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   2006| July-September  | Volume 2 | Issue 3  
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Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers
SN Geeta, TK Padmanabhan, J Samuel, K Pavithran, S Iyer, MA Kuriakose
July-September 2006, 2(3):100-104
DOI:10.4103/0973-1482.27584  PMID:17998687
Background: Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. Purpose: To compare acute toxicities of two chemotherapy schedules for head and neck cancers. Materials and Methods: A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. Results: Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [ P =0.005] and multivariate [ P =0.007] analysis. Conclusions: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.
  16 7,358 696
Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: A prospective randomized study
I Mallick, SC Sharma, D Behera, S Ghoshal, AS Oinam
July-September 2006, 2(3):119-125
DOI:10.4103/0973-1482.27586  PMID:17998689
Aims: Endobronchial brachytherapy (EBBT) is an established modality for the palliation in advanced non-small cell lung cancer. We compared three different schedules using EBBT with or without external radiation (XRT) in this setting. Materials and Methods: Forty-five patients were randomized to three treatment arms. Arm A received XRT to a dose of 30 Gy/ 10 fr/ 2 weeks and two sessions of EBBT 8 Gy each. Arm B received the same XRT and a single session of EBBT 10 Gy at 1 cm. Arm C received only a single fraction of brachytherapy to a dose of 15 Gy at 1 cm without XRT. Symptomatic response rates, duration of symptom palliation, obstruction scores, quality of life outcomes and complications were assessed and compared. Results: The overall symptomatic response rates were 91% for dyspnea, 84% for cough, 94% for hemoptysis and 83% for obstructive pneumonia. There was no significant difference between the arms. The median time to symptom relapse was 4-8 months for all symptoms and the median time to symptom progression was 6-11 months. The results were comparable between groups except for hemoptysis, where a shorter palliation was seen in Arm C that achieved statistical significance ( P < 0.01). Quality of life showed significant improvement, with maximum benefit in Arm A. Complication rates were low. Only one patient died of fatal hemoptysis. Conclusion: EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, either alone or in conjunction with XRT. The difference between the treatment arms were not statistically significant in most categories, but patients treated with XRT and two endobronchial sessions of 8 Gy had the most consistent benefit in terms of all the parameters studied.
  11 6,459 552
Trastuzumab: Is the new evidence revolutionary?
Anusheel Munshi, Pritanjali Singh, Rakesh Jalali
July-September 2006, 2(3):144-146
DOI:10.4103/0973-1482.27592  PMID:17998695
A few years back, the survival benefit of trastuzumab in HER 2 positive breast cancer patients presenting with metastatic disease was proven in a randomized setting. Recently a number of randomized trials have reported their results in the adjuvant setting in HER 2 positive patients. These trials have been considered by some as a landmark in the evolution of breast cancer management. Although the data is encouraging, it need to be seen in a proper perspective keeping in mind the limitations and the side effects reported. This article stresses the use of Herceptin in carcinoma breast patients in adjuvant setting with a cautionary eye.
  9 7,579 749
Proportionate increase in incidence of colorectal cancer at an age below 40 years: An observation
Madhumay Pal
July-September 2006, 2(3):97-99
DOI:10.4103/0973-1482.27583  PMID:17998686
Aim: Colorectal cancer is particularly a disease affecting individuals above 40 years of age and 90% of cases occur in persons over the age of 50. Genetic and familial factors, viz, HNPCC and FAP, contribute to less than 20% and environmental or acquired factors are the cause of the rest. The aim of this study is to find out the relative proportion of patients <40 years of age affected by this disease, registered in our institute. Materials and Methods: Colorectal cancers registered in the calendar years of 2003 and 2004 in our institute were analyzed in this study. Data from Population Based Cancer Registry (P.B.C.R.) for Bangalore, Mumbai, Delhi and Chennai for the year 1988 were taken for comparison. Results: The results show that our institute's figures exceed the generally accepted figure for 'incidence of the disease below the age of 40 years' by less than 10% of both the total incidence of the disease and those of P.B.C.R. for Bangalore, Mumbai and Chennai. The corresponding figure for females in Delhi P.B.C.R. shows a little similarity to our institute's figure. Conclusion: This observation indicates a changing pattern of colorectal cancer occurrence. This change may be a regional one or may be a result of genetic or environmental changes.
  8 7,348 481
Concurrent chemo-irradiation using accelerated concomitant boost radiation therapy in loco-regionally advanced head and neck squamous cell carcinomas
RS Vivek, M Baludavid, R Mohanram, Chitra , Amanullah , Vijayalakshmi , Bala , Kalaiyarasi , Saravanan
July-September 2006, 2(3):90-96
DOI:10.4103/0973-1482.27582  PMID:17998685
Purpose: To investigate the feasibility of combining concomitant boost-accelerated radiation regimen (ACB) with full-dose mono-chemotherapy using cisplatin and to assess its local response and acute toxicity patterns in patients with advanced loco-regional head and neck squamous cell carcinoma (HNSCC). Materials and Methods: Between July 2004 and August 2005, a pilot study involving 27 patients with stage III to IVB (AJCC-6th) HNSCC of the oropharynx, hypopharynx and larynx who met the eligibility criteria was undertaken. Twenty-four of these patients (median age - 53 years) were analyzable. The radiation dose was 72 Gy in 42 fractions over 6 weeks, delivered in one daily fraction of 1.8 Gy during the first 3.5 weeks and two fractions per day, 1.8 Gy and 1.5 Gy boost-separated by >6 h interval, during the last 2.5 weeks. cisplatin, 100 mg/m2, was given in intravenous (i.v.) infusion on day 1 and day 22. Tumor and clinical status were assessed and acute toxicities were graded. Results: Out of 27 patients, 24 patients received both radiation and chemotherapy as per protocol and were available for analysis. The loco-regional response rates were as follows: an overall response of 95.8% (23 patients), a complete response of 79.1% (19 patients), a partial response of 16.7% (4 patients) and progressive disease in 4.2% (1 patient). Dysphagia, nausea, vomiting and bone marrow suppression were the most common side effects and were associated with cisplatin administration. One patient (3.7%) died of complications (pneumonia and sepsis), 3 patients (12.5%) had acute grade 4 toxicity and 21 patients (87.5%) had acute grade 3 (17 patients) or grade 2 (4 patients) toxicity. Conclusion: This data shows that it is feasible to combine ACB and full-dose mono-chemotherapy using cisplatin with manageable, although substantial, toxicity. The compliance to therapy was high and the loco-regional response achieved compared favorably with ACB alone or other concurrent chemoradiation regimens using standard or altered fractionation regimens tested by the Institute. It also compares well with the available literature. An extended phase II trial; and a new phase III trial, comparing ACB plus cisplatin against standard radiation plus cisplatin, are being planned at the Institute to determine whether the use of ACB in the concurrent chemoradiation setting further improves outcome.
  5 6,615 461
Prevalence of psychiatric disorder in asymptomatic or minimally symptomatic cancer patients on treatment
Sanjib Kumar Mishra, Prashant Kumar Mohapatra, Kausik Bhattacharya, Tejpal Gupta, Jai Prakash Agarwal
July-September 2006, 2(3):136-139
DOI:10.4103/0973-1482.27590  PMID:17998693
Background: Cancer not only affects organ systems physically but can also affect the mind as a psychiatric disorder. Appropriate treatment can be clinically efficacious and cost-effective. With this background, a study was conducted in a regional cancer center to assess the prevalence of psychiatric disorder amongst cancer patients and correlate it with socio-demographic parameters. Materials and Methods: Asymptomatic or minimally symptomatic cancer patients on active anticancer treatment, fulfilling inclusion criteria, were served psychiatric assessment questionnaire. The demographic and the medical data were obtained from subjects and their medical records. Correlation of prevalence of psychiatric disorder with socio-demographic parameters was done using the Chi-square test. Results: Thirty-eight patients returned the questionnaire duly filled. Of them, 24 (63%) had some psychiatric disorder. All these 24 patients were suffering from depression - 15 (63%) from major depression and 9 (37%) from minor depression. Only 6 (25%) patients had anxiety disorder. The prevalence of psychiatric disorder in patients aware of the diagnosis and prognosis was 58 and 55% respectively. This was significantly higher as compared to the patients who were not aware of their diagnosis and prognosis ( P -value 0.019 and 0.05 respectively). Conclusion: High prevalence of psychiatric disorder, especially depression, amongst the cancer patients - particularly in those who were aware of the diagnosis and prognosis. A majority of these disorders are eminently treatable. Routine psychiatric evaluation of all cancer patients is a matter of debate that needs to be addressed in larger prospective surveys.
  5 6,446 432
Diagnostic value of silver nitrate staining for nucleolar organizer regions in selected head and neck tumors
Behnam Eslami, Hessam Rahimi, Farzaneh Rahimi, Monir Moradzadeh Khiavi, Asghar Ebadifar
July-September 2006, 2(3):129-131
DOI:10.4103/0973-1482.27588  PMID:17998691
Background: The present study is aimed to assess the usefulness of silver nitrate staining of nucleolar organizer regions (NORs) as a quantitative criterion for the diagnosis of selected head and neck tumors. Materials and Methods: The silver nitrate staining technique was used on 195 paraffin blocks collected from 85 patients. The samples consisted of 21 squamous cell carcinoma (SCC) of larynx, 28 SCC of oral mucosa and 36 samples of most common salivary gland tumors. Mann-Whitney U-Test was used for data analysis. Results: A significant difference was seen in the number of AgNOR dots between oral and laryngeal SCC with surrounding dysplastic and normal tissues ( P < 0.001) and also between mucoepidermoid carcinoma and adenoid cystic carcinoma with pleomorphic adenoma and normal salivary gland tissue ( P < 0.001). Conclusion: The silver nitrate staining for NORs is a useful method for aiding the diagnosis of malignant and dysplastic mucosal lesions and also malignant and benign salivary gland tumors.
  3 7,874 515
Spinal cord response to altered fractionation and re-irradiation: Radiobiological considerations and role of bioeffect models
Sanjay S Supe, KM Ganesh, T Naveen, Samuel Jacob, BN Sankar
July-September 2006, 2(3):105-118
DOI:10.4103/0973-1482.27597  PMID:17998688
The aim of radiation oncologist is to implement an uncomplicated loco regional control of cancer by radiation therapy. The bioeffect of a physical dose depends on the nature of the tissue, fractionation scheme, dose rate and treatment time. The transformation of absorbed dose into a bioeffect dose is controlled by treatment variables and the radiobiological characteristics of the relevant tissue. Various bioeffect models have been proposed to predict the biological effect of radiotherapy treatments. Dale has proposed extrapolated response dose (ERD) equations for external beam therapy, intracavitary brachytherapy and interstitial brachytherapy. Within the context of the LQ model, the parameter which quantifies the overall biological effect on a given tissue is the biologically effective dose (BED) which is obtained by applying repopulation correction to ERD (Orton,). Thames proposed the total effect (TE) concept based on the incomplete repair LQ model which accounts for the biological effect of a fractionated course of radiotherapy. Spinal cord myelitis limits the dose to tumours in the head and neck, thoracic and upper abdominal regions resulting in reduction of tumour control probability. Radiation myelopathy is one of the most devastating complications of clinical radiotherapy. Treatment techniques that are designed to minimize the risk of spinal cord injury are likely to underdose the tumour consequent failure to control the disease. Since radiation myelopathy results in severe and irreversible morbidity, it is important to establish the tolerance dose of the spinal cord. A number of patients have recently been reported to have developed radiation myelopathy following hyperfractionated accelerated radiotherapy. As the survival rates of patients increase, radiation oncologists are more frequently faced with the problem of treatment of late recurrence or second tumours situated within or close to previously treated site. A rationale for taking a decision in treating in such a condition is even more complex than the original condition and requires knowledge of the kinetics of decay of occult injury of the previous treatment. To test the validity of ERD, clinically reported data of altered fractionation to the spinal cord for 7 patients reported by Wong et al , Saunders et al and Bogaert et al , were analysed, ERD values were calculated and compared with compiled clinical literature data of 3233 patients for the incidence of spinal cord myelitis reported by Cohen and Creditor, Wara et al , Abbatucci et al and Jeremic et al for conventional fractionation. ERD values were estimated with α/β of 2.5 Gy for the conventional and altered fractionation data. To test the validity of TE concept for clinical data of re-irradiation tolerance of the spinal cord, the data of the 22 patients compiled by Nieder et al were used. Clinical data compiled from the literature of Cohen and Creditor, Wara et al , Abbatucci et al and Jeremic et al , were used for comparison.
  3 10,659 983
Polyclonal antibody-mediated mitotic inhibition in Chinese hamster ovary cells
R Maddaly, PV Deepa, GM Pai, B Preetha, S Ghosh, SFD Paul
July-September 2006, 2(3):126-128
DOI:10.4103/0973-1482.27587  PMID:17998690
The nucleus of a mammalian cell undergoes profound reorganization when the cell enters mitosis and a number of proteins involved at various levels of the cell cycle have been characterized. The presence of mitotic-specific proteins has been reported and their roles are important in understanding the mechanics of cell division. The ability of antibodies to recognize mitotic protein antigens and further inhibit mitosis is potentially valuable in their role as therapeutic and diagnostic agents in cancer therapy. In this study, we have aimed to analyze proteins isolated from mitotic cells of Chinese hamster ovary (CHO) cells and their significant role in inhibiting mitosis. The proteins extracted from mitotic cells were processed and antibodies produced. It was observed that the secondary response that yielded an antiserum of 1:8 titer was predominantly IgG. The antiserum was effective in inhibiting mitosis in CHO cells in culture in a dose-dependent manner. Although inhibition of mitosis was apparent by cell proliferation studies, there was no apparent effect of the antiserum on other cell morphology and culture characteristics. The unique molecular structure of the antibody by which it bivalently binds to a broad array of antigenic epitopes serves as the foundation of its utility. These antibodies, being polyclonal in nature, are targeted against a whole range of proteins; and their multiple epitopes involved in process of cell division might hence mediate recognition or inhibition of function of such proteins in a wholesome manner and thus accomplish inhibition of mitotic progression.
  2 5,952 272
Supraestructure maxillectomy and orbital exenteration for treatment of basal cell carcinoma of inferior eyelid: Case report and review
JS Villalon-Lopez, CA Valle-Mejia, A Patino-Lara, BA Moreno-Perez, JA Munoz-Lopez, A Alcantar-Andrade
July-September 2006, 2(3):140-143
Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor for development of illness such as severe solar burns during childhood or adolescence. BCC is mainly located on sun-exposed sites, head and neck being the areas of more incidences; although nose, eyelids and periorbitary tissue are unfavorable due to cosmetic results that BCC involves. Tumors can be classified as nodular, superficial, micronodular, morphea variety, infiltrating, pigmented, metatypic and fibroepithelioma of Pinkus. Several treatment options such as surgical and nonsurgical are available. The goal of treatment is complete excision of the tumor with preservation of surrounding structures in a way aesthetically acceptable. Mohs' micrographic surgery is the standard treatment for all nonmelanoma skin cancers. Orbital exenteration is also used for treatment of malignancies of ocular tissues, mainly squamous cell carcinoma, sebaceous cell carcinoma and BCC. The tissue beneath the surgical site can be left for second-intention granulation or covered with a cutaneous implant of partial thickness. The case of a 77-year-old patient is presented with BCC of inferior eyelid of 14 years' duration, formerly managed with radiotherapy; however, due to recurrent illness and invasion to the maxillary antrum, he needed supraestructure maxillectomy with left orbital exenteration.
  1 8,429 454
A new indication of sildenafil in medicine: Hypoxic cell sensitizer for penile cancer
Nagraj G Huilgol, Amit Jain
July-September 2006, 2(3):132-135
DOI:10.4103/0973-1482.27589  PMID:17998692
Purpose: To evaluate the feasibility and results of sildenafil used as radiosensitizer by causing penile vasodilatation and reducing tumor hypoxia in radical radiotherapy for penile cancer. Materials and Methods: Three men with histopathologic diagnosis of squamous carcinoma of penis were treated with radical external radiotherapy with concomitant sildenafil. Acute and late adverse events were noted according to RTOG toxicity criteria. Response to radiotherapy, as well as disease-free and overall survivals, was evaluated. Results: All three patients achieved tumescence, completed the treatment and achieved complete response. One patient had recurrence at 10 months and died of the disease after 23 months from starting the treatment. Other two patients are disease-free and alive at 48 and 53 months respectively. No excess acute or late adverse event was observed. Conclusion: Sildenafil may act as radiosensitizer by causing penile vasodilatation and reducing hypoxia. Larger controlled studies are required to validate the hypothesis.
  1 6,910 384
3D conformal and intensity modulated radiation therapy: Physics and clinical applications
C Mekala
July-September 2006, 2(3):147-147
  - 4,288 319
Clinical target volumes in conformal and intensity modulated radiation therapy
Anusheel Munshi
July-September 2006, 2(3):148-148
  - 3,401 263
Cola, controversies, and carcinogenesis
Nagraj G Huilgol
July-September 2006, 2(3):89-89
DOI:10.4103/0973-1482.27581  PMID:17998684
  - 4,266 258
Tribute to Professor N. Anantha (1936-2006)
Bidhu K Mohanti
July-September 2006, 2(3):149-149
  - 3,021 146