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   Table of Contents - Current issue
July-September 2019
Volume 10 | Issue 3
Page Nos. 129-151

Online since Friday, January 17, 2020

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Palliative hypofractionated radiotherapy in advanced non- small cell lung cancer: A single-institute prospective study p. 129
Rajan Yadav, Aastha Shah
Background: A Single Institute Prospective Study was carried out in 75 patients of Advanced Non Small Cell Lung Cancer using three different arms using standard regime and the hypofractionated radiotherapy regime. Methods and Materials: Between July 2010 and September 2011, 75 patients with biopsy proven NSCLC were treated with schemes 1(17 Gy in 2 fractions over 2 weeks; 25 patients), 2 (30 Gy in 10 fractions over two weeks; 25 patients), or 3 (39 Gy per 13 fractions over three weeks; 25 patients). There were 66 evaluable patients. 2 of them died during the study(treatment phase) and 6 were lost to follow up. The minimum follow-up time was 24 months. Results: There was no overall survival difference in all the three arms(p_ .2). The median survival was 6.2 months(arm A:8.5 Gy in 2 fractions one week apart) 6.7 months(arm B:30 Gy in 10 fractions) and 6.8 months(arm C:39 Gy in 13 fractions). Conclusion: Hypofractionated Palliative radiotherapy regime using 17 Gray in two fractions is as effective in alleviation of symptoms as is the standard regime of 30 Gray in 10 fractions and 39 Gray in 13 fraction with no statistical difference in overall survival.
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A prospective study comparing hemoglobin levels and response in patients of locally advanced carcinoma cervix receiving accelerated chemoradiation versus conventional chemoradiation p. 135
Poorva Vias, Harpreet Angural, Rajeev Kumar Seam, Manoj Kumar Gupta, Manish Gupta, Vikas Fotedar, Anup Negi
Introduction: Carcinoma cervix still forms a major burden in India; also, anemia is seen commonly in Indian females. Hemoglobin (Hb) level is one of the prognostic factors in carcinoma cervix. The association of Hb levels with response is not well established. However, Hb levels >11 g% have shown good response in a number of studies. Materials and Methods: This study enrolled patients with carcinoma cervix, <70 years old with Stage IIA to IVA, histologically squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. Accelerated concurrent chemoradiotherapy 50 Gy in 25# 6 days a week with weekly cisplatin was given in the study arm. In the control arm, conventional chemoradiation was given, 50 Gy in 25# five fractions per week with weekly cisplatin. Response was compared in both the arms based on Hb levels. Both the arms had 45 patients. Results: Combining patients of both the arms, 66% of patients with Hb <11 had complete response (CR) and 81% of patients with Hb >11 had CR which was not significant, but a trend of better response was seen toward patients with higher levels of Hb. However, no significant difference was seen in both the arms. Conclusion: Hb levels remain a prognostic factor for carcinoma cervix, but the levels of Hb are still debatable. More prospective studies are needed to assess the effect of Hb. Furthermore, use of erythropoietin and blood transfusions needs to be studied in prognosis of carcinoma cervix.
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Changes in magnetic resonance imaging parameters and chemo-radiotherapy response among cervical cancer patients attending a regional cancer center of North India p. 141
Divya Gupta, Rajiv Kumar Seam, Manoj Gupta, Sanjeev Sharma, Mitasha Singh, Shikha Sood
Objective: This study was planned to evaluate the effectiveness of dynamic contrast-enhanced magnetic resonance and diffusion-weighted imaging techniques in evaluating tissue hypoxia and thus develop an early predictor of treatment response in cervical cancer. Materials and Methods: This prospective study was conducted at a regional cancer center of North India from 2013 to 2014. It was conducted among locally advanced carcinoma cervix patients. Magnetic resonance imaging (MRI) was carried out at three time points, namely, prior to commencement of, after 2 weeks of start, and after 4–5 weeks of chemo-radiotherapy. A total of 48 MRI scans were performed. Change in dynamic contrast perfusion parameters (Ktrans, Kep, Ve, and IAUC) and values of apparent diffusion coefficient (ADC) between different time points was calculated. Results: A total of 19 patients underwent 48 MRI scans. The percentage tumor volume regression (PTR) between the first and third MRI volumes ranged from 36.9% to 100%. The percentage diameter regression calculated between the first and third MRI ranged from 10% to 100%. The tumor volume and diameter reduced significantly from pre- to post-treatment. As compared to pretreatment parameters, it was observed that the values of Ve, IAUC, and ADC demonstrated an increase from baseline to the subsequent MRI; however, Kepand Ktransshowed an opposite trend. Conclusion: A higher value of Ktransis associated with a better tumor response to treatment. These changes can help in predicting response to therapy.
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Reirradiation in head-and-neck cancers in resource-constraint centers p. 147
Shabnum Thakur, Aman Sharma, Manish Gupta
The local recurrence in head-and-neck cancers (HNCs) is the preeminent pattern of presentation in treatment failure. Reirradiation is a useful modality to treat inoperable HNC patients with recurrent disease. Surgery may be persuasive in some patients, but this is often not feasible in all because of the location or extent of lesions. Nasopharynx and oropharynx have the locations which are inaccessible for surgery. It is presumed that because of the high risk of complications, reirradiation should be avoided. However, reirradiation in HNCs can be an option in patients with recurrence/second primary with longer duration and in resource-constraint centers. We report an interesting case of reirradiation in HNC treated with the conventional technique.
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Linear no-threshold and radiation hormesis p. 150
Badri N Pandey
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