A quasi-experimental study was conducted at Radiation Oncology Department of National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh, between November 2020 and October 2021, to determine the efficacy of cryotherapy in comparison to standard oral care to prevent oral mucositis in head and neck cancer patients during receiving CCRT. A total 100 Patients (50 patients in each arm) were included in this study according to inclusion and exclusion criteria by purposive sampling technique. All patients in Arm A and Arm B received total 66 Gray in 33 daily fractions, 1 fraction per day, 5 fractions per week and inj. Cisplatin 40mg/m² was given intravenously 2/3 hours before radiotherapy on 1st day and then weekly. Arm A received cryotherapy and Arm B received standard oral care. Intervention started from the 1st day of CCRT up to the end of CCRT. WHO oral mucositis grading and visual analogue scale (VAS) were employed to determine the effects. All the information was recorded in a pre-tested semi-structured questionnaire. Total 100 patients (50 patients in each arm) were enrolled. Mean age of the patients of Arm A and Arm B was 55.28±7.82 and 55.92±8.33 respectively. Male and female ratio was 6.14:1 in two Arms. Other demographic profile, baseline characteristics were statistically not significant in both arms (P>0.05). The grade-3 mucositis appeared after 5th week in Arm B and after 6th week in Arm A. The incidence of grade- 3 mucositis after 5th week during CCRT to 4 weeks after completion of therapy was 6% vs 0%, 14% vs 6%, 22% vs 10%, 14% vs 6%, 8% vs 2%, respectively for arm B and Arm A (P<0.05). Total number of patients suffering from grade 3 mucositis was 6 (12%) and 12 (24%) for Arm A and Arm B respectively (p value was <0.05). The mean duration of grade-3 or more mucositis between Arm A and Arm B was 2.04±1.78 and 10±1.72 days respectively (P<0.05). The difference of median pain intensity between two arms was not statistically significant for 1st and 2nd week (P>0.05). However, it was significant after 3rd week during CCRT to 4 weeks after completion of CCRT (P<0.05). Cryotherapy during CCRT may be beneficial to prevent oral mucositis and pain than maintaining standard oral care. CBMJ 2023 January: vol. 12 no. 01 P: 03-11
A cross-sectional, descriptive study was conducted to see the pattern of clinicopathological features of head and neck cancer patients in a tertiary level hospital. The study was conducted between January and April of 2017 in National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh. Data was collected from a total number of 69 histopathologically and clinically confirmed patients. A male predominance (2.14:1) was noted except for oral cavity cancer (1:1). Mean age for males and females were (56.15±11.47) years and (54.50±7.16) years respectively. Positive history of associated factors like smoking (60.34%), betel nut and betel leaf (81.36%), smokeless tobacco (56.90%) was prevalent among majority of the participants except for alcohol (6.90%). Smoking was prevalent only among males. Knowledge regarding the role of associated factors was very poor, e.g., smoking (10.61%), betel nut & leaf (7.58%), smokeless tobacco (6.06%), alcohol (7.58%) for causing cancer. 10.71% patients gave positive family history of cancer (1st degree relative). 27.59% patients gave history of treatment by homeopathy/traditional healers. The most common sites of cancer in males were larynx (27.3%) followed by oral cavity (20.5%). In case of female patients, most common sites were oral cavity (40.9%) followed by larynx (22.7%). Most common histopathological type was squamous cell carcinoma (91.94%). Lymph node metastasis were present in 47.62% patients, whereas only 1.56% patients had distant metastasis and 3.13% had recurrent/residual disease. 18.64% patients gave history of definitive surgery. To conclude, most of the patients usually reported with advanced stages of cancer; however, preventable factors were found among all of them. Unfortunately, they had very poor knowledge about those preventable factors which warrants an immediate and elaborate public health program to fill up this vast gap of knowledge. Prevention and early diagnosis should be main arsenal to combat head and neck cancer. CBMJ 2022 July: vol. 11 no. 02 P: 108-113
A quasi-experimental study was conducted to compare palliative radiotherapy between 20 Gy in 5 fractions and 30 Gy in 10 fractions in superior vena cava syndrome due to carcinoma of lung. This study was done in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, from September 2017 to August 2018. A total of 60 patients were enrolled in the study – 30 in each group. In Arm A, patients received 20 Gy in 5 fractions in 1 week, while in Arm B, patients received 30 Gy in 10 fractions in 2 weeks. Every patient was evaluated routinely to see the treatment outcome and toxicities. The mean age of Arm-A was 57.53±5.5 years and that of Arm-B was 57.40±5.4 years. After treatment, improvement of symptoms (e.g., edema, venous distension, dyspnea) of SVCS was observed. After 1 month of radiotherapy, complete resolution of venous distension occurred in majority of the patients (73.3% vs. 80%) and partial resolution occurred in rest of them (26.7% vs. 20%) in arms A and B respectively. Most of patients showed complete resolution of edema (83.3% vs. 86.7%), while few had partial resolution (16.7% vs. 13.3%) in arms A and B respectively. Symptoms of SVCS did not recur in any of the patients of both arms. Performance status also improved in all patients. Assessment of tumor response at the last follow-up showed partial response in 66.7% patients of Arm-A and 73.3% patients of Arm-B. Stable disease was observed in 33.3% patients of Arm-A and 26.7% patients of Arm-B. None of the patients showed disease progression. Toxicities included dysphagia (26.7% vs. 33.33%), fatigue (23.33% vs. 20%), nausea and vomiting (16.67% vs. 20%) and skin reaction (16.67% vs. 13.33%) in Arm-A and Arm-B respectively. All of those toxicities were grade-1 and easily controlled. There was no statistically significant difference between two treatment groups in terms of palliation of symptoms of SVCS, tumor response and toxicities. To summarize, although tumor response was not much satisfactory, both 20 Gy in 5 fractions and 30 Gy in 10 fractions are equally effective radiotherapy regimens in palliation of symptoms of SVCS due to lung cancer with tolerable toxicities. Hence, 20 Gy in 5 fractions can be a reasonable treatment choice in a resource-poor country like Bangladesh. CBMJ 2023 January: Vol. 12 No. 01 P: 33-40
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