ABSTRACT
PURPOSE: We report the outcomes of patients treated with palliative radiotherapy (pRT) to the primary tumour in the context of well-controlled metastatic disease after initial chemotherapy. MATERIALS AND METHODS: Clinical records of 132 patients with metastatic esophago-gastric (OG) cancer treated with palliative chemotherapy (pCT) between January 2009 and June 2013 were reviewed. Ninetyseven patients had responding or stable disease after 3 months of chemotherapy, of whom 53 patients received pRT to the primary tumour after initial chemotherapy in the presence of well-controlled metastatic disease (group A, pCT-RT). The remaining 44 patients were treated with pCT alone (group B, pCT). Treatment-related outcomes were assessed in above groups including time to local progression (TTLP), progression-free and overall survival. RESULTS: The median overall survival for patients treated with pRT after initial chemotherapy (group A) was 23.3 months (95% confidence interval [CI], 17.70 to 28.89 months) and significantly higher than the 14 months (95% CI, 10.91 to 17.08 months) in patients treated with pCT alone (group B) (p < 0.001). The use of pCT-RT was an independent predictor of OS in multivariate analysis. Local recurrence was observed in 12/53 of patients (23%) in group A compared to 16/44 (36%) in group B. The median TTLP was significantly higher in patients after pCT-RT at 17.3 months (5.23 months to 44.50 months) compared to 8.3 months (range, 4.10 to 25.23 months) in patients treated with pCT alone (p=0.006). CONCLUSION: The possibility of pRT influencing systemic disease in advanced OG cancer has not been reported, and results from the present study present strong arguments for investigation of this therapeutic strategy in a randomized trial.
Subject(s)
Humans , Drug Therapy , Esophageal Neoplasms , Multivariate Analysis , Palliative Care , Radiotherapy , Recurrence , Stomach NeoplasmsABSTRACT
Background: Consumption of unpasteurized milk is fairly common in Indian society which may lead to various health problems like Brucellosis, anthrax etc. Aims & Objective: To educate and motivate people for use of packed and pasteurized milk. Materials and Methods: This was cross sectional study done in urban slums of Indore. The study done in 120 families, 30 families were selected randomly from each slum who used milk from street vendors. Milk samples were collected from these families for quality testing. Educational intervention regarding advantages of pasteurized milk was given and repeat survey after one month was done to observe behaviour change. Statistical analysis done by chi square test, Mac Nemar test with p value <0.05 was considered significant. Results: Unawareness about benefits of pasteurized milk (84%) and flexibility of making payment to the street vendors were the major causes for purchase of milk from street vendors. Gerber test and corrected lactometer test revealed 50% and 73% samples were moderate to grossly dilute. Standard plate count for bacteriological analysis revealed all samples (100%) to be good (E. coli count < 10,00,000/ml) but none of them was very good (< 2,00,000/ml) . boiled milk samples had better quality , chi square p < 0.0001. Educational intervention resulted in behaviour change of 27(22.5%) families which was significant, Mac Nemar p <0.0001. Conclusion: Educational intervention had significant effect on behaviour change of people and the families who continued to take milk from street vendors even after educational intervention had no specific reason for it.
ABSTRACT
Presentation and results of metastatic spinal cord compression [MSCC] treated with radiotherapy at Salmaniya Medical Complex [SMC] between July and December 1997 are reported. Out of 96 cancer patients who were treated with radiotherapy, 12 [12.5%] patients had MSCC. This incidence of MSCC was higher than the incidence in the literature. Five patients were ambulatory, three patients had mono/para paresis and four patients had paraplegia berfore the treatment. Radiotherapy dose ranged from 40 Gy in 20 fraction to 20 Gy in 5 fraction. Following radiotherapy patients who presented with mono/paraparesis regained the ambulation and patients who had no neurological signs at presentation maintained ambulation till the last follow up [median 5 months]. Neurological improvement in patients with paraplegia was not enough to make them ambulatory. Compared to earlier reports of MSCC treated with surgery at SMC, there appeared to be an increase in the number of patients with MSCC and its diagnosis at early stage. Radiotherapy was effective in preventing paraplegia in patients with MSCC who were diagnosed and referred early for management. The increase in the number of MSCC as factual or a reference pattern should be assessed in long term analysis