MRI versus clinical assessment in staging and response evaluation in locally advanced cervix cancer patients treated with concurrent chemo-radiation in a tertiary cancer center: a prospective study

Background: Carcinoma cervix is staged most commonly with FIGO staging even though it has a number of pitfalls, for standardization of treatment and epidemiological purpose. The objectives of this prospective study are to evaluate the role of MRI in staging of locally advanced cervix cancer and correlate with the FIGO staging and to assess the role of MRI in evaluating treatment response.Methods: 58 biopsy proved locally advanced carcinoma cervix patients who satisfied the inclusion and exclusion criteria from January 2014 to October 2015 were recruited. After the standard pretreatment evaluation including MRI abdomen and pelvis patients were started on concurrent chemo-radiation. Pelvic External beam radiation (EBRT) to a dose of 45Gy/23 fractions for a period of 4.5 weeks with cisplatin 40mg/m2 weekly once. Followed by intracavitary brachytherapy HDR weekly once 7Gy/fraction x 3 fractions. Treatment response assessed as per RECIST criteria. As a part of follow up, three monthly clinical evaluation and 4-6 months MRI evaluation were done.Results: Agreement between MRI and clinical stage was evaluated by calculating the kappa value as the measure of agreement. The kappa value obtained was 0.18 which showed poor agreement between the two, while comparing clinical and MRI assessment with regard to treatment response, the kappa value obtained was 0.08 signifying poor agreement.Conclusions: Correlation of FIGO and MRI staging reveals significant discordance between the two and on further evaluation it is seen that MRI staging correlates well with the local recurrence of the disease

Transplant ineligible multiple myeloma patients presenting as paraplegia/paraparesis a prospective single institution study

Background: Multiple myeloma a plasma cell neoplasm characterized by heterogeneous myriad of presentation with paraparesis or paraplegia in 20% cases due to spinal cord compression by vertebral collapse, compression or fracture.Methods: This is a prospective observational study of thirty transplant ineligible multiple myeloma patients with paraplegia/paraparesis. Pretreatment evaluation done as per standard protocol including MRI whole spine. Involved spine XRT 8Gy single fraction followed by BLD (Bortezomib 1.3mg/m2 weekly once, Lenalidomide 10mg/m2 for 21 days, oral dexamethasone 40 mg weekly once). Neurological parameters, time to neurological and tumor response at 6 months assessed. Patients in very good partial response or complete response were maintained on Lenalidomide and bisphosphonate therapy for a period of two years. The duration of symptoms and time to response were analyzed with Mann Whitney Cox test.Results: 15 patients were grade 0 power and others grade 1 or 2. Median time to any neurological response was 2.97 weeks. 63.3% of patients achieved power of grade 5, 30% grade 4 and 6.7% grade 3 powers. 23.3% patients received complete response while 63.3% patient’s very good partial response.Conclusions: Bedridden myeloma patients had an excellent improvement in quality of life and tumor control with this treatment schedule.

Transplant ineligible multiple myeloma patients presenting as paraplegia/paraparesis a prospective single institution study

oai:ojs.msjonline.org:article/1Background: Multiple myeloma a plasma cell neoplasm characterized by heterogeneous myriad of presentation with paraparesis or paraplegia in 20% cases due to spinal cord compression by vertebral collapse, compression or fracture.Methods: This is a prospective observational study of thirty transplant ineligible multiple myeloma patients with paraplegia/paraparesis. Pretreatment evaluation done as per standard protocol including MRI whole spine. Involved spine XRT 8Gy single fraction followed by BLD (Bortezomib 1.3mg/m2 weekly once, Lenalidomide 10mg/m2 for 21 days, oral dexamethasone 40 mg weekly once). Neurological parameters, time to neurological and tumor response at 6 months assessed. Patients in very good partial response or complete response were maintained on Lenalidomide and bisphosphonate therapy for a period of two years. The duration of symptoms and time to response were analyzed with Mann Whitney Cox test.Results: 15 patients were grade 0 power and others grade 1 or 2. Median time to any neurological response was 2.97 weeks. 63.3% of patients achieved power of grade 5, 30% grade 4 and 6.7% grade 3 powers. 23.3% patients received complete response while 63.3% patient’s very good partial response.Conclusions: Bedridden myeloma patients had an excellent improvement in quality of life and tumor control with this treatment schedule.