ACHIEVEMENTS CUM PERFORMANCE REPORT

2003-2004

CANCER INSTITUTE (WIA)

CHENNAI – 600 020

ACHIEVEMENTS CUM PERFORMANCE REPORT

OVERVIEW

The Cancer Institute (WIA) had an eventful year in 2003, with preparations being made for the

Golden Jubilee in 2004. Our Chairman, Dr.V.Shanta, was honored with the Guild of service (Central)

Award - in recognition of her contribution in the field of medicine; the Cosmo Award – for being an eminent

and distinguished citizen of the country; the Kamaraj Centenary Award for contribution to fight against

cancer; Alliance Francaise award for her meritorious service towards cancer patients and she delivered the

Dr.M.Snehalatha Memorial Oration.

After 2 years of struggle, the customs duty exemption for consumables and equipments for

Research was received by the Institute. In connection with this, the Institute would like to thank

Shri.S.Venkitaramanan I.A.S. (Retd), Shri C.S.Rao, Shri. V.Lakshmi Ratan, Shri. Vijay L.Kalker and

others, who made this possible. Our sustained efforts, have benefited all the Regional Cancer Centers, as

well, as the Regional Cancer Centers have been now included under Institutions eligible to claim customs

duty exemption for Research consumables and equipments.

The 20 varai 20 public donation scheme was inaugurated by Mr. Kamalahasan. The scheme aims

to raise a contribution of Rs.20 crores through donation of Rs.20 or its multiples from the public. The funds

are needed for replacing several aging equipments, including the Linear Accelerators, Cobalt tele-therapy

unit and for purchase of newer equipments for patient treatment and Research. Subsequently several fund

raising activities were initiated, including one on 16th August.

The Annual No Tobacco Day was held on 7th June 2002, in the Madras University auditorium, with

the Theme being "Tobacco free films and Fashions". The meeting was sponsored by the WHO and had

more than 1000 participants. The meeting was inaugurated by Hon.Thiru A.Raja, Minister of State for

Health, Govt. of India. Several Film and TV personalities spoke on the occasion and pledged not to use

tobacco.

The Annual Cancer Survivor’s Day was celebrated on 15th June 2002. There was an

overwhelming response from our patients and relatives, who attended this function in large numbers. Mrs.

Girija Vaidyanathan, Health Secretary, Govt. of Tamilnadu, was the Chief Guest. Mr.N.Ram, Editor,

Frontline, and several TV personalities participated in the event.

The Rotary club of Madras Metro, the Rotary Foundation of the Rotary International,

the Rotary International Clubs of Malaysia and Indonesia, made a kind donation of Rs.20 lakhs towards

the purchase of a new Mammography unit, to replace the old unit. The unit was inaugurated by His

Excellency, the Governor of Tamilnadu, on 28th August, 2003.

A kind donation of Rs.21 lakhs was made by the Chennai Willingdon Corporate Foundation

towards the purchase of a Real time PCR unit. The unit was inaugurated by Hon. Minister for Health, Thiru

Thalavai Sundaram on 23rd October, 2003.

The Mahesh Memorial Trust held the foundation stone laying ceremony for the proposed New

Pediatric ward at the Main Institute campus on 5th October, 2003. The ward will have a day care unit, ICU,

dining hall, play area, mother's room etc.

The Rotary Club of Madras Metro renovated the Dharamsala housing the Male General Ward.

This has tremendously improved the ambience and has contributed to improving the psychological well

being of the patients. They have also promised to renovate the Female General Ward section as well.

The WHO has funded a Palliative care program which commenced operation from February 2003

and a Population screening programme in the Thiruvanmiyur area, which was launched in March 2003.

Dr. B.Nagarajan, Prof and Head, Dept. of Tumour Microbiology, received the Indira Gandhi award

for Outstanding contribution in the Chosen Profession. Dr. N.Mayilvahanan, Consultant Orthopaedic

Oncologist at the Institute, was awarded the B.C.Roy award for the Limb salvage surgeries done

predominantly at the Institute. Mrs. M.Gnanasundari, Nursing Staff in the post-operative ward received the

Vocational Service award from Rotary Club of Madras Central. Dr. R.Priyadharshini was awarded a one

year Fellowship under the Training and Research in Italian Laboratories (TRIL) programme, by the Abdus

Salam International Center for Theoretical Physics and will spend a year in Italian Institutions, training in

Nuclear Medicine, diagnostic radiology, MRI etc. Dr. A.Vasanthan, Chairman, Division of Radiation

Oncology was appointed as a member of the ICMR (Indian Council of Medical Research) task force on

management of cancers.

Dr. R.Swaminathan was deputed to visit IARC, Lyon to analyze data on Cancer Survival for the 2nd

Volume of the IARC Monograph on "Cancer Survival In Developing Countries". Dr. Nirmala Nancy was a

visiting Scientist in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, for training in

newer techniques in Molecular Oncology. Dr. Vikas Mahajan underwent training in Hepatic Surgery under

Prof. K.C.Tan and Prof. London Lucian Ooi, in Singapore.

THE COLLEGE OF ONCOLOGICAL SCIENCES

The College conducts super-specialty training in Medical Oncology, Surgical Oncology and Radiation

Oncology; is recognized for Ph.D. training in its departments by the T.N.Dr.M.G.R.Medical University, Anna

University of Technology and Madras University; conducts the M.Sc. Medical Physics course under the

Anna University of Technology.

Students who have completed their degrees / courses are

Ph.D.Dr. B.Santhanaraj Dr. P.KumariDr. N.Vivekanandan Dr. R.Srivani

D.M.(Medical Oncology) M.Ch (Surgical Oncology)Dr.Devanand Dr.V.SrideviDr.Subba Rao Dr.BargaviDr.Sanjay Piplani Dr.Praveen Garg

M.Sc (Medical Physics)Anand, M.R. Murugan, A. Arun Kumar, T. Sasikaladevi, T.Balaji, . Sellakumar, PN.Gaurav Sanyal Tamil Kumar, PGypson Joe Anto Timothy Peace Balasingh, S.Jisha Kumari, R. Ukash Ahamed IbrahimKaviarasu, K. Vikraman, SKayalvizhi, L. Vivekanandan, C.Mahalakshmi, S. Yogesh Kumar, R.Merlin Praveena Kumari, A.

Dr.Anita Chandra completed her M.Sc. Oncology course at Queen's Medical Center, Nottingham and was

awarded with Diploma in Child Health from the Royal College of Pediatrics.

The Institute also offers Radiotherapy Technician Training course, which is approved by the AERB. In 2002,

the AERB approved the start of the Radio-Diagnosis Technician Training course.

STUDENTS UNDER TRAINING

Nine students are currently registered for M.Ch., and 9 for D.M.; 3 for M.D.(Radiation Oncology), 1 for

D.M.R.T, 1 for Ph.D. in Biochemistry; 5 for Ph.D in Molecular Oncology; 19 students for M.Sc. (Medical

Physics), 5 students for the Certificate Course in Radiotherapy Technology and 6 students for the Certificate

course in Radio-diagnosis Technology. In addition, nearly hundred students from all over the country

underwent Observership training in clinical and research departments.

LECTURES, CONFERENCES, SEMINARS, WORKSHOPS AND CME PROGRAMMES

1. The Gynaec Oncology Workshop was held from 23rd - 25th, January 2003 and was attended by

more than 100 delegates from all over the country. National and International faculty demonstrated

operative procedures and conducted training sessions.

2. A “Cancer Registry Training Workshop” was organized for oncologists, physicist, statisticians and

computer persons from four Regional Cancer Centres in Allahabad, Cuttack, Kolkata and Nagpur

during March 17-21, 2003 and one other Regional Cancer Centre in Patna during 23-25 June 2003.

The faculty for the workshops comprised Dr. R. Swaminathan, Dr. Nalini, Mrs. R. Rama, Mr. S.

Devarajan, Ms. M. Kavitha, Mr. J.Murugaian and Mr. P.Thangavel.

3. CME on CML & Glivec in April, 2003.

4. A “Workshop on Cancer Registration” was organized for the personnel from Vital Statistics Division

(Birth & Death Registrars), Corporation of Chennai on 14.6.2003 – about 60 delegates participated.

5. Medical Records and Registration departments of the Government and Private hospitals and other

institutions in Chennai on 18.6.2003 – 125 delegates

6. CME on breast cancer on 21.06.2003

7. A National level workshop on “Cancer Registration: Principles & Methods” under the auspices of the

National Cancer Registry Program of the Indian Council of Medical Research (ICMR), New Delhi,

during November 11-12, 2003. – Attended by 100 delegates from cancer the registries all over India.

8. XIX Annual Review Meeting of Cancer Registries in India under the auspices of the National Cancer

Registry Program of the Indian Council of Medical Research (ICMR), New Delhi, during November

13-14, 2003.

INVITED LECTURES

Dr. Srinivasa Madhavan, Consultant in Radiation Oncology, Dublin, Ireland, visited the Institute in

November, 2003 and gave a lecture on radio-therapeutic management of prostate cancers, especially with

conformal radiotherapy.

In addition Tumour Boards and clinical audits were conducted every Friday. Clinical Demonstration, didactic

lectures, Journal club sessions, Departmental seminars in the different disciplines were conducted Monday

thro’ Saturday every week for 10 months in a year.

CLINICAL STATISTICS FOR THE YEAR 2003

Total number of cases seen 1,07,647Total number of new cases registered 13,012Total numbers of cases seen on follow up 94,635Total number of subjects attended screening clinic 404Total number of new cancer cases registered 7,963Percentage of patients treated free 68%

REGIONWISE DISTRIBUTION OF NEW CASES State Total

No. %

Chennai 3664 28.2Rest of Tamilnadu 5536 42.5Andhra Pradesh 3007 23.1Kerala 209 1.6Assam 193 1.5Other states 394 3.0Outside India 9 0.1Total 13012 100.0

DIAGNOSTIC PROCEDURESRadiological studies 182295Odelca camera studies 3725Contrast radiography 44350Mammography 7120USGM 139989CT scans 101260Scintiscans 4076Biochemical investigations 413295Clinical Pathology 212802Histopathology sections 416869Specimen Dissections Done 2517Cytology smears 47580Bone marrow aspirations and biopsies 2785Cytochemical studies 176CSF Study 1083Bacteriological studies 16186Cytogenetic studies 600Electron Microscopy studies 150Immuno-histochemistry and cytochemistry 1107Immunophenotyping & DNA study by FACSCAN 175

TREATMENT PROCEDURES Operative procedures 10198Teleradiation treatment 170092LDR Selectron cases 542 HDR Micro Selectron cases 733 (a) Intracavitary therapy 650 (b) Interstitial/Intraluminal therapy 83Treatment Planning (a) 2D Plans 2603 (b) 3D Plans 103Chemotherapy treatment 404982Allogenic Bone-marrow transplant 3Autologous Transplant & Cord blood Transplant 5Metabolised Radio-active isotopes 2764mCiBlood Transfusions 2292Blood component therapy 3699Dental treatments 7056

RESEARCH PROJECTS INCLUDING CLINICAL RESEARCH 2003

DEPT. OF MOLECULAR ONCOLOGY

ONGOING PROJECTS

Detection and quantitation of minimal residual disease in Acute Lymphoblastic Leukemias (ALL)

using Real Time PCR:

a. Chromosomal Translocation: (E2A-PBX-1, MLL-AF4, mBCR-ABL and TEL-AML1)

Fifty-five patients clinically diagnosed and immuno-phenotyped as ALL were studied for detection of

fusion gene transcripts at presentation using Real Time PCR. All the 55 patients cDNA amplified for GAPDH

gene (Taqman) confirming integrity of the RNA. Eleven of the 55 (20%) ALL revealed one of the 4 risk

stratifying translocations by Real Time PCR. Five patients (45.5%) PCR amplified for the E2A-PBX1, 2

(18%) for ALL type mBCR-ABL, 3 (27%) for TEL-AML1 fusion gene transcripts and one for MLL-AF4

translocation in this series of patients. The specificity of the PCR products was confirmed by melting curve

analysis. Sequencing of the translocations revealed no variations in the breakpoints.

b. Gene Rearrangements

DNA from BM/PB of 60 leukemia patients at presentation and 20 remission samples were isolated,

quantitated by Real Time PCR using RNAse P standards and studied for gene rearrangements by PCR-

Heteroduplex analysis. DNA from BM/PB of 60 leukemia patients at presentation and 20 remission samples

were isolated, quantitated by Real Time PCR and studied for gene rearrangements by PCR-Heteroduplex

analysis. In T-ALL, TCR γ rearrangements were observed in 18/22 (81.9%) cases and TCR δ

rearrangements are observed in 9/22 cases (40.9%). Vγ1-Jγ1 is the most common rearrangement. In the

pediatric calla patients, 7 revealed Vδ2-Dδ3 rearrangement. Sequencing the Homoduplex, design of Allele

specific oligonucleotides (ASO) specific for each patient and Taqman probes to J gamma-1, J delta-1, D

delta-3 and IgH regions are being done to quantitate MRD in ALL.

The DST funds the above studies.

Hereditary cancer prevention and detection programme

Population based Hereditary Cancer Registry

This project funded by WHO, covers the Chennai Metropolitan area and is the first Population based

Hereditary cancer registry in the country. A total of 206 cases have been collected. This includes 130

families where 2 members are affected with cancer and 47 families where more than two members are

affected with cancer. There are 20 hereditary breast and ovarian families and 3 HNPCC families. Thirteen

early onset colorectal cancer cases and 14 early onset breast cancer cases have been registered. There are

two cases of early onset ovarian cancer.

Hereditary cancer clinic

So, far 358 cases have been registered in the clinic. This includes 151 families where 2 members are

affected with cancer and 98 families where more than two members are affected with cancer. There are 44

hereditary breast and ovarian families and 11 HNPCC families. Sixty-one early onset colorectal cancer

cases and 26 early onset breast cancer cases have been registered. There are three cases of early onset

ovarian cancer.

Hereditary breast and ovarian cancer study

A total of 37 cases have been analyzed for mutations in the BRCA1 and BRCA2 genes and for CHEK2 1100

del C. Four pathogenic mutations have been identified in these cases. Two of these are novel and have

been submitted to Gene Bank. Many known polymorphisms were identified both in BRCA1 and BRCA2

genes in all except one case. CHEK2 1100 del C was not seen in any of the cases so far analyzed.

Hereditary colo-rectal cancer study.

Under this study a total of 43 cases have been analyzed. First screen was done by microsatellite instability

analysis (MSI), followed by mutational screen of hMLH1 and hMSH2 gene using d-HPLC. Five mutations

have been identified and four of them are novel; Four are deleterious. Few polymorphisms were also

identified. The novel mutations have been submitted to the Gene Bank.

Both the above studies are funded by the DBT.

Development of Diagnostics in Small round cell malignant tumours

Small round cell malignant tumors can present diagnostic difficulty, as they may not be

distinguishable by light microscopy. Cytogenetics studies have revealed specific chromosomal translocation

in these tumors. The objective of the project was to develop a RT-PCR based assay for the diagnosis of

small round cell malignant tumors mainly the Ewing's’ sarcoma and Rhabdomyosarcoma.

Approximately 85% of Ewing's’ sarcoma harbor the translocation t(11: 22) which creates a functional

EWS-FLI1 fusion gene. Most cases of Rhabdomyosarcoma have been found to have a t(2:13) or t(1:13)

translocation which results in the formation of PAX3-FKHR or PAX5-FKHR fusion transcript respectively.

Twelve biopsy samples were collected from patients whose clinical and radiological data were compatible

with a diagnosis of Ewing's’ sarcoma or small round cell malignant tumor. Histo-pathological diagnosis of

Ewing's’ sarcoma was made in seven cases and in four round cell tumors only a differential diagnosis was

given and one sample was diagnosed as embryonal Rhabdomyosarcoma.

Out of seven Ewing’s sarcoma cases, 6 (88 %) expressed EWS-FLI fusion transcript. Of the four

diagnosed as round cell tumors, two showed EWS-FLI1 translocation. One of the histo-pathologically

identified Ewing's’ sarcoma case, did not show either the t(11:22) or the t(21:22 translocations. PCR

products were taken for direct sequencing. Sequence of amplified product revealed two different EWS-FLI 1

in-frame junctions (62% showed type 2 and 38% showed type 1). We have also standardized the RT-PCR

assay for Rhabdomyosarcoma. The case diagnosed as Rhabdomyosarcoma showed the PAX3-FKHR

fusion transcript, which was confirmed by sequencing.

Identification of genes involved in radio-responsiveness in cervical cancer using Differential Display

Our earlier studies involving gene expression analysis by differential display using tumor biopsy

samples taken before radiation and after 10Gy of tele-radiation between a patient who responded to

treatment and a patient who failed treatment identified CDC27 gene to be differentially expressed.

Subsequent Immuno-histochemical analysis of pre- and post treatment tumour samples from 15 patients,

showed that there was down-regulation of expression of CDC27 protein in seven patients in the post

treatment samples compared to pre treatment sample. Down-regulation was associated with poorer

response.

In order to corroborate the in-vivo findings, cervical cancer cell lines SiHa and C33A, were studied

for CDC27 expression. These cell lines had been earlier described to exhibit differential radio-sensitivity,

with C33A being more sensitive than SiHa. Our studies on the dose survival patterns of the two cell lines

also demonstrated similar effect. At 10 Gy dose, nearly 25% of the SiHa cells survived compared to less

than 5% of C33A To study the expression levels of CDC27 before and after 10Gy of radiation The cells from

the two cell lines were irradiated in duplicates, and independently to a dose of 10Gy delivered in five

consecutive daily fractions of 2Gy. The nuclei from the un-irradiated cells and the irradiated cells were

isolated and stained for CDC27 and analyzed for the expression. Using FACS, the nuclei of SiHa were

found to show a marked down-regulation of CDC27 expression after treatment with 10 Gy radiation, with 6%

of the nuclei expressing CDC27 compared to nearly 74% of the C33A nuclei expressing CDC27 after 10 Gy

radiation.

The present study has identified for the first time that CDC27 levels may be altered in response to

radiation and down-regulation of the levels has been found to be associated with a poorer outcome to

radiotherapy in patients with cancer of the cervix. The in vitro study using cell lines has also corroborated the

in vivo data, in as much as the less radiosensitive cell line, SiHa, showing a marked down-regulation of

CDC27 after exposure to 10 Gy radiation compared to the radio-sensitive cell line C33A.

Differential displays performed on pre and post treatment samples (10 Gy) of SiHa cell line yielded a

318 bp fragment differentially expressed in the 10Gy sample. The differential expression was confirmed in

northern blots using total RNA isolated from duplicate samples from an independent experiment. The

fragment was cloned and sequenced. The sequence showed high similarity (e-139) to a EST clone. The

characterization of the clones by sequencing is ongoing.

This study was supported by the DAE.

IDENTIFICATION OF PROGNOSTIC MARKERS AND GENES RELATED TO DRUG RESISTANCE

MECHANISMS IN OSTEOSARCOMA

Osteosarcomas are highly malignant bone tumors predominantly seen in pediatric age group and

young adults. The crude incidence rate of osteosarcoma has been found to be 0.8/100,000 population

(males) and 0.6/100,000 population (females) (Madras Metropolitan Tumor Registry). The etiology of

osteosarcoma is not known. Even though, the intensive chemotherapeutic regimens has increased the cure

rates to 60-70%, failure still occur due to the spread of the disease, outside of the site of origin, most

commonly to lungs. Drug resistance is of major concern in the management of osteosarcoma. To further

enhance osteosarcoma therapy, it would be very important to identify newer prognostic markers and also, to

develop new therapeutic strategies based on most effective combination of cytotoxic drugs.

A pilot study was done on the pattern of expression of FGFR1, FGFR2, FGFR3, BCL2, p53, MDM2

and MDR1 and assessment of its prognostic significance using immuno-histochemical approach in 47 high-

grade non-metastatic osteosarcoma cases. Of the 47 osteosarcoma cases studied, FGFR1 and FGFR2

expression was found to be cytoplasmic (59.6% and 80.9% respectively) and nuclear (34% and 61.7%

respectively). The FGFR3, BCL2 and MDR1 were expressed only in the cytoplasm (48.9%, 57.4% and 20%

respectively) and in the case of p53 and MDM2 in the nucleus (34% and 27.7% respectively). The over

expression of p53 (p<0.003) were found to correlate with poorer disease free survival.

The 143B osteosarcoma cell line have been selected for resistance to adriamycin, cisplatin and ifosfamide

by intermittent exposure to stepwise increasing concentration of the drug. Three drug resistant

osteosarcoma 143B cell lines to cisplatin, adriamycin and ifosfamide have been established. The folds of

resistance generated have been determined by the difference in percentage of viable cells between wild

type and drug resistant cells through Micro culture Tetrazolium Test. The differential expressed genes

between wild type and drug resistant 143B cells would be identified using differential display.

Development and Clinical evaluation of Dendritic Cell Vaccine for HPV related cervix cancer.

In the case of cervical cancer patients with HPV infection, the Immune system seems to play a

significant role. The presence of high risk HPV alone is not sufficient though critical. The dysfunction is due

to loss of effective presentation of antigenic peptide to the Immune cells and aberrations in effector systems.

Dendritic cells are potent Antigen Presenting Cells hence this property can be exploited to increase the

population of both specific CD4 and CD8 T cells.

The aims of the project are to utilize monocytes derived from the peripheral blood of cervical cancer

patients and convert them into dendritic cells. So far blood and biopsy samples have been collected from 13

patients, monocytes derived from these patients were converted to immature dendritic cells using IL4 and

GM-CSF. The immature dendritic cells are to be primed with either the tumour cell lysate or total tumour

RNA along with cytokines TNF alpha and IL1 beta to obtain mature dendritic cells that are potent antigen

presenting cells.

This is a DBT funded study.

DEPT OF IMMUNOLOGY AND HEMATOLOGY

ONGOING PROJECTS

1.Immunophenotyping of Acute lymphoblastic leukemia cases

is being carried out since late 1989 with the objective of identifying the immuno-phenotypic subtype

of ALL cases for its diagnostic, therapeutic and prognostic significance. A total of 671 newly diagnosed,

untreated ALL cases have been studied till December 2003. Of this, 414 were paediatric cases and 257

were adult ALL cases. Study was conducted by flowcytometric immuno-fluorescent technique using a panel

of 20 monoclonal antibodies. Analytical study of accrued data reveal that 36.4% of paediatric ALL cases

were T subtype and 34.2% were C-ALL. Among adult ALL cases, 39.2% were T-ALL and 23.8% were C-

ALL. 85% of paediatric T-ALL cases had their origin from the more mature thymic compartments 11 and

111. 15% of paediatric T-ALL cases had their origin from immature thymic compartment 1.

Among total number of ALL cases studied, 65.7% were from lower socioeconomic group. Among T-

ALL cases, 65% were from lower socioeconomic strata. Predominance of T-ALL, paucity of C-ALL and

increased frequency of paediatric T-ALL from more mature thymic compartments are in variance with

reported western data. Predominance of T-ALL cases among lower socioeconomic group is statistically

significant.

Over a period of 10 to 14 years, we notice a gradual reduction in paediatric T-ALL cases and a

proportionate rise in paediatric C-ALL cases. This could be due to the fast development in the related

environmental factors in our geographic setting.

2. DNA Analysis in Acute Lymphoblastic Leukemia Cases.

Is being carried out since 1993 with the objective of determining the ploidy status and proliferative

activity in ALL cases. A total of 368 new ALL cases have been studied till December 2003. Study was

conducted by flowcytometric method using Propidium iodide as DNA dye. 58.4% of cases showed DNA

diploidy, 41.6% of cases showed DNA aneuploidy and 24.2% of cases showed increased S-phase fraction.

DNA diploidy indicates prognostically unfavorable category. S-phase fraction study has therapeutic

significance.

3. Immunophenotypic characterization of Lymphoma cases.

Is being carried out since 1990, with the objective of studying immuno-phenotypic characterization of

Histo-pathologically problematic Lymphoma cases. A total of 782 Adult NHL cases were immuno-

phenotyped till December 2003. 41.2% were found to be T-NHL and 58.8% were B-NHL. Study was

conducted by immuno-histochemical method using appropriate monoclonal antibodies from a panel of 8

monoclonal antibodies, via LCA, UCHL 1, L26, Kappa, Lambda, CD68, CD15 and CD30.

A total of 90 paediatric NHL cases were immuno-phenotyped till 2003. 78.2% were T-NHL and

16.9% were B-NHL. 85.3% of paediatric T-NHL and 44.6% of paediatric B-NHL were lymphoblastic in

nature.

4. Immunophenotypic Characterisation of Solid Tumours.

is being carried out since 1990 with the objective of identifying cell markers of diagnostic

significance. A total of 4389 cases of neoplasm of uncertain histogenesis were studied till December 2003.

Study was conducted on paraffin sections or fine needle aspiration smears by immuno-histochemical

method. Appropriate monoclonal antibodies were selected from among 30 monoclonal antibodies available.

Analysis of data reveals that in 80% of instances the study helped in arriving at a more precise diagnosis. In

20% of cases it was non-contributory mostly due to inadequate specimen or poor quality of tissue.

5. Prognostic Marker Study on Breast Carcinoma Cases.

Is being carried out with the objective of evaluating its prognostic significance. A total of 2103 Breast

carcinoma cases were subjected to ER and PR status study since 1996. 40.5% were ER positive and

28.9% were PR positive. Study of Cathepsin D, c-erbB2 and p53 was started since late 1998. So far a total

of 986 cases were studied. Analysis on the accrued data reveal that 18.2% of cases were C-ErbB2 positive,

55.7% were Cathepsin D positive and 31.2% of cases were p53 positive.

6. Early detection of micro-metastasis in histologically node negative Ca Breast cases by

Cytokeratin study on axillary lymph nodes.

This study has been started during current year to evaluate presence of cytokeratin positive

epithelial cells in axillary lymph nodes of histologically node negative breast cancer cases with the objective

of detecting micro-metastasis. This study has considerable therapeutic significance. A total of 150 cases

were studies so far. 6 (4%) of them showed micro-metastasis.

7. C-ErbB2 evaluation on ER and PR positive Breast Carcinoma cases with metastasis under

Herceptin Trial.

This study has been started since Nov.2002. A total of 6 cases have been studied so far.

8. Immuno-histochemical characterization of Gastrointestinal Stromal Tumours (GIST) with C-Kit.

This has been started since Dec.2002. C-Kit proto-oncogene is supposed to have an important role

in the development of tumour. This study has diagnostic and therapeutic significance. Study is under

progress.

9. Demographic study of Immunophenotypic Characterisation of Acute Lymphoblastic Leukemia

cases.

A total of 19 cases were studied so far. Among paediatric ALL cases, 63% were T-

Immunophenotype and 27% were Calla positive. This data is in agreement with our reported and published

data on hospital population. Study is continuing.

10. Oestrogen Receptor Evaluation for U.K. based Atlas Trial.

This study is going on since 2000. More than 261 cases have been evaluated for ER status so far,

for its therapeutic utility.

11. Project entitled “A comprehensive retrospective immuno-histochemical evaluation of axillary

nodal status for micro-metastasis and prognostic marker status in primary tumour in breast cancer

patients” is being funded by ICMR.

During the year 2003, a total of 60 node negative breast cancer cases have been studied under this

project. A total of 2 cases showed micro metastasis in axillary lymph nodes. 55 cases were subjected to ER

study 16 (30%) showed ER positivity in primary breast tumour. PR study was done on 54 cases. 16 (30%)

showed PR positivity 8 out of 48 cases studied for C-ErbB2 showed positivity (16.7%) 39 out of 49 cases

showed for Cathepsin D showed positivity (80%). 13 out of 44 cases studied for p53 showed positivity

(30%). Second year study is on progress.

DEPT. OF TUMOUR MICROBIOLOGY

Report on the completed Indo-French Collaboration "Prognostic Value of Cytokine in Cervical

Cancer".

Cancer Uterine Cervix in women is of high incidence as reported world over, especially in the Asia-

Pacific region. The prognosis of invasive cervical carcinoma is based exclusively on clinical staging, which is

not always able to predict clinical outcome especially for early stage tumors. Different abnormalities in the

level of cytokine production have been found in invasive cervical carcinomas such as an increase of IL6

production and a defect in IFNγ mRNA expression in cancer patients. By means of new biotechnologies

such as quantitative Polymerase Chain Reaction (PCR) or In situ PCR, we have determined their

concentrations and distribution directly at the tumor site. A comparison of these molecular diagnosis

approaches with reference techniques such as immuno-cytochemistry were performed. A correlation

between cytokine expression and different clinical parameters such as tumor stage, lymph node status, HPV

expression, survival, disease free interval were studied. This will help to better define the role of cytokines

as prognostic markers in cervical carcinoma and identify high risk cervical carcinoma patients for whom neo-

adjuvant chemotherapy or intensive therapy would be appropriate. Analysis of DNA adducts that index DNA

damage and instability was also performed. These toxic biological endpoints are potential markers with

implications in intermediate therapeutic management.

1 Development and validation of original techniques to detect and quantitate immune parameters in

tumor tissue.

a) In situ RT-PCR

Up until now, immuno-cytochemistry remains the standard technique to analyze the expression of molecules

in tissue. However, this technique is of low sensitivity and does not allow an accurate quantitation of markers

in tumor tissue. In addition secreted molecules which do not concentrate in a cell compartment are not well

characterized by this approach. In order to increase the threshold of sensitivity to detect immune

parameters in situ, we have developed an original in situ RT-PCR method to analyze the expression of

cytokine mRNA. We have identified the different fixative procedures and permeabilization steps which permit

the accurate and specific detection of cytokines. The use of biotinylated primers, the introduction of

recombinant Thermus thermophilus (rTth) DNA polymerase and a decreased duration of each cycle of PCR

by combining the annealing and hybridization steps improved the reproducibility of the techniques and

morphological preservation of the cells. Different cytokines such as IL-6, IFNα and TNFα were successfully

analyzed by this method. We are trying to couple this high sensitive method to immunocytochemistry

analysis to phenotype the cells responsible for the secretion of cytokines in cervical carcinoma patients.

b) Comparison of different quantitative RT-PCR techniques.

To ensure the reliability of the technique used to quantitate mRNA, we have compared a competitive

PCR assay developed in our laboratory to the real time PCR (Taq Man). The sensitivity and the specificity of

the two techniques appeared similar. The presence of an internal standard during the competitive RT-PCR

allows absolute quantitation of mRNA. The presence of an external standard during the Taq Man technique

may introduce a bias, which could be circumvented by performing several measures for a same point. Since

the Taq Man technique has appeared easier and faster to perform, this technique has been selected to

quantitate cytokine mRNA expression in cervical carcinoma biopsies.

2. Analysis of the role of Interleukin-17, a T cell derived cytokine in the control of human

cervical tumor growth.

IL-17 is produced by memory CD4-T cells. It is a pro-inflammatory cytokine, which induces the

expression of IL-6, IL-8 and G-CSF. Using different cervical tumor cell lines we failed to demonstrate a direct

in vitro effect of IL-17 on the growth rate of these cells. However, we have shown that IL-17 promotes the

tumorigenicity of human cervical tumors transplanted in nude mice. Indeed two cervical cell lines transfected

with a cDNA encoding IL-17 exhibited a significant increase in tumor size as compared to the parent tumor

when transplanted in nude mice. This effect is mediated in part by the secondary induction of IL-6 and is

associated with a macrophage infiltration. To assess the clinical relevance of this observation we have

analyzed the expression of IL-17 in biopsies derived from cervical carcinoma patients. We found that IL-17 is

expressed in most cases and as expected is associated with the infiltration of CD4+T cells. Recently in

immunocompetent mice, we have shown that IL-17 inhibits the tumor growth of immunogenic tumor,

whereas it exhibits either no activity or a pro-tumoral activity against non immunogenic murine tumors. IL-17

like other cytokines such as IL-6, IL-10, TNFr could therefore be considered as a two faces cytokine with

potential pro or anti-tumor activity depending on the immunogenicity of the tumor.

3. Analysis of the expression of cytokines and other parameters in human invasive cervical

carcinomas a) IL-6 and IL-8 as prognosis marker in invasive cervical carcinoma

Two possible candidates with prognostic potential have been identified in this study – cytokines IL-6

and IL-8 secretion by tumor cells. IL-6 positivity was found both in tumor and stromal cells, suggesting the

existence of both autocrine and paracrine loop. Significant correlation between the stromal positivity of IL-6

with macrophages in the stroma tends to confirm the macrophages as one of the chief sources of this

cytokine. IL-8 positivity was also found to be present both in tumor and stromal cells. While tumor cell

secretion of these cytokines showed a poor prognosis, stromal cell secretion did not. This clearly indicates

their secretion by stromal cells as a normal function whose levels get elevated during the growth of tumor.

Systematic evaluation of their levels in more number of patients with a longer follow-up is warranted for a

definitive conclusion of their prognostic potential.

b) Identification of a group of cervical carcinoma patients with decreased levels of both TH1 and TH2

cytokine mRNAs.

We have selected the real time PCR (Taq-Man) to measure the expression of IFNγ (TH1 cytokine),

IL-4 (TH2 cytokine) and IL-17 (TH0 cytokine) in biopsies derived from invasive cervical carcinoma patients

belonging to different clinical stages. We identified a group of cervical carcinoma patients with undetectable

intratumoral T cell-derived cytokine mRNAs, as IFNγ, IL-4 and IL-17 expression could not be detected in 5,

25 and 9 of the 52 biopsies analyzed, respectively. Global downregulation of type 1 and type 2 cytokines

was observed in a subgroup of patients who more frequently presented advanced stage tumors. Biopsies of

patients with no IFNγ gene expression did not appear to be less infiltrated by T cells than control biopsies

with measurable IFNγ gene expression These results clearly demonstrate that, in some clinical situations,

the decrease in intratumoral type 1 cytokines is not associated with a type 2 polarization, but rather reflects

global deactivation of T cells at the tumor site.

c) Macrophages and dendritic cells infiltration in invasive cervical carcinomas.

By using DC Lamp a marker for mature dendritic cells (DC), it has been shown by

immunocytochmistry (frozen and paraffin sections) that most tumors contained mature DC located around

the tumor, whereas immature DC appeared inside the tumor as evidenced by the staining character with

CD1a antibodies. As observed in other cancers, this suggests a maturation block of dendritic cells. We have

also observed expression of MIP3Œ, a chemokine, which preferentially attracts immature dendritic cells and

may explain the presence of these cells in the stroma. We now are trying to explain mechanisms underlying

the defect in the maturation of dendritic cells inside cytokines by the tumors) Expression of FC gamma

receptors by tumor cells. In contrast to metastatic melanoma, cervical tumors were found to be negative for

Fc gamma IIB expression. This was evidenced by immuno-cytochemistry on paraffin sections, using the

polyclonal anti-Fc gamma RII B IgG.

d) Analysis of DNA adducts in invasive cervical carcinomas.

The levels of 8-oxodeoxyguanosine, which is implicated in several cancers, was high in chronically

inflamed cervix as against invasive cancers. It is possible that this modification is an early event in

carcinogenesis. The levels of bulky aromatic adducts of the PAH type were significantly higher in the

invasive cancer group when compared to normal and dysplastic cervix. This suggests their possible role in

cervical carcinogenesis. Since tobacco chewing is a common habit among Indian population, it is possible

that tobacco constituents-related immuno-suppression is an important feature in the promotion of cervical

carcinogenesis.

DEPT OF BIOCHEMICAL ONCOLOGY

COMPLETED PROJECTS:

“Immunoscintigraphy of experimental tumor models using 99mTc labeled human anti EGFR

monoclonal antibody” –DAE project completed on 30th September,2003.

Summary of the Project:

The objective of this project was to evaluate the in vivo diagnostic potential of human anti-EGFR

monoclonal antibody generated in this laboratory using animal tumor models. Tumor xenografts with over-

expression of EGFR were induced in the flank region of BALB/c and Nude mice using carcinoma cell lines

like A431, epidermoid carcinoma and MDAMB468, Breast carcinoma cell line. Tumors > 0.5 cm in diameter

were used for gamma imaging. Scan pictures were taken at 2h and 24h time intervals after i.v administration

of 50-100μCi of the 99mTc labeled MAb using Hitachi model 1500 Gamma camera. Highly discreet tumor

images were visualized at the 24h scan due to specific uptake of the labeled MAb by the tumor. There was

comparatively much less uptake in the liver and G.I. Tract. These results were comparable to those of Bio-

distribution studies performed at the end of each scan which revealed significantly high uptake of radiolabel

by the tumor, with minimum concentration in normal tissues. The Bio-distribution of radio-labeled Ab has

also been studied after administration to normal mice which revealed very low uptake by the G.I Tract.

These results might indicate that this MAb has useful clinical application for early in vivo diagnosis of

human cancers, which over-express EGFR.

ONGOING PROJECTS:

1. DST- FIST Project: For Computational and Networking.

The Central computing and Networking facility established under this project has been

utilized for teaching trainee students, for Research data storage and Retrieval, Statistical analysis and

Graphical representation of Research data, collection and survey of literature for research purposes, etc.

2. Epitope Mapping:

To determine the nature of epitope recognized by the anti-EGFR MAb, the technique for

Immunoprecipitation using 35S labeled EGFR has been standardized by incorporating 35S Methionine into

MDA MB468 cells in culture and incubating an aliquot of the cell lysate with protein A Sepharose bound 4H3

antibody and subjecting the immunoprecipitate for SDS-PAGE analysis followed by Autoradiography which

revealed the formation of a discreet band of 170kD. Further studies on Tunicamycin assay are in progress.

3. Mechanism of growth inhibition of EGFR over-expressing cell lines by MAb CIBCNSH3 at different

phases of cell cycle

Carcinoma cells of MDAMB468 cell line were seeded into petri plates and were treated with

varying concentrations of Anti-EGFR MAb for 48h. The treated cells were collected and stained with

propidium iodide and subjected to FACS scan analysis. The results showed the accumulation of cells in Go/

G1 phase with higher concentrations of anti-EGFR MAb and very low % of accumulation of cells in control

group i.e., without MAb. This preliminary study revealed that anti-EGFR MAb could arrest the carcinoma

cells in Go phase and bring about apoptosis.

4) Anti-tumor activity of anti-EGFR MAb in comparison with chemotherapeutic agents like Cisplatin

MAbs directed to the extra cellular domain of EGFR are known to inhibit the growth of

carcinoma cells, thereby preventing tumor cell proliferation and tumor growth. In order to evaluate the anti-

tumor activity of anti-EGFR MAb, in vitro studies have been performed using cell lines with high expression

of EGFR.

About 5X103 cells in 100μl of DMEM were seeded in to a 96-well falcon plate. After

incubation for 4h at 370c, MAb was added at different concentrations in triplicates to the wells and Cisplatin

at a concentration of 2.5μg, 5μg/ml to another set of wells. The cells were further incubated for a period of 4

days. After incubation, the cells were fixed in glutaraldehyde and stained with methylene blue. The O.D was

measured using a BIOTEK ELISA reader. The results showed that the anti-EGFR MAb inhibited cell growth

to a greater extent when compared to the conventional drug Cisplatin. Further studies are in progress.

DEPT OF CYTOGENETICS

ON GOING PROJECTS:

Samples from different types of malignancies from patients are being evaluated for cytogenetic study and

karyotype analysis as routine for diagnosis and primary study for FISH. Samples are being subjected to

short-term culture of 24 hrs, 48 hrs, 72 hrs and 6 days based on the tissue type. Samples are being

processed for fixed chromosomal preparations, G-banding pattern, micro-photography and karyotyping.

Karyotypes are analyzed for numerical and structural chromosomal aberrations especially for reciprocal

chromosomal translocations.

Chromosomal translocations are specific for particular type of malignancy and even sub-types of leukemia.

The findings are being correlated with clinical features, immuno-phenotyping, hematological and histo-

pathological aspects.

DEPT OF ELECTRON MICROSCOPY

COMPLETED PROJECTS:

ULTRASTRUCTURAL CHARACTERIZATION OF SPINDLE CELL TUMORS AND SMALL ROUND CELL

TUMORS:

11 biopsy samples from various sites such as bone, soft tissue, kidney, bladder, etc., which were histo-

pathologically classified as Malignant Spindle cell tumors and 16 samples reported a s Malignant Round cell

tumors were processed for Transmission Electron microscopy. At electron microscopic magnifications, the

spindle cell neoplasms could be further sub-classified. Two were in favor of MFH; one showed thick and

thin filaments with aborted Z lines favoring RMS; one showed features of fibromatosis; one consistent with

GIST where the spindle cells had nuclei with transverse folds and cytoplasmic filaments with focal densities.

Among the round cell malignant tumors, a few dense core granules could be detected in 2 metastatic small

cell carcinomas. In one lymph node biopsy presence of lymphocytes, macrophages and tumor cells with

lipid granules was suggestive of Burkitt's lymphoma.

ONGOING PROJECTS:

FINE STRUCTURAL STUDIES ON FINE NEEDLE ASPIRATION BIOPSIES AND PARAFIIN EMBEDDED

SECTIONS:

Formalin fixed paraffin embedded tissue sections can be processed for Transmission electron microscopy

in situations where fresh specimens are not available. Though ultra-structural features are not well

preserved after formalin fixation, certain characteristic features, which could be identified on screening large

number of sections, would help in confirming the light microscopic findings. A few cases have already been

tried where EM has added to the diagnosis, while in 2 cases features were not definitive. Similarly, a few

fine needle aspirates from soft tissue tumors have been processed for EM. The tumors could be

characterized using these samples also. Studies on the above types of samples are still continuing.

EPIDEMIOLOGY DIVISION AND CANCER REGISTRY

COMPLETED PROJECTS

ICMR project on “Development of an Atlas of Cancer in India” under MMTR, year 2002.

The project envisaged collection of data from the MMTR data sources on invasive cancer cases who

are non-residents of Chennai City. A total of 6256 cases registered during the year 2002 were sent to ICMR

in the prescribed format as required

ICMR project on “Development of an Atlas of Cancer in India” under HCR, Cancer Institute, year

2002.

The project involved abstraction of data from the registry records on all patient attendances. A total

of 6327 cancer cases were computerized and sent to ICMR as required.

ICMR project on “Patterns of Care and Survival Studies on Cancer Cervix, Breast and Head & Neck:

A hospital based study”.

Data on 1060 cases of cancer cervix and 834 cases of female breast cancer, treated in 1997-98 at

CI and followed through 1st January 2003 formed the study material. The complete follow up at 5 years from

diagnosis was 76%. The overall survival at 1,3,5 years from diagnosis were 92%, 69% and 62% for cervix

and 91%, 66% and 59% for breast cancers. A sample of 100 cases of head and neck cancers treated in

2002 were abstracted as part of a feasible study. The data on all the above has been sent to ICMR as

required.

ONGOING PROJECTS

MMTR – partly funded by ICMR

A continuing project since 1982 forming the basis of many research activity in the department including

population based cancer survival and descriptive epidemiological studies.

HCR – partly funded by ICMR.

A continuing project since 1984 forming the basis of the Patterns of care and hospital based survival studies.

ICMR project on “Development of an Atlas of Cancer in India” under MMTR, year 2003.

A continuing activity since 2001. Data on invasive cancers among the non-residents of Chennai City are

collected from the MMTR data sources. A total of 4436 cases have been registered so far. It is estimated

that a total of 6500 cases will form the study material.

ICMR project on “Development of an Atlas of Cancer in India” under HCR, Cancer Institute, year

2003.

A continuing activity since 2001, Data on 2030 cases of invasive cancers attending the Cancer Institute

(WIA), Chennai, in 2003 have been abstracted into the prescribed form so far. This project has enabled the

timely availability of recent data and strengthened the existing HCR.

IARC project on “Estimation of population based survival rates from Common Cancers in Chennai,

India”

A total of 20743 cases of invasive top ten ranking cancers registered in MMTR during 1990-99 formed the

study material. The follow up is nearing completion. The data is to form a part of the second IARC

Monograph on “Cancer survival in Developing Countries” expected to be released in the year 2004.

WHO project on “Awareness and Early Detection of Cancer”

A total of 14706 households have been covered so far and data on 64706 individuals collected so far from

the Thiruvanmiyur area (Div 154 & 155). Apart from three medical camps conducted in the study area, ‘two’

clinics on ‘early detection of cancer’ manned by the personnel from the Cancer Institute (WIA) are regularly

functioning in the Corporation Health Centres. A total of 2500 subjects have attended these clinics. Seven

cancers have been identified: cervix (4), breast (1) and oral cavity (2). A total of 287 cases of pre-cancerous

conditions of all of these cancers have been detected and are on follow up.

Monograph on “Cancer Cervix: A Hospital Based Study”

A total of 13,143 cases of invasive cervix cancers, which received treatment at the Cancer Institute (WIA)

during 1960-94 and followed through 1st January 2003 formed the study material. An increasing trend in

survival over calendar time was forthcoming. (This monograph is a CI Golden Jubilee publication and is

scheduled to be released in June 2004).

Monograph on “Cancer Breast: A Hospital Based Study”

A total of 5688 cases of invasive breast cancers, which received treatment at the Cancer Institute (WIA)

during 1960-97 and followed though 1st January 2003 formed the study material. An increasing trend in

survival over calendar time was forthcoming. (This monograph is a CI Golden Jubilee publication and is

scheduled to be released in June 2004).

DEPT OF RADIATION ONCOLOGY

COMPLETED PROJECTS

HIGH DOSE RATE VERSUS LOW DOSE RATE BRACHYTHERAPY FOR CARCINOMA OF THE

UTERINE CERVIX: A RANDOMIZED COMPARISON OF THE EFFICACY AND NORMAL TISSUE

MORBIDITY

The objectives of this trial were to compare the efficacy of HDR vs. LDR intracavitary brachytherapy

in the treatment of stages II B and III B squamous cell carcinomas of the uterine cervix, and to compute the

doses of irradiation delivered to specific volumes of bladder and rectum with dose volume histograms and to

correlate them with the bladder and rectal morbidities. The eligible patients were stratified by stage and then

randomized into the following two arms:

External radiotherapy + LDR brachytherapy

External radiotherapy + HDR brachytherapy

Teleradiation was given with 6 MV x-rays delivering a total dose of 50 Gy in 5 weeks to the whole pelvis.

LDR brachytherapy was done by a single intracavitary application, delivering a dose of 20 Gy to Point A,

within a week after the completion of teletherapy, at a dose rate of 160 – 180 cGy / hour. In the HDR

brachytherapy arm, three intracavitary applications, with an interval of one week in between, were done by

remote afterloading technique, delivering a dose of 15 Gy to Point A, at a dose rate of 36 - 48 Gy / hour. The

first application was done after 30 Gy of external therapy, so that the overall treatment time was equal in

both arms. Dose volume histograms were obtained, with CT slices of the pelvis taken with the applicators

loaded with dummy sources, and the mean dose values in the bladder and rectal volumes were worked out.

The doses at specific reference points for the rectum and the bladder as defined by the ICRU Report 38

were also calculated. 400 patients were included in the study, 200 patients with stage II B disease and 200

with stage III B disease. 100 patients with stage II B disease and 100 with stage III B disease were

randomized to the HDR arm and the rest to the LDR arm. In the LDR arm, out of the 168 patients who had

completed the treatment and followed up for ≥ 6 months, 151 patients (89.9%) achieved CR. 136 out of 157

patients achieved CR in the HDR arm. The 2-year NED rate was 71.6% in the LDR arm and 75.5% in the

HDR arm. The early morbidities were also comparable in both the arms. The patients are being followed up

for assessing the long-term morbidity in both arms.

REGIONAL HYPERTHERMIA COMBINED WITH RADIOTHERAPY FOR LOCALLY ADVANCED

CERVICAL CANCERS

The objective of this trial was to evaluate the role of hyperthermia in potentiating the local control

achieved by radiotherapy in patients with stages II B, III A and III B squamous cell carcinomas of the uterine

cervix, considered suitable for radical radiotherapy. The eligible patients were stratified by stage and then

randomized into the following two arms:

Radical Radiotherapy

Radical Radiotherapy + Hyperthermia

All patients were treated with 6 MV x-rays to a total dose of 50 Gy in 5 weeks to the whole pelvis, followed

by LDR brachytherapy by remote afterloading technique, delivering a further dose of 20 Gy to Point A. If the

patient was not suitable for intracavitary therapy, teletherapy was continued to a further dose of 15 Gy using

reduced fields. Hyperthermia was delivered immediately following radiotherapy once a week, usually on

Tuesdays, in the radiotherapy + hyperthermia group. Tumor temperature of more than 410 C but not more

than 440 C was attempted and it was maintained for one hour. 100 patients were randomized, 50 in each

arm. 92% of the patients in the Radiotherapy + Hyperthermia arm and 80% of the patients in the

Radiotherapy only arm achieved CR. 2-year NED rates were 84.2% and 66.7% in the study and control

arms respectively. The early reactions appeared to be a little more in the hyperthermia arm compared with

the control arm (7 versus 3), but all the reactions were of grade I or II only, except in one patient who

developed grade III blistering due to hyperthermia. The patients were being followed up for assessing the

long-term effects in both arms.

ONGOING PROJECTS

ATLAS – Adjuvant Tamoxifen Longer Against Shorter

This is a large simple randomized study to asses the efficacy and safety of prolonging the use of adjuvant

tamoxifen in carcinoma breast patients, irrespective of the original histological type of the disease, nodal

status, or whether the tumor was estrogen receptor positive or negative, who have received any type of

curative surgery, with or without any adjuvant therapy, apparently to be free from disease, is receiving

tamoxifen and where both the woman and her doctor are uncertain whether to continue tamoxifen or not.

The women will be randomized either to stop tamoxifen or to continue tamoxifen for at least 5 extra years.

Overall survival analysis will be complemented by subsidiary analyses of deaths from specific causes, such

as breast cancer, myocardial infarction, endometrial cancer, etc. The incidence of second primary tumors,

in particular, contra-lateral breast cancer, other female cancers and liver cancer, non-fatal myocardial

infarctions and other vascular events requiring hospitalization will also be examined. The analyses will be

stratified by the duration of tamoxifen given prior to randomization, age, ER status and by other prognostic

factors recorded at randomization. Altogether 490 patients have been registered in the project. Among them

440 patients have been randomized, 220 are allotted to continue AE and 220 to stop AE. ER study has been

conducted on 245 patients so far (72 are ER positive, 149 ER negative and ER study is not possible due to

poor quality of slides in 24 patients).

DEPT. OF MEDICAL ONCOLOGY

ONGOING PROJECTS

GIPAP (GLIVEC International Patient Assistance Programme). GLIVEC ® (Imatinib) is a new tyrosine

kinase inhibitor which has been approved for use in CML and GIST. The major draw back logistically for its

use is the cost which will be approximately Rs.1 Lakh/month. Novartis in association with Max foundation,

U.S.A, has started the GIPAP programme to assist patients who cannot afford the medicine, by giving it free

of cost. Cancer Institute (WIA) has been identified as one of the 10 centers in India for identifying and

enrolling eligible patients. So far 180 patients have been enrolled from the Institute and are receiving

GLIVEC free of cost. This also includes patients who have been referred from other places in South India

like Coimbatore & Hyderabad.

Late Effects Clinic Assessment of long term toxicities in survivors of paediatric cancer patients

Influence of Cranial Radiation & Chemotherapy of Acute Lymphoblastic Leukaemia children – on

cognitive functioning.

Role of Astymin- 3 (Essential Amino acid preparation) Amino-acid infusion in patients on

chemotherapy or in patients undergoing chemo-radiotherapy.

It is planned to randomize 60 patients for this project. Forty patients enrollment has been completed

so far. The aim of the study is to see whether weekly amino-acid infusion will mitigate the toxicities of

treatment.

Arimidex and Herceptin in metastatic breast cancer.

Totally 7 patients were screened and 2 patients were enrolled for the trial. Both patients had

progressive disease and they have succumbed to their illness.

Randomized phase II trial comparing Paclitaxel + Carboplatin versus Paclitaxel + Carboplatin +

Lactoferrin in unresectable advanced non small cell lung cancer.

DEPT OF SURGICAL ONCOLOGY

COMPLETED PROJECTS:

1. Intra-arterial chemotherapy - pilot study in non-metastatic Osteosarcoma:

Accrual of 12 patients for the intra-arterial chemotherapy arm is completed. All these patients had non-

metastatic extremity osteosarcomas who were borderline for limb salvage surgery due to various reasons.

Of these 12 patients, 2 patients defaulted treatment at various stages before surgery and the remaining 10

patients underwent surgery. Of these 10 patients, 7 patients (70%) underwent a limb salvage surgery

(including one radical fibulectomy). 3 patients underwent amputation after neo-adjuvant chemo and one

underwent amputation post limb salvage surgery for wound infection and secondary haemorrhage.

Of the 10 patients who underwent surgery, 3 patients (30%) had good necrosis (> 90% necrosis). Four

patients are alive without disease, four developed distant metastasis (3 in the lung and 1 in the spine) of

whom one patient expired. Four patients are lost to follow up including the two who did not undergo surgery.

2. Conventional vs. Escalated Dose Chemotherapy Study:-

12 patients have been recruited into the escalated arm and 14 into the conventional arm so far. In the

conventional arm, 9 patients underwent limb salvage surgery and none had an amputation. No patients had

good necrosis following neo-adjuvant chemotherapy (0%). 8 out of 9 patients are alive.

DEPT OF NUCLEAR MEDICINE

COMPLETED PROJECTS:

1.Assessment of response of limb sarcoma to neo-adjuvant chemotherapy with Tc99m Sesta MIBI

The advent of chemotherapy drugs (as neo adjuvant treatment) has facilitated conservative resection (Limb

salvage Surgery) in limb tumors (Bone and soft tissue tumors) .In previous decades mutilating surgeries like

amputation used to be the mode of treatment for these patients. In this context we have studied the uptake

ratio of Tc99m Sesta MIBI in limb tumors before any treatment was given and again after the neo-adjuvant

chemotherapy. Both Osteosarcoma and Ewing’s sarcoma were studied. It has been widely reported that

Multi-drug Resistant gene (MDR1) expression in tumors can give rise to resistance to these drugs. We have

correlated the response of these patients with the washout of MIBI from these tumors.

Methods: 44 patients with limb tumors (34 Osteosarcoma and 10 Ewing’s Sarcoma) were studied. In

Osteosarcoma (OS) patients, the 1st study was done before any chemotherapy and 2nd study after 3-4

courses of chemotherapy. In Ewing’s Sarcoma (ES) patients 1st study was done before any treatment was

given, 2nd after 3 courses, 3rd after 6 courses and 4th after 12 courses of chemotherapy. The uptake ratio

(UR) was calculated by dividing the number of counts in the involved tumor site by the number of counts in

the contralateral symmetrical uninvolved site. Response ratio (RR) was calculated using uptake ratios in the

first two studies in all patients. The wash out ratio of MIBI from the tumor site was also calculated in the first

study. These ratios were correlated with clinical and histopathological responses.

Results: 26 out of 34 OS patients had WR of more than 60 % over a period of 2 hours. Still 19 patients had

responded clinically and had Limb salvage Surgery (LSS).

Conclusion: There was no direct correlation between washout ratios and clinical responses in most of the

patients. Those with high WR had responded clinically and had conservative surgery (LSS).

2.Role of Scinti-mammography in the evaluation of response to Neo-adjuvant chemo radiotherapy in

Ca breast.

Gene resistance is one of the major obstacles in the treatment of patients with chemotherapy. In this study

we have tried to corroborate the wash out rates of Sesta MethoxyIsoButylIsonitrile(MIBI) from the tumour to

the presence of Multi-Drug Resistant (MDR) gene in the tumour cells.

Method: 51 patients were included in the study before they began any treatment. We did a baseline scinti-

mammography before any biopsy was done. A second scan was done a month after the completion of

Chemotherapy and Radiotherapy. The wash out rates have been calculated in the pre and post scinti-

mammogram. Result: We found that all our patients had wash-out rates greater than 60% and yet had

responded clinically to the treatment regime. Conclusion: Discrepancy could be ascribed to heterogeneity of

the tumours, subsets of cells expressing varying and multiple resistant mechanisms may co-exist. Reduced

blood flow to the tumour could be held accountable for poor penetration of MIBI in patients.

DEPT OF RADIOLOGY AND IMAGING SCIENCES

COMPLETED PROJECTS

1. Selective arteriography for intra-arterial chemotherapy in bone tumours prior to limb conservation

procedures.

2. Selective arteriography with contrast radiography identifies feeding vessels in the region of tumors for

effective intra-arterial chemotherapy and has a definite role when limb salvage procedure is contemplated.

ONGOING PROJECTS

1. Value of selective arteriography for evaluation of status of internal carotid artery and collaterals in

evaluation of its ligature in skull base surgeries.

Pre-operative assessment of collateral circulation of ipsilateral internal carotid arterial system is essential for

planning its division. Selective arteriography of contra-lateral internal carotid artery for assessing the

collateral circulation in opposite side, intra-arterial balloon insuflation in ipsilateral internal carotid artery for

45 minutes and immediate R.N.I. of brain for perfusion have been done in five cases. These procedures are

extremely informative in deciding the ligation of internal carotid artery in skull base surgeries.

2. Usefulness of mammo-sonography to evaluate dense breasts imaged with mammography.

About 40-45% of patients screened by mammography have dense breasts. In these cases, mammo-

sonography has been used and is found to differentiate the solid and the cystic lesions and identify and

characterize the calcifications. This is also useful in guided FNAC procedures.

3. Role of Color Doppler mammo-sonography in solid breast lesions.

The vascular color Doppler studies in 15 cases of solid breast mass lesions have yielded valuable

information about blood flow patterns with reference to the characterization of nature of masses – benign

and malignant. Study is continued for evaluation of diagnostic criteria.

DEPT OF PATHOLOGY

ONGOING PROJECTS

1. Role of routine applications of stain for mucin in cervical carcinomas.

Categorization of Cervical Carcinomas based on only of their morphological appearance in

Haematoxylin and Eosin stained sections yield incomplete and often erroneous diagnosis. Many mucin-

secreting carcinomas show a higher incidence of lymph node metastasis and have poorer prognosis.

Routine application of stains for mucin was carried out in 855 cases of cancer cervix and 744 cases were

morphologically thought to be squamous cell carcinomas. After mucin stain 32 cases were diagnosed as

adeno squamous carcinoma and 712 cases were diagnosed as squamous cell carcinomas. Without mucin

stain 9.5% cases would have been diagnosed as squamous cell carcinomas erroneously.

2. Study of Helicobacter pylori in patients presenting with gastric symptoms and to evaluate any

possible role with gastric cancer:

H.pylori is a gram-negative spiral bacilli and is a causative agent in the development of chronic

antral gastritis and leads to atrophic gastritis. This condition predisposes to pre cancerous changes in the

stomach. The infection rarely resolves spontaneously and the bacteria remains in the gastric epithelium for

years giving rise to gastritis and atrophy. Antibacterial therapy can eradicate H.pylori.

In our Institute 186 cases of gastric biopsies were suitable for H.pylori study by Giemsa stain. Out of them

83 cases showed positive staining for H.pylori (44.6%). Most of the H.pylori positive cases showed antral

gastritis. Seven adenocarcinoma patients out of 40, also showed associated H.pylori infection (17.5%). All

these H.pylori positive patient will be followed up to see whether these cases will lead to any malignancy or

not. Giemsa staining is an easy stain and can be carried out routinely for all gastric biopsies. Antral biopsy

is ideal for H.pylori study and all gastric patients should have biopsy from gastric antrum along with biopsy

from site of lesion.

DEPT OF CYTOLOGY

COMPLETED PROJECTS

Cell Block Studies In Urine Cytology

The aim of the study is to see whether cell block technique will improve the diagnostic accuracy of

urine cytology where the material is hemorrhagic.

Urine cytology is a very useful technique for the diagnosis of Carcinoma of the bladder. However in

many cases where the urine specimen is mixed with blood the processing becomes difficult and the

resultant smears may not be very representative. This study was initiated to see where the cell block

technique using the centrifuged deposit from the urine samples will improve the pick up of malignant cells.

67 samples of blood mixed urine were studied . Pap stained smears and cell blocks of urine sediment were

studied. 33 smears were positive for malignant cells. While the cell block showed positive in 35 cases. All

cases which showed malignant cells by Pap stained smears were positive by cell block technique. In two

cases where the smear did not show malignant cells the cell block sections show few groups of malignant

cells.

RESULT: Cell block techniques in hemorrhagic urine samples improved the pickup of malignant cells

marginally. It is very likely that the pick up can be improved if RBCs are lysed before cell blocks preparation

is done.

DEPT OF CLINICAL MICROBIOLOGY

ONGOING PROJECTS

Increasing incidence of Coagulase Negative Methicillin resistant Staphylococcal infection.

Coagulase negative staphylococci formerly regarded as harmless inhabitants of the skin and

mucosal linings are now recognized as a major cause of nosocomial infections in wards and ICU’s

We isolated about 18 strains of coagulase negative methicillin resistant staphylococci CONMAR from blood,

pus and respiratory samples. Identification of staphylococci as coagulase negative was based on absence of

coagulase enzyme, production of catalase and use of mannitol salt agar medium. These methicillin resistant

isolates expressed resistance to multiple antibiotics, being sensitive only to Vancomycin, Teicoplanin,

Linezolid, Imipenem and Clindamycin.

Specimens/samples

Blood Pus Tracheal Throat swab 11 3 2 2

Among the 11 CONMR staphylococcal blood isolates 9 (81%) were from pediatric patients causing

bacteremia. Hence coagulase negative staphylococci should be kept in mind as the cause of nosocomial

bacteremia in pediatric patients.

DEPT OF MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING

COMPLETED PROJECTS:

1. Study on the variation in implant catheter positions in interstitial HDR brachytherapy

2. Studies of lung, heart and brain using radio-nuclide imaging

3. Comparison of reconstruction methods and volume determination in SPECT imaging.

4. Development of a user friendly soft ward for simple dosimetric calculation in radiotherapy.

5. Clinical implementation of IAEA TRS 398 dosimetric protocols for high energy photon and electron

beams.

6. Clinical implementation of AAPM TG 51 dosimetric protocols for high energy photon and electron beams.

7. Fabrication of indigenous Farmer type ionization chamber and TPR 20/10 water phantom.

ONGOING PROJECTS

1. An analysis of TG21,TG51 ,TRS277 and TRS 398 protocols for calibration of high energy

photon and electron beams using water proof chambers and in water.

2. QA Testing of RFA and Eclipse Treatment Planning Systems based on AAPM TG53 protocol.

BLOOD BANK

COMPLETED PROJECT

Transfusion transmitted virus study.

The incidence of hepatitis in immuno compromised patients (Medical Oncology cases) like

AML/ALL/Lymphoma at the Institute was studied and the role of transfusion inducing hepatitis is found to be

negligible.

ONGOING PROJECT

To study the benefits in the use of irradiated blood components.

Transfusion associated GVHD (TA-GVHD) is an intensive immunologic reaction mediated by

transfused immuno competent lymphocytes directed against an immuno compromised host. Prophylactic

gamma irradiation of cellular blood components is currently the most efficient and reliable way to prevent

TA-GVHD.

PUBLICATIONS

1. Rajkumar T and Vijayalakshmi N. Is there a role for surrogate markers of pre-malignant lesions of cervix

in India? Proc. Indian Natl Sci Acad. B69 (1), 73-82, 2003.

2. Rajkumar T, Sridhar H, Balaram P, Vaccarella S, Gajalakshmi V, Nanadakumar A, Ramdas K, Munoz N,

Herrero R, Franceschi S and Weiderpass E. Oral cancer in Southern India: The influence of body size,

diet, infections and sexual practices. Eur. J. Cancer Prevention, 12, 135-143, 2003.

3. Rajkumar T, Franceschi S, Vaccarella S, Gajalakshmi V, Sharmila A, Snijders PFJ, Munoz N, Meijer CJL,

Herrero R. The role of paan chewing and dietary habits in cervical carcinoma in Chennai, India. Br J

Cancer, 88: 1388-1393, 2003.

4. Franceschi S, Rajkumar T, Vaccarella S, Gajalakshmi V, Sharmila A, Snijders PFJ, Munoz N, Meijer CJL,

Herrero R. Human papilloma virus and risk factors for cervical cancer in Chennai, India: A case control

study. Int. J Cancer, 107: 127-133, 2003.

5. Rajkumar T, Soumittra N, Nirmala Nancy, Swaminathan R, Sridevi V, Shanta V BRCA1, BRCA2 and

CHEK2 (1100 del C) germline mutations in hereditary breast and ovarian cancer families in South India.

Asian Pac J Cancer Prevent. 4: 203-208, 2003.

6. Rajkumar T. Cancer in the next decade. Reach, 2003.

7. Nirmala Nancy and Rajkumar T Detection of minimal residual disease in ALL. Lalit Kumar ed., Progress

in Haematologic Oncology. The Advanced Research Foundation, New York. 45-60, 2003.

8. Herrero R, Castellsague X, Pawlita M, Lissowska J, Kee F, Balaram P, Rajkumar T, Sridhar H, Rose B,

Pintos J, Fernandez L, Idris A, Martinez C, Nieto A, Talamini R, Tavani A, Bosch FX, Snijders PJF,

Viscidi R, Munoz N, Franceschi S. The viral etiology of oral cancer: evidence from the IARC multi-center

study. JNCI, 95: 1772-1783, 2003.

9. Rajkumar T. Molecular mechanisms of cancer. Dr.V.Shanta, ed., Update in Oncology, Indian Journal of

Clinical Practice (in press).

10.Rajkumar T. Hereditary cancers. Dr.V.Shanta, ed., Update in Oncology, Indian Journal of Clinical

Practice (in press).

11.Rajkumar T. Molecular Biology of oesophageal cancer. S.Subash, ed., Principles and practical

procedures in cancer oesophagus. Jaypee Brothers Medical Publishers (P) Ltd. (in press).

12.Rajkumar T, Soumittra N, Durgatosh Pandey, Karunakaran Nirmala Nancy, Vikas Mahajan and Urmila

Majhi. Mutation analysis of hMSH2 and hMLH1 in colo-rectal cancer patients in India. Genetic Testing (in

press).

13.Rajkumar T, Gopal G, Selvaluxmi G. CDC27 is involved in radiation response in squamous cell

carcinoma of the cervix. Eur J Gynaecol Oncol. (Accepted).

14.Shanta V, Gajalakshmi V, Swaminathan R. India, Chennai (Madras). In: Cancer Incidence in Five

Continents, Vol. VIII. (eds) Parkin DM, Whelan SL, Ferlay J, Teppo L and Thomas DB. (2002), IARC

Scientific Publications No. 155, Lyon, IARC. pp 236-237.

15.Shanta V, Swaminathan R and Kavitha M. Population Based Cancer Registry, Chennai: Cancer Institute

(W.I.A), Adyar, Chennai, In: Two year Report of the Population Based Cancer Registries, 1997-98.

National Cancer Registry Program, Indian Council of Medical Research, New Delhi, 2003, pp 88-97.

16.Shanta V, Swaminathan R and Rama R. Hospital Based Cancer Registry, Cancer Institute (W.I.A),

Adyar, Chennai (Madras). In: Five Year Consolidated Report of the Hospital Based Cancer Registries

1994-98- An assessment of the burden and care of cancer patients. National Cancer Registry Program,

Indian Council of Medical Research, New Delhi, 2003, pp xxi-xxii.

17.Shanta V, Swaminathan R and Rama R. Cancer Institute (W.I.A), Chennai: A seat of hospital and

population based cancer registries. SOUVENIR, XIX Annual Review Meeting of the National Cancer

Registry Program, New Delhi 2003.

18.Swaminathan R, Rama R and Shanta V. An appraisal of active follow up system in the hospital cancer

registry, Cancer Institute (W.I.A), Chennai. CRAB 2003; 10(1):23-29.

19.Swaminathan R. Theoretical concepts of logistic regression. In: Jayakumari s and Jayadevan S (eds)

Proceedings of the “Workshop on Application of Logistic Regression in Medical Research, Academy of

Medical Sciences, Kerala, 2003.

20.Shanta V, Swaminathan R, Nalini S, Rama R and Kavitha M. Hospital & Population Cancer Registries,

Cancer Insititute (W.I.A), Chennai, 2001-2002. Consolidated report on “Development of an Atlas of

Cancer in India”, World Health Organization, New Delhi and Indian Council of Medical Research, New

Delhi, 2003. (In press)

21.Swaminathan R, Shanta V, Rama R. Cancer registration, pattern and trend in India in the last two

decades. (In press) Indian Journal of Clinical Practices (Oncology Update).

22.Shanta V and Swaminathan R. Cancer incidence and mortality in Chennai: A Biennial Report,

1999-2000. Madras Metropolitan Tumor Registry, Indian Council of Medical Research, 2003. (In press)

23.Shanta V. Swaminathan R and Rama R. Biennial Report 1999-2000 of the Hospital Cancer Registry,

Chennai, National Cancer Registry Program, Cancer Institute (W.I.A), Chennai, 2003. (In press).

24.R.Krishnakumar, R.Priyadarshini, K.Manivannan, B.Shanmugasundaram, Anuradha Quantification of

Right to Left Shunt by Tc99m Macro aggregated Albumin - A case report. Indian Journal of Nuclear

Medicine, September 2003.

25.R.Krishnakumar, R.Priyadarshini, B.Shanmugasundaram, Bulkis Begum, Anuradha. Assessment of

response of limb sarcoma to neoadjuant chemotherapy with Tc99m Sesta MIBI. World Journal of Nuclear

Medicine-supplement (in press).

26.R.Krishnakumar, R.Priyadarshini, Bulkis Begum. “Comparison of Ga 67 and Tc99m Tetrofosmin uptake

in lymphoma. World Journal of Nuclear Medicine-supplement (in press).

27.R.Krishnakumar, R.Priyadarshini, Balkis Begum, B.Shanmugasundaram, K.Manivannan "Cerebral

perfusion SPECT study in base of skull tumors - C.I. experience”. World Journal of Nuclear medicine (in

press).

28.A.Meenakshi, R. Suresh Kumar, V. Ganesh and N. Sivakumar. Immunohistochemical assay (IHC) to

study C-erbB-2 status of breast cancer using monoclonal antibody CIBCgp185”. Human Antibod, 2003.

29.Srivani R, Pritibha K, Selvaluxmy G, Nagarajan B, Molecular logistics of cytokines in cervical cancer.

Current Science, Vol 84, No 3, 434-438, 2003.

30.Srivani R and Nagarajan B. (2003) A Prognostic Insight on in Vivo Expression of IL-6 in Uterine Cervical

Cancer. Int. J. Gynecol Cancer 13: 331-339.

31.A Gey, P Kumari, A Sambandam, F. Lecuru, L. Cassard, C. Badoual, C Sautès- Fridman, B Nagarajan,

WH Fridman, E Tartour. (2003) Identification and characterization of a group of cervical carcinoma

patients with profound downregulation of intratumoral type 1 (IFNγ) and type 2 (IL-4) cytokine mRNA

expression. Eur J. Cancer, 39: 595-603.

32.Nagarajan B (2003) Prognostic Markers in Human Epithelial Tumors. Proceedings Int. Congress Anti

Cancer Treatment Paris.

33.Nagarajan B (2003) Molecular Characterization of Human Epithelial Tumors. Dr. V.R.Khanolkar Oration,

National Academy of Medical Sciences.

34.Ravoori S., Vadhanam MV., Nagarajan B., Gupta RC (2003) Modulation of novel subgroups of DNA

adducts during human cervical cancer development. Proc. Am. Assoc. Cancer Res., Vol. 44, pp. 111

35.Shirley Sunder Singh, Urmila Majhi, Anita Chandra. Adeno cortical Carcinoma in Children. Indian Journal

of Medical and Paediatric Oncology, Vol 23 No.3 – 4. Sep – Dec 2002.

36.Shirley Sunder Singh, Urmila Majhi et al. Bilateral adrenal metastases from bilateral small cell

neuroendocrine carcinoma of the ovary-Indian Journal of Surgery, Vol.65(4) Pages 378-380, 2003.

37.Shirley Sunder Singh, Urmila Majhi, et al. Sclerosing Hemangioma of the lung – A case Report- J Indian

Medical Association (in press).

38.Shirley Sunder Singh, Urmila Majhi, et al. Gynandroblastoma of the ovary- Indian Journal of cancer (in

press).

39.Shirley Sunder Singh, Urmila Majhi, et al. Infantile heamangioendothelioma of the liver- Annals of

National Academy of Medical sciences (in press).

40.Sagar T G, Chandra A, Ramanan S G. Childhood Hodgkin’s disease treated with COPP/ABV hybrid

chemotherapy. A progress report. Med Pediatr Oncol 2003; 40: 66-69.

41.Anita Chandra, T.G.Sagar, ShirleySunder Singh et.al. Primary fibrosarcoma of the Ovary. Indian Journal

of Pathology and Microbiology (in press).

42.T.G.Sagar, Anita Chandra. “Hodgkin’s Disease” chapter in Postgraduate Oncology Update. (in press).

43.T.G.Sagar, S.G.Ramanan, P.S.Sreedharan. Ifosphamide based intensive MCP-842 protocol in diffuse

intermediate and high grade NHL. Indian Journal of Medical & Paediatric Oncology 2003; 24(3).

44.Sreedharan P.S. Leukaemia & Lymphoma chapter in ‘Case book of haematology ‘ Jaypee brothers.

45.T.G.Sagar "How do I treat Childhood Hodgkin’s Lymphoma". Indian Journal of Medical & Paediatric

Oncology (in press).

PRESENTATIONS

Dr. Shanta V, Chairman, Cancer Institute (W.I.A) & Principal Investigator, ICMR, was an invited speaker in

the following:

1. “XII Annual Gynaec Oncology Meeting” (AIGCON) held at CMC Vellore on 27th Nov 2003 – Chief

Guest.

2. “Dr. M.Snehalatha Memorial Oration” at the Government Royapettah Hospital. Topic

–“Contemporary issues in Ovarian Cancer” on 6th Nov 2003.

3. “International Network for Cancer Treatment and Research (INCTR) – Breast Cancer Strategy

Group Meeting” held at Cairo, Egypt during 16-17 Oct 2003- Invited to attend the meeting.

4. “Workshop on Lymphoma” held at Cairo, Egypt during 16-17 Oct 2003- Invited to attend the

workshop.

5. “Challenges are conquered – Update in Medical Oncology” at Continued Medical Education

Programme organized by the Arignar Anna Memorial Cancer Hospital, Kancheepuram in September

2003

6. “Cancer-what one needs to know” - Invited speaker in “Science city-popular lecture series” in

September 2003

7. “IV Annual Surgical Oncology Workshop -Gynaec Maligancy” held in January 2003 at Cancer

Institute (W.I.A) Chennai – Invited speaker on “An overview of Gynaec malignancy in India”

Dr.R.Swaminathan was an invited speaker in the following:

1. “WHO Workshop on community Based Research in Oncology” held at the Regional Cancer Centre,

Patna, during Nov 29-30, 2003.- Invited speaker on the “System of active follow up at Cancer

Institute (W.I.A), Chennai” and presented the results of the “Modified District Cancer Control

Program conducted at Tiruchi & Perambalur districts in Tamil Nadu in 2001-2002

2. XIX Annual Review Meeting of Cancer Registries, National Cancer Registry Program of ICMR,

November 11-14, 2003 - delivered lectures on

(i) An overview of MMTR and operational strategies to other registries for improving the

quality of registration

(ii) Cancer incidence and mortality in Chennai, India: 1999-2000 and

(iii) Results of the feasibility of conducting the study on Patterns of Care and Survival from

cancers of the cervix and female breast, based on retrospective Hospital Cancer

Registry data.

3. Workshop on “Current trends in Bio-Statistics” organized by the Madurai Kamaraj University,

Madurai. - Lecture on “Recent Developments in Methods for Cancer Survival Analysis” on 1st Oct

2003.

4. Modified District Cancer Control Program - Review meetings held by the Ministry of Health,

Government of India at New Delhi on March 20, 2003. Presented the analysis of data collected from

more than 200,000 subjects in the districts of Trichy and Perambalur in Tamil Nadu.

5. “Workshop on Can Reg 4/ ICD-O-3” held at Bangalore, 4-7 March 2003, organized by the Indian

Council of Medical Research in collaboration with International Agency for Research on Cancer,

Lyon, France – an invited delegate.

6. “Training Workshop on Tobacco Cessation for the establishment of Tobacco Cessation Sub-

Centres” held at Cancer Institute (W.I.A.) Chennai on 13th Feb 2003 – Talk on “Tobacco Related

Cancers in Chennai– Incidence and Trend”

7. Workshop on “Application of Logistic Regression in Medical Research” held at Dept. of Community

Medicine, Academy of Medical Sciences, Kannur, Kerala on 10th Jan 2003 – Lecture on “Theoretical

concepts of logistic regression” and a faculty member.

Dr. Nalini, Tutor was an invited speaker in XIX Annual Review Meeting of Cancer Registries National

Cancer Registry Program of ICMR, November 11-14, 2003 handled the exercises on extent of disease and

coding.

Mrs R. Rama, Statistical Assistant, was an invited speaker in XIX Annual Review Meeting of Cancer

Registries National Cancer Registry Program of ICMR, November 11-14, 2003 - delivered lecture on the

Hospital Cancer Registry at Cancer Institute.

Ms M Kavita, Statistical Assistant, was an invited speaker in XIX Annual Review Meeting of Cancer

Registries National Cancer Registry Program of ICMR, November 11-14, 2003 – dealt with the statistical

methods for cancer registry in cancer registration and exercises.

Dr. B. Nagarajan has been awarded with the prestigious Dr. V.R. Khanolkar Oration from the Academy of

Medical Sciences (India) and the oration was delivered in April 2003 at Indore.

Dr. B. Nagarajan delivered a Guest lecture at the Association of Radiation Oncologists, Cochin November

2003.

Dr. B. Nagarajan Guest lecture at the International Conference on Cancer Research, Silchar, Assam

December 2003.

Dr.T.G.Sagar delivered a lecture titled INCTR 02-04-protocol meeting at Tata Memorial Hospital, Mumbai,

March 2003.

Dr.T.G.Sagar gave a lecture titled “Metastatic Breast Cancer “ at Oncology 2003 at Tata Memorial Hospital,

Mumbai, April 2003..

Dr.P.S.Sreedharan spoke on “Newer agents in CML and Cancer Institute experience with Glivec” – CME at

Cancer Institute. April 2003-

Dr.S.G.Ramanan gave a lecture titled ‘Role of growth fractors in haematology’ in the symposium sponsored

by Dr.Reddys Laboratory , Chennai.

Dr.S.G.Ramanan delivered a lecture titled ‘Role of chemotherapy in Non-small cell lung cancer’ AROI

TamilNadu Chapter meeting.

Dr.S.G.Ramanan spoke on the ‘Role of pegylated liposomal anthracycline’ in the Kerala chapter of AROI

meeting held at Calicut.

Dr.S.G.Ramanan participated in the CME at Vadodara – He was a panelist on the discussion on gynaec

malignancy and spoke on the role of chemotherapy in breast cancer.

Dr.S.G.Ramanan gave a lecture titled "Role of chemotherapy in gynecologic Malignances" in the Oncology

CME at Vijayawada.

Dr.Ramachandran presented a Poster "Carcinoma Ovary – Neoadjuvant Chemotherapy, CI experience" in

the Gynaec Oncology workshop at CI, Chennai, January 2003.

Dr.Ramachandran presented a Poster on "Nasopharynx Carcinoma - Chemotherapy with radiotherapy".

Extending Horizons meeting in February 2003, Mumbai.

Dr.Pranoy presented a poster on "Lymphoma of orophaynx & nasopharynx" in the 2nd National meet on

Head & Neck Oncology at Calcutta, January 2003.

Dr.Parnoy presented a poster titled "Extranodal NHL" in the Extending horizons meeting held in February

2003, Mumbai.

Dr. A. Vasanthan delivered Dr. Ida B. Scudder Memorial Oration titled, “Clinical trials in carcinomas of the

buccal mucosa, uterine cervix and stomach and extremity soft tissue sarcomas” in the Nineteenth Annual

Conference of the Association of Radiation Oncologists of India (Tamil Nadu & Pondicherry chapter) held at

Chennai in November, 2003.

Dr. A. Vasanthan delivered the Presidential Address during the inauguration of the 19th Annual conference

of the Association of Radiation Oncologists of India, Tamil Nadu and Pondicherry chapter, which was held in

November, 2003 at Chennai.

Dr. A. Vasanthan was the moderator of the panel discussion on the management of uterine cervical

cancers during the Nineteenth Annual Conference of the Association of Radiation Oncologists of India

(Tamil Nadu & Pondicherry chapter) held at Chennai in November, 2003. Dr. G. Selvaluxmy was one of the

panelists and she discussed her experiences in Brachytherapy of uterine cervical cancers.

Dr. G. Selvaluxmy presented a paper titled, “High dose rate versus low dose rate brachytherapy for

carcinoma of the uterine cervix: A randomized comparison of the efficacy and normal tissue morbidity” in the

25th National Annual Conference of the Association of Radiation Oncologists of India, held at Kochi, in

November, 2003.

Dr.Puspha Viswanathan gave an invited talk on “ Fundamentals of Transmission Electron Microscopy" at

Saveetha Dental College, Chennai on 21st Aug. 2003.

Dr.Puspha Viswanathan gave a talk on “Heavy Metal Status in Food” at Madras Veterinary College,

Chennai on 20th Nov. 2003 at the Seminar on “Occurrence, detection and control of pollutants and

contaminants in dairy and food industry”.

Shirley Sunder Singh made a Oral presentation titled "Pathological assessment of response to

neoadjuvant chemoradiotherapy in locally advanced breast cancer and an evaluation of variables

associated with complete response", in the IAPM Conference held in Orissa.

Shirley Sunder Singh made a Poster presentation titled "Unusual sites of metastases from primary tumours

involving the skin, ovary and eye" in the IAPM Conference held in Orissa.

Dr.Ravi Kannan spoke on Oral Cancer and prevention at Carborundwin Universal Ltd. in Chennai on

26.02.2003.

Dr.Ayyappan spoke on Skin cancer at the Annual Rapid Review Course 2002-2003 held at SRMC on

14.02.03.

Dr.R.Ravi Kannan spoke on Oral Cancer at the Annual Rapid Review Course 2002-2003 held at SRMC on

19.02.03.

Dr.Ravi Kannan went to Silchar to Cachar Cancer Centre for transfer of Surgical Technology in Oncologic

Surgery and demonstrations of surgery in March 2003 and again in Nov. 2003.

Dr.Ravi Kannan attended the Head and Neck Oncology Conference between 1st and 5th Oct. 2003 held at

New Delhi and was a panellist in a discussion on (a) Thyroid Cancer, (b) Hypopharyngeal Cancer, (c)

Salivary Gland, (d) Oral Cancer. He also gave a lecture on Management options in cancer of tongue.

Dr.Ravi Kannan spoke on Reconstruction of Tongue Cancer in a symposium on Tongue Cancer on

10.10.2003, at the Asia Pacific Cancer Congress held at Bali, Indonesia.

Dr.Ravi Kannan went to IMSACON 2003, Kochi on 26th - 28th Sept. and spoke on Advances in

Management of oropharyngeal.

Dr.Ravi Kannan attended a conference on malignancies in Cachar Cancer Hospital on 2nd - 4th Dec. 2003

and performed demo surgery.

Dr.Vikash Mahajan went to Singapore and attended a workshop on Nutrition Franc Asia 2003. He also

observed liver transplant and liver surgery with Dr.K.C.Tan and at Singapore General Hospital.

Dr.Ayyappan attended a laparoscopic surgery workshop held at Coimbatore in Nov. 2003.

Dr.Durgatosh Pandey went to Kanchipuram and presented a paper on Testicular Cancer.

Dr.Ravi Kannan was a panellist in a discussion on Management of Papillary Carcinoma Thyroid organised

on 21st June 2003 in Chennai City Br. of ASI.

Dr.Sridevi went to Gem Hospital, Coimbatore for 2weeks from 3rd March 2004 to 15th March 2004, as a

trainee in basic advanced laparoscopy.

Dr.Sridevi attended CME organised by IMA at Vijayawada on Gynaecologic malignancies in December

2003.

Dr.Sridevi attended II Annual Conference of Association of Gynaec Oncologist at CMC, Vellore between

27th Nov.2003 and 29th Nov. 2003.

R.Krishnakumar presented two papers at the Asian Regional Cooperative Council for Nuclear Medicine,

6-8 February 2003, Dhaka, Bangladesh

a. Assessment of response of limb sarcoma to neoadjuant chemotherapy with Tc99m Sesta MIBI (Oral)

b. Comparison of Gallium-67 and Tc-99mTetrofosmin uptake in lymphoma (Poster)

Dr.R.Krishnakumar presented a paper on the “Postoperative management of Differentiated Thyroid Cancer

at the Institute with I 131 and subsequent follow up” at the National Consensus Conference on the

management of Differentiated Thyroid Cancer, organized by the Amrita Institute of Medical Sciences &

Research Centre, Kochi, April 12 & 13th, 2003

Dr.R.Krishnakumar presented a paper on “Cerebral Perfusion SPECT studies in Base of Skull Tumors

management - C.I. experience” at the X Annual Conference of Medical Physics and Radiation Safety. 30th &

31st, Aug 03 held at Chennai.

Dr.R.Krishnakumar presented a paper on “Tumor imaging with Isotopes” at the 9th annual Conference of

SNM (I) Southern chapter held at Chennai, Sep13th, Sep.03.

Dr.R.Krishnakumar presented a paper “SestaMIBI- is it a predictor of treatment response in tumors? ” at

the 1st annual Conference of Association of Nuclear Medicine Physicians of India (ANMPI) held at Chennai,

Sep., 03.

Dr.R.Krishnakumar presented a paper “Sesta MIBI- Is it a predictor of treatment response in tumors? ” at

the 19th annual Conference of the Association of Radiation Oncologists of India (TN and Pondicherry

chapter) held at Chennai, 1st, 2nd, Nov.2003.

Dr.R.Thendral presented a paper titled “Anesthetic management of esophagectomy – 7 years experience

from teriary care center” – in the Indian Society of Anesthesiologist conference, held in Aug, 2003.

Dr.T.Rajkumar gave a guest lecture in

• IBMS, Taramani on “Hereditary cancer”.

• Cancer Institute (WIA) on the National Technology Day on “Molecular revolution coming your way”.

• Janaki College for Women, on “ABC of Cancer”

• IIT, Madras on “ Molecular approaches to cancer prevention”.

• XVII APCC conference in Bali, on “Biological basis of CT+RT in nasopharyngeal cancer”.

• National AROI meeting in Kochi on

i. “Molecular Biology of breast cancer”,

ii. “Molecular markers of diagnostic and prognostic significance in cervical

cancer”.