TATA MEMORIAL CENTRE A Grant-in-Aid Institution of the Department of Atomic Energy, Government of

Tata Memorial Hospital

Centre for Epidemiology

Advanced Centre for Treatment, Research and Education in Cancer

ANNUAL REPORT 2014 -15 Mission & Vision of the Tata Memorial Centre

Mission Statement : “The Tata Memorial Centre mission is to provide comprehensive cancer care to one and all through our motto of excellence in service, education and research”. Vision of the Tata Memorial Centre “As the premier cancer centre in the country, we will provide leadership for guiding the national policy and strategy for cancer care by: Promoting outstanding services through evidence based practice of oncology. Emphasis on research which is affordable, innovative and relevant to the needs of the country. Committed to impart education in cancer for students, trainees, professionals, employees and the public”.

2 Tata Memorial Centre Annual Report 2014-2015 CONTENTS

Messages Director TMC ...... 7 Director TMH ...... 9 Director (Academics) ...... 10

Governing Council ...... 11 Awards ...... 12 Campaigns ...... 13 Executive Summary ...... 14 TMC Annual Events ...... 18 Augmentation of New Facilities...... 19 Visitors ...... 21 Trends ...... 22 Performance Statistics ...... 23 TATA MEMORIAL HOSPITAL Disease Management Group [DMG] Adult Hematolymphoid ...... 28 Bone and Soft Tissue ...... 31 Breast Services ...... 33 Gastrointestinal ...... 38 Gynecology ...... 40 Head and Neck ...... 44 Neuro - Oncology ...... 49 Pediatric Hematolymphoid ...... 52 Pediatric Solid Tumors ...... 56 Thoracic Oncology ...... 58 Uro-Oncology ...... 61 DMG Support Services Clinical Nutrition...... 63 Dental & Prosthetic Surgery ...... 63 Occupational Therapy ...... 64 Physiotherapy ...... 64 Pulmonary Medical Unit...... 65 Speech Therapy ...... 65 Departments Anesthesiology, Critical Care & Pain...... 66 Plastic & Reconstructive Surgery ...... 68 Palliative Care ...... 69 Psychiatry ...... 70

Tata Memorial Centre / DMG 3 Pathology ...... 71 Biochemistry ...... 72 Cytopathology ...... 73 Hematology ...... 74 Molecular Pathology ...... 75

Cancer Cytogenetics ...... 77 Microbiology ...... 78 Transfusion Medicine ...... 79 Nuclear Medicine & Molecular Imaging ...... 80 Radio-Diagnosis ...... 81 Medical Physics ...... 83 General Medicine ...... 84 ...... 85 Staff Clinic ...... 86 Tissue Bank...... 87 Digital Library ...... 88 Information Technology ...... 89 Medical Graphics ...... 90 Administration Medical Administration ...... 91 Medical Social Service ...... 91 General Administration ...... 92 Research TMC Research Administration Council [TRAC] ...... 98 Clinical Research Secretariat / DAE Clinical Trial Coordinator [CRS / DAE CTC] ...... 99 Institutional Ethics Committee [IEC] ...... 100 Data Safety Monitoring Subcommittee [DSMSC]...... 105 Research Projects ...... 107 Education Academic Activities ...... 118 List of PG Superspeciality Courses ...... 119 Training Programmes ...... 120 Conferences / Workshops ...... 121 Staff Achievements...... 123 Centre for Cancer Epidemiology Cancer Epidemiology ...... 128 Preventive Oncology ...... 129 Medical Records, Biostatistics and Epidemiology ...... 130

4 Tata Memorial Centre Annual Report 2014-2015 ACTREC Message from the Director, ACTREC ...... 132 Overview of ACTREC ...... 133 Clinical Research Centre  Department of Medical Oncology ...... 137  Department of Radiation Oncology ...... 138  Department of Surgical Oncology...... 139  Department of Anaesthesiology, Critical Care and Pain ...... 140  Department of Radiodiagnosis ...... 141  Department of Transfusion Medicine ...... 142  Department of Nursing ...... 143  Pathology Lab ...... 144  Hematopathology Lab ...... 145  Microbiology Lab ...... 146  Composite Lab ...... 147  Clinical Pharmacology Lab ...... 148  Translational Research Lab ...... 149  Biomedical Engineering Lab...... 150 Cancer Research Institute  Bhattacharyya Lab ...... 152  Bose Lab ...... 153  Chilakapati Lab ...... 154  Chiplunkar Lab ...... 155  De Lab ...... 156  Dutt Lab ...... 157  Gupta Lab ...... 158  Kalraiya Lab ...... 159  Mahimkar Lab ...... 160  Maru Lab ...... 161  Prasanna Lab ...... 162  Ray Lab ...... 163  Rukmini Lab ...... 164  Sarin Lab ...... 165  Shilpee Lab ...... 166  Shirsat Lab...... 167  Sorab Lab ...... 168  Teni Lab ...... 169  Vaidya Lab ...... 170  Varma Lab ...... 171  Venu Lab ...... 172  Waghmare Lab ...... 173  Other Research/ Service Projects – Dr. Joshi ...... 174  Other Research/ Service Projects - Dr. Warawdekar ...... 174

Tata Memorial Centre / DMG 5 CRI - Research Support Facilities  Anti Cancer Drug Screening Facility ...... 175  Bioinformatics Centre (BTIS) ...... 175  Biorepository ...... 176  Common Facilities ...... 176  Common Instrument Room ...... 177  Comparative Oncology Program & Small Imaging Facility ...... 177  Digital Imaging Facility ...... 178  DNA Sequencing Facility ...... 178  Electron Microscopy Facility ...... 179  Flow Cytometry Facility ...... 179  Histology Facility ...... 180  Laboratory Animal Facility ...... 180  Macromolecular Crystallography & X-ray Diffraction Facility ...... 181  Mass Spectrometry Facility ...... 181 Administrative & Core Infrastructure Groups  General Administration ...... 182  Medical Administration ...... 185  Information Technology ...... 186  Library ...... 187  Photography ...... 187  Science Communication & Professional Education Cell ...... 188 Scientific Resources: Core Committees in ACTREC ...... 189 New Projects approved by the ACTREC Institutional Ethics Committee during 2014 ...... 192 Academics at ACTREC ...... 194 Conferences, Scientific Meetings & Guest Seminars ...... 196 Staff Achievements ...... 199 TMC Publications Staff Publications ...... 201

6 Tata Memorial Centre Annual Report 2014-2015 Message From Director - TMC

The aim and focus this year like the preceding years, draws inspiration and direction from the long standing vision of efficacious cancer care and control for one and all. This year the major thrust has been in the domains of epidemiology, public health and treatment. Epidemiological data which helps us to accurately determine the nature and extent of the problem becomes an all-important referential for strategy and planning. Data collected from various cancer registries set up by TMC across India, with adequate representation from rural urban and semi urban segment demonstrates some germane findings. A review of trends in cancer revealed that in women of India the rise in breast and ovarian cancer was offset by a steep reduction in uterine . This reduction in uterine cervical cancer bears a direct correlation to personal hygiene and sanitation since it is more evident in areas where running water with privacy of bathroom has been provided. We also noted that in the region where cervical cancer is high, our Muslim brethren had lowest incidence of this cancer compared to that in Hindu and Christian community. This could be explained on the basis of circumcision in early years of life guaranteeing good genital hygiene and not allowing transmission of viral infection like HPV (Human Papilloma virus) which can cause cancer. Rise in breast cancer is supplemented with findings of geographical variations to the tune of 9 per 100,000 in rural population to a demonic increase of 32 per 100,000 in urban population. The causes of these variants find reason in formative years spent in natural environs, adopting endemic lifestyles complemented with lack of obesity which seem offer an adequate protection against breast cancer. Subsequently thus, establishing the link between breast cancer and obesity / unhealthy lifestyles (late first full term pregnancy and lack of breast feeding). Another perturbing thought was that of Punjab carrying the highest incidence of cancer. This was diametrically opposite to rural India statistics of low incidence as compared to urban parts. Data from Sangrur and Mansa shed light on the anomaly – Punjab could no longer be considered as “rural” it had stealthily donned modernism and crept into the “urban” zone. The statistics thus bespeak of an incidence of cancer in Punjab that is comparable to semi urban India. A paradox which sought clarity was the common perception that cancer in India has been on an upswing. India over the past decades, unlike other emerging economies like China Russia and Brazil has only witnessed a relatively stable incidence of cancer which belies the existent beliefs of a rise of cancer in India. The data from registries cleared the haze by indicating that though the total number of cancer patients in India has increased, the incidence per 100,000 populations remains stable. The increase in the number of cases can be attributed to the rising population and increasing life expectancy. Registries have also offered some reassuring data about cancer in the vicinity of nuclear power stations in

Tata Memorial Centre / DMG 7 India. The incidence of cancer in people working in or residing in the vicinity of power stations has been similar to that in semi-urban/urban Indian population. Public Health efforts towards anti-tobacco activity over the last decade reaped benefits by way of an encouraging dip in the incidences of oral cancer in cancer registry. Cancer care primarily revolves around fulfilling the tenets of access to care & uniform care across India. It is envisioned that efficacy in access to healthcare could be well achieved through a hub and spoke model. TMC commissioned the first spoke in Sangrur, Punjab. Radiotherapy unit and a day care facility for administering are functional already. It is anticipated that by the middle of next year surgical services will be also commissioned. Hubs will be created at Chandigarh, Vishakhapatnam & Guwahati to be part of a major project of National Cancer Grid. Sixty four centres have enrolled onto this grid for uniform care in India. The grid has offered over 10 cancer journals across 64 centres for updating knowledge. To guarantee QA/QC of cancer care a peer review process has been adopted. The first peer review was conducted for Kacchar Cancer Centre in Assam. It resulted in technology transfer and training of technicians creating human resource that would offer optimum care in remote parts of India. These efforts coupled with our thoughts on cancer control for India were also implementable in other low resource settings and these resulted into 4 publications in Lancet Oncology, sharing it with the rest of world. Testing latest and improved technology for increasing quality of care has been our forte and this year we acquired Robotic surgery. This technology will be tested for its suitability for Indian environment over the coming years. Research has been the eternal bedrock of evolution and development. Two new avenues are being explored as possible significates and criterion in cancer mystique. The first is hypoxia in solid tumours and the second is micro-environment. Hypoxia is being assessed on NGS platform for mRNA and microRNA. The testing for hypoxia in breast cancer is midway through and is scheduled to commence shortly for oral squamous cell carcinoma and whereas pancreatic cancer is being evaluated for hypoxia as well as micro-environment. Organoids have been evolved for pancreatic cancer in laboratory in collaboration with Princess Margaret Hospital in Canada. Overall it has been a fruitful year from public health point of view with some infant steps in translation and basic research. We seek to consolidate and strengthen our mission for cancer care with every passing year in the hope and conviction that we will do and offer our best in setting world class standards of cancer care.

Dr R A Badwe

8 Tata Memorial Centre Annual Report 2014-2015 Message From Director - TMH

Mindful of the exponential increase in the number of care-seekers at the hospital year after year, we have strived to undertake pioneering initiatives that aid in ensuring faster, friendlier, cost-effective and more accurate patient care. Technology has been at the forefront of this endeavor and the year 2014 saw an extensive adoption of newer technologies in various modalities of cancer care delivery at the hospital. The smart card based financial transactions previously introduced, have found new and varied applications during the year. Self-operated kiosks, accessed with the help of smart cards, enable the patients to view their medical records, report status and account balances, at their convenience; obviating the need to wait in long queues for such activities. We extended further our constant efforts of going ‘paperless’ by adopting ‘filmless’ operation with stoppage of printing radiographic films, namely X-rays, CT scans and MRIs. This was possible due to the upgradation of High Definition Picture Archiving and Communication System (PACS) which helps clinicians access and view radiology images from any location within the hospital. In view of an increased dependency on diagnostic scans, addition of radiology equipment and growing number of patients, the storage capacity of PACS has been upgraded from 30TB in 2013 to 58TB in 2014. The robotic bar coding system for labeling samples of blood collection was introduced leading to greater efficiency and more importantly accuracy. This system has helped in reducing the time taken for labeling blood samples, the requirement of manpower and occurrence of human errors; thereby improving the throughput at the blood collection area which caters close to 800-1000 patients daily. Giving boost to the clinical capabilities of our doctors, the institute added newer state-of- the-art medical equipment. The Hybrid DSA-CT machine was a first of its kind installation in India wherein an angiography machine is coupled with a Computed Tomography (CT) scanner to allow the physicians to use the equipment independent of each other or simultaneously without the need to move the patient between rooms. The machine thus facilitates complex interventional procedures with higher degree of precision and efficiency. The hospital has always been renowned for its cutting-edge surgical expertise and towards this, we have added the Robot to our surgical armamentarium. In addition, a state-of-the- art carbon dioxide LASER has been procured through a generous philanthropic donation. We also upgraded our cardiology facilities with the addition of 3D Echocardiography. In our quest for excellence we introduced several new diagnostic molecular assays, which aid contemporary management of pediatric and several adult tumours viz. sarcomas, brain tumours, lymphoma, of colon, breast, lung, and gastrointestinal stromal tumours. Our research facilities earned the prestigious AAHRPP (Association for the Accreditation of Human Research Protection Programs) accreditation which certifies towards the highest standards of research in cancer care and patient safety measures. Space constraints force me to restrict listing other hospital achievements in this message and I encourage you to go through individual department reports highlighting many of these. Once again I place on record the untiring efforts of each and every one of our employees in helping us keep the hospital at the pinnacle of cancer care in the country. (Dr. A. K. D’Cruz)

Tata Memorial Centre / DMG 9 Message from Director Academics, TMC

TATA MEMORIAL CENTRE, is a stand – alone post graduate and superspeciality centre as one of the constituent Institute of Homi Bhabha National Institute (Deemed to be University) under Dept. of Atomic Energy, Govt. of India. Our Institute is recognized by Medical Council of India, New Delhi for undertaking MD, DM/M.Ch programme in Oncology and other subjects, namely, Anesthesiology, Radiology, Radiotherapy, Nuclear Medicine, Microbiology, Immuno-Hematology & Blood Transfusion Medicine, Pathology and Palliative Medicine. It also conducts postgraduate and doctoral programmes and encourages research in all sub-sets of cancer biology. During 2014 the intake capacity of post-graduate students, increased by three- fold to provide specialized and trained human resource in oncology and related subjects in the country. Under Homi Bhabha National Institute, a two years certified Fellowship programme is conducted in sub-sets of oncology and other subjects. Twenty Fellowships are offered every year. The centre continued to conduct Six month training programs for sponsored candidates from State Government Medical colleges, Central Government Hospital, Public Sector Undertaking Hospitals and Regional Cancer Centres across the country. Specialized training programmes in the field of oncology and related subjects were conducted for doctors from South East Asia Region and South African Countries These received appreciation of its applicability from WHO and UICC. Several specialists from developing countries participated as ‘Observers’ for hands- on training in various aspects of cancer management. The Centre also conducts Post-Doctoral Fellowship programs and P.hD program at Advanced Centre for Training, Research and Education in Cancer at Kharghar, Navi Mumbai in Life Sciences and Health Sciences. Specialists from Punjab (Government Medical College, Amritsar and Patiala, Sangrur have been trained. DM and M.Ch. residents have been deputed at the outpatient and day care services at Sangrur, Punjab. Considering the growing needs for professionals for management of clinical trial sites, a post graduate course in Clinical Research was initiated during the year, and it received good response from science and pharma graduates. A summer school in Oncology for Under-Graduate and Post Graduate Students from Medical Colleges across the country was organized in collaboration with Kings Hospital, London.

Dr. Kailash Sharma

10 Tata Memorial Centre Annual Report 2014-2015 Governing Council Tata Memorial Centre

Chairman Dr. R. K. Sinha, Chairman, AEC & Secretary,Dept.of Atomic Energy. Member Dr. N. K. Ganguly, Distinguished Biotechnology Fellow & Advisor,Translational Health Science & Technology Institute, National Institute of Immunology,New Delhi& Former Director, ICMR. Member Shri Jayant Kumar Banthia, Ex – Chief Secretary, Govt. of . Member (Ex-Officio) Dr. C.B.S. Venkataramana, Additional Secretary (R & D), DAE, Mumbai. Member Shri. Praveen P. Kadle, Sir Trust, 24, Homi Bhabha Street, Bombay House, Mumbai – 400 001. Member Mr. S. J. Phansalkar, Sir Dorabji Tata Trust, 24, Homi Bhabha Street, Bombay House, Mumbai – 400 001. Member Smt.R. F. Savaksha, Sir Dorabji Tata Trust,24, Homi Bhabha Street, Bombay House, Mumbai – 400 001. Member (Ex-Officio) Dr. R. A. Badwe, Director, Tata Memorial Centre, Mumbai – 400 012. Co-opted Member Shri R.A. Rajeev, Jt. Secretary (Finance), DAE, Mumbai. Co-opted Member Dr. Snehalata S. Deshmukh, Ex- Vice Chancellor, . Permanent Invitees Dr. A. K. D’Cruz, Director, Tata Memorial Hospital. Dr. K. S. Sharma, Director (Academics), Tata Memorial Centre. Dr. S. V. Chiplunkar, Director, Advanced Centre for Treatment Research and Education in Cancer,Kharghar, Navi Mumbai – 410 210 Dr. D. Raghunadharao, Director, Homi Bhabha Cancer Hospital& Research Centre, Visakhapattnam. Secretary Dr. Venkata V.P.R.P., CAO, TMC

Tata Memorial Centre / DMG 11 Recognitions For Research

Association for the Accreditation of Human Research Protection Programs

Forum for Ethical Review Committees in Asia and the Western Pacific Region

12 Tata Memorial Centre Annual Report 2014-2015 Swachh Bharat Mission

CAMPAIGNS Tata Memorial Centre observed ‘Swachh Bharat Mission’on 2nd October 2014, the occasion of 150th Birth Anniversary of Mahatma Gandhi. The Director, TMC administered the ‘Swachh Bharat Shapth to the Staff of TMC. In his address to the staff on the occasion, he said, that he perceived the Prime Minister’s mission of cleanliness, as cleanliness not just from in and round us but within us as well. He urged that, every individual should not only initiate cleanliness but continue throughout the year and for rest of the life. One must contribute to cleanliness at workplace, travel/ tourist places, home and area around residence. He appealed to all, to dedicate atleast two hours every week for this cause. At the closing of this event, he urged, every individual should ensure cleanliness in the department. He also said that the cleanliness drive would be reviewed on 26th of January, 2015. The pledge was administered in Hindi and English.

SYMPOSIUM A symposium was organized on 3rd Jan 2015 on “ Good Governance” ( Su-ShasanDiwas). Speaking on the occasion, the Director, TMC said “The purpose of governance is essentially to make things smooth for our patients and make things congenial for all people working with us and our colleagues. The success of Governance lies in satisfying these two goals. Governance means functioning in harmony.He compared good governance, or governance through harmony to human body. He felt no other thing functions as harmoniously as our own body. All organs work harmoniously and help clean toxins and maintain the body. He further stated that the word corpora emanates for our body. The word “corporation” or an Institute/ company, comes from this word. The various departments of institution should function in harmony like our body organs. Our patients represent the heart. Thus our activities should be focused for the well functioning of our heart and that can happen only when we have a harmonious approach to our functions.

Tata Memorial Centre / DMG 13 Executive Summary - TMC

TATA MEMORIAL CENTRE The Department of Surgical Oncology Telecobalt Units, Conventional The Tata Memorial Centre [TMC] has 31 surgeons on the faculty, Simulator (Imaging), a CT Simulator comprising Tata Memorial Hospital supported by registrars, specialty (Somatom-Emotion) with Virtual [TMH], the Advanced Centre for fellows and research fellows. Simulation and a fully equipped Mould Treatment, Research and Education in The Surgical Oncology department has Room. The PET-CT and MRI Based Cancer [ACTREC], and Centre for Cancer spearheaded the field of cancer surgery Treatment Planning for newer radiation Epidemiology [CCE] is a grant-in-aid in the country for several decades. techniques are networked with institution under the administrative Surgical services are comprehensive for Radiodiagnosis and Nuclear medicine control of Dept. of Atomic Energy, Govt. cancer at all sites and are offered both and Molecular Imaging departments. of India. The mandate of TMC is Service, at TMH and ACTREC for optimum The CT - Simulator (Light Speed) is Research and Education. The TMC utilization of operating rooms. During capable of image acquisition for 4D continued to provide the highest the year 8,107 major surgeries and treatment planning & Gated standard of patient care through its 34,405 minor surgical procedures were Radiotherapy along with advanced services and research, and capacity performed. Increasing application of linear accelerators with facilities for building by imparting knowledge minimally invasive surgery, skull base Image Guided (IGRT). through various educational activities. procedures, major vascular The equipment like – Tomotherapy Hi- replacements, and limb salvage and Art IGRT Accelerator, Bhabhatron II Tata Memorial Hospital micro-vascular surgery has further Cobalt Unit at ACTREC are being upgraded. The Radiation Oncology Services: strengthened the department. Induction of the latest Da Vinci Xi Information System (ROIS) is useful in The year saw an overall increase of 7.2% Robotic system boosted minimal access maintaining patient appointments, in new cases registered as compared to radiotherapy treatment records, last year. During the year, 37,731 new surgery and about 49 procedures were performed. The service information archival and departmental cases were registered in addition to the audit. 5,441 new cases registered in upgraded the operating microscope Preventive Oncology. About 21,687 with facilities for providing fluorescence The Medical Oncology services for the referral cards were issued for guided resections. Immediate planning and delivery of chemotherapy investigations like mammography, postoperative outcomes are is achieved with a team of 21 specialists pathology and second opinion. Total comparable with the best in the world. supported by registrars, fellows and beds increased by 8.64% in 2014 [ 579 The department of Anaesthesiology observers. The respective disease in 2013 to 629 in 2014 ]. anaesthetized 19,841 patients. The management groups plan the The Disease Management Groups recovery room catered to 9326 patients treatment protocols depending on the [DMG] formed for each cancer site, and a total of 2,952 patients were site of the disease. They advise ensured evidence based diagnosis, admitted to post-surgical and medical treatment based on chemotherapy treatment and management of the ICU’s of which 1,152 patients were regimen and participate in DMG based treatment modalities for holistic patient ventilated. 2,550 patients were treated research projects. Chemotherapy is care, viz. surgery, radiation and for acute pain and a total of 6,920 delivered through Day Care Units and chemotherapy as combination or patients were treated at the chronic In-patient services. independent, for each individual pain clinics, of which 3,459 were new The Department of Nuclear Medicine patient. This also ensured better patients. and Molecular Imaging provides outcome and quality of life for the In the year department of Radiation comprehensive nuclear oncology patient. There are 11 DMGs namely, services. The department undertakes Head and Neck, Breast, Gynaecology, Oncology offered radical or palliative conducting and reporting functional Thoracic, Bone and Soft Tissue, radiotherapy treatment to 6,135 hybrid imaging studies that includes Gastrointestinal, Uro Oncology, Neuro patients. The department is equipped PET/CT & SPECT/CT, planar and dynamic Oncology, Paediatric Solid Tumours, with state of art equipments like - Linear isotope studies and uptake studies with Adult Hematolymphoid and Pediatric Accelerators replaced by modern units Hematolymphoid. such as “True beam” and “Unique” LA’s, thyroid Probe. PET/CT scans are

14 Tata Memorial Centre Annual Report 2014-2015 available as service using four 18F techniques. Physiotherapy treatment is diagnosis of cancers. Total 1,85,999 labelled radiopharmaceuticals and two extended to patients admitted in the pathological investigations and 24,893 68Ga labelled radiopharmaceuticals. Private and General wards, critically ill Cyto Pathological investigations were Using nine technetium labelled and two patients in the Intensive Care Unit and performed. Post operative support is iodine 131 labelled the patients attending the Out Patients complemented by other laboratory radiopharmaceuticals fifteen planar Department. A total of 8,438 patients services like biochemistry, emergency and SPECT studies are performed were offered Physiotherapy services. laboratory. Infectious complications are routinely. Low dose 131I, 153 samarium A total number of 3,403 patients were assisted with an accurate diagnosis by EDTMP, 177 Lutetium EDTMP are given seen by the Psychiatry Service, including the department of Microbiology which to appropriate patients. Post therapy 1,668 new referrals and 1,735 reviews, performed 1,90,375 microbiological scan studies are performed after 131I, seen as part of consultation and liaison tests. 153 Samarium EDTMP and 90Y inputs of the psycho-oncology service. The departments of general medicine microspheres therapy using SPECT/CT Screening of patients for psychiatric and chest medicine provide the & PET/CT. disorders was undertaken in the wards requisite support for preoperative The equipment’s in the Radiology and continues as part of the service. evaluation of patients as well as other department to advanced Digital Imaging Twelve Mentoring and Capacity medical complications. End of life care technology, like - 1.5 T MRI, LOGIQ* E9 Building group sessions conducted for and pain relief is achieved through the survivors of childhood cancer. Monthly with XD-clear ultrasound, portable services of the department of Palliative support group meetings were facilitated ultrasound, LuminosdRF - Fluoroscopy Medicine which also offers home visits. by Psychiatric Unit for brain tumour System with human touch technology Out patient services of the department patients. The nursing services are and such others, facilitating speedy registered 3,692 new adult patients and important for patient care. A team of diagnosis for patients. A total of 256 new pediatric patients. There were about 350 specially trained nurses 1,40,694 radiological investigations 5,114 follow up visits. Home based constantly strive to provide efficient and were conducted showing huge volume palliative care service registered 538 consistent care and quality services to rise over the previous year. patient. The department also runs new patients for palliative home care The physical and psychological support specialized PG and Doctoral training and did 2,765 home visits in 283 plays an important role in the total programs under HBNI. working days. Among the visits 938 rehabilitation of patients. The were doctor visits, 1868 were nurse Dental a major player of Head Neck Occupational therapy services are visits and 2,484 were medical social DMG support services, providing dental provided on OPD and IPD basis. In the worker visit. care and maxillofacial prosthetic year 2014, 9,101 OPD patients and rehabilitation required for cancer The department of Preventive Oncology 3,621 IPD patients received patients. During the year 12,776 (PO) conducts hospital and community Occupational Therapy services and patients were seen of which 1,247 based clinics for the prevention, overall 187 orthoses, 39 prostheses and patients were treated with prosthetic screening and early detection of 37 temporary prosthesis were rehabilitation and several other services common cancers. 7,015 new patients prepared. In all 220 Lymphedema kits were offered. were registered in the PO clinic at TMH and 1410 Jaw stretcher keys were in 2014. During the same period over prepared by Occupational Therapy The Department of Transfusion 1,50,000 patients continued to be Department at RRC, EBMH. The Speech Medicine collected 22,765 units of followed up in the TMC Urban Outreach Therapy Dept. rehabilitated total 3,499 blood through outdoor voluntary patients. Physiotherapy Department is donation camps. The voluntary platelet Programme and 1,10,000 were committed to restoring patients to their donors registered through platelet registered under the TMHMOP highest level of function and donation awareness camps increased programme which covers the project independence through individualized six fold this year. affected population near BARC. 1,703 new patients registered for quit tobacco therapeutic exercise program and a The department of Pathology provided clinic. The department is recognized as wide range of state of the art histopathology services for accurate

Tata Memorial Centre / DMG 15 a WHO Collaborating Centre for Cancer Clinical Research Awards & Recognitions Prevention, Screening and Early During the year the DAE-CTC funded 10 Tata Memorial Centre was awarded the Detection. clinical trials, 102 studies were provided ‘Rajbhasha Shield’ for 10th consecutive with statistical assistance, and years effective implementation of Academic Activities supported translation of informed Official Language for the year 2014-15. The TMC educational activities are consent documents for 49 studies. The The research facilities achieved affiliated to Homi Bhabha National “Clinical Research Methodology recognition of prestigious AAHRPP Institute (HBNI) Mumbai, a Deemed Course” and “Good Clinical Practice (Association for the Accreditation of University, for Post Graduate training in Workshop” were organized. The EBM Human Research Protection Programs) oncology and other broad specialties, conference for 2014 focused on accreditation which certifies the highest covering Surgical oncology, Plastic “Perioperative Care: Improving standards of research in cancer care and Surgery, Gynecological Oncology, Head Outcomes after Surgery” and patient safety measure. and Neck Oncology, Pediatric Medical “Oncologic Imaging: A Multidisciplinary Oncology, Radiation oncology, Perspective” and was attended by 376 TMC also achieved Prestigious FERCAP Gastroenterology and Critical Care. The delegates. Award from forum for Ethical Review MD program is conducted in Committees in Asia and the Western The Institutional Ethics Committees Anesthesiology, Radiology, Pathology, Pacific Region, as recognition for the were accredited by AAHRPP and Transfusion Medicine, Microbiology, Strategic Initiative for Developing FERCAP- SIDCER ( A WHO / TDR and Nuclear Medicine. Doctoral Capacity in Ethical Review (SIDCER). initiative) in 2014. programs in basic sciences like Epidemiology and Medical Physics are also conducted. During the year it registered 109 students for postgraduate studies. Short term courses in the areas of Radiotherapy technology, medical imaging technology, Masters in Nursing, Infection Control, Palliative care, cytotechnologist and other laboratory technologies are offered. The institute offered training to 157 trainees and 470 observers during the year 2014.

16 Tata Memorial Centre Annual Report 2014-2015 ACTREC

The Centre’s basic, applied and clinical indicate a tissue specific role of K8/K18 Research findings from the Translational research projects drive towards the in malignant transformation/ Research Lab clearly indicated that translational platform for cancer progression of carcinomas. Putative chromatin fragments from dead cells patients. The Centre’s clinicians and driver genes associated with oral induce epigenetic changes, stemness scientists are engaged in collaborative have been identified. and cancer in living cells. projects within ACTREC, with Tata The significance of epigenetics in gastric The Academic Programs of the Centre Memorial Hospital and with national/ cancer and hepatocarcinoma is being include the Doctoral program and international partners from Academia investigated. Immunological studies several training programmes. During and Industry. The Centre’s research focus on understanding the immune 2014, a total of 108 graduate students projects receive institutional, scenario, immune dysfunction in cancer were working towards the Ph.D. degree. intramural or extramural funding. patients, and development of cell based A new batch of 13 junior research fellows, 246 trainees from colleges, During the year 2014, the CRI received immunotherapy for cancer treatment. universities, academic/ research a sum of Rs. 8.30 crore from Under the Science Initiative Program in institutions and hospitals from across governmental agencies (DBT, DST, Ayurveda, the mode of action of the country were accepted in various ICMR, LTMT, etc) to support 43 out of bhasmas is being examined. The fly lab labs in CRI and departments in CRC. 182 on-going projects. Ten new (Drosophila melanogaster – fruit fly) lab Twenty one national and international projects, to the tune of Rs. 3.18 crore, was established, to study the conferences, workshops, symposia, etc. for a three year period received Rs.1.55 relationship between growth and were organized at ACTREC. The centre crore from the above government patterning in developing tissues, and its also organized DBT sponsored agencies. relevance to cancer workshop on ‘Applications in The Cancer Research Institute is The CRC commissioned a new 22-bed Bioinformatics’ in January and the 10th engaged in research on normal, stem ward. Over 2100 major procedures (Jan National Research Scholars Meet in Life cell, cancer cell & molecular biology, – Nov), 70 allogeneic/ autologous/ Sciences in December 2014. The Centre structural biology, cell signalling & unrelated donor bone marrow invited national and international macromolecular interactions, genetics transplants and cord transplants, 11 experts to conduct and deliver lectures & epigenetics, immunology & haplo-identical transplant were at research seminars on a various topics chemoprevention. The protein conducted; and admitted about 1000 in- pertaining to biology and cancer. The interaction research focused on patients in the Leukemia/ Lymphoma Centre also conducted a number of identifying novel therapeutic strategies Ward and around 50 outpatients/ day Cancer Awareness Programs for the for cancer treatment, and their role in were seen in the adult hematolymphoid general public as a social responsibility OPD. regulating cell cycle progression and initiative. neoplastic progression. Findings

Tata Memorial Centre / DMG 17 TMC Annual Events

The 12th EBM 2014 conference focused He is also an Honorary Fellow of the on Perioperative Care: Improving Royal College of Anaesthetists, UK, the Outcomes After Surgery and Oncologic American College of Surgeons, the Imaging: A Multidisciplinary German Surgical Society and the Perspective, held during 27th February German Anaesthesiological Society. nd to 2 March 2014. His research interests focus on surgical The Perioperative Care: Improving pathophysiology, acute pain physiology Outcomes After Surgery Several and treatment, the transition from international and national speakers acute to chronic pain, postoperative deliberated on evidence based patient fatigue and organ dysfunction. These st care for improved clinical outcomes The Hospital Day Oration on 1 March efforts have condensed to form the during the perioperative period. The 2014 was delivered by Prof. Henrik concept of ‘fast-track surgery’ with the Workshops on performing and Kehlet on “Improving Outcomes After aim of achieving the ‘pain and risk-free interpreting Cardiopulmonary exercise Surgery: On The Fast Track”. Professor operation’ He has published more than testing (CPET), first of this kind in India Henrik Kehlet, gastrointestinal 700 articles within perioperative and Thoracic Anaesthesia - Lung surgeon, and former professor of pathophysiology, pain relief and surgical isolation techniques and Paravertebral surgery, Copenhagen University, outcome summarized into the concept analgesia held on 28th February 2014, Denmark. He is now Professor of of ‘fast-track surgery’, which also were the highlights of the programme. perioperative therapy and Head of includes a focus on perioperative fluid Section of Surgical Pathophysiology, management. He has delivered more The Oncologic Imaging: A Rigshospitalet, Copenhagen University. Multidisciplinary Perspective – The than 200 lectures at international meeting held during March 1-2, 2014, scientific meetings, including several focused on the role of imaging in honorary lectures. oncology. The discussions highlighted important clinical issues in different disease systems in oncology and identifying the best imaging methods based on current evidence. The limitations of imaging, controversial issues and the scope of imaging in future research areas were also discussed. This two day event was preceded by a preconference workshop on Feb 27-28, 2014. The workshop focused on state of art oncologic imaging in various disease regions. Renowned international and national faculty contributed in both events.

Two EBM books - Guidelines for Improving Outcomes After Surgery (Part Perioperative Care: Improving B) were released during the event. Outcomes After Surgery (Part A) and These books were distributed to all Guidelines for Perioperative Care: medical college libraries of India and are also are accessible from TMC website.

18 Tata Memorial Centre Annual Report 2014-2015 Augmentation in the year 2014

Hyperion X7 digital OPG machine Department of Philips Ingenia 1.5 T MRI Department of Radiodiagnosis Radiodiagnosis.

LOGIQ* E9 with XDclear ultrasound equipment: The Siemens’ LuminosdRF - Fluoroscopy System, Department LOGIQ* E9 with XDclear, Department of Radiodiagnosis of Radiodiagnosis

Tata Memorial Centre / DMG 19 3 D Scanner RFA, Department of Medical Physics

Davinci Xi-System for Robotic Surgery

20 Tata Memorial Centre Annual Report 2014-2015 Visitors to TMC

H.E. Dr. Sai Mauk Kham, Vice President of Myanmar along Honourable Chief Minister Mr. Devendra Fadanvis visited with dignitaries Tata Memorial Hospital on the eve of World Cancer Day.

Faculty Students Other Visitors a) Dr. Anjali Jaydeep Kelkar, Oct.1, a) Hospital Administration Students a) Sr. Executive of GlaxoSmithKline 2014, verification visit of Molecular from Father Muller Medical College, Pharmaceuticals Limited. April 2, Diagnostics Laboratory. Mangalore. 2014 b) Mr. Irfan Allana, Chairman & b) Students from Lords Universal b) Medical Officers from Armed Forces Managing Director, Allana Sons, Junior College of Commerce & Medical College, Pune. Sept. 16, visited with the Terry Fox Science. 2014 Committee members on Dec. 12, c) Visitors from strategy office 2014 Germany. Sept. 3, 2014.

Tata Memorial Centre / DMG 21 TRENDS

22 Tata Memorial Centre Annual Report 2014-2015 Performance Statistics

2013 2014 Patient Chart Files- General 22035 23639 Patient Chart Files- Private 13162 14092 Patient Chart Files- Total (A) 35197 37731 Referrals for Investigations/ Second Opinion (B) 20305 21687 Preventive Oncology (C) 5739 5441 Total Registrations (A+B+C) 61241 64859

INPATIENT SERVICES Admissions 23445 26224 No. of Admissions Average Length of stay (Days) 7 6.3 Bed Occupancy % 89 88

SURGICAL ONCOLOGY Major OT Procedures 11104 8107 Minor OT Procedures [33484 Corrected] 18418 34305

MEDICAL ONCOLOGY Day Care Day Care- General 56249 62674 Day Care- Private 25312 28225 Bone Marrow Transplants at ACTREC 78 75

DIGESTIVE DISEASES AND CLINICAL NUTRITION Endoscopies [To be included in Min.O.T] 7040 6149 Nutrition Clinic 4781 14385

ANESTHESIOLOGY, CRITICAL CARE & PAIN No. of ICU Admissions 2592 2952 Patients in Recovery Ward 9267 9326 Pain Clinic 2975 3459

RADIATION ONCOLOGY External Beam Therapy 5700 5771 2589 3204 Treatment Planning / Beam Modification 13221 10999 Special Radiotherapy Techniques (IGRT, IMRT, SRS, SRT, TSET etc.) 3112 4820

Tata Memorial Centre / DMG 23 2013 2014 IMAGING SERVICES Radiology Conventional Radiography 56326 57556 Ultrasonography / colour Doppler 36274 40403 Mammography 9957 11384 C.T. Scan 20668 23883 M.R.I Scan 3994 4024 Interventional Radiology 3078 3444

NUCLEAR MEDICINE PET-CT 11211 13180 SPECT-CT 5191 5204 C.T. Scan 220 54

GENERAL MEDICINE ECG 29780 30484 Echo Cardiography 7446 8900 Pulmonary Function Tests 3459 3628

LABORATORY DIAGNOSTICS Pathology 91842 141788 Haemato Pathology 460936 429506 Biochemistry 1897758 2224118 Cyto Pathology 23920 24893 Molecular Pathology 1137 2102 Microbiology 157744 190375

TRANSFUSION MEDICINE Blood and Platelet Units Collected 21735 22765 Other Services 167866 183015 Cytogenetics 6500 6700

OTHER CLINICAL SERVICES Stoma Care 4213 4827 Occupational Therapy 13018 14606 Physiotherapy 8070 8438 Speech Therapy 3324 3499

24 Tata Memorial Centre Annual Report 2014-2015 2013 2014 Psychiatry and Clinical Psychology 2511 3403

DENTAL SERVICES Prosthetic Services 1055 1273 Other Services 11121 15855

TISSUE BANK Allografts Produced 10003 10200

PALLIATIVE MEDICINE No. of Patients 7202 9062 Home Care Visits 1715 2765

MEDICAL SOCIAL WORK Guidance 23500 23573 Counselling 10216 11313

EDUCATION Residents 238 242 Fellows 15 11 Medical Observers 400 470 Nursing Trainees 614 Paramedical Students 23 35

RESEARCH PROFILE Extramural Projects 11 10 Institutional (Intramural/ No Funding Required) 66 81 Intramural + Extramural Projects 4 1 P.G. Thesis (Dissertation) 77 98

PUBLICATIONS International 169 256 National 123 132 Book Chapters 534

Conferences / Workshops/ Seminars 74 50

Tata Memorial Centre / DMG 25

Convener : Dr. Hari Menon Secretary : Dr. Navin Khattry The Adult Hemato-Lymphoid – DMG

MEDICAL ONCOLOGY PATHOLOGY RADIO-DIAGNOSIS Dr. Hari Menon, Dr. Tanuja Shet, Dr. Suyash Kulkarni, Dr. Navin Khatri, Dr. Sumeet Gujral, Dr. Nitin Shetty, Dr. Manju Sengar, Dr. Sridhar Epari, Dr. Nilesh Sable Dr. Bhausaheb Bagal, HEMATO-PATHOLOGY NUCLEAR MEDICINE & Dr. Uma Dangi, Dr. P. G. Subramanian, MOLECULAR IMAGING Dr. Hasmukh Jain Dr. Prashant Tembhare, Dr. Venkatesh Rangarajan, RADIOTHERAPY Dr. Nikhil Patkar, Dr. Archi Agrawal Dr. Siddhartha Laskar, Dr. Syed Hassan CLINICAL PHARMACOLOGY Dr. Nehal Khanna, CYTOGENETICS Dr. Vikram Gota Dr. Jayant Sastri Goda Dr. Pratibha Kadam Amare, PSYCHIATRIST Ms. Hemani Jain Dr. Jayita Deodhar

Services  The dedicated hemato-pathology catering to Lymphoma/Leukemia and molecular hematology patients and their families, a Lymphoma The AHL-DMG multidisciplinary group laboratory facilities, enables Leukemia Foundation has been caters to the management of a variety comprehensive diagnosis including established, wherein donors have a of hematological malignancies in a rare entities. platform to contribute in the form of comprehensive manner. financial assistance. The corpus The management of hematological The Joint clinics (JC) screen patients generated is used mostly in assisting in malignancies is based on evidence and before treatment is instituted. The the initial treatment of the patient and protocol. The emphasis on personalized purpose of JCs is to advice the best at times sustaining therapy until such therapy was based on the cytogenetic treatment options and also to time that other aid starts flowing in. and molecular profiling of scrutinize, approve or modify planned hematolymphoid malignancies. therapies. Quality improvement Emphasis was given to : The medical social workers support the measures JC activities, they identify funding  Rapid diagnosis and early institution The DMG maintains ongoing quality agencies who financially support of therapy to immediately alleviate improvement measures with patients with curable malignancies symptoms and life threatening continuous audits of treatment needs to be funded. A general problems at presentation, protocols, chemotherapy regimens, information booklet is provided to all their morbidity and mortality,  Identifying curable hematological patients. malignancies and ensuring treatment compliance in long-term treatment completion by providing To consolidate the efforts that the therapy and implementation of assistance, hospital has been making towards modifications derived from such audits.

28 Tata Memorial Centre Annual Report 2014-2015 Key Indicators

Volume Indicators TABLE-1 Registration 2014 General Private Total Hospital 23,493 14,160 37,653 New Cases 2,055 1,395 3,450 Second Opinion - 469 469 OPD Follow ups 35,468 17,463 52,931

ACTREC – BMT Unit statistics

TABLE-2 ACTREC Registration 2014 New Cases - TMH 143 BMT Referrals 248 OPD Follow ups 5,882 BMT OPD Follow Up 3,483 Autologous Transplant 41 Allogenic Transplants 35

The DMG registered 3,919 patients in ACTREC (BMT & Chemotherapy). The is done at ACTREC. Besides the routine 2014 as against 3,467 in 2013 and 2,836 OPDs for Leukemia, Lymphomas and BMT OPD at ACTREC a separate BMT in 2010. 52,931 patients on follow up Myeloma are run separately. OPD at TMC is operational on Thursday were seen in the various outpatient Considering the steady increase in the and Friday by the BMT consultant to departments during the year. The outpatients the OPD timings have been counsel potential patient for transplant. lymphoma/myeloma clinic and the sorted into two slots separating the new Outcome indicators measured as 30- leukemia clinic registered 1,119 and 357 and follow-up patients respectively. The Day Mortality for January – December patients respectively in 2014. new CML patients are followed up at 2014 (actual numbers) is described as The outpatient service conducts four TMH and once they have achieved a per disease in the table-3. OPDs, 2 at TMC (Gen & Pvt.) and 2 at stable response subsequent follow up

TABLE-3 Morbidity/ Mortality (n=2360) Febrile Neutropenia Median – 80 % Range 5 % - 100 % 30 Days Mortality 3.8 % (n = 90 / 2360 )

Process Indicator – Percentage compliance with evidence based clinical guidelines

Tata Memorial Centre / DMG 29 TABLE-4 Medical Oncology Treated at TMH 2360 Referred at Local Place 261 Average IN-Patients per month 266 Average Time to start Therapy Median – 9 Range 3 days - * 3 Weeks Compliance to guidelines 89.7 % (range 74.1% - 97.3 %) Drop Out Rate On Therapy 6.2 % (n= 172 / 2759) Before Starting Therapy 8.7 % (n= 301 / 3450) Upfront Palliation Only 4% (n = 138)

Research Research / Clinical Trials

Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 28 9 1 1 28 9 5684

Publications Several training programmes are Patient Education organized for DM students and Visiting The DMG impart education to patients, The DMG members contributed 21 DM and non-DM trainees from other through monthly meetings, patient scholarly communications of which 13 institutions and international fellows/ advocacy and support group meetings, were published in international trainees for observership in the unit cancer awareness program for journals, and 4 in national journals. The (clinical and laboratory). Lectures are community and Lymphoma Awareness rest four were contributed as book also organized for oncology nursing Program on occasion of World chapters. staff/ trainees and BMT Fellowship of 1 Lymphoma Awareness day. year post DM. The DMG organized four Education CMEs and a national webcast for The DMG members have constantly medical oncology trainees. been involved at the national and international level as faculty for various conferences, delivering lectures, presenting data and teaching postgraduates and junior colleagues who are in the field of oncology.

30 Tata Memorial Centre Annual Report 2014-2015 Convener: Dr. Siddhartha Laskar Bone & Soft Tissue – DMG Secretary: Dr. Bharat Rekhi

SURGERY PATHOLOGY NUCLEAR MEDICINE & Dr. Ajay Puri Dr. Nirmala Jambhekar MOLECULAR IMAGING Dr. Ashish Gulia Dr. Bharat Rekhi Dr. Venkatesh Rangarajan MEDICAL ONCOLOGY Dr. Saral Desai Dr. Nilendu Purandare Dr. Jyoti Bajpai RADIO-DIAGNOSIS PHYSIOTHERAPY Dr. Jaya Ghosh Dr. Shashikant Juvekar Dr. Ajeeta Hsabnis Dr. Girish Chinnaswamy Dr. Subhash Desai Dr. Sarika Mahajan Dr. Tushar Vora Dr. Amit Janu PALLIATIVE CARE RADIATION ONCOLOGY Dr. Sunil Dhiliwal Dr. Siddhartha Laskar Dr. Nehal Khanna

The activities of the Bone & Soft Tissue related to bone and soft tissue. It also clinico pathological meeting and joint Disease Management Group are guided focuses in building capacities in the clinic to ensure holistic management by the institutional motto of Service, management of bone and soft tissue approach. The multidisciplinary joint Research, & Education. It is the malignancies through its training clinic discusses vital issues to ensure endeavour of the DMG to deliver programmes. optimizing integrated patient comprehensive patient care in an management, the clinico pathological effective & efficient manner besides Service meeting discuss diagnostic dilemmas conducting research directed towards The DMG functions through three joint and the joint clinic for physical optimising treatment for malignancies clinics viz., multidisciplinary clinics, joint rehabilitation of patients is addressed. Key Indicators Volume Indicators Surgery Radiation Medical Pathology Radiology Nuclear & OccTh (OT) Oncology Oncology Bio-Imaging PhysioTh (PT) Major: 687 EBRT: 352 Rad: 330 Spec: 476 XRay:1,500 PET-CT:435 OT: 4,051 Minor: 857 Brachy: 26 Pall: 32 Biop: 1,716 CT:1,452 SPECT: 210 OPD:1,401 MRI:1,653 IPD: 2,650 USG:151 PT: 510 Complications & Mortality Modality Morbidity/ Mortality Pts./ Grade Surgery (n=687) Morbidity Infection Bone (6%) Prosthesis (11%) Vascular Inj <1% Neural Com <3% Mortality 1/189 (0.14%) Radiotherapy (n=378) Acute Toxicity Grade I: 14% Grade II: 11% Grade III: 9% Mortality Nil Chemotherapy (n=362) Morbidity (FN Requiring Admission) 140 (38%) Mortality 4 (1.1%)

Tata Memorial Centre / DMG 31 5 Year survival rates (Updated Results of TOSS Data) Diagnosis (Numbers) Overall Survival Disease Free Survival Median follow up (months) Entire Group (495) 57.3 48.2 65(43-105) Ewing’s Sa (94) 67.9 53.6 74 (46-102) STS (137) 60.8 47.8 73 (51-102) OGS (178) 48.3 39.1 50 (31-88)

Research Development and refining of improve local control of tumor indigenous prosthesis and salvaging of continued to be the focus of research. Members of the DMG are also involved limbs have been the thrust area of in both clinical & basic research The department of Medical Oncology research, resulting in cost reduction of activities. The large majority of research has been involved in evolving newer prosthetic surgeries for patients. In conducted within the DMG has been strategies to optimize chemotherapy for order to achieve comprehensive and investigator initiated prospective and osteosarcomas e.g. the use of holistic treatment, the efforts to study retrospective studies. The primary focus antiangiogenic agents and the use of the efficacy of non-surgical treatment of most research have been aimed at dose dense regimens. Efforts have been modalities and evolution of nutritional looking at treatment outcomes in terms made to evolve optimal sequencing status. The use of Image Guidance of disease control, survival, treatment strategies for chemotherapy and also to (IGRT) and conformal techniques and related complications & functional evaluate strategies for perioperative optimal use of brachytherapy to outcomes. chemotherapy.

Research/ Clinical Trials Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Inv. Initiated Sponsored Inv. Initiated Sponsored Inv. Initiated Sponsored Inv. Initiated Sponsored 12 01 03 Nil 09 01 1,172 74

Education management of bone and soft tissue training programmes were also tumors. The training programs involved conducted for visitors from within and Several continuing education both clinical and non-clinical members outside the country. programmes were organised in each of the DMG. Short term and long term sub-speciality to build capacity in the

32 Tata Memorial Centre Annual Report 2014-2015 Convener: Dr. Vani Parmar Breast Oncology – DMG Secretary Dr. Tanuja Shet

Clinicians: RADIATION ONCOLOGY NUCLEAR MEDICINE & Dr. Rajiv Sarin MOLECULAR IMAGING SURGICAL ONCOLOGY Dr. Ashwini Budrukkar Dr. Venkatesh Rangarajan Dr. Rajendra Badwe Dr. Rakesh Jalali Dr. Sneha Shah Dr. Vani Parmar Dr. T. Wadasadawala Dr. Indraneel Mittra (Prof. Emeritus) BASIC SCIENTISTS Dr. Nita Nair PATHOLOGY Dr. Abhijit De Dr. Prabha Yadav Dr. Sangeeta Desai Dr. Narendra Joshi Dr. Shalaka Joshi Dr. Tanuja Shet Dr. Pradyumma Mishra Dr. Akshita Singh Dr. Asawari Patil Dr. Ujjwala Warawdekar Dr. Ayushi Sahay MEDICAL ONCOLOGY Dr. Sudeep Gupta RADIO-DIAGNOSIS Dr. Jaya Ghosh Dr. Meenakshi Thakur Dr. Jyoti Bajpai Dr. Seema Kembhavi Dr. Seema Gulia Dr. Subhash Ramani

The Breast DMG continues to strive  Oncoplasty and primary breast Service towards improved quality patient care reconstructive procedures are In all / a total of 4,221 cases registered through research, service and offered by trained experts in the with Breast DMG (4,095 at TMH and education. In the year 2014, as field, thereby extending the 126 at ACTREC); the General to Private compared to 2013, total registrations of indications of breast conservation category ratio being 52:48. 2,084 major, new breast cancer cases went up by surgery. 2,018 were primary surgeries for 8.6% (4,221 vs 3,857 respectively) and  Hypofractionated Radiation therapy malignancy and 2,700 minor OT cases operated increased by 14%. This is being implemented to reduce the procedures were performed by the was not associated with any increase in duration of Radiotherapy thereby DMG . Breast conservation surgery was morbidity or positive margins requiring making it more feasible to patients offered to 990 patients (46%). The revision surgery. The quality indicators and facilitating better turnover. conservation rates were higher in early were also checked to audit the  Accelerated Partial Breast breast cancers (70%) versus 30% in procedures. Irradiation is offered as a service for locally advanced. The Uniqueness of the DMG is manifest those women that meet the ASTRO The overall morbidity was 7.5% due to following attributes: guidelines for the same. (including wound re-exploration 0.5%,  As a single centre, the DMG treats  Evidence based management is debridement and re-suturing), with the largest number of breast cancer undertaken with molecular-based positive resection margins requiring patients from India and across the personalized targeted therapy and revision surgery after breast adjacent borders countries including chemotherapy. conservation in 4.2% cases. the African continent. Additional interventions included venous access port placement (50), bilateral salpingo-oophorectomy (33), neck node dissections (43), oncoplasty (58), and LD flaps (52) were also conducted.

Tata Memorial Centre / DMG 33 Quality Indicators a) Volume indicators Category Surgical Oncology Registrations Year 2013 2014 TMH ACTREC Total General 1,933 (50.14%) 2,086 111 2,197 (52.05%) Private 1,923 (49.86%) 2,009 15 2,024 (47.95%) Total Registrations 3,857 4,095 126 4,221 Major Surgery 1,829 1,402 682 2,084 Minor Surgery 3,179 3,045 – 3,045

Radiation type 2013 2014 Adjuvant RT 814 797 Palliative RT 500 747 APBI 26 42 Total 1,340 1,586 Chemotherapy Type 2,013 2,014 Adjuvant Chemotherapy 1,463 1,876 Palliative Chemotherapy 1,500 1,600 Total 2,963 3,476 Referred outside – 2,082

The minor OT registered 2700 minor  Revised radiation therapy protocols: of Postoperative Care and Counseling procedures. There was a planned adjuvant RT offered for all patients and Lymphoedema Kits. Total amount starting of core biopsy procedures at the with 1-3 LN positive axilla; Hypo- Rs.21.16 L spent towards patients by private OPD since March 2014, on all fractionation regimens initiated to support groups for surgery, afternoons, due to high volumes of the reduce duration of RT; delaying chemotherapy, investigations (free or procedure and considering patients’ systemic chemotherapy therapy concessional) and supportive care. V- convenience. This accounted for an after HDR for 6 weeks to reduce care and Cancer Patients’ Aids additional 345 cases in minor wound morbidities. Association also supported patients procedures performed in the out-  Adjuvant chemotherapy schedules financially for various requirements patient clinic (thus, total minor cases for locally advanced cancers. including prosthesis and drugs. 3045).  Adjuvant Tamoxifen for 10 years in b) Outcome Indicators: Radiation therapy was offered to 1,586 all age groups and menopausal (18% increase since 2013) and the status and 1. 30 day mortality and complication rates – There was no reported 30- Department of Medical Oncology  Routine use of bisphosphonates in administered systemic therapy to 3,476 day mortality. The overall surgical adjuvant therapy in morbidity (including wound re- women (compared to 2,963 in 2013) postmenopausal women. indicating a 17% decrease in absolute exploration in 0.5%, debridement number of cases. Financial Support: and re-suturing) was seen in 7.5%. Other treatment policy decisions that Patients were financially supported for 2. Positive margin and re-excision rates have been incorporated into standard treatment through various funds - 4.2% (all positive margins re- practice following updated evidence in namely Women’s Cancer Initiative- excised) literature, and after BCWG TMH, Maina Foundation, Vasantha 3. Completion mastectomy rates = 2 of consideration and consensus in 2013- Trust and Madat Trust. Mahindra & 922 (0.2%) 2014 are as follows: Mahindra Pvt. Ltd., funded by provision 4. Median nodal yield for quality of

34 Tata Memorial Centre Annual Report 2014-2015 surgery: Axillary sampling= 5 LN; NACT or NAHT in the various Cancer from March 2012 to June Clearance= 12 LN; >= 10 LN subtypes. 2014. dissected in 87.1% 5. Can we avoid axillary lymph node A retrospective analysis of 5. Lymphoedema Rates – Total 59 dissection in patients 1-2 positive everolimus in hormone receptor cases in 2014 (3%); reported only sentinel lymph nodes in the Indian (HR) positive MBC, who had moderate lymphoedema, none with setting. recurrence or progression while severe lymphoedema. Early breast cancer patients with 1- receiving previous therapy with a 2 positive nodes in axillary sampling non-steroidal aromatase inhibitor c) Outcome indicators for had 30.5% additional nodes (NSAI) in MBC, was conducted in survival, and other early elsewhere in the axilla (all patients treated from March 2012 outcomes macrometastases). The actual to June 2014. For a Clinical Benefit Audits were conducted over the year, percentage may even be higher if Rate of 68%, there were 30% PRs, the treatment outcome indicators multiple sections from the nodes 38% SD, 32% PDs. Everolimus was established in different groups of are studied. active in all subgroups with no single statistical differences across patients, are listed briefly as below: Conclusions: It may not be subgroups. The mean PFS was 21.6 1. Validation of Software Based Clinical appropriate to apply the results of (3-76) weeks. Decision Support System for Breast not clearing the remaining axilla Cancer Treatments in a Tertiary Care even if SN positive, to our general 10. Retrospective analysis of Clinical Cancer Center in India. population. Possibly, only a select Benefit Rate and Toxicity of Eribulin subset of patients who fit the therapy in Metastatic Breast Cancer Once prospectively validated, this inclusion criteria of the ACOSOG Z11 from November 2012 to July 2014. System can support global access to could be offered observation of the evidence based clinical decision and 11.Taxane-Based Combination axilla in spite of 1-2 nodes positive. can be extended to other cancer Chemotherapy in Breast Cancer sites. 6. Impact of age as an independent Experience from a Tertiary Care prognostic factor for lymph node Cancer center in India. 2. A study on Contralateral Breast metastasis and survival in breast Screening Mammography : cancer. d) Process Indicators: theIndian Perspective indicated that 7. Women who presented with Following are the results of Audits with low breast cancer incidences in conducted for Surgical, Radiation and India mammography is neither Oligometastatic disease were compared to those with locally Medical Specialties. The Surgical Audit useful nor cost effective in the advanced and wide spread was carried out on cases operated in diagnosis of contralateral breast metastatic disease. The audit March and July 2014. All cases selected cancer at the time of diagnosis. showed that patients presenting were with 2014 registration which 3. Lymph node ratio as an alternative with locally advanced breast cancer summed up to 209 cases. Surgical to pN staging in node positive breast and diagnosed with oligometastases timelines were evaluated in 51 upfront cancer. have better outcome as compared operated cases. Medical Oncology audit The study showed that lymph node to women presenting with multiple carried out in random 47 case files to ratio may serve as a better metastatic disease at first check details and chemo-toxicity. prognostic marker as compared to presentation, and in fact their Radiation Oncology audit was carried the conventional pN staging and outcome is more similar to women out in 164/209 cases where RT was needs validation in larger studies. with locally advanced non- advised. 4. Differential response to metastatic breast cancer. neoadjuvant chemotherapy in 8. Results of patients who received Hormone receptor positive large Accelerated Partial Breast operable or locally advanced breast Irradiation from Aug 2000 to Dec cancer was studied during the year. 2011 It is necessary to consider hormonal Median FU: 70 months (1-160); manipulation in addition to Recurrences: 177/506; 5-year DFS: chemotherapy in the neoadjuvant 68% setting for HR+VC breast cancer for 9. Retrospective analysis of Clinical women. The study indicated that Benefit Rate and Toxicity of specific molecular markers need to Everolimus therapy in Hormone be evaluated to predict response to Receptor Positive Metastatic Breast

Tata Memorial Centre / DMG 35 1. Compliance audit - Surgery

Cases lost (not re-visited) immediately after registration 1.9% Registration to First JC/first consult and then no further visits 3.3% Lost (No re-visits) after first Joint Clinic and Investigations 7% Lost after second JC and treatment planning 4% Lost after surgery 0% Overall drop-out rate 16.4%

2. Timelines for Surgery Private General Registration to First JC Day 0 Day 1 First JC to Surgery 22 days(min 4 d) 23 days(min 6 d) Last NACT to Surgery 27 days(min 14 d) 41 days(min 16d)

 Most of the delays beyond 3-4 weeks from JC were in patients with medical co-morbidity such as DM, HTN, Cardiac disease, etc requiring physician’s opinion. Very few had no clear cause documented.  Target set for surgery waiting time was 4 weeks: Target was achieved in 80% in 2014  Audits for reasons for delays: Long waiting list, Medical co-morbidity and fitness issues, Counts low post NACT

3. Compliance audit – Chemotherapy  Chemotherapy 207/209 advised (99%);  2 advised Neoadjuvant hormone therapy  All patients complied with advice.  Audited details in 47 patients (all types)  Completion of adjuvant chemotherapy in 75%  Reasons for discontinuing was primarily chemo toxicity especially neuropathy

4. Compliance audit – RT  Radiation therapy -164/209 advised (78.5%). Taken at TMC 34%; Referred out in 66%  99% complied with advice.

5. Breast related plastic procedures- audit for timelines  JC decision to surgery: 18.1 days (1-39 d)  Waiting time average for free flaps: could vary with OT slot availability. Weekly one OT kept blocked for Breast WBR. Average of >6-8 weeks waiting.

36 Tata Memorial Centre Annual Report 2014-2015  Waiting time average for pedicled various DMG members. These included study, TNBC study, Accelerated Partial flaps: varies with OT slot availability. 51 open and accruing studies, 25 closed Breast Irradiation, CONSET, Ethnic Average waiting 2-4 weeks. and completed accrual on follow up or Research Initiative(ERI) Study for risk being analyzed, and 21 completed and factors, Taxane toxicity and Quality improvement measures: reported studies. Of these, there are 43 progesterone, and Perioperative The DMG maintains ongoing quality active plus 10 closed investigator Herceptin single dose study. improvement measures with initiated studies as prospective, Further progress has been made on continuous audits of specific subtypes retrospective or observational trials/ translational and basic research front and outcome indicators. Additionally a studies and dissertations; 6 active and with analysis of tumor tissue on RNA morbidity database is maintained for 12 closed but on follow up industry- (and mRNA) sequencing being peri-operative infections and concerns. supported studies; and 2 accruing 3 completed on the fresh tumor samples As per the results of the recent audit, closed Collaborative Group studies in to assess effect of progesterone and to the timelines appear to be reasonable, 2014. evaluate hypoxic modulation in the with scope for further improvement tumor to understand biology of cancer Practice changing research: especially in reducing waiting times for metastases and factors that might surgery and expediting the surgical Some of the original research carried influence the same. The cell line studies intervention in spite of large patient out at TMC has resulted in practice have also made progress with early load. changes in 2014, like role of low axillary results suggesting specific alterations in sampling in cN0 operable breast cancer some genes. The analysis is ongoing at Research: and role of locoregional therapy in ACTREC and NIBMG, Kolkata. primary metastatic breast cancer. There has been continued interactive The animal studies are making steady inter-disciplinary inputs in research, Proluton preoperatively is being offered as routine care in all high risk node progress, previously being delayed due dissertational and service to issues with viability of nude mice but improvements by all constituent positive operable breast cancer before upfront surgery. the matter is being addressed department members during the year. proactively so as to enable the In 2014, in all 97 studies and trials were The potential practice changing studies successful progress of studies planned listed as ongoing under supervision by ongoing are namely, Exercise Trial, in the nude mice, including Voltage Gated Sodium Channel(VGSC) understanding of biology of metastases and its modulation. Research / Clinical Trials Patients Total No. of Clinical Trials Completed Ongoing Accrued in 2014 Investigator Sponsored Collaborative Investigator Sponsored Collaborative Investigator Sponsored Collaborative Total Initiated Initiated Initiated 69 21 6 25 15 4 44 6 2 1996

Tata Memorial Centre / DMG 37 Convener : Dr. Shailesh Shrikhande Gastrointestinal – DMG Secretary : Dr. Shaesta Mehta

SURGICAL ONCOLOGY PATHOLOGY EPIDEMIOLOGY Dr. Shailesh Shrikhande Dr. Mukta Ramadwar Dr. Rajesh Dikshit Dr. Mahesh Goel Dr. Kedar Deodhar RADIO-DIAGNOSIS Dr. Avanish Saklani Dr. Munita Bal Dr. Supreeta Arya MEDICAL ONCOLOGY DIGESTIVE DISEASES AND Dr. Suyash Kulkarni Dr. Vikas Ostwal CLINICAL NUTRITION Dr. Nitin Shetty Dr. Shaesta Mehta Dr. Ashwin Polnaya RADIATION ONCOLOGY Dr. Prachi Patil Dr. Shyam Kishore Shrivastava NUCLEAR MEDICINE & Dr. Reena Engineer ANAESTHESIOLOGY, CRITICAL CARE MOLECULAR IMAGING Dr. Supriya Chopra AND PAIN Dr. Venkatesh Rangarajan Dr. Paramanand Jain Dr. Nilendu Purandare PALLIATIVE MEDICINE Dr. Archi Agrawal Dr. Mary Ann Muckaden

In the year 2014, DMG recorded highest Surgical Services Radiotherapy number of major Hepato- Volume Indicators: Of the total of 1,306 A total of 534 patients received radical pancreaticobiliary cancer resections surgeries performed during the year, radiotherapy (337 patients) and and laparoscopic colorectal cancer 936 were performed at TMH (836 palliative radiotherapy (197 patients). resections, in the past decade. elective surgeries and 120 emergency The highest being renal cancers patients The Robotic Colorectal/Gastric/ operations) and the remaining 370 were (218). Intensity Modulated Pancreatic resections were initiated. performed at ACTREC. Patients were Radiotherapy (IMRT) (70), 3D Minimal Access and of Interventional treated with radiotherapy (RT), Conformal Radiotherapy (213), radiology services were initiated at chemotherapy (CT), application and Stereotactic radiotherapy (7) and ATCREC. The DMG made efforts to clinical nutrition. The DMG performed conventional radiotherapy (54) were improve patient follow up and endoscopic procedures on 6,149 the common techniques used in consolidated the prospective databases patients, 903 patients were given providing the RT services. of all organ systems. chemotherapy (CT) and 14,385 and 19,192 patients were offered nutritional Radio-Diagnosis Service and OPD consultations respectively. A total of 1,401 procedures were performed for the patients. The DMG General Clinical Services Medical Oncology offered large range of radiology The DMG registered a total of 7,461 2,021 patients (1,155 general and 866 services; the major radiology services patients during the year, of which 4,132 private category patients) received comprised of CT guided biopsies / FNAC, were from general and 3,329 were from chemotherapy in the form of CTRT, USG guided biopsy (456) USG guided private category. The K-Ras testing in adjuvant CT, non adjuvant CT for anal, Fine Needle Aspiration Cytology (FNAC) Colorectal Cancer (CRC) and c-kit colorectal, gastric, pancreas, renal and (432), Percutaneous Transhepatic mutation testing in Gastrointestinal rectal, cancers. Complication rates of Biliary Drainage PTBD (589), and stromal tumors (GIST) was established. patients undergoing chemotherapy: emergency angioembolisation (74). The DMG achieved to regulate the Grade 1 – 81 %, Grade 2 – 64 %, Grade Interventional radiological procedures treatment to 97.4% in compliance to 3 – 16 %, Grade 4 – 2 % included Radiofrequency Ablation in the Evidence Based Management Hepatocellular Cacinoma, Radio- guidelines. frequency Ablation of Colo-Rectal Liver Metastases, Transarterial Radio-

38 Tata Memorial Centre Annual Report 2014-2015 embolisation for Unresectable Education § The DMG conducted several Hepatocellular Carcinoma and, analysis educational programmes viz. CMRs, § Live Transmission of Whipple of “Drug Eluting Beads for Workshops etc. Resection to Dubai was conducted Hepatocellular Carcinoma” for the UAE Cancer Congress, § A handbook for Residents in October 2014. Gastrointestinal Surgery was Nuclear Medicine published and was edited by § A live demonstration of Surgical Imaging procedures were conducted on Doctors A Desouza, M Goel and Procedures: Whipple Resection, a total of 1,790 patients of which, the Shrikhande S V. Hepatectomy, Radical Gastrectomy major procedures were Tc HYNIC TOC with D2 lymphadenectomy, SPECT-/CT (120), F FDG PET/CT (1,578). Outcome Indicators: Laparoscopic Anterior resection in Mortalities in Elective Surgeries: November 2014, during the Pathology 25 / 816 (3.06%) Oncosurg Conference at Tata A pathological tests of 8,970 sample Memorial Hospital. Mortalities in Emergency surgery: performed covering small biopsies on 7 / 120 (5.83%) 2,247 samples, FNAC on 1,651 samples § The DMG hosted the 11th Annual and exfoliate cytology on 1,015 Conference of the Indian Chapter of Morbidity: 20.3 % samples. The K ras and c kit was IHPBA, the highlights were cadaveric performed on 30 and 24 samples liver dissection course, medical respectively. The average turnaround writing workshop and live operative time for all samples was six days. demonstration of complex HPB surgeries by renowned international faculty, January 2014.

Research Research / Clinical Trials (basic and clinical research, investigator intiated, industry sponsored) 20 of which 2 are completed and rest ongoing important one to include.

No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 24 10 2 3 22 7 No of patients to be (Investigator accrued 2,394. initiated 14, Thesis 7 Overall patients Extramural 3) accrued 1,210

Tata Memorial Centre / DMG 39 Convener Dr. Sudeep Gupta Gynaecology – DMG Secretary Dr. Amita Maheshwari

Surgical Oncology Pathology Cancer Biology Dr. Amita Maheshwari Dr. Bharat Rekhi Dr. Shubhada Chiplunkar Dr. Rajendra Kerkar Dr. Kedar Deodhar Dr. Tanuja Teni Dr. Shylasree Thumkur Dr. Santosh Menon Dr. Murali Chilakapati Dr. Pritha Ray Medical Oncology Microbiology Dr. Sudeep Gupta Dr. Rohini Kelkar Nuclear Medicine & Molecular Dr. Jaya Ghosh Imaging Cytology Dr. Jyoti Bajpai Dr. Venkatesh Rangarajan Dr. Swati Dighe Dr. Seema Gulia Dr. Sneha Shah Radiodiagnosis Radiation Oncology Preventive Onclogy Dr. Meenakshi Thakur Dr. Shyam Shrivastava Dr. Surendra Shastri Dr. Nilesh Sable Dr. Reena Engineer Dr. Gauravi Mishra Dr. Palak Popat Dr. Umesh Mahantshetty Dr. Sharmila Patil Dr. Supriya Chopra

The Gynaecologic Oncology Working ovarian cancer. One major trial (CRACx) of a nurse counselor were employed on Group made significant progress in reached maturity and is likely to impact a regular basis in the general medical service, education and research in 2014. clinical practice in the near future and oncology OPD. The surgical oncology cervix Cancer continued to be to be the another major trial (NACT cervix) is unit successfully initiated Robotic most common cancer, followed by nearing complete accrual. The services Surgery services in the gynaecologic domain.

Key Indicators A. Volume Indicators – Number of patients treated. Number of new patients registered: 3,323; General: Private : 2,158:1,165 (65%: 35%)

Total number of major surgeries performed 790 (TMH :704 / ACTREC : 086) TMH ACTREC General : Private 321 (45.5%): 383(54.5%) 086 CA Cervix 109 09  Open 074 05 RAH + Bil. PLND 060 03 Bil. PLND 011 01 RAH (Inoperable) 001 – Pelvic exenteration 002 –  Laparoscopic 035 – Lap Type III TLRH + Bil. LPLND 022 – Lap Bil. LPLND 012 –

40 Tata Memorial Centre Annual Report 2014-2015 Ca. Uterus 096 07  Endometrial carcinoma 079 Open 048 Laparoscopic 024 Robotic 007  Uterine Sarcoma 017 Ovarian cancers 355 56  Primary Cytoreduction 098 16  Interval Cytoreduction 247 40 Secondary Cytoreduction 010 00 Vulval cancers 20 01 Miscellaneous 124 13 Note: Of the 72 patients posted for radical hysterectomy for cervical cancer 18 were patients recruited in the NACT Trial and the remaining 56 were treated off-trial. Of these 56, 35 (62.5%) were successfully treated using the laparoscopic approach Total minor surgical procedures done 392 Nil Patients receiving Radiotherapy 775  Private 171  General 604 Patients receiving Radical RT 567 Patients receiving Palliative RT 208 Cervical Cancers 667  Radical 470  Post operative + Vault 29 (Study patients at ACTREC)  Palliative 168 Endometrial Cancers 50  Radical/ Post operative 39  Palliative 11 Vaginal Cancers + Vulval Cancers 18  Radical + Post Op 13  Palliative 05 Ca Ovary 17  Post OP 03  Palliative 14 Miscellaneous: (Unknown primary/Inguinal Nodes/Bone mets etc) 23 No. of Brachytherapy procedures performed Intracavitary : 1660 ( 554 Patients) Interstitial : 205 (52 Patients) Planned Chemotherapy 1,500

Tata Memorial Centre / DMG 41 Outcome Indicators: 30-day mortality and complication Rates Surgery: TMH ACTREC Major surgical morbidity 038 (5.4%) 04 (4.6%) Intra-Op 017 (2.4%) 00  Unplanned visceral injury 012 (1.7%) 00  Major hemorrhage 005 (0.7%) 00 Post-Op 021 (3.2%) 04  Major wound infection 011 (1.5%) 00  Burst abdomen 003 (0.4%) 02  Sepsis needing ICU admission 006 (0.14%) 00  Other 001(0.14%) 00 Post-Surgical 30-day Mortality 03 (0.42%) Nil Septic shock 02 00 ARDS with pneumonitis 01 00

Radiotherapy Toxicity

Radical RT N = 567 Grade II Grade III Skin 40 (8-10%) 24 (4.5%) GI (Mainly Diarrhea) 48 (9%) 35 (6.5%) GU (Dysurial Frequency) 76 (13%) 26 (5%)

Chemotherapy Toxicity

Toxicities Percentage Haematological (Grade III/IV) 06 18.2% Neuropathy (Any Grade) 11 33%

B. Outcome Indicators: 5 year survival rates I. Gestational Trophoblastic Neoplasm : >95% II. Cervical cancer Stage III B: 60% III. Relapsed Ovarian Cancer: Median survival 22 months IV. Endometrial cancer: 97%

42 Tata Memorial Centre Annual Report 2014-2015 Research Research / Clinical Trials Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued (N=44) (N=05) (N=39) Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 41 03 04 01 37 02 Approx 6,910 (including 2,600 from the patterns of care study)

In addition to the above, two Gynaecology trials were submitted to IRB for approval and 4 trials were terminated during the year. Another trial study, “Concomitant Chemo-Radiation in Advanced Stage Carcinoma Cervix : A Phase III Randomized Trial (CRACx Study)” reached maturity and the results are likely to impact clinical practice in the near future.

Tata Memorial Centre / DMG 43 Convener Dr. J.P. Agarwal Head and Neck – DMG Secretary Dr. Shubhada Kane

Surgical Oncology Radiodiagnosis Speech Therapy Dr. Anil K. D’cruz Dr. Supreeta Arya Dr. Gurmit Bachher Dr. Devendra Chaukar Dr. Shashikant Juvekar Nuclear Medicine & Molecular Dr. Prathamesh Pai Pathology Imaging Dr. Pankaj Chaturvedi Dr. Shubhada Kane Dr. Venkatesh Rangarajan Dr. Gouri Pantvaidya Dr. Munita Bal Dr. Nilendru Purandare Dr. Anuja Deshmukh Dr. Rajiv Kumar Dr. Sneha Shah Dr. Sudhir Nair Dr. Asawari Patil Dr. Archi Agrawal Dr. Deepa Nair Plastic & Reconstructive Surgery Cancer Biology Medical Oncology Dr. Prabha Yadav Dr. Shubhada Chiplunkar Dr. Kumar Prabhash Dr. Vinay Shankhadar Dr. Murali Chilakapati Dr. Vanita Noronha Dr. Dushyant Jaiswal Dr. Manoj Mahimkar Dr. Amit Joshi Dr. Tanuja Teni ENT Surgery Radiation Oncology Dr. Milind Vaidya Dr. Chris Desouza Dr. Rajiv Sarin Dr. Jai Prakash Agarwal Dental & Prosthetic Surgery Dr. Sarbani Ghosh Laskar Dr. Kanchan Dholam Dr. Ashwini Budrukkar Dr. Karthik Sadashiva Dr. Tejpal Gupta Dr. Vedang Murthy

The Head and Neck DMG provides state Service Key Indicators of the art care in all phases of A team of experts from different management for patients with head and Workload specialties customize the management neck cancer, using a multidisciplinary of patients by designing the most The DMG registered a total of 9,366 approach to ensure the best possible effective combination of Surgery, patients, a 8.23 % increase over the outcome for both common and not so Radiation, and/or Chemotherapy to suit previous year. About 5,044 major and common cancers of the head and neck the individual patient’s needs in a multi about 2,500 minor OT procedures were region. It also promotes the importance disciplinary Joint Clinic (JC). All newly performed. An increase in major OT of scientific research, responsible diagnosed patients as well as patients procedures by 5.6% over 2013 was medical care, and a healthy who have undergone a complete observed. environment through public education staging evaluation are usually evaluated and anti-tobacco advocacy. during this clinic. These treatment plans Head and Neck cancers are one of the are based on the most up-to-date major varieties of cancers in the Indian understanding of treating the cancer in population. The Disease Management general and the individual patient in Group comprises all three major particular. oncology specialists (surgical, radiation and medical oncology), and is effectively supported by other ancillary and rehabilitative services, providing effective, evidence based care for Head & Neck cancer.

44 Tata Memorial Centre Annual Report 2014-2015 No of patients undergone Surgery:

Radiotherapy A total of 1064 patients were treated with radiotherapy, which includes 552 patients were offered definitive radiotherapy, where a 369 and 143 patients were offered adjuvant and palliative treatment respectively. About 20.50% more patients received definitive therapy.

No. of patients undergoing radiotherapy Chemotherapy A total of 1671 patients received chemotherapy. Among the different chemotherapy modalities, 616 patients were treated with Neo adjuvant chemotherapy, 577 patients were given chemo -radiation therapy (CTRT) and 478 were treated with

Tata Memorial Centre / DMG 45 palliative therapy. Thus over the previous year 48.53 % more patients received Neo-adjuvant Chemotherapy (NACT). No of Patients treated with Chemotherapy Dental services: The dental and prosthetic services offered 12,776 consultations, 1,247 prosthesis and 3,034 FGA. It also continued to offer routine dental services. Speech Therapy: 1,960 new patients were offered speech rehabilitation services through 4,006 sittings. Diagnostics

Pathology Path specimens 14,095 FNAC 4,066 Exfoliative Cytology 692 Frozen sections 2,492 Radiology CT Scan 2,546 MRI 1,975 USG 4,114 USG Guided Biopsy/FNAC 523

Outcome Indicators-30 Day mortality & complication rates Surgery : TOTAL 2,162 Morbidity – 31% ( major 34%, Minor 66%) Mortality – 0.4% Radiotherapy – TOTAL 1,098 95 % treatment completion Mortality 0.7% Complications Dermatitis - Grade 0-2: 92%, Grade 3: 0.4% Mucositis - Grade 0-2: 92%, Grade 3 : 0.4% NGT placement : 21% Weight loss : Median: 2kg (range: 0-14 Chemotherapy TOTAL -1,049, 86.04% compelte3d NACT and 85.65% completed CTRT Mortality : 0.55% Complications Toxicity(Grade 3-4) : 40% Febrile Neutroponia: 10% Mucositis: 5.6%

46 Tata Memorial Centre Annual Report 2014-2015 Outcome Indicators-5 year Survival rates Stage 1 and 2 Oral cancers: Two and five-year disease-free survival- 65% and 52% Stage 3 and 4 Oral cancers: Two and five-year disease-free survival: 63.8% and 53.3%, Radical Radiotherapy: 5 year disease free survival - 53% Chemo Radiotherapy: 5 year disease free survival - 58 % Palliative Radiotherapy: 55% PFS at 12 months NACT in oral cavity cancer: Patient undergoing surgery had 2 year survival rate of 42% as compared to median survival of 10 months patients’ not undergoing Surgery. Palliative chemotherapy: Median OS was 8 months NACT(Hypopharynx /Larynx) : The overall response rate was 66%, including 6% complete response and 60% partial response. The median PFS : 20 months. Organ preservation rate: 62%. Process Indicator A data for 200 consecutive patients who were registered in the month of Feb 2014 were collected and analyzed. On the basis of this analysis following points were observed which are mentioned in the flow chart below. 166 patients reported to JC for consultation, of which 107 patients received treatment at TMH. Of the 166 patients, 143 patients were offered radical treatment and 23 were referred for palliative treatment. Compliance to Evidence Based medicine Guidelines Joint clinic decisions were reviewed by a panel of three head and neck oncologists and were compared with the available evidence based medicine guidelines published by the hospital. If the guidelines were not followed, the reasons for the same were also documented. A compliance of 87.5% was observed. Research Research within the DMG focuses on evaluating standards of care in randomized settings, challenging dogma and evaluating new technology/ drugs and has the potential of generating high quality evidence to support translation into standard of care. The DMG members actively participate in National and International multicentric trials and have been responsible for conceptualizing, designing and implementing several prospective trials with either intramural or extramural support. The DMG members also participate in trials supported by the pharma. The DMG also has several ongoing basic science and translational research studies.

Research / Clinical trials in the year 2014 at TMH & ACTREC

Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 19 0 13 3 32 4 944

Tata Memorial Centre / DMG 47 List of important clinical trials comparing metronomic Education chemotherapy with chemotherapy along with their significance and The DMG provides extensive training to (single agent cisplatin), in patients impact on patient care. post-graduate students, residents, with metastatic, relapsed or 1. Phase II Study Of 3-Dimensional fellows, National & International inoperable squamous cell Conformal Radiotherapy (3D-CRT) observers and the allied medical carcinoma of Head and Neck. Vs.Intensity Modulated professionals in comprehensive head Radiotherapy (IMRT) For Squamous 5. Bio-SMART- Biological imaging and neck cancer care. Education is Cell Carcinoma Of The Head & neck before, during, and after provided through the activities like (HNSCC). Simultaneous Modulated academic meetings, student thesis Accelerated Radiation Therapy in 2. 3DCRT vs IMRT- Phase II Study Of 3- meetings, multidisciplinary clinic (joint head and neck squamous cell Dimensional Conformal Clinics), skull base clinics, and clinical carcinoma (Bio-SMART). Radiotherapy (3D-CRT) Vs.Intensity ward grand rounds, teaching rounds, Modulated Radiotherapy (IMRT) For 6. PRET RCT in Shoulder dysfunction – seminars and workshops. The DMG Squamous Cell Carcinoma Of The Effect of Progressive Resistive offers fellowships for professionals in Head & neck (HNSCC) Exercise Training on shoulder joint head and Neck surgery, dental and range of motion operative Head and prosthetic surgery and Speech 3. Mandible Preservation - The role of Neck cancer patients undergoing rehabilitation units. The DMG trained neo adjuvant chemotherapy for radiotherapy; a randomized trial. 63 national and 4 international observer mandibular preservation in locally trainees during the year 2014. The M advanced operable squamous cell 7. HPV in India – Prevalence and Ch programme enrolled four students carcinoma of the oral cavity. Clinical impact of p16 positive head and neck cancer in India and its in 2014. 4. Metronomic CT - A prospective interaction with tobacco use. randomized phase II Study

48 Tata Memorial Centre Annual Report 2014-2015 Convener : Dr. Aliasgar Moiyadi Neuro-Oncology – DMG Secretary : Dr. Tejpal Gupta

Neuro-Surgery Pediatric Medical Oncology Nuclear Medicine & Dr. Aliasgar Moiyadi Dr. Purna Kurkure Molecular Imaging Dr. Prakash Shetty Dr. Girish Chinnaswamy Dr. Venkatesh Rangarajan Adult Medical Oncology Dr. Tushar Vora Dr. Nilendu Purandare Dr. Maya Prasad Dr. Hari Menon Psychiatry Basic Neuro-Oncology Radiation Oncology Dr. Jayita Deodhar Dr. Tejpal Gupta Dr. Neelam Shirsat Occupational Thearpy Radiodiagnosis Dr. Rakesh Jalali Dr. Goda Jayant Sastri Dr. Sanya Shroff Dr. Nikhil Merchant Dr. Supreeta Arya Pathology Neuro-Oncology Research Fellow Dr. Subhash Ramani Dr. Shubhada Kane Dr. Abhishek Puri Dr. Ashwin Polnaya Dr. Epari Sridhar Dr Siddharth Pant Dr. Amit Janu Dr. Ayushi Sahay Dr. Abhishek Mahajan COMPREHENSIVE CARE FOR PATIENTS WITH BRAIN AND SPINE TUMORS Service Key Indicators Neuro-oncology DMG provides psychological and neuro-endocrine Volume indicators comprehensive care for patients with outcomes compared to conventional A steady increase in registration of brain and spine tumors. This includes radiation therapy in children/young patients was observed. The DMG outpatient as well as inpatient (elective adults with benign/low-grade brain registered 1,595 patients during the and emergency services). tumors. This has shown a potential in year which included 312 patients who The DMG has made concerted efforts changing the practice. sought second opinion. to enhance patient care. On the A separate ‘Phakomatoses Clinic’ for diagnostics side, new investigations Of the total registrations, 61.5% and patients with neurocutaneous introduced in pathology include IDH- 38.5% belonged to the general and syndromes was initiated to improve the mutation testing both Immuno Histo- private category respectively. The quality of care for these patients. Chemistry (IHC) as well as Polymerase gender ratio was 65% male and 35% Chain Reaction (PCR), 1p19q deletion female patients. It was observed that Fluorescent in Situ Hybridization (FISH), the21 %, 31% and 34 % patients were EGFR mutation (FISH) and Methyl in the age group of 1-20, 21-40 and 41- Guanine Methyl Transferase (MGMT) 60 years respectively. methylation (PCR). Further comprehensive preoperative imaging is done for most preoperative patients (at TMH and ACTREC) in order to plan surgery optimally as well as to create a database. This includes routine Magnetic Resonance (MR) sequences as well as special functional MR evaluations. Special surgical planning (navigation) MR sequences are used when necessary. A randomized controlled trial, demonstrated the benefit of high- precision fractionated stereotactic conformal radiation therapy in preserving long term neuro-

Tata Memorial Centre / DMG 49 Neurosurgery Operations

TMH ACTREC TOTAL Demographics Males 70 128 198 Females 47 83 130 Adult 88 178 266 Paediatric 29 33 62 Surgery - type Craniotomy (supratentorial) 68 165 233 Posterior fossa 16 (4.87%) 23 (7.01%) 39 (11.89%) Retro-mastoid 8 (2.43%) 14 (4.26%) 22 (6.70%) Trans-sphenoidal 07 (2.13%) 0 (0.00%) 07 (2.13%) Others 18 (5.48%) 09 (2.74%) 27 (8.23%) Nature of Surgery Elective 96 (29.26%) 208 (63.41%) 304 (92.68%) Emergency 21 (6.04%) 3 (0.91%) 24 (7.31%)

Radiotherapy indicators

Radiation Therapy administered within the institute

Sr. No. Technique of RT TMH ACTREC 1 Conventional RT 103 Nil 2 3D-CRT 169 Nil 3 IMRT/IGRT 74 72 4 Stereotactic Radiosurgery 2 Nil Total 348 72 Referred outside for radiation therapy 342 22 GRAND TOTAL 690 94

MEDICAL ONCOLOGY chemotherapy (either temozolomide or and 20 patients with primary CNS Patients with high-grade gliomas and PCV regimen). Around 200 patients lymphoma were treated with DeAngelis ‘aggressive’ low grade gliomas receive received concurrent temozolomide protocol. concurrent and adjuvant chemotherapy during radiotherapy and over 500 Approximately 65 paediatric brain (Temozolomide) and patients with patients received adjuvant tumour patients received recurrent, progressive, transformed temozolomide in 2014. Fifteen patients chemotherapy in 2014. gliomas are treated with salvage received Bevacizumab +/- Irinotecan

50 Tata Memorial Centre Annual Report 2014-2015 Outcome Indicators

30-day morbidity and mortality (for elective cases)

MORBIDITY (MINOR) MORBIDITY (MAJOR) MORTALITY TMH 18(15.4%) 22(18.8%) 14 (4.4%) ACTREC 29(15.2%) 32(13.7%) 7 (3.3%) Outcome Indicator- 5year survival rates Sr. No. Diagnosis 5-year overall survival 1 Craniopharyngioma 95% (using SCRT) 2 Meningioma Benign/Low Grade 89% 3 Medulloblastoma Average-Risk 85% High-Risk 65% (3-yr) 4 Glioblastoma Median Survival 17 months 2-year survival 29% 5 year survival 11%

Research apart) for craniospinal irradiation and data) to around 65% . and the regimen tumor bed boost in children average- is now included as routine clinical Stereotactic conformal radiation risk medulloblastoma without upfront practice. therapy has resulted in significantly chemotherapy has resulted in lesser better preservation of long term neuro- The use of mage-guided intensity- incidence and severity of sensorineural psychological and neuro-endocrine modulated radiation therapy (IMRT) for hearing loss. outcomes compared to conventional benign/low-grade intracranial tumors radiation therapy in children and young The addition of carboplatin has resulted in excellent local control adults with benign and low-grade brain concurrently with craniospinal and overall survival with minimal acute tumors. irradiation in high-risk/metastatic and medium-term morbidity. Given the embryonal CNS tumors improved 3- improved therapeutic ratio, IMRT is The use of hyperfractionated radiation year outcomes from H”50% (historical increasingly being offered to patients therapy (1Gy twice daily, 6-8 hours with benign/low-grade tumors.

Resarch/Clinical Trails Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 13 0 3 3 10 3 359 (28%) of 1283 patients

Tata Memorial Centre / DMG 51 Convener: Dr.Brijesh Arora Secretary : Dr.Gaurav Narula Paediatric Hematolymphoid – DMG

Surgical Oncology Nuclear Medicine & Psychiatry and Clinical Psychology Dr Sajid Qureshi Molecular Imaging Dr. Jayita Deodhar Dr. Venkatesh Rangarajan Ms. Savita Goswami Pediatric Medical Oncology Dr. Sneha Shah Dr Shripad Banavali. Molecular Hematology & Dr. Seema Medhi Dr.Brijesh Arora Cytogenetics Dr.Gaurav Narula Pathology Dr. Pratibha Amare Kadam Dr. Sumeet Gujral Dr. Anuradha Chougule Clinical Pharmacology Dr. Tanuja Seth Dr.Vikram Gota Occupational Therapy Dr. P. G. Subramanian Dr. Shruti Velaskar Radiation Oncology Dr. Sridhar Epari Dr. Jagmohan Lal Meena Dr. Siddhartha Laskar Dr. Prashant Tembhare Dr.Nehal Khanna Dr. Nikhil Patkar Medical Social Worker Mrs. Neelima Dalvi Mr. Chandu Parab

Every Child with Curable Cancer Should Get a Chance at Cure

Service NGOs. They also need neat and clean a volunteer platelet donor registry. This accommodation at reasonable prices. A initiative has ensured provision of blood Paediatric Hematolymphoid provides corpus under the “Pediatric cancer products to patients whenever contemporary, comprehensive and Foundation-ImPaCCT” funds has been required. compassionate family-centred holistic created to support financial needs. With clinical care focussing on the needs of the help of St Jude Child Care Centre, both children and their families which Key indicators Borges home and other organisations, includes socio- economic, financial, Key Cancer Benchmarks: The DMG most of pediatric patients stay in facility nutritional, transfusion help, registers epidemiological data for all near TMH and in ACTREC. the accommodation, emotional, patients, this data is audited to depict nutritional assessment of patients is bereavement and also counsels the trends in disease volumes, treatment conducted by a team of nutritionists patient and the family. These services compliance and completion, treatment and are counselled . They provide are well-coordinated by the social delivery, mortality and morbidity rates guidance about diet especially low cost support group team and is facilitated and survival of each disease food supplements. A low cost enteral through the childhood cancer subcategory in PHLG. supplement along with dietetics foundation called “ImPaCCT - Improving department. This team has created Paediatric Cancer Care &Treatment” Volume Indicators many recipes from LCEF and their use Foundation. A total of 827 patients were registered have shown good response in patients. during the year. The cumulative patient Curable malignancies need to be funded More than 75,000 midday meals with visit exceeds 35,000 as majority of these in the initial period to decrease refusal snack have been distributed. rates through provision of Seed money. require intense, curative and prolonged A non formal education is provided to The team of social workers and therapies with multiple outpatient and children with assistance from NGOs like volunteers works in tandem with TMH inpatient visits. of the total of 827 / 671 “little-More”, Cankids-Kidscan and Medical Social Service Department, and (81%) belonged to General Category Mindsprings. A drive called “ Save a Life several other trusts and NGOs. All and 156 (19%) were Private category “ was initiated with help from Nargis young curable children are adopted by patients. The DMG saw a total of 35,210 Dutt Foundation to recruit platelet hospital and rest are supported through patients as follow up cases. There were donors from colleges & corporate various governmental schemes and 610 new cases of acute leukemias and houses in Mumbai. and has resulted in 186 new cases of lymphomas.

52 Tata Memorial Centre Annual Report 2014-2015 Outcome Indicators transfusion, education etc for the Currently, 86.8% patients are being children. This has helped in dramatically treated as per TMH protocols at TMH The social support group consisting of decreasing the abandonment rates and 8% at other hospitals under TMH social workers, data managers for from >20% in 2009 to 4% in 2014. The guidance, a considerably improvement patient tracking, counselors, current treatment refusal and over the previous years with reduction psychologists, and multiple NGOs abandonment (TRA) is primarily in the rates of TRA. ensures holistic care of children and observed diseases requiring expensive their family during treatment by therapy with very poor outcome. providing support for accommodation, No of paediatric patients treated

Disease sub types Total No. No. Of patients Treated At TMH No of patients Treated under TMH guidance elsewhere ALL 505 440 25 AML 105 83 4 CML 16 15 0 NHL 132 113 7 HL 54 47 4 LCH 11 11 0 JMML 4 3 1 Total 827 712 41

Mortality: In year 2010, the mortality rates were very high. The overall induction mortality rates were 8% with approximately 10% patients dying in ALL and 16% in AML during induction period. Most of these deaths have been toxic deaths due to infection. This has been reduced to 4.1% in 2014 with 4.5% & 6% induction deaths in ALL & AML respectively. Similarly, the post induction mortality which represents late events of toxic deaths as well as relapses have been reduced from 18% to 1.2%. The disease free survival amongst BMT patients is 70% and transplant related mortality is 6%.

DISEASE TOTAL TOTAL Mortality in 2014 REGISTERED EXPIRED BEFORE RX WITHIN 45 DAY’S AFTER 45 DAY’S NO. (%) NO. (%) NO. (%) ALL 505 36 7 1.38 23 4.55 6 1.18 AML 105 16 8 7.61 6 5.71 2 1.90 CML160000000 NHL 132 4 1 0.75 3 2.27 0 0 HL 54 3 0 0 2 3.7 1 1.85 LCH110000000 JMML410000125 TOTAL 827 60 16 1.9 34 4.11 10 1.20

Tata Memorial Centre / DMG 53 Survival: The current Survival rates in PHLG are among the best in the country and are comparable to the rest of the world in most disease subgroups. 5-yr overall survival of Pediatric hematological malignancies (TMH) Cancer Event-free survival(%) Overall survival(%) ALL (B-lineage) 73 76 ALL(T-lineage) 80 80 AML 40 44 NHL (T-lymphoblastic) 91 90 NHL (B-NHL) 74 82 NHL(ALCL) 50 71 Hodgkin’s disease 90 94 Langerhans cell histiocytosis 72 82 Chronic Myeloid leukemia 84 100

Research sponsored clinical trials. lymphoblastic leukemia in India called “ICiCle”(Indian Childhood Collaborative Apart from delivering exceptional care, A) Acute Lymphoblastic Leukaemia Group) which has been DMG is active in basic, clinical and successfully piloted in 2013. The translational research targeted to Leukemia: protocol development meeting was understand disease biology, improve Development of indigenous held at Tata Memorial Hospital on diagnosis & risk stratification, enhance scientifically designed locally feasible December 23, 2012 & March 2014 treatment outcome, minimize adverse protocols: In this regard, PHLG has which laid the foundation of the treatment complications, provide cost systematically developed and piloted 3 backbone of this protocol. This protocol effective and regionally relevant protocols in collaboration with National is based on current state of art in ALL curative therapy, and to develop a Cancer Institute, USA and INCTR, and includes risk stratification based on sustainable model for low middle Brussels, Belgium. These include MCP- clinical and cytogenetic factors, income countries across the globe. 841, MCP-943 and INCTR-02-04. MCP- 841 is the only indigenously developed response to therapy and minimal The DMG has undertaken a total of 61 and highly successful protocol from residual disease which is the first of its research studies. Out of 61, 21 were India and is currently being followed in kind in whole country. In addition, student research (15 completed), 57 most pediatric oncology units in the cranial radiation has been dispensed studies were initiated by investigators country. Currently, DMG is actively with from more than 99% patients and (26 completed) and 4 studies were involved in developing the national high dose methotrexate would be protocol for treatment of acute integral part of systemic therapy. This

Research/Clinical Trials Total No. of Clinical Trials Completed Trials Ongoing Trials Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 57 4 26 1 31 3

54 Tata Memorial Centre Annual Report 2014-2015 is likely to significantly decrease the Hence, PHLG continues to explore the of Modified BFM-90 (with reduced treatment related morbidity, cost of use of high dose Cytarabine methotrexate dose) in lymphoblastic therapy and improve the outcome consolidation for improving the lymphoma hav e been comparable to across all risk groups with minimal outcome of this sub group. This western studies. A pilot study for therapy. Further this would answer 2 modified approach has An immunochemotherapy with rituximab key questions related to duration of improvement in the outcome of ALL in added to MCP-842 for high risk B-NHL steroids in induction of ALL as well as more than 80% in both B & T-lineage has been undertaken. choice of anthracycline in delayed ALL, are observed. Prognostic markers: PHLG has intensification. This multicentric prospectively studied the role of early B) Acute Myeloid Leukemia:- protocol involving more than 15 centres metabolic response in B-NHL and ALCL across the country has been submitted AML:-The group has been using oral has found it to be an important to ICMR for funding. The protocol has metronomic maintenance therapy in prognostic marker which has been been piloted in TMH for last 2 years and AML patients with good outcome which presented in SIOP 2013. PHLG would be has significantly improved the quality of are comparable to international using early morphologic and metabolic ALL treatment through provision of outcomes despite higher initial toxic response to delineate high risk group for optimal MRD based risk stratified deaths. using rituximab based MCP-842. therapy to maximize cure rates at least APML:- DMG has also studied the role PHLG has also piloted modified LCH-III cost. DMG has also spearheaded the of indigenous metronomic standardization of MRD and ALL with addition of oral metronomic chemotherapy along with ATRA, etoposide in high risk multisystem RO+ cytogenetics across the country by daunomycin and maintenance organising national level investigator LCH with promising results. The group chemotherapy in patients with APML. has shown that novel PSGA is a very and technician training programs This novel indigenous regimen has supported by DMG. good tool for nutritional assessment in shown promising response with limited children. It has been also observed that morbidity and mortality. It is being used Novel approaches for High risk ALL:- use of acyclovir, as secondary in all sick APML patients in our DMG. prophylaxis, in immune-compromised Many patients with B-Lineage ALL and This was presented in SIOP-2014. contacts of chicken pox, is highly most patients with T-ALL do not have The results of the evaluation of the role efficacious and much cheaper good outcome with current protocols. compared to intravenous Varicella immunoglobulin.

Tata Memorial Centre / DMG 55 Convener: Dr. Sajid Qureshi Secretary: Dr. Seema Kembhavi Paediatric Solid Tumor – DMG

Surgical Oncology Radiation Oncology Nuclear Medicine & Dr. Sajid Qureshi Dr. Siddharth Laskar Molecular Imaging Dr. Nehal Khanna Dr. Venkatesh Rangarajan Medical Oncology Dr. Sneha Shah Dr. Purna Kurkure Pathology Dr. Girish Chinnaswamy Dr. Mukta Ramadwar Palliative Care Dr. Tushar Vora Dr. Bharat Rekhi Dr. Maryann Muckaden Dr. Maya Prasad Dr. Navin Salins Radiodiagnosis Dr. Seema Kembhavi Honorary Ophthalmologist Dr. Palak Popat Dr. Nandan Shetye

Service facilitating support. A social support The joint clinics were regularly held for team interacts with and counsels deciding on integrated treatment plan The Pediatrics solid tumor DMG consists patients to decrease abandonment of and meetings were also conducted to of a mix of experts like pediatric treatment and improve treatment discuss diagnostic and treatment oncologist, pediatric surgeon, pediatric compliance for better survival. These dilemmas. The paediatric patients are radiation oncologist, pathologist and interactions are weekly to facilitate this registered in the database, supported radiologist and meets regularly to support. by the Indian Paediatric Oncology address clinical, patient requirements, Initiative (IPOI) of the Jiv Daya academic, scientific and administrative The DMG registered a total of 1,050 Foundation. matters. The DMG treats patients at patients performed 315 surgeries both campuses of the centre i.e. at TMH including major, minor and vascular The Clinical guidelines for individual and ACTREC. accesses. The DMG captures the data solid tumors were reviewed and for patients with extra cranial and non- staging, risk stratification and treatment The Socio economic assessment of extremity osseous tumors. The DMG pathways were outlined based on the patients is conducted at their initial visit. regularly conducts audits. The audits for contemporary evidence in literature This helps in identifying of emergency the Retinoblastoma, hepatoblastoma, and proceedings from important management and need of financial and salivary gland tumors and paediatric world congresses. These social support. Patients are counseled rhabdomyosarcoma were completed clinical guidelines are reviewed and and directed to social workers for during the year. updated on a regular basis. Key Indicators Volume Indicators A total of 1,050 pediatric patients were registered during the year

Diagnosis General Private Total STS 92 23 115 Neuroblastoma 60 17 77 GCT 53 4 57 Renal Tumor 42 12 54 Misc 79 18 97 No malignancy 14 5 19 Retinoblastoma 33 5 38 Hepatoblastoma 25 4 29 No investigation 16 11 27 Total 414 99 513

56 Tata Memorial Centre Annual Report 2014-2015 Surgery A total of 315 surgical procedures were performed at TMH and ACTREC. These are - Surgeries TMH ACTREC Total Major 98 47 145 Minor 19 31 50 Pediatric vascular access 48 4 52 Adult vascular access 0 68 68 Total 165 150 315

Chemotherapy brachytherapy and conventional Education 328 and 16 patients were offered radical radiotherapy. However about 4% did The DMG continues to conduct DM and palliative chemotherapy, with not complete the radiotherapy. Acute programme and 2-year fellowship in 11.6% Morbidity and 5.2% Mortality. toxicity related to radiotherapy was Pediatric Oncology under the aegis of observed namely, 14% in grade I, 11% HBNI. The DMG also organises a lecture Radiotherapy in Grade Ii, and 09% in grade III. series on all aspects of management of 177 patients were treated with various 112 new and 548 follow up patients Pediatric solid tumors. Observers from radiotherapy modalities viz., radical, attended the after completion therapy various institutes in India were accepted palliative, ketlar, Ext Radiotherapy, clinic. in the Pediatric oncology service at Tata Memorial Hospital as part of training program. The members participated at various international and national workshops, meetings and conferences.

Research Research/Clinical Trials Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 14 3 5 - 7 3 1417

Tata Memorial Centre / DMG 57 Convener : Dr. C.S. Pramesh Thoracic Oncology – DMG Secretary : Dr. Sarbani Ghosh

Surgical Oncology Medical Gastroenerology Radiology Dr. C S Pramesh Dr. Shaesta Mehta Dr Subhash Ramani Dr. George Karimundackal Dr. Prachi Patil Dr Abhishek Mahajan Dr. Sabita Jiwnani Dr Amitkumar Janu Pulmonary Medicine Medical Oncology Dr Sandeep Tandon Interventional Radiology Dr Kumar Prabhash Dr Suyash Kulkarni Pathology Dr Vanita Noronha Dr Ashwin Polnaya Dr Nirmala Jambhekar Dr Amit Joshi Dr Rajeev Kaushal Palliative care Radiation Oncology Dr Neha Mittal Dr Jayita Deodhar Dr. Jai Prakash Agarwal Nuclear Medicine & Epidemiology Dr. Sarbani Ghosh Molecular Imaging Dr Atul Budukh Dr Venkatesh Rangarajan Dr Nilendu Purandare

The Thoracic Oncology Disease  increasing number of complex early involvement of the palliative Management Group (DMG)is a thoracic surgical procedures care team multidisciplinary team comprising of including the surgical treatment of The initiation of the “high-risk” specialised surgeons, medical and tracheo bronchial tumors, advanced multidisciplinary meeting with thoracic radiation oncologists with active mediastinal and chest wall tumors surgeons, anesthesiologists, critical care support from a pulmonary physician,  management of complex airway specialists and pulmonary physicians, a specialized pathologists, radiologists, problems including unique feature of the DMG has led to palliative care physicians and tracheobronchial stenting and laser increasing numbers of high-risk patients physiotherapists. Service in the DMG therapy being considered for surgery and also involves the participation of  evidence based management of improved outcomes, optimizing the cardiovascular surgeons, endocrine advanced lung and esophageal care of patients with multiple specialists, basic scientists and cancers with molecular-based technology experts. In addition the comorbidities prior to surgery. Active DMG has a vibrant teaching/ training personalized targeted therapy and participation from the physiotherapy programme and is involved in several chemotherapy department on postoperative rounds relevant research activities.  state of the art radiotherapy ensures individualized attention to services including tomotherapy, specific patients. Service image-guided and stereotactic body Another notable achievement was the radiotherapy initiation of the Esophageal and lung The thoracic oncology DMG is amongst  cancer support group, which has invited the few specialized multidisciplinary Immediate postoperative, post groups in the country treating a wide chemotherapy and radiation talks, discussions focusing on patient- variety of lung, esophageal, chest wall therapy outcomes comparable with centric problems. The involvement and mediastinal tumors. similar high volume centres in the from patients has been encouraging world. and this provides them a forum for Specific unique strengths of the  In addition to the above the DMG exchange of experiences, discussing DMG include also has a very effective programme their fears, concerns and closer interaction with other patients and their  largest thoracoscopic surgery for palliation of both advanced treating physicians. In addition, the programme in the country esophageal and lung cancers, with

58 Tata Memorial Centre Annual Report 2014-2015 availability of dedicated counselors for high volume centres in the world. A  Dedicated counsellor for lung cancer patients with thoracic cancers and the large number of patients are operated patients institution of early palliative care into by minimally invasive surgery including  Availability of 68Galium DOTA the treatment continuum are some thoracoscopy, laparoscopy and robotic Peptide for neuro-endocrine tumors more initiatives to improve the overall surgery. experience for patients. The thoracic medical oncology unit has Research Quality improvement measures amongst the highest volumes in the The thoracic DMG conducts several The DMG maintains ongoing quality country and treated 1,414 patients with investigator-initiated and sponsored improvement measures with lung cancer and 503 patients with research studies. Some of the studies continuous audits of peri-operative, esophageal cancer. These include initiated earlier were published and post chemotherapy and post neoadjuvant, adjuvant and palliative presented in high impact journals and radiotherapy morbidity and mortality, chemotherapy including targeted international conferences respectively. estimation of postoperative infections therapy. Overall response rates, toxicity The randomized trial evaluating the role and treatment compliance. and survival figures were similar to high of perioperative erythromycin to quality thoracic oncology centres prevent delayed gastric emptying in Key Indicators worldwide. patients undergoing esophagectomy was presented in the biennial Volume & Outcome indicators Thoracic radiation oncology treated 503 conference of the International Society patients with lung cancer with The DMG is amongst the highest for Diseases of the Esophagus in compliance of 98% and 77 patients with volume thoracic centres in the world. A Vancouver. Ongoing randomized trials total of 3,802 new patients, comprising esophageal cancer with a compliance include the trials comparing radical over 10% of the hospital registrations rate of 91 percent. Short and medium three-field vs two field esophagectomy were registered in the DMG in 2014, of term outcomes have been meticulously for operable esophageal cancer, and which 2,263 (59.6%) were general and documented and periodic audits neoadjuvant chemotherapy with 1,537 (40.4%) were private patients. conducted to monitor performance neoadjuvant chemoradiation for Lung cancers were the majority, 2,374 critically. All modern techniques of locoregionally advanced esophageal (62.4%) followed by esophageal cancer radiation including IGRT, IMRT, 3DCRT cancer. In addition, several new studies 1,070 (28.1%). and SBRT are available and used were initiated this year and planned for regularly to provide superior treatment the next year. The thoracic surgical unit is the highest outcomes. volume thoracic oncology centre in The CHEST (Cancers of the Hypopharynx and Esophagus Trial) India and operated 197 patients with Newer initiatives in the DMG esophageal cancer, 104 patients with screening trial is underway in Ratnagiri  Robotic surgery for thoracic cancers district with over 33,000 individuals lung cancer, 145 patients with having been screened and given health pulmonary metastases, 35 patients with  Stereotactic radiotherapy for lung awareness for upper aerodigestive tract mediastinal tumors and 32 patients cancers cancers. Extensive health education and with chest wall tumors. In addition,  Lung and esophagus cancer patient awareness of health hazards of tobacco several minor procedures including support group use is an integral part of the diagnostic and therapeutic  Pharmacovigilance program for programme. Several other randomized bronchoscopy, port insertions, chemotherapy drugs trials were initiated in advanced lung intercostal drainage, pleurodesis etc  Introduced early palliative care for and esophageal cancers. Several articles were performed. Early post-operative lung cancer patients were published by DMG members in outcomes are comparable with most various peer reviewed journals.

Tata Memorial Centre / DMG 59 Research / Clinical Trails Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 8 1 5 3 22 4 35,750 patients

Education residents and fellows from across the addition, training is provided in country. A lung practicum was diagnostic bronchoscopy to 24 The DMG contributes dedicated conducted in the department of physicians from across the country teaching sessions and on-the job radiation oncology, a limited hands on annually training for the MCh (Surgical course focusing especially on Oncology), DM (Medical Oncology) and stereotactic radiotherapy in lung MD (Radiation Oncology) courses. In Achievements of members cancers. addition, a two-year fellowship in Members of the DMG serve as faculty thoracic surgical oncology is offered The DMG participated in the annual in several national and International under the Homi Bhabha National surgical oncology workshop (Oncosurg meetings, serve on the editorial board Institute and is the only one of its kind 2014) for post-graduate students and and act as reviewers for several high- in the country. The teaching programme practicing surgeons, which is a three- impact, indexed journals such as the is highly structured and includes day operative workshop attended by Lancet Oncology, Annals of Thoracic didactic lectures, seminars and case- more than 300 delegates. The DMG has Surgery, Annals of Surgery, IJMPO, IJC, presentations. Regular orientation several trainees - ten thoracic surgical Cancer, Clinical Oncology, etc., hold lectures are taken for all new registrars fellows (two 2-year fellowships, two leadership positions in important and fellows working in thoracic surgery one-year fellowships and six 6-month societies like the International Society nine times a year. Two comprehensive fellowships);twelve senior M.Ch (Surg for Diseases of the Esophagus, ISMPO, CMEs were conducted covering the Onco) registrars, fifteen junior M.Ch ISES and ICON. They also serve as faculty entire spectrum of lung cancer which (Surg Onco) registrars six medical and and examiners for post graduate was attended by postgraduates, twelve radiation oncology registrars examinations for Universities within the rotate through the DMG every year. In country.

60 Tata Memorial Centre Annual Report 2014-2015 Convener : Dr. Umesh Mahantshetty Urology – DMG Secretary : Dr. Ganesh Bakshi

Surgical Oncology Radiodiagnosis Cancer Cytogenetics Dr. Ganesh Bakshi Dr. Meenakshi Thakur Dr. Pratibha Kadam Amre Dr. Gagan Prakash Dr. Suyash Kulkarni Basic Sciences, ACTREC Dr. Nilesh Sable Medical Oncology Dr. Shubhada Chiplunkar Dr.Kumar Prabash Nuclear Medicine & Dr. Kishore Amin Dr.Vanita Noronha Molecular Imaging Dr. Ashok Varma Dr.Amit Joshi Dr. Venkatesh Rangarajan Medical Records & Epidemiology Dr. Nilendu Purandare Radiation Oncology Dr. Ganesh Balasubramanium Dr. Archi Agrawal Dr. Shyam K Shrivastava Dr. Rajesh Dikshit Dr. Umesh Mahantshetty Pathology Dr. Vedang Murthy Dr Sangeeta Desai Dr.Santosh Menon

Service Key Indicators Surgical Oncology The Urology Oncology DMG is a multi Volume Indicators (Number of patients The Urologic Oncology Surgical Service disciplinary group comprising of Uro- treated at each sub-site) offers the entire spectrum of the “state- of-the-art” surgical procedures for Oncologists, surgeons, pathologists, Two thousand one hundred and three medical oncologists, radiation management of urological cancers and patients (General- 1,097, and Private - has in fact pioneered, standardized and oncologists, radiologists, 1,006) registered with the DMG. The epidemiologists, basic and translational popularized most of these procedures DMG attended to 6,500 follow up in the country research scientists and staff from other patients and saw 345 patients as referral supportive groups etc. and aims to cases. Minimal Access Surgery the form of deliver optimum patient care as well as laparoscopy and endourology is bring all clinical and translational Outcome indicator included in the repertoire as a routine. research under one umbrella to ensure Complication rates (As per Clavien The number of laparoscopic urological optimum outcomes. The Urology Dindo system) oncology surgeries almost doubled as Oncology Group members work actively Grade 1 – 5.8% compared to previous year. During the with other DMG members and staff Grade 2 – 0.9% year, a total of 655 major surgeries and towards optimum patient care and Grade 3 – 0.7% 3,677 minor surgical procedures were outcome. Grade 4 – 0.5% performed at TMH and ACTREC, apart There has been a substantial increase from diagnostic and therapeutic Grade 5 – 0.1% in number of patients for renal, bladder, endoscopic procedures. Robotic surgery prostate, penile and testicular cancers Outcome indicator (5 yr survival rates) was introduced during the year and with increasing numbers of patients The survival rates for all urological since its installation, 14 robotic with renal, bladder and Prostate cancers are extremely good, most of urological surgeries viz., Prostatectomy, cancers. them being highly curable neoplasms radical Nephrectomy, and radical and are comparable with the figures Cystectomy have been performed, of reported from other reputed uro- which 10 were Radical Prostatectomy. oncology centres. Process indicator Around 98% compliance with evidence based guidelines. 2% non compliance due to reasons concerned to patient and relatives.

Tata Memorial Centre / DMG 61 Table showing Uro-Oncology Patients by sub-site and Intent of Treatment (TMH + ACTREC)

Diagnosis Radical Post-Op Palliative Grand Total Prostate Cancers 67 10 130 207 Renal Cancers 1 - 45 46 Testicular Cancers 16 10 26 Ureteral Cancers 1 - - 1 Urethral Cancers 1 - - 1 Urinary Bladder Cancers 13 4 20 37 Adrenal tumors 1 3 6 10 Penile Cancers 4 10 2 16 Miscellaneous - 2 12 14 Grand Total 104 29 225 358

Radiation Oncology Pathology compliance to EBM guidelines. The The Radiotherapy OPD attended to The histopathology offered diagnostic treatment approaches have been 1,206 private and 1650 general category services to about 685 cases of urethelail developed with aim of organ and of patients which included new, follow carcinomas, 402 prostate cancer, 227 function preservation, based on the up and referral patients. The RT Testis cancers, 92 penile cancer cases, development of organ preservation compliance rate of 96.5% was observed. and 227 renal tumors cases. The turn- surgeries and non surgical management The patients received state-of-the art around time of the pathology services protocols, the treatment results are radiotherapy including conventional for big specimens for 758 patients has continuously monitored. radiotherapy (RT) to a total 44 patients, been 9 days and 7 days for 428 small 3D- CRT to 15 patients, IMRT 76, biopsies patients. The turnaround time Education brachytherapy to 05 patients with for cytology services for 2,338 non The CME for 2014 was held on 2012- cancers. A steady increase in use of high gynecology patients was 1 day, and 3 2014 at Tata Memorial Hospital on dose rate brachytherapy for penile days for other cytology services to 227 ‘Nuclear Imaging and Therapeutics in (penile conservative therapy) and patients. A total of 236 TRUS Guided Uro-Oncological cancers’. prostate cancers was observed. biopsies were conducted. Continued Training of Surgical Chemotherapy Outcome Indicator Oncologists and Surgeons in the basic practices of Urologic Oncology as a part A total of 380 patients were seen in Over the years the DMG achieved a low of the comprehensive MCh Surgical Medical Oncology OPDs. 30 day mortality and morbidity in the Oncology programme. service. The DMG observed a 98% Research Research/Clinical Trials

Total No. of Clinical Trials Completed Trials Ongoing Trials Overall Patients Accrued (N=19) (N=3) (N=16) Investigator Sponsored Investigator Sponsored Investigator Sponsored Initiated Trials Initiated Trials Initiated Trials 17 2 2 1 15 1 1111 pts

62 Tata Memorial Centre Annual Report 2014-2015 DMG Support Services

CLINICAL NUTRITION regular follow-ups of all previously feeds. Regular monitoring and referred patients who are on Medical assessment is done to know the Mrs. Anjali Nair, Chief Dietician Nutrition Therapy, Monitor their compliance with feeds and their Dieticians take daily ward rounds, prescribed diet compliance. Correct prognosis. Patients and their attendants Assess, referred patients for Nutritional nutrient intakes as per the latest are counseled, educated and trained to Intervention, Study their Nutritional investigations / reports and other handle the Enteral and Parenteral requirements and Clinical profiles, indications. Examine the patient’s feeding methods and to manage their examine their ability to consume and tolerance towards the Therapeutic associated complications. Provide digest planned diet schedule and plan feeds. Special care is given to the guidelines to kitchen supervisors and a Medical Nutrition Therapy. Keep patients on Enteral and Parenteral kitchen staff and train them to prepare therapeutic feeds.

DENTAL AND PROSTHETIC SERVICES

Dr. Kanchan Dholam, Head Service Research Dr. Karthik M.S, 12,776 patients were seen in the Out The departmental research focuses on Dental & Prosthetic Surgery unit is Patients Department. 1,247 patients evaluation of responsiveness of head involved in dental care and maxillofacial were treated with prosthetic and neck cancer patients after oral prosthetic rehabilitation of head and rehabilitation following ablative rehabilitation and risk factors based on neck cancer patients undergoing surgery, 315 maxillary prosthesis which diet and oral hygiene in squamous cell surgery, radiotherapy, chemotherapy. included immediate, intermediate and carcinoma of the oral cavity and oro- The main domain is to offer dental permanent maxillary obturators and pharynx treatment with prosthetic rehabilitation palatal prosthesis following (intra oral and extra oral) for patients maxillectomy. 557 guide plane Education prosthesis following mandibulectomy, undergoing oncology treatment. Short training courses in Maxillofacial 11 tongue prosthesis following total Maxillofacial Prosthetic care is offered Prosthetics were organised for glossectomy and 13 palatal to patient undergoing maxillectomy by observers from various specialities and augmentation prosthesis following fabrication of obturators. lectures were organized for students of partial glossectomy, 63 complete and physiotherapy, occupational therapy, partial dentures and 7 implant retained speech therapy and Nursing. intra oral prosthesis. 1,013 patient were treated with Prophylaxis and 3,036 fluoride gel applications were provided to patients undergoing radiotherapy. A total of 5,858 extractions were done.

Tata Memorial Centre / DMG 63 OCCUPATIONAL THERAPY

Dr. Manjusha Vagal, OIC During the year, 9,121 out patients and patients through variety of craft/ Dr. Rebecca Marri 3,621 inpatients received occupational creative activities. The centre aims at Dr. Shruti Velaskar services including mobilization, holistic rehabilitation of patients Dr. Jagmohan Lal Meena functional training, gait training, through social events. It coordinates lymphedema treatment, and orthosis with various NGOs to organize activities and prosthesis. Fifteen patients like sports, festivals celebrations and Service received occupational therapy with recreational trips for the patients. The aim of the department is to assist palliative Home Care visits. The cancer patient to manage the department prepared 187 orthoses, 39 Education limitations caused by cancer and prostheses and 37 temporary prosthesis Occupational therapy Interns from maximize personal productivity and for the patients. In all 220 lymphedema various teaching and public hospitals well being. These limitations include the kits and 1,410 Jaw stretcher keys were within the city were trained. Awareness physical, functional, psychological or prepared at Rehabilitation Research program were conducted for Observers emotional difficulties. Centre (RRC), Ernest Borges Memorial from various faculties viz., Palliative Home (EBRH). The department provides occupational Medicine, Dental services, and Nursing. services to patients from all cancer sites The RRC at EBRH is an extension of the A workshop on “Splinting Techniques viz., breast, head and neck, bone and department, which provides leisure and Hands” was conducted. soft tissues, gynecology, and others. recreational activities to the paediatric

PHYSIOTHERAPY DEPARTMENT

Dr. Anuradha Daptardar, O.I.C. Service Research Dr. Vincent Singh Respiratory optimization in 735 patients The department’s research focuses on Dr. Ajeeta Hasabnis undergoing Thoracic Surgery was exercise based management of fatigue Dr. Manali Kamat attained through Pulmonary in lung cancer patients and role of Dr. Sarika Mahajan Rehabilitation Program, and KIO Br-Ca exercise in women with breast cancer, Physiotherapy Department is Ph underwent post-operative group committed to helping patients to attain therapy rehabilitation program. Lymph Education edema treatment was offered to 344 highest level of function and Workshop on “Rehabilitation in Breast patients as per the International independence through individualized Cancer” and “Cancer Rehabilitation” Consensus of Lymph edema therapeutic exercise program. and a CME on Rehabilitation in management. 302 head and neck and Physiotherapy treatment is extended to Orthopedic Oncology - lung cancer patients were detected for patients of all categories, Intensive Care ”Orthoncorehab” were organized cancer related fatigue. The other Unit patients and the patients attending during this year. Orientation and services include Rehabilitation of the Out Patients Department. A total of training programs were organized for Shoulder and Neck Dysfunction (1,552), 8,438 patients were offered students of Physiotherapy from BPT, management of Trismus, Post operative Physiotherapy services during the year. Physiotherapy colleges, trainee nurses, respiratory care (2,919) following major The department innovated a dentists and others were organized surgeries, Mobilization and Ambulation modification to the existing spirometer, during the year. (510) in Orthopedic Oncology, Pain to improve cardiopulmonary efficiency relief (508) and Treatment of Sub in laryngectomy patients and acquired mucous fibrosis (158) patients. an ‘Active Passive Trainer’ to improve mobility, endurance and strength in orthopedic cancer patients

64 Tata Memorial Centre Annual Report 2014-2015 PULMONARY MEDICAL UNIT

Dr. S.Tandon, Head schedule to reduce pulmonary Education morbidity. The unit offered consultation The unit’s constant efforts in raising to more than 5,000 cross - referrals awareness in diagnosing and treating Service patient in the Pulmonary Medical OPD, respiratory co-morbidity for pre- The Pulmonary Unit which is a part of and a significant and steady increase in existent or iatrogenic (post-therapy) in the Thoracic DMG assesses referred referrals has been observed over the cancer patients, has resulted in a steady patient for respiratory evaluation and past few years. in order to facilitate increase of referrals from all clinicians. management. It also works in Thoracic and Anesthesia Services the collaboration with the Rehabilitation “Six minute Walk Test” was introduced Services to ensure an optimum to assess effort tolerance for fitness in Research preoperative pulmonary evaluation patients with borderline high-risk Currently the unit focuses on increasing respiratory optimization and exercise respiratory function. its contribution to the Thoracic DMG clinical research activities through clinically relevant joint research projects.

SPEECH THERAPY

Dr.(Mrs.) Gurmit Kaur Bachher, Head Service Research The department provided services to a The departmental research focused on The department deals with the total of 3,499 patients which included quality of life in patients with soft tissue management of disorders of speech, 1960 new registrations. It supported or free fibular graft reconstruction and language, hearing, communication and 914 patients with laryngeal cancers, and tongue cancers, and conducts swallowing in children and adults. 1,544 patients with oral cancers. It also evaluation studies like the evaluation of Speech therapists work closely with attended to 1,034 patients from other prosthetic rehabilitation with obturator. caretakers and other professionals, such cancer sites. The department activities as ENTs, head & neck surgeons, include assessment of impact of disease neurologists, pediatricians, radiation Education on speech, and other vegetative Oncologists, nurses, maxillo-facial The department initiated two courses functions and hearing acuity, and voice surgeons and general physicians to viz., Rehabilitation after oral cancers, analysis to qualify the degree of severity enhance patients’ functional abilities. and Rehabilitation after laryngeal in speech. The rehabilitative process cancers. starts with pre-operative counseling. Patients with oral and ablative surgeries are taught deglutition exercises. Patients with head and neck cancer undergoing RT have difficulty in swallowing and loss of voice. Such patients are evaluated at regular intervals, to maintain good voice quality and avoid adverse effects caused during and after radiation therapy.

Tata Memorial Centre / DMG 65 Anaesthesiology, Critical Care and Pain

Dr. Jigeeshu Divatia, Head

Dr. Kailash Sharma, Dr. Madhavi Shetmahajan Dr. Bhakti Trivedi Director (Academics) Dr. Nayana Amin Dr. Shilpushp Bhosale Dr. Parmanand Jain Dr. Vandana Agarwal Dr. Amol Kothekar Dr. Raghubir Gehdoo Dr. Sumitra Bakshi Dr. Malini Joshi Dr. Atul Kulkarni Dr. Priya Ranganathan Dr. Jeson Doctor Dr. Vijaya Patil Dr. Reshma Ambulkar Dr. Swapnil Parab Dr. Aparna Chatterjee Dr. Madhavi Desai Dr. Sohanlal Solanki Dr. Sheila Myatra Dr. Raghu Thota Dr. Raman Sareen (Professor Emeritus)

The Department comprising of the The department introduced hospital nurses have been trained in Divisions of Critical Care and the anaesthesia services for GI endoscopy basic cardio-pulmonary resuscitation Division of Pain, support all operating procedures at TMH and interventional through the “Train the Trainer” facilities at TMH and ACTREC. The radiology and MRI procedures at programme. department consists of 24 permanent ACTREC, during the year under report. staff, 1 ad-hoc lecturer, 31 senior Pre-anaesthesia check-up, anaesthesia residents (including fellows), 5 DM notes and ICU notes are now (Critical Care) candidates, 1 trainee and electronically maintained. Over 200 50 post-graduate students.

Factual data for 2014

Anaesthesia Services 2014 2013 Tata Memorial Hospital Elective Major OT cases 7,281 7,756 (OTs 1 – 12A and HBB OT 22 & 23) Emergency cases 826 630 Minor OT cases 4,914 (GA cases only) 18,418 (GA + cases under local) Bone Marrow OT cases 1,570 1,000 Radiotherapy OT cases 1,650 1,391 Paediatric radiotherapy cases 341 214 CT scan and Interventional Radiology cases 591 454

66 Tata Memorial Centre Annual Report 2014-2015 Critical Care services ICU admissions 2,638 (1,046 ventilated admissions) 2,292 (902 ventilated admissions) Recovery Room admissions 7,344 7,323 Pain Services Patients seen by Acute Pain Services 2,550 1,975 Chronic Pain OPD 6,920 ACTREC Major OT 2,317 2,143 Radiotherapy OT 195 174 MRI 99 Not applicable Interventional Radiology 57 Not applicable Critical Care services Recovery Room admissions 1,982 1,944 ICU admissions 314 (106 ventilated) 300 (100 ventilated)

Service Research The department also conducted two The department provides the following The department has more than 35 short terms courses, viz., ICU services at TMH AND ACTREC. clinical studies which were either technicians’ course and the hospital CPR Course for nurses and doctors Anaesthesia service including pre- completed or ongoing in 2014. More than 2800 patients were accrued on respectively and organized an anaesthesia check up is provided at orientation lecture series in pain both campuses viz. TMH (25 locations) these studies. Project discussion meetings are held at regular intervals management for hospital nurses. and ACTREC (7 locations). The pre Members of the department have been anaesthesia check up was provided to to discuss projects before submission for IRB approval. invited as faculty at several national and 18291 patients at both campuses. A international conferences in 2014. high-risk joint clinic for surgical patients Some of the department staff serves on is also conducted. Critical Care division Education the Institutional Ethics Committee and maintains a 14 bedded ICU and 23 The department continued with the the Data and Safety Monitoring Sub- bedded PACU at TMH and a 7 bedded MCI recognized MD (Anaesthesia) committee. ICU/ PACU at ACTREC. The Pain Division course. Several conferences, courses provided acute pain services to a total and seminars as part of Continuing of 2,550 patients and a total of 6920 Education activity for PG students, patients were treated at the chronic intensivists, and Nurses were organized. pain clinics, of which 3,459 were new Few of these are – “Anesthesia Review patients. Course”, National Airway Conference, annual two-day workshop on hemodynamic monitoring (THEMATICC), and two-day annual conference – “Education in Cancer Pain” (ECAP).

Tata Memorial Centre / Departments 67 Plastic and Reconstructive Surgery

Dr. Prabha Yadav, Head

Dr. Dushyant Jaiswal Dr. Vinay Kant Shankhdhar

The Department of Plastic and Research 2) M. Ch.(Plastic & Reconstructive Reconstructive Surgery provides its The department has initiated setting up Surgery) program has generated services to various surgical oncology an anatomy laboratory for cadaveric enormous interest amongst specialties and DMG’s. We work to dissection at ACTREC and is in its surgeons across the country, provide our patients the best of primary formative stage. The basic construction planning to pursue the plastic reconstruction, secondary has been completed. The lab would be surgery specialty . This program reconstruction and a variety of problem be functional by end of 2015. The entered in to its second academic solving and salvage surgeries. department members are also engaged year and registered second batch of in multiple clinical studies in association students. Service with Head & Neck and Breast DMG’s. Plastic &Reconstructive services operated 1,100 major cases and 230 Education minor procedures in 2014. Free micro 1) ONCORECON 2014 - is the fourth in vascular tissue transfers (Free Flaps) our series. This five day ONCORECON USP, continues to be our main operative workshops with the aim of training workload. We performed 600 free flaps and sensitizing, plastic surgeons and (20% increases from 2013, 70% oncosurgeons was organized during increases from 2012) with a 95.5 % the year. It was conducted in 5 success rate. These numbers are by far batches in March, April, July, the largest in the country and possibly September and November in the world for a single centre. 85% of benefiting a total of 20 delegates these free flaps were performed on from across the country. First four Head & Neck cases. Breast days were devoted to observing reconstruction accounted 48 (9%) of surgeries in operation theatres these cases, which is a very positive along with case capsules and trend considering the state of breast discussion, relevant detailed reconstruction in our country. Take back PowerPoint and edited videos to operation theatre was required for presentation. On the fifth day hands 71 (11.83 %) patients, 59 (10%) of these on cadaveric dissection was cases were explored for a thrombosis demonstrated. event, 34 (57.62%) of these were salvaged successfully. 500 pedicle flaps and other major surgeries were performed.

68 Tata Memorial Centre Annual Report 2014-2015 Palliative Medicine

Dr. Mary Ann Muckaden, Head

Dr. Jayita Deodhar Dr. Naveen Salins

YEAR OF EDUCATION AND ADVOCACY.

The department was instrumental in 19.99% increase in new OPD The department imparts education to creating end of life care consortium, registrations, 22.27% increase in doctors, nurses, social workers and involving members of Indian outpatient visits, 10.40% increase in trainees through several programs like Association of Palliative Care (IAPC) and new home based palliative care conferences, CMEs, and short term Indian Society of Critical Care Medicine registrations and 61.22% increase in courses. During the year the (ISCCM) to realize a common vision of home care visits. department conducted training through providing best end of life care for the Outpatient services of the department NCD-NRHM program for doctors, family dying. The consortium outcomes were registered 3,692 new adult patients and physician training and conducting IAPC a) Consensus position statement of 256 new pediatric patients. There were certificate course in Essentials of IAPC on End of Life Care. b) Joint Society 5,114 follow up visits. Out of the 3,692 Palliative Care. Pediatric Palliative Care Guidelines on End of Life Care c) End of newly registered adult patients, 1,077 training, Certificate Course in Palliative Life Care Education through CME and were from Mumbai, 628 were from rest Care for doctors and nurses, a CME on webinars conducted and d) of Maharashtra and 1,987 were from End of life Care, National Fellowship in Impleadement in the Supreme Court of out of Maharashtra. Palliative Medicine Program. The India for an unambiguous End of Life training program on Essential of Care policy. 538 new patients were registered for Palliative care was also conducted at palliative home care, and made 2,765 different centres across the country viz., home visits in 283 working days. Among Bengaluru, Ahmedabad, and Indore. Service the visits 938 were doctor visits, 1868 In comparison to 2013, there was were nurse visits and 2,484 were The department hosted the first medical social worker visits. Specialist international conference of palliative care Consultation Liaison International Children’s Palliative Care services were also offered during 2,029 (ICPCN) attended by 235 delegates from inpatient visits. 38 countries. This conference concluded in an International Declaration – ICPCN Declaration of Mumbai 2014 that Research highlighted on pediatric palliative care, The department staff is engaged in euthanasia and child protection. about 18 new ongoing studies, and five research projects. Five clinical audits were conducted. The department is also engaged in interdisciplinary studies.

Education

Tata Memorial Centre / Departments 69 Psychiatric Unit

Dr. Jayita Deodhar, Head

Mrs. Savita Goswami Ms. Lekhika Sonkusare

The Psychiatric Unit is committed to A total number of 3,403 patients were Education provide comprehensive psychological seen in 2014, including 1,668 new The Psychiatric Unit participated in and psychiatric assessment and care of referrals and 1,735 reviews. education programs for postgraduate cancer patients with a definitive or The unit adopted several methods to nursing, palliative care and suspected diagnosis of cancer. impact quality in patient care viz., rehabilitation services. Psychiatric Unit Psychological or emotional distress is monitoring of medication and is also engaged in academic activity in seen in about 50% of cancer patients. investigations, standardized assessment association with DMGs and other There is a high prevalence of psychiatric using clinical global impression scale institutes like TISS. Staff members were disorders like adjustment disorder, and using standardized proforma for invited as speakers at various regional depression and delirium. The service care givers’ assessment for coping and national academic meets. caters to patients at any point in their styles. ‘cancer journey’ and their relatives. The The unit observed the World Mental unit also recognizes the need for Health Day, which deliberated on understanding psychological issues and Research ‘Caring for patients’ and participated in concerns of the staff working in a stress The research focuses on efficacy of panel discussion on the World intensive environment and provides psychosocial interventions in patients, Lymphoma Awareness Day. care and support as appropriate. quality of life in patients with Low Grade Psychiatric Unit conducted a special Gliomas, depression in patients under session on “Issues regarding diagnosis Services palliative care, and other aspect like of advanced cancer” for Support Group domiciliary in palliative care. The Psychiatric Unit conducts for Thoracic cancer patients during the psychological assessment of all cancer year under report. patients in both adults and children. The services of the unit include psychometric and neuropsychological testing, and IQ assessments. The services are also extended to the staff providing patient care. The unit also liaisons with specialized clinics like Survivors Clinic (After Completion of Therapy) and Palliative Care. Individual and group psychotherapeutic sessions are conducted. The unit conducts sessions for mentoring and capacity building for Brain Tumour Foundation and Childhood Cancer Survivors Group (Ugam).

70 Tata Memorial Centre Annual Report 2014-2015 Pathology

Dr. Nirmala Jambhekar, Head

Dr. Santosh Menon Dr. Rajiv Kumar Dr. Ayushi Sahay Dr. Neha Mittal Dr. Asawari Patil, OIC ACTREC Pathology Dr. E. Sridhar Dr. Saral Desai Dr. Ujjwala Joshi, OIC, Anatomic Path Lab Dr. Shubhada Kane, Dr. P. G. Subramanian, Mrs. Manisha Kulkarni, OIC Head Dept. of Cytopathology OIC , Haematopathalogy Pathology Academic Program Dr. Sangeeta Desai, Dr. Mukta Ramadwar Mrs. Neelam Prabhudesai OIC Molecular Pathology Dr. Kedar Deodhar Mr. Nitin Shinde Dr. Sumeet Gujral, Dr. Bharat Rekhi Dr. Omshree Shetty Dr. Tanuja Shet Dr. Munita Bal Service previous year. The automation for IHC Education The department of pathology with the staining, has significantly improved The department continued its help of its team of experts provide wide qualitative of stained slides with educational activities through its range of diagnostic services namely, reduced staining time and repeat recognized MD Courses, training surgical pathology, fine needle testing. A considerable increase of 12% programs in onco-pathology for doctors aspiration cytology, exfoliative cytology, is also observed in Referral cases. and technicians, and post graduate and molecular pathology tests of the The department workflow was observers from across the country. The solid tumours, biochemistry and automated. The indigenous software department regularly organized / hematopathology. These diagnostic “Diagnostic Information System” with conducted workshops, CMEs and services are offered to inhouse patients application of barcode technology was conferences as a part of continuing and the expertise is extended to developed in-house, which enabled education for staff and providing a patients throughout the country. It also tracking of slides at each workstation. platform to share and update maintains an ICMR Funded National This enabled computerized tracking of knowledge. Tumor Tissue Repository to facilitate the tissue at every subsequent station, All diagnostic laboratories are NABL samples for research in pathology. reducing. Transcriptional errors and accredited. The department offered diagnostic helped in tracking progress of the slide services to a total of 55,121 cases during making process. the year. Over all there has been a rise Total Number of samples received in 2014 n=55, 121 in all services mainly in, frozen section (6,228), small biopsy (25,160 tests) and Immunohistochemistry (IHC) tests (80,348). The scope of work and accruals of the surgical pathology has escalated by 7.5% over the previous year and the maximum rise of 20% is noted in the small biopsy category. The number of tests performed in the Immunohistochemistry laboratory increased by 18% and the number of tests offered has risen by 5% over the

Tata Memorial Centre / Departments 71 Biochemistry

Dr. (Mrs.) Meera Ghadge, OIC

Dr. Nitin Inamdar Service Research Dr. Pranab Sadhukhan The department is engaged in routine The departmental research focuses on Mrs. Purva Naik biochemistry diagnostic and Tumor studying Prognostic Factors in Multiple Dr. (Mrs.) Geeta Rathnakumar Marker Services and follows good Myeloma Patients. Dr. Bhoopal Shinde laboratory practices. The Diagnostic Mr. Tanaji Matle Mrs. Madhuri Godambe Information Systems facilitates services Education in timely and cost effective manner. The The department conducts Advanced equipment are bi-directionally Clinical Biochemistry Technologist interfaced. Training Course and also arranges The department performed a total of lectures for the staff on various topics, 22,21,230 investigations including supports clinical trials and conducts routine biochemistry, tumor marker, M.D. (Pathology) practical exams. The protein electrophoresis and department is recognized and affiliated immunofixation . to University of Mumbai for M.Sc The department participated in (Biochemistry) and has enrolled two international Quality Control students. Programme. The department organized a CME and Workshop in Clinical Biochemistry in November 2014.

72 Tata Memorial Centre Annual Report 2014-2015 Cytopathology

Dr. Shubhada Kane, Head

Mrs. Dulhan Ajit Mrs. Maya Uke Mrs. Swati Dighe Mrs. Bilkis Patel

The department offers diagnostic The department adopted several Research services in cytopathology and quality control measures including The important research activities immunocytochemistry for the primary monitoring of smear adequacy, staining focused to study efficacy of Liquid Based diagnosis of precancer and cancer. The quality, 3-tier screening and turnaround Cytology (LBC) in diagnosing thyroid department also caters to the needs of time. In addition, the diagnostic tumours, cytomorphology in poorly patients from various other hospitals all proficiency test for staff, and clinical differentiated cancer of thyroid and over India. The diagnostic services of audits were performed. The salivary glands, and microarray the laboratory are NABL accredited. department initiated Synoptic technique for validation of multiple Reporting to ensure a uniform and immunocytochemistry Markers. Service unambiguous format for reporting. The workload of the department Service of Immunocytochemistry on Education comprised of 24,893 cases consisting smears was expanded with validation of 27 immunomarkers, providing accurate The department trains MD Pathology 16,880 exfoliative and 8,013 fine needle and Dentistry students, and aspirations. An overall increase of 4.1% diagnosis and obviates the need for biopsy in most of these cases. Cytotecnicians in technical, diagnostic in the workload was observed across all and quality control aspects of the sites. Major increase was noted in On-site adequacy testing on imprint cytopathology. A Continuel Medical non-gynaecological sites especially oral cytology was provided on image-guided Eduction (CME) on Grey Zones in (52.6%) and Cereberal Spinal Fluid (CSF) biopsies of difficult lesions in the Cytopathology and Hands on Workshop (24%) specimens. The detection rate of Radiology OPD, facilitating early in Liquid Based Cytology was organized. oral dysplasia has increased by 45% as diagnosis and ensuring representative compared to previous year. biopsy, reducing diagnostic time to two The annual External Quality Assurance hours in critical cases. Scheme (EQAS) program in Diagnostic Cytology showed an increase of 30.6% participation over the previous year The department staff participated in DMG meetings, CMEs, Conferences and Workshops held in and outside TMH.

Tata Memorial Centre / Departments 73 Haematopathology

Dr. P.G. Subramanian, OIC

Dr. Sumeet Gujral Dr. Prashant Tembhare Mr. Yajamanam Badrinath Dr. Nikhil Patkar Dr. Ashok Kumar Dr. Shruti Chaudhary Mr. Shashikant Mahadik

Service Molecular testing for diagnosis, sub Research The services of Hematopathology typing and monitoring of The laboratory is involved in following Laboratory include diagnostics services hematolymphoid malignancies are major research projects: for hematological malignancies, routinely performed.  The genetics of hematological monitoring of patients while on therapy The laboratory initiated testing of malignancies and their influence on for all malignancies and preoperative & Minimal residual disease in Acute prognosis of disease and response postoperative hematological workup of Lymphoblastic leukemia in children. to cancer chemotherapy. surgical patients. Acute Myeloid leukemia which is used  Gene mutations in acute myeloid The state of the art hematology routinely to tailor the treatment for leukemia and their influence in analysers and coagulation analysers are individual patient based on response to outcome, interfaced with hospital information initial treatment. This helps in  Immunogenetics of chronic system. Quality control checks are preventing intensive treatment in good lymphocytic leukemia, performed to provide results with responders, reduces treatment side minimal errors. effects and, costs as well. The molecular  Role of CD116 in MRD detection in acute myeloid leukemia. The laboratory does immunopheno- testing is done to personalize treatment typing of blood, bone marrow and body for patients so that there is better fluids hematolymphoid malignancies by outcome. Education The laboratory continued with MD, DM, flow cytometry. Investigations like Molecular diagnostics service was and fellowship program in detection of Minimal residual disease provided to more than 3,500 patients. for Acute Leukemias and Multiple hematopathology. A course on As national referred laboratory, it Myelomas and involvement of molecular diagnostics was initiated for received samples from all over the hematolymphoid malignancies in technicians inducting four students. The country. cerebrospinal fluid and other rare sites laboratory continued to conduct several are also conducted. short term courses and advanced Name of the Tests Total No. of Tests performed training courses in oncologic pathology for technicians and pathologists like Routine Hematology 3,22,915 complete blood count and Coagulation studies 98,105 Immunophenotyping, flow cytometry Bone Marrow Aspiration Smears and body fluids 8,276 and molecular hematology. Thirty M.D. Pathologists from various parts of the Cytochemistry 3,799 country, joined the department as Flow cytometric Immunophenotyping 5,158 Observers and were trained in Molecular Hematopathology 3,988 morphology, cytochemistry and flow cytometry.

74 Tata Memorial Centre Annual Report 2014-2015 Molecular Pathology

Dr. Sangeeta Desai, OIC

Dr. Omshree Shetty

Routine Molecular Diagnostics of solid Glioblastomas and laboratory are available on the tumors by Polymerase Chain Reaction Oligodendrogliomas, and FISH test for electronic medical records. (PCR), Reverse Transcriptase TFE3 gene rearrangement, as routine Polymerase Chain Reaction (RTPCR), diagnostics services. the newly acquired Service Gene sequencing, and Fluorescence in Genetic analyzer ABI3500 (Gene The lab observed increase in the situ Hybridization (FISH), are some of sequencer) facilitated several new tests number of requisitions raised for the tests performed in this laboratory. viz. Gene sequencing for BRAFV600E, molecular diagnostics tests. It observed Molecular Pathology is one of the well IDH1 and IDH2 for Gliomas, C-KIT 117% increase in PCR requisitions and recognized referral laboratories for both mutation analysis for Exon 9, 11, 13 and 85% increase in FISH requisitions as PCR and FISH tests. Tests viz. HER2/Neu 17 for Gastrointestinal Stromal Tumors compared to previous year. gene amplification in breast cancer, Alk1 (GIST) were standardized and gene rearrangement in Lung cancer introduced as routine diagnostic The laboratory participated in the help in determining target based services. These helped predicting College of American Pathologists (CAP) therapies. Detection of sarcoma response to a specific drug and External Laboratory Improvement translocations by qualitative PCR is one prognostic implications. The unit Survey program on routine basis as well of the cheapest and the reliable tests introduced FISH test for TFE3 gene as UK NEQUAS proficiency tests. The in management of pediatric soft tissue rearrangement to analyze monthly trend analysis for the routine tumors. The division recently translocations in renal cell carcinomas. diagnostic tests are conducted to introduced Methylation specific PCR for The diagnostic reports generated by the identify shortcomings and assesses the progress and helps in accordingly amending the routine work flow.

Research Several research projects are going on in the facility. Currently eight translational research related projects are going on in the laboratory with the dedicated project staff working on each one of them. The research is focused on several topics like breast cancer subtype, marker identification Recurrence prediction ANXA1 expression in Human Papilloma Virus (HPV) positive penile carcinoma, microRNA (miRNA) as a Potential Biomarker in Breast Cancer and such others.

Tata Memorial Centre / Departments 75 Education fellowship program provides rigorous The laboratory staff or research fellow One year fellowship is offered to training for performing PCR, FISH, participate in the weekly CMEs to postgraduates under the Molecular Primer designing, Gene sequencing, present and discuss papers pertaining Pathology Academic program. The Data Analysis, and interpretation. to the molecular diagnostics and recent advances in molecular oncology.

Emergency Laboratory

Mr. Deepak Birwatkar, OIC

Service Education The Lab provides common diagnostic The department conducts in- house tests in biochemistry & hematology to CME’s for the staff & all staff also support the needs of all cancer patients participates in outside conferences. in evening and night shift & 24 hrs on Sundays & Holidays in minimum Type No. of investigations turnaround time. Biochemistry 4,48,608 The department has the state of art CBC 47,246 equipments in biochemistry, hematology & coagulation profile with Coagulation 25,640 bidirectional interface and online Total 5,21,494 reporting. The motive of the lab is to issue accurate & quick report to critically ill patients mainly from casualty and ICU. The department observed a rise of 11.41% in the services offered during the year. During the year 2014 department added CRP, Methotrexate, CSF Biochemistry & Urine biochemistry on clinician’s request.

76 Tata Memorial Centre Annual Report 2014-2015 Cancer Cytogenetics

Dr. Pratibha Kadam Amare, Head

Mrs Sharayu Kabre Ms. Hemani Jain

Service Research The faculty were as invited and guest Laboratory is a recognized referral The deparment particaptes in two speaker at various conferences and laboratory for Cancer Cytogenetics tests translation research projects, focusing institutions within the country and which include molecular cytogenetics on Multiple Myeloma and Acute abroad. and conventional karyotyping. In year Myeloid Leukemia (AML) and continues 2014, total 6,700 cases were referred with eleven other clinical research trial for cancer cytogenetics studies. projects focusing on AML, Chronic Laboratory performed total 11,336 Myeloid Leukemia (CML), Acute tests, which included 2,243 tests Lymphoblastic Leukemia (ALL) L and referred from outside centres . The lymphoma. department observed an overall increase of 15% in services, with Education significant increase in molecular The department is involved in Post cytogenetics services for myeloid graduate teaching Programs namely, malignancies. A comprehensive profile M.Sc. Biotechnology, Applied Medical of 8-14 FISH markers in AML, MDS, Sciences and Post-graduate Oncology Myeloproliferative disorders, ALL, CLL Nursing program. The department is and Multiple Myeloma were developed also associated with the DM Medical by the laboratory. External Proficiency Oncology program, and program, CAP evaluation showed Hematopathology Research Fellow excellent performance of six cycles of training program. Orientation program cytogenetic tests. in Cancer Cytogenetics for consultants, registrars and students are routinely conducted. . Laboratory offered training in Cancer Cytogenetics, Molecular Genetics to 25 Lab Scientists, clinicians, Pathologists and post-graduate students. Three students completed one year Advanced Cancer Cytogenetics training program.

Test Modality No. Test Turn around time Fluorescence in situ Hybridization (FISH) 8,781 2-4 days Conventional karyotyping 2,555 10-12 days

Tata Memorial Centre / Departments 77 Microbiology

Dr. Rohini Kelkar, Head

Dr. Sanjay Biswas Dr. Vivek Bhat Mrs. Hema Rajpal Mrs. Priyanka Dixit

The introduction of automation in Service Research molecular diagnostics has significantly A 21 % increase in workload has been Focus is on in vitro studies on improved the accuracy of results and recorded during the year. The susceptibility pattern of new antibiotic reduced the turnaround time for department restarted the services on combinations, microbiology of reporting results. holidays to cater to the increasing needs healthcare associated infections like The introduction of galactomannan of critically ill patients other ventilator associated pneumonias, the assay has augmented the early and emergencies. role of copper in reducing the microbial rapid diagnosis of aspergillosis in The department has performed a total bio-burden on touch surfaces in the critically ill patients. The introduction of of 1, 90,375 tests, an increase of 21 % critical care unit and the molecular automated minimum inhibitory in the workload as compared to 1, epidemiology of mycobacterial concentrations of antibiotics has 57,744 tests in 2013. This includes infections in cancer. assisted in improved accuracy and 33,930 tests in bacteriology, 1, 28,562 quality of results for bacterial infections tests in serology, 4,983 tests in Education in patients with sepsis. mycology, 10,949 tests in Continuing educational activities in mycobacteriology, 8,567 tests in clinical infection control (certificate course), microbiology and 3,384 tests in postgraduate students for the MD molecular microbiology. degree in Microbiology and other Source of data: Departmental registers. educational activities for hospital hygiene and healthcare worker safety.

78 Tata Memorial Centre Annual Report 2014-2015 Transfusion Medicine

Dr. Sunil Rajadhyaksha, Head

Dr. Anita Tendulkar Dr. Priti Desai Dr. Meenakshi Singh

The Department of Transfusion therapeutic phlebectomy (8), resulted in better throughput and Medicine strives to respond to the ever leukapheresis, and plasma exchange accurate results. increasing and specialized transfusion were also performed. The department requirements of patients, with a focus issued 307 units of whole blood, 19,482 Research on providing safe blood components. units of packed cells Research focused on Single Donor The department observes quality Blood Collection: Platelets on (SDPs) with Platelet system norms and high technical Additive Solution which may potentially standards. Total No. of donors 25,154 help transfuse SDP across ABO group registered barriers. An audit of platelet transfusion Service Total No. of donors deferred 5,494 practices in Medical Oncology patients The blood collection was augmented by Total Donors 19,660 was carried out. increasing the number of outdoor blood donation camps by about 50%. The Blood brought from 1,133 outside blood banks Education department organized 123 outdoor Besides offering MD course in Total Blood availablefor 20,793 blood donation and 7 platelet donation Immunohematology and Blood issue camps during the year. The department Transfusion, the department is achieved 98.5% componentization. The recognized as training centre by pheresis donation increased by 16% The Platelet Donation Recruitment Programmes were organized in Ministry of Health and Family Welfare, over the previous year. A total of 5,413 Government of India for training of voluntary platelet donors were association with Nargis Dutt Memorial Charitable Trust (NDMCT) and a blood bank officers and technicians. The registered through platelet donation Department participates in academic awareness camps and collected about Walkathon helped in promoting blood donation. The Platelet Donation exchange programme with other 3,105 platelet through donations and teaching institutes. observed a six fold increase in collection Recruitment Drive was organized in over the previous year. The department association with Past Students The faculty participated in national and performed irradiation of 26,882 blood Association of Borivli Education Society. international meetings and as experts products. Several other specialized Automation of immunohaemtological in decision making activities of National therapeutic procedures like – techniques improved the quality and AIDS Control Organisation (NACO), Ministry of Health and Family Welfare, 2013 2014 Government of India. Blood & Platelet Units collected 21,735 22,765 The Department continues to receive Blood Grouping 52,341 56,901 observers for training in specialized areas including aphaeresis and Cross Matching 32,191 35,371 component separation. A Wet Blood Components 56,106 60,126 workshop on “Red Cell Antibody Plateletpheresis 3,150 3,722 Screening and identification”, was organized for the department staff. Specialised Procedures 24,078 26,895

Tata Memorial Centre / Departments 79 Nuclear Medicine & Molecular Imaging

Dr. Venkatesh Rangarajan, Head

Dr. Nilendu Purandare Dr. Sneha Shah Dr. Archi Agrawal Mrs. Bhakti Shetye Ms. Priya Monterio

The Nuclear imaging department is Research Education engaged in providing comprehensive The department is engaged in audit of The department trained four imaging nuclear diagnostic services. radiation field and burden in high specialist in PET/CT. The department is volume planar studies especially bone engaged in inter-institutional Training of Service scans, radiation burden in high volume Post Graduates during the year. Trainees The diagnostics services of the PET radio pharmacy and for National Board of Nuclear Medicine department include functional hybrid radiopharmaceuticals using QA / WC affiliated to K.E.M. Hospital and Jaslok imaging that includes PET/CT & SPECT/ test; and Finger dosimetry. Hospital were trained for 4 weeks is a CT, planar and dynamic isotope studies part of external rotation. and uptake studies with thyroid Probe. Dr V Rangarajan is co-author of a IAEA The PET/CT scans using four 18F technical document on current labelled radiopharmaceuticals and two indications and impact of SPECT/CT in 68Ga labelled radiopharmaceuticals, oncology. Nine technetium labelled and two iodine 131 labelled radiopharma- ceuticals fifteen planar and SPECT studies are routinely performed. Low dose 131 I, 153 samarium EDTMP, 177Lutetium EDTMP are administered to appropriate patients. Post therapy scans are performed after 131I,153 Samarium EDTMP and 90Y microspheres therapy using SPECT/CT & PET/CT. The department performed 13,180 PET/CT scans, 5,204Planar, SPECT, and ISOTOPE STUDIES and 54 CTs. Interaction with other departments facilitated understanding of individual requirements of cancer patients.

80 Tata Memorial Centre Annual Report 2014-2015 Radiodiagnosis

Dr. Meenakshi Thakur, Head

Dr. Supreeta Arya Dr. Nilesh Sable Mr. Wadiraj Kulkarni Dr. Shashikant Juvekar Dr. Palak Popat Mr. Prandurang Wagh Dr. Subhash Desai Dr. Nikhil Merchant Mr. Shripad Kulkarni Dr. Subhash Ramani Dr. Seema Kembhavi Mr. Mahadeo Salunke Dr. Suyash Kulkarni Dr. Ashwin Polnaya Mr. Sathish Pandit Dr. Nitin Shetty Dr. Amit Janu Mr. Bhausaheb Sangle Dr. Abhishek Mahajan Mr. Trilokinath Mishra Mr. Ajay Girdhar

Service Minister, Mr. Devendra Fadnavis Research include: Images from the digital imaging The department was part of the 12th modalities i.e. CT, MRI, Ultrasound, 1. The new Philips Ingenia 1.5 T MRI Annual Evidence based conference of Computerized Radiography, DSA and 2. Siemens’ Luminos dRF - Fluoroscopy TMC in February 2014 with sessions on Digital Mammography, are now all System “Oncologic Imaging: A Multidisciplinary stored in the PACS and transmitted 3. LOGIQ* E9 with XDclear ultrasound Perspective”. The Department across the hospital network so that as equipment Contributed and Released a book on – soon as the images are acquired by each 4. MyLab™25Gold Mobile Ultrasound “Evidence based Guidelines on Imaging of these modalities, they can be viewed in various common Cancers”. by the referring clinicians without any (portable) delay on the computer in their office, 5. Hyperion X7 digital OPG machine A CME was organized on MRI, CT Scan, OPD, or any other site in the hospital. 6. Portable Digital Radiography system Radiation Protection, Computed Radiography and Digital Radiography by The department has thus become “Optima XR220amx” our technologists. completely filmless and the radiology report of each examination is stored in Department Workload the Radiology Information System (RIS) so that they can be viewed along with the corresponding studies. With the integration of voice recognition, advanced visualization, as well as accreditation and compliance software, it has helped us better complement the use of our existing PACS solution by sharing all patient data between systems. New equipments installed in 2014 inaugurated by Maharashtra Chief

Tata Memorial Centre / Departments 81 An International CME Programme was Education The department currently has 11 Senior held on Fusion of Imaging and Therapy From this year our P.G. Students shifted Registrars, 3 Fellows (1 in Interventional with recent Advances in Technology from Mumbai University of Health Radiology & 2 in Cancer imaging) and (FITRAT). Science (MUHS) to Homi Bhabha 20 Junior Registrars. Dr. S.M. Desai was actively involved with National Institute (HBNI). Two year “Advanced Diploma in Medical BARC - Mumbai and RRCAT - Indore with Department has post MD Imaging Technology” course for the medical application of synchrotron superspeciality programs; 2 - year radiology technologist under radiation and laser optics. With IGCAR - Fellowship in Cancer Imaging and Maharashtra State Board of Technical Kalpakkam, he is involved in Fellowship in OncoIntervention. Education is in place along with a magnetoencephalography. training program for Radiology Technologist in CT, MRI, Interventional Radiology and Mammography (only for females).

82 Tata Memorial Centre Annual Report 2014-2015 Medical Physics

Dr. Deepak Deshpande, Head

Mr. Rajesh Kinhikar Ms. Swamidas Jamema Mr. Rituraj Upreti Mr. Suresh Chaudhari Mrs. Vijaya Somesan

The Department of Medical Physics Stereotactic (SRT/SRS) and Intensity Research with a team of 12 Medical Physicists and Modulated Radiotherapy (IMRT), Image The departmental staff is involved in other technical staff works in close Guided Radiotherapy (IGRT) many other clinical projects along with association with department of treatments. The department also Department of Radiation Oncology. Radiation Oncology. Calibration, Quality advises other departments like Several audits, evaluation, validation Assurance, maintenance of teletherapy Diagnostic Radiology, Transfusion and comparative studies on intensity and brachytherapy machines, Medicine, Tissue Bank, Bio-imaging and modulated radiotherapy, USG based procurements of radioactive sources, ACTREC (CRI) for their requirements of IGRT in radiotherapeutic management treatment planning and dosimetry for radiation protection, QA, source of cervical cancers, and dosimetric treatment of radiotherapy patients, and procurement and disposal as per AERB characteristics of flattening filter free radiation safety of the staff are some of guidelines. and Hi-Art II Tomotherapy were its important functions. The The Médical physicists are responsible conducted. department is equipped with state of for treatment planning for external and art facilities and equipment. brachytherapy and calculate treatment Education time and ensure administration of Service The department is recognized for Ph D accurate dose to patients. The program for medical physics under The department is equipped with many département planned for 1,414 cases of HBNI. The department continued to sophisticated equipment like treatment external therapy with 1,123 TPS plans conduct post-graduate diploma planning systems TPS (Eclipse, for complex techniques like 3DCRT, IMR (PGDRTT) training course for Oncentra, i-Plan), dosimeters & etc. and 764 cases of brachytherapy in Radiotherapy technologists, and is also calibration instruments ( DOSE1, 2014. Radiation Oncology Information engaged in training doctors, medical Unidos,), 3-D Water Phantom (Blue System (ROIS) is effectively used for physicists and technologists. Several Phantom, Scanditronix), In Vivo calculations and quality assurance of short term training programs were also Dosimetry System (DPD12), TLD reader various machines. conducted. The staff is encouraged to (Rexon), Film Dosimetry System The department collaborated with MD update their knowledge through (Omnipro), Gafchromic Film dosimetry Anderson Cancer Center for OSL – participation in national and system etc. irradiation for various photon and international conferences. The department is actively involved in electron machines and dosimeter were dosimetry, data acquisition of various performed for machines like Trilogy- Telecobalt machines, Linear Photons and Electrons, 2,100 C/D- Accelerators and brachytherapy Photons and Electrons, etc. It also machines. The physicist are engaged in collaborated with Virginia planning and execution of sophisticated Commonwealth University, to study techniques like 3D Conformal treatment feasibility for cloud based information with Multi-leaf collimator (MLC), exchange program.

Tata Memorial Centre / Departments 83 General Medicine

Dr. Aruna Alahari, Head

Dr. Sheela Sawant Dr. PTV Nair Dr. Anuprita Daddi Mrs. Kalpana Adke Mrs. Manjiri Mirwankar

The Department of General Medicine The department provided a total of Research is an important clinical service of the 11,563 consultations during the year. It The departmental research focused on Hospital offering medical consultation performed 8,900 echocardiography early detection of cardiotoxicity in to patients with pre-existing co- tests, 3,628 pulmonary function test, cancer patients, HIV related lymphomas morbidities and for treatment induced 30,484 electrocardiograms and and head and neck cancers, and medical complications. The Department conducted 62 cardio-pulmonary Metabolic syndrome in childhood consists of a dedicated medical team as exercise test during the year. cancer survivors. well as trained technicians. Super specialty clinics : Patients are evaluated and treated for Education cancer related and unrelated co- A. AIDS Malignancy clinic enrolled 86 new cases and had 167 follow up The department staff participated and morbidities like hypertension, diabetes, were invited as speakers at various respiratory and thyroid diseases, and consultations, and were offered multi disciplinary treatment. national and international conference ischemic heart disease through its three and seminars. super specialty clinics. it also supports B. Cancer Thrombosis clinic manages management of patients, management cancer patients with venous of emergencies and medical events in thrombo-embolism. It registered the peri-treatment course and 184 cases and had 971 patients for facilitates bedside portable follow-up consultations. echocardiography for patients in the C. Cardio- oncology clinic Adjuvant wards. therapies can potentially cause a wide range of acute and late cardiac Service complications. This clinic focuses on The Department provides prevention, early detection and investigational and clinical services management of cardiovascular namely, 2D and 3 D echocardiography complications associated with with Colour Doppler for evaluation of cancer therapy. Fifty three new cardiac and valvular function for cases and 296 follow up cases of patients in wards and ICU, chemotherapy induced LV Cardiopulmonary stress test, dysfunction were evaluated during Pulmonary Function testing and the year. Two hundred and forty Electrocardiography services. A cases of after Completion Treatment comprehensive cardio-respiratory risk (ACT) underwent cardiac evaluation. assessment is conducted for high risk Point of care testing of BNP and lung cancer patients. Troponin-I was initiated and has been helpful in early detection and monitoring of cardiotoxicity.

84 Tata Memorial Centre Annual Report 2014-2015 Nursing

Mrs. Swapna Joshi, Nursing Superintendent

Mrs. S. Retnamony Mrs. Carmine Lasrado Ms. Anita D’Souza, Mrs. Manorama Anilkumar Mrs. Shweta Ghag (Professor & Vice Principal) Mrs. Sindhu Nair Ms. Maria Carvalho, Mrs. Prathepa Jagdish, (Professor & Principal) (Lecturer)

Service Implementation of bar code system at Education The Nursing department focuses on workstations in patient care areas, The staff members of the department care and patient safety. The department ensured safety in drugs administered attended CMEs, training courses, strives to provide quality services methods and procedures. Wrist bands national and international workshops through efficient nursing and has are provided to patients in the out- and have presented papers, posters at enhanced its efforts for patient patient procedure room and in-patients, different forum. Operation Theater experience. The clinical nurse specialist ensuring complete procedures. Nurses were trained to assist for robotic is committed to providing exceptional Occupational safety is ensured with surgery. The department also provides service and safe care to patients and provision of cytotoxic cabinets in wards training and observer ship their families and improves outcomes. and other areas of chemotherapy opportunities in the clinical wards. 40 A special team of nurses deal with preparation and administration. Nurses from Punjab and central venous access device and Vishakhapattanam were trained in treated 110 cases during the year. A chemotherapy administration and team of nurses provided stoma therapy patient care. The Nursing department to a total of 4,827 OPD cases. Patients in collaboration with Oncology Nurses were also were counseled and trained Association of India (ONAI) organized on usage of stoma bags. 16th National and 3rd International conference on “Moving on with changing dimension in oncology nursing”. Two certificate courses on ‘central venous assess devices’ for trained nurses and Enterostomal therapy were successfully conducted. Nurses are encouraged to develop academic expertise and qualifications in oncologic nursing through post graduate and short term training programs.

Tata Memorial Centre / Departments 85 Staff Clinic

Dr. Sandeep Tandon, Head

Dr. Pankaj Rajput

The routine activities of the staff clinic Service is to look after the well being of the The Staff Clinic provided medical TMH staff, which include clinical and treatment to 3,306 TMH staff including medical. It is also concerned with 1,872 super staff , 993 labour staff and occupational health of the staff. Thus, their dependents and 441 temporary managing and reporting Needle stick project staff for their day to day Injuries, Vaccinating staff against ailments. In 2014, the clinic had Hepatitis B, conducting pre- approximately 42,627 consultations 367 employment examination, preparing pre-employment examinations, 442 health-related policies and guidelines Hepatitis B vaccinations and 112 Needle are part of its activity. Positive health is stick injuries were treated and reported. encouraging and regular checkups are conducted for early detection of The clinic initiated automation of clinical modifiable and treatable risk factors for notes linked to prescription and lifestyle Diseases like Hypertension, employee numbers on the Central Diabetes, Dyslipidemias etc. Information System (CIS) / Electronic Medical Records (EMR) ensuring computerized records. The health related data of all TMH staff was documented the risk factors of various occupational, communicable and lifestyle Diseases. This facilitated timely execution of interventional policies and reducing long-term disease morbidity of individuals.

86 Tata Memorial Centre Annual Report 2014-2015 Tissue Bank

Dr. Astrid Lobo Gajiwala, Head

Ms. Urmila Samant Ms. Cynthia D’Lima

amnion dressings were used in 364 patients for the management of radiation ulcers, bedsores and surgical wounds to improve radiotherapy outcomes and quality of life.

The Tissue Bank is a unique facility in compliance with international Of the total products of 10,200, 4,479 the country that provides processed, standards, and the distribution of grafts. vials of bone granules, 1,203 bone grafts and 2 tendons, 916 amnion dressings gamma-sterilized human bone, amnion 1,646 chorion grafts were used for and chorion for the treatment and Service patients outside TMH. rehabilitation of patients with a wide In 2014 the Tissue Bank motivated variety of disease conditions. The Bank 1,119 amnion donors and 1,122 bone Research caters to the needs of patients, both in donors, resulting in an increase in the Research activities focused on the TMC as well as across the country. Its number of grafts produced from 10,003 activities cover conducting public and clinical efficacy of the Tissue Bank in 2013 to 10,200 in 2014. These products including new indications for professional awareness programmes to included 4,759 bone grafts, 2,837 promote the donation of tissues and existing grafts and the development of amnion dressings and 2,604 chorion new and/or customized grafts for utilization of allografts, liaising with grafts. regulatory bodies, networking with specific surgical and medical requirements. Audits to validate and donor hospitals and tissue retrieval In TMH 132 bone grafts were used in improve tissue banking practices were centres in Mumbai and outside for the 50 patients, for biological reconstruction of the defects produced also conducted. Results were presented donation of tissues, processing and by ablative surgery for cancer. 2,160 at national and international radiation sterilisation of tissues in conferences and published in an Number and Type of Allografts Produced and Utilized international journal.

Sr. No. Grafts Produced Utilized The department continued to support IAEA project on assessing efficacy of 2013 2014 2013 2014 irradiation of amnion dressings. The 1. Amnion 2,347 2,837 2,699 3,076 bank collaborated with IIT, TIFR, and UB-DAE, CBS to develop bone substitute 2. Chorion 1,377 2,604 782 1,646 scaffolds. The department supported 3. Bone Granules 1,464 1,200 1,193 1,075 student research. 4. Demineralised Freeze- 3,465 2,395 2,719 3,404 Dried Bone Granules Education 5. Freeze-Dried Bone 1,117 1,054 968 1,131 Public and professional awareness programmes were organized at TMH 6. Demineralised Freeze- 91 48 152 140 and other venues to promote tissue Dried Bone donation and utilization. Observers to 7. Frozen Bone 142 62 145 64 the Tissue Bank were introduced to the 8. Tendon 0 0 02 02 regulatory requirements and basics of TOTAL 10,003 10,200 8,660 10,538 Tissue Banking. The staff participated in skill enhancing meetings, seminars and 10,538 grafts were used in TMH and 684 hospitals and nursing homes across conferences and served as reviewers to the country. journals.

Tata Memorial Centre / Departments 87 Digital Library

Dr. Medha Joshi, Head

The Digital Library was established with Services The usage data of Electronic resources the objective of effectively using state The library collection focuses on for subscribed and on trial access were of art technology for communication Oncology and its various specialties to collected, monitored and analyzed. This and distribution of information support organizational activities of helped in deciding on the utility, resources and services with the aim of clinical service, research and education. continuation for subscription and providing speedy and timely access The library has a collection of over 7,837 addition of new databases. across campus and facilitate single printed books and more than 20,000 login. bound journals. More than 700 articles Education Over the decade the library managed (staff publications and articles from The library tutorials for information to fulfill these aims. It strengthened its Indian Journals) were indexed during literacy skills focusing on search the year. The library continued electronic collection along with print techniques to end users citation subscription to 177 journals which publications. The library continues to management tools and CINHAL were included 135 e-journals and renewed support information needs of clinical continued through-out the year. More subscription of four e-databases. To and other staff of TMC, walk- in visitors than 80 end-users benefited from these further facilitate evidence based and also supported several online service, research and education, ‘Up To tutorials. The library inducted one requests. Date’ and ‘Clinical Keys’ were made library trainee for practical knowledge. The Library Webpage facilitates quick available. outreach support providing details of The library resources are often used collection, links to full text for both remotely via web access using library subscribed and open access free webpage. Document supply is the most contents on the web. The use of online used service of the library and is availed form feeds helping users to directly and by TMC members, libraries across quickly communicate with library has country, industry and individual visitors. increased considerably. About 83% of Seven hundred and seventy three (24% the requests for articles were supported rise over previous year) document in soft formats, providing immediate supply requests for a total of 2,248 support and minimizing use of the scholarly articles were received by the paper. library. Of these, 47 % requests were received through web-based form feeds and of the total request, 83% request were electronically satisfied, improving the response time. The library supported 1,464 articles (96%) requests from its collection and 51 articles (4%) through inter library loan service, which indicates our self sufficiency.

88 Tata Memorial Centre Annual Report 2014-2015 Information Technology

Mr. Mahesh Mangrulkar, IT Manager, TMC

Mr. Vivek Marathe Mr. Sanjay Sinha Mr. Pravin Kalsekar Mr. Sandhya Joshi

The department ensures uninterrupted Service The software and hardware network and system. Software The department coordinated with ECIL requirement for administrative development and maintenance, for the development of web based activities of the centre were also hardware maintenance, network clinical information system for breast supported. Systems for accounts, HRD monitoring, user training, trouble Disease Management Group (DMG) and and general administration were shooting procedures, solving day-to-day Radiation Oncology Information developed, modified to satisfy newer user problems, data analysis, system. Several existing laboratory and requirements like bank transfers, billing, conducting meetings with users etc. are departmental systems and modules are In-patient bills, assets managements, the major departmental activities. It modified routinely to add new features deputation leave system, plays a pivotal role through automated and fine tune existing ones, namely the reimbursement and similar others. A systems and network services and new CIS, tumor tissue repository, RIS, Patient File tracking system was introduced on functionalities are added regularly to Admin module, Operation theatre, trial basis, to control the movements of support the functioning of Tata reports from laboratories ROIS, to patient files. PABR smart card forms Memorial Centre in the thrust areas of include doctors and nurses notes, dose were synchronized between ACTREC the hospital. Hospital Information calculations in MOIS, final diagnosis, and TMH. KIOSKs were placed in patient System runs 24x7 on a DB2 Database and several others. Laboratory waiting areas to facilitate easy access to with IBM power Server with High instruments/machines in Hemato- patient reports, smart card statements Availability & Disaster Recovery pathology and biochemistry and other related information. The features. The front end software is laboratories were interfaced with generates reports and data for systems developed in Visual Basic & .NET. The Diagnostics Information system to like Clinical Information System, Patient main features of the system are provide coagulation profile and Admin, billing & receipting system, modularity, scalability, built in security automated labeling. The medical Diagnostic Information system, and flexibility to timely address oncology information system (MOIS) Radiology Information system, unforeseen situations. Many was implemented during the year. The Operation Theatre module etc for applications were developed during the department’s SMS broadcasting comparison and utility. Nurses were year to support patient services. services facilitates alerting messages to trained Hospital Information System, patients for appointments, smart card and Microsoft office. balances, reports, etc. About 12 lakhs SMS alerts were sent during the year.

Tata Memorial Centre / Departments 89 Medical Graphics

Mr. Nilesh N. Ganthade, OIC

Medical Graphics Department supports enable their usability training, scientific Forty national and international your visual communication and printing publications and presentations. meetings, symposiums, conferences needs of medical and non medical The department’s digital expertise workshops were audio- video recorded professionals. The visualization creates graphical presentations of during the year. specialists create imagery that advances accurate medical illustrations, images, Clinical Photography 1,089 medical science knowledge and and clinical photography with audio empowers health literacy for patients visual contents, supporting clinical, Scientific Poster 165 Preparation and the public. academic, research requirements in The Department is a fully equipped with healthcare communications. The pre D.T.P / Artwork of 2 40 latest digital technologies such as digital and post treatment clinical images of Various conferences DSLR cameras, full HD specialised 1089 patients provided a visual clue to poster, banners, surgical audio-video recorder, LIVE clinicians, facilitating evaluation of Leaflets etc. surgical broadcasting facility over clinical treatment and direct further Surgical Videos in O.T. 55 internet using latest hi-definition video decisions. Fifty five surgeries were video Illustration work for 65 codec, High resolution scanning and recorded, enabling archival of surgery the clinical papers printing equipments to facilitate techniques for educational and archival of images and videos, and demonstrative use.

90 Tata Memorial Centre Annual Report 2014-2015 Dr. Narayan H.K.V., Medical Administration Medical Superintendent, TMC

Dr. Sarita Khobrekar Mr. Rajeev Sawant Dr. Anuradha Daptadar Dr. S. Tandon Dr. Sandeep Sawakare Dr. Manjusha Vagal Mrs. Swapna Joshi Mrs. Neelima Dalvi Mrs. Chitra Hingnekar

The Medical Administration is Dispensary-YoY Turnover and Variance responsible for supervision and facilitation of patient care activities. These activities include registration and evaluation of patients, ambulatory care, wait listing and admission, patient grievance redressal and patient safety and quality assurance. The functioning of the following departments is facilitated:

Central Sterile Supplies Department Mr. Rajeev Sawant, Head The department supports the entire hospital including the 23 operation theatres with sterile equipment and  The Average No. of Transactions per Medical Social Service unit supports supplies. The department is well day was 2,309 as against 1,993 in the patients through counseling, explaining equipped with five state-of-the-art previous year- an increase of 15.82% treatment procedures, extends financial Steam Sterilizers, one Ethylene Oxide support and facilitates accommodation, Sterilizer, one plasma sterilizer, two  The implementation of Smart Card to meet the challenges of illiteracy, lack Washer Disinfectors and one Ultrasonic for dispensary transactions has of resources, low health budget and Cleaning Machine. The department facilitated the above performance high treatment cost, minimizing provides uninterrupted service for with only 0.5% of the transactions dropout and facilitating treatment patient care needs with twenty loads of being done by cash payment over compliance. steam sterilizers, 30 Cubic Feet the counter, thereby reducing the Materials, one load of 5 Cubic Feet of turnaround time (TAT). The department builds funds to Gas Sterilizer per day and 6-8 loads of 5 facilitate treatment expenses of Cubic Feet of Plasma Sterilizer per day. Medical Social Services patients through networking and Several other items like gowns, linen advocacy activity usually with packs, gauze gloves etc. are all sterilized Mrs. Neelima Dalvi, individuals and Trusts. and are provided as per the needs of Medical Social Worker During the year, 34,886 patients the hospital. The department initiated Medical Social Services Unit with its benefitted through its services. It the processing and packing of all counselled 11,313 patients and guided surgical instruments including MIS and team of eight trained social workers makes significant contribution towards 23,573 patients for treatment. Needy Robotic Surgeries. patients were provided with drugs alleviation, suffering and improving worth Rs 118,53,668. Pharmacy quality of life of a large number of The department extends support at the  The total turnover of the Dispensary cancer patients, by providing social palliative and lymphomas clinics for for the year 2014-15 increased by support. adult and pediatric patients and 14.28% The hospital patients come from varied organizes fun filled events for patients social strata and need social and on occasions of women day, and economic support the challenge of the celebrates festivals.

Tata Memorial Centre / Administration 91 Dr. Venkata V.P.R.P. Chief Administrative Officer, TMC General Administration

Mr. G.S. Dhanoa Mr. P.K. Sukumaran Mr. Raju Kotian Chief Engineer, TMC H.R.D. Officer Administrative Officer Mr. A.N. Sathe Mrs. Indira Pasupathy Mrs. Rajlaxmi K. Naik Senior Administrative Officer Joint Controller [F&A], TMC OIC House Keeping Department Mr. S.H. Jafri Mrs. S.E. Brid Mr. A.L. Kuvalekar Senior Public Relations Officer Purchase Officer Stores Officer Mr. R.P. Jaiswar Mr. Johnson Lukose Senior Personnel Officer Deputy Chief Security Officer

Administration The goal of Human Resource The Accounts Department is Tata Memorial Hospital being premier Development Department (HR) is to responsible for patient billing, cancer centre, the prime task of the ensure optimum utilization of receipting and settling accounts of administration is to function in unison manpower by placement of right different categories of patients i.e smart with medical administration to facilitate persons at right places. Recruitment card, cash paying, trust and company simplified patient service procedures actions for various posts, after following referred. The department is also and ensure overall smooth functioning all procedures have been taken and 58 responsible for budgeting, utilisation of of the Tata Memorial Centre. personnel were appointed during this the plan and non-plan grants, year. Special Recruitment drive for filling submission of various reports to DAE The Chief Administrative Officer is ably up backlog vacancies reserved for SC/ regarding utilisation of funds and status supported by a team of officers such as ST/OBC/PH through direct recruitment of plan projects. Chief Engineer and his team, Sr. Public was conducted. A total of 15 disabled Relations Officer, Sr. Administrative During the financial year 2014-15, persons in different categories are Rs.217 Crore received as Non-Plan grant Officer, Sr. Personnel Officer, HRD employed in TMH. Officer, Joint Controller of [F&A], was utilized completely. The Plan grant Purchase Officer, Dy. Chief Security The department conducted staff sanctioned was Rs.175.60 Crore and the Officer, Administrative Officer and promotional activities and promoted 68 proposed targets were achieved. Stores Officer. employees. 32 employees Smart card services were implemented superannuated / voluntarily retired across the hospital for all categories of An approximate amount of Rs.16 lacs during the year. The department was disbursed to employees as advance patients, resulting in ease in transacting facilitates recruitment of trainees for services in TMC. towards housing, motor cycle, motor various short term and long term car and computers. The Administration training programmes. These are Personnel Department organized supported 1,239 employees for advanced specialized skill courses for training program for labour staff National Deputation and 355 Doctors, Nurses and Technicians across through Central Board for Worker’s employees for International Deputation the country. About 165 trainees were Education, Ministry of Labour & during the year. The administration benefitted during the year. Employment, Govt. of India. The Centre added 221 members, received 689 has the backing of 852 number of claims of which 398 were sanctioned Skills of in house employees were labour staff governed under under Contributory Health Service developed through various training Brihanmumbai Municipal Corporation Scheme [CHSS]. During the year 2014, programmes and workshops. Staff [BMC], who plays an important role in a total 100 requests were received members were deputed for training the areas of Cleanliness, Transport of under Right to Information Act 2005 programmes conducted by ATI, DAE and Specimens, documents etc., which are and information was provided within ISTM, New Delhi. As part of Green HR important functions in delivery of care. the stipulated period. During the year, initiatives, submission of Immovable All the labour staff were trained on the First Appellate Authority received Property Return was converted to behavioural aspects, communication, 13 appeals which were resolved within online process. family budget, dignity of labour, the stipulated time. absenteeism, etc. Weekly meetings

92 Tata Memorial Centre Annual Report 2014-2015 were conducted with the recognized Departments, as and when required. Department and Laboratories and Union to resolve the common issues for The stores stocks consumable and non calibration of all laboratory equipments. smooth functioning of the hospital work consumable items except drugs and It also coordinated to maintain the including patient care. Allocation of surgical items. Presently it holds stocks supply of medical gas lines throughout man power to different wards, of 351 items. The inventory of the the year. The cell also looked after departments and sections was fulfilled department is computerized supporting disposal of obsolete items. to maintain a high standard of timely supply of requested items and is Condemnation and Disposal Cell has cleanliness and hygiene. The Personnel completely a paperless activity. disposed off routine scrap of 400 Kg. per department continued to provide The main activity of the Engineering day tunes to 146 tonnes approx. mediclaim cashless benefit to labour Department is maintenance of the amounting to approx. Rs.16 lakhs. staff. As per the revised BMC circular, hospital buildings, equipments and The Security Department ensures re-fixation of the pension was adopted machines. Its maintenance measures safety of department, staff and patients for 217 pensioners. ensure prevention of destruction to and safe guards the property. Major The Purchase Department facilitates infrastructure due to high usage and theft incidents were promptly detected. procurement of consumables and also to ensure down time of The department facilitates transport capital equipments. Total purchase equipments to the minimum. This service to staff and patients. Vigilance orders worth around Rs.260 crores were enables smooth functioning of the Awareness Week was observed from released during the year. The hospital and avoids inconvenience to 27.10.2014 to 01.11.2014. Shri. Ahmad department’s import cell facilitated care givers and patients. Javed, IPS, Director General Home acquisition of capital equipments, The department plays a major role in Guards, Maharashtra delivered a consumables, spare parts, worth Rs.200 expanding the patient care facilities of lecture on “Combating Corruption – crores. It also ensured rates contracts TMC with in-house project Technology as an enabler” during the for regularly required consumables. management. It facilitates and monitors awareness week. The protocols of Consumables, spares, worth Rs.50 the construction of environmental Security arrangements for Heads of crores from Non Rate Contract cell and friendly buildings of - Centre for Cancer States and Nations were meticulously other essential services for the hospital Epidemiology (built-up area 60,000 followed. Fires fighting training and worth Rs.10,89,68,519 were procured. sqft), Hematolymphoid Block (built up emergency evacuation mock drills were Global tendering was initiated for area 1,40,000 sq.ft) and Archive and organized for staff. establishment of Hadron Beam Therapy Record Storage (built up area 15,000 The Food Services department caters to equipment worth 300 crores. sq.ft) at ACTREC. needs of patients, and TMH staff and The Centralized Stores Department The department coordinates with the also offers catering services during ensured environment friendly disposal Engineering Procurement and conferences, meetings and other method for empty cartridges. Physical Construction (EPC) Consultants for the events. The patient food is prepared in verification and tagging of assets was upcoming projects at Haffkine’s plot (5 consultation with dietitian. It caters to conducted routinely. No discrepancy acres) for construction of Hadron Beam around 1500 people (doctors, nurses was observed in ledger and physical Therapy facility, Woman and Children and patients) daily. It served balance during the annual stock taking. Wing, hostels for doctors and dormitory approximately 37 national and During the financial year, the store for patients. international conferences and meetings of dignitaries during the year. monitored receipt and issue of The Maintenance and Verification Cell consumables worth Rs.444 lacs to cater shoulders main responsibility of the M The Housekeeping Department (HKD) routine requirements of the various and V Cell and extended in-house help strives to provide a clean, infection free departments. for Repairs and Maintenance of Medical and pleasant atmosphere to support The main function of Stores is to stock equipments in critical areas like speedy recovery of patients. and support regular requirements of Operating theatres, Intensive Care Unit, The high standards of cleanliness and the various Wards / OPDs / Labs / Recovery Ward, Central Sterile Supplies hygiene are ensured using latest

Tata Memorial Centre / Administration 93 equipment, materials and techniques. During the visits of national and Patient Support Services international personalities, the PR The premises are kept pest-free through TMC patients receive support from a department facilitates to showcase the regular pest control services. The other large number of non-governmental specialized activities of various activities include relocation of organizations. This support helps in the departments in the hospital. The Equipment and furniture, Flower delivery of holistic care of patient. The arrangements, Garden maintenance, department facilitated delegates with accommodations, tours and travel, etc. following is a brief account of these Green Waste Recycling (organic manure organizations. plant), Coordinating complaints of for attending the various national and Electrical, Civil, Linen and laundry with international conferences, meetings V-care Foundation: Helps supervise the their respective departments, and seminars of the Hospital. toy room in the pediatric ward, provides implementing allocation of Doctor’s ‘Hindi Fortnight’ an annual event was infection control kits for all general Quarters, and Foyer & Stage celebrated. . Various competitions in patients in the in the pediatric ward. arrangement. This huge task is achieved Hindi like essay writing, debate, Distributes gifts to children at the time through meticulously planning & spelling, knowledge of Official words, of discharge, cancer survivor day and on scheduling of its activities. singing etc were organized for the staff. the Divali festival to enlighten their sprit Tata Memorial Centre was awarded the to fight with cancer and live happily. Regular in-house training programme th for effective performance and including ‘Rajbhasha Shield’ for 10 consecutive CPAA [Cancer Patients Aid Association] motivating and mentoring is organized year. : Provides complan energy drink for staff. throughout the year to pediatric patients, also provides ration to support The aim of the Public Relations (PR) the patients families. Celebrates a week Department is to interact with patients, in month of September with Rose day, identify difficulties and facilitate and Fun & Magic moments in wards, improve the patient facilities in the showers gifts like goody bags and hospital. The PR Staff regularly interacts announce a Winner-in-life Awards to with the patients to identify their needs the patient during this week. on the premises, and co-ordinate with competent authorities for correction, Cankids : provides emergency medical improvement and satisfying the assistance, adoption of children for non requirements. formal education at the “Chattal” Clinics held in OPD, formal education at The Helpline initiated under the Dept “CanShalla”, which is a special school for continues to co-ordinate and streamline cancer children, parent support group the activities of 16 NGO’s and individual forum and awareness and advocacy volunteers, who offer help to the initiatives. patients in the form of finance, offer guidance and distribute food, clothes, Cuddles Foundation : provides nutrition toys and other necessities received as support by giving a constant supply of donations. Free lunch and cloak room nutrition products to both indoor services are also facilitated through patients and out patients. Full time NGOs, individual trust and Corporate. dieticians support and supply of The railway counter continued to infection control products are provided. facilitate reservations for cancer Love & Care : provides ration to the patients. patients families as a support and care. Several programmes like outings, Distributes gifts to elevate sprit to live cultural programmes, yoga sessions, and fight the disease. movie shows etc were organized in Indian Cancer Society : provides association with NGOs as recreational emergency funds for treatment activities for the patients. initiation, and complete financial Life Insurance Policy Claims for patients adoption of many patients for the are processed by the PR Department. timely treatment and care. Provides 179 deaths claims were processed ration to the cancer patients. It also during the year. offers counseling and rehabilitation services to the patients.

94 Tata Memorial Centre Annual Report 2014-2015 Make-A-Wish Foundation : Identifies Sanjivani Life beyond Cancer : Arranges 3. Nutrition support is provided to and helps children suffering from life cancer detection and awareness camps every child coming to the hospital threatening diseases and fulfills a and makes documentary films on breast by way of mid-day meals and special dream wished by them to cancer and also arranges conference for healthy snacks. unleash the experience of a life time the cancer survivors to share their 4. The foundation helps to organize dream. The wishes involve giving them experience for the patients. blood and platelet donors for the a simple toys or travel to a desired Gurnani Sati Charitable Trust : patients, without which it would not destination with beloved ones or Distribution of Tea and Biscuits daily in be able to take intensive treatment. arranging a visit of favorite celebrity of morning through the Helpline of TMH. 5. Non-formal education is provided to the children. Gunvati Kapoor Charitable Trust : the children while they are away JASCAP : provides financial assistance Arranges cancer detection camps and from school for long periods of time. and maintains a book stall at the provides ration for the support to the 6. Foundation organizes Art therapy hospital in which they provides books family of cancer patient. workshops to help the children on cancer information in various forget about their aches and pains languages Braj Gauri Trust : Provides support to the patients with free clock room and to keep their minds occupied. Little More : helps with birthday service at TMH 7. The foundation also organizes celebrations of the children and extends birthdays of every child taking Vasantha Memorial Trust : provides educational support, arranges musical treatment at the hospital. This is to counseling to the families and also helps programs and gift distributions for give children happy memories of the with financial assistance to leukemia children, also provides ration to support hospital when they go back home and breast patients. the families. after getting cured. All these and many more organizations Sadbhavana Foundation : provides 8. The foundation organizes “HOPE”, help us ensure that each and every child counseling, financial support planning, the celebration of “Victory over coming to the hospital is given proper funds for treatment, and most Cancer” which is biggest Paediatric care from the beginning to the entire importantly bereavement support to social event of the hospital. period of the treatment. the patients and their families whose 9. Part of the funds, also goes towards child is suffering from cancer. Also ImPaCCT Foundation : supporting the families who have arranges cancer detection camps in “ImPaCCT Foundation”, an acronym for lost their children fighting the battle rural areas and in Mumbai. Provides of cancer, as bereavement funds. blood and platelet and distributes gifts “Improving Paediatric Cancer Care and 10.The foundation also enhances to the patients. Treatment Foundation”, was established in October 2010 to ensure delivery of cancer care by JACAF : Arranges detection and cancer that every child with cancer coming to supporting salaries of social awareness camps in rural areas. TMH receives treatment and other workers, dieticians, infection control Distributes toys, fruits and nutritional support regardless of the family officers, pharmacists and nurses for food products to the patients, also background. Since childhood cancers giving better quality care to arranges for blood and platelets. are highly curable but the treatment is children. St. Jude India Childcare Centre : intensive and prolonged, it takes more ImPaCCT Foundation thus provides Provides the children a clean and secure than just finances to treat a child with Holistic care to every child coming to place to stay in while on treatment at cancer. Therefore the activities of the hospital, because “Every child with the hospital. Their “Home away from ImPaCCT Foundation are structured in curable cancer deserves a chance at home” concept has been a big support order to meet these needs. cure”. to the department over the years. They also arrange to take children on outing Activities of ImPaCCT Foundation: After Completion of Treatment as short one day trips and arranges 1. The foundation helps raise funds for (ACT) Clinic different entertaining programs. the treatment of poor patients Improvement in therapy for childhood Women’s Cancer Initiative : Arranges without them having to approach cancer over last several decade has led one day conference on the information multiple organizations. to excellent survival in developed of latest technology transfer in Breast 2. The foundation arranges countries. Studies of large cohorts of Cancer for the Doctor. accommodation for the families childhood cancer survivor in Europe who are coming from out of town and North America have well and cannot provide for their own documented the probability of various accommodation. late effects & there adverse impact on

Tata Memorial Centre / Administration 95 Quality of Life (QOL). The potential of Treatment (ACT) Clinic to emphasize UGAM public health implications such large that ACTs are needed beyond treatment number of high risk individuals in to achieve “CURE” in its full dimensions. Vision- society have thus become evident. The aims of the clinic are  To ensure that every childhood cancer survivor finds his/her way to There is an increasingly perceived need  To monitor growth, development & celebrate life after winning battle for optimal delivery of life-long health sexual maturation of survivor. care to this growing, vulnerable with cancer.  To monitor late effects of therapy. population. Pediatric oncologists in  To facilitate their life’s journey on developing countries are currently  To address psycho-social problem of correct path & in right direction. preoccupied with refilling delivery of the survivor. care to attain survival rates which are  Rehabilitation for useful productive Mission- comparable to developed world. adulthood.  Self-empowerment of the young However, they have an obligation to  To provide feedback for future survivors. actively build long term follow up & protocol modification to obviate/  Helping children with cancer survivorship programme as integral part minimize late effects. currently undergoing treatment. of pediatric Oncology initiative.  Social awareness and re-bonding Childhood cancer survivor receive From Feb 1991 to December 2014 with society. highest quality care during the active cohort of 1,706 survivors (off therapy phase of their treatment, but can be lost and disease free for >2 years) has been Adolescent & Young Adult Mumbai in transition to the more passive follow created in ACT Clinic. These survivors based survivors from ACT clinic, inspired up phase of survivorship. are followed up in a longitudinal by survivor from across the globe with manner at the frequency depending on whom they interacted during A long term follow up clinic for survivor probability of risk of late effects. 111 International Society of pediatric of childhood cancer was initiated at Tata survivors were enrolled & added to this Oncology (SIOP) Meeting in October Memorial Hospital in February 1991 th cohort while 654 survivors were 2007, came together on 7 June 2009, drawing inspiration from the model of followed up in ACT clinic from Jan 2014 (First Sunday of June), celebrated as care established at St. Jude Children – Dec 2014. Cancer survivor day by the National research Hospital, USA. This clinic was Coalition for cancer survivorship appropriately named After Completion (NCCS). They formed a voluntary support group, UGAM under the survivorship programme of Indian Cancer Society & have made pioneering efforts in bringing Cancer Survivorship issues from the closet to the public domain. UGAM means “To Rise” underscoring determination of childhood cancer survivor to rise above all obstacles in life & be VICTORS. They are functioning with following vision and mission.

96 Tata Memorial Centre Annual Report 2014-2015

Ms. Rohini Hawaldar, TMC Research Administrative Council TRAC Administrator (TRAC)

TRAC was constituted with the broad accreditation. The centre was AAHRPP mandate to maintain and improve accredited with “Gold Seal” assuring basic, translational and clinical research. research participants, researchers, The main activity focuses on sponsors, government regulators, and implementation of human research the general public of excellence and protection program, identify thrust protection of the research participants. areas for research, support and The Institutional Insurance policy for encourage collaborative national and investigator initiated research studies international research, review pre- was implemented. proposals, and provide and review The TRAC was also involved in utilization of financial provisions. Development and implementation of The TRAC members met on two software for IEC administration, occasions during the year. The council preparation of HRPP manual, conducts emphasized revision of SOP for IEC and regular audits of functioning, Beta CRS to ensure conduct of scientifically testing of software (OVERTURE from and ethically sound research. It Allegro Systems) for research studies. provided continuous support for The council focuses its future activities preparation of Association for the on quality control and develope online Accreditation of Human Research submission system for research Protection Programs (AAHRPP) projects.

98 Tata Memorial Centre Annual Report 2014-2015 Clinical Research Secretariat and Dr. Ashwini Budrukkar Department of Atomic Energy Officer In Charge Clinical Trials Co-ordinator

Clinical Research Secretariat (CRS) along focused on “Perioperative Care: with Department of Atomic Energy Improving Outcomes after Surgery” and Clinical trials unit (DAE-CTC) facilitates “Oncologic Imaging: A Multidisciplinary research at Tata Memorial Hospital for Perspective”. The meeting was over a decade. The DAE-CTC unit and attended by 376 participants. Two CRS supports clinical research in order Evidence Based Medicine books were to propagate practice of evidence based released during this conference. These medicine. It also builds capacity of comprehensive books cover all cancer researchers and trial coordinators sites and are useful as pocket reference through several education and training guide for clinicians and residents in programs Several path breaking clinical training. trials in various spheres of oncology In its endeavor to disseminate have been supported by the CRS/DAE- knowledge and to promote evidence CTC. This support has been in the form based practices, DAE-CTC unit and of infrastructure, trained manpower, Clinical Research Secretariat (CRS) study design, statistical assistance, data provides organizational support for management and analyses, data conferences. Assistance was provided monitoring, and co-ordination of clinical to organize eight conferences in various trials, etc In 2014 10 new clinical trials specialties and National Cancer Grid were financially supported through meetings during the year. CRS/ DAE- DAE-CTC funds. CRS provided statistical CTC, also trains clinicians and students assistance to 102 new studies and in research methods. A “Clinical extended, help in Informed Consent Research Methodology Course” translations to forty nine studies. covering research methodology, The Annual Evidence Based Medicine statistical analysis and research ethics meeting was organized as continued was conducted and was attended by efforts towards promoting Evidence 280 participants. Two workshops on based medical practice. The 2014 “Good Clinical Practice” were also Evidence Based Medicine meeting organized and attended by about 250 participants.

Tata Memorial Centre / Research 99 Institutional Ethics Committee (IEC)

Dr. George Karimundackal, Dr. Siddhartha Laskar, Member Secretary, Member Secretary, Institutional Ethics Committee-I Institutional Ethics Committee-II

The Institutional Ethics Committees-I & renewed. The assurance number is aspects of broad range of topics such II (IECs) are constituted by the Director, FWA00006143. as disclosures of diagnosis, diagnosis of brain death, indications for stopping Tata Memorial Centre (TMC) under IECs are also registered with HHS and resuscitation, true informed consent, authority vested by the Governing have IORG Nos. IRB00003414, etc. However IECs do not participate in Council of the TMC. IECs are appointed IRB00007802 for IEC-I & IEC-II for duration of 2 years. Both administrative matters, nor does it respectively and is renewed function as a grievance cell. Institutional Ethics Committees periodically. function with the same purpose and The two committees namely TMC - SOPs. The mandate of the IEC is to establish, Institutional Ethics Committees- I and formalize and reaffirm the Institution’s Tata Memorial Centre- IECs are II (TMC-IECs) are involved in the review commitment to promotion of high of industry sponsored, investigator registered with Drug Controller General ethical standards in clinical research, initiated research proposals and India. IEC-I has Ethic Committee professional education and to safeguard student research projects. The two Registration No. ECR/170/Inst/MH/2013 the dignity, rights & well-being of committees meet once every month to issued under Rule 122DD of the Drugs potential research participants. The IEC facilitate timely and accurate ethical & Cosmetic Rules 1945. IEC-II has Ethic also provides a forum for discussing and reviews. The strength of each of Ethics Committee Registration No. ECR/414/ analyzing ethical issues in all research Committees consists of 15 members Inst/MH/2013 issued under Rule 122DD activities of TMC. and has both in-house staff and experts of the Drugs & Cosmetic Rules 1945. from outside the institution. Institution has a Federal Wide The Terms of Reference and revised The committees are constituted as per Assurance (FWA) with the Department versions of SOPs are published on the TMC website. IEC ensures highest the DGCGI / CDSCO guidelines and of Health and Human Services (DHHS) scientific and ethical standards of schedule Y and the membership has through the Office for Human Research research at TMC. It is the endeavor of representation from a wide range of Protections (OHRP) and is periodically IECs to provide guidance on bioethical experts and stakeholders.

100 Tata Memorial Centre Annual Report 2014-2015 The membership for the year 2014-2016 is listed below: Institutional Ethics Committee-I w.e.f April 2014, Registration No. ECR/170/Inst/MH/2013 Sr. No. Names & Position Affiliation Expertise 1. Dr. Tapan Saikia, Head of Medical Oncology & Research Director, Medical Chairperson Prince Aly Khan Hospital, Mazagaon, Mumbai Oncologist 2. Dr. Nithya Gogtay, Professor, Clinical Pharmacology, KEM Hospital Clinical Co- Chairperson Pharmacologist 3. Dr. George Karimundackal, Associate Professor, Dept. of Surgical Oncology, Surgeon Member Secretary Tata Memorial Hospital 4. Mrs. Manisha Naikdalal, Member of Ethics Committees at KEM Hospital(ECRHS) Lay Person Member & Hinduja Hospital(CREC) 5. Ms. Sandhya Vora, Managing Trustee V Care Foundation Social scientist/ Member NGO representative 6. Dr. Pradnya Talawadeker, Country Coordinator for India Association Medico-legal expert Member Children Pallative Care Project 7. Dr. Sanjay Gupta, Scientific Officer, Advanced Centre for Treatment, Basic Scientist Member Research and Education in Cancer (ACTREC) 8. Dr. Sarbani Ghosh Laskar, Professor, Dept. of Radiation Oncology, TMH Radiation Oncologist Member & Member-Secretary, Data Safety and Monitoring Subcommittee, Tata Memorial Hospital 9. Dr. J. V. Divatia, Professor and Head, Department of Anaesthesia, Anaesthetist Member Critical Care & Pain, Tata Memorial Hospital 10. Dr. Vani Parmar, Professor, Dept. of Surgical Oncology , Surgeon Member Tata Memorial Hospital 11. Dr. Umesh Mahanshetty, Professor, Dept. of Radiation Oncology, Radiation Oncologist Member Tata Memorial Hospital 12. Dr. Girish Chinnaswamy, Associate Professor, Dept. of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital 13. Dr. Manju Sengar, Professor, Dept. of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital 14. Dr. Mukta Ramadwar, Professor, Dept. of Pathology, Pathologist Member Tata Memorial Hospital 15. Dr. Seema Kembhavi, Associate Professor, Dept of Radiodiagnosis, Radiologist Member Tata Memorial Hospital

Tata Memorial Centre / Research 101 Institutional Ethics Committee-II w.e.f April 2014 Registration No. ECR/414/Inst/MH/2013

Sr. No. Name & Position Affiliation Expertise 1. Dr.(Mrs) Urmila Thatte Professor & Head, Dept. of Clinical Pharmacology, Clinical Chairperson KEM Hospital Pharmacologist 2. Dr. Vinay Deshmane Consultant in Surgical Oncology & Breast Diseases, Surgeon Co-Chairperson P.D. Hinduja National Hospital & Medical Research Centre 3. Dr. Siddhartha Laskar Professor, Dept. of Radiation Oncology, Radiation Oncologist Member Secretary Tata Memorial Hospital 4. Mr. P. K. Rao Founder/ Trustee of JASCAP, Jeet Association for Lay person Member Support to Cancer Patients since 1996 5. Dr. A. Lobo Gajiwala Head, Dept. of Tissue Bank, Tata Memorial Hospital Theologian Member 6. Dr. Swati Gadgil Anaesthesiologist & Medico-legal Consultant, Medico-legal Expert Member (till Oct 2014) Director, Ishwar Hospitals Member, Institutional Ethics Committee, Dr. Leena V. Gangolli Nirmala Niketan College of Home Science, Consultant, Medico-legal Expert Member (wef Nov 2014) Children’s Palliative Care Program, Consultant, Silver Innings Foundation 7. Dr. Renuka Munshi Head, Dept. of Clinical Pharmacology Clinical Member TN Medical College & BYL Nair Hospital, Pharmacologist 8. Dr. Rajiv Kalraiya Scientific Officer, Advanced Centre for Treatment, Basic Scientist Member Research and Education in Cancer (ACTREC) 9. Dr. Prachi Patil Associate Professor, Dept. of Digestive Diseases and Gastroenterologist Member Clinical Nutrition, Jt. Secretary, Data Safety and Monitoring Subcommittee, Tata Memorial Hospital 10. Dr. Devendra Chaukar Professor, Dept. of Surgical Oncology, Surgeon Member Tata Memorial Hospital 11. Dr. Hari Menon Professor, Dept of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital 12. Dr. Priya Ranganathan Associate Professor, Dept. of Anaesthesia, Anesthesiologist Member Tata Memorial Hospital 13. Dr. Kedar Deodhar Professor, Dept. of Pathology, Pathologist Member Tata Memorial Hospital 14. Dr. M H Thakur Professor & Head, Dept. of Radio-diagnosis, Radiologist Member Tata Memorial Hospital 15. Ms. Rohini Hawaldar Scientific Officer, Tata Memorial Hospital Statistician Member

102 Tata Memorial Centre Annual Report 2014-2015 IEC PROCESS Continuing review applications, IEC II The IEC functions as per the SOPs laid amendments and completion reports The committee conducted 11 full board down for this institution. All research for each projects are also reviewed. committee meetings and reviewed a projects/clinical trials involving human The Data Monitoring & Safety total of 79 research projects. Of these, subjects are processed through the IEC. Committee (DSMSC), subcommittee of a total of 50 projects were approved, IEC ensures the scientific and ethical the IEC, monitors the conduct of 28 projects were subjected to validity of the research and the approved projects and reviews the modifications/ resubmission/ and are protection of safety, rights and deviations/ violations and serious awaiting approval. 1 project was confidentiality of the research subjects. adverse events (SAE) . It recommends exempted from review. Submitted projects are assigned to the compensations for research In addition to these, the ICE – II also IEC – I or IEC – Ii as per their date of participants for trial related injuries. reviewed and discussed 175 submissions. Each project is allocated a amendments, 104 violations/ waivers/ unique “IEC Identification Number”. IEC PERFORMANCE IN 2014: deviations, 148 status reports, 294 The review process is as per the SOP. IEC I letters during the year. . Each project is reviewed for its scientific, The committee conducted 11 full board Seven subcommittee meetings were ethical, and statistical aspects. committee meetings and reviewed a conducted by the IEC-I. discussed 26 Independent consultants are invited for total of 101 research projects. Of these, projects. Of these, 21 projects were expert comments whenever necessary. a total of 68 projects were approved, approved and five projects are awaiting Decisions are arrived at by consensus 33 projects were subjected to approval for fulfilling committee’s or by voting if the members fail to reach modifications/ resubmission/ or are recommendations for modifications a consensus. Intramurallly funded awaiting approval. In addition to these, and resubmission. 36 projects projects are scored by the members as the committee reviewed and discussed submitted in 2013, were approved on per the IEC scoring sheet. 229 amendments, 83 violations/ re submission with revisions. waivers/ deviations, 149 status reports, The average duration from IEC 492 letters. submission to decision was 11.5 weeks.

Summary IEC- I Project discussed Approved Approved with Resubmit/ modifications Not approved Pending for meeting 2013 2014 2013 2014 2013 2014 2013 2014 2014 69 101 40 68 23 25 06 06 01

IEC- II Project discussed Approved Approved with Resubmit/ modifications Not approved Pending for meeting 2013 2014 2013 2014 2013 2014 2013 2014 2014 82 79 55 50 24 19 03 05 04

IEC- I expedited review Projects discussed Approved Approved with Resubmit modifications 2013 2014 2013 2014 2013 2014 2013 2014 12 26 12 21 0 05 0 0

Tata Memorial Centre / Research 103 IEC- I & II Projects Extramural Institutional* Sponsored Thesis Discussed (Intra Mural / (Pharma / Trade) No Funding) 2013 2014 2013 2014 2013 2014 2013 2014 2013 2014 163 180 07 07 53 69 27 15 76 89 * Includes projects approved for funding, awaiting funding and short research conducted without funds.

The SOPs were revised to incorporate Tata Memorial Centre -IEC was awarded Education the requirements of Schedule Y, , Full Accreditation by the Association for The TMC IEC organized SOP training for Association for the Accreditation of the Accreditation of Human Research all the departments, DMGs, IEC/DSMSC Human Research Protection Program Protection Programs (AAHRPP) in June members, researchers and research (AAHRPP) recommendations, adopt 2014. AAHRPP is an independent, non- staff at TMH and ACTREC. changes to comply with USA 45 CFR, profit accrediting body, which uses a and suggestions from members. An voluntary, peer-driven, educational The IEC s would continue with its efforts automated system for IEC model to ensure that IECs meet rigorous for comprehensive Human Research administration was developed in-house standards of Human Research Protection Program and increase and implemented. Protection Program (HRPP) for quality awareness about AAHRPP policies and and protection in research. procedures; conduct audits and introduce online submission of research protocols.

104 Tata Memorial Centre Annual Report 2014-2015 Data Safety Monitoring Subcomittee Dr. Sarbani Ghosh Laskar, Secretary DSMSC

The Data Safety Monitoring Sub- scientific and ethical integrity of the institutional studies and other studies Committee (DSMSC), a subcommittee study. The primary responsibility of the as and when required or referred to by of the TMC Institutional Ethics DSMSC is to review and address Serious the IECs. The DSMSC, through its Committee (IEC) I & II, is responsible for Adverse Event (SAE) and unexpected monthly meetings continuously over monitoring patient safety during the events involving all trials. It is also sees the studies, identifies and course of the study to ensure the required to regularly monitor addresses various safety issues.

The composition of the DSMSC for the year 2014-2016 is as follows Composition of DSMSC w.e.f. April 2014 Sr. No. Names Affiliation Expertise 1. Dr. Sarbani Laskar, Professor, Dept of Radiation Oncology, Radiation Oncologist Secretary, Tata Memorial Hospital DSMSC Member, IEC-I 2. Dr. Prachi Patil, Associate Professor & Assistant Gastroenterologist, Medical Jt. Secretary, DSMSC Dept of Digestive diseases & Clinical Nutrition, Gastroenterologist Member, IEC-II Tata Memorial Hospital 3. Dr. Tabassum Wadasadawalla, Assistant Professor, Dept of Radiation Oncology, Radiation Oncologist Member Tata Memorial Hospital 4. Dr. Sabita Jiwnani, Member Assistant Professor , Dept of Surgical Oncology, Surgeon Tata Memorial Hospital 5. Dr. Nita Nair, Assistant Professor, Dept of Surgical Oncology, Surgeon Member Tata Memorial Hospital 6. Dr. Santosh Menon, Assistant Professor, Dept of pathology, Pathologist Member Tata Memorial Hospital 7. Dr. Sneha Shah, Assistant Radiologist, Bio-imaging Unit, Radiologist Member Tata Memorial Hospital 8. Dr. Madhavi Desai, Assistant Anesthetist ‘E’ Dept of Anesthesia, Anesthetist Member Tata Memorial Hospital 9. Dr. Jaya Ghosh, Assistant Professor, dept of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital, 10. Dr. Supriya Sastri, Assistant Professor & assistant Radiation Oncologist, Radiation Oncologist Member Dept of Radiation Oncology, Advanced Centre for Treatment, Research & education in cancer (ACTREC) 11. Mr. Sanjay Talole, Scientific Officer ‘D’, Dept of Medical Records, Statistician Member Biostatistics & Epidemiology, Tata Memorial Hospital 12. Dr. Vanita Noronha, Assistant Professor, Dept of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital 13. Dr. Gauravi Mishra, Additional Professor, Dept. of Preventive Oncology, Preventive Oncologist Member Tata Memorial Hospital

Tata Memorial Centre / Research 105 Sr. No. Names Affiliation Expertise 14. Dr. Sheela Sawant, Associate Professor, Physician Member Dept. of General Medicine, Tata Memorial Hospital 15. Dr. Gouri Pantvaidya, Associate Professor, Dept. of Surgery, Surgeon Member Tata Memorial Hospital 16. Dr. K Manjunath N, Associate Professor, Dept of Pharmacology, Pharmacologist Member Advanced Centre for Treatment, Research & Education in cancer (ACTREC) 17. Dr. Sumitra Bakshi, Associate Professor, Dept of Anesthesia, Anesthetist Member Tata Memorial Hospital 18. Dr. Tushar Vora, Associate Professor, Dept of Medical Oncology, Medical Oncologist Member Tata Memorial Hospital

Service The committee conducted 12 meetings during the year to review, SAEs reported, Annual Status Reports/ Continuing Review Application for all studies and the observations with comments are forwarded to IEC for discussion. To maintain the 21 day timeline of DCGI/ CDSCO, the SAEs on regulatory trials were evaluated continuously through e- mail group of 6 members consisting of the secretaries of the IEC 1 and 2, two lead discussants, and the two secretaries of the DSMSC. The committee receives an average of 50 SAE reports per month. A total of 540 SAE reports on 47 clinical trials were received and reviewed during the year. A total of 177 Status report were trial. It continued to maintain database Tata Memorial Centre –IEC/DSMSC was received and reviewed. In addition the for SAEs occurring at TMH, to support awarded Full Accreditation by the DSMSC also received 65 off site safety tracking follow-up on significant events Association for the Accreditation of reports for SAEs for other sites. The and monitor the current status on the Human Research Protection Programs DSMSC monitored 18 trials during the study events occurring on a trial. An (AAHRPP) year. automated system for DSMSC The DSMSC plans to Outsource trial functioning has been developed in- The Continuing review form, SAE monitoring to external monitors in house which facilitates tracking all SAE reporting form and the Monitoring form order to increase the scope of this report for ongoing trials and generating were revised to include extensive exercise and improve the coverage, reminders of Continuing Review details of the different aspects of the revise SOPs and flag events in real time Applications. during the next year.

106 Tata Memorial Centre Annual Report 2014-2015 Research Projects

Principle Investigator Project Title Mrs. Achrekar, Meera Developing an information booklet about sexual dysfunction and its measures and assessing its effect on knowledge of male patient’s undergone surgery for urological cancer at tertiary care center. Dr. Agarwal, Jai Prakash Correlation of functional tumour volume of primary lung cancer with histopathological tumour size in early stage NSCLC : Primer to contouring in high dose high precision radiotherapy Dr. Alahari, Aruna Study of Metabolic Syndrome in Adult survivors of childhood cancers Dr. Ambulkar, Reshma A questionnaire survey of knowledge and practice of evidence-based medicine among peri-operative physicians in India Dr. Amin, Nayana Audit On Compliance Of Pre-Operative Fasting Guidelines Among Peadiatric Population In A Tertiary Cancer Hospital Audit on perioperative mortality and morbidity in paediatric patients undergoing oncosurgical procedures Dr. Arora, Brijesh A collaborative, multicentre, national trial for newly diagnosed patients with acute lymphoblastic leukaemia (ICiCLe-2014) A prospective observational study to assess the side effects of Imatinib in pediatric patients with chronic myeloid leukemia Dr. Arya, Supreeta Laryngeal squamous carcinoma: A retrospective study to evaluate accuracy of MDCT to aid decision between laryngeal conservation and total laryngectomy. Dr. Badwe, Rajendra A prospective study to determine concordance rate between intraoperative clinical assessment of level III axillary lymph node and histo-pathological node status in primary breast cancer An Audit of HER2 Positive Tumors - Is Hormone Positivity A Potential Differentiating Factor? Dr. Bajpai, Jyoti A Double Blind Randomized Controlled Trial of Renal Protective Effects of Normal saline plus Placebo Versus Normal Saline Plus Mannitol Prior to Cisplatin Containing Chemotherapy Regimens in Solid Tumors CLR_12_10 “A Randomized, Open Label, Two Period, Single Dose, Two Way Crossover, Bio availability Study of Paclitaxel Injection Concentrate for Nano-dispersion (PICN) and Abraxane in Patients with Locally Recurrent or Metastatic Breast Cancer”. Osteosarcoma: Targeting Microenvironment in Perioperative period by Antiangiogenic drugs Celecoxib and Propranolol Protocol No. SB3-G31-BC- “A Phase III Randomised, Double-Blind, Parallel Group, Multicentre Study to Compare the Efficacy, Safety, Pharmacokinetics and Immunogenicity between SB3 (proposed trastuzumab biosimilar) and Herceptin® in Women with Newly Diagnosed HER2 Positive Early or Locally Advanced Breast Cancer in Neoadjuvant Setting”. Validation of EORTC QLQ-BM 22 module into Indian language (Marathi) to study Quality of Life of osteosarcoma patients from a tertiary care cancer centre. Validation of EORTC QLQ-OV28 module into Indian languages (Hindi and Marathi) to study Quality of Life of Ca ovary patients from a tertiary care cancer centre

Tata Memorial Centre / Research 107 Principle Investigator Project Title

Dr. Bakshi, Sumitra A prospective, randomized trial to evaluate role of McGrath MAC videolaryngoscope in placement of double lumen tubes Audit of pain management following emergency laparotomy: A prospective observational study from an Indian tertiary cancer hospital. Prospective trial evaluating role of McGrath MAC blade in insertion of Double lumen tube in patients with limited glottis view with standard MacIntosh scope. Dr. Bakshi, Ganesh Retrospective audit of nephron sparing surgeries for renal masses at TATA MEMORIAL CENTRE Retrospective study to evaluate prognostic value of Lymph node density in carcinoma urinary bladder in patient undergoing radical cystectomy. Dr. Bal, Munita To study clinicopathological spectrum of pleomorphic adenoma: benign, recurrent and malignant transformation Dr. Banavali, Shripad A retrospective analysis of clinical characteristics, treatment and outcome of children with Burkitt lymphoma treated with modified MCP 842 protocol at Tata Memorial Centre from 1997-2013. Advancing Cancer-care through CANScriptTM Enabled Personalized Treatment (ACCEPT): A non-randomized, investigator initiated, observational trial to measure predictive power of CANScriptTM for chemotherapeutics and targeted therapy in patients with newly diagnosed, locally advanced head & neck cancer and refractory / relapsed triple negative breast cancer. Dr. Budrukkar, Ashwini ENT-COBRA: Multicenter data collection system to increase the visibility of Head and neck brachytherapy (ENT-BT)contribution in cancer treatment by the analysis of homogeneous and heterogeneous extended series of patients with long follow-up and to validation of high technology by learning machine Prospective observational study for quantification of volumetric and geometric changes in the target volume and parotid during intensity modulated radiotherapy in locally advanced oropharyngeal cancers. Dr. Chatterjee, Aparna Does a Supreme Laryngeal Mask Airway (SLMA) selected on the basis of a patient’s weight provide an optimal fit in Indian population? Pattern of patient referral to the pain clinic of a tertiary cancer centre: a retrospective observational study Dr. Chaukar, Devendra Utility of pectoralis major myofascial flap in reducing pharyngocutaneous fistula rates after salvage total laryngectomy. Dr. Chougule, Anuradha Genomic Profiling in Thyroid Carcinoma Study to evaluate the prevalence of epidermal growth factor receptor (EGFR) mutation status in small cell lung cancer (SCLC) in india Dr. D Cruz, Anil Analysis of quality of life in tongue cancer patients Maxillectomies: a 10 year experience from a single institution Sequential Multifunctional MRI (Mf-MRI: DWI, MRS, DCE-MRI) In Squamous Head and Neck Tumours: Can These Parameters Act as the Markers To Predict Clinical Response To neoadjuvant chemotherapy? Dr. Dangi, Uma Protocol No. RI-02-002 - A multicenter, retrospective medical record review study to describe real-world treatment patterns and safety among patients receiving rituximab (MabThera® or Reditux™) to treat B-cell non-Hodgkin’s lymphoma in India Mrs. De O Carvalho, Maria A study to assess the problems faced and coping strategies adopted by patients who have undergone radiation therapy for cancer of cervix at Tertiary cancer care centre.

108 Tata Memorial Centre Annual Report 2014-2015 Principle Investigator Project Title

Dr. Deodhar, Jayita Adolescents with Bone & Soft Tissue Cancer : Efficacy of psychosocial interventions for patients and their siblings Dr. Deodhar, Kedar Anal canal melanoma: A retrospective histomorphological review with clinicopathological correlation Immunohistochemical evaluation of novel biomarkers in cervix cancer: a tissue microarray based study Dr. Deshpande, Deepak Dose Accumulation using deformable image registration for Adaptive Radiotherapy (ART). Dosimetric characteristics of flattening filter free (FFF) beams from True Beam linear accelerator and Hi-Art II Tomotherapy. Dr. Dholam, Kanchan Squamous cell carcinoma of the oral cavity and oro-pharynx in patients aged 18-45 years:A Case- Control study to evaluate the risk factors with emphasis on stress,diet, oral hygiene and family history Dr. Divatia, Jigeeshu A multicentric, observational, prospective drug utilization study of antibacterial agents with special focus on vancomycin and colistin in patients admitted to the Medicine Intensive Care units (MICU) of major hospitals. Audit of consumption of inhaled anaesthetic agents using nitrous oxide versus medical air as a carrier gas. Dr. Engineer, Reena USG based brachytherapy in carcinoma cervix Dr. Gehdoo, Raghuveersingh Post operative analgesia following thoracic surgery- a retrospective comparison between epidural and IVPCA based analgesia Dr. Ghadge, Meera 5-Hydroxyindoleacetic acid and serotonin in 24 hours urine of patients with neuroendocrine tumors. Dr. Ghosh, Sarbani A Cross sectional study to estimate the incidence of Second primary Cancers in patients with locally advanced non-nasopharyngeal Head and Neck Squamous Cell Carcinoma (HNSCC) treated with radical, non-surgical methods. A retrospective analysis of adult nasopharyngeal carcinoma treated with Intensity Modulated RadioTherapy (IMRT) at Tata Memorial Hospital (TMH). Dr. Ghosh, Jaya A retrospective audit of breast cancer patients who have received short course adjuvant or neo adjuvant trastuzumab through patient assistance program Protocol No. B3271002 - A Phase 3, randomized, double-blind study of PF-05280014 plus Paclitaxel versus Trastuzumab plus Paclitaxel for the first-line treatment of patients with HER2-Positive Metastatic Breast Cancer Dr. Ghosh, Sarbani Correlation of Metabolic and Anatomic Imaging in Patients with Nasopharyngeal Carcinoma and Evaluation of their Impact on Clinical Outcomes Dr. Gota, Vikram An open label, non-randomized, single dose, parallel, bioequivalence study of two formulations of Erlotinib (Innovator - Tarceva and generic - Tyrokinin) or Gefitinib (Innovator - Iressa and generic - Xefta) in adult non-small cell lung cancer (NSCLC) patients with non-squamous histology, who have undergone atleast one previous chemotherapy Protocol No. RLS/0314/020- A two stage, randomized, multicentric, open label, multiple dose, two-treatment, twosequence, two-period, crossover, steady state bioequivalence study of test Nilutamide 150 Mg tablets (from EirGen Pharma Ltd.,Ireland) with reference Nilandron 150 mg tablets of Sanofiaventis U.S. LLC in prostate cancer patients under fasting condition. Dr. Gujral, Sumeet Flow cytometric study of TCR Vß antigen expression patterns in healthy individuals and its application in T cell clonality evaluation

Tata Memorial Centre / Research 109 Principle Investigator Project Title

Dr. Gulia, Seema Protocol No. MYL-Her 3001- A Multicenter, Double-Blind, Randomized, Parallel-Group Phase III Studyof the Efficacy and the Safety of Hercules Plus Taxane Versus Herceptin® Plus Taxane as First Line Therapy in Patients With Her2-Positive Metastatic Breast Cancer Protocol No. TRA.12.001.02.1- A prospective, randomized, multi-centric clinical study to compare Trastuzumab (Test Product, Zydus) with Trastuzumab (Reference Product, Roche/Genentech ) in patients with metastatic breast cancer. Protocol Number CT-P6 3.2 -”A phase 3,Double-Blind, Randomized, Parallel- Group,Active-Controlled Study to Compare the Efficacy and Safety of CT-P6 and Herceptin as Neo adjuvant and Adjuvant Treatment in Patients with HER2-Positive Early Breat Cancer” Dr. Gupta, Sudeep A prospective observational study of Chemotherapy Induced Nausea Vomiting (CINV) in patients receiving Anthracycline based chemotherapy for Breast Cancer” A Prospective Study To Evaluate The Incidence Of Peripheral Neuropathy In Taxane Based Chemotherapy In Epithelial Ovarian Carcinoma Protocol No. MO28231- A Multicentre , Single Arm Study of Trastuzumab Emtansine (T-Dm1) In Her2-Positive Locally Advanced or Metatstatic Breast Cancer Patients Who have Received Prior Anti-Her2 And Chemotherapy-Based Treatment Retrospective and anonymized study on breast tumors for identification of markers predictive of risk of recurrence. Risk factors in carcinoma breast: A questionnaire based FOGSI project of endocrinology and study of breast committees. Dr. Hampapur, Venkat Narayan Ease of accessibility to quality ‘Public Tertiary healthcare services’ in Mumbai Dr. Jain, Parmanand A prospective observational study to assess the efficacy of the meniscus test in predicting the correct epidural catheter placement An Observational study of prevalence of depression and anxiety among cancer pain clinic patients Dr. Jalali, Rakesh Dose Constraint Model to Predict Neuroendocrine Dysfunction in Young Patients With Benign And Low Grade Brain Tumours Treated With Stereotactic Conformal Radiotherapy Prospective Evaluation Of Quality Of Life In Patients With Recurrent High Grade Glioma Treated With Re-Irradiation Dr. Jiwnani, Sabita Feasibility and implications of thoracoscopic dissection of internal mammary nodes in central and inner quadrant breast cancer Protocol No. CLDK378A2301-A phase III multicenter, randomized study of oral LDK378 versus standard chemotherapy in previously untreated adult patients with ALK rearranged (ALK-positive), stage IIIB or IV, non-squamous non-small cell lung cancer. Dr. Joshi, Amit An Observational Study to evaluate factors predicting survival in patients of NSCLC with compromised PS. Germ Cell tumor outcome and long term follow up study (GTOF) Longitudinal Assessment of Quality of Life among Stage IV Non Small Cell Lung Cancer Patients in India Patient support program for metastatic castration resistant prostate cancer patients who have been prescribed Taxotere (Docetaxel) and Jevtana (Cabazitaxel) at Tata Memorial Centre, Mumbai. Prospective observational study of thromboembolic events in patients of advanced stage non small cell lung cancer (NSCLC) treated with platinum based chemotherapy

110 Tata Memorial Centre Annual Report 2014-2015 Principle Investigator Project Title

Dr. Joshi, Malini Effect of Prophylactic Dexmedetomidine on Haemodynamic Response To Double Lumen Tube Intubation Under General Anaesthesia. Dr. Kadam Amare, Pratibha Cytogenetic analysis helps identification of prognostic groups in multiple myeloma: the experience from India. Ms. Kalaivani Effect of Structured Teaching Program on Knowledge related to Self Identification and Management of Hand Foot Syndrome among patients receiving chemotherapy for colon cancer at Tertiary Cancer Care Centre Dr. Karimundackal, George Effectiveness of MRI brain in detecting asymptomatic brain metastases in operable NSCLC Patient participation in oncological decision making - How much do Indian patients understand? Patient participation in oncological decision making - What do Indian patients expect? Pattern of mediastinal lymph node involvement in resected NSCLC according to tumor location. A retrospective study Pleural lavage cytology as a prognostic marker in patients undergoing pulmonary metastasectomy Role of skeletal muscle index in predicting early postoperative complications following oesophageal cancer surgery. Dr. Kelkar, Rohini Microbiology of Ventilator Associated Pneumonia in a tertiary care cancer centre. Molecular epidemiology and resistance patterns of mycobacterial isolates from a cancer hospital Dr. Kembhavi, Seema Imaging Spectrum of liver tumors in children Dr. Khattry, Navin An Open-Label Bosutinib Treatment Extension Study For Subjects With Chronic Myeloid Leukemia (CML) Who Have Previously Participated In Bosutinib Studies B1871006 or B1871008. Dr. Kulkarni, Suyash Retrospective analysis of Safety & Efficacy of Percutaneous radiofrequency ablation in treatment of unresectable colorectal liver metastases. Dr. Kulkarni, Atul Evaluation and validation of the four scoring systems; the acute physiology and chronic health evaluation (APACHE) IV, simplified acute physiology score (SAPS) III, mortality probability model (MPM) 0-III and Cancer Mortality Model (CMM) in critically ill cancer patients The Fluid-Translation of Research into Practice Study (Fluid-TRIPS) Validation of MACOCHA score in predicting difficult intubations in cancer patients in the ICU and A prospective audit of airway management and its complications in ICU Dr. Kumar, Rajiv Assesment of Human Papilloma Virus in Oesophageal Cancer Detection and Standardization of MET, ROS and RET by Fluorescent In Situ Hybridization (FISH) in Lung Adenocarcinoma Detection Of Fibroblast Growth Factor Receptor (FGFR) In Squamous Carcinoma And Neuroendocrine Tumours Of The Lung Dr. Kurkure, Purna A prospective study to investigate the impact of malnutrition on the pharmacokinetics of anticancer drugs in young children Outcome of childhood acute promyelocytic leukemia treated with sequential arsenic trioxide(ATO), and all trans retinoic acid (ATRA) based therapy: A retrospective study from a tertiary care centre.

Tata Memorial Centre / Research 111 Principle Investigator Project Title

Dr. Laskar, Siddhartha A retrospective study to evaluate long term outcomes in paediatric patients of Nasopharyngeal Carcinoma treated with high precision radiotherapy in Tata Memorial Centre Dr. Mahantshetty, Umesh Patterns of Relapse, Salvage Therapy and its Outcome in Locally Advanced Cervical Cancer treated with Radical Radio (Chemo) therapy - A retrospective analysis. Dr. Maheshwari, Amita Preoperative and intraoperative assessment of myometrial invasion and histological grade in endometrial cancer:Role of MRI and frozen section Dr. Manjunath K Protocol No.RLS/0314/021- A multicentre, randomized, open-label, single dose, two- treatment, three-period, three sequence, partial replicate, crossover, pivotal bioequivalence study of Test capecitabine 500 mg tablet manufactured by Reliance Life Sciences Pvt. Ltd., India with Xeloda® (capecitabine 500 mg) manufactured by Roche Pharma AG, Germany in adult, human, cancer patients under fed condition. Dr. Menon, Hari Analysis of outcomes from a retrospective analysis of T-Lymphoblastic lymphoma patients (Age >=15) from 2005 - 2012 Incidence of invasive fungal infection in patients undergoing chemotherapy for acute myeloid leukemia - impact of antifungal prophylaxis. A prospective, multicenter, observational study in India Outcomes of chronic myeloid leukemia in early chronic phase receiving Imatinib therapy - A retrospective analysis Dr. Menon, Santosh Prognostic index scoring as a tool for predicting risk of lymph nodal metastasis in penile squamous cell carcinoma Dr. Menon, Hari Protocol CINC424AIC01 Myeloproliferative neoplasms Epidemiological Registry in Growing and Emerging markets. The MERGE Study. Retrospective Analysis of patients with Acute Myeloid Leukemiawith t (8,21) cytogenetics-survival outcomes and predictive factors- A single centre study. Study of trough plasma imatinib levels and its correlation with early responses in Chronic Myeloid leukemia in chronic phase. Dr. Mishra, Gauravi A Pilot Study on Comparative Evaluation of Results of Pap Smears and HPV Hybrid Capture 2 performed on Cervical Samples before and after Application of Acetic Acid Comparative Evaluation of Efficacy of Different Methods of Tobacco Cessation Interventions among BEST Employees in Mumbai : A Randomized Controlled Trial Impact of smoke free cabs (as part of smoke free public places ) on cab drivers in Mumbai, India Dr. Muckaden, Mary Assessment of prevalence of dyspnoea in advanced cancer and its impact on quality of life: a prospective randomized study Role of Megestrol acetate versus Dexamethasone for improvement in appetite and fatigue in patients with cancer associated anorexia cachexia: A prospective single blinded randomized controlled trial Dr. Myatra, Sheila Can transiently increasing tidal volume to 8 ml/Kg PBW and measuring PPV improve the reliability of PPV in patients receiving low tidal volume ventilation? Prospective Study To Determine the Incidence And Risk Factors Associated With ICU Delirium In Indian Cancer Patients. Mrs. Nair, Reena A study to find out the problems faced by young adult survivors of childhood malignancies at a tertiary cancer centre. Dr. Nair, Deepa Prophylactic antibiotics in operable oral cancer: short course versus prolonged course - a randomized control trial

112 Tata Memorial Centre Annual Report 2014-2015 Principle Investigator Project Title

Dr. Noronha, Vanita Retrospective analysis of patients who have received docetaxel, platinum and 5- fluorouracil as induction chemotherapy for ca esophagus and gastroesophageal junction. Retrospective analysis of patients with small cell lung cancer with compromised performance status. Dr. Ostwal, Vikas PROTOCOL NUMBER: BEVZ92-A-01-13- Open label randomized bioequivalence study to evaluate the pharmacokinetic (PK) and safety profile of Bevacizumab Biosimilar (BEVZ92) in combination with FOLFOX or FOLFIRI versus Bevacizumab (AVASTIN®) in combination with FOLFOX or FOLFIRI as first-line treatment in patients with metastatic ColoRectal Cancer (mCRC) Dr. Pai, Prathamesh To determine chief patient concerns at outpatient clinics after diagnosis and treatment of their head and neck cancers using Patient Concern Inventory(PCI) questionnaire at Tata Memorial Hospital-Mumbai Dr. Parekh, Amrita Agreement between noninvasive blood pressure (NIBP) measured at the arm and ankle Dr. Parmar, Vani Observational study to compare accuracy of clinical examination under anaesthesia, Axillary ultrasound and Histo-pathological examination for axillary nodal staging in women with clinically N0 Carcinoma Breast. Retrospective audit to assess the impact of tumour biology on locoregional treatment in breast cancer Retrospective review of outcomes of breast cancer patients with oligometastases To assess the cosmetic outcome in patients undergoing breast conservation surgery (BCS) with or without deep approximation of the primary surgical cavity Dr. Patil, Prachi A hospital based registry to study the distribution, patterns of care and outcomes of rare tumors of the digestive tract Dr. Patil, Vijaya Changes in coagulation profile and epidural catheter safety for liver resection in malignancy. Eosinophilia in surgical patient & its impact on perioperative management Dr. Patil, Prachi Patterns of care for biliary tract cancers: a single center experience Prevalence and predictors of malnutrition and its impact on quality of life in patients with Gastric cancer - a single centre prospective study Prevalence and predictors of malnutrition in patients with esophageal cancer- a single centre prospective study. Dr. Patil, Asawari Prognostic significance of histological tumor regression in primary tumor and nodal metastases in patients with oral squamous cell carcinoma, treated by neo adjuvant chemotherapy followed by surgery: A retrospective study Dr. Patil, Vijaya Ultrasound Confirmation of Endotracheal tube placement with the saline filled cuff technique and comparison of depth of insertion with chest X-ray Dr. Patil, Prachi Yield of esophagogastroduodenoscopy and colonoscopy in cancer of unknown primary: a prospective single centre study Dr. Pimple, Sharmila Compliance, perceptions and attitudes of Bus employees and commuters towards smoke free bus policy (as part of smoke free public places) in Mumbai, India Dr. Prabhash, Kumar A randomized trial to compare skin toxicity of Gefitinib versus Erlotinib in patients with unresectable locally advanced or metastatic Non Small Cell Lung Cancer (NSCLC) who failed previous platinum based chemotherapy Comparative study of QOL of patients on Pemetrexed versus Erlotinib in Maintenance therapy for Advanced NSCLC (Other than Squamous Cell Carcinoma) Retrospective analysis of efficacy of Gefitinib in Non Small Cell Lung Cancer

Tata Memorial Centre / Research 113 Principle Investigator Project Title

Dr. Pramesh C.S. Effect of screening with low-dose CT scan and visual examination on lung and oral cancer mortality - a pilot survey prior to initiating a randomized trial Hand sewn versus stapled esophago gastric anastomosis - Does the type of anastomosis influence quality of life in long term survivors? Validation of the clavien dindo classification in esophageal surgery Dr. Purandare, Nilendu A pilot project to evaluate PET-CT as predictive factor for response and resection of tumor in oral cavity cancer Prediction of tumor response to neo-adjuvant therapy in adenocarcinomas of the gastroeosphageal junction (AEG) using FDG PET/CT. Dr. Puri, Ajay Retrospective audit - Treatment Of Non Metastatic Primary Sacral Tumors Vascular Resections in Extremity Sarcomas : Retrospective audit of survival and surgical morbidity Dr. Rajadhyaksha, Sunil A study of hemolysis in red cell concentrates during transportation Dr. Rangarajan, Venkatesh Evaluation of radioimmunoconjugate (131I and Rituximab) SPECT imaging for staging of CD-20 positive Non-Hodgkin Lymphomas Standardizing interpretation criteria for early Response evaluation with 18f-FDG PET/ CT in pediatric lymphoma Dr. Rekhi, Bharat Clinicopathological Spectrum of Pseudosarcomatous Lesions of Soft Tissues Differential expression of specific skeletal muscle markers in rhabdomyosarcomas Dr. Saklani, Avanish A Comparison between Laparoscopic and Open Surgery for Colorectal Cancer Peritoneal cytology in operable colorectal cancers - a prospective study Dr. Sareen, Raman Audit of Postoperative pain management practices in Children in a tertiary cancer hospital: A prospective observational study. Dr. Sengar, Manju The molecular landscape of diffuse large B-cell lymphomas on the Indian sub-continent Therapeutic Drug Monitoring Of Posaconazole In Adult Patients Receiving Posaconzole Prophylaxis During AML Induction: A Feasibility Study. Dr. Shah, Sneha Interim treatment response assessment in lymphoma by using different criteria on FDG PET CT Dr. Sharma, Kailash A prospective randomized controlled study to compare between clinical assessment methods and lung ultrasonography to confirm position of double lumen tube in elective thoracic surgeries involving one lung ventilation, at Tata Memorial Hospital Evaluation of Success Rate of Cobra PLA and LMA Supreme in Novices, our experience from a teaching hospital. Dr. Shet, Tanuja Histopathologic grading system in Phyllodes Tumors (PTs) - In search of a prognostically relevant system Dr. Shetty, Omshree Association of ANXA1 expression in HPV positive Penile Carcinoma Granulomas in draining nodes in Breast Cancer: Tuberculosis or resolved metastasis? Study of circulating microRNA (miRNA) as a Potential Biomarker in Breast Cancer Dr. Shrikhande, Shailesh A retrospective analysis of clinical characteristics, treatment and outcome of patients with locally advanced or metastatic gall treated at Tata Memorial Centre, Mumbai from January 2012 to Oct 2013 Perihilar and intrahepatic cholangiocarcinoma : challenges and future perspectives Dr. Shrivastava, Shyam Kishore Radiation Incidents And Contributing Factors In External Beam Radiotherapy-Audit In Department Of Radiation Oncology

114 Tata Memorial Centre Annual Report 2014-2015 Principle Investigator Project Title

Dr. Shylasree, TS Surgery in young women (=/ <40 years) in gynaecological oncology, retrospective analysis of clinical practice at a tertiary referral centre Dr. Singh, Vincent Exercise for the management of cancer-related fatigue in advanced lung cancer planned for systemic palliative therapy: randomized controlled trial. Dr. Solanki, Sohan Comparison of actual and ideal body weight on appropriateness of ProSeal laryngeal mask airway in Indian overweight patients - a randomized open label study. Ultrasonographic assessment of cross-sectional area of internal jugular vein and relationship of internal jugular vein and carotid artery Ms. Sunder, Irene An audit of practice followed by nurses while handling peripherally inserted central catheter (PICC) at Tertiary Cancer Care Centre. Dr. Tendulkar, Anita High hemoglobin in blood donores:Validating portable hemoglobinometer Dr. Thakur, Meenakshi Retrospective audit and radiopathological correlation of breast lesions excised by hook wire localisation method Role of MDCT in pre operative staging of the urinary bladder cancers Role of MRI in Evaluation of Malignant Lesions of the Breast Dr. Thota, Raghu A survey on approach to anticipated difficult airway management among anaesthesiologists with a focused interest in Airway management . Postoperative residual curarization and critical respiratory events in post anaesthesia care unit: an observational study Ms. Vagal, Manjusha Vaginal stenosis following treatment of cervical cancers and the effectiveness of rehabilitation interventions: A retrospective study Dr. Wadasadawala, Tabassum Pattern of Loco-Regional Recurrences in breast cancer, its retreatment and clinical outcomes

Tata Memorial Centre / Research 115

Dr. Kailash Sharma, Director (Academics) Academics

Tata Memorial Centre is affiliated to Academic Activities Observership programme at Homi Bhabha National Institute (HBNI) The Hospital offers education through Tata Memorial Centre Mumbai, a Deemed University, for PG various activities like PG courses, and • Approximately 470 specialist training in oncology and other broad training through short term observer including dental surgeons have specialty. The institution is a “Grant in ship and other training programs. About visited Tata Memorial Centre as Aid Institution” affiliated to Homi 110 post graduate medical students Observer from all over India in the Bhabha National Institute under the were registered in 2014 for PG courses year 2014. Department of Atomic Energy. in various disciplines. Two major post • In the year 2014, 17 overseas The academic division of the centre graduate courses viz. “M.Sc. - Clinical specialists as observer and over looks and facilitates all educational Research and diploma in Fusion approximately 35-40 Oncology activities under Tata Memorial Hospital Technology”, was approved by HBNI and trainees have visited TMC for 06 (TMH), the Advanced Centre for initiated during the year. Month training. Treatment, Research and Education in • Various specialist and dental Cancer (ACTREC), and Centre for Cancer Six months training programme surgeons from all over the country Epidemiology (CCE). at Tata Memorial Centre visits under observership program Tata Memorial Centre is a recognized The training programs are in the form every year around 350 – 400 training centre in cancer education and of short term courses and research by several national and observerships. The primary aim of such Collaborative Exchange International organizations, including short term training programs is to train Programme various specialists on sponsorship basis WHO, IAEA and INCTR. The TMC – The centre is engaged in collaborative in oncology and other supportive Academics continued to build capacities educational exchange programme with branches. by imparting knowledge through Seth G.S. Medical College & KEM various educational activities and Hospital, Children Wadia Hospital and research. Lokmanya Tilak Municipal General Hospital. Under this program students from these institutes are posted for practice and wider experience and knowledge.

118 Tata Memorial Centre Annual Report 2014-2015 Superspeciality Courses

Sr.No Name of the Postgraduate Course Approved by Affiliated To Duration in No. of intake Years capacity Year 2014 1 M.Ch.(Surgical Oncology) 3 16 2 M.Ch.(Gynecological Oncology) 3 02 3 M.Ch (Plastic Surgery) 3 02 4 M.Ch. (Head & Neck Oncology) 3 04 5 D.M.(Medical Oncology) 3 14 6 D.M. (Critical Care) 3 02 Homi 7 D.M. (Paediatric Oncology 3 02 Bhabha Medical 8 D.M. (Gastroenterology)National 3 02 Council of Institute 9 MD (Pathology )India, New 3 12 (Deemed 10 MD (Anesthesiology)Delhi 3 20 University) Approved 11 MD (Radio-diagnosis)(HBNI) 3 10 12 MD (Radiotherapy) 3 16 13 MD (Microbiology) 3 01 14 MD (Immuno Hematology & Blood Transfusion) 3 03 15 MD (Nuclear Medicine) 3 02 16 MD (Palliative Medicine) 3 02 17 P.hD (Medical Physics) 3 — (04 Internal TMC Employee & 05 External BARC Employee) HBNI 18 P.hD (Epidemiology) 3 06 (Out of Total 06, 01 Sponsored Candidate) 19 DNB (Nuclear Medicine) NBE 3 02 20 02 Yrs Certified Fellowship HBNI National Board 2 11 of Examination 21 M.Sc Nursing (Oncology) MAHARSHTRA MAHARSHTRA 206 NURSING COUNCIL NURSING COUNCIL & INDIAN NURSING & INDIAN NURSING COUNCIL COUNCIL 22 Advance Diploma in 2 07 DTE & Maharashtra State Radiotherapy Technology MSBTE, Board of Technical 23 Advance Diploma in Medical Imaging TechnologyMumbai Education (MSBTE) 2 15 Total 155

Tata Memorial Centre / Education 119 Training Programme From January 2014 To December, 2014

SR. NO. NAME OF THE TRAINING PROGRAMME DEPARTMENT No. of Trainees 1 Certificate course in Hospital Infection control Nursing Department 16 2 Certificate course in Preventive Oncology Preventive Oncology 12 3 Six months Advanced Hematology Training Course for Technologists 4 4 Six Months Molecular Haematology Training Course for TechnologistsHaematology 4 5 Six months training course in Flow Cytometry 4 6 Advanced Clinical Biochemistry Technologist Training Course Biochemistry 4 7 Advanced Cancer Cytogenetic Training Course Cancer cytogenetics 4 8 Advanced MRI Imaging Training Course for Technologists Radiodiagnosis 2 9 Train the Trainers Program in Palliative Care Palliative Medicine 11 10 PB Desai / UICC Fellowship Onco - Pathology, 2 Surgical Oncology, Radiation Oncology 11 Certified Training in Oncology for Doctors — 24 12 Oncology Speech Rehabilitation for Graduate Speech Therapists Head & Neck Oncology 1 13 Post Basic Diploma in Oncology Nursing Nursing Department 11 14 Certificate Course for Medical Secretary M.S. Office 2 15 Library Trainees Library Sciences, TMH 1 16 Certificate course in Intensive Care Nursing Nursing Department 20 17 Certificate Course in Enterostomal Therapy Nursing Department 7 18 Certificate course for CVAD Nursing Department 14 19 Apprenticeship Trg. Programme for PET/CT Nuclear Medicine 4 20 Apprenticeship Training ( BOAT) Pathology, Cytology 7 21 Oncology Training (Defence Doctor) Anaesthesiology 3 Total 157

120 Tata Memorial Centre Annual Report 2014-2015 Conferences/Workshop/Seminars in the year 2014

Name of Conference Date Department January IHPBA Conference 9th Surgical Oncology Training Programme for super & labour staff 20th to 22th General Administration Nurses Annual Day 24th Nursing ONCORECON Workshop 20th to 24th Surgical Oncology CME On challenges in Radiation Protection In Radiology 25th Radio-Diagnosis February Cytopathology Conference 1st & 2nd Cytopathology 1st Intern. Children’s Pall. Care Network (ICPCN) Conference 9th to 12th Palliative Care Workshop & Symposium On “ Complex Neurosurgery” & 20th to 22nd Neurosurgery Live Surgical Workshop Evidence based management conference 2014 27th & 28th CRS March EBM 2014 1st & 2nd CRS Echocardiography Workshop 8th & 9th Anaes., Critical Care & Pain Training Programme for super & labour staff 10th to 12th General Administration ONCORECON Workshop 10th to 14th Surgical Oncology Children Palliative Care Training 12th to 14th Palliative Care Paediatric Oncology Workshop 15th Medical Oncology Comprehensive Rehabilitation in Bone & Soft Tissue Tumors 22nd Physiotherapy TEP Conference 22nd & 23rd Head & Neck Oncology April Workshop (ONAI) 4th & 5th Infecttion Control Office Teaching Pathologist Conference 12th Pathology Anaesthesia Review Course 2014 18th to 20th Anaes., Critical Care & Pain Oncorecon Workshop 21st to 25th Surgical Oncology Molecular Epidemiology Workshop 21st to 25th Centre for cancer Epidemilogy MAY Cloud Based Collaboration For Radiotherapy Clinical Trials 6th to 8th Radiation Oncology & Training 4th Basic Haematology Course 30th & 31st Pathology

Tata Memorial Centre / Education 121 Name of Conference Date Department June Ugam, Childhood cancer survivor support group- 1st Medical Oncology Annual Function CVAD Workshop 2nd Nursing CET & VIVa for ADMIT Course 25th Academic Office Rehabilitation in Breast Cancer 28th Physiotherapy July 4th Postgraduate training programme in oncology for 17th to 20th Occupational Therapy occupational therapist August Comprehensive Critical Care 2nd & 3rd Anaes., Critical Care & Pain September OTP Course & Ortho Onco Meet 6th & 7th Surgical Oncology CRM Workshop 2014 13th & 14th CRS International Pediatric Oncology Nutrition Workshop 27th & 28th Medical Oncology October CPR Workshop 10th Anaes., Critical Care & Pain World Hospice & Palliative Care Day 11th Palliative Medicine THEMATIC 2014 18th & 19th Anaes., Critical Care & Pain CME in Surgical Pathology 31st Pathology November CME in Surgical Pathology 1st Pathology Workshop Nursing Education 5th Nursing AAHRPP Workshop 7th & 9th IRB 15th National Conference ONAI 13th to 15th Nursing 1st CME & Workshop in clinical Biochemistry 16th Biochemistry ONCOSURG 2014 21st to 23rd Head & Neck Oncology TMC National Conference 21st To 25th Anaes., Critical Care & Pain TMC National Conference on the Difficult Airway 28th to 30th Anaes., Critical Care & Pain December CME Programme a(All India Level) 6th & 7th Radio-Dignosis 3rd National Conference on Tabacco or Health 13th & 16th Preventive Oncology 11th Annual Workshop on “Cancer Rehabilitation” 19th & 20th Physiotherophy 4th CME for medical Lab Technologiest 20th & 21st Haematopathology 8th CME on Histotechnology 26th & 27th Pathology

122 Tata Memorial Centre Annual Report 2014-2015 Staff Achievements

Dr Vandana Agrawal Member Secretary to National Body - Indian Society of Critical Care Medicine since Feb 2014, re-elected for 2nd term (Feb 2015-2016). Dr Reshma Ambulkar Appointed Treasurer, Mumbai branch of Indian Society of Critical Care Medicine for the period 2013 - 2014 Dr. R.A. Badwe Honored with ‘Praman Patra’ for his services in the field of medicine from Government of Punjab. Dr Ganesh Balasubramaniam Nominated, Expert Committee member of Board for Research in Nuclear Science(BRNS), DAE for various health Survey Projects. Dr Shilpushp Bhosale Selected for one-year paediatric critical care fellowship at Sick Kids Hospital, Toronto Dr. Pankaj Chatuvedi Awarded, BMJ award for health Awarded, Oral Cancer Foundation award for contribution in the field of oral cancer. Awarded, Sushrut Award 2015, National Oral health program by Dr. A.P.J Abdul Kalam. Dr. Gauraiya Chinchalker Bruce Davis Gold Medal in Palliative Care. Dr. S Chopra Awarded, Best Paper Award in Young Radiation Oncologists Conference , YROC, AROI Ms. Pooja Dalvi Awarded, 1st Prize in oral paper presentation on Annual The Cytometry Society Meeting and 15th Indo-US Clinical Cytometry workshop 2014 at AIIMS , New Delhi. Dr. Anuradha. A. Daptardar Awarded, Significant Achievement Award, by the Indian Association of Physiotherapists for contribution in the field of Oncology Physiotherapy. Dr. J Deodhar Office bearer, Indian Psychiatric Society- West Zonal Branch (2012 – 2014) Dr. Anuja Deshmukh Awarded, Best Poster prize with Gold Medal, “Retrospective study of Major glossectomy in tertiary cancer centre”, organized by 14th National Conference of FHNO. Dr. D.D. Deshpande Invited expert (Chairman), Committee of Department of Scientific and Industrial Research (DSIR), Govt. of India, Delhi for review of project of developing indigenous Simulator Mr. Nilesh Deshpande Awarded, 2nd Prize for poster ( Flow cytometric assessment of T-cell clonality using T- Cell receptor Vâ analysis is a sensitive & rapid method for the diagnosis of T-CLPDs) on 15th Indo US Flow Cytometry Workshop in Lucknow. Dr J V Divatia Dr. E. Tambe oration: “Anaesthesia and Patient Outcomes” Annual Meeting of ISA Nagpur, Nagpur, January 25, 2014 International Guest Editor, Intensive Care Medicine (Journal of the European society of Intensive Care Medicine) MahaCriticon 2014 oration: “Errors in the ICU” Maharashtra State ISCCM Conference, Aurangabad, September 19-21, 2014. Member, ICMR Expert Group on Antimicrobial Resistance Oration : “End of Life Care in Indian ICUs” Criticare CME at , ISCCM Cochin: May 17-18, 2014 President, All-India Difficult Airway Association Dr Jeson Doctor Awarded, 2nd prize in the “Young Talent Search” Competition organized by ISCCM Mumbai Branch for Criticon Mumbai 2014. Presentation on “5 most important points to improve intensive care in India” Member, National Executive Committee and Treasurer of All India Difficult Airway Association (AIDiAA) since June 2014.

Tata Memorial Centre / Education 123 Dr. R. P. Gehdoo Awarded ‘Fellow’ Indian College of Anesthesiologists (FICA), 28-29th June 2014. Mr. Sampat Godage Awarded, 1st Prize for poster [ P6/D1-PANDA-pattern on ADVIA2120i is highly Sensitive and very specific tool in the identification of Acute Promyelocytic Leukemia (APML) ] on 4th CME for Medical Lab. Technologists 2014 at Tata Memorial Hospital, Mumbai. Dr. S. Gujral Member, ICMR task force for guidelines on immunophenotyping Dr. Ashish Gulia Awarded, S.S. Yadav Gold Medal for best scientific presentation at 59th annual national orthopedic conference of Indian Orthopedic Association at IOACON 2014 (Hyderabad, India). Ms. H. Jain Awarded, 1st Poster award, “Chromosome 5, 7 and 8 aberrations study in newly diagnosed adult and pediatric AML: A single institution study.”37th Ann Conference of Mumbai Hematology Group MHG Group ,22nd-23rd March, 2014 Poster Presentation.” Dr. Puneet Jain Awarded, 2nd Prize for case presentation titled “A case of multiple alloantibodies in a patient of primitive neuro-ectodermal tumour (PNET)” during the CME organized at PD Hinduja Hospital, Mumbai on 22nd August 2014. Awarded, 3rd prize for oral presentation titled “antibody titres in group O donors by microplate method” during 3rd Annual conference of ISTM (TRANSMEDCON 2014), Ahmedabad, 14-16th November 2014. Dr. P. N. Jain Bamacharan Hemlata Dhar oration : National conference of geriatric society of India, GSICON , Nagpur, on 8th Nov 2014 Member, Executive body in International Association for the Study of Pain (IASP) in developing countries chapter (2014-16) at Buenos Aires, 6th October, 2014 Dr. R. Jalali Gen Secretary, Indian Society of Neuro Oncology and Convener, Mumbai Award for Excellence in Pediatric Clinical Research in SNO for Neuro-Oncology (SNO) Awarded, SNO Excellence in Pediatric Clinical Research in Neuro-Oncology Ms. Swapna Joshi President, TNAI Maharashtra State Branch Chairperson, Paediatric Nursing, TNAI(National Level) Dr. P. S. Kadam Amare Awarded, 2nd Poster award, “CLL with IgH translocation is a distinct subclass, further subtyped into IgH-BCL2 and IgH-BCL3 with unique clinicopathologic and genetic features” 37th Ann Conference of Mumbai Hematology Group MHG Group ,22nd-23rd March, 2014 Dr. S.S. Kulkarni Secretary, Indian Society of Vascular and Interventional Radiology (ISVIR) Dr. S.S. Kulkarni Founding Member of Indian Society of Interventional Oncology Dr. A. P. Kulkarni President Elect, National Executive body of Indian Society of Critical Care Medicine (2014-2016) Dr. S. Laskar Elected President of the Forum for Young Radiation Oncologists of India, AROI, India Dr. S. Laskar Elected Vice President (Junior) of the Association of Radiation Oncologists of India (AROI), AROI, India Ms. Carmine Lazarado President AORN Dr. Abhishek Mahajan Awarded, Distinction in the MRes Program at King’s college London. Dr. U Mahantshetty Associate Editor, IJROBP. Dr. Santosh Menon Awarded, Best Poster Award ‘Spermatocytic Seminoma: Clinico-pathologic case series from a tertiary oncology cancer institute in India”, London Uropathology 2014 conference. Mr. Trilokinath Mishra President, Society of Indian Radiographers (Regd)-(A National Association of Radiographers) Mr. Trilokinath Mishra Special Executive Officer (SEO) – Govt. of Maharashtra. Dr. Mary Ann Muckaden Chair, International Children’s Palliative Care Network, Lead in Indo-American Cancer Association for Palliative Care Training and Lead for the End of Life Care Consortium (joint association of Indian Association of Palliative Care and Indian Journal of Palliative Care)

124 Tata Memorial Centre Annual Report 2014-2015 Dr. Sheila Myatra Awarded, Fellowship of the American College of Critical Care Medicine (FCCM) 2014 to be awarded at ACCM Convocation in January 2015 Member Organizing committee, World Airway Management Meeting, Dublin 2015 Dr. Swapnil Parab Awarded, 1st Prize for Video Presentation at National Airway Conference (NAC-2014) at Mumbai. Awarded, 2nd prize for Free Paper Presentation at National Conference (ISACON 2014), Madurai, India. Dr. Vijaya Patil KN Shah oration : GISACON, Annual Anaesthesia meeting by Gujarat ISA, 12th October 2014 Dr. Ajay Puri President-Elect, Asia Pacific Musculoskeletal Oncology Society. Dr. S.B. Rajadhyaksha Oration: King George Medical University, Lucknow. Dr. V. Rangarajan Principle lead country coordinator, IAEA-RCA project on hybrid imaging in Oncology. Dr. Bharat Rekhi Member, subcommittee for development of management guidelines for Epithelial Ovarian Cancer, Indian Council of Medical Research Elected Member, Executive Committee of the Indian Academy of Cytology for 2015-17 Mrs. Sulochana Retnamony President ONAI Dr. R. Sarin Chairperson, ICMR Expert group meeting for Stem Cell Research & Therapy, New Delhi, ICMR, New Delhi ICMR Task Force for National Guidelines for Evidence Based Management Guidelines - Breast Cancer, ICMR Scientific Advisory Committee, ICPO, ICMR New Delhi Dr. Aekta Shah Awarded, Second prize, “Retrospective audit of the results of ALK gene rearrangement by FISH in lung adenocarcinoma and correlation with histopathology subtypes”, XXXth ICON meeting, Ahemedabad, April 2014. Dr. S. S. Shastri Chair Committee, Development of Resource Stratified Screening Guidelines for Cervical Cancer. Expert, Committee on Regional Control of Non-Communicable Diseases.WHO-SEARO Expert, Development of Breast Cancer Screening Guidelines Handbook, IARC. Expert, Guidelines Committee for WHO Position paper on Mammography, Geneva. Humanitarian Award, American Society of Clinical Oncology (ASCO) on June 1, 2014 at the 50th Annual Conference of ASCO in Chicago, Illinois, USA. Oration: Hugh Barber Oration, Annual meeting of the American Society of Gynecologic Oncology, March 2014. Dr. S. V. Shrikhande Honorary fellowship, Royal College of Surgeons of - FRCS (Ad Eundem). Dr. S. K. Shrivastava Awarded, SCRAC Award, Nanavati Hospital, Mumbai Oration: AMPI Oration, Association of Medical Physicist’s of India Oration: Clinical Perspective & Safety during Advanced Radiation Therapy Treatment, at AMPICON, Association of Medical Physicist’s of India Oration: Dr GN Agarwal Oration, 28thFoundation day celebration KGM University, Lucknow Oration:Dr TB Patel Oration Gujarat Cancer & Research Institute, Ahmedabad Dr. Sohanlal Solanki Editor, Global Journal of Anesthesiology, Italy Dr. P. G. Subramanian Coordinator, Multicentric Minimal residual disease based risk stratification therapy trial for pediatric ALL under ICICLE group Dr. T. Wadasadawalla Gold Medal, Best paper presentation, Kochi .

Tata Memorial Centre / Education 125

Cancer Epidemiology

Dr. Rajesh Dikshit Dr. Atul Budukh

Service Research Education The objective of Centre for Cancer Some of the ongoing research focused The education and training programme Epidemiology (CCE) established in 2009 on identifying causes of gall bladder consists of short term and long term under the TMC is to conduct cancer cancer, lung cancer in non smokers and training and doctoral degree epidemiological research and build brain tumours due to mobile phone programmes in epidemiology. The capacity through education. The new usage. The project to develop low cost educational programmes are affiliated building for the centre is housed at and feasible technology to detect HPV to faculty of Health Sciences, HBNI. A ACTREC campus will be operational by from menstrual pad is also ongoing. The doctoral research on risk factors for end of 2015. cohort study at Barshi continued. breast cancer in rural and urban India by a student was completed during the The centre aims at studying cancer year. Several training programmes and burden, identifying the role of genetics workshops were organized, namely, and lifestyle related cancer causing Cancer Registration in collaboration factors, and building capacity through with IARC, Molecular Epidemiology education and training in the field of workshop in collaboration with US-NCI cancer epidemiology and public health. and a training programme on improve The activities focus around two main quality of cause of death certification aspects namely, descriptive and coding was also organised in epidemiology and analytical collaboration with to US-CDC. epidemiology and, it also extended its expertise for education and training. As a part of IARC Regional Hub, a new cancer registry was established in Bhutan and the cross sectional survey for CHSS beneficiaries at NPICL sites was completed. A migration tool for easy data porting of cancer registry called Cancer Registry software (CANREG-5) was developed.

128 Tata Memorial Centre Annual Report 2014-2015 Dr Surendra S. Shastri, Preventive Oncology Head

Dr Sharmila A. Pimple Dr Gauravi A. Mishra

Service Education Research The objective of the department of The department conducted 6 certified The department continued the follow- Preventive Oncology is to conduct training courses for medical and up observations in 2 large randomized hospital and community based clinics paramedical personnel. The controlled trials in Mumbai and one in for the prevention, screening and early department also trained Medical Barshi. Five case control/ cross- detection of common cancers. Officers and Paramedical staff of the sectional observational studies, one 5,441 new patients and 4,626 follow up Directorate of Health Services, biomarker development/ validation rd cases were registered in the Preventive Government of Maharashtra. The 3 study and one health economics study Oncology clinic at TMH in 2014 and National Conference on Tobacco or are also being conducted in the registered 1703 new patients at the quit Health was organised in the month of department. tobacco clinic. The department is December . Over 50 public lectures, Nine papers were published in recognized as a WHO Collaborating exhibitions and awareness programmes international peer-reviewed journals Centre for Cancer Prevention, Screening were arranged by the department in including in Nature, Lancet Oncology and Early Detection. Mumbai, Navi Mumbai, Sangrur and and JNCI. Four books chapters were Mullanpur. During the same period over 1,50,000 authored by departmental staff in 2014. patients continued to be followed up in the TMC Urban Outreach Programme and 1,10,000 were registered under the TMHMOP programme which covers affected population near BARC.

Tata Memorial Centre / Centre of Cancer Epidemiology 129 Dr B Ganesh, Medical Records, Biostatistics and Head Epidemiology

The department is responsible for Cancer Trend in TMH issuance patient case files and scanning of previous case files to maintain medical records of the institution in electronic format. The department is also the custodian of the Clinical Information System (CIS) and it involved in its design and implementation at various Disease Management Group clinics. The Hospital Based Cancer Registry is one of the major activities of the Department and collects demographic and clinical data of the patients registered in TMH. In the year 2014, the department abstracted data from approx. 35,000 case file records, of which about 21,500 were cancer cases. The department continued the survival study for Cancer Breast, Cancer Cervix and Head and Neck Cancers cases under the “Patterns of Care & Survival Studies (POCSS) Project. The Project has collected data from 6,074 Breast cancer, 2,640 Cervix cancer and 8,600 Head and Neck cancer cases. The department also supports research activity by designing, analysis and interpretation of Clinical Data. It has set up a new Population Based Cancer Registry (PBCR). The Department runs PBCR registries in Ratnagiri, Sindhudurgh, Tarapur, Karwar, Rawatbhata, Kakrapar, Kalpakkam, Kudankullam and . Health Checkup activities for the population in Kaiga, Rawatbhata and Kota have also been initiated. Regular data entry training programmes Education are organized for medical The department is actively involved in control. It also trains cancer registry transcriptionists and the data captured teaching Nurses, Ph. D. and Research personnel in other cancer centres run is routinely monitored. To enable easy Students in epidemiology and infection by Department of Atomic Energy. and real time data capturing to registry data base, a tablet based PBCR system is under development.

130 Tata Memorial Centre Annual Report 2014-2015

Message from the Director, ACTREC

ACTREC (Advanced Centre for Treatment, Research & Education in Cancer), TMC has evolved to become a comprehensive cancer Centre dedicated to patient care and has provided leadership in areas of cancer research and clinical care. The Centre has embarked on developing new areas in basic and clinical research that will be a step towards personalized and integrative medicine. The Centre continued to receive the NABL accreditation for its diagnostic services. In May 2014, a 22 bed ward for Pediatric surgery and interventional radiology was commissioned. Over 400 new direct registrations and 4854 patients were referred to ACTREC. State-of-art intraoperative image guided neurosurgery and navigable 3D fluorescence ultrasound based surgery guided resections of malignant gliomas have led to improved treatment outcomes. Bone marrow transplant unit performed over 70 allogenic/autologous/unrelated donor bone marrow transplants and cord transplants during 2014. Eleven haploidentical transplant procedures were also performed with good success rate. The Clinical Pharmacology Lab has developed pharmacokinetics guided optimization of cancer drugs. Biodistribution studies are being conducted for radioimmunotherapies developed in collaboration with BARC. The research programs at Cancer Research Institute integrate both basic and clinical approaches to address questions related to cancer biology, cancer prevention and development of newer therapeutic modalities. The innovative partnership between ACTREC scientists and clinicians at ACTREC and TMH facilitated through several intramural and extramural supported projects has helped in exploring newer avenues in cancer research. Department of Biotechnology, Govt of India, has recognized ACTREC as a nodal Centre for training scientists from North Eastern Region in Bioinformatics and Biotechnology areas. These training programs will be conducted in various disciplines for students and teachers involving the expertise available at ACTREC. The Academic Program at ACTREC continues to attract young talent from all over the country. This year thirteen students received Ph.D. (Life Science) degree under Homi Bhabha National Institute. The Centre has become a hub for several workshops and training programs. ACTREC staff has enthusiastically conducted several Cancer Awareness programs and cultural events with active participation from patients and their family members. In the years to come ACTREC will develop innovative research programs that will help understand the complexities of cancer and offer state-of-art personalized care to our patients.

Shubhada Chiplunkar

132 Tata Memorial Centre Annual Report 2014-2015 Overview of ACTREC

The Advanced Centre for Treatment, extramurally funded projects to the for Tata Memorial Centre’s Diagnostic Research and Education in Cancer tune of Rs. 3.18 crore for a three year Services - Clinical Biochemistry, Clinical (ACTREC), located in Kharghar, Navi period were sanctioned by the above Pathology, Haematology & Mumbai, is a constituent unit of the mentioned funding agencies, of which Immunohaematology, Microbiology & Tata Memorial Centre. ACTREC Rs.1.55 crore was received during the Serology, Histopathology, comprises of the Clinical Research calendar year 2014. A total of 97 Cytopathology and Genetics in Centre mandated to perform clinical indexed publications accrued from accordance to ISO 15189:2007. A new research, conduct clinical trials and research conducted by faculty of the 22-bed ward for Pediatric, Surgery, Solid develop indigenous technology, a 108 Centre, during 2014. Of these, 63 Tumor and Interventional Radiology bed Research Hospital where cancer articles were on basic/ applied research patients was commissioned in May patients enrolled on various protocols while 34 covered clinical/ translational 2014. The current bed strength at the receive radiotherapy, surgery, research and medical technology. ACTREC Hospital is 82 admission beds, chemotherapy or bone marrow During 2014, 27 regular staff members 10 beds for ICU and recovery, 13 beds transplantation, and the Cancer were appointed at the Centre in the for day care, and three beds for MRI Research Institute which focuses on medical, scientific, nursing, technical recovery. During 2014, 4854 new basic and applied research on cancer. and auxiliary cadres, while five patients were referred to ACTREC and Under its education program, the employees superannuated and one 441 new direct registrations took place Centre inducts research scholars into its employee took voluntary retirement. here. In all, there were 4293 Ph.D. program, provides short term/ During the year, several developments admissions, 2317 major operations, 666 summer training, and conducts took place at the Clinical Research new radiotherapy referrals and 75 bone workshops, symposia, conferences and Centre (CRC) and the Hospital of the marrow transplants at ACTREC (see seminars on varied aspects of biology Centre. Continuation of NABL figure). and cancer. accreditation was granted in June 2014 The Centre’s basic, applied and clinical research projects drive towards the translational platform for cancer patients. The Centre’s clinicians and scientists engage in collaborative projects within ACTREC, with the Tata Memorial Hospital (TMH) as well as with national/ international partners from Academia and Industry. The Centre’s research projects receive institutional, intramural or extramural funding. During the year 2014, 182 projects were on-going at the Centre. A sum of Rs. 8.30 crore was received from governmental agencies (DBT, DST, ICMR, LTMT, etc) to meet the expenditure on 43 of these on-going projects. In addition, 10 new

Tata Memorial Centre / ACTREC 133 Continuation of NABL accreditation was & epigenetics, immunology & on over 300 subjects revealed that the granted in June 2014 for medical testing chemoprevention. Interactions technology could be used for oral facility of Tata Memorial Centre’s between proteins involved in cell cycle cancer diagnosis. The technology also Diagnostic Services in the disciplines - checkpoint control are under study in a helped classify normal and malignant Clinical Biochemistry, Clinical Pathology, bid to identify novel therapeutic cervical cancers. Exfoliated cells and Haematology & Immunohaematology, strategies for cancer treatment. One of body fluids were explored successfully Microbiology & Serology, the studies examines the desmosome for oral and cervical cancer diagnosis. Histopathology, Cytopathology and plaque protein - plakophilin3, and how Genetic studies focussed on two major Genetics in accordance to ISO its expression or loss modulates aspects of oral cancer biology - genomic 15189:2007. transformation and metastasis. The role alterations at the level of copy number The department of Surgical Oncology of the proteins 14-3-3σ and 14-3-3γ in across the genome, and identification performed over 2300 major procedures regulating cell cycle progression and of genes/ gene clusters underlying in its four operation theatres during the neoplastic progression is also being altered genomic loci. Array comparative calendar year, and conducted studied. Identification of the functions genomic hybridization analyses of outpatient clinics for newly registered of keratins, vimentin and their advanced stage oral cancers revealed and follow-up cases. State-of-the-art associated proteins in epithelial chromosomal gain of region 11q22.1- intraoperative image-guided homeostasis/ cancer and their use as q22.2 associated with nodal metastasis, neurosurgery techniques, specifically biomarkers in oral cancer is being loco-regional recurrence and shorter navigable 3D ultrasound based surgery attempted. Loss of K5/ gain of K1 and survival. Putative driver genes and fluorescence guided-resections of K8/18 correlated significantly with the associated with oral carcinogenesis malignant glioma have led to improved degree of dysplasia, fibrosis, and have been identified. The significance patient outcomes. Minimally invasive recurrence. Findings indicate a tissue of epigenetics is under investigation in laparoscopic GI surgery commenced at specific role of K8/K18 in malignant gastric cancer and hepatocarcinoma. the Centre from mid 2014. The Bone transformation/ progression of The genome-wide alteration in histone Marrow Transplant Division of Hemato- carcinomas. 3D co-cultures of oral acetylation pattern signifies the Lymphoid Unit (Adult) performed over tumour epithelial cells and fibroblasts importance of using HDAC inhibitor in 75 allogeneic/ autologous/ unrelated are being set up to study epithelial- conjunction with standard donor bone marrow transplants and mesenchymal interactions during oral chemotherapy. Reversible reduction of cord transplants during 2014. Eleven carcinogenesis. H3Ser10 phosphorylation only in G1 haplo-identical transplant procedures Novel functions of two key proteasomal phase cells in response to ionizing were also performed during the year; assembly chaperones PSMD9 and radiation-induced DNA damage raises ~65% of these are alive without disease. PSMD10 were discovered by predicting the possibility of using specific This year almost 1000 in-patients were and identifying their interacting inhibitors to achieve efficient cell death admitted in the 17-bed Leukemia/ partners, and validating the relevance during radiotherapy. Lymphoma Ward and around 50 of these interactions for functions in Immunological studies focussed on outpatients/ day were seen in the adult normal physiology and cancer. A novel understanding the immune scenario hematolymphoid OPD. The department ATPase activity in 14-3-3 protein was and reasons for immune dysfunction in of Transfusion Medicine conducted identified. The structure, function and cancer patients, and on the outdoor blood collection camps and specificity of pro-apoptotic proteins and development of cell based indoor voluntary blood donations to their role in cancer are being studied. A immunotherapy for cancer treatment. collect, process and issue blood/ blood unique N-terminal mediated dual Several studies examined the molecular components to patients requiring allosteric regulatory activation network mechanisms and potential modulation transfusion support. Research findings of the protease HtrA2 was elucidated, of the cytotoxic action of γδ T cells in from the Translational Research Lab its activator and binding partner were breast, oral and gall bladder cancer and clearly indicated that chromatin identified and characterized, and 2.0Å in leukemia. A simple and non-invasive fragments from dead cells induce resolution crystals of a pathological real time PCR-based method was epigenetic changes, stemness and mutant were obtained. The mechanism developed to detect Epstein Barr virus cancer in living cells. of human papillomavirus E2 mediated DNA in plasma/ urine of The Cancer Research Institute is activation of the extrinsic apoptotic nasopharyngeal carcinoma patients. engaged in research on normal, stem pathway was also established. Raman Under the Science Initiative Program in cell, cancer cell & molecular biology, spectroscopy is being investigated as a Ayurveda, the mode of action of structural biology, cell signalling & cancer screening tool with emphasis on bhasmas is being examined. In the macromolecular interactions, genetics oral and cervical cancers. In vivo studies chemoprevention arena, identification

134 Tata Memorial Centre Annual Report 2014-2015 and delineation of the mechanisms of Another study examines the effect of students were working towards the action of chemopreventive agents from neutrophilic proteases on membrane Ph.D. degree at ACTREC. A new batch Indian foods/ beverages [curcumin, proteome of tumor cells and on their of 13 junior research fellows joined the black tea polyphenols (PBPs), crude behavior, which could unravel the role Centre in July 2014. Under the Centre’s polyphenolic extracts of grapes] is of inflammation in cancer progression. Training program, 246 trainees from receiving attention. Curcumin, PBPs and Over the past year, the fly lab colleges, universities, academic/ grape extract exhibited anti-initiating (Drosophila melanogaster – fruit fly) lab research institutions and hospitals from and anti-promoting activities, by was established at ACTREC and across the country were accepted in modulating carcinogen metabolism by requisite methodologies were various labs in CRI and departments in phase I and phase II enzymes and also standardized. With the help of CRC. During the year 2014, 21 local, carcinogen/ tumor promoter-induced Drosophila genetics, cellular, molecular national and international conferences, inflammation, cell proliferation and and biochemical analysis of signaling workshops, symposia, etc. were apoptosis. A detailed study of signal molecules, coupled with confocal and organized at ACTREC, beginning with transduction pathways showed that live imaging microscopy, the the DBT-sponsored Workshop on polyphenols modulated kinase mechanisms underpinning glia ‘Applications in Bioinformatics’ held in functions. development and growth control will be January, and ending with the 10th Molecular profiling of BCR/ABL – elucidated, in order to define the National Research Scholars Meet in Life induced chronic myeloid leukemia in relationship between growth and Sciences 2014 in December. The Centre chronic phase and blast crisis (lymphoid patterning in developing tissues, and its also hosted 14 experts from India and and myeloid) and in acute lymphoid relevance to cancer. abroad who delivered research leukemia is being undertaken, in a bid The Academic Programs of the Centre seminars on a variety of topics to stratify patients and correlate with include the Doctoral program in the Life pertaining to biology and cancer. The the clinical behavior of their disease, for Sciences under the Homi Bhabha Centre also conducted a number of identification of therapeutic targets and National Institute, a deemed University. Cancer Awareness Programs for the for better disease management. During 2014, a total of 108 graduate general public as a social responsibility initiative.

Tata Memorial Centre / ACTREC 135 C L I N I C A L R E S E A R C H C E N T R E

Dr. Shubhada Chiplunkar (Director, ACTREC) Dr. Sudeep Gupta (Dy. Director, CRC-ACTREC)

Anaesthesiology, Critical Care & Pain Microbiology & Composite Lab Dr. Reshma Ambulkar (OIC) Dr. Vivek Bhat (OIC) Dr. Bhakti Trivedi Dr. Preeti Chavan (OIC) Dr. Amol Kothekar Nursing Dr. Malini Joshi Dr. Raghu Thota Mrs. Meera Achrekar (Asst. Nursing Suptdt) Biomedical Engineering Pathology Dr. Amit Sengupta (Technical Consultant) Dr. Asawari Patil (OIC) Cancer Genetics Dr. Epari Sridhar Dr. Rajiv Sarin Dr. Saral Desai* Clinical Pharmacology Radiation Oncology Dr. Vikram Gota Dr. Tejpal Gupta (OIC) Dr. NK Manjunath Dr. Vedang Murthy Clinical Research Secretariat, ACTREC Dr. Supriya Sastri Dr. Tejpal Gupta Dr. Jayant Sastri Goda (Clinician Scientist) Mrs. Sadhana Kannan Dr. Tabassum Wadasadawala General Medicine Radiodiagnosis Dr. Prafulla Parikh Dr. Seema Kembhavi Hematopathology - Molecular Dr. Ashwin Polnaya Dr. Nikhil Patkar (Clinician Scientist) Dr. Amit Kumar Janu Dr. Prashant Tembhare (Clinician Scientist) Surgical Oncology Medical Administration Dr. MS Qureshi Dr. Prashant Bhat (Asst. Med. Suptdt) Dr. Aliasgar Moiyadi (OIC) Mrs. Chital Naresh Dr. Vinayak Shankhdhar Medical Oncology Dr. Sudhir Nair (Clinician Scientist) Dr. Sudeep Gupta Dr. Deepa Nair Dr. Navin Khattry (OIC) Dr. Prakash Shetty Dr. Manju Sengar Transfusion Medicine Dr. Amit Joshi Dr. Shashank Ojha (OIC) Dr. Jaya Ghosh Dr. Minal Poojary Dr. Tushar Vora Mrs. Manda Kamble Dr. Hasmukh Jain Translational Research Medical Physics Ms. SV Jamema Dr. Indraneel Mittra (Dr. Ernest Borges Chair) Ms. Reena Phurailatpam Dr. Ranjan Basak *Resigned in 2014

136 Tata Memorial Centre Annual Report 2014-2015 Department of Medical Oncology

Dr. Navin Khattry Officer-in-Charge

Medical Oncologists Dr. Sudeep Gupta Dr. Manju Sengar Dr. Amit Joshi Dr. Jaya Ghosh Dr. Tushar Vora Dr. Hasmukh Jain Dr. Bhausaheb Bagal Dr. Kumar Prabhash

Overview Donor Registries. An unrelated cord tumours, in the new second floor ward The department of Medical Oncology transplant program was also started in in Paymaster Shodhika, are always started its services in ACTREC in 2006. April 2010. Since January 2013, haplo- occupied. Initially it was restricted to identical transplants are being done for administering concomitant chemo- patients who do not have a fully Clinical Research therapy with radiotherapy for head and matched related or unrelated donor. Faculty members of the Department are neck cancers and cancer of cervix but, These are the most challenging involved in several collaborative over the last 3 years, chemotherapy in transplants and, over the last 2 years, research projects, both in the neoadjuvant, adjuvant and palliative ~20 such transplants have been hematolymphoid and the solid tumour setting is being administered for various performed; disease free survival is 65%. units. A phase I trial unit with two beds other solid tumours. The Bone Marrow This hospital is one of the largest commissioned a few years ago have Transplant unit shifted to ACTREC in centres doing these challenging patients from the Department at all 2007 due to the rising incidence of life transplants. A funding mechanism was times. threatening infections in the old unit at initiated in 2009 to offer free or greatly the Tata Memorial Hospital (TMH). subsidized BMT as a life saving measure Education for deserving poor patients. Since then, Since then, around 400 autologous and The department of Medical Oncology at 75 such autologous and allogeneic allogeneic transplants have been ACTREC has an active education transplants have been performed under performed with overall transplant program, which encompasses daily this scheme. related mortality of 7-8% (2% in academic sessions pertaining to autologous, 12% in allogeneic), Adult Hematolymphoid Unit: A 17-bed transplantation and hematolymphoid comparable to the best centres across leukemia/ lymphoma ward and adult neoplasms for the DM students posted the world. Since October 2011, adult hematolymphoid OPD was also set up in ACTREC, and a fortnightly Journal patients with hematolymphoid in 2011. During 2014, around 1000 club that covers faculty and students neoplasms not undergoing transplant patients were treated as in-patients, from the departments of medical, are also being treated at ACTREC. and daily ~50 patients were seen as out- radiation and surgical oncology. During patients, from Monday to Friday. 2014, faculty and four students from Service Adult Solid Tumour Unit: The number the BMT and solid tumour units Bone Marrow Transplantation: Seventy of patients with solid tumours seen in presented their research findings at five transplants were performed in the outpatient department has steadily major international meetings. This year, ACTREC in 2014. Encouraged by the increased and, in the year 2014, six students with projects on bone initial success and in order to cater to approximately 4,500 patient visits took marrow transplantation and the needs of those who do not have an place. Tumours pertaining to Head and hematolymphoid neoplasms as also HLA-matched sibling, an ambitious Neck region, breast, ovary, cervix and one faculty and two students with program of matched unrelated donor gastrointestinal region comprise the projects on solid tumours were selected transplant was successfully initiated in bulk of cancers treated by the for the Australia and Asia Pacific Clinical November 2009, using HLA matched Department at ACTREC. The five in- Oncology Research Development stem cells from international Unrelated patient beds dedicated to solid Workshop (ACORD) held in Australia.

Tata Memorial Centre / ACTREC 137 Department of Radiation Oncology

Dr. Tejpal Gupta Officer-in-Charge

Radiation Oncologists Dr. Vedang Murthy Dr. Supriya Sastri Dr. Jayant Sastri Goda Dr. Tabassum Wadasadawala Medical Physicists Ms. SV Jamema Ms. Reena Phurailatpam

Overview Service Education The department of Radiation Oncology, During 2014, 364 patients were treated Apart from the informal education and besides providing quality service and with radiotherapy as compared to ~ 900 training to residents and fellows in the education, also conducts translational patients per year in the past; this drop OPDs and Joint Clinics, the Department and clinical research in collaboration was largely due to non-availability of the runs an active educational program with colleagues from site-specific Bhabhatron-II and the linear involving ward rounds, seminars, disease management groups at TMH as accelerator. The majority of patients journal club, and planning meeting, well as scientists at Cancer Research were planned and treated on the most of which are held jointly with Institute. In keeping with ACTREC’s Tomotherapy machine using other departments of ACTREC and emphasis on technology development contemporary high-precision delivery TMH. In 2014, faculty members of the and assessment, an indigenously and verification techniques (IMRT with Department actively participated in developed multi-leaf collimator system volumetric image-guidance) either on local, national, and international was installed on the Bhabhatron-II Institutional Ethics Committee- conferences/ meetings as organizers, telecobalt unit which is awaiting approved research protocols or as invited faculty and delegates. Technical commissioning approval. The old linear residents of Navi Mumbai who can now staff members too were encouraged to accelerator (Siemens Primus) was register directly at ACTREC. participate in local and national decommissioned and the existing meetings/ training courses. bunker modified to install a state-of- Clinical Research the-art linear accelerator (Varian Over the years, the Department has laid TrueBeam). The year also witnessed the emphasis on cutting-edge research with replacement of the old 4-slice CT- the potential to inform or change scanner with an integrated PET/CT practice. Faculty members are actively scanner, which is now being used engaged in several collaborative routinely for radiotherapy planning. translational/ clinical research projects as Principal Investigators or Co- Investigators.

138 Tata Memorial Centre Annual Report 2014-2015 Department of Surgical Oncology

Dr. Aliasgar Moiyadi Officer-in-Charge

Surgical Oncologists Dr. M. S. Qureshi Dr. Vinay Shankhdhar Dr. Sudhir Nair Dr. Deepa Nair Dr. Prakash Shetty

Overview service continued the use of state-of- presently conducting a randomized trial The department of Surgical Oncology the-art intraoperative image-guided comparing the use of sononavigation in has been providing continued care to a surgery techniques, specifically malignant gliomas. This is the first such wide range of cancer patients. The navigable 3D ultrasound based surgery study anywhere in the world, and is service runs four regular operating and fluorescence guided-resections of expected to conclude in 2017. theatres, five days a week, and provides malignant gliomas, both of which have inpatient care. The department also improved patient outcomes. Minimally Education runs regular outpatient OPDs for newly invasive laparoscopic GI surgery has During 2014, faculty members of the registered and follow-up cases. commenced since mid 2014 and is Department presented their clinical and being implemented regularly with plans research findings at over 25 national/ Service for further expansion. international conferences. Dr. Gauri Pantvaidya of TMH’s Surgical Oncology During the report year 2014, over 2300 Research major procedures were performed at department, jointly with Dr. Rukmini ACTREC, including major surgeries in Faculty members of the Department are Govekar of CRI, ACTREC, co-ordinated pediatrics, head-neck, breast, gastro- involved in various DMG coordinated the conduct of three quarterly sessions intestinal, gynecology, urology and research projects in collaboration with of the training program in ‘Laboratory neurosurgery (see figure). The inpatient their counterparts at TMH, and with IIT- techniques in translational research’ for bed strength was increased to 35 (from B and BARC. Neurosurgery services are M.Ch. surgical oncology students. 28 in 2013). In a bid to streamline pre- and postoperative care, two new OPDs (postoperative follow-up OPD and presurgical evaluation OPD) were started in late 2014. The neurosurgery

Tata Memorial Centre / ACTREC 139 Department of Anaesthesiology, Critical Care and Pain

Dr. Reshma Ambulkar Officer-in-Charge

Anaesthesiologists Dr. Bhakti Trivedi Dr. Malini Joshi Dr. Raghu Thota Intensivist Dr. Amol Kothekar

Overview Service Research The department of Anaesthesiology, During 2014, the Department provided All the faculty members of the Critical Care and Pain at ACTREC services during 2317 major OT Department are principal investigators provides anaesthesia, critical care and procedures and 195 procedures in the of clinical studies, some of which were pain management services to the radiotherapy OT; these figures were completed in 2014 while others are on- patients at this centre. The Department marginally higher than the 2013 figures. going. Before submitting planned has five permanent staff members and The Department introduced projects to the Institutional Review eight senior residents at ACTREC, anaesthesia for interventional radiology Board (IRB), the investigators routinely besides full-time consultants and and MRI procedures at ACTREC for the engage in project discussion meetings. residents from TMH who visit the first time in 2014, and provided support centre. for 57 interventional radiology and 99 Education MRI procedures. Critical care services The Department at ACTREC, in concert were provided for 1982 recovery room with that at TMH, conducted a three- admissions and 314 ICU admissions day annual Anaesthesia Review Course, (106 of which were ventilated). in which over 300 postgraduate students participated. The department also organized a National Airway Conference in November 2014. The Critical Care division held an annual two-day workshop on Hemodynamic Monitoring in which a large number of intensivists from all over India took part. The Pain division organized an annual two-day Conference on ‘Education in Cancer Pain’. Departmental faculty served as invited faculty at many national conferences in 2014.

140 Tata Memorial Centre Annual Report 2014-2015 Department of Radiodiagnosis

Radiologists Dr. Shashikant Juvekar Dr. Seema Kembhavi Dr. Ashwin Polnaya Dr. Amit Kumar Janu

Overview Service scans. In case of MRI scans, a 47.3% The department provides diagnostic During 2014, 1614 conventional increase was noted in the average imaging services in the form of radiological investigations were patients/ month (134 in 2014 vs. 91 in conventional radiography, sonography performed, that included 1455 chest, 95 2013). Advanced MR imaging including (USG - transabdominal, endocavitatory bone, and 64 abdomen and pelvis X- diffusion tractography and functional and small parts), colour Doppler, rays. The average figure for diagnostic MR imaging was also performed at diagnostic and planning CT (computed X-rays/ month showed a 17% increase ACTREC. Computed tomography and tomography) and MRI (magnetic (135 in 2014 vs. 115 in 2013). A total of MRI examination of were also resonance imaging) scans with and 505 USG/ colour Dopplers were performed as a part of animal research without intravenous contrast, and performed in 2014. In all, 2248 projects. interventional radiological procedures diagnostic CT scans performed; the like image-guided fine needle aspirage monthly average increased by 19.8% Education cytology (FNAC), biopsies and drainage (175 in 2014 vs. 146 in 2013). In Senior faculty of the department procedures. The CT scan machine was addition, 416 radiotherapy planning CT presented their findings as oral decommissioned during the year. The scans were performed; the average presentation/ posters / scientific PET-CT installation was initiated in monthly patient number showed a exhibits at eight international and six August 2014, with a view to make it 15.7% decrease (59 in 2014 vs. 70 in national conferences during the report functional in January 2015. The MRI unit 2013). In all, 1445 MRI scans were year. Six staff members of the had an incident on 8th November 2014, performed: 878 brain, 175 spine, 19 department were deputed to attend after which it was shut down for repairs. PNS, 85 neck, 52 extremities, 97 continuing medical education Emergency services such as urgent x- abdomen, 127 pelvis and 18 breast programs. rays, sonography, doppler studies, CT/ MRI scans are available 24 hrs a day as well as on weekends and holidays.

Tata Memorial Centre / ACTREC 141 Department of Transfusion Medicine

Dr. Shashank Ojha Officer-in-Charge

Blood Bank Officer Dr. Minal Poojary Scientific Officer Mrs. Manda Kamble

Overview Service Education The department of Transfusion During the year 2014, a total of 2126 Lab members participated in weekly Medicine (DTM) continually strives to blood units were collected, from which journal club, data presentation, and maintain high standards in the provision 3897 components (packed cells, lectures. Faculty and staff members of safe blood and blood components. platelets, plasma) were prepared. In all, participated in nine national The major donor and lab services 1325 leucodepleted products, and 2281 conferences/ scientific meetings and offered by DTM include blood irradiated blood products (apheresis underwent training to keep abreast collection, blood grouping and cross- platelets, RDPs and packed cells) were with the latest developments in the matching, transfusion transmitted also prepared. In all, 3667 blood field. DTM also imparted specialized infection (TTI) testing, plateletpheresis, grouping and 4517cross matching were training in hematopoietic stem cell peripheral blood stem cell harvest, also performed. A total of 112 stem cell harvesting and transplant, blood component preparation, preparations (69 autologous, 43 banking and apheresis. In March 2014, cryopreservation and storage of allogeneic) were achieved during 2014. DTM and diagnostic laboratories of components and stem cells, and issue ACTREC jointly organized a ‘Quality of blood/ blood products. The Research conclave of diagnostic laboratories and Department proactively maintains a Senior faculty members of the group transfusion medicine services’. quality check over collected are involved in a research project hematopoietic stem cells, their involving the determination of select processing, cryopreservation, storage, biochemical reference intervals in inventory maintenance and issue. DTM Indian voluntary blood donors. has introduced a ‘Voluntary Donor Club’ to tide over the crisis of platelet donors and rare group donors. By increasing blood donation camps, a 100% switch over to voluntary blood donation and improved the blood bank inventory has been achieved, ensuring timely provision of blood to end users.

142 Tata Memorial Centre Annual Report 2014-2015 Department of Nursing

Mrs. Meera Achrekar Asst. Nursing Superintendent

Overview services are also provided to the Education The Nursing department is an integral enhanced OPD services and new 23-bed On-going advancements in cancer care part of the healthcare system at ward for pediatrics, surgical and medical require that the knowledge skills of ACTREC, and provides comprehensive oncology patients commissioned during nurses are updated regularly. Newly nursing care to cancer patients of all 2014. Internal audits on drug recruited nurses go through an ages. Nurses at ACTREC are provided administration, thrombophlebitis, pain intensive induction program, while in- the opportunity to develop the ability management, pressure ulcers and service programs, clinical teaching and to deliver therapeutic care, and are waste management were conducted in weekly case presentations are involved in augmenting nursing practice 2014. The SBAR (situation background conducted regularly for the nursing through implementation of patient assessment recommendation) form was staff. Nurses were encouraged to attend safety goals, continuing education and introduced for communication of shift local/ national conferences, workshops research. handover between nurses in a written and certification programs in Central form, thus ensuring patient safety. An Venous Access Device, chemotherapy audit using simple random sampling administration, infection control, etc. Service was undertaken to verify if all the The Nursing department provides On request, four nurses from various patient related information is local/ national hospitals were provided quality nursing care to the ACTREC documented. hospital’s outpatient departments, specialized training in bone marrow operation theatres, recovery rooms, transplant nursing. The department intensive care units, day care wards (for organized a one day Workshop on patients requiring short term ‘Making nursing visible: imperatives and chemotherapy infusions, transfusion of strategies’ at ACTREC in August 2014, blood/ blood products and hydrations), in collaboration with the state branch and all the inpatient wards. Nursing of the Trained Nurses Association of India.

Tata Memorial Centre / ACTREC 143 Pathology Lab

Dr. Asawari Patil Officer-in-Charge

Pathologists Dr. Epari Sridhar Dr. Saral Desai (resigned in May 2014) TMC staff pathologists on rotation

Overview Service Research The Pathology lab at ACTREC is a The lab processes an average of 200 The faculty members are engaged as constituent part of the Department of paraffin blocks every day, and carefully principal investigator or co-investigator Pathology, TMC. The lab provides archives all the slides and blocks for in various funded/ non-funded DMG diagnostic services including future retrieval and issue to projects and have research histopathology, frozen section, pathologists, scientists and clinicians for collaborations with ACTREC scientists. immunohistochemistry and cytology their research projects. During 2014, Thesis projects of 11 junior residents for patients treated at ACTREC as well the lab processed 2491 surgical (MD students) were completed during as outside referral cases. The mandate pathology samples, 1952 frozen section 2014. is to provide accurate, reliable reports samples, 287 cytology samples, and in time. The lab is accredited by NABL performed 2950 immunohisto- Education for all services except cytology. The chemistry (IHC) tests. The lab also The pathologists participated in many laboratory participates in EQAS performed validation of over 100 local/ national/ international (External Quality Assessment Scheme) antibodies for IHC testing. conferences as faculty/panelist and to offered by national and international present their findings (oral agencies. presentations/ posters). Technical staff members were encouraged to participate in continuing medical education activities.

144 Tata Memorial Centre Annual Report 2014-2015 Hematopathology Lab

Hematopathologists Dr. Sumeet Gujral Dr. PG Subramanian Dr. Nikhil Patkar Dr. Prashant Tembhare

Overview The Hematopathology Lab – Molecular Division, is a referral diagnostic lab for molecular testing of hematolymphoid neoplasms, established formally in August 2013 as a patient service and translational research lab for the Tata Memorial Centre (TMC). Since then, the lab has witnessed an exponential growth in samples received for molecular testing. This lab probably has the highest workload for molecular hemato-oncology in India (accompanying figures); yet it is very quality conscious and participates in EQAS programs of the College of American Pathologists as well as UK NEQAS.

Service The laboratory performs molecular testing for a wide range of hematological malignancies. Some of the tests are not available in India - such as testing for somatic hypermutations in lymphomas as well as CCAT/ enhancer binding protein alpha gene mutations (CEBPA).

Education The lab conducts an Advanced Molecular Hematology Training Course every year, in which four technologists are provided the requisite training.

Tata Memorial Centre / ACTREC 145 Microbiology Lab

Dr. Vivek Bhat Officer-in-Charge

Overview Service examines ‘Central line associated The Microbiology lab at ACTREC is a During 2014, 9127 samples were infections in bone marrow transplant constituent part of the Department of processed for bacteriology, culture and and hematolymphoid cancer patients’. Microbiology, TMC. It is NABL susceptibility testing (blood, body Pseudomonas aeruginosa, E. coli, accredited, and provides patient and fluids, pus, urine, feces, etc), serology coagulase negative staphylococci are hospital related services towards (HBsAg, HIV, HCV, PCT, RMA, etc) and common isolates in these patients. The bacteriological culture and clinical microbiology testing (urine, other projects involve determination of susceptibility testing. Reports of isolates feces). Sterility testing services were select biochemical reference intervals are generally provided within 24 hours, provided for Blood Bank services (PBSC, In Indian voluntary blood donors; and susceptibility results within 48 SDP, RDP, etc) and also for the OT/ICU/ correlation between colistin disc hours. Critical reports are immediately Brachytherapy/ BMT unit. The lab also diffusion and MIC breakpoints in conveyed to the clinicians, facilitating helped identify fungi in clinical material, Enterobacteriaceae; and role of PCT, early specific treatment and/or and performed susceptibility testing for CRP and ANC in culture confirmed antibiotic de-escalation when required. yeasts. SWOT (Strengths, Weaknesses, infections. Clinical microbiology testing, rapid Opportunities, Threats) of the sample serological testing and manual/ collection area was carried out. Based Education automated antifungal susceptibility on the findings, corrective actions were The lab participates in the training testing and fungal identification from taken, leading to a considerable program of the Centre and, during clinical material are also offered by the reduction in the waiting time for the 2014, one trainee worked under Dr. lab. Sterility testing is provided for patients. Bhat’s supervision on her MSc Blood Bank products and for bone dissertation. The faculty is involved in marrow transplant patients, besides Research teaching and case discussion sessions surveillance activity for OT/ ICU/ BMT/ The faculty is involved in five on-going for students of MD Microbiology, and Brachytherapy units. The lab also research projects. The on-going study lectures for Master of Hospital provides infection control and waste on ‘Oral cavity flora in patients receiving Administration and PG Diploma in management support to the hospital, chemo-radiotherapy for head & neck Hospital Administration course at TISS, assists in investigating outbreaks, cancer’ seeks to identify Candida spp, Mumbai. During the year, training monitors the emergence of multidrug and select bacteria in post operative sessions on infection control and waste resistant organisms and provides cancer patients undergoing CT-RT and management were conducted for TMC comprehensive antimicrobial RT, and study their susceptibility to nurses/ other staff, and regular CME for susceptibility data to clinicians. certain drugs. Initial findings suggest laboratory staff. The faculty also made Candida infections to be common oral/ poster presentations at national/ amongst these patients. Another study international conferences.

146 Tata Memorial Centre Annual Report 2014-2015 Composite Lab

Dr. Preeti Chavan Officer-in-Charge

Overview mice and dogs are also processed protein and absolute neutrophil count The Composite lab is NABL accredited, hematology and biochemistry, as a part in culture confirmed infections was also and provides 24 hours medical of research studies. SWOT (Strengths, conducted. Data revealed that C- laboratory services to the ACTREC Weaknesses, Opportunities, Threats) reactive protein - although a non- hospital. It consists of clearly analysis of the sample collection area specific marker of infection, is a more demarcated sections for sample was carried out during 2014. Based on reliable indicator. Another study collection (blood, urine, stool, etc), the findings, corrective actions were involved a comparison of haematology, biochemistry, molecular taken, which led to a considerable chemiluminescence and immunoassay hematology and cytology. reduction in the waiting time for technique for cyclosporine drug patients. estimation. Both provided comparable Service results, and can be used Research interchangeably for cyclosporine CBC, peripheral blood smear assessment. examination and coagulation tests are The lab is involved in research studies involving the determination of select carried out routinely in the hematology Education section. Routine biochemistry tests biochemical reference intervals In such as LFT, RFT, electrolytes, cardiac Indian voluntary blood donors; The lab participates in the Centre’s enzymes, osmolality, immunoglobulins, identification of oral cavity flora in training program and during the year, tumor markers, vitamin assays, thyroid patients receiving chemo-radiotherapy four trainees - one undergraduate, two function tests, drug assays, ferritin, etc for head and neck cancer; evaluation of master’s and one DMLT, worked on and immunoassays for TFT, vitamins, hematological and biochemical small projects in the lab. In house drugs and tumor markers are routinely parameters in post-transplant patients, training sessions on sample collection carried out. Cytology involves slide and evaluation of deferred donors for and interpretation of laboratory values processing and staining of cytology and platelet apheresis. A study to examine were conducted for ACTREC nurses and FNAC specimens. Blood samples from the role of procalcitonin, C-reactive regular CMEs for laboratory staff.

Tata Memorial Centre / ACTREC 147 Clinical Pharmacology Lab

Clinical Pharmacologists Dr. Vikram Gota Dr. NK Manjunath

Overview Service Education Research in this lab encompasses The lab offers services in the form of Group members meet at a weekly (a) drug development, and (b) clinical therapeutic drug monitoring of journal club. The lab accepted thirteen pharmacokinetics studies. This lab has antifungal agents including voriconazole trainees during 2014 – eleven for their generated very interesting data on and posaconazole. While the service Master’s dissertation. Dr. Gota pharmacokinetics guided optimization was offered to BMT patients till last participated in four national and three of treatment for drugs such as imatinib year, it was extended to pediatric and international meetings during 2014; in CML and 13-cis-retinoic acid in adult hematolymphoid units this year. three members of his group won neuroblastoma. Biodistribution studies Over 200 BMT and hematolymphoid awards at national meetings. The group were conducted for radioimmuno- patients benefitted from this service. organized the 2nd ACTREC Symposium therapies developed by BARC for NHL in Clinical Pharmacology in October (131I-Rituximab and 177Lu-Rituximab) Research 2014. The department also contributed 131 and breast cancer ( I-Trastuzumab). Clinical pharmacokinetic studies yielded to the ‘Advanced Techniques in Anti Clinical studies are now being planned very interesting data on pemetrexed Cancer Drug Evaluation Workshop’ held for these compounds. The lab is also pharmacokinetics and hyponatremia in at ACTREC in November 2014. engaged in two industry sponsored NSCLC patients. The severity of phase I development of new chemical hyponatremia on treatment correlated entities. The bioanalytical capability of positively with the area under plasma this department increased treme- concentration-time curve (AUC) of ndously with the installation of a LC/ pemetrexed. Another notable finding MS/MS system in 2014. was in a pediatric study of neuroblastoma where very young children in whom 13-cis-retinoic acid (13-cisRA) was administered after cutting open the capsule had significantly lower exposure to 13-cisRA and inferior outcomes compared to others who could swallow capsule as a whole. It makes a strong case for developing pediatric friendly liquid formulations.

148 Tata Memorial Centre Annual Report 2014-2015 Translational Research Lab

Dr. Ernest Borges Chair Dr. Indraneel Mittra

Overview Research apoptotic chromatin fragments, The main focus of research in the Work on this project continued during especially those derived from cancerous Translational Research Lab is 2014, wherein research focused on cells, have uniquely modified histones examination of the role of circulating examining how chromatin from dead which upon integration into healthy cell chromatin in cancer and chronic cells induces epigenetic changes, genomes bring about major epigenetic degenerative diseases. Several hundred stemness, and cancer in living cells. re-programming in the recipients, billion cells die in the adult human body When dead cancer cells are co-cultured leading to stemness and cancer. daily due to normal physiology. A with healthy cells, the Cfs emanating considerable amount of fragmented from the dead cells can oncogenically Education chromatin (Cfs) enters into the transform recipient cells. Cells The senior faculty participated in the circulation in healthy individuals, and in transformed by Cfs from both these Cold Spring Harbor Laboratory meeting higher quantities in disease pathologies sources show marked activation of on ‘Epigenetics and Chromatin’ in including ageing and cancer. Research genes that impart stemness and form September 2014. Lab members from this lab has shown that Cfs isolated spheroid-like structures when grown participated in regular in house from the blood of cancer patients and under defined conditions suggesting academic sessions, and were healthy individuals can freely enter into that they have acquired properties of encouraged to attend scientific healthy cells, integrate into their cancer stem cells. These findings have meetings, and workshops. genomes, trigger a DNA-damage-repair- generated the hypothesis that response and activate apoptotic pathways. Furthermore, Cfs from cancer patients, but not from healthy individuals, can oncogenically transform recipient cells. On the other hand, DNAfs isolated from the same cancer patients are inactive even when applied at 10X higher doses. This finding suggests the involvement of tumour- derived histones present in cancer Cfs in the oncogenic process.

Tata Memorial Centre / ACTREC 149 Biomedical Engineering Lab

Technical Consultant Dr. Amit Sengupta

Overview mathematical models are receiving screening methods/ techniques to The task entrusted to this lab is to set good reviews from across the world. diagnose cancer at an early stage. up interdisciplinary bioengineering and While hyperbaric oxygen therapy Exploiting the laws of thermodynamics, gynecology research facilities in relation successfully controlled cancer efforts are on to develop a label free to cancer research. The thrust area of progression, it impacted overall survival bio-sensor for early cancer screening bioengineering is cancer theranostics - due to its genotoxicity and other and therapy. The possibility of using the development of newer, affordable, deleterious effects; it may therefore not Raman spectroscopy as a sensitive, label free diagnostic tools, imaging be useful as a radio-chemo sensitizer. molecular biophysical, bedside techniques and analytical software, and These findings underline the need for a diagnostic tool is also being explored. treatment protocols through the better genetically modified pre clinical While the ex vivo study generated amalgamation of clinical, experimental, model to study cancer. Another study useful data, classifiers and clinical theoretical, and engineering research examines the usefulness of metronomic protocol to discriminate sentinel techniques. The ultimate aim is to therapy on terminally ill cancer metastatic lymph nodes in breast improve the quality of life of cancer patients, by checking for any cancer patients, translation of the patients who are diagnosed late and for modulatory effect/s on blood vessels, emerging protocol into a bedside smart whom the main line treatment may not vascular dynamics, biorheology, stem diagnostic system is still a distant goal. be affordable or useful. cell expression and pharmacokinetics, with a view to remove any ambiguity in Education Clinical Research protocol and identify prognostic The lab participates in the Centre’s Published findings of the lab’s study on markers. Primary and secondary end training program and, during the year, the effect of hyperbaric oxygen in points, overall survival, and quality of accepted nine trainees – seven for their control of mammary tumor growth in life are also being examined. Search is Master’s dissertation and two for C3H mice using experimental and also on for affordable and sensitive research experience.

150 Tata Memorial Centre Annual Report 2014-2015 C A N C E R R E S E A R C H I N S T I T U T E

Dr. Shubhada Chiplunkar (Director, ACTREC)

Basic Research Team

 Dr. Kishore Amin  Dr. Rajiv Kalraiya  Dr. Dibyendu Bhattacharyya  Dr. Jyoti Kode  Dr. Kakoli Bose  Dr. Pradnya Kowtal  Dr. Pradip Chaudhari  Dr. Manoj Mahimkar  Dr. Murali Krishna Chilakapati  Dr. Girish Maru*  Dr. Shubhada Chiplunkar  Dr. Rita Mulherkar*  Dr. Sorab Dalal  Dr. Asha Ramchandani*  Dr. Abhijit De  Dr. Pritha Ray  Dr. Amit Dutt  Dr. Rajiv Sarin  Dr. Shilpee Dutt  Mrs. Sharada Sawant  Mr. Nikhil Gadewal  Dr. Neelam Shirsat  Dr. Poonam Gera  Dr. Tanuja Teni  Dr. Rukmini Govekar  Dr. Milind Vaidya  Dr. Rajiv Gude*  Dr. Ashok Varma  Dr. Sanjay Gupta  Dr. Prasanna Venkatraman  Dr. Syed Hasan  Dr. BV Venugopalareddy  Dr. Arvind Ingle  Dr. Sanjeev Waghmare  Dr. Narendra Joshi  Dr. Ujjwala Warawdekar  Dr. Aarti Juvekar*

Principal Investigators (PIs) are shown in bold * Retired during 2014

Tata Memorial Centre / ACTREC 151 Bhattacharyya Lab

Dr. Dibyendu Bhattacharyya Principal Investigator

Overview Research Education The focus of work in Bhattacharyya lab Recent findings from this lab show that The Principal Investigator is a is on intracellular organelle biogenesis the GTPase ARFI is capable of recognized guide for Ph.D. in the Life and dynamics primarily with a focus on controlling Golgi size by altering Sciences of Homi Bhabha National the size control mechanism of such cisternal maturation kinetics. The Institute. Presently, five research compartments. Organelles’ size and important roles of nuclear import for scholars (Ms. Madhura Bhave, Ms. Abira shapes are greatly altered in cancer and size control of nucleus of human cells Ganguly, Ms. Prasanna Iyer, Mr. Bhawik such alteration is a hallmark of have also been discovered. Kumar Jain, Mr. Praveen Marathe) are cancerous cells. Using basic cell working on their doctoral dissertation biological approach along with under his guidance. The lab also advanced microscopic techniques, participates in the training program of attempts are being made to understand the Centre, wherein one post doc and the underlying mechanisms that govern two trainees were accepted in the lab the size control mechanism of Golgi and during 2014. Lab members participated nucleus. Yeast and cell lines are the in weekly data presentation sessions, model systems being used, and in the and presented their work findings at near future culturing of neurons will be four local/ national conferences. initiated.

152 Tata Memorial Centre Annual Report 2014-2015 Bose Lab

Dr. Kakoli Bose Principal Investigator

Overview adapter-independent cell death Education The long-term objective of Bose Lab is pathway and will further the The lab is recognized for the Ph.D. to achieve a broad understanding of understanding of papillomavirus E2 degree in Life Sciences of the Homi structure, function and specificity of protein in general. Bhabha National Institute, and currently proapoptotic proteins involved in there are six graduate students (Ms. alternate apoptotic pathways and their Research Nitu Singh, Mr. Lalith K. Chaganti, Mr. role in cancer utilizing multidisciplinary Highlights of the research findings of Raja Reddy Kuppili, Ms. Saujanya approach. The lab currently focuses on this lab include establishment of the Acharya, Mr. Ajay Wagh, Mr. K. two major proteins: human HtrA2/Omi model of HtrA2 activation via its N- Raghupati) working on their doctoral (high temperature requirement terminal domain. The dual regulatory dissertation. The lab also participates protease A2) and human papillomavirus switch for HtrA2 activation has also actively in the Centre’s training regulatory E2 protein. HtrA2/Omi is a been identified. Crystals at 2.0 Å program, wherein eleven trainees unique trimeric serine protease that resolution of a pathological mutant of worked either for their Master’s performs critical cellular functions the HtrA2 have been obtained and currently dissertation or for research experience mechanisms of which still remain the structure is being solved. The during 2014. The lab members meet elusive. It is also associated with several interaction of HtrA2 with two of its once a week for data presentation and critical diseases such as cancer and known binding partners has been journal club. Faculty and students of the neurodegenerative disorders, making it characterized and its interaction with a lab visited seven local/ national an important therapeutic target. putative ligand has been established. conferences and workshops to present Therefore, intricate dissection of its Hax-1 has been established as an their research findings in poster or oral structure and dynamics is being activator of HtrA2 - not a substrate, presentations. performed using structural tools and which is contrary to the available identification of its novel partners is information in the literature. DUSP-9 being attempted, which will shed light has been identified and characterized on its biological role and thus provide a as an HtrA2 binding partner. The means to manipulate it with desired mechanism of human papillomavirus E2 characteristics. Currently, other mediated activation of the extrinsic members of this protease family such apoptotic pathway has been as HtrA1, -3 and -4 are also being established and it has been compared studied. This research also with the classical pathway of cell death. encompasses understanding the mechanism of interaction between high-risk papillomavirus (HPV) regulatory E2 protein and proteins of the extrinsic apoptotic pathway. This information will unravel a novel

Tata Memorial Centre / ACTREC 153 Chilakapati Lab

Dr. Murali Krishna Chilakapati Principal Investigator

Overview Research model. Urine based classification of Cancer has gained the epidemic In vivo studies on over 300 patients have adenocarcinoma and pre- proportions in recent years and will indicated feasibility of non-invasive adenocarcinoma conditions in rat soon be the leading cause of death. delineation of oral cancer, pre-cancer, breast was demonstrated. Other studies Screening and early detection are age-related effects and early events like include detection of drug resistance, important tools to reduce cancer CFE/ MAC. Recently a correlation of prediction of recurrence and measuring morbidity/ mortality. Thus, there is an spectral and biomarkers has been therapeutic drug levels of Imatinib. urgent need to develop sensitive, demonstrated. In a study of 100 These leads are now being actively preferably-non invasive methods for patients, Raman spectroscopic pursued for clinical applications. early diagnosis. Optical spectroscopic classification of healthy and cervical methods like infra red absorption, cancer subjects was demonstrated, and Education Raman and fluorescence spectroscopy the vagina has been identified as a The lab is recognized for the Ph.D. are being contemplated as adjunct/ suitable internal control; the latter program in Life Sciences of the Homi alternative approaches. Among these, would be useful in screening camps Bhabha National Institute (a deemed Raman is best suited for non-invasive where colposcopy is unavailable. On University). At present four graduate and online applications. Chilakapati lab site instrument and stringent students - Ms. Rubina Shaikh, Mr. is actively pursuing the development of experimental conditions are hurdles for Piyush Kumar, Ms. Aditi Sahu and Mr. Raman based methods, with a focus on in vivo applications. Hence, studies on Tanmoy Bhattacharjee are working on the development of in vivo/ in situ exfoliated cells and body fluids have their Ph.D. dissertation. The lab also methods for routine screening and been indicated. Serum based participates in the training program of diagnosis, developing minimally classification of healthy buccal mucosa the Centre; five trainees worked on invasive microspectroscopy methods and tongue cancer was shown in 150 their M.Sc dissertation in 2014. Lab using body fluids and cell smears, and subjects. Discrimination of tissues from members also attended five national/ exploration of 1H NMR, Raman and healthy subjects, tobacco habitues, international conferences to present infrared spectroscopy for oral cancer premalignant and malignant tissues their research findings. diagnosis using saliva. Raman imaging using buccal exfoliated cells was also is also being used for correlation of demonstrated on 100 subjects, in line spectral and biomolecules/ cancer with earlier studies on cervical biology. Other research areas include exfoliated cells. Hamster buccal pouch synthesis, optical and photothermal cancer model was used to study cancer characterization of metallic progression by Raman, and correlated nanoparticles for biomedical with histopathology and applications, and experimental immunohistochemistry. The ability to carcinogenesis investigations in animal distinguish normal, pre-fibroadenoma models. and fibroadenoma breast conditions in vivo was shown in Sprague-Dawley rat

154 Tata Memorial Centre Annual Report 2014-2015 Chiplunkar Lab

Dr. Shubhada Chiplunkar Principal Investigator

Co-Investigator Dr. Jyoti Kode

Overview Research murine melanoma model which may be The focus of research in Chiplunkar lab Various projects undertaken in this lab due to immune dysfunction contributed γ is on understanding the immune investigate the molecular mechanisms by attenuated IFN- signalling. scenario and reasons for immune underlying the ability of γδ T cells to kill dysfunction in cancer patients, with the bisphosphonate treated breast/ oral Education long term goal of developing cell based tumor cells and leukemic (T-ALL) blasts. The Principal Investigator is a immunotherapy approaches for cancer Studies demonstrated that Notch recognized Ph.D. guide in Life Sciences treatment. Basic areas focus on signaling plays a key role in regulation under the Homi Bhabha National understanding the cross talk between of effector functions of γδ T cells Institute (deemed University). During bisphosphonate-stimulated tumor through transcriptional and epigenetic 2014, one student – Mr. Dimpu Gogoi cells/ γδ T cells and osteoclasts, role of mechanisms. In gall bladder cancer was awarded the Ph.D. degree, while Notch in regulation of γδ T cells and patients, γδ Th17 was identified as a seven students – Ms. Swati Phalke, regulatory T cells, and epigenetic new subtype that contributed to Ms. Aparna Chaudhari, Mr. Asif Amin regulation and anti-tumor effector inflammation and was associated with Dar, Mr. Rushikesh Patil, Ms. Gauri Mirji, functions of γδ T cells. Work on cancer poor survival. γδ+ RANKL+ subset was Mr. Sajad Bhat and Ms. Shalini KS includes understanding of the role of increased in peripheral blood of breast worked on their Ph.D. dissertation Th17 and regulatory T cells in gall cancer patients compared to that of under her guidance. The lab also bladder cancer, and genomic and healthy individuals indicating their actively participated in the Centre’s functional studies in TCR γδ T-ALL ability to home to the bone. For the first training program, wherein ten trainees patients. Other projects study the role time, a potentially important function (nine with the PI and one with the Co-I) of galectin-3 in modulating tumor- for 2', 5', oligoadenylate synthase (OAS2 undertook training here. Weekly data specific immunity and lung metastasis - antiviral gene) as a paracrine negative presentations form a part of the in in mice, and development of a simple regulator of T-cell function was house academic activity of the lab. Lab and non-invasive method for established in oral cancer (OC) patients. members participated in five prognostication and monitoring of Further in these patients, increased international and seven national treatment response based on analysis frequency of MDSCs and Tregs resulted conferences during 2014. of EBV DNA. Under the ‘Science in T cell tolerance and induction of Initiative Program in Ayurveda’, the chronic inflammation which may immune scenario generated in mice facilitate tumour growth. Studies treated with Bhasmas and anupans demonstrated that absence of Galectin- (vehicle) is being investigated. 3 facilitated lung metastasis in B16F10

Tata Memorial Centre / ACTREC 155 De Lab

Dr. Abhijit De Principal Investigator

Overview The mandate of the lab is translating diverse experimental therapeutics and cancer diagnostics developed through research for the patient benefit. The research focus of De Lab is preclinical molecular functional imaging and cancer, involving real time visualization and quantitative measurement of cellular/ physiological processes at the molecular/ genetic level. Research diagnostic imaging. A software IHC In the imaging guided cancer drug involves miniaturized medical imaging Profiler was developed in-house for screening program, bioluminescence guided methodologies to test multiple automated IHC staining analysis of resonance energy transfer (BRET) based facets of experimental medicine and digital IHC images. Experimental sensor strategy is being developed to concept therapeutics in live cells and approaches are being developed to study protein-protein interactions in small animal models. A major focus is study modulation of endogenous hNIS vivo. This will enable functional on the use of preclinical imaging for expression using cell and preclinical screening in vitro in live cells, with lead therapeutic evaluation of human mouse models. hNIS promoter-reporter testing in physiologic mouse model. The sodium iodide symporter (hNIS) gene vector and engineered BC cells have multiplexed BRET systems developed targeted radio-iodine therapy for breast been developed to study regulation of and validated in this lab can monitor cancer. A phase I trial has been initiated hNIS function. A couple of HDAC functional responses of signaling at TMH to evaluate the feasibility of inhibitors showing preferential pathways, such as STAT3 post- performing NIS based targeted radio- elevation of endogenous hNIS translational modifications in breast iodine therapy. In another line of expression in breast cancer cells have cancer. research, synthetic nano-scale been identified, and on-going work with translational medicines are being these pharmacological targets shows Education developed for breast and oral cancer. promise. p53 protein has been The Principal Investigator is a Organo-metallic nano-material identified as a negative regulator of recognized guide for Ph.D. in Life consisting of gold nanoparticles and hNIS transcription in breast cancer cells. Sciences of the Homi Bhabha National thermolabile biodegradable liposome Several novel findings will help in Institute. At present, there are five has been developed and tested for devising clinically relevant protocols for research scholars – Ms. Sushmita photo-thermal therapy using preclinical application in the breast cancer clinic in Chatterjee, Ms. Madhura Kelkar, imaging guidance in tumor xenograft the future. In the cancer nano- Ms. Shalini Dimri, Mr. Arijit Mal and model. Optical imaging sensor therapeutics program, gold Ms. Maitreyi Rathord working on their technology is also being developed to nanoparticles were tested for laser doctoral dissertation and two monitor breast cancer target proteins mediated photo-thermal therapy in postdoctoral research associates in the such as STAT3 and EpCAM, which can breast cancer cells; these findings have lab. The lab also participates in the facilitate functional screening of gene been published in Nanoscale (IF 6.8). A Centre’s training program and, during mutations and inhibitor compounds lymph targeted nanoparticle carrying the year, four trainees worked in the lab against specific cancer proteins/ Tamoxifen was developed as a common – one for her Master’s dissertation and pathways. breast cancer medicine. A nano- three for research experience. The formulation is being developed for faculty and lab members also siRNA delivery to cancer cells. In breast Research participate in weekly data presentation cancer cells, EpCAM status during the hNIS over-expression was in >80% of and journal club, and presented their development of radiation resistance over 200 breast cancer samples studied, research findings in oral/ poster was evaluated, and EpCAM targeted indicating its potential use in radioactive presentations at local/national/ RNA/ DNA aptamer is being tested as a I-131/ I-125/ I-124 compatible international conferences and candidate breast cancer imaging probe. radioiodine therapy/ SPECT/ PET based meetings.

156 Tata Memorial Centre Annual Report 2014-2015 Dutt Lab

Dr. Amit Dutt Principal Investigator

Overview cell carcinoma (HNSCC) using SNP arrays characterize the functional relevance of The overall aim of Dutt lab is to and next generation sequencing activated oncogenic tyrosine kinases in understand the biological basis of technology, in a bid to identify activating tongue squamous cell carcinoma in a various human cancers to guide mutations in HNSCC genomes that bid to identify genetic vulnerabilities development of clinical therapeutics. could represent therapeutic and potential targets for new therapies. vulnerabilities. Genome-wide RNAi Research efforts involve integrated screen with human pooled tyrosine characterization of somatic alterations Education kinase shRNA libraries in HNSCC cell of cancer-specimens by performing Dutt lab is recognized for Ph.D. in Life lines is being run to discover genome-wide analysis of copy number Sciences from the Homi Bhabha vulnerabilities among multiple cell lines changes using SNP arrays, genomic re- National Institute. At present there are established in house from Indian tongue sequencing using next generation 6 research scholars – Mr. Pawan cancer patients. In the area of sequencing platforms, and low Upadhyay, Mr. Pratik Chandrani, progestogenomics, the goal is to throughput loss-of-function pooled Mr. Prajish Iyer, Mr. Mukul Godbole, identify transcriptional targets of RNAi mediated genetic screen using Ms. Trupti Togar and Ms. Vidyalakshmi progesterone in human breast cancer tumor derived cell lines established in Sethunath working for their doctoral in order to understand the mechanism house. Considerable efforts also focus dissertation. Two trainees worked in the by which progesterone exerts its on experimental evaluation of lab during 2014 for research experience. biological effect through transcriptional functional relevance of somatic targets in human breast cancer cells. The lab has a regular in house data alterations identified by genomic Human lung cancer is being profiled to presentation and journal club program approaches, using molecular and discover additional mutationally in which all the members of the lab cellular approaches. activated oncogenes besides EGFR and participate. A weekly joint meeting with ALK, which could provide novel other research groups at ACTREC is also Research therapeutic targets for this deadly conducted. During 2014, lab members Prime among the research disease. Attempts are also being made participated in several national investigations conducted in Dutt lab is to generate the first landscape of conferences and presented their the one that aims to define the cancer genetic alterations in human findings through oral or poster genome of head and neck squamous retroperitoneal liposarcoma and to presentations.

Tata Memorial Centre / ACTREC 157 Gupta Lab

Dr. Sanjay Gupta Principal Investigator

Overview Research Education Every cell in an organism contains same An on-going study in gastric cancer The lab is recognized for Ph.D. in Life genes, but different genes are suggests that histone modification Sciences of the Homi Bhabha National expressed in different cell types. This pattern - H3 Serine10 phosphorylation, Institute. At present, there are six genetic information is competently is altered in malignancy and is regulated doctoral students – Ms. Monica Tyagi, managed by epigenetic mechanisms - by the enzyme, MSK1. Further, genome- Mr. Shafqat Ali Khan, Mr. Saikat epigenome for facilitating the wide hypo-acetylation in gastric tumor Bhattacharya, Ms. Divya Velga Reddy, expression of specific genes. Partly, it tissue with increase in HDAC enzymes Ms. Asmita Sharda and Mr. Ramchandra relies on a DNA-histone protein signifies the importance of HDAC Amnekar. Dr. Gupta is also a co-guide complex called chromatin. Histones are inhibitor with standard chemotherapy. for Mr. Suresh Subramanian, Scientific emerging as key players in human Also, the reversible reduction of H3 Officer at BARC. Eight trainees worked health and are known to be altered in Serine10 phosphorylation in only G1 in the lab during 2014 for their Master’s different physiological states. Research phase cells in response to ionizing dissertation and three as collaborative performed in the lab focuses on radiation induced DNA damage raises trainees. Faculty and lab members meet epigenetics and chromatin biology, with the possibility of its modulation by twice a week for data presentation, an emphasis on understanding how cell specific inhibitors for efficient cell death abstract and journal club, and cycle specific alteration in histones during radiotherapy. The histone participate in national/ international affects their role in DNA damage variants story unfolds further and conferences to present their research response; the clinical significance of suggests that altered transcription findings through invited, oral or poster alteration in covalent modification of factor interactions with the key co- presentation. histones in human cancers; repressors p53 and Sox9 partly transcriptional regulation of histone contribute to the differential expression variants, variant-specific PTMs and their of histone variants, H2A.1 and H2A.2 in binding partners during carcinogenesis; hepato-carcinogenesis. Further, studies how structure and function of show non-redundant roles of H2A.1 and chromatin fiber is altered with the H2A.2 isoforms which differ in only replacement of canonical histones by three amino acid residues. The H2A.2/ histone variants; and finally, the H2B dimer is more stable compared to question of how to translate the H2A.1/H2B dimer and this contributes information into diagnostic and to more stable H2A.1 containing therapeutic tools for better nucleosome. Also, H2A.1 over management of cancer. expression leads to higher proliferation, without affecting the migratory potential of cells.

158 Tata Memorial Centre Annual Report 2014-2015 Kalraiya Lab

Dr. Rajiv Kalraiya Principal Investigator

Overview Research reciprocal regulation, the lab has demonstrated for the first time that The research focus of Kalraiya lab is to With reference to glycobiology and its glycosylation at serine-30 (S30) on K18 understand the role of altered relevance to malignant progression, positively regulates phosphorylation at glycosylation on proteins at the cell sialic acids (α 2,6) on highly branched an adjacent S33. Mutation at S30 has surface in two important processes in N-oligosaccharides on melanoma cells were seen to promote adhesion and the same effect on solubility and cancer, viz., invasion and metastasis. stability of K18 and on filament The lab has demonstrated how the induce secretion of MMP-9. Activation of MMP-9 at the invading front was architecture as that of S33 mutation. highly branched N-oligosaccharides Assays to explore the mechanisms expressed on cancer cells alter the facilitated by co-localization of membrane tethered form of MMP (MT- involved in progesterone (PG) mediated properties and localization of key survival advantage to breast cancer molecules like integrin receptors into 1 MMP), with integrin receptors carrying such oligosaccharides. Their patients showed that it affected specialized membrane microdomains role in regulating movement and adhesion, movement and secretion of and alter their properties, in turn degradation of basement membrane MMPs in receptor negative breast facilitating cancer cell invasion. The was also demonstrated. Terminal cancer (4T1) cells in vitro. A single depot terminal substitutions on these N- substitutions in the form of poly-N- injection of PG at half the dose used for glycans in the form of poly N-acetyl acetyl-lactosamine (polyLacNAc) were humans (normalized for mice, based on lactosamine (polyLacNAc) substitutions shown to serve as high affinity ligand body surface area), prevented lung have been shown to serve as anchor for for galectin-3, expressed in highest metastasis significantly. circulating melanoma cells to get amounts on all the major tissue arrested on the lung vascular compartments of the lung including the Education endothelium expressing galectin-3 surface of its vascular endothelium. The lab is recognized for the Ph.D. constitutively on its surface. The PolyLacNAc/ galectin-3 pair was shown degree in Life Sciences of the Homi mechanism and modes to inhibit these to participate in the arrest and Bhabha National Institute (a deemed interactions and thus metastasis are extravasation of melanoma cells in the university). During 2014, one student – being explored. The lab also investigates lungs. Inhibition of polyLacNAc Mr. Amit Ranjan was awarded PhD the role of a novel type of glycosylation synthesis or the competitive inhibitors degree, two students Mr. Akhil Kumar (O-glcNAcylation) seen on nuclear and for endogenous galectin-3 both Agarwal and Mr. Manohar Dange inhibited lung metastasis. The proteins cytoplasmic proteins in regulating the submitted their PhD thesis, while carrying polyLacNAc on melanoma cells properties of keratin 8/18, and its impact Mr. Shyam More and Ms. Poonam have been identified using mass on the cellular properties important for Kakade are in the final stages of their spectrometry and the mechanism by malignant progression. The mechanism PhD program. The lab also participated which one such carrier protein LAMP1 by which a single depot injection of in the training program of the Centre progesterone provides survival facilitates metastasis has been elucidated. The role of the novel and accepted nine trainees in the lab – advantage to breast cancer patients, six for the Master’s dissertation, one for especially those bearing receptor glycosylation (O-glcNAcylation) in regulating keratin 8/18 function and its research experience and two as negative breast cancer is being explored relevance to cellular properties has collaborative trainees, during the report using an animal model. been elucidated. As opposed to period.

Tata Memorial Centre / ACTREC 159 Mahimkar Lab

Dr. Manoj Mahimkar Principal Investigator

Overview Research inhibition of proliferation and induction Research activities of this lab focus on Analysis of chromosomal alterations of apoptosis. understanding the genetic basis of and gene expression changes tobacco related cancers, specifically the reportedly are better predictors of Education identification of putative genomic clinical outcome. Array comparative The lab is recognized for the Ph.D. biomarkers responsible for oral genomic hybridization analysis of program of the Homi Bhabha National carcinogenesis. Cancer progresses advanced stage oral cancers revealed Institute. Presently there are three through the accumulation of genetic chromosomal gain of 11q22.1-q22.2 research scholars working on their Ph.D. and epigenetic changes, ultimately region associated with loco-regional thesis – Ms. Priyanka Bhosale, resulting in gross genomic instability recurrence and shorter survival. These Ms. Rasika Hudlikar and Ms. Usha Patel. and changes in gene expression. Non- observations are being validated by The lab participates in the Centre’s random copy number alterations are FISH; preliminary data indicate that training program and, during this year, one of the key mechanisms responsible amplification of this locus is associated nine trainees worked on small projects for changes in gene expression. with nodal metastasis. Putative driver under the PI for their B.Tech./M.Sc. Therefore investigations of this lab focus genes associated with oral dissertation. on two major aspects of oral cancer carcinogenesis have been identified by biology: (a) Genomic alterations at the integrating DNA copy number and gene level of copy number across the expression data. Extensive genomic genome, and (b) Identification of genes/ analysis of oral precancerous lesions is gene clusters underlying these altered on-going. Comprehensive evaluation of genomic loci using microarray. biomarkers such as epidermal growth Microarray based global transcriptomic factor receptor (EGFR), hypoxia analysis is also being used to study inducing factor α (HIF-α), HPV and their sequential development of lung correlation with the clinical outcome of adenomas in A/J mice induced with the patients singly or in combination is also tobacco smoke carcinogens - under way. In the chemoprevention benzo(a)pyrene [B(a)P] and 4- studies, the PBP rich fraction of black (methylnitro-samino)-1-(3-pyridyl)-1- tea down-regulated B(a)P and NNK butanone (NNK). Chemoprevention induced cell proliferation (diminished using phytochemicals is a promising PCNA and Bcl-2 expression) and approach for lung cancer management. enhanced apoptosis (increased Bax The chemopreventive efficacy of expression) through phosphorylation of polymeric black tea polyphenols (PBPs), p38 and Akt. Anti-inflammatory action abundantly found in black tea, to inhibit of PBP was evident from reduced Cox-2 [B(a)P] and NNK induced lung adenoma expression. The protective effects of is also being examined. PBP fractions could be through

160 Tata Memorial Centre Annual Report 2014-2015 Maru Lab

Dr. Girish Maru* Principal Investigator *superannuated in May 2014

Co-Investigator Dr. Asha Ramchandani* *superannuated in July 2014

Overview of Research polyphenolic extracts had been clearly Education During the year, efforts were directed demonstrated in several experimental The lab participated in the Centre’s at collating the findings of the on-going models. Chemoprotection resulted training program and three trainees research programs on chemo- from modulation of carcinogen (two with the PI, and one with the Co-I) modulation of carcinogenesis directed metabolism by phase I and phase II worked in the lab during 2014. towards the identification and enzymes, carcinogen/ tumor promoter- delineation of the mechanisms of action induced inflammation, cell proliferation of chemopreventive agents from Indian and apoptosis. Evaluation of signal foods and beverages, and development transduction pathways revealed that of surrogate endpoint biomarkers. The modulation of kinase functions by anti-initiating and anti-promoting polyphenols was responsible for the activities of curcumin, polymeric black chemoprotective effects. tea polyphenols (PBPs) and crude grape

Tata Memorial Centre / ACTREC 161 Prasanna Lab

Dr. Prasanna Venkatraman Principal Investigator

Overview The research focus of Prasanna Lab is in understanding some basic, hitherto unanswered questions on the structural, mechanistic and cell biological aspects of protein degradation by the proteasome. Advances made in the lab on two proteasomal chaperones PSMD9 and PSMD10 have led the way to a system wide study employing novel Using buried information on been identified and experimentally computational approaches to deduce conformational dynamics, a whole body validated using a stem cell model. novel functions to identify bottlenecks of novel genes/ proteins can be tested Limited low throughput screening using in the protein interaction and regulatory for ‘druggability’. siRNA against putative interacting networks using ex vivo model systems. partners of gankyrin has led identified This could serve as a paradigm to Research bottle necks in cell growth and viability characterize differences between On-going research projects involve of cancer cells. This will be validated in normal and cancer samples and a robust assay and rescue experiments identify/ recognize therapeutically dissection of the fine structure and domain motif specificity of PSMD9 with by ectopic expression of the wt protein vulnerable nodes and edges in the and non interacting mutant. network. Building on the observed its interacting partners using high novel ATPase activity of 14-3-3 proteins, resolution biophysical approach, and studies are on to see if this activity is solving the structure at atomic Education necessary for the ex vivo and in vivo resolution. These would pave way for The Principal Investigator is a functions of this phospho protein the design of small molecule inhibitors recognized guide for Ph.D. in Life κ binding and scaffold protein. The of PSMD9 that can inhibit NF B activity. Sciences for Homi Bhabha National program PNSAS - developed in house, Identification of the minimal motif Institute. Of the seven research scholars has helped identify desmoglein 2 involved in binding of the proteasome in the lab, Ms. Padma Nanaware and will be studied using site directed (Dsg-2) as an authentic substrate of Mr. Manoj Ramteke obtained the PhD mutagenesis and functional assays. The matriptase and led to the prediction degree in 2014, Mr Nikhil Sangith role of PSMD9-RPS14 interaction in p53 that steady state levels of Dsg-2 submitted his thesis, while Mr. Indrajit regulation during ribosomal stress and regulated by matriptase may be Sahu, Ms. Mahalakshmi important in controlling cell adhesion/ possible role of PSMD9 in transcriptional control of protein Ramachandran, Mr. Sheikh Burhan ud invasive properties of some epithelial din Farooqee and Mr. Saim Mulla are cancers. Testing this possibility on translation/ degradation such as in non- sense mediated mRNA decay is being working on their dissertation. Three primary tissues of recurrent/ non postdoctoral fellows worked on various recurrent breast cancer patients has identified. In collaboration with IIT-B, Mumbai, an integrated computational projects of the lab during 2014. The lab indicated that the levels of the enzyme also participates in the centre’s training could be a predictive marker for relapse. and experimental approach is being program and ten trainees worked under The study will be extended to a larger taken to discovering and analyzing her supervision for six for M.Sc. cohort of blinded samples. In an regulatory networks in systems biology. dissertation and four for research independent effort towards crystallizing It is proposed to build and test a experience. The lab has an active in biological information from voluminous network model to examine the cell fate data in high throughput studies, a decisions regulated by the proteasomal house data presentation and journal method has been developed to validate chaperones PSMD9 and PSMD10 in a club program, and several lab members experimentally determined well-defined cellular model system. presented their research findings as oral phosphorylation sites using structural Using micro array data and network or poster presentations at national/ principles. It has identified allowed/ approach, a putative novel role for international conferences in 2014. disallowed regions of phosphorylation. PSMD10 in neuronal differentiation has

162 Tata Memorial Centre Annual Report 2014-2015 Ray Lab

Dr. Pritha Ray Principal Investigator

Overview Research repression in chemo resistant cells, the Ovarian cancer, commonly known as Recently published research from this molecular regulation of IGF-1R “silent lady killer” is a challenging lab indicates that expression of insulin expression in chemoresistant cells and disease worldwide due to late diagnosis like growth factor receptor (IGF-1R), a the association of Hox genes with and acquisition of resistance to receptor tyrosine kinase and activator heterogeneity of epithelial ovarian standard chemotherapeutic molecules. of PIK3CA/Akt and MAPK/ERK signaling cancer and other aspects of drug Research in the Lab focuses majorly on is upregulated at early stages of resistant ovarian cancer. three aspects of epithelial ovarian resistance and decreased when the cells cancer: Understanding the major are highly resistant to Cisplatin or Education signaling pathways responsible for Paclitaxel or both. Oscillation of IGF-1R The Principal Investigator is a acquired chemoresistance for an expression involves both transcriptional recognized guide for Ph.D. in Life endeavor to early detection of and post-translational regulation. A Sciences under the Homi Bhabha chemoresistant ovarian cancer; small cohort of ovarian cancer patients National Institute (a deemed Assessing association of cancer stem who have undergone 3-4 cycles of University). At present, five students- cell with chemoresistant ovarian platinum/taxane therapy demonstrated Ms. Snehal Gaikwad, Mr. Ram K Singh, cancer; Investigating molecular upregulated IGF-1R expression in Ms. Subhoshree Chatterjee, heterogeneity in epithelial ovarian primary tumors. Picropodophyllin, a Mr. Bhushan Thakur and Mr. Ajit cancer. Research in this lab involves small and specific inhibitor of IGF-1R Dhadve, are working on their doctoral cellular and molecular biological, shows maximal reversal of chemo dissertation. The lab also participates in proteomics, phage display screening resistance at early stages. In a separate the Centre’s training program, wherein approaches and in vivo preclinical study, a novel series of di-fluorinated one research associate and four trainees imaging techniques, using indigenously propanedione derivatives were seen to worked under her supervision. Lab developed various drug resistant synergistically augment paclitaxel members participate regularly in the in models of ovarian cancer cells and mediated caspase 3 activation in house data presentation, and during patient samples. ovarian cancer cells. Besides these, 2014 they attended two national and investigations are on to determine how one international conference. PIK3CA/Akt signaling escapes p53

Tata Memorial Centre / ACTREC 163 Rukmini Lab

Dr. Rukmini Govekar Principal Investigator

Overview anemia in CML, which highlighted the Education The research focus of Rukmini Lab is to unforeseen contribution of neutrophilic The lab is recognized for PhD in Life understand the molecular basis of protease to the premature senescence Sciences of the Homi Bhabha National lineage decisions in hemopoiesis using of erythrocytes in CML. Taking clue from Institute. Two research scholars, Ms. Philadelphia chromosome positive these observations, the effect of Mythreyi Narasimhan and Mr. Rahul lymphoid and myeloid leukemia as a proteases secreted by tumor infiltrating Mojidra, are working on their doctoral model system. In this set of leukemias, neutrophilic on membrane proteome of dissertation. Fourteen students the pluripotent hemopoietic stem cell tumor cells and on their behavior is underwent training in the lab as a part harbors a chromosomal translocation presently being investigated. of their Master’s degree dissertation and the product of this transgene is a program. Lab members regularly constitutively active tyrosine kinase. Research engage in data presentation as well as Chronic myeloid leukemia (CML) from The lab is presently involved in two presentation of published articles in an this group progresses either to research projects. In the first one in-house journal club. During 2014, the lymphoid or myeloid blast crisis. A entitled ‘Proteomic and PI co-ordinated (along with Dr. Gauri subsection of patients with acute phosphoproteomic profiling of BCR/ABL Pantvaidya of TMH) co-ordinated the lymphoid leukemia are Philadelphia positive leukemias’, mass spectrometry conduct of three quarterly sessions of chromosome positive. Comparative is being used to determine the the training program in laboratory proteomic profiling of these leukemias proteomic profiling of cell lines techniques in translational research for which harbor a common chromosomal representing lymphoid and myeloid M.Ch. surgical oncology students.. She aberration but progress to distinct blast crisis of CML. In the second project was also invited to deliver lectures at hemopoitic lineages would throw light examines ‘The effect of cathepsin G - a local/ national workshops. on the molecular basis of lineage neutrophilic protease, on the decisions in hemopoiesis. Further the membrane proteome of MCF 7 cells’. A profiles can assist in an understanding comparison of proteomic profile of of the resistance of CML blasts to the cathepsin G treated/ untreated cells has currently used tyrosine kinase inhibitor identified substrates of cathepsin G in therapy and also in the identification of the membrane fraction of MCF 7 cells. an alternate therapeutic target. These results will be further validated Another area of focus of the lab has in patient samples. evolved from previous studies on

164 Tata Memorial Centre Annual Report 2014-2015 Sarin Lab

Dr. Rajiv Sarin Principal Investigator

Co-Investigator Dr. Pradnya Kowtal

Overview Research Education The research focus of Sarin Lab is to In 2014, over 650 new hereditary cancer The Principal Investigator is a understand the molecular basis of families were enrolled and counselled recognized guide for Ph.D. in Life inherited and somatic cancers, and with DNA banking. Molecular genetic Sciences of the Homi Bhabha National develop translational algorithms analysis and reporting along with risk Institute. With two post doctoral through molecular biology and management of mutation carriers was fellows, three graduate students functional genomics. The lab is done for over 100 families. Novel (Ms. Nikhat Khan, Mr. Moquitul Haque, interrogating these questions through mutations in BRCA1 were characterized Ms. Vasudha Mishra) working on their three projects: a large cohort of 3000 using comprehensive in-silico and Ph.D. dissertation, fifteen trainees families with various inherited cancer functional studies. Haplotype analysis (14 with the PI and one with the Co-I), syndromes along with their DNA and of hereditary colorectal cancer families the lab has an active weekly academic EBV lymphoblastoid cell line bank; harboring the same genetic defect in a program of data presentation/ journal BRCAGEL case-control study of 2800 mismatch repair gene showed shared club. Three parallel one week hands on breast cancer cases/ matched healthy haplotypes amongst the families training workshops were conducted in controls; and oral cancer patients with indicating common ancestry. In the October 2014: Workshop I: Cancer full clinical and pathological annotation, BRCAGEL case control study, 600 new Genetics Counselling, Workshop II: follow-up and exome/ whole genome subjects were enrolled in 2014. Basic Techniques in Molecular Biology; sequenced as part of the International Association of clock genes and Workshop III: Advanced Techniques in Cancer Genome Consortium (ICGC) chronotype with breast cancer risk was Molecular and Genetic analysis. project, in collaboration with NIBMG, reported. Clinical correlation of the Kolkata. exome sequencing data for gingivo buccal cancers form the ICGC cohort Service pooled with TCGA data showed the The lab provided genetic counselling, survival advantage in tumors with genetic testing and risk management somatic mutations in the lipid guidance as appropriate for 650 new metabolism pathways. Novel BRCA1 hereditary cancer families. mutations were characterized using comprehensive in-silico and functional studies. Haplotype analysis of hereditary colorectal cancer families confirmed founder effect of a common germline mutation in MLH1 gene.

Tata Memorial Centre / ACTREC 165 Shilpee Lab

Dr. Shilpee Dutt Principal Investigator

Overview clinicians at ACTREC and TMH to extend Glioma recurrence has been shown. The long term goal of Shilpee lab is to the findings from in vitro model system Data from this lab provides novel gain insights into the molecular basis of to patient samples, and lead to possible insights into an unexplored multi-step radiation and chemo resistance in translational benefits of these studies. process of radiation survival and relapse cancer. Initial efforts are directed in glioblastoma that can be exploited for towards understanding epigenetic Research therapeutic interventions for regulation of chromatin structure and The lab has an active research program glioblastoma and generate rationales the DNA damage response (DDR) of a that encompasses four major projects: for novel combinational targeted cell. DDR pathway is a well appreciated Chromatin regulation of DNA damage therapies. key player in conferring chemo and repair (DDR) pathway in radiation radiation resistance to the cancer cells. resistant Glioblastoma; Dynamics of Education However, how epigenetics and double strand break repair in The lab is recognized for Ph.D in Life chromatin structure are regulated and chemoresistant leukemias and Sciences from the Homi Bhabha contribute in modulating DNA repair of Glioblastoma; Omics approach to National Institute. At present there are therapy resistant cancer cells is unclear. elucidate the molecular mechanisms of four research scholars - Ms Ekjot Kaur, Attempts are being made to understand resistance to cancer therapy; Role of Mr. Sameer Salunkhe, Ms. Jacinth therapy related molecular mechanisms cancer stem cells in cancer Rajendra and Ms. Jyothi Nair, working that link chromatin and DNA damage therapeutics. Radiation induced for their doctoral dissertation. The lab repair. Furthermore, to get a homotypic cell fusions of resistant participated in the Centre’s training comprehensive understanding of Glioma cells have been identified as a program with nine trainees working for different intracellular signaling novel non-genetic mechanism to their M. Sc dissertation. Lab also pathways, crosstalk between them, and sustain survival and relapse. This is the participated in the ‘open day’ their contribution towards conferring first study to show that radiation conducted by ACTREC. The lab has therapeutic resistance, the total resistant Glioma cells acquire a regular in house data presentation and transcriptome and proteome of the reversible non-proliferative phenotype journal club program in which all the sensitive and resistant cancer cells is by phosphorylating Cdk1 (Y15) to members of the lab participate. A also being analyzed to identify key undergo cell-cell fusion, an otherwise weekly joint lab meeting with other signaling pathways that could provide rare event between two cancer cells to research groups at ACTREC is also novel targets for therapeutic form multinucleated giant cells conducted. Lab members participated intervention. Towards this end, in vitro (MNGCs). Cell fusions induce in a number of national conferences resistance models primary patient senescence, high expression of during the year and presented their samples of glioblastoma and leukemia senescence associated secretory findings through oral or poster have been generated, and we employ proteins (SASPs) and activation of pro- presentations. cell biology, molecular biology, survival signals (pAKT, BIRC3 and Bcl-xL) biochemistry and microscopy based in MNGCs. For the first time, the approaches. We are collaborating with importance of cell to cell fusions during

166 Tata Memorial Centre Annual Report 2014-2015 Shirsat Lab

Dr. Neelam Shirsat Principal Investigator

Overview subgroup having the most distinctive tumours. One tumour was identified as miRNA profile. WNT subgroup specific, an astrocytoma based on the lack of chr Brain tumours are the leading cause of miR-193a expression inhibited 1p/19q codeletion and the presence of cancer related deaths, particularly in anchorage-independent growth of ATRX and TP53 mutation, while another children and young adults. Exome medulloblastoma cell lines. MiR-224 tumour lacking IDH1/IDH2 mutation sequencing of oligodendroglioma, an expression increased radiation was found to be closer to glioblastoma adult brain tumour that is often difficult sensitivity of both medulloblastoma based on the presence characteristic to distinguish from an astrocytoma, and glioblastoma cells, and down- genetic alterations (Figure). Thus, identified a number of novel genetic regulated the apoptosis inhibitor 5 besides histopathological characteri- alterations and indicated the need of gene. MiR-148a expression inhibited zation, molecular characterization of molecular characterization for accurate tumorigenic and invasive potential of adult gliomas is necessary for accurate diagnosis. Medulloblastoma is a medulloblastoma cells lines. Neuropilin common malignant brain tumour in diagnosis. 1 (NRP1) was identified as a novel miR- children. Genome wide expression 148a target. NRP1 expression in profiling studies have demonstrated Education medulloblastomas was associated with that it is comprised of 4 core molecular The Principal Investigator is recognized poor survival, with little or no subgroups. Molecular subgrouping of as a guide for Ph.D. in Life Sciences of expression in majority of the WNT over 200 medulloblastomas has been the Homi Bhabha National Institute. tumours. This observation is consistent done using a miRNA based assay that During 2014, the lab had seven with high miR-148a expression, low was developed last year. The functional graduate students – Ms. Ratika Kunder incidence of metastasis, and excellent role of a number of miRNAs was awarded the Ph. D. degree in May survival of the WNT subgroup tumours. differentially expressed in the molecular 2014, while Mr. Kedar Yogi, Ms. Pooja The tumour suppressive effect of miR- subgroups of medulloblastomas has Panwalkar, Mr. Satish Kumar Singh, 148a expression in medulloblastoma been investigated. Mir-148a and miR- Mr. Vijay Padul, Ms. Shalaka Masurkar cells accompanied by the down- 193a have been identified as miRNAs and Ms. Raikamal Paul are working on regulation of NRP1, ROCK1 and DNMT1 having therapeutic potential. their doctoral dissertation. The lab also expression makes miR-148a an participates in the Centre’s training attractive therapeutic agent for the program and during 2014 took four Research treatment of non-WNT trainees. Lab members participate in MicroRNA profiling of medullo- medulloblastomas. In another study, weekly journal club and data blastomas identified a number of exome sequencing of 11 tumours presentation. miRNAs to be differentially expressed diagnosed histopathologically as in the four molecular subgroups of oligodendrogliomas identified medulloblastomas, with the WNT chromosome 1p/19q co-deletion in 9

Tata Memorial Centre / ACTREC 167 Sorab Lab

Dr. Sorab Dalal Principal Investigator

Overview lab has also demonstrated that loss of Education γ The lab has two specific goals: the first 14-3-3 leads to an increase in The Principal Investigator is a guide for is to understand the mechanisms centrosome number, perhaps due to an Ph.D. in Life Sciences of the Homi preventing cell cycle progression in increase in the activity of the cdk1 Bhabha National Institute. At present, response to DNA damage, and exploit kinase. Attempts are now being made six graduate students (Ms. Mansa these pathways as targets for to exploit these observations to identify Gurjar, Mr. Srikanta Basu, therapeutic intervention; the second is targets for therapeutic intervention. It Mr. Kumarkrishna Raychaudhari, to understand the biogenesis of the cell- has also been demonstrated that loss Ms. Sonali Vishal, Ms. Arunabha Bose cell adhesion junction, the desmosome of plakophilin3, a desmosomal plaque and Mr. Akash Dubey) are working on and determine the consequences of protein, leads to an increase in the their Ph.D. dissertation. The lab desmosome dysfunction to expression of LCN2 and MMP7, and that accepted ten trainees in 2014. Lab development, tumor progression and this increase in gene expression is members participate in weekly data metastasis. required for invasion, tumor presentation/ journal club, and progression and metastasis. The attended three local/ national observations suggest that these conferences in 2014. Research molecules could be further developed Work during the past year has as prognostic markers or as targets for γ demonstrated that loss of 14-3-3 leads therapeutic intervention. Finally, it has to defects in desmosome formation in been determined that loss of 14-3-3σ cell lines in vitro and in the testis in vivo, leads to induction of the Epithelial resulting in sterility in male mice. Mesenchymal Transition, because of an Experiments to determine whether loss increase in the levels of c-Jun, a γ of 14-3-3 in other tissues leads to a transcription factor required for the disruption in desmosome formation are expression of EMT transcription factors now being performed. Work from this such as slug.

168 Tata Memorial Centre Annual Report 2014-2015 Teni Lab

Dr. Tanuja Teni Principal Investigator

Overview Research Education The research focus of Teni Lab is on Among the three interacting partners of Teni Lab is recognized for Ph.D. degree gaining insight into the molecular basis Mcl-1 studied, USP9X and TCTP in Life Sciences of Homi Bhabha of oral and cervical tumorigenesis. The exhibited a strong positive correlation National Institute and five doctoral projects undertaken in this lab aim to: with Mcl-1, and the role of USP9X in students – Ms. Rupa Vishwanathraman, (1) understand the mechanisms Mcl-1 stabilization in oral cancers was Mr. Prasad Sulkhshane, Mr. Mohd. underlying altered expression of select also confirmed. Targeting of Mcl-1 with Yasser, Ms. Rajashree Kadam and apoptosis pathway genes: Mcl-1, BH3 mimetic obatoclax induced Ms. Dhanashree Mundhe, are presently survivin and clusterin, as also p53 family autophagy-dependent but caspase- working on their doctoral theses. The members in oral cancers; (2) identify independent cell death in oral cancer lab also participates in the training radioresistance-related genes and cells. Studies also demonstrated over program of the Centre where four proteins using FIR regimens in vitro and expression of all six survivin isoforms, trainees worked in the lab for masters genomic and proteomic approaches in with survivin wt and DeltaEx3 as the dissertation or research experience in oral cancers; (3) assess prevalence of predominant expressed splice variants 2014. The lab also has an in-house human papilloma virus (HPV) in head and downregulation of secretory weekly program of data presentation and neck cancers, significance of HPV clusterin in oral cancer cells. and journal club. Faculty and students viral load analysis as an indicator of Differentially expressed proteins in of the lab attended various treatment response in cervical cancers, radioresistant versus parental oral conferences/ workshops and presented diagnostic performance of HPV-E6/E7 cancer cell lines namely prohibitin, their research findings in the form of mRNA versus oncogenic HPV DNA as a moesin, PCNA, vimentin, HSP-70, oral or poster presentations. secondary triage test for VIA positive keratin 8 and 14-3-3 sigma were women in cervical cancer screening validated by Western blotting. The program, and association of HPV with overall prevalence of HPV DNA in head Bak and Bax protein expression in head and neck tumors was 39.4%, and 495 and neck cancers; (4) role of activins/ VIA positive women out of the total inhibins, members of the TGFβ family 3839 women screened for cervical in oral cancers. cancer have consented and been enrolled for diagnostic HPV DNA or E6/ E7 mRNA testing.

Tata Memorial Centre / ACTREC 169 Vaidya Lab

Dr. Milind Vaidya Principal Investigator

Co-Investigator Mrs. Sharada Sawant

Overview Research lingual carcinogenesis revealed The main research focus of Vaidya Lab Data from the lab revealed a significant alterations in known and novel proteins; is to investigate the functions of keratin, correlation between loss of K5/ gain of these were validated in rat and human vimentin and their associated proteins K1, K8/18 and histological grade of tissues. Global protein profiling of rat in epithelial homeostasis/ cancer, and dysplasia/fibrosis as well as recurrence tongue tissues at various stages of oral their use as biomarkers in oral cancer. free survival (Figure); these could serve carcinogenesis led to the identification Several projects examine the use of as surrogate markers for diagnosing oral of a novel marker - Tenascin N involved keratins as prognostic markers in potentially malignant disorders and in oral cancer development. To study + human oral precancer and cancer; the could aid prognostication in oral cancer the role of cancer stem cells, CD44 role of keratin 8 phosphorylation in patients. Findings were also suggestive enriched population and parental neoplastic progression of squamous cell of a tissue specific role for K8/K18 in AW13516 cells were injected in nude carcinomas (SCC); role of linker proteins malignant transformation/ progression mice. Mice injected with the former in keratin mediated regulation of beta- of carcinomas. For transgenic model showed tumour recurrence, with the 4 integrin signaling in neoplastic development, keratin 8 tumour cells expressing stem cell progression of SCC; role of keratin 8, 18 phosphomutants were cloned under markers (ABCG2, vimentin, EGFR, etc). and vimentin during epithelial K14 promoter and introduced into mesenchymal transition (EMT) using lentiviral vector (pCCL), followed by Education oral organotypic co-culture model; and virus production and injection in testes The lab is recognized for Ph.D. in Life the significance of aberrant vimentin of mice. 3D co-cultures of normal oral Sciences of the Homi Bhabha National expression during early and late events epithelial cells and fibroblasts are being Institute. Four graduate students – Mr. of human oral oncogenesis. The lab is developed to study EMT during oral Biharilal Soni (submitted thesis), Ms. also engaged in projects involving global carcinogenesis. For the first time, Richa Tiwari, Ms. Crismita Demello, and protein profiling of sequential changes aberrant vimentin expression was Mr. Pratik Chaudhari are presently during rat lingual carcinogenesis and noted in human oral precancerous working on their doctoral theses. different stages of tongue cancer in lesions. Up/ down regulation of Eighteen students (15 with the PI, three humans, as also on the enrichment and vimentin expression in cell lines derived with the Co-I) underwent training in the characterization of cancer stem like cells from dysplasia and oral SCC led to lab during 2014. The lab members meet and their possible role in human oral changes in cell motility, invasion and regularly for data presentation and cancer. quantitative alterations in K14 and journal club. Faculty and students beta4 integrin expression. I-TRAQ attended six national/ international analysis during sequential stages of rat meetings and presented their findings as oral/ poster presentation.

170 Tata Memorial Centre Annual Report 2014-2015 Varma Lab

Dr. Ashok Varma Principal Investigator

Overview NCoA2, RNA binding domains and squamous cell carcinoma treated with Varma Lab integrates genomics, NUP153 proteins were crystallized. In radiotherapy, and aiming further for proteomics, biophysical, structure another project, MERIT-40, RAP80 and urine proteomics in cancer biomarker biology and bioinformatics based its mutant protein have been purified discovery. approaches to unravel the structure and functionally characterized using in- based functional activities of cancer silico and in-vitro approach. The Education associated proteins. The group also molecular model of RAP80 and MERIT The Principal Investigator is a targets druggable targets for better 40 could unravel the pathogenicity recognized guide for Ph.D. in Life inhibitor designing. The lab is well associated with the reported mutations. Sciences under the Homi Bhabha equipped with state-of-the-art facility Protein-protein interaction studies of National Institute. During 2014, two for macromolecular crystallography, different cellular proteins like BARD1, research scholars – Mr. Dilip Badgujar protein-protein interactions study. X-ray BAP1, MERIT40, RAP80, CsTF, ZBRK1, and Mr. Vikrant undertook work on diffractometer and isothermal titration FANCI and FANCD2 are also under way their doctoral dissertation under the PI’s calorimetry are being used to to understand the genomic integrity of guidance. The lab participated in the determine three dimensional structures complex molecules. Other on-going Centre’s training program and accepted of proteins and protein-protein projects include structural studies of 12 trainees to work in the lab during interactions respectively. Diffraction MAPKs family responsible for different 2014. Lab members also participate in data is also being collected from human cancers; and identification of the in house journal club/ data synchrotron facility using remote data protein biomarkers in head and neck presentation twice a week. collection facility. Proteomics based approach is being explored for early diagnosis, prognosis and cancer biomarker discovery.

Research There are several on-going projects of the lab, one of which is on BRCA1/2, wherein different functional domains of BRCA1 and 2 have been expressed and purified using bacterial systems. Crystallization is under way; the transactivation domain and BRCT domain could crystallize as a native protein and also with complexes. The complex crystals of BRCA1 BRCT with different phospho-peptide like Abraxas,

Tata Memorial Centre / ACTREC 171 Venu Lab

Dr. BV Venugopalareddy Principal Investigator

Overview Research Education The research focus of Venu Lab is on Currently the lab is actively engaged in The Principal Investigator is recognized elucidating the mechanisms two projects involving Hippo pathway for Ph.D. in Life Sciences of the Homi underpinning glia development and regulation in glia growth control and Bhabha National Institute, and has one growth control, with the long term goal development, and Hippo pathway graduate student – Mr. Mukund to define the relationship between regulation by post translational Sudharsan. The lab also participates in growth and patterning in developing modifications. Over the past year, the the Centre’s training program wherein tissues and its relevance to cancer. fly lab has been successfully established ten trainees worked either for their Much of the research takes benefit of at ACTREC and several methodologies Master’s dissertation or for research the genetic model organism -Drosophila involving fly genetics and experiments, experience. The lab members meet Melanogaster (Fruit fly), and in-vitro and Drosophila tissue staining and twice a week for data presentation/ human cell line models to study how imaging have been standardized. This journal club. Lab members attended tissue growth/ homeostasis is achieved. lab has recently discovered a role for local/ national conferences to present The technical approaches include tumor suppressor- Merlin (human their research findings. Drosophila genetics, cellular, molecular homologue -Neurofibromatosis type-2, and biochemical analysis of signaling NF2), in Drosophila glia development molecules, coupled with confocal and and growth through Hippo signaling. live imaging microscopy. Glial cells along with the neurons constitute the central nervous system (CNS) and are fundamental to CNS development. Hippo signaling is a relatively novel tumor suppressor pathway that controls organ growth and size from flies to humans. Furthermore, Hippo signaling inactivation has been reported in several human cancers. Using genetic and proteomic approaches, it is proposed to harness the mechanisms that define Hippo signaling in Drosophila glia growth control.

172 Tata Memorial Centre Annual Report 2014-2015 Waghmare Lab

Dr. Sanjeev Waghmare Principal Investigator

Overview cancer stem cell regulation for potential there are four graduate students – Waghmare Lab focusses on studying the cancer therapeutics; and defining the Mr. Rahul Sarate, Mr. Gopal Chovatiya, molecular and cellular mechanisms that role of signaling pathways in novel Ms. Sweta Dash and Mr. Raghava Reddy govern stem cell regulation, and how tumor-initiating cells from human Sunkara working on their doctoral perturbations in these mechanisms lead breast cancer lines. dissertation. The lab also participated to cancer. Signaling pathways such as in the training program of the Centre, Wnt/ Notch/ Sonic hedgehog, TGF-β, Education wherein four trainees worked for EGFR, etc. regulate stem cell renewal, The lab is recognized for the PhD research experience. Lab members and genes affected in these pathways program in Life Sciences of Homi participate in weekly in-house lab are associated with cancer. Therefore, Bhabha National Institute. Presently presentation/ journal club, and it is very crucial to study the genes presented posters at national meetings. involved in signaling pathways that control self-renewal of normal stem cells and their malignant counterparts, cancer stem cells. Mouse skin and human epithelial cancers such as head and neck cancer are being used as models to unravel the mechanisms that govern adult stem cell regulation and cancer. These studies will allow the identification of genes involved in stem cell regulation and cancer, and explain how these genes work at the cellular level to develop normal tissue and also repair injured tissue to maintain homeostasis. The findings could also be useful in cancer therapeutics.

Research Research projects of this lab involve elucidation of the role of enhancing factor/ secretory phospholipaseA2-IIA in hair follicle stem cells and cancer; K14-sPLA2 mice showing loss of hair follicle stem cells dissecting the role of Sfrp1 (secreted frizzled-related protein) in hair follicle A) Phenotype; B & C) H & E staining; D) FACS analysis of hair follicle stem cell regulation and cancer; stem cells (a6+/CD34+). WT – Wild-type; TG – Transfenic; IFE 0 molecular signaling in human oral Interfollicular epidermis; HF – hair follicle

Tata Memorial Centre / ACTREC 173 Dr. Narendra Joshi Scientific Officer ‘F’ Other Projects - I

Overview of Research Service Education The year 2014 saw initiation of a study The lab performed chimerism analysis The lab participates in the Centre’s to examine the effects of vitamin D3 and on 750 follow up specimens, and training program; one trainee worked progesterone on the immune- baseline STR analysis for 100 donor/ under Dr. Joshi’s supervision during modulatory phenotypes of breast recipients of bone transplants 2014. Lab members participate in cancer cell lines. Four cell lines with performed in the BMT unit of ACTREC weekly group discussions/ journal club. different phenotypes were procured and at other Centres. During 2014, two from ATCC, and their culturing was vital changes were implemented in STR initiated. Experimental methods/ analysis: A shift to using DNA isolation protocols were standardized. Gene kits, which reduced the reporting time expression data in breast cancer tissues from a fortnight to a week, and charges was analysed to enable preparation of were implemented for the tests two manuscripts. Meta-analysis of data performed to recover the cost of on IL-6 -174G/C polymorphism in consumables. various cancers was completed and published in Human Immunology. Efforts to clone HLA-B*4006 and beta- 2 microglobulin genes were continued with a new vector.

Dr. Ujjwala Warawdekar Scientific Officer ‘E’ Other Projects - II

Overview of Research in the peripheral blood of breast cancer test and control arms, and clinically This lab focuses on assessing minimal patients are being monitored. In the relevant analysis is in progress. A residual disease in solid tumours, to pre-operative depot progesterone systematic review of the utility of gauge the efficacy of therapy and administration trial, 38 new patients extracellular matrix proteins as outcome of the disease. The prognosis were accrued this year taking the total diagnostic/ prognostic markers in solid of cancer patients is largely determined to 65. CTC isolation involves density tumours is under way. by blood borne dissemination of centrifugation and immunomagnetic tumour cells from the primary site to enrichment, detection and Education enumeration using multicolour flow distant organs like bone and lung, and One trainee worked under cytometry, followed by validation of the the subsequent outgrowth of these cells Dr. Warawdekar’s supervision during data with quantitative RT-PCR and in the new microenvironment. The 2014. levels of circulating tumour cells (CTCs) microscopy. CTCs were detected in both

174 Tata Memorial Centre Annual Report 2014-2015 CRI - Research Support Facilities Anti-Cancer Drug Screening Facility

Dr. Aarti Juvekar1 / Dr. Jyoti Kode2 Officer-in-Charge

1 Superannuated in November 2 Took charge in December

normal mice. Interesting leads were identified during the screening of 105 The Anti-Cancer Drug Screening Facility xenograft models for carrying out drug compounds on 12 cell lines under a (ACDSF) supports the efforts of anti- screening. During the report year, 1972 multicentric CSIR funded project on cancer drug development in India, with compounds were received from 241 ‘Affordable cancer therapeutics’. A 5- in vitro and in vivo anti-cancer drug customers for testing anti-cancer day hands-on workshop on ‘Advanced screening assays developed in-house. activity. Of these, 1916 compounds techniques in anti-cancer drug ACDSF has over 45 human tumor cell were tested in vitro on cell lines, while evaluation’ was conducted by ACDSF in lines, 10 murine tumor models and 28 56 compounds were tested in-vivo in November 2014 at ACTREC.

Bioinformatics Centre (BTIS)

Dr. Ashok Varma Officer-in-Charge

Scientific Officer ‘D’ Mr. Nikhil Gadewal

The DBT supported Bioinformatics proteins; structure based inhibitor acknowledging the contributions of this Centre (BTIS), which is equipped with designing of CHK1, CHK2, WEE1 kinases. centre. BTIS is funded by DBT in support excellent computational facilities and BTIS has provided services to analyze of staff/ contingency, etc, and to infrastructure, provides bioinformatics Next Gen deep sequencing data with organize training programs for the support to the scientists, clinicians and software like bcl2fastq, FASTQC faculty/ research scholars from the students of the Centre. Different Burrows-Wheeler Aligner, etc. BTIS North-East Region in January 2014, BTIS software are used to train scientists in faculty members have close conducted a 2-day Bioinformatics molecular modeling, microarray collaborations within ACTREC and other Training Workshop targeting the faculty expression analysis, and structure academic institutions, and are invited and research scholars of colleges/ guided inhibitor design. Major projects to deliver lectures in academic universities. BTIS has its dedicated in which BTIS is involved include: institutions. Two Ph.D. students of the website: protein-protein docking for BRCA1, Coordinator have submitted their http://www.actrec.gov.in/ MERIT40, RAP80, ABRAXAS and WNT thesis; other PhD students of ACTREC basic_main.htm(ii)http:// signaling pathways; in-silico approach too have utilized the facility. In 2014, www.actrec.gov.in/bioinformatics/ to categorize the pathogenicity of four publications accrued in peer index.htm mutations in cancer associated reviewed international journal

Tata Memorial Centre / ACTREC 175 Biorepository

Dr. Kishore Amin Scientific Officer ‘F’

The Biorepository facility is designed to promote the safe handling, receipt, processing, storage, inventory control and distribution of all types of biological specimens, surplus tumour, adjoining normal tissues and blood from cancer patients, and to provide them on request to scientists and clinicians for their Institutional Review Board - approved research projects. Patient 2014, the majority were head and neck various protocols in Tata Memorial consent is procured initially. Tumour (H&N – sub sites were buccal mucosa, Centre. Attempts were also made to samples are collected from operation tongue, alveolus, gingivo buccal sulcus, generate cell lines from tumour tissue theatres and snap frozen in liquid retro molar trigone and lip) and breast samples from different sites. Thus, the nitrogen for further downstream tumour samples. Other tumour types ACTREC Biorepository facilitates cancer processing. The facility houses ultra-low included neurological, gastrointestinal, researchers to dissect tumour tissues mechanical freezers, vapor-phase liquid genitourinary, gynecological, etc. for intricate research challenges; the nitrogen freezers and modern Cryopreserved tissue samples were data procured could serve as opening equipment. Of the tissue samples provided to eight Principal Investigators avenues for discovering novel therapies, accrued in the Biorepository during with approved projects depending on and early cancer diagnosis.

Common Facilities

Dr. Sanjay Gupta Officer-in-Charge

The Common Facilities (CF) provide a located on different floors and wings of maintained by the CF technicians. A variety of services like X-ray developing Khanolkar Shodhika (KS). The isotope new x-ray developing machine machine, ultra-pure water purification research facility has state-of-art (Promax ADC from Prognosys) was system, radioactive handling room for equipment like biohazard hoods, purchased in 2014. All the major CF 32P and 125I, bacterial culture hoods, ice radioactivity monitors, incubators, equipment are covered under annual making machines and cold room facility centrifuges, and gamma/ beta counters. maintenance contract, with the to all the research groups of the Centre. In addition, autoclaves and ovens of all mandate of providing safe, sustainable, All the CF are well-equipped with high- the research labs in KS are also efficient and reliable facilities. end research equipment and are

176 Tata Memorial Centre Annual Report 2014-2015 Common Instrument Room

Mr. Uday Dandekar Officer-in-Charge

breakdowns and subsequent downtime of the instruments, requisite spares for centrifuges, low temperature freezers, CO2 incubators, etc. and consumables like centrifuge tubes, thermal paper rolls, etc. are procured on a regular basis and kept in stock in the CIR. Qualified technical staff members attached to the CIR handle routine maintenance and Over the past 37 years, the Cancer and students, round the clock - even on render help to the end users, thus Research Institute has maintained holidays. A bioruptor, cell ensuring proper use of the equipment. Common Instruments Room (CIR) - a electroporator, sonicator and tabletop CIR also provides technical support to facility which houses routinely required high speed centrifuges were newly other research laboratories in the scientific equipment, with a view to procured and installed in this facility procurement and maintenance of optimize their utilization and make during 2014, taking the total equipment capital equipment. them available for the use to all the staff count to 84. With a view to reduce Comparative Oncology Program & Small Animal Imaging Facility

Dr. Pradip Chaudhari Scientific Officer ‘F’

The major focus of this facility during received at this clinic where 39 CT scans research. The second aspect of this 2014 was on its Comparative Oncology were performed on these patients for program focuses on preclinical small program involving small animal diagnostic purposes, five animals were animal imaging and research on spontaneous cancer care and treated using radiation therapy, and radiopharmaceuticals, where management, and its further utility for nine cases received single/ combination diagnostic radionuclides such as translational research. Pet animals agent chemotherapy. An animal cancer Technetium-99m, Iodine-125, suffering from spontaneous cancer are tissue repository has been started to Lutetium-177 and Fluorine-18 being referred to the ACTREC animal preserve the biological samples for complexes are being evaluated for their oncology clinic for diagnosis and further basic cancer research. In all, 39 fresh utility in cancer diagnosis and management. The most common tumor tissue samples have been treatment. The Small Animal Imaging spontaneous animal cancers are accrued and kept at -196°C while 75 facility focuses on radioisotopic imaging mammary gland carcinoma, canine formalin-fixed tissues obtained from of rodents – both mice and rats, using transvenereal tumor, lymphoma, soft animal cancer biopsies and surgeries microPET/ SPECT-CT scanner, for various tissue sarcoma and osteosarcoma. have been stored in the repository for in housel and external research During the year, 141 referral cases were their use in comparative oncology projects.

Tata Memorial Centre / ACTREC 177 Digital Imaging Facility

Dr. Dibyendu Bhattacharyya Officer-in-Charge

The ACTREC Digital Imaging facility LSM780 microscope, (3) 3i Mariana provides microscopic acquisition and (ADIF) is a state of the art imaging spinning disk confocal microscope, (4) analysis services for wide-field and the facility housing several advanced Leica SP8 confocal microscope with different confocal platforms listed imaging platforms. At present, the STED super resolution system, (5) Leica above, to the entire ACTREC community facility boasts of the following DMI600B microscope - from as well as to many outsider users. instrumentation: (1) LSM510 confocal Bhattacharyya lab, (6) Axio Imager .Z1, microscope, (2) Multiphoton confocal and (7) Axio Vert 200M. The facility

DNA Sequencing Facility

Dr. Pradnya Kowtal Officer-in-Charge

The DNA sequencing facility at ACTREC caters to the needs for capillary electrophoresis and DNA sequencing of researchers from the Centre, other DAE institutes and a few colleges from Mumbai. The facility is used to detect germline and somatic mutations in cancer, to confirm data generated by used for DNA sequencing, fragment server is 36 hours. Users of this facility site directed mutagenesis or obtained analysis and single nucleotide are charged minimally per sequencing from other sequencing technologies like polymorphism analysis, and are reaction. The facility carried out Next Generation Sequencing (NGS). The operated by two scientific assistants. ~28,260 reactions (sequencing + facility has two automated DNA Since the last five year, the facility has fragment analysis + single nucleotide sequencers from Applied Biosystems – been working six days per week. The polymorphisms) during the current one has eight capillaries and the other average turnaround time from receiving year. 48 capillaries. Both the sequencers are the samples to depositing data on the

178 Tata Memorial Centre Annual Report 2014-2015 Electron Microscopy Facility

Mrs. Sharada Sawant Officer-in-Charge

installation and research training, it was functionally available from September 2014. Presently, the EM facility is accepting samples for EM processing from in-house users at a minimal charge of Rs. 500/sample. The facility processes mainly biological samples in the form In May 2014, the Centre procured a new 12,00,000 x. Along with the microscope, of solid tissue, monolayer cell cultures Transmission Electron Microscope (JEM the Centre has also procured EM related and single cell suspension. During the 1400 Plus from JEOL Asia), which is the accessories such as Scanning last three months of the year, the facility latest, most advanced model of EM with Transmission Electron Microscope has processed 60 samples for ultrathin one nanometer resolution and mode, Tomography module and Energy sectioning, scanning and imaging for magnification range between 50 x and Dispersive Spectroscope (EDS). After eight working groups of the Centre.

Flow Cytometry Facility

Dr. Shubhada Chiplunkar Officer-in-Charge

stem cell analysis, side cell population, detection of circulating tumor cells, cell proliferation by CFSE, measurement of calcium flux, intracellular antigen measurement, mitochondrial membrane potential, drug resistance, reactive oxygen , intracellular cytokine detection, cytometric bead array for cytokine analysis and live cell Flow Cytometry (FCM) is a centralized analysis. Software used include sorting. During 2014, 67 users used facility which is used by scientists and FACSDiva, CellQuest Pro, FlowJo, FCAP FACSCalibur and 44 used FACSAria. The clinicians from ACTREC and other Array and Modfit. Facility staff train facility also offers services to outside outside institutes. FCM houses two flow users in data analysis, and provide users on payment basis, and provides cytometers (FACSAria and FACSCalibur assistance in data interpretation or demonstrations/ training for visiting from Becton Dickinson). FACSAria is experimental designing, when required. clinicians, scientists and students on equipped with 3 lasers (633 nm, 488 nm Research applications include request. A two-day Basic Course in Flow and 405 nm) and can perform 11 color immunophenotyping, multicolor Cytometry - Hands-on Workshop-II was analysis and sorting (4 way). analysis, DNA content and cell cycle conducted at the Centre in July 2014 FACSCalibur is equipped with one 488 analysis, ploidy determination, under the auspices of the Mumbai nm laser and can perform 3 color apoptosis studies by Annexin V staining, Immunology Group.

Tata Memorial Centre / ACTREC 179 Histology Facility

Dr. Arvind Ingle Officer-in-Charge

Histology is a service facility that provides slides of unstained as well as haematoxylin and eosin (H&E) stained histology sections of animal tissue samples including bone and tumour tissues to different laboratories of CRI- ACTREC. During 2014, this lab received 5312 tissue samples in fixative and, after processing, supplied 4544 stained and 14726 unstained slides to 22 in- samples. During the report period, 932 eight research labs. Histology also house user labs. The facility also tissues were processed for cryo- provides blocks of multiple tissues by provided logistic support for frozen sectioning and 442 H&E stained and pecking method using a microarray sectioning of human/ animal tissue 1326 unstained slides were supplied to machine.

Laboratory Animal Facility

Dr. Arvind Ingle Officer-in-Charge

The main objective of the Laboratory Animal Facility (LAF) is to breed, maintain and supply laboratory animals to institutional scientists. Breeding and experimentation of all Nude and SCID mice is undertaken in IVC cages. During the year 2014, LAF undertook planned breeding of 25 different strains of mice, 2 strain of rat, and 2 strains of hamsters; and supplied 3858 normal mice, 411 pathogens, and carried out PCR based undertook genotyping of 146 ptch KO Nude mice, 725 NOD SCID mice, 54 rats, tests for infectious agents and viruses mice. As a part of the embryo freezing and 31 hamsters to 25 institutional using 60 random samples from 15 program, LAF collected 1396 embryos researchers against 76 IAEC sanctioned strains. The facility provided services of at the 8-cell to morula stage from 249 research proposals. LAF also supplied rodent pathogen testing by PCR method mice of 9 strains (A/J, C3H/J, CD1, Swiss, 12436 normal mice, 1204 rats, and 82 to an outside organization. Genetic Swiss/ba, smo/smo, C57BL/6, EGFP, and hamsters as either breeding nuclei or purity was checked by skin grafting and NOD SCID) and froze the embryos in experimental animals to 18 different biochemical marker testing in rat and cryo-vials under liquid nitrogen by CPCSEA registered outside mouse strains. LAF also undertook PCR vitrification using the cryo-protectant organizations in the country. During based tests for genetic purity using 10 ethylene glycol. 2014, LAF routinely tested animal microsatellite markers in 12 mouse samples, food, water, bedding material strains. Using flow cytometry, the T- and Education and room air samples for B-cell profile was assessed in 28 blood The facility participates in the Centre’s microbiological, clinico-pathological, samples of Nude/ SCID and in control training program; one trainee worked and serological detection of 13 rodent BALB/c and Swiss mice. LAF also here on her B.Tech. thesis in 2014.

180 Tata Memorial Centre Annual Report 2014-2015 Macromolecular Crystallography and X-Ray Diffraction Facility

Dr. Ashok Varma Officer-in-Charge

This facility has been inducted in helps in the smooth functioning of the diffraction data collected from this ACTREC during 2012. The dedicated facility. The focus of the facility is to help facility. Faculty from this facility teach facility has a Microstar Microfocus users in crystallization of different basics of diffraction to visiting scientists, Rotating Anode and an integrated macromolecules, and further studies of provide training to scientists from computer controller motorized Image X-ray diffraction to get the three different institutions and to participants Plate Detector. Remote data collection dimensional structure. So far, 53 to the Bioinformatics and ACDS facility is available to get access to the crystals have been analyzed using the workshops, and offer diffraction Synchrotron facility located in different facility. Different groups from the services to scientists from IIT-B, parts of the world. Prof. MV Hosur, Raja Centre use the facility and two students’ BARC, etc. Ramanna Fellow attached to the Centre, theses from Varma lab contain

Mass Spectrometry Facility

Dr. Rukmini Govekar Officer-in-Charge

graduate students from KLE College, Nipani and Modern College, Pune. The facility also has a system for off-line analysis of liquid chromatography (LC) -separated samples, wherein the LC system (Agilent 1200 series micro LC) is coupled to a robotic MALDI-plate spotter (Bruker Proteineer). This year, the scope of MS- applications in the The Mass Spectrometry facility at sequencing and molecular weight facility expanded by the addition of a ACTREC has a MALDI-TOF/TOF (Bruker determination of small molecules such new Nano-LC-MS-MS platform Ultraflex II) platform which was as polyethylene glycol. The facility was (ABSCIEX 5600 plus). The facility is now extensively used during 2014 to analyze also used by scientists from institutes better equipped to handle several other over 540 samples from in-house users of repute in and around Mumbai, such applications such as MS-based primarily for identification of proteins as BARC, QbD Research and differential quantification and analysis by peptide mass fingerprinting, Development Lab Pvt. Ltd., and by of post-translational modifications, etc.

Tata Memorial Centre / ACTREC 181 General Administrative & Administration Core Infrastructure Groups

Sr. Administrative Officer Mr. M.Y. Shaikh Administrative Officer (II) Ms. M.A. Sharma Jr. Administrative Officer Mr. Vilas Pimpalkhare DCA, ACTREC Mrs. P. Kamala Accounts Officer II Mrs. Sandhya Patil OIC, Engineering section Mr. P.B. Baburaj Purchase Officer Mr. S.C. Kirkase Jr. Stores Officer Ms. P. Kotenkar DCSO, ACTREC Mr. R.M. Chavan

Within the Administrative group, The department also ensured merit etc. It has provided timely welfare Human Resource Development carries based review and promotions of measures and facilities necessary for out the functions of entire manpower employees by holding yearly DPC in maintaining an excellent working planning, recruitment of staff (regular respect of all the above cadres. Day to atmosphere, imparted training by as well as on contract) and training the day administrative functions deputing 32 staff within and outside human resources of the Centre. In 2014, encompassed e-attendance control, Mumbai, convened in-house weekly 27 regular staff members were maintenance of leave records, updation administration lectures to update the appointed in different grades in the of staff records with regard to pay knowledge of the staff. Periodical Medical, Scientific, Nursing, Technical fixation/ re-fixation matters, settlement training/ demonstration of computer and Auxiliary cadres, adhering to the of personal claims, release of software like LTC, national/ reservation policies of the Government retirement/ terminal benefits becoming international deputation, Time- keeping, Leave Module, Contributory of India. Around 100 contract staff due on superannuation/ death cases, Health Service Scheme (CHSS), members were also deployed this year and payment in time of staff, time to Employee Portal and implementation of through M/s. G.A. Digital, TMC, to time performance appraisal/ monthly the same for facilitation of staff distribute the work load because of the attendance reports, proper follow-up of members was carried out. One increased inflow of cancer patients and matters/ decisions taken during various Computer Programmer was deployed direct registration facility initiated at the meetings, diplomatic and amicable on contract basis to assist the HRD Centre. handling and settling of inquiry matters, programs.

182 Tata Memorial Centre Annual Report 2014-2015 Timely payment of PRIS, update campus are well maintained by a Management System (FMS) were allowance to eligible employees, professionally trained horticulturist and implemented during 2014. Hospital and providing duplicate Service Book to team of gardeners. A ‘Nisarg-Runa other income to the extent of Rs.11.50 staff, service verification of staff those Biogas Plant’ is running successfully on crore was generated. A total of 182 completed 25 years of service, are other the campus, and ensures the disposal projects are on-going in various activities carried by HRD. of organic/ kitchen waste in an eco laboratories at ACTREC during the Implementation of the Reservation friendly manner. Housekeeping report year. A sum of Rs. 8.30 crore was Policy of the Govt. of India duly adopted services maintain cleanliness, good received for 43 projects from by TMC in respect of SC/ ST/ OBC/ PWD/ sanitation and hygienic conditions on government agencies, viz., DBT, DST, Ex-Serviceman is carried out regularly the campus. During the year, a number ICMR, LTMT, etc. In addition, funds for and systematically, and all efforts have of training sessions were organized for 10 new projects to the tune of Rs. 3.18 been made to ensure and achieve the housekeeping and horticulture workers. crore were sanctioned, of which Rs. 1.55 prescribed percentage of reserved ACTREC received a Garbage Tipper crore were received in ACTREC accounts posts. TMC merit scholarships were vehicle this year as a donation under the during the calendar year 2014. awarded to three children of ACTREC Swachh Bharat Abhiyaan program. The staff members. During 2014, five staff Garbage ground was revamped this Engineering members achieved superannuation, year for segregation of wet and dry Engineering services comprising of Civil, while one staff member took voluntary garbage. The CRC entrance was Electrical, Mechanical and Air retirement from 31.1.2014. renovated this year. Signage at different conditioning, facilitate the Administration (Estate Management): locations on the campus was requirements of research laboratories The department controlled and refurbished for better guidance. Neon and hospital wing of the Centre. The managed all the outsourced activities signage of ACTREC has been installed scope of works include operation and aimed at the effective functioning of on top of Khanolkar Shodhika; it is maintenance of 33 KV receiving station, various systems, viz., Hostels, Guest visible from a distance at night enabling 11 KV substations, transformers, House and Faculty Club, Staff and easy location of the Centre. lighting and power distribution, DG sets, Patient Canteens, Retreat, Cafeteria, central air-conditioning plants, Medical Transportation, Horticulture, Pest Finance and Accounts Gas System, LPG distribution system Control services, Photocopier machines, The focus of the Finance and Accounts through pipe lines, supply of liquid Courier/ Post & Telegraph services, department has been effective nitrogen, hospital and lab furniture, clearing of service bills, as well as management of funds, judicious pumping stations, low temperature refilling of gas cylinders in laboratories/ budgetary controls, and review of facilities, laboratory equipment. BMT/ Patient Hostels, Guest House at financial outflow. Maintenance of Engineering also handles building Faculty club. Disposal of biodegradable/ requisite documentation and other maintenance including additions, bio-medical waste is done in relevant records was done in conformity alterations and modifications in a compliance with highest standards set with the instructions issued by constructed area of ~5,00,000 sq.ft. as per the government norms. Department of Atomic Energy, Govt. of area on a 60 acre plot. Engineering also Arrangement of accommodation for India from time to time. Procurement looks after water management of the patient’s families at Lords & Melbourne of various supplies, material and campus, sewer waste management, Hostel and effective functioning of equipment required for the Centre was water distribution system for Railway Reservation system are undertaken, by following the relevant horticulture, storm water drain of effectively handled by the department. financial provisions, viz. General campus, liaison work with local The Centre takes pride in the large Finance Rules, Purchase Procedure, authorities, etc. The Centre is further variety of flora on its campus. A garden besides Fundamental Rules and expanding by addition of five more th covering an area of ~1500 sq. mtrs, a Supplementary Rules in respect of buildings in the XII Five Year Plan. This plant nursery for in-house needs, and manpower/ salary expenditure. New department is coordinating with lawns at different locations in the Payroll System and Financial Architects/ Consultants for designing

Tata Memorial Centre / ACTREC 183 the buildings by providing inputs about holidays, and issue these to the end on-campus security, increasing the all requirements through regular users at the Centre in fulfillment of the height of the boundary walls, increasing meetings. Construction is in progress for indents received. Stores also checks and lighting at designated areas, two buildings - Centre For Cancer follows up on the installation of surveillance system at the entrance and Epidemiology and Archive bldg and equipment, computer peripherals, other vital areas, and revamping of the further the design of Hematolymphoid furniture. An Asset Register is fire alarm system have been proposed. Block frozen for inviting tender. maintained and updated regularly to Ceremonial Parades were performed at record asset numbers and ensure ACTREC on Republic Day and Purchase physical asset verification for audit Independence Day by the Security and inspection/ insurance purpose, etc. Purchase department aims to provide Fire Office staff of ACTREC. Proper Equipment details are fed in the newly efficient services to the entire Centre by liaison was maintained with the local developed Equipment Program. In all, way of arranging and delivering goods Police, RTO, CIDCO, Municipal 316 major/ minor equipment, laptops, as per the approved quality, and authorities, and other outside agencies. minimizing the supply time. Processing computers, printers, ACs, office Security section also assists indents, enquiries, comparative equipment, furniture, etc were Administration in managing the statements, purchase orders and acquired during 2014. On an average, Centre’s Transportation activities, viz. reminders are executed through in- ~400 stock/ non-stock indents are efficient running of the shuttle bus house Material Management System received monthly. Coding of items is services, condemnation of old vehicles, (MMS) developed in house by the done regularly. Physical stock obtaining RTO licenses for newly Information Technology department. verification by internal and external procured vehicles, etc. committees was done in September Implementation of MMS assisted in A Security Audit of ACTREC was carried efficient functioning of procurement and March; physical verification of assets was also done. Online PSNs for out by officials of the Intelligence activities and obtaining the materials Bureau and the Office of the with ease. During the report year, non-stock material are placed for Commissioner of Police, Navi Mumbai Purchase department initiated E- approval before the MMC every week. on 3rd September 2014. The queries of tendering process, one of the Non-stock material is received after the team were satisfactorily dealt with. important and requisite protocols as per thorough checking, follow up is done with the vendor, and a discrepancy Vigilance Awareness Week was DAE norms. Till date, Purchase section th was able to call three E- tenders on a register is maintained. A total of 7495 observed at ACTREC from 27 October st trial basis. During 2013-14, goods and GRINs pertaining to complete/ partial to 1 November 2014. Shri KL Prasad, equipment worth value of Rs. 33.8 supply of stock, non-stock, cash and IPS, Commissioner of Police, Navi crore, consumables worth Rs. 22.5 crore imprest purchases, equipment and Mumbai, was the Chief Guest at the and contract for supply of spares/ AMC cylinders were generated during 2014. function organized on the first day of worth Rs. 3.5 crore were delivered by GRINs were immediately prepared on vigilance week. Shri Prasad shared his the department. receipt of the material, inspected, listed thoughts and expertise on curbing and sent within a week to vendors to corruption at all levels. Shri Anil Kumar, Stores avoid hardship in payment matters. All IPS, Inspector General of Security, The main function of the Stores GRINs were properly documented and Department of Atomic Energy, visited st department is to receive stock and non- filed for future reference. ACTREC on 1 December 2014 to stock material such as chemicals/ review the present Security scenario at reagents, consumables, surgical items, Security ACTREC. He was briefed about the printing/ stationery items, Regulation of the movement of men, present security set up and measures miscellaneous items, engineering material and vehicles on campus, and proposed to improve the system. items, cash purchase and imprest items, ensuring the safety and security of Security section efficiently coordinated major and minor equipment, refilled ACTREC property, personnel and the visit of Ms. Swati Pandey, Director Administration, Department of Atomic CO2 and N2 cylinders, and consignments students round the clock is the prime arriving after office hours and on responsibility of this section. To improve Energy, on 24th December 2014.

184 Tata Memorial Centre Annual Report 2014-2015 Medical Administration

Dr. Prashant Bhat Asst. Medical Superintendent

Quality Manager Ms. Chital Naresh

Medical Administration proactively seeks patient feedback through strategically located ‘Patient Feedback Redressal’ boxes that are freely accessible to the patients, and feedback Overview with a focus on better patient care. from the patients is analyzed regularly. Since August 2013, ACTREC services During 2014, feedback was obtained The mandate of Medical Administration from 153 patients. Patients’ suggestions is to ensure provision of quality, have been opened to cancer patients from Navi Mumbai and Raigad districts. were put up for consideration uninterrupted healthcare to all the New registrations in select specialties whenever found feasible and patients attending ACTREC’s in practicable, while complaints received outpatient, inpatient, diagnostic, and are now being handled directly at ACTREC. During 2014, a total of 4854 from the patients were communicated clinical support services, achieved new patients were referred to ACTREC to the respective departments for through close coordination with the and 441 new direct registrations took corrective action. Several patients also faculty and staff of CRC. The AMS’ office appreciated the services of staff oversees Medical Administration and place here. In all, there were 4293 admissions, 2317 major operations, 666 member/s who had served them during actively encourages feedback from their treatment at ACTREC. Medical patients, and pursues improvement as new radiotherapy referrals and 75 bone marrow transplants at ACTREC. Administration also analyzed incidents an on-going process. Incident reporting through the Incident Reporting system. Medical Administration oversaw the is handled by the office and appropriate The office received 17 reported planning and commissioning of the 2nd process of root cause analysis is carried incidents during the year, and root floor 22-bed ward for Pediatrics, out in order to track the causes for the cause analysis of these incidents was Surgery, Solid Tumors and incident and incorporate remedial conducted and preventive measures Interventional Radiology; the ward was measures. Medical administration also were initiated. monitors patient service billing and inaugurated in May 2014. The services provided under research department also coordinated the beta Education testing of PET CT in collaboration with protocols. It also co-ordinates material Dr. Bhat is visiting faculty for the MHA WIPRO GE; the project is in the final procurement including capital and Executive PGDHA program at TISS, stages of installation. Turnkey work for equipment, medicines and surgicals for and is the internship supervisor for installation of a new Linear accelerator the Pharmacy, and also chairs the MHA students and project guide for two at ACTREC was initiated during the year. material management committee. This TISS students’ dissertation. As per the office also coordinates major and minor Based on Desktop Surveillance calendar plan for 2014, Medical projects being undertaken for conducted in June 2014, NABL granted Administration conducted several infrastructure development. As a part continuation of accreditation for the training programs on Basic safety in of the Infection Control Committee, medical testing facility of Tata Memorial laboratories, Orientation on the revised Medical Administration implements Centre – Diagnostic Services in the Quality Management System, Infection plans and processes to prevent disciplines of Clinical Biochemistry, control and safety practices, Pre- infections and also oversees the Clinical Pathology, Haematology and analytical errors and trouble shooting, compliance of the Biomedical Waste Immunohaematology, Microbiology and Waste management for the Management according to the regional and Serology, Histopathology, Cyto- laboratory and nursing staff. In addition, requirements. pathology and Genetics, in accordance Medical Administration also to ISO 15189:2007 as per the existing coordinated and conducted the NABL Service scope and authorized signatories. The Assessors Training program. During 2014, Medical Administration office also oversaw preparation of the contributed significantly towards Hematopathology laboratory (set up in initiating measures for the continual August 2013) for NABL accreditation in improvement in all the patient services the forthcoming year.

Tata Memorial Centre / ACTREC 185 Information Technology

Mr. Prasad Kanvinde IT Co-ordinator

Officers Mr. Padmakar Nagle Mr. M. Sriram Mr. Anand Jadhav

In fulfilment of its mandate, the maintained on a newly acquired state Software Information Technology (IT) of the art IBM power6 - 520 server class Patient information processing at the department of ACTREC provides machine that runs on 24x7 mode and Centre is essentially online, multi- computational facility, infrastructure provides information processing facility location and round-the-clock. In 2014, and support for information access, to various user departments. A updates for PABR, DIS, RIS, OT, processing, printing, archiving, summation of the activities of IT Accounts, Pharmacy, Purchase, and dissemination, etc. ACTREC has a department during 2014 is provided Stores modules were made available, campus wide 100 Mbps LAN with below. which enabled end users to make copper/ fiber cable, embellished with seamless transactions on the remote ~600 LAN nodes, eight servers and a Networking server of TMH for patient services. The secured wifi network. The campus is Day-to-day support, upkeep, earlier integrated ROIS module was connected to the Internet through a 50 administration and maintenance of updated and deployed successfully Mbps National Knowledge Network passive and active network components along with seamless data migration (NKN) information gateway with a constitute vital networking activities. across TMH and ACTREC. Major redundant 20 Mbps Reliance The Centre is in process of upgrading changes/ updates in the web based connectivity. The Centre has a live mail the network back bone connectivity on EMR were carried out in tandem with server that holds over 300 email 10 Gbps, and in accordance upgraded the paperless drive. The Clinical accounts of staff and students. various networking devices including Information System module was also Redundant/ fail safe configuration on firewall, switches and routers in phase updated with modifications to achieve the firewall ensures 99% uptime of 1. The 2nd phase will be started sooner. paperless service. Smart card system internet and mail facilities. A dedicated The centre has also acquired state of has been introduced for limited number point to point leased circuit of 12 Mbps art, latest wireless network devices on of patients in ACTREC. between ACTREC and TMH facilitates new standards with 600Mbps sharing of patient information, PACS bandwidth with high availability images, etc. Under the NKN project, the configuration of wireless controller Centre has successfully established ensuring 99.9% uptime of the network. seamless connectivity to the NKN grid at gigabit per second speed. Under ANUNET network, the Centre has Hardware established successful connectivity with The major activity during 2014 was UTKARSH a high end cluster of servers procurement of around 150 PCs, 20 for bio-informatics data processing. The printers, a midsized Internet application hospital information system (HIS) is server, Smart card system for patients, information/application kiosks, etc.

186 Tata Memorial Centre Annual Report 2014-2015 Library

Mr. Satish Munnolli Librarian

The ACTREC library proactively acquires The library subscribes to over 90 core during the report year include Web of and delivers scientific and clinical journals in the cancer domain, and Science, Wiley online, World e-Book information to its users to support on- users at the Centre have unlimited library, Conference Proceedings, going learning activities, research and access to over 2350 journals on Citation Index, Biochemistry and Cell quality patient care. The fully ScienceDirect under the DAE - Elsevier Biology, and Genome. The library automated library has a spacious consortia. Clinical Key and UpToDate are maintains a record of staff publications, reading area and its Wi-Fi enabled two new online sources incorporated in and offers services with respect to environment facilitates access to the current year. The library updated citations, h-index, Impact Factor. The scientific information on the library’s bibliographic management application Library provided 914 articles against the desktop consoles, as well as users’ - EndNote from the previous version to request of 1282 during 2014. laptops and other computing devices. X7. Sources enabled on a trial basis

Photography

Mr. Shivner Sawant Officer-in-Charge

major events on the campus, carefully archiving them, and making them available for use in the Centre’s print publications and website. During 2014, the section provided photographic support for 27 events held at ACTREC, including 10 national and 3 The Photography section provides banners, programs, certificates, badges, international conferences. The section pivotal support to the scientific and invitation cards, envelopes, letterheads, also undertakes identity card printing medical staff and students of the Centre workshop protocols, etc, using on the data card printer for Security and in photo-recording of experimental advanced computing and desktop Administration. The section also takes results (gels, animal experiments, publishing equipment and software. care of the presentation equipment and patients, etc), preparing posters and The section is also responsible for taking assists users during audiovisual slide presentations, as well as designing photographs of the campus, presentations in the Centre’s auditoria and printing of flyers, brochures, infrastructure, staff members and all and meeting venues.

Tata Memorial Centre / ACTREC 187 Science Communication and Professional Education (SCOPE) Cell

Dr. Aparna Bagwe Officer-in-Charge

The SCOPE Cell has been mandated to website. The Cell also provided vital colleges/ universities across the country oversee two vital programs of ACTREC support for the Centre’s Cancer were allocated for training to faculty of - science communication and Awareness Program. the Centre (225 short term trainees, 12 professional education. During 2014, in In support of the Centre’s doctoral summer trainees, six observers and fulfilment of its commitment to the program, SCOPE Cell handled the three postdocs). As a part of her science communication programs of the JRF2014 intake beginning with the call academic responsibilities, Dr. Bagwe Centre, the Cell edited and compiled for projects, prescreening applications delivered lectures on ‘Laboratory Safety ACTREC’s 2013 annual report that forms (1241 applications for 13 JRF projects), at ACTREC’ to the new trainees. During a component of the Tata Memorial conduct of written entrance exam and 2014, the Cell also provided logistic Centre’s 2013-14 report. On request, interviews, up to selection of the JRFs. support for eight educational visits from Dr. Bagwe provided editing services for The Cell also oversaw the year long students of colleges, institutes and manuscripts and conference material. academic coursework for the fresh universities from across the country and The Cell assisted by the Steno Pool recruits; this included schedule newly recruited scientific officers from handled information dissemination preparation and conduct of orientation, the Atomic Energy Review Board, about lectures, seminars, conferences lab visits, lab allotment, core course/ members of the BARC Officers and meetings in ACTREC through emails elective lectures and exams, correcting Association, and contestants of the and circulars. Staff of the Cell helped objectives, collating marks, preparing DAE’s All India Essay Contest on Nuclear design and upload webpages for transcripts, and DC formation. The Cell Energy. The Cell, jointly with the Events conferences and workshops held at the also coordinated the short term and Committee, also conducted the Centre’s Centre, and handled routine uploads of summer training program of the Centre, Open Day in December 2014. tenders/ advertisements on to the in which 246 UG and PG students from

188 Tata Memorial Centre Annual Report 2014-2015 Scientific Resources: Core Committees in ACTREC

ACTREC Apex Committee for Research ACTREC Institutional Ethics Committee and Academics (AACRA) ACTREC IEC, constituted as per the ICMR guidelines for Ethics AACRA, which was established in April 2006, acts as the apex Committees, has the mandate for combined scientific and research and academics committee to: carry out the mandate ethics review of research projects being conducted at ACTREC. given to ACTREC by the Scientific Advisory Committee, This committee monitors research studies involving human promote basic, interdisciplinary, translational and disease subjects and use of tissues collected/ banked during oriented research, recommend and coordinate measures for diagnostic or therapeutic procedures. achieving excellence in research and academics. Chairperson Dr. Rita Mulherkar, Basic Scientist, Chairperson Dr. SV Chiplunkar, Director, ACTREC (Retired) ACTREC Co-Chairperson Dr. Sudeep Gupta, Dy. Director, Co-Chairperson Dr. Nobhojit Roy, Surgeon, CRC-ACTREC BARC Hospital Members Dr. Neelam Shirsat Member-Secretary Dr. Vedang Murthy, Dr. Rajiv Sarin Radiation Oncologist, ACTREC Dr. Rajiv Kalraiya Members Dr. Vikram Gota, Clinical Pharmacologist, ACTREC Dr. Aliasgar Moiyadi, Surgeon, ACTREC Dr. Tejpal Gupta, Radiation Oncologist, ACTREC Basic Sciences Research Group Dr. Kumar Prabhash, BSRG is a forum of basic scientists at ACTREC where scientific Medical Oncologist, TMH issues related to academic and research programs, Dr. Navin Khattry, infrastructure development, organization of symposia and Medical Oncologist, ACTREC meetings, updates on research support facilities, Dr. Bharat Reiki, Pathologist, TMH opportunities for extramural and intramural funding support and related matters are discussed. Dr. Prasanna Venkatraman, Basic Scientist, ACTREC Chairperson Dr. SV Chiplunkar, Director, ACTREC Dr. BB Singh, Legal expert – Advocate, Co-Chairperson Dr. Sudeep Gupta, Dy Director, Mumbai High Court CRC - ACTREC Dr. Manoj Mahimkar, Member Secretary Dr. Tanuja Teni Basic Scientist, ACTREC Members All Principal Investigators & Mrs. Sadhana Kannan, Co-Investigators Biostatistician, ACTREC All Officers-in-Charge, CRI Facilities Ms. Lakshmi R., Social Scientist Mrs. Deepa Ramani, Lay person

Tata Memorial Centre / ACTREC 189 Institutional Animal Ethics Committee Institutional Radiation Safety Committee IAEC fulfills the requirements of the Committee for the IRSC is mandated to ensure that the guidelines of the Atomic Purpose and Control and Supervision of Experiments on Energy Regulatory Board for the use, storage, handling and Animals (CPCSEA), Ministry of Environment and Forests, Govt. disposal of radioactivity are followed in the respective areas of India. IAEC reviews animal study proposals and advises by the designated officers, along with guidelines defined by the investigators to ensure optimal use of the animals as per IRSC. At ACTREC, radioactive sources are used for in-vitro CPCSEA guidelines. assays, radiation treatment and radiodiagnosis procedures Chairperson Dr. SV Chiplunkar in clinical and preclinical setup. IRSC monitors the safe handling, use and disposal of radioactive sources, and Secretary Dr. Arvind Ingle occupation safety aspects while working in the radiation Members Dr. Manoj Mahimkar areas. Dr. Pradip Chaudhari Chairperson Dr. Shubhada Chiplunkar, Director, Dr. Pritha Ray ACTREC Dr. Renuka Munshi, Member Secretary Dr. Pradip Chaudhari, Radiation Safety Scientist from outside Officer, CRI Mrs. Ranjana Baburao, Members Dr. DD Deshpande, Head, Non-scientific socially aware member Medical Physics Div., TMH CPCSEA Dr. DD Manjramkar Dr. JP Agarwal, Main Nominee Dept of Radiation Oncology, TMH CPCSEA Dr. HD Sarma Dr. SL Juvekar, Radiodiagnosis Dept, Link Nominee ACTREC Dr. Shashank Ojha, Institutional Biosafety Committee Dept of Transfusion Medicine, ACTREC IBSC serves as the nodal point for implementation of the Ms. Reena Devi, CRC, ACTREC biosafety guidelines for recombinant DNA research, their Ms. Siji Nojin Paul, CRC, ACTREC production and release into the environment, and setting up containment conditions for certain experiments as set by the Ms. Sneha Mithun, Recombinant DNA Advisory Committee of DBT. Research Dept of Nuclear Medicine, TMC projects involving the use or production of microorganisms or biologically active molecules that might cause a biohazard Academic Committee must be notified to the IBSC in the DBT-prescribed format. The Academic Committee oversees all matters pertaining to The IBSC permits genetic engineering activity on classified the JRF program and coordinates the academic coursework organisms only at places where such work should be (core course and electives), JRF entrance exam paper setting, performed. The committee members are empowered to and ensures the smooth conduct of the course exams. subject the storage facility, work place, etc. to inspection. Convenor Dr. Neelam Shirsat Chairperson Dr. Rajiv Kalraiya Members Dr. Manoj Mahimkar Member Secretary Dr. Manoj Mahimkar Dr. Sanjay Gupta Members Dr. Sanjay Gupta Dr. Kakoli Bose Dr. Pritha Ray Dr. C. Muralikrishna Dr. BV Venugopala Reddy Dr. Pritha Ray Dr. Shashank Ojha Dr. Sanjeev Waghmare DBT-Nominee Dr. Shubha Tole, TIFR Outside Expert Dr. Geetanjali Sachdeva, BARC

190 Tata Memorial Centre Annual Report 2014-2015 Internal Complaints Committee Anti-Ragging Committee In pursuance of section 4 read with its applicable subclauses In May 2014, an Anti-Ragging Committee was constituted at of the aforesaid act, the Internal Complaints Committee (ICC) ACTREC in terms of the decision taken by the Government of at TMC-ACTREC is empowered to enquire into the complaints India, duly notified through the Homi Bhabha National related to the sexual harassment of women at the workplace. Institute (HBNI) under whose affiliation the Centre conducts Presiding Officer Dr. Tanuja Teni its Ph.D. program in Life Sciences. This committee looks into the matter of complaints of ragging at ACTREC. Members Mrs. Meera Achrekar Chairperson Dr. Sanjay Gupta Mrs. Bhagyashree Tillu Members Dr. Prasanna Venkatraman Mr. Mushtaq Shaikh Dr. Rukmini Govekar Outside Expert Mrs. Usha Banerji Dr. Sanjeev Waghmare Student Members Ms. Abira Ganguly Mr. Raja Reddy Kuppili

Tata Memorial Centre / ACTREC 191 New Projects approved by the ACTREC Institutional Ethics Committee during 2014

Principal Investigator Name of the Project/ Trial Dr. Tanuja Teni Role of anti-apoptotic McL-1 gene in human oral cancers Dr. Shailesh Shrikhande Phase III randomised controlled trial comparing D2 versus D3 lymphadenectomy on outcomes of non-metastatic, resectable, but locally advanced, gastric cancer following neoadjuvant (perioperative) chemotherapy (ELANCe trial) Dr. Sudhir Nair Human papilloma virus in head and neck squamous cell carcinoma - prevalence and molecular studies Ms. Reena Devi To study characteristics of optically stimulated luminesecence dosimeters (OSLD) and establish Phuraliatpam the dosimetry system for in-vivo patient dosimetry Dr. Tanuja Teni Expression of survivin isoforms and p53 family members in tobacco chewing-associated oral cancers Dr. Amit Dutt Whole genome sequencing for identification of oncogenic mutations in cervical adenocarcinoma Dr. Ujjwala Warawdekar Enrichment, isolation and culture of circulating tumour cells Dr. Jaya Ghosh Study evaluating the activity of methotrexate, 6 mercaptopurine, 6 thioguanine and propranolol in ovarian cancer cell lines Dr. Vedang Murthy Evaluation of HPV association with proapoptic proteins BAK and BAX in HNSCC patients Dr. Tejpal Gupta A randomized multicenter trial of accelerated hypo - vs. normo-fractionated radiotherapy for head and neck squamous cell carcinoma (IAEA-HYPNO trial) Dr. Preeti Chavan Determination of select biochemical reference intervals in Indian voluntary blood donors Dr. Sorab Dalal Regulation of the epithelial mesenchymal transition (EMT) by 14-3-3σ Dr. Vikram Gota CSF distribution of high dose versus standard dose Geftinib and Erlotinib in lung cancer patients with brain metastases Dr. Vivek Bhat Prospective observational study of oral caity flora in patients receiving chemo-radio-therapy for head and neck cancer Dr. Vikram Gota Targetting deacetylases and methytransferases to improve outcomes after allogeneic bone marrow transplantation in chemo-conditioning based murine model of acute graft versus host disease Dr. Pritha Ray A genome wide screen for molecular mechanisms underlying the Cisplatin - Paclitaxel dual chemoresistant phenotype in late-stage ovarian carcinomas Dr. Rakesh Jalali Correlation of clinical and radiological parameters with various molecular subtypes of medulloblastoma

192 Tata Memorial Centre Annual Report 2014-2015 Principal Investigator Name of the Project/ Trial

Dr. Kakoli Bose Elucidating allosteric activation mechanism of proapoptotic serine protease HtrA2 Dr. Pradeep Chaudhari Immunohistochemistry profiling of canine neoplasms Dr. Epari Sridhar Gliomas in children and young adults: BRAF, FGFR1 and MYB gene alterations-diagnostic, prognostic and clinical relevance Dr. Vikram Gota Evaluating the potential of dabigatran etexilate in treatment of metastatic colon cancer Dr. Narendra Joshi Identification of endogenous control gene for normalization of gene expression data of oral tumors Dr. Vikram Gota Phase I clinical trial of Bioplatin an oral therapeutic nano particle in patients with advanced solid tumors Dr. Kumar Prabhash Comparative study evaluating quality of life of chemotherapy versus oral TKI in third line and beyond setting for advanced non-small cell lung cancer Dr. Tejpal Gupta Clinical utility of 18-F-FDG-PET/CT for diagnosis, staging, response evaluation, and prognostication in patients with primary central nervous system lymphoma (PCNSL) Dr. Prasanna Regulatory network of PSMD9 a proteasomal chaperone Venkataraman Dr. SB Rajadhyaksha Flow cytometric platelet crossmatching approach for selection of platelets for transfusion in hematopoietic stem cell transplant patients

Tata Memorial Centre / ACTREC 193 Academics at ACTREC

Education is the third vital mandate of successful completion of which is BRCTs domain. (Guide: Dr. Ashok ACTREC, and is given due impetus. The mandatory for registration. Varma) formal academic programs of the During the report year, 13 doctoral  Mr. Dimpu Gogoi: Role of notch in Centre encompass an active doctoral students who had completed work regulation of gamma delta T program, a training program, and a towards their doctoral dissertation lymphocytes and regulatory T cell training course on laboratory were awarded the Ph.D. (Life Sciences) functions. (Guide: Dr. Shubhada techniques in translational research. Chiplunkar) Other educational activities include its degree of the Homi Bhabha National  Mr. Hemant Dhamne: Lentiviral Open Day, educational visits, and Institute; their details are given below. vector mediated long term outreach programs to create cancer expression of therapeutic proteins. awareness. Award of the Ph.D. Degree (Guide: Dr. Rajiv Kalraiya) in Life Sciences  Mr. Sumeer Raina: Lentiviral vector Doctoral Program (Homi Bhabha National Institute) mediated gene transfer as an The Academic and Training Programs  Ms. Pallavi Goel: Characteri-zation antiviral and antitumoral Office, chaired by Dr. SV Chiplunkar, of HHV-6 using an Indian isolate: an intervention strategy. (Guide: Dr. oversees the Ph.D. (Life Sciences) in-vitro study. (Guide: Dr. Robin Rajiv Kalraiya) program at ACTREC. This program is  Mr. Peeyush Goel: Effect of a affiliated to the Homi Bhabha National Mukhopadhyaya)  Mr. Amit Ranjan: Role of b1,6 methylxanthine compound and Institute (HBNI), a deemed university anticancer agent on integrin established in 2006 under the aegis of branched N-linked oligosaccha- mediated adhesion and induced the University Grants Commission and rides in regulating key cellular apoptosis in breast cancer cells. which encompasses all the units of the processes involved in cancer cell (Guide: Dr. Shubhada Chiplunkar) Department of Atomic Energy. Intake of invasion. (Guide: Dr. Rajiv Kalraiya)  Mr. Manoj Ramteke: Identification Junior Research Fellows and the year-  Mr. Surya Pratap Singh: long formal academic coursework is Development of in vivo Raman of a novel ATP binding site and handled by the SCOPE Cell, and all the diagnostic methodologies for oral demonstration of ATP hydrolysis by matters post registration are handled pre-cancers and cancers. (Guide: mammalian 14-3-3 isoforms. jointly by ACTREC Administration and Dr. Murali Krishna Chilakapati) (Guide: Dr. Prasanna Venkatraman)  ATP Office. During the year 2014, a total  Ms. Ratika Kunder: MicroRNA Mr. Mohd. Zahid Kamran: Effects of 108 graduate students were enrolled profile of medulloblastomas. of methylxanthine on STAT3 into the Centre’s Ph.D. program. In May (Guide: Dr. Neelam Shirsat) mediated regulation of cytokines 2014, an Anti-Ragging Committee was  Mr. Ajit Kumar Sharma: Histone, involved in tumor development and constituted at ACTREC in terms of the chromatin structure and their role tumor induced angiogenesis in decision taken by the Government of in DNA repair during melanoma cells. (Guide: Dr. India, duly notified through HBNI. carcinogenesis. (Guide: Dr. Sanjay Shubhada Chiplunkar) In July 2014, a new batch of 13 students Gupta)  Ms. Padma Nanaware: joined the Centre and started their one  Mr. Dilip Badgujar: Structural and Identification of protein interaction year HBNI academic coursework, functional characterization of networks of Gankyrin in cancer. (Guide Dr. Prasanna Venkatraman)

194 Tata Memorial Centre Annual Report 2014-2015 Training Program alternate Saturdays every month during Open Day is a popular event amongst ACTREC has an active training program the surgical residents’ three month local college students. that accepts (a) students or staff of rotation at ACTREC. This structured academic/research institutions who program includes lectures and Educational Visits come to learn a specific technique demonstrations on topics like DNA ACTREC regularly accepts educational (observers), (b) undergraduate students extraction, amplification, electro- visits from students of science degree seeking research exposure during the phoresis, CGH, IHC, western blotting, colleges and universities from across college’s summer break (summer immune dysfunction, etc and is a good the country. The students and trainees), (c) graduate students seeking forum for interaction between clinicians accompanying faculty are shown to work on their Master’s dissertation and scientists. After each session, the around select labs of the Centre. (dissertation trainees), and participants present papers on Besides student groups, this year also saw visits from newly recruited (d) individuals who have completed translational research topics covered in scientific officers of the Atomic Energy academic study who wish to gain that particular session. Regulation Board and members of the research experience (short term BARC Officers Association. A total of trainees). During 2014, a total of 246 Open Day eight educational visits took place trainees were assigned to senior faculty Open Day 2014 was conducted on 4th during 2014. - scientists and clinicians of the Centre and 5th December 2014. Around 520 - 129 were for six month dissertation, students and faculty from science, 96 trainees for experience, 12 were medical, and related colleges/ Cancer Awareness summer trainees, 6 observers, and 3 institutions from Mumbai and Navi Program (CAP) postdocs. Mumbai participated in this educational Since the past three years, ACTREC has event. Batches of twelve students and been conducting outreach programs for Basic Program in an accompanying faculty member from the general public and focused groups ten different colleges visited ACTREC in like school or college students, Translational Research the morning/ afternoon session on each neighborhoods, parishes, etc in a bid to This training program in ‘Laboratory of the two days. The program included create awareness about cancer. Two techniques in translational research’ for a poster session, introductory talk CAP lecture series were conducted at M.Ch. students of TMH is coordinated about ACTREC, and visits to ten SIES College, Navi Mumbai – Dr. Supriya jointly by Dr. Rukmini Govekar of demonstrating labs where varied Chopra was the lead speaker on 18th ACTREC and Dr. Gouri Pantvaidya of aspects of cancer research/ diagnosis or February 2014 and Dr. Sudhir Nair on TMH. Teaching sessions are held on treatment were highlighted. ACTREC’s 21st July 2014.

Tata Memorial Centre / ACTREC 195 Conferences, Workshops, Symposia organized at ACTREC during 2014

January to March SCA Software Learning Workshop 2013-14 Coordinator: Students Council of ACTREC 23-24 January DBT-sponsored Workshop on ‘Applications in Bioinformatics’ Coordinator: Dr. Ashok Varma 30 January Half Day Symposium to appreciate the work of Dr. Rita Mulherkar & Dr. Rajiv Gude Coordinator: Director’s Office & Dr. Neelam Shirsat February to December Training Program on ‘Laboratory Techniques in Translational Research’ – 3 sessions Coordinators: Dr. Rukmini Govekar, ACTREC & Dr. Gouri Pantvaidya, TMH 8 March National CME on ‘Quality Conclave of Laboratory and Transfusion Services’ Chairperson: Dr. Vivek Bhat 22-23 March 37th annual Mumbai Hematology Group Conference Organizing Secretary: Dr. Bhausaheb Bagal, TMC & Mumbai Hematology Group 21-22 April Course in ‘Molecular Epidemiology’ Organizer: Dr. Rajesh Dikshit, TMC 22-23 May Internal Audit Training on ISO 15189:2012 and NABL 112 Coordinator: Ms. Chital Naresh 23-27 June NABL Assessor’s Training Course Coordinator: Ms. Chital Naresh 10-11 July MIG ‘Basic Course in Flow Cytometry-II’ 2014 Organizing Secretary: Dr. Jyoti Kode & Mumbai Immunology Group 7 August TNAI Workshop on ‘Making Nursing Visible: Imperatives and Strategies’ Organizer: Mrs. Meera Achrekar & Trained Nurses Association of India 13 September Biophysics Paschim Meeting (BPP 7) - One-day Symposium Organizer: Dr. Kakoli Bose & Biophysics Paschim 16-18 September MAMB Undergraduate Workshop on ‘Cancer Research’ Jt. Organizers: ACTREC & Dr. MG Deo, Moving Academy of Medicine & Biomedicine 19-20 September ACTREC Monsoon Retreat Coordinator: Dr. Tanuja Teni 16-18 October The 2nd ACTREC Symposium on Clinical Pharmacology - ‘Application of PK-PD Modeling in Clinical Research’ Organizing Secretary: Dr. Vikram Gota

196 Tata Memorial Centre Annual Report 2014-2015 27-31 October Pre ICGC Workshops on Cancer Genetics Counselling; Basic Techniques in Molecular Biology; Advanced Techniques in Molecular and Genetic Analysis Organizer: Dr. Rajiv Sarin 1-2 November 2nd Indian Cancer Genetics Conference (ICGC 2014) Organizer: Dr. Rajiv Sarin 3-7 November Hands-on Workshop on ‘Advanced Techniques in Anti-Cancer Drug Evaluation’ Organizing Secretaries: Dr. Aarti Juvekar & Dr. Jyoti Kode 4-5 December Open Day 2014 Coordinator: Dr. Aparna Bagwe 8-9 December 12th Meeting of DST’s Program Advisory Committee on ‘Health Sciences’ Coordinators: Dr. Sudeep Gupta & Dr. Vikram Gota 18-19 December 10th National Research Scholars Meet in Life Sciences - 2014 Organizers: GSM Committee

Guest Seminars

22 January Targeted therapies in AML Dr. Satyananda Patel, Hospital St. Louis, Paris, France 22 January Living healthy without medicines Dr. RN Varma, Retd. Scientist & Arya Jitendra, Acharya Swadeshi Gurukulam, Ujjain 30 January Immunobiology of multiple myeloma Dr. Prabhala Rao, Harvard Medical School & VA Boston Healthcare System, Boston, USA 6 February Biology of mammalian prions Prof. Adriano Aguzzi, Institute of Neuropathology, University Hospital Zurich, Switzerland 25 February Empowering normal cells to trigger cancer cell apoptosis Dr. Vivek Rangnekar, Markey Cancer Centre, University of Kentucky, Lexington, USA 25 March Circulating tumour cells as prognostic markers of treatment response in melanoma Dr. Mel Ziman, Edith Cowan Univ. & University of Western Australia, Perth, Australia 8 April Functional role of S100A16 in oral carcinogenesis Dr. Dipak Sapkota, Gade Laboratory for Pathology, University of Bergen, Norway 13 April Fine-tuning bone and colon cancer - two tales of microRNAs Dr. Subree Subramanian, University of Minnesota, Minneapolis, USA 24 June Targeting inflammation in metabolism and cancer Dr. Vinay Tergaonkar, Institute of Molecular and Cell Biology, Singapore 18 July Functional epigenomics of melanoma progression Dr. Kunal Rai, MD Anderson Cancer Center, Houston, USA

Tata Memorial Centre / ACTREC 197 26 September Deciphering metastasis - unraveling the molecular circuitry of tumor cells and the metastatic niche Dr. Radhika Nair, Kinghorn Cancer Centre & Garvan Instt. of Medical Research, Sydney, Australia 7 October Pathogenomics: computational methods for pathogen identification in human diseases Dr. Chandra Sekhar Pedamallu, Broad Institute of MIT and Harvard, Cambridge, USA 30 October Disentangling galectin-1-based patterning functions in organogenesis Dr. Ramray Bhat, Lawrence Berkeley National Laboratory, Berkeley, USA 31 October Stromal cells promote resistance to death signals in mantle cell lymphoma Dr. Lalit Sehgal, Postdoctoral Fellow, MD Anderson Cancer Center, Houston, USA 13 November Breaching the barrier of plasma membrane with a protein needle Dr. Nusrat Sanghamitra, Institute of Integrated Cell Material Science, Kyoto University, Japan

Patient Support Programs

30 January Entertainment program for cancer patients and their care givers Co-ordinators: Mrs. Bhagyashree Tillu & The Greater Bombay Co-operative Bank Ltd 22 March Meeting with parents of cancer patients Co-ordinators: Dr. Sripad Banavali, TMH & St. Jude India Childcare Centers 11 April Reiki Attunement Session for patients and their relatives Co-ordinator: Mrs. Bhagyashree Tillu 21 June CML and CIST Support Group Meeting of ACTREC and TMH patients Co-ordinators: Dr. Navin Khattry & The Max Foundation 22 September National Cancer Rose Day Co-ordinator: Mrs. Bhagyashree Tillu

198 Tata Memorial Centre Annual Report 2014-2015 Staff Achievements

Dr. Reshma Ambulkar  Chairperson: Hands on Workshop –III - Advanced  Treasurer: Indian Society of Critical Care Medicine, Techniques in Anti-Cancer Drug Evaluation, ACTREC, Navi Mumbai branch Mumbai: November 2014  Presidential Oration: 33rd Annual Convention of Indian Mr. Srikanta Basu Association for Cancer Research, Thiruvnathpuiram: th  First Prize in Oral Presentation: 10 National Research February 2014 Scholars’ Meet, ACTREC, Navi Mumbai: December 2014. Dr. Sorab Dalal Mr. Amir Ali Bukhari  Secretary: Indian Association of Cancer Research (till  Award for Best Oral Presentation: Symposium on March 2014) Advances in Breast Cancer, Goa: October 2014. Dr. Kartik Doshi Mr. Pratik Chaudhari  JC Patel and HM Bhatia Award as first prize for oral  Prof. VC Shah Award for Best Platform Presentation: All presentation: 37th Annual Conference of the Mumbai India Cell Biology Conference, Lucknow: December 2014 Hematology Group, Mumbai: March 2014 Dr. Shubhada Chiplunkar Ms. Poonam Gamre  Chairperson: Scientific Advisory Committee, MGM  ARTTI - Young Technologist 2014: 18th National Institute of Health Sciences, Navi Mumbai Conference of the Association of Radiation Therapy  Co-Chairperson: Steering Committee, Task Force on Technologists of India (ARTTICON-2014), Regional Cancer Translational Immunology, Indian Council of Medical Centre, Medical College, Shimla: October Research 2014.  Member: Review Committee on Genetic Manipulation, Dr. Sanjay Gupta Department of Biotechnology  Associate Editor: Journal of Integrated-Omics – a  Member: Project Review Committee, Division of Non- methodological journal. communicable Diseases (Oncology), Indian Council of Medical Research Dr. Tejpal Gupta  Member: Scientific Advisory Committee, Indian Council  Treasurer: Indian Society of Neuro-Oncology of Medical Research Dr. Arvind Ingle  Member, Subcommittee on Control of Cervical Cancer,  TurnKey Facility Leader of the Year- 2014 Award of the Indian Council of Medical Research ALN Magazine, USA.  Member, Advisory Committee & Basic Sciences  President: Laboratory Animal Scientists Association Committee, Board of Research in Nuclear Sciences, (LASA) of India. Department of Atomic Energy  Member: Board of Radiation and Isotope Technology Mr. Prajish Iyer   Member: Academic Council and Board of Studies in Life Best Poster Award (sponsored by Nature Reviews Sciences, Homi Bhabha National Institute Cancer): Next Gen Genomics and Bioinformatics Technologies Conference, NIMHANS, Bangalore:  President, Indian Association for Cancer Research (till November 2014 March 2014)  Secretary: Mumbai Immunology Group Dr. Rajiv Kalraiya  Chairperson: Mumbai Immunology Group’s Hands on  Liverpool-India Fellowship: Institute of Translational Workshop-II - Basic Course in Flow Cytometry, ACTREC, Medicine, University of Liverpool, UK Navi Mumbai: July 2014

Tata Memorial Centre / ACTREC 199 Ms. Ekjot Kaur Mr. Vimal Sathyan  Sitaram Joglekar Award for best oral presentation: 33rd  First Prize in Transfusion Medicine Quiz: 39th Annual Annual Convention of Indian Association for Cancer Conference of the Indian Society of Blood Transfusion & Research, : February 2014. Immunohematology (Transcon -2014), Patiala: October 2014 Mr. Krunal Kavathiya  Dr. GB Parulkar Award as first prize for poster Mr. Bhushan Thakur presentation: 7th International Conference of South Asian  Director’s Prize for Best Participant among the Ph.D. Chapter of American College of Clinical Pharmacology, students in Oral session: All India Cell Biology Conference, Mumbai: April 2014 Lucknow: December 2014 Ms. Padma Nanaware Dr. Ashok Varma  Best Poster Award: Annual meeting of the Proteomics  Coordinator: Establishment of DBT Biotechnology/ Society, India, IIT-Bombay, Mumbai: December 2014 Bioinformatics training centre for teachers and research scholars from the North Eastern Region and other Mr. Rushikesh Patil underserved regions of India: BTIS, ACTREC: 2014-19.  Dr. GP Talwar Young Scientist Award for Oral Presentation: 41st annual conference of Indian Immunology Society, Dr. Tabassum Wadasadawala Madurai Kamaraj University, Madurai: December 2014.  Gold Medal for Best Oral Presentation: International Conference on Multidisciplinary Management of Breast Ms. Sanhita Rath Cancer (Breast Oncology-2014), Kochi: March 2014.  Dr. SM Karandikar Award at third prize for oral presentation: 7th International Conference of South Asian Mr. Mohd. Yasser Chapter of American College of Clinical Pharmacology,  Award for Best Essay: 6th annual meeting of Proteomic Mumbai: April 2014 Society, India, IIT-B, Mumbai: December 2014. Dr. Supriya Sastri  Best Paper Award: Young Radiation Oncologists Conference, Visakhapatnam: January 2014

200 Tata Memorial Centre Annual Report 2014-2015 TMC Staff Publications

International Jonnalagadda S, Robbins TK, Shah Montorsi M, Neoptolemos C, Yeo 1 Adhikary A, Chakraborty S, JP, Patel SG, Gil Z, Leider-Trejo L CJ, Traverso LW (2014) - When to Mazumdar M, Ghosh S, (2014) - The origin of regional perform a Mukherjee S, Manna A, Mohanty failure in oral cavity squamous cell pancreatoduodenectomy in the S, Nakka KK, Joshi S, De A, carcinoma with pathologically absence of positive histology? A Chattopadhyay S, Sa G, Das T negative neck metastases. JAMA consensus statement by the (2014) - Inhibition of epithelial to Otolaryngology Head and Neck International Study Group of mesenchymal transition by E- Surgery. 140(12):1130-7. Pancreatic Surgery. Surgery. cadherin up-regulation via PMID:25074731 155(5):887-892. PMID: 24661765 repression of slug transcription 6 Anantharaman D, Chabrier A, 10 Athawale RB, Jain DS, Singh KK, and inhibition of E-cadherin Gaborieau V, Franceschi S, Gude RP (2014) - Etoposide degradation: Dual role of SMAR1 Herrero R, Rajkumar T, Sawant T, loaded solid lipid nanoparticles for in breast cancer cells. Journal of Mahimkar MB, Brennan P, Mckay curtailing B16F10 melanoma Biological Chemistry. 289: 25431- JD (2014) - Genetic Variants in colonization in lung. Biomedicine 25444. PMID: 25086032. Nicotine Addiction and Alcohol and Pharmacotherapy. 68(2):231- 2 Agarwal AK, Gude RP, Kalraiya RD Metabolism Genes, Oral Cancer 240, 2014. PMID:24560352 (2014) - Regulation of melanoma Risk and the Propensity to Smoke 11 Babu D, Bhamre R, Katna R (2014) metastasis to lungs by cell surface and Drink Alcohol: A replication - Intramuscular haemangioma of Lysosome Associated Membrane study in India. PLoS ONE. the tongue. Annals of the Royal Protein- 1 (LAMP1) via galectin-3. 9(2):e88240. PMID: 24505444 College of Surgeons of England. Biochemical and Biophysical 7 Arora B, Banavali S, Vora 96(6):15-17. PMID:25198963 Research Communications. T, Chinnaswamy G, Prasad 12 Babu KG, Prabhash K, Vaid AK, 449(3):332-337. PMID: 24845565 M, Paradkar A, Kurkure Sirohi B, Diwakar RB, Rao R,Babu 3 Agarwal AK, Kalraiya RD (2014) - PA, Havaldar R, Narula G, Talole S KG, Prabhash K, Vaid AK,Sirohi B, Glycosylation regulates the (2014) - A randomized open Diwakar RB, Rao R,Kar M, expression of Lysosome labeled parallel group phase iii Malhotra H, Nag S, Goswami C, Associated Membrane Protein-1 study of antibiotics alone vs. Raina V, Mohan R (2014) - (LAMP1) on the cell surface. antibiotics plus g-csf in pediatric Nimotuzumab plus Journal of Bioscience and cancer patients with febrile chemotherapy versus Technology. 5(3):556-563. neutropenia in a low-income chemotherapy alone in advanced setting. Pediatric Blood and 4 Aggarwal A, Chopra S, Paul SN, non-small-cell lung cancer: a Cancer. 61(s2):s117. Engineer R, Srivastava SK (2014) - multicenter randomized open- Evaluation of internal target 8 Arya S, Rane P, Deshmukh A label Phase II study. Onco Targets volume in patients undergoing (2014) - Oral cavity squamous cell and Therapy. 7:1051-1060. image guided intensity modulated carcinoma: Role of pretreatment PMID:24966687 adjuvant radiation for gastric imaging and its influence on 13 Badwe RA, Dikshit R, Laversanne cancers. British Journal of management. Clinical Radiology. M, Bray F (2014) - Cancer Radiology. 87(1033): 20130583. 69(9):916-30. PMID:24908285 incidence trends in India. PMID: 24288401 9 Asbun HJ, Conlon K, Fernandez- Japanese Journal of Clinical 5 Amit M, Yen TC, Liao CT, Cruz L, Friess H, Shrikhande SV, Oncology. 44(5):401-407. Chaturvedi P, Agarwal JP, Kowalski Adham M, Bassi C, Bockhorn M, 14 Balakrishnan B, Chiplunkar SV, LP, Kohler HF, Ebrahimi A, Clark JR, Büchler M, Charnley RM, Dervenis Indap MM (2014) - Methanol Cernea CR, Brandao JS, Kreppel M, C, Fingerhutt A, Gouma DJ Extract of asper prevents Zöller JE, Bachar G, Shpitzer T, Hartwig W, Imrie C, Izbicki JR, bone resorption in Bolzoni AV, Patel RP, Lillemoe KD, Milicevic M, ovaryectomised mice model.

Tata Memorial Centre / Publications 201 Journal of Osteoporosis. vol. mutation carriers: Results from Journal of Biomedical Optics. 2014, Article ID 348189, 9 pages. the Initial screening round of the 19(12):126005. PMID: 25478870 15 Balakrishnan B, Indap MM, Singh IMPACT study. European Urology. 23 Bhagat M, Qureshi S, Kembhavi SP, Krishna CM, Chiplunkar SV 66:489-499. PMID: 24484606. S, Ramadwar M, Desai (2014) - Turbomethanol extract 17 Banerjee S, Mahantshetty U, S, Chinnaswamy G, Vora T, Laskar inhibits bone resorption through Shrivastava S (2014) - S, Khanna N (2014) - Non regulation of T cell function. Bone. Brachytherapy in India - a long hepatoblastoma liver tumors in 58:114-125. PMID:24140785 road ahead. Journal of children - a single centre 16 Bancroft EK, Page EC, Castro E, Contemporary Brachytherapy. experience. Pediatric Blood and Lilja H, Vickers A, Sjoberg D, Assel 6(3):331-335. PMID:25337139 Cancer. 61(s2):s105-433. M, Foster CS, Mitchell G, Drew K, 18 Barreto SG, Dutt A, Chaudhary A 24 Bhagat M, Qureshi S, Ramadwar Mæhle L, Axcrona K, Evans DG, (2014) - A genetic model for M, Shetty N, Chinnaswamy Bulman B, Eccles D, McBride D, gallbladder carcinogenesis and its G, Vora T, Kurkure P (2014) - The Asperen C, Vasen H,. Kiemeney dissemination. Annals of impact of optic nerve resection LA, Ringelberg J, Cybulski C, Oncology. 25(6):1086-1097. length on survival in Wokolorczyk D, Selkirk C, Hulick PMID: 24705974 Retinoblastoma. Pediatric Blood PJ, Bojesen A, Skytte A, Lam J, 19 Barreto SG, Pawar S, Shah S, Talole and Cancer. 61(S2):S379. Taylor L, Oldenburg R, Cremers R, S, Goel M, SV Shrikhande (2014) 25 Bhargava A, Bunkar N, Khare NK, Verhaegh G, van Zelst-Stams WA, - Patterns of failure and Mishra PK, Mishra DK (2014) - Oosterwijk JC, Blanco I, Salinas determinants of outcomes Nanoengineered strategies to M, Cook J, Rosario DJ, Buys S, following radical re-resection for optimize dendritic cells for Conner T, Ausems MG, Ong K, incidental gallbladder cancer. gastrointestinal tumor Hoffman J, Domchek S, Powers J, World Journal of Surgery. immunotherapy: from biology to Teixeira MR, Maia S, Foulkes WD, 38(2):484-489. PMID: 24196171 translational medicine. Taherian N, Ruijs M, Helderman- 20 Basu S, Joshi A (2014) - 99mTc Nanomedicine. 9(14):2187-2202. van den Enden AT, Izatt L, HYNIC-TOC imaging and 177Lu PMID: 25405796 Davidson R, Adank MA, Walker DOTA-octreotate treatment in 26 Bhat V, Kelkar R, Biswas S, L, Schmutzler R, Tucker K, Kirk J, non-iodine-concentrating Natarajan G (2014) - Ventilator- Hodgson S, Harris M , Douglas F, dedifferentiated thyroid associated pneumonia: Survey of Lindeman GJ, Zgajnar J, carcinoma alternative diagnosis infection control practices in Tischkowitz M, Clowes VE, metastases: an unusual. Clinical intensive care units of 15 tertiary Susman R, Cajal T, Patcher N, Nuclear Medicine. 39(7):632-634. care hospitals in Mumbai. Gadea N, Spigelman A, van Os T, PMID:24873792 American Journal of Infection Liljegren Al, Side L, Brewer C, Control. 42:935-940. PMID: Brady AF, Donaldson A, 21 Basu S, Sirohi B, Shrikhande SV 25087150 Stefansdottir V, Friedman E, Chen- (2014) - Dual tracer imaging Shtoyerman R, Amor DJ, approach in assessing tumor 27 Bhattacharjee T, Kumar P, Maru G, Copakova L, Barwell J, Giri VN, biology and heterogeneity in Ingle A, Krishna CM (2014) - Swiss Murthy V, Nicolai N, Teo neuroendocrine tumors: its bare mice: A suitable model for S,Greenhalgh L,Strom S, correlation with tumor transcutaneous in vivo Raman Henderson A, McGrath J, multifaceted implications for spectroscopic studies of breast Gallagher D, Aaronson N, Ardern- personalized clinicalcorrelation cancer. Lasers in Medical Science. Jones A, Bangma C, Dearnaley D, with tumor proliferation index 29(1):325-333. PMID: 23708992 Costello P, Eyfjord J, Rothwell J, and possible management 28 Bhattacharyya A, Krishnan S, Dalvi Falconer A, Gronberg H, Hamdy decisions, with focus on PRRT. Mitra S, Tiwari R, Ghosh FC, Johannsson O, Khoo V, Kote- European Journal of Nuclear D, Ferdousi S, Saha Jarai Z, Lubinski J, Melia AU, Medicine and Molecular Imaging. V, Bhattacharya S (2014) - McKinley J, Mitra AV, Moynihan 41(8):1492-1496. PMID:24863431 Prevalence and outcome of C, Rennert G, Suri M, Wilson P, 22 Behl I, Kukreja L, Deshmukh A, multidrug resistant bacterial Killick E, The IMPACT Singh SP, Mamgain H, Hole AR, sepsis in children on Collaborators, Moss S, Eeles RA Krishna CM (2014) - Raman chemotherapy. Pediatric Blood (2014) - Targeted prostate cancer mapping of oral buccal mucosa: a and Cancer. 61(S2):S389. screening in BRCA1 and BRCA2 spectral histopathology approach.

202 Tata Memorial Centre Annual Report 2014-2015 29 Bhave M, Papanikou E, Iyper P, radiotherapy in patients with AK (2014) - A study of mucosal Pandya K, Jain BK, Ganguly A, uncured cushings disease. melanoma of the oral cavity in Sharma C, Pawar K, Austin II J, Day Pituitary. 17(1):60-67. India: a rare tumor. Ear, Nose and KJ, Rossanese OW, Glick BS, PMID:23381232 Throat Journal. 93(8):E4-7. Bhattacharyya D (2014) - Golgi 34 Carr R, Fanti S, Paez D, Cerci PMID:25181674 enlargement in Arf-depleted yeast J, Györke T, Redondo F, Morris 40 Chaudhari UK, Metkari SM, cells is due to altered dynamics of TP, Meneghetti C, Auewarakul Manjaramkar DD, Sachdeva G, cisternal maturation. Journal of C, Nair R, Gorospe C, Chung Katkam R, Bandivdekar AH, Cell Science. 127(Pt1):250-257. JK, Kuzu I, Celli M, Gujral S, Padua Mahajan A, Thakur MH, Kholkute PMID: 24190882 RA, Dondi M (2014) - Prospective SD (2014) - Echography of the 30 Biswas NK, Das S, Maitra A, Sarin international cohort study cervix and uterus during the R, Majumder PP (2014) - Somatic demonstrates inability of interim proliferative and secretory phases mutations in arachidonic acid PET to predict treatment failure in of the menstrual cycle in bonnet metabolism pathway genes diffuse large B-cell lymphoma. monkeys (Macaca radiata) Journal enhance oral cancer post- Journal of Nuclear Medicine. of the American Association for treatment disease-free survival. 55(12):1936-1944. Laboratory Animal Science Nature Communications. 5:5835. PMID:25429159 JAALAS. 53(1):18-23. PMID: 25517499 35 Cerci JJ, Györke T, Fanti S, Paez D, PMID:24411775 31 Bockhorn M, Uzunoglu FG, Meneghetti JC, Redondo F, Celli 42 Chaudhury S, Thakur B, Chatterjee Adham M, Imrie C, Milicevic M, M, Auewarakul C, Rangarajan V, S, Ray P (2014) - Molecular Sandberg AA, Asbun HJ, Bassi C, Gujral S, Gorospe C, Campo MV imaging aided improvement in Büchler M, Charnley RM, Conlon Chung JK, Morris TP, Dondi M, drug discovery and development. K, Cruz LF, Dervenis C, Fingerhutt Carr R (2014) - Combined PET and Current Biotechnology. 3(3):218- A, Friess H, Gouma DJ, Hartwig biopsy evidence of marrow 237. W, Lillemoe KD, Montorsi M, involvement improves prognostic 43 Chavan P, Chauhan B, Joshi A, Neoptolemos JP, Shrikhande SV, prediction in diffuse large B-cell Ojha S, Bhat V (2014) - Differential Takaor K, Traverso W, Vashist YK, lymphoma. Journal of Nuclear diagnosis of thrombocytopenia in Vollmer C, Yeo CJ, Izbicki JR (2014) Medicine. 55(10):1591-1597. hematopoietic stem cell - Borderline resectable pancreatic PMID:25214642 transplant patients. Journal of cancer: A consensus statement by 36 Chandarana M, Jiwnani S, Hematology & Thromboembolic the International Study Group of Karimundackal G, Pramesh CS Diseases. 2(6):168. Pancreatic Surgery (ISGPS). (2014) - Lymphadenectomy in 44 Chavarri-Guerra Y, Liedke PE, Surgery. 155(6):977-988. esophageal cancer: the real Pramesh CS,Badovinac-Crnjevic PMID:24856119 issues. Annals of Thoracic Surgery. Goss PE, Strasser-Weippl K, Lee- 32 Bouche G, André N, Banavali S, 98(1):389-390. PMID:24996739 Bychkovsky BL, Fan L, Li J,T, Berruti A, Bocci G, Brandi G, 37 Chatterjee S, De A (2014) - Sheikine Y, Chen Z, Qiao YL, Shao Cavallaro U, Colleoni M, Applications of lentiviral vectors in Z12, Wu YL, Fan D, Chow, LW, Curigliano G, Desidero TD, Eniu A, molecular imaging. Frontiers in Wang J, Zhang Q, Yu S, Shen G, Fazio N, Kerbel R, Hutchinson L, Bioscience (Landmark Ed). He J (2014) - Challenges to Ledzewicz U, Munzone e, Pasquier 19:835-853. PMID:24896320 effective cancer control in China, E, Graciela Scharovsky O, Shaked 38 Chaturvedi P, Datta S, Nair S, Nair India, and Russia. The Lancet Y, Stìrba J,Villalba M, Bertolini F, D, Pawar P, Vaishampayan S, Patil Oncology. 15(5):489-538. Cinieri S (2014) - Lessons from the A, Kane S (2014) - Gross PMID:24731404 fourth metronomic and anti- examination by the surgeon as an 45 Chawre S, Jha S, Rawat-Pawar angiogenic therapy meeting, 24- alternative to frozen section for E, Chaudhari D, Deshmukh 25 June 2014, Milan. assessment of adequacy of A, Goswami S, Dalvi N, Prasad Ecancermedicalscience. 8:463. surgical margin in head and neck M, Dhanmankar V, Kurkure P PMID:25228919 squamous cell carcinoma. Head (2014) - Rediscovering the joy of 33 Budyal S, Lila AR, Jalali R, Gupta and Neck. 36(4):557-563. PMID: learning -YCMOU initiative for T, Kasliwal R, Jagtap VS, Bandgar 23765548 childhood cancer survivors. T, Menon P, Shah NS (2014) - 39 Chaturvedi P, Lerra S, Gupta P, Pai Pediatric Blood and Cancer. Encouraging efficacy of modern PS, Chaukar DA, Agarwal JP, DCruz 61(s2):s159. conformal fractionated

Tata Memorial Centre / Publications 203 46 Chinnaswamy G, Prasad Metastasis. 31(6): 661-673. PMID: 58 Dhawan VV, Joshi GV, Jain AS, M, Dhamankar V, Vora T, Gupta 24952269 Nikam YP, Gude RP, Mulherkar R, T, Moiyadi A, Sridhar E, Banavali 51 Daniel A, Prakasarao A, David B, Nagarsenkar MS (2014) - S, Jalali R, Kurkure P (2014) - Joseph L, Krishna CM, Apoptosis induction and anti- Combat (combined oral Koteeswaran D, Ganesan S (2014) cancer activity of LeciPlex metronomic biodifferentiating - Raman mapping of oral tissues formulations. Cellular Oncology. antiangiogenic treatment) for cancer diagnosis. Journal of 37:339-351. PMID: 25204961 therapy in poor prognosis Raman Spectroscopy. 45(7): 541- 59 Divatia JV, Ambulkar R (2014) - pediatric malignant brain tumors- 549. Anesthesia and cancer is there a role? Pediatric Blood 52 Dar AA, Patil RS, Chiplunkar SV recurrence: what is the. Journal of and Cancer. 61(s2):s185. (2014) - Insights into the Anaesthesiology. 30(2):147-150. 47 Chopra S, Dora T, Chinnachamy relationship between toll like PMID:24803747 AN, Thomas B, Engineer R, receptors and gamma delta T cell 60 Divatia JV, Jog S (2014) - Intensive Kannan S, Mahantshetty U, responses. Frontiers in care research and publication in Phurailatpam R, Paul SN, Immunology. 5(2):Art 366. PMID: India: quo vadis?. Intensive Care Shrivastava SK (2014) - Predictors 25132835 Medicine. 40(3):445-447. PMID: of grade 3 or higher late bowel 53 Dawood S, Lei X, Dent R, Gupta S, 24441668 toxicity in patients undergoing Sirohi B, Cortes J, Cristofanilli M, 61 Divya R, Bhattacharya S, Gupta S pelvic radiation for cervical Buchholz T, Gonzalez-Angulo AM (2014) - Histone chaperones: cancer: results from a prospective (2014) - Survival of women with functions beyond nucleosome study. International Journal of inflammatory breast cancer: a deposition. Advances in Radiation Oncology Biology large population-based study. Bioscience and Biotechnology. Physics. 88(3):630-635. Annals of Oncology. 25(6):1143- 5(6):546-556. PMID:24521678 1151. PMID:24669011 62 Dugad JA, Dholam KP, Chougule 48 Chopra S, Patidar A, Dora T, 54 Desai S, Kumar A, Laskar S, Pandey AT (2014) - Vacuum form sheet as Moirangthem N, Paul SN, BN (2014) - Differential roles of a guide for fabrication of orbital Engineer R, Mahantshetty U, ATF-2 in survival and DNA repair prosthesis. Journal of Prosthetic Shrivastava SK (2014) - Vaginal contributing to radioresistance Dentistry. 112(2):390-392. displacement during course of induced by autocrine soluble PMID:24445029 adjuvant radiation for cervical factors in A549 lung cancer cells. cancer: Results from a prospective 63 Ferlay J, Soerjomataram I, Dikshit Cellular Signalling. 26(11):2424- IG-IMRT study. British Journal of R, Eser S, Mathers C, Rebelo M, 2435. PMID:25041846 Radiology. 87(1042):20140428. Parkin DM, Forman D, Bray F PMID:25135439 55 Dhamne H, Chande AG, (2014) - Cancer incidence and Mukhopadhyaya R (2014) - mortality worldwide: sources, 49 Choughule A, Sharma R, Trivedi V Lentiviral vector platform for methods and major patterns in (2014) - Coexistence of KRAS improved erythropoietin GLOBOCAN 2012. International mutation with mutant but not expression concomitant with Journal of Cancer. 136(5):E359-86. wild-type EGFR predicts response shRNA mediated host cell elastase PMID:25220842 to tyrosine-kinase inhibitors in down regulation. Plasmid. 71:1- human lung cancer. British Journal 64 Fu SH, Jha P, Gupta PC, Kumar R, 7. PMID: 24325878 of Cancer. 111(11):2203-2204. Dikshit R, Sinha D (2014) - PMID:25117816 56 Dhanda S, Thakur M, Kerkar R, Geospatial analysis on the Jagmohan P (2014) - Diffusion- distributions of tobacco smoking 50 Dange MC, Srinivasan N, More SK, weighted imaging of gynecologic and alcohol drinking in India. PLoS Bane SM, Upadhya A, Ingle AD, tumors: diagnostic pearls and ONE. 9(7):e102416. Gude RP, Mukhopadhyaya R, potential pitfalls. RadioGraphics. PMID:25025379 Kalraiya RD (2014) - Galectin-3 34(5):1393-1416. PMID:25208287 expressed on different lung 65 Garon EB, Ciuleanu TE, Prabhash compartments promotes organ 57 Dhar H, Dabholkar JP, Kandalkar K, Syrigos KN, Goksel T, Park k, specific metastasis by facilitating BM, Ghodke R (2014) - Primary Garbunova V,Kowalyszyn RD, arrest, extravasation and organ thyroid schwannoma Pikiel J, Czyewicz G, Orlov SV, colonization via high affinity masquerading as a thyroid Lewanski CR, Thomas M, Bidoli P, ligands on melanoma cells. nodule. Journal of Surgical Case Dakhil S, Gans S, Kim JH, Clinical and Experimental Reports. 2014(9). pii: rju094 Grigorescu A,Karaseva N, Reck M,

204 Tata Memorial Centre Annual Report 2014-2015 Cappuzza F, Alexandris E, Sashegyi 71 Gomes RM, Kumar RK, Desouza A, of he pelvis at a tertiary cancer A, Yurasov S, Perol M (2014) - Saklani A (2014) - Implantation center in india. Pediatric Blood Ramucirumab plus docetaxel metastasis from adenocarcinoma and Cancer. 61(s2):s148. versus placebo plus docetaxel for of the sigmoid colon into a PMID:24932034 second-line treatment of stage IV perianal fistula: a case report. 77 Gulia A, Puri A, Ramanujan V non-small-cell lung cancer after Annals of Gastroenterology. (2014) - Non operative disease progression on platinum- 27(3):276-279. PMID:24975988 management of aneurysmal bone based therapy (REVEL): a 72 Gota V, Kavathiya K, Doshi K, cyst with percutaneous sclerosant multicentre, double-blind, Gurjar M, Prabhash K (2014) - injections in children - early randomised phase 3 trial. The High plasma exposure to results from a prospective Lancet. 84(9944):665-73. pemetrexed leads to severe observational study. Pediatric PMID:24933332 hyponatremia in patients with Blood and Cancer. 61(s2):s273. 66 Ghoshal A, Dighe M, Deodhar J, advanced non small cell lung 78 Gulia A, Puri A, Ramanujan V Dhiliwal S, Damani A, Muckaden cancer receiving platinum (2014) - Oncological outcome of MA (2014) - Relevance of doublet chemotherapy pediatric extremity skeletal canadian health care evaluation pemetrexed. Cancer chondrosarcomas at a tertiary project (canhelp) questionnaire Management and Research. sarcoma treatment centre. for patients on homecare in 6:261-265. PMID:24940080 Pediatric Blood and Cancer. Mumbai. BMJ Spportive & 73 Gota V, Kavathiya K, Doshi K, 61(s2):s148. Palliative Care. 4(Suppl 1):A83- Gurjar M, Damodaran SE, 79 Gulia S, Bajpai J, Gupta S, A84. Noronha V, Joshi A, Prabhash K Maheshwari A, Deodhar K, Kerkar 67 Goda JS, Dutta D, Raut N, Juvekar (2014) - High plasma exposure to RA, Seth V, Rekhi B, Menon S SL, Purandare N, Rangarajan V, pemetrexed leads to severe (2014) - Outcome of gestational Arora B, Gupta T, Kurkure P, Jalali hyponatremia in patients with trophoblastic neoplasia: R (2014) - Can multiparametric advanced non small cell lung experience from a Tertiary Cancer MRI and FDG-PET predict cancer receiving pemetrexed- Centre in India. Clinical Radiology. outcome in diffuse brainstem platinum doublet chemotherapy. 26(1):39-44. PMID: 24051171 glioma? a report from a Cancer Management Research. 6: 80 Gulia S, Dangi U, Biswas S,Kelkar prospective phase-II study. 261-265. PMID: 24940080 R, Menon H, Sengar M (2014) - Pediatric Neurosurgery. 74 Gridelli C, de Marinis F, Thomas M, Prevalence and patterns of 49(5):274-81. PMID:25277867 Prabhash K, El Kouri C, Blackhall cytomegalovirus DNAemia in 68 Goel PN, Gude RP (2014) - F, Bustin F, Pujol JL, John WJ, San adult patients with acute Pentoxifylline regulates the Antonio B,Zimmermann A, lymphoblastic leukemia on cellular adhesion and its allied Visseren-Grul C, Paz-Ares chemotherapy. Leukemia and receptors to 4 extracellular matrix LGChouaki N, (2014) - Final Lymphoma. 55(5):1209-1211. components in breast cancer efficacy and safety results of PMID:23865832 cells. Biomed Pharmacother. 68: pemetrexed continuation 81 Gulia S, Arora B, Narula 93-99. PMID: 24269001 maintenance therapy in the G, Chinnaswamy elderly from the. Journal of 69 Gogoi D, Dar AA, Chiplunkar SV G, Subramamanium PG, Banavali Thoracic Oncology. 9(7):991-997. (2014) - Involvement of Notch in SD (2014) - A prospective PMID:24926544 activation and effector functions randomized trial of L- of ³´ T cells. Journal of 75 Gulia A, Puri A, Kulkarni S (2014) asparaginase versus prednisolone Immunology. 192(5): 2054-62. - Radiofrequency ablation for in prevention of tumour lysis PMID: 24489102 epiphyseal chondroblastomas in syndrome in acute lymphoblastic 70 Gokhale PS, Sonawani A, Idicula- children emergence of a new leukemia patients with Thomas S, Kerkar S,Tongaonkar H, modality of treatment. Pediatric hyperleucocytosis. Pediatric Mania-Pramanik J (2014) - HPV16 Blood and Cancer. 61(s2):S272. Blood and Cancer. 61(s2):S258. PMID:24960541 E6 variants: Frequency, 82 Gupta P, Giri J, Srivastav S, Chande association with HPV types and in 76 Gulia A, Puri A, Laskar S (2014) - AG, Mukhopadhyaya R, Das PK, silico analysis of the identified Oncological and functional Ukil A (2014) - Leishmania novel variants. Journal of Medical outcome with multimodality donovani targets tumor necrosis Virology. 86(6):968-974. management of malignant factor receptor-associated factor PMID:24610458 pediatric musculoskeletal tumors (TRAF) 3 for impairing TLR4-

Tata Memorial Centre / Publications 205 mediated host response. The Androgen receptor as a regulator - epidemiological paradigm. FASEB Journal. 28(4): 1756- of ZEB2 expression and its Pediatric Blood and Cancer. 68. PMID: 24391131 implications in epithelial to 61(s2):s290-s295. PMID: 83 Gupta S, Kerkar RA, Dikshit R, mesenchymal transition in 94 Jain H, Sengar M, Menon H, Badwe RA (2014) - Authors reply prostate cancer. Endocrine related Chandrakanth MV (2014) - Blastic (to Is human papillomavirus cancer. 21(3):473-486. plasmacytoid dendritic cell vaccination likely to be a useful PMID:24812058 neoplasm: a rare subtype of strategy in India? South Asian J 89 Jadhav S, Kasaliwal R, lele V, myeloid leukemia. Hematology Cancer(South Asian Journal of Rangarajan V, Chandra P,Shah H, Oncology and Stem Cell Therapy. Cancer) 2(4):193-7.) (3(1):94-95). Malhotra G, Jagtap VS, Budyal S, 7(2):97-98. PMID:24785508 PMID: 24665459 Lila AR, Bandgar T,Shah NS (2014) 95 Jain H, Sengar M, Menon H, Dangi 84 Gupta T, Mohanty S, Kannan S, - Functional imaging in primary U, Biswas S, Chandrakanth MV Jalali R (2014) - Prospective tumour-induced osteomalacia: (2014) - Dengue fever as a cause longitudinal assessment of relative performance of FDG PET/ of febrile neutropenia in adult sensorineural hearing loss with CT vs somatostatin receptor- acute lymphoblastic leukemia: a hyperfractionated radiation based functional scans: a series of single center experience. therapy alone in patients with nine patients. Clinical Hematology Oncology and Stem average-risk medulloblastoma. Endocrinology. 81(1):31-37. Cell Therapy. 7(3):125-126. Neuro–Oncology Practice. PMID:24528172. PMID:24793316 1(3):86-93. 90 Jadhav S, Kasaliwal R, Shetty NS, 96 Jha S, Rawat-Pawar E, Goswami 85 Gupta T, Nair V, Jalali R (2014) - Kulkarni S, Rathod K, Popat B, S, Dhamankar V, Prasad Stem cell niche irradiation in Kakade H, Bukan A, Khare S, M, Kurkure P, Jalali R, Nagrulkar glioblastoma: providing a ray of Budyal S, Jagtap VS, Lila AR, A, Joshi S, Garware A (2014) - hope? CNS Oncology. 3(5):367- Bandgar T, Shah NS (2014) - Rehabilitation of childhood 376. PMID:25363009 Radiofrequency ablation, an cancer patients- collaborative effective modality of treatment in 86 Hajare SN, Gautam S, Nair AB, efforts of srcc -centre for child tumor-induced osteomalacia: a Sharma A (2014) - Formulation of development (ccd) with tata case series of three patients. The a nasogastric liquid feed and shelf- memorial hospital (tmh), & ugam- Journal of Clinical Endocrinology life extension using gamma childhood cancer survivors and Metabolism. 99(9):3049- radiation. Journal of Food support group. Pediatric Blood 3054. PMID:24960541 Protection. 77(8):1308-1316. and Cancer. 61(s2):s105-433. PMID: 5198591 91 Jain AS, Goel PN, Shah SM, 97 Jindal A, Mathur A, Pandey U, Dhawan VV, Nikam Y, Gude RP, 87 Hartwig W, Vollmer CM, Fingerhut Sarma HD, Chaudhari P, Dash A Nagarsenker MS (2014) - A, Yeo CJ, Neoptolemos JP, Adham (2014) - Development of 68 Ga- Tamoxifen guided liposomes for M, Andrén-Sandberg A, Asbun HJ, labeled fatty acids for their targeting encapsulated anticancer Bassi C, Bockhorn M, Charnley R, potential use in cardiac metabolic agent to estrogen receptor Conlon KC, Dervenis C, Fernandez- imaging. al of Labelled positive breast cancer cells: In Cruz L, Friess H, Gouma DJ, Imrie Compounds and vitro and in vivo evaluation. CW, Lillemoe KD, Miliæeviæ MN, Radiopharmaceuticals. 57(7): Biomedicine & Pharmacotherapy. Montorsi M, Shrikhande SV, 463-469. PMID: 24966158 68: 429-438. PMID: 24721327 Vashist YK, Izbicki JR, Büchler MW 98 Joh J, Jenson JB, Ingle AD, (2014) - Extended 92 Jain D, Athavale RB, Bajaj A, Sundberg JP, Ghim SJ (2014) - pancreatectomy in pancreatic Shrikhande S, Goel P, Nikam Y, Searching for the initiating site of ductal adenocarcinoma: Gude R (2014) - Unraveling the the major capsid protein to Definition and consensus of the cytotoxic potential of generate virus-like particles for a International Study Group for Temozolomide loaded into PLGA novel laboratory mouse Pancreatic Surgery (ISGPS). nanoparticles. DARU Journal of papillomavirus. Experimental and Surgery. 156(1):1-14. Pharmaceutical Sciences 22(1): Molecular Pathology. 96:155-161. PMID:24856668 18. PMID: 24410831 PMID: 24389228 88 Jacob S, Nayak S, Fernandes G, 93 Jain D, Mathur R, Lahoti 99 Joshi M, Ali Anwar M, Ullah Barai RS, Menon S, Chaudhari UK, B, Sharma S (2014) - Colorectal M, Kuruppu C (2014) - Kholkute SD, Sachdeva G (2014) - carcinoma in pediatric age group International trends in health

206 Tata Memorial Centre Annual Report 2014-2015 science librarianship part 12: tumours. Clinical Radiology. An Analysis From the EMBRACE South Asia (India, Pakistan and Sri 69(9):900-8. PMID:24863003 Study Brachytherapy for Locally Lanka) Health Information and 106 Khan SA, Tyagi M, Sharma AK, Advanced. International Journal Libraries Journal. 31(4):318-324. Barreto SG, Sirohi B, Ramadwar of Radiation Oncology Biology PMID:25443029 M, Shrikhande SV, Gupta S (2014) Physics. 89(1):88-95. 100 Joshi NN, Bhat S, Hake S, Kale M, - Cell-type specificity of â-actin PMID:24725693. and Kannan S (2014) - Opposing expression and its 111 Krishna H, Majumdar SK, effects of pro- and anti- clinicopathological correlation in Chaturvedi P, Sidramesh M, Gupta inflammatory cytokine gene gastric adenocarcinoma. World PK (2014) - In vivo raman polymorphisms on the risk for Journal of Gastroenterology. spectroscopy for detection of oral breast cancer in western Indian 20(34):12202-12211. neoplasia: a pilot clinical study. women: a pilot study. PMID:25232253 Journal of Biophotonics. 7(9):690- International Journal of 107 Khan TH, Srivastava N, Srivastava 702. PMID:23821433 Immunogenetics. 41(3):242-249. A, Sareen A, Mathur RK, Chande 112 Kumar G, Tajpara P, Bukhari AB, PMID: 2416486 AG, Musti KV, Roy S, Ramchandani AG, De A, Maru GB 101 Joshi NN, Kannan S, Kotian N, Bhat Mukhopadhyaya R, Saha B (2014) (2014) - Dietary curcumin post- S, Kale M, Hake S (2014) - - SHP-1 plays a crucial role in CD40 treatment enhances the Interleukin 6 -174G>C signaling reciprocity. Journal of disappearance of B(a)P-derived polymorphism and cancer risk: Immunology. 193(7): 3644-3653. DNA adducts in mouse liver and Meta-analysis reveals a site PMID: 25187664 lungs. Toxicol Rep. 1: 1181-1191. dependent differential influence 108 Kim H, Jesena A, Parmar V, Sato PMID: 19817699 in ancestral north Indians. Human N,Wang HC, Lokejaroenlarb S, 113 Kumar R, Desai S, Pai T, Pramesh Immunology. 75(8):901-908. Shin E, Noguchi S (2014) - An open CS, Jambhekar NA (2014) - PMID: 24994460 label randomised parallel group Pulmonary adenofibroma: 102 Joshi P, Nair S, Chaturvedi P, multicentre study to compare clinicopathological study of 3 Shivakumar T, DCruz AK, Nair D goserelin 10.8 mg given every 12 cases of a rare benign lung lesion (2014) - Thyroid gland weeks with goserelin 3.6 mg given and review of the literature. involvement in carcinoma of the every 4 weeks in premenopausal Annals of Diagnostic Pathology. hypopharynx. Journal of women with estrogen receptor 18(4):238-243. PMID:24908371 Laryngology and Otology. positive advanced breast cancer 114 Kumar S, Jena L, Galande S, Daf S, 128(1):64-67. PMID:24429057 (PRESTIGE study). European Mohod K, Varma AK (2014) - 103 Kane SV, Prabhudesai NM, Ojha Journal of Cancer. 50(S2):164. Elucidating molecular interactions SS, Shetty NS, Kulkarni SS, Kulkarni 109 Kinhikar RA, Tambe CM, Patil K, of natural inhibitors with HPV-16 AV (2014) - The role of squash Mandavkar M, Deshpande DD, E6 oncoprotein through docking cytology in rapid on-site adequacy Gujjalanavar R, Yadav P, Budrukkar analysis. Genomics and checking and rapid diagnosis in A (2014) - Estimation of dose Informatics. 12(2):64-70. PMID: image-guided gun biopsy at a enhancement to soft tissue due to 25031569 tertiary cancer center. Acta backscatter radiation near metal 115 Kumar S, Jena L, Galande S, Daf S, Cytologica. 58(1):33-41. PMID: interfaces during head and neck Varma AK (2014) - Molecular 24296489 radiothearpy-a phantom docking explains atomic 104 Kaur E, Gupta S, Dutt S (2014) - dosimetric study with interaction between plant- Clinical implications of MTA radiochromic film. Journal of originated ligands and oncogenic proteins in human cancer. Cancer Medical Physics. 39(1):40-43. E7 protein of high risk human Metastasis Reviews. 33(4):1017- PMID: 24600171 papillomavirus type 16. 24. PMID:25374266 110 Kirchheiner K, Nout RA, Tanderup International Journal 105 Kembhavi SA, Rangarajan V, Shah K, Lindegaard JC, Westerveld Bioautomation. 18(4):315-324 S, Qureshi S, Arora B, Juvekar S, H,Haie-Meder C, Petriè P, 116 Kumar S, Dongre A, Arora Laskar S, Vora T, Chinnaswamy G, Mahantshetty U, Dörr W, Pötter R B, Kurkure P, Chinnaswamy Ramadwar M, Kurkure P (2014) - (2014) - Manifestation Pattern of G, Rekhi B (2014) - Retrospective Prospective observational study Early-Late Vaginal Morbidity After analysis of outcomes of patients on diagnostic accuracy of whole- Definitive Radiation with relapsed, refractory and body MRI in solid small round cell (Chemo)Therapy and Image- metastatic sarcomas who have Guided Adaptive Cervical Cancer: received metronomic

Tata Memorial Centre / Publications 207 chemotherapy. Pediatric Blood diagnosing blunt trauma to the 128 Manjappa AS, Goel PN, Gude RP, and Cancer. 61(S2):S236-S237. pancreas: A prospective study Murthy RSR (2014) - Anti- 117 Kurkure P, Prasad M, Dhamankar with systematic review. Injury. neuropilin antibody Fab2 V, Goswami S, Dalvi N (2014) - 45(9):1384-93. PMID:24702828 fragment conjugated liposomal Adolescent and young adult (AYA) 123 Mahantshetty U, Kalyani N, docetaxel for active targeting of survivors of childhood cancers- a Engineer R, Chopra S, Jamema S, tumours. Journal Of Drug challenge in after completion of Ghadi Y, Deshpande D, Shrivastava Targeting. 22(8): 698-711. PMID: therapy (ACT) clinic. Pediatric S (2014) - Reirradiation using high- 24766186 Blood and Cancer. 61(s2):s105- dose-rate brachytherapy in 129 Manoharan Y, Kanniyappan U, 433. recurrent carcinoma of uterine Vadivel J, Prakasa Rao A, Ganesan 118 Laskar S, Khanna N, Puri A, cervix. Brachytherapy. 13(6):548- B, Dornadula K, Munusamy B D, Qureshi S, Gulia A, Vora T, Rekhi 53. Krishna CM, Ganesan S (2014) - B, Medhi S, Desai S, Chinnaswamy 124 Mahantshetty U, Shrivastava S, Fluorescence spectroscopic G Juvekar S, Desai S, Ramadwar Kalyani N, Banerjee S, Engineer characterization of salivary M, Jambhekar N, Muckaden M R, Chopra S (2014) - Template- metabolites of oral cancer (2014) - Interstitial brachytherapy based high-dose-rate interstitial patients. Journal of for childhood soft tissue brachytherapy in gynecologic Photochemistry and Photobiology sarcomas: long-term disease cancers: a single institutional B.130: 153-160. PMID: 24333763 outcome and late effects. experience. Brachytherapy. 130 Maru G (2014) - An update on International Journal of Radiation 13(4):337-342. PMID:24176863 cancer prevention approaches. Oncology Biology Physics. 125 Mahore A, Ramdasi RV, Pauranik Biomedical Research Journal. 1(2): 90(1):S113-114. A, Epari S (2014) - Tumour bleed 146-172. 119 Laskar S, Kumar DP, Khanna N, manifesting as spontaneous 131 Mhatre D, Mahaleb SD, Menon H, Sengar M, Arora B, extradural haematoma in Khatkhatayc MI, Desai SS, Jagtap Rangarajan V, Muckaden MA, Nair posterior fossa. BMJ Case DD, Dhabalia JV, Tongaonkar HB, R, Banavali S (2014) - Radiation Reports. Bcr2014205175. Desai MP, Dandekar SP, Varadkar therapy for early stage PMID:25008340 AM (2014) - Development of an unfavorable hodgkin lymphoma: 126 Maiers M, Halagan M, Joshi S, ELISA for sPSP94 and utility of the is dose reduction feasible? Ballal HS, Jagannatthan L, sPSP94sPSA ratio as a diagnostic Leukemia and Lymphoma. Damodar S, Srinivasan P, Narayan indicator to differentiate between 55(10):2356-2361. S, Khattry N, Malhotra P, Minz benign prostatic hyperplasia and PMID:24354681 RW, Shah SA, Rajagopal R, Cereb prostate cancer. Clinica Chimica 120 Laskar S, Kalyani N, Khanna N, Yang SY, Parekh S, Mammen J, Acta. 436:256-262. N, Vora T, Qureshi Daniels D, Weisdorf D (2014) - PMID:24952364 S, Chinnaswami G, Kembhavi HLA match likelihoods for Indian 132 Mishra PK, Raghuram GV, Jain D, S, Ramadwar M, Upreti patients seeking unrelated donor Jain SK, Khare NK, Pathak N (2014) R, Kurkure P (2014) - Helical transplantation grafts: a - Mitochondrial oxidative stress tomotherapy for askins tumor of population-based study. Lancet induced epigenetic modifications chest wall: clinical outcomes. Haematology. 1(2):e57-e63. in pancreatic epithelial cells. Pediatric Blood and Cancer. 127 Mallath MK, Taylor DG, Badwe RA, International Journal of 61(s2):s165. Rath GK, Shanta V, Pramesh CS, Toxicology. 33(2):116-129. PMID: 121 Lo-Coco F, Hasan SK (2014) - Digumarti R, Sebastian P, 24563415 Understanding the molecular Borthakur BB, Kalwar A, Kapoor S, 133 Mitra A, Sirohi B, Shrikhande SV pathogenesis of acute Kumar S, Gill JL, Kuriakose MA, (2014) - Neoadjuvant therapy in promyelocytic leukemia. Best Malhotra H, Sharma SC, Shukla S, pancreatic cancer. Current Practice and Research Clinical Viswanath L, Chacko RT, Pautu JL Medicine Research and Practice. Haematology. 27(1):3-9 PMID: (2014) - The growing burden of 4(2):56-61. 24907012 cancer in India: epidemiology and 134 Moiyadi A, Shetty P (2014) - 122 Mahajan A, Kadavigere R, Sripathi social context. The Lancet Navigable intraoperative S, Rodrigues GS, Rao VR, Oncology. 15(6):e205-e212. ultrasound and fluorescence- Koteshwar P (2014) - Utility of PMID:24731885 guided resections are serum pancreatic enzyme levels in complementary in resection

208 Tata Memorial Centre Annual Report 2014-2015 control of malignant gliomas: one clinico-microbiological Oncology. 31(9):188. size does not fit all. Journal of perspective: Review article. PMID:25148898 Neurological Surgery. Part A, Prosthetic joint infections- a 147 Noronha V, Patil VM, Joshi A, Central European Neurosurgery. clinico-microbiological Krishna MV, Dhumal S, Juvekar S, 75(6):434-441. PMID:24971685 perspective: Review article. World Pai P, Chatturvedi P, Chaukar DA, 135 Moiyadi A, Syed P, Srivastava S Journal of Clinical Infectious Agarwal JP, Ghosh S, Murthy V, (2014) - Fluorescence-guided Diseases. 4(3):9-15 D’cruz A, Prabhash K (2014) - surgery of malignant gliomas 142 Nair SV, Rathod SN, Nikam S, Induction chemotherapy in based on 5-aminolevulinic acid: Gupta T, Chaturvedi P, Sarin R, technically unresectable locally paradigm shifts but not a panacea. Agarwal J (2014) - Impact of advanced carcinoma of maxillary Nature Reviews Cancer. 14(2):146. radical treatments in the quality sinus. Chemotherapy Research PMID: 24457418 of life for patients with advanced and Practice. Vol.(2014), Article ID 136 Moiyadi AV (2014) - Objective buccal mucosa cancers: a one- 487872, 6 pages PMID: 24900922 assessment of intraoperative year longitudinal study. Journal of 148 Pai S, Qureshi S, Singhal ultrasound in brain tumors. Acta Clinical Oncology. 32:Suppl; abstr N, Banavali S, Ramdwar Neurochirurgica. 156(4):703-704. e17034 M, Chinnaswami G, Prasad PMID:24499993 143 Nanaware P, Ramteke M, M, Vora T, Aurora B, Narula G 137 More Y, Sharma S, Chaturvedi P, Somavarapu AK, Venkatraman P (2014) - Extrarenal rhabdoid DCruz AK (2014) - Gingivobuccal (2014) - Discovery of multiple tumor: rare but clinicians scare. mucosal cancers: resection to interacting partners of gankyrin, Pediatric Blood and Cancer. reconstruction. Current Oinion in a proteasomal chaperone and an 61(s2):s105-433. Otolaryngology and Head and oncoprotein –Evidence for a 149 Palve V, Mallick S, Ghaisas G, Neck Surgery. 22(2):95-100. common hot spot site at the Kannan S, Teni T (2014) - PMID:24406686 interface and its functional Overexpression of Mcl-1L splice relevance. Proteins. 82(7): 1283- 138 Mummudi N, Jalali R (2014) - variant is associated with poor 1300. PMID: 24338975 Palliative care and quality of life prognosis and chemoresistance in in neuro-oncology. F1000Prime 144 Narula G, Wanve B A, Arora oral cancers. PLoS One. Reports. (E-Collection). 6:21 B, Banavali S D (2014) - Impact on 9(11):e111927. PMID: 25409302 PMID:25165570 outcome of a modified langerhans 150 Pandey R, Mehrotra D, Kowtal P, cell histiocytosis (lch) protocol 139 Murthy V, Narang K, Ghosh-Laskar Mahdi AA, Sarin R (2014) - with intensified high risk S, Gupta T, Budrukkar A, Agrawal Mitochondrial DNA from archived induction and augmented JP (2014) - Hypothyroidism after tissue samples kept in formalin for prolonged maintenance-a single 3-dimensional conformal forensic odontology studies. institution experience. Pediatric radiotherapy and intensity Journal of Oral Biology and Blood and Cancer. 61(s2):s105- modulated radiotherapy for head Craniofacial Research. 4(2):109- 433 and neck cancers: Prospective 113. data from two randomized 145 Nebhnani D, Fernandes G, Menon 151 Pandey R, Mehrotra D, Mahdi AA, controlled trials. Head and Neck. S, Naik L (2014) - Primary renal Sarin R, Kowtal P (2014) - 36(11): 1573-1580. PMID: synovial sarcoma presenting in Additional cytosine inside 23996654 the first trimester of pregnancy. mitochondrial C-tract D-loop as a Journal of Obstetrics and 140 Muwonge R, Wesley RS, Nene progression risk factor in oral Gynaecology of India. 64(Suppl BM, Shastri SS, Jayant K, Malvi SG, precancer cases. Journal of Oral 1):22-3. PMID:25404798 Thara S, Sankaranarayanan R Biology and Craniofacial Research. (2014) - Evaluation of cytology 146 Noronha V, Joshi A, Jandyal S, 4(1):3-7. and visual triage of human Jambhekar N, Prabhash K (2014) 152 Pantvaidya GH, Pal P, Vaidya papillomavirus-positive women in - High pathologic complete AD, Pai PS, DCruz AK (2014) - cervical cancer prevention in remission rate from induction Prospective study of 583 neck India. International Journal of docetaxel, platinum and dissections in oral cancers: Cancer. 134(12):2902-2909. fluorouracil (DCF) combination implications for clinical practice. PMID:24272364 chemotherapy for locally Head and Neck. 36(10):1503- advanced esophageal and 141 Nair PK, Bhat VG, Vaz MK (2014) - 1507. PMID: 23996343 junctional cancer. Medical Prosthetic joint infections- a

Tata Memorial Centre / Publications 209 153 Panwar H, Raghuram GV, Jain D, Urology Annals. 6(1):18-22. Pediatric Blood and Cancer. Ahirwar AK, Khan S, Jain SK, PMID:24669116 61(s2):231. Pathak N, Banerjee S, Maudar KK, 160 Patil VM, Prabhash K, Noronha V, 165 Pramesh C, Rangarajan V, Shah Mishra PK (2014) - Cell cycle Joshi A, Muddu V, Dhumal S, Arya S, Laskar S, Karimundackal deregulation by methyl S, Juvekar S,Chaturvedi P, Chaukar G, Jiwnani S (2014) - A phase II isocyanate: Implications in liver D, Pai P, Kane S, Patil A Agarwal parallel group randomized trial of carcinogenesis. Environmental JP, Ghosh-Lashkar S, DCruz AK the impact of perioperative oral Toxicology. 29(3): 284-297. PMID: (2014) - Neoadjuvant erythromycin gastric tube motility 22223508 chemotherapy followed by in patients undergoing 154 Paramanandam VS, Roberts D surgery in very locally advanced esophagectomy. Diseases of the (2014) - Weight training is not technically unresectable oral Esophagus. 27(S1):3A-168A. harmful for women with breast cavity cancers. Oral Oncology. 166 Pramesh CS, Badwe RA, Borthakur cancer-related lymphoedema: a 50(10):1000-1004. BB, Chandra M, Raj EH, Kannan T, systematic review. Journal of PMID:25130412 Kalwar A, Kapoor S, Malhotra H, Physiotherapy. 60(3):136-143. 161 Patkar N, Subramanian PG, Nayak S, Rath GK, Sagar TG, PMID:25086730 Deshpande P, Ghodke K, Sebastian P, Sarin R, Shanta V, 155 Patel K, Patil A, Mehta M, Gota V, Tembhare, P, Mascarenhas R, Sharma SC, Shukla S, Vijayakumar Vavia P (2014) - Oral delivery of Muranjan A, Chaudhary S, Bagal M, Vijaykumar DK, Aggarwal A, paclitaxel nanocrystal (PNC) with B, Gujral S, Sengar M, Menon H Purushotham A, Sullivan R (2014) a dual Pgp-CYP3A4 inhibitor: (2014) - MYD88 Mutant - Delivery of affordable and Preparation, characterization and Lymphoplasmacytic Lymphoma / equitable cancer care in India. antitumor activity. International Waldenstroms Lancet Oncology. 15(6): e223- Journal of Pharmaceutics. 472(1- Macroglobulinemia has distinct e233. PMID: 24731888 2):214-223. PMID: 24954663 clinical and pathological features 167 Prasad M, Dhamankar 156 Patel K, Tyagi M, Monpara J, Vora as compared to its mutation V, Goswami S, Dalvi N, Arora L, Gupta S, Vavia P (2014) - negative counterpart. Leukemia B, Narula G, Banavali S D, Kurkure Arginoplexes: An arginine- Lymphoma. 56(2):420–425. P (2014) - Late effects in longterm anchored nanoliposomal carrier PMID: 24828863 survivors of childhood hodgkin for gene delivery. Journal of 162 Pawar S, Mahantshetty lymphoma: a single centre Nanoparticle Research. 16:2345. U, Deodhar K, Teni T (2014) - A experience. Pediatric Blood and 157 Patil T, Kowtal PK, Nikam A, simple cost-effective modification Cancer. 61(s2):s310. Barkume MS, Patil A, Kane SV, improves the quality of 168 Puntillo KA, Max A, Timsit JF, Juvekar AS, Mahimkar MB, Kayal immunocytochemical staining in Vignoud L, Chanques G, Robleda J (2014) - Establishment of a cervical scrape samples G, Roche-Campo F,Mancebo J , tongue squamous cell carcinoma characterized by presence of Divatia JV, Soares M, Ionescu DC, cell line from Indian gutka chewer. excess mucus. Journal of Maggiore SM, Rusinova K, Journal of Oral Oncology. vol. Histotechnology. 37(1):3-8. PMID: Owczuk R, Egerod I,Grintescu IM, 2014, Article ID 286013, 9 pages. 25620823 Vasiliu IL, Papathanassoglou ED, 158 Patil V, Prabhash K, Marfatia S, 163 Prabhakar V, Balasubramanian R, Kyranou M, Joynt GM, Burghi GF, Patel M, Gupta K, Kamble S (2014) Sathe P, Krishna CM, Juvekar A Freebairn RC, Ho KM, Kaarlola - PCN157 Health related quality of (2014) - In vitro anticancer activity A,Gerritsen RT, Kesecioglu J, Sulaj life in patients with metastatic, of monosubstituted chalcone MM, Norrenberg M, Benoit DD, relapsed, or inoperable squamous derivatives. International Journal Seha MS, Hennein A, Periera FJ, cell carcinoma of the head and of Tumor Therapy. 3(1):1-9. Benbenishty JS, Abroug F, Aquilina neck in India. Value in Health. 164 Pradhan N, Punatar S, Panda A,Monte JR, An Y, Azoulay E (2014) 17(3):A95. S, Gupta A, Prasad M, Narula - Determinants of procedural pain intensity in the intensive care unit. 159 Patil VM, Noronha V, Prabhash K, G, Vora T, Chinnaswamy G, Arora The Europain® study. American Muddu V, Bhosale B, Bakshi G, B, Banavali S, Kurkure P, Quereshi Journal of Respiratory and Critical Joshi A (2014) - Palliative S (2014) - Epidemiology and Care Medicine. 189(1):39-47. chemotherapy in carcinoma outcome of rare renal tumors in PMID:24262016 penis: does platinum and taxane pediatric population in a single combination holds a promise? tertiary care centre in India.

210 Tata Memorial Centre Annual Report 2014-2015 169 Purandare NC, Pramesh 176 Puri A, Gulia A, Desai S, Chorge S S, Khanna N, Kurkure P, Shah S, CS,Karimundackal G, Jiwnani S, (2014) - Intramedullary extension Shankdhar V, Yadav P (2014) - Agrawal A, Shah S, Kulkarni M, in periosteal osteosarcoma - does Primary non-metastatic Ewing Laskar SG, Rangarajan V (2014) - it portend aggressive biology? sarcoma of the jaw in children: Incremental value of 18F-FDG Pediatric Blood and Cancer. Results of surgical resection and PET/CT in therapeutic decision- 61(s2):s274-s275. primary reconstruction. Journal of making of potentially curable 177 Puri A, Gulia A, Hawaldar Surgical Oncology. 110(6):689- esophageal adenocarcinoma. R, Ranganathan P, Badwe RA 695. PMID:24963839 Nuclear Medicine (2014) - Does intensity of 184 Qureshi SS, Kembhavi S, Communications. 35(8):864-869. surveillance affect survival after Ramadwar M, Chinnaswamy G, PMID:24751701 surgery for sarcomas? results of a Laskar S, Talole S, Desai S, Khanna 170 Puranik AD, Purandare N, Agrawal randomized noninferiority trial. N, Vora T, Kurkure P (2014) - A, Shah S, Rangarajan V (2014) - Clinical Orthopeadics and Related Outcome and morbidity of Bone marrow metastases in an Research. 472(5):1568-1575. surgical resection of primary otherwise operable gall bladder PMID: 24249538 cervical and cervicothoracic cancer: rare site of distant 178 Puri A, Gulia A, Khanna N, Laskar neuroblastoma in children: a metastases detected on FDG PET/ S (2014) - Should percentage comparative analysis. Pediatric CT. Clinical Nuclear Medicine. necrosis influence the decision for Surgery International. 30(3): 267- 39(2):e169-e172. PMID: adjuvant radiotherapy after 73. PMID: 24264427 23877515 surgical excision in ewing 185 Ramteke MP, Shelke P, 171 Puranik AD, Purandare NC, sarcoma? Pediatric Blood and Ramamoorthy V, Kumar A, Agrawal A, Shah S, Rangarajan V Cancer. 61(s2):S224. Gautam AKS, Nanaware PP, (2014) - Imaging spectrum of 179 Puri A, Gulia A, Suman MB (2014) Karanam S, Mukhopadhyay S, peritoneal carcinomatosis on FDG - Does the addition of topical Venkatraman P (2014) - PET/CT. Japanese Journal of vancomycin decrease the Identification of a novel ATPase Radiology. 32(10):571-578. incidence of surgical site infection activity in 14-3-3 proteins- PMID:25120221 in bone tumors? Pediatric Blood evidence from enzyme Kinetics, 172 Puranik AD, Purandare NC, and Cancer. 61(s2):S248-249. structure guided modeling and mutagenesis studies. FEBS Lett. Agrawal A, Shah S, Rangarajan V 180 Puri A, Sharma V, Gulia A, Sharma 588(1):71-78. PMID: 24269678 (2014) - Segmental misty S, Verma AK (2014) - mesentery on FDG PET/CT: an Management of giant cell tumour 186 Ranganathan P (2014) - The uncommon manifestation of radius in a three year old child (mis)use of statistics: Which test mesenteric lymphoma. Clinical with an improvised technique. where? Perspectives in Clinical Nuclear Medicine. 39(1):84-90. Journal of Clinical and Diagnostic Research. 5(4):197. PMID:23797224 Research. 8(14):QD04-6. PMID:25276632 173 Puri A (2014) - Extending the PMID:25654002 187 Ranjan A, Bane SM, Kalraiya RD frontiers of limb salvage- 181 Purwar P, Bambarkar S, Jiwnani S, (2014) - Glycosylation of the geographically and surgically. Pramesh CS (2014) - Prognostic laminin receptor (±3²1) regulates Operative Techniques in significance of lymph node counts its association with tetraspanin Orthopaedics. 24(2):135-142. in operable esophageal cancer. CD151: Impact on cell spreading, 174 Puri A, Pruthi M, Gulia A (2014) - Annals of Thoracic Surgery. motility, degradation and invasion Outcomes after limb sparing 97(6):2229. PMID:24882321 of basement membrane by tumor cells. Experimental Cell Research. resection in primary malignant 182 Qureshi S, Kembhavi S, Bhagat 322(2):249-64. PMID: 24530578 pelvic tumors. European Journal M, Vora T, Chinnaswamy of Surgical Oncology. 40(1):27-33. G, Laskar S, Khanna N, Ramadwar 188 Ranjan A, Kalraiya RD (2014) - PMID: 24239184 M, Kurkure P (2014) - Prognostic Invasive potential of melanoma 175 Puri A, Gulia A, Crasto S (2014) - implications of mulifocality in cells correlates with the Chemotherapy induced necrosis hepatoblastoma. Pediatric Blood expression of MT1-MMP and as a prognostic marker in and Cancer. 61(s2):s145-146 regulated by modulating its association with motility osteosarcoma do we need to raise 183 Qureshi SS, Kembhavi S, Bhagat receptors via N-Glycosylation the the bar? Pediatric Blood and M, Laskar S, Chinnaswamy G,Vora receptor. BioMed Research Cancer. 61(s2):s275. T, Prasad M, Ramadwar M, Desai PMID:25114467

Tata Memorial Centre / Publications 211 International. Vol. (2014), Article complication. Pediatric Blood and of Medical Physics. 39(4):206-211. ID 804680, 10 pages. Cancer. 61(s2):105-433. PMID:25525307 189 Rastogi S, Qureshi S, Vora 195 Rent P, Qureshi S, Rent E, Puri 199 Sahu I, Sangith N, Ramteke T, Chinnaswamy G, Prasad A, Gulia A, Bhagat M, Moiyadi M,Gadre R, Venkatraman P (2014) MAYA, Laskar S, Khanna A, Chinnaswamy G, Arora - A novel role for the Proteasomal N, Ramadwar M, Medhi B, Banavali S (2014) - Chaperone PSMD9 and hnRNPA1 S, Kurkure P (2014) - Is three drug Epidemiology of pediatric in enhancing IºB± degradation chemotherapy protocol for all malignancies in India. Pediatric and NF-ºB activation–Functional stages of wilms tumor a practical Blood and Cancer. 61(s2):s105- Relevance of predicted PDZ compromise for suboptimal 433. domain-motif interaction. FEBS staging in developing country? Is 196 Rubina S, Sathe P, Dora TK, Chopra Journal. 281(11): 2688-2709. it worth & safe? Pediatric Blood S, Maheshwari A, Murali Krishna PMID: 247207 and Cancer. 61(s2):S232. C (2014) -In vivo raman 200 Sakhavalkar PU, Bhoosreddy AR, 190 Rekhi B, Qureshi SS, Narula G, spectroscopy of human uterine Agarwal JP, Upasani MN (2014) - Gujral S, Kurkure P (2014) - cervix: exploring the utility of Mouth wash a survey on utility Rapidly progressive congenital vagina as an internal control. perception and awareness among rhabdomyosarcoma presenting Journal of Biomedical Optics. physicians treatin head neck with multiple cutaneous lesions: 0001;19(8):087001. cancer. Unique Journal of Medical an uncommon diagnosis and a 197 Sadetzki S, Langer CE, Bruchim R, and Dental Sciences. 2(1):15-21. therapeutic challenge. Pathology, Kundi M, Merletti F, Vermeulen R, 201 Sangith N, Srinivasaraghavan K, Research and Practice. Kromhout H, Lee AK, Maslanyj M, Sahu I, Desai A, Medipally S, 210(5):328-333. PMID: 24635971 Sim MR, Taki M, Wiart J, Somavarappu AK, Verma C, 191 Rekhi B, Singhvi T (2014) - Armstrong B, Milne E, Benke G, Venkatraman P (2014) - Discovery Histopathological, Schattner R, Hutter HP, Woehrer of novel interacting partners of immunohistochemical and A, Spinelli J, Lacour B, Delmas D, PSMD9, a proteasomal molecular cytogenetic analysis of Remen T, Radon K, Weinmann chaperone: Role of an unusual 21 spindle cell/sclerosing T,Klostermann S, Heinrich S, and versatile PDZ-domain motif rhabdomyosarcomas. APMIS. Petridou E, Bouka E, interaction and identification of 122(11):1144-1145. PMID: Panagopoulou P, Dikshit R, putative functional modules. 24730567 Nagrani R, Even-Nir H, Chetrit A, FEBS Open Bio. (4):571-583. 192 Rekhi B, Vogel U, Basak R, Desai Maule M, Migliore E, Filippini G, PMID: 25009700 SB, Jambhekar NA (2014) - Miligi L, Mattioli S, Yamaguchi N, 202 Savanur MA, Eligar SM, Pujari R, Clinicopathological and molecular Kojimahara N, Ha M, Choi KH, Chen C, Mahajan P, Borges A, spectrum of Ewing Sarcomas/ Mannetje A, Eng A, Woodward A, Shastry P, Ingle A, Kalraiya RD, PNETs, including validation of Carretero G, Alguacil J, Aragones Swamy BM, Rhodes JM, Yu LG, EWSR1 rearrangement by N, Suare-Varela MM, Goedhart G, Inamdar SR (2014) - Sclerotium conventional and array FISH Schouten-van (2014) - The MOBI rolfsii lectin induces stronger technique in certain cases. kids study protocol: challenges in inhibition of proliferation in Pathology Oncology Research. assessing childhood and human breast cancer cells than 20(3):503-516. PMID: 24293381 adolescent exposure to normal human mammary electromagnetic fields from 193 Rengan AK, Jagtap M, De A, epithelial cells by induction of cell wireless telecommunication Banerjee R, Srivastava R (2014) - apoptosis. PLoS One. 9(11): Technologies and possible Multifunctional gold coated e110107. PMID: 24364905 association with brain tumor risk. thermo-sensitive liposomes for 203 Sawant S, Vaidya M, Chaukar D, Frontiers in Public Health. 2:124 multimodal imaging and photo- Alam H, Dmello C, Gangadaran P, PMID:25295243 thermal therapy of breast cancer Kannan S, Kane S, Dange P, Dey N, cells. Nanoscales. 6(2):916-923. 198 Sahani G, Sharma SD, Sharma PK Ranganathan K, DCruz AK (2014) PMID: 24281647 (2014) - Acceptance criteria for - Clinical significance of aberrant flattening filter-free photon beam 194 Rent E, Qureshi S, Rent P, Bhagat vimentin expression in oral from standard medical electron M, Singhal N (2014) - Chyle leak premalignant lesions and linear accelerator: AERB task following surgical management of carcinomas. Oral Diseases. group recommendations. Journal neuroblastoma: an underrated 20(5):453-465. PMID: 23865921

212 Tata Memorial Centre Annual Report 2014-2015 204 Sawant SS, Vaidya MM, Chaukar institutional experience. Journal 216 Shrikhande SV, Pai E (2014) - DA, Gangadaran P,Singh of Medical Physics. 39(3):197-202. Enhanced recovery after surgery A,Rajadhyax S, Kannan S, PMID:25190999 in laparoscopic gastric cancer Padmavathi A, Kane S, Pagare S, 209 Sharma S, Punjabi V, Zingde SM, surgery: many questions, few Kannan R, D’cruz AK (2014) - Gokhale SM (2014) - A answers. Journal of Minimal Clinicopathological features and comparative protein profile of Access Surgery. 10(3):105-106. prognostic implications of loss of Mammalian erythrocyte PMID:25013324 K5 and gain of K1, K8 and K18 in membranes identified by mass 217 Shylasree TS, Bryant A, Howells oral potentially malignant lesions spectrometry. Journal of REJ (2014) - Chemoradiation for and squamous cell carcinomas: Membrane Biology. 247(11): advanced primary vulval cancer. Immunohistochemical analysis. 1181-9. PMID: 25150706 The Cochrane Database of Edorium Journal of Tumor Biology. 210 Sharma S, Ray S, Moiyadi A, Systematic Reviews. CD003752. 1: 1-22. Sridhar E, Srivastava S (2014) - PMID:21491387 205 Sehgal L, Mukhopadhyay A, Rajan Quantitative proteomic analysis 218 Simha V, Patel FD, Sharma SC, Rai A, Khapre N, Sawant M, Vishal SS, of meningiomas for the B, Oinam AS, Krishnatry R, Bhatt K, Ambatipudi S, Antao N, identification of surrogate protein Dhanireddy B (2014) - Evaluation Alam H, Gurjar M, Basu S, Mathur markers. Scientific Reports. 4: of intrafraction motion of the R, Borde L, Hosing AS, Vaidya MM, 7140. PMID: 25413266 organs at risk in image-based Thorat R, Samaniego F, Kolthur- 211 Shastri A, Shastri SS (2014) - brachytherapy of cervical cancer. Seetharam U, Dalal SN (2014) - 14- Cancer screening and prevention Brachytherapy. 13(6):562-567. 3-3³ meditated transport of in low-resource settings. Nature PMID:25030951. plakoglobin to the cell border is Review Cancer. 14(12):822-9. 219 Singh N, D’Souza A, Cholleti A, required for the initiation of PMID:25355377 Sastry MG, Bose K (2014) - Dual desmosome assembly in vitro and regulatory switch confers tighter in vivo. Journal of Cell Science. 212 Shastri SS, Mittra I, Mishra GA, control on HtrA2 proteolytic 127(Pt10):2174-2188. PMID: Gupta S, Dikshit R, Singh S, Badwe activity. FEBS Journal. 281(10): 24610948 RA (2014) - Effect of VIA screening by primary health workers: 2456-2470. PMID: 24698088 206 Shah SM, Goel P, Jain AS, Pathak Randomized controlled study in 220 Singh RK, Gaikwad SM, Jinager A PO, Padhye SG, Govindarajan S, Mumbai, India. Journal of (2014) - IGF-1R inhibition Ghosh SS, Chaudhary P, Gude RP, National Cancer Institue. potentiates cytotoxic effects of Gopal V, Nagarsenker MS (2014) - 106:(3):dju009. PMID: 24563518 chemotherapeutic agents in early Liposomes for targeting stages of chemoresistant ovarian hepatocellular carcinoma: Use of 213 Shet T (2014) - Time to change the cancer cells. Cancer Letter. conjugated arabinogalactan as way we diagnose mucinous 354(2):254-262. PMID:25157649 targeting ligand. International carcinomas of breast. Human Journal of Pharmaceutics. 477(1- Pathology. 45(2):434-435. 221 Singh RK, Gaikwad SM, Jinager A, 2): 128-139. PMID:25311181 PMID:24439233 Chaudhury S, Maheshwari A, Ray P (2014) - IGF-1R inhibition 207 Shaikh R, Dora TK, Chopra S, 214 Shetty N, Noronha V, Joshi A, potentiates cytotoxic effects of Maheshwari A, Kedar K D, Rangarajan V, Purandare N, chemotherapeutic agents in early Bharat R, Krishna CM (2014) - In Mohapatra PR, Prabhash K (2014) stages of chemoresistant ovarian vivo raman spectroscopy of - Diagnostic and treatment cancer cells. Cancer Lett. 354:254- human uterine cervix: exploring dilemma of dual pathology of 262. PMID: 25157649 the utility of vagina as an internal lung cancer and disseminated control. Journal of Biomedical tuberculosis. Journal of Clinical 222 Singh SP, Krishna CM (2014) - Optics. 19(8). PMID:25104415 Oncology. 32(6):e7-e9. Raman spectroscopy of oral PMID:24395843 tissues: Correlation of spectral 208 Sharma PK, Sharma PK, Swamidas and biochemical markers. Anal JV, Mahantshetty U, Deshpande 215 Shivakumar T, Nair S, Gupta T, Methods. 6:8613-8620. DD, Manjhi J, Rai DV (2014) - Dose Kannan S (2014) - Concurrent optimization in gynecological 3D chemoradiotherapy with weekly 223 Singhal N, Qureshi image based interstitial versus three-weekly cisplatin in S, Chinnaswami G, Kembhavi brachytherapy using martinez locally advanced head and neck S, Rangarajan V, Desai S, Shah universal perineal interstitial squamous cell carcinoma. S, Kurkure P, Agrawal A, Bhagat M template (MUPIT) -an Cochrane Database Syst Rev. 1: (2014) - Role of PET- CT in staging CD010906.

Tata Memorial Centre / Publications 213 of pediatric round cell tumors. can 230 Soni BL, Marimuthu A, Pawar H, Purushotham AD (2014) - Cancer it eliminate the need for bone Sawant SS, Borges A, Kannan R, research in India: National marrow biopsy? Pediatric Blood Pandey A, Ingle AD, Harsha HC, priorities, global results. Lancet and Cancer. 61(s2):S246. Vaidya MM (2014) - Quantitative Oncology. e213-e222. 224 Sinha RK, Bojjireddy N, Kanojia D, proteomic analysis of different PMID:24731887 Subrahmanyam G (2014) - Type II stages of rat lingual 234 Sundberg JP, Stearns TM, Joh J, PtdIns 4-kinase ² associates with carcinogenesis. Clinical Proctor M, Ingle A, Silva KA, CD4–p56lck complex and is Communication Oncology. 1(1):2. Dadras SS, Jenson AB, Ghim SJ involved in CD4 receptor 231 Soon SS, Chia WK, Chan ML, Ho (2014) - Immune status, strain signaling. Molecular and Cellular GF, Jian X, Deng YH, Tan CS, background, and anatomic site of Biochemistry. 395(1-2): 231-9. Sharma A, Segelov E, Mehta S, Ali inoculation affect mouse PMID: 24972704 R, Toh HC, Wee HL (2014) - Cost- papillomavirus (MmuPV1) 225 Sinukumar S, Patil P, Engineer effectiveness of aspirin adjuvant induction of exophytic papillomas R, Desouza A, Saklani A (2014) - therapy in early stage colorectal or endophytic trichoblastomas. Clinical outcome of patients with cancer in older patients. PLoS PLoS One. 9(12): e113582. PMID: complete pathological response One. 9(9):e107866. 25474466 to neoadjuvant PMID:25250815 235 Tandon N, Banavali S, Arora chemoradiotherapy for locally 232 Stupp R, Hegi ME, Gorlia T, Erridge B, Kembhavi S (2014) - Baseline advanced rectal cancers: the SC , Perry J, Hong Yong, Aldape, high resolution ct scan (HRCT) Indian scenario. Gastroenterology Benoit Lhermitte Kenneth D thorax for detecting respiratory Research and Practice. 21(1):76- Pietsch T, Grujicic D, Steinbach JP, infection in patients with acute 78. PMID: 25610460 Wick W, Tarnawski R, Nam D, Hau myeloid leukemia (AML) at 226 Sirohi B, Philip DS, Shrikhande SV P, Weyerbrock A, Taphoorn MJB, presentation. Pediatric Blood and (2014) - Regorafenib in Shen C, Rao N, Thurzo L, Cancer. 61(s2):s203. gastrointestinal stromal tumors. Herrlinger U, Gupta T, Kortmann 236 Tendulkar A, Shah S, Patil D, Future Oncology. 10(9):1581- R, Adamska K, McBain C, Brandes Tambe M (2014) - Platelet 1587. PMID:25145429 AA, Tonn JC, Schnell O, Wiegel T, donation drives: a novel initiative Kim CY, Nabors LB, Reardon DA, 227 Sirohi B, Rastogi S, Dawood S, to recruit platelet donors. van den Bent MJ, Hicking C, Talole S, Ramadwar M, Shetty N, Transfusion and Apheresis Markivskyy A, Picard M, Weller M, Shrikhande SV (2014) - Treatment Science. 50(3):407-410. for the European Organisation for of patients with advanced gastric PMID:24793425. Research and Treatment of cancer: experience from an Indian 237 Thiagarajan S, Nair S, Nair D, Cancer (EORTC), the Canadian tertiary cancer center. Medical Chaturvedi P,Kane SV, Agarwal JP, Brain Tumor Consortium, and the Oncology. 31(10):138. DCruz AK (2014) - Predictors of CENTRIC study team, Cilengitide PMID:25228200 prognosis for squamous cell combined with standard carcinoma of oral tongue. Journal 228 Solanki SL, Doctor JR, Patil VP treatment for patients with newly of Surgical Oncology. 109(7):639- (2014) - Positive end-expiratory diagnosed glioblastoma with 644. PMID:24619660 pressure valve malfunctioning methylated MGMT promoter detected by capnography and (CENTRIC EORTC 26071-22072 238 Thompson BA, Spurdle AB, Plazzer airway pressure waveform. study): a multicentre, JP, Greenblatt MS, Akagi K, Al- Annals of Cardiac Anaesthesia. randomised, open-label, phase 3 Mulla F, Bapat B, Bernstein I, 17(3):255-257. PMID:24994745 trial. Lancet Oncology. Capellá G, den Dunnen JT, du Sart 229 Somavarapu AK, Balakrishnan S, 15(10):1100-1108. PMID: D, Fabre A, Farrell MP, Farrington Gautam AK, Palmer DS, 25163906 SM, Frayling IM, Frebourg T, Goldgar DE, Heinen CD, Holinski- Venkatraman P (2014) - Structural 233 Sullivan R, Badwe RA, Rath GK, Feder E, Kohonen-Corish M, interrogation of Pramesh CS, Shanta V, Digumarti Robinson KL, Leung SY, Martins A, phosphoproteome identified by R, D’Cruz A, Sharma SC, Viswanath Moller P, Morak M, Nystrom M, mass spectrometry reveals L, Shet A, Vijayakumar M, Lewison Peltomaki P, Pineda M, Qi M, allowed and disallowed regions of G, Chandy M, Kulkarni P, Bardia Ramesar R, Rasmussen LJ, Royer- phosphoconformation. BMS MR, Kumar S, Sarin R, Sebastian Pokora B, Scott RJ, Sijmons R, Structural Biology. 14: 9. PMID: P, Dhillon PK, Rajaraman P, Trimble Tavtigian SV, Tops CM, Weber T, 24618394 EL, Aggarwal A, Vijaykumar DK, Wijnen J, Woods MO, Macrae F,

214 Tata Memorial Centre Annual Report 2014-2015 Genuardi M; on behalf of InSiGHT; Shrikhande SV, Vollmer CM, Yeo 245 Vikrant, Sawant UU, Varma AK The InSiGHT collaborators are as CJ, Charnley RM (2014) - (2014) - Role of MERIT40 in follows:, Castillejo A, Sexton A, Definition of a standard stabilization of BRCA1 complex: a Chan AK, Viel A, Blanco A, French lymphadenectomy in surgery for protein-protein interaction study. A, Laner A, Wagner A, van den pancreatic ductal Biochem Biophys Res Commun. Ouweland A, Mensenkamp A, adenocarcinoma: A consensus 446(4):1139-44. PMID: 24667604 Payá A, Betz B, Redeker B, Smith statement by the International 246 Vora L, Tyagi M, Patel K, Gupta S, B, Espenschied C, Cummings C, Study Group on Pancreatic. Vavia P (2014) - Self-assembled Engel C, Fornes C, Valenzuela C, Surgery. 156(3):591-600. nanocomplexes of anionic Alenda C, Buchanan D, Barana D, PMID:25061003 pullulan and polyallylamine for Konstantinova D, Cairns D, Glaser 240 Tyagi M, Khade B, Khan SA, Ingle DNA and pH-sensitive intracellular E, Silva F, Lalloo F, Crucianelli F, A, Gupta S (2014) - Expression of drug delivery. Journal of Hogervorst F, Casey G, Tomlinson histone variant, H2A.1 is Nanoparticals Research. 16:2781 I, Blanco I, Villar IL, Garcia-Planells associated with the 247 Vora T, Surwade G, Shah J, Bigler J, Shia J, Martinez-Lopez undifferentiated state of N, Tandon S, Prasad J, Gille JJ, Hopper J, Potter J, Soto hepatocyte. Experimental Biology M, Chinnaswamy G, Arora JL, Kantelinen J, Ellis K, Mann K, and Medicine . 239(10):1335- B, Banavali S (2014) - Time-trend, Varesco L, Zhang L, Le Marchand 1339. PMID: 24764240 over 10 years, of increasing multi- L, Marafie MJ, Nordling M, 241 Upraity S, Shaikh S, Padul V, drug resistant superbugs in Tibiletti MG, Kahan MA, Shirsat NV (2014) - miR-224 pediatric oncology unit of a Ligtenberg M, Clendenning M, expression increases radiation tertiary. Pediatric Blood and Jenkins M, Speevak M, Digweed sensitivity of glioblastoma cells. Cancer. 61(s2):s105-433. M, Kloor M, Hitchins M, Myers M, Biochemical and Biophysical Aronson M, Valentin MD, Kutsche 248 Wirth MD, Burch JB, Hébert JR, Research Communications. M, Parsons M, Walsh M, Kansikas Kowtal P, Mehrotra-Kapoor A, 448(2):225-230. PMID: 24785373 M, Zahary MN, Pedroni M, Heider Steck SE, Hurley TG, Gupta PC, N, Poplawski N, Rahner N, Lindor 242 Varghese F, Bukhari AB, Malhotra Pednekar MS, Youngstedt SD, NM, Sala P, Nan P, Propping P, R, De A (2014) - IHC Profiler: An Zhang H, Sarin R (2014) - Case– Newcomb P, Sarin R, Haile R, open source plugin for the control study of breast cancer in Hofstra R, Ward R, Tricarico R, quantitative evaluation and India: Role of PERIOD3 clock gene Bacares R, Young S, Chialina S, automated scoring of length polymorphism and Kovalenko S, Gunawardena SR, immunohistochemistry images of chronotype. Cancer Investigation. Moreno S, Ho SL, Yuen ST, human tissue samples. PLoS One. 32(7):321-329. PMID: 24903750 Thibodeau SN, Gallinger S, 9(5):e96801. PMID: 24802416 249 Yadav K, Bakshi G, Prakash G Burnett T, Teitsch T, Chan TL, 243 Vasanth Karthik R, Ranganathan P, (2014) - Simultaneous bilateral Smyrk T, Cranston T, Psofaki V, Kulkarni AP, Sharma KS (2014) - adrenelectomy for Steinke-Lange V, Barbera VM Does cuff pressure monitoring pheochromocytoma in MEN (2014) - Application of a 5-tiered reduce postoperative syndrome: case report with scheme for standardized pharyngolaryngeal adverse review literature. International classification of 2,360 unique events after LMA-ProSeal Journal of Surgery Case Report. mismatch repair gene variants in insertion? A parallel group 5(8):487-490. PMID:24981168 the InSiGHT locus-specific randomised trial. Journal of 250 Yadav K, Bakshi G, Prakash G, database. Nature Genetics. Anesthesia. 28(5):662-667. Tamhankar A, Verma K (2014) - 46(2):107-117. PMID: 24362816 PMID:24643810 Simultaneous bilateral 239 Tol JA, Gouma DJ, Bassi C, 244 Vikrant, Nakhwa P, Badgujar DC, laparoscopic adrenalectomy for Dervenis C, Montorsi M, Adham Kumar R, Rathore KK, Varma AK pheochromocytoma in multiple M, Andrén-Sandberg A, Asbun HJ, (2014) - Structural and functional endocrine neoplasia (MEN) Bockhorn M, Büchler MW, characterization of the MERIT40 syndrome: case report with ConlonKC, Fernández-Cruz L, to understand its role in DNA review literature. International Fingerhut A, Friess H, Hartwig W, repair. Journal of Biomolecular Journal of Surgery Case Reports. Izbicki JR, Lillemoe KD, Milicevic Structure and Dynamics. 32(12): 5(8):487-490. PMID:24981168 MN,Izbicki JR, Lillemoe KD, 2017-2032. PMID: 24125081 251 Yadav K, Shrikhande S, Goel M Milicevic MN, Neoptolemos JP, (2014) - Post hepatectomy liver

Tata Memorial Centre / Publications 215 failure: concept of management. National papillary neoplasm of the bile Journal of Gastrointestinal Cancer. 1 Agarwal JP, Upasani MN, Ghadi Y, duct : a rarity. Indian Journal of 149(5):713-724. PMID:25104504 Munshi A (2014) - Postradiation Pathology and Microbiology. 252 Yadav LR, Biswal MN, Vikrant, hypertrichosis: A paradox. Journal 57(1):144-145. PMID:24739857 Hosur MV, Varma AK (2014) - of Cancer Research and 8 Barreto SG, Chaubal GN, Talole S, Tetrameric ZBRK1 DNA binding Therapeutics. 10(1):203-206. Desouza A, Suradkar K, Gaikwad domain has affinity towards 2 Agrawal A, Jatale P, Purandare N, V, Goel M, Shrikhande SV (2014) - cognate DNA in absence of Zinc Shah S, Rangarajan V (2014) - Rare Rectal cancer in young Indians-Are ions. Biochemical and Biophysical splenic metastasis of renal cell these cancers different compared Research Communications . carcinoma detected on (99m)Tc- to their older counterparts?. 450(1):283-288. PMID: 24924633 MDP Rare splenic metastasis of Indian Journal of 253 Yarnold J, Offersen BV, Olivotto I, renal cell carcinoma detected on Gastroenterology. 33(2):146-150. Poortmans P, Sarin R (2014) - (99m)Tc-MDP bone scan. Indian PMID:24048679 Radiotherapy for breast cancer, Journal of Nuclear Medicine. 9 Bhandare S, Shrikhande S, Bakshi the TARGIT-A trial. Lancet. 29(1):60-61. PMID:24591791 G, Deodhar KK (2014) - Isolated 383(9930):1717-1718. PMID: 3 Agrawal A, Kembhavi S, Purandare adrenal metastasis: a case report. 24835613 N, Shah S, Rangarajan V (2014) - Indian Journal of Pathology and 254 Yaseer M, Shaikh R, Krishna CM, Report of two cases of Microbiology. 57(1):150-151. Teni T (2014) - Raman fluorodeoxyglucose positron PMID:24739860 spectroscopic study of emission tomography/computed 10 Bhargava A, Pathak N, Varshney S, radioresistant oral cancer sublines tomography appearance of Shrivastava M, Mishra PK (2014) - established by fractionated hibernoma: A rare benign tumor. Molecular detection of window ionizing radiation. PLoS ONE Indian Journal of Nuclear phase hepatitis C virus infection 9(5):e97777. PMID: 24841281 Medicine. 29(1):40-2. PMID: in voluntary blood donors and 255 Yathiraj PH, Ghosh-Laskar S, Datta 24591783 health care workers in a Cohort D, Rangarajan V, Purandare 4 Agrawal A, Purandare N, Shah S, from central India. Indian Journal N, Gupta T, Budrukkar A, Murthy Puranik A, Banavali S, Rangarajan of Community Medicine. V, Kannan S, Agarwal JP (2014) - V (2014) - Response assessment 39(1):51-52. PMID: 24696542 Randomized controlled trial to in metronomic 11 Bhatnagar S, Devi S, Vinod N, Jain compare3-dimensional conformal chemotherapy:RECIST or P, , Durgaprasad G, Maroo SH, radiation therapy (3DCRT) to PERCIST?. Indian Journal of Patel KR (2014) - Safety and intensity modulated radiation Nuclear Medicine. 29(2):74-80. efficacy of oral transmucosal therapy (IMRT) in head and neck PMID:24761057 fentanyl citrate compared to squamous cell carcinoma. 5 Ahmad QG, Yadav PS, Shankhdhar morphine sulphate immediate International Journal of Radiation VK, Nambi GI (2014) - release tablet in management of Oncology Biology Physics. Anterolateral thigh twin free flaps breakthrough cancer pain. Indian 90(s1):S98. from a single donor site-a Journal of Palliative Care. 256 Yuvaraj M, Udayakumar K, Jayanth modification based on the oblique 20(3):182-187. PMID:25191003 V, Aruna PR, Bharanidharan G, branch of the lateral circumflex 12 Bhukal I, Thimmarayan G, Bala Koteeswaran D, David BM, Murali femoral artery. Indian Journal of I, Solanki SL, Samra T (2014) - Krishna C, Ganesan S (2014) - Surgery. 76(2):165-168. Comparison of serum triglyceride Fluorescence spectroscopic PMID:24891789 levels with propofol in long chain characterization of salivary 6 Bakshi SG, Jain PN, Kannan S triglyceride and propofol in metabolites of oral cancer (2014) - An assessment of basic medium and long chain patients. Journal of pain knowledge and impact of triglyceride after short term Photochemistry and pain education on Indian anesthesia in pediatric patients. Photobiology. B, Biology. Anaesthesiologists-a pre and post Saudi Journal of Anaesthesia. 130:153-160. questionnaire study. Indian 8(s1):s53-s56. PMID:25579522 Journal of Anaesthesia. 58(2): 13 Chandarana MN, Raghu S, Bhagat 127-31. PMID: 24963174 M, Qureshi S (2014) - Embryonal 7 Bal MM, Goel M, Ramadwar M, rhabdomyosarcoma of the broad Deodhar K (2014) - Intraductal ligament. Indian Journal of

216 Tata Memorial Centre Annual Report 2014-2015 Medical and Paediatric Oncology. 21 Deodhar JK, Prabhash K, Agarwal 29 Garg A, Chaturvedi P, Gupta PC 35(1):103-105. PMID:25006297 JP, Chaturvedi P (2014) - Clozapine (2014) - A review of the systemic 14 Chaudhury S, Maheshwari A, Ray and cancer treatment: adding to adverse effects of areca nut or P (2014) - Ovarian cancer: An ever the experience and evidence. betel nut. Indian Journal of challenging malady. Biomedical Indian Journal of Psychiatry. Medical and Paediatric Oncology. Research Journal. 1(1):34-55. 56(2):191-193. PMID:24891711 35(1):3-9. 15 Chavan CA, Kaore MP, Ingle AD, 22 Deshpande SS, Kane S, Arya S 30 Goel M, Gaikwad V, Dharia T, Kurkure NV, Akhare SB, (2014) - Extramedullary Kulkarni S, Shetty N, Shrikhande Bhandarkar AG (2014) - plasmacytoma in the carotid SV (2014) - Preresection Immunohistochemical study of a space: expanding the differential transarterial chemoembolization rare case of bovine diagnosis. Indian Journal of for hepatocellular carcinoma: an ameloblastoma. Indian Journal of Radiology Imaging. 24(4):410- experience with 23 patients. Veterinary Pathology. 38(4):275- 414. PMID:25489135 Indian Journal of 277. 23 Dhir AA, Sawant SP, Daddi A Gastroenterology. 33(5):432-439. PMID:25037076 16 Chawla R, Myatra SN, (2014) - Management and Ramakrishnan N, Todi S, Kansal outcome of anthracycline 31 Gole P, Madke B, Khopkar U, S, Dash SK (2014) - Current cardiomyopathy. Indian Heart Kumar P, Noronha V, Yadav M practices of mobilization, Journal. 66(2):s78-s79. (2014) - Side effects of sorafenib analgesia, relaxants and sedation 24 Dholam KP, Gurav S, Dugad J, and sunitinib: a new concern for in Indian ICUs: a survey conducted Banavali S (2014) - Correlation of dermatologist and oncologist. by the Indian society of critical oral health of children with acute Indian Dermatology Online care medicine. Indian of Critical leukemia during the induction Journal. 5(1):89-91. Care Medicine. 18(9):575-584. phase. Indian Journal of Medical PMID:24616870 PMID:25249742 and Paediatric Oncology. 32 Gore M and Govekar R (2014) - 17 Chopra S, Mathew AS, Engineer R, 35(1):36-39. PMID:25006282 Preliminary assessment on choice Shrivastava SK (2014) - Positioning 25 Divatia J (2014) - Blood of matrix based on high-dose radiation in transfusion in anaesthesia and hydrophobicity/hydrophilicity of multidisciplinary management of critical care: Less is more. Indian proteins in analysis by MALDI-Tof- unresectable cholangio- Journal of Anaesthesia. 58(5):511- Tof mass spectrometry. Bionano carcinomas: review of current 514. PMID: 25535410 Frontier. 7(2):7-9. evidence. Indian Journal of 26 Divatia JV (2014) - Burnout in the 33 Gota VS, Patial P (2014) - Toward Gastroenterology. 33(5):401-407. ICU: Playing with fire?. Indian better quality of anticancer PMID:25135161 Journal of Critical Care Medicine. generics in India. Indian Journal of 18 Dandekar M, DCruz AK (2014) - 18(3):127-128. PMID:24701060 Cancer. 51(3): 366-368. PMID: 25494140 Organ preservation strategies: 27 Doctor JR, Ranganathan P, Divatia review of literature and their JV (2014) - Paraplegia following 34 Goyal VK, Solanki SL (2014) - applicability in developing epidural analgesia: a potentially Anesthetic management of a case nations. South Asian Journal of avoidable cause? Saudi Journal of of spontaneous rupture of Cancer. 3(3):147-50. Anaesthesiology. 8(2):284-286. diaphragm. Saudi Journal of PMID:25136519 PMID:24843349 Anaesthesia. 8(Suppl.1):s128- s129. PMID: 2538512 19 Datta S, Chaturvedi P, Mishra 28 Epari S, Bhatkar R, Moyaidi A, A, Pawar P (2014) - A review of Shetty P, Gupta T, Kane S, Jalali R 35 Gulia A, Puri A, Pruthi M, Desai S Indian literature for association of (2014) - Histomorphological (2014) - Oncological and smokeless tobacco with spectrum and functional outcome of periosteal malignant and premalignant immunohistochemical osteosarcoma. Indian Journal of diseases of head and neck region. characterization of Orthopaedics. 49(3):279-284. Indian Journal of Cancer. hemangioblastomas: an entity of PMID:24932034 51(3):200-208. PMID:25494105 unclear histogenesis. Indian 36 Gupta A, Khattry N (2014) - 20 Deodhar J (2014) - Commentary. Journal of Pathology and Current status of hematopoietic Indian Journal of Palliative Care. Microbiology. 57(4):542-548. stem cell transplant in chronic 20(3):187-188. PMID:25191004 PMID:25308004 myeloid leukemia. Indian Journal of Medical and Paediatric

Tata Memorial Centre / Publications 217 Oncology. 35(3): 207-10. PMID: a high volume Nuclear Medicine Therapeutics. 10(3):693-695. 25336791 Department. Indian Journal of PMID:25313762 37 Gupta H, Kane S, Nuclear Medicine. 29(4):227-234. 51 Kapre NM, Dabholkar JP (2014) - Balasubramaniam V (2014) - PMID:25400361 PET scan in head and neck Bilateral dacryoceles associated 44 Joshi A, Agarwala V, Noronha tumours PET scan in head and with bilateral alacrimia with V, Dhumal S, Juvekar S, Prabhash neck tumours in a developing punctal and canalicular agenesis. K (2014) - Response to oral country like India: is it a must? Saudi Journal of Ophthalmology. metronomic chemotherapy in Indian Journal of Otolaryngology 28(1):72-75. PMID:24526864 carcinoma of the buccal mucosa: Head and Neck Surgery. 66(1):97- 38 Hada M S, Sable M, Kane S V, Pai a case report. Indian Journal of 101. PMID:24605310 PS, Juvekar SL (2014) - Calcifying Cancer. 51(3):400-401. 52 Khobagade KH, Bakshi GK, epithelial odontogenic tumor: a PMID:25494166 Prakash G (2014) - Tongue trail to clinico-radio-pathological 45 Joshi A, Dhumal SB, Manickam kidney. Indian Journal of Medical dilemma. Journal of Cancer DR, Noronha V, Bal M, Patil and Paediatric Oncology. Research and Therapeutics. VM, Prabhash K (2014) - 35(1):106-108. PMID:25006298 10(1):194-196. PMID:24762511 Recurrent sinonasal 53 Kinhikar RA, Pawar 39 Ingle AD, Shinde A (2014) - teratocarcinosarcoma with AB, Mahantshetty U, Murthy Microbiological assessment of intracranial extension: case V, Dheshpande DD, Shrivastava SK laboratory rodents: Perspectives report. Indian Journal of Cancer. (2014) - Rapid arc, helical from laboratory animal facility of 51(3):398-400. PMID:25494165 tomotherapy, sliding window ACTREC. Journal of the American 46 Joshi A, Dhumal SB, Noronha intensity modulated radiotherapy Association for Laboratory Animal V, Bonda A, Pandey A, Pandey and three dimensional conformal Science. 2(1): 1-9. A, Raja Manickam DK, Prabhash K radiation for localized prostate 40 Jain P, Padole D, Bakshi S (2014) - (2014) - Oral cutaneous cancer: a dosimetric comparison. Prevalence of acute neuropathic leishmaniasis mimicking Journal of Cancer Research and pain after cancer surgery: a carcinoma of tongue: a case Therapeutics. 10(3):575-582. prospective study. Indian Journal report. Indian Journal of Cancer. PMID: 25313742 of Anesthesia. 58(1):36-42. 51(3):401-402. PMID:25494167 54 Kode J, Taur P, Gulia A, Jambhekar PMID:24700897 47 Joshi NN (2014) - Single N, Agarwal M, Puri A (2014) - 41 Jain R, Choudhury N, Chudgar nucleotide polymorphisms in Pasteurization of bone for tumour U, Harimoorthy V, Desai P, Perkins human health and disease: eradication prior to J, Johnson ST (2014) - Detection Towards resolution of a reimplantation - an in vitro & pre- and identification of red cell conundrum. Journal of clinical efficacy study. Indian alloantibodies in multiply Biomedical Research. 1(1):56-70. Journal of Medical Research. transfused thalassemia major 48 Joshi P, Dutta S, Chaturvedi P, Nair 139(4):585-597. PMID:24927346 patients a prospective study. S (2014) - Head and neck cancers 55 Kotnis A, Mulherkar R (2014) - Indian Journal of Hematology and in developing countries. Rambam Novel inhibitor of DNA ligase IV Blood Transfusion. 30(4):291-296. Maimonides Medical Journal. with a promising cancer PMID:25435730 5(2):e0009. PMID:24808947 therapeutic potential. Current 42 Jha AK, Purandare NC, Shah S, 49 Joshi P, Nair S, Chaturvedi P, Nair Science. 39(3):339-340. PMID: Agrawal A, Puranik AD, D, Agarwal JP, DCruz AK (2014) - 24845497 Rangarajan V (2014) - PET Delay in seeking specialized care 56 Krishnatry R, Gupta T, Murthy reconstruction artifact can be for oral cancers: experience from V, Ghosh-Laskar S, Budrukkar minimized by using sinogram a tertiary cancer center. Indian A, Chaturvedi P, Nair S, Nair correction and filtered back- Journal of Cancer. 51(2):95-97. D, Kumar P, Joshi A, Agarwal JP projection technique. Indian PMID:25104185 (2014) - Factors predicting time to Journal of Radiology Imaging. 50 Joshi P, Nair S, Nair D, Chaturvedi distant metastasis in radically 24(2):103-106. PMID:25024515 P (2014) - Incidence of occult treated head and neck cancer. 43 Jha AK, Singh AM, Shetye B, Shah papillary carcinoma of thyroid in Indian Journal of Cancer. S, Agrawal A, Purandare Indian population: case series and 51(3):231-235. PMID:25494111 NC, Monteiro P, Rangarajan V review of literature. Journal of 57 Kumar DS, Naronha V, Joshi A (2014) - Radiation safety audit of Cancer Research and (2014) - Carcinomatous

218 Tata Memorial Centre Annual Report 2014-2015 meningitis in non-small cell lung statement of Indian association of 71 Nagraj J, Chatterjee S, Pal T, Sakpal cancer: palliation with intrathecal palliative care. Indian Journal of AS, Gota V, Ramaa CS, Ray P treatment. Indian Journal of Palliative Care. 20(3):171-181. (2014) - A novel series of di- Medical and Paediatric Oncology. PMID:25191002 fluorinated propanedione 35(1):75-78. PMID:25006289 65 Macaden SC, Salins N, Muckaden derivatives synergistically 58 Laskar SG, Lewis S (2014) - Is M, Kulkarni P, Joad augment Paclitaxel mediated quality of life the heart of the A, Nirabhawane V, Simha S (2014) caspase 3 activation in ovarian issue in head and neck cancers?. - Guidelines for prevention of cancer cells. Journal of Cancer Indian Journal of Palliative Care. hospital acquired infections. Research Therapeutics. 20(3):169-170. PMID:25191001 Indian Journal of Critical Care 10(3):701-709. PMID: 25313764 59 Laskar SG, Lewis S (2014) - Medicine. 18(3):149-163. PMID: 72 Nagrani RT, Budukh A, Koyande Pathology of radiation toxicity and 24701065 S, Panse NS, Mhatre SS, Badwe R its implication on quality of life. 66 Madke B, Gole P, Kumar P, (2014) - Rural urban differences in South Asian Journal of Cancer. Khopkar U (2014) - breast cancer in India. Indian 3(3):145-146. PMID:25136518 Dermatological side effects of Journal of Cancer. 51(3):277-281 PMID:25494122 60 Laskar SG, Yathiraj PH (2014) - epidermal growth factor receptor Acute radiation toxicity in head inhibitors: PRIDE complex. Indian 73 Noronha V, Joshi A, Prabhash K and neck and lung malignancies. Journal of Dermatology. (2014) - Beyond ten cycles of South Asian Journal of Cancer. 59(3):271-274. PMID:24891659 cabazitaxel for castrate-resistant 3(1):5-7. PMID:24665437 67 Menon S, Goyal P, Suryawanshi P, prostate cancer. Indian Journal of Cancer. 51(3):363-365. 61 Lewis S, Salins N, Rao MR, Kadam Tongaonkar H, Joshi A, Bakshi G, PMID:25494139 A (2014) - Spiritual well being and Desai S (2014) - Paraganglioma of its influence on fatigue in patients the urinary bladder: A 74 Pandey A, Bhosale B, Pandita V, undergoing active cancer directed clinicopathologic spectrum of a Singh A, Ghosh J, Ghosh J, Bajpai J treatment: a orrelational study. series of 14 cases emphasizing (2014) - Carboplatin Journal of Cancer Research and diagnostic dilemmas. Indian hypersensitivity in relapsed Therapeutics. 10(3):676-680. Journal of Pathology and ovarian carcinoma: a therapeutic PMID:25313759 Microbiology. 57(1):19-23. challenge. Indian Journal of PMID:24739826 Medical and Paediatric Oncology. 62 Linga VG, Ganta RR, Kalpathi 35(1):17-20. PMID:25006278 KI, Gundeti S, Rajappa 68 Mishra GA, Kulkarni SJ, Digumarti R, Paul TR, Tandon A SV, Majmudar PV, Gupta 75 Parikh P M, Prabhash K, Govind K (2014) - Response to imatinib SD, Shastri SS (2014) - B, Digumarti R, Pandit S, Banerjee mesylate in childhood chronic Community-based tobacco I, Biyani R, Deshmukh A Doval D, myeloid leukemia in chronic cessation program among women Bhattacharyya G S, Gupta S phase. South Asian Journal of in Mumbai, India. Indian Journal (2014) - Standard operating Cancer. 3(4):203-205. of Cancer. 51(5):S54-S59. PMID: procedure for audio visual PMID:25422804 25526250 recording of informed consent: an initiative to facilitate regulatory 63 Linga VG, Patchva 69 Mukherjee A, Sarma H, Saxena S, compliance. Indian Journal of DB, Mallavarapu KM, Tulasi Kumar Y, Chaudhari P, Goda JS, Cancer. 51(2):113-116. V, Kalpathi KI, Pillai A, Gundeti Adurkar P, Dash A, Samuel G PMID:25104190. S, Rajappa SJ, Digumarti R (2014) (2014) - Bioevaluation of (125) I - Thiopurine methyltransferase Ocu-Prosta seeds for application 76 Parikh P, Patil V, Agarwal JP, polymorphisms in children with in prostate cancer brachytherapy. Chaturvedi P, Vaidya A, Rathod acute lymphoblastic leukemia. Indian Journal of Medical S, Noronha V, Joshi A, Jamshed A, Indian Journal of Medical and Research. 139(4): 555-560. PMID: Bhattacharya GS, Gupta S, Desai Paediatric Oncology. 35(4):276- 24927341 C, Advani SH, Pai P, Laskar S, 280. PMID: 25538405 70 Myatra S (2014) - Ramesh A, Mohapatra PN, Vaid AK, Deshpande M, Ranade AA PN, 64 Macaden SC, Salins N, Muckaden Dexmedetomidine: toward a Vaid AK, Deshpande M, Ranade M, Kulkarni P, Joad A, paradigm shift in ICU sedation. AA Vora A, Baral R, Hussain MA, Nirabhawane V, Simha S (2014) - Indian Journal of Critical Care Rajan B, DCruz AK, Prabhash K End of life care policy for the Medicine. 18(5):271-272. (2014) - Guidelines for treatment dying: consensus position PMID:24914253

Tata Memorial Centre / Publications 219 of recurrent or metastatic head 83 Patwardhan S, Jalili NG, Thatte U, Medical and Paediatric Oncology. and neck cancer. Indian Journal of Pramesh CS (2014) - Quality and 35(1):96-98. PMID:25006295 Cancer. 51(2):89-94. completeness of data 90 Puranik AD, Purandare NC, Shah PMID:25104184 documentation in an investigator- S, Agrawal A, Rangarajan V (2014) 77 Parikh PM, Prabhash K, initiated trial versus an industry- - Unilateral vocal cord paralysis: Bhattacharyya GS, (2014) - Ignore sponsored trial. Indian Journal of An unusual cause and rare molecular oncology at your peril. Medical Ethics. 11(1):19-24. imaging pattern seen on FDG PET/ Indian Journal of Cancer. PMID:24509104 CT in a case of oropharyngeal 51(2):150-153. PMID:25104198 84 Pimple S, Shastri SS (2014) - cancer. Indian Journal of Nuclear 78 Patel KA, Rajderkar SS, Naik Comparative evaluation of human Medicine. 29(2):125-127. PMID: JD, Behere VS (2014) - A study of papilloma virus DNA test verses 4761073 certain correlates of job colposcopy as secondary cervical 91 Puri A (2014) - Limb salvage in satisfaction among judicial cancer screening test to triage musculoskeletal oncology: recent personnel, in a district of Western screen positive women on advances. Indian Journal of Plastic Maharashtra. Indian Journal of primary screening by visual Surgery. 47(2):175-184. Occupational and Environmental inspection with 5% acetic acid. PMID:25190911 Indian Journal of Cancer. Medicine. 18(2):68-74. PMID: 92 Puri A, Gulia A, Pruthi M (2014) - 51(2):117-123. PMID:25104191 25568601 Outcome of surgical resection of 79 Patil PS, Mohandas KM, Bhatia SJ, 85 Pimple S, Gunjal S, Mishra pelvic osteosarcoma. Indian Mehta SA (2014) - Serum ferritin GA, Pednekar MS, Majmudar Journal of Orthopaedics. and the risk of hepatocellular P, Shastri SS (2014) - Compliance 48(3):273-278. PMID: 24932033 to gutka ban and other provisons carcinoma in chronic liver disease 93 Purwar P, Bambarkar S, Jiwnani of COTPA in Mumbai . Indian of viral etiology: a case-control S, Karimundackal G, Laskar Journal of Cancer. 51(5):S60-S66. study. Indian Journal of SG, Pramesh CS (2014) - PMID: 25526251 Gastroenterology. 33(1):12-18. Multimodality management of PMID: 24006121 86 Pramesh CS, Badwe RA, Sinha RK esophageal cancer. Indian Journal 80 Patil V M, Noronha V, Joshi A, (2014) - The national cancer grid of Surgery. 76(6):496-503. of India. Indian Journal of Medical Krishna V M, Dhumal S,Chaudhary 94 Raina S, Chande AG, Baba M, and Paediatric Oncololgy. V, Juvekar S, Pai P S, Pankaj C, Mukhopadhyaya R (2014) - A 35(3):226-227. PMID:25336795 Chaukar D, Dcruz AK, Prabhash K reporter based single step assay (2014) - Referral pattern for 87 Purandare NC, Gandhi A, Puranik for evaluation of inhibitors neoadjuvant chemotherapy in the AD, Agrawal A, Shah S,Patil A, targeting HIV-1 Rev–RRE head and neck cancers in a Rangarajan V (2014) - Use of FDG/ interaction. Indian Journal of tertiary care center. Indian Journal PET CT to diagnose malignancy as Virology. 25: 101-106. PMID: of Cancer. 51(2):100-103. the cause of mucocele of the 24426316 PMID:25104187 appendix. Indian Journal of 95 Ramani CV, Kundagulwar GK, Gastroenterology. 33(1):79-81. 81 Patil V, Shetmahajan M (2014) - Prabha YS, Dushyanth J (2014) - PMID: 23982705 Massive transfusion and massive Anomalous superficial ulnar transfusion protocol. Indian 88 Purandare NC, Puranik AD, Shah artery based flap Indian Journal Journal of Anaesthesia. S, Agrawal A, Rangarajan V (2014) of Plastic Surgery. 47(1):124-126. 58(5):590-595. PMID: 25535421 - Post-treatment appearances, PMID:24987217 pitfalls, and patterns of failure in 82 Patil VM, Noronha V, Joshi A, 96 Rane SU, Menon S, Desai S, Bakshi head and neck cancer on FDG Kumar P, Muddu VK, Dhumal S, G, Joshi A (2014) - Granulosa cell PET/CT imaging. Indian Journal of Arya S, Juvekar S, Pai P, tumor of testis: Nuclear Medicine. 29(3):151-157. Chatturvedi P, Devendra AC, clinicopathological correlation of PMID:25210280 Ghosh S,DCruz AK (2014) - Weekly a rare tumor. Indian Journal of chemotherapy as Induction 89 Puranik AD, Purandare NC, Bal Pathology and Microbiology. chemotherapy in locally advanced MM, Shah S, Agrawal A, (2014) - 57(4):564-573. PMID:25308008 head and neck cancer for patients Extraskeletal osteosarcoma: An 97 Rane SU, Shet T, Sridhar E, Bhele ineligible for 3 weekly maximum uncommon variant with rare S, Gaikwad V, Agale S, Shinde tolerable dose chemotherapy. metastatic sites detected with S, Prabhat D, Fernandes G, Hastak Indian Journal of Cancer. 51(1):20- FDG PET/CT. Indian Journal of M, Tampi C, Narurkar S, Patel 24. PMID:24947091

220 Tata Memorial Centre Annual Report 2014-2015 K, Madiwale C, Shah K, Shah 105 Rekhi B, Motghare P (2014) - 111 Sarin R (2014) - Big Data V4 for L, Sawaimoon S, Lad P (2014) - Cyclin D1 and p16INK4 positive integrating patient reported Interobserver variation is a endometrial stromal sarcoma: a outcomes and quality-of-life significant limitation in the case report with new insights. indices in clinical practice. Journal diagnosis of Burkitt lymphoma. Indian Journal of Pathology and of Cancer Research Therapeutics. Indian Journal of Medical and Microbiology. 57(4):606-608. 10(3):453-455. PMID: 25313720 Paediatric Oncology. 35(1):44-53. PMID:25308017 112 Shankar R, Qureshi SS, Sugoor P, PMID :25006284 106 Rekhi B, Rangwalla H, Chinoy RF Kembhavi S, Yadav PS, Mukta R 98 Ranganathan P (2014) - Meta- (2014) - Curious case of a primary (2014) - Colossal squamous cell analysis: Adding apples and intranodal kaposi sarcoma, carcinoma of the face in a child oranges? Indian Journal of Critical confirmed by with Xeroderma Pigmentosum. Care Medicine. 18(1):50-51. immunohistochemistry, in an HIV- Journal of the Indian Association PMID:24550619 positive African male. Journal of of Pediatric Surgeons. 19(3):185- 99 Rangarajan B, Binoy V, Hingmire Cancer Research and 186. PMID: 25197203 SS, Noronha V (2014) - Tolvaptan. Therapeutics. 10(1):2013-2014. 113 Sharma S, Chaukar DA (2014) - South Asian Journal of Cancer. PMID:24762522 International Federation of Head 3(3):182-184. PMID:25136528 107 Rekhi B, Thorat S, Parikh G, Neck Oncology Society 5(th) 100 Rastogi S, Gulia S, Bajpai J, Ghosh Jambhekar NA (2014) - Malignant World Congress/American Head J, Gupta S (2014) - Oligometastatic ossifying fibromyxoid tumors: a Neck Society 2014 update. Indian breast cancer: a mini review. report of two rare cases displaying Journal of Medical and Paediatric Indian Journal of Medical and retained INI1/SMARCB1 Oncololgy. 35(3):228-230. Paediatric Oncololgy. 35(3):203- expression. Indian Journal of PMID:25336796 206. PMID:25336790 Pathology and Microbiology. 114 Shetty N, Gupta S (2014) - Eribulin 57(4):652-653. PMID:25308036 101 Rath S, Nathani A, Patel D, drug review. South Asian Journal Kulkarni P, Gota V (2014) - Status 108 Rekhi B, Vinarkar S, Shylasree ST of Cancer. 3(1):57-59. PMID: of technology transfer in India – (2014) - Bilateral ovarian serous 24665449 The much needed magic remedy. cystadenofibromas coexisting 115 Shome D, Kalita D, Jain V, Sarin R, Current Science. 106(8): 1058- with an incidental unilateral Maru GB, Bellare JR (2014) - 1060. Brenner tumor and Walthard cell Carboplatin loaded rests in bilateral Fallopian tubes: 102 Rathod S, Munshi A, Paul S, polymethylmethacrylate nano- an unusual case with diagnostic Ganesh B, Prabhash K, Agarwal JP particles in an adjunctive role in implications and histogenesis. (2014) - Thymoma: first large retinoblastoma: an animal trial. Indian Journal of Pathology and Indian experience. Indian Journal Indian Journal of Ophthalmology. Microbiolgy. 57(2):347-348. of Cancer. 51(2):109-112. 62(5):585-589. PMID: 24881606 PMID:24943791 PMID:25104189 116 Shrikhande SV, Gaikwad V, Purohit 109 Salins N (2014) - Time for change: 103 Rekhi B, Adamane S (2014) - D, Goel M (2014) - Major integrating palliative medicine to Myxoinflammatory fibroblastic abdominal cancer resections in mainstream medicine. Indian sarcoma with areas resembling cirrhotic patients: How frequent Journal of Palliative Care. hemosiderotic fibrolipomatous is postoperative hepatocellular 20(2):97-98. PMID:25125862 tumor: a rare case indicating decompensation?. Indian Journal proximity between the two 110 Sankaranarayanan R, Nene BM, of Gastroenterology. 33(3):258- tumors. Indian Journal of Shastri S, Rajkumar R, Muwonge 264. PMID:24214581 Pathology Microbiology. R, Swaminathan R, Malvi SG, 117 Shrikhande SV, Gaikwad 57(4):647-8. 57(4):647-648. Desai S, Kelkar R, Hingmire V, Desouza A, Goel M (2014) - Is PMID:25308033 SJayant K, Kane SV (2014) - laparoscopic surgery the standard Response to article titled “US- 104 Rekhi B, Desai SS, Gulia A, Puri A, of care for GI luminal cancer?. funded measurements of cervical Jambhekar NA (2014) - Indian Journal of Surgery. cancer death rates in India: Intraosseous myoepithelioma: a 76(6):444-452. PMID: 25614719 scientific and ethical concerns” by rare, distinct tumor entity. Indian 118 Shrikhande SV, Sirohi B, Barreto Eric J Suba. Indian Journal of Journal of Pathology and SG, Chacko RT, Parikh PM, Pautu Medical Ethics. 11(3):175-8. Microbiology. 57(2):269-271. J, Arya S, Patil P, Chilukuri PMID:25101550 PMID:24943762 SC, Ganesh B, Kaur T, Shukla

Tata Memorial Centre / Publications 221 D, Rath GS (2014) - Indian Council Research consensus document for Mishra GA1, Gunjal SS, Pimple SA, of Medical Research consensus the management of colorectal Majmudar PV, Gupta SD, Shastri document for the management of cancer. Indian Journal of Medical SS (2014) - Impact of gutkha and gastric cancer. Indian Journal of and Paediatric Oncololgy. pan masala ban in the state Medical and Paediatric Oncology. 35(3):192-196. PMID:25336788 Maharashtra on users and 35(4):239-243. PMID: 25538398 125 Sirohi B, Singh A, Jagannath P, vendors. Indian Journal of Cancer. 119 Shrikhande SV, Sirohi B, Barreto Shrikhande SV (2014) - 51(2):129-132. PMID:25104193 SG, Chacko RT, Parikh PM, Pautu Chemotherapy and targeted 132 Yadav P (2014) - Recent advances J, Arya S, Patil P, Chilukuri therapy for gall bladder cancer. in head and neck cancer SC, Ganesh B, Kaur T, Shukla Indian Journal of Surgical reconstruction. Indian Journal of D, Rath GS (2014) - Indian Council Oncology. 5(2):134-141. Plastic Surgery. 47(2):185-190. of Medical Research consensus PMID:25114467 PMID:25190912 document for the management of 126 Sirohi B, Barreto SG, Singh gastrointestinal stromal tumors. A, Batra S, Mittra A, Rastogia Indian Journal of Medical S, Ramadwar M, Shetty N, Goel Paediatric Oncology. 35(4):244- M, Shrikhande SV (2014) - 248. PMID: 25538399 Epirubicin, oxaliplatin, and 120 Siddiqui SS, Jha A, Konar N, capectabine is just as “MAGIC”al Ranganathan P, Deshpande DD, as epirubicin, cisplatin, and Divatia JV (2014) - Radiation fluorouracil perioperative exposure among medical chemotherapy for resectable professionals working in the locally advanced gastro- Intensive care unit. Indian Journal oesophageal cancer. Journal of of Critical Care Medicine. Cancer Research and 18(9):591-595. PMID:25249743 Therapeutics. 10(4):866-870. 121 Singh R, Gupta S, Pawar SB, Pawar PMID:25579520 RS, Gandham S V, Prabhudesai S 127 Sonavane S, Rani D, Asopa (2014) - Evaluation of ER, PR and R, Upadhye T, Pawar D (2014) - HER 2 receptor expression in Postoperative distal ureteric and breast cancer patients presenting bladder cuff recurrence in a Grade to a semi urban cancer centre in I renal transitional cell carcinoma. Western India. Journal of Cancer Indian Journal of Nuclear Research and Therapeutics. Medicine. 29(4):264-266. 10(1):26-28. PMID:24762482 PMID:25400371 122 Sinukumar S, Gomes RM, Kumar 128 Srivastava D, Solanki SL, Singh PK RK, Desouza A, Saklani A (2014) - (2014) - Dexmedetomidine in Sporadic giant mesenteric upper gastrointestinal endoscopy fibromatosis. Indian Journal of of a patient with ejection fraction Surgical Oncology. 5(3):242-245. 25%. Saudi Journal of PMID:25419076 Anaesthesia. 8(4):571-572. PMID: 123 Sirohi B, Gupta S, Raghunadharao 25422626 D, Shrikhande SV (2014) - Clinical 129 Upadhyay P, Dwivedi R, Dutt A trials in India: At uncertain (2014) - Applications of next- crossroads? Indian Journal of generation sequencing in cancer. Medical Paediatric and Oncology. Current Science. 107(5): 795-802. 35(2):133-5. PMID: 25197173 130 Vaidyanathan V, Nair D, Juvekar 124 Sirohi B, Shrikhande SV, Perakath SL, D’Souza C (2014) - Jugular B, Julka PK, lele V, Kaur T, Shukla foramen chondrosarcoma (Case DK, Rath GK, Raghunandharao D, report). Indian Journal of Otology. Chaturvedi A, Nandakumar A, 20(2):86-88. Ramadwar M, Bhatia V, Mittal R, 131 Wani M A, Jan F A, Khan N A, (2014) - Indian Council of Medical Pandita K K, Khurshid R, Khan S H

222 Tata Memorial Centre Annual Report 2014-2015 Publications in 8 Singh SP, Krishna CM (2014) - Metastasis. In: Desai P, editor. Raman spectroscopy of oral Clinical Perspectives in Oncology. Proceedings / Newsletters tissues: Correlation of spectral New Delhi: Jaypee Brothers and biochemical markers. Medical. 2014. 1 Behl I, Mamgain H, Deshmukh A, Proceedings of SPIE: BIOS 8926O- 2 Agarwal S, Krishnatry R, Prabhash Kukreja L, Hole AR, Krishna CM 8926O-5. K, Agarwal JP. Non Surgical (2014) - Raman microspectro- 9 Tyagi M, Khan SA, Gupta S (2014) Treatment Plan for Organ scopic study of oral buccal - Histone post-translational Preservation. In: Pradhan S A, mucosa. Proceedings of SPIE:BIOS modifications as biomarks in Monnier P, Pai PS editor. Surgery 89400D-89400D -7. cancer: Dream or reality? in treatment of larynx & 2 Munnolli SS, Pujar SM (2014) - Proteomics Society, India (PSI) Hypopharynx. New Delhi: Lloyds Impact of highly cited Indian News Letter 2(1):7-10, 2014. Publishing House. 2014 Cancer research papers on 3 Arora B, Sodhi V. Lymphomas in altmetric explorer: An exploratory Patents (Applied) Children. In: Desai PB, editor. study. In: Sangam SL, Biradar BS, 1 Mittra I, Samant UC, Modi GK, Practical Clinical Oncology. New editors. Third National Mishra PK, Bhuvaneshwar GS. Delhi: Jaypee Brothers Medical Conference on Scientometrics, Big Method for ex-vivo separation of Publishers. 2014. Pp 624-643. Data Analytics (BDA) and Libraries apoptotic chromatin fragments 4 Badwe R, Gupta S, Goyal G. Shankaragahatta. Department of from blood or plasma for Hormonal Dependence of PG Studies and Research in Library prevention and treatment of Malignant Cell. In: Desai PB, and Information Science. diverse human diseases. editor. Practical Clinical Oncology. Kuvempu University; 2014. 72-80. Application No: 14/100, 950 New Delhi: Jaypee Brothers 3 Rubina S, Sathe P, Dora TK, Chopra Publication No. US 2014/0099293 Medical Publishers. 2014. Pp 74- S, Maheshwari A, Murali Krishna A1 83. C (2014) - In vivo Raman 5 Balasubramaniam G. Geographic spectroscopy of cervix cancers. Books Variations in Frequency and Proceedings of SPIE: BIOS 1 Deodhar KK, Chitale A. Diagnostic Incidence: a Global Perspective. 89400E-89400E-6. problems of tumors of female In: Desai PB, editor. Practical 4 Sahu A, Shah N, Mahimkar M, genital tract: Selected Topics. Clinical Oncology. New Delhi: Garud M, Pagare S, Nair S, Krishna (DIAGNOSTIC PROBLEMS IN Jaypee Brothers Medical CM (2014) - Raman spectroscopy TUMOR PATHOLOGY SERIES) Publishers. 2014. Pp 9-14 and oral exfoliative cytology. (Volume 3) Chitale Publications. 6 Chandrani P, Dutt A. Domain Proceedings of SPIE:BIOS 89262N- 2014 Specific Targeting of Cancer. In: 89262N-4. 2 Engineer R, Chopra S, Shrivastava Kumar R, editor. Nuclear 5 Sahu A, Talathi S, Sawant S, SK. Role of Radiotherapy In Rectal Signaling Pathways and Targeting Krishna CM (2014) - Classification Cancer. Elsevier Health Sciences. Transcription in Cancer. New York: of oral cancers using raman 2014 Springer. 2014. Pp 299-310. 7 De A, Arora R, Jasani A. spectroscopy of serum. 3 Juvekar S. Evidence based Engineering Aspects of Proceedings of SPIE:BIOS 89390E- Management of Cancers In India: Bioluminescence Resonance 89390E-7. Guidelines for Imaging in Energy Transfer Systems. In: Cai 6 Shaikh R, Sathe P, Dora TK, Chopra Oncology. Mumbai: Tata W, editor. Engineering in S, Maheshwari A, Krishna CM Memorial Centre. 2014 Translational Medicine. London: (2014) - In vivo Raman 4 Ranganathan P, Shetmahajan M, Springer; 2014. Pp 257-300. spectroscopy of cervix cancers. Divatia J. Evidence based Proceedings of SPIE: SPIE; 2014. 8 De A. Bioluminescence. In: eLS . Management of Cancers In India: Chichester: John Wiley & Sons 7 Shenoy M, Hole AR, Shridhar E, Peri-Operative care Improving Ltd; 2014. Moiyadi AV, Krishna CM (2014) - Outcomes After Surgery. Mumbai: 9 Desai P, Balasubramaniam G. Raman spectroscopy of gliomas: Tata Memorial Centre. 2014 Cancer of the Esophagus. In: Desai An exploratory study. PB, editor. Practical Clinical Proceedings of SPIE:892808- Book chapters Oncology. New Delhi: Jaypee 892808-6. 1 Agarwal JP, Kalyani N. Brothers Medical Publishers. Management of Skeletal 2014. Pp 222-232

Tata Memorial Centre / Publications 223 10 Desai P, Parikh B, Huilgol N, Skin Cancer. In: Aggarwal BB, Sung 26 Puri A, Jambhekar N. Bone Balasubramaniam G. Carcinoma B, editors. Inflammation and Tumors and Soft Tissue Sarcomas. Stomach. In: Desai PB, editor. Cancer. New York: Springer. 2014. In: Desai PB, editor. Practical Practical Clinical Oncology. New 437-479. Clinical Oncology. New Delhi: Delhi: Jaypee Brothers Medical 19 Maru GB, Kumar G, Ghantasala S, Jaypee Brothers Medical Publishers. 2014. Pp 233-244. Tajpara P. Polyphenol-Mediated Publishers. 2014. Pp 536-549. 11 Desai P, Patel K, Parikh B, Huilgol In Vivo Cellular Responses during 27 Sarin R. Genetics and Cancer. In: NG, Balasubramaniam G. Carcinogenesis. In: Watson RR, Desai P, editor. Practical Clinical Carcinoma of the Cervix. In: Desai Preedy VR, Zibadi S, editors. Oncology. New Delhi: Jaypee PB, editor. Practical Clinical Polyphenols in Human Health and Brothers Medical (P); 2014. 84- Oncology. New Delhi: Jaypee Disease. Amsterdam: Academic; 97. Brothers Medical Publishers. 2014. 1141-179. 28 Sehgal L, Usmani A, Dalal SN, SS 2014. Pp 379-393. 20 Moiyadi AV. Intraoperative Majumdar. Generation of 12 Desai P, Patel K, Parikh B, Huilgol Ultrasound in Neurosurgical Transgenic Mice by Exploiting NG, Balasubramaniam G. Oncology Scope and Utility. In: Spermatogonial Stem Cells In vivo. Endometrial Cancer. In: Desai PB, Hayat E, editor. Tumors of the In: Singh SR, Coppola V, editors. editor. Practical Clinical Oncology. Central Nervous system. Mouse Genetics: Methods and New Delhi: Jaypee Brothers Netherlands: Springer; 2014. Protocol. New York: Springer; Medical Publishers. 2014. Pp 394- 149-158. 2014. 327-37. 402 21 Muckaden MA, Deodhar J, Atreya 29 Sengar M. Adult Lymphomas. In: 13 Engineer R. Radiotherapy for S. Palliative care and Quality of life Desai PB, editor. Practical Clinical Uterine sarcomas. In: Rajaram S, in advanced cancer. In: Desai PB, Oncology. New Delhi: Jaypee Chitrathara K, Maheshwari A, editor. Practical Clinical Oncology. Brothers Medical Publishers. editor. Uterine Cancer: Diagnosis New Delhi: Jaypee Brothers 2014. Pp 644-652. & Treatment. London: Springer. Medical Publishers. 2014. Pp 674- 30 Sharma KS, Jain PN. Cancer Pain 2014 684. Management. In: Desai PB, editor. Practical Clinical Oncology. New 14 Jalali R, Krishna U. Management 22 Parikh R, Desai P, Delhi: Jaypee Brothers Medical of Brain Metastasis. In: Desai PB, Balasubramaniam G, Parikh B, Publishers. 2014. Pp 666-673. editor. Practical Clinical Oncology. Arneja SK. Ovarian Cancer. In: New Delhi: Jaypee Brothers Desai PB, editor. Practical Clinical 31 Shastri S, Shastri A. Primary and Medical Publishers. 2014. Pp 577- Oncology. New Delhi: Jaypee Secondary Prevention of 584 Brothers Medical Publishers. Common Cancers. In: Desai PB, editor. Practical Clinical Oncology. 15 Jalali R, Krishna U. Management 2014. Pp 363-378. New Delhi: Jaypee Brothers of Primary Brain Tumors In: Desai 23 Parikh R, Desai P, Borges A, Patel Medical Publishers. 2014. Pp 15- PB, editor. Practical Clinical K, Arneja SK, Huilgol NG, 23. Oncology. New Delhi: Jaypee Jankharia B, Parikh B, 32 Shrikhande SV, Jagannath P. Brothers Medical Publishers. Balasubramaniam G. Breast Pancreatic Malignancies. In: Desai 2014. Pp 560-576 Cancer. In: Desai PB, editor. PB, editor. Practical Clinical Practical Clinical Oncology. New 16 Kelkar R. Microbial Pathogens and Oncology. New Delhi: Jaypee Delhi: Jaypee Brothers Medical Infection Control in Brothers Medical Publishers. Publishers. 2014. Pp 325-362. Immunocompromised cancer 2014. Pp 310-324. Patients. In: Desai PB, editor. 24 Patil V, Sharma K. Emergencies in 33 Singh RK, Gaikwad SM, Chatterjee Practical Clinical Oncology. New Oncology. In: Desai PB, editor. S, Ray P. Stem Cells: The Holy Grail Delhi: Jaypee Brothers Medical Practical Clinical Oncology. New of Regenerative Medicine. In: Cai Publishers. 2014. Pp 685-705. Delhi: Jaypee Brothers Medical W, editor. Engineering in 17 Kurkure P. Pediatric Oncology: A Publishers. 2014. Pp 609-613. Translational Medicine. London: Journey From Nihilism to Cautious 25 Pramesh CS, Badwe R. Springer; 2014. 19-69. Optimism. In: Desai PB, editor. Translational Research in 34 Tongaonkar HB, Bakshi GK, Practical Clinical Oncology. New Oncology. In: Desai PB, editor. Menon S, Prabhash K, Joshi A. Delhi: Jaypee Brothers Medical Practical Clinical Oncology. New Renal Cell Carcinoma. In: Desai PB, Publishers. 2014. Pp 614-623. Delhi: Jaypee Brothers Medical editor. Practical Clinical Oncology. 18 Maru GB, Gandhi K, Ramchandani Publishers. 2014. Pp 112-119. New Delhi: Jaypee Brothers A. The Role of Inflammation in Medical Publishers. 2014. Pp 454- 473.

224 Tata Memorial Centre Annual Report 2014-2015 ACTION TAKEN REPORT ON AUDITOR’S OBSERVATIONS ON ANNUAL STATEMENT OF ACCOUNTS FOR 2014-15

NAME OF INSTITUTION : TATA MEMORIAL CENTRE Parel, Mumbai 400 012

Paragraph Expected month No. of and year for Auditors Auditors Comments (to be reproduced in full) Action Taken completion of Report Action (1) (3) (4) (5) 1. We have audited the attached financial statements of This is a Tata Memorial Centre (the Centre) which comprises statement of fact. Balance Sheet as at 31st March, 2015 and the Statement of No action. Income and Expenditure Account for the year ended on that date, as required by the Bombay Public Trusts Act, 1950 (the Act), and a summary of significant accounting policies and other explanatory information. 2 The trustees are responsible for the preparation of these This is a financial statements that give a true and fair view of the statement of fact. financial position, financial performance and receipts and No action. payments of the Centre in accordance with the Accounting principles and Accounting Standards generally accepted in India. This responsibility includes the design, implementation and maintenance of internal control relevant to the preparation and presentation of the financial statements that give a true and fair view and are free from material misstatement, whether due to fraud or error. 3. Our responsibility is to express an opinion on these financial This is a statements based on our audit. We conducted our audit in statement of fact. accordance with the Standards on Auditing issued by the No action. Institute of Chartered Accountants of India. Those standards require that we comply with the ethical requirements plan and perform the audit to obtain reasonable assurance about whether the financial statements are fee of any material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the Centre’s preparation and fair

Tata Memorial Centre / Financial Statements 225 Paragraph Expected month No. of and year for Auditors Auditors Comments (to be reproduced in full) Action Taken completion of Report Action (1) (3) (4) (5) presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Centre’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of the accounting estimates made by trustees as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. 4. In our opinion and to the best of our information and according to the explanations given to us, the financial statements give the information required by the Act in the manner so required, we report that : (a) In the case of the Balance Sheet, of the state of affairs of the Centre as at 31st March, 2015. (b) In the case of income and Expenditure Account of This is a the Excess of income over expenditure of the statement of fact. Centre for the year ended on that date. No action.

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