Diagnostic potential of serum HSP90 beta for HNSCC and its therapeutic prognosis after local hyperthermia therapy.

The present pilot study aims to investigate the diagnostic and prognostic efficacy of serum HSP90 beta in Head and Neck Squamous Cell Carcinoma (HNSCC) patients subjected to localized hyperthermia therapy (HT). Serum levels of HSP90 beta were measured by ELISA and its diagnostic and prognostic efficacy was determined by receiver operating characteristic curve (ROC) analysis. HNSCC patients showed significantly (P<0.05) higher serum levels of HSP90 beta (65.6±13.08 ng/ml) compared to Healthy Controls (HC: 23.5±3.8 ng/ml). No significant difference was observed in serum HSP90 beta levels between complete responders (CR) and non-responders (NR) in the chemo-radiation therapy (CRT) cohort. However, in CRT+HT cohort, CR showed significantly (P = 0.02) lower serum HSP90 beta levels at 24 h after HT (25.6±9.04 ng/ml) compared to NR (130.5±34.2 ng/ml). Youden's index values between HNSCC versus HC, CR versus NR (CRT) and CR versus NR (CRT+HT) were found to be 0.47, 0.45 and 0.80, respectively. Thus, alterations in the serum HSP90 beta after HT suggest its potential in prognosis of HT response in HNSCC patients. Elevated levels of HSP90 beta may serve as a promising diagnostic serum bio-marker for HNSCC. However, further validation in larger patient samples is needed for clinical translation of HSP90 beta as diagnostic and prognostic biomarker.

Body Image Scale: Evaluation of the Psychometric Properties in Three Indian Head and Neck Cancer Language Groups.

Background: Body image is a subjective concept encompassing a person's views and emotions about their body. Head and neck cancer (HNC) diagnosis and treatment affects several psychosocial concepts including body image. Large numbers of HNC patients are diagnosed each year in India but there are no suitable measures in regional languages to assess their body image. This study assessed the psychometric properties of the Body Image Scale (BIS), a measure suitable for clinical and research use in HNC populations, translated into Tamil, Telugu and Hindi and compared body image distress between language groups. Methods: Translated versions of BIS were completed by HNC patients recruited from three cancer centers across India one time only. Psychometric evaluation was conducted including factor analysis using principal component analysis and internal consistency reliability using Cronbach's alpha. Patients completed the EORTC Quality of Life Questionnaire (QLQ) C-30 and EORTC QLQ HN-35 measures to enable exploration of convergent and discriminant validity. ANOVA was used to calculate difference in mean values for body image. Results: Our sample included 621 HNC patients (Tamil = 205, Telugu = 216, Hindi = 200). Factor analysis revealed a one-factor solution and Cronbach's alpha coefficients ranged between 0.891 and 0.969 indicating good reliability. Hypothesized correlations between similar and different constructs were as expected, supporting construct validity. On the BIS, we found a statistically significant difference (F = 11.0954, P < 0.05) between means of Tamil, Telugu, and Hindi groups, with higher body image scores in Telugu (M = 12.86; SD = 7.65) and Hindi groups (M = 12.52; SD = 7.36) indicating more symptoms/body image distress, when compared to Tamil population (M = 9.28; SD = 10.04). Conclusion: The reliability and validity of the three translated Indian versions of the BIS were maintained, providing a method for assessing body image of HNC population worldwide speaking Tamil, Telugu, and Hindi across the illness trajectory.

Treatment-related communication experiences and expectations among Indian cancer patients receiving radiation therapy and their family members: A qualitative study.

OBJECTIVE: To explore Indian cancer patients' and their primary family caregivers' (PFC) experiences and expectations of treatment-related communication with their physician while undergoing radiation therapy. METHODS: Participants, comprising patient-PFC dyads (n = 32), patients only (n = 33) and PFC only (n = 7), were recruited from one hospital in Mumbai, India. Semi-structured interviews explored participants' perceived role in cancer-related decision-making, diagnosis and prognosis communication experiences with the physician, communication expectations of their treating physician, and information needs. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. RESULTS: Main themes included: (i) patients' passive role in treatment communication, (ii) family as an integral part of the medical consultation, and (iii) dyads' expectations and beliefs about the role of the physician. CONCLUSION: Indian cancer patients played a passive role in treatment decision-making while physicians were seen as primary medical decision-makers. Further, PFCs provided the final consent for the treatment plan and acted as a mediator/moderator between the patient-physician. PRACTICE IMPLICATIONS: These findings suggest the need for (i) interventions such as question prompt lists that may improve patient activation and caregiver preparedness, and (ii) triadic communication training interventions for optimal communication between the three stakeholders (i.e., patient, physician and PFC).

Indian Cancer Patients' Needs, Perceptions of, and Expectations from their Support Network: a Qualitative Study.

Psycho-oncology research in India reveals that family caregivers and oncologists are primary medical decision-makers frequently acting on behalf of the patient. Thus, patients are rarely asked about their wants and needs. This study aimed to understand Indian cancer patients' needs and expectations from their support network. Twenty-six cancer patients participated in semi-structured interviews exploring patients' needs, perceptions of their support network and the type of support they would prefer, and their experiences of receiving this support. The interviews were analyzed using Interpretive Phenomenological Analysis. Emergent themes included: (i) role of the oncologist: being the primary medical decision-maker, communicating in a style consistent with patient preferences; (ii) role of the immediate family: being emotionally available, helping with navigating the hospital system, aiding in medical adherence; (iii) role of relatives and friends: giving advice and providing tangible aid and services; and (iv) role of other cancer patients: helping with coping with the illness. The study highlights Indian patients' ability to define their supportive network and assign specific roles to them. The study implies the need to develop communication training programs and peer-to-peer support groups to address patients' unmet communication needs and aid in coping.

Study on the measurement of photo-neutron for15 MV photon beam from medical linear accelerator under different irradiation geometries using passive detectors.

AIM OF STUDY: The photo-neutron dose equivalents of 15 MV Elekta precise accelerators were measured for different depths in phantom, for various field sizes, at different distances from the isocenter in the patient plane and for various wedged fields. MATERIALS AND METHODS: Fast and thermal neutrons are measured using passive detectors such as Columbia Resin-39 and pair of thermoluminescent dosimetry (TLD) 600 and TLD 700 detector from Elekta medical linear accelerator. RESULTS: It is found that fast photo-neutron dose rate decreases as the depth increases, with a maximum of 0.57 ± 0.08 mSv/Gy photon dose at surface and minimum of 0.09 ± 0.02 mSv/Gy photon dose at 15 cm depth of water equivalent phantom with 10 cm backscatter. Photo neutrons decreases from 1.28 ± 0.03 mSv/Gy to 0.063 ± 0.032 when measured at isocenter and at 100 cm far from the field edge along the longitudinal direction in the patient plane. Fast and thermal neutron doses increases from 0.65 ± 0.05 mSv/Gy to 1.08 ± 0.07 mSv/Gy as the field size increases; from 5 cm × 5 cm to 30 cm × 30 cm for fast neutrons. With increase in wedge field angle from 0° to 60°, it is observed that the fast neutron dose increases from 0.42 ± 0.03 mSv/Gy to 0.95 ± 0.05 mSv/Gy.s CONCLUSIONS: Measurements indicate the photo-neutrons at few field sizes are slightly higher than the International Electrotechnical Commission standard specifications. Photo-neutrons from Omni wedged fields are studied in details. These studies of the photo-neutron energy response will enlighten the neutron dose to radiation therapy patients and are expected to further improve radiation protection guidelines.

A retrospective analysis of patients with head and neck cancer treated with radiation, hyperthermia, and cetuximab: A brief report of outcome.

PURPOSE: Advanced head and neck cancer continues to have a dismal outcome. Chemoradiation remains the current standard of care. Chemoradiation has not achieved the desired increase in survival in locally advanced head and neck cancer. This is a retrospective analysis of six patients treated with hyperthermia, radiation therapy, and cetuximab. We wished to determine if this combination treatment would further improve the outcome. MATERIALS AND METHODS: Six patients with squamous cell cancer of the head and neck region were treated with hyperthermia, cetuximab, and radiation therapy. The end points assessed were acute toxicity and immediate response. RESULTS: All the six patients received the planned doses of cetuximab and radiation therapy. Two patients did not complete the planned hyperthermia sessions. All patients developed mucositis and acneiform rashes. None had thermal burns. One hundred percent complete response was observed in all the patients. CONCLUSION: Addition of hyperthermia to cetuximab and radiation therapy is feasible and shows impressive response rates with manageable toxicity profile. Further studies evaluating the same are needed to confirm these findings.

Intensity-modulated radiation to spare neural stem cells in brain tumors: a computational platform for evaluation of physical and biological dose metrics.

BACKGROUND: Neurocognitive effects following whole-brain and partial-brain irradiation can cause considerable morbidity. Sparing of neural stem cells (NSCs) is proposed as an avenue for reducing the long-term radiation-induced defects in learning, memory, and intelligence. We performed an analytical study to spare the NSC from partial-brain irradiation by intensity-modulated radiotherapy (IMRT). OBJECTIVE: The aim of this study is to achieve maximal sparing of NSC during irradiation of brain tumors using biologically equivalent dose (BED) for all plans. The consequent clinical benefit will possibly be in terms of acute effects on stem cells and delayed neurologic sequelae to brain. A tool to modulate various physical and biological dose metrics has been used to study the optimization of radiation therapy for brain tumors with constraints imposed on total radiation to NSC. MATERIALS AND METHODS: A total of 10 successive patients of grade III and IV gliomas of brain, who underwent total or near total excision of brain tumors, were included in the study. Patients underwent computed tomography and magnetic resonance imaging fusion for contouring. Computational codes used to analyze the efficacy of the plan are quality of coverage, homogeneity index, and conformity index. Wide range of radiosensitivity parameters were evaluated by using equivalent uniform dose and tumor control probability (TCP) to predict tumor control with and without sparing of NSC. RESULTS: The physical and biological dose metrics were modulated by fitting standard deviation of 0.3% for all plans. The maximum NSC sparing was achieved in IMRT plans with constraints applied to local TCP. Similarly, for BED of plans with and without constraints, the estimated mean reduction in acute complications of NSC achieved was 12.23% (range, 4.27-28.33%). The estimated mean reduction in BED for late complications of late-reacting brain tissue is 14.69% (range, 7.39-33.56%).