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Purpose/Aim: Forward planned intensity-modulated radiotherapy (forward IMRT) with breath-hold (BH) technique is considered optimal by most practitioners for treating left-sided breast cancer. Regional nodal irradiation including axilla and supraclavicular fossa (SCF) increases can increase dose-to-organs at risk (OAR) especially lung. This study was done to assess the potential of inverse planned IMRT (inverse IMRT) to achieve significant reduction in dose to OAR. Materials and Methods: Ten patients with left-sided breast cancer treated with Active Breath Co-ordinator BH technique were included in the study. Forward IMRT plans were generated in both BH and free breathing (FB) scans. Inverse IMRT plans were generated in FB scan using Tomotherapy-Direct and Tomotherapy-Helical techniques. Contouring was done as per the ESTRO consensus contouring guidelines. The dose prescribed was 40 Gy in 15 fractions. Statistical significance was tested using one-way ANOVA for parametric data and Kruskall-Wallis test for nonparametric data. Multiple comparison tests were done by using Bonferroni test. P <0.05 was considered to denote statistical significance. Results: Inverse IMRT plans achieved superior homogeneity index compared to forward IMRT with BH. Tomotherapy-Direct reduced dose to ipsilateral lung, compared to the forward IMRT with BH while achieving similar doses to other OAR. Tomotherapy-Helical plans achieved significantly better conformity index and reduced maximum dose to left anterior descending artery compared to forward IMRT plans, but low dose to other OAR was significantly worse. Conclusion: For left-sided breast, axilla, and SCF radiotherapy, inverse IMRT with Tomotherapy-Direct plan achieved better homogeneity index and reduced dose to ipsilateral lung compared to forward IMRT with BH. [ABSTRACT FROM AUTHOR]

Introduction: Meta-analyses have shown concurrent chemoradiotherapy (CCRT) provides no survival benefit over radiotherapy in patients of head and neck squamous cell carcinoma (HNSCC) aged over 70 years. This study was performed to determine the adverse-effect profile, compliance, functional and oncological outcomes in patients of HNSCC over 70 years of age treated with CCRT.Materials and Methods: Retrospective analysis of stage III/IV HNSCC in patients above 70 years of age who received CCRT at our institution (n = 57). Cox-proportional hazards regression model was used for statistical analysis.Results: There were 57 patients of stage III/IV HNSCC who underwent curative CCRT. 61% completed chemotherapy with no deaths and acceptable toxicity. The predictors of recurrence were poorer performance status (P = 0.031) and treatment breaks (P = 0.04). Tube dependence was associated with 2.7 times higher risk of mortality (P = 0.005).Conclusion: CCRT should be considered standard of care in those over seventy with good performance status. Patients with tube dependence have a higher risk of persistent disease or treatment related mortality. [ABSTRACT FROM AUTHOR]

Background and Aim: The majority of nasopharyngeal carcinoma (NPC) reports on the outcome and prognostic factors are from endemic high-risk regions. Data on the outcome of Indian patients are sparse. In this study, we retrospectively analyzed the outcome of NPC patients treated radically with conformal radiotherapy (RT). The primary objective was to assess the outcome, and the secondary objectives were to assess treatment-related morbidities and the impact of various prognostic factors on the outcome.Materials and Methods: Sixty-eight patients with biopsy-proven NPC who received radical conformal RT, i.e., three-dimensional conformal RT or intensity-modulated RT (IMRT) during 2004-2013 were analyzed. All patients received conformal RT with or without chemotherapy. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 20.0) software, IBM, USA. Survival analysis was performed using Kaplan-Meier method. For calculating the hazard ratio of the prognostic factors, univariate and multivariate Cox regression analyses were done. Chi-square test was used to determine the association.Results: In this study, with a median follow-up of 43 months, the overall survival (OS), disease-free survival, and cause-specific survival were 91, 85.2, and 98.4% at 2 years and 78.3, 72.8, and 88.2% at 3 years, respectively. The locoregional failure was low (3%), and the 5-year cause-specific survival with chemoradiation was excellent (79%), even with 50% of the patients being nonmetastatic Stage IV. Eleven out of 12 failures were distant metastases. The treatment-related late morbidities were acceptable and better with IMRT. Significant prognostic factors affecting the outcome were composite stage of the disease and the interval between diagnosis and treatment initiation.Conclusion: In locally-advanced NPC, excellent local control is possible with modern conformal RT with concurrent chemotherapy. Distant metastases remain a therapeutic challenge despite systemic chemotherapy. Novel systemic therapies are needed in the future for improving the OS of these patients. [ABSTRACT FROM AUTHOR]

Introduction: It is estimated that around 10% of all head and neck cancer patients in India are aged over 70 years. Elderly patients are often subjected to palliative or inadequate treatment for head and neck cancers in spite of being candidates for curative intent therapy. In this study we evaluated our use of radical radiotherapy in carcinoma larynx for patients over seventy years of age to determine morbidity, likelihood of completing therapy, functional and oncological outcomes.Materials and Methods: 132 patients of squamous cell carcinoma of the larynx treated between 2005-2015 at Amrita Institute of Medical Sciences, Kochi who were seventy years of age or older were included. The endpoint for analysis was overall survival. Survival curves were generated using Kaplan Meier method and univariable analysis was performed using log rank test.Results: The median age of patients was 77 years (range 70-102). All patients (100%) completed radiotherapy with 6 (5%) requiring treatment breaks. All patients had at least minor (grade I/II) toxicities. Grade III toxicities were seen in 10 (8%) of patients. No grade IV reactions or treatment related deaths occurred. When a univariate analysis was performed for determinants of major toxicities with age range, performance status, smoking, number of co-morbidities or TNM stage, no determinants were statistically significant. 2-year disease free survival for stage I, II, III and IV was 100%, 98%, 80% and 64% respectively, and the 2-year overall survival for all four stages was 100%.Conclusion: Patients over seventy years tolerate radical radiotherapy for treatment of laryngeal cancer. In spite of minor toxicities, all patients completed treatment and had good oncological outcomes. Patients with stage III/IV unfit for concomitant chemotherapy administration treated with radiotherapy alone had a good disease free survival. Curative intent therapy should not be withheld from elderly patients on the basis of age. [ABSTRACT FROM AUTHOR]

A prospective pilot study of therapeutic outcome in locally advanced Head and Neck Cancers treated with conventional chemo-radiation and the hypoxic radio-sensitizer Nimorazole Abraham A. G, Anoop R, Pushpaja K. U, Menon A, Mony U, Dinesh M Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi Aim: To study the efficacy of Nimorazole as a hypoxic radio-sensitizer in locally advanced oro-pharyngeal, hypo-pharyngeal and laryngeal cancers treated with standard of care chemotherapy and conventional radiation therapy. Objectives: The primary objectives of the study were to compare the acute toxicity as well the efficacy in terms of local tumour control of Nimorazole in combination with chemo-radiation to chemo-radiation alone, in patients with locally advanced head and neck cancers. Other study objectives included testing patient derived plasma samples for Osteopontin as a marker for hypoxia to predict efficacy of Nimorazole and to identify a correlation between sensitivity to radiation, HPV status and p53 mutations in hypoxic tumours. Materials and methods: Population: 22 patients diagnosed with biopsy proven locally advanced oro-pharyngeal, hypo-pharyngeal and laryngeal cancers who were planned for treatment with conventional fractionated radiation therapy and concurrent chemotherapy were planned for inclusion in the trial. Interventions: 11 patients enrolled in the study were given Nimorazole and conventional chemo-radiation and 11 patients received only conventional chemo-radiation. The patients were evaluated regularly for acute toxicity. Plasma samples were collected prior to start of treatment and weekly during treatment and were tested for Osteopontin levels by ELISA. Tissue samples were evaluated for p53 and p16 by IHC and validated by an expert pathologist specialising in head and neck cancers. Results: Patients in both arms of the trial were comparable with regards to disease stage and subsites. All patients completed the planned course of treatment without breaks. At median follow-up of 6 months, the local disease control rates were similar in both the arms of the trial. There was increased incidence of grade 2 mucosal reactions in the Nimorazole arm of the trial. Longer follow-up will be required to clarify the differences in local failures and overall survival. A non-significant correlation between local control, osteopontin levels, HPV status and p53 mutational status was noted in the trial cohort. Conclusion: The use of Nimorazole along with concurrent chemo-radiation is a safe option for treating patient with locally advanced head and neck cancers. Mutational markers and circulating hypoxia markers can give added information for identifying the patients who benefit most from the treatment. Irrespective of the stage of disease, it is the tumours with increased hypoxic signatures that are likely to benefit from the use of a hypoxic radio-sensitiser like Nimorazole. [ABSTRACT FROM AUTHOR]