Introduction:The prospective interventional single-institution randomized control study was carried out to compare the pain relieving efficacy among different bisphosphonates at the cost of incidence of skeletal-related events (SRE).Materials and Methods:During June 2008 and May 2011, 256 patients with painful bone metastasis in solid tumors with a pain score of at least 5 were randomized into three arms: zoledronic acid (4 mg, i.v.), ibandronate (6 mg, i.v.) and pamidronate (90 mg, i.v.). Radiation was given to all patients, either 800 cGy single fraction or 20 Gy in five fractions. The ANOVA test was used for analysis. The Pearson test was used to correlate pain scores with proportions of responders as statistical estimation of pain relief.Results:With a mean baseline pain score of 6.5 ± 1.2, there was no difference in pain scores among the three treatment arms, assessed at 3 months and at the end of the study. However, the pain scores at 6 months were statistically reduced in zoledronic acid-receiving patients (1.5 ± 0.4) unlike the scores in patients receiving ibandronate (3.1 ± 0.5) and pamidronate (2.3 ± 0.4), with a P-value of 0.024. The response was statistically significant at 6 months (0.039) and at the end of the study (0.023), in favor of zoledronic acid. Pearson's correlation demonstrated a statistically significant positive correlation between pain scores and response rates. There were no statistical differences in the narcotic scores among the treatment arms during the study period. The overall duration of pain relief was not different in any of treatment arms. The time of detection of hypercalcemia was no different; however, the incidence of hypercalcemia was significantly less in the zoledronic acid arm (28.3%) against 44.6% and 50% in ibandronate and pamidronate arms, respectively, with a P-value of 0.041.Conclusion:The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

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Background:Chemotherapy combined with radiotherapy can improve outcome in locally advanced esophageal cancer.Aim:This study aimed to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) and sequential chemoradiotherapy (SCRT) in unresectable, locally advanced, esophageal squamous cell carcinoma (ESSC).Materials and Methods:Forty-one patients with unresectable, locally advanced ESCC were randomized into two arms. In the CCRT arm (Arm A), 17 patients received 50.4 Gy at 1.8 Gy per fraction over 5.6 weeks along with concurrent cisplatin (75 mg m-2 intravenously on day 1 and 5-fluorouracil (1000 mg m-2 continuous intravenous infusion on days 1-4 starting on the first day of irradiation and given after 28 days. In the SCRT arm (Arm B), 20 patients received two cycles of chemotherapy, using the same schedule, followed by radiotherapy fractionated in a similar manner. The endpoints were tumor response, acute and late toxicities, and disease-free survival.Results:With a median follow up of 12.5 months, the complete response rate was 82.4% in Arm A and 35% in Arm B (P = 0.003). Statistically significant differences in frequencies of acute skin toxicity (P = 0.016), gastrointestinal toxicity (P = 0.005) and late radiation pneumonitis (P = 0.002) were found, with greater in the CCRT arm. A modest but non-significant difference was observed in median time to recurrence among complete responders in the two arms (Arm A 13 months and Arm B 15.5 months, P = 0.167) and there was also no significant difference between the Kaplan Meier survival plots (P = 0.641) of disease-free survival.Conclusions:Compared to sequential chemoradiotherapy, concurrent chemoradiotherapy can significantly improve local control rate but with greater risk of adverse reactions.

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The name atypical teratoid/rhabdoid tumor (AT/RT), a histological variant of Wilm's tumor exemplifies the tumor's disparate mixtures of rhabdoid, primitive neuroepithelial, mesenchymal and epithelial components. AT/RT is much more frequently seen in infants and young children and is rare in adults. Prognosis of AT/RT is poor with most of the patients dying shortly after the diagnosis. [1] The literature suggests that the use of more aggressive therapies (including surgery, chemotherapy with or without stem-cell support, intrathecal chemotherapy, and early radiotherapy), may lead to some prolongation of the natural history of this tumor. [2,3] A 24-year-old female was admitted in the neurosurgery ward of Institute of Post Graduate Medical Education and Research and S.S.K.M Hospital, Kolkata with complaints of repeated headache for 2 months, few episodes of vomiting and unable to open her right eye for 1 month. On general physical examination patient was conscious, afebrile, with stable vital signs and good hydration. There was mild pallor, with no cyanosis, edema, and icterus. On central nervous system examination, there was right sided third cranial nerve palsy. No other neurological deficit was found. Other systemic examinations were within normal limits. Magnetic resonance imaging brain showed a mass lesion in the medial aspect of right temporal lobe and in suprasellar region [Figure 1]. After 10 days, right temporal craniotomy with gross excision of the tumor was done under general anesthesia. Operative specimen was sent for histopathological examination and immuno-histochemistry. Section showed cerebral tissue and a tumor composed of rhabdoid cells in abundant myxoid matrix, cells were round to spindle with a moderate amount of eosinophilic granular cytoplasm with hyper chromatic nuclei [Figure 2] suggestive of AT/RT (World Health Organization Grade four). Immuno-histochemistry depicted that tumor cells were positive for vimentin, epithelial membrane antigen, S-100, and glial fibrillary acidic protein (GFAP) and immune-negativity for CD-31; CD-34 and cytokeratin with loss of expression of nuclear INI1 protein. The Mib-1 labeling index was 12-15%. After 2 weeks of surgery, a computed tomography scan brain was done and showed ill-defined residual mass in right medial temporal lobe and post-operative changes in right temporal region [Figure 3]. However, after surgery general condition of the patient did not improve satisfactorily and the patient was referred for adjuvant therapy. A post-operative chest X-ray, ultra-sonography abdomen and routine blood parameters were all within normal limits. The patient underwent adjuvant craniospinal irradiation (CSI) to 36 Gy, followed