A comparison of six fractions per week chemoradiation versus five fractions per week of conventional chemoradiation in carcinoma cervix: A prospective controlled study

Aims: The standard of care for carcinoma cervix stage IB2-IVA is five fractions per week of radiotherapy (RT) with concurrent cisplatin. We compared the standard treatment with six fractions per week of RT with concurrent Cisplatin to see whether the later had improved survival outcomes with comparable toxicities. Settings and Design: 46 patients of carcinoma cervix with stage IB2-IVAwere randomized into two arms. Materials and Methods: Study arm: 46 Gy/23 fractions/26 days, 6 fractions/week with injection CDDP 40 mg/m2 and Control arm: 46 Gy/23 fractions/31 days, 5 fractions/week with injection Cisplatin 40mg/m2. Patients in both the arms received LDR brachytherapy to a dose of 29 Gy at point A. Statistical Analysis Used: The primary end points were disease-free survival (DFS) and overall survival (OS). Compliance to treatment and treatment toxicities were the secondary end points. P value ≤0.05 were considered significant. Results: The study was carried out during June, 2014–April, 2015. Statistical analysis was done in May, 2019. Of 46 patients, 39 patients completed the treatment. The study and control arms had 17 and 22 patients, respectively. Median follow-up period is 45 months (range: 1–54 months). 3-year DFS rates and OS was 69.5% vs. 72.7% (P = 0.73) and 63% vs. 68% (P = 0.45) in study and in control arm, respectively. There was no significant difference in acute and late radiation toxicities between two arms. Conclusion: Chemoradiotherapy with six fractions per week seems feasible and equally efficacious in terms of survival outcomes and toxicity profile. Further prospective randomized controlled study is required to prove the merit of altered fractionation with concurrent cisplatin

Free radicals and antioxidants in normal versus cancerous cells — An overview

Oxygen is vital for aerobic processes of metabolism and respiration- It has been also implicated in many diseases and degenerative conditions. Free radicals formed from reactive oxygen and nitrogen species act as key players in the initiation and progression of tumor cells and enhance their metastatic potential. The imbalance in the formation and use of free radicals in the tissue creates oxidative stress. Inadequacy in normal cells antioxidant defense system or excessive free radical formation or even both can cause the cell to experience the oxidative stress. This review outlines the involvement of free radicals in different aspects of cancer, from prevention to initiation, progression, treatment and to reduce morbidity and mortality.

Biliary Ascariasis: Our Experience and Review of Literature.

Background/Aim: Ascariasis is endemic in the tropics especially amongst those living in poor sanitary conditions. Although most commonly it infests the small intestine, it can sometimes migrate to the biliary tract. We herein aimed to study the clinical manifestations, complications, diagnostic modalities and the most appropriate treatment modality for this condition. Materials and Methods: Fifteen cases of hepatobiliary ascariasis presenting over a period of 1.5 years were studied. All the patients were adults and presented to the emergency with acute biliary symptoms. Results: In this study, biliary ascariasis was found to be more common in middle aged females. The common presentations included upper abdominal pain and jaundice. Complications observed included acute pancreatitis and cholangitis. Ultrasonography could establish the diagnosis in 86.67% cases. Medical management could successfully treat 86.67% patients with ERCP being required in the remainder. Conclusion: In endemic countries, ascariasis should be considered as a differential diagnosis in patients presenting with acute biliary symptoms. Ultrasonography is a useful non invasive test to diagnose the condition and medical management remains a reasonable first line treatment option.

Superiority of non-capsulated 14C-urea breath test over capsule based method for detection of Helicobacter pylori infection – a preliminary report.

Background: 14C-urea breath test (14C-UBT) is employed as a ‘gold standard’ technique for the detection of active gastric Helicobacter pylori infection and is recommended as the best option for “test-and-treat” strategy in primary health care centers. Aim: To compare the performance of capsulated and non-capsulated 14C-UBT protocols for the detection of H. pylori infection in patients. Methods: Fifty eight H. pylori infected patients underwent routine upper GI endoscopy and biopsies were processed for rapid urease test (RUT) and histopathology examination. Capsulated 14C-UBT was done in a novel way by using 74 kBq of 14C-urea along with 6.0 MBq of 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) to simultaneously monitor the movement and the fate of ingested capsule after delineating the stomach contour by using 20.0 MBq of 99mTechnetium pertechnetate (99mTcO4-) under dual head gamma camera. Noncapsulated 14C-UBT was performed within 2 days of the previous test and the results of these protocols were compared. Results: In 3 out of 58 H. pylori positive cases (5.17%), 14C-UBT results were found to be negative by using the capsulated method. Interestingly, on monitoring the real time images of the capsule in these cases it was found that misdiagnosis of H. pylori infection occurred mainly due to either rapid transit of the 14C-urea containing capsule from the upper gastric tract or its incomplete resolution in the stomach during the phase of breath collection. Conclusion: Use of non-capsulated 14C-UBT protocol appears to be a superior option than the conventional capsule based technique for the detection of H. pylori infection.

Development of an electronic radiation oncology patient information management system.

The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information.