Indu Voruganti Maddali MD, MS, FRCPC

All Publications

• FINAL RESULTS OF AN INTERNATIONAL DELPHI CONSENSUS STUDY REGARDING THE OPTIMAL MANAGEMENT OF RADIATION PNEUMONITIS Voruganti, I., Cunningham, C., McLeod, L., Harrow, S., Louie, A. ELSEVIER IRELAND LTD. 2022: S72

  View details for Web of Science ID 000873193100173

• Patient consent preferences on sharing personal health information during the COVID-19 pandemic: "the more informed we are, the more likely we are to help". BMC medical ethics Tosoni, S., Voruganti, I., Lajkosz, K., Mustafa, S., Phillips, A., Kim, S. J., Wong, R. K., Willison, D., Virtanen, C., Heesters, A., Liu, F. F. 2022; 23 (1): 53

  Abstract

  Rapid ethical access to personal health information (PHI) to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences.A total of 183 patients in the pandemic cohort completed the survey via email, and responses were compared to the distinct pre-pandemic cohort (n = 222); all were patients of a large Canadian cancer center. The survey covered (a) broad versus study-specific consent; (b) opt-in versus opt-out contact approach; (c) levels of comfort sharing with different recipients; (d) perceptions of commercialization; and (e) options to track use of information and be notified of results. Four focus groups (n = 12) were subsequently conducted to elucidate reasons motivating dominant preferences.Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples (90% vs. 79%, p = 0.009), sharing information with the health care institution (97% vs. 83%, p < 0.001), sharing information with researchers at other hospitals (85% vs. 70%, p < 0.001), sharing PHI provincially (69% vs. 53%, p < 0.002), nationally (65% vs. 53%, p = 0.022) and internationally (48% vs. 39%, p = 0.024) compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts (50% vs. 51% uncomfortable, p = 0.58). Significantly more pandemic cohort patients expressed a wish to track use of PHI (75% vs. 61%, p = 0.007), and to be notified of results (83% vs. 70%, p = 0.012). Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved.In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort (~ 50%) remained unchanged. Focus groups identified that the ability to track and receive results of studies using one's PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises.

  View details for DOI 10.1186/s12910-022-00790-z

  View details for PubMedID 35596210

  View details for PubMedCentralID PMC9122733

• Response letter to the Editor of Radiotherapy and Oncology regarding the paper "Stereotactic body radiotherapy for head and neck skin cancer" by IS Voruganti et al. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Karam, I., Voruganti, I. S., Poon, I. 2022; 170: 248-249

  View details for DOI 10.1016/j.radonc.2022.03.003

  View details for PubMedID 35278592

• Final results of an International Delphi Consensus study regarding the optimal management of radiation pneumonitis Cunningham, C., Voruganti, I., McLeod, L., Louie, A., Harrow, S. ELSEVIER IRELAND LTD. 2022: S56

  View details for Web of Science ID 000774314500121

• Stereotactic body radiotherapy for head and neck skin cancer. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Voruganti, I. S., Poon, I., Husain, Z. A., Bayley, A., Barnes, E. A., Zhang, L., Chin, L., Erler, D., Higgins, K., Enepekides, D., Eskander, A., Karam, I. 2021; 165: 1-7

  Abstract

  To report outcomes of Stereotactic Body Radiotherapy (SBRT) for head and neck skin cancer (HNSC) patients treated at a high-volume center.A retrospective review of HNSC SBRT patients from 2012 to 2019 was conducted. Kaplan-Meier method was used to estimate local control (LC), locoregional control (LRC) outside of SBRT field, overall survival (OS), progression-free survival (PFS) and late toxicity (LT). Univariate and multivariate analyses were performed. Grade 3-4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0.One hundred and six medically unfit HNSC patients (112 lesions) were included. Median follow-up was 8 months. Median patient age at diagnosis was 86 years (range: 56-102 years). The majority of patients had advanced disease (overall stage III-IV [n = 90, 85%]) with median gross tumor volumes (GTV) of 31 cm3 (range: 17-56 cm3). Treated sites were: primary (n = 51), nodal (n = 47) or primary plus nodal (n = 8). SBRT doses ranged from 32-50 Gy delivered twice weekly in 4-6 fractions to the gross tumor volume (GTV). One and 2-year LC rates were 78% (69-88) and 67% (53-82), respectively. One-year LRC outside of SBRT field, OS, PFS and LT rates were 72% (62-84), 53% (43-65), 52% (40-62), and 7% (2-17), respectively. Thirty-three patients (31%) developed acute grade ≥ 3 treatment-related toxicity, most commonly dermatitis (n = 31). Nine patients (8%) experienced late grade ≥ 3 toxicity, including 7 grade 3 fibrosis, 1 grade 3 bone radionecrosis and 1 grade 4 skin ulceration. No treatment-related deaths (grade 5) were observed.SBRT provides durable disease control with acceptable toxicity for medically unfit high-risk HNSC patients unable to undergo standard of care curative treatment approaches.

  View details for DOI 10.1016/j.radonc.2021.10.004

  View details for PubMedID 34648871

• OPTIMAL MANAGEMENT OF RADIATION PNEUMONITIS: PRELIMINARY FINDINGS OF AN INTERNATIONAL DELPHI CONSENSUS STUDY Voruganti, I., Cunningham, C., McLeod, L., Harrow, S., Louie, A. ELSEVIER IRELAND LTD. 2021: S29

  View details for Web of Science ID 000722897700063

• Initial findings of an international Delphi consensus study regarding the optimal management of radiation pneumonitis Harrow, S., Cunningham, C., Voruganti, I., Louie, A. ELSEVIER IRELAND LTD. 2021: S64-S65

  View details for Web of Science ID 000657005700157

• The use of personal health information outside the circle of care: consent preferences of patients from an academic health care institution. BMC medical ethics Tosoni, S., Voruganti, I., Lajkosz, K., Habal, F., Murphy, P., Wong, R. K., Willison, D., Virtanen, C., Heesters, A., Liu, F. F. 2021; 22 (1): 29

  Abstract

  Immense volumes of personal health information (PHI) are required to realize the anticipated benefits of artificial intelligence in clinical medicine. To maintain public trust in medical research, consent policies must evolve to reflect contemporary patient preferences.Patients were invited to complete a 27-item survey focusing on: (a) broad versus specific consent; (b) opt-in versus opt-out approaches; (c) comfort level sharing with different recipients; (d) attitudes towards commercialization; and (e) options to track PHI use and study results.222 participants were included in the analysis; 83% were comfortable sharing PHI with researchers at their own hospital, although younger patients (≤ 49 years) were more uncomfortable than older patients (50 + years; 13% versus 2% uncomfortable, p < 0.05). While 56% of patients preferred broad consent, 38% preferred specific consent; 6% preferred not sharing at all. The majority of patients (63%) preferred to be asked for permission before entry into a contact pool. Again, this trend was more pronounced for younger patients (≤ 49 years: 76%). Approximately half of patients were uncomfortable sharing PHI with commercial enterprises (51% uncomfortable, 27% comfortable, 22% neutral). Most patients preferred to track PHI usage (61%), with the highest proportion once again reported by the youngest patients (≤ 49 years: 71%). A majority of patients also wished to be notified regarding study results (70%).While most patients were willing to share their PHI with researchers within their own institution, many preferred a transparent and reciprocal consent process. These data also suggest a generational shift, wherein younger patients preferred more specific consent options. Modernizing consent policies to reflect increased autonomy is crucial in fostering sustained public engagement with medical research.

  View details for DOI 10.1186/s12910-021-00598-3

  View details for PubMedID 33761938

  View details for PubMedCentralID PMC7992944

• Glioblastoma Spinal Cord Metastasis With Short-Term Clinical Improvement After Radiation. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Climans, S. A., Voruganti, I. S., Munoz, D. G., Mason, W. P. 2020; 47 (6): 869-871

  View details for DOI 10.1017/cjn.2020.122

  View details for PubMedID 32522302

• OPTIMAL MANAGEMENT OF RADIATION PNEUMONITIS: PRELIMINARY FINDINGS OF AN INTERNATIONAL DELPHI CONSENSUS STUDY Voruganti, I., Cunningham, C., McLeod, L., Harrow, S., Louie, A. V. ELSEVIER IRELAND LTD. 2020: S58-S59

  View details for Web of Science ID 000606975500135

• THE USE OF PATIENT HEALTH INFORMATION OUTSIDE THE CIRCLE OF CARE: NEEDS AND PREFERENCES OF PATIENTS AT A LARGE ACADEMIC CANCER CENTRE Voruganti, I., Tosoni, S., Wong, R., Willison, D., Virtanen, C., Heesters, A., Liu, F. ELSEVIER IRELAND LTD. 2020: S74

  View details for Web of Science ID 000606975500174

• OUTCOMES FOLLOWING SBRT FOR HEAD AND NECK SKIN CANCER: A SINGLE INSTITUTIONAL EXPERIENCE Voruganti, I., Poon, I., Zhang, L., Husain, Z., Chin, L., Erler, D., Higgins, K., Enepekides, D., Eskander, A., Karam, I. ELSEVIER IRELAND LTD. 2020: S56

  View details for Web of Science ID 000606975500129

• Chest wall toxicity after stereotactic radiation in early lung cancer: a systematic review. Current oncology (Toronto, Ont.) Voruganti, I. S., Donovan, E., Walker-Dilks, C., Swaminath, A. 2020; 27 (4): 179-189

  Abstract

  Radiation-induced chest wall pain (cwp) and rib fracture (rf) are late adverse effects after stereotactic body radiation therapy (sbrt) for stage i non-small-cell lung cancer (nsclc); however, the literature about their incidence and risk factors shows variability. We performed a systematic review to determine the pooled incidence of cwp and rf in the relevant population.A literature search using the prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines considered English publications in medline and embase from January 1996 to August 2017. Abstracts were screened, followed by full-text review and data extraction.The database searches identified 547 records. Twenty-eight publications comprising 3892 patients met the inclusion criteria. Median reported ages and follow-up durations fell into the ranges 67-82 years and 12-84 months. Prescriptions fell into the range of 40-70 Gy in 3-10 fractions. Despite study heterogeneity, the pooled incidences of cwp and rf were estimated to be 8.94% and 5.27% respectively. Nineteen studies reported cwp grade: 58 of 308 patients (18.8%) experienced grades 3-4 cwp (no grade 5 events reported). Thirteen studies reported rf grade: grades 3-4 rf were observed in 9 of 113 patients (7.96%). A high chest wall V30 was an important predictor of cwp and rf.In patients with stage i nsclc, rates of cwp and rf after sbrt are low; however, tumour location, accurate toxicity reporting, and dose-fractionation schemes might alter those rates. Prospective correlation with dosimetry and quality of life assessment will further improve the understanding of cwp and rf after sbrt.

  View details for DOI 10.3747/co.27.5959

  View details for PubMedID 32905234

  View details for PubMedCentralID PMC7467794

• The use of patient health information outside the circle of care: Consent preferences of patients from a large academic cancer centre. Liu, F., Tosoni, S., Voruganti, I. S., Wong, R., Virtanen, C., Willison, D., Heesters, A. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000560368304531

• WELL-MED: A MULTIDISCIPLINARY APPROACH TO SUPPORTING RADIATION ONCOLOGY WELLNESS Voruganti, I., Ackerman, I., Millar, B., Follwell, M., Croke, J. ELSEVIER IRELAND LTD. 2019: S48

  View details for Web of Science ID 000493893300109

• A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization. Case reports in medicine Voruganti, I. S., Godwin, J. L., Adrain, A., Feller, E. 2018; 2018: 1413724

  Abstract

  Radioembolization (RE) is a selective internal radiation therapy (SIRT) delivering targeted, high-dose, intra-arterial radiation directly to the vascular supply of liver tumors. Complications can occur due to aberrant deposition or migration of radiation microspheres into nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI) tract. We report a case of gastric ulcers due to yttrium-90 (90Y) seed migration to the stomach to alert clinicians to this rare cause of gastric injury. A 57-year-old woman with stage IV breast cancer with liver and lung metastases presented to the hospital with 2 months of worsening nausea and vomiting. Two months prior, she had received SIRT with 90Y microspheres without complications. Upper GI endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies revealed black, spherical foreign bodies, consistent with 90Y microspheres, documenting radiation injury. Radiation-induced UGI ulceration is caused by direct radiation injury from beta-radiation. Delay in diagnosis may be due to the nonspecificity of symptoms and temporal delay of symptom onset from SIRT, which was 2 months in our patient. Also, complaints may be attributed erroneously to adjuvant chemotherapy or widespread metastatic disease. Clinicians must consider radiation-associated toxicity in any SIRT-treated patient developing abdominal symptoms.

  View details for DOI 10.1155/2018/1413724

  View details for PubMedID 29849654

  View details for PubMedCentralID PMC5925165

• Cost and Selection of Ophthalmic Anti-Vascular Endothelial Growth Factor Agents. Rhode Island medical journal (2013) Li, E., Greenberg, P. B., Voruganti, I., Krzystolik, M. G. 2016; 99 (5): 15-7

  Abstract

  Anti-vascular endothelial growth factor (anti-VEGF) drugs - ranibizumab, aflibercept, and off-label bevacizumab - are vital to the treatment of common retinal diseases, including exudative age-related macular degeneration (AMD), diabetic macular edema (DME), and macular edema (ME) associated with retinal vein occlusion (RVO). Given the high prevalence of AMD and retinal vascular diseases, anti-VEGF agents represent a large cost burden to the United States (US) healthcare system. Although ranibizumab and aflibercept are 30-fold more expensive per injection than bevacizumab, the two more costly medications are commonly used in the US, even though all three have been shown to be effective and safe for treatment of these retinal diseases. We investigated the availability and content of professional ophthalmic guidelines on cost consideration in the selection of anti-VEGF agents. We found that current professional guidelines were limited in availability and lacked specific guidance on cost-based anti-VEGF drug selection. This represents a missed opportunity to encourage the practice of value-based medicine. [Full article available at http://rimed.org/rimedicaljournal-2016-05.asp, free with no login].

  View details for PubMedID 27128510

• Live-cell, temporal gene expression analysis of osteogenic differentiation in adipose-derived stem cells. Tissue engineering. Part A Desai, H. V., Voruganti, I. S., Jayasuriya, C., Chen, Q., Darling, E. M. 2014; 20 (5-6): 899-907

  Abstract

  Adipose-derived stem cells (ASCs) are a widely investigated type of mesenchymal stem cells with great potential for musculoskeletal regeneration. However, the use of ASCs is complicated by their cellular heterogeneity, which exists at both the population and single-cell levels. This study demonstrates a live-cell assay to investigate gene expression in ASCs undergoing osteogenesis using fluorescently tagged DNA hybridization probes called molecular beacons. A molecular beacon was designed to target the mRNA sequence for alkaline phosphatase (ALPL), a gene characteristically expressed during early osteogenesis. The percentage of cells expressing this gene in a population was monitored daily to quantify the uniformity of the differentiation process. Differentiating ASC populations were repeatedly measured in a nondestructive fashion over a 10-day period to obtain temporal gene expression data. Results showed consistent expression patterns for the investigated osteogenic genes in response to induction medium. Peak signal level, indicating when the most cells expressed ALPL at once, was observed on days 3-5. The differentiation response of sample populations was generally uniform when assessed on a well-by-well basis over time. The expression of alkaline phosphatase is consistent with previous studies of osteogenic differentiation, suggesting that molecular beacons are a viable means of monitoring the spatiotemporal gene expression of live, differentiating ASCs.

  View details for DOI 10.1089/ten.TEA.2013.0761

  View details for PubMedID 24367991

  View details for PubMedCentralID PMC3938923

• The Memory Tree The Intima: A Journal of Narrative Medicine Voruganti, I. 2014: 4
• Molecular characterization of a novel 55.1 kb (G)gamma((A)gammadeltabeta)(0)-thalassemia deletion in two Canadian families. Hemoglobin Voruganti, I., Eng, B., Waye, J. S. 2009; 33 (6): 422-7

  Abstract

  We report two Canadian families in which there are four carriers of a novel (G)gamma((A)gammadeltabeta)(0)-thalassemia deletion. The patients all have mild microcytosis and hypochromia, and elevated levels of Hb F ranging from 9.7 to 17.3%. The precise endpoints of the deletion have been identified and are unique relative to other forms of (G)gamma((A)gammadeltabeta)(0)-thal reported in the literature. The deletion encompasses approximately 55.1 kb, beginning approximately 1.6 kb downstream of the (G)gamma-globin gene and extending approximately 29.0 kb downstream of the beta-globin gene.

  View details for DOI 10.3109/03630260903333088

  View details for PubMedID 19958187