By : Sakshi Jaiswal
It is time to rephrase the saying ‘It is like cancer and there is no cure’ by putting an end to the fear of being diagnosed by the dreadful disease. A 67-year-old resident of South Delhi, Mr N K Choudhary, proved that with hope and courage even the deadliest battles can be won by beating cancer – not once or twice – but as many as six times in a period of 13 years. Mr Choudhary was first diagnosed with oral cancer in 2005, followed by recurrence in 2007, 2010, 2014 and twice in 2018.Heapproached Dr Dinesh Singh, Director – Radiation Oncology, Max Super Specialty Hospital, Vaishaliwhen his oral cancer was detected for the third time in 2010 and started his treatment under the team. Mr Choudhary, visited Max Vaishali for his radiotherapy treatment for the 5th time.
In 2005, Mr Choudhary was diagnosed for the first time with tongue cancer for which he had undergone laser excision (removal of tumor using laser) and with few lifestyle modification, he was cancer free for two years and then he developed recurrence in the neck again in the year 2007 for which he underwent modified neck dissection for which he underwent adjuvant radiotherapy. And he was cured and was cancer-free for the next three years.
However, in 2010 he developed a new primary cancer in hisright tonsil which was treated with concurrent chemo radiotherapy or in this case, re irradiationas he had undergone radiotherapy earlier as well. And through this procedure he led a cancer free life for the next four years.In 2014, unfortunately again, he was diagnosed with carcinoma of left last end of the tooth plate (retro molar trigone region) and hence, had to undergo a surgery (Composite resection with PMMC flap reconstruction) followed by an adjuvant radiation making it his third time of an effective radiotherapy.In February 2018, he again developed a small nodule in his face, lower lip with pus-like discharge. Biopsy from the lip wassquamous cell carcinoma.
Dr Arun Goel Director Surgical Oncology Max Hospital Vaishali said that seeing the complexity of the case and the recurrence rate after all possible treatment, an internal tumour board meeting of doctors at Vaishali was scheduled to discuss this complex case and its further treatment. It was finally decided that since the surgery already happened four times in the same location and nearby organs, re-doing the surgery at the same location again for the fifth time would bemutilating and would therefore, lead to a functional defect, it was decided by the tumour board that the cancer would be treated with ‘Concurrent Chemoradiotherapy’, if feasible.
Post six months, the patient had recurrence in tongue again for the sixth time. Biopsy found out it to be a case of squamous cell carcinoma tongue.
Patient was still under anaesthesia was shifted from OT to brachytherapy room under the radiotherapy department along with all sterilized conditions. For this patient specifically, aseptic corridors were created, and appropriate measures were taken to make sure that even the lift and passages are infection-free. Intraoperative brachy therapy was delivered at high dose of 10 Gy (grey) single sitting wherein, usually, only 2 Gy is given to a patient. The procedure took place for 5 hours, and went successfully and he was free from cancer.
Through his whole journey which was filled with hardships, challenges and bleakness, one person who constantly supported him and stood still through thick and thin, was his wife, Mrs Ganga Choudhary. Cancer is a disease that not only affects one person but the entire community surrounding that person especially the partner.
Speaking on the complexity of the case, Dr Dinesh Singh, Director – Radiation Oncology, Max Super Specialty hospital, Vaishali says, “This case is unique since the patient is a non-smoker and has never used tobacco in his life. Also, from a clinical point of view, administering radiotherapy even for the second time at the same geographical area is a big challenge because the normal surrounding tissues are at a risk of undergoing radiation necrosis. However, those patients who successfully are able to undergo re irradiation get good results. In this particular case, the patient was able to overcome radiotherapy successfully for the 5th time which is extremely rare. It was a very big challenge both for surgical oncology team and radiation oncology team. I could not find any previous reference or case study in which re-radiation was done for 5th time.”
Six months post radiotherapy, Mr. Choudhary is doing well and there are no signs and symptoms of tissue necrosis. His recent PET CT scan has also shown complete resolution with no evidence of disease.