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   2008| January-March  | Volume 4 | Issue 1  
    Online since March 25, 2008

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The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: A randomized control trial
PD Madan Kumar, PS Sequeira, Kamalaksha Shenoy, Jayaram Shetty
January-March 2008, 4(1):3-8
DOI:10.4103/0973-1482.39597  PMID:18417894
Aims: The present study was done to assess the effect of three alcohol-free mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies. Materials and Methods: Eighty patients with head and neck malignancies, scheduled to undergo curative radiotherapy, were randomly assigned to receive one of the three alcohol-free test mouthwashes (0.12% chlorhexidine, 1% povidone-iodine, or salt/soda) or a control. The patients were instructed to rinse with 10 ml of the mouthwash, twice a day, for a period of 6 weeks. Mucositis was assessed at baseline and at weekly intervals during radiation therapy, using the World Health Organization criteria for grading of mucositis. The baseline demography of the four groups was matched for age, sex, stage of cancer, and whether the patient had cancer of oral or extraoral regions. A post hoc test for repeated measures was used to find the difference of mean mucositis scores between the groups at various week intervals. Results: Among the 76 patients who completed the study, patients in the povidone-iodine group had significantly lower mucositis scores when compared to the control group from the first week of radiotherapy. Their scores were also significantly lower when compared to the salt/soda and chlorhexidine groups from the fourth and fifth week, respectively, after radiotherapy. Conclusions: This study demonstrates that use of alcohol-free povidone-iodine mouthwash can reduce the severity and delay the onset of oral mucositis due to antineoplastic radiotherapy.
  25,242 2,516 22
An overview on applications of optical spectroscopy in cervical cancers
Murali Krishna Chilakapati, GD Sockalingum, MS Vidyasagar, M Manfait, Donald J Fernanades, BM Vadhiraja, K Maheedhar
January-March 2008, 4(1):26-36
DOI:10.4103/0973-1482.39602  PMID:18417899
Despite advances in the treatment modalities, cervical cancers are one of the leading causes of cancer death among women. Pap smear and colposcopy are the existing screening methods and histopathology is the gold standard for diagnosis. However, these methods have been shown to be prone to reporting errors, which could be due to their subjective interpretation. Radiotherapy is the mainstay of treatment for the locally advanced stages of cervical cancers. The typical treatment regimen spans over 4 months, from the first fraction of radiation to clinical assessment of tumor response to radiotherapy. It is often noticed that due to intrinsic properties of tumors, patients with the same clinical stage and histological type respond differently to radiotherapy. Hence, there exists a need for the development of new methods for early diagnosis as well as for early prediction of tumor radioresponse. Optical spectroscopic methods have been shown to be potential alternatives for use in cancer diagnosis. In this review, we provide a brief background on the anatomy and histology of the uterine cervix and the etiology of cervical cancers; we briefly discuss the optical spectroscopic approach to cervical cancer diagnosis. A very brief discussion on radiation therapy and radiation resistance is also provided. We also share our experiences with the Raman spectroscopic methodologies in cervical cancer diagnosis as well as in the prediction of tumor radioresponse.
  12,457 1,048 18
Sarcomatoid squamous cell carcinoma of uterine cervix: Pathology, imaging, and treatment
Milind Kumar, Amit Bahl, Daya Nand Sharma, Shipra Agarwal, Dhanapathi Halanaik, Rakesh Kumar, Goura Kishore Rath
January-March 2008, 4(1):39-41
DOI:10.4103/0973-1482.39604  PMID:18417901
Sarcomatoid squamous cell carcinoma of the cervix is a rare tumor. Only 16 cases have so far been reported in literature. We report here one such tumor occurring in a 54-year-old postmenopausal woman. Our case report describes the clinical, pathological, and PET scan characteristics of this tumor. The patient was treated with concurrent chemoradiotherapy and is disease free at 6-months follow-up.
  12,117 580 5
Implications of contrast-enhanced CT-based and MRI-based target volume delineations in radiotherapy treatment planning for brain tumors
Niloy R Datta, Rajasekar David, Rakesh K Gupta, Punita Lal
January-March 2008, 4(1):9-13
DOI:10.4103/0973-1482.39598  PMID:18417895
Delineation of various target volumes using contrast-enhanced magnetic resonance imaging (MRI) and/or computed tomography (CT) constitutes the primary step for radiation therapy planning (RTP) in brain tumors. This study presents a quantification and comparative evaluation of the various clinical target volumes (CTV) and gross target volumes (GTV) as outlined by contrast-enhanced CT and MRI, along with its implications for postoperative radiotherapy of brain tumors. Twenty-one patients of gliomas were considered for this prospective study. Peritumoral edema as CTV and residual tumor as GTV were delineated separately in postoperative contrast-enhanced CT and MRI. These volumes were estimated separately and their congruence studied for contrast-enhanced CT and MRI. Compared to MRI, CT underestimated the volumes, with significant differences seen in the mean CTV (mean ± SD: −62.92 ± 93.99 cc; P = 0.006) and GTV (mean ± SD: −21.08 ± 36.04 cc; P = 0.014). These differences were found to be significant for high-grade gliomas (CTV: P = 0.045; GTV: P = 0.044), while they were statistically insignificant for low-grade gliomas (CTV: P = 0.080; GTV: P = 0.117). The mean differences in the volumes for CTV and GTV were estimated to be −106.7% and −62.6%, respectively, taking the CT volumes as the baseline. Thus, even though, electron density information from CT is essential for RTP, target delineation during postoperative radiotherapy of brain tumors, especially for high-grade tumors, should be based on MRI so as to avoid inadvertent geographical misses, especially in the regions of peritumoral edema.
  9,150 720 7
Radiofrequency ablation of hepatic metastasis: Results of treatment in forty patients
GK Rath, PK Julka, S Thulkar, DN Sharma, Amit Bahl, S Bhatnagar
January-March 2008, 4(1):14-17
DOI:10.4103/0973-1482.39599  PMID:18417896
Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm). A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%). One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size.
  8,390 572 12
Prognostic and diagnostic value of serum pseudocholinesterase, serum aspartate transaminase, and serum alinine transaminase in malignancies treated by radiotherapy
Arun Chougule, Sofia Hussain, Dwaraka Prasad Agarwal
January-March 2008, 4(1):21-25
DOI:10.4103/0973-1482.39601  PMID:18417898
Background: There is substantial evidence that environmental factors cause or accelerate the onset of malignancy. Environmental factors, due to the presence of many pollutants and carcinogenic agents, alter cellular growth, which leads to biochemical changes in the blood. Materials and Methods: In the present study, we estimated serum pseudocholinesterase (PCHE), serum aspartate transaminase (AST), and serum alanine transaminase (ALT) in 92 patients with head and neck cancer and 71 patients with cancer of the uterine cervix; all of them were patients attending our department for radiation therapy. We also estimated PCHE, AST, and ALT levels in 30 healthy normal individuals. The estimations in cancer patients were done before the start of radiotherapy, midway through radiotherapy (30 Gy dose), at the end of radiotherapy, and during subsequent monthly follow-up visits over a period of at least 6 months. Results and d0 iscussion: We have observed that the PCHE levels were lower (31-49% of normal value) in all patients with malignancies, except in those with stage II head and neck cancers. We also found that the levels start increasing as radiotherapy progresses. The patients with no detectable/visible disease activity at 6 months follow-up showed PCHE values in the normal range. Similarly, the AST and ALT values were much higher (138-229% of normal value) in all the malignant cases as compared to the normal healthy individuals. The values decrease and approach normal levels as radiotherapy progresses and, in 92% of head and neck cancer cases [stages IIA, IIB, and IIIA] with no disease activity, the PCHE, AST, and ALT were normal or near normal; the corresponding figure in cancer cervix cases was 89%. From the present study we conclude that PCHE, AST, and ALT can be used as good prognostic biochemical tumor markers in the management of malignancies of the head and neck and uterine cervix.
  8,332 498 16
Criteria for deciding cost-effectiveness for expensive new anti-cancer agents
Rajiv Sarin
January-March 2008, 4(1):1-2
DOI:10.4103/0973-1482.39685  PMID:18417893
  7,295 758 22
Execution of mantle field with multileaf collimator: A simple approach
Ramachandran Prabhakar, Kunhi Parambath P Haresh, Pappiah S Sridhar, Macharla A Laviraj, Pramod K Julka, Goura K Rath
January-March 2008, 4(1):18-20
DOI:10.4103/0973-1482.39600  PMID:18417897
Background: Until very recently mantle field radiotherapy remained the gold standard for the treatment of favorable early-stage Hodgkin's lymphoma. The classic mantle includes all the major lymph nodes above the diaphragm and extends from the inferior portion of the mandible to the level of the insertion of the diaphragm. Aims: To describe a simple technique that has been devised to treat the mantle field with the help of multileaf collimator and using computed tomography (CT)-based treatment planning. Materials and Methods: CT scan was performed with the patient in the supine position and the datasets were transferred to the Eclipse™ treatment planning system. Elekta Precise™ linear accelerator equipped with 40 pairs of multileaf collimator (MLC) was used for the execution of the mantle field. The MLC's shapes were designed to take the shape of the conventional customized blocks used for treatment of mantle field. The anterior mantle field was divided into three separate MLC segments with the collimator kept at 0°. The first MLC segment was shaped to cover the neck, clavicular regions, and mediastinum. The second and the third MLC segments covered the right and left axilla, respectively. The posterior fields were opposed to the anterior subfields in a similar fashion. The dose was prescribed at the midplane, using reference points. Results and Conclusion: The technique described in this study is very simple, easy to implement, and avoids unnecessary delay in the execution of the mantle field. The mantle field can be easily shaped with the multileaf collimators, without any collimator rotation.
  6,971 434 5
Coexistence of carcinoma breast and Paget's disease of bone
S Sundaraiya, PK Pradhan, A Gupta, M Jain, SK Mishra, BK Das
January-March 2008, 4(1):48-49
DOI:10.4103/0973-1482.39608  PMID:18417905
We report a case of a patient with carcinoma breast who was incidentally diagnosed to be also suffering from Paget's disease of bone on a routine radionuclide bone scan. CT-guided biopsy and histopathology later confirmed the diagnosis.
  6,875 337 3
Accelerated partial breast irradiation: An advanced form of hypofractionation
Ashwini Budrukkar
January-March 2008, 4(1):46-47
DOI:10.4103/0973-1482.39607  PMID:18417904
Altered fractionation schedules are being increasingly investigated in the treatment of breast cancer. Two such schedules that are frequently compared are hypofractionated external beam radiation therapy (HERT) and accelerated partial breast irradiation (APBI). Though these two modalities are considered separately, APBI is an actually an advanced form of hypofractionation, where acceleration of the treatment is possible due to the smaller volume being irradiated. HERT as well as APBI are investigational at present and are being tested in randomized trials. This article looks at the advantages of APBI as a hypofractionation schedule.
  6,053 546 2
Endobronchial metastasis of follicular thyroid carcinoma presenting as hemoptysis: A case report
RAS Kushwaha, Sanjay Kumar Verma, Sanjay Vineet Mahajan
January-March 2008, 4(1):44-45
DOI:10.4103/0973-1482.39606  PMID:18417903
Endobronchial metastasis secondary to follicular thyroid carcinoma is extremely rare. Here, we report a case of follicular thyroid cancer in 58-year-old male who presented with hemoptysis. Computed tomography of the chest revealed multiple lung metastases. Flexible fiberoptic bronchoscopy revealed a fragile polypoid mass 5 cm distal to the vocal cords; biopsy taken from this mass revealed follicular thyroid carcinoma.
  5,352 378 1
Chest wall metastasis from hepatocellular carcinoma in the absence of a primary: An unusual presentation
Kaustav Talapatra, Reena Engineer, Jai Prakash Agarwal, Shilpa Vyas, Shyam Kishore Shrivastava
January-March 2008, 4(1):42-43
DOI:10.4103/0973-1482.39605  PMID:18417902
Metastatic hepatocellular carcinoma (HCC) has an aggressive course with a very poor outcome. The common hematogenous metastatic sites are the lungs, bones, and adrenal glands. The chest wall is an extremely rare site of metastasis from HCC. We report a rare presentation in a gentleman, where the chest wall metastasis kept progressing in spite of treatment, without any evidence of a detectable primary.
  5,307 344 3
Dysplastic hematopoiesis and underlying dysthyroidism
Riad Akoum, Michel Saade, Wafic Tabbara, Emile Brihi, Marwan Masri, Khaled Habib, Gerard Abadjian
January-March 2008, 4(1):50-50
DOI:10.4103/0973-1482.39609  PMID:18417906
  5,387 241 -
Radiotherapy for management of skin cancers in fibrodysplasia ossificans progressiva: A case report and review of the literature
John Antony Frew, Charles G Kelly
January-March 2008, 4(1):37-38
DOI:10.4103/0973-1482.39603  PMID:18417900
Fibrodysplasia ossificans progressiva (FOP) is a rare condition of ectopic calcification leading to increasing disability throughout life, with most patients being wheelchair bound by the age of 30. Ectopic calcification can be triggered by trauma and it is therefore important to minimize biopsies and operative procedures in affected individuals. We report a 46-year-old FOP patient who was successfully treated with radiotherapy for a basal cell carcinoma. There are no previous reports in the literature on the management of skin malignancies in these patients and very limited literature on outcome following external beam radiotherapy.
  4,738 352 1