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EDITORIAL
Year : 2012  |  Volume : 8  |  Issue : 6  |  Page : 53-54

The first special issue.... of many more to come!


Department of Radiation Oncology, Advanced Center for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Center, Mumbai, India

Date of Web Publication24-Jan-2012

Correspondence Address:
Vedang Murthy
Department of Radiation Oncology, Advanced Center for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Center, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.92215

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How to cite this article:
Murthy V. The first special issue.... of many more to come!. J Can Res Ther 2012;8, Suppl S2:53-4

How to cite this URL:
Murthy V. The first special issue.... of many more to come!. J Can Res Ther [serial online] 2012 [cited 2019 Sep 17];8:53-4. Available from: http://www.cancerjournal.net/text.asp?2012/8/6/53/92215

The burden of oral cancer and the urgent need to take drastic steps in curbing the tobacco menace have been elucidated in the accompanying editorial of this special issue by Dr. Chaturvedi. [1] In addition to the prevention and early detection strategies that have been suggested, there has to be a concerted effort to improve the treatment outcomes of patients with a cancer that often afflicts the population that has the least access to specialized and multidisciplinary care that oral cancer treatment demands. To make matters worse, in spite of the best possible care, the treatment leaves permanent and often severe effects, which are sometimes 'worse than the cause'. It is this complexity and that has prompted the Journal of Cancer Research and Therapeutics (JCRT) to choose oral cancers as the topic of this first special issue.

Although by no means comprehensive, this special issue attempts to put in perspective the current evidence related to the treatment of oral cancers. Radiotherapy has been a cornerstone of oral cancer management since the middle of the last century. The treatment techniques have, however, undergone a significant change only in the last decade. With the advent of high precision radiotherapy and its firm integration in the management of various cancer sites, there has been an attempt to follow suit and use this technology in the adjuvant setting in oral cancers as well. On the face of it, when dose escalation is not an issue and the target tissues are difficult to define due to distortion of the anatomy by surgery and complex reconstruction (as with oral cancers), techniques such as Intensity Modulated Radiotherapy (IMRT) do not lend themselves easily to routine use. Target delineation in the operated neck needs experience and a geographical miss can become really dangerous, due to the steep dose gradients produced by IMRT. As radiation oncologists have gained more confidence with IMRT in general, its use in oral cancers has increased. Bhide et al., have reviewed the literature and succinctly presented the evidence for moving from conventional radiotherapy to more advanced techniques for oral cancers. [2] This should help the readers in putting the use of this technology in perspective and use it judiciously by weighing the pros and cons.

The presence of critical structures related to taste, smell, mastication, swallowing, and speech, and the treatment of the head and neck region with radiation is associated with significant and often longstanding sequelae. The use of modern technology and better understanding of the biological basis of these toxicities have helped somewhat in alleviating the side effects. However, it would not be an exaggeration to state that of all the sites, adjuvant radiotherapy for oral cancers is probably the most difficult treatment to undertake not only for the patient, but also for the treating oncologist. Basu et al., in this issue, have detailed the spectrum of toxicity seen with radiation and elaborated on their management. [3] It is important for the treating oncologist to have a fundamental understanding of the complex interplay between lack of saliva, inflammation of the mucosa, and swallowing difficulties due to radiation. The review provides the reader with an insight into these toxicities and tips on management based on both evidence and 'experience'.

Randomized trials in oral cancer have been infrequent. Western investigators have had little interest or reason to undertake them to produce robust data, as the disease continues to afflict the poor, particularly in the developing world. Non-enrollment has been a real barrier to complete well-meaning trials in the west, but this information is lacking in India. A currently ongoing landmark trial of adjuvant therapy in oral cancers, in India, has provided an opportunity to understand the issues related to non-enrollment in randomized trials. In this special issue, Murthy et al., report in detail the patient- and treatment-related factors that hinder enrollment in a large randomized trial. [4] Even as the reasons for non-enrollment may seem obvious and may be hypothesized by experienced investigators, this is the first study that actually documents the reasons in detail, in a tertiary care center, located in a large metropolis in India. This will hopefully enable future investigators to design trials with a better understanding of the enrollment barriers and help in quicker recruitment and a smoother conduct of trials.

It is likely that JCRT will continue the trend of publishing special issues focusing on specific cancer sites. If that happens, we would hopefully come a full circle with the next special issue on oral cancers in about 12 to 15 years. I sincerely hope by then there would be a marked reduction not only in the tobacco abuse and oral cancer burden in India, but also a much wider availability of trained specialists to do a competent job. This is clearly possible with the sustained efforts of individuals and groups and an earnest will of policy makers.

 
 > References Top

1.Chaturvedi P. Effective strategies for oral cancer control in India. J Cancer Res Ther 2012;8 Suppl 2:S55-56.  Back to cited text no. 1
    
2.Bhide SA, Ahmed M, Newbold K, Harrington KJ, Nutting CM. The role of intensity modulated radiotherapy in advanced oral cavity carcinoma. J Cancer Res Ther 2012;8 Suppl 2:S67-71.  Back to cited text no. 2
    
3.Basu T, Laskar SG, Gupta T, Budrukkar A, Murthy V, Agarwal JP. Toxicity with radiotherapy for oral cancers and its management: A practical approach. J Cancer Res Ther 2012;8 Suppl 2:S72-84.  Back to cited text no. 3
    
4.Murthy V, Awatagiri KR, Tike PK, Ghosh-Laskar S, Gupta T, Budrukkar A, et al. Prospective analysis of reasons for non-enrollment in a phase III randomized controlled trial. J Cancer Res Ther 2012;8 Suppl 2:S94-99.  Back to cited text no. 4
    




 

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