Holistic approach in whole brain radiotherapy for brain metastasis

1. S301
© 2019 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow
treated with IL-RT have low rates of contralateral neck failures.
These patients should be spared of contralateral neck RT, pending
results from any randomized controlled trials.
Abstract
Holistic approach in whole brain radiotherapy for brain
metastasis
Kanhu Charan Patro, Partha Sarathi Bhattacharya,
Chitta Ranjan Kundu, V. Krishna Reddy, P. Madhuri, Rashmi Sukla,
A. C. Prabu, A. Srinu, Anil Kumar, Subhra Das
Department of Radiotherapy, Mahatma Gandhi Cancer Hospital
and Research Institute, Visakhapatnam, Andhra Pradesh, India,
E-mail: drkcpatro@gmail.com
Whole brain radiotherapy is the most standard therapy in brain
secondaries. Over the years the development of newer technologies
and newer chemotherapy drugs targeting the targetable mutations
the survival has reached more than 5 years. With whole brain
radiotherapy the cognitive function declines over the years and apart
from this the hidden side effects go unnoticed and quality of life
also deteriorates with passage of time. Here we suggest the holistic
approach to address these issues. The main side effects of whole
brain radiotherapy are diminution of cognitive function, xerostomia,
hair loss, deafness. Here we planned the cases of whole brain
radiotherapy addressing these issues with arc therapy sparing scalp,
cochlea, parotid and hippocampus according to the RTOG guidelines
and presenting the dosimetric analysis. Whenever possible we
should plan to spare these structures. We can also consider hypo
fractionated limited field radiotherapy or stereotactic radiosurgery for
more therapeutic benefit.
Abstract
Socioeconomic factors affecting transtuzumab usage in breast
cancer patients belonging to hilly regions of north India
Rajesh Pasricha, Pragya Singh, Laxman Pandey, Ajas Ibrahim,
Ajeet Singh Bhadoria, Sweety Gupta, Deepa Joseph, Manoj Gupta,
Bina Ravi
All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
E-mail: drrajesh_pasricha@yahoo.com
Introduction: Breast cancer is the most common malignancy
in women worldwide and is a prototype of global cancer disparity.
While breast cancer mortality is decreasing in developed countries,
it continues to increase in low- and middle-income countries.
Trastuzumab in combination with chemotherapy is standard of care
and essential drug for patients with Her2 positive breast cancer.
Despite the availability of biosimilars, it is still out of reach for many
patients in underdeveloped areas of India. Access to trastuzumab is
limited for various reasons such as lack of drug funding or because of
high treatment costs. This study examines access to trastuzumab and
identified potential barriers to its use in a large tertiary care hospital
in underserved and resource restricted hilly region of Northern
India (Uttrakhand). Materials and Methods: In a cross-sectional
study all patients diagnosed with Her2 positive breast cancer who
underwent treatment in our institute from January -December 2018
were included. All relevant details like age, stage, treatment details,
receptor status (ER/PR/ Her2) were recorded. All Her2 positive
patient who had 3+ score on immunohistochemistry (IHC) were
considered positive. These patients were investigated to look into
various factors for acceptance or non -acceptance of transtuzumab
like socio-economic status, funding of treatment, education status
and reasons for non-usage of drug. Patients were categorised into
BEST PROFFERED PAPER MORE THAN 40
Abstract
Single institutional retrospective analysis of postoperative
buccal mucosa cancers treated with ipsilateral radiotherapy
Madhup Rastogi, Ajeet Kumar Gandhi, Satyajeet Rath,
Sambit Swarup Nanda, Harikesh B. Singh, Siddarth Kumar,
Rohini Khurana, S. P. Mishra, Anoop Kumar Srivastava,
Avinav Bharati
Department of Radiation Oncology, Dr. Ram Manohar Lohia
Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,
E-mail: drmadhup1@gmail.com
Background: Curative surgical resection with neck dissection
remains the ideal initial treatment modality in localized carcinoma
buccal mucosa (BM). Depending on the adverse risk factors,
adjuvant radiotherapy (RT) is indicated. Usually, adjuvant RT (if
indicated), is delivered to tumour bed and bilateral neck nodes.
However, selected patients could be treated with ipsilateral RT to
tumour bed and neck nodes (IL-RT). Literature on patterns of failure
in this group of patients is sparse. Purpose: We aimed to analyse
the failure patterns and survival outcome in these cohort of patients
treated at our institute. Methodology: 116 patients of post-operative
BM cancers treated with IL-RT from June 2013 to Jan 2019 were
included in this retrospective analysis. RT dose was 60-66 Gray in
30-33 fractions over 6-6.5 weeks delivered by linear accelerator
using 3-dimensional conformal radiotherapy techniques. Patients
treated with bilateral RT and those treated with concurrent chemo-
radiotherapy were excluded from the present analysis. All outcomes
were evaluated from the time of registration. Local, regional and
loco-regional control was defined as time from registration to failure
in tumour bed, regional nodes or both, respectively. Disease free
survival (DFS) and overall survival (OS) were defined as time from
registration to failure at any site (local, regional or distant) and
death from any cause, respectively. Kaplan Meier method was used
for all outcome analysis. Results: The median age was 46 years
(range 25-80). Patient characteristics are described in Table 1.
Median RT completion time and the overall treatment time were 6.2
weeks (range 5.9-7.1) and 11.6 weeks (range 8.5-19), respectively.
92 patients received 60 Gy, 7 patient 64 Gy and the rest received
66 Gy. The median follow-up time was 24.4 months (range 5-54.2).
The 2-year local, regional and loco-regional control rates were
88.4%, 89.5% and 80.9%, respectively. The 2-year DFS and
2-year OS rates were 77.4% and 79.5%, respectively. The crude
rates of failures at primary site, ipsilateral and contralateral neck
were 10.3%, 11.2% and 3.4%, respectively. Five patients (4.3%)
had distant failures. 23 patients died of cancer and 2 patients died
of non-malignant causes. Conclusion: Post-operative patients of
BM cancers with intermediate risk factors necessitating RT alone
Table 1: Patient characteristics
Patient characteristics Distribution (%)
Gender (male: female) 110 (94.8):6 (5.2)
T stage (T1:T2:T3:T4) 11 (9.5):63 (54.3):20 (17.2):22 (18.8)
N stage (N0:N1:N2) 68 (58.6):37 (31.9):11 (9.5)
Overall TNM stage (I: II: III:
IV) (as per AJCC 7th
ed.ition)
4 (3.4):40 (34.5):28 (24.1):44 (37.9)
Risk factors for postoperative
RT (>pT3:pN+:PNI:LVI:DOI
≥10 mm)*
42 (36):48 (41.3):31 (26.7):80 (68.9)
Number of risk factors for
postoperator RT (1:2:3:>4)
10:60:17.5:12.5
Grade (1:2:3:Unspecified) 57 (49.1):32 (27.6):6 (5.2):21 (18.1)
*The total may not add up to 100%. RT=Radiotherapy, PNI=Peri‑neural
invasion, LVI=Lympho‑vascular invasion, DOI=Depth of invasion
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2. S302 Journal of Cancer Research and Therapeutics - Volume 15 - Supplement Issue 2 - 2019
AROICON 2019 Abstracts: Best Proffered Paper More Than 40
high, middle and lower socioeconomic status by using appropriate
scale. The data was analysed by using SPSS Version 20.0 and
Open epi software. Chi square test of significance was applied to
test association between variables. Results: Total 310 patients were
diagnosed as carcinoma breast during study period, out of which 68
patients were Her2 positive (22%). Of these 68 patients 24 (35%)
received transtuzumab. Majority of transtuzumab recipient belong to
upper and middle socio-economic status as compared to lower class
(83.3% vs 16.7%, p=0.001). The treatment of maximum (91.7%)
users were met by out of pocket expenditure whereas only two
patients were beneficiary of some form of government health scheme
support. It was also observed that most of the transtuzumab user
patients were well educated (above high school level) compared to
those who did not took the drug (83% vs 36%, p= 0.0001). Among
44(65%) patients who did not received the drug, majority had
education level below high school (63% vs 36%) although most of
them had monthly high income (54% vs 37%). 26 (59%) patients
reported financial issue as the main cause of not taking transtuzumab
whereas the remaining 18 (41%) patients cited the reason that they
were not offered this drug by treating physician probably assuming
that patient will not be able to afford this treatment. Except 2 patients,
all transtuzumab non recipient patients were also financing their
treatment themselves and had no support like government aid or
insurance. Even those two non-user patient who had financial support
from government scheme denied use of transtuzumab this may be
due to their low socioeconomic class as well as poor education
status. Conclusion: The majority of Her2 positive patient are unable
to received transtuzumab treatment due to financial constraints,
non-availability of health insurance and poor government support
for treatment. Patient’s socioeconomic class, monthly income & their
education level significantly influenced the usage of drug. Education
level of patients is probably equal if not more important factor than
monthly income determining transtuzumab use. Treating oncologist
should also overcome their personal biases about socio-economic
status of a patients and should offer the drug wherever indicated as
this was the second most common reason for non-usage of drug.
Moreover, Improvement in education standard will automatically
raise socioeconomic status as well as disease awareness among
the patient which would make them vigilant and receptive to life
saving beneficial but costly treatment like transtuzumab. Tremendous
efforts are required for cost reduction by using low cost biosimilars,
patient education as well as implementation of government health
scheme to bridge the gap in treatment management of Her2 positive
patients.
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