Background: Lung cancer is one of the leading causes of cancer related morbidity and mortality among both the sexes. It accounts for 13% of all new cancer cases and 19% of cancer related deaths worldwide. In India, lung cancer constitutes 6.9% of all new cancer cases and 9.3% of all cancer related deaths in both sexes. Majority of them present in advanced disease. Aim: This study aims to identify the contributing factors for delays in lung cancer diagnosis and treatment. Methods: This is a retrospective cross-sectional observational study which was conducted at Department of Oncology, Mysore Medical College and Research Institute, India. Records of the all histologically confirmed lung cancer patients from the year 2011 to 2016 were reviewed. Results: A total of 133 patients were identified with lung cancer and their records were evaluated. Out of these 133 patients, 60% of the cases were males. The median age was 63 years with the youngest being 37 and the eldest was 83 years. Majority of patients were in stage III (59%) and IV (36%). About 89% of the patients were smokers. Non–small cell lung cancer accounted 83% (squamous cell 66.5%, adenocarcinoma 30.5%, large cell 1.5% and neuroendocrine 1.5%) and small cell lung cancer was 17%. A total of 17% (26) of patient were on empirical antitubercular treatment (ATT) since the onset of current symptoms. While analyzing delay with independent T test showed mean delay of 25.01 days (± SD 6.17) in patient without ATT and with ATT delay was 57.09 days (± SD 8.05) ( P ≤ 0.01). Thirty five percentage (46) of patient received treatment within 1 month from the first hospital visit, 28% (37) within two months and 37% (50) within 3-4 months of the first hospital visit. The delay to hospital visit was shorter in advanced cancer and small cell cancer maybe because of the acute presenting symptoms. Conclusion: Various factors contributing for the delays are lag time from symptom onset to first visit with primary physician, delay due to investigation and symptomatic treatment under primary physician care, delay further aggravated by empirical but inappropriate ATT, further delay due to diagnostic procedure to establish the cancer diagnosis. Thus proper and timely referral to the specialist from primary physician will reduce these delays and help to avoid situation where curable disease become incurable and significantly alters the prognosis.
INTRODUCTIONRadiotherapy is the standard treatment in locally advanced (IIB-IVA) and early inoperable cases. The current standard of practice with curable intent is concurrent chemoradiation in which intracavitary brachytherapy is an integral component of radiotherapy. This study aims at assessing the efficacy of HDR ICBT (High-dose rate intracavitary brachytherapy) in terms local response, normal tissue reactions, and feasibility. METHODS AND MATERIALSA total of 20 patients of stage IIIB cancer of the uterine cervix were enrolled in the study and were planned to receive concurrent chemotherapy weekly along with EBRT (external beam radiotherapy) to a dose of 50 Gy/25 Fr. Suitability for ICBT was assessed at 40 Gy/20 Fr. 6/20 patients were suitable at 40 Gy and received HDR ICBT with a dose of 5.5 Gy to point A in 4 sessions (5.5 Gy/4 Fr). The remaining 14/20 patients completed 50 Gy and received HDR ICBT with a dose of 6 Gy to point A in 3 sessions (6 Gy/3 Fr). RESULTSA total of 66 intracavitary applications were done and only one application required dose modification due to high bladder dose, the pelvic control rate was 85% (17/20). 10% (2/20) had stable disease and 5% (1/20) had progressive disease at one year of follow up. When toxicity was considered only 15% developed grade I and grade II rectal complications. Patient compliance and acceptability was 100%. Patients were very comfortable with the short treatment time as compared with patients on LDR ICBT (low-dose rate intracavitary brachytherapy) treatment interviewed during the same period. CONCLUSIONThis study proves that HDR brachytherapy is efficacious and feasible in carcinoma of cervix stage IIIB. It also proves that good dose distribution can be achieved with HDR intracavitary facility by the use of dose optimization. The short treatment time in HDR ICBT makes it possible to maintain this optimised dose distribution throughout the treatment providing a gain in the therapeutic ratio and ensuring zero radiation hazards to the medical personnel. KEYWORDSCancer cervix, Brachytherapy, High-dose rate, Low-dose rate.HOW TO CITE THIS ARTICLE: Maruthavanan S, Shanthilal M. High-dose rate brachytherapy in carcinoma cervix stage IIIB.
Background: Patients with malignancy undergoing chemotherapy, surgery, and radiation therapy experience a variety of symptoms that affect their quality of life (QOL). This necessitate the assessment of QOL on their subjective evidence that can be utilized in diagnosis, predicting prognosis, patient monitoring and clinical decision making. This information will help health care professionals to design interventions and recommend the appropriate treatment, thereby improving the QoL of patients. In this study we aim to assess the QoL of patients receiving adjuvant and neo-adjuvant therapy for Lung, Breast, and Colorectal cancer, in addition to making correlations according to type of treatment and disease stage. Methods: A prospective observational study was carried out in the radiation oncology department from March 2021 to September 2021 in Krishna Rajendra Hospital, Mysuru, India. We used the European Organization for Research and Treatment of Cancer quality of questionnaire [EORTC QLQ – C30] Version 3.0 to assess the QoL of patients. Patients were interviewed twice, when they came to have their chemotherapy regardless of the cycle number and during the next visit. Results: The number of patients enrolled in the study were 107. Most of participants were female 83%. About 73.8% diagnosed with breast cancer. In patients treated with adjuvant versus neo-adjuvant treatment, the functional scores and global health status scores were statistically significant p=0.038 and p=0.010 respectively with mean scores 63.54 in favour of adjuvant therapy. These results represent a better QoL in patients received adjuvant versus neo-adjuvant therapy. The mean values of global health status score in patients diagnosed with lung cancer during the two assessments (47.72, 51.51) were lesser than those in patients diagnosed with breast cancer (63.71,63.50) and colorectal cancer (58.82,58.82), indicating patients with lung cancer had poor QoL compared to breast and colorectal cancer patients. Conclusion: Patients received adjuvant therapy had better QoL compared to those received neo-adjuvant therapy. The QoL in lung cancer patients were majorly affected as compared to QOL in breast and colorectal cancer patients. there is a strong correlation between the type of treatment and disease stage.
BACKGROUNDThis study is aimed to evaluate the effect of fluconazole on prevention of oral candidacies and in reduction of severity of oral mucositis induced by radiotherapy. METHODSThe study was conducted on 48 head and neck cancers patients. Cases were randomised into study (22/48) and control groups (26/48). Both groups received radiotherapy with or without chemotherapy. Oral swabs were collected before start of radiation three weeks later and at the end of radiation. Oral swabs were cultured for candidial growth. Study group patients received oral fluconazole 50 mg/day throughout the course of radiation and control group patients received no fluconazole prophylaxis. Patients were examined weekly for oral mucositis and were graded according to CTC version 2.0. RESULTSOral swabs were taken from all patients before start of radiotherapy showed candidial growth in 22.9% (11/48). During the course of radiation treatment, oral candidial culture was positive in 42.3% (11/26) of control group patients and 40.9% (9/22) of study group (p=0.644). There was statistically significant reduction in the severity of mucositis in the study arm (p=0.021). In the study arm, there was grade 0 in 27.2% (6/22), grade 1 in 27.2% (6/22), grade 2 in 31.8% (7/22), grade 3 in 22.7% (5/22), and no grade 4. In the control arm, there was no grade 0 noted, grade 1 was seen in 19.2% (5/26), grade 2 in 61.5% (16/26), grade 3 in 15.3% (4/26), and no grade 4. Patients in whom candidial culture was negative had less severe mucositis as compared to patients with positive candidial culture (p=0.029). CONCLUSIONProphylactic use of oral fluconazole is effective in reducing the severity of oral mucositis by reducing oral candidiasis.
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