Browsing by Author "Nigam, J"
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Item Clinicopathological correlation of cancer stem cell markers Oct-4 and CD133 expression as prognostic factor in malignant lesions of gallbladder: An immunohistochemical study(Indian Association of Pathologists and Microbiologists, 2019-09) Fatima, N; Srivastava, AN; Nigam, J; Tandon, N; Ahmad, R; Kumar, VBackground: Gallbladder cancer (GBC) is the most frequent biliary tract cancer, with high morbidity and poor prognosis, and shows early metastasis and invasiveness. No reliable biomarkers are available for detection of GBC progression. Aim: To investigate the immunohistochemical expression of Oct-4 and CD133 in malignant and nonneoplastic lesions of gallbladder and to analyze the clinical significance of the expressions related to clinicopathological parameters. Settings and Design: This is a prospective case control study, conducted in medical college background. Materials and Methods: A total of 103 cases of gallbladder were grouped into malignant lesions (n = 48) and nonneoplastic lesions (simple epithelial hyperplasia; n = 35 and chronic cholecystitis; n = 20). All tissue samples were evaluated for expression of Oct-4 and CD133 using immunohistochemistry in an effort to elucidate the correlation between their expressions with clinicopathological parameters. Statistical Analysis: The final score was calculated by multiplying the intensity to the percentage of positive cells. The scores ?2 were considered as positive. Results: Significant positive correlation of higher expression levels of Oct-4 and CD133 were observed in malignant as compared to nonneoplastic lesions of gallbladder (P < 0.0001). High expression of Oct-4 and CD133 were significantly associated with tumor grading (Oct-4, P = 0.04; CD133, P = 0.02), staging (Oct-4, P = 0.03; CD133, P = 0.02), and liver metastasis (Oct-4, P = 0.01; CD133, P = 0.007). Significantly reduced survival was observed with high expression of Oct-4 (P = 0.002). No significant correction was observed between CD 133 and survival. Conclusion: This study revealed that high expression level of Oct-4 may provide a new insight for the prognosis of the disease in terms of clinical staging and grade.Item Dosimetric comparison and clinical correlation between conventional four field radiotherapy versus three-dimensional conformal radiotherapy in cancer cervix(Siddharth Health Research and Social Welfare Society, 2019-12) Agarwal, S; Chauhan, AK; Kumar, P; Nigam, J; Kumar, PIntroduction: With sectional imaging, wide variations are reported in pelvic anatomy of individual patients raising concerns over adequate coverage of target volume with conventional radiotherapy based on standard bony landmarks. Three-dimensional conformal radiotherapy (3DCRT) is reported to decrease normal tissue toxicity, along with decrease in chances of geographic miss. Present study is done for dosimetric comparison of Planning Target Volume (PTV) and Organs at Risk (OAR) in cancer cervix patients treated with conventional and conformal radiotherapy along with clinical correlation in terms of side effects and tumor response. Materials and Methods: Fifty patients of cancer cervix underwent planning contrast enhanced CT scan. Target volumes & OAR were contoured. Patients were randomized into conventional & conformal arms. Conventional fields were planned using standard bony landmarks. CT based radiotherapy planning was done for 3DCRT arm. Field sizes &dose volume histogram (DVH) were recorded & compared for target coverage & OAR sparing in both arms. All patients received concurrent chemotherapy followed by brachytherapy. Results: Field sizes used for the 3DCRT plans were significantly larger than those used for the conventional plans (p= 0.000). Optimal PTV coverage was significantly improved using 3DCRT as compared to conventional radiotherapy (p= 0.0001). Dose homogeneity in both arms were almost similar (p= 0.292), while conformity index was better in 3DCRT which was statistically significant between the groups (p= 0.000). Mean dose to the Planning Target Volume was increased significantly in the CT based plan when compared with the standard four field plan (p= 0.0001).Difference in doses to the organs at risk (urinary bladder, and small bowel)and their side effects were statistically significant across both groups. There was no difference in tumor response. Conclusion: The present study showed significantly better target volume coverage & dose homogeneity with 3DCRT which may translate into better local control & survival but longer follow up is required to validate it.Item Dosimetric parameters of heart and left ventricle – comparison of 3D CRT and IMRT in left cancer breast(Siddharth Health Research and Social Welfare Society, 2019-12) Mehta, A; Kumar, P; Silambarasan, N; S., N; Nigam, J; Kumar, P; Chauhan, ABackground: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose. Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared. Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5). Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle.