Intergenerational communication on sexuality and HIV/AIDS: Exploring feasibility of building effective youth-adult partnerships to reduce young people\u27s HIV vulnerabilities

In India, over one-third of all reported AIDS cases occur among people aged 15–24 years. Young people need competencies to navigate daily-life situations and engage in productive activities, and the relationships they form with adults and peers are the source of support and guidance critical to the development of their competencies. The peer-based approach is integral to sexual health and HIV-prevention programs for youth. However, in some settings, program and policy directions have been hampered by adult beliefs of what young people should be permitted to know. Recent projects show that working on changing the norms and beliefs of adults in the community facilitates work with youth. However, program strategies remain ad-hoc possibly because of a lack of a clear and agreed-upon set of conditions to suggest the need for, as well as inform the design and implementation of, an intergenerational approach. This brief presents findings from a study that addresses this gap by documenting existing patterns of, and barriers to, intergenerational communication on sexuality and HIV/AIDS. It also provides information for designing interventions that promote effective youth-adult partnerships to address HIV risk

Ten years survival results of randomized study comparing weekly vs. triweekly cisplatin with concurrent radiation in locally advanced carcinoma cervix

Background: The current standard of treatment for locally advanced cervical cancer is concurrent chemo-radiation with improved overall survival (OS) by 6% with manageable toxicities. The cisplatin 40 mg/m2 given weekly is the widely practiced regimen for 4–6 cycles concurrently with irradiation. Materials and methods: Two hundred and twelve patients with histologically proven squamous cell carcinoma of cervix with stages IIB to IIIB were enrolled between 2007–2011. External beam radiation dose of 45 Gy in 25 fractions was delivered over 5 weeks. Brachytherapy was delivered by manual afterloading cesium-137 (Cs137) low dose brachytherapy (LDR) using modified Fletcher suit intracavitary applicators to a total dose of 30 Gy to Point A or interstitial template to dose of 21 Gy/3 fractions with remote afterloading iridium-192 (Ir192) high dose brachytherapy (HDR). Patients were randomized to arm A receiving 40 mg/m2 of concurrent cisplatin weekly and arm B receiving 100 mg/m2 of concurrent cisplatin triweekly. Results: One hundred and nine patients were randomized to weekly cisplatin and one hundred and three patients to triweekly cisplatin at the end of recruitment. At ten years, the OS was higher in the weekly arm (79.8%) compared to triweekly arm (70.9%). Disease free survival (DFS) was almost equal (76.1% and 73.8%) in the weekly and three-weekly arms. There is definite significance in overall DFS with patients receiving the cumulative cisplatin doses of more than 250 mg (p = 0.028). The patients with more than 45 years of age had better overall survival (OS) (79%) with statistical significance 31 (p = 0.020). Conclusion: Both cisplatin based triweekly and weekly concurrent chemotherapy are equally effective in terms of OS and DFS

Prognostic significance of primary tumour volume in nasopharyngeal carcinoma – a single institute study

Introduction: Nasopharyngeal carcinoma is very uncommon in the southern part of India, the age-adjusted incidence rate is less than 1 per 1,00,000 population. This study is undertaken to evaluate the outcome of nasopharyngeal carcinoma and its correlation with Primary tumor volume. Material and methods: Total of 50 non-metastatic nasopharyngeal carcinoma patients treated with concurrent chemo radiation between January 2013 and December 2015 were included in the study. All patients were treated via IMRT with dose of 66-70Gy, along with concurrent chemotherapy. Initial tumour volume was measured from CT based contouring and mean dose delivered was calculated. All patients were followed up for survival, relapse and metastasis. Results: The median follow up for the group was 24 months. The median Gross tumor volume of primary disease and nodal disease was 61.6 cubic centimetres and 35.4 cubic centimeters respectively. The 2 year Disease free survival and Overall survival for the entire group was 64% and 68% respectively. There was significant difference (p-0.018) between disease free survival of low volume disease group (LVD) which was 78 % as compared to high volume disease (HVD) group 52 % at 24 months, similarly Overall survival was also significantly better (p-0.015) in LVD group as compared to HVD group 80% vs 55% at 24 months. Among the treatment related factors adjuvant chemotherapy significantly improved the outcome in HVD group but no difference was seen in LVD group. Conclusion: Our patients had large volume primary disease, the OS and DFS was significantly better in LVD patients, adjuvant chemotherapy after concurrent chemoradiotherapy had no additional benefit for LVD patients but improved DFS and MFS in HVD Patients

Hyperfractionated radiotherapy and concurrent chemotherapy in locally advanced hypopharyngeal cancers– an institutional experience

Aim: To determine whether hyperfractionated radiotherapy with concurrent cisplatin improves outcome in advanced hypopharyngeal cancers. Methodology: From 2012 to 2014, twenty three patients diagnosed with squamous cell carcinoma of hypopharynx (Stg III-7, Stg IVA-14, and Stg IVB-2) were assigned to receive total dose of 75.9 Gy in 66 fractions @ 1.15 Gy/fraction, twice daily with inter-fraction interval of 6 hours, 5 days/week, over 45 days. Spinal cord shielding was done at 50.6 Gy in 44 fractions. Concurrent chemotherapy was delivered with cisplatin 40 mg/m2 once weekly. The tumor response was assessed at 6 weeks and 3 months after the completion of treatment. Results: All the recruited 23 patients completed the planned treatment. The complete response at 6 weeks and 3 months post treatment for primary and node was observed in 16/23 and 18/23, 13/23 and 16/23patients respectively. The grade I and II toxicities encountered during the treatment were mucositis (16 patients), radiation dermatitis (20 patients), neutropenia (9 patients), and leucopenia (18 patients). Grade 3 reactions seen were mucositis (6 patients), neutropenia (3 patients), leucopenia (2 patients), skin (2 patients) and none of the patients had grade IV reactions. The nutrition was maintained with feeding nasogastric tubes and parentral infusion though out the treatment. The median follow up was 18 months with a median overall survival of 24 months and median disease free survival was 18 months without any statistical significance. Conclusion: Hyperfractionated radiotherapy combined with concurrent weekly cisplatin treatment for locally advanced hypopharyngeal cancers can be considered with rigorous monitoring and management of the toxicities

Weekly vs. tri-weekly cisplatin based chemoradiation in carcinoma cervix: a prospective randomized study of toxicity and compliance

Background: Addition of chemotherapy to radiation has improved 5-year survival by 6%. However, the optimal dose and schedule of concurrent cisplatin is not well defined, though widely accepted practice is the weekly schedule of 40 mg/m2 for 5 weeks. Repeated admissions for weekly cisplatin drain the limited resources in high volume centres. We intended to study the compliance and toxicity of two cisplatin schedules in our patients diagnosed with carcinoma cervix. Materials and methods: Between 2007–2011, 212 patients, histologically proven squamous cell carcinoma with stages IIB to IIIB were randomized into two arms. All patients were planned for external beam radiotherapy 45 Gy/25frs over 5 weeks followed by Intracavitary or Interstitial brachytherapy to a total BED dose of 75–85 Gy. Single agent cisplatin given concomitantly, was scheduled weekly (40 mg/m2/cycle, 5 cycles) in an arm A and three weekly (100 mg/m2/cycle, 2 cycles) in an arm B. Toxicity and compliance were evaluated weekly according to the RTOG guidelines. Analysis of the compiled data was done using SSPS version 20. Results: Of the evaluable 212, 109 patients received weekly cisplatin chemotherapy and 103 patients received three weekly cisplatin. The most common acute toxicity observed was grade I–II leucopoenia. The upper and lower gastrointestinal reactions were high in three weekly arms, which was statistically significant (57% and 42.7%, p < 0.05). Proctitis was observed in 10% of patients in both of the arms and only two patients had Gr1 cystitis after 6 months of treatment. Conclusions: Tri-weekly cisplatin based concurrent chemoradiation can be adopted in high volume centres with manageable haematological and gastrointestinal acute toxicities