Prophylactic Para-Aortic Extended Field Irradiation with Concurrent Chemotherapy for FIGO Stage IIIC1 Cervical Cancer Using Intensity Modulated Radiotherapy Technique: Acute Toxicity and Dosimetric Assessment

PURPOSE/OBJECTIVE(S)

To evaluate the efficacy of P - PART with concurrent chemotherapy in LACC with the use of intensity modulated radiotherapy technique (IMRT). Our Primary endpoint was to assess acute toxicities and secondary endpoint was to assess loco-regional control (LRC), disease free-survival (DFS), para-aortic recurrence free survival (PA-RFS).

MATERIALS/METHODS

A total of 30 patients of squamous cell carcinoma of cervix with stage IIIC1 (FIGO-2018) were recruited in this prospective, single arm interventional phase II study between January 2021 to September 2022. 18FDG-PET CT was performed and those with positive PALN were excluded. IMRT was used to deliver a dose of 50 Gy in 25 fractions to whole pelvis and PALN chain below renal hilum till aortic bifurcation received 45 Gy in 25 fractions. Concurrent cisplatin was administered weekly at 40 mg/m2 during radiation. On completion of external beam radiotherapy, high dose rate intracavitary brachytherapy was given at 7 Gy per fraction in 3 fractions prescribed to HR-CTV. Acute toxicities were assessed using CTCAE version 5.0.

RESULTS

Median age was 50 years (37-66 years). All patients had completed treatment as per protocol. All patients had positive pelvic nodes with the maximum nodal short axis dimension of 14 mm (10-18 mm). All patients had positive internal iliac group of LNs, only 2(6.6%) patients had positive common iliac group of Ln. Median number of concurrent cisplatin cycles given were 5 (3-5 cycle). Median overall treatment time was 56 days (52-63 days) and median follow up was 15 months (3-22 month). Median cumulative dose to HR-CTV was 84.3Gy (Range:79.2-86.9Gy). Cumulative median EQD2 to 2cc of bladder and rectum were 69.11Gy (Range:59.17 - 80.07 Gy) and 64.6 Gy (Range: 60.1-66.3Gy) respectively. 7(23.3%) patients having grade 3 diarrhea and 2(6.67%) patients had grade 3 anemia while no significant genitourinary or other toxicities were noted. Patient characteristics, dosimetric data are described in Table-1. All patients underwent clinical and radiological assessment at the time of last follow up with one (3.33%) patient experiencing local failure at 9 months of follow up, hence crude LRC rate is 96.6%, DFS is 13.5 months (5-22 months) and PA-RFS is 16 months (8-23 months) till last date of follow up.

CONCLUSION

Prophylactic EFRT with concurrent chemotherapy using IMRT technique yielded excellent short term clinical outcomes with acceptable toxicity profiles. Longer follow up will elucidate late toxicity and long-term clinical outcomes.

Prospective Evaluation of Locoregional Control in Oral Cavity Squamous Cell Carcinoma with Infratemporal Fossa Involvement Treated with Surgery and Adjuvant Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

Oral cavity squamous cell carcinoma (OCSCC) is the most common head and neck cancer in India. Definitive surgery with or without post-op radiotherapy (PORT) with or without chemotherapy (CT) provides better outcomes in locally advanced OCSCC as compared to definitive chemoradiotherapy. T4b OCSCC with infra temporal fossa (ITF) involvement has varied outcome depending on the extent of ITF involvement, with low and mid ITF having relatively favorable prognosis. We aimed to prospectively evaluate outcomes in patients of OCSCC with low or mid ITF involvement treated with curative surgery followed by adjuvant concurrent chemoradiotherapy (CCRT).

MATERIALS/METHODS

A total of 20 patients of T4b OCSCC (as per AJCC 8th edition) with low or mid ITF involvement were included in this single arm prospective interventional study from January 2021 to October 2022. Patients with involvement of skull base, carotid artery, prevertebral fascia and/or pterygomaxillary fissure were excluded. All patients were treated with definitive surgery with ITF clearance followed by adjuvant CCRT as indicated. Loco-regional control (LRC), Disease free survival (DFS), Overall survival (OS) were assessed using Kaplan-Meier survival analysis. Acute toxicities were assessed according to the CTCAE v5.0.

RESULTS

Patient characteristics are summarized in table 1. Median follow-up was 11.5 months (4-21months). All patients received adjuvant CCRT with weekly cisplatin 40mg/m2 to a median number of 6 cycles (5-7 cycles). Median RT dose was 64Gy (60-64Gy). All patients tolerated treatment well. Grade 3 oral mucositis, odynophagia were seen in 8 (40%) patients each and skin toxicity, oral pain in 6 (30%) and 5 (25%) patients respectively. No grade 4 toxicities were observed LRC at three month was 73.68% with 4 local and 1 locoregional failure only. LRC at one year was 36.8% with 8 local, 1 locoregional, 2 locodistant and 1 distant failure only. Median DFS was 10.4 months. Median OS was not reached; four patients died. LRC at three months was better for patients with low ITF disease as compared to mid ITF disease (85.7% vs. 40% (p = 0.04) and at one year was 42.8% vs. 40% (p = 0.50).

CONCLUSION

Selected patient of locally advanced OCSCC with low ITF involvement may benefit from trimodality therapy of surgery with ITF clearance followed by adjuvant CCRT. Acute toxicity profile was acceptable in our study.

Mature Cystic Teratoma at Fallopian Tubes: A Case Series

Benign tumors of the fallopian tube are uncommon. Teratomas are most frequently found in the ovary and fallopian tube teratoma is extremely rare. To date, around 70 cases have been described, and most of them were discovered by chance. Here we present two cases of fallopian tube dermoid cyst. The first case is of a woman who was unable to conceive for 4 years with a right ovarian dermoid. She was managed with laparoscopic cystectomy when she was found to have a small teratoma-like lesion at the fimbrial end of the left fallopian tube. The second case is of a female who underwent elective caesarian section and was found to have a teratoma-like lesion at the right fallopian tube. Histopathology of both cases were reported as mature cystic teratoma. These cases suggest the need for careful examination of the pelvic organs for other pathology apart from the primary surgical sites.

Keywords

case reports; dermoid cyst; fallopian tube; infertility.

Whole plant response of Pongamia pinnata to drought stress tolerance revealed by morpho-physiological, biochemical and transcriptome analysis

BACKGROUND

Pongamia is considered an important biofuel species worldwide. Drought stress in the early growth stages of Pongamia influences negatively on the germination and seedling development. Due to lack of cultivar stability under drought stress conditions, establishment of successful plantation in drought hit areas becomes a major problem. To address this issue, drought stress response of four Pongamia genotypes was studied at morphological, physio-chemical and transcriptome levels.

METHODS AND RESULTS

Drought stress was levied by limiting water for 15 days on three months old seedlings of four genotypes. A significant effect of water stress was observed on the traits considered. The genotype NRCP25 exhibited superior morpho-physiological, biochemical drought responses. Also, the genotype had higher root length, photosynthetic pigments, higher antioxidant enzymes and solute accumulation compared to other genotypes. In addition, transcript profiling of selected drought responsive candidate genes such as trehalose phosphate synthase 1 (TPS1), abscisic acid responsive elements-binding protein 2 (ABF2-2), heat shock protein 17 (HSP 17 kDa), tonoplast intrinsic protein 1 (TIP 1-2), zinc finger homeodomain protein 2 (ZFP 2), and xyloglucan endotransglucolase 13 (XET 13) showed only up-regulation in NRCP25. Further, the transcriptome responses are in line with key physio-chemical responses exhibited by NRCP25 for drought tolerance.

CONCLUSIONS

As of now, there are no systematic studies on Pongamia drought stress tolerance; therefore this study offers a comprehensive understanding of whole plant drought stress responsiveness of Pongamia. Moreover, the results support important putative trait indices with potential candidate genes for drought tolerance improvement of Pongamia.

Primary biliary cirrhosis associated pustular vasculitis

The association between primary biliary cirrhosis (PBC) and cutaneous vasculitides is well recognized. Pustular skin lesions though, have been described in association with hepatobiliary diseases other than PBC. Once the more common infective pustular rashes have been excluded, the differential diagnoses for a pustular skin rash are acute generalized exanthematous pustulosis (AGEP), Sweet's Syndrome (SS), pyoderma gangrenosum (PG) and pustular vasculitis(PV). We present a case of pustular vasculitis associated with PBC.

Peripheral neuropathy associated with nodular prurigo

Nodular prurigo is characterized by nodules and papules that are intensely pruritic. Thalidomide is used to treat patients with recalcitrant disease. Because thalidomide may cause peripheral neuropathy, it is current practice to perform nerve conduction studies to exclude subclinical neuropathy before treatment. The clinical record of eight patients with nodular prurigo, in whom thalidomide treatment was proposed, were looked at. Five of them showed evidence of subclinical neuropathy, thereby contraindicating the use of thalidomide. None of the patients had any symptoms of a peripheral neuropathy and none was taking any medications with a recognized potential to cause peripheral neuropathy. We propose that nodular prurigo may be associated with an underlying peripheral neuropathy in a subset of patients. In patients with nodular prurigo and demonstrable peripheral neuropathy, there may be a role for treatment with agents such as amitryptiline and gabapentin, which are normally used for neuropathic pain.