Assoc Prof. Kailash Narayan
Associate Professor Kailash Narayan, MBBS MD PHD FRANZCR, has been Head of the Gynaecology Oncology Service, Peter MacCallum Cancer Centre, Melbourne, and Associate Professor, Department of Obstetrics & Gynaecology, Royal Women’s & Mercy Hospital for Women.
After graduating in medicine he completed a MD in biophysics in India, then, in 1981, a PhD in Experimental Pathology on “Effects of Beta-irradiation on Mammalian Tissues” at John Curtin School of Medical Research Australian National University, Canberra. During this time he studied angiogenesis, lymphangiogenesis, inflammation, tissue remodelling, and effects of irradiation on microvasculature in –vivo using autologous thyroid grafts in rabbit ear chamber. This led to a good understanding of the functions of terminal lymphatics and its role in clearing removing cellular debris and migrating cells from the interstitial tissue.
In 1987 he obtained a Diploma of Royal Australasian College of Radiology (Radiation Oncology) and became a Senior Consultant Radiation Oncologist, Head & Neck Cancer. He also became an Associate in the Dept. of Surgery, then a Senior Associate in the Dept. of Pathology, University of Melbourne. During this time I treated H&N cancer patients, participated in clinical studies in combined modality treatment of H&N cancer and also carried out laboratory research. The clinical studies related to the use altered radiation fractionation, concurrent chemo-radiotherapy and the use of elective neck dissection in H&N cancer patients. This led to improved loco-regional cancer control in H&N cancer patients. His laboratory research involved working with mouse tumours and study of tumour vasculature, morphology of infiltrative and expansile tumours and the effects of irradiation on tumour vasculature using micro-vascular corrosion casts and scanning electron microscopy. This led to some understanding of the process of radiation response in tumours, differential radiation response in microvasculature of infiltrative and expansile tumours, disruption of irradiated tumour architecture, tumour cells removal and repopulation.
From 1995 to 2003 he was a Principal Specialist at Peter MacCallum Cancer Institute before commencing his current role. In 1996 he took charge of Gynaecological radiation oncology at PeterMac. Apart from treating gynaecological cancers using radiotherapy, he became especially interested in advanced cervix cancer patients. Using MRI and PET scan and knowledge gained from rabbit ear chamber and vascular casting experiments, he begun exploring the clinical biology of advanced cervix cancer.
At the same time, he started using image guided brachytherapy in the treatment of cervix cancer. In light of his earlier laboratory research experience, this clinical work led him to discover several links along the clinical biology of advanced cervix cancer. These were, the association of corpus invasive cervix tumour and lymph-node metastasis, differential radiation response in node negative and node positive tumours and possibility of tumour dissemination due to and during radiotherapy. It also led him to identify a sub-group of patients with very poor prognosis with a high risk of developing distant metastasis; a group not identified by either conventional staging or any tumour markers. This became the basis of enrichment for “High risk” patients for a NH&MRC funded international “OUTBACK” study under the auspices of ANZGOG. Presently this study “A Phase III trial of adjuvant chemotherapy following chemoradiation as primary treatment for locally advanced cervical cancer compared to chemoradiation alone: THE OUTBACK TRIAL” is successfully accruing patients.
More recently, following his interest in morphology, imaging and long term clinical observation through a prospective database he was able to show the systemic effects of hypoxemia due to low bone marrow reserve and smoking. Low bone marrow reserve reflected as a drop in haemoglobin during treatment and chronic smoking resulting in more invasive disease in cervix cancer. He has been continually involved in research and regularly author articles in peer reviewed journals