Dinshaw Leads Cancer Revolution At Tata

Dr. Ketayun Dinshaw

Radiation therapy is used in the treatment of two-thirds of all cancer patients in India today. It is often the treatment of choice as primary therapy, and is frequently used in combination with surgery or chemotherapy and for palliation in advanced cases. At the Tata Memorial Centre, Mumbai, India, where Dr. Ketayun Dinshaw is director, 400 patients receive radiation treatment every day.

As a radiation oncologist-turned-hospital administrator at one of India's foremost cancer hospitals, Dr. Dinshaw has played a significant role in the evolution of modern health care in that country, and radiation therapy has led the way. Her hospital's department of radiation oncology can deliver both external beam therapy and brachytherapy (temporary implantation of radioactive pellets or wires into the tumor). New, high precision treatment design and delivery methods such as three-dimensional conformal radiotherapy, in which the radiation beam is automatically adjusted to the shape of the tumor during treatment from several angles, and intensity modulated radiotherapy, in which the strength of the beam is similarly adjusted, are available. Both of these treatments minimize the amount of normal tissue in the irradiated field. The cancer treatment methods available at Tata Memorial Hospital rival any in the world.

Over the past 25 years, Dinshaw has revolutionized cancer medicine in India, refining multi-modal treatments as the exception rather than the rule. Most recently, she has turned her attention to expanding the hospital's capabilities for clinical research. Clinical trials—a relatively new concept in India—are underway in treating various cancers including breast, cervical, head and neck, lymphomas and leukemias.

"We are very keen to be involved in new collaborations with INCTR," Dinshaw says. "Cervix is the most common cancer in my country, and in certain metropolitan areas breast cancer is overtaking it. It will be extremely useful to be part of organized trials that might evolve from INCTR's strategy groups in these areas."

Dinshaw joined the staff of the Tata Memorial Hospital, Mumbai, in 1974, and seven years later was named head of the department of radiation oncology. In 1995, she was appointed director of the Tata Memorial Hospital, and two years later was selected to oversee the Tata Memorial Centre (Tata Memorial Hospital and Cancer Research Institute) as well.

Throughout her tenure, she has been a driving force in establishing the highest standards, organizing and refurbishing all departments, providing modern instrumentation for diagnosis and treatment of cancer, and establishing modern management systems and computerization in the hospital.

One of her earliest initiatives was fostering an integrated team approach to cancer treatment, encouraging radiologists and surgeons to review new patients in the Lymphoma Joint Clinic. Together, the doctors established clinical protocols, and now channel cancer patients into appropriate treatment programs according to set guidelines—in the context of ongoing clinical trials. A vibrant scientific review committee and hospital ethics committee monitor and guide all research programs in the Tata Memorial Hospital.

A new facility housing the Advanced Centre for Treatment Research and Education in Cancer (ACTREC) opened just last year. The Cancer Research Institute at ACTREC will focus on molecular genetics, molecular epidemiology, immunology, virology and newer areas of genomics and drug development. The Clinical Research Centre aims to introduce translational research from the bench to the bedside and will focus on specific clinical trials. Validation by sophisticated laboratory methodologies, predictive and prognostic assays, and tumor markers will bridge intense interaction between scientists and clinicians. Indigenous development of teletherapy units and models will also be addressed at ACTREC, which is expected to be a hub of excellence in the region.

"Between the hospital and the research centre, we are strongly positioned to provide leadership in all areas of medical services, education and research," she says. "While we have concentrated on providing the best patient service, we are also interested in all aspects of basic and clinical research, and in providing post-graduate training. We place emphasis on teaching and using our wealth of excellent clinical material for research."