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In recent years, there has been a drastic surge in neurological disorders with sporadic cases contributing more than ever to their cause. Radiation exposure through diagnostic or therapeutic routes often results in neurological injuries that may lead to neurodegenerative pathogenesis. However, the underlying mechanisms regulating the neurological impact of exposure to near-low doses of ionizing radiation are not known. In particular, the neurological changes caused by metabolomic reprogramming have not yet been elucidated. Hence, in the present study, C57BL/6 mice were exposed to a single whole-body X-ray dose of 0.5 Gy, and 14 days post-treatment, the hippocampus was subjected to metabolomic analysis. The hippocampus of the irradiated animals showed significant alterations in 15 metabolites, which aligned with altered tyrosine, phenylalanine, and alpha-linolenic acid metabolism and the biosynthesis of unsaturated fatty acids. Furthermore, a multiomics interaction network comprising metabolomics and RNA sequencing data analysis provided insights into gene-metabolite interactions. Tyrosine metabolism was revealed to be the most altered, which was demonstrated by the interaction of several crucial genes and metabolites. The present study revealed the regulation of low-dose radiation-induced neurotoxicity at the metabolomic level and its implications for the pathogenesis of neurological disorders. The present study also provides novel insights into metabolomic pathways altered following near-low-dose IR exposure and its link with neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease.
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BACKGROUND: In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. METHODS: A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. RESULTS: Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. CONCLUSIONS: Optimized protocol DRLs were proposed for comparison purposes.
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INTRODUCTION: This study compared the submental surface electromyography (sEMG) duration and amplitude during dry swallowing between irradiated head and neck cancer (HNC) survivors and age-matched normal individuals. Further, the relationship between submental and infrahyoid sEMG in the irradiated HNC group was explored. METHOD: Forty participants (20 HNC survivors and 20 age-matched normal individuals) participated in this study. The HNC survivors had completed organ preservation cancer treatment (at least 1-month post-treatment). They were on a complete oral diet without enteral supplementation (FOIS score> 4). Submental and infrahyoid sEMG activity was calculated for three trials of saliva swallow for each participant using sEMG. The duration and amplitude parameters considered were: onset duration - duration from the onset of swallowing to the maximum amplitude, offset duration - duration from the maximum amplitude to the end of the swallowing activity, total duration, and maximum amplitude. RESULTS: The study found that irradiated HNC survivors exhibited prolonged temporal measures, particularly in the offset duration, which suggested a delayed descent of the hyolaryngeal complex during swallowing. Additionally, the HNC group showed a positive correlation between submental and infrahyoid sEMG. Furthermore, it was observed that the rate of increase in the duration of submental sEMG during subsequent swallowing was greater in HNC survivors which could be due to reduced salivation. CONCLUSION: Compared to age-matched normal individuals, irradiated HNC survivors manifest alterations in the submental muscle activities during dry swallowing as measured using sEMG. The temporal and amplitude changes are likely to have arisen as a consequence of postradiation changes.
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Purpose: Head and neck cancer (HNC) patients often face difficulties with swallowing, which can be due to the cancer itself or the treatment modalities like radiation therapy. The presentation of HNC can vary between developing and developed countries due to socioeconomic factors. The current study aimed to profile the swallowing function of HNC patients before starting radiation therapy in a tertiary hospital in India. Method: This cross-sectional observational study examined patients with HNC who were scheduled for radiation therapy. The Functional Oral Intake Scale (FOIS) and Karnofsky Performance Status Scale were used to assess the patients' swallowing status and functional abilities, respectively. The study also evaluated the relationship between swallowing function and clinical-demographic factors. Results: Our assessment of 162 HNC patients found that the cancer site significantly affects swallowing. Although 92% of patients had an oral diet, 64% made dietary modifications. Patients with non-oral intake had either oral or pharyngeal cancer, and over 80% of oral cancer patients and 60% of those with pharyngeal cancer had already made changes to their diet. Patients with laryngeal cancer had a better oral intake, with 58% reporting no swallowing issues. Conclusion: Patients with HNC scheduled for radiation therapy may experience varying degrees of swallowing difficulty. Early intervention and teaching of safe swallowing strategies are crucial to prepare for the potential worsening of swallowing difficulties resulting from the treatment. Advanced tumor stages and oral/pharyngeal cancers increase the risk of significant swallowing issues.
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PURPOSE: The study aimed at evaluating the Effectiveness of Comprehensive Intervention Programme (CIP) on Quality of life (QOL), fatigue, self-efficacy, and psychosocial distress among Head and Neck Cancer (HNC) patients receiving radiotherapy treatment. METHODS: Single-centre non-RCT time series study was conducted among 134 HNC patients (67 observed, followed by 67 subjected to CIP). FACT- H&N, FACT-F, Cancer Behavior Inventory and psychosocial distress scales were used to assess QOL, fatigue, self-efficacy, and psychosocial distress respectively. CIP was provided to the intervention arm twice a week during the course of radiation therapy along with the standard care; the control arm received only standard care. Data were collected before commencing radiotherapy, and post-test assessments were carried out at the end of radiotherapy treatment, and at 3 and 6 months after completion of radiotherapy. RESULTS: Repeated measures ANOVA revealed a statistically significant improvement with CIP in QOL (F (1.917) = 454.103, p = 0.001), fatigue (F (2.106) = 183.775, p = 0.001), self-efficacy (F (2.429) = 190.861, p = 0.001), and psychosocial distress (F (2.288) = 290.105, p = 0.001) in the intervention arm. CONCLUSION: The CIP implemented to address multitude of issues in HNC patients receiving radiotherapy, proved to be effective in reducing the impact of treatment on QOL, fatigue, self-efficacy and psychosocial distress in HNC patients receiving radiotherapy.
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Neoplasias de Cabeza y Cuello , Oncología por Radiación , Humanos , Calidad de Vida , Autoeficacia , Neoplasias de Cabeza y Cuello/radioterapia , Fatiga/etiologíaRESUMEN
OBJECTIVE: India has a significant burden of Head and Neck cancer (HNC) patients. Patients afflicted with HNC often encounter difficulties in speech, voice, and swallowing, either due to the disease itself or the treatment they receive. The rehabilitation of HNC patients is crucial, and Speech and Language Pathologists (SLPs) have a significant role in it. The current study aimed to understand the practices followed by SLPs in India while rehabilitating HNC patients. METHODS: A questionnaire was developed and validated by five Speech-language pathologists, before circulation as an E-survey. The target participants were SLPs working in hospitals across India. The final online version of the questionnaire remained open for eight weeks. RESULT: A total of 75 Hospital-based SLPs working in India participated in the survey. The responses depict notable trends and differences in the assessment and management approaches. HNC patients who had undergone surgery were more likely to be referred for rehabilitation than those who received non-surgical treatments. Only 36% of the SLPs reported getting pre-operative referrals for HNC patients. The time point for initial assessment and intervention, as well as the protocols used, varied across different hospitals. About 50% of participants had instrumental swallow evaluation facilities in their hospitals, and the majority of hospitals only used instrumental swallow evaluation for 1-3 assessments per week. CONCLUSION: Variability exists in several aspects of SLP practice for HNC patients offered across Hospitals in India. All HNC patients do not get access to speech-language pathology services. Developing standardized protocols towards early evaluation, intervention and enhancing compliance could improve SLP-led rehabilitation of HNC patients in India.
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Neoplasias de Cabeza y Cuello , Habla , Humanos , Patólogos , Encuestas y Cuestionarios , Derivación y ConsultaRESUMEN
Cervical cancer (CC) is a key contributor to cancer-related mortality in several countries. The identification of molecular markers and the underlying mechanism may help improve CC management. We studied the regulation and biological function of the chromosome 14 microRNA cluster (C14MC; miR-379/miR-656) in CC. Most C14MC members exhibited considerably lower expression in CC tissues and cell lines in The Cancer Genome Atlas (TCGA) cervical squamous cell carcinoma and endocervical adenocarcinoma patient cohorts. Bisulfite Sanger sequencing revealed hypermethylation of the C14MC promoter in CC tissues and cell lines. 5-aza-2 deoxy cytidine treatment reactivated expression of the C14MC members. We demonstrated that C14MC is a methylation-regulated miRNA cluster via artificial methylation and luciferase reporter assays. C14MC downregulation correlated with poor overall survival and may promote metastasis. C14MC activation via the lentiviral-based CRISPRa approach inhibited growth, proliferation, migration, and invasion; enhanced G2/M arrest; and induced senescence. Post-transcriptional regulatory network analysis of C14MC transcriptomic data revealed enrichment of key cancer-related pathways, such as metabolism, the cell cycle, and phosphatidylinositol 3-kinase (PI3K)-AKT signaling. Reduced cell proliferation, growth, migration, invasion, and senescence correlated with the downregulation of active AKT, MYC, and cyclin E1 (CCNE1) and the overexpression of p16, p21, and p27. We showed that C14MC miRNA activation increases reactive oxygen species (ROS) levels, intracellular Ca2+ levels, and lipid peroxidation rates, and inhibits epithelial-mesenchymal transition (EMT). C14MC targets pyruvate dehydrogenase kinase-3 (PDK3) according to the luciferase reporter assay. PDK3 is overexpressed in CC and is inversely correlated with C14MC. Both miR-494-mimic transfection and C14MC activation inhibited PDK3 expression. Reduced glucose uptake and lactate production, and upregulation of PDK3 upon C14MC activation suggest the potential role of these proteins in metabolic reprogramming. Finally, we showed that C14MC activation may inhibit EMT signaling. Thus, C14MC is a tumor-suppressive and methylation-regulated miRNA cluster in CC. Reactivation of C14MC can be useful in the management of CC.
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Metilación de ADN , Regulación Neoplásica de la Expresión Génica , MicroARNs , Neoplasias del Cuello Uterino , Femenino , Humanos , Línea Celular Tumoral , Movimiento Celular/genética , Proliferación Celular/genética , Metilación de ADN/genética , Genes Supresores de Tumor , MicroARNs/genética , MicroARNs/metabolismo , Familia de Multigenes , Neoplasias del Cuello Uterino/genética , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/metabolismoRESUMEN
Neurodegenerative disorders are a debilitating and persistent threat to the global elderly population, carrying grim outcomes. Their genesis is often multifactorial, with a history of prior exposure to xenobiotics such as pesticides, heavy metals, enviornmental pollutants, ionizing radiation etc,. A holistic molecular insight into their mechanistic induction upon single or combinatorial exposure to different toxicants is still unclear. In the present study, one-month-old C57BL/6 male mice were administered orally with malathion (50 mg/kg body wt. for 14 days) and single whole-body radiation (0.5 Gy) on the 8th day. Post-treatment, behavioural assays for exploratory behaviour, memory, and learning were performed. After sacrifice, brains were collected for histology, biochemical assays, and transcriptomic analysis. Transcriptomic analysis revealed several altered processes like synaptic transmission and plasticity, neuronal survival, proliferation, and death. Signalling pathways like MAPK, PI3K-Akt, Apelin, NF-κB, cAMP, Notch etc., and pathways related to neurodegenerative diseases were altered. Increased astrogliosis was observed in the radiation and coexposure groups, with significant neuronal cell death and a reduction in the expression of NeuN. Sholl analysis, dendritic arborization and spine density studies revealed decreased total apical neuronal path length and dendritic spine density. Reduced levels of the antioxidants GST and GSH and acetylcholinesterase enzyme activity were also detected. However, no changes were seen in exploratory behaviour or learning and memory post-treatment. Thus, explicating the molecular mechanisms behind malathion and radiation can provide novel insights into external factor-driven neurotoxicity and neurodegenerative pathogenesis.
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Acetilcolinesterasa , Malatión , Anciano , Humanos , Animales , Masculino , Ratones , Lactante , Malatión/toxicidad , Fosfatidilinositol 3-Quinasas , Ratones Endogámicos C57BL , EncéfaloRESUMEN
BACKGROUND: Quality of life (QOL) is impaired in patients with head and neck cancers (HNC) due to illness and treatment-associated morbidity. Although there is evidence from the studies on interventions' role in improving QOL receiving radiation therapy, these are not systematically synthesised. In this scoping review, we searched and synthesised the evidence on interventions to improve the QOL and its impact among patients with HNCs. METHODS: This scoping review was conducted using the framework proposed by Arksey and O'Malley, and the extensions suggested by Levac et al. were incorporated. Two reviewers independently searched four electronic databases using key thesaurus and free-text terms, and the data was extracted, tabulated, synthesised and reported as categories. RESULTS: Seventy-nine papers reported various interventions of diverse nature such as pharmacological, physical, nutritional, complementary and alternative therapies, psychosocial, oral care related, laser and photobiomodulation therapies, rehabilitative, educational, technology-based, surgical, device-related and nurse lead interventions. Most studies reported clinically meaningful impact of interventions on QOL, although the outcome differences were often statistically insignificant. Few studies reported a combination of interventions to address the multidimensional concerns faced by patients with HNCs. None of the studies examined the impact of interventions on QOL among long-term survivors of HNCs. CONCLUSION: As QOL concerns in patients with HNCs are multifaceted, more extensive studies with complex multi-component interventions and robust research designs are warranted.
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Terapias Complementarias , Neoplasias de Cabeza y Cuello , Humanos , Calidad de Vida , Neoplasias de Cabeza y Cuello/radioterapia , SobrevivientesRESUMEN
C1orf74, also known as URCL4, has been reported to have higher expression and be associated with poor prognosis in lung adenocarcinoma patients, and its role in regulation of the EGFR/AKT/mTORC1 pathway has been recently elucidated. In the current study, we used publicly available data and experimental validation of C1orf74 gene expression and its association with prognosis in cervical cancer patients. qRT-PCR was performed using RNA from cervical cancer cell lines and twenty-five cervical cancer patients. Data from TNMplot revealed that mRNA expression of the C1orf74 gene in primary tumor tissues, as well as metastatic tissues from cervical cancer patients, was significantly higher compared to normal cervical tissues. HPV-positive tumors had higher expression of this gene compared to HPV-negative tumors. qPCR analysis also demonstrated higher expression of C1orf74 in HPV-positive cervical cancer cell lines and most cervical cancer patients. The promoter methylation levels of the C1orf74 gene in cervical cancer tissues were lower compared to normal cervical tissues (p < 0.05). Collectively, our study indicates that higher expression of the C1orf74 gene caused by hypomethylation of its promoter is associated with poor overall survival in cervical cancer patients. Thus, C1orf74 is a novel prognostic marker in cervical cancer.
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Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Femenino , Humanos , Neoplasias del Cuello Uterino/metabolismo , Línea Celular Tumoral , Infecciones por Papillomavirus/patología , Cuello del Útero/metabolismo , Expresión GénicaRESUMEN
Radiation exposure can cause gut dysbiosis and there is a positive correlation between gut microbial imbalance and radiation-induced side effects in cancer patients. However, the influence of radiation on the gut-brain axis (GBA) and its neurological consequences are not well understood. Therefore, this study aimed to investigate the impact of pelvic irradiation on gut microbiota and the brain. Sprague Dawley rats were irradiated with a single dose of 6 Gy, and faecal samples were collected at different time points (7 and 12-days post-irradiation) for microbial analysis. Behavioural, histological, and gene expression analysis were performed to assess the effect of microbial dysbiosis on the brain. The findings indicated alterations in microbial diversity, disrupted intestinal morphology and integrity, neuronal death-related brain changes, neuroinflammation and reduced locomotor activity. Hippocampal gene expression analysis also showed a reduced expression of neural plasticity-related genes. Overall, this study demonstrated that pelvic irradiation affects gut microbiota, intestinal morphology, integrity, brain neuronal maturation, neural plasticity gene expression, and behaviour.
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Disbiosis , Microbioma Gastrointestinal , Humanos , Ratas , Animales , Ratas Sprague-Dawley , Encéfalo , HecesRESUMEN
Extracellular vesicles (EVs) are lipid-bound vesicles produced into the extracellular space by cells. Apoptotic bodies (ApoBD), microvesicles (MVs), and exosomes are examples of EVs, which act as essential regulators in cell-cell communication in both normal and diseased conditions. Natural cargo molecules such as miRNA, messenger RNA, and proteins are carried by EVs and transferred to nearby cells or distant cells through the process of circulation. Different signalling cascades are then influenced by these functionally active molecules. The information to be delivered to the target cells depends on the substances within the EVs that also includes synthesis method. EVs have attracted interest as potential delivery vehicles for therapies due to their features such as improved circulation stability, biocompatibility, reduced immunogenicity, and toxicity. Therefore, EVs are being regarded as potent carriers of therapeutics that can be used as a therapeutic agent for diseases like cancer. This review focuses on the exosome-mediated drug delivery to cancer cells and the advantages and challenges of using exosomes as a carrier molecule.
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Exosomas , Vesículas Extracelulares , Neoplasias , Humanos , Vesículas Extracelulares/metabolismo , Sistemas de Liberación de Medicamentos , Exosomas/metabolismo , Neoplasias/tratamiento farmacológico , Neoplasias/metabolismo , Transducción de SeñalRESUMEN
Objectives: Patients diagnosed with head-and-neck cancer (HNC) face unique challenges in comparison to other types of cancers. Sources of psychosocial distress (PSD) are multifactorial and recognising the key attributes would facilitate better understanding of the experienced distress, potentially enabling directed intervention strategies. The present research was conducted to explore the key attributes of PSD from HNC patients' perspective to develop a tool. Material and Methods: The study adopted a qualitative approach. The data were collected from nine HNC patients receiving radiotherapy through focus group discussion. Data were transcribed, read and reread through for searching the meanings and patterns, to familiarise with the data and obtain ideas on experiences related to PSD. Similar experiences identified across the dataset were sorted and then collated into themes. Detailed analysis of themes and related quotes of the participants are reported with each theme. Results: The codes generated from the study are grouped under four major themes; 'Irksome symptoms are distressing,' 'Distressing physical disability inflicted by the situation,' 'Social Curiosity - a distressing element' and 'Distressing uncertainty of future'. The attributes of PSD and the magnitude of psychosocial problems were reflected in the findings. Conclusion: Psychosocial health of HNC patients is greatly impacted due to disease and/or treatment. Dynamic patterns of attributes identified from the study contributed to developing a tool on PSD. The findings of this study also necessitate the need for constructing an intervention for reducing PSD based on the attributes from the HNC patient's perspective.
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Introduction: Perianal tumours are a rare site of malignancy, and tumours primarily involving the perineal body without vaginal and anal canal involvement are uncommon. Case summary: A 67-year-old woman presented with a lesion involving the perineum and rectovaginal septum without extension into vaginal or anorectal mucosa and with skip lesions in the vulva. Biopsy was confirmative of squamous cell carcinoma, with p16 positive. A complete metastatic workup with MRI of the pelvis and CECT thorax and abdomen was done. She was diagnosed with perianal carcinoma stage cT2N0M0 Stage II (American Joint Committee on Cancer 8th Edition of Cancer Staging) since the lesion reached the anal verge. Given the location of the tumour (perineal body), comorbidities and advanced age, she received radical radiotherapy with an intensity-modulated radiotherapy technique - 56 Gy in 28 fractions with the intention of organ preservation. The response assessment with MRI at 3 months showed a complete tumour response. She has been disease-free for 3 years and is on regular follow-ups. Conclusion: Isolated perineal body squamous cell carcinomas are unusual, and synchronous vulvar skip lesion makes this case unique. Radical radiotherapy achieved organ preservation with tumour control and minimal toxicity in an elderly frail patient.
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Background: In August 2017, the European Commission awarded the "European Study on Clinical Diagnostic Reference Levels (DRL) for X-ray Medical Imaging" project to the European Society of Radiology to provide up-to-date Diagnostic Reference Levels based on clinical indications. This work aimed to conduct an extensive literature review by analyzing the most recent studies published and the data provided by the National Competent Authorities to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for Radiation Therapy Computed Tomography. Objective: To review the literature on established DRLs and methodologies for establishing Diagnostic reference levels in radiation therapy planning computed tomography (RTCT). Methods: Eligibility criteria: A cohort study (observational design) reporting DRLs in adult patients undergoing computed tomography (CT) for radiation therapy for the region head and neck or pelvis were included. The comprehensive literature searches for the relevant studies published between 2000 and 2021 were performed using PubMed, Scopus, CINHAL, Web of Science, and ProQuest. Results: Three hundred fifty-six articles were identified through an extensive literature search. Sixty-eight duplicate reports were removed. The title and abstract of 288 studies were assessed and excluded if they did not meet the inclusion criteria. Sixteen of 288 articles were selected for full-text screening (studies conducted between 2000 and 2021). Five articles were included in the review after the full-text screening. Conclusions: A globally approved standard protocol that includes scanning techniques, dose measurement method, and DRL percentile needs to be established to make a valuable and accurate comparison with international DRLs.
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BACKGROUND: Radiomics involves the extraction of quantitative information from annotated Computed-Tomography (CT) images, and has been used to predict outcomes in Head and Neck Squamous Cell Carcinoma (HNSCC). Subjecting combined Radiomics and Clinical features to Machine Learning (ML) could offer better predictions of clinical outcomes. This study is a comparative performance analysis of ML models with Clinical, Radiomics, and Clinico-Radiomic datasets for predicting four outcomes of HNSCC treated with Curative Radiation Therapy (RT): Distant Metastases, Locoregional Recurrence, New Primary, and Residual Disease. METHODOLOGY: The study used retrospective data of 311 HNSCC patients treated with radiotherapy between 2013-2018 at our centre. Binary prediction models were developed for the four outcomes with Clinical-only, Clinico-Radiomic, and Radiomics-only datasets, using three different ML classification algorithms namely, Random Forest (RF), Kernel Support Vector Machine (KSVM), and XGBoost. The best-performing ML algorithms of the three dataset groups was then compared. RESULTS: The Clinico-Radiomic dataset using KSVM classifier provided the best prediction. Predicted mean testing accuracy for Distant Metastases, Locoregional Recurrence, New Primary, and Residual Disease was 97%, 72%, 99%, and 96%, respectively. The mean area under the receiver operating curve (AUC) was calculated and displayed for all the models using three dataset groups. CONCLUSION: Clinico-Radiomic dataset improved the predictive ability of ML models over clinical features alone, while models built using Radiomics performed poorly. Radiomics data could therefore effectively supplement clinical data in predicting outcomes.
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Neoplasias de Cabeza y Cuello , Recurrencia Local de Neoplasia , Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Estudios Retrospectivos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/radioterapia , Aprendizaje AutomáticoRESUMEN
BACKGROUND: Head and neck cancer (HNC) patients often undergo radiation therapy as part of their treatment. However, radiation therapy can have many side effects, including oral toxicities. Evaluating these toxicities is often considered a challenging task for practicing clinicians due to the lack of assessment tools. The objective of this study is to culturally adapt, translate and validate the Vanderbilt Head and Neck Symptom Survey (VHNSS), an instrument designed to assess oral toxicities and changes in oral functioning in HNC patients receiving radiation therapy. METHODS: The VHNSS 2.0 was first culturally adapted and translated, following which 36 HNC patients undergoing radiation therapy were identified through the incidental sampling method. The translated version of VHNSS 2.0 was then administered to these patients. Internal consistency was assessed using Cronbach's alpha and Mc Donald's Omega. Test-retest reliability was also analyzed. RESULTS: Items of the translated version of VHNSS 2.0 showed good content validity. The omega values yielded higher reliability coefficients than the Cronbach's alpha coefficient. Test-retest reliability was found to be 0.8, indicating good reliability. CONCLUSIONS: Results of this study suggest that the translated Kannada version of the VHNSS 2.0 is linguistically equivalent to the original version. Hence, this tool can be considered a valid and reliable patient-reported tool to evaluate oral symptomatology in HNC patients speaking the Kannada language.
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BACKGROUND: Head and Neck Cancer (HNC) patients are at increased risk of psychosocial distress compared with patients with other forms of cancer. Various symptoms of the disease and side effects of treatment are attributing factors for distress. This systematic review aimed to identify the prevalence of psychosocial distress among HNC patients receiving radiotherapy. METHODS: The following search engines from 2000-2021 were searched: PubMed, CINAHL, Cochrane, Web of Science, ProQuest, Scopus, and Embase. Citation checking and extensive reference checking were also conducted. Cross-sectional, longitudinal, cohort, exploratory and prospective, repeated measure studies published in English were included. Newcastle Ottawa Scale assessed the quality, and the data were extracted on a validated data extraction form. RESULTS: Out of 782 articles, eleven records met the eligibility criteria, including 776 HNC patients receiving radiotherapy. Data were synthesized and summarized descriptively as measurements were not homogenous. Prevalence estimates of depression or depressive symptoms were calculated. Outcomes were measured with various measuring tools and reported in frequency, percentage, mean, and standard deviation in various studies. All studies reported depression ranging from 9.8% to 83.8%, and pooled estimated prevalence of depression among HNC patients receiving radiotherapy is 63% (95% CI 42-83) with significant heterogeneity (I2= 97.66%; p<0.001). An increase in the trend is observed along with treatment progression. Another three studies reported anxiety along with depression. Physical symptoms, body image, low social support, fatigue specific radiotherapy regimens were the predictive factors of depression. CONCLUSION: HNC patients are psychosocially distressed during radiotherapy, and the distress is steadily increased during the therapy. The predictive factors could serve as potential areas of intervention and supportive therapy during radiotherapy.
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Neoplasias de Cabeza y Cuello , Calidad de Vida , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/psicología , Estudios Transversales , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Estudios Prospectivos , Calidad de Vida/psicologíaRESUMEN
Objective: To analyze whether deep inspiratory breath hold (DIBH) would be dosimetrically beneficial irrespective of radiotherapy planning techniques for patients with left breast cancers requiring adjuvant radiotherapy. Methods: Planning CT scans were taken in free-breathing (FB) as well as deep-inspiration breath hold (DIBH) for patients requiring adjuvant radiotherapy for left breast cancers. After registration, three radiotherapy plans - 3D-conformal radiotherapy (3DCRT), intensity modulated RT (IMRT), and volumetric modulated arc-therapy (VMAT) - were generated for both FB and DIBH scans for each patient. The dose-volume parameters were collected from the dose-volume histogram and analyzed. A paired t-test is used for statistical analysis of the parameters. Findings: The study was conducted on thirteen patients. The mean dose of the left lung was reduced with DIBH by 32%, 24%, and 6% (8.6 Gy, 6.6 Gy, and 6.4 Gy) with 3DCRT, IMRT, and VMAT, respectively. The mean heart dose was reduced by 3.3 Gy (2.2 vs 5.5 Gy), 2.2 Gy (7.5 vs 9.7 Gy), and 1.2 Gy (5.8 vs 7 Gy) with 3DCRT, IMRT, and VMAT with DIBH. Similarly, the left anterior descending artery (LAD) mean dose was relatively reduced by 80%, 34%, and 20% when compared with the FB scans for 3DCRT, IMRT, and VMAT respectively, with max dose in the 3DCRT plan. Novelty/Applications: DIBH appears to have maximum benefit in achieving a better sparing of organs-at-risk for patients being considered for 3DCRT, and to a lesser extent with even IMRT and VMAT techniques.
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Thymomas originates from the epithelial cells of thymic tissue. These tumors commonly occur in the anterior mediastinum. However, thymomas can arise anywhere from the aberrant or remnant thymus in the neck or mediastinum. Ectopic cervical thymoma is a rare disease. It is important to be aware that cervical masses can also be thymomas rather than thyroid or parathyroid masses. Here, we present a case of a 62-year-old female who presented with swelling in the neck and was diagnosed with cervical thymoma type AB.