Outcomes of Hypofractionated Radiation Therapy in Locally Advanced Non-small cell Carcinoma Lung : A Single Institutional Experience

Introduction: Radical treatment in locally advanced non small cell carcinoma lung presents a management dilemma in patients with compromised performance status. Hypofractionated EBRT resolves this by confering high efficacy while avoiding excessive early toxicity. Objectives: To evaluate the efficacy and tolerance of hypofractionated radiotherapy in locally advanced lung cancer patients with compromised performance status. Methods: From January 2019 to January 2020,62 patients were enrolled to receive hypofractionated radiotherapy with 40Gy in 16 fractions with 5 fractions per week (2.5Gy per fraction) because of compromised performance status. Follow-up was conducted at 6 weeks and 3 months for symptomatic and radiological response (RECIST Criteria 1.1) .All results were evaluated statistically. Results: Mean age was 72.7years (+ 6.66) with 66.12% (n=41) above 70 years and 85% in ECOG PS 3. Out of 61 patients, 20% had complete response, 75% had partial response and 3% had stable disease at 6 weeks which progressed to 33% with complete and 62% with partial response at 3 months. 85% achieved symptom palliation. Radiation pneumonitis of grade 2 and above war observed in 60.65% and 62.29% and esophagitis of grade 2 and above was observed in 40.98% and 13.11% at 6 week and 3 months respectively. Conclusions: Hypofractionated RT confers the benefit of avoiding excessive early toxicity while maintaining high efficacy and be a finer alternative in patients with compromised performance status and/or advanced age

Definitive chemoradiation in non metastatic squamous cell carcinoma anal canal: a single institution experience

Background: To analyze the oncological outcomes in anal canal squamous cell carcinoma treated with concurrent chemoradiotherapy. Materials and Methods: A single centre retrospective hospital based study with sample size of 51 patients of anal canal Squamous cell carcinoma treated with concurrent chemoradiotherapy with mitomycin @10mg/m2 and 5FU based. Disease free survival (DFS), Colostomy free survival (CFS) and Overall survival (OS) rates were calculated by Kaplan-Meier method. Results: Among 51 eligible patients, after a median follow up of 46 months (range 10-68 months). The 3year Disease free survival (DFS) was 73.9%. 3patients developed locoregional recurrence while 1patient developed distant metastasis. At 3 years Overall survival (OS) rate was 77%. Out of 44 patients 6 patients lost to follow up while 2 patients died due to progressive disease and 2 due to non cancer causes. 3year Colostomy free survival (CFS) rate was 59%. Total 18 out of 44 patients underwent colostomy. No grade 3 or 4 late toxicities occurred after completion of treatment. Conclusion: This study concluded that definitive chemoradiotherapy achieves good local control, overall survival and colostomy free survival with acceptable toxicity and can be recommended as standard treatment in patients with carcinoma anal canal

Dosimetric and volumetric analysis in endobronchial brachytherapy treatment of carcinoma lung patients: A pilot study

Background: To analyze the radiation doses received by Organ at Risk (OAR) nearby the target volume and volumetric changes in the target volume in carcinoma lung patients irradiated in three treatment session of endobronchial brachytherapy (EBBT). Methods: Dosimetric analysis was conducted on patients of carcinoma Lung received three session of Endobronchial brachytherapy treatment in High Dose Rate brachytherapy unit with Ir-192 source. A flexible Lumencare catheter was inserted into the bronchus and positioned catheter tip at the tumor. Length of the implanted catheter was measured with the source position simulator device. Acquired three dimensional CT image data set with x-ray marker was sent to TPS to generate an optimized treatment plan. The OAR’s and target volume were delineated for the accurate assessment of doses in each brachytherapy treatment session. The prescribed dose was normalization at 1.0cm from the center of the catheter. Doses to OAR’s and target volume were noted down from the DVH and detailed dose volume table from TPS. The prescribed dose was 7Gy per fraction in three fractions. Doses to OAR’s and Target volumes were also evaluated for each treatment session of the patient. The change in the volume of the target irradiated was noted down from the dose volume table in TPS. Results: Thirty sessions were evaluated in this study as these were infrequent procedures to perform. Average mean dose to Esophagus was varied from 1.18Grey to 0.85Grey, average maximum dose to Heart was varied from 4.77Grey to 3.69Grey and average maximum dose to left coronary artery was varied from 0.44Grey to 0.91Grey. Average changes in the volume of a Target volume was found in varied from 20.45cc to 13.70cc in each treatment session and found there is signification volume reduction in the target volume irradiated. Conclusion: This study showed that the doses to OARs are significantly increased in second and third session of EBBT and the doses to OAR’s were in their tolerance limit. There is a significant volume reduction in volume of the target in second and third treatment EBBT session. It implies that the EBBT is much effective in the treatment of lung carcinoma patients having disease lesion in primary and secondary bronchus

Dosimetric study for mastectomy carcinoma left breast cases with volumetric modulated arc therapy (VMAT)

Background: Radiation therapy for breast cancer has evolved from conventional to 3-dimentional radiation therapy (3-DCRT) and through more precise IMRT and VMAT. 3-DCRT is preferred for ca breast treatment as it reduces low dose area in contra lateral lung but with the advances in radiotherapy image guided techniques can deliver precise and lower doses to OARs with better coverage. This study is aimed to evaluate the doses of PTV, heart and ipsi-lateral lung with contra lateral lung doses delivered by VMAT technique. Method and material: Total 10 patients of carcinoma left breast with mastectomy were selected for VMAT planning with prescription of 45 Gy/20#. Eclipse 16.1 treatment planning system was used and treatment was delivered by True Beam with 6 MV photon energy with image guidance. The VMAT technique includes the non-continuous partial arc and continuous partial arc to deliver the dose. Dose volume histogram (DVH) was used to analyze for doses of planning target volume (PTV) and organs at risk (OARs). Results: PTV was covered with average 94.96% of prescribed dose. The average homogeneity index was found 0.02 and average conformity index was found 0.97 for VMAT plans. Mean doses for heart were measured 14.49±2.11Gy and for V25Gy 11.16±1.97Gy. Ipsilateral lung mean doses were observed 16.23±1.01 Gy, V20Gy doses were 28.73±1.52Gy, V30Gy doses were 14.78±2.5Gy and V40Gy doses were 5.59±1.98Gy. The contralateral lung mean doses were reported 7.69±1.79Gy and V10Gy 19.05±2.05Gy. Average planning target volume was 1710.98cc. The average homogeneity index was 0.02 and conformity index was 0.96. Conclusion: OARs doses with the use of VMAT with continuous and partial arcs are within limit and PTV coverage was also satisfactory. The contralateral lung doses were also within limit. For more precise treatment and low doses of heart and contra lateral lung VMAT technique can be preferred for carcinoma left breast treatment

Comprehensive survey on nanobiomaterials for bone tissue engineering applications

One of the most important ideas ever produced by the application of materials science to the medical field is the notion of biomaterials. The nanostructured biomaterials play a crucial role in the development of new treatment strategies including not only the replacement of tissues and organs, but also repair and regeneration. They are designed to interact with damaged or injured tissues to induce regeneration, or as a forest for the production of laboratory tissues, so they must be micro-environmentally sensitive. The existing materials have many limitations, including impaired cell attachment, proliferation, and toxicity. Nanotechnology may open new avenues to bone tissue engineering by forming new assemblies similar in size and shape to the existing hierarchical bone structure. Organic and inorganic nanobiomaterials are increasingly used for bone tissue engineering applications because they may allow to overcome some of the current restrictions entailed by bone regeneration methods. This review covers the applications of different organic and inorganic nanobiomaterials in the field of hard tissue engineering

Cost‑Effectiveness of TrueNat as Compared to GeneXpert as a Diagnostic Tool for Diagnosis of Pediatric Tuberculosis/MDR Tuberculosis under the National Tuberculosis Elimination Program of India

Background: According to a study on global burden of tuberculosis (TB), India witnessed 60,000 pediatric deaths in the year 2015. In India, most of the children do not get diagnosed with tuberculosis for various reasons. Aims and Objectives: This study will evaluate the cost‑effectiveness of TrueNat and GeneXpert diagnostic strategies used for tuberculosis detection in children, thus aiding policymakers for taking evidence‑based decisions. Materials and Methods: For this cost‑effectiveness study, a systematic review was done to extract the evidence for estimates of effectiveness of current TB diagnostic tools. Evidence pertinent to cost per test including all direct, indirect costs and health benefits in terms of quality‑adjusted life years were researched and documented. Full economic evaluations available in the literature were also explored. Results: The results of the study showed that TrueNat is more cost‑effective when compared to GeneXpert in the diagnosis of pediatric tuberculosis cases leading to more life years gained and deaths averted. 13,260 additional cases can be detected with TrueNat with an incremental cost of $14.36 per additional case detected. The incremental cost‑effectiveness ratio per life year gained was found to be 20.01.Conclusion: TrueNat proved to be beneficial and cost‑effective as compared to GeneXpert MTB being used in case of children. We recommend the use of TrueNat diagnostic test in India as it is in congruence with Indian health‑care settings

Assessment of quality of life in resectable gastric cancer patients undergoing chemoradiotherapy as adjuvant treatmentLetter to the Editor

Introduction: Quality of life (QOL) is increasingly recognized as an important endpoint in cancer therapies. However, few data are available on QOL in patients who have received radiotherapy as adjuvant treatment for cancer stomach. Methods: Thirty patients who underwent curative resection were enrolled and received chemoradiotherapy (45 Gy in 25 fractions using three-dimensional conformal radiotherapy technique), together with 5-fluorouracil and leucovorin. The European Organization for Research and Treatment of Cancer QOL questionnaire C30 and STO Q22 was assessed at four time points: pre- and postchemoradiotherapy and at 1-month and 6-month follow-up. Results: Mean age of the patients was 54 years. Male:female ratio was 4:1. Stage II and Stage III disease was present in 60% and 30% of patients, respectively. All patients were able to complete the chemoradiotherapy protocol. Our study found out significant impairment in QOL for emotional functioning, fatigue, nausea and vomiting and dyspnea. Results showed that QOL levels decrease postchemoradiotherapy; however, QOL levels returned to baseline at 1-month and 6-month follow-up period. Conclusion: Chemoradiotherapy as adjuvant treatment for cancer stomach patients who have undergone resection with curative intent is a safe and well-tolerated regimen with respect to QOL

Prognostic Factors in Elderly Patients with High-grade Gliomas: A Retrospective Analysis of 24 Cases

Background and Objectives: Due to the aging of the population, diagnosis of high-grade gliomas (HGGs) in the elderly is becoming more common. The purpose of this study was to report our experience in 24 elderly patients with HGGs and evaluate the value of different prognostic factors. Design and Setting: Retrospective analysis of 24 elderly patients of ≥60 years with newly diagnosed HGGs, who were treated at our department between January 2009 and December 2012, was done. Patients and Methods: Age, gender, Karnofsky performance scale (KPS) score, extent of surgery, and use of temozolomide were evaluated using univariate and multivariate analyses. Survival was determined using the Kaplan–Meier method, and differences were compared using the log-rank test. Cox regression analysis was conducted to identify the independent prognostic factors. Results: The median overall survival of the patient cohort was 10 months. The 1- and 2-year survival rates were 45.8% and 16.6%, respectively. The analysis revealed that KPS score and use of concomitant chemotherapy were significant prognostic factors. Conclusion: The results of our analyses demonstrate that KPS score and use of concomitant chemotherapy yield encouraging outcomes in elderly patients with HGGs, validating the results published in research papers