Asian Pacific Journal of Cancer Care

Evaluating the Response of Hypofractionated Radiotherapy verses Conventional Radiotherapy with Concurrent Cisplatin in Advanced Fixed Node Head and Neck Carcinoma

2024-04-23T05:27:50+00:00

Background: The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumour sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).

Objectives: To evaluate the efficacy of hypofractionated radiotherapy in advanced unresectable head neck cancer, in terms of response rate and evaluate the local and systemic toxicities of hypofractionated regimen with symptomatic improvement of radiotherapy and treatment compliance.

Methods: A total of 50 cases of locally advanced head and neck cancer (stage cT4b and/or N3) without any evidence of distant metastasis were included in this study. These 50 cases were randomly distributed into study and control group containing 25 each. Radiotherapy consists of a single fraction of 6 Gy Per week for a total of 6 weeks. If the patient received less than 6weeks of treatment, he/she was excluded from study. Total dose given was 36 Gy in 6 fractions. All the patients were treated by unilateral or bilateral portal till 24 Gy and then off cord planning was done. Patients with complete disease regression after initially planned 36 Gy (BED-57.6Gy, considering alpha/beta of 10 and corresponding EQD2-48Gy) were offered further dose escalation depending upon tumour regression status, tolerability and toxicity according to institutional guidelines. Partial responders are given no treatment up to end of treatment period.

Results: Among the study and control group, incidence of carcinoma of tonsil was 12% and 20%, carcinoma of base of tongue was 24% and 16%, carcinoma larynx 16% and 24%, respectively and Hematological toxicities (reference to blood hemoglobin level), Renal (reference to blood urea) were assessed according to WHO toxicity criteria in all cases weekly up to six weeks Among the study and control group, 8% and 12% had no acute hematologic reactions (χ2 = 0.22, p > 0.05), 56% and 48% had grade I hematologic reactions (χ2 = 0.32 p > 0.05,), 28% and 36% had grade II hematologic reactions (χ2 = 0.36, p > 0.05) and 8% and 4% had grade III hematologic reactions (χ2 = 0.35, p > 0.05) respectively. No patient had had grade IV hematological toxicity. Among the study and control group, 80% and76% had no acute renal toxicity. (χ2 = 0.11, p > 0.05), 20% and 24% had grade I hematologic reactions (χ2= 0.11 p > 0.05). No patients from either group develop grade II, III and IV renal toxicity.

Conclusions: HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.

A Review of Literature on Thymoma: An Indolent Tumor of Anterior Mediastimum

2024-04-23T05:58:12+00:00

Thymic tumours are a heterogeneous group of malignancies with a range of clinical presentations. The most common types are thymoma and thymic carcinoma, but overall it remains a rare cancer, and one without a clear aetiology. About 50% are diagnosed incidentlly with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management. Different types of treatments are available for patients with thymoma. Thymectomy to remove the tumor is the most common treatment of thymoma. We present a case of 20 yr old male presented with shortness of breath, cough, chest pain and fever for past 15 days. Mediastinal widening and modratly pleural effusion in right sided chest seen on chest xray. CECT chest show soft tissue density lesion in anterior and superior mediastinum. FNAC was done that showed feature of thymoma. Biopsy also done that confirmed lymphocytic rich type B thymoma.

Small Cell Carcinoma of Anal Canal: A Rare Case Report from a Tertiary Cancer Centre

2024-04-23T06:33:30+00:00

Extrapulmonary small cell carcinoma (EPSCC) is very rare with an incidence of 0.1 to 0.4% in the United states and the exact incidence in other regions is unknown. Anal canal involvement is extremely rare contributing to < 1% of all EPSCC. Inspite of its rarity, it is of clinical importance due to its aggressive nature. Most of the patients present with lungs and liver metastasis at diagnosis even in early stage tumors. It has a dismal survival rate of 58% at 6-month and 6% at 5-years in contrast to squamous cell carcinoma of anal canal. Exact ethiopathogenesis is unknown. Association with HIV has been seen like squamous cell carcinoma of anal canal. There is very little literature evidence and management is not clear like that of squamous cell carcinoma anal canal. Here we present the case of a 63 year old HIV positive male who presented with small cell carcinoma of anal canal to our institute and the challenges we faced in diagnosis and management.

Radical Radiotherapy in Primary Extra Nodal Lymphoma of Tonsil: A Rare Case Report

2024-04-23T06:52:49+00:00

Primary non-Hodgkin’s lymphoma (NHL) usually arises within the lymphnodes, but 20-30% account for extranodal sites. Non-Hodgkin’s lymphoma (NHL) of the Waldeyer’s ring is a clinical rarity. Among these tumors, palatine tonsils are most frequently involved. Most common high-grade rapidly growing NHL is diffuse large B-cell lymphoma (DLBCL), reaching about 80% in some of the studies. For aggressive localized Extranodal Lymphoma, systemic therapy is the primary treatment modality unless patients are unfit for, or refuse, such therapy. Here, we report a 71 years old elderly gentleman who presented with complaints of left tonsillar swelling, difficulty in swallowing and change in voice since 10 days. He was diagnosed as localised Primary Extra nodal NHL - DLBCL of left tonsil. But he was unfit for chemotherapy in view of elderly age and multiple comorbidities, hence he received radical radiotherapy. During the treatment, he had symptomatic relief. He responded to radical radiotherapy well & is on regular follow up.