Outcome of Adjuvant Radiotherapy and Adjuvant Chemoradiation for Oral Cancers with Close Margins of Resection.

Oral cancers comprise 50% of all head and neck malignancies in India which can be attributed to tobacco chewing. Advanced oral cancers are managed with surgery followed by adjuvant radiotherapy or adjuvant chemoradiation. There is paucity of studies regarding need for adjuvant treatment in oral cancers with close margins i.e. ≤ 0.5 cm after formalin fixation. This study aims at documenting the oncological outcome with regards to loco-regional control, disease-free survival, overall survival and complications of adjuvant radiotherapy and adjuvant chemoradiation in operated oral cancer patients having close margins of resection. In this Retrospective cohort study, 163 patients with stage T1-T4 oral cancers operated between 2015 and 2019 who have fulfilled the inclusion and exclusion criteria, received adjuvant treatment and could be followed up for at least one year were included. At the end of 45 months, the overall survival was 74.7% and disease specific survival was 82.7%. Among the 7 patients who defaulted radiotherapy, 4 patients succumbed to the disease. Complications were bone marrow depression (2 patients), dysphagia (17) and Trismus (1). Adjuvant radiotherapy should be given in oral cancer patients with close margins of resection since it improves the oncological outcome and disease specific survival and the benefit often outweighs the risk.

A Randomized Controlled Trial on Pranayama and Yoga Nidra for Anxiety and Depression in Patients With Cervical Cancer Undergoing Standard of Care.

Introduction Cervical cancer might intensify the psychological distress among patients with cervical cancer and the distress caused by the diagnosis and treatment. So, depression and anxiety are at higher levels in patients with cervical cancer. Yoga Nidra and Pranayama are thought to reduce the aftereffects of chemotherapy and radiotherapy potentially. So, in this study, we used the techniques of Yoga Nidra and Pranayama to evaluate their effect on patients with cervical cancer undergoing standard care. Methodology Seventy women with cervical cancer were randomized into experimental and control groups. The experimental group of patients with cervical cancer received 30 minutes of yoga intervention twice daily five days a week, for six weeks. The control group was given only the standard of care. The outcome measures were assessed using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The assessment was done at baseline, second, fourth, and sixth weeks. Results The results of within­group comparisons in both groups showed that there was a significant improvement in depression and anxiety scores, with P ≤ 0.05 being considered statistically significant. Between groups, analysis shows that in the preintervention, there was no difference between the yoga and control group as P > 0.05. After the yoga intervention, there was an enhancement in depression and anxiety scores.  Conclusions The results of the study concluded that the Yoga Nidra and Pranayama module can be given as adjuvant therapy to the standard of care in patients with cervical cancer for treating the disease and treatment-related anxiety and depression.

Perception of women on safety and efficacy of contraceptives: A comparative study.

Background: Contraceptive information and services are fundamental to the health and human rights of all individuals. Low contraceptive use is a major challenge faced in India. To determine whether a lack of awareness of contraceptive methods was a factor, we assessed the perception of women on contraceptive methods, their safety and efficacy and further determined whether their demographic background played any role in their perception. Materials and Methods: Reproductive-aged women from both rural and urban backgrounds of Bangalore and Tumkur, Karnataka, were individually questioned in a community setting using both Google Forms and personal interviews from September 2022 to December 2022. The questions consisted of limited demographic information and specific questions related to the knowledge and beliefs of women on the efficacy and safety of contraceptive methods and assessed situational awareness. Results: Although awareness was more amongst urban women (99.1%) compared with rural women (79%), the practice was significantly higher amongst rural women (63.2%) compared with urban women (36.7%). Perception showed variations with respect to age, education, religion and parity. A major religion-wise disparity was observed. With regard to safety, oral contraceptive pills (60.9%) and condoms (51.8%) were unanimously perceived to be the most and least harmful to health. The most commonly perceived short-term complications were found to be body changes, and mood swings, tiredness and infertility with no data to support the claim were the most commonly chosen long-term complication. Conclusion: From the study, we concluded that more educated women were not immune to misinformation. The efficacy rates of different methods were highly underestimated with methods with higher failure rates perceived to be more effective. Results demonstrate that women are ill-informed about the long-term complications of various methods.

Outcome of Treatment in Verrucous Carcinoma of Oral Cavity: A Tertiary Rural Hospital Experience.

Verrucous carcinoma of oral cavity is a highly well differentiated variant of squamous cell carcinoma with a low potential for invasion and metastasis. It is prevalent in the tobacco quid chewing population in our region. In this observational study, we reviewed the medical case records of 58 patients treated for oral verrucous carcinoma staged T2 to T4a. All patients underwent wide excision of tumour which included marginal mandibulectomy in 22 and hemimandibulectomy in 23 patients along with neck dissection saving the accessory nerve and internal jugular vein. 5 patients were found to have bone involvement along the alveolar sockets. 11 patients had other associated premalignant lesions in oral cavity. Only 2 patients had lymph node metastasis without extra nodal spread in submandibular region. With a mean follow up of 6 years and minimum follow up of 1 year, 3 patients had local recurrence. All these 3 patients had bone involvement and 2 of them had lymph node metastasis on histopathological examination. 3 patients who had associated premalignant lesions developed second primary in oral cavity after 3 years. In our experience, verrucous carcinoma has good prognosis when treated by surgery. Bone involvement along alveolar sockets and associated oral premalignant lesions adversely affect the outcome. There was no difference in the outcome between selective and modified radical neck dissection. Therefore selective neck dissection (supraomohyoid) would be adequate in treating these patients. Adjuvant radiotherapy can be reserved for T4a lesions or for positive margins.

Outcome of compartment resection of locally advanced oral cancers extending to infratemporal fossa: a tertiary rural hospital experience.

Locally advanced oral cancers extending to infratemporal fossa (ITF) are a challenge to head and neck surgeons. These tumors are classified as T4b whenever the masticator space (MS), pterygoid muscles (PM), and pterygoid plates (PP) are involved according to AJCC classification. Until recently, these tumors were considered inoperable and treated only with palliative intent. However, a few studies in the last decade showed that many of these tumors could be resected with a reasonably favorable prognosis by compartment resection of ITF, particularly when the tumor was below sigmoid notch of mandible. A few studies attempted to downstage these tumors by neo-adjuvant chemotherapy before attempting resection. Oral Squamous cell carcinoma has a high prevalence in South India. Majority of these patients are females addicted to tobacco quid chewing and present with locally advanced disease. In this retrospective analysis, we evaluated the outcome of treatment of oral squamous cell carcinoma extending to ITF and staged T4b in 52 patients. All patients underwent Composite resection including compartment resection of ITF followed by adjuvant treatment. 20 patients had received neo-adjuvant chemotherapy. Pectoralis major myocutaneous flap was the mainstay of reconstruction. After mean follow-up of 2 years, 31 patients are alive and disease free. 14 patients had local recurrence in ITF and 2 patients had recurred in cervical nodes. 8 patients died due to disease and 6 are on palliative care. Neo-adjuvant chemotherapy did not benefit the outcome. Close margins of resection, extra nodal spread from lymph nodes and supra notch and involvement of posterior part of ITF were factors which predisposed to recurrence.

Quantification of Dose-Volume and Dose-Length Parameters for Cervical Esophageal Stricture in Head and Neck Irradiation with the 3DCRT and IMRT Technique.

PURPOSE: To quantify and compare dose-volume and dose-length parameters of cervical esophagus between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT) and to correlate with incidence of cervical strictures in head and neck cancer irradiation with radical intent. MATERIALS AND METHODS: Forty consecutive head and neck cancer patients who received radical radiation therapy, either with 3DCRT (n = 20) or IMRT (n = 20), between December 2011 and August 2012 were retrospectively analyzed and followed up for at least 4 years post-treatment completion. RESULTS: The volumes of cervical esophagus receiving ≥54 Gy (V54) and ≥60 Gy (V60) and lengths receiving circumferential dose of ≥50 Gy (L50) and ≥54 Gy (L54) were significantly higher in patients treated with IMRT as compared to 3DCRT (P ≤ .05). At the end of minimum 4 years' post-treatment, nine patients had documented symptomatic strictures; three patients were treated with 3DCRT and six patients with IMRT technique. CONCLUSION: IMRT technique in entire-neck irradiation is associated with increased spillage dose to the cervical esophagus, and thereby increased risk for late sequelae. The cervical esophagus has to be considered as an organ at risk and constraints need to be given in IMRT planning, particularly for lower-neck irradiation.