A review article on the dosimetry in intraluminal HDR brachytherapy of lung carcinoma.

Lung cancer is one of the most common cancers in the world. Intraluminal brachytherapy (BT) is one of the most adopted treatment modalities for lung malignancies with Ir-192 source in radiotherapy. In intraluminal BT, treatment delivery is required to be very accurate and precise with respect to the plan created in the treatment planning system (TPS). The BT dosimetry is necessary for better treatment outcomes. Therefore in this review article, some relevant studies were identified and analyzed for dosimetric outcomes in intraluminal BT in lung malignancies. The dosimetry in BT for plan verification is not presently in practice, which needs to be performed to check the variation between the planned and measured doses. The necessary dosimetric work done by the various researchers in intraluminal BT such as the Monte Carlo CYLTRAN code was used to calculate and measure the dose rate in any medium. Anthropomorphic phantom was used to measure doses at some distance from the source with Thermo luminescence dosimeters (TLDs). The dosimetric influence of air passage in the bronchus was evaluated with the GEANT4 Monte Carlo method. A pinpoint chamber was used to measure and quantify the impact of inhomogeneity in wax phantom for the Ir-192 source. The Gafchromic films and Monte Carlo methods were used to find the phantom and heterogeneities, which were found to underestimate the dose for the lungs and overestimated for the bones in TPS. The exact tool to quantify the variation in planned and delivered doses should be cost-effective and easy to use possibly with tissue equivalent phantoms and Gafchromic films in lung malignancies treatment.

Angle of concavity in planning target volume can be adopted as selection criteria for intensity-modulated radiation therapy or three-dimensional conformal radiotherapy technique in brain tumors.

Introduction: With innovation of medical imaging, radiotherapy attempts to conform the high dose region to the planning target volume (PTV). The present work aimed to assess the angle of concavity in PTV can be adopted as selection criteria for intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT) technique in Brain tumors. Materials and Methods: Thirty previously irradiated patients with brain tumors were replanned with both 3DCRT and IMRT technique. Angle of concavity (dip) in the PTV near the organs at risk was measured in the contoured structure set images of each patient. These cases were divided into three groups where angles were 0°, >120° and <120°. Dose of 60 Gy/30# was fixed. Results: In Group 1, the IMRT plan had better TV95% as compared to 3DCRT respectively with significant P value (P = 0.002). Mean of conformity index (CI) and Homogeneity Index (HI) were comparable. For Group 2 (angle >120°), the IMRT plan had better TV95% as compared to 3DCRT respectively with a significant P value (P = 0.021). HI and CI were not significant. For Group 3 (<120°), IMRT plan had better TV95% as compared to 3DCRT respectively with a significant P value (P = 0.001). HI and CI were better in IMRT arm with significant P value. Conclusion: The results from this study showed that the angle of concavity can be considered as an additional objective tool for selection criteria whether tumor can be treated with IMRT or 3DCRT. Tumors where angle of concavity was <120°, HI and CI provided more uniformity and conformity of dose distribution inside PTV with significant P values.

Definitive chemoradiation in nonmetastatic squamous cell carcinoma anal canal: A single-institution experience.

Purpose: The purpose of the study was to analyze the survival outcomes and toxicities in squamous cell carcinoma anal canal treated with definitive chemoradiotherapy. Materials and Methods: Retrospective analysis of 51 patients with squamous cell carcinoma anal canal treated with chemoradiotherapy was done. Data were collected and analyzed for disease-free survival (DFS), colostomy-free survival (CFS), overall survival (OS), and acute/late toxicities. Results: Out of total 51 patients, only 44 patients had a follow-up of more than 36 months and were analyzed. After a median follow-up of 46 months (range 10-68 months), the 3-year DFS was 73.9%. Three patients developed locoregional recurrence, while one patient developed distant metastasis. At 3-year OS rate was 77%. Out of 44 patients, six patients lost to follow-up, while two patients died due to progressive disease and two due to noncancer causes. 3-year CFS rate was 59%. Most common grade >3 acute toxicities were skin reactions in nine (18%), followed by hematological in eight (16%) patients. Conclusion: Definitive chemoradiotherapy in anal canal results in good oncological outcomes with sphincter preservation. No severe treatment-related toxicities were observed.

Study of dosimetry and clinical factors for assessment of xerostomia in head and neck squamous cell carcinoma treated by intensity-modulated radiotherapy: A prospective study.

AIM: Clinical and dosimetric factors related to toxicity in terms of xerostomia in patients with head and neck squamous cell cancer (HNSCC) treated with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Patients older than 18 years, with the WHO Performance Status Score <2 with primary diagnosis of HNSCC Stage II, III, and IV who had undergone primary or postoperative radiotherapy (RT) treated by IMRT at the center, from November 2015 to November 2016 were included in the study. Patients were assessed by physical examination and questioned to score their quality of life for dryness (HNDR) and stickiness (HNSS) by EORTC-HN-35 (Hindi or English version) at baseline (before treatment), at 3, 6, and 12 months following treatment. The validation of EORTC-HN-35 for HNDR and HNSS in patients was handed. RESULTS: Thirty patients were included in the study. The mean symptom score values for HNSS at baseline, 3, 6, and 12 months' post-RT treatment were 17.8, 62.2, 64.4, and 20.8, respectively. Dryness and stickiness also increased over 3-6 months in follow-up but slightly relieved at 12 months, but it could not reach to baseline. In subgroup analysis, at baseline mean score of dryness of mouth in elderly patients (≥60 years) (P = 0.248), poor performance status (Eastern Cooperative Oncology Group 2) (P = 0.80) and patients with advanced stage (Stage III and IVA) (P = 0.185) was higher. Correlation of normal tissue complication probability for xerostomia with contralateral mean parotid gland showed insignificant linearity with shallow curve. CONCLUSION: Patients remained symptomatic for xerostomia chiefly till 6 months' postirradiation, but it was slightly relieved in 12 months but could not reach the baseline. Dosimetric sparing ofcontralateral parotid resulted in decreased probability of developing xerostomia.

Factors Influencing the Severity of Acute Radiation-Induced Skin and Mucosal Toxicity in Head and Neck Cancer.

Background and purpose Radiotherapy is a crucial part of cancer therapy armamentarium, but it is associated with skin and mucosal toxicity in a substantial proportion of patients with head and neck cancer. Its extent, however, depends on several patient-related and treatment-related factors. In-depth knowledge of these is prudent for better patient management. Aim The aim of this study is to assess the factors influencing the severity of acute radiation-induced skin and mucosal toxicity in patients with head and neck cancer receiving external beam radiotherapy. Materials and methods This longitudinal observational study included all patients receiving curative external beam radiotherapy for head and neck cancer aged 18 years or above from January 2018 to December 2018. Patient-related and treatment-related characteristics including age, gender, type, staging and site of cancer, history of smoking and diabetes, surface area exposed, and concurrent chemotherapy were compared in patients experiencing severe and non-severe acute skin and mucosal toxicity using the Radiation Therapy Oncology Group (RTOG) scoring system. Results Higher age (p = 0.002), TNM stage IV (p = 0.023), and concurrent administration of chemotherapy (p = 0.002) were statistically associated with severe acute radiation-induced skin and mucosa toxicity, whereas gender, surface area irradiated, history of smoking, and diabetes did not show such an association. Conclusion Older patients with TNM stage IV malignancy receiving concurrent chemotherapy are at a high risk of developing skin and mucosal toxicity that might interfere with the treatment protocol and warrant hospitalization, compromising their quality of life.

Study of volumetric and dosimetric changes during fractionated radiotherapy in head and neck cancers: A single centre experience.

AIMS AND OBJECTIVE: The assessment of volumetric and dosimetric changes in the head-and-neck cancer during fractionated radiotherapy by intensity-modulated radiotherapy (IMRT) technique. MATERIALS AND METHODS: A single-center prospective observational hospital-based study with a sample size of 20 cases of the head-and--neck squamous cell carcinoma over 1 year treated with chemoradiotherapy 66-70 Gy/33-35#@2 Gy/fraction with weekly cisplatin 35 mg/m2. After contouring of target volumes (TVs) and organs at risk (OARs) in initial computed tomography (CT) scan, all patients were planned and treated by the IMRT technique. We re-delineated the TVs and OARs in the second (CT15#) and third (CT30#) planning CT scan, and the initial plan was implemented in the re-CT scan dataset with the same optimization and doses. The volumetric and dosimetric changes during fractionated radiotherapy of TVs and OARs were evaluated and compared. Nonparametric Wilcoxon-signed-rank test was used to compare the means between each plan. RESULTS: For all 20 patients, plans were compared for volumetric and dosimetric parameters on repeat CT scans. The mean variation in gross tumor volume (GTV) and planning TV (PTV) was significant after 15 and 30 fractions of radiotherapy. On dosimetric evaluation, there was a significant increase in doses to GTV and OARs (parotid, spinal cord, and cochlea) with a significant P value. However, doses to the OARs were not exceeded the maximum tolerance limit. CONCLUSION: This prospective single-center study concluded that two repeat imaging, along with re-planning improved TV coverage and decreased doses to the normal tissue. Larger studies with more sample sizes are required to set the criteria for replanning.

Validation of a Novel 'Supportive Oral Care Protocol' (SOCP), a Model for Care in Head and Neck Cancer Patients at Tertiary Cancer Centre in India.

India has a huge burden of head and neck cancer and specifically oral cancer. Supportive oral care is not a standard of care in our population and is often neglected. Currently, there are no specific guidelines for such care in India which could be followed. The aim of this study is to validate a novel institutional supportive oral care protocol (SOCP) for head and neck cancer patients. This protocol is specific to our population developed for head and neck/dental oncology experts working in cancer centres to provide comprehensive care. This is a cross-sectional validity study. Fifteen dental oncology experts working in cancer centres/hospitals across India and six oncology experts from our centre were enrolled. All experts provided their inputs on 41 points of the SOCP. The data was analysed for item validity, content validity index and inter-rater agreement. The statistical analyses used were kappa measure for inter-rater agreement and content validity index for item-wise agreement. Out of 861 responses from all the reviewers, 91% agreed, 8.4% agreed with modification and 0.6% disagreed. The content validity index and agreement between reviewers ranged from 0.9 to 1 for kappa measure. The SOCP of our institution was shown to be a valid protocol. SOCP addresses oral and dental supportive care and rehabilitation as part of overall comprehensive care for head and neck cancer patients in our population.

Bladder Preservation with Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation for the Treatment of Muscle-invasive Carcinoma of the Bladder: A Single-Center Experience.

Purpose The purpose of the study was to evaluate the short-term response and acute toxicities in muscle-invasive carcinoma urinary bladder treated with neoadjuvant chemotherapy followed by concurrent chemoradiation. Materials and Methods Thirty patients with muscle-invasive bladder cancer were treated with three cycles of neoadjuvant chemotherapy every 3 weeks. Response assessment was done after 4 weeks with repeat cystoscopy and imaging. Responders were treated with concurrent chemoradiation 60 Gy/30# at 2 Gy/# along with weekly injection cisplatin 35 mg/m 2 . Response assessment was done by new response evaluation criteria in solid tumors (version 1.1). Treatment-related acute toxicities were scored using common terminology criteria for adverse events version 4.0. Results Of the 30 patients, 25 patients responded to neoadjuvant chemotherapy with complete response in 17 patients (56.67%) and partial response in eight patients (26.66%). Five patients (16.66%) showed poor response and were advised radical cystectomy, of which four underwent radical cystectomy and one patient opted for concurrent chemoradiation. Of 26 patients who completed chemoradiation, complete response was seen in 21 patients (80.76%) and partial response was seen in four patients (15.38%). Only one patient developed progression of disease in the form of lung metastasis. All the patients with residual disease were advised to undergo salvage cystectomy. Among the patients receiving chemoradiation, grade 2 cystitis and diarrhea was seen in 10 patients (38.46%) and four patients (15.38%), respectively. Only one patient developed grade 3 diarrhea. Conclusion Bladder preservation treatment is an effective, safe, and convenient option for patients presenting with muscle-invasive carcinoma bladder. Neoadjuvant chemotherapy followed by chemoradiation was well-tolerated with an acceptable rate of complications.

Cancer Pain, Anxiety, and Depression in Admitted Patients at a Tertiary Care Hospital: A Prospective Observational Study.

CONTEXT: Pain is the most common symptom in admitted cancer patients. The association between the severity of cancer pain and distress symptoms such as depression and anxiety is a subject of research. AIMS: The aim is to study the prevalence of pain, anxiety, and depression in admitted cancer patients and determine the association between pain and anxiety and depression at a tertiary cancer care institute. SETTINGS AND DESIGN: This was prospective observational study. SUBJECTS AND METHODS: We enrolled 393 cancer inpatients prospectively after written informed consent. Their disease details, presence, severity, and character of pain were recorded. Numerical Pain Scale was used for pain scores, self-reporting Hospital Anxiety and Depression Scale for anxiety and depression. STATISTICAL ANALYSIS USED: Normal data were analyzed with parametric, nonnormal with nonparametric methods, and categorical with the Chi-square test. RESULTS: The prevalence of moderate-to-severe pain was 41.5%, anxiety 20.3%, and depression 24.8%. Proportion of patients with anxiety and depression was 9.2% and 17.7% in patients with no pain; about 32.8% and 36.7% with severe pain, respectively (P < 0.000). In patients with no depression 6% had anxiety; with depression 44.9% had anxiety (P < 0.000). Odd's ratio to have anxiety and depression was 4.44 (95% confidence interval [CI] 2.0318-9.7024) and 2.92 (95% CI 1.5739-5.4186), respectively, in patients with pain as compared to no pain (P < 0.00). There was a positive correlation between pain, anxiety, and depression scores. CONCLUSIONS: There is strong association between the presence and severity of pain and distress symptoms such as anxiety and depression in admitted cancer patients.

Objective and subjective assessment of xerostomia in patients of locally advanced head-and-neck cancers treated by intensity-modulated radiotherapy.

BACKGROUND: Parotid-sparing intensity-modulated radiotherapy (IMRT) effectively reduces xerostomia in head-and-neck cancer (HNC). Changes in the salivary output at 1 year were studied and correlation with quality of life (QOL) changes in patients of locally advanced HNC (LAHNC) was drawn. MATERIALS AND METHODS: Between October 2009 and October 2011, 20 patients of LAHNC were treated with IMRT using simultaneous integrated boost technique. High-risk clinical target volume (CTV) was given a dose of 66 Gy/30 fr, intermediate-risk CTV 60 Gy/30 fr, and low-risk CTV 54 Gy/30 fr. The saliva flow rate was estimated for 5 min at rest (unstimulated) and after using lemon drops (stimulated) for the next 5 min, at baseline (pretreatment), and 3, 6, and 12 months following treatment. Evaluation of patients' perception of dry mouth was done using EORTC-QLQ-C30 and HN35 questionnaires at the same time points. RESULTS: Baseline unstimulated and stimulated salivary flow rates were 0.659 ml/min and 1.69 ml/min, respectively. At 3 months, a significant reduction in unstimulated (0.346 ml/min) and stimulated (0.80 ml/min) flow rate was observed. Unstimulated flow rate continued to decrease further till 6 months (0.295 ml/min), but slight improvement was seen in stimulated flow rate (0.91 ml/min). At 12 months, minimal recovery was observed in both unstimulated (0.362 ml/min) and stimulated flow rates (1.09 ml/min). EORTC-QOL questionnaire mean scores for dryness and stickiness of saliva were 10 and 15 at baseline and increased to 36 and 25, respectively, at 3 months. At 6 months, symptom score for dryness further increased to 45 and then decreased to 33 at 12 months. Stickiness score remained static from 3 to 12 months. Salivary flow rate correlated well with dry mouth (P < 0.05) but not with the perception of sticky saliva (P = 0.82) at 6 months and beyond. CONCLUSIONS: Both salivary flow rate and xerostomia-related questions worsened at 3 months even with IMRT and showed a similar pattern of recovery.

Clinical and endoscopic response to high dose rate endobronchial brachytherapy in malignant lung tumors: A single centre experience.

PURPOSE: The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB). MATERIALS AND METHODS: Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy. Using Speiser's scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis, and postobstructive pneumonia) and degree of obstruction were graded. RESULTS: Symptomatic response for cough, dyspnea, and hemoptysis was seen in 88%, 75%, and 96%, respectively, with a significant P value (<0.05). Obstructive pneumonia was resolved in 94% of patients. Endoscopic response in terms of degree of obstruction was seen in 84% of patients. Acute toxicities in the form of radiation bronchitis were seen in 32% of patients, whereas 8% of patients experienced esophagitis. Bronchospasm was seen in one patient during treatment. CONCLUSION: HDR brachytherapy is a highly effective, safe, convenient therapy in alleviating symptoms of endobronchial obstruction with endoscopic response in the majority of cases. Thus, HDR-BT is a promising treatment for palliation of patients presenting with symptoms of endobronchial obstruction with an acceptable rate of complications.

Retrospective Analysis of Spectrum of Presentation and Treatment Outcome in Extremity Sarcomas: A Single-Centre Experience.

INTRODUCTION: The most common site for soft tissue sarcoma is extremity. As complete surgical resection is possible in majority, outcome of this subset is relatively better. There is paucity of data regarding extremity soft tissue sarcoma (STS) from sub-Himalayan and hilly geographical regions. MATERIALS AND METHODS: Retrospective analysis was done for extremity STS visiting the study center over a period of 5 years. Data were collected and analyzed for demography, disease characteristics, treatment modalities, and outcome. RESULT: Extremity STS constituted 32.8% of all STS enlisted. Most common subtype noted was pleomorphic STS. Metastatic disease at presentation was noted among 7/43 cases with lung being the most common metastasis site. Wide local excision was done in 37 cases while amputation was required in 5 cases. Adjuvant radiotherapy was given in 27 cases while 18 cases received adjuvant chemotherapy. At median follow-up of 47 months, the overall survival and event-free survival were noted as 47.64% and 41.49%, respectively. CONCLUSION: This study depicts single-center experience of extremity STS. The population analyzed was from sub-Himalayan region with significant lost to follow-up. Pooling of data from different centers has been advocated to derive conclusive results.

Assessment of quality of life in resectable gastric cancer patients undergoing chemoradiotherapy as adjuvant treatment.

INTRODUCTION: Quality of life (QOL) is increasingly recognized as an important endpoint in cancer therapies. However, few data are available on QOL in patients who have received radiotherapy as adjuvant treatment for cancer stomach. METHODS: Thirty patients who underwent curative resection were enrolled and received chemoradiotherapy (45 Gy in 25 fractions using three-dimensional conformal radiotherapy technique), together with 5-fluorouracil and leucovorin. The European Organization for Research and Treatment of Cancer QOL questionnaire C30 and STO Q22 was assessed at four time points: pre- and postchemoradiotherapy and at 1-month and 6-month follow-up. RESULTS: Mean age of the patients was 54 years. Male:female ratio was 4:1. Stage II and Stage III disease was present in 60% and 30% of patients, respectively. All patients were able to complete the chemoradiotherapy protocol. Our study found out significant impairment in QOL for emotional functioning, fatigue, nausea and vomiting and dyspnea. Results showed that QOL levels decrease postchemoradiotherapy; however, QOL levels returned to baseline at 1-month and 6-month follow-up period. CONCLUSION: Chemoradiotherapy as adjuvant treatment for cancer stomach patients who have undergone resection with curative intent is a safe and well-tolerated regimen with respect to QOL.

A dosimetric comparison between three-dimensional conformal radiation therapy and intensity-modulated radiation therapy in the treatment of posterior fossa boost in medulloblastoma.

AIMS: To compare three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) in posterior fossa (PF) boost in children with medulloblastoma (MB); dosimetrically evaluating and comparing both techniques with regard to target coverage and doses to organs at risk. SETTINGS AND DESIGN: Structured. SUBJECTS AND METHODS: Seven previously irradiated patients of MB were retrieved and re-planned with both 3DCRT and IMRT techniques. Dosimetric comparison was done by performing two plans for the PF boost for the same patient. Prescription dose and normal tissue constraints were identical for both plans. STATISTICAL ANALYSIS USED: SPSS, version 19, statistical software package was used. For quantitative data, paired t-test was applied to calculate the difference between two means. RESULTS: Mean values of planning target volume (PTV); PTV95% and PTV5% in IMRT were 97.19% and 106.07% and for 3DCRT were 96.57% and 106.33%, respectively. The dose homogeneity was better in IMRT (1.091) as compared to 3DCRT (1.100), but was not statistically significant (P = 0.341). Conformity index was comparable in both the plans, i.e., 3DCRT (0.979) and IMRT (0.976) with P = 0.819. IMRT plan provided reduced mean dose to cochlea relative to the 3DCRT plans with P = 0.032 for the right cochlea and 0.020 for the left cochlea. IMRT showed no advantage over 3DCRT in sparing the anterior cranial structures where mean doses to the right and left lens were 0.61 Gy and 0.56 Gy for IMRT and 0.16 Gy and 0.09 Gy for 3DCRT, respectively. CONCLUSIONS: IMRT technique was able to improve homogeneity index, spare the cochleae, but 3DCRT plans were superior in sparing anterior cranial structures without compromising the dose to PF.

Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students.

INTRODUCTION: UTI is a well known entity amongst young girls, and the majority of girls have recurrent infections within one year. Anything that disturbs the usual vaginal environment would result in conditions favouring the production of unwanted microorganisms leading to infections of this very sensitive area. Studies have shown that, there is an evident relation of UTI's among students and practices of personal hygiene. AIM: To determine association between the behavioural risk factors and UTI among nursing girls. MATERIALS AND METHODS: The present study was undertaken amongst unmarried nursing students of a Medical College Hospital. A predesigned pretested questionnaire was used to know the personal hygiene of students and to find out its association with UTI in the last three months. Chi-square test was used to analyse the data. RESULTS: A significant association was observed between perineal hygiene and UTI. The major risk factors of UTI identified were incorrect perineal washing technique, use of synthetic/silk innerwears, not sundrying the innerwears, improper menstrual hygiene. CONCLUSION: There are still major gaps in the knowledge regarding causation of UTI among the nursing students. This calls for an urgent need for educational talks periodically addressing these gaps.

Is aspiration as detected on pretreatment video fluorography, a harbinger of poor quality of life and early mortality in cancers of the upper aerodigestive tract treated with radiotherapy?

BACKGROUND: Patients with cancers of the upper aerodigestive tract (head and neck cancer (HNC)) tend to aspirate, either due to disease or treatment. The association of aspiration (documented on video fluorography (VFG)) with quality of life (QOL) and unexpected mortality was studied prospectively in patients treated with simultaneous integrated boost technique of intensity-modulated radiotherapy (SIB-IMRT). MATERIALS AND METHODS: Moderately advanced (stage III/IV) HNC were treated by SIB-IMRT delivering 66 Gy/30 fr, 60 Gy/30 fr, and 54 Gy/30 fr to high, intermediate, and low risk volumes, respectively. They underwent serial VFG and QOL assessments (Quality of Life Questionnaire-Core 30 (QLQ-C30) and head and neck-35 (HN35) European Organisation for Research and Treatment of Cancer (EORTC) tools) at 0, 3, and 6 months. Pharyngeal musculature (PM) was additionally delineated on planning computed tomography (CT) scans as potential organs at risk (OARs). RESULTS: Between November 2009 and May 2011, 20 HNC were treated as per protocol. All patients were fit (Karnofsky performance status (KPS) ≥ 80). Based on VFG findings, seven patients (4/9 oropharynx and 3/11 laryngopharynx) were grouped as aspirators (A) and remaining 13 as non-aspirators (NA). The QOL study showed that pretreatment coughing and swallowing difficulties were greater in group A versus NA and remained persistently higher. In group A, deaths attributable to aspiration were seen in 3/7 patients, while none occurred in the NA group (Fisher's exact P = 0.03). The mean PM dose was 60 Gy in both the groups and mean V60 was similar at 69 and 67% in A and NA groups, respectively. CONCLUSIONS: VFG helps identify patients who aspirate and are at risk of premature death due to its complications, alerting caregivers to direct attention appropriately.

Trends in Weaning Practices among Infants and Toddlers in a Hilly Terrain of a Newly Formed State of India.

BACKGROUND: Weaning plays a major role in determining the nutritional status of a child. Poor weaning practices during infancy and early childhood, resulting in malnutrition, contribute to impairment of cognitive and social development, poor school performance and reduced productivity in later life. The objective of this study is to know weaning practices of mothers of difficult terrain. METHODS: Cross-sectional study was conducted in all villages under Rural Health Training Center, the field practice area of Department of Community Medicine. A total of 500 mothers with children within 3 years of age were included in the study. Pre-tested pre-designed semi-structured questionnaire was used to collect information on weaning practices. RESULTS: Majority of children (51.57%) were weaned at >6 months and were observed to be more under nourished (79.34%) as compared with those between 4 months and 6 months (61.50%). Majority of boys were weaned earlier than girls irrespective of the age of the weaning. Malnutrition was found in majority of those children who were weaned inadequately in terms of both frequency and amount. CONCLUSIONS: The present study revealed suboptimal weaning practices among the mothers of hilly region. Thus, appropriate educational strategies should be directed particularly on counteracting various myths related to infant feeding Moreover, promotion of appropriate feeding should target not only on maternal caregivers, but also on other family members, particularly husbands and grandmothers, taking into account the social and cultural situation of the area.

Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: comparison of two fractionation schemes.

CONTEXT: Among patients with locally advanced head and neck squamous cell cancers (LAHNSCC), the prognosis after nonresponse or progression despite induction chemotherapy (IC) is dismal, and further treatment is often palliative in intent. Given that nonresponse to chemotherapy could indicate subsequent radioresistance, we intended to assess the outcomes with two different fractionation schemes. AIMS: To compare the outcomes of two fractionation schemes- 'standard' (consisting 3GyX5 daily fractions for 2 consecutive weeks) versus 'hybrid' (6GyX3 fractions on alternate days during the 1(st) week, followed by 2GyX5 daily fractions in the 2(nd) week). SETTINGS AND DESIGN: Prospective randomized controlled two-arm unblinded trial. MATERIALS AND METHODS: Patients with locally advanced oropharyngeal, laryngeal, and hypopharyngeal cancers treated with a minimum of two cycles of taxane, platinum, and fluorouracil-based IC were eligible if residual disease volume amounted <30 cm(3). Kaplan-Meier survival curves were compared by the log-rank test. Response rates were compared using the unpaired t-test. Quality of life (QOL) was measured via patient reported questionnaires. RESULTS: Of the initially enrolled 51 patients, 45 patients (24 from standard arm, and 21 from the hybrid arm) were eligible for analysis. Despite being underpowered to attain statistical significance, there still seemed to be a trend towards improvement in progression-free (Hazard ratio (HR) for progression: 0.5966; 95% CI 0.3216-1.1066) and overall survival (HR for death: 0.6062; 95% CI 0.2676-1.3734) with the hybrid arm when compared to the standard arm. Benefits were also observed with regards to response rates and QOL. Rate of complications were similar in both arms. CONCLUSIONS: In comparison to the routinely used palliative fractionation scheme of 30 Gray (Gy) in 10 fractions (Fr), the use of hybrid fractionation which integrates hypofractionation in the 1(st) week, followed by conventional fractionation in the 2(nd) week, could possibly offer better response rates, QOL increments, and potential survival benefits among LAHNSCC patients even after failing to respond to IC.