Single Fraction versus Multiple Fraction Radiotherapy for Palliation of Painful Vertebral Bone Metastases: A Prospective Study.

CONTEXT: Metastatic bone disease is a commonly encountered problem in oncology practice. The most useful and cost effective treatment is radiotherapy (RT). Different fractionation schedule of RT can be used to treat such condition. AIMS: Assessment of pain response in patients with vertebral bone metastasis after treating them with various radiation fractionations and to compare the toxicity profile in the treatment arms. SETTINGS AND DESIGN: A prospective randomized study was designed to include total 64 patients from July 2010 to May 2011. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to vertebra were selected for the study. Patients were randomized to two arms receiving multiple fraction of RT with 30 Gy in 10 fractions and 8 Gy in single fraction RT, respectively. MATERIALS AND METHODS: Patients with age >75 years, Karnofsky Performance Status (KPS) <40, features of cord compression were excluded from study. Initial pain response was assessed using Visual Analogue Scale (VAS) and compared using the same scale at weekly interval up to 1 month after treatment completion. RESULTS: Arm A comprised of 33 patients while 31 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Eleven patients were lost to follow-up. Initial pain scores were 7.23 ± 0.765 and 7.51 ± 0.55 in arm A and arm B, respectively. Pain scores reduced significantly in both the arms after 1 month (4.39 ± 1.82 in arm A; 5.25 ± 2.39 in arm B). Time of initiation of pain response was earlier in arm A (P = 0.0281), statistically significant. Mild G-I toxicity was noted in both the arms but differences in two arms were not statistically significant (P = 0.49), no interruption of treatment was required because of side effects. CONCLUSIONS: Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

First surveillance of SARS-CoV-2 and organic tracers in community wastewater during post lockdown in Chennai, South India: Methods, occurrence and concurrence.

Surveillance of SARS-CoV-2 and organic tracers (OTs) were conducted in the community wastewater of Chennai city and the suburbs, South India, during partial and post lockdown phases (August-September 2020) as a response to the coronavirus disease 2019 (COVID-19) pandemic. Wastewater samples were collected from four sewage treatment plants (STPs), five sewage pumping stations (SPSs) and at different time intervals from a suburban hospital wastewater (HWW). Four different methods of wastewater concentrations viz., composite (COM), supernatant (SUP), sediment (SED), and syringe filtration (SYR) were subjected to quantitative real time-polymerase chain reaction (qRT-PCR). Unlike HWW, STP inlet, sludge and SPS samples were found with higher loading of SARS-CoV-2 by SED followed by SUP method. Given the higher levels of dissolved and suspended solids in STPs and SPSs over HWW, we suspect that this enveloped virus might exhibit the tendency of higher partitioning in solid phase. Cycle threshold (Ct) values were < 30 in 50% of the HWW samples indicating higher viral load from the COVID-19 infected patients. In the STP outlets, a strict decline of biochemical oxygen demand, >95% removal of caffeine, and absence of viral copies reflect the efficiency of the treatment plants in Chennai city. Among the detected OTs, a combination of maximum dynamic range and high concurrence percentage was observed for caffeine and N1 gene of SARS-CoV-2. Hence, we suggest that caffeine can be used as an indicator for the removal of SARS-CoV-2 by STPs. Our predicted estimated number of cases are in line with the available clinical data from the catchments. Densely distributed population of the Koyambedu catchment could be partly responsible for the high proportion of estimated infected individuals during the study period.

Pattern of Failure with Locally Advanced Cervical Cancer­ A Retrospective Audit and Analysis of Contributory Factors

Background: The majority of the global burden of cervical cancer is affecting developing countries. Despite improvement in treatment of patients presenting at a locally advanced stage, approximately 50% experience recurrence within the 1st two years. This study was conducted to analyse contributory factors for recurrence within 24 months. Methods: The present retrospective study was undertaken to analyse factors affecting recurrence, type of failure and the follow up pattern of patients who completed treatment with a minimum follow-up period of 6 months during the study period of 5 years. Results: Out of 323 patients included in the study, 112 (34.7%) presented with recurrence within the follow-up period. The stage and histology had a significant impact on disease free survival (DFS). Of those who were followed-up regularly, recurrence was observed in 28.7% with a DFS of 81.3 months, in contrast to the 48. 5% patients with a DFS of 45.0 months for whom follow-up was irregular. The failure pattern was mostly in the form of nodal recurrence (61%). On univariate analysis, treatment time, EBRT and ICBT gap and mean EQD2 point A were found to associated with a better outcome in terms of 2yr DFS. On Cox regression analysis, stage, histology, treatment gap (HR-0.48) and follow up pattern (HR-0.24) retained their effects on survival. Point A dose was higher in patients without recurrence (P value 0.000) unlike other assymmetric parameters. Conclusion: Apart from point A cumulative dose (mean EQD2), stage, histology and treatment gap were the factors that affected early local failure. An interesting result was that follow-up pattern had a significant impact on DFS period.