Oral and dental care before radiotherapy: Guidelines and development of a time?bound protocol

Involvement of multidisciplinary team is the mainstay in the holistic treatment outcome in head and neck cancer patients. Achieving a state of oral health is regarded as an essential treatment goal before radiation therapy but, it may get overlooked due to many competing priorities, lack of multidisciplinary facilities and/or incoordination, and limited overall awareness with regards to means of achieving oral health and in a time?bound manner and its relevance in improving quality of life in cancer survivors. Radiation inflicts an immense amount of damage upon the entire maxillofacial complex and consequently oral treatment after radiotherapy may remain untreated and/or undertreated. It is, therefore, vital to eliminate oral foci of infections well within a time frame before radiation so that tumor prognosis is not compromised.This article describes the current guidelines combined with a time?bound protocol developed in our center to not only prepare a patient for conventional radiotherapy but also to provide a logical perspective towards the feasibility of the oral rehabilitation post?cancer cure. The protocol aims to maximize the quality of life in head and neck cancer survivors by; patient education, minimizing preventable oral complications, and retaining strategic teeth for function, aesthetics, speech, and prosthetic support. The time?bound pre?radiation oral care protocol is rational, achievable, and is aligned towards the sustained oral health care goals in head and neck cancer patients and can be utilized as a useful resource in multidisciplinary head and neck cancer care facilities

Breast cancer in males: a PGIMER experience.

AIM: Male breast cancer is a rare disease representing 1% of all breast cancers and less than 1% of all cancers in men. Because of its rarity, carcinoma breast has not been studied extensively and this prompted us to carry out this retrospective study. The aim of the study was to observe the clinical and pathological features, evaluate the prognostic factors and to co-relate the outcome in patients of male breast cancer. MATERIALS AND METHODS: Thirty patients of male breast cancer treated in the department of radiotherapy from year 1996-2000 were retrospectively analyzed. RESULTS: The actuarial five- year disease free survival was 40%. Three out of 30 i.e. 10% patients had loco-regional recurrence and all of them had locally advanced disease at presentation. Distant metastasis occurred in 9 patients of whom 6 patients had T3-T4 tumor and 1 patient had T1-T2 tumor. CONCLUSION: Modified radical mastectomy followed by external radiation therapy is the standard treatment for male breast cancer. Hormone therapy, as an adjuvant treatment, is the first line approach in a majority of patients and chemotherapy is reserved for patients with poor prognostic factors.

Rhabdomyosarcoma of Head and Neck -A Ten Year Review

Rhabdomyosarcoma is an aggressive malignant skeletal neoplasm arising from embryonal mesenchyme. It accounts for over 50% of all paediatric soft tissue tumours. It may OCCur in any site of tile body but the most common sites of tumor occurrence are orbit (12%) and head and neck (16%). Use of multimodality approach to treatment, including multidrug chemotherapy, radiotherapy has resulted in a dramatIc improvement in the outlook of affected children. Orbit has long been recognized as a favourable site as compared to other head and neck sites due to paucity of lymphatics and high response rates seen with radiation therapy and chemotherapy. A ten year relrosprvyibr analysis of 31 patients of Rhabdomyosarcomas of head and neck was done. The main outcome measures were age, gender, histopathologic type, treatment received ,follow up period. and eventual outcome. Most of our patients presented with an advanced stage. A complete response of 91.6% and 28.2% was seen in orbit and other non orbital head and neck sites respectively. The 5- year disease free survival in patients of orbital rhabdomyosarcoma was 83.3%

Testicular Choriocarcinoma Stage IV : Treated with Combination Chemotherapy

Choriocarinoma, a rare variety of testicular germ cell tumour, is associated with poor prognosis. A stage IV choriocarcinoma treated successfully with combination chemotherapy is being reported.

Comparative Evaluation of Concurrent Chemotherapy & Hyperfractionated radiotherapy Versus Conventional Radiotherapy alone in the Treatment of Locally Advanced Carcinoma Cervix-A Prospective Randomised Study

The aim of this study was to determine whether the addition of concurrent cisplalin and hyperfractionation in external pelvic radiotherapy improves local control and survival in patients with locally advanced carcinoma cervix as compared to treatment with conventional radiptjerapy alone. The morbidity of two treatment protocols was also compared. Sixty patients of newly diagnosed squamous cell carcinoma cervix, FIGO stage 118 and III were randomised into the following two treatment protocols: Group A (study group): Cisplatin30 mg/m2 weekly x 5 courses and external beam pelvic radiotherapy 50 Gy/33#4.5 weeks with hyperfractionation in first and following weeks. Group B (control group) : External beam pelvic radiotherapy 46 Gy/23#/4.5 weeks. Patients in both the group were then treated with intracavitary brachytherapy by LDR/MDR Selectron and a dose of 28 Gy was delivered to point A. The patients who were not suitable for intracavitary treatment were treated by supplementary external beam pelvic radiotherapy 20 Gy/ 10#/2" ceks. The actuarial local control at 4 years was 60% in group A and 42% in Group 8 9p<0.05). The a Cluarial disease free survival at 4 years was 52% in Group A and 35% in Group 8 (p<0.05). Only grade I acute and delayed haematological toxicity and grade I nausea and vomiting as acute toxicity "ere significantl) higher for Group A patients as compared to Group 8. Concomitant chemotherapy with hyperfraclionated radiotherapy is well tolerated and seems to offer potential benefit for imprOl ing the locoregional control in locally advanced carcinoma of cervix.