ABSTRACT
Cancer is one of the leading causes of morbidity and mortality worldwide & cancer pain is experienced by patients with advanced, metastatic and terminal disease. Buprenorphine, a partial µ-receptor agonist and antagonist at the kopioid receptor, shows no clinically relevant accumulation of active metabolites, and pharmacokinetics remain unchanged in renal insufficiency. In elderly cancer patients, the use of opioids for control of cancer pain is a therapeutic challenge, as these group of patients often associated with renal and hepatic comorbidity that limited the use of strong opioids like morphine. Methods : A retrospective observational study was conducted in elderly patients to estimate the efficacy of transdermal buprenorphine patch for controlling of cancer pain as well as to assess the safety of the patch. For pain control Numerical Rating Score (NRS) was used & for safety assessment Grade 3 or 4 toxicity were recorded.Hepatic & renal toxicity were measured at baseline, at 1st month & at 3rd month of treatment & lastly at 6th month of treatment. Results : Majority of the patients showing good to excellent global satisfaction with Buprenorphine patch and 57% of patients suffered from constipation along with 38% nausea & vomiting. It was found that there was a significant reduction in pain intensity from baseline with a p value of <0.05. There was no significant hepatic or renal toxicity found in the study. Conclusion : Transdermal buprenorphine patch is effective and safe in elderly cancer patients for pain control. Further studies should be performed in order to find safe and effective opioid methods necessary to give greater insight into the difficult balance between analgesia and toxicity
ABSTRACT
Background : The presenting study was performed to assess the efficacy in terms of tumour response and toxicity profile of a curative intent organ preservation approach in Inoperable Non-metastatic Muscle-Invasive Urinary Bladder Carcinoma. Materials and Methods : Prospective Interventional Single-Arm, Single Center study with a duration of one and half year in which 47 patients with Muscle-invaded Bladder Cancer were treated with Radiotherapy with 64 Gy in 32# along with Concurrent Chemotherapy with three weekly injection Cisplatin in dose of 70 mg/m2. Response evaluation was done using both Clinical and Radiological means and categorized using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. For adverse events measurement: NCI CTCAE (Common Terminology Criteria for Adverse Events, v4.1) and RTOG/EORTC Acute and Late Morbidity criteria was used. Results : Of the 47 patients who completed chemoradiation, complete treatment response was seen in 25 patients (53.2%), 17 patients (36.2%) had partial response on initial assessment and one patient had disease progression both in form of locoregional and distant (lung) metastasis. Stable disease found in (8.5%). Patients with residual disease were advised to undergo salvage treatment. Grade 3 Nephrotoxicity reported in one patient, Grade 2 Cystitis in 32 patients (68.1%), while Grade 2 Diarrhoea occurred in four patients (8.5%). Hematological toxicity attributable to Chemoradiotherapy included Grade 2, Grade 3 Neutropenia seen in 6.4% and 2.1% respectively and Grade 2 Anaemia in 4.3% patients. Conclusion : Concurrent Chemoradiotherapy is well-tolerated, effective and convenient curative treatment option for patients with Inoperable Non-metastatic Muscle Invasive Carcinoma of Urinary Bladder