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Year : 2019  |  Volume : 15  |  Issue : 9  |  Page : 301-302

Best proffered paper more than 40


Date of Web Publication28-Nov-2019

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How to cite this article:
. Best proffered paper more than 40. J Can Res Ther 2019;15, Suppl S2:301-2

How to cite this URL:
. Best proffered paper more than 40. J Can Res Ther [serial online] 2019 [cited 2019 Dec 14];15:301-2. Available from: http://www.cancerjournal.net/text.asp?2019/15/9/301/271703




 > Abstract: Single institutional retrospective analysis of postoperative buccal mucosa cancers treated with ipsilateral radiotherapy Top


Madhup Rastogi, Ajeet Kumar Gandhi, Satyajeet Rath, Sambit Swarup Nanda, Harikesh B. Singh, Siddarth Kumar, Rohini Khurana, S. P. Mishra, Anoop Kumar Srivastava, Avinav Bharati

Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, E-mail: drmadhup1@gmail.com

Background: Curative surgical resection with neck dissection remains the ideal initial treatment modality in localized carcinoma buccal mucosa (BM). Depending on the adverse risk factors, adjuvant radiotherapy (RT) is indicated. Usually, adjuvant RT (if indicated), is delivered to tumour bed and bilateral neck nodes. However, selected patients could be treated with ipsilateral RT to tumour bed and neck nodes (IL-RT). Literature on patterns of failure in this group of patients is sparse. Purpose: We aimed to analyse the failure patterns and survival outcome in these cohort of patients treated at our institute. Methodology: 116 patients of post-operative BM cancers treated with IL-RT from June 2013 to Jan 2019 were included in this retrospective analysis. RT dose was 60-66 Gray in 30-33 fractions over 6-6.5 weeks delivered by linear accelerator using 3-dimensional conformal radiotherapy techniques. Patients treated with bilateral RT and those treated with concurrent chemo-radiotherapy were excluded from the present analysis. All outcomes were evaluated from the time of registration. Local, regional and loco-regional control was defined as time from registration to failure in tumour bed, regional nodes or both, respectively. Disease free survival (DFS) and overall survival (OS) were defined as time from registration to failure at any site (local, regional or distant) and death from any cause, respectively. Kaplan Meier method was used for all outcome analysis. Results: The median age was 46 years (range 25-80). Patient characteristics are described in [Table 1]. Median RT completion time and the overall treatment time were 6.2 weeks (range 5.9-7.1) and 11.6 weeks (range 8.5-19), respectively. 92 patients received 60 Gy, 7 patient 64 Gy and the rest received 66 Gy. The median follow-up time was 24.4 months (range 5-54.2). The 2-year local, regional and loco-regional control rates were 88.4%, 89.5% and 80.9%, respectively. The 2-year DFS and 2-year OS rates were 77.4% and 79.5%, respectively. The crude rates of failures at primary site, ipsilateral and contralateral neck were 10.3%, 11.2% and 3.4%, respectively. Five patients (4.3%) had distant failures. 23 patients died of cancer and 2 patients died of non-malignant causes. Conclusion: Post-operative patients of BM cancers with intermediate risk factors necessitating RT alone treated with IL-RT have low rates of contralateral neck failures. These patients should be spared of contralateral neck RT, pending results from any randomized controlled trials.
Table 1: Patient characteristics

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 > Abstract: Holistic approach in whole brain radiotherapy for brain metastasis Top


Kanhu Charan Patro, Partha Sarathi Bhattacharya, Chitta Ranjan Kundu, V. Krishna Reddy, P. Madhuri, Rashmi Sukla, A. C. Prabu, A. Srinu, Anil Kumar, Subhra Das

Department of Radiotherapy, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India, E-mail: drkcpatro@gmail.com

Whole brain radiotherapy is the most standard therapy in brain secondaries. Over the years the development of newer technologies and newer chemotherapy drugs targeting the targetable mutations the survival has reached more than 5 years. With whole brain radiotherapy the cognitive function declines over the years and apart from this the hidden side effects go unnoticed and quality of life also deteriorates with passage of time. Here we suggest the holistic approach to address these issues. The main side effects of whole brain radiotherapy are diminution of cognitive function, xerostomia, hair loss, deafness. Here we planned the cases of whole brain radiotherapy addressing these issues with arc therapy sparing scalp, cochlea, parotid and hippocampus according to the RTOG guidelines and presenting the dosimetric analysis. Whenever possible we should plan to spare these structures. We can also consider hypo fractionated limited field radiotherapy or stereotactic radiosurgery for more therapeutic benefit.


 > Abstract: Socioeconomic factors affecting transtuzumab usage in breast cancer patients belonging to hilly regions of north India Top


Rajesh Pasricha, Pragya Singh, Laxman Pandey, Ajas Ibrahim, Ajeet Singh Bhadoria, Sweety Gupta, Deepa Joseph, Manoj Gupta, Bina Ravi

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, E-mail: drrajesh_pasricha@yahoo.com

Introduction: Breast cancer is the most common malignancy in women worldwide and is a prototype of global cancer disparity. While breast cancer mortality is decreasing in developed countries, it continues to increase in low- and middle-income countries. Trastuzumab in combination with chemotherapy is standard of care and essential drug for patients with Her2 positive breast cancer. Despite the availability of biosimilars, it is still out of reach for many patients in underdeveloped areas of India. Access to trastuzumab is limited for various reasons such as lack of drug funding or because of high treatment costs. This study examines access to trastuzumab and identified potential barriers to its use in a large tertiary care hospital in underserved and resource restricted hilly region of Northern India (Uttrakhand). Materials and Methods: In a cross-sectional study all patients diagnosed with Her2 positive breast cancer who underwent treatment in our institute from January -December 2018 were included. All relevant details like age, stage, treatment details, receptor status (ER/PR/ Her2) were recorded. All Her2 positive patient who had 3+ score on immunohistochemistry (IHC) were considered positive. These patients were investigated to look into various factors for acceptance or non -acceptance of transtuzumab like socio-economic status, funding of treatment, education status and reasons for non-usage of drug. Patients were categorised into high, middle and lower socioeconomic status by using appropriate scale. The data was analysed by using SPSS Version 20.0 and Open epi software. Chi square test of significance was applied to test association between variables. Results: Total 310 patients were diagnosed as carcinoma breast during study period, out of which 68 patients were Her2 positive (22%). Of these 68 patients 24 (35%) received transtuzumab. Majority of transtuzumab recipient belong to upper and middle socio-economic status as compared to lower class (83.3% vs 16.7%, p=0.001). The treatment of maximum (91.7%) users were met by out of pocket expenditure whereas only two patients were beneficiary of some form of government health scheme support. It was also observed that most of the transtuzumab user patients were well educated (above high school level) compared to those who did not took the drug (83% vs 36%, p= 0.0001). Among 44(65%) patients who did not received the drug, majority had education level below high school (63% vs 36%) although most of them had monthly high income (54% vs 37%). 26 (59%) patients reported financial issue as the main cause of not taking transtuzumab whereas the remaining 18 (41%) patients cited the reason that they were not offered this drug by treating physician probably assuming that patient will not be able to afford this treatment. Except 2 patients, all transtuzumab non recipient patients were also financing their treatment themselves and had no support like government aid or insurance. Even those two non-user patient who had financial support from government scheme denied use of transtuzumab this may be due to their low socioeconomic class as well as poor education status. Conclusion: The majority of Her2 positive patient are unable to received transtuzumab treatment due to financial constraints, non-availability of health insurance and poor government support for treatment. Patient's socioeconomic class, monthly income & their education level significantly influenced the usage of drug. Education level of patients is probably equal if not more important factor than monthly income determining transtuzumab use. Treating oncologist should also overcome their personal biases about socio-economic status of a patients and should offer the drug wherever indicated as this was the second most common reason for non-usage of drug. Moreover, Improvement in education standard will automatically raise socioeconomic status as well as disease awareness among the patient which would make them vigilant and receptive to life saving beneficial but costly treatment like transtuzumab. Tremendous efforts are required for cost reduction by using low cost biosimilars, patient education as well as implementation of government health scheme to bridge the gap in treatment management of Her2 positive patients.





 
 
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