Long-term treatment results of conventional and hypofractionation radiotherapy in postmastectomy cancer breast patients: A retrospective study from rural cancer center of Maharashtra, India.

AIM: This study aims to evaluate the long-term treatment outcome of conventional and hypofractionation radiotherapy in postmastectomy cancer breast patients. MATERIAL AND METHODS: A total of 140 postmastectomy breast cancer patients were included in this retrospective study, who were treated from 2012 to 2014 with chemotherapy and various fractionation radiotherapy schedules. Radiotherapy treatment records for study group-I received radiotherapy 4256 cGy in 16 fractions over 3½ weeks, group-II patients received 4005 cGy in 15 fractions over 3 weeks, and conventional radiotherapy group-III received 5000 cGy in 25 fractions over 5 weeks. RESULTS: The median follow-up of patients from all groups was 60 months (range 9 to 111 months). There were 39 cases with disease failure, 13 (26%) in group I (42.56 Gy), 16 (40%) in group II (40.05 Gy), and 10 (20%) in group III (50 Gy). There were 4 locoregional recurrences (LRRs), two isolated, and 11 distant failures in group I, 3 LRRs (1 isolated LRR) and 15 distant failures in group II, and only one LRR and 9 distant failures in group III. The disease-free survival (DFS) were 74%, 60%, and 80%, respectively, in groups I, II, and III (P =0.044). CONCLUSION: The long-term results of this study show that hypofractionation radiotherapy in postmastectomy cases is well tolerated and acute and late side effects are also comparable to conventional fractionation. In our study, locoregional and distant failure seems slightly higher with hypofractionation schedules than in other studies, highlighting the need for more studies with long-term follow-up in postmastectomy patients.

Serum 25-hydroxy vitamin-D levels in head and neck cancer chemoradiation therapy: Potential in cancer therapeutics.

Background: To evaluate the relation between serum-25-hydroxy Vitamin-D levels (S25OHVDL) and concurrent chemoradiation therapy (CTRT) toxicities in patients of head and neck squamous cell cancer (HNSCC). Methods: After an institutional ethics committee approval, consecutive HNSCC patients who received radical/adjuvant CTRT were prospectively evaluated. Patients were assessed for CTRT toxicities using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE-v5.0) and the response was evaluated according to Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST-1.1). S25OHVDL was assessed at the time of the first follow-up. Patients were divided into group A (Optimal) and group B (suboptimal) according to S25OHVDL. The treatment toxicities were correlated with S25OHVDL. Results: Twenty-eight patients were evaluated for the study. S25OHVDL was optimal in eight (28.57%) and suboptimal in 20 patients (71.42%). Mucositis and radiation dermatitis were significantly more in subgroup B (P-value 0.0011 and 0.0505, respectively). Relatively lower but nonsignificant hemoglobin and peripheral white blood cell counts were observed in subgroup B. Conclusion: Suboptimal S25OHVDL was associated with significantly more skin and mucosal toxicities in HNSCC patients treated with CTRT.

Marathi translation, linguistic validation, and cross-cultural adaptation of speech handicap index and voice handicap index in patients of head and neck squamous cell cancer.

Background: Patient reported treatment outcomes is a better way to measure the quality of life (QOL). This study was undertaken to translate the speech handicap index (SHI) and voice handicap index (VHI) in Marathi language and its linguistic validation and cross-cultural adaptation in patients of head and neck squamous cell cancer (HNSCC). Methods: SHI and VHI were translated into Marathi with prior permission from the respective authors of original English questionnaire (RAs). The translation procedure for each tool included two forward translations (English to Marathi), the formation of first intermediate Marathi translation (FIT), two back translations (Marathi to English) of FIT, and interim Marathi translation (IT) formation. The second intermediate Marathi translation (SIT) was prepared after face validation of IT by a subject expert. Pretesting of SIT was done in 20 patients of HNSCC to validate linguistic and cross-cultural adaptation. By incorporating the patient's suggestions, the final Marathi translation was prepared and sent to primary authors for approval. Results: The grammatically and conceptually acceptable and face validated SIT was prepared and administered to HNSCC patients. The patients of the oral cavity and larynx were in SHI and VHI group, respectively (ten patients in each group). The questionnaire was well understood reflecting its linguistic and cross-cultural adaptation. Some of the patients suggested changes in a few words which were then corrected, rechecked with back translation, and final Marathi translated questionnaire was prepared. It was approved by RAs. Conclusion: Marathi translation of SHI and VHI are well accepted and comprehensible. It can be used for future studies.

Marathi Translation and Linguistic Validation of an Updated European Organization for Research and Treatment of Cancer Quality of Life Module for Head and Neck.

Aim This study was aimed to translate an updated European Organization for Research and Treatment of Cancer (EORTC) quality of life module for head and neck (EORTC QLQ-H&N43) in grammatically and conceptually acceptable Marathi language and its linguistic validation. Materials and Methods Approval was obtained from the Institutional Ethics Committee. The permission for translation was obtained from the EORTC translation unit (TU). The EORTC guidelines for the translation were followed to form a translation for pilot testing which was administered to 10 Marathi speaking head and neck squamous cell cancer (HNSCC) patients who gave informed written consent for the participation in the study. Patients were interviewed personally. The final Marathi translation was prepared and sent to EORTC TU for approval. Statistical analysis was performed using SYSTAT version 12 by Cranes software, Bengaluru, Karnataka, India. Results After getting permission, the translation files were received from EORTC TU, including Marathi EORTC QLQ-H&N35 for reference. Two forward translations, reconciled translation, back translations, first interim translation, translation for proof editing, and second interim translation (SIT) were prepared. This SIT was pilot tested in 10 Marathi-speaking HNSCC patients. Each patient was interviewed regarding difficulty in answering, confusing or offensive word, and reframing sentence. The questionnaire was well understood by patients reflecting its linguistic validity. After incorporating the changes as per the patient's interview, updated translation was prepared and sent to EORTC TU which was accepted and approved by EORTC. The psychometric analysis of pilot testing showed that the questionnaire is acceptable. Conclusion Marathi translation of EORTC QLQ-H&N43 is well accepted and understandable. It can be used for future studies.

Significance of ovoid separation with various applications of high-dose-rate-intracavitary radiotherapy in carcinoma of uterine cervix: a study from rural centre of Maharashtra, India.

AIMS: To analyze the differences in dose distribution, with ovoid separation in various applications, by different radiotherapists in the same patient of carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary Radio therapy (ICRT). SETTINGS: Pravara Rural Hospital and Rural Medical College. DESIGN: Retrospective study. MATERIALS AND METHODS: Retrospective analysis of six cases of carcinoma uterine cervix, randomly chosen in the period from January 2004 and December 2007. Three selected radiotherapists performed the applicator placement for ICRT on the aforementioned patients in a consistent pattern-three consecutive ICRT treatments separated by weekly intervals. Ovoid separation was categorized into three groups: < 25 mm, 26-35 mm and > 36 mm. Prescribed point 'A' isodose lines with maximum separation laterally in right and left parametrium and antero-posteriorly in lateral plane was calculated for all 36 isodose charts for the 18 ICRT applications. RESULTS: In this study, there proves to be a significant difference in the ovoid separation between the applications of the different radiotherapists in the same patient with multiple fractions of HDR-ICRT. The applications done by 'A' radiotherapist resulted in an ovoid separation of < 25 mm more often, 'B' radiotherapist of > 36 mm while, 'C' radiotherapist fell in between the two. DISCUSSION AND CONCLUSION: With more ovoid separation, lateral dose to parametrium was improved; however, antero-posterior dose was not significantly affected. In order to determine the best dose distribution, as evident in the dose charts of 'C' radiotherapist, it is recommended to choose the optimum ovoid separation in accordance to the patient's anatomy.

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: a study from rural centre of Maharashatra, India.

AIM: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses. RESULTS: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B. DISCUSSION AND CONCLUSION: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

Radical radiotherapy treatment (EBRT + HDR-ICRT) of carcinoma of the uterine cervix: outcome in patients treated at a rural center in India.

AIM: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT). MATERIALS AND METHODS: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. RESULTS: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well. DISCUSSION AND CONCLUSION: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.