Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers

Lasrado, Savita,Moras, Kuldeep,Pinto, George Jawahar Oliver,Bhat, Mahesh,Hegde, Sanath,Sathian, Brijesh,Luis, Neil Aaron Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.10

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

Clinicopathological Profile of Head and Neck Cancers in the Western Development Region, Nepal: A 4-Year Snapshot

Lasrado, Savita,Prabhu, Prashanth,Kakria, Anjali,Kanchan, Tanuj,Pant, Sadip,Sathian, Brijesh,Gangadharan, P.,Binu, V.S.,Arathisenthil, S.V.,Jeergal, Prabhakar A.,Luis, Neil A.,Menezes, Ritesh G. Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.12

Regional cancer epidemiology is an important basis for determining the priorities for cancer control in different countries worldwide. There is no reliable information about the pattern of head and neck cancer in western Nepal and hence an attempt was here made to evaluate the situation based on hospital data, which provide the only source in the western region of Nepal. A clinicopathological analysis of head and neck cancers treated between 2003 and 2006 in Manipal Teaching Hospital affiliated to Manipal College of Medical Sciences, Pokhara, Western Development Region, Nepal was performed. A total of 105 head and neck cancer cases were identified with a male to female ratio of 1.8:1. The median ages of male and female patients were 62 and 64 years, respectively. Ninety-seven (92.4%) of the cancer patients were suffering from carcinoma, three (2.9%) had blastoma, three (2.9%) had sarcoma, and two (1.9%) had lymphoma. The majority (61.9%) of carcinoma cases were squamous cell carcinoma followed by anaplastic carcinoma (7.2%). Of the carcinoma cases, the most common site of primary lesion was larynx (19.6%), followed by the thyroid (14.4%), the tongue and hypopharynx with 10.3% cases each. Comparative analysis among males and females did not reveal any sex difference in type of head and neck cancers. The head and neck cancer pattern revealed by the present study provides valuable leads to cancer epidemiology in western Nepal and useful information for health planning and cancer control, and future research in western Nepal.

An analysis of UAE Quality Winners: A case study

( Flevy Lasrado ),( Bostjan Gomiecek ) 한국품질경영학회 2015 한국품질경영학회 학술대회 Vol.2015 No.2

Purpose: Nations have been globally engaged in developing national quality frameworks or awards during the last three decades. Today more than 80 countries have their own award criteria, although they are mostly based on international renowned quality and excellence awards. Indeed such quality and business excellence frameworks reportedly assure link to organization’s economic performance as well many other tangible and intangible benefits. The purpose of this paper is to present the analysis of quality award winners in the UAE. Design/Methodology/Approach: This research is based on information gathered by means of document analysis extracted from the Dubai Quality Award office in the form. The data were further analyzed based on DQA criteria Findings: The enablers that drive the organizations towards performance excellence in the case of the ten winning UAE organizations are discussed. The common enablers across the organizations that have emerged are discussed as well. Originality/Value: This paper is based on direct results obtained by the Dubai Quality Award Office.. It is the first study in this respect to analyze the results. The results of this research should be useful for many organizations planning to embark on the excellence journey.

Short Term Test-Retest Reliability of Contralateral Inhibition of Distortion Product Otoacoustic Emissions

Mohan Kumar Kalaiah,Alina Lasrado,Nikita Pinto,Usha Shastri 대한청각학회 2018 Journal of Audiology & Otology Vol.22 No.4

Background and Objectives: Strength of medial olivocochlear reflex can be measured reliably using contralateral inhibition of distortion product otoacoustic emissions (DPOAEs) when its fine structure is considered. However, measurement of fine structure of DPOAE is difficult with clinical equipment. Thus, this study investigated the clinically relevant test-retest reliability of contralateral inhibition of DPOAEs. Subjects and Methods: Twenty-six young adults withnormal hearing sensitivity participated. DPOAEs were recorded at 27 discrete f2 frequenciesbetween 800 Hz and 8,000 Hz at frequency resolution of 8 points per octave with and withoutcontralateral white noise presented at 50 dB SPL. To check for short term inter-sessionreliability, contralateral inhibition of DPOAEs were recorded in three sessions, two recordingsessions on first day separated by 30 minutes and third time after one week of the first session. Within each session, DPOAEs were recorded twice in single probe-fit condition to testfor intra-session reliability. Results: Cronbach’s alpha was calculated having poor reliability (α≤0.7) of contralateral inhibition of DPOAEs in both intra-session and inter-session conditionsfor most of the tested frequencies. 95% confidence intervals of contralateral inhibition magnitudealso showed large variability. Conclusions: The current results showed that thoughDPOAE amplitudes were highly reliable across sessions, amount of inhibition of DPOAEs wasnot reliable when DPOAEs were measured at discrete frequencies. These findings are concurrentwith the literature.