ABSTRACT
Background: The purpose of this prospective study is to determine the effectiveness and cosmetic outcome of shorter fractionated radiotherapy in post-operative invasive breast cancer patients. Methods: Between July 2009 and June 2011, 216 post-operative cancer breast patients were treated with this regimen on cobalt60. The chest wall and supraclavicular area were treated using a tangential parallel pair, & direct supraclavicular portal with wedges as necessary, to a dose of 40 Gy / 15 fractions (study group) (133 cGy for tangential and 266 cGy for supraclavicular field each). (Control Group received 50 Gy / 25#) No additional boost was given. The median duration of follow-up surviving patients are 3 years. Results: From July 2009 to July 2011 (2 years), 216 histopathologically proven cases of Invasive ductal carcinoma of Breast were included in this study. All patients with early and locally advanced stage breast cancer were treated with hypofractionated and conventional schedule of radiotherapy. At baseline 80.19% in the study and 75.45% of patients in the control group were being rated as excellent or good. At 2 years, the percentages of patients with an excellent or good cosmetic outcome were 75.80% in the study and 73% in the control group. Grade II skin reactions were more in control (60%) as compared to study group (49%). A radiation schedule delivering 40 Gy / 15 # seems to offer control rates of locoregional tumour relapse & late adverse effects at least as favourable as the standard schedule of 50 Gy / 25#. Conclusion: Shorter fractionation schedule is very much effective in preventing recurrent breast cancer and it provides a high level of patient satisfaction as well as reduce money and overall treatment time. Its shorter duration offers the added advantage of a more efficient use of resources and greater patient convenience.
ABSTRACT
Background: Objective of current study was to observe the local control, progression free survival and organ preservation for locally advanced head and neck cancer by using induction Chemotherapy followed by concurrent chemoradiotherapy. Methods: 102 patients enrolled in this study with stage III-IVB of head & neck cancer. Patients were assessed and treated by faculty of the department as per NCCN guidelines. Group A patients received three courses of cisplatin (100mg/m2) and paclitaxel (175mg/m2) at every 21 days interval followed by concurrent chemoradiothearpy with cisplatin 30mg/m2 on weekly basis while group B received only concurrent chemoradiothearpy. Radiotherapy consisted of total dose up to 66-70 Gy. by conventional fractionation schedule. Results: From August 2011 to July 2013, total 102 patients have completed 14 months of follow up after completing definitive treatment group A : 48 and group B: 54 patients. Response evaluation was done after one and half months of completion of chemoradiotherapy in both arms. Complete response rate was 60.42% and 38.88 % in study and control arm respectively while partial response was 72.92% and 55.56%. Most common grade III or IV toxicity was mucositis in group A and skin reaction in control arm. At a median follow-up 13 months the median progression free survival in group A was 11.5 months and 9 months in group B. Conclusion: Response to induction chemotherapy was useful as predictive factor for ultimate outcome and progression free survival. But our study shows statistically significant improvement in complete response rate in group A as compared to group B (p<0.05). Our induction chemotherapy with two-drug regimen followed by concurrent chemoradiotherapy was well tolerated with manageable toxicity and good locoregional control.
ABSTRACT
Head and neck cancers are not curable yet but survival and local control has been increased due to concurrent treatment approach. Study was conducted to assess the role of concurrent Gemcitabine (2'2' Difluro Deoxycytidine) along with radiotherapy in treatment of Head and Neck cancers and to assess local control as well as disease free survival achieved due to chemoradiation. 100 patients were enrolled in this study, 50 patients received Radiotherapy (Group A- Control group) alone and 50 patients received Concurrent Chemoradiotherapy (Group B- Study group). Patients in study group received Gemcitabine 200mg/m2 on weekly basis for 5-7 cycles over 30 mins. Radiation delivered after 2 hours of IV infusion. Conventional radiotherapy was given in dose ranging from 66-70Gy in 33-37# for 6-7weeks. In this study, Grade 3 mucositis and Grade 2 pharyngeal toxicity were common i.e, 56% and 54% respectively in study group and 30% and 38% respectively in control group. Hematological toxicity i.e., Grade 1 leucopenia was seen in 28%. Even though the toxicities were high in study group compare to control group but they were tolerable and acceptable. The response was better in concurrent group than radiotherapy alone (Control group) CR 52% vs 40%, PR 34% vs 36% and SD 14% vs 24%. Concurrent use of gemcitabine and radiotherapy is a effective modality in treatment of head and neck cancers with acceptable toxicity. Improved local control shows that Gemcitabine acts as a sensitizers and has synergistic action along with radiotherapy.