A reliable diagnosis of PAD can be made using the ankle-brachial index (ABI). This is a simple, noninvasive and reasonably accurate screening recommended in all diabetic individuals >50 years of age. However, ABI measurement has its drawbacks because medial calcification of the tibial arteries making them non-compressible, resulting in unusually

background: Concurrent chemoradiotherapy (CRT) is the most effective approach in controlling advanced head and neck cancer. Cisplatin is the most extensively cytotoxic agent investigated concurrently with radiation therapy as well as in neoadjuvent and adjuvant setting, also the taxanes (paclitaxel and docetaxel) have demonstrated significant activity in head and neck cancer so we started this study to confirm the efficacy of concurrent chemoradiotherapy followed by three cycles of adjuvant chemotherapy (cisplatin and docetaxel) in treating patients with locoregional advanced head and neck cancer. patient and Methods: Between February 2003 and August 2005, 36 patients with advanced head and neck cancer were treated at King Abdul Aziz Hospital and Oncology Center Jeddah, with a full course of conventional radiotherapy (70 Gy). Patients were scheduled to receive two cycles of concurrent cisplatin (100mg/m 2) administered on weeks one and five of radiotherapy. Subsequently a further three cycles of adjuvant chemotherapy comprising a combination of cisplatin (60mg/m 2) and docetaxel (60mg/m 2) repeated every three weeks. All patients were assessed for response immediately after the concomitant phase and at two months after completion of treatment. Follow up was maintained for a range from 6 to 36 months. Toxicity profile, pattern of failure, two years disease free and overall survival rates were estimated. Results: The median age of patients was 44 years with male to female ratio of 2.3:1. 64% of the patients had a primary tumor of the nasopharynx. Undifferentiated carcinoma was the major pathological subtype. The planned dose of radiotherapy was completed in 92% of patients, and 83% completed the three cycles of adjuvant chemotherapy. Mucositis and neutropenia were the commonly recorded side effects, with no reported toxic death. 31 patients went into complete remission (CR) after the first phase of treatment. Another three patients were turned into CR after the adjuvant phase. During the period of follow up, five patients relapsed (three locoregional & two systemic relapse). The estimated two year disease free and overall survival rates were 78% and 89% respectively. Conclusion: Concurrent chemoradiotherapy had improved the results of treatment in patients with advanced head and neck cancer concerning locoregional control, disease free survival and overall survival; however more was achieved, especially concerning reduction of distant failure, by addition of adjuvant chemotherapy. Docetaxel in combination with cisplatine is reported to be an effective combination in the adjuvant setting.

The aim of this study is to describe in detail forward planning intensity-modulated radiation therapy (FP-IMRT) technique used in our center for the treatment of head-and-neck cancer and to confirm that in centers without the capabilities of inverse planning intensity-modulated radiation therapy (IP-IMRT) or in situations where patients are not ideal candidates for that technique, FP-IMRT can be useful and can achieve a good dose distribution with sparing of parotid glands. Patients and Methods: Between June 2007 and April 2008, 19 patients with primary head-and-neck cancers were treated at King Abdul Aziz Hospital and Oncology Center Jeddah, using FP-IMRT techniques. In our study we follow the RTOG H-0022 protocol, thirty daily fractions over six weeks are used to simultaneously deliver 66Gy (2.2Gy/fraction) to the gross tumor (primary and enlarged nodes) with margins based on radiological and clinical justification (clinical target volume 1), 60Gy (2Gy/fraction) to the soft tissue and nodal regions adjacent to the previous volume (clinical target volume 2) and 54Gy (1.8Gy/fraction) to elective nodal regions as well as margin to account for patient motion and setup errors (clinical target volume3). These are biologically equivalent to 70, 60 and 50Gy, respectively, if given in 2Gy per fraction. The maximum dose to the brainstem and spinal cord are to be maintained below 54 and 50Gy, respectively. The mean dose to the parotid is to be maintained below 26Gy, or at least 50% of one of the parotid is to be maintained below 30Gy. All patients treated with a 7 gantry angles, including an anterior, 2 lateral, 2 anterior oblique and 2 posterior oblique angles with a total of 22 beam shapes formed by multileaf collimators (MLC). The segments used in a given angle are tailored to maximize the coverage of the target while minimizing the normal tissue exposure. All patients were treated with 6MV photon produced by Siemens (Oncor Impression) accelerator with autosequencing of all treatment segments. Results: The aim of having at least 95% and 98% of the volume of CTV1 to receive at least 95% and 90% of the prescribed dose, respectively, was fulfilled in all cases. The criterion of having at least 95% and 98% of the volume of CTV2 to receive at least 95% and 90% of the prescribed dose was not met in five and six patients, respectively, with an average of 92.8% of the volume received 95% of the dose and 97.3% of the volume received 90% of the dose. On the other hand the percentage of the volume of CTV3 who received 95% of dose had a wide range from 81% to 99% with an average of 88.3% and the percentage that received 90% of the dose ranged from 85% to 100% with an average of 94.5%. The maximum dose to the spinal cord was ranged from 50 to 39Gy (average 45.1Gy), however the dose to 10% of the spinal cord volume present in the field ranged from 47 to 30Gy (average 39.3Gy). On the other hand the dose to the brain stem was below 54Gy in all cases. We succeed to keep the mean dose of both parotid glands below 26Gy in four patients, ...

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