MOULD abstract

1. Journal of Cancer Research and Therapeutics - Supplement 1 - 2014 - Volume 10 S1
ORAL PRESENTATIONS
36th
Annual Conference of the Association of Radiation Oncologists of India
(AROICON 2014)
November 6th
- November 9th
2014, Imphal, India
Breast
Role of addition of Taxanes to the standard neoadjuvant
chemotherapy regimen in the multimodality management of
Locally advanced Breast Cancer
Shraddha Raj
Anbarasi Kumaresan Cancer Institute, Adyar, Chennai.
E‑mail: shraddharaj@ymail.com
Background: The importance of incorporating taxanes in the
management of breast cancer has been well established. In our
study, we have changed the sequence in order to lessen the overall
treatment time and to improve the results. Aims and Objectives: To
determine the efficacy and safety profile of Paclitaxel in combination
of FAC regimen and compare it with the existing FAC regimen in the
multimodality management of Locally Advanced Breast Carcinoma.
Materials and Methods: A total of 130 patients of LABC were
randomised into 2 arms to receive following treatment‑ ArmI (c‑Arm):
Neoadjuvant Chemotherapy with FAC followed by Surgery and Radical
Radiotherapy. Arm II (s‑arm): Neoadjuvant Chemotherapy with PFAC
followed by Surgery and Radical Radiotherapy. All the patients under
both the arms received the Chemotherapy for 6 cycles.After completion
of chemotherapy, the response (OR, CR, PR) and toxicities were
noted. Then, the patients were sent for surgery, and subsequently,
Radical Radiotherapy was administered to all patients. The patients
were followed up for a maximum of 24 months after treatment, till
Aug ‘10. Results: The s‑ arm shows 78.5% Overall Response (OR)
as compared to 63.1% in the c‑arm, with an absolute benefit of 15.4%
(P value0.0335). At the end of 24 month follow‑up, the cumulative
DFS is 72% in the s‑arm, and 64% inthe c‑arm, showing a benefit of
8%. (P value‑0.2253). And, the cumulative OS is 79% in the s‑arm, as
compared to 66% in the c‑arm (P value‑ 0.0395).There was a statistically
significant rise in the Peripheral Neuropathy (P value 0.0001) as well
as diarrhoea (P value 0.0001) in the study group. The occurrence of
anaemia (P value‑ 0.054) and leucopenia (P value‑ 0.014) were also
significant. Conclusion: The present work entails that the addition of
Paclitaxel to the standard chemotherapy regimen in the neoadjuvant
setting, followed by Surgery and Radical Radiotherapy enhanced the
Overall Response and Overall Survival significantly.
Gynaecological Malignacy
Investigation on the role of low dose radiation as chemo‑potentiator
in locally advanced carcinoma cervix: A new treatment paradigm
based on radiobiological advantage
Saikat Das
E‑mail: drsaikatdas@gmail.com
Background: With standard chemoradiation locally advanced
Carcinoma of the uterine cervix (>FIGO stage IIB) often has
suboptimal response due to tumor size and hypoxia. Radiobiologically,
chemo‑potentiating effect of low dose radiation therapy (LDRT) in
the range of 40‑100 cGy enhances cell killing by cellular arrest in G2
phase (induced radio‑resistance or IRR) thus augmenting the effect of
G2 cycle specific chemotherapy. Purpose: To examine the response
of cervical cancer cell line (HeLa cell line) to low dose radiation using
clonogenic assay and mathematical modeling of the low dose response
by Joiner’s induced repair model. Translational study to evaluate
the clinical response of ultra‑fractionated low dose radiation and
chemotherapy in locally advanced carcinoma cervix. Methods: Survival
of HeLa cells following exposure to single and fractionated low doses
of Ƴ (gamma)‑ray was measured by clonogenic assay. The low dose
cellular response was modeled by Joiner’s induced repair model
(S.F. = e‑αr (1+(αs/αr ‑1) e‑D/Dc) D‑βD2). In the clinical component
of the study (Phase II design) patients with squamous cell carcinoma
cervix (FIGO stage IIB‑IIIB) were included. Patients received two
cycles of paclitaxel (175 mg/m2), carboplatin, (AUC × 5), and four
concurrent 80‑cGy fractions of radiotherapy (two each on Days 1 and
2, and 22 and 23). Clinical and radiological response was assessed
after 3 weeks. All patients received standard treatment following
neo‑adjuvant treatment. Results: HeLa cell line demonstrated marked
low dose response consisting of an area of HRS and IRR in the dose
region of <1 Gy. The two gradients of the low dose region (αs and αr)
were distinctly different with a transition dose (Dc) of 0.30 Gy. In the
fractionated radiotherapy experiments, for the schedules 0.5 GyX 4,
0.8 GyX 4, 1 GyX 2 and 2 Gy single dose the survival fractions were
0.36 ± 0.05, 0.26 ± 0.06, 0.13 ± 0.05 and 0.05 ± 0.02 respectively. In
the Phase II design, total 24 patients (80% IIIB and 20% IIB) were
recruited. Mean gross tumor volume (GTV), based on T2 high resolution
MRI, before and after neoadjuvant treatment were 54.36 ± 9.75 vs.
11.45 ± 2.39, P < 0.0001 (paired t‑test). GTV volumes based on CT and
MR were highly correlated (R2 = 0.87). The incidence of grade 3 and 4
neutropenia was 33% and 8% respectively during the entire period of
treatment. There was no grade 3 or 4 acute non‑hematological toxicity.
Conclusion: Neo‑adjuvant LDRT and chemotherapy prior to definitive
chemoradiation is a novel and feasible approach in cervical cancer
with a favorable toxicity profile. This treatment paradigm resulted in
significant reduction in the GTV, superior response rate and therefore
is a good alternative option for bulky, hypoxic cervical tumors.
Head and Neck
ComparisonBetweenIMRT,3DCRTandConventionalRadiotherapy
Technique in Laryngeal Cancer: A single institution experience.
Deep Shankar Pruthi*, Meenu Gupta*, Vipul Nautiyal*, Saurabh Bansal*,
Manisa Pattanayak**, Sunil Saini**, Mushtaq Ahmad*
Department of Radiation oncology*, Surgical Oncology**, Cancer
Research Institute, Swami Rama Himalayan University, Dehradun.
E‑mail: dsp008@gmail.com
Aim: To compare the outcome and toxicity profile of Intensity modulated
radiation therapy (IMRT) versus Three‑dimensional conformal
radiotherapy (3DCRT) versus conventional technique for laryngeal
carcinomas–Aretrospective analysis. Methods: Retrospective analysis
of non‑operated biopsy‑proven squamous cell carcinoma of Larynx
between time period Jan 2010 – Dec 2012 treated with radical EBRT
was done. The primary end point was Overall Survival, Local Control
and Toxicity Profile. Results: A total of 84 patients were included in
study. Out of these 21 treated with IMRT, 33 with 3DCRT and 30 with
conventional technique completed the treatment. The mean age was
59.3 years (range 38‑78 years, median 60 years) and male: female
ratio 15.8:1. The AJCC stage distribution included 11 patients (52.3%)
with stage I and II in IMRT, 17 (51.5%) in 3DCRT group and
11 (33.3%) in conventional group. Stage III and IV (M0) included
10 patients (47.6%) in IMRT, 16 (48.4%) in 3DCRT and 19 (63.3%) in
conventional group. Most common site was supraglottis (50 patients)
followed by glottis (34 patients). Most common histopathology was
moderately differentiated (53 patients) followed by poorly differentiated
(17 patients), well differentiated and CIS were 7 patients each. Median
Dose to CTV for all techniques was 66Gy. Median overall survival
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2. Abstracts
Journal of Cancer Research and Therapeutics - Supplement 1 - 2014 - Volume 10
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was 26.5 months, 24.5 months and 24 months for IMRT, 3DCRT and
conventional technique respectively. 2 year LC was 75.7% (IMRT),
70.3% (3DCRT) and 66.6% (conventional) respectively. The 1 year
and 2 year OS was 80.9% and 71% for IMRT, 81% and 68% for
3DCRT group and 80% and 63% for conventional technique. Among
toxicities, 14.2% (3) developed Grade I mucositis, 28.5% (6) Grade II
Mucositis for IMRT, 30.3% (9) developed Grade I mucositis and
39.3% (13) Grade II mucositis in 3DCRT group, 23.3% (7) developed
Grade I mucositis and 73.3% (22) grade II mucositis and 1 patient
developed grade III mucositis for conventional technique. Grade I and 2
dysphagia was 9.5% (2) and 4.7% (1) for IMRT, 12.1% (4) and 9% (3)
for 3DCRT and 60% (18) and 26.6% (8) for conventional technique.
Acute Grade II Laryngitis was seen in 23.8% (5) for IMRT and 39.3% (8)
in 3DCRT and 46.6% (14) for conventional technique. Grade II skin
reaction developed in 9.5%, 72.7% and 85% of patients respectively.
Conclusion: No significant difference of OS was found while comparing
IMRT vs 3DCRT vs 2D. But results of toxicity profile showed that IMRT
is better compared to 3DCRT or 2D technique. However sample size
is too small to draw statistically significant conclusions.
Assessment of nutritional status and changes in lean body weight
in patients with head and neck cancer undergoing treatment
Kailash Mittal, Nishu Bala, Piyush Kumar, DP Singh, Kranthi Kumar,
Bindu
E‑mail: drkkmittal@gmail.com
Introduction: The incidence of malnutrition among cancer patients has
been estimated at between 40 and 80%. Cancer cachexia has been
implicated in the deaths of 30-50% of all cancer patients. Malnutrition
is a common problem in patients with head and neck cancer. During
treatment (radiotherapy alone or combined with chemotherapy
or surgery) malnutrition may develop or aggravate as a result of
reduced dietary intake due to treatment‑related oral symptoms, such
as chewing and swallowing problems, pain, dry mouth, sticky saliva,
and taste disturbances and (chemo) radiation‑induced mucositis. In
malnourished patients, lean mass depletion results in reduced response
to cancer treatment, reduced physical activity, reduced quality of life,
and prolonged length of hospital stay. Aims and Objective: The
purpose of this study was to assess the nutritional status and changes
in Lean Body Weight (LBW) in patients with Head and Neck cancer
undergoing treatment (Radiotherapy, either alone or combined with
Chemotherapy and Surgery). Material and Methods: Forty Seven
histo‑pathologically proven head and neck cancer patients presenting
to the Radiotherapy Department from December 2012 to April 2014
for radical intent radiotherapy with or without chemotherapy, were
included in this study. Nutritional status using PG‑SGA tool and
changes in LBW were assessed. LBW was calculated from Body
Fat % which in turn was derived from 4‑ site skin fold thickness using
Durnin and Womersley equation. Patients were assessed in the
week before and at completion of treatment. Results: Mean age was
50.68 years. Site wise distribution was as: Oropharynx‑ 51% (24/47),
Hypopharynx‑ 8.5% (4/47), Nasopharynx‑ 2% (1/47), Larynx‑ 13% (6/47)
and Oral cavity‑ 24.5% (12/47). Stage wise (I: II: III: IV) distribution was
3:17:16:11 respectively. According to SGA classification 34% (16/47)
patients were well‑nourished and Pretreatment prevalence of
suspected or moderate and severe malnutrition was 66% (31/47).
Scored PG‑SGA identified 78.72% (37/47) of patients as requiring
active (20/47) or critical (17/47) nutritional intervention. Eighty seven
percent patients (41/47) received Chemoradiation (CCRT) and rest
had Radiotherapy alone; three patients were candidates for Post‑op
CCRT. Median Duration of treatment was 8 weeks. After treatment
97.4% (46/47) patients were identified as having need for active
or critical nutritional intervention. Mean PG‑SGA Score before and
after the treatment was 7.28 vs 11.02 (P = 0.0001), respectively,
indicating statistically significantly worsening of nutritional status.
During treatment, body weight (‑ 4.32 ± 4.13 kgs; P = 0.0001) and
LBW (‑ 2.03 ± 2.34 kgs; P = 0.00012) significantly declined with LBW
representing 47% of total weight loss. There was a trend for higher
LBW loss in moderately or severely malnourished patients. Decline
in LBW didn’t reach statistical significance (P = 0.34) across the SGA
classes (A, B and C) indicating global decline in LBW irrespective of
pretreatment SGA classification. Conclusion: Patients with Head
and Neck Cancer fail to maintain nutrition status during treatment and
results in significant decline in body weight and LBW. Chemoradiation
in such patients should combine nutrition with activities to support lean
tissue anabolism.
Sandwich mould brachytherapy for cancer lip‑a non invasive
approach
Kanhu Charan Patro, E. B. Rajmohon
E‑mail: drkcpatro@gmail.com
Abstract: Carcinoma lip one of the common malignancies among
gutkha chewers. Surgery is the mainstay of treatment. Radiotherapy
is another option for cosmetic region. External beam radiotherapy can
be considered for where surgery is not feasible, medical co morbidity,
and when surgery is not acceptable for cosmetic disfigurement.
Brachytherapy can be considered for node negative diseases,
interstitial brachytherapy is a established procedure. Here we are
describing another brachytherapy procedure called sandwich mould
as a curative option for node negative disease. A 67 year old male
presented with 2 skip lesions on lower lip, one is measuring 3 cm × 3 cm
and another is at right angle of mouth 3 cm x 2 cm without any neck
node. Patient was not interested for surgery because of cosmetic
issues. Options are discussed with patient and patient was agreed for
sandwich mould brachytherapy. A mould was made on a orfit frame.
around 22 needles are planned in two plane. A CT based plan was
done. Patient received @3.5Gy twice dally fraction for 15 fractions
BED 2Gy equivalent calculated and discharged with grade 3 RTOG
skin and mucosal toxicity. The toxicity increase till 3 weeks of radiation.
now there is complete response of tumor. We concluded that sandwich
mould brachytherapy is a good option and can be accepted as good
option comparing to other options and more suitable for patients having
medical co‑morbidity and patients are not accepting the cosmetic
defects. It is also a good option comparing to interstitial as non invasive.
Advances in Radiation treatment
Stereotactic Body Radiotherapy using Xsightspine tracking
system for multiple myeloma in trochanter using cyberknife – A
case study
D. Sankara Mahadev, N. Janardhan, P. Bhavani, J. Surendran,
N. SyedIbrahim
Omega Hospitals, Hyderabad‑500 034, India.
Email: drdoddala@gmail.com
Introduction: A 75 year old female presented with complaints of pain
in right leg. Patient was advised to undergo PET scan for diagnosis
after preliminary tests. PET scan revealed the presence of metabolically
active lytic lesion in the greater trochanter with breaks in the cortex.
Another metabolically active mixed lytic and scelerotic lesion in
the body of L5 vertebra with demonstrable soft tissue component
extending to the left side was also present. Biopsy from right femoral
lesion confirmed the condition as plasma cell neoplasm which could
be Multiple Myeloma. Patient was put under chemotherapy. Following
this, Stereotactic Body Radiotherapy was considered for both L5 and
right trochantric lesion due to the lesion size, less critical structures
nearby, patients age, an overall shorter treatment time and stay
in hospital. Aim and Objective: Though, both the lesion size was
indicative for Cyberknife based SBRT, lack of a suitable tracking system
for the trochantric lesion posed a challenge. However, a previous
study suggested about the effectiveness of XSightSpine tracking
algorithm for pelvic bone lesion when the lesion is located not greater
than 17 cm radial, while keeping the tracking mesh at the centre of
L4‑L5 vertebrae. But, in this study, the objective was set to assess the
clinical effectiveness of keeping the tracking mesh at the level of the
right trochantric lesion due to an acceptable heterogeneity present in
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3. Abstracts
Journal of Cancer Research and Therapeutics - Supplement 1 - 2014 - Volume 10 S3
the trochanter while ensuring meticulous visual check throughout the
delivery. Materials and Methods: Immobilization was made using
vacloc and planning CT images were acquired as per hospital protocol.
PET assisted CTV delineation was done for SUV values greater the
3.0 for which a 1 mm margin is considered as PTV. Right trochanter
PTV volume was about 67 cc. Planning was done using Multiplan
version 4.6 with Iris collimator for a prescription dose of 24 Gy in 3
fraction. An isodose line level of 81% is accepted for delivery. The only
critical structure near the right trochantric lesion was the right femoral
head. The dose to 10cc volume of femoral head is 8.9 Gy. The treatment
time for each fraction was about 30 minutes. Treatment was delivered
using Cyberknife VSI system. Overall translational and rotational errors
for all the three fractions observed were lesser than 2 mm and 30.
Results and Discussion: A seven month follow up PET showed an
evidence of significant response in right greater trochanter with post
treatment SUV value of 0 whereas the pre‑treatment PET SUV value
was 8.2. Patient is also free pain and with no side effects. In view of
this, the effectiveness of XSightSpine tracking algorithm for a non‑spine
region should be chosen only when an acceptable heterogeneity for
spine tracking algorithm is observed and a very meticulous check during
the entire course of delivery should also be done.
Breast
Retrospective analysis of efficacy and toxicity of hypofractionated
radiotherapy in breast cancer
Rohini Khurana, Ritusha Mishra, Madhup Rastogi, Rahat Hadi,
M. L. B. Bhatt
E‑mail: drrohinisethi@gmail.com
Aim: To study the efficacy and toxicity of hypofractionated radiotherapy
in breast cancer. Material and Methods: Between October 2012 and
September 2014,140 patients of histopathologically proven carcinoma
breast were registered in Radiation Oncology OPD in our tertiary
care centre. These patients received stage appropriate treatment
including radiotherapy for locoregional disease control wherever
indicated. However during the course we started hypofractionated
radiotherapy as there was enough evidence in literature in its favour.
This study tries to analyse the patient characteristics at presentation,
risk factors, surgery performed along with status of axillary lymph
node dissection and the efficacy as well as toxicity of hypofractionated
radiotherapy. Observation: Of the 140 registerd patients it was
observed that 58% were postmenopausal and 98%had history of
painless lump; 4%were nulliparous, 45% had upper outer quadrant
involvement followed by central quadant involved in 23% cases. The
data regarding the surgical details show that 20% patients underwent
breast conservation surgery and 85% patients had adequate axillary
lymph node dissection while 4% cases underwent sentinel lymph
node biopsy. Early breast cancer constituted 28% i.e.Stage I and II,
22% were metastatic at the time of presentation while remaining 50%
patients belonged to locally advanced group. Most commonly used
first line chemotherapeutic agents were anthracycline and taxanes
and 4% patients received lapatinib, 8% patients received targeted
therapy against Her2/neu. The data regarding radiation therapy
reveals that 30% patients received hypofractionated radiotherapy
dose given as 4240cGy in 16 fractions; 24% had conventional
radiotherapy dose given as 5000cGy/25# while 24% patients did
not received radiotherapy. In hypofractionated radiotherapy the skin
reactions were Grade I in 80% and Grade II in 20%, dysphagia grade I
in 30%lymphedema was seen in 2% of cases, pulmonary toxicity and
brachial plexopathy was not seen yet in any of the patients. Medical
oophorectomy was done in 2 patients while radiation oophorectomy
was done in a patient who had history of liver transplant.During
follow up 5% had locoregional recurrence while 6% had distant
relapse. Conclusion: Hypofractionated radiotherapy seems to be
equally efficacious and no more toxic than conventionally fractionated
radiotherapy in carcinoma breast. Further follow up is required to
observe the long term toxicity profile.
Genitourinary
A prospective observational feasibility study of hypofractionated
radiotherapy in localized carcinoma prostate‑Indian Scenario
Vijay Anand Reddy P.
E‑mail: vijayanandpreddy@gmail.com
Introduction: Studies have shown prostate cancer to have a low
α/β (1.5Gy) when compared to the surrounding normal tissues.
Several studies have shown the isoeffectivess of hypofractionation
in localised carcinoma prostate. Aims and Objectives: The aim of
the present study is to assess the feasibility of using hypofractionated
radiotherapy regimen for localized adenocarcinoma prostate, by
evaluating the acute and late toxicities, biochemical response and
quality of life. Methods: This is an ongoing phase II study where
patients with localized adenocarcinoma prostate (low, intermediate
and high risk node negative) were treated with radiotherapy
on NovalisTx with volumetric modulated arc technique. Twenty
patients accrued between November 2011 and November 2013
were analysed preliminarily. The regimen followed was 67.5Gy in
25 fractions at 2.7Gy per fraction to the prostate and 50Gy in 25
fractions to the lymphnodes in high risk patients. All intermediate
and high risk patients used hormonal therapy. Toxicities (RTOG
toxicity criteria) and quality of life scores (EORTC QlQc‑30 and
PR‑25) were assessed every week during radiotherapy and at 3,6,
9 and 12 months after radiotherapy. Results: Twenty patients were
analyzed, of which 4/20 (20%) were low risk, 3/20 (15%) intermediate
and 13/20 (65%) high risk. Median age was 68.5yrs (60‑80 yrs).
Median P.S.A. at presentation was 19.43 ng/ml. Median follow up
period is 12 months. Acute gastrointestinal toxicities were maximum
at 5th
week during RT while the acute genitourinary toxicities were
maximum at 4th
week during RT. Most of the patients (55%) had
grade 1‑2 toxicities. On evaluation of late toxicities, it was seen
that the genitourinary toxicities were maximum at 6 months while
the gastrointestinal toxicities were maximum at 9months post RT.
QOL analysis revealed improvement in global health score, role,
emotional, social and physical functioning scores at 12 months
when compared to pretreatment. Urinary and bowel symptoms score
reached peak at the end of treatment and declined at 3 months post
RT compared to the baseline. Urinary and bowel symptoms score
had a peak again at 9 months post RT. Median P.S.A. at the end
of 12 months post RT was 0.013ng/ml. None of the patients had
late grade 3 and above gastrointestinal and genitourinary toxicities.
None of the patients had a biochemical relapse during the follow
up period. None of the patients had treatment interruptions due to
toxicities. Conclusion: This study shows that hypofractionation in
localised adenocarcinoma prostate is feasible and is associated with
acceptable acute and late toxicities and improvement in quality of life.
Head and Neck
Hyponatremia: Is there an association with disease profile in head
and neck malignancies? Audit from a tertiary cancer care centre
Chelakkot G. Prameela, Rahul Ravind, P Md. Zaheeruddin
Clinical Associate Professor, & Consultant, Department of Radiation
Oncology, Amrita Institute of Medical Sciences. Kochi. Kerala. 682041
E‑mail: cgprameela@gmail.com
Background: Incidences of 3%‑30% of hyponatremia in hospital
population in general, and up to 58.1% in cancer patients, have
been quoted by Kumar et al. from MD Anderson[1]
. Prognostic value
of low serum sodium concentration for mortality has been well
described for myocardial infarction, congestive heart failure and
also for cancer[2]
. Increased incidence of hyponatremia was noticed
among our patients with head and neck malignancies on external
beam radiation. Hence we retrospectively analysed incidence and
patterns of hyponatremia and also the factors that might influence
hyponatremia, in patients with head and neck malignancies, as
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4. Abstracts
Journal of Cancer Research and Therapeutics - Supplement 1 - 2014 - Volume 10
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an institutional audit. Materials and Methods: Patients with head
and neck cancers treated with radical intent from January, 2011 to
December, 2012 were analysed. Data from electronic medical records
were retrieved. Hyponatremia was graded according to CTCAE
version 3.0, as Grade 0, if >135 mEql/L, Grade I, if between 130 mEq/L
to 135 mEq/L, Grade II, if between 120 and 130, and Grade III, if
<120 mEql/L. Patients were grouped based on their sodium status while
on treatment, into group I (hyponatremic) and group II (eunatremic).
Each of these groups was sub‑grouped asAand B based on treatment
interruptions. The individual variables looked into were sex, age, stage
of disease; surgical status, concurrent chemotherapy status, and
initial sodium status, and univariate and multivariate analysis of these
were done. Results: Study‑group included 271 patients. 68.3% had
developed hyponatremia. Group IA [70 patients] had hyponatremia and
interruptions to treatment, and comprised of patients > 50, advanced
stage needing chemoradiation, and also had initial hyponatremia.
Group IIB the other extreme of the spectrum included young patients,
with early stage not requiring concurrent chemotherapy, were
eunatremic initially and had uninterrupted treatment. Age (>50‑years)
was a significant factor in the development of hyponatremia, in
multivariate analysis (P‑0.018). Advanced stage was associated with
increased incidence of hyponatremia (P‑<0.001). Surgery prior to
radiation, (univariate ‑ P‑0.009; multivariate ‑ P‑0.005), and concurrent
chemotherapy (univariate ‑ P‑<0.001; multivariate ‑ P‑<0.001)
significantly increased the risk of developing hyponatremia.
Hyponatremia prior to initiating radiation also carried significant risk
of developing hyponatremia on radiation (univariate ‑ P‑<0.001;
multivariate ‑ P‑<0.001). Incidence of interruptions to radiation
treatment was higher in patients having hyponatremia (P‑0.002).
Conclusion: One fourth population of head and neck malignancies
belong to elderly[3]
. Factors predictive of improved survival on univariate
analysis suggested by Suntharalingam et al.[4]
are, age <50 years,
concurrent chemotherapy using carboplatin and/or paclitaxel and
treatment breaks of less than five days. Our analysis indicates an
increased sodium imbalance in head and neck malignances.Age, stage
of disease, surgery, chemotherapy, and hyponatremia prior to start of
treatment, were found to be significant, independent risk factors for
developing hyponatremia. Hyponatremia is a biochemical diagnosis
that is easily detected clinically and is correctable with cost‑effective
out‑patient care. Further information on this would help to have a
clearer perspective in the management of these patients and to improve
outcomes and quality of life.
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