Salvage Endoscopic Nasopharyngectomy for Locally Recurrent T1 and T2 Nasopharyngeal Carcinoma.

Assessment of salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma (rNPC). This is a retrospective study of ten rNPC who underwent salvage endoscopic nasopharyngectomy. Recurrent status for each recurrence was determined before surgery and only recurrent T1 (rT1) and recurrent T2 (rT2) were taken up for surgery after review with radiation oncology colleagues. There were seven rT2 and three rT1 patients. Two patients have undergone simultaneous radical neck dissection (RND) together with endoscopic nasopharyngectomy for associated neck nodes. Outcome of the study was done in turn of disease free, disease residual and disease recurrence. Locally disease free and overall survival rates were 40% (4/10) and 50% (5/10) respectively. Locally disease free till the last follow up was achieved in 4 patients while one patient is on palliative chemotherapy post-surgery for locally positive disease for the last three years. Of the four patients that are locally disease free, two patients received chemoradiation (CTRT) post-surgery while two patients only underwent endoscopic nasopharyngectomy for rT1. There were no any major operative complications except nasal crusting. Recurrent T1 and T2 can be manage with endoscopic nasopharyngectomy and post-surgery ctrt should be given in feasible patients. To detect early recurrent and improve the survival, regular endoscopic follow up is needed.

Prevalence of Tobacco Use in Young Adult Literate Girls of 18-25 Years in Meghalaya, India: A Cross-Sectional Study.

BACKGROUND: Several national-level surveys have recognized a high prevalence of tobacco use in North-eastern (NE) India. However, information on tobacco use in specific population subgroups still lacks from the region. The present study determines the prevalence and influence of determinants like education and family income on tobacco use in senior school and college-going girls in Shillong, Meghalaya. Additionally, the prevalence of dual use of smoking and smokeless (SLT) tobacco with alcohol and non-tobacco Pan Masala has been examined. METHODS: A cross-sectional study was conducted among 18-25 years girls in educational institutions in Shillong.  Data were analysed using statistical software SPSS version 22. The categorical data presented as frequency (%). Chi-square was employed to see the association between variables. RESULTS: (i) 8.10% of girls were current users of all forms of tobacco; 1.85% were smokers, 4.0% used SLT, and 2.25% were dual users of tobacco (ii) Of the 6.25% current users of SLT, 5.4% used a single smokeless tobacco product whereas 0.85% used multiple products of SLT (iii) 79.5% of tobacco smokers and 30.2% of current SLT users were dual users with alcohol (iv) 37.2% tobacco smokers and 18.5% SLT users were dual users with non-tobacco Pan Masala (v) Tobacco smoking was positively associated with educational status and family income whereas SLT use was independent of educational status and income of girls' families. CONCLUSIONS: The study shows a relatively high prevalence of tobacco use and dual tobacco use with alcohol in the study population of educated young adult girls, underscoring a public health concern. It is recommended that an education-based comprehensive awareness program be initiated for tobacco and alcohol control in Meghalaya to improve knowledge and health-seeking behaviour change in this high- risk subgroup to control increasing NCDs.

Impact of Educational Level and Family income on Breast Cancer Awareness among College-Going Girls in Shillong (Meghalaya), India.

BACKGROUND: Breast cancer (BC) is the most common cancer among women in India and shows an increasing trend. The mammography screening seems unfeasible as a public health service in India. Thus, breast self-examination (BSE), followed by clinical breast examination (CBE), is the affordable method to downstage BC. A cross-sectional study was conducted with senior school and college-going girls in Shillong (Meghalaya) to study the impact of girls' academic level and family income on breast cancer knowledge and the prevalence of BC's known risk factors in girls.  Methods: A self-administered questionnaire was employed to collect relevant information. The data were analysed using statistical software SPSS version 22. The categorical data presented as frequency (%) and the comparison made using Chi-square or Fisher exact test. RESULTS: (i) 78.2% girls knew about breast cancer, 19.2% of these were aware of BSE, and 22.9% of BSE knowing ever performed it (ii) Awareness of breast cancer and BSE, and its practice is significantly associated with their academic level and family income (iii) The consumption of alcohol beverages and physical activity of girls was positively associated with educational level and family income (iv) Body mass index (BMI) was weakly associated with family income with an insignificant relationship with academic level (v) oily food consumption related inversely with the level of education irrespective of family income (vi) there was a positive correlation between parents education and family income. CONCLUSIONS: The results show a severe lack of breast cancer knowledge in senior school and college-going girls under the survey. To spread community awareness, we suggest a public health policy-driven educational intervention through culturally relevant mass/social media on the risk factors of breast cancer and practice of BSE. It is also recommended that dedicated facilities be created for breast cancer early diagnosis in the public health system.

Indian clinical practice consensus guidelines for the management of squamous cell carcinoma of head and neck.

Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract and are the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines or recommendations for the management of HNCs, these may not be appropriate for Indian scenarios. In an effort to discuss current practices, latest developments and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical and radiation oncologists and dentists) was formed. A review of literature from medical databases was conducted to provide the best possible evidence base, which was reviewed by experts during a consensus group meeting (January, 2019) to provide recommendations.

5th Rib Osteo-pectoralis Major Myocutaneous Flap-Still a Viable Option for Mandibular Defect Reconstruction.

Reconstruction of mandible is of paramount importance following ablative surgery for oral cancer. Though osteocutaneous micro-vascular free flap is generally accepted to be the mainstay of mandibular reconstruction, other reconstructive options are also done for mandibular reconstruction with good results. Seventeen patients of oral cavity cancer involving the alveolus who had underwent hemi-mandibulectomy were reconstructed using 5th rib osteo-pectoralis major myocutaneous flap. Procedure related pleural tear occurred in 3 patients during harvesting of the rib which were repaired intra-operatively with no post-operative complications. There were 2 failures in our series, in the rest 15 patients the flap had taken up; have good oral continence taking semi-solid diet and have satisfactory cosmetic appearance. This study shows that 5th rib osteo-pectoralis major myocutaneous flap is a quick, easy to learn, one stage reconstructive procedure with a good predictable cosmetic and functional outcomes.