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Byline: Deep. Pruthi, Puneet. Nagpal, Manish. Pandey, Harpreet. Singh Background: Many acute toxicities are associated with concurrent chemoradiation in cervical carcinoma, which includes burning micturition, burning defecation, pain lower abdomen, [...]

Background: Inflammation, when associated with cancer, has been shown to correlate with a worse prognosis. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) serve as markers of inflammation. This study aims to investigate the influence of pretreatment NLR, PLR, and MLR on treatment outcomes and their correlation with sarcopenia in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) undergoing definitive chemoradiotherapy. Method: In this retrospective study, 240 LA-HNSCC patients who received a radiotherapy dose of 70 Gy/35 fractions over 7 weeks in conjunction with chemotherapy were enrolled. Pretreatment NLR, PLR, and MLR were determined. Sarcopenia was evaluated by measuring skeletal muscle mass at the C3 level using radiotherapy planning computed tomography scans. The impact of NLR, PLR, and MLR on complete response rate and disease-free survival was calculated. The median followup duration for patients was 26 months. Results: Inflammatory markers were notably higher in elderly patients, females, and those with laryngeal primary tumours. Patients achieving a complete response exhibited lower values than those who did not. Patients with significant sarcopenia demonstrated elevated mean values of inflammatory markers. Patients with NLR<3, PLR<145, and MLR<0.4 experienced more favorable outcomes regarding complete response rate and disease-free survival. Conclusion: Inflammatory markers such as NLR, PLR, and MLR are independent prognostic factors in HNSCC patients. Elevated values are associated with sarcopenia and inferior treatment outcomes, indicative of more aggressive tumour behavior. These markers are straightforward to calculate and should be routinely employed for early prognosis assessment. [ABSTRACT FROM AUTHOR]

Objectives: Image-guided radiotherapy maximizes therapeutic index of brain irradiation by reducing setup errors during treatment. The aim of study was to analyze setup errors in the radiation treatment of glioblastoma multiforme and if decrease in planning target volume (PTV), margin is feasible using daily cone beam CT (CBCT) and 6D couch correction. Materials and Methods: Twenty-one patients (630 fractions of radiotherapy) were studied in which corrections were made in 6° of freedom. We determined setup errors, impact of setup errors of initial three fractions CBCT versus rest of the treatment with daily CBCT, and mean difference in setup errors with or without application of 6D couch and volumetric benefit of reduction of PTV margin from 0.5 cm to 0.3 cm. Results: The mean shift in the conventional directions, namely, vertical, longitudinal, and lateral was 0.17 cm, 0.19 cm, and 0.11 cm. There was significant change in vertical shift when first three fractions were compared with rest of the treatment with daily CBCT. When the effect of 6D couch was nullified, all directions showed increased error with longitudinal shift being significant. The number of setup errors of magnitude >0.3 cm was more significant when only conventional shifts were applied as compared with 6D couch. There was significant decrease in volume of brain parenchyma irradiated when margin of PTV was reduced from 0.5 cm to 0.3 cm. Conclusion: Daily CBCT along with 6D couch correction can reduce setup error which allows reduction in PTV margin during radiotherapy planning in turn improving the therapeutic index. [ABSTRACT FROM AUTHOR]

Cancer is considered to be an age related disease because the incidence of most types of cancers increases with age rising more rapidly beginning in midlife. Adolescents and young adults are a distinct population, which is not a usual age for diagnosis of tumors that are usually found in older adults. Tumors in this group of patients tend to be different from tumors found in children or older adults. The treatment of such patients is challenging as they are at a higher risk of developing long-term side effects. In this case series, we report 3 cases of adult cancers that presented at an unusually younger age highlighting the fact that there is a recent shift in paradigm in terms of age of presentation of cancer. We present 3 cases namely, supraglottic larynx squamous cell carcinoma in a 21-year-old female, adenocarcinoma of the rectum in a 22-year-old male, and adenocarcinoma of the stomach and gastro-esophageal junction in a 25-year-old male. With this case series we want to highlight this recent change in the age presentation of adult cancers and this could foreshadow the future trend of the disease. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiation had been the standard of care for locally advanced oropharyngeal cancers. The addition of newer targeted therapies such as cetuximab has resulted in improved locoregional control rates along with tolerable toxicities. The aim of this study was to evaluate the response with addition of newer generation of systemic targeted agents (gefitinib and erlotinib) in combination with chemoradiotherapy for locally advanced oropharyngeal cancer. Materials and Methods: A total of fifty patients of locally advanced carcinoma oropharynx were randomized by odd–even technique to two arms. Arm A (24 patients) received radiotherapy along with concurrent weekly carboplatin 150 mg and daily gefitinib 250 mg, whereas Arm B (25 patients) received erlotinib 150 mg daily along with same chemoradiation regimen as in arm A. Results: The mean age group in the gefitinib and erlotinib groups was 56.9 and 55.1 years. The most common subsite was base of tongue followed by tonsil. The complete response rate was nearly the same in both the arms at the end of treatment. At the end of 1 and 2 years, the disease-free survival (DFS) was more in the gefitinib group as compared to erlotinib group (41.6% vs. 29.1%) and (33.3% vs. 25%), respectively. Conclusion: There was no significant improvement in DFS and OS with the administration of tyrosine kinase inhibitor (TKI) along with concurrent chemoradiotherapy. This might be attributed to the fact that longer duration of TKI was not administered, variable bioavailability of TKIs, and other immune-dependent mechanism when compared to cetuximab and other monoclonal antibodies. [ABSTRACT FROM AUTHOR]

Background: Oral mucositis is a common and debilitating painful side effect of many forms of chemotherapy and radiation therapy. Mucositis may lead to dose reductions and unplanned interruptions of chemotherapy and/or radiotherapy (RT) and often affects patients' quality of life.Aim: The objective of the study was to assess the efficacy of the ayurvedic preparation in decreasing the severity of mucositis in head-and-neck cancer patients receiving concomitant chemoradiotherapy.Materials and Methods: In this prospective randomized study, the patients were divided into three groups. Group 1 patients received conventional mucositis treatment, whereas Group 2 patients received ayurvedic preparation Yashtimadhu in addition to conventional treatment. Group 3 patients received honey for local application in oral cavity as well as one tea spoon of honey twice daily orally in addition to routine conventional treatment. All the patients were assessed for mucositis at the end of every week during the RT for a period of 6 weeks.Results: A significant difference was observed between the groups at each time point. Nearly 42.85% of patients in conventional treatment arm developed Grade 3 mucositis, 20% of patients developed Grade 3 mucositis in group where honey was given, and only 15.5% of patients developed Grade 3 mucositis in Yastimadhu group. Unplanned treatment breaks and hospitalization of patients were reduced with the use of yashtimadhu as compared to other two groups.Conclusion: Yashtimadhu was observed to be effective and delayed the development of severe form of mucositis. The drug appeared to be more efficient in the management of radiation-induced mucositis. [ABSTRACT FROM AUTHOR]