Introduction: Breast cancer treated with adjuvant hypofractionation radiotherapy with two different techniques, i.e., volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) and their effects in terms of loco-regional control and adverse effects in terms of cutaneous, pulmonary, and cardiac outcomes are compared. Materials and methods: This is a prospective non-randomized observational study. VMAT and IMRT plan for 30 breast cancer patients who were supposed to receive adjuvant radiotherapy were prepared using a hypofractionation schedule. The plans were dosimetrically evaluated. Objective: Dosimetric comparative analysis of IMRT and VMAT in hypofractionated radiotherapy in breast cancer is done and tested whether VMAT has a dosimetric advantage over IMRT. These patients were recruited for a clinical assessment of toxicities. They were followed up for at least three months. Result: On dosimetric analysis, planning target volume (PTV) coverage (PTV_ V95 ) of both VMAT (96.41 ± 1.31) and IMRT (96.63 ± 1.56) were similar with significantly lower monitor units required with VMAT plans (1,084.36 ± 270.82 vs 1,181.55 ± 244.50, p = 0.043). Clinically, all patients tolerated hypofractionation through VMAT (n = 8) and IMRT (n = 8) satisfactorily in the short term. No cardiotoxicity or appreciable falls in pulmonary function test parameters were observed. Acute radiation dermatitis poses challenges similar to standard fractionation or any other delivery technique. Conclusion: PVT dose, homogeneity, and conformity indices were similar in both VMAT and IMRT groups. In VMAT, there was high-dose sparing of some critical organs like the heart and lungs at the cost of the low-dose baths to these organs. Increased risk of secondary cancer will require a decade-long follow-up study to indict the VMAT technique. As we move toward precision in oncology, “one-size-fits-all” can never be an acceptable dictum. Each patient is unique and therefore we must offer, and the patient must “choose wisely.”
BACKGROUND: Breast, cervical and oral cancers are the leading causes of cancers in India. High mortality with these cancers is due to presentation in the advanced stages. In India, doctors practically cannot treat each and every patient due to a huge doctor: patient ratio. In such a situation, nursing and paramedical staff can be helpful in providing their services in identication, screening and diagnosing of these cancers. AIM: The present study was undertaken with an aim to evaluate the awareness of nurses and paramedical staff regarding breast, cervical and oral cancers. STUDY SETTING AND DESIGN: The prospective, observational study was conducted at at Smt. Rajmata Vijyaraje Sindhia Medical College & Hospital, Shivpuri and at District Hospital, Shivpuri. PARTICIPANTS AND METHODS: 300 nursing and paramedical staff working in the above institutions were enrolled after verbal consenting. A self-administered structured questionnaire was administered to them. After an intervention in the form of discussion, the same questionnaire was readministered. The data from these questionnaires were evaluated and results presented. This questionnaire consisted of sections related to prevention, risk factors, associated symptoms and detection methods. RESULTS: Before intervention, 17.3% participants had knowledge about prevention, 19% about risk factors, 10% about the symptoms and 8% about early detection technique. After intervention, there was an improvement in these domains. The mean post-test knowledge score was signicantly higher than pre-test knowledge score (P<0.05). CONCLUSION: Overall we found that nursing and paramedical staff lack knowledge about these three major cancers. After imparting knowledge, there was an improvement in their knowledge. To make these nursing and paramedical staff competent enough to identify, screen, diagnose these cancers, there is requirement of knowledge centers.
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