Aim: To compare the effect of two RT schedules for thoracic palliation in advanced NSCLC patients (30 Gy in 10 fractions over two weeks and 27 Gy in 6 fractions over three weeks, 2 fractions per week) on pulmonary symptoms, radiological response of the primary thoracic tumour, pulmonary functions and acute toxicities. Material and method: A hospital based quantitative prospective follow-up study. Total 104 advanced NSCLC patients were randomized into two fractionation arms. Evaluation was done pretreatment and 4 weeks after end of RT. Symptoms palliation and radiological response to RT & radiation pneumonitis were assessed by using RTOG 4-point scale and Revised (RECIST) guideline version 1.1 respectively. Radiotherapy was given by Cobalt-60 teletherapy machine. Results: Total 96 patients were evaluated for symptom palliation, radiological response and acute toxicities. The percentage of patients achieving symptom palliation was slightly higher in the control arm. At 1st month of follow-up, 16.67% & 18.75% patients in Study & control arm showed PR. Post-RT mean FVC and FEV1 showed a tendency for improvement in both mean FVC and FEV1 in compare to baseline. Treatment was well tolerated both arms. Grade I nausea and vomiting developed in 43% and 37.5% patients in Study and Control Arm respectively. 58% & 39% patients developed Grade 1 radiation pneumonitis as cough & dyspnea in study and control arms respectively. Grade 2 radiation pneumonitis was developed in 2 patient of study arm at 3rd week of follow-up but they lost follow up. Around 31% patients developed Grade1 esophagitis as dysphagia in both arms at 1 week of follow-up which was reduced up to 7% by 2nd week. A very few patients developed grade1 skin reaction as dermatitis in 1st week of treatment. The difference in symptom palliation, radiological response, pulmonary functions and acute toxicities in both arms was not statistically significant. Conclusion: The two RT fractionation schedules showed equal efficacy in terms of symptoms palliation, radiological response of the primary thoracic tumor, pulmonary functions and acute toxicities. Thus the 27 Gy/6 fractionation arm appears preferable compared to 30 Gy/10 arm to minimize the patients’ visits and load on the machines.
Background: The purpose of our study is to identify the incidence of hypothyroidism following radiotherapy in head and neck cancer patients in Rajasthan India and to assess the time period for the development of hypothyroidism for early treatment to reduce hypothyroid related morbidity and mortality. Methods: A prospective study conducted in Department of Radiation Oncology, S.M.S Medical College and attached group of hospital, Jaipur, Rajasthan. with 50 patients of histopathologically proven head and neck cancer receiving external beam to whole neck on telecobalt. Results: The patients were followed up for a period of six months. 7 (14%) patients were found to have hypothyroidism which was strongly significant with the p value of 0.02. Conclusion: We concluded that thyroid function tests should be made routine prior RT and during follow up period as early as 6 months and carried out lifelong. Keywords: Thyroid function test, Head neck cancer, Follow-up.
Context: Cancer patients usually have various psychological complications, depression being the most common among them. Depression poses difficulties in continuing the prescribed treatment within the scheduled time frame, ultimately affecting the outcome. Aims: The aims of this study were to determine the magnitude of depression and various factors associated with it, to initiate the timely intervention. Subjects and Materials: Brief Edinburgh Depression Scale was used to measure depression in 203 cancer patients who received chemotherapy at Department of Radiotherapy, SMS Medical College, Jaipur; in August 2017, were above 18 years of age, and could read, understand, and write. Association of depression with various factors such as age, gender, education and occupation details, income, marital status, history of other comorbid disease, type and site of cancer, presence of metastases, number of chemotherapy cycles going on, and source of cost of therapy, was also computed. Results: Of 203 patients, depression was present in 130 (64%) patients. Statistically significant association of depression was found with both extremes of the age ( P = 0.04), paid treatment ( P = 0.03), and <4 chemotherapy cycles ( P = 0.04). No significant association was seen between depression and gender, occupation, performance status, site of cancer, presence of coexisting disease, and metastases. Conclusions: The magnitude of depression was high (present in 64% of patients) which often gets unnoticed. Depression should routinely be screened among cancer patients receiving chemotherapy and patients found to have depression should be referred to a psychiatrist for timely management.
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