What Did the Pandemic Teach Us About Palliative Radiation in Head and Neck Cancer?

Objective: To assess the feasibility and efficacy of palliative radiotherapy dose regimens for patients with locally advanced head and neck cancer. Methods: Fifty patients of previously untreated, inoperable, stage IVA and IVB squamous cell carcinoma of the head and neck, deemed unfit for radical treatment, were included in the study from May 2020 to June 2020. Two palliative radiotherapy regimens were used. First was a single fraction radiation with 8 Gy for patients with limited life expectancy and poor performance status, which was repeated after 4 weeks in case of good symptom relief. The second regimen was used for patients with good performance status and consisted of fractionated radiation with 30 Gy in 10 fractions over 2 weeks, which was followed by supplementary radiation with 25 Gy in 10 fractions over 2 weeks in patients with good symptomatic response at 2 weeks. Symptoms were assessed at baseline and at the end of 4 weeks after treatment completion using the numerical rating score. Patients were followed up for a median of 4.5 months and assessed for symptom control and overall survival. Results: Forty-eight patients completed treatment and were included for analysis. Of the 24 patients who received single fraction radiation, 13 (54.2%) were given the second dose. Improvement in pain and dysphagia were reported in 57.9% and 60% patients, respectively. A total of 55.5% noted decrease in size of the neck node. Twenty-four patients received fractionated radiation and 15 (62.5%) were given the second course after 2 weeks. Relief in pain and dysphagia was reported in 68.2% and 63.6% patients, respectively. There were no grade 3/4 toxicities. Symptom control lasted for at least 3 months in 30% of the patients who received single fraction radiation and 54.2% of the patients who received fractionated radiation. The estimated 6-month overall survival of the entire cohort was 51.4%. Conclusion: Judicious use of palliative radiation in advanced incurable head and neck cancers provides effective and durable symptom relief and should be used after careful consideration of patient prognosis, logistics of treatment, and goals of care.

Impact of Telemedicine on Healthcare Delivery in Gastrointestinal Cancer Patients during the COVID-19 Pandemic.

Background: COVID-19 pandemic necessitated to change the normal OPD practices in view of lockdown and to decrease the exposure of patients and health care workers. Hence our institute adopted the telemedicine route to cater to the needs and grievances of patients. In this article we have analysed the impact of telemedicine on gastrointestinal cancer patients in Radiotherapy and Oncology OPD during COVID-19 pandemic. Methodology: Retrospective data was extracted from the files of the patients who were seen through telemedicine. Time period for this study was kept from 1st September 2020 to 31st October 2020. Patients with only gastrointestinal malignancies were enrolled in the study. Patients were called telephonically to get their feedback on the telemedicine experience. Every patient completed a set of questionnaires. Physical OPDs were also running simultaneously with appointments made through telemedicine to reduce crowding and maintain social distancing. Results: In total, data of 157 patients was obtained. Sixty three percent of the patients were from rural background while 37% had urban residence. Median age of the patients was 55 years (range,13-80years). Thirty eight percent patients had stage IV,51.6% had stage III while 8.9% had early-stage malignancies. Sixty percent of the patients had either received or were on radical treatment while 39.5% were taking palliative treatment. Approximately 53% of OPD visits could be avoided with telemedicine. Overall, the experience of telemedicine received an encouraging response with 87.3% of patients responding affirmatively to repeat the telemedicine if given opportunity. Conclusion: Telemedicine has led to un-interrupted delivery of cancer care, particularly for patients who were on active surveillance and live at remote places from the hospital. Our study demonstrated patient and healthcare staff safety along with the benefits of health care facilities to patients during this period of pandemic, though assessment of long-term impact on patient outcomes and health care systems needs to be done.

Clinical behaviour and outcome in pediatric glioblastoma: current scenario.

Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018-2019.