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1.
Gulf J Oncolog ; 1(45): 7-14, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38774928

RESUMO

INTRODUCTION: Technical innovations in radiation therapy treatment planning and delivery over the last two decades have changed the practice of radiation therapy dramatically. The benefit of improved dose homogeneity and better sparing of critical structures in helical tomotherapy compared with conventional linac-based IMRT has been reported. This study was conducted to compare acute toxicities (skin, mucous membrane, salivary gland and hematological) during treatment and overall treatment time in Head and Neck Cancer patients treated with IMRT and Helical Tomotherapy and to assess the quality of life of patients during treatment between two groups. MATERIALS AND METHODS: The study involved thirty patients with histologically proven Squamous cell carcinomas of Head and Neck. They were treated with concurrent chemoradiotherapy, to a dose of 60-70 Gray in 30-35 fractions. The study consists of 2 arms which are standard IMRT and Tomotherapy arm. Fifteen consecutive patients were treated under IMRT and 15 patients were treated under Helical tomotherapy, along with concurrent chemotherapy. After completion of planning, plans were evaluated and dose to the targets, organs at risk were tabulated. Patients were assessed weekly for acute toxicities (skin reactions, mucositis, xerostomia, haematological toxicities) during the course of the treatment as per RTOG criteria. Quality of life of patients were assessed using FACT/ NCCN HNSI questionnaire in local language at day 1, day 21 and at completion of radiotherapy. RESULTS: Grade 2-3 skin reactions, mucositis, anemia, leukopenia and thrombocytopenia were predominant in both arms. Treatment time from start of radiotherapy to completion of radiotherapy varied from 39 days to 68 days. Majority of patients completed radiotherapy within 50-56 days. Mean quality of life score did not show much difference between IMRT and tomotherapy arms. CONCLUSION: The study did not show any statistically significant difference in overall treatment time, acute toxicities- skin reactions, xerostomia, mucositis& hematological toxicities and quality of life of patients during radiotherapy between IMRT and Helical Tomotherapy. Dosimetric benefits of Tomotherapy over IMRT do not translate into clinical benefit in terms of reduced acute toxicities, lesser overall treatment time and better quality of life of patients. KEY WORDS: Head and Neck Carcinoma, IMRT, Tomotherapy, RTOG, toxicity, FACT/ NCCN HNSI, quality of life.


Assuntos
Neoplasias de Cabeça e Pescoço , Qualidade de Vida , Radioterapia de Intensidade Modulada , Humanos , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Carcinoma de Células Escamosas/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Lesões por Radiação/etiologia
2.
J Contemp Brachytherapy ; 15(6): 414-421, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38230405

RESUMO

Purpose: To compare dose volume parameters of target and organs at risk in vaginal vault brachytherapy using ovoids or cylinder in post-operative endometrial carcinoma. Material and methods: The study was done among 25 histologically proven post-operative endometrial carcinoma patients requiring vaginal brachytherapy. All patients underwent both cylinder and ovoids application alternatively on weekly basis. Ovoids size ranged from 2 to 3 cm diameter. Diameters of cylinder ranged between 2.5 and 3.5 cm. Bladder, rectum, urethra, and clinical target volume (CTV) were contoured on CT simulation images. Prescribed dose was 6-7 Gy in 2-3 fractions at 0.5 cm from the surface of applicator. Results: The mean values of D90, D50, V150, V100, V90, and V50 of CTV were comparable between cylinder and ovoids plans. The mean dose of CTV was significantly higher with cylinder than with ovoids, and D100 was significantly higher with ovoids (mean = 15.63 Gy vs. 14.64 Gy, p = 0.016, and D100 = 37.82% vs. 42.86%, p = 0.042, for cylinder vs. ovoids). In the dosimetry of the vault, D90, D50, V100, V90, V50, and mean of the vault did not show any significant difference between cylinder and ovoids. The V150 was significantly higher with cylinder plans than ovoids, and D100 of the vault was significantly higher with ovoids plans (V150 = 14.81% vs. 6.86%, p = 0.02, and D100 = 37.77% vs. 44.80%, p = 0.029, for cylinder vs. ovoids). D0.1cc, D1cc, D2cc, and mean for the bladder, rectum, and urethra were comparable between the cylinder and ovoid plans. Conclusions: The present study showed that the dose to organs at risk, most of the dosimetric parameters of CTV, and vault were comparable between the cylinder and ovoid plans. Both applicators provide good reproducibility. The choice of applicator will ultimately depend on the institutional policies and oncologist decision. However, in patients with dog-ear configuration of the vagina, ovoids may be preferred as per ABS guidelines.

3.
Apoptosis ; 21(5): 578-93, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26921178

RESUMO

TRAIL, an apoptosis inducing cytokine currently in phase II clinical trial, was investigated for its capability to induce apoptosis in six different human tumor cell lines out of which three cell lines showed resistance to TRAIL induced apoptosis. To investigate whether Anacardic acid (A1) an active component of Anacardium occidentale can sensitize the resistant cell lines to TRAIL induced apoptosis, we treated the resistant cells with suboptimal concentration of A1 and showed that it is a potent enhancer of TRAIL induced apoptosis which up-regulates the expression of both DR4 and DR5 receptors, which has been observed in the cellular, protein and mRNA levels. The death receptors upregulation consequent to A1 treatment was corroborated by the activation of p53 as well as phosphorylation of p38 and JNK MAP kinases and concomitant inactivation of NFκß and ERK signaling cascades. Also, A1 modulated the expression of key apoptotic players like Bax, Bcl-2 and CAD along with the abatement of tumor angiogenesis in vivo in EAT mouse model. Thus, post A1 treatment the TRAIL resistant cells turned into TRAIL sensitive cells. Hence our results demonstrate that A1 can synergize TRAIL induced apoptosis through the upregulation of death receptors and downregulation of anti-apoptotic proteins in cancer context.


Assuntos
Ácidos Anacárdicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Apoptose , Ligante Indutor de Apoptose Relacionado a TNF/farmacologia , Ácidos Anacárdicos/administração & dosagem , Animais , Proteínas Reguladoras de Apoptose/metabolismo , Caspase 3/metabolismo , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Lipossomos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Camundongos , Proteínas Quinases Ativadas por Mitógeno/metabolismo , NF-kappa B/metabolismo , Neoplasias/genética , Neoplasias/metabolismo , Neoplasias/patologia , RNA Mensageiro/metabolismo , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/genética , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Transdução de Sinais/efeitos dos fármacos , Proteína Supressora de Tumor p53/metabolismo , Regulação para Cima
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