CONCOMITANT CHEMORADIATION IN LOCALLY ADVANCED CARCINOMA CERVIX: COMPARING DOUBLET VERSUS SINGLE AGENT CHEMOTHERAPY.
Abstract Purpose: To compare the efficacy and toxicity of two definitive concomitant chemoradiotherapy schedules (doublet combination and single agent) along with radical external beam radiotherapy (EBRT) in the management of locally advanced carcinoma of the uterine cervix (LACCx). Material and method: Previously untreated, 60 patients of LACCx (FIGO stage IIB-IIIB) were taken for definitive treatment by concurrent chemo-radiation. These patients were randomly assigned either; Study group I, the Doublet chemotherapy(Gemcitabine + Cisplatin) administration and Control group II, the Single-agent chemotherapy(Cisplatin) administration group. EBRT was given as 50Gy/ 25Fr/ 5 weeks. Chemoradiation was followed by weekly HDR Intra-cavitory brachytherapy (ICBT), 3 sessions of 700cGy each. Observations were made at the end of treatment and 6 months of follow up. Response to treatment and toxicity were investigated. Results: At the end of treatment, disease response in study and control respectively at the end of treatment was as follows: Stage IIB (CR- 52.63% versus 38.09%), Stage IIIA (CR- 100% versus 100%) and Stage IIIB (CR- 55.56% versus 25.0%). Overall disease response for the group I and II, at the end of sixth months follow up was as follows: CR- 93.33% versus 83.33%, PR- 3.33% versus 13.33%, and recurrence- 3.33% versus 3.33% respectively. Most severe acute hematological toxicity observed was Grade 2 in 40.0% versus 16.67% patients, respectively. Similar was the trend of acute skin & mucosal reactions and acute gastrointestinal toxicity. Though a higher number of patients in the study group experienced more acute toxicities, these were acceptable and manageable. Skin and mucosal reactions at 6 months follow up were not significantly higher in the doublet group compared to the single agent group. Conclusion: Administration of doublet combination chemotherapy; is better compared to single-agent chemotherapy administration in terms of disease control (though not statistically significant)with manageable toxicity profile; given concurrent with EBRT, for management of locally advanced carcinoma cervix. A larger study may establish the very role of the new regimen, especially in a resource-limited setup where patients present with advanced/ bulky...
CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. CoQ10 has a role in carcinoma breast, cervix, lung, prostate, melanoma, cancer chemotherapy and cancer related fatigue. Future trends involving CoQ10 in many cancers needs more clinical trials for better understanding of CoQ10 efficacy.. Oral CoQ10 administration can correct CoQ10 deficiency since it increases CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. CoQ10 has a role in carcinoma breast, cervix, lung, prostate, melanoma, cancer chemotherapy and cancer related fatigue. Future trends involving CoQ10 in many cancers needs more clinical trials for better understanding of CoQ10...
ABSTRACT Fine needle aspiration cytology, though, is a reliable, minimally invasive procedure with high sensitivity, specificity and diagnostic accuracy, still it has its limitations in making out diagnosis of thyroid nodules. Here we present an uncommon case of 52 years old Indian female with complaint of mass on antero-medial aspect neck. Fine needle aspiration cytology was suggestive of colloidal goiter. For cosmetic indication, thyroidectomy was done and histopathological examination sought to confirm the cytological diagnosis. The incidental finding was uncommon, revealing papillary thyroid microcarcinoma. Worth emphasizing is the possibility of uncommon malignant disease like thyroid microcarcinoma, in view of limitations of fine needle aspiration cytology in apparently benign thyroid...
Abstract Nodular hidradenoma or clear cell hidradenoma is a rare skin adnexal tumor arising from eccrine sweat glands. Skin adnexal tumors situated in breast parenchyma are very rare and is one of differential diagnosis of breast masses. We report a case of 60 years old female with a left breast lump and bloody nipple discharge being suspected as a malignant breast mass. A final diagnosis of nodular hidradenoma breast was made after excision biopsy and immunohistochemistry study. A patient is a diagnosed case of carcinoma endometrium and underwent panhysterectomy in 2007. Postoperative histopathology revealed well-differentiated endometrial adenocarcinoma without invasion of the myometrium. She received postoperative radiation therapy and intravaginal brachytherapy in 2008 and is on regular follow-up since...
With the advent of effective and intensive chemotherapy, we are able to achieve better response rates as well as improved survival but the side effects remain a constraint. This article intends to discuss one of the side effects of chemotherapy i.e. neuropathy; culprit agents, mechanism and therapeutic strategies to manage it.
ROLE OF PHYSIOTHERAPY IN PREVENTION AND MANAGEMENT OF LYMPHEDEMA IN POST-OPERATIVE BREAST CANCER PATIENTS
After surgery for breast cancer, the most common postoperative complication is secondary lymphedema which may sometimes be more challenging to manage than the disease itself. This systematic literature review aims to highlight the role of physiotherapy in management of secondary lymphedema in post-operative patients of breast cancer and its current status. The literature review has been conducted using available textbooks and online database of PubMed, Medline, SciELO, LILACS (Latin American and Caribbean Literature) and EMBASE. Online search has been made through English literature mainly, from 1990 to 2015 and focused on research or review articles. Review found physiotherapy; with appropriate combination of techniques, started early; has been very effective in prevention and management of lymphedema in post-operative breast cancer...
Background: Immediate breast reconstruction (IBR) in breast cancer is a well-accepted option but is not commonly offered in India. The purpose of this study is to evaluate the quality of life after IBR. Materials and methods: This prospective study has been conducted over 40 patients of operable carcinoma breast, who underwent either modified radical mastectomy (MRM) in control group or MRM followed by IBR using autologous tissue in the study group. Both the groups were evaluated in terms of technical issues, morbidity, clinical outcome and quality of life (QoL). The psychological satisfaction in either group was studied by body image scale. Results: In the postoperative period, complication rate of 35% was noted in the study group as compared to 10% in the control group. In the study group, 95% of the patients were satisfied with the body image. Among these, 20% of patients were highly satisfied, 75% were moderately satisfied. On the other hand, 80% of the patients undergoing MRM alone were not satisfied at all. Conclusion: Immediate breast reconstruction following mastectomy is a logically better option to preserve the femininity, gives a higher level of patient satisfaction and significantly improves the quality of...
Head and neck cancer forms the major chunk of cancer patients in developing country like India. About 2/3rd of the patients present in locally advanced stage in which the cure rates are low. Concomitant chemoradiation with platinum compounds is the standard treatment for such patients as it offers organ and function preservation with better quality of life. MACH-NC update (2009) shows that concomitant chemoradiation provides an absolute survival benefit of 6.5% at 5 years. Many chemotherapeutic agents including 5-FU, taxanes and biologically targeted therapy have been investigated in an effort to maximize the locoregional and survival in locally advanced head and neck cancer. Oral chemotherapeutic agent gives the ease of self medication on daily basis without the need for hospital admission and intravenous infusion. Theoretically daily administration of oral chemotherapy agent mimics the continous infusion of a parenteral agent. Since infusional 5-FU along with Radical RT has achieved a complete response rate of 68% for 5-FU arm versus 56% for placebo arm (p=0.04) with the overall median survival of 33 months for 5-FU versus 25 months for placebo arm, Capecitabine (analog of 5-FU) in low doses have been used in concomitant setting for locally advanced head and neck cancer. Overall response rate observed has been 33-89% with manageable toxicity and near total patient compliance. The maximally tolerated dose to be given daily during radiation therapy is 500 mg/m2 b.i.d. Lower dose doses of 250-350 mg/m2 have also been used in concomitant with lesser toxicity and greater...
PALLIATIVE CHEMORADIOTHERAPY VERSUS RADIOTHERAPY ALONE FOR MANAGEMENT OF LOCALLY ADVANCED HEAD & NECK CARCINOMA PATIENTS WITH POOR PERFORMANCE STATUS
Introduction: Palliative external beam radiotherapy (EBRT) and chemotherapy is commonly practiced for management of locally advanced head & neck carcinoma (LAHNC) patients with poor performance status. This study compares EBRT alone and EBRT along with low dose Gemcitabine. Method: Study was conducted in Department of Radiotherapy, PGIMS Rohtak, in 2008-09; on histopathologically proven, untreated 60 cases of LAHNC, having KPS 60-70. Patients were randomly assigned either control group (n=30), given EBRT alone as 20Gy/5Fr/5days or study group (n=30), given EBRT as 20Gy/ 5Fr/ 5days and Gemcitabine 200 mg/m2 i.v. 2 hour prior to radiotherapy on day 1. Mean age was 53 years (26-84 years). Male:female ratio was 5:1. Most common primary site was base of tongue followed by larynx. Major symptoms were pain, difficulty in swallowing and altered voice. Patients were staged as per AJCC 2002; 2/3rd were stage IVA and 1/3rd were IVB. Despite randomization, there was no significant difference between two groups in age, sex, primary site, stage, and performance status. The side effects were graded as per RTOG criteria. Results: Objective response, 3 months post-treatment, in the chemoradiotherapy and radiotherapy alone group respectively was: CR 7% vs 0%; PR 30% vs 33%; stable disease 56% vs 46% and progressive disease 7% vs 20%. Subjective response, similarly was better in study group through out; even significantly better in dysphagia at 3 months follow up. Acute skin reactions were: Grade I- 73% vs 47% at 2 weeks and 60% vs 40% at 1 month respectively. Acute mucosal reactions were: Grade I- 30% vs 17%, Grade II- 43% vs 17% respectively. No hematological and grade III/IV skin or mucosal reactions observed. Differences in reactions were not statistically significant. Conclusion: In management of LAHNC patients with poor performance status, addition of low dose Gemcitabine to palliative radiotherapy gives better disease control and symptomatic relief without unmanageable side...
Disease and treatment-related swallowing dysfunction are quite common in head and neck malignancies. Though the use of high-end technology like Intensity modulated radiotherapy (IMRT) has led to a reduction in morbidity still, the issue of tolerability comes whenever a higher dose of radiation is used for tumor control. The goal of this review is to emphasize the need for documentation of pretreatment swallowing functions and look into the prospects to improve swallowing function, thence quality of life after radiotherapy by studying factors leading to this impairment. We also looked into the benefit of physiotherapy exercises to increase the capacity of...