Dosimetric analysis and clinical outcomes of brachial plexus as an organ-at-risk in head-and-neck cancer patients treated with intensity-modulated radiotherapy

Objectives: To document the dose received by brachial plexus (BP) in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck squamous cell carcinoma (HNSCC) and report the incidence of brachial plexopathy. Methods: Newly diagnosed patients of HNSCC treated with radical or adjuvant IMRT were included in this retrospective study. No dosimetric constraints were applied for BP maximum dose equivalent dose (EQD2 α/β = 3). Patients with minimum 6-month follow-up were included and patients with suspicion of plexopathy were evaluated further. Results: Sixty-seven patients were eligible and 127 BP were analyzed. The mean BP maximum dose (BPmax) was 62.4 Gy (+6.9), while mean BP volume was 28.1 cc (+4.1). Proportion of patients receiving BPmax >66 and >70 Gy were 34.7% and 14.2%. The mean BPmax for T4 tumors was significantly higher than T1 tumors (65 vs. 57.5 Gy, P = 0.005) but when adjusted for N-category, T-category was not independently significant in accounting for BPmax >66 or >70 Gy. Mean BPmax for N0 versus N2+ was 59.8 versus 65.6 Gy (P = 0.0001) and N1 versus N2+ was 61.6 versus 65.6 Gy (P = 0.018). After adjusting for T-category, patients with N2+ had a mean 4.2 Gy higher BPmax than N0-N1 (P = 0.0001). Stage III–IV patients had a mean six Gy higher BPmax doses than Stage I–II disease (P = 0.0001). With a median follow-up of 28 months (interquartile range 16–42), no patient had brachial plexopathy. Conclusion: Clinically significant plexopathy was not seen in spite of majority having over 2-years follow-up and a third of patients having dose above the recommended tolerance. Only nodal category independently influenced dose to the brachial plexii

Significance of salivary phosphodiesterase level in oral squamous cell carcinoma patients.

Oral cancer, more specifically oral squamous cell carcinoma (OSCC) consider as common cancer that 300,000 people diagnosed per year worldwide. The only effective treatment for OSCC is surgical intervention. Over the past two decades, overall disease condition has not improved although advancement of treatment has considerably increased. The phosphodiesterase (PDEs) are responsible for the hydrolysis of the second messengers with a fundamental role in the transduction of the intracellular signals. In numerous pathological conditions such as cellular differentiation, apoptosis, and tumor invasivity the different PDF activity has been observed that shown role in pathophysiological mechanism. The role of PDEs as an intervention factor for activation of angiogenesis by influencing a tumor growth has been shown. The objective of this study was to estimate and compare salivary PDEs levels in healthy controls and biopsy-proven oral cancer patients before definitive therapy. Study was done in patients age between 25-65 years biopsy proven oral cancer patients and control group. After obtaining prior consent from biopsy-proven oral cancer patients (n=26) (before onset of any definitive treatment) and age- and sex-matched healthy controls (n=29), salivary sample was collected for estimation of the activity of phosphodiesterases (PDEs).

Effectiveness of pranayama on the levels of serum protein thiols and glutathione in breast cancer patients undergoing radiation therapy: A randomized controlled trial.

The effect of Pranayama on the levels of protein thiols and glutathione was studied among breast cancer patients receiving radiation therapy. 160 patients were randomised into experimental and control group using block randomisation. The experimental group received fractionated radiation for five days a week and performed Pranayama (Nadishodhana, Brahmari and Sheethali) for 30 minutes twice daily for five days a week. The control group received only radiation. Blood samples were collected from both the groups at the end of six weeks of radiation therapy and analysed for the levels of serum protein thiols and glutathione. An independent sample ‘t’ test showed a significant difference in the level of serum protein thiols between the two groups (t = 4.43 p 0.001). A Mann- Whitney U test showed a significant difference (z = –3.07 p 0.002) in the level of glutathione as well. These Pranayama techniques improve the antioxidant status of breast cancer patients receiving radiation therapy.

Nasal NK/T cell lymphoma presenting as a lethal midline granuloma.

Nasal NK/T cell lymphomas are aggressive, locally destructive, midfacial, necrotizing lesions. The nonspecific clinical symptoms constitute a major stumbling block in the early diagnosis and management of these lymphomas. We report here a case of probable nasal NK/T cell lymphoma in an apparently healthy male that progressed rapidly in a short span of time and was managed subsequently with chemotherapy and external beam irradiation with which the lesion regressed.

Effect of low level helium-neon (He-Ne) laser therapy in the prevention & treatment of radiation induced mucositis in head & neck cancer patients.

BACKGROUND & OBJECTIVES: Oral mucositis is a common debilitating complication of radiotherapy occurring in about 60 per cent of cancer patients. Considerable buccal toxicity of radiotherapy or chemotherapy in cancer patients to become discouraged and can affect their quality of life. In addition, such toxicity can alter the treatment plan. At present, there is no clinically appropriate prophylaxis efficacious antidote for mucositis. The low level laser (LEL) appears to be a simple, non-traumatic technique for the prevention and treatment of radiation induced mucositis. Therefore the present study was carried out to find out the effect of low-level helium-neon (He-Ne) laser in the prevention and treatment of radiation induced mucositis in head and neck cancer patients. METHODS: The patients with carcinoma of oral cavity with stages II-IV a being uniformly treated with curative total tumour dose of 66 Gy in 33 fractions over 6 wk were selected for the study. The patients were divided based on computer generated randamosization into laser (study group) and control groups with 25 patients in each group. Both study and control groups were comparable in terms of site of the lesion, stage of the cancer and histology. The study group patients were treated with He-Ne laser (wavelength 632.8 nm and output of 10mW) and control group patients were given oral analgesics, local application of anaesthetics, 0.9 per cent saline and povidine wash during the course of radiotherapy. RESULTS: All patients tolerated the laser treatment without any adverse effect or reactions. The result showed a significant difference in pain and mucositis (P<0.001) between the two groups. At the end of radiotherapy (after 6 wk) mean pain sure and mucositis grade were significantly lower (P<0.001) in the study group compared to control. INTERPRETATION & CONCLUSION: The low-level He-Ne laser therapy during the radiotherapy treatment was found to be effective in preventing and treating the mucositis in head and neck cancer patients. Further studies need to be done on a larger sample to find the mechanism.