patient samples, we included only crucial and extensively reported risk factors in our questionnaire (tobacco consumption, smoking, and alcohol). HPV status was identified from the collected patients’ tissue samples in our laboratory as the HPV status of the patients was not available in the medical records. Thus, obtaining information on the HPV status from the patient’s general report would be more informative and would have enabled a wider analysis. HPV testing was performed on all the tissue samples collected, and it was not restricted to a particular subset of cancers, such as oropharyngeal cancers. The results obtained delineated HPV positivity in the oropharyngeal region. Though the sample collection was performed from a single center, we had multiple patients from diverse regions of western Tamil Nadu (Coimbatore, Erode, Salem, Tirupur, Nilgiris, and Dharmapuri). Certain ethical constraints, a limited number of patients reporting to the hospital due to the COVID-19 pandemic, and the unwillingness of the patients to participate in the study were the reasons for not including a larger sample size from diverse centers across Tamil Nadu. Measures are being taken to collect samples from other hospitals and tertiary centers to conduct a large cohort study. In conclusion, we will take the readers’ comments into consideration in the work being continued in our laboratory. Financial support and sponsorship This study was supported by Rashtriya Uchchatar Shiksha Abhiyan (RUSA) under the Bharathiar Cancer and Theranostics Research Center (BCTRC) Scheme. Conflicts of interest There are no conflicts of interest.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We thank Mondal et al.[1] and Nagpal et al.[2] for their critical comments on our article, “Gated radiation therapy for patients with breast cancer to reduce the dose to the lung and heart: A comparative cross-sectional study.”[3] The deep inspiratory breath-hold (DIBH) technique reduces radiation dose to the heart in patients with left-sided breast cancer. Many devices are commercially available to conduct treatment via the DIBH technique, like Real-time Position Management Gating solutions from Varian systems and Active Breath Controller (ABC) from Elekta systems. Treatment with ABC involves a mouthpiece that cannot be reused. Thus, before subjecting patients to the DIBH technique-based treatment, we trained the patients with a spirometer to assess if they could hold their breath until two balls were raised in the spirometer. Only then, eligible patients underwent the radiation planning computed tomography simulation scan. In their study, Nagpal et al. measured the cardiac distances from the chest wall as a predictor of percentage reduction in dose to the heart. Irrespective of the distances, if patients can hold their breath, they should be given the benefit of treatment with the DIBH technique rather than the free-breathing technique.[4] In their study, Ferdinand et al., observed the correlation between the heart volume and maximum heart depth in the field as a predictor of cardiac dose reduction via the DIBH technique.[5] Many studies have reported different predictors for cardiac-sparing radiation techniques worldwide. Sardaro et al.[6] estimated that a 1 Gy increase in the mean heart dose equates to a 4% increase in the risk of late heart disease, and Darby et al.[7] estimated that a 1 Gy increase in the mean heart dose causes a 7.4% increase in the rate of major coronary events, like myocardial infarction or death from ischemic heart disease. Chakraborty et al. estimated that the disability-adjusted life years averted would be 622.53 if all Indian patients with left-sided breast cancer (estimated 61,272.65/year) were treated with DIBH. The incremental cost-effectiveness ratio was $4132.90 per disability-adjusted life year, which was 2.11 times the Indian per-capita gross domestic product (2016–2017: $1957.11). Thus, Chakraborty et al. demonstrated that DIBH is cost-effective in developing nations, where cardiac illness is the most prevalent non-communicable disease.[8] Though the mean heart dose of 4.50 ± 0.96 Gy was slightly higher with DIBH in our study[3] compared to other studies, we saw a significant decrease in the mean dose of the heart compared to the free breathing technique. Nevertheless, we would like to continue to give this benefit of DIBH technique-based radiation therapy to all patients with left-sided breast cancer in our institute. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"Authors’ reply Mondal et al. and Nagpal et al.","authors":"R.A Sunil, Sanjeet Kumar Mandal, Nithin Bhaskar Valuvil","doi":"10.4103/crst.crst_286_23","DOIUrl":"https://doi.org/10.4103/crst.crst_286_23","url":null,"abstract":"We thank Mondal et al.[1] and Nagpal et al.[2] for their critical comments on our article, “Gated radiation therapy for patients with breast cancer to reduce the dose to the lung and heart: A comparative cross-sectional study.”[3] The deep inspiratory breath-hold (DIBH) technique reduces radiation dose to the heart in patients with left-sided breast cancer. Many devices are commercially available to conduct treatment via the DIBH technique, like Real-time Position Management Gating solutions from Varian systems and Active Breath Controller (ABC) from Elekta systems. Treatment with ABC involves a mouthpiece that cannot be reused. Thus, before subjecting patients to the DIBH technique-based treatment, we trained the patients with a spirometer to assess if they could hold their breath until two balls were raised in the spirometer. Only then, eligible patients underwent the radiation planning computed tomography simulation scan. In their study, Nagpal et al. measured the cardiac distances from the chest wall as a predictor of percentage reduction in dose to the heart. Irrespective of the distances, if patients can hold their breath, they should be given the benefit of treatment with the DIBH technique rather than the free-breathing technique.[4] In their study, Ferdinand et al., observed the correlation between the heart volume and maximum heart depth in the field as a predictor of cardiac dose reduction via the DIBH technique.[5] Many studies have reported different predictors for cardiac-sparing radiation techniques worldwide. Sardaro et al.[6] estimated that a 1 Gy increase in the mean heart dose equates to a 4% increase in the risk of late heart disease, and Darby et al.[7] estimated that a 1 Gy increase in the mean heart dose causes a 7.4% increase in the rate of major coronary events, like myocardial infarction or death from ischemic heart disease. Chakraborty et al. estimated that the disability-adjusted life years averted would be 622.53 if all Indian patients with left-sided breast cancer (estimated 61,272.65/year) were treated with DIBH. The incremental cost-effectiveness ratio was $4132.90 per disability-adjusted life year, which was 2.11 times the Indian per-capita gross domestic product (2016–2017: $1957.11). Thus, Chakraborty et al. demonstrated that DIBH is cost-effective in developing nations, where cardiac illness is the most prevalent non-communicable disease.[8] Though the mean heart dose of 4.50 ± 0.96 Gy was slightly higher with DIBH in our study[3] compared to other studies, we saw a significant decrease in the mean dose of the heart compared to the free breathing technique. Nevertheless, we would like to continue to give this benefit of DIBH technique-based radiation therapy to all patients with left-sided breast cancer in our institute. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_282_23
Ruchika Thukral, Ajat S. Arora, Tapas Dora
We thank Kapoor and Mahajan,[1] Fazal et al.,[2] and Gupta and Rangarajan[3] for their keen interest, valuable appreciation, and insightful comments on our article, “Artificial intelligence-based prediction of oral mucositis in patients with head-and-neck cancer: A prospective observational study utilizing a thermographic approach.”[4] We agree with Fazal et al.[1] that, when assessing oral mucositis, it is imperative to give due consideration to the patient’s clinical history and conduct a thorough physical examination. These aspects hold paramount importance in the evaluation process. At the Homi Bhabha Cancer Hospital, Tata Memorial Center, Sangrur, India, we maintain patient records both in the electronic medical record (EMR) system and physical files, while also conducting regular patient examinations. We completely acknowledge the validity of the comment by Fazal et al.[1] that doctors invest significant time in evaluating medical images, and the automation of thermal image processing with the help of artificial intelligence would reduce computational time.[5,6] In the future, more efforts should be made to improve the computational algorithms for larger datasets. We agree with the comments by Kapoor and Mahajan[2] that radiation-induced mucositis takes a minimum of 5–14 days to evolve, and thus, the data acquisition must be done within that specific time slot. Thermal imaging of patients with head-and-neck cancer was conducted over a four-week period as part of a preliminary (pilot) study. Our study[4] was cross-sectional, but thermal data were acquired every week; hence, in many cases, the thermal data were possibly from the same patient in consecutive weeks, but we did not document the data (details) on a weekly basis, which could have provided better clarity to the thermal data. Obtaining real-time data is an extremely time-consuming process, given the concurrent focus on uninterrupted treatment for patients with head-and-neck cancer during the data acquisition phase. The aim of our study[4] was to check the predictability of artificial intelligence-based thermal imaging for oral mucositis. We did not document the clinical aspects. To clarify, we included all cases that received a curative radical radiation dose of 70 Gy; we did not include any patients who received palliative radiotherapy. We agreed with the observation of Gupta and Rangarajan[3] that a larger sample size could have made the deep learning method more sensitive.[7] Real-time thermal data acquisition is a time-consuming process, and data acquisition is still ongoing. In the future, more efforts will be made to improve the computational algorithm on larger thermal datasets that contain images from patients with all grades of mucositis. We thank Gupta and Rangarajan[3] for their recommendations. We will go through the Medical Image Computing and Computer Assisted Intervention Society (MICCAI) and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) checklists a
{"title":"Authors’ reply to Kapoor and Mahajan, Fazal et al., and Gupta and Rangarajan","authors":"Ruchika Thukral, Ajat S. Arora, Tapas Dora","doi":"10.4103/crst.crst_282_23","DOIUrl":"https://doi.org/10.4103/crst.crst_282_23","url":null,"abstract":"We thank Kapoor and Mahajan,[1] Fazal et al.,[2] and Gupta and Rangarajan[3] for their keen interest, valuable appreciation, and insightful comments on our article, “Artificial intelligence-based prediction of oral mucositis in patients with head-and-neck cancer: A prospective observational study utilizing a thermographic approach.”[4] We agree with Fazal et al.[1] that, when assessing oral mucositis, it is imperative to give due consideration to the patient’s clinical history and conduct a thorough physical examination. These aspects hold paramount importance in the evaluation process. At the Homi Bhabha Cancer Hospital, Tata Memorial Center, Sangrur, India, we maintain patient records both in the electronic medical record (EMR) system and physical files, while also conducting regular patient examinations. We completely acknowledge the validity of the comment by Fazal et al.[1] that doctors invest significant time in evaluating medical images, and the automation of thermal image processing with the help of artificial intelligence would reduce computational time.[5,6] In the future, more efforts should be made to improve the computational algorithms for larger datasets. We agree with the comments by Kapoor and Mahajan[2] that radiation-induced mucositis takes a minimum of 5–14 days to evolve, and thus, the data acquisition must be done within that specific time slot. Thermal imaging of patients with head-and-neck cancer was conducted over a four-week period as part of a preliminary (pilot) study. Our study[4] was cross-sectional, but thermal data were acquired every week; hence, in many cases, the thermal data were possibly from the same patient in consecutive weeks, but we did not document the data (details) on a weekly basis, which could have provided better clarity to the thermal data. Obtaining real-time data is an extremely time-consuming process, given the concurrent focus on uninterrupted treatment for patients with head-and-neck cancer during the data acquisition phase. The aim of our study[4] was to check the predictability of artificial intelligence-based thermal imaging for oral mucositis. We did not document the clinical aspects. To clarify, we included all cases that received a curative radical radiation dose of 70 Gy; we did not include any patients who received palliative radiotherapy. We agreed with the observation of Gupta and Rangarajan[3] that a larger sample size could have made the deep learning method more sensitive.[7] Real-time thermal data acquisition is a time-consuming process, and data acquisition is still ongoing. In the future, more efforts will be made to improve the computational algorithm on larger thermal datasets that contain images from patients with all grades of mucositis. We thank Gupta and Rangarajan[3] for their recommendations. We will go through the Medical Image Computing and Computer Assisted Intervention Society (MICCAI) and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) checklists a","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_224_23
Gokul Sarveswaran, Prashant Mathur
In Ain, France, a low-income, immigrant community with low literacy levels participated in a study by Balamou et al.[1] to evaluate the effects of an eight-week cancer educational intervention on the participants’ screening outcomes, cancer knowledge, and self-efficacy. The study highlighted the importance of targeted educational interventions for populations facing multiple socioeconomic and literacy-related barriers. Vulnerable populations, characterized by factors such as low education, low socioeconomic status, migration, and limited healthcare access, bear a disproportionate burden of cancer incidence and mortality. Additionally, these groups often engage in high-risk behaviors, including tobacco and alcohol use, obesity, physical inactivity, and inadequate consumption of fruits and vegetables, which further elevate their susceptibility to cancer.[2,3] The convergence of socioeconomic disadvantages and these risk factors amplify the vulnerability of these populations to cancer. The study by Balamou et al.[1] sheds light on a crucial topic, given the significant burden of cancer in India and other developing countries and the potential impact of educational interventions. In this editorial, we examine the role of cancer educational interventions in optimizing cancer screening activities, with a specific focus on India’s low literacy population, while referencing similar studies conducted globally to highlight best practices and potential strategies for implementation. Global impact of cancer Cancer is a significant global public health issue, representing the leading cause of death worldwide. In 2020 alone, it accounted for over 10 million deaths, comprising nearly one in six deaths.[4] India, with its vast population and diverse socioeconomic landscape, faces unique challenges in combating cancer. Low literacy rates prevalent among certain segments of the Indian population hinder effective cancer prevention and screening efforts. However, targeted cancer educational interventions present an opportunity to bridge this knowledge gap and empower individuals with the necessary information to make informed decisions. Low literacy rates in India India’s literacy rates have improved over the years, but a considerable portion of the population still faces literacy challenges. According to the National Statistical Office’s 2017–2018 report, the overall literacy rate in India was 77.7%.[5] However, this figure masks regional disparities, with some states reporting literacy rates as low as 66.4%.[6] This low literacy scenario poses a significant barrier to effective cancer prevention and screening initiatives. A study conducted by Tripathi et al.[7] examined the impact of low literacy on cancer knowledge and prevention behaviors in a rural Indian population. The study found that individuals with lower literacy levels had limited awareness of cancer symptoms, risk factors, and the importance of screening. This lack of knowledge contributed to delays in
{"title":"Educational interventions to improve participation of communities in cancer screening programs","authors":"Gokul Sarveswaran, Prashant Mathur","doi":"10.4103/crst.crst_224_23","DOIUrl":"https://doi.org/10.4103/crst.crst_224_23","url":null,"abstract":"In Ain, France, a low-income, immigrant community with low literacy levels participated in a study by Balamou et al.[1] to evaluate the effects of an eight-week cancer educational intervention on the participants’ screening outcomes, cancer knowledge, and self-efficacy. The study highlighted the importance of targeted educational interventions for populations facing multiple socioeconomic and literacy-related barriers. Vulnerable populations, characterized by factors such as low education, low socioeconomic status, migration, and limited healthcare access, bear a disproportionate burden of cancer incidence and mortality. Additionally, these groups often engage in high-risk behaviors, including tobacco and alcohol use, obesity, physical inactivity, and inadequate consumption of fruits and vegetables, which further elevate their susceptibility to cancer.[2,3] The convergence of socioeconomic disadvantages and these risk factors amplify the vulnerability of these populations to cancer. The study by Balamou et al.[1] sheds light on a crucial topic, given the significant burden of cancer in India and other developing countries and the potential impact of educational interventions. In this editorial, we examine the role of cancer educational interventions in optimizing cancer screening activities, with a specific focus on India’s low literacy population, while referencing similar studies conducted globally to highlight best practices and potential strategies for implementation. Global impact of cancer Cancer is a significant global public health issue, representing the leading cause of death worldwide. In 2020 alone, it accounted for over 10 million deaths, comprising nearly one in six deaths.[4] India, with its vast population and diverse socioeconomic landscape, faces unique challenges in combating cancer. Low literacy rates prevalent among certain segments of the Indian population hinder effective cancer prevention and screening efforts. However, targeted cancer educational interventions present an opportunity to bridge this knowledge gap and empower individuals with the necessary information to make informed decisions. Low literacy rates in India India’s literacy rates have improved over the years, but a considerable portion of the population still faces literacy challenges. According to the National Statistical Office’s 2017–2018 report, the overall literacy rate in India was 77.7%.[5] However, this figure masks regional disparities, with some states reporting literacy rates as low as 66.4%.[6] This low literacy scenario poses a significant barrier to effective cancer prevention and screening initiatives. A study conducted by Tripathi et al.[7] examined the impact of low literacy on cancer knowledge and prevention behaviors in a rural Indian population. The study found that individuals with lower literacy levels had limited awareness of cancer symptoms, risk factors, and the importance of screening. This lack of knowledge contributed to delays in ","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"278 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135701138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Towards a comprehensive head-and-neck oncological radiology (HNOR) consortium: Are we there yet?","authors":"T. Basu, A. Mahuvakar, A. Karpe","doi":"10.4103/crst.crst_53_23","DOIUrl":"https://doi.org/10.4103/crst.crst_53_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"113 1","pages":"148 - 149"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76115008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preoperative imaging of perforators for breast reconstructive surgeries: The way forward","authors":"Amit Gupta, Sweety Gupta, A. Mondal","doi":"10.4103/crst.crst_38_23","DOIUrl":"https://doi.org/10.4103/crst.crst_38_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"158 1","pages":"153 - 154"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74325895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_316_22
Akhil P Santhosh, A. Gogia
{"title":"Rezvilutamide in metastatic, hormone-sensitive prostate cancer","authors":"Akhil P Santhosh, A. Gogia","doi":"10.4103/crst.crst_316_22","DOIUrl":"https://doi.org/10.4103/crst.crst_316_22","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"69 1","pages":"172 - 173"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79373623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Authors' reply to Bhargav and Mayilvaganan","authors":"S. Saha, V. Noronha, K. Prabhash","doi":"10.4103/crst.crst_78_23","DOIUrl":"https://doi.org/10.4103/crst.crst_78_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"62 1","pages":"171 - 172"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90098579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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