Background & objectives:Patients with head and neck cancer (HNC) undergoing chemoradiotherapy (CRT) suffer from fatigue causing a decrease in functional capacity and quality of life (QoL). Limited research in the field of exercise training among these patients demanded the need for this study to assess the effects of exercise training on functional capacity and quality of life.Methods:A randomized controlled trial was conducted on 48 patients with HNC undergoing CRT. The exercise group received an individually tailored, supervised, exercise programme for six weeks, while the control group did not receive any form of exercise. Functional capacity and QoL were assessed at baseline and at the end of the intervention using the six minute walk distance (6MWD) and medical outcomes survey short form 36 (SF 36).Results:The mean age of patients was 52 yr with 42 males. After six weeks, the 6MWD improved by 42 metres (P<0.05) in the exercise group while the control group showed a decrease by 96 metres (P<0.001). There was an improvement on the mental component score (MCS) of SF36 for the exercise group (4.8; P<0.05) and the physical component score (PCS) remained almost the same, while a decrease in PCS and MCS was seen in the control group (-5.9; P=0.064 and -17.3; P<0.05). When 6MWD and SF36 were compared between the groups, there was a statistically significant difference (P<0.001) seen after six weeks.Interpretation & conclusions:Our results showed that the functional capacity and QoL decreased among those not receiving a supervised exercise program, while exercise training improved functional capacity and QoL in HNC patients undergoing CRT.

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Recently, medical image fusion has emerged as an impressive technique in merging the medical images of different modalities. Certainly, the fused image assists the physician in disease diagnosis for effective treatment planning. The fusion process combines multi-modal images to incur a single image with excellent quality, retaining the information of original images. This paper proposes a multi-modal medical image fusion through a weighted blending of high-frequency subbands of nonsubsampled shearlet transform (NSST) domain via chaotic grey wolf optimization algorithm. As an initial step, the NSST is applied on source images to decompose into the multi-scale and multi-directional components. The lowfrequency bands are fused based on a simple max rule to sustain the energy of an individual. The texture details of input images are preserved by an adaptively weighted combination of high-frequency images using a recent chaotic grey wolf optimization algorithm to minimize the distance between the fused image and source images. The entire process emphasizes on retaining the energy of the low-frequency band and the transferring of texture features from source images to the fused image. Finally, the fused image is formed using inverse NSST of merged low and high-frequency bands. The experiments are carried out on eight different disease datasets obtained from Brain Atlas, which consists of MR-T1 and MR-T2, MR and SPECT, MR and PET, and MR and CT. The effectiveness of the proposed method is validated using more than 100 pairs of images based on the subjective and objective quality assessment. The experimental results confirm that the proposed method performs better in contrast with the current state-of-the-art image fusion techniques in terms of entropy, VIFF, and FMI. Hence, the proposed method will be helpful for disease diagnosis, medical treatment planning, and surgical procedure. INDEX TERMS NSST, grey wolf optimization, chaotic function, image fusion, MRI, PET, SPECT. I. INTRODUCTION A variety of medical imaging technologies available today capture images with distinct modalities which focus on organ or tissue information. Generally, multi-modal medical images provide complementary details of various human organs of the body. High-resolution images are acquired through computed tomography (CT) imaging technique that captures skeletal structures, and third-party implants, while the magnetic resonance (MR) imaging detects the internal body The associate editor coordinating the review of this manuscript and approving it for publication was Yong Yang.

Introduction Muscle wasting conditions such as sarcopenia may be highly prevalent in advanced head and neck cancer (HNC) patients (16–71%), with these prevalence rates substantially greater in those who have received chemo-radiotherapy (CRT). According to the updated European Working Group on Sarcopenia in Older People consensus statement, sarcopenia is defined as the age-related loss of muscle strength, muscle mass and physical performance. The high prevalence of sarcopenia in HNC patients is concerning as it has been associated with substantially increased risk of CRT toxicity, respiratory complications and early mortality. With the high prevalence of HNC and sarcopenia in India and the strong link between sarcopenia and poor HNC patient outcomes, it is important to screen for the presence of sarcopenia in Indian patients receiving CRT for HNC. Methods This longitudinal pilot study aimed to routinely monitor 19 men receiving CRT for their HNC for a variety of sarcopenic-related outcomes over three time points during their 7 weeks of CRT. Participants were required to be male, with a minimum age of 30 years, with a Stage III, IVa or IVb diagnosis of HNC and be currently undergoing a 7 weeks course of CRT in an oncology department. Outcomes included probable sarcopenic diagnosis were estimated by the SARC-F, handgrip strength, skeletal muscle mass was estimated by bioelectrical impedance and physical performance was assessed by the Timed Up and Go. Repeated measures ANOVA and Bonferroni post-hoc tests were used to identify significant differences at the three time points with a p < 0.05. Results The 19 participants in this trial at a mean age of 56.5 ± 10.2 years (range = 39–75 years), with most (n = 13, 68.4%) employed in laboring occupations. At baseline, 31.5% (n = 6) of the participants already had probable sarcopenia based on their total SARC-F score, with this increasing to 89.4% (n = 17) at the end of 7 weeks CRT. In addition, significant decreases in strength, skeletal muscle mass and Timed Up and Go performance were observed, with these declines significantly greater at 7 weeks than 3 weeks after commencing CRT. Conclusions Patients with HNC undergoing 7 weeks of CRT showed clinically significant increases in the incidence of probable sarcopenia based on their total SARC-F score as well as clinically significant declines in handgrip strength, skeletal muscle mass and Timed Up and Go performance. Due to the relationship between sarcopenia and a host of adverse events related to CRT in HNC patients, these results suggest that oncologists and their allied health teams should routinely monitor these patients during CRT and provide the relevant exercise therapy and nutritional support to those patients in need.

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Introduction: To evaluate the adverse drug reactions (ADRs) due to cancer chemotherapy in a tertiary care hospital in South India. Materials and Methods: This was a retrospective descriptive study. The data was obtained from patients who developed, at least, one ADR due to cancer chemotherapy during the period June 2014 to May 2015. The causality of the ADRs were evaluated by WHO-UMC causality assessment system and Naranjo's ADR probability scale, the severity of ADRs were assessed by Hartwig and Siegel ADR severity assessment scale, and preventability of ADRs were determined by the Schumock and Thornton ADR preventability assessment scale. Results: One hundred fourteen ADRs due to cancer chemotherapy were reported in 73 patients. Hyponatremia (20.2%), neutropenia (11.4%), infections of the lung (11.4%), leucopenia (9.6%) were the commonly suspected ADRs. Cisplatin (62.3%), carboplatin (18.4%), cetuximab (3.5%), gefitinib (2.6%) were the commonly suspected medications. As per the WHO-UMC causality assessment system 66(57.8%) ADRs were possible and 48(42.1%) were probable. Naranjo's ADR probability scale showed that 74(64.9%) ADRs were possible and 40 (35.1%) were probable. There was a very good agreement between the two scales (kappa=0.853). All ADRs were classified as level 4 severity barring one. None of the ADRs reported were preventable. Conclusion: Since 80% of the ADRs were suspected to be due to platinum containing anticancer drugs this provides a focus for further research on devising methods for prevention or early detection of ADRs. Prompt detection of ADRs is important to decrease morbidity and mortality.Key words: Adverse Drug Reaction, Cancer Chemotherapy, Naranjo's ADR probability scale, Causality assessment, Pharmacovigilance, WHO-UMC causality assessment system. Correspondence RESULTSOne hundred fourteen ADRs due to cancer chemotherapy were reported in 73 patients during the study period. Among the ADRs reported, 63(55.3%) were in males and 51(44.7%) in females. The mean age of the patients was 55.98 ± 6.53 years in males and 52.96 ± 10.09 years in females. Oropharyngeal malignancy (24.6%) was the most common groups of cancers followed by malignancy affecting the digestive organs (16.7%), female genital organs (15.8%) and breast (7%). Among these, malignancy of cervix uteri (14.9%) and esophagus (14.9%) were the most common cancers. The gender-wise distribution of different malignancies is shown in Table 1. ADRs affecting blood (38.5%) were the most common suspected category of ADR, followed by metabolic abnormalities (29.8%) and infections (15%). Table 2 shows the various ADRs reported in the study population. Hyponatremia (12%), respiratory tract infection (9%) and neutropenia (7%) accounted for 44.4% of the ADRs in males. Hyponatremia (21.6%); neutropenia, diarrhea, anemia (11.8%); leucopenia, thrombocytopenia (9.8%) accounted for 76.6% of the ADRs in females. Seventy-four (64.9%) ADRs were considered to be recovering at the time of reporting, 253 impairing host protective mechanisms...

Objective: To review the role of physiotherapy and its effects in hospice care of patients with advanced cancer. Methods: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, CINAHL and PEDro. The search strategy was devised, articles were screened, and 2 independent reviewers conducted data extraction. Eligible studies were methodologically assessed for quality rating using modified Downs and Black’s checklist. The extracted data was summarized according to site/stage of cancer, details of intervention, outcome measures and the results. Result: The total number of screened articles were 2102, out of which 9 were identified as suitable for the purposes of comprehensive review. The studies included exercise therapy, massage therapy, relaxation therapy, compression bandaging and use of TENS as the various physiotherapy interventions under consideration. Studies were generally of low to moderate quality. A broad range of outcomes were employed including physical symptoms like loss of function, pain, fatigue, edema, sleep disturbances and quality of life. The findings of the studies supported the benefits of the interventions. Conclusion: A structured exercise protocol, massage therapy, TENS and compression bandaging are useful in alleviating the symptoms experienced by patients with advanced cancer in hospice care. The reduced symptom burden has reflected as an improvement in their quality of life. However, there is a further need for high quality studies to strengthen the findings of this review.

Transmission of radiation fluence through patient's body has a correlation to the planned target dose. A method to estimate the delivered dose to target volumes was standardized using a beam level 0.6 cc ionization chamber (IC) positioned at electronic portal imaging device (EPID) plane from the measured transit signal (St) in patients with cancer of uterine cervix treated with three-dimensional conformal radiotherapy (3DCRT). The IC with buildup cap was mounted on linear accelerator EPID frame with fixed source to chamber distance of 146.3 cm, using a locally fabricated mount. Sts were obtained for different water phantom thicknesses and radiation field sizes which were then used to generate a calibration table against calculated midplane doses at isocenter (Diso,TPS), derived from the treatment planning system. A code was developed using MATLAB software which was used to estimate the in vivo dose at isocenter (Diso,Transit) from the measured Sts. A locally fabricated pelvic phantom validated the estimations of Diso,Transit before implementing this method on actual patients. On-line dose estimations were made (3 times during treatment for each patient) in 24 patients. The Diso,Transit agreement with Diso,TPS in phantom was within 1.7% and the mean percentage deviation with standard deviation is −1.37% ±2.03% (n = 72) observed in patients. Estimated in vivo dose at isocenter with this method provides a good agreement with planned ones which can be implemented as part of quality assurance in pelvic sites treated with simple techniques, for example, 3DCRT where there is a need for documentation of planned dose delivery.