RESUMO
OBJECTIVES: Palliative radiotherapy regimens for advanced head and neck cancers vary in doses and treatment times. Their quality of life (QoL) implications are not clearly established. METHODS: We randomised patients with advanced, non-metastatic, head and neck squamous cell carcinomas (stage IVA-B) with WHO performance score of 2 or higher to receive 30 Gy in 10 fractions over two weeks (arm A) or 20 Gy in 5 fractions over one week (arm B). QoL was assessed using European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-H&N35 questionnaires at baseline and postradiotherapy. The primary endpoint was the EORTC-defined global health status. Secondary endpoints were functional and symptom scores of QoL, response to radiotherapy and acute toxicities. The primary aim was to evaluate the one-week regimen in terms of QoL to the longer regimen. RESULTS: 110 patients were randomised, the number of patients in the final analysis was 95: 49 in arm A and 46 in arm B. Baseline characteristics were similar. Clinical outcomes post-treatment were comparable. Postradiotherapy, there were improved scores for functional and symptom scales, the differences were non-significant. The duration of treatment was significantly reduced in arm B (p<0.01) with a lower score for financial difficulty (p<0.001). The difference in global health status (primary endpoint) was non-significant (p=0.82). The median overall survival was 7 months, the median progression-free survival was 5 months and these did not vary between the two groups. CONCLUSION: One-week palliative radiotherapy for head and neck cancers achieves similar QoL and clinical outcomes as more protracted radiotherapy schedules with significantly reduced treatment time and financial toxicity.
RESUMO
A worldwide outbreak of a respiratory illness, first detected in December 2019 in Wuhan city, Hubei province, China is ongoing. The disease is caused by a novel coronavirus, SARS-CoV-2 and on February 11, 2020, was officially named Coronavirus Disease 2019 (COVID-19) by the World Health Organization. Within few weeks, it has spread globally to the extent that World Health Organization declared it as a global pandemic on March 11, 2020. India's first positive case was reported on January 30th in Kerala. Before March 3rd, India had 3 cases of coronavirus in Kerala all of which were treated and discharged. On March 3rd, India's 4th case was diagnosed in the state of Rajasthan. Indian government had announced a number of preventive measures to minimize the entry and spread of coronavirus. On March 3rd, India announced the suspension of all visas issued to Italy, Iran, South Korea and Japan. India banned international flights from March 22nd. A 21-day lockdown across the country was imposed from March 26th, which later got further extended. Rigorous contact tracing and tracking of COVID patients and monitoring home quarantine helped in preventing community transmission. The aim of this work is to describe the experience with clinical and epidemiologic features, as well as with the management of COVID-19 patients in north India. This is a descriptive study of the 17 COVID-19 infected patients confirmed with polymerase chain reaction (PCR) and admitted to a tertiary care centre in India from March 11th 2020 to April 16th 2020. The present work also provides insight in to treatment provided and final outcome of the patients infected with COVID-19 in India. Laboratory investigations in COVID-19 patients in the Indian subcontinent reveal lymphopenia as predominant finding in hemogram. Patients with older age and associated comorbidities (COPD, hypertension and diabetes) seem to have greater risk for lung injury, thereby requiring oxygen support during the course of disease.
