Short-course radiotherapy with consolidation chemotherapy versus conventionally fractionated long-course chemoradiotherapy for locally advanced rectal cancer: randomized clinical trial.

BACKGROUND: The trial hypothesis was that, in a resource-constrained situation, short-course radiotherapy would improve treatment compliance compared with conventional chemoradiotherapy for locally advanced rectal cancer, without compromising oncological outcomes. METHODS: In this open-label RCT, patients with cT3, cT4 or node-positive non-metastatic rectal cancer were allocated randomly to 5 × 5 Gy radiotherapy and two cycles of XELOX (arm A) or chemoradiotherapy with concurrent capecitabine (arm B), followed by total mesorectal excision in both arms. All patients received a further six cycles of adjuvant chemotherapy with the XELOX regimen. The primary endpoint was treatment compliance, defined as the ability to complete planned treatment, including neoadjuvant radiochemotherapy, surgery, and adjuvant chemotherapy to a dose of six cycles. RESULTS: Of 162 allocated patients, 140 were eligible for analysis: 69 in arm A and 71 in arm B. Compliance with planned treatment (primary endpoint) was greater in arm A (63 versus 41 per cent; P = 0.005). The incidence of acute toxicities of neoadjuvant therapy was similar (haematological: 28 versus 32 per cent, P = 0.533; gastrointestinal: 14 versus 21 per cent, P = 0.305; grade III-IV: 2 versus 4 per cent, P = 1.000). Delays in radiotherapy were less common in arm A (9 versus 45 per cent; P < 0.001), and overall times for completion of neoadjuvant treatment were shorter (P < 0.001). The rates of R0 resection (87 versus 90 per cent; P = 0.554), sphincter preservation (32 versus 35 per cent; P = 0.708), pathological complete response (12 versus 10 per cent; P = 0.740), and overall tumour downstaging (75 versus 75 per cent; P = 0.920) were similar. Downstaging of the primary tumour (ypT) was more common in arm A (P = 0.044). There was no difference in postoperative complications between trial arms (P = 0.838). CONCLUSION: Reduced treatment delays and a higher rate of compliance were observed with treatment for short-course radiotherapy with consolidation chemotherapy, with no difference in early oncological surgical outcomes. In time- and resource-constrained rectal cancer units in developing countries, short-course radiotherapy should be the standard of care.

Psoriasis and Helicobacter pylori.

Recently, several reports have been pointing to a possible relationship between Helicobacter pylori infection of gastric mucosa and dermatological diseases. Association has been reported for urticaria, rosacea, Sjogrens syndrome and Henoch-Schonlein purpura. It has also been suggested that Helicobacter pylori may be one of the organisms capable of triggering psoriasis. We did Helicobacter pylori serology in 50 clinically typical psoriatic patients presenting to the Department of Dermatology, SMHS Hospital, Srinagar to determine if antibodies to Helicobacter pylori could be found in them. These psoriatic patients were without any known gastrointestinal complaints. An equal number of healthy individuals constituted the control group. The prevalence of Helicobacter pylori sero-positivity in psoriatic patients was significantly higher (P < 0.05) than in control group.

Verrucous epidermal naevus associated with woolly hair naeves.

An unusual case of verrucous epidermal naevus associated with woolly hair naevus of the scalp is being reported.

Dexamethasone cyclophosphamide pulse therapy in pemphigus: experience in Kashmir valley.

Thirty patients of pemphigus have been treated with Dexamethasone Cyclophosphamide Pulse (DCP) in our hospital in the past three years. Of these twelve patients are off all treatment and are in complete remission while the rest are in different phases of the treatment and responding quite well to the pulse therapy. Only one case of relapse has been experienced till date.