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Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract and are the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines or recommendations for the management of HNCs, these may not be appropriate for Indian scenarios. In an effort to discuss current practices, latest developments and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical and radiation oncologists and dentists) was formed. A review of literature from medical databases was conducted to provide the best possible evidence base, which was reviewed by experts during a consensus group meeting (January, 2019) to provide recommendations. [ABSTRACT FROM AUTHOR]

Background: Comprehensive geriatric assessment (CGA) in routine practice is not logistically feasible. Short geriatric screening tools are available for selecting patients for CGA. However none of them is validated in India. In this analysis we aim to compare the level of agreement between three commonly used short screening tools (Flemish version of TRST (fTRST), G8 and VES-13.Methods: Patients ≥65 years with a solid tumor malignancy undergoing cancer directed treatment were interviewed between March 2013 to July 2014. Geriatric screening with G8, fTRST and VES-13 tools was performed in these patients. G8 score ≤14, fTRST score ≥1 and VES-13 score ≥3 were taken as indicators for the presence of a high risk geriatric profile respectively. R version 3.1.2 was used for analysis. Cohen kappa agreement statistics was used to compare the agreement between the 3 tools. p value of 0.05 was taken as significant.Results: The kappa statistics value for agreement between G8 score and fTRST, between VES-13 and fTRST and between VES-13 and G8 were 0.12 (P = 0.04), 0.16 (P = 0.07) and 0.05 (P = 0.45) respectively. It was found that maximum agreement was observed for VES-13 and fTRST. The agreement value of VES-13 and fTRST observed was 59.44 %(39.63% for high risk profile and 19.81% for low risk profile). The agreement value of G-8 and fTRST was 39.62% (2.83% only for high risk profile and 36.79% for low risk profile). The lowest agreement was between G8 and VES-13, 35.84% (7.54% for high risk detection and 28.30% for low risk detection).Conclusion: There was poor agreement (in view of kappa value been below 0.2) between the 3 short geriatric screening tools. Research needs to be directed to compare the agreement level between these 3 scales and CGA, so that the appropriate short screening tool can be selected for routine use. [ABSTRACT FROM AUTHOR]

Background: A small proportion of Non-Small Cell Lung Cancers (NSCLC) are detected with Anaplastic Lymphoma Kinase (ALK) mutation by immunohistochemistry (IHC) but are negative by Fluorescence in situ Hybridization (FISH). Data on responses and outcome of this subset of patients when treated with crizotinib is limited. We analyzed the outcomes of such patients who received crizotinib.Patients and Methods: Demographics, treatment details, response to treatment, date of progression and date of death were collected for patients who were IHC positive and FISH negative for ALK mutation from a prospectively maintained database. Depending upon feasibility, patients received either platinum based doublet chemotherapy or the ALK inhibitor crizotinib as first line therapy. Outcomes were compared to our previously published historical cohort of FISH positive patients who were treated with crizotinib.Results: Thirteen patients were detected to be IHC+/FISH- and out of these seven received crizotinib. Objective response rate for crizotinib was 57.15% with an estimated mean PFS of 9.6 months (95% CI 3.8 -15.5 months). The difference in ORR of ALK IHC+/FISH- when compared to our historical cohort of ALK FISH positive treated with crizotinib was not statistically significant (57.15% vs 69.8%; P = 0.265). Estimated mean and median PFS was similar between the two cohorts (median PFS 6.0 months vs 14 months; mean PFS 9.6 months versus 14.7 months; P = 0.467).Conclusion: NSCLCs positive for ALK mutation by IHC but not detected by FISH show good response to crizotinib and merit treatment with the same. [ABSTRACT FROM AUTHOR]

Aim: To report safety and efficacy of chemotherapy incorporating the combination of paclitaxel and platinum in patients with advanced penile carcinoma. Materials and Methods: Retrospective analysis of patient with advanced penile carcinoma undergoing palliative chemotherapy with paclitaxel and platinum combination. The demographic profile, indication of treatment, chemotherapy details, toxicity and survival outcome were noted. Statistical analysis was done for estimation of progression free survival and overall survival. Factors affecting these outcomes were sought for. Results: Eighteen patients with a median age of 47.5 years (31-68 years) were offered palliative intent chemotherapy over a period of 2.5 years. ECOG performance was 1 in 12 patients (66.7%) and 2 in 6 patients (33.3%).The grade of tumor was poorly differentiated in 8 patients (44.4%), moderately differentiated in 5 (27.8%) and we1l differentiated in 5 patients (27.8%). Twelve patients had previous surgical treatment (66.7%), with 2 of them having received groin radiation in past. The indication for treatment was metastatic disease in 7 patients (38.9%) and locally advanced disease in 11 patients (61.1%). Out of 18 patients 13 received chemotherapy. Paclitaxel and carboplatin combination was given in 10 patients (76.9%) while paclitaxel and cisplatin was received by 3 patients (23.1%). The median numbers of cycles received were 3 (1-6 cycles). Response rate was 30.8%. The median estimated progression free survival (PFS) and overall survival (OS) for patients receiving atleast one cycle of chemotherapy (n = 13) were 96 days and 246 days respectively. Among tested variables the median OS in patients who had received 2 or more cycles was 351 days versus 55 days in those who received less than 2 cycles (P = 0.025). However, after applying Bonferroni correction, the difference was no longer significant. There was no toxicity related death or life threatening complication. Conclusion: Our institutional protocol of platinum-based doublet with paclitaxel is effective, well-tolerated and has the advantage being delivered on an outpatient basis alone. Overall, we believe that paclitaxel-platinum is an effective regimen that needs to be investigated further in larger studies. [ABSTRACT FROM AUTHOR]

Context: The increasing popularity of intensity-modulated radiotherapy (IMRT) stems from its ability to generate a more conformal plan than hitherto possible with conventional planning. As a result, IMRT is in widespread use across diverse indications. However, the inherent nature of IMRT delivery makes it monitor unit inefficient and leads to increased normal tissue integral dose. This in turn may result in an increased risk of radiation-induced second malignancies. Aim: To calculate the risk of second malignancy post-IMRT. Settings and Design: Observational study in a tertiary care institute. Materials and Methods: Eighteen previously untreated patients with head and neck cancers (n = 10) and prostate cancer (n = 8) were selected. In these patients, selected infield organs around the planning target volume were contoured, viz. brain and thyroid in patients with head and neck cancer and bladder, rectum and small intestine in patients with carcinoma prostate. The estimates of radiation-induced malignancies in these organs and the whole of the body were derived using the concept of Organ Equivalent Dose. Statistical Analysis Used: Descriptive statistics (SPSS version 12). Results: The modal estimated incidence of radiation-induced malignancies was 129.87, 1.4, 0.10, 3.42, 7.789 and 129.85 per 10,000 person-years for the brain, thyroid, bladder, rectum, small intestine and whole body respectively. Conclusions: The estimated risk of radiation-induced malignancies in the thyroid and rectum was similar to the available literature, while the risk for bladder carcinomas was lower than that reported. However, the calculated risk of radiation-induced tumors of the brain was more than that reported with conventional radiation therapy. We propose that estimation of the risk of radiation-induced malignancies should be a part of the plan evaluation process and special care should be taken before using this modality in young patients with benign tumors in the head and neck region. [ABSTRACT FROM AUTHOR]

Aim: Compare the planning target volume (PTV) coverage in three different shielding techniques in cranial irradiation. Settings and Design: Tertiary care center, prospective study. Materials and Methods: The whole brain and meninges were contoured in ten planning CT scans, and expanded by 5 mm for the PTV. Shielding was designed using the French Society of Pediatric Oncology (SFOP) guidelines (SFOP plan), in-house recommendation (with 1 cm margin from the orbital roof and sphenoid wing) on a igitally Reconstructed Radiograph (DRR) and a third plan was generated using a 3D conformal radiation technique (3DCRT). The coverage of the PTV was noted using the isodose covering 95% of the PTV(D95), minimum dose within the PTV(Dmin), and maximum dose within the PTV(Dmax). The location of PTV not covered by the 95% isodose curve was noted. The median dose and maximum dose (Dmax) to both eyes and maximum dose Dmax for the lens were noted. Statistical Analysis: General linear model method repeated the measure of analysis of variance test (ANOVA). Results: PTV coverage was significantly poorer in the SFOP and in-house plans as compared to 3DCRT plan (P=0.04). Median volume of PTV not covered by 95% isodose curve was 4.18 cc, 1.01 cc, and 0 cc in SFOP, in-house, and 3DCRT plan, respectively. Conclusions: In the absence of volumetric planning techniques, SFOP guidelines lead to inadequate coverage and the in-house method is recommended. [ABSTRACT FROM AUTHOR]

Background: Intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT) is an attractive method for the treatment of head and neck cancers with sparing of the salivary function. Aims: To assess the feasibility, toxicity, and tumor control using SIB-IMRT in locally advanced head and neck cancers in the Indian setting. Settings and Design: The study was conducted in a regional cancer center in northern India. A review of the treatment result of the first 20 patients is presented. Methods and Materials: SIB-IMRT was planned for 20 patients—14 patients were treated with the SIB-72 schedule delivering a dose of 72 Gy, 66 Gy, and 57 Gy to the PTVGTV, PTVCTV1, and PTVCTV2 in 33 fractions. Six patients were treated with the SIB-66 schedule delivering 66 Gy, 60 Gy, and 54 Gy to the above-mentioned volumes in 30 fractions. Patients were monitored for toxicity using the CTCAE v 3.0 criteria. Descriptive analysis of toxicity and actuarial estimates of the loco-regional control and survival are presented. Results: Grade III mucositis was seen in 65% patients. None of the patients had Grade III dermatitis. The projected 2-year overall survival was 95%. Conclusion: SIB-IMRT schedules evaluated were found to be safe and effective and are being subjected to further prospective studies. [ABSTRACT FROM AUTHOR]

Background: Cisplatin based chemoradiation (CTRT) is the standard of care in locally advanced head and neck cancers. Limited treatment options are available in patients unfit for cisplatin. Aims: This audit was carried out to study the toxicities, tolerance and outcomes of carboplatin based CTRT in patients who were not eligible for cisplatin. Materials and Methods: A total of 63 locally advanced head and neck cancer patients treated between January 2011- October 2015 were administered carboplatin based CTRT. The dose of carboplatin was AUC-2 weekly for maximum 7 cycles. Toxicity was coded as per CTCAE version 4.03. SPSS version 16 was used for analysis. Statistical Analysis: Descriptive statistics was performed. Progression free survival (PFS) and overall survival (OS) were estimated by Kaplan Meier survival analysis. Cox proportional hazard model was used for identifying factors affecting PFS and OS. Results: The reasons for patients being unfit for cisplatin were low serum creatinine clearance in 41 (65.07%), sensorineural hearing loss in 18 (28.57%), uncontrolled medical comorbidity in 03 (4.76%) and old age in 1 patient (1.6%) respectively. 53 patients (84.1%) completed planned radiotherapy. Median number of chemotherapy cycles administered was six. Grade 3-4 toxicities were seen in 32 patients (50.8%). The median OS and PFS were 28 months (95%CI 20.9-34.6 months) and 17 months (95%CI 08.2-25.7 months) respectively. Age was the only factor significantly affecting OS and PFS. Conclusion: Carboplatin based CTRT is well tolerated in patients unfit for cisplatin and seems to have superior outcomes than those reported in radical radiotherapy studies. [ABSTRACT FROM AUTHOR]