A prospective study to assess the predictive factors of radiation-induced oral mucositis in head-and-neck carcinoma and its impact on treatment outcome: Long-term results and lessons learned

Background: Radiation-induced oral mucositis (RIOM) is one of the major dose-limiting toxicities in head-and-neck cancer patients. It is due to normal tissue damage by radiation. It is a potential hazard to treatment delivery as it threatens to alter the therapeutic ratio. The radiation oncologist must find a way to balance between tumor control and sparing of normal mucosa to validate the age-old principle of cancer treatment. The onus lies on them to find the contributory factors to curb them accordingly. Objective: The objective of the study was as follows: (1) To find out the factors associated with RIOM in head-neck squamous cell cancer (HNSCC) and (2) to assess the impact of the RIOM on treatment outcome. Materials and Methods: This was a single-institutional, prospective, non-randomized, and open-label study. All cases were treated after informed consent and tumor board approval. This was an observational study with standard treatment according to the stage of the disease. Results: Tumor site, poor oral hygiene, modality of radiation, addiction, and fractionation appeared to be the significant predictive factors of RIOM in HNSCC. Conclusion: This study helps to identify the contributory factors and gives a comprehensive understanding of the same. More multi-institutional subsite-specific studies are warranted to validate the same.

Efficacy of sodium antimony gluconate and ketoconazole in the treatment of kala-azar--a comparative study.

The present study was undertaken to determine the efficacy of ketoconazole in comparison to sodium antimony gluconate (SAG) in the treatment of kala-azar. The study was conducted at two centres: All India Institute of Medical Science, New Delhi and Calcutta School of Tropical Medicine, Calcutta. A total of 180 patients with proven kala-azar were recruited. After preliminary investigations, the patients were randomly divided into 2 groups: One group received ketoconazole in a dose of 600 mg/ day in 3 divided doses for 4 weeks while the other group was treated with SAG at a dose of 20 mg/kg/day up to a maximum of 850 mg/day for 4 weeks. The patients were followed up by clinical examination, liver functions, haemogram and the bone marrow/splenic aspiration. Responders were followed up at 3 and 9 months of intervals. Of 90 cases in SAG, 78 (81.7%) got cured initially while under ketoconazole group, only 26 (33.3%) of 78 patients responded initially (p < 0.001). After 3 months of follow up, 75 of 78 SAG-responders (96.2%) and 24 of 26 ketoconazole-responders (92.3%) continued to be in remission. Despite the fact that 2 patients in each group were lost to follow up at 9 months, similar observations were noted with only one relapse in SAG group. The response to SAG was comparable at the two centres. However, the response to ketoconazole was better at Delhi centre as compared to that at Calcutta. There were no significant side effects or hormonal changes in any of the patients in ketoconazole group at Delhi centre. Significantly higher side effects were reported at Calcutta centre in ketoconazole group (P < 0.05). No satisfactory explanation can be given for this difference in response to ketoconazole at two centres. However, it is known that leishmanial parasites of different geographical origin differ in their response to different drugs and this could be one of the reasons for difference observed in response rate to ketoconazole as the study involved different populations of people.

Studies on the life cycle of Artyfechinostomum oraoni Bandyopadhyay, Manna & Nandy 1989: embryogenesis & development in the intermediate host.

A study was undertaken to elucidate the life cycle of the parasite A.oraoni, isolated from man. For the purpose, operculated eggs were isolated from faeces of oraon tribals belonging to the village Bandipore, district North 24-Parganas of West Bengal province of India. The purified eggs were incubated at different temperatures, salinity and pH. Larvae (miracidia) could be observed to develop between the 7th and 8th day of incubation at a temperature range between 22 degrees-30 degrees C. While the optimum pH was observed to be neutral, larval development did not take place at salinity beyond 0.8 per cent. To identify the correct intermediate host, all available species of snails from the study village were colonised and infected with the laboratory hatched miracidia from human derived operculated eggs. It was observed that of all the snails infected, only Lymnaea supported the development of rediae from miracidia, which could be observed on the 32nd post infection day. Considering the results of the experimental study, it was hypothesised that Lymnaea spp. of snails under natural condition also, might act as the first intermediate host for A. oraoni.