Context:Sequential induction chemotherapy with cisplatin and 5-fluorouracil (PF) along with interferon-alpha2b and concurrent chemoradiation offers superior loco-regional control for locally advanced carcinoma of oral tongue.Aims:The study was designed to evaluate the beneficial role of induction PF chemotherapy and interferon-alpha2b followed by chemoradiation over definitive chemoradiation only for patients with locally advanced carcinoma of oral tongue.Settings and Design:Phase II randomized, prospective, open-labeled, single-institutional study.Methods and Material:Fifty patients were randomized into 2 arms. Arm A patients were treated with induction chemotherapy with PF regimen for 3 cycles and interferon alpha 2b, 3MU biweekly for 6 such followed by chemoradiation with cisplatin 30 mg/ m2/ week and external radiotherapy. Arm B patients received chemoradiation only, in the same dose schedule as in Arm A. Statistical analysis used: Chi-square test was done to find out the statistical correlation between the two arms. For plotting the disease-free survival (DFS) and overall survival (OS) for the two arms, Kaplan-Meier method was used.Results:The loco-regional response rate of patients treated with interferon containing induction chemotherapy followed by concurrent chemoradiation was superior to concurrent chemoradiation only. However the toxicities and treatment interruption were more in patients treated with induction chemotherapy.Conclusions:In locally advanced carcinoma of oral tongue, induction chemotherapy with cisplatin and 5-fluorouracil (PF) along with interferon alpha 2b followed by concurrent chemoradiation may produce superior loco-regional control with manageable toxicities that needs to be validated by more randomized trials with adequate number of patients.

Risk factors for breast cancer do not differ significantly between developed and developing countries. Hence appropriate time has come for developing countries to incorporate breast cancer risk factors in health education and to consider pharmacological interventions in high risk women.

background: Brachytherapy for carcinoma cervix has moved from point a based planning to optimization of dose based on hr-cTV. Guidelines have been published by Gec esTrO on hr-cTV delineation based on clinical gynecological examination and Mr sequences. These have given significant clinical results in terms of local control. however, many centers around the country and worldwide still use cT based planning, which restricts hr-cTV delineation, as disease and cervix can rarely be differentiated on a planning cT. Various studies have been done to develop cT based contouring guidelines from the available data, but enough evidence is not available on the clinical outcome when treatment is optimized to hr-cTV contoured on cT images. The purpose of this study is to find out the relation between local control and dosimetry of hr-cTV as delineated on cT images.Materials and methods: patients of locally advanced carcinoma cervix treated radically with eBrT of 50 Gy in 25# and at least 4 cycles of concurrent weekly cisplatin having a complete or partial response to eBrT were taken for study. all patients had completed cT based Intracavitary brachytherapy to 21 Gy in 3# of 7 Gy per # with dose prescription at point a and optimizing dose to reduce bladder and rectal toxicity. Follow up data on locoregional recurrence was obtained. hr-cTV delineation was done retrospectively on the treatment plan following guidelines by Viswanathan et al. eQD2 doses for eBrT+BT were calculated for point a and hr-cTV D90. The dosimetric data to hr-cTV and to point a were then compared with patients with locoregional control and with local recurrence. results: 48 patients were taken, all had squamous cell carcinoma. The median age was 48 years. 33.33% were stage IIa, the rest were stage IIB. Median follow-up was 30 months with 25% developing recurrence of the disease. hr-cTV D90 eQD2 dose was significantly higher in patients with locoregionally controlled disease than in patients with local recurrence (83.97 Gy 10 vs. 77.96 Gy 10 , p = 0.002). patients with hr-cTV D90 eQD2 dose greater than or equal to 79.75 Gy 10 had better locoregional control than patients receiving dose less than 79.75 Gy 10 (p = 0.015). Kaplan Meier plot for pFs showed significantly improved pFs for patients receiving hr-cTV D90 dose of at least 79.75 Gy 10 (log-rank p-value = 0.007). Three year progression free survival was 87.1% in patients receiving hr-cTV D90 dose of at least 79.75 Gy 10 . conclusion: cT based hr -cTV volume delineation with the help of pre brachytherapy clinical diagrams and MrI imaging may be feasible in a select subgroup of patients with complete or near-complete response to external beam radiation.

Background: Cancer care has suffered during the covid-19 pandemic due to diversion of manpower to treat covid patients and introduction of lockdown measures. Delay in treatment is detrimental to cancer patients. During the national lockdown, many patients were not able to visit our treatment facility. We conducted this study to evaluate the detriment caused by the pandemic on cancer care in terms of disease progression and the socio economic factors associated with delay in presentation.Materials and Methods: Patients visiting our OPD who were being treated at our department and could not visit the facility during the lockdown were selected. Present status of the disease was assessed using clinical examination and radiological tests. Psycho social distress was assessed using PO BADO SF questionnaire. Disease progression, cause of delay was assessed against various factors like per capita family income, cost of transportation etc. Appropriate statistics was used to analyse and represent the data. Results: 50% patients had disease progression. “High cost of transportation” was the most common response given by patients for not visiting the treatment facility during the lockdown. Most patients being treated with radiotherapy (69%) had responded either “high cost of transportation” or “lack of proper accommodation” as cause of delay (p 0.065). Patients with treatment gap of 80 days or more had higher per capita family income, higher cost of transportation during the lockdown and larger distance between residence and treatment facility. 77.5% patients had psycho social distress according to assessment by PO BADO SF questionnaire.Conclusion: COVID 19 pandemic control measures have impacted cancer care in resulting in disease progression, treatment delays and psycho-social distress. A number of factors may have contributed to the treatment delays like high cost of transportation during the lockdown, longer distance between residence and hospital.

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