The Indian scenario of head and neck oncology – Challenging the dogmas

Tuljapurkar, Vidisha; Dhar, Harsh; Mishra, Aseem; Chakraborti, Swagnik; Chaturvedi, Pankaj; Pai, Prathamesh

doi:10.4103/2278-330x.187573

Cited by 27 publications

(10 citation statements)

References 38 publications

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“…Head and neck cancers form about 30% of the total malignancies registered in a year in India. More than 400,000 new cases are diagnosed per annum [ 1 , 2 ]. Radiotherapy plays a major role in the management of this diverse spectrum of malignancies in the definitive, adjuvant and palliative setting.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of coplanar and non-coplanar volumetric-modulated arc therapy in head and neck cancer treated with radiotherapy

et al. 2020

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Head and neck cancers form about 30% of the total malignancies registered in a year in India. More than 400,000 new cases are diagnosed per annum [1,2]. Radiotherapy plays a major role in the management of this diverse spectrum of malignancies in the definitive, adjuvant and palliative setting. The major proportion of patients in India present in the advanced stages of the disease which further cements the position of radiotherapy in the plan of management. In the radical scheme of treatment of head and cancers, Purpose: To evaluate the dosimetric variations in patients of head and neck cancer treated with definitive or adjuvant radiotherapy using optimized non-coplanar (ncVMAT) beams with coplanar (cVMAT) beams using volumetric arc therapy. Materials and Methods: Twenty-two patients of head and neck cancer that had received radiotherapy using VMAT in our department were retrospectively analyzed. Each of the patients was planned using coplanar and non-coplanar orientations using an optimized couch angle and fluences. We analyzed the Conformity Index (CI RTOG), Dose Homogeneity Index (DHI), Heterogeneity Index (HI RTOG), low dose volume, target and organs-at-risk coverage in both the plans without changing planning optimization parameters. Results: The prescription dose ranged from 60 Gy to 70 Gy. Using ncVMAT, CI RTOG , DHI and HI RTOG , and tumor coverage (ID 95%) had improved, low dose spillage volume in the body V 5Gy was increased and V 10Gy was reduced. Integral dose and intensity-modulated radiation therapy factor had increased in ncVMAT. In the case of non-coplanar beam arrangements, maximum dose (D max) of right and left humeral head were reduced significantly whereas apex of the right and left lung mean dose were increased. Conclusion: The use of ncVMAT produced better target coverage and sparing of the shoulder and soft tissue of the neck as well as the critical organ compared with the cVMAT in patients of head and neck malignancy.

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Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of coplanar and non-coplanar volumetric-modulated arc therapy in head and neck cancer treated with radiotherapy

et al. 2020

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“…Head-and-neck cancer (HNC) is a major health problem in India with 77,000 new cases being diagnosed every year,[1] accounting for 3% of all neoplasms. There are enormous challenges associated with it due to the disease itself, and intense and prolonged treatment that demands efficacious and persistent caregiving.…”

Section: Introductionmentioning

confidence: 99%

Assessment of caregivers' strain during radiation therapy of head-and-neck cancer patients: An institutional report using modified caregivers' strain index scale

Manir¹,

Ghosh²

2019

Indian J Palliat Care

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Aims:Very little works have been reported on the issues of burden perceived by the caregivers of head-and-neck cancer (HNC) patients. Job of the caregiver is complex, and it limits their social, psychological, and economical well-being. Our study aims at assessing caregivers' strain during radiation therapy (RT) of HNC patients using the Modified Caregivers' Strain Index (MCSI) Scale.Materials and Methods:In this single-institutional cross-sectional study, we interviewed caregivers of HNC patients undergoing curative RT. Along with MCSI, a 13-point questionnaire, which was self-administered in local languages; we collected baseline data of patients and their caregivers. Scores were evaluated. For each question, score varies 0–2. Higher the Median Hazard Score (H Score), more was the level of the strain.Results:We interviewed 24 participants. Response rate was 100%. About 45.8% of patients were in Stage III. The median age of caregivers was 40 years; 58.3% were male, 79.2% were employed, and 58.3% were belonging to the upper-lower class. Nearly 66.6% were spouse of the patients and 70.8% belong to joint family. In MCSI score analysis, H Score was 22 (range 14) with a minimum score of 14 and maximum score of 26. The most common score was 20. About 65.1% of participants responded Score 2 in all aspects of strain indices. Travel time had a significant positive association with total H Scores (Pearson's r = 0.663, P < 0.05).Conclusion:Majority of the caregivers was suffering from severe physical, personal, emotional, and social/financial strain. This issue must be addressed in holistic cancer care.

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“…[12] The majority of the patients with SCCHN in India presents an advanced stage and pose a challenge for treatment. [45] Advanced Stage (III or IV) often requires multimodal therapy, consisting of a combination of surgery, radiotherapy (RT), and/or chemotherapy. [6]…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of nimotuzumab with concurrent chemoradiotherapy in unresectable locally advanced squamous cell carcinoma of head and neck: An Indian rural hospital experience

Rawat

Tandan

Patel

et al. 2019

South Asian J Cancer

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Context:Nimotuzumab is the only anti-epidermal growth factor receptor monoclonal antibody which can be safely added to concurrent chemoradiotherapy (CRT) to improve efficacy in the management of unresectable, locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). However, the evidence available on this is limited.Aims:We retrospectively investigated efficacy and safety of nimotuzumab when combined with chemoradiation for LA-SCCHN.Settings and Design:Hospital records of 39 patients from January 2012 to December 2016 diagnosed with locally advanced (Stage III-IVb), unresectable SCCHN, and treated with concurrent CRT with weekly nimotuzumab were reviewed retrospectively after fulfilling the inclusion/exclusion criteria.Subjects and Methods:Tumor response was calculated as per response evaluation criteria in solid tumors criteria 1.1. Association of tumor response with independent variables was assessed. Overall survival (OS) and progression-free survival (PFS) were calculated. All patients were assessed for toxicity as per common terminology criteria for adverse events Common Terminology Criteria for Adverse Events v 4.0 (U.S. Department of health and human services, National Institutes of Health, National Cancer Institute).Results:At 6 months after completion of treatment, objective response rate was 97.44% with 26 (66.67%) patients attaining Complete response (CR), 12 (30.77%) patients with Partial response (PR), and one patient (2.56%) had stable disease. Subgroup analysis did not show a significant association of tumor response with independent factors. OS at 1 and 2-year was 100% and 72.9%, while PFS at 1 and 2-year was 87% and 54.40%. The incidence of Grade I, II, III, and IV toxicity was 30%, 18.18%, 41.82%, and 10%, respectively. No grade V toxicity was observed. Common adverse events observed were mucositis (33.64%), skin reaction (24.55%), neutropenia (20.91%), vomiting (18.18%), and diarrhea (2.73%).Conclusions:Nimotuzumab is an efficacious and safe option when added to concurrent CRT in unresectable, LA-SCCHN.

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The Indian scenario of head and neck oncology – Challenging the dogmas

Cited by 27 publications

References 38 publications

Dosimetric comparison of coplanar and non-coplanar volumetric-modulated arc therapy in head and neck cancer treated with radiotherapy

Dosimetric comparison of coplanar and non-coplanar volumetric-modulated arc therapy in head and neck cancer treated with radiotherapy

Assessment of caregivers' strain during radiation therapy of head-and-neck cancer patients: An institutional report using modified caregivers' strain index scale

Safety and efficacy of nimotuzumab with concurrent chemoradiotherapy in unresectable locally advanced squamous cell carcinoma of head and neck: An Indian rural hospital experience

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