Early hematological effects of chemo-radiation therapy in cancer patients and their pattern of recovery - a prospective single institution study

The purpose of this prospective study is to understand the early hematological effects of chemo-radiation therapy in cancer patients, their pattern of recovery and to ascertain their prognostic value. 255 diagnosed cancer patients planned for definitive treatment with radiation therapy alone or with chemotherapy were included in this two year prospective study. A complete blood count was done at baseline, weekly during the course of therapy and thereafter, monthly for a period of 6 months. For the purpose of grading clinical toxicity, the Common Toxicity Criteria, CTCAE v2.0 was used while RECIST criteria was used to define the tumor response rates. This study was statistically analyzed using SPSS software. 255 patients were included in the study wherein head and neck cancers comprised the major patient population [28.6%] followed by cervix [18.8%] and breast [15.7%]. Out of these, 37% in head-and-neck cancer subgroup, and 58.3% in cervix had anemia at start of treatment. 92.2% cases with chemoradiation developed anemia during treatment, while with radiation alone it was 95.5%. This was statistically significant in patients with cancer uterine cervix [p < 0.01]. At the end of treatment 65% patients with normal hemoglobin had complete responses [CR], while 58.3% with mild anemia and 33.3% with moderate anemia had CR [p=0.1]. Severe anemia during treatment is a poor prognostic indicator and is usually a sign of advanced disease. Leucopenia and thrombocytopenia occur more commonly during chemoradiotherapy as against radiotherapy alone, but improves with supportive management

Superior vena cava obstruction [SVCO] in patients with advanced non small cell lung cancer [NSCLC]

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival [OS], Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates [MVA] and analyzed on SPSS software [version 19.0; SPSS, Inc., Chicago, IL]. Thirteen patients [72%] had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 [28%] progressed to SVCO after initiating treatment with chemotherapy. Twelve [68%] patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 [62%], while the median biologically equivalent dose delivered was 28 Gy. Six [33%] patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3 +/- 1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score [p=0.02], and partial response to chemotherapy [p= 0.001] have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients [p = 0.05] have a better OS. RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients