Clinical outcome after high dose rate intracavitary brachytherapy with traditional point 'A' dose prescription in locally advanced carcinoma of uterine cervix: dosimetric analysis from the perspective of computed tomography imaging-based 3-dimensional treatment planning.

OBJECTIVE: To analyze tumour response and toxicity with respect to cumulative radiotherapy dose to target and organs at risk (OARs) with computed tomography (CT)-based image guided adaptive brachytherapy planning for locally advanced carcinoma cervix. METHODS: Patients were treated with two-dimensional concurrent chemoradiotherapy to whole pelvis followed by intracavitary brachytherapy (ICBT) with dose prescription to point 'A'. CT image-based delineation of high-risk clinical target volume (HR-CTV), urinary bladder, rectum and sigmoid colon was done with generation of dose-volume histogram (DVH) data and optimization of doses to target and OARs. Follow up assessments were done for response of disease and toxicity with generation of data for statistical analysis. RESULTS: One hundred thirty-six patients were enrolled in the study. Delineated volume of HR-CTV ranged from 20.9 to 37.1 mL, with median value of 30.2 mL. The equivalent dose in 2 Gy per fraction (EQD2) for point 'A' ranged from 71.31 to 79.75 Gy with median value of 75.1 Gy and EQD2 HR-CTV D90 ranged from 71.9 to 89.7 Gy with median value of 85.1 Gy. 69.2% of patients showed complete response and after median follow-up of 25 months, 50 patients remained disease free, of whom, 74.0% had received ≥85 Gy to HR-CTV D90 versus 26.0% receiving <85 Gy to HR-CTV D90. CONCLUSION: s Amidst the unavailability of magnetic resonance imaging facilities in low middle income countries, incorporation of CT-image based treatment planning into routine practice for ICBT provides the scope to delineate volumes of target and OARs and to generate DVH data, which can prove to be a better surrogate for disease response and toxicity.

A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC.

INTRODUCTION: To investigate the effect of different hypo fractionated thoracic radiotherapy schedules in relation to thoracic pain relief, overall survival and post radiotherapy HRQOL in metastatic NSCLC. MATERIAL AND METHODS: Stage IV NSCLC and had intra-thoracic symptoms, included in the study. Patients were randomly assigned to three treatments arms. (i) 17 Gy in 2 fractions in one week (ii) 20 Gy in five fractions in one week. (iii) 30 Gy in 10 fractions in two weeks. BPI module was used to assess pain score before and after the thoracic radiotherapy. Functional assessment of cancer therapy-G (FACT-G) used to investigate changes in HRQOL. Clinicians' assessment of symptom improvement were recorded at 2(nd), 6(th) and 12(th) weeks after completion of TRT. RESULTS: Pain relief, HRQOL and OS were equivalent in all the three arms. The median OS were 6 months, 5 months, 6 months in arm A, B and arm C, respectively. CONCLUSION: Protracted palliative thoracic radiotherapy renders no added advantage of relief of symptoms, HRQOL and overall survival compared to short course palliative TRT in metastatic NSCLC.

Baseline Demographic Profile and General Health Influencing the Post-Radiotherapy Health Related Quality-of-Life in Women with Gynaecological Malignancy Treated with Pelvic Irradiation.

BACKGROUND: Cancer specific survival and quality-of-life (QOL) assessment are important in evaluating cancer treatment outcomes. Baseline demographic profiles have significant effects on follow-up health related QOL (HRQOL) and affect the outcome of treatments. MATERIALS AND METHODS: Post-operative gynaecological cancer patients required adjuvant pelvic radiation enrolled longitudinal assessment study. Patients had completed the short form-36 (SF-36) questionnaire before the adjuvant radiotherapy and functional assessments of cancer therapy-general module at 6(th) month's follow-up period to assess the HRQOL. Baseline variables were race, age, body mass index (BMI), education, marital status, type of surgery, physical composite scores (PCS) and mental composite scores (MCS) summary scores of the SF-36. Univariate and multivariate regression analysis used to determine the influence of these variables on post-radiotherapy HRQOL domains. RESULTS: Baseline PCS, MCS, age, education and marital status had positively correlation with post-radiotherapy HRQOL while higher BMI had a negative impact in univariate analysis. In multivariate regression analysis, education and MCS had a positive correlation while higher BMI had a negative correlation with HRQOL domains. CONCLUSION: Enhance our ability to detect demographic variables and modify those factors and develops new treatment aimed at improving all aspect of gynaecological cancer including good QOL.

A Retrospective Six Years Analysis of Survival and Late Morbidity of Post-operative Gynaecological Malignancy Treated with External Radiotherapy Followed by Brachytherapy in Medical College & Hospitals, Kolkata.

BACKGROUND: Cervical and endometrial carcinoma incidentally found in the surgical specimen with high risk pathological finding or with gross residual disease. MATERIAL AND METHODS: Between 2004 and 2010, 320 cervical and endometrial cancer patients were treated with EBRT and brachytherapy after having undergone total/subtotal hysterectomy. Sixty patients were lost to follow-up. RESULTS: Median follow-up was 21 months. Endometrial and cervical cancer with a high risk for local recurrence achieved CR 93.8 and 89 %, respectively. 56 % patients experienced CR with residual disease with cervical cancer. Median OS for endometrial and cervical cancer with residual disease was 8.5 and 24 months, respectively. Grade 3 adverse events were 5 and 3.5 % for rectum and bladder, respectively. CONCLUSION: The incorporation of chemotherapy during pelvic radiotherapy followed by HDR interstitial brachytherapy for residual disease is inadequate and improves survival. We are still in learning phase of brachytherapy in post-operative gynaecological malignancy cases; expertise will be developed by practice.

Retrospective analysis of the clinical and demographic variables on the outcomes after second-line treatment in advanced non-small cell lung cancer.

BACKGROUND: Platinum based doublets chemotherapy are the standard of care for metastatic or advanced non-small cell lung carcinoma. This leads to modest survival advantage and improve quality-of-life. However, patients with advanced or metastatic disease eventually present disease progression and needs second-line systemic therapy in a selected group of patients or other supportive measures. There is very little knowledge available from the literature about the prognostic variables in patients, who receive second-line therapy. MATERIALS AND METHODS: We retrospectively reviewed 329 patients received second-line treatment from July 2007 to September 2011 in the Department of Radiation Oncology, Burdwan Medical College and Hospital. For statistical analysis, 12 potential prognostic variables included. Univariate and multivariate regression analysis carried out to identify the prognostic variables associated with survival. RESULTS: The results of univariate analysis for overall survival (OS) and survival after second-line therapy identified to have prognostic significance: Age, sex, performance status, smoking history, serum lactate dehydrogenase, histopathology, first-line chemotherapy and its response and second-line therapy except the stage at diagnosis and site of failure after first-line therapy. The multivariate Cox regression analysis has shown that only performance and second-line therapy were independent prognostic variables for survival after second-line treatment and above these prognostic factors; age, smoking status and progression free survival also for OS. CONCLUSION: The performance status has shown consistent result as a prognostic factor in univariate and multivariate analysis for OS and survival after second-line therapy. These findings may also facilitate pretreatment prediction of survival and be used for selecting patients for the correct choice of cytotoxic therapy.

Palliation of dysphagia in advanced, metastatic or recurrent carcinoma oesophagus with high dose rate intraluminal brachytherapy--an eastern Indian experience of 35 cases.

Oesophageal cancer, a disease with high morbidity and mortality, has a relatively high incidence in eastern India, usually presenting at advanced stage. The main aim of treatment for majority of patients remains palliation of dysphagia, which can be effectively done by intraluminal brachytherapy with or without external radiotherapy. Between January 2006 to January 2010 a total of 35 patients with advanced/metastatic (24/35) or recurrent (11/35) oesophageal carcinoma were treated with intraluminal high dose rate (HDR) iridium192 source brachytherapy at Medical College Hospitals, Kolkata. Selection for palliative brachytherapy includes one or more of the following criteria: Lesion more than 5 cm long on imaging studies or upper GI endoscopy, Karnofsky performance status < or = 50%, Locoregional recurrence. Palliative external radiotherapy (20 Gy/5# or 30 Gy/10#) was given to 11 patients (31.42%) before brachytherapy. All patients treated with 2 fractions of high dose rate-intraluminal brachytherapy (HDR-ILRT) one week apart with 600 cGy per fraction at 1 cm off axis. Thirty-five patients were treated with palliative HDR-ILRT. Significant improvement in swallowing status was seen in 20 patients (57.14%) since just after treatment up to 7.5 months. However, 9 patients (25.71%) showed no improvement, and 6 patients (17.14%) showed no changes in dysphagia scoring. Only 3 patients developed ulceration and 2 developed fistula immediately after treatment and 5 patients developed stricture. Median dysphagia-free survival was 6 months. Median overall survival was 8 months. It is concluded that intraluminal brachytherapy is an effective method for palliation of dysphagia for reasonably prolonged period.

Skin rash as a surrogate marker of clinical response of targeted therapy using gefitinib in advanced or metastatic non-small-cell lung cancer--a retrospective study.

This retrospective review of a single institution case series study was conducted to correlate the objective response and skin rash of gefitinib in patients with advanced or metastatic non-small-cell lung cancer(NSCLC). One hundred and forty-nine patients with advanced or metastatic NSCLC were treated with gefitinib (250 mg/day) as second line systemic therapy. Baseline patient characteristics were: More than 75% patients were above 50 years of age, males 64%; adenocarcinoma 52%. Sixty-one patients were excluded from the analysis due to varying reasons; only 88 remaining in the analysis. Partial response was observed in 15 patients (17%), and 34 patients (38.6%) had stable disease. The rest 39 patients (44.3%) had progressive disease on gefitinib therapy. There was a significantly longer median time to progression (TTP) of 7 months in females as compared to 5 months in males (p = 0.001). A highly significant association (p = 0.001) was observed between the grade of skin toxicity and the median time to disease progression, with the median TTP being 4 months in patients experiencing no skin toxicity as compared to 7 months with those grade 2 skin toxicity and 12 months with grade 3 skin toxicity. Gender (p = 0.003), and presence of skin toxicity (p = 0.0001) were having significant difference in median overall survival. On multivariate testing of the same using Cox regression analysis only presence of skin toxicity (p = 0.012) and gender (p = 0.003) was found to significant factors. Thus it can be concluded that occurrence of skin rash and female gender were associated with improved survival with gefitinib for recurrent NSCLC patients.