ABSTRACT
Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05). When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.
ABSTRACT
Subcorneal Pustular Dermatosis (SPD) is a chronic, benign, recurrent, pustular eruption of idiopathic nature mainly involving the trunk, intertriginous area and flexor aspects of limbs. It is a neutrophilic dermatosis and the exact aetiology is unknown. There are only limited number of studies on the clinical and histopathological aspects of subcorneal pustular dermatosis as well as the associations of subcorneal pustular dermatosis especially in our country. Hence the study is of significance at present.METHODSA descriptive study was done on 37 patients with clinical features of SPD who attended a tertiary care hospital in Kerala during a period of one and a half years. A detailed history, dermatological and system examination, histopathology, immunofluorescence & relevant laboratory investigations were done, and results were analysed using appropriate biostatistics.RESULTSMajority of the patients were females and belonged to sixth decade. 97.3% of patients had recurrence of the disease during summer season. Trunk and intertriginous areas were predominantly affected. Hypothyroidism was observed in 21.6% of patients. Four patients developed chronic plaque psoriasis during the follow up.CONCLUSIONSSubcorneal Pustular Dermatosis is a chronic relapsing pustular eruption which can mimic various other conditions in our daily practice. Many diseases including inflammatory diseases, malignancies and metabolic diseases have been reported to be associated with SPD. Hence a better understanding of the associations and underlying conditions helps in providing effective treatment for the patients.