With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.

Background: Progressive urbanization and adoption of the "western" lifestyle contributes to the rising burden of cardiovascular diseases in the developing

West syndrome is a genetically heterogeneous electro-clinical syndrome starting in early infancy. Short-term goal of therapy is spasm control and with standard hormonal or vigabatrin treatment, spasms can be controlled in 60 to 80% of patients in 2 weeks to 3 months period. Hormonal treatment with oral steroid is an alternative therapy to injectable adrenocorticotropin hormone, especially in low resource areas. Vigabatrin is preferred in tuberous sclerosis patients. Long-term aim of treatment is sustained remission of seizures and better neurodevelopmental outcome. About 50 to 70% of children are spasm free for prolonged duration, but epilepsy with multiple seizure types including Lennox–Gastaut syndrome is evident in 20 to 40% of children in long-term follow-up. Though hypsarrhythmia is helpful for the diagnosis, prognostic role of the resolution of electroencephalographic abnormalities is still uncertain. Seizures can be controlled in 40 to 60% of the patients, but only 12 to 40% children have normal neurodevelopmental outcome and a third of children are left with severe disabilities. Children with unknown etiology and normal development at spasm onset have better clinical outcome. Young age at onset, nonstandard therapy have less favorable outcome. Surgery is helpful for spasm control in patients with structural lesions and refractory spasms even in the absence of structural lesions.

Introduction: A significant proportion of patients with advanced squamous cell carcinoma of head and neck (HNSCC) are unsuitable for radical treatment and we aim to evaluate the acute toxicity, symptom relief and disease response after palliative hypo fractionated radiotherapy in such patients. Methods: A prospective observational study was conducted from November 2014 to November 2015 at the Department of Radiation Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur in 30 patients with stage III or stage IV HNSCC who received radiotherapy of 30 Gy in 10 fractions over two weeks. Pain, dysphagia, insomniaand dyspnoea at presentation were assessed using 11 point numerical scale. Acute treatment toxicities we reassessed using Common Terminology Criteria for Adverse Events (CTCAE) at the end of two weeks. After six weeks of completion of radiotherapy, percentage of symptom relief and disease response based on Response Evaluation Criteria in Solid Tumors (RECIST) were recorded. A few patients were selected for further curative radiotherapy. Results: Common symptoms were pain (86.7%) and dysphagia (50%). Two-third of patients with pain and dysphagia, and about 90% patients with dyspnoea and insomnia had more than 75% symptom relief. An objective response rate of 70% and disease progression of 13.3% were observed. Acute radiation toxicities were acceptable with no grade 3 or 4 toxicities. It was observed that 46.3% of patients had mucositis, 13.3% had dysphagia, and 6.7 % had hoarseness and dermatitis each. Conclusion: Palliative radiotherapy is a suitable modality of treatment for patients with advanced HNSCC for symptom relief and tumour control, with acceptable toxicity.

Purpose: Radiotherapy is a major modality for treating cervical cancer patients. Conventionally, superior border of treatment portal in cervical cancer is kept at L4-L5 intervertebral spaces; however, newer concepts suggest that aortic bifurcation should be the determining factor for the superior border. This study aims to observe the level of aortic bifurcation in cervical cancer patients. Methods and materials: A retrospective observational study was conducted in cervical cancer patients undergoing radiotherapy between July 2019 and August 2020 in B.P. Koirala Memorial Cancer Hospital, Bharatpur. Histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stages II and III carcinoma cervix patients referred for radiation therapy were included in the study. Baseline variables including age group, FIGO stages were noted from the hospital record. Computed Tomography (CT) simulation images were reviewed from the treatment planning system to detect the levels of aortic bifurcations. Results: Total 281 patients of carcinoma cervix were registered for the study with age ranging from 29 years to 87 years and the commonest age group being 51-60. The maximum patients were of stage IIB (46.6%). The aortic bifurcations levels varied from mid L3 to L5-S1 intervertebral space and the commonest level observed was mid L4 vertebra in 70 (24.9%) patients. Conclusion: Anatomical variation in the level of aortic bifurcation, considered as the superior CTV border in pelvic radiotherapy in cervical cancer, demands the conventional superior border, L4-L5 intervertebral space, to be shifted more superior to include common iliac nodes in the treatment field.