Management of giant cell tumor of bone in the era of denosumab: A case series and review of the literature

Giant cell tumor (GCT) of the bone also known as osteoclastoma typically arises from the meta-epiphyseal region of the long bone and comprises 5% of all bone tumors and 20% of benign bone tumors. Understanding pathogenesis is the key to successful systemic therapy with denosumab, a RANK-ligand inhibitor. In this context, we report seven GCT bone-treated denosumab and radiotherapy cases with a diverse clinical presentation from our institute, NRS Medical College, and Hospital Kolkata

TOXICITY AND TREATMENT OUTCOME OF ACCELERATED FRACTIONATION RADIOTHERAPY VERSUS CONVENTIONAL FRACTIONATED CONCOMITANT CHEMORADIATION IN LOCALLY ADVANCED CERVICAL CARCINOMA: A PROSPECTIVE STUDY

Abstract Background and objectives: The benefit of concurrent chemoradiation is often not achievable because of poor tolerance due to increased toxicity, which is a common problem in our setting where a significant portion of carcinoma cervix patients presents at an elderly age, with medical co-morbidities, and with poor performance status. In addition, many patients refuse chemotherapy. Accelerated radiation therapy remains one of the possible alternatives there. Hence, we would like to perform a prospective study to compare treatment results between Pure Accelerated Radiation versus Concomitant Chemoradiation in Locally Advanced Squamous Cell Carcinoma of Cervix. Material and methods. After the initial investigative work up a total of Sixty-two (n=62) histologically confirmed squamous cell carcinoma of cervix Locally advanced Stage (FIGO- stage IB2 to IVA.) with ECOG performance status 0-2 patients were randomized into two arms: Arm A (Study arm, n=30 ) - Patients received  6 (Six) fractions per week of External Beam Radiotherapy without chemotherapy and Arm B (Control arm, n=32) patients received concurrent chemoradiation with 5 (Five) fractions per week of radiation with Weekly Injection of Cisplatin at the dose of 40 mg /m2. Results: Overall response rates between the two arms were similar and statistically not significant (p- value=0.352). All acute late toxicities are similar in both arms except acute renal toxicity which is more in the control arm and the difference is statistically significant (p-value =0.005) Conclusions: In developing countries like India with limited treatment facilities, pure accelerated radiotherapy with brachytherapy, without concurrent chemotherapy may be a good option and it can be viewed as an equally effective option for the elderly patients, the patients who refuse, those who have contraindications for chemotherapy or have comorbidities. Further multicenter, controlled, phase III trials will be needed to prove the benefit of the shortening overall treatment time and compare the efficacy with chemoradiation. Keywords: Accelerated fractionation, chemoradiation, cervical cancer