Although both the regimens had different toxicity profiles the quality of life was better for patients on the AC-P regimen.

This report describes the authors'experience with salvage surgery in 78 patients with carcinoma of the buccal mucosa who failed after high-dose radical radiation therapy at Regional Cancer Centre, Trivandrum, India. Forty-four patients (56%) required a hemimandibulectomy for adequate tumor clearance. Fifty-four patients (69'/0) required a primary reconstructive procedure for wound closure. Follow-up periods ranged from 28 months to 63 months (median follow-up, 41 months). Thirteen patients (17%) developed nonfatal postoperative complications. Thirty-one patients recurred after surgery, five of whom were again salvaged by further surgery. Overall, the recurrence rate was 36%. Most of the recurrences (26/31) were at the primary site. The overall 5-year actuarial disease-free survival after salvage surgery was 59.7%. T stage of the recurrent tumor and its skin infiltration emerged as factors which significantly influenced disease-free survival (P < 0.05). Cancer 68295-299,1991. ANCER OF THE BUCCAL MUCOSA is the com-C monest cancer in men and third most common cancer among women in Kerala, South India.' Eleven percent of all cancers in men and 7% of all cancers in women treated in Regional Cancer Centre, Trivandrum, India, during the years 1982 to 1985 were buccal mucosal cancers. More than 95% of these patients are habituated to tobacco.' This is mostly in the form of chewing betel quid that contains tobacco, betel leaf, arecanut, and calcium hydroxide. Most buccal mucosal cancers are treated primarily by radiation, with surgery reserved as a salvage procedure for persistent or recurrent disease in our institution. This policy has evolved from our institutional experience, constraints in the availability of surgical services. and preference of the patient as well as the physician who is initially responsible for his care. The Surgical Oncology Service as a distinct specialty was initiated in 1983 and since then considerable experience has been accumulated in this division on the surgical management of head and neck cancers. This division concentrates on head and neck surgery since head and neck cancers constitute approximately 40% of all cancers in men and 20% of all cancers in women.3 Surgical salvage of radiation therapy failures is one of the major activities of this division. In this report we describe our experience and findings on salvage surgery of 78 buccal mucosal cancer patients who were initially treated with tumoricidal doses of radiation therapy. Materials and Methods We have reviewed the case records of 85 patients with buccal mucosal cancer who had salvage surgery after radiation therapy failure in our division between 1983 and 1987. Seven patients were excluded from the final analysis because of inadequate details about the disease. Hence 78 patients were evaluable for the study. Of them 54 were men and 24 women with a ma1e:female ratio of 2.25:l. There was one patient younger than 40 years, 15 patients between 40 and 49 years of age, 29 patients between 50 and 59 years, 23 patients between 60 and 6...

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Background: Lenalidomide plus Dexamethasone (Len-Dex) and VAD (Vincristine, Doxorubicin and Dexamethasone) regimen are the two common drug therapies employed in the treatment of Multiple myeloma.Objectives: To compare the efficacy of Len-Dex versus VAD regimen based on complete remission achieved with treatment in newly diagnosed cases of multiple myeloma in a tertiary care hospital in Kerala.Methods: Eighty patients (forty in each group) of newly diagnosed cases of multiple myeloma, who were willing to give the informed consent, were included in the study. Patients were allocated by the treating physician to two groups; one group was given Len-Dex (lenalidomide + dexamethasone) regimen and the other VAD (Vincristine, Adriamycin, Dexamethasone) regimen. A total of six cycles were given for both groups. Their baseline investigations and follow up investigations were collected at regular intervals, based on these values, the outcome was classified as partial remission and complete remission and the results were compared and analyzed.Results: Among the forty patients in each group, 17 (38%) on VAD regimen and 28 (62%) on Len-Dex regimen achieved complete remission. The statistical analysis was done using chi square test (χ2= 6.13, df= 1, p= 0.01) which showed statistically significant difference.Conclusions: The study showed that the efficacy of Lenalidomide-Dexamethasone (Len-Dex) combination therapy is clearly higher than that of VAD regimen among the study population. The overall efficacy of Len-Dex combination is 70% and that of VAD regimen is only 42.5%.