I am very passionate and hardworking student since my young age. My dream is to become a doctor, where I can fulfill the needs of poor and sick patients with new approaches. Because of that intention, I strived hard in pre-university and secured state 5th rank. My dream journey started in Chongqing Medical University in china, where I was awarded the excellent student award in the period of 2007-2011. The natural calamities like an earthquake in china made me look another dimension of education how to help the patients who are in agony and misery. The human sense of counseling and helping made me look the other dimension of the doctor outside the circle.While in my graduation the interests developed in the field of oncology where I got an opportunity to study post graduation and took radiation oncology to bring a change in the lives of the patients. I had completed my three years residency in radiation oncology (Diplomate of National Board, DNB) at Regional Cancer Centre, Allahabad, India. I had participated in various national and international conferences held in India (Best of ASCO, RGICON,YROC,ICRO etc). I have the keen interest in pursuing my research in molecular oncology, pediatric cancers, bone cancers and gi cancers.
Oropharyngeal cancer is primarily a disease of elderly, frequently seen in patients older than age 45. A group of oropharyngeal cancer patients has been considered in our study because of rising trends of its incidence due to tobacco abuse even in youngsters.
- To Evaluate the Local Response in Arm A and Arm B.
- To Assess Acute toxicities as per RTOG criteria.
- To assess late toxicities as per RTOG Criteria.
- To evaluate loco-regional responses, overall survival and disease free survival.
Materials and Methods:
Squamous cell carcinoma of the oropharynx (stage:T3-T4a N0-N2 M0) including all ages, both sexes 54 patients reporting to KNMH, for a period of February 2014-June 2015, were enrolled and subjected to NACT. Complete and partial responders were enrolled in this study, and computer randomized the patients into 2 arms: Arm A (Conventional EBRT) and Arm B (IMRT). Both the groups received 70 Gy/35 fractions/7 weeks as per institutional protocol.
Out of 54 patients, only 46 patients (85%) completed NACT. After completion of neoadjuvant chemotherapy, we found radiologically 24%, 63% and 13% as complete, partial and non-responders respectively. Acute toxicities like skin reactions, mucosal reactions, xerostomia, pharyngitis/ hoarseness, upper GI side effects, and hematological complications are more in Arm A than Arm B. Patients in arm B has tolerated the local radiation therapy compared to the patients in arm A. The quality of life of patients in arm B compared to arm A was appreciable during the local treatment.
At 6th-month follow-up local control, disease-free survival, overall survival, found in arm Avs arm B was 45% vs 50%, 25% vs 35%, 85% vs 95% respectively. Progressive disease and lost to follow-up was 15% vs 10%, 10% vs 5% respectively. Patients died in arm Avs arm B was 5% vs 0% respectively. Late radiation toxicities were assessed clinically at 6 months as per RTOG criteria and results had found not statistically significant.
As observed in our study, 40 patients out of 54 had been down staged. With down staging the disease subsequent to NACT, the patient improved symptomatically as far as swallowing, anorexia, tumor related pain, weight loss were considered. However, this study definitely showed down staging and better treatment tolerance towards IMRT arm in locally advanced oropharyngeal carcinoma. A long term study for longer follow-up required for any statistically significant result. A better response can be expected in early stage disease.
POINTS TO BE TAKEN FROM THE PRESENTATION :
- There is no established rule or guideline recommending the implication of neoadjuvant chemotherapy in locally advanced oropharyngeal cancers till now,but the NACT has definitely downstaged and downsized the tumor bulk and minimized the tumor-related complications like pain, swallowing, anorexia etc.
- NACT has Improved the nutritional status, the psychological and emotional confidence of the patients which empowered hope in them and compliance towards the assigned treatment protocol.
- The delivery of local therapy in the form of radiation became much feasible in treatment planning and optimizing the plan in order to achieve the desired profile.
- IMRT has shown less treatment-related complications and the quality of life has been enriched compared to the standard conventional EBRT technique.
- A long term study for longer follow-up with large sample size is required for any statistically significant result.