PurposeRandomized trials on the effect of external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) for endometrial carcinoma are very few. In view of this, the current study was conducted with the hypothesizes: whether the escalated dose of 26 Gy (VBT alone) in comparison with various major international trials (PORTEC-2) has any difference in rates of disease-free and overall survival with fewer adverse effects in low resource setting like India.Material and methodsAn open-labeled, non-inferiority, randomized control trial was undertaken at a regional cancer center among patients with stage IA or IB high-intermediate risk endometrial carcinoma. A total of 50 patients were divided equally among two arms of combined EBRT with VBT (arm I) and VBT alone (arm II). A dose of 50-50.4 Gy in 25-28 fractions of EBRT with 2 fractions of VBT 6.5 Gy each were delivered to patients in arm I and 4 fractions of VBT 6.5 Gy each to patients in arm II, and were followed up for 60 months.ResultsDuring the median follow-up of 36.5 months, two patients developed loco-regional recurrence in arm II, three (arm II), and one (arm I) developed distant metastasis. The 5-year survival rates for arms I and II were 96.0% vs. 92.0% overall, and 88.0% vs. 84.0% disease-free, respectively, and were not found to be statistically significantly different. Dermatological, gastro-intestinal toxicities, and cystitis were lower in the VBT group compared to combined group.ConclusionsVBT alone is as effective as EBRT+VBT in ensuring loco-regional control and achieving comparable survival rates, with fewer toxic effects for patients with stage I intermediate- and high-risk endometrial carcinoma. The dose escalation did not make a difference in the survival rates and was like in the other major trials (PORTEC-2).
BACKGROUND ESWL is suitable for stones smaller than 2 cm situated in upper and middle calyx. The routine insertion of DJ stents during ESWL of renal calculi is controversial. Some studies support the role of DJ stents in facilitating stone passage and preventing renal colic whereas other reports claim that stent causes significant lower urinary tract symptoms, hematuria, urinary tract infection and can even lower the stone-free rate. METHODS This is a prospective study conducted among 81 patients each in stented and non stented group who underwent ESWL for renal calculus. The primary outcome measured was stone fragmentation .The secondary outcomes measured were renal colic, urinary tract infection, steinstrasse and stent related LUTS. RESULTS Stone fragmentation rates in stented and non-stented groups were 91.4% and 86.4% respectively (p-value > 0.05). Ureteric colic in the stented group was only 14.8% but 45.7% in the non-stented group had ureteric colic (p-value <0.05). Lower urinary tract symptoms were significantly higher in the stented group (44.4%) when compared to the non-stented group (13.6%) and the p-value was < 0.05. The occurrence of steinstrasse and urinary tract infection were similar in both groups. CONCLUSIONS Double J stents neither improve the stone fragmentation nor lead to enhanced passage of stone fragments in patients undergoing ESWL. DJ stent effectively prevents ureteric colic which occurs due to the passage of fragments down the ureter. Patients with DJ stent have statistically significant lower urinary tract symptoms. The occurrence of UTI and Steinstrasse was seen in both groups and was unrelated to the presence of DJ stent.
ESWL is considered as a standard treatment for renal calculi less than 20 mms, but the outcome of this therapy depends on different factors including stone composition, stone location, pelvicalyceal anatomy and stone size. This study was conducted to assess the treatment outcomes of patients undergoing ESWL for renal calculi and the factors influencing it. This was a descriptive study conducted in the Department of Urology, Government Medical College,Thiruvananthapuram. The study period was one year and 150 patients were enrolled. Overall success rate of ESWL in our study was 76.7%. Regarding the treatment outcomes our study concluded that the overall success rate of ESWL is 76.7%. But factors like lower calyceal location, skin to stone distance >10 cm, density > 950 HU and size >1.5 cms are associated with failure of fragmentation by ESWL.
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