No abstract

Introduction: Advanced laryngeal cancer carries significant morbidity with deterioration sinquality of life. The Radiation Therapy Oncology Group (RTOG) 91-11 study found that in the management of advanced laryngeal cancers, Concurrent Chemotherapy and Radiation (CCRT) produced significant organ preservation compared with other treatment modalities without compromising locoregional control and survival outcomes. These studies lead to the employment of CCRT for advanced laryngeal cancer with the aim of organ preservation. Aim: To assess the rate of laryngeal preservation in patients undergoing CCRT in a tertiary care centre. Materials and Methods: The present prospective, interventional study was conducted in the Department of Radiotherapy, Government Medical college, Thrissur, Kerala, India comprising the newly diagnosed patients with locally advanced laryngeal cancers from July 2019 to August 2020. Conventional radiotherapy with a dose of 66 Gray in 33 fractions over 6.5 weeks was given concurrently with injection cisplatin 100 mg/m2 intravenously every three weeks and periodically followed-up for one year. Results: Out of 50 study participants, 40% of the target population were between 51-60 years of age and 90% of the cases were males. The rates of laryngeal preservation were found to be 88% according to this study. The study proved that laryngeal preservation was significantly lower in cases with age 61-70 years, with those with Eastern Cooperative Oncology Group (ECOG) performance score of 2, nodal stage N3 and stage IV disease and in those with fewer chemo cycles. There was no relationship between laryngeal preservation sex, tumour stage, composite stage. Conclusion: These results show that the rates of laryngeal preservation were found to be higher in advanced laryngeal cancers undergoing radiotherapy with concurrent chemotherapy. Locoregional control was higher without causing severe toxicities. This study shows that higher rates of laryngeal preservation could be achieved with good locoregional control thereby leading to organ preservation and avoidance of severe morbid surgical procedures.

BACKGROUND Concurrent chemotherapy is a well-established treatment modality for locally advanced head and neck cancer. The concept of concurrent chemotherapy and radiation was introduced in an attempt to improve the local control and possibly influence the survival because of the high rate of local and distant failures observed with the combination of surgery and postoperative radiation. The relevance of this study was to assess the efficacy of our treatment and patience compliance and also study the effect in patients treated with cisplatin based concurrent chemo radiotherapy in advanced head and neck cancer. METHODS The prospective study was conducted in the Department of Radiotherapy, Government Medical college, Thrissur, Kerala comprising the newly diagnosed patients with locally advanced head & neck cancers over one year. Conventional radiotherapy with a dose of 66 Gy in 33 fractions over 6.5 weeks was given concurrently with Inj cisplatin 100 mg / 2 IV every 3 weeks and periodically followed up for one year. RESULTS This study revealed that complete response rate was higher in 61 – 70 year age group compared to lower age groups. Complete response cases were slightly higher in T1 disease compared to higher stages. Regarding nodal status, complete response and DFS were more in N0 tumours and worst in N3 tumours. It was found that complete response rates were slightly higher in stage III than stage IV. Comparing the grade of the tumour, complete response cases were slightly higher in WD and MD compared to PD. Complete response rate and disease free survival (DFS) were slightly higher in cases who had more than two chemotherapy cycles compared to one cycle. CONCLUSIONS Concurrent chemo radiation was not well tolerated in our study group. Only 23.5 % patients were able to complete the planned treatment. The positive side was that complete response was found in about 79.4 % of study patients & DFS at one year was 80 %. KEY WORDS Concurrent Chemo Radiation, Head and Neck Cancer, Cisplatin

Introduction: Breast cancer is a leading cause of morbidity among women all around the world. Monitoring the survival pattern and identifying the prognostic factors on survival are always great concerns in cancer researches. Cure rate regression model is a useful statistical tool to predict the cure rate of cancer diseases and to determine the factors associated with survival of patients. Aim: The current study aimed to estimate the cured proportion and to make out the factors associated with survival time of infiltrating ductal breast carcinoma patients in a tertiary care hospital of central Kerala. Materials and Methods: The retrospective cohort study was conducted in the Department of Radiotherapy of a major tertiary care hospital of central part of Kerala, India. A total of 313 female patients diagnosed with infiltrating ductal breast cancer during January 2012 to December 2015 were considered for the study. The impact of the covariates, age at diagnosis of disease, grade of cancer, stage of disease, tumour stage, status of regional lymph node, distant metastasis, and triple negative status on survival of patients were studied. The parametric mixture cure rate regression model was used for estimation and inferential procedures. The cure rate with respect to each study variable and their role on long term survival of patients were investigated. Results: Mean age of patients was 51.95±10.91 years. The minimum cure rate found out (29.8%) among the patients presented with distant metastasis. The bivariate analysis showed the factors, stage of cancer, (T-stage), status of regional lymph node and distant metastasis status influence significantly on incidence of death due to breast cancer in long run period and grade of cancer determines the survival of patients at shorter duration of time. The presence of regional lymph node and distant metastasis status were found out to be two important indicators that determine cure rate of infiltrating ductal breast cancer patients in multivariate analysis. The hazard of patients living with higher grade cancer was seen 1.48 times more than that of others (Hazard Ratio=1.48, p-value <0.001). Conclusion: The cure rate of patients estimated between 29.8% and 69.6% with respect to various factors under study. The status of regional lymph node and distant metastasis status were found to be associated with cure rate of patients. The study results showed that the grade of cancer is one significant factor that determines survival of patients. The study recommends cure rate regression model as a useful tool to analyse breast cancer survival data in the presence of cured proportion.