Mamidipudi Srinivasa Vidyasagar

Efficacy of He-Ne Laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients

OBJECTIVE The objective of this study was to evaluate the efficacy of low-level lasers for the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. MATERIAL AND METHODS Twenty-four hospitalized patients with oral cancer, scheduled to undergo radiotherapy at KMC, Manipal, were enrolled in the present study and assigned to laser (Group I)/control group (Group II). They were treated using He-Ne laser (lambda = 632.8nm, output = 10 mW and energy density = 1.8 J/cm(2)). Patients were subjected to treatment using laser scanner for 8 days and subsequently were treated using laser probe at 6 anatomic sites in the oral cavity for 5 minutes each. The patients were evaluated on each day of treatment for pain severity (NRS), functional impairment (FIS), and oral mucositis (RTOG) and were followed until the end of cancer treatment. Statistical analysis was done using SPSS version 10. RESULTS Laser therapy applied prophylactically during radiotherapy can reduce the severity of oral mucositis, severity of pain, and functional impairment.

Evaluation of the antineoplastic activity of guduchi (Tinospora cordifolia) in cultured HeLa cells

Exposure of HeLa cells to 0, 5, 10, 25, 50 and 100 microg/ml of guduchi extracts (methanol, aqueous and methylene chloride) resulted in a dose-dependent but significant increase in cell killing, when compared to non-drug-treated controls. The effects of methanol and aqueous extracts were almost identical. However, methylene chloride extract enhanced the cell killing effect by 2.8- and 6.8-fold when compared either to methanol or aqueous extract at 50 and 100 microg/ml, respectively. Conversely, the frequency of micronuclei increased in a concentration-dependent manner in guduchi-treated groups and this increase in the frequency of micronuclei was significantly higher than the non-drug-treated control cultures and also with respect to 5 microg/ml guduchi extract-treated cultures, at the rest of the concentrations evaluated. Furthermore, the micronuclei formation was higher in the methylene chloride extract-treated group than in the other two groups. The dose response relationship for all three extracts evaluated was linear quadratic. The effect of guduchi extracts was comparable or better than doxorubicin treatment. The micronuclei induction was correlated with the surviving fraction of cells and the correlation between cell survival and micronuclei induction was found to be linear quadratic. Our results demonstrate that guduchi killed the cells very effectively in vitro and deserves attention as an antineoplastic agent.

Evaluation of micronuclei frequency in the cultured peripheral blood lymphocytes of cancer patients before and after radiation treatment

The frequency of micronucleated binucleate lymphocyte (MNBNC) was determined in the peripheral blood lymphocytes of patients suffering from various types of cancer before the onset of radiation treatment, middle (mid-) of the treatment and after completion of the treatment (post-treatment). The frequency of micronuclei increased significantly in the pretreatment sample of cancer patients when compared with the normal untreated healthy volunteers. During the middle of the radiotherapy an approximate two or > two-fold increase was observed in the micronuclei frequency in most of the patients when compared with the concurrent pretreatment samples. Immediately after the completion of treatment, the frequency of micronuclei further increased, and this increase was significantly higher than that of pretreatment and mid-treatment samples. Out of 27 patients analyzed, only nine patients did not have any history of smoking, tobacco chewing or alcohol consumption, while the remaining 18 patients had a history of either smoking, tobacco chewing or alcohol consumption or combination of two or all habits at the time of blood collection.

Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on lymphedema in clinical settings. However, there is a dearth of evidence regarding the effect of home-based exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program. Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-based exercise program. The individualized home-based exercise program led to improvement in affected upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.

Prediction of radiotherapy response in cervix cancer by Raman spectroscopy: A pilot study

Radiotherapy is the choice of treatment for locally advanced stages of the cervical cancers, one of the leading female cancers. Because of intrinsic factors, tumors of same clinical stage and histological type often exhibit differential radioresponse. Radiotherapy regimen, from first fraction of treatment to clinical evaluation of response, spans more than 4 months. Clinical assessment by degree of tumor shrinkage is the only routinely practiced method to evaluate the tumor response. Hence, a need is created for development new methodologies that can predict the tumor response to radiotherapy at an early stage of the treatment which can lead to tailor‐made protocols. To explore the feasibility of prediction of tumor radioresponse, Raman spectra of cervix cancer tissues that were collected before (malignant) and 24 h after patient was treated with 2nd fraction of radiotherapy (RT) were recorded. Data were analyzed by Principal Components Analysis (PCA) and results were correlated with clinical evaluation of radioresponse. Mean Raman spectra of RT tissues corresponding to different levels of tumor response, complete, partial, and no response, showed minute but significant variations. The unsupervised PCA of malignant tissues failed to provide any classification whereas RT spectra gave clear classification between responding (complete and partial response) and nonresponding conditions as well as a tendency of separation among responding conditions. These results were corroborated by supervised classification, by means of discrimination parameters: Mahalanobis distance and spectral residuals. Thus, findings of the study suggest the feasibility of Raman spectroscopic prediction of tumor radioresponse in cervical cancers.

Low Level Helium Neon Laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients – A randomized controlled trial

BACKGROUND Patients receiving chemoradiotherapy (CRT) for oral cancer (OC) often develop oral mucositis (OM). OM associated pain severely affects oral functions and nutrition of the patient, resulting in narcotic analgesic use and CRT interruption. Laser therapy has shown some promising results in preventing and treating OM caused by cancer therapies. So in this trial we used prophylactic Low Level Helium Neon (He-Ne) Laser for the prevention and treatment of CRT induced OM in OC patients. MATERIALS AND METHODS This double blinded trial block randomized 121 primary OC patients scheduled to undergo CRT [RT dosage=66 Gray/33 fractions for 5 days/week and chemotherapy (3 weekly Cisplatin)] into laser (n=60) and placebo (n=61) group. Laser group received He-Ne Laser (λ=632.8 nm, P=24 mW, ED=3.5 J/cm(2)) while placebo received sham treatment just before radiation for 6.5 weeks. OM (RTOG/EORTC Scale), its associated pain, and total parenteral nutrition (TPN), were assessed on every week by a blinded assessor. Also opioid analgesic use, weight loss and any CRT break were recorded. Data was analyzed using descriptive statistics, t-test and Man Whitney U test. Level of significance was set at p<0.05. RESULTS Incidence of severe OM (29% vs. 89%, p<0.001) and its associated pain (18% vs. 71%, p<0.001), opioid analgesic use (7% vs. 21%, p<0.001)and TPN (30% vs. 39% p=0.039) was significantly less in laser than placebo group patients. Also duration of severe OM and pain experienced was less in laser than placebo group. CRT break required only for placebo group (9%) patients. CONCLUSION Low Level He-Ne Laser decreased the incidence of CRT induced severe OM and its associated pain, opioid analgesics use and TPN.

Inhibition of Radiation-Induced DNA Damage by Jamun, Syzygium cumini, in the Cultured Splenocytes of Mice Exposed to Different Doses of γ-Radiation

The radioprotective property of 50 mg/kg body weight jamun (Syzygium cumini) extract was studied in the cultured splenocytes of mice exposed to 0, 0.5, 1, 2, 3, or 4 Gy of γ-radiation. The spleens of irradiated mice were removed aseptically and the splenocytes were extracted from the individual spleens and cultured. The micronuclei were prepared 72 hours after irradiation in binucleate splenocytes by blocking cytokinesis with cytochalasin-B. Irradiation of mice resulted in a dose-dependent elevation in the micronucleated splenocytes. The exposure of mice not only elevated splenocytes bearing one micronucleus but also cells bearing 2 and multiple (>2) micronuclei indicating induction of complex DNA damage after irradiation. Oral treatment of mice with 50 mg/kg body weight of jamun leaf extract protected against the radiation-induced micronuclei formation. Jamun extract also protected against the formation of 2 and multiple micronuclei indicating repair or inhibition of complex DNA damage. The assessment of lipid peroxidation in mice brain homogenate has indicated a concentration dependent inhibition of lipid peroxidation by jamun extract. Studies in a cell free system revealed that jamun extract inhibited the formation of OH, O2−, DPPH, and ABTS+ free radicals in a concentration dependent manner. Our study demonstrates that jamun extract protected mice against the radiation-induced DNA damage and inhibition of radiation-induced free radical formation may be one of the mechanisms of radioprotection.

Optimization in high dose rate vaginal cylinder for vaginal cuff irradiation

Summary Aim The aim of this study is to evaluate the influence of high dose rate (HDR) brach-ytherapy source step size, source dwell position, dose prescription depth, dose specification points and optimization technique on dose distribution around Microselectron HDR brachytherapy vaginal cylinders and to evaluate the influence of distal dwell position and optimization technique on rectal and bladder dose of patients treated for vaginal cuff irradiation. Materials/Methods Orthogonal radiographs of vaginal cylinders of diameter 2.0, 2.5, 3.0 and 3.5cm form the basis of the study. Dose distribution using the PLATO brachytherapy treatment planning system (version 14.1) was generated. Two different HDR cylinder models, namely the non-curved dome model (NCDM) and curved dome model (CDM), were studied. To evaluate bladder and rectum dose in the patients NCDM was used. Results CDM gives more uniform dose distribution around the cylinder than NCDM. Dose prescription at 5mm depth from the surface results in very high dose to apex and dome as compared with the surface dose prescription. Dose prescription depth and dwell positions influence the length of prescription isodose. Optimization method and dwell positions affect the bladder and rectal dose of the studied patients. Conclusions Uniform dose distribution can be obtained for HDR vaginal cylinders by appropriately selecting dose specification points and optimization method. Dose distribution can be configured to provide a uniform dose on the surface, if the apex and curved surface of the cylinder are considered for dose specification and optimization. Appropriate HDR parameters are identified to minimize the dose to the apex of the vaginal cylinder, essential to reduce the dose to overlying small bowel and reduce the dose to rectum and bladder.

Symptoms experienced by cancer patients and barriers to symptom management

Background: People living with cancer experience wide variety of symptoms. If symptoms are not managed well, it may hamper an individuals ability to continue his or her activities of daily life. Treatment of symptoms relieves suffering and improves the rate of recovery as well as the quality of life. Objectives: To assess the symptoms of suffering among cancer patients and to identify the perceived barriers to their symptom management. Materials and Methods: A cross-sectional study was carried out among 768 cancer patients selected by stratified sampling with a proportionate selection from each stratum. Data were collected from cancer patients by interview technique using structured validated questionnaire. Results: Majority of the samples (30.2%) belonged to the age group of 51–60 years, most of them were diagnosed with head and neck cancer (40.1%) and 57.7% had stage III disease. The majority of the patients studied had pain (77%), tiredness (96.5%), disturbed sleep (96.4%), weight loss (63.3%), and irritability (85.7%). Most of the patients had lack of appetite (89.4%), feeling of sadness (96.6%), worry (94.5%), and feeling of nervousness (82.8%). Majority of the patients had some misconception regarding symptoms, that is, increasing pain signifies disease progression (92.7%), medicine to control pain may weaken the immune system (89.9%) and pain is inevitable for cancer patients (78.5%). Seventy-seven percent of samples reported that the anxiety or depression is expected after the diagnosis of cancer. Conclusion: This study provides an overview of symptoms among cancer patients and barriers experienced by them.

Non-Hodgkin's lymphoma: is India ready to incorporate recent advances in day to day practice?

BACKGROUND Non Hodgkins Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base. METHODS AND RESULTS We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%. CONCLUSIONS NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues.