Comparison of two multifraction radiotherapy schedules in management of painful bone metastases: A single institution prospective study.

BACKGROUND: Metastatic disease of bone is a common complication of most of the advanced malignancies. The majority of patients with bone metastases (BM) experience pain during their disease course and pain control can significantly improve their quality of life. Radiotherapy (RT) is an important modality in the management of BM and different schedules are followed worldwide. AIM: The aim of this study was to compare two multi-fractionated RT regimens (30Gy in 10 fractions and 20Gy in 5 fractions) with respect to the patient's performance, response and pain score in palliative management of painful BM. METHODS: This prospective observational study was undertaken between October 2015 and September 2017 at a government medical college in central India. Two fractionation regimens (30 Gy/10 fractions and 20 Gy/5 fractions) were used to treat 50 patients with painful BM (n = 25 in each arm). Patients were treated on telecobalt machine and response assessment done in terms of complete/partial/intermediate response and pain progression. Assessment was performed at one, two and three months post treatment. Statistical analysis was done using Fisher's exact test, student t-test and Chi-square test. A value of P < 0.05 was considered significant. RESULTS: There were 9 males (36%) and 16 females (64%) in arm A, and 15 males (60%) and 10 females (40%) in arm B. The median age was 47.50 years (range 28-81 years) in arm A and 54 years (range 34-85 years) in arm B. There was no statistically significant difference between the two groups in terms of pain palliation at a 1 month (p = 0.73), 2 month (p = 0.75) or 3 month (p = 0.71) follow up. In addition, the mean performance scores at the end of 3rd month in the 2 arms did not show any statistically significant difference (p = 0.51). CONCLUSION: A shorter treatment schedule (5 fractions) was equally efficacious as the standard schedule (10 fractions) in our setting. With the advantage of shorter overall treatment time and avoidance of re-irradiation, this schedule may be favourable for high volume centres.

Bone metastases incidence and its correlation with hormonal and human epidermal growth factor receptor 2 neu receptors in breast cancer.

AIM: In this paper, we present a prospective observational study, which determines the incidence of bone metastases and its correlation with hormonal receptors (estrogen receptor [ER]/progesterone receptor [PR]) and human epidermal growth factor receptor 2 (HER2) in breast cancer. MATERIALS AND METHODS: From October of 2015 to July 2017, 262 patients were eligible for the study, of which 98 patients presented/developed bone metastases. ER/PR and HER2 receptor status were determined, and bone scintigraphy with a technetium-99 m was carried out on each patient during the study. RESULTS: The incidence rate of bone metastases as found in this study was 25.25%, and the mean and median age at diagnosis were 47.23 and 46, respectively (age range = 28-80). Bone metastases were more prevalent in ER-positive tumors (P = 0.043), tumors with lymph node positivity (P = 0.002), and lower grade tumors (P = 0.002), whereas visceral metastases were more common with ER-tumors (P = 0.005), tumors with higher grade (P = 0.012), and tumors with lymph node positivity (P = 0.034). In this study cohort, the spine and pelvis were the most commonly involved subsites of bone metastases (P < 0.001). CONCLUSION: This study demonstrates that the metastatic patterns in breast cancer strongly correlate with various breast cancer subtypes, mainly designated by ER, PR, and HER2. Hormone receptor-positive tumors show a predilection for bones as the first site of relapse compared to hormone-receptor-negative tumors which have a proclivity to develop as visceral metastases.

Role of serum prostate-specific antigen as predictor for bone metastases in newly diagnosed prostate cancer.

INTRODUCTION: Prostate cancer is most frequently diagnosed cancer of men and bone is the most common site of metastasis. There is a lack of consensus for the selection criteria for bone scan in low-risk patients. Western guidelines do not recommend use of bone scan in asymptomatic patients and in low prostate-specific antigen (PSA) values. We try to correlate the PSA value with bone metastases through bone scan in the Indian population. MATERIALS AND METHODS: A total of 68 histologically newly diagnosed prostate cancer subjected to bone scan were retrospectively analyzed. The patients were stratified into four groups according to their PSA level: The first group of patients had PSA level ranging from 0 to 10 ng/ml (n = 4), the second group had PSA level ranging from 10.1 to 20 ng/ml (n = 13), the third group had PSA levels 20.1-100 ng/ml (n = 23), and the fourth group has PSA >100 (n = 28). RESULTS: The incidence of osseous metastases proven by bone scan was found to be zero (0 out of 4) for PSA level 0-10 ng/ml; 38.46% (5 out of 13) for PSA level 10.1-20, 60.87% (14 out of 23) for PSA level 20.1-100 ng/ml, and 100% for PSA >100 (P < 0.005) (95% confidence interval 1.01-1.1). For cut-off value of PSA ≤10 ng/ml, sensitivity and specificity were 100% and 19.05%, respectively, with positive predictive value of 73.44%. CONCLUSION: The correlation between PSA value and presence of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The screening bone scan at initial diagnosis should be included for all patients with PSA >10 ng/ml in Indian setting.

Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: An institutional experience.

INTRODUCTION: Cystosarcoma phyllodes of the breast, an uncommon sarcoma found primarily in women of the age group of 35-55 years, constitutes <1% of all breast neoplasms. These tumors are resistant to chemotherapy and hormonal therapies and often recur aggressively after initial surgery. Limited research is available about the role and effectiveness of adjuvant radiotherapy in reducing recurrences. OBJECTIVES: Surgery has been the primary treatment modality to date but with high recurrence rates. The purpose of this retrospective study is to highlight the role of postoperative time for adjuvant radiotherapy in aggressive borderline and malignant phyllodes tumor (PT). MATERIALS AND METHODS: This retrospective study reviewed 13 histopathologically proven borderline and malignant PT, treated with radiation therapy to the dose of 50 Gray by external beam radiotherapy (EBRT) after primary surgical management. RESULTS: The mean age at presentation was 33 years. Right laterality was more common (60% cases). Although all patients presented with lump, those who had pain as an added symptom turned out to be histopathologically malignant later on. Histopathologically, 66.6% patients were malignant, 20% borderline, and 13.3% benign. High mitotic index and stromal activity were observed in younger patients. Patients who received EBRT within a month of surgery had no local recurrence, whereas those who received EBRT after a month developed local recurrence (P = 0.012). CONCLUSION: Adjuvant radiotherapy is appropriate treatment for aggressive borderline and malignant PT. This study revealed that time interval between surgery to initiation of EBRT plays a significant role in the prevention of recurrence.

Comparative susceptibility and effect of mild Aspergillus fumigatus infection on three strains of chickens.

A single Comb White Leghorn strain (Dryden X Auburn = DAX) was more susceptible to Aspergillus fumigatus infection and suffered significantly greater mortality than the Athens-Canadian or a Vantress X Arbor-Acres cross exposed soon after hatching. The unexposed controls of the three types weighed significantly more than the corresponding exposed survivors at 5 weeks of age.