Study of efficacy of Hypofractionated Radiotherapy 8 Gray in single fraction in Palliation of pain secondary to bone Metastasis

Objectives: To determine the efficacy of hypo-fractionated radiotherapy 8 Gray in 1 fraction for palliation of pain secondary to bone metastasis

Study Design: Quasi-experimental study

Place and Duration of Study: Oncology department, Combined Military Hospital, Rawalpindi, Sep 2012 to Nov 2013

Patients and Methods: Forty three patients were included after permission from concerned authorities and Hospital Ethical Committee. OPD registration numbers, name, age, gender, Eastern Cooperative Oncology Group [ECOG] performance status [PS], diagnosis of primary malignancy along with histopathology and sites of skeletal metastasis were recorded. Radiotherapy 8 Gy in 1 fraction was administered using 6MV [mega voltage] Primus Linear Accelerator with 2-2.5 cm margin around the gross disease at the Oncology department, CMH Rawalpindi. Pain score was recorded using visual analogue scale on the day of administering radiotherapy [day 0] and thirty days [day 30] after radiotherapy to assess response to treatment

Results: There was a statistically significant [<0.001] improvement in the scores of pain with treatment at day 30. Thirty four out of forty three patients [86 percent] showed an improvement in pain score

Conclusion: Based on our results hypofractionated radiotherapy 8 Gy in 1fraction is an effective modality in the palliation of pain secondary to bone metastasis

Quad shot - hypofractionated radiotherapy for palliation in advanced squamous cell carcinoma of head and neck

Objective: The objective of this study was to determine the efficacy of quad-shot radiation therapy for palliation in locally advanced and metastatic inoperable squamous cell carcinomas of head and neck

Study Design: A quasi-experimental study

Place and Duration of Study: Oncology department, Combined Military Hospital Rawalpindi, from Sep 2012 to Sep 2013

Material and Methods: Thirty five patients were included with histologically confirmed advanced inoperable squamous cell carcinoma in head and neck region, performance status 2 or 3 and survival >/= 3 months. Patients were treated with radiation therapy 14 Gy in four fractions, megavoltage beam, twice daily fractions [at least 6 hours apart], for 2 consecutive days. Symptoms due to cancer [pain and dysphagia] were assessed as per common toxicity criteria adverse event version 4.0 on day 0 before treatment and day 21 after start of treatment

Results: Grades of pain and dysphagia showed significant improvement after treatment with a p-value <0.001. A total of 91.4% patients showed an improvement in grade of pain [32 out of 35 patients] and 45.7% of patients showed improvement in grade of dysphagia [16 out of 35 patients]. There was a statistically significant decrease in grades of pain and dysphagia after treatment

Conclusion: The short duration of hypofractionated radiotherapy with Quad Shot was effective with respect to symptom palliation in locally advanced and metastatic inoperable head and neck cancers

Early and late outcome of coronary artery bypass grafting surgery in patients with poor left ventricular function

Objective: our aim of study was to determine early and late outcomes of CABG in patients with poor left ventricular function. The CABG surgery is beneficial in patients who have poor left ventricular function manifested by an ejection fraction 30% or even less. These are the high risk patients but CABG surgery not only promotes their survival but also improve their functional status. They are easy victims of increased operative mortality and diminished long term survival

Methods: in our study we identified 63 patients who underwent CABG surgery despite poor LV function. Data was collected during their follow up visits or telephonic follow up conducted by us. We used pre op. IABP in 2[3.17%] patients. Among these 63 patients 36[57.14%] were documented as healthy and Stable, 9[14.29%] were expired during follow up and in 18[28.57%] follow up was not continued because 4[6.35%] have no contact numbers and 14[22.22%] phones were switched off. The average duration from 2008 to 2015 was taken to be 42.5 months approximately. Each patient necessarily received at least one IMA. : The surgical strategy included approach through median sternotomy. All cases were started as off-pump CABG. Elective conversion to on-pump CABG was done for cases not tolerating off-pump

Results: in this retrospective study we have analyzed the early and late outcomes of CABG in low EF group. Main findings of the study are an acceptable hospital mortality i.e. mortality rate among patients with EF <30% is 1.59% at our tertiary care center However, post-surgery complications prevailed.3 [4.7%] patients encountered deep wound infection and same ratio suffered renal failure. We observed the early outcomes i.e. in hospital mortality evaluated to be 1.58%. These results reflect improving results of surgery in this high risk group

Conclusion: our study demonstrated that all of our patients received at least one arterial graft i.e. internal mammary artery. The minimum standard set by STS is that at least 95% of the patients must receive internal mammary artery. This contributes to the survival benefit of the patients and also improves the quality of life and reduces reoperation rates. In this retrospective study we have analyzed the outcome of CABG in low EF group. Main findings of the study are acceptable hospital mortality. We concluded that acceptable morbidity and mortality rates prevailed among this high risk group at our tertiary care center. We believe that improvements in cardiac anesthesia, surgical technique, extracorporeal perfusion, perioperative care and postoperative management have contributed significantly to better outcomes

Comparison of frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion

To compare the frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion. Randomized controlled trial. General surgical department, Combined Military Hospital, Rawalpindi, Pakistan, from Jan 2010 to Dec 2010. Sixty patients of clinically diagnosed wrist ganglia were randomized into groups A and 'B' with 30 patients in each group. After approval by the hospital ethical committee, patients in group 'A' were subjected to aspiration and injection of methyl-prednisolone acetate 40 mg/ml and those in group 'B' underwent surgical excision of the ganglion. Patients were explained the procedure they were subjected to and they were also counselled about the risk of recurrence after a particular procedure and after that informed written consent was obtained from them. Patients were followed up at intervals of 2 weeks, 6 weeks, 3 months and 6 months after the procedure to look for recurrence in both groups. On follow up at 6 months, 12 [40%] patients in group A while only 2 [6.66%] patients in group B had recurrence of the ganglion. No complications were noted. This difference was found to be statistically significant [p = 0.0023]. Recurrence of wrist ganglion is considerably less in patients treated with surgical excision and should be preferred over aspiration and steroid injection

Therapeutic effects of whole brain radiotherapy with carboplatin as radiation sensitizer in management of brain metastasis

To determine the efficacy of whole brain radiotherapy [WBRT] with carboplatin as radiation sensitizer in metastatic brain disease in our adult population. Quasi-experimental study. Department of Oncology, Combined Military Hospital [CMH], Rawalpindi, Pakistan from July 2011 to September 2012. Forty two patients with metastatic brain disease having ECOG performance status [PS] 3 or less with normal hematological and biochemical profile were treated with WBRT with 6MV Photon beam on linear accelerator using parallel opposed lateral beams to a dose of 30 Gys in 10 fractions. Carboplatin was administered in a dose of 150 mg/m2 on day 1 and 6 of WBRT. Improvement in PS and radiological response on CT scan/ MRI brain before and 30 days after the WBRT using response evaluation criteria in solid tumors [RECIST] was evaluated. Out of 42 patients, 38 [90%] showed improvement in PS, 4 [10%] showed either no improvement or worsening of PS [p< 0.001]. Seventeen [41%] patients had complete response, 19 [45%] had partial response, 3 [7%] showed stable disease and 3 [7%] had progressive disease. None of the patients showed grade 3/4 toxicity during treatment. WBRT with carboplatin as radiation sensitizer is effective in palliation of patients with metastatic brain disease

Association of age with steroid receptor and her-2/neu receptor status in breast cancer patients at combined military hospital Rawalpindi

To determine the association of steroid receptor expression and HER-2/Neu expression in different age groups in breast cancer patients at Combined Military Hospital Rawalpindi. Descriptive study Department of Oncology, CMH Rawalpindi, from Jan 2009 to December 2010. A prospective study in which 257 patients, of both genders more than 18 years old with histopathological diagnosis of carcinoma breast, were stratified into three age groups [<35 years, 35-50 years and >50 years]. Estrogen and progesterone receptor and HER-2/neu receptor status was determined in all the patients. Positive status of either estrogen or progesterone receptor was considered as steroid receptor positive. Association of HER-2/neu with the steroid receptors was determined in all the age groups. Estrogen receptor was positive in 95 [38.2%] patients. Progesterone receptor was positive in 144 [57.8%] patients. Steroid receptor was positive in 160 [64.3%] patients. One third [32.9%] of the patients were positive for HER-2/neu. Positive cases of HER-2/neu were significantly higher in negative steroid receptor cases as compared to positive cases [50.6% vs. 23.1%, OR = 3.324, p<0.001]. In age groups "35 - 50 years" and "> 50 years", this inverse association of HER-2/neu status with steroid receptor was significant. HER2/neu receptor status should be determined in all patients but if it is not possible due to the local availability of facilities as well as affordablility of the patients, patients who are steroid receptor negative should be referred to laboratories capasle for accurate determination of HER-2/neu receptor status as these patients are more likely to be positive for HER-2/neu receptor status

Frequency and severity of neutropenia in diffuse large beta-cell non Hodgkin's lymphoma after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolone

Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. As much as 3.3% of patients suffered from grade IV neutropenia [absolute neutrophil count of <0.5x10[9]/L], 3.3% had grade III neutropenia [absolute neutrophil count of 0.5x10[9]/L- 0.9x10[9]/L], 6.6% had Grade II neutropenia [absolute neutrophil count 1.0x10[9]/L-1.4x10[9]/L and 10% had Grade I neutropenia [absolute neutrophil count 1.5x10[9]/L-1.9x10[9]/L. Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population