Adaptive radiotherapy in lung cancer: dosimetric benefits and clinical outcome.

OBJECTIVE: Anatomical changes during radiotherapy (RT) might introduce discrepancies between planned and delivered doses. This study evaluates the need for adaptive treatment in lung cancer RT. METHODS: 15 patients with non-small-cell lung cancer, undergoing radical RT with or without concurrent chemotherapy, consecutively underwent planning CT scans at baseline and after 44-46 Gy. Target volumes were delineated on both scans. Phase I delivered 44-46 Gy to the initial planning target volume (PTV). Two Phase II plans for 16-20 Gy were developed on initial and mid-treatment scans, the treatment being delivered with the mid-treatment plan. The second CT structure set was fused with the initial scan data set using dose wash. Volumetric and dosimetric changes in target volumes and critical structures were assessed. RESULTS: There was significant reduction in primary gross tumour volume (34.00%; p = 0.02) and PTV (34.70%; p < 0.01) in the second scan. In Plan 2, delivering the same dose to the initial PTV would have resulted in a significantly higher dose to the lung PTV (V20, 52.18%; V5, 21.76%; mean, 23.93%), contralateral lung (mean, 29.43%), heart (V10, 81.47%; V5, 56.62%; mean, 35.21%) and spinal cord (maximum dose, 37.53%). CONCLUSION: Treatment replanning can account for anatomical changes during RT and thereby enable better normal tissue sparing, while allowing radical target doses with the possibility of maximizing local control. ADVANCES IN KNOWLEDGE: This study supports the sparse dosimetric data regarding the quantitative tumour volume reduction, re-emphasizing the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control, and adds to the existing body of literature.

Developments in chemical approaches to treat tuberculosis in the last decade.

Tuberculosis (TB) caused by Mycobacterium tuberculosis claims millions of lives each year globally. Although it can be controlled by currently available drug regimen (DOTS), yet the emergence of multidrug resistance (MDR) and extensively drug resistance (XDR) TB is a growing concern. The increasing rate of MDR-TB, co-infection with HIV and XDR-TB necessitates the development of new anti-TB agents that have a practical impact on tuberculosis control. This review article gives a brief introduction of tuberculosis, present day problems, traditional and new anti-TB drug targets, currently used drugs, their mode of action, the pipeline compounds and a short description of new chemical entities (NCE's) as antitubercular agents developed in last 10 years.

Retained foreign body in sino-orbital region.

It is rare to find foreign bodies in nose and paranasal sinuses. The further rarity is to encounter impacted foreign body in this region and route of entry being through the orbit. We are here by presenting a case, where a metallic foreign body was retained for duration of 4 months in sino - orbital region.

Effect of cadmium on growth, ultramorphology of leaf and secondary metabolites of Phyllanthus amarus Schum. and Thonn.

The pollution is increasing in the environment by different kinds of human activities, which results in the accumulation of heavy metals including cadmium in the soil and water and it causes different types of problems to living beings. As the plants are utilized by human being as food and medicine, therefore, it is mandatory to see the effect of metals on plants. In this context, efforts have been made to observe the effect of different concentration of Cadmium (Cd) on Phyllanthus amarus Schum. and Thonn., because Cd is the widespread metal and the plants response to low and high level of exposure is a complex phenomenon. P. amarus is mostly grown as weed in agricultural and waste lands. It is a reputed plant used in Indian indigenous systems of medicine with hepatoprotective, diuretic, stomachic properties and is recently being used for the treatment of hepatitis B. The study revealed that Cd causes significant decrease in fresh and dry weight, length of root and shoot, protein, chlorophyll, carotenoids and sugar and increase in starch content. It is interesting to note that the therapeutically active compounds-phyllanthin and hypophyllanthin, enhanced at certain levels of Cd due to abiotic stress. Besides, the ultramorpholical changes were also observed in stomatal opening and wax deposition on both the surfaces of leaves.

Zinc Requirement for Stomatal Opening in Cauliflower.

Zn deficiency induced increases in epicuticular wax deposits, lamina thickness, degree of succulence, water saturation deficit, diffusive resistance, and proline accumulation and decreases in carbonic anhydrase activity, water potential, stomatal aperture, and transpiration in the leaves of cauliflower (Brassica oleracea L. var botrytis cv Pusa) plants. Restoration of Zn supply to the deficient plants increased stomatal aperture, transpiration, and carbonic anhydrase activity significantly within 2 h. However, leaf water potential in the Zn-deficient plants did not recover within 24 h after resupply of Zn. The guard cells in epidermal peels from the Zn-deficient leaves had less K+ than those from the controls. Stomatal aperture in the epidermal peels from Zn-deficient leaves was 64% less than in the controls when the epidermal strips were floated on 125 mM KCl. Supplementing the ambient medium 25 mM KCl with ZnCl2 enhanced stomatal aperture in both control and Zn-deficient peels, and the effect was significant in the latter. The observations indicate involvement of Zn in stomatal opening, possibly as a constituent of carbonic anhydrase needed for maintaining adequate [HCO3-] in the guard cells, and also as a factor affecting K+ uptake by the guard cells.