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Background: Radiotherapy in head-and-neck cancer (HNC) is a challenging task, and the anatomical alterations occurring during the course of intensity-modulated radiotherapy (IMRT) can be compensated by adaptive radiotherapy (ART) which utilizes repeat computed tomography (CT) scans during the treatment course for replanning. In this study, the clinical and dosimetric benefits of ART were compared with the conventional IMRT. Materials and Methods: Sixty patients with locally advanced HNC were randomized into two arms to receive IMRT up to a curative dose of 70 Gy with concurrent weekly chemotherapy and were prospectively analyzed between March 2018 and March 2019. Repeat CT scan was acquired after the 3rd week of radiation. Patients in the study arm underwent replanning, whereas those in the control arm continued with the first IMRT plan. Assessment was done weekly till the end of treatment and at 1, 3, and 6 months post IMRT for disease response and toxicities. Tumor volume reduction rate (TVRR) and dose reduction to organs at risk were also recorded. Results: Complete response was observed in 90% and 96.7% patients in the control and study arms, respectively, at the end of 6 months. Insignificant differences were found between the two arms in terms of toxicities. Xerostomia was statistically significantly higher in the control arm at 6 months (P = 0.01). TVRR was found to be 31.85%. Dose to spinal cord, ipsilateral, and contralateral parotid reduced by 4.3%, 6%, and 2.2%, respectively, with ART. Conclusion: Mid-treatment adaptive replanning can help in better target coverage and minimize toxicities in HNC patients
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Background: Brain metastases are the most common intracranial malignancy in adults and their management poses a significant healthcare problem. Of the various options available, whole brain radiotherapy (WBRT) remains the mainstay of treatment. Nonetheless, there is a need to develop fractionation schedules for best symptom palliation and prolonged survival. This prospective study aims to compare treatment outcome in terms of overall survival in two different WBRT schedules and determine the prognostic factors affecting this outcome.Methods: Sixty previously untreated patients with symptomatic brain metastases were randomized in two arms of 30 patients each to receive WBRT. Arm A patients received 30Gy in 10 fractions (long-course) and arm B received 20Gy in 5 fractions (short-course). All patients were assessed during and after completion of WBRT at 1, 3, 6, 9 and 12 months.Results: At 12 months post WBRT, the objective response rate i.e. complete and partial response (CR+PR) was 6.67% in arm A and 13.34% in arm B (p=0.96). Both WBRT regimens showed similar survival (p=0.65). On multivariate linear regression analysis, age ≤65 years, Karnofsky performance score (KPS) ≥70 and lack of extra-cranial metastases were significantly associated with improved survival at the end of 12 months post WBRT. EORTC QLQ-C30 showed similar improvement in quality of life in both the arms (p=0.86).Conclusions: This study suggests comparable results in the two fractionation schedules. Therefore, short-course WBRT may be used as a more convenient option in favour of shorter hospital stay and lesser burden on RT machines.
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Coexistence of acute epiploic appendagitis with acute pyelonephritis is a rare occurrence. Present study report here a case of a 36-year-old male with a past history of appendectomy presenting with complaints of pain abdomen, nausea, increased frequency of micturition and dysuria. On examination, there was tenderness and guarding in the left iliac fossa. CECT abdomen revealed resolving acute epiploic appendagitis with acute pyelonephritis. He was managed conservatively with antibiotics and anti-inflammatory agents to which he responded. Thus, epiploic appendagitis is a benign self-limiting condition which when diagnosed early prevents unnecessary surgical interventions.
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Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.