Study of socio-demographic determinants of esophageal cancer at a tertiary care teaching hospital of Western Maharashtra, India.

BACKGROUND: Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. OBJECTIVES: The present study was carried out to find out the socio-demographic determinants of esophageal cancer in a tertiary care teaching hospital of western Maharashtra, India. MATERIALS AND METHODS: A retrospective hospital record-based study was carried out for the period of five years (2007-2011) in the department of Radiotherapy of Pravara Rural Hospital, Loni, western Maharashtra, India. A total of 5879 patients were diagnosed with cancer, of them, 207 (3.52%) patients had esophageal cancer. Data was collected on the basis of the patients' record in the hospital and analyzed in the form of percentage and proportions whenever appropriate. RESULTS: Out of total 5879 patients who were diagnosed with cancer during the five studied years, 207 (3.52%) patients had esophageal cancer, of which 121 (58.46%) were males and 86 (41.54%) were females, which show predominance of males over females. Most of the patients (28.50%) belonged to lower class, while only 9.66% were from upper class. Majority of the patients (54.14%) had a history of tobacco chewing, followed by smoking (cigarette, bidi, or both) in 36.94% and alcohol in 21.65%. CONCLUSION: The present study shows that esophageal cancer constitutes 3.52% of cancer cases. There is a need to screen the high-risk group of people, improve socio-economic status, and efforts must be made to introduce a set of preventive measures that have the potential to significantly reduce the burden of disease and to help bridge the gap between research and public awareness.

Significance of ovoid separation with various applications of high-dose-rate-intracavitary radiotherapy in carcinoma of uterine cervix: a study from rural centre of Maharashtra, India.

AIMS: To analyze the differences in dose distribution, with ovoid separation in various applications, by different radiotherapists in the same patient of carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary Radio therapy (ICRT). SETTINGS: Pravara Rural Hospital and Rural Medical College. DESIGN: Retrospective study. MATERIALS AND METHODS: Retrospective analysis of six cases of carcinoma uterine cervix, randomly chosen in the period from January 2004 and December 2007. Three selected radiotherapists performed the applicator placement for ICRT on the aforementioned patients in a consistent pattern-three consecutive ICRT treatments separated by weekly intervals. Ovoid separation was categorized into three groups: < 25 mm, 26-35 mm and > 36 mm. Prescribed point 'A' isodose lines with maximum separation laterally in right and left parametrium and antero-posteriorly in lateral plane was calculated for all 36 isodose charts for the 18 ICRT applications. RESULTS: In this study, there proves to be a significant difference in the ovoid separation between the applications of the different radiotherapists in the same patient with multiple fractions of HDR-ICRT. The applications done by 'A' radiotherapist resulted in an ovoid separation of < 25 mm more often, 'B' radiotherapist of > 36 mm while, 'C' radiotherapist fell in between the two. DISCUSSION AND CONCLUSION: With more ovoid separation, lateral dose to parametrium was improved; however, antero-posterior dose was not significantly affected. In order to determine the best dose distribution, as evident in the dose charts of 'C' radiotherapist, it is recommended to choose the optimum ovoid separation in accordance to the patient's anatomy.

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: a study from rural centre of Maharashatra, India.

AIM: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses. RESULTS: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B. DISCUSSION AND CONCLUSION: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

Radical radiotherapy treatment (EBRT + HDR-ICRT) of carcinoma of the uterine cervix: outcome in patients treated at a rural center in India.

AIM: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT). MATERIALS AND METHODS: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. RESULTS: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well. DISCUSSION AND CONCLUSION: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.