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Maiden Civil-Military Medical Meet

A two-day national level medical conference called Continued Medical Education (CME) Program on “Recent Developments in Lung Cancer” was inaugurated by Rear Admiral R J Nadkarni, VMS, Chief of Staff, Southern Naval Command, at Puzhamukham hall, Naval Base, Kochi the other day.
The program, attended by oncologists from across the country, is being organized at the naval hospital INS Sanjivini under the aegis of Indian Co-operative Network in Oncology (ICON) and Armed Forces Oncology Group (AFOG).

The welcome address was delivered by Surgeon Commodore (Dr) Subhas Ranjan, NM, VSM, the Commanding Officer of INHS Sanjivini. Many eminent speakers including Dr Purvish M Parikh, former head of the department, Tata Memorial Hospital, Dr R Rangarao (Max Hospital, Delhi), Dr T Raja (Apollo Hospital, Chennai) and Dr Debnarayan Dutta (Amrita Hospital, Kochi) delivered talks on a wide range of topics, including Application of Molecular Diagnostic techniques, Targeted Therapy and Local Therapy in Metastatic Lung Cancers.

The conference intended to provide a forum for discussion on the latest developments in lung cancer diagnostics and management. This is the third national meet of its kind and the first ever at Kochi post collaborations between ICON and AFOG since early 2000 towards understanding the problems associated with cancer and sharing of best practices in treatment protocols in the military and civil hospitals.

News clippings:
The New Indian Express: Maiden Civil-Military Medical Meet
India Breaking Now: Maiden Civil Military Medical Meet

High Precision Radiation Therapy Workshop and CME Conducted at Amrita Hospital

Inauguration of Workshop on High Precision Radiation and CME

Inauguration of Workshop on High Precision Radiation and CME

The department of Radiation Oncology at Amrita Institute of Medical Sciences, Kochi recently conducted Amrita Annual High Precision Radiation Therapy Workshop and CME over the course of three days on 30th June, 1st and 2nd July 2017. The workshop focused on imparting hands on training on the use of CyberKnife. The academic session included a live demonstration on the treatment of liver tumors. Liver tumors are very common in Kerala and it is difficult to treat using traditional methods in certain cases. However, radiosurgery serves as a treatment option for these patients. Additionally, the experts taking these sessions represented top hospitals across the country including Tata Memorial Hospital, Fortis Hospital and Apollo Hospital just to name a few.

CyberKnife is an option in Inoperable and Recurrent Liver Cancer: Dr Debnarayan Dutta

Hepatocellular carcinoma is a cancer of the liver cells. It is usually associated hepatitis infections, toxins (hepato-toxins), many chemicals we use daily, alcohol and also with substance abuse. As per the ICMR data, incidence of hepatocellular carcinoma ranges from 0.7 to 7.5 per 100,000 in the Indian population. Liver cancer is a problem in Kerala; there is an assumption that the incidence is higher than the national average.

Workshop in progress

Workshop in progress

Majority of these primary liver cancers (hepatocellular carcinoma) are treated with surgery, trans-arterial chemo embolization (TACE) and radiofrequency ablation (RFA). But, as majority the of these patients are presented with advanced disease since recurrence is common. Many patients have blockade in the portal vein (portal vein thrombosis), and they have only few treatment options available. These patients are usually on palliative chemotherapy with dismal prognosis. Many of these patients have preserved functional status (good general condition), and there is a dilemma regarding their management. There is a need to explore newer treatment options in these ‘difficult to treat’ patients. Sometimes, surgery is also difficult in patients with small lesions close to porta hepatis (blood vessels) and subdiaphramatic (below the diaphragm – subdiaphramatic location) location. These patients usually don’t have any suitable treatment option and are treated with chemotherapy.

Primary liver cancer is relatively chemotherapy and radio-resistant. Higher doses of radiation or specific chemotherapy are required to have any significant clinical benefit. There is a technical challenge in delivering high dose to the liver tumour and sparing other parts of normal liver. Hence, radiation therapy was never considered as a viable option in liver tumours, till recently. We have recently found a technique to deliver high dose of radiation to the tumour safely. The liver is sensitive to radiation therapy, and tolerance is low. It means that even a low dose of radiation on the whole liver will cause ‘radiation induced liver injury’. Normal radiation therapy with high ‘scattering’ of dose leads to high ‘mean’ dose to liver. Therefore, it is difficult to deliver high dose with standard radiation equipment. Liver moves with respiration, hence we need to treat a larger area with standard radiation equipment, and hence higher dose to liver is delivered.

Primary liver tumour (Hepatocellular carcinoma, cholangiocarcinoma) need a higher dose of radiation needs to be delivered, which not possible with standard radiation machines. With available radiation machines deliver higher dose to normal liver and less than appropriate dose to the tumour. A high dose to liver is associated with toxicity and lower dose to tumour with response to treatment. Hence, with standard radiation therapy techniques there are higher side effects and lower response to treatment. Radiation therapy was never considered an option previously as an option even in inoperable or recurrent disease. There are only few systemic therapy options in hepatocellular carcinoma (Sorafinib) and the outcome is par below the expectations.

Amrita Hospital to Collaborate with BBCI

Signing of MoU with BCCI

Signing of MoU with BCCI

Amrita Institute of Medical Sciences signed an MoU with Dr. B. Borooah Cancer Institute (BBCI) for clinical, academic and research collaboration. The MoU was signed at a function held at BBCI auditorium in Guwahati by Dr. A.C. Katraki on behalf of BBCI and Dr. Debnarayan Dutta, Head, Radiation Oncology, Amrita Hospital, Kochi.

The function was attended by Dr. R. Bhuyan, Director, Health Services, who was also the chief guest. As part of the MoU, postgraduate students from both the institutes will participate in teaching and training programmes. Faculties representing Amrita Hospital, Kochi will participate in clinical and academic programmes at BBCI four to six months intervals while faculties from BBCI will also get an opportunity to train students at Amrita Hospital.

It is also expected that Amrita Hospital and BBCI can be mutually supportive for capacity development in various fields of oncology, clinical and academic collaboration and advancement of research projects for the benefit of the people of the country in general and the Northeast region in particular. BBCI is a recognized institute for cancer treatment, education and research and experts hope this MoU can act as a platform for broad based collaboration in oncology between Amrita Hospital and Dr. B. Borooah Cancer Institute.

Read a few more news clippings reading this event:

The Telegraph: Pact on Cancer Technology

Medical Buyer: BBCI, Kochi Institute Sign MoU for Research

The Assam Tribune Online: BBCI-Kochi institute sign MoU for research-The Assam Tribune Online

Kerala CM inaugurates state’s first Centre For High-precision Radiation Therapy at Amrita Institute of Medical Sciences



Kerala Chief Minister Pinarayi Vijayan inaugurated the state’s first Centre for High-Precision Radiation Therapy for cancer patients at the 1,300-bed Amrita Institute of Medical Sciences (Amrita Hospital) on March 11, 2017. The facility, equipped with the latest, high-output models of CyberKnife (M6 version) and Tomotherapy, will offer quick and painless treatment of cancerous tumors with very high precision of radiation delivery. This development comes as a huge relief to cancer patients from Kerala who till now had to travel to other parts of India or even abroad at a great cost for high-end cancer treatment, as this capability did not exist in the state.

Addressing the audience, Kerala Chief Minister Pinarayi Vijayan said, “Amrita Institute of Medical Sciences is among the best hospitals in India. Its new Centre for High-Precision Radiation Therapy will be of tremendous benefit to the people. The Government recognizes the need for quality healthcare, and appreciates the important role that non-Government hospitals are playing in the state. This is for the first time that such a facility for non-invasive treatment of cancer is established in Kerala, even though it has been available in other parts of the country for many years. It is a much-needed addition to Kerala’s healthcare system, more so because the incidence of cancer in the state has been going up steadily.”

Dr. Debnarayan Dutta, Head, Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, who is among the first CyberKnife specialists in India said, “This is Kerala’s first centre for high-precision radiotherapy equipped with state-of-the-art CyberKnife and Tomotherapy systems for highly effective and efficient radiation delivery. These two technologies represent a paradigm shift in cancer care. They offer out-patient, short duration treatment with minimal side effects. At Amrita Hospital, we are offering these world-class radiosurgery facilities with fully robotic radiation delivery system at almost one-fourth the prevailing treatment cost, with no waiting time for patients.”

CyberKnife is used for treating small-size cancerous tumours like brain tumours, moving targets (tumours which move during treatment) such as lung, liver and prostate cancer, and metastatic diseases. The treatment, which is completely painless with minimal toxicity, lasts only a few minutes, and patients can go home immediately. CyberKnife is the only radiation therapy system in the world to track tumour movement in real time, allowing sub-millimeter accuracy in treatment delivery. Tomotherapy delivers radiation doses very precisely to irregular tumours and larger-size tumours. These modern radiosurgery systems deliver precise dose of radiation to cancerous cells while sparing healthy tissue, unlike traditional radiation treatment.

Such advanced care for patients was urgently needed in Kerala because of the rising incidence of cancer, currently hovering around the figure of 160 in males and 153 in females per 100,000 population annually. Dr. Debnarayan Dutta added “The incidence of cancer found in Kerala is similar to Western countries, unlike other parts of India. For example, while cervical cancer is the most common cancer found in Indian women, in Kerala breast cancer is the most common. The incidence of prostate cancer, liver cancer, and colon cancer is also higher in the state, while the incidence of head and neck cancer is less. This unique type of cancer incidence in Kerala poses a challenge in treatment and needs high-end facilities like CyberKnife and Tomotherapy.”
At Amrita Hospital, this high-precision radiation therapy treatment is being made available at almost one-fourth the prevailing cost, bringing it within the reach of the common man. Patients not only from Kerala, but also from India, the Middle East, as well as the SAARC and Central African countries are expected to avail of these facilities, thus reversing the flow of patients looking for high-end treatment with CyberKnife and Tomotherapy

Shri. Pinarayi Vijayan, Chief Minister, Kerala; Dr. Sanjeev K. Singh, Medical Superintendent, Amrita Hospital; Dr. Prathapan Nair, Principal, School of Medicine, Kochi; Swami Purnamritananda Puri, General Secretary, Mata Amritanandamayi Math; Shri. P. Rajeev, Ex-member of Parliament, Ernakulam; Dr. Debnarayan Dutta, Head, Radiation Oncology, Amrita Hospital; Smt. Soumini Jain, Mayor of Kochi; Prof. K. V. Thomas, Member of Parliament, Ernakulam; Sri. Hibi Eden, MLA, Ernakulam; Dr. Prem Nair, Medical Director, Amrita Hospital; Smt. Ambika Sudarsan, Member, Kochi Municipal Corporation; and Dr. K. Pavithran, Head, Medical Oncology were present at the event.

News clippings:
The Hindu: Ensure Cost Effective Treatment to the Commoner – Pinarayi
DNA: First Facility for Non-Invasive Cancer Treatment in Kerala
India Today: First Facility for Non-Invasive Cancer Treatment in Kerala
Business Standard: First Facility for Non-Invasive Cancer Treatment in Kerala

Obesity could lead to cancer, finds study

Nearly everyone knows that obesity is a major cause of cardiovascular problems and diabetes. But what many do not know is that extra kilos can also lead to that emperor of maladies — cancer. Obesity is now pandemic and researchers have noted a statistically increased risk of developing cancers, especially that of the breast, endometrium, colon and rectum, among overweight people. Several studies including one by National Cancer Institute,USA, indicate that there is a direct link between obesity and cancer. Doctors who conducted these studies say unless obese individuals make appropriate dietary changes, obesity could soon overtake tobacco as the top cause of cancer.

The Overseas Development Institute, an independent think tank, found that Indians constitute a huge chunk of the one in three adults who are obese, a total of up to 1.46 billion across the world. Simultaneously, a 16-year-long study published in the New England Journal of Medicine, which followed 90,000 American adults, revealed that the heaviest participants were more likely to develop and die from cancer than participants with healthy weight.

“Though there are no Indian studies on the subject, research done abroad is relevant to us as well as we are increasingly aping the West in terms of diet. The number of obese people in India has increased exponentially,” Rigid Lifeline Hospitals surgical gastroenterologist Dr J S Rajkumar said. The surgeon recently submitted a paper to the Journal of Obesity and Metabolic Research exposing the link between cancer and obesity. He said though the answer to how obesity causes cancer may be different for each type of cancer, the overall explanation is that obesity triggers changes in bodily functions, which can lead to harmful cell growth and cell division.

Explaining the link, senior diabetologist Dr A Ramakrishnan said the link between obesity and cancer is insulin resistance. “Both obesity and cancer result from body losing its ability to burn fat as fuel. Obesity is linked to excess levels of insulin circulating in blood and this can stimulate harmful cell proliferation. It also increases oxidative stress levels in overweight people, increasing risk of cancer,” he said. Stressing on the link between obesity and breast, colon and endometrial cancer, oncologist Dr Debnarayan Dutta of Apollo Hospitals said excess fat cells, when partially metabolised, become carcinogenic. “In women, obesity exposes them to higher estrogen levels because estrogen is produced in fat tissue. Obese women therefore have more estrogen, which can lead to insulin resistance and the development of more fat tissue, which produces even more estrogen, making it a vicious cycle that raises the risk of estrogen-sensitive cancers,” he said. Dr Rajkumar said overweight people can significantly reduce the risk of developing cancer through behavioural, pharmaceutical and surgical strategies.

News clipping:

Times of India: Obesity could lead to cancer finds study

Kin often hint at withdrawal of medication

They bear the pain and wait for death. At times, they decide their fate. Some times doctors and families decide it is time for them to go. Even as the Supreme Court has invited states to deliberate on `passive euthanasia’ (withdrawal of medical treatment with the intention of causing a terminally ill patient’s death), doctors say the practice prevails but is not spoken of.

Senior geriatrician Dr V S Natarajan said relatives of the patients often came up with the request. Many do not ask the doctor directly for passive euthanasia, but hint at withdrawal of medical support. “When elderly patients are in the last stages of their life, sometimes relatives do not wish to prolong treatment. A few from lower and middle class backgrounds come with these requests,” he said. Financial constraints often drove families to make such requests, he said.

Dr Mallika Tiruvadanan of Lakshmi Pain and Palliative Care Trust said terminally-ill patients often requested doctors to withdraw life support and stop medication. “This is not because they want to die.They have a desire to live but cannot battle the pain,” she said.”Families also make such requests only because they want to end the misery of their loves ones. But, it is the doctor’s duty to explain the various options available to manage pain,” she added.

Dr Debnarayan Dutta, consultant, radiation oncologist, Apollo Speciality Cancer Hospital, said, “We lack good palliative care centres in India. A good support system can go a long way to help patients with terminal illnesses.Everyone has the right to live a dignified life,” he said. Like other countries, India should have an effective support system that includes caretaking and counselling to prevent patients from going into depression, he added.

Legal experts say even if the Supreme Court legalizes passive euthanasia it has to face the test in the Parliament. “If the Supreme Court legalises passive euthanasia, it is bound to be a landmark judgement. After that laws like IPC 304 (culpable homicide not amounting to murder) and IPC 306 (instigating suicide), must be amended by the Parliament,” said former Madras High Court judge K Chandru.

News clipping:
Times of India: Kin often hint at withdrawal of medication

Chennai hospital completes 1,000 CyberKnife surgeries

Dr Dutta at the Press Meet

Dr Dutta at the Press Meet

The Apollo Specialty Cancer Hospital in Chennai has noted that in India, surviving cancer has become less tedious and more promising with the increasing instances of patients resorting to CyberKnife radio surgeries. The surgery is helping in treating previously inoperable tumours. In the last three years alone, several patients from Kolkata have undergone CyberKnife surgeries at the Apollo Specialty Cancer Hospital in Chennai, in their fight against cancer and got treated for conditions, previously considered non-treatable, hospital authorities claimed.

The facility in Chennai has successfully completed over 1,000 CyberKnife radio surgeries, so far, with patients from the Middle East, SAARC, Africa, Australia, USA, UK and South West Asia, who have been visiting the Centre seeking help with cancer. Patients from Kolkata who have been benefited from CyberKnife technology include a 56 year old doctor diagnosed with bilateral orbital lymphoma- rare disease involving both the eyeball regions, who had his vision restored after two years of follow up; and a 70 year old man who was suffering from liver cancer, but is now leading a normal life, officials said. “Even among those identified with conditions that are yet to find a cure, and expected survival is less than six months, Cyberknife radiation with minimal side-effects has helped patients live longer- like the 60 year old man with Infra-temporal fossa recurrence who has outlived his disease for two years now,” officials claimed.

“Cancer is age agnostic. But until recently, the treatment for it had to be tailored to suit the age and co-morbid situations, if any, of patients. Now with superior technology like Cyberknife at our disposal, given its ability to administer focused radiation with minimal side-effects, patients across age groups can be benefited with this technology,” said Dr. Debnarayan Dutta, Consultant, Radiation Oncologist at Apollo Speciality Cancer Hospital, Chennai. “Even non-cancerous conditions like AVMs & terminal -stage associated Cancer metastasis, can be treated or controlled better with Cyberknife,” he said. The Apollo Speciality Cancer Hospital is the first in the country to introduce life-saving technologies like the 64-Slice PET-CT Scan with Time of Flight, South Asia’s most advanced Digital Mammogram with 3D Tomosynthesis etc.

Commenting on this achievement, Prathap C Reddy, Founder & Chairman, Apollo Hospitals Group, said, “Cutting edge technologies such as CyberKnife has brought us closer to our goal of bringing world-class cancer care to India and making cancer cure faster, safer and surer.” “It’s heartening to know that we are playing a pivotal role in enabling superior global health delivery and moving towards making India the preferred destination for cost effective world class healthcare,” he said. CyberKnife is the world’s first and only state-of-the-art radiotherapy equipment for robotic radiosurgery, which allows the radiation oncologists to treat pathologies painlessly, without requiring any surgery, the hospital said.

CyberKnife uses pencil beams of radiation, which can be directed to any part of the body from any direction with the help of a robotic arm. The system tracks the tumour, detects any movement of the tumour or patient, and automatically corrects its positioning. It then targets the tumour with multiple beams of high-energy radiation and destroys abnormal tissue without causing any damage to the surrounding areas. The treatment is so accurate that it is now possible to treat intracranial and extracranial tumors previously thought to be inoperable.

News clipping:
Sify: Chennai hospital completes 1000 CyberKnife surgeries

‘Cancer has an answer today’

Apollo Cancer Institute, Chennai has added one more feather to its cap by successfully completing treatment of over 500 patients with CyberKnife and the “results have been very promising” with the breakthrough technology, a non-invasive alternative to surgery.

Talking about the success story, Dr Debnarayan Dutta, consultant radiation oncologist at the Chennai speciality hospital, who was in the city, said Apollo joined the global league of hospitals equipped to provide 360-degree cancer care some two years ago with the installation of CyberKnife, the world’s first and only robotic radiosurgery system designed to treat tumours anywhere in the body. “More than 500 patients with brain, spine, lung, liver and prostrate cancer have been benefited from CyberKnife treatment,” he added.

The CyberKnife uses real-time image guiding technology and computer-controlled robotics to deliver an extremely precise dose of radiation to targets, avoiding the surrounding healthy tissues while adjusting for patient and tumour movement during the treatment. “Many of the complications associated with conventional cancer therapies are minimised or eliminated by the CyberKnife system,” Dr Dutta said, adding, the patient experiences “dramatic pain relief after such treatment.”

News clipping:
Assam Tribune: ‘Cancer has an answer today’