Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1426
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (286 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Abstract
 » Introduction
 » Methodology
 »  References
 »  Article Tables

 Article Access Statistics
    Viewed10445    
    Printed360    
    Emailed0    
    PDF Downloaded620    
    Comments [Add]    
    Cited by others 15    

Recommend this journal

 

  Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 57  |  Issue : 5  |  Page : 1-5
 

Indian clinical practice consensus guidelines for the management of squamous cell carcinoma of head and neck


1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
3 Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
4 Department of Surgical Oncology, Cochin Cancer Research Centre, Cochin, Kerala, India
5 Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences (KLESIDS), Bangalore, Karnataka, India
6 Department of Radiation Oncology, Max Super Speciality Hospital, Saket, New Delhi, India
7 Department of Medical Oncology, HCG Cancer Centre, Ahmedabad, Gujarat, India
8 Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
9 Department of Radiation Oncology, Civil Hospital, Shillong, Meghalaya, India
10 Department of Medical Oncology, Indraprastha Apollo Hospital, New Delhi, India
11 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
12 Department of Radiation Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India
13 Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
14 Department of Radiotherapy, Christian Medical College, Vellore, Tamil Nadu, India
15 Department of Surgical Oncology, Max Super Speciality Hospital, Saket, New Delhi, India
16 Department of Surgical Oncology, HCG Cancer Centre, Bangalore, Karnataka, India
17 Department of Radiation Oncology, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu, Jammu and Kashmir, India
18 Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Delhi, India

Date of Submission25-Jul-2019
Date of Decision13-Nov-2019
Date of Acceptance29-Dec-2019
Date of Web Publication25-Feb-2020

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.278971

Rights and Permissions

 » Abstract 


Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract and are the sixth most common cancer worldwide. In India, around 30–40% of all cancers are HNCs. Even though there are global guidelines or recommendations for the management of HNCs, these may not be appropriate for Indian scenarios. In an effort to discuss current practices, latest developments and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical and radiation oncologists and dentists) was formed. A review of literature from medical databases was conducted to provide the best possible evidence base, which was reviewed by experts during a consensus group meeting (January, 2019) to provide recommendations.


Keywords: Chemoradiation, consensus, head and neck cancer, Indian guidelines, recommendations


How to cite this article:
Prabhash K, Babu G, Chaturvedi P, Kuriakose M, Birur P, Anand AK, Kaushal A, Mahajan A, Syiemlieh J, Singhal M, Gairola M, Ramachandra P, Goyal S, John S, Nayyar R, Patil VM, Rao V, Roshan V, Rath G K. Indian clinical practice consensus guidelines for the management of squamous cell carcinoma of head and neck. Indian J Cancer 2020;57, Suppl S1:1-5

How to cite this URL:
Prabhash K, Babu G, Chaturvedi P, Kuriakose M, Birur P, Anand AK, Kaushal A, Mahajan A, Syiemlieh J, Singhal M, Gairola M, Ramachandra P, Goyal S, John S, Nayyar R, Patil VM, Rao V, Roshan V, Rath G K. Indian clinical practice consensus guidelines for the management of squamous cell carcinoma of head and neck. Indian J Cancer [serial online] 2020 [cited 2022 Jul 2];57, Suppl S1:1-5. Available from: https://www.indianjcancer.com/text.asp?2020/57/5/1/278971





 » Introduction Top


Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract including oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.[1],[2] Squamous cell carcinoma (SCC) constitutes for >90% of HNCs. Among all etiologic factors, smoking and chewing of tobacco are considered important for the development of HNCs. In India, there is a significant increase in the incidence of HNCs and there is variability in the management of these patients.

According to GLOBOCAN 2018 report, worldwide HNC statistics indicate that there are 834,860 cases of HNC per year, resulting in approximately 431,131 deaths per year. High incidence rates have been reported from developing countries including India, Pakistan, Bangladesh, Taiwan, and Sri Lanka.[3] HNCs account for approximately 30–40% of all cancer sites, in India.[4],[5] The Cancer Atlas project by the Indian Council for Medical Research (ICMR) reports incidences of different cancers across India. The incidence in Assam, Manipur, Mizoram, Tripura, and Nagaland has been reported to be higher (54%). The world's highest incidence of cancers in men, which was of the lower pharynx (11.5/100,000 people) and the tongue (7.6/100,000 people), was reported from Mizoram. Pondicherry has also reported the incidence of mouth cancer in males (7.8–8.9/100,000); however, the highest incidence of nasopharyngeal cancer has been reported from Nagaland.[6–11] The possible reasons for the higher incidence of HNCs in India include extensive use of tobacco, pan masala (which include betel quid, areca nuts, and slaked lime), and gutkha. [Table 1] summarizes the HNC statistics of India (GLOBOCAN 2018).
Table 1: GLOBOCAN 2018 report showing HNC statistics of India

Click here to view


Even though there are global guidelines or recommendations for the management of HNCs (NCCN 2018; ESMO; SEOM 2017), these recommendations may not be appropriate for Indian scenarios.[1],[12],[13],[14] While the existing international guidelines provide recommendations on the management of HNC universally, the objective of these guidelines is to bring consensus on the management of HNC in the Indian context. It is intended to give a comprehensive and simpler overview of treatment recommendations in the form of algorithms, which cover all aspects of disease stages along with resectability criteria, positive margins criteria, and various modalities of the treatment. Recommendations are made considering Indian evidence-based available treatment options. It also provides tabular summaries of all anatomical site-wise evidence considered for recommendations.

Genetically and etiologically, our patient profiles are different showing more unfavorable outcomes. Compared to the western world, these patients require an aggressive treatment and optimal use of chemoradiation.[15] Prevalence of usage of smokeless tobacco and per capita consumption of alcohol is different in different countries, with India showing 25.9% and 5.7 liters versus 3.6% and 9.8 liters in United States of America, respectively.[16],[17] In India, among patients diagnosed with HNC, 86.5% were reported as tobacco users and 23.2% were reported as alcohol users.[18] Habits of chewing tobacco, areca nuts, slaked lime, gutkha, betel quid, and alcohol consumption add to further adverse prognosis. Tobacco allows long exposure and causes discoloration because of which early changes are masked resulting in an advanced presentation. In oral cancer patients, tobacco users have shown lower survival than nontobacco users (median overall survival [OS] at 5 years: 43% vs. 72%, respectively). Tobacco and alcohol frequently coexist and lead to adverse prognosis. Five-year OS in patients who consumed both alcohol and tobacco was 29%.[19] There is a delayed diagnosis with most commonly reported sites being oropharynx, hypopharynx, oral cavity, and presence of predominantly human papillomavirus (HPV)-negative tumors.[20],[21] Delayed diagnosis leads to poor prognosis with 5-year median OS varying from 100% at stage 1 to 42% at stage 4.[19] According to a study conducted by Tata Memorial Hospital, India, about 57% of the HNC patients present with comorbidities, the majority being hypertension, cardiac, and respiratory. One-fifth of these patients had moderate-to-severe comorbidities that were predictors of deviation from an ideal treatment plan of guideline-concordant therapy, leading to poor survival outcomes.[21] Patients with comorbidities show lower survival rate than patients with no comorbidities (median OS at 5 years: 16% vs. 84%, respectively).[19] About 25–50% of these patients are found nutritionally compromised prior to commencement of treatment. Poor nutritional status affects their physical function, quality of life, and OS.[22] Around 30% of HNC patients in India and Southeast Asia present with genetic abnormalities like preponderance of Ha-ras mutations, loss of heterozygosity of Ha-ras, N-ras amplification, and N-myc amplification. These ras oncogenes mutations are uncommon in the western world.[23] Michmerhuizen et al. noted distinct differences in genomic aberrations in Indian patients compared to other regions in terms of EGFR, MYC, PIK3CA, CDKN2A, TRMP3, USP9X, FAT1, FAT3, FAT4, TP53, FAT1, CASP8, HRAS, and NOTCH1. The HPV prevalence also varies between regions (7.1% in India vs. 21.4% in Eastern Europe). Divergence in sexual activity in different populations can be one of the reasons for this difference.[24] RTOG0522 trial conducted in United States of America showed an HPV-positive rate of 73%, whereas an Indian study showed an HPV-positive rate of 7.4–10.5% of total oropharyngeal carcinoma.[18] These various factors make a compelling reason to bring a common consensus for managing this predominant cancer type in our country. Additionally, available Indian guidelines for the management of HNC are not updated regularly.[25],[26],[27],[28]

There are various patient-related factors, which affect overall prognosis and influence the treatment decisions. These factors include the age of the patient, performance status, nutritional status, associated comorbidities, active smoking, HPV-associated oropharyngeal cancers, and tumor programmed death-ligand 1 expression status, which is a predictive marker for response to anti-programmed cell death protein 1 therapy. Management of SCC of head and neck includes radiotherapy as an integral part of treatment along with chemotherapy, targeted therapy, and immunotherapy. In India, most of the government institutes still use conventional radiotherapy 2D/3D conformal therapy by cobalt 60 for external beam radiotherapy. Evidence showing improved treatment outcomes using conventional radiotherapy not only helps in wide accessibility of treatment for a greater number of patients but also will encourage health insurance systems to support health care in India. The India-specific guidelines will be of help in decisions of universal health insurance coverage and that ultimately will reduce overall financial toxicity of patients and the nation.


 » Methodology Top


A review of literature from medical databases as mentioned in annexure was conducted to provide the best possible evidence base for the recommendations. Current guidelines, meta-analyses, cross-sectional studies, systematic reviews, and key cited articles related to HNCs were reviewed by the group of experts (medical, surgical and radiation oncologists and dentists) and recommendations relevant to Indian scenarios were developed. The consensus group meeting was convened on January 19, 2019, with the goal of discussing current practices and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs. Recommendations for each section of the consensus document and overall recommendations were agreed by all the participants. In the case where there was no or little evidence, the consensus group discussed the expert's experience and judgment, and recommendations were provided.

The initial draft was developed by an independent medical writing agency under the guidance of consensus group experts, which was subsequently discussed during the consensus group meeting. The draft was then revised and circulated for comments to group members and other experts across the country for their inputs, and the revisions were done until all the participants agreed to the content.

Recommendations are organized by topic and assigned evidence level ratings on the basis of the quality of supporting evidence, all of which have also been rated for strength. Recommendations are graded as A (strongly recommend), B (intermediate), C (weak), and D (not recommended). The evidence levels are grouped in four levels (I–IV) as shown in [Table 2]. HNCs should be staged according to the eighth edition of AJCC classification, which is based on grouping of T, N, and M categories [Table 3].[27]Recommendations of early and locally advanced disease for each sub-site are covered in site specific articles and the very advanced disease for all sub-sites is presented towards the end in a separate article.

Table 2: Evidence levels

Click here to view
Table 3: TNM categories for different anatomical subsites of head and neck cancer (TNM eighth edition, 2017)

Click here to view


In summary, these recommendations are based on available literature as mentioned in annexure, particularly from India, and consensus of meeting participants. Further, the group intends to update these recommendations on a regular basis. The choice of treatment should be decided by the multidisciplinary team. Rehabilitation, counseling, and nutritional therapy are important to improve patient's adherence to the treatment and patient survival.

Acknowledgement

We acknowledge the significant contribution of J Balawardana, C Vithanage, S Resnayaka from Sri Lanka during the meeting and S Ghosh Laskar, S Ranjan, P Chavan, R Halkud and C Ramachandra for their involvement and insights. We also acknowledge the medical writing support provided by an independent medical writing agency, IQVIA. We are fully responsible for the content of this manuscript and the recommendations described in the review reflect the views and opinions of the authors only.

Financial Support and Sponsorship

Oral Cancer Task Force (OCTF) with a multidisciplinary expert panel, has a long standing commitment to work for early detection and management of oral cancer in underserved populations. The task force members have taken this educational initiative of developing India specific consensus guidelines for management of head and neck cancer under its ambit. The meeting and supplement were supported by an unrestricted grant by Biocon Foundation.

Conflicts of interest

Oral Cancer Task Force (OCTF) members and authors do not have any conflicts of interest.

 
 » References Top

1.
Gregoire V, Lefebvre JL, Licitra L, Felip E; On behalf of the EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21:v184-6.  Back to cited text no. 1
    
2.
Vigneswaran N, Williams MD. Epidemiologic trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am 2014;26:123-41.  Back to cited text no. 2
    
3.
Krishna Rao SV, Mejia G, Roberts-Thomson K, Logan R. Epidemiology of oral cancer in Asia in the past decade-An update (2000-2012). Asian Pac J Cancer Prev 2013;14:5567-77.  Back to cited text no. 3
    
4.
Bhattacharjee A, Chakraborty A, Purkaystha P. Prevalence of head and neck cancers in the north east-An institutional study. Indian J Otolaryngol Head Neck Surg 2006;58:15-9.  Back to cited text no. 4
    
5.
Sharma JD, Baishya N, Kataki AC, Kalita CR, Das AK, Rahman T. Head and neck squamous cell carcinoma in young adults: A hospital-based study. Indian J Med Paediatr Oncol 2019;40:18-22.  Back to cited text no. 5
  [Full text]  
6.
Nandakumar A. National Cancer Registry Programme. Consolidated Report of the Population Based Cancer Registries. Incidence and Distribution of Cancer: 1990-96. Bangalore, India: National Cancer Registry Programme (ICMR); 2001.  Back to cited text no. 6
    
7.
Bhattacharjee A, Bahar I, Saikia A. Nutritional assessment of patients with head and neck cancer in north-East India and dietary intervention. Indian J Palliat Care 2015;21:289-95.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Ganapati M. India has some of the highest cancer rates in the world. BMJ 2005;330:215.  Back to cited text no. 8
    
9.
Mudur G. India has some of the highest cancer rates in the world. BMJ 2005;330:215.  Back to cited text no. 9
    
10.
Joshi P, Dutta S, Chaturvedi P, Nair S. Head and neck cancers in developing countries. Rambam Maimonides Med J 2014;5:e0009.  Back to cited text no. 10
    
11.
Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN, Parkin DM. Geographic pathology revisited: Development of an atlas of cancer in India. Int J Cancer 2005;116:740-54.  Back to cited text no. 11
    
12.
Chan AT, Grégoire V, Lefebvre JL, Licitra L, Hui EP, Leung SF, et al. Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23:vii83-5.  Back to cited text no. 12
    
13.
Iglesias Docampo LC, Arrazubi Arrula V, Baste Rotllan N, Carral Maseda A, Cirauqui Cirauqui B, Escobar Y, et al. SEOM clinical guidelines for the treatment of head and neck cancer (2017). Clin Transl Oncol 2018;20:75-83.  Back to cited text no. 13
    
14.
Nibu KI, Hayashi R, Asakage T, Ojiri H, Kimata Y, Kodaira T, et al. Japanese clinical practice guideline for head and neck cancer. Auris Nasus Laryn×2017;44:375-80.  Back to cited text no. 14
    
15.
Szturz P, Wouters K, Kiyota N, Tahara M, Prabhash K, Noronha V, et al. Low-dose vs. High-dose cisplatin: Lessons learned from 59 chemoradiotherapy trials in head and neck cancer. Front Oncol 2019;9:86.  Back to cited text no. 15
    
16.
National Cancer Institute and Centers for Disease Control and Prevention. Smokeless Tobacco and Public Health: A Global Perspective. Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute. NIH Publication No. 14-7983; 2014. Available from: https://cancercontrol.cancer.gov/brp/tcrb/global-perspective/SmokelessTobaccoAndPublicHealth.pdf. [Last accessed on 2019 Dec 10].  Back to cited text no. 16
    
17.
Global Status Report on Alcohol and Health 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/en/. [Last accessed on 2019 Dec 10].  Back to cited text no. 17
    
18.
Patil VM, Noronha V, Joshi A, Agarwal J, Ghosh-Laskar S, Budrukkar A, et al. Arandomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer. Cancer 2019;125:3184-97.  Back to cited text no. 18
    
19.
Lohia N, Bhatnagar S, Singh S, Prashar M, Subramananiam A, Viswanath S, et al. Survival trends in oral cavity cancer patients treated with surgery and adjuvant radiotherapy in a tertiary center of Northern India: Where do we stand compared to the developed world? SRM J Res Dent Sci 2019;10:26-31.  Back to cited text no. 19
  [Full text]  
20.
Prabhash K, Patil VM, Noronha V, Joshi AP, Bhattacharjee A, Mathrudev V, et al. Nimotuzumab-cisplatin-radiation versus cisplatin radiation in HPV-negative oropharyngeal cancer. Ann Oncol 2019;30:1121 (Abstract). Available from: https://doi.org/10.1093/annonc/mdz252.013. [Last accessed on 2019 Dec 01].  Back to cited text no. 20
    
21.
Agarwal JP, Adulkar D, Swain M, Chakraborty S, Gupta T, Budrukkar A, et al. Influence of comorbidity on therapeutic decision making and impact on outcomes in patients with head and neck squamous cell cancers: Results from a prospective cohort study. Head Neck 2019;41:765-73.  Back to cited text no. 21
    
22.
Namratha PK, Urooj A. Nutritional implications in head and neck cancer-A Review. Indian J Nutri 2014;1:103.  Back to cited text no. 22
    
23.
Paterson IC, Eveson JW, Prime SS. Molecular changes in oral cancer may reflect aetiology and ethnic origin. Eur J Cancer B Oral Oncol 1996;32:15-3.  Back to cited text no. 23
    
24.
Michmerhuizen NL, Birkeland AC, Bradford CR, Brenner JC. Genetic determinants in head and neck squamous cell carcinoma and their influence on global personalized medicine. Genes Cancer 2016;7:182-200.  Back to cited text no. 24
    
25.
D'cruz A, Lin T, Anand AK, Atmakusuma D, Calaguas MJ, Chitapanarux I, et al. Consensus recommendations for management of head and neck cancer in Asian countries: A review of international guidelines. Oral Oncol 2013;49:872-7.  Back to cited text no. 25
    
26.
Parikh P, Patil V, Agarwal JP, Chaturvedi P, Vaidya A, Rathod S, et al. Guidelines for treatment of recurrent or metastatic head and neck cancer. Indian J Cancer 2014;51:89-94.  Back to cited text no. 26
[PUBMED]  [Full text]  
27.
TATA Guideline. Evidence based management of cancers in India. Guidelines for head and neck cancers. Available from: https://tmc.gov.in/tmh/PDF/Head%20and%20Neck.pdf. [Last accessed on 2019 Jan 17].  Back to cited text no. 27
    
28.
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC Cancer Staging Manual. 8th ed. Springer International Publishing: American Joint Commission on Cancer; 2017.  Back to cited text no. 28
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Development and Validation of Subjective Financial Distress Questionnaire (SFDQ): A Patient Reported Outcome Measure for Assessment of Financial Toxicity Among Radiation Oncology Patients
Mukhtar Ahmad Dar, Richa Chauhan, Krishna Murti, Vinita Trivedi, Sameer Dhingra
Frontiers in Oncology. 2022; 11
[Pubmed] | [DOI]
2 Swallowing Outcomes in Supraglottic Cancer Patients After Transoral Robotic Surgery With Early Dysphagia Management Using Standardized Functional and Objective Measures
Surender K Dabas, Hitesh Gupta, Yash Chadda, Ashwani Sharma, Reetesh Ranjan, Himanshu Shukla, Bikas Gurung, Ranjit Padhiari, Anand Subash
Annals of Robotic and Innovative Surgery. 2022; 3(1): 18
[Pubmed] | [DOI]
3 Prospective analysis of goal-directed fluid therapy vs conventional fluid therapy in perioperative outcome of composite resections of head and neck malignancy with free tissue transfer
Pushplata Gupta, SoumiH Chaudhari, Vaibhav Nagar, Deepshikha Jain, Anita Bansal, Akanksha Dutt
Indian Journal of Anaesthesia. 2021; 65(8): 606
[Pubmed] | [DOI]
4 Oral cancer management in the SARS-CoV-2 Pandemic—Indian scenario
KarlaM Carvalho, RidhimaB Gaunkar, Aradhana Nagarsekar
Journal of Family Medicine and Primary Care. 2021; 10(3): 1090
[Pubmed] | [DOI]
5 Can BMI be a predictor of perioperative complications in Head and Neck cancer surgery?
Kamal Joshi, Poonam Joshi, Teertha Shetty, Sudhir Nair, Pankaj Chaturvedi
Polish Journal of Surgery. 2021; 93(SUPLEMENT): 13
[Pubmed] | [DOI]
6 Effect of Two Different Tranexamic Acid Doses on Blood Loss in Head and Neck Cancer Surgery: A Randomized, Double-Blind, Controlled Study
Mittapalli J Babu, Praveen K Neema, Habib M Reazaul Karim, Samarjit Dey, Ripudaman Arora
Cureus. 2021;
[Pubmed] | [DOI]
7 Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients
Chindhu Shunmugasundaram, Haryana M. Dhillon, Phyllis N. Butow, Puma Sundaresan, Claudia Rutherford
Quality of Life Research. 2021; 30(9): 2649
[Pubmed] | [DOI]
8 Study of Serum Zinc and Copper Levels and Tumor Pathology: A Pilot Study in People Affected with Head and Neck Cancers
Avinash Kundadka Kudva, Shamprasad Varija Raghu, Pavan Kumar Achar, Suresh Rao, Sucharitha Suresh, Manjeshwar Shrinath Baliga
Indian Journal of Otolaryngology and Head & Neck Surgery. 2021;
[Pubmed] | [DOI]
9 Dental Care in Head and Neck Cancer Patients Undergoing Radiotherapy
Jyotiman Nath, Punit Kumar Singh, Gautam Sarma
Indian Journal of Otolaryngology and Head & Neck Surgery. 2021;
[Pubmed] | [DOI]
10 Role of Narrow Band Imaging in Laryngeal Lesions: A Prospective Study from Southern India
J. Justin Ebenezer Sargunaraj, Suma Susan Mathews, Roshna Rose Paul, Rajiv C. Michael, Meera Thomas, Mahasampath Gowri, Rita Ruby A. Albert
Indian Journal of Otolaryngology and Head & Neck Surgery. 2021;
[Pubmed] | [DOI]
11 Adjuvant therapy in the management of operable salivary duct carcinoma: correlating evidence with a retrospective review
Jeyaanth Venkatasai, Anindita Das, Punitha Kaliamurthi, Balu Krishna Sasidharan, Manu Mathew, Ashish Singh, Aparna Irodi, Meera Thomas, Subhashini John, Rajiv C. Michael, Amit J. Tirkey, Rajesh Isiah, Simon Pavamani
Journal of Radiotherapy in Practice. 2021; : 1
[Pubmed] | [DOI]
12 Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer
Johannes J. Fagan, Vanita Noronha, Evan Michael Graboyes
American Society of Clinical Oncology Educational Book. 2021; (41): 279
[Pubmed] | [DOI]
13 Assessment of quality of life among head-and-neck cancer patients
Afsana Nizar, Betty Rani Isaac
Indian Journal of Medical Sciences. 2021; 0: 1
[Pubmed] | [DOI]
14 Correlation between Symptom Burden and Perceived Distress in Advanced Head and Neck Cancer: A Prospective Observational Study
Shrenik P. Ostwal, Richa Singh, Priti Rashmin Sanghavi, Himanshu Patel, Queenjal Anandi
Indian Journal of Palliative Care. 2021; 27: 419
[Pubmed] | [DOI]
15 Genetic Variants of DNA Repair Genes as Predictors of Radiation-Induced Subcutaneous Fibrosis in Oropharyngeal Carcinoma
Ankita Gupta, Don Mathew, Shabir Ahmad Bhat, Sushmita Ghoshal, Arnab Pal
Frontiers in Oncology. 2021; 11
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer | Privacy Notice
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow