Comparison of the Locoregional Outcome, Toxicities, and Compliance between Hypofractionated and Conventional Chemoradiotherapy for Head‑and‑Neck Cancers

Introduction:Head‑and‑neck cancer (HNC) treatments are elusive, and the hunt for an appropriate radiation strategy continues.Hypofractionation has the potential to provide several advantages, including a shorter overall duration that reduces rapid repopulation, dosage escalation with a higher biologically effective dose, and patient convenience. Hypofractionation is also beneficial in minimizing the danger of catching an infectious agent by reducing the number of hospital visits during the height of the COVID‑19 epidemic. Materials and Methods: Between January 2020 and August 2021, 120 patients with squamous cell carcinoma of the head‑and‑neck subsites were randomly allocated to either the hypofractionated arm A (n = 60) or the standard fractionation arm B (n = 60) with concomitant treatment. Results:Locoregional tumor response, acute and late toxicity, and compliance were the study’s endpoints. The normal tissue toxicities of each patient undergoing radiation were monitored weekly. Clinical and radiographic evaluations of locoregional control were conducted. Conclusion:Hypofractionation effectively overcomes tumor repopulation in rapidly growing tumors such as HNC, and we conclude in our study that the hypofractionated chemoradiation schedule appears to be more efficacious, with relatively superior locoregional control when compared to conventional chemoradiation with comparable normal tissue toxicities and compliance

Assessment of quality of life among head-and-neck cancer patients

Objectives: To assess QOL of different head and neck cancer patients. Materials and Methods: A cross sectional study of 35 subjects with HNC was selected based on the type of cancer. After a background study, 35 subjects were chosen classifying on the type of cancer and were assessed using an interview schedule. Results: Physical as well as emotional score was poor among the group (312.5 and 349.5). The results had a high degree of variation. Conclusion: QOL among HNC patients were concluded to be poor

Metronomic palliative chemotherapy in locally advanced, recurrent and metastatic head-and-neck cancer: A single-arm, retrospective study of a regional cancer center of North India (Asia)

Background: Head-and-neck cancer is the most common cancer in developing countries of Southeast Asia. Most of the patients present to the hospital in advanced stage and have a poor prognosis. This study aims to evaluate the efficacy and toxicity profile of oral metronomic chemotherapy (MCT) in the form of methotrexate and celecoxib in locally advanced, recurrent and metastatic head-and-neck cancers. Materials and Methods: This was a single-arm retrospective observational study that included posttreatment patients with locally advanced, recurrent and metastatic disease in the year 2016 (January 1, to December 31, 2016). A total of 84 patients warranting palliative chemotherapy but not willing to take intravenous chemotherapy were included in the study. The oral MCT schedule consisted of oral celecoxib (200 mg twice daily) and oral methotrexate (15 mg/m2/week). Response evaluation was done using the Response Evaluation Criteria in Solid Tumors criteria version 1.1, and toxicity profile was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Descriptive statistics and Kaplan–Meier analysis were performed. Results: Eighty-four patients, 68 males and 16 females, with a median age of 62 years (range: 35–80 years), were enrolled in the study to receive oral MCT. The Eastern Cooperative Oncology Group performance status was 0–1 in 62 patients and 2–3 in 22 patients. The primary sites of disease were buccal mucosa (18), tongue (22), tonsil (24), lower alveolus (7), hypopharynx (10), and soft palate (3). The best clinical response rate in post oral MCT was seen in the first 4 months (120 days). Objective response was observed in 67% of patients in the form of stable disease (56%) and partial response (11%). Disease progression was observed in 27% of patients. The median follow-up was 192 (6.4 months) days. The median estimated overall survival was 195 (6.5 months) days. The median estimated progression-free survival was 110 (3.6 months) days. Symptomatic relief with respect to pain was reported in about 75% of patients. Eighteen (21%) patients had Grade I–II mucosal reactions. Grade III–IV mucosal reactions were observed in five (6%) patients. Seventy-eight (93%) patients died at the end of the study at 1 year. Dose reduction was required in 15 (18%) patients. Conclusion: Oral MCT using celecoxib and methotrexate is an effective, economical, and well-tolerated regimen with good pain control and low toxicity profile in patients with locally advanced, recurrent and metastatic head-and-neck cancer.

Head and neck squamous cell carcinoma in HIV, HBV and HCV seropositive patients - Prognosis and its predictors

Introduction: Patients receiving treatment for head-and-neck squamous cell carcinoma (HNSCC) also may have coexisting viral infections caused by HIV, HBV, and HCV (seropositive). There is scarce literature regarding the clinical presentation and treatment outcomes for these patients with coexisting viral infections (seropositive HNSCC). We conducted this study to assess the clinical presentation and treatment outcomes (overall survival [OS] and disease-specific survival [DSS]) of seropositive HNSCC patients. Methodology: This was a retrospective cohort study on seropositive HNSCC patients registered at our center from 2012 to 2014. The viral infections were identified by the presence of the antibodies to these viruses in the patient's blood samples. Results: Out of the 19,137 HNSCC patients registered, 156 patients had HBV, HCV, and/or HIV infection. Among these, HBV infection was the most common (n = 86/156, 55.1%) followed by HIV infection (n = 36/156, 23.1%) and HCV infection (n = 29/156, 18.6%). The oral cavity was the most common subsite involved. Majority of these patients presented at an advanced stage (advanced T stage – 71.8% and node positive – 62.2%). The majority of the patients received curative-intent treatment (65.4%). The OS at 3 years for these HNSCC patients with coexisting HIV, HBV, and HCV infection was 60%, 62.6%, and 57.5%, respectively, and their DSS at 3 years was 58.8%, 78.6%, and 53.8%, respectively. Conclusions: Seropositive patients with HNSCC often present in the advanced stage but have a good survival if treated appropriately

Palliative head-and-neck radiotherapy with cyclical hypofractionated radiotherapy (Quad Shot): A single-institutional experience

Background: This study aims to report on our institutional experience of palliative radiotherapy (RT) in the locally advanced head and neck by cyclical hypofractionated RT (Quad Shot) which is a short-course palliative regimen with good patient compliance, low rates of acute toxicity, and good response rates. Objectives: The objectives of the study were to review the use of the Quad Shot technique at our institution to quantify the palliative response in locally advanced head-and-neck cancer. Materials and Methods: Between April 2017 and July 2019, 45 patients with biopsy-proven squamous cell carcinoma of the head-and-neck region at the Department of Radiotherapy, Nil Ratan Sircar Medical College, Kolkata, which were deemed to be fit for palliative RT by departmental tumor board were given cyclical hypofractionated palliative RT as 14 Gy in four fractions over 2 days, twice daily, repeated every 4 weeks for a maximum of 3 cycles. Retrospective assessment was done for improvement in pain and dysphagia and also response to treatment. Results: Pain response occurred in 66.7% of the patients. The mean pain scores decreased significantly from pre- to post-treatment, 47.4 to 21.5 (P < 0.0001). The mean initial dysphagia score improved from 21.9 to 38.2 (P = 0.0002). About 60% of patients developed mucositis (≤ Grade 2), while no Grade 3 mucositis was reported. A total of 30 patients had partial response (66.67%) and 6 patients had stable disease. However, a total of nine patients had progressive disease which included those patients that were given fewer courses of Quad Shot. Conclusion: In locally advanced head-and-neck cancer patients particularly with poor performance status or elderly patients who are in dire need of some form of local therapy for symptom control and palliation, the hypofractionated palliative RT regimen (Quad Shot) offers an effective and quick treatment option which is beneficial both clinically and in logistics issue.

Reducing planning target volume margins decreases dose to parotid glands in head and neck cancers - a dosimetric analysis

Introduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup and reproducibility is a challenge. This daily variability causes setup errors which accounts planning target volume margins. Reduced PTV margins have to be taken to decrease the dose to the parotid glands, without compromising on loco regional control rates. The present study is done to identify setup errors and see the feasibility to decrease the PTV margins by creating dummy radiotherapy plans in order to decrease dose to parotid glands. Material and Methods: 420 portal images were evaluated for setup errors in three dimensions (Antero Posterior, Left to Right and Superior to Inferior) which were performed in ten patients of oropharyngeal squamous cell carcinoma. All patients were treated in supine position using immobilization cast. After target volume delineation a PTV margin of 7mm was given. Dosimetric parameters of PTV and organs at risk were assessed. PTV margins were calculated according to three methods proposed by Stroom, Van Herk and ICRU 62. Dummy radiotherapy plans were generated using new PTV margins and compared with 7mm PTV margins. The data was analyzed using 3-way ANNOVA test for statistical significance. Results: The optimum PTV margins were 4mm in LR and SI direction and 7mm in AP direction. The PTV parameters (V95, D95, Dmax, Dmean, HI and CI) had no significant difference among different radiotherapy plans with different PTV margins. There was a significant decrease in the dose to right parotid (39.12 Gy to 32.88Gy; p-0.04), left parotid (37.90 to 31.21Gy; p-0.03) and parotid combined (38.65 to 31.45 Gy; p-0.01) when 7mm PTV margins were reduced to 4mm PTV margins. The results of dummy radiotherapy plans using asymmetric PTV margins (LR-4mm, SI-4mm and AP-7mm) and symmetrical PTV margins (4mm in all directions) are compared with PTV margins (7mm in all directions), in terms of PTV and OAR dosimetric parameters. Conclusion: The decreased PTV margins of 4mm decreases the dose to the parotid significantly. The implementation of radiotherapy plans needs to be supplemented by daily IGRT.

Efficacy of Zinc Preparation for Radiation-induced Oral Mucositis in Head and Neck Cancers ：A Meta-analysis / 中国药房

OBJECTIVE： To systematically evaluate therapeutic efficacy of Zinc preparation for radiation-induced oral mucositis （ROM） in head and neck cancers， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Medline， Embase， the Cochrane library， CJFD，VIP and Wanfang database， RCTs about additional use of Zinc preparation （trial group） in adjunctive treatment of ROM in head and neck cancers base on routine treatment or blank control （control group） were collected during database establishment to Dec. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0， Meta-analysis was carried out for the incidence of ROM within 2 weeks after medication， total incidence of ROM and the incidence of serve ROM by using Rev Man 5.3 statistical software. RESULTS： A total of 8 RCTs were included， involving 550 patients. Results of Meta-analysis showed that there was no statistical significance in the incidence of ROM within 2 weeks [OR＝0.55， 95％CI（0.26，1.17）， P＝0.12]， total incidence of ROM [OR＝0.59， 95％CI（0.08，4.39）， P＝0.60] or the incidence of serve ROM [OR＝0.58， 95％CI（0.23，1.47）， P＝0.25] between 2 group. CONCLUSIONS： Based on routine therapy or blank control， additional use of Zinc preparation can not reduce the incidence and control the development of ROM in head and neck cancers.

Frequência de comorbidades associadas ao tratamento radioterápico de cabeça e pescoço / Frequency of comorbities associated with radiotherapic head and neck treatment

Introdução: a radioterapia é uma das principais modalidades de tratamento das neoplasias malignas de cabeça e pescoço. Entretanto sua ação não se restringe às células cancerígenas, produzindo efeitos colaterais comumente reportadas pelos pacientes. Objetivo: avaliar a ocorrência de comorbidades de interesse para o Cirurgião-dentista, relacionadas ao tratamento oncológico em pacientes submetidos a radioterapia de cabeça e pescoço (RCP) associada ou não a quimioterapia em um serviço de referência do Sistema Único de Saúde na cidade de Salvador-BA. Metodologia: foram incluídos 35 indivíduos submetidos a RCP associado ou não a quimioterapia. Foi realizada consulta odontológica a cada 48 horas, a fim de identificar queixas de disgeusia, disfagia e xerostomia e a instalação de lesões orais, como candidíase e mucosite oral. Resultados: 82,9% da amostra foi composta de indivíduos do gênero masculino e 17,1% do feminino, com idade média de 58,2 anos. Com relação às comorbidades relativas ao tratamento radioterápico em região de cabeça e pescoço, pode-se observar alta prevalência de mucosite oral (74,28%), disfagia (60%), candidíase (40%) e, em menor número, disgeusia (22,85%) e xerostomia (14,28%). Conclusão: a RCP, embora se apresente como uma eficiente modalidade terapêutica para neoplasias malignas, usualmente se associa a uma série de complicações na região irradiada. Na amostra estudada, a mucosite oral foi a comorbidade mais frequente, seguida de disfagia e candidíase.

Introduction: radiation therapy is one of the main treatment modalities for malignant head and neck neoplasms. However its action is not restricted to cancer cells, producing side effects commonly reported by these patients. Objective: evaluating the occurrence of comorbidities of interest to the dentist related to cancer treatment in patients undergoing head and neck radiotherapy (CPR) associated or not with chemotherapy in a reference service of the Unified Health System in Salvador-BA. Metodology: 35 individuals submitted CPR with or without chemotherapy were included. Dental appointments were performed every 48 hours to identify complaints of dysgeusia, dysphagia and xerostomia and oral lesions development such as candidiasis and oral mucositis. Results: 82.9% of the sample was composed of males and 17.1% females, mean age 58.2 years. It is possible to observe an occurrence of oral mucositis (74.28%), dysphagia (60%), candidiasis (40%) and, in a smaller number, dysgeusia (22.85%) and xerostomia (14.28%) the occurrence of oral mucositis in the head and neck region may be observed. Conclusion: head and neck radiotherapy, although presenting as an efficient therapeutic modality for malignant neoplasms, is usually associated with a series of complications in the irradiated region. In the studied sample, oral mucositis was the most prevalent comorbidity, followed by dysphagia and candidiasis.

Clinicopathological study of cervical lymphadenopathy at rural tertiary health care centre

Background: To describe the diversity of clinical manifestations, laboratory findings and outcome of chikungunya fever in patients attending SMS Hospital, Jaipur during the epidemic of 2016 (September to November).Methods: All cases of febrile illness with polyarthralgia/polyarthritis diagnosed as chikungunya were analyzed. Diagnosis was made by ELISA based IgM serology and RT PCR assay.Results: A total of 200 cases were studied. All of them presented with fever, severe crippling joint pain & tenderness, headache, anorexia and body rash. On examination, there was periarticular edema, erythema, and tenderness in joints with post auricular and cervical lymphadenopathy. Unusual manifestations were hyper pigmentation of face and forehead and scrotal ulcers. On investigations patient had leucopenia with elevated level of SGOT, SGPT with normal bilirubin levels. Other complications observed were encephalopathy, encephalitis, myocarditis and hepatitis. There was no mortality in this group.Conclusions: Chikungunya though prevalent is under-reported. The diagnostic certainty is mandated by presence of febrile transiently crippling polyarthragias / arthritis. On analyzing a large series, unusual clinical features may emerge

Multiple Regression Analysis of Predictors of Bone Scintigraphy Positivity in Patients with Head and Neck Cancers / 대한핵의학회잡지

PURPOSE: The value of bone scintigraphy (BS) in patients with head and neck cancers (HNCs) has been questioned, with conflicting findings regarding positivity yield with some reports recommending BS be omitted from work-up of HNC patients since it rarely yields positive results. This study aims to determine the positivity yield of BS in HNCs and to determine predictors for BS positivity to help tailor appropriate BS utilization.METHODS: BS studies of HNC patients were reviewed, the positivity yield was determined. Clinical predictors for BS positivity including age, sex, site of cancer, staging, histological grading were analyzed using univariable and multivariable logistic regression.RESULTS: Among the 259 BS studies included, 35 (13.5%), 194 (74.9%), and 30 (11.6%) were positive, negative, and equivocal for bone metastasis, respectively. After exclusion of equivocal cases, 229 were analyzed in the regression models. Independent predictors of BS positivity include site of tumor at the nasopharynx (OR 4.37, 95% C.I. 1.04–18.41, p = 0.044), age less than 45 years (OR 3.01, 95% C.I. 1.24–7.33, p = 0.015), and presence of distant metastasis to other organs (OR 3.84, 95% C.I. 1.19–12.43, p = 0.025).CONCLUSIONS: In contrast to several studies, bone metastasis as detected by BS was found in a relatively high proportion of patients with HNCs. Independent predictors of BS positivity include the age of less than 45 years, tumor site at the nasopharynx, and the presence of extraskeletal distant metastasis. BS could be useful in patients with these characteristics which enhance the pretest probability of bone metastasis.

Recent progress in protecting salivary gland function after radiotherapy for patients with head and neck cancers / 中华放射医学与防护杂志

Radiation-induced salivary glands damage is one of the most frequent complications of head and neck cancers after radiation therapy. It leads to a series of symptoms which severely affect the quality of life, such as soreness of mouth, difficult talking, dysphagia and so on. Therefore, it is important to protect the function of salivary glands. In this review, relevant approaches to protecting the function of salivary glands after receiving the radiotherapy are discussed from several aspects,such as radioprotective drugs, radiotherapy technology molecular biology.

The necessity of a specialized training program for head and neck surgeon: what should be done to become an extraordinary head and neck surgeon / 中国癌症杂志

Head and neck cancers contain a wide range of diseases which put threats to public health. Training of specialized head and neck surgeon is a must for the development of the specialty. Surgical treatment of head and neck cancers can easily compromise normal appearance and function of patients owing to the complicated anatomical structures of the area. Therefore, treatments often demand multidisciplinary involvement led by surgeons. Attentions should be paid to diverse cancers, multiple techniques, distinct surgeries, complex anatomy and function protection when training a specialized head and neck surgeon. A specialized surgeon must be devoted to basic research, have a full picture of the disease, be involved in multidisciplinary treatment and focus on specialized surgical maneuvers. To become a specialized head and neck surgeon, one should go through basic knowledge of the area, read extensively, keep up with the literature and never stops practicing. The undisputed factor is that an extraordinary head and neck surgeon can not only benefit patients but also promote the profession.

Multi detector computerized tomography scans aid in the staging of Head and Neck cancers

Introduction/Objectives: To assess the efficacy and correlation of MDCT scans in the clinical staging of patients with HNCs prior to therapeutic intervention. Methodology: Thirty-four HNCs were studied according to the 2005 WHO. Clinical AJCC 6th edition & radiological staging. Results: 14 Squamous Cell Carcinoma (SCC 41.2%) mean age 49.4 + 14.7 years, 13 Nasopharyngeal Carcinoma (NPC 38.2%) mean age 37.1 + 20.5 years, 3 Odontogenic Carcinoma (ODC 8.8% made up of 2 cases ameloblastic carcinoma 5.9% and 1 case of ameloblastic carcinosarcoma 2.9%). Others cases were 3 Adenocarcinoma (8.8%) and 1 Sinonasal Carcinoma NC (2.9%). Mean age insignificant according to gender (p = 0.342). Sensitivity, specificity, positive & negative predictive values and accuracy of clinical and radiological nodal involvements were: (47.4%; 80%; 61.8%; 75%; 54.5%) & (78.9%; 93.3%; 85.3%; 93.8%; 77.8%) respectively. Difference between clinical and radiological stages was statistically significant (X2= 260.8; p=0.01). There was a low but positive correlation between the clinical and radiologic stages (Pearson's correlation r = 0.6). Conclusion: MDCT was significantly more accurate than clinical examination in the TNM of HNCs using AJCC/UICC TNM guidelines. Authors recommend MDCT as first line imaging technique in resource limited settings (AU)

Twice‑weekly palliative radiotherapy for locally very advanced head and neck cancers.

PURPOSE: The purpose of the following study is to evaluate the efficacy of a twice‑weekly hypofractionated palliative radiotherapy schedule in locally very advanced head and neck cancers. MATERIALS AND METHODS: Patients with locally very advanced, head and neck cancers were prospectively evaluated after twice‑weekly palliative radiotherapy regimen of 32 Gy in 8 fractions. Median age was 55.5 years and the predominant primary site was oral cavity (46%). Majority (70.6%) had Stage IV B disease. Disease related distressing symptoms such as pain, bleeding, skin fungation, respiratory symptoms due to tumor burden, were prospectively assessed before the start of treatment, at conclusion and at 6‑12 weeks of completion of treatment. RESULTS: A total of 126 patients were enrolled in the study. Ninety three (73.8%) patients who completed the planned treatment of 32 Gy in 8 fractions were included in the symptom analysis. Overall response rates were 42% at primary disease and 55% at nodal disease. At conclusion of radiotherapy 76.3% of the patients reported improvement in pain scores (P = 0.001) and 42.8% patients reported improvement in anxiety and depression levels (P = 0.001). At first follow‑up after 6‑12 weeks significant improvement in pain scores (P = 0.001) and anxiety/depression levels (P = 0.001) persisted. The median survival of the patients was 5.5 months. Acute grade III mucositis was seen in one patient (1.2%) while none had grade III skin reactions. CONCLUSION: The proposed radiotherapy regimen is effective for sustained symptom palliation with low acute toxicity in locally very advanced head and neck cancers. It delivers a moderately high dose while being logistically simpler for the patient.

Epidemiology of Head and Neck Cancers in Maiduguri-Northeastern Nigeria.

Head and neck cancers is one of the common health problems in our environment affecting relatively the youth. The paucity of literature on community based studies in Nigeria to determine the incidence of the disease obscure its burden, pattern and magnitude. This study presents epidemiological characteristics of head and neck cancers in Maiduguri as seen during the period of insurgency. A 5 year retrospective review of patients seen from January, 2010 to December, 2014 with histologically diagnosed head and neck cancers. Data extracted from the records of histopathology department of University of Maiduguri Teaching Hospital was analyzed using SPSS version 16.0. Of the 7655 patients, 1312 (17.14%) were cancers and 217 (16.54%) of this was head and neck malignancies. Average age was 35.5years with SD±20.07. About 69% of cases were epithelial in origin and 60.83% of patients were less than 41 years of age. The age group worse affected by carcinoma is older than those with sarcoma and lymphoma. Head and neck is not uncommon in Maiduguri even in the face of insurgency, it is also among one of the common health problems of the relatively young. This therefore call for in-depth research on aetiological factors. Relevant authorities shall also establish oncology centers which will promote education, screening programmes, early detection, prevention and control of head and neck cancers.

Efficacy of second‑line erlotinib in patients postprogression of first‑line chemotherapy in head and neck cancers.

BACKGROUND: Oral tyrosine kinase inhibitor (gefitinib and erlotinib) have been used in the palliative treatment of head and neck cancers with limited success. In this report, we aim to quantify the symptomatic benefit, progression‑free survival (PFS) and overall survival (OS) when erlotinib is given as second‑line treatment in Head and neck cancers. METHODS: This was a post‑hoc retrospective analysis of a randomized study comparing metronomic chemotherapy with cisplatin. A patient who progressed on chemotherapy and had a PS0‑2 were offered second‑line chemotherapy. Patients who had received erlotinib (150 mg PO OD) as second line treatment were selected for this analysis. Erlotinib was discontinued in case of either progression of disease or if the patient had intolerable side effects. Patient were monitored 1‑week after the start of erlotinib and subsequently at monthly intervals. The toxicity was recorded in accordance with CTCAE version 4.02 (NCI,USA) and the response were graded in accordance with RECIST version 1.1. All of these patients were followed‑up till death. RESULTS: Twenty‑three patients were identified. The median age of these patients at the start of the second line was 47 years (interquartile range 40.5–51.75 years). The primary site of distribution was oral cavity primary in 17 patients (77.3%) and nonoral cavity primary in 05 (22.7%) patients. The immediate last chemotherapy regimen received was cisplatin in 9 patients (40.9%) and metronomic chemotherapy in 13 patients (59.1%). Symptomatic benefits post second‑line erlotinib was seen in 18 patients (81.8%). The most common adverse events (any grade) seen were anemia in 20 patients (90.9%), rash in 10 patients (45.5%) and diarrhea in 7 patients (31.8%).The best radiological response documented were a partial response in 04 patients (19.2%). The median estimated PFS and OS were 110 days (95% confidence interval [CI]: 61–175 days) and 156 days (95% CI: 126–185 days) respectively. CONCLUSION: Erlotinib single agent has promising activity in the second line and needs to be explored in future studies.

Weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy.

OBJECTIVE: To study the safety and efficacy of weekly chemotherapy as part of induction chemotherapy, in locally advanced head and neck cancer for patients, who are unfit for upfront radical treatment. MATERIALS AND METHODS: It is a retrospective analysis of on‑use weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer, who are technically unresectable are unfit for upfront radical treatment. Induction chemotherapy given was a 2 drug combination of paclitaxel (80 mg/m2) and carboplatin AUC 2. The decision to give weekly induction chemotherapy was given on the basis of presence of 2 more following features: Poor performance status (ECOG PS 2‑3), presence of uncontrolled co morbidities, BMI below 18.5 kg/m2 and age more than 60 years. The Statistical Package for the Social Sciences software (SPSS version 16.0) was used for analysis. The response rates, toxicity (accordance with CTCAE vs. 4.02), completion rate (Cp) of radical intent treatment post neoadjuvant chemotherapy (NACT), progression‑free survival (PFS) and overall survival (OS) are reported. RESULTS: Fifteen patients were considered for such therapy. Fourteen out of fifteen patients completed NACT. The median numbers of planned weekly cycles were 6 (3-8). Response (CR + PR) was seen in 10 patients. Overall grade 3-4 toxicity was seen in 6 patients. No toxicity related mortality was noted. The calculated completion rate (Cp) of radical intent treatment post NACT was 46.7%. The median PFS and OS were 10.36 months (95% CI 6.73-14.00 months) and 16.53 months (95% CI 4.22-28.84). CONCLUSION: Use of induction chemotherapy with weekly regimen is safe and effective selected cohort of patients with locally advanced disease who are unfit for upfront radical treatment.

Infection of human papillomaviruses in cancers of different human organ sites.

Clinico-epidemiological and molecular studies have established the casual link between Human Papillomavirus (HPV) infection and cervical cancer as also association of HPV infection with several other cancers. In India, cervical cancer is a leading cancer among women and almost all cases of cervical cancer show prevalence of High Risk (HR)-HPV infection. HPV has been also detected in a significant proportion of oral, esophageal, anal, vaginal, vulvar, and penile cancer and in a small percentage of lung, laryngeal, and stomach cancer in India. Due to lack of organized HPV screening program, insufficient infrastructure and trained manpower and inadequacy in cancer registries, there are not much data available on the countrywide HPV prevalence and its type distribution in different cancers in India. Forthcoming introduction of recently developed HPV vaccines in India given a new urgency to know the prevalence and distribution of various HPV types in different organ sites for the management and monitoring of vaccination program and its impact on prevalence of other cancers. This review, summarizes studies on the prevalence of HPV infection in cancers of different organ sites in India.

Quality assurance of stereotactic radiotherapy in head and neck cancer / 医疗卫生装备

Objective To introduce the methods for quality assurance of stereotactic radiotherapy in head and neck cancers.Methods Firstly,thirty cases were randomly selected.Secondly,patients were set up with Topsland fixtures,and their heads & necks were fixed with plastic masks,on which windows were open and the signs of reposition were marked.Thirdly,the treatment plan was designed by GE-helical CT-scan and Topsland plan system.Finally,after certification eligibility,the treatment plan was performed to record the parameters of anterior-posterior and analysis errors of setting up.Results: The testing results revealed that the position error was no more than 2mm.Conclusion: QA is a very important measure to guarantee the precision of stereoscopic directional radiotherapy.Only when the QA measure has been strictly carried out,the precise and satisfactory effect can be obtained.

A Clinical Study of Head and Neck Tumors Involving the Superior Mediastinum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, approaches to the superior mediastinum for head and neck surgeons are mainly limited to stomal recurrence. Recently, the need to approach to the superior mediastinum is increasing due to increasing thyroid surgery by head and neck surgeon. This study was designed to evaluate the approaches to mediastinum in head and neck tumors involving the superior mediastinum and to analyse the outcome of surgery in terms of morbidity and mortality. MATERIALS AND METHODS: At the department of otolaryngology-head and neck surgery of Hallym university, 15 patients who had been diagnosed as head and neck tumors involving the superior mediastinum from May 1990 to August 1998 were evaluated retrospectively. RESULTS: Of the 15 patients, the tumors involving the superior mediastinum were thyroid cancer (5 cases), hypopharyngeal cancer (4 cases), cervical esophageal cancer (2 cases), laryngeal cancer (1 case), and substernal goiter (3 cases). The surgical techniques used for approach to the superior mediastinum were suprasternal approach, clavicle resection, median sternotomy, and sternal manubrium resection. Eight patients are alive without recurrence, one patient is alive with disease, and six patients died, among them, four patients died of postoperative complication and two died of recurrent cancer. CONCLUSION: The mediastinal approach in itself is not complex and dangerous, however, in the treatment of head and neck cancers involving mediastinum, the surgeon should be careful in choosing the surgical method and approach. The surgeion should also take into consideration morbidity and mortality of the surgery, degree of tumor invasion and others, such as age of the patient.