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4 results

  • Comparison of conventional and hypofractionated radiation after mastectomy in locally advanced breast cancer: a prospective randomised study on dosimetric evaluation and treatment outcome

  • Sumana Maiti, Suman Meyur, Bidhan Chandra Mandal, Lekshmi R Shenoi, Susmita Biswas, Siddhartha Basu
  • Journal:
    Journal of Radiotherapy in Practice / Volume 20 / Issue 1 / March 2021
    Published online by Cambridge University Press:
    17 January 2020, pp. 30-38
  • Background:

    Although hypofractionated radiotherapy has been standardised in early breast cancer, even in post-mastectomy no such consensus has been developed for locally advanced breast cancer (LABC), probably due to complex planning and field matching. This study is directed towards dosimetric evaluation and comparison of toxicity, response and disease-free survival (DFS) comparison between hypofractionation and conventional radiotherapy in post-mastectomy LABC.

    Methodology:

    In total, 222 female breast cancer patients were randomly assigned to be treated with either hypofractionated radiotherapy (n = 120) delivering 40 Gy in 15 fractions over 3 weeks or conventional radiotherapy (n = 102) with 50 Gy in 25 fractions over 5 weeks after modified radical mastectomy (MRM) along with neoadjuvant and/or adjuvant chemotherapy. All patients were planned with treatment planning software and assessed regularly during and after treatment.

    Results:

    Median follow-up period was 178 weeks in conventional arm (CRA) and 182 weeks in hypofractionation arm (HFA). There exists a dosimetric difference between the two arms of treatment, in spite of similar dose coverage [planning treatment volume (PTV) D90 92·04% in CRA versus 92·5% in HFA; p = 0·49], average dose in HFA is less than that of CRA (p < 0·001); so is the maximum clinical target volume (CTV) dose (p < 0·001). Similarly, average lung dose in HFA arm is significantly lower than CRA (9·9 versus 10·84; p = 0·06), but the V20Gy of lung and V30Gy of heart had no difference. The toxicity of radiation was comparable with similar mean time to produce toxicity [CRA: 7 W, HFA: 10 W; hazard ratio 0·64, 95% confidence interval (CI) = 0·28–1·45]. Three-year recurrence event was alike in two arms (CRA: 4·9%, HFA: 5·8%; p = 0·76). Mean DFS in CRA is 230 weeks and that of HFA is 235 weeks with hazard ratio 1·01 (95% CI = 0·32–3·19; p = 0·987).

    Conclusion:

    Though biologically effective dose (BED) in hypofractionation is lesser than that of conventional fractionation, there are indistinguishable toxicity, locoregional recurrence, distant failure rate and DFS between the two modalities.

  • 4 - Is cannabis becoming more potent?

  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book:
    Marijuana and Madness
    Published online:
    05 November 2011
    Print publication:
    27 October 2011, pp 35-54

  • Summary

    The psychoactive ingredients of cannabis are the terpenophenolic cannabinoids. The main psychoactive cannabinoid is tetrahydrocannabinol (THC). In Canada, seized cannabis products are submitted for THC analysis for court purposes. Data on cannabis potency is generally obtained from the analysis of law enforcement seizures. In the Netherlands, data have been derived from cannabis products purchased in coffee shops since 1999. A study on the THC content of fresh illicit cannabis products seized on entry into the United Kingdom was conducted by the Laboratory of the Government Chemist (LGC). Cannabidiol, the main non-psychotropic constituent of cannabis, does not bind to the cannabinoid receptors, probably exerting its effects through novel cannabinoid receptors mediating non-CB1/CB2 receptor effects. In conclusion, it is clear that high-potency cannabis products are freely available on the international drug markets, and that cannabis products have at least a two-fold increased THC content compared with pre-2000 products.