Cancer Research by Dr. A.K.D’Cruz – Tata Memorial Centre: Reported by Dr. Nilesh D. Mehta
Head and neck cancer is a common malignancy in several regions of the world. The primary risk factors associated with head and neck cancer include tobacco use, alcohol consumption, and certain viruses. Human papillomavirus and Epstein-Barr virus (EBV) have also been implicated in certain head and neck cancers.
In the western world, there is a higher prevalence of HPV related oral cancers. Oral cancer affects more than 300,000 people worldwide and is especially common in parts of the world where tobacco use is high. Tobacco use and excessive alcohol consumption are estimated to account for 90% of oral cancer diagnosis. Mouth and tongue cancers are more common in the Indian subcontinent whereas in the United States, head and neck cancer accounts for 3 percent of malignancies, with almost 60,000 Americans developing head and neck cancer annually and 12,000 dying from the disease.
Given the magnitude of this malignancy in India, Dr. A. K. D’Cruz embarked upon an extremely important clinical trial at Tata Memorial Centre in Mumbai, India. There has been an age-old debate about the management of neck nodes in patients who present with early stage oral cancers. Historically, two options have been utilized with either a wait and watch approach and performing a therapeutic neck dissection at the time of disease becoming apparent in the neck. Alternatively, elective neck dissection is also performed at the same time as treating the primary oral cancer. Which of these two options is superior? This question has been unanswered for decades.
Results of the first 500 patients of this clinical trial from Tata Memorial Centre in India were presented at the Plenary session of ASCO meeting in Chicago on May 31, 2015. Plenary sessions are reserved for extremely important and practice altering research that affects day-to-day lives of our patients.
This clinical trial was initiated at Tata Memorial Centre, Mumbai in 2004 and the results revealed that elective neck dissection improves overall survival by 12.5% compared to a Wait and watch approach and reduces risk of death by 36%. Importantly, elective neck dissection reduces the risk of recurrences compared to a Wait and watch approach by 55%. In his concluding remarks, Dr. A. K. D’Cruz, Director of Tata Memorial Hospital, Professor and Chief Head Neck Services, mentioned, “elective neck dissection should be the standard of care for early oral node negative squamous cell cancers”. For every eight patients who undergo elective neck dissection, one death is prevented. For every four patients who undergo elective neck dissection, one recurrence is prevented.
Following his excellent presentation, Dr D’Cruz was kind enough to share some thoughts on cancer care with me. He was particularly eager to share a National Cancer Grid in India that is a consortium of 63 hospitals collaborating information sharing and thus being able to streamline cancer care. This initiative is likely to gather momentum in various parts of the country and ultimately will lead to better cancer care in India. This is being supported by Department of Atomic Energy and the focus is to practice evidence based medical treatment. Dr Cruz who received his initial medical education in Bangalore has become a pioneer in the management of head and neck cancers in India. He is the President of Foundation of Head and Neck Oncology. His presentation was received extremely well while he eloquently shared information to cancer doctors from over 100 countries.
Dr. D’Cruz’s efforts were supported by his entire team that included M. Dandekar, R Vaish, N Kapre, S Gupta, R Hawaldar, S Kane, S Arya, S Ghosh-Laskar, JP Agarwal, G Pantvaidya, D Chaukar, A Deshmukh, P Chaturvedi, P Pai, S Nair, D Nair, R Badwe.
Ironically, his presentation on oral cancer coincided with World No-Tobacco Day on May 31, 2015.
Dr. Nilesh D. Mehta MD, FACP