Prospective Study to Compare Efficacy of Conventional Chemoradiotherapy with Hypofractionated Chemoradiotherapy in Locally Advanced Carcinoma of Oropharynx.

AIMS: Chemoradiotherapy is the standard treatment for advanced Oropharyngeal squamous cell carcinoma (OPSCC). Upcoming hypofractionation has led to better compliance and non-inferior results in various sites such as breast and prostate cancer etc.  This study prospectively compared a dose-intensified schedule in advanced OPSCC with standard hypofractionation. MATERIALS AND METHODS: Patients with advanced stage III and IV OPSCC suitable for radical chemoradiotherapy were eligible. Patients were alternatively allocated to both the treatment arms. Arm A planned to receive 64 Gy in 25 fractions (#) with concurrent cisplatin and Arm B received standard fractionation 70 Gy in 35 # with concurrent cisplatin. All patients completed a median follow up of 6 to 18 months.  The primary end point was acute toxicity (less than 3 months) and late toxicity at 1 year. Secondary end point was disease free survival and overall survival at 1 year. RESULTS: 44 patients in arm A and 49  patients in arm B were recruited over 18 months. 34 patients completed full-dose radiotherapy in both arms. Maximum acute toxicity in arm A in terms of skin reaction was Grade II in 47.05% cases and mucositis grade II in 67.6% cases. In arm B grade II skin toxicity was seen in 47.1% and mucositis grade II was seen in 79.4 % cases. Ryle's tube dependency was seen in 38.2 % cases in arm A and 50% in arm B.  Complete response rate at 3 months was equivalent in both arms in Arm A (100%), and in Arm B (96.7%). Disease free survival (DFS), Overall survival (OS) at 3 month, 6 months, and 12 months was comparable. CONCLUSIONS: 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with equivalent results and better compliance. Shorter fractionation schedule is more acceptable and we look forward for more randomized control trials.

Expression Analysis of Survivin and XIAP in Gallbladder Cancer: a Case-control Study in Indo-Gangetic Plain.

PURPOSE: Gallbladder cancer is a highly mortal disease with poor prognosis because of late presentation of disease. Survivin and X-linked inhibitor of apoptosis (XIAP) are one of the two important members of inhibitors of apoptosis. Thus, this study aimed to look at the expression of Survivin and XIAP in gallbladder cancer patients. METHODS: Survivin and XIAP expression were investigated in tissues of gallbladder cancer patients (40 cases) and compared with cholelithiasis as control (40 cases) by using immunohistochemistry. Their expression was correlated with clinicopathological parameters. RESULTS: Significantly higher (p < 0.05), Survivin protein was expressed in gallbladder cancer (n = 67.5%) than control (n = 35%). But it did not show any significant association with any of the clinicopathological parameter while XIAP was not expressed in the GBC patients (p > 0.05). CONCLUSION: Overexpression of Survivin in gallbladder cancer suggests its possible role and association with poor prognosis. But XIAP has not been found to be associated with gallbladder carcinogenesis.

Re-irradiation for head and neck squamous cell carcinoma.

INTRODUCTION: Local recurrences after curative treatment have a potential for cure with salvage surgery or with re-irradiation. METHODS: We reviewed the PubMed for articles published in English with key words squamous cell carcinoma, recurrent, re-irradiation, prognostic factors to find relevant articles describing prognostic factors, re-irradiation, and outcome for recurrent head and neck squamous cell carcinoma. RESULTS: Various factors including age, performance status, time for recurrence, previous radiation dose volume and site of recurrence, previous use of chemotherapy are all prognostic factors in recurrent head and neck squamous cell carcinoma. Surgery is feasible in very select subgroup of patients and must be done when feasible. Re-irradiation with the aid of modern sophisticated technology is safe and confers durable and clinically meaningful survival benefit. Re-irradiation in head and neck recurrent squamous cell carcinoma may provide an expected median survival of 10-12months. Chemotherapy may be added along with radiation in the recurrent setting. CONCLUSION: Treatment approaches may have to be personalized. Re surgery must be done in all patients in whom it is feasible. In patients in whom surgery is not feasible, re-irradiation must be evaluated as a therapeutic option especially in patients with limited volume recurrence.

Primary Enterolith in a Patient with Intestinal Tuberculosis: A Case Report.

Primary enterolithiasis is a rare surgical ailment. The underlying cause is intestinal stasis. Numerous anatomical and micro environmental factors such as enteritis, incarcerated hernia, malignancy, diverticula, blind loops, and enteroenterostomy predispose to clinically significant concretions. Enterolithiasis in tuberculosis can be due to the presence of strictures, intestinal bands, or interbowel/parietal adhesions, leading to intestinal stasis. Secondary enterolithiasis is generally caused by gallstones or renal stones migrating to the gastrointestinal tract due to fistula formation. During stasis, food particles act as a nidus and calcium salts are deposited over the food particles, leading to stone formation. A 57-year-old male patient presented to the Emergency Department of Jawaharlal Nehru Medical College, AMU, Aligarh, with features of intestinal obstruction. The patient underwent emergency laparotomy, revealing 2 strictures in the distal ileum with 15.24cm of the bowel between them containing a 2×2 cm enterolith. The strictured segment was resected, and end ileostomy and mucus fistula were created. The patient's postoperative recovery was fine, and he wasdischarged with ileostomy on antitubercular treatment (after histopathologicalconfirmation). Ileostomy closure wasplanned after 6 weeks. The incidence and prevalence of enterolithiasis has been on the rise recently because of advancement in radiological imaging studies. Endoscopic and surgical stone removal along with the treatment of the underlying pathology is recommended.

Gastric Trichobezoar with Rapunzel Syndrome: A Case Report.

Bezoars are collections of non-digestible matter that usually accumulates in stomach and can extend to small bowel. Trichobezoars (concretions of hair) are unusual and are usually found in young psychiatric females, who often deny eating their own hair (trichophagy). We are presenting a case of gastric trichobezoar with a long thin tail in a 20 years young female with a history of trichophagia. Patient was managed by exploratory laparotomy and anterior gastrotomy. Postoperatively she recovered well and was discharged in satisfactory condition with advice for psychiatric follow-up.

Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience.

OBJECTIVE: Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. METHODS: Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan-Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of <0.05 was considered significant for all statistical analysis. RESULTS: Median age was 56 years (range: 12-84 years). Male to female ratio was 31:12. Stage was T1, T2 and T3 in 2, 17 and 18 patients respectively. Sixteen patients underwent surgery. Thirty-six patients received RT (14 received definitive RT, 11 had post-operative RT and 11 had RT with palliative intent). Eight patients (16%) received chemotherapy (5 received concurrent with RT, 2 had adjuvant and 1 had neo-adjuvant chemotherapy). Nine patients (of 11 patients) achieved a complete response (CR) and 2 achieved a partial response (PR) after surgery plus post-operative RT. Nine patients and 5 patients respectively achieved CR and PR after definitive RT (with or without concurrent chemotherapy). Of the 11 patients who received palliative RT, 2 had very good objective response (>50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage (p=0.05) and facial nerve palsy at presentation (p=0.0008) were significant predictors of inferior PFS. CONCLUSION: Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease.

Hydatid cyst of gall bladder.

Gall bladder hydatid cyst is a rare entity. Concurrent occurrence of gall blader hydatid cysts along with liver cysts, especially with the biliary channels clear of cysts, is very rare. We report a 27-year-old man with a gall bladder hydatid cyst that was diagnosed only after opening the resected specimen of the gall bladder.