Diagnosis of post-radiotherapy local failures in nasopharyngeal carcinoma: a prospective institutional study

This prospective study was conducted to evaluate and compare the efficacies of nasopharyngoscopy and CT scan in the diagnosis of local failure of external beam radiotherapy [EBRT] for nasopharyngeal carcinoma. Total 52 patients of histopathologically proven nasopharyngeal carcinoma treated with external beam radiotherapy [EBRT], were included in this study. For every patient computed tomography [CT], nasopharyngoscopy and nasopharyngeal biopsies were performed 3 months after completion of EBRT. Three months after completion of EBRT, 9 patients [17.3%] had evident disease on histological examination of biopsies. Nasopharyngoscopy showed 77.78% sensitivity, 93.03% specificity, 70% positive predictive value and 95.24% negative predictive value in diagnosing the residual/recurrence of tumor. There was statistically significant agreement between the endoscopic findings and the histological findings [Kappa reliability coefficient=0.562, p<0.01]. On the other hand, CT scan showed a 55.56% sensitivity, 39.53% specificity, 16.13% positive predictive value and 80.95% negative predictive value in diagnosing the residual tumor/recurrence. There was no statistically significant agreement between the CT scan findings and the histological findings [Kappa reliability coefficient = 0.038, p>0.05]. Nasopharyngoscopy should be considered the primary follow-up tool after radiotherapy of nasopharyngeal carcinoma. CT scan should be reserved for patients with histological or any symptomatic indications. Routine postnasal biopsies are not required

Double primary malignancies: a clinical and pathological analysis report from a regional cancer institute in India

Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Cancer victims could survive longer due to settling treatment modalities, and then would likely develop a new metachronous malignancy. This article aims to report our observed trend of increasing, in prevalence of both synchronous and metachronous second primary malignancy, among the cancer victims, and to review the relevant literature. A hospital based retrospective gathering of prospective data, among the patients that have diagnosed with second de novo malignancy. The study has conducted over a 4 years period from 2009 to 2012. All patients that have diagnosed with a histologically proven second malignancy as per Warren and Gates criteria have included. Various details which have regarded site, age at presentation, sex, synchronous or metachronous, treatment have recorded. Among 41 cases of multiple primary malignancies that have observed, 8 were synchronous [19.51%] and 33 were metachronous [80.49%]. Out of 41 patients, 25 [60.98%] were females and 16 [39.02%] were males. The most common sites of primary tumor were head and neck cancers that have followed by gynecological cancers, breast cancer, lung cancer, esophageal cancer, and then the others. Among the second malignancy, the most common site was breast and gastrointestinal tract that have followed by lung and gynecological cancers. Out of the total number of cases with double location, 14 tumors [34.15%] have belonged to the breast, out of which 5 [12.20%] have represented first locations and 7 [17.07%] have been second locations. Both locations have belonged to the breast in 2 patients [4.9%]. In 5 cases [12.20%], there were associations of breast-cervix and in 6 cases [14.63%], there were association of lung-head and neck cancers. The incidence of multiple primary malignancies has not been rare at all. Screening procedures have especially been useful for the early detection of associated tumors, whereas careful monitoring of patients has treated for primary cancer, and then a good communication between patients and medical care team would certify not only an early detection for secondary tumors, but only finally and subsequently, an appropriate management

Palliative hypofractionated radiotherapy in locally advanced head and neck cancer with fixed neck nodes

The locally advanced head and neck cancer with fixed nodes are incurable and has a short survival. This study aims to evaluate the symptom relief, disease response and acute toxicity after palliative hypofractionated radiotherapy. Between December 2010 to June 2011, previously untreated 50 patients who had histopathologically proved of head and neck squamous cell carcinoma with fixed node of stage IV, Eastern Cooperative Oncology Group [ECOG] performance status 2-3 were offered palliative radiotherapy [20 Gy/5Fr/5 Days]. Patients were evaluated at 15[th] and 30[th] day after completion of treatment for disease response [WHO], palliation of symptoms using symptomatic response grading and acute toxicities [Radiation Therapy Oncology Group, RTOG]. The most common presenting complaint was pain followed by dysphagia. Majority of patients [60-70%] had appreciable relief in their presenting symptom. In our study, we observed Partial Response [PR] in majority of patients [92%]; no patient had progressive or stable disease. None of the patients experienced radiation toxicities that required hospital admission. Almost all patients showed grade one and two acute skin and mucosal toxicities one month after completion of treatment. Advanced head and neck cancer with fixed neck node should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in great proportion of patients.