Indian Journal of Cancer Education and Research

Purpose: To compare and analyse chemoradiotherapy with either weekly docetaxel or weekly cisplatin for treatment of locally advanced head and neck cancer in terms of tumor response and toxicities. Methods: This was a comparative analytical study. Adult patients (age ≥ 18 years) with LAHNSCC planned for chemoradiation and Karnofsky performance status of >70% were randomly assigned in 1:1 to either radiation with concurrent docetaxel 20mg/ once weekly or concurrent cisplatin 30mg/ m2 for a maximum of six cycles. Comparison of treatment response and acute and late toxicities were done. Results: A total of 50 patients were enrolled in the study between September 2022 and February 2024. The overall response rate was slightly higher in the DocetaxelRT arm compared to the Cisplatin-RT arm (87% vs. 80%). Complete response rates were 34.8% in the Docetaxel-RT group and 20% in the Cisplatin-RT group (P = 0.25), while partial response rates were 52.8% and 60%, respectively (P = 0.58). In terms of toxicity, Grade III mucositis was significantly more common in the Docetaxel-RT arm (65.2%) compared to the Cisplatin-RT arm (28%). Additionally, the incidence of grade 3 acute skin reactions was higher with Docetaxel-RT (28.1% vs. 4%), as was the occurrence of subcutaneous fibrosis at six months posttreatment (13% vs. 8%). Conclusion: Weekly Docetaxel (20 mg/m²) administered concurrently with radiotherapy in patients with locally advanced head and neck cancer demonstrates a favorable toxicity profile and comparable efficacy to weekly Cisplatin. Further validation through larger phase II/III trials and multicentre studies is warranted to optimize dosing strategies and assess long-term outcomes, including survival benefits.

Background: Radiotherapy is designed to deliver radiation in a precise, safe, and efficient manner to manage both cancerous and non-cancerous conditions. Among the available methods for dose verification, in vivo dosimetry stands out as the most direct approach for assessing the actual radiation received by the patient during treatment. This technique enables a comparison between the intended and administered doses, offering an additional layer of quality control alongside imaging verification and dose calculations. In vivo dosimetry is especially valuable in complex treatment modalities like intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), where accurate dose delivery is critical due to steep dose gradients and the involvement of nearby healthy tissues. By placing dosimeters on or inside the patient, clinicians can obtain real-time data on delivered doses, helping ensure that the treatment plan is followed precisely. Moreover, in vivo dosimetry plays a crucial role in identifying discrepancies that may arise from setup errors, machine malfunction, or patient movement during therapy. It serves as a real-time verification tool that can detect under-dosing or overdosing, allowing clinicians to take corrective actions promptly. This proactive approach enhances patient safety, ensures treatment effectiveness, and builds confidence in the reliability of advanced radiotherapy techniques. Aim: To assess in vivo dosimetry of scattered radiation from dental implants in head and neck cancer patients. Objectives: To study the difference between actual radiation dose delivered and radiation dose planned in patients with head and neck cancers with metallic dental implants. Materials and Methods: This was a single-institution prospective observational study. Treatment and follow-up data for all patients were available in their medical records and were extracted and reviewed as part of this evaluation. Result: There was no significant difference in actual radiation dose planned and radiation dose delivered on that particular implant. Conclusion: It has been observed that with the help of GaF Chromic film dosimetry, the difference in actual radiation dose planned on that particular implant and actual radiation dose delivered to that particular implant has been calculated and it has been observed there is no significant difference.

Background: Human papillomavirus (HPV) infection is the leading cause of cervical cancer, with infected individuals at significantly higher risk. Early detection of high-risk HPV strains is crucial for effective cancer prevention. Loopmediated isothermal amplification (LAMP) has emerged as a promising alternative to polymerase chain reaction (PCR) for DNA amplification, offering rapid, costeffective, and isothermal amplification without the need for thermal cycling. Objective: This study aimed to develop a point-of-care (POC) method for HPV screening using LAMP, targeting high-risk HPV strains through the amplification of the E6 and E7 genes. The performance of LAMP was compared with PCR and histopathology findings. Methods: LAMP primers were designed targeting conserved regions of high-risk HPV genomes using three bioinformatics tools: Primer Explorer V4, Opti Gene, and Premier Biosoft. Primer selection was based on melting temperature (Tm), GC content, and secondary structure formation. The LAMP assay was optimized for a one-tube reaction, and positive samples were visually detected using a neutral red indicator. Results: Primers designed with Primer Explorer V4 demonstrated the best performance, with optimal Tm values, high specificity, and minimal secondary structure formation. The LAMP assay successfully detected high-risk HPV strains with rapid amplification and visual detection. Compared to PCR and histopathology, LAMP showed high concordance, making it a reliable screening tool. Conclusion: LAMP, when combined with the PrimerExplorer V4 primer design, is an efficient and reliable method for rapid detection of high-risk HPV. This method has the potential to serve as a point-of-care cervical cancer screening tool, particularly in resource-limited settings.

Pancreatic cancer is a highly aggressive malignancy often diagnosed at an advanced stage, leading to significant pain that severely affects patient’s quality of life. The pain is primarily due to tumour invasion of the splanchnic nerves, which transmit nociceptive signals from the pancreas and surrounding structures. Traditional analgesic treatments, such as opioids, often become inadequate over time, prompting the need for alternative palliative interventions. Splanchnic plexus neurolysis (SPN) is a minimally invasive procedure that involves the chemical or thermal disruption of the splanchnic nerves, offering effective pain relief for patients with advanced pancreatic cancer. This procedure can be performed percutaneously or through endoscopic ultrasound (EUS) guidance. SPN has shown to significantly reduce pain, decrease opioid use, and improve overall functional status and quality of life in many patients. This case report explores the use of SPN in a patient with advanced pancreatic cancer and discusses its role in palliative care.

Abdominal wall varicosity manifests as enlarged, winding veins on the anterior abdominal wall that is prominent enough to assess blood flow direction. While this condition can stem from several underlying causes, careful clinical examination can help distinguish between cirrhosis with portal hypertension and obstruction of the inferior vena cava (IVC) or superior vena cava (SVC). Clinical Assessment To determine blood flow direction in these veins, clinicians should follow a systematic approach: 1. Identify a vein segment free of branches for at least 3 cm 2. Place two fingers close together over the middle of this segment 3. Move both fingers in opposite directions to “milk” and completely empty the vein 4. Release one finger and observe the speed and direction of blood flow 5. Repeat the procedure in the opposite direction Budd-Chiari Syndrome Connection Budd-Chiari syndrome (BCS), while uncommon, should be considered when evaluating abdominal wall varicosity. This condition occurs when hepatic venous outflow becomes obstructed. The underlying causes typically fall into two categories: • Inherited hypercoagulable states • Acquired prothrombotic conditions Over half of BCS cases stem from acquired prothrombotic states, particularly myeloproliferative disorders including: • Polycythemia vera • Paroxysmal nocturnal hemoglobinuria • Essential thrombocytosis • Agnogenic myeloid metaplasia • Myelofibrosis Clinical Presentation The manifestation of BCS varies significantly, ranging from asymptomatic cases to acute hepatic failure. The severity depends on two key factors: • The extent and speed of hepatic vein occlusion • The development of venous collateral circulation to decompress liver sinusoids Notably, when large abdominal veins (typically the inferior vena cava or portal vein) become thrombosis, collateral vessels may develop in the abdominal wall. These collaterals can lead to visible abdominal varicosities during physical examination, serving as an important diagnostic indicator.