e20544 Background: Palliative care services are usually provided by trained nurses and volunteers in India. Home care services in our center are provided through trained nurses with palliative care physician providing assistance when required for new complaints or interventions. Methods: A prospective study was conducted in all patients under our home care between 02/01/2012 to 08/31/2013. Trained palliative care nurses conducted 4 visits at 2 week intervals and sought physician assistance when required. Primary endpoint was change in symptoms and well being measured using patient reported Palliative care Outcome Scale score (POS), with a reduction in the POS score indicating an improvement. Differences in total POS score were tested using the Friedman test. Linear regression was used to find factors significantly influencing relative change in POS scores between first and last visit. P values < 0.05 were taken as significant. Results: 111 patients were recruited in the study period mainly having head neck (32%), gastrointestinal (23%) and lung cancers (14%). 27 patients (24.3%) died between the 1st and 4th follow-up visits. The Table shows the changes in POS score at each visit. Improvement was noted in all subdomains of the POS score across the visits. None of the patients had an increase of the POS score. Prevalence of bedsore reduced from 20.5% in 1st visit to 9.5% in fourth visit. Proportion of patients with ryles tube (16.8% vs 14.6%), catheter (57.9% vs 56.6%) and ascites (6.5% and 7.1%) remained stable between first and fourth visits. Mean reduction in POS was 78.3% (SD 20.4%). Patients without comorbidities, with ascites and infected wound in first visit had a significantly poorer reduction in POS scores (P=0.008, 0.048 and 0.0001 respectively). Conclusions: Effectiveness of this unique model of homecare is reflected by significant reduction in total POS scores. However patients with infected wounds and ascites had less reduction in POS scores, indicating need for further improvement in service delivery. Mean (standard deviation) of POS scores at each visit. Visit 1 Visit 2 Visit 3 Visit 4 P Value POS 9.62 (4.45) 4.07 (2.94) 1.85 (1.85) 1.32 (1.42) < 0.001

Recently, an increase of global incidence has been observed for various types of cancers.Diet, lifestyle and environmental factors have an evident correlation to the development of breast cancer.Breast cancer is one of the leading causes of cancer related death in women.Several studies also revealed that excessive free radical generation and decreased antioxidant status had been implicated in cancer.These factors rekindled our interest upon the interaction of free radicals and antioxidants and hence the present study was undertaken to evaluate the significance of non enzymic antioxidants: glutathione, albumin and ascorbic acid levels in breast cancer patients.The study population was divided into 3 groups as follows: Group I control subjects (age group 21 -60), Group II: breast cancer Patients (age group 21 -35) and Group III breast cancer patients (age group 36 -60).Highly statistically significant increases in glutathione, albumin and ascorbic acid levels were observed in Group I as compared to other groups.No significant differences in glutathione, albumin and ascorbic acid levels were observed in a group comparison between Group II and Group III.This relative decline of non enzymic antioxidants in breast cancer patients may be due to an increased generation of reactive oxygen species or free radicals.The results obtained emphasize the need of more detailed study involving a large number of newly detected cancers for evaluating the role of these antioxidant parameters in the prevention of cancer.

We are reporting a case of pneumonia associated with pleural effusion during the neutropenic phase of induction chemotherapy. In spite of being Adenosine deaminase negative, the pleural effusion responded only to empiric therapy with antitubercular agents. The diagnosis was confirmed with positive PCR testing for mycobacterium tuberculosis.

Aim: To study the use of RapidArc techniques in the treatment of prostate cancer patients with hip prosthesis.Background: An important aspect of treatment planning is to achieve dose homogeneity inside the planning target volume (PTV). Especially for those patients presenting with hip prosthesis, it becomes a challenging task to achieve dose uniformity inside the PTV.Materials and methods: Five prostate patients presenting with hip prosthesis who had undergone radical radiotherapy were selected for this study. Depending on the composition of prosthesis, a predefined set of Hounsfield values were assigned to each study set. RapidArc plans were generated on an Eclipse treatment planning system. Two arcs that include clockwise and counter-clockwise arcs were used in all these cases. To avoid beams passing through the prosthesis, a simple structure was defined around it with 1 cm margin and a strict dose constraint applied to the block during VMAT optimization.Results: The mean D2/D98 ratio of PTV for all the patients was 1.06 +/- 0.01. The mean percentage rectum volume receiving 50 Gy, 60 Gy, 70 Gy and 75 Gy for all the patients were 33.1 +/- 5.9, 21.7 +/- 5.5, 13.8 +/- 4.4 and 9.5 +/- 3.0, respectively.Conclusions: This study shows that using a double arc RapidArc technique is a simple and effective treatment method of treating prostate cancer in patients presenting with a hip prosthesis. The definition of a beam avoidance structure encompassing the prosthesis and applying strict dose constraints to it reduces the beam contribution to the prosthesis. (C) 2013 Greater Poland Cancer Centre. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

© 2012. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Glassy cell carcinoma (GCC) is a rare clinical entity involving uterine cervix with aggressive course and relatively poor prognosis. The most common presentation is abnormal bleeding or discharge per vaginum of recent origin. Histologically it is diagnosed by characteristic "Glassy" cells. All the three modalities (i.e. surgery, radiotherapy and chemotherapy) have been tried in various clinical settings, showing different clinical outcome. The common consensus regarding diagnosis and optimal treatment modalities is yet to emerge. The case presented here not only represents a rare histopathological diagnosis, but also reemphasizes the importance of Her2 neu immunostains as a bad prognostic marker. Key words: glassy cell carcinoma; radiotherapy; Her2 neu; cervix. DOI: http://dx.doi.org/10.4038/sljog.v33i2.4010 Sri Lanka Journal of Obstetrics and Gynaecology 2011; 33: 65-67

Sir, We congratulate the authors on this valuable work which puts in focus an important aspect of oncology practice.[1] The off-label use of drugs will be important and is viewed favorably by the authors but there are certain aspects which need to be addressed especially in a developing country like ours. There is always a concern with the use of off-label drugs that, if the patient develops unfavorable side effects or outcome, then it would be difficult for the prescriber to withstand legal process.[2] In our country, law is still evolving and yet to come to terms with regard to medical profession and is seen that court rulings have heterogeneous nature in alleged cases ofmedical negligence and malpractice suits. Medical Council of India, state medical councils, and Indian Medical Association or state doctors' association remains separate entities with no or little coordination or unanimity between them. The inflammatory media remains another hindrance leading to the erosion of doctors-patient trust. There remains a perpetual fluid situation regarding the medical malpractice and I wonder how difficult it would be for a sued oncologist to explain his position regarding the use of off-label drugs. Most of the hospitals barring a few institutions fail to formulate departmental protocols and the treatment ends up being the chosen best method either by the doctor who is on duty that day or according to the specialty doctor he or she first sees. Multidisciplinary meets or clinics are yet evolving in most of the centers. Even if the protocols exist, the plea of off-label use may be misused as a defense against following departmental protocols or guidelines. It takes away the initiative to actually design protocols or include such patients in scientific trials. In such a scenario, encouraging off-label use has its own pros and cons but its overall impact will be hard to comprehend. Also the concern that off-label use is promoted by pharmaceutical companies is very much there.[3] The information on the basis of which the prescription of off-label drugs is made should be carefully scrutinized. It is likely that the information is mostly conflicting and sketchy and hence the interpretation according to the individual oncologist will also vary hugely. Taking a shared decision with the family is extremely important but as would be experience of many treating professionals such information sharing may lead later the families to complain that "experimentation" was done. So we would rather have departmental protocols to follow, and if we feel off-label drugs are warranted, we should rather get approval from a multidisciplinary board. We should make every effort to scientifically analyze results in such patients. If the analysis results are encouraging, an off-label drug in the present may become an approved drug in future.

INTRODUCTION:Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice.MATERIALS AND METHODS:We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients.RESULTS:Most responders had an oncology experience of three to seven years (20/35). Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer.CONCLUSION:Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.

Primary rhabdoid tumor of lung is a rare histological and clinical entity. Lung tumors with rhabdoid features have been included as variants of large-cell carcinoma in the 1999 World Health Organization (WHO) classification of lung tumors. A large-cell carcinoma with a rhabdoid phenotype (LCCRP) is unusual, with only 38 cases reported till date. We report the clinical details of one such case that was treated with pneumonectomy and adjuvant chemotherapy. We also present a review of the literature. To identify relevant articles, we searched PubMed, Ovid, and IngentaConnect databases using the key words 'rhabdoid,' 'lung cancer,' and 'primary rhabdoid tumor of lung.'

Cylindric cell carcinomas (transitional cell carcinomas) are a rare and distinct histopathological entity presenting in the head and neck region. They have been known by myriads of nomenclature like cylindric carcinomas, nonkeratinizing sinonasal carcinoma, papillary carcinoma, cylindrical or columnar cell carcinoma, intermediate cell carcinoma, Schneiderian carcinoma, and Ringertz carcinoma. They are considered a variant of nonkeratinizing squamous cell carcinoma. Cylindric carcinomas are usually described in the sinus and nasal cavity and rarely said to involve nasopharynx and larynx. Only passing references have been made for its presentation in oropharynx including tonsils and the base of the tongue. We report here a rare case of transitional cell carcinoma presenting in the base of the tongue. There are no separate treatment recommendations in the literature, and the management is on the lines of treatment of squamous cell carcinoma. We report here a case of cylindric cell carcinoma presenting in the base of the tongue. The patient was staged as having cT2 N3 M0 (Stage IV B) disease. The patient received palliative radiotherapy of 20 Gy in five fractions followed by chemotherapy with injection paclitaxel and carboplatin. A partial response to treatment was achieved at the time of writing this report.

Objective: The use of non-platinum drugs in concurrent chemoradiation in carcinoma cervix has not been well explored and hence a two arm study was planned to compare the outcome of concomitant cisplatin or gemcitabine in locally advanced carcinoma cervix.Methods: Thirty six patients were evaluated in this study for response rates and complications. These patients were divided into two arms, sixteen patients in the cisplatin arm and twenty patients in the gemcitabine arm. Cisplatin and gemcitabine were given as i.v. infusion at doses of 40 mg/m(2) and 150 mg/m(2) respectively for five weeks concomitant with radiotherapy. All patients had received pelvic radiotherapy to a dose of 50 Gy/25 fraction/5 weeks by four field box technique followed by high-close-rate brachytherapy (3 sessions, each of 7.5 Gy to point A).Results: Median follow up was of 10.4 months (range, 3 to 36 months) and 10.9 months (range, 2 to 49 months) in the cisplatin and gemcitabine arms, respectively. At first follow up, 68.8% in the cisplatin arm and 70% in the gemcitabine arm had achieved complete response (p=0.93). Similar response rates were noted in different stages in both arms. None of the patients except one developed grade 4 toxicity. Similar toxicity profiles were observed in both arms. Local disease control, distant disease free survival and overall survival was 68.8% vs. 70%, 93.8% vs. 85%, 68.8% vs. 60% in the cisplatin and gemcitabine arms, respectively.Conclusion: Weekly gemcitabine had similar disease control and tolerable toxicity profile with cisplatin. Gemcitabine may be used as an alternative to cisplatin in patients with compromised renal function.

Brain metastases constitute one of the most common distant metastases of cancer and are increasingly being detected with better diagnostic tools. The standard of care for solitary brain metastases with the primary disease under control is surgery followed by radiotherapy. Radiotherapy is also the primary modality for the treatment of multiple brain metastases, and improves both the quality of life and survival of patient. Unfortunately, more than half of these treated patients eventually progress leading to a therapeutic dilemma. Another course of radiotherapy is a viable but underutilized option. Reirradiation resolves distressing symptoms and has shown to improve survival with minimal late neurotoxicity. Reirradiation has conventionally been done with whole brain radiotherapy, but now studies with stereotactic radiosurgery have also shown promising results. In this review, we focus on reirradiation as a treatment modality in such patients. We performed a literature search in MEDLINE (www.pubmed.org) with key words brain metastases, reirradiation, whole brain radiotherapy, stereotactic radiosurgery, interstial brachytherapy, and brain. The search was limited to the English literature and human subjects.

Sarcomatoid squamous cell carcinoma of the cervix is a rare tumor. Only 16 cases have so far been reported in literature. We report here one such tumor occurring in a 54-year-old postmenopausal woman. Our case report describes the clinical, pathological, and PET scan characteristics of this tumor. The patient was treated with concurrent chemoradiotherapy and is disease free at 6-months follow-up.