Treatment Outcome Of External Beam Radiotherapy (EBRT) With Intracavitary Radiotherapy (ICRT) In Ca Cervix: An Institutional Experience

Introduction : Ca Cervix is the second most common malignancy in Indian women. Most of the cases present in advanced stage. Radiotherapy is an important modality of treatment. Combination of EBRT and ICRT is an effective strategy which is based on the principle that we are able to give high radiation dose to tumor while sparing surrounding normal tissue.Aim and Objectives :The aim was to evaluate the 3 year overall survival (OS) and disease-free survival (DFS) of patients treated by EBRT and ICRT. The objectives were to evaluate radiation toxicities and to evaluate rate of residual disease, recurrence and distant metastases.Materials and Methods : It is a Retrospective analytical study. We analyzed 468 newly diagnosed cases of Ca Cervix registered in department between January2009 to December2013. Out of which 382 completed radical radiotherapy (EBRT+ICRT).Results : At the end of 3 years 58(15.18%) patients lost to follow-up, 48(12.56%) residual disease, 60(15.70%) local recurrence and 26(6.80%) had distant metastases. The DFS was 73.91% in Stage-I and 62.8% in Stage-II while 51.38% in Stage-III and 29.82% in Stage-IV. The OS was 82.6% in Stage-I, 71.9% in Stage-II, 65.19% in Stage-III and 42.1% in Stage-IV. The difference between early and advanced disease is statistically significant with p-value of 0.016. Conclusions : EBRT and ICRT is effective treatment in terms of overall survival and disease-free survival. Associated radiation induced rectal and bladder toxicities are acceptable & manageable. Early stage and overall treatment time are favorable prognostic factors for 3 year DFS & OS.

Assessing Role of Oral Glutamine Supplementation in Radiation Induced Oral Mucositis in Head and Neck Cancers

Background:Radiotherapy with or without concurrent chemotherapy forms the mainstay of treatment of head and neck cancers. Oral mucositis is one of the most common complications of Chemo Radio-Therapy(CRT) which outweighs the systemic complaints both in terms of severity and difficulty in management. The aim of our study was to assess the role of oral glutamine supplementation in prevention of oral mucositis in patients receiving CRT to the head and neck. Methods: This was a Prospective Randomized study performed between April 2017 to November 2017.Total 60 patients (30 in each arm) were enrolled. Patients in ARM A were advised to take Glutamine crystalline powder dissolved in water to be consumed daily within 1 hour before radiation and were again asked to repeat the same dose 7 to 8 hours post radiation. Glutamine Treatment was 5 days/week on Radio-therapy days only. Patients in ARM B were given Placebo twice a day in same fashion as ARM A.Weekly Cisplatin was given in both arms. Results: Average no of days for onset of mucositis in glutamine arm was 17 days vs 32 days in control arm. 26.67% of patients in the glutamine arm developed mucositis in the 5th to 6th week, whereas 60% patients in the control arm developed mucositis as early as the 3rd week. 13% of the patients in the glutamine arm developed G3 mucositis whereas 23.3% of patients in the control arm developed G3 mucositis. 46.6% percent of patients in the glutamine arm received complete six cycles of chemotherapy, whereas only 13.33% of the patients in the control arm could complete six cycles of chemotherapy(p<0.001) 93.3% of patients in the glutamine arm completed treatment within the stipulated period of 7 weeks, whereas only 33.3% patients in the control arm completed treatment within 7 weeks.(p<0.05). Conclusion: Glutamine significantly decreases the onset as well as the severity of mucositis in patients receiving CRT to the head and neck thus translating into lesser treatment gaps and improvement in patient quality of life.

Role of Neoadjuvant Chemotherapy followed by Concurrent Chemo-radiation in Locally Advanced Cervical Carcinoma: Our Experience

Background: Cervical carcinoma is the second most common cancer in females in India. Majority of them are reported in advanced stage. We have given platinum based neoadjuvant chemotherapy followed by CTRT in our study to reduce the local recurrence and decrease the tumor burden. The primary objective of our study was to assess the efficacy of NACT in terms of clinical and radiological response at the end of completion of treatment. Methods: This was a single arm prospective study in which we enrolled 79 patients from  2015-2017 who received 3 cycles of NACT, triweekly Cisplatin and 5-FU followed by concurrent chemo radiation (Radiotherapy-External beam radiotherapy 50Gy/25# plus intracavitary brachytherapy). Response was assessed at 12 weeks of completion of treatment by MRI pelvis using RECIST criteria 1.1 and toxicities were assessed weekly using CTCAE 4.03. Results: Mean age was 54 years; compliance rate was 88.6%. Complete response rate was 58.57% and partial response rate was 18.57% at 12 weeks post-treatment. Grade 2 or higher toxicities were seen in 52.85% patients during NACT and chemo radiation. Skin toxicities were seen in 37.14% followed by rectal-32.85%, haematological-27.14% and urinary bladder-24.28%. Conclusions: Neoadjuvant chemotherapy followed by Concurrent chemo radiation is a feasible treatment option with a good response rate with acceptable rate of treatment related toxicities.