Abstract-Cisplatin is a very effective chemotherapeutic, but the risk of nephrotoxicity frequently hinders the use of its higher dose. This study was designed as a prospective observational cohort study to evaluate the efficacy of urinary renal tubular enzyme α-Glutathione-s-transferase(α-GST) for predicting kidney injury in cisplatin treated cancer patients. Venous blood samples were collected from all the patients, before the administration of cisplatin (baseline), and at 12h, 24h, 48h and 20days after cisplatin infusion and a random urine sample was collected before and at 2h , 6h, 12h, 24h and 48h after cisplatin administration. Serum creatinine was estimated by Jaffe's method using commercial reagent kit and α -GST was estimated in all the urine samples by colorimetric kinetic assay using NBD-Cl. There was a 20.5% incidence of acute kidney injury after cisplatin administration based on AKIN criteria. The mean urinary α-Glutathione S Transferase levels at different time intervals show a clear temporal rise, especially from 2hrs after cisplatin administration, till 12hrs and at a slower rate thereafter. The AUC of >0.8 for α-GST in all the timed urine samples after cisplatin administration indicated its good performance in predicting kidney injury. Urinary levels of proximal tubular enzyme, α-GST is found to be useful in predicting early kidney injury induced by cisplatin.
Background : Spleen being in close proximity to radiation field in patients of gastric and gastroesophageal carcinomas treated with radiotherapy will inadvertently receive a part of the dose. The purpose of this study was to determine the impact of radiation dose and fractional volume of irradiated spleen in the setting of chemoradiation therapy for gastric and gastroesophageal junctional cancers on haematologic toxicity. Materials and Methods: 40 patients with gastric and gastroesophageal junctional cancers who received concurrent chemoradiation were retrospectively analysed in the Department of Radiation oncology, Father Muller Medical College. Splenic dose-volume histogram (DVH) parameters were calculated as mean splenic dose (MSD) and percentage of splenic volume receiving 10 Gy (V10), 20 Gy (V20), 30 Gy (V30) and 40 Gy (V40) dose and correlated with clinical blood parameters.Mean, percentage, standard deviation and Student paired t-test were used to analyse the results. Results: All the patients experienced haematological toxicities, including 7 patients with grade 3 leukopenia and 3 had grade 4 leukopenia, 19 with grade 2 thrombocytopenia and 4 had grade 3 thrombocytopenia, 28 with both leukopenia and lymphopenia. Mean dose to the spleen was 32 Gy (range 27-37). Higher spleen V10-V40 was correlated with leukopenia, lymphopenia and thrombocytopenia. Conclusion: This dosimetric study demonstrates that splenic radiation was correlated with haematological toxicities, however role of chemotherapy as cause for toxicity could not be assessed as separate variable in this study. Future clinical correlational studies are needed to significantly determine the splenic dose contraints. Key Messages: Radiation therapy for gastric and gastroesophageal carcinoma leads to significant dose to spleen causing an impact in acute haematological toxicities.
Background: Interfraction variations occur due to tumour regression during cervical intarcavitary brachytherapy (ICR) requiring replanning with every fraction. This study aimed to determine the correlation of interfraction variations in positioning of applicator and its relationship with relative dosimetry if the dwell time and source positions of the plan of first fraction were applied to other subsequent fractions. Materials and Methods: This is a retrospective review of the orthogonal radiographs of cervical cancer patients treated from 2013 to 2016 in our institute, receiving ICR with the same dose prescription to point A using a tandem and two ovoids applicators. A hypothetical second and third plan were obtained by applying the same source positions and dwell time as in the first fraction plan. The dose delivered to point A, point B, cervical point, bladder point and rectal point were determined. The actual doses in the treated second and third fractions were compared with these hypothetical plans for any significant change in relative dosimetry. Statistical differences between groups were analysed using 2 tailed paired t test.Results: There was consistant increase in the doses to the point B, bladder point and rectal point in all the hypothetical plans with statistically significant difference observed for point B (p=0.001), rectal point (p=0.000) and bladder point(p=0.041). Conclusion:The conception of avoiding the replanning if similar interfraction conditions are achieved looks promising but the significant findings observed in this study warrants strongly to continue as per current recommendation of replanning with every fraction of brachytherapy.
Introduction Bone metastasis is a common manifestation of malignancy. Bone metastases causes various morbidities and affect the quality of life. External beam radiotherapy is the mainstay of treatment of uncomplicated painful bone metastases. Different radiotherapy fractionation schedules are in practice for palliation of painful bone metastases. Objectives This study was aimed to compare and report the outcomes of various fractionation schedules of radiation therapy (RT) in terms of pain relief and quality of life in patients with painful bone metastases. Materials and Methods Eighty patients were randomized into four treatment arms with different RT fractionation schedules, namely, 8 Gy in 1 fraction, 20 Gy in 5 fractions, 24 Gy in 6 fractions, and 30 Gy in 10 fractions. Patients were assessed for pain by visual analog scale (VAS), performance status and quality of life before initiating the treatment, on the day of completion of treatment, and 1 week, 1 month, and 3 months of treatment completion. Results Majority of the metastases constituted from breast followed by lung cancer. Of these, 27.5% had metastases to the thoracic vertebra, 26.25% to the lumbar vertebra, 22.5% to the pelvis, 8.75% to the sternum, 6.25% each to cervical vertebra and femur, and 1.25% each to humerus and ribs. The mean VAS score prior to start of RT was 5.31, 5.21, 5.54, and 4.87 in arms A, B, C, and D, respectively. At the end of treatment, the scores were 3.0, 3.29, 2.77, and 2.47, respectively. At the end of 3 months, the scores were 1.54, 0.57, 0.54, and 0.60, respectively. The pain reduction was significant in all the four arms (p < 0.05). Also, 25% of the patients’ arm A had complete pain relief, whereas 45% of patients in arms B, C, and D had complete pain relief. In arm A, the performance status failed to improve at 3 months when compared with 1-week post-RT but the improvement was significant in the remaining three arms. There was improvement in the quality of life in all the arms, both in terms of function and symptoms. The mean score of symptomatic quality of life based on the EORTC BM22 module prior to start of RT was 38.14, 34.91, 28.85, and 29.17 in arms A, B, C, and D, respectively. There was a significant drop to 9.29, 6.55, 5.13, and 6.11 at 1-month posttreatment in the four arms, respectively. The outcomes in terms of functional quality of life showed a similar trend. Conclusion This study demonstrated that pain reduction by various RT fractionation schedules were similar, and no statistically significant difference was noted. Performance status and quality of life improved in all the four treatment arms post-RT.
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