Profile of Malignant Spinal Cord Compression: One Year Study at Regional Cancer Center.

BACKGROUND AND OBJECTIVES: Malignant spinal cord compression is an oncologic emergency, unless diagnosed early and treated appropriately, can lead to permanent neurological impairment and compromised quality of life of patients. We analyzed the epidemiology and the effect of common interventions on the outcome in these patients. PATIENTS AND METHODS: We conducted a prospective study of 77 patients in the year 2014 and recorded relevant patient and disease characteristics. All patients received corticosteroids. Eight patients were operated upon, and radiotherapy was delivered in 62 patients. RESULTS: Most of the patients were in the age group of 41-60 years and there was no gender preponderance in patients. Female breast cancer was the most common incident (15.5%) malignancy followed by multiple myeloma, lung, and prostatic carcinoma. Lower dorsal spine was the most common site of compression (35%) followed by lumbar (31%) and mid-dorsal (26%) spine. 70 (91%) patients had cord compression subsequent to bone metastasis while as other patients had leptomeningeal metastasis. In 31 (40%) patients, spinal cord compression was the presenting symptom. Overall, only 26 patients had motor improvement after treatment. CONCLUSION: Grade of power before treatment was predictive of response to treatment and overall outcome of motor or sensory functions. Neurodeficit of more than 10 days duration was associated with poor outcome in neurological function.

Oral glutamine: Is there a role in the amelioration of radiation-induced mucositis? A prospective case-control study at a tertiary care centre in North India.

BACKGROUND: The most frequently occurring painful and dose-limiting side effect of radiation therapy (RT) to the head and neck region is oral mucositis (OM). Several studies demonstrated that glutamine may reduce the severity and the duration of OM significantly during RT and chemo-radiotherapy in patients with head and neck cancer (HNC). MATERIALS AND METHODS: Between January 2021 and August 2022, a prospective single institutional case-control study compared the efficacy and safety of oral glutamine on radiation-induced mucositis in patients with HNC. Of 60 biopsy-proven patients with HNC, 30 patients in the study arm received oral glutamine suspension (10 g in 500 mL of water) orally once daily, 2 hours before RT, receiving definitive or adjuvant RT and chemo-radiotherapy, while as 30 patients in the control arm received placebo with the same dose and schedule (n = 30 in the study arm and n = 30 in the control arm). RESULTS AND ANALYSIS: A total of 27 (90%) in the glutamine arm and 28 (93.33%) patients in the control arm developed mucositis. Grade 3 mucositis (13.33%) and Grade 4 mucositis (6.66%), respectively, were significantly less (P = .040 and P = .004) in the glutamine arm. The mean duration of grade 3 and grade 4 mucositis was significantly less in the glutamine arm (8.94 days in the study arm vs. 14.54 in the control arm; P = .0001). The mean time of onset of OM was significantly delayed in the glutamine arm in comparison to the control arm with P < .001. CONCLUSION: Glutamine delays the onset of OM and decreases the severity of OM in patients of HNC receiving RT with or without chemotherapy.

Radiation Therapy and its Effects Beyond the Primary Target: An Abscopal Effect.

Radiation therapy (RT) has been used for the treatment of various malignancies since decades with curative or palliative intent. RT for primary disease is often used with curative intent while its use in metastatic settings has been essentially palliative. However, in certain malignancies with metastatic disease, RT to primary disease has led to the regression of not only the primary site but also of the metastatic sites, a phenomenon known as "abscopal effect." Keeping in view the positive effects of RT beyond the primary site, we review the clinical utility of RT regarding its abscopal effect.

Breast specific functional and symptom analysis in female breast cancer survivors.

CONTEXT: The disease and surgery of the breast not only evoke a fear of mutilation and loss of feminity but is also responsible for psychosocial, behavioral, and sexual problems. AIM: To analyze prospectively the time trends in "breast specific functional and symptom scale scores in female breast cancer survivors." SETTINGS AND DESIGN: The prospective study was conducted in the Department of Radiation Oncology at Tertiary Referral Hospital. MATERIALS AND METHODS: A total of 154 operated (mastectomy) female breast cancer patients who were referred to the Department of Radiation Oncology for chemoradiation ± target therapy (trastuzumab) ± hormonal therapy (tamoxifen) were included in the study. Seven patients were excluded from the final analysis due to their refusal to consent. The patients were assessed by using European Organization for Research and Treatment of Cancer Quality of Life-BR23 questionnaire module (which incorporates five multi-item and three single items scales) at 1st visit (0 month), 6, 12, and 24 months interval, respectively. RESULTS: The symptom scores and future perspectives scale showed improvement with time, but body image and sexual functioning and enjoyment scales showed the deteriorating trend. P < 0.05 was considered as significant. CONCLUSION: The female breast cancer survivors failed to improve their body image, sexual functioning, and sexual enjoyment scales but did well in other BR23 scales. Besides the family and spousal/marital support these patients got closer to their religion which has been seen to influence their psychosocial well-being optimistically and need further studies to establish the role of religious practices/beliefs.

Nasopharyngeal Carcinoma: A 15 Year Study with Respect to Clinicodemography and Survival Analysis.

Nasopharyngeal carcinoma (NPC) is a rare malignancy in Kashmir with distinct pattern, hence we planned to study its clinicodemographic and survival profile. Kashmir has unique lifestyle and dietary habits which may be the source of carcinogenic compounds, most likely implicated in causation of NPC. A total of 148 patients of NPC registered from January 2000 to December 2014 were analyzed. The Mean ± SD age was 45.15 ± 17.092 years (range 11-85 years). The males were 72.3 % (N = 107) with male: female ratio of 2.61:1. Most of the patients were from rural area 81.90 % (N = 95) and non-smokers were 53.44 % (N = 62). Neck swelling was commonest presentation. WHO Type III NPC was commonest histopathological diagnosis 65.3 % (N = 92). Stage IV 36.1 % (N = 51) was commonest stage followed by stage III was 32 % (N = 46). Majority of the patients of NPC received CCRT 68.7 % (N = 78) followed by SCRT 13 % (N = 15) and Induction + CCRT 13 % (N = 15). The overall mean survival of NPC was 49.56 months. There was no significant correlation of age, gender, smoking, histopathology and treatment on the overall survival. However the stage was the only strong predictor of overall survival. Also the patients with intracranial extension had low survival which is turn depicts the advanced stage of disease. NPC survival is directly related to the stage of the disease irrespective of the treatment modality received. The negative EBV status in our patients implies that there are other risk factors involved in the causation of NPC for which further studies are needed to establish the etiological insult.

Clinicoepidemiological analysis of female breast cancer patients in Kashmir.

AIM: The aim of this study was to analyze the demographic features, reproductive history and stage at disease presentation among the female breast cancer patients. DESIGN AND SETTING: The present prospective hospital-based study was conducted in Department of Radiation Oncology, University Teaching and Tertiary Referral Hospital. MATERIALS AND METHODS: After approval from the Institute's ethical committee, 132 female breast cancer patients surgically treated either by mastectomy or breast conserving surgery (BCS) and then referred to the department of radiation oncology for further management and/or follow-up as per the hospital protocol, were enrolled in the study (January 2010 to December 2011) after obtaining a written informed consent from the patients. The patients were diagnosed by histology [fine needle aspiration cytology (FNAC), true cut or excision biopsy], mammography and ultrasonography (USG). The patients were analyzed as per the demographic and reproductive history and the stage of disease at presentation. The data collected were expressed as percentage (%), mean, median and standard deviation (SD). RESULTS: The mean age at presentation was 46.6 ± 10.2 years. The majority of patients were from rural areas, married, multiparous and post-menopausal. The commonest stage at disease presentation was IIb. CONCLUSION: In comparison to the rest of Indian scenario, more awareness related to breast cancer among post-menopausal and the rural females is needed. The role of peri-menopausal status, which represent 10% (n = 14) patients needs to be established in relation to breast cancer.

Cancer in Kashmir, India: burden and pattern of disease.

BACKGROUND: Incidence and prevalence of cancers differ in different regions of the world. To study the profile of different cancers in a particular cancer belt helps to know the exact incidence of different cancers in that region and their likely etiology. The aim of this study was to analyze the incidence of different cancers in Kashmir valley. MATERIALS AND METHODS: Retrospective study of patients registered at our Regional Cancer Centre (RCC) from Jan. 2009 to Dec. 2011 was carried out. All patients were histologically proven malignancies and were referred to the RCC for proper staging and treatment. All patients were properly evaluated and treated. RESULTS: A total of 8648 patients were registered during this period. Esophageal cancer was the most common cancer followed by cancers of Lung, Stomach, Colorectal, Breast, Non-Hodgkin's Lymphoma, Gastro esophageal junction, Ovary, Skin, Gallbladder, Multiple Myeloma, Acute Lymphoid Leukemia, Urinary Bladder, Prostate and Hodgkin's lymphoma. CONCLUSION: Pattern of malignancies in valley is different from rest of the India. Gastrointestinal malignancies are the commonest malignancies in Kashmir valley followed by lung cancer in males and breast cancer in females.

Hypofractionated radiotherapy as local hemostatic agent in advanced cancer.

PURPOSE: Tumor bleeding continues to remain a challenge in an oncological setting, and radiotherapy has been studied as a local hemostatic agent. We studied the role of local radiotherapy in controlling bleeding at our center. MATERIALS AND METHODS: We reviewed 25 treated cases (cancer urinary bladder: 12, lung cancer: 5, cervical cancer: 4, uterine cancer: 1, rectal cancer: 2, schwanoma: 1) at our center from March 2008 to December 2010. All patients had either an advanced or recurrent disease. Radiotherapy schedule was either 20 Gray in 5 fractions or 15 Gray in 5 fractions and was delivered with Cobalt 60. RESULTS AND CONCLUSION: Of 25 patients, 22 (88%) responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding.