A comparison of results by sequential and concurrent chemo radiotherapy in locally advanced carcinoma esophagus.

Aim: Many Trials using sequential and concurrent chemo radiotherapy have been done so far and has established the role of concurrent chemo radiotherapy in treatment of inoperable carcinoma esophagus. In this study, we have compared the results of concurrent chemo radiotherapy with sequential chemo radiotherapy. We have treated inoperable carcinoma esophagus in both the settings and present here the comparison of results in the two settings. Materials and Methods: There were 26 patients of carcinoma esophagus in sequential and 31 in concurrent chemo radiotherapy arm. In sequential arm methotrexate and Cisplatin followed by radiotherapy was given whereas in concurrent arm, Cisplatin was given once weekly along with radiotherapy. Results: The 2 year survival was 38% in sequential and35.5% in the concurrent setting and the median survival was 19.5 and 18 months respectively in the two arms.The toxicities in both the arms were comparable. P value of 0.4774 with confidence interval of 95% was obtained, which is not significant. Dysphagia was improved earlier in sequential than in the concurrent arm. Conclusion: As the results and toxicities in both the arms are almost similar with better symptom control, so larger randomized trials are required to assess the response and the use of methotrexate in sequential chemo radiotherapy can be further explored.

Evaluation of 99m Tc-DTPA renal scanning for localization and shielding of the kidneys in patients candidate for abdominal radiotherapy

Clinical radiation nephropathy can result in considerable morbidity and/or mortality. Renal tolerance [TD5/5] has been stated to be 20 Gy when irradiation has been delivered to both kidneys in 3-5 weeks. Therefore to minimize renal toxicity in these patients, localization and shielding of the kidneys are essential. This study was carried out to evaluate the role of 99mTc-DTPA renal scintigraphy in renal localization for perfect shielding. From April 2000 to March 2001, thirteen patients had complete history, physical examination, serum creatinine level, complete blood count, urinalysis and abdominal sonography. Then the patients were referred to nuclear medicine department. After I.V. injection of 10 mCi 99mTc-DTPA, the kidneys were localized by gamma camera and marked on skin. All patients received abdominal radiation with A-P and P-A fields with cobalt 60 machine up to 3000-5000CGY. Kidneys were shielded posteriorly after 1500cGY with 5 HVL [Half value layer] blocks. After minimum follow-up of 24 months, no evidence of increasing blood pressure, edema, proteinuria, rising in serum creatinin or changing in kidney size was found. The results show that localization of kidneys by 99mTc-DTPA is a useful, easy and safe method to shield kidneys in these patients