Ophthalmology

"Indovation" in ophthalmology – The potential power of frugal innovations Santosh G Honavar Indian Journal of Ophthalmology 2019 67(4):447-448

Papilledema or pseudopapilledema? Lin Liu, Michael D Yu, Carol L Shields Indian Journal of Ophthalmology 2019 67(4):449-449

Techniques of anterior capsulotomy in cataract surgery Bhavana Sharma, Robin G Abell, Tarun Arora, Tom Antony, Rasik B Vajpayee Indian Journal of Ophthalmology 2019 67(4):450-460 Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

Consensus statement and guidelines for use of dilute atropine sulphate in myopia control Siddharth S Kesarwani, Mumbai Group of Paediatric Ophthalmologists and Strabismologists  Indian Journal of Ophthalmology 2019 67(4):461-463 Purpose: To develop a consensus statement for use of dilute atropine in control of myopia progression in children based on review of existing literature, opinions and suggestions of the members of the Group of Paediatric Ophthalmologist and Strabismologists, Mumbai (GPOS). Methods: Literature review, group discussions, questionnaire study and consensus building by supermajority voting. Results: About 65% of paediatric ophthalmologists in Mumbai have started prescribing atropine sulphate 0.01% as routine in their patients showing myopia progression. Majority of the respondents who have used it for >1 year in their patient population are extremely happy with the results. About 47% respondents expressed concerns regarding some yet unknown side effects of long-term use in our patient population. Majority of the respondents agree that it is safe and have rarely encountered side effects with its use. Conclusion: Atropine sulphate 0.01% is a safe and effective treatment for myopia control. Most trained paediatric ophthalmologists recommend its use in children with progressive simple myopia.

Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series Giacomo De Benedetti, Agostino S Vaiano Indian Journal of Ophthalmology 2019 67(4):464-471 Purpose: To compare the efficacy and safety profile of oral azithromycin with that of doxycycline over 9 months in patients experiencing failure with conservative and topical treatment for Meibomian gland dysfunction (MGD), to assess recurrence of MGD, and to determine the number of treatments required. Methods: This is a randomized controlled trial with a cross-over design at a tertiary care center. In all, 115 consecutive patients underwent a complete ophthalmological examination before being randomly assigned to oral treatment with doxycline (4 g for 30 days) or azithromycin (1.25 g for 5 days). Patients were evaluated at 3, 6, and 9 months. Therapy was switched or conservative management maintained according to signs and symptoms. Results: In the azithromycin group, 83.25% of the patients were stable after one treatment, 16.5% needed a further one or two treatments (some had previously been switched to doxycycline), and 5.77% did not improve despite treatment. In the doxycycline group, 33.79% of patients were stable after one treatment, 66.21% needed a further one or two treatments (some had previously switched to azithromycin), and 29.41% did not improve despite treatment (P < 0.05). Minimal gastrointestinal adverse effects (nausea, diarrhea, abdominal cramp, and decreased appetite) were reported, mostly unchanged at the follow-up visits. At the first visit, more adverse effects were reported in the doxycycline group (14/51, 24%) than in the azithromycin group (3/52, 6%; P < 0.005). Conclusion: Both antibiotics were effective and safe for treating patients with persistent MGD, although azithromycin was superior when the reduced dose and the shorter course of therapy (5 days vs. 4 weeks) were taken into consideration. Given the chronic nature of the disease and the improvement in some signs with minimal adverse effects, a shorter therapy seems a safer and more logical alternative to longer regimens.

Human amniotic membrane as a drug carrier – An in-vitro study using fortified cefazolin ophthalmic solution Sajeev Hitha Sara, Namperumalsamy Venkatesh Prajna, Srinivasan Senthilkumari Indian Journal of Ophthalmology 2019 67(4):472-475 Purpose: Our previous study demonstrated the drug reservoir function of human amniotic membrane (HAM) using stable moxifloxacin as a model drug. The purpose of the present study is to evaluate whether HAM can be used as a drug carrier for extended release of extemporaneous preparation of cefazolin. Methods: HAM Buttons (1 Control, 5 Test) were incubated in a freshly prepared (1 ml) sterile topical solution of cefazolin 5% (w/v) for 3 h and 24 h at two different temperatures. The groups were designated as follows: Group IA: Soaking duration 3 h at 4°C; Group IB: Soaking duration 3 h at room temperature; Group IIA: Soaking duration 24 h at 4°C; and Group IIB: Soaking duration 24 h at room temperature. The release kinetics of cefazolin from different groups of drug-laden HAM was studied for a period of 5 days. Samples were assayed for estimation of cefazolin content at different time intervals by High Performance Liquid Chromatography (HPLC) with Photodiode array (PDA) detector. Results: Three-hour cefazolin treatment with HAM at 4°C caused high drug entrapment (24%) compared to room temperature (11%; P < 0.005); however, the release kinetics was not significantly different between Group IA and IB as well as Group IIA and IIB up to the study period. Increase in drug treatment duration did not show increase in entrapment, but caused two-fold (IA Vs IIA) and 1.6-fold (IB Vs IIB) less drug entrapment at 4°C and room temperature, respectively. Conclusion: The results reveal that HAM may be a suitable drug carrier for extended delivery of fortified formulations without compromising stability.

Commentary: The human amniotic membrane: Fortifying nature's gift to ophthalmology Swapna S Shanbhag, Pragnya Rao Donthineni, Vivek Singh, Sayan Basu Indian Journal of Ophthalmology 2019 67(4):476-476

The prevalence and risk factors for cataract in rural and urban India Sumeer Singh, Shahina Pardhan, Vaitheeswaran Kulothungan, Gayathri Swaminathan, Janani Surya Ravichandran, Suganeswari Ganesan, Tarun Sharma, Rajiv Raman Indian Journal of Ophthalmology 2019 67(4):477-483 Purpose: To report the prevalence and risk factors of cataract and its subtypes in older age group. Methods: A total of 6617 subjects were recruited from both rural and urban areas. A detailed history including data on demographic, socioeconomic and ocular history was obtained. Lens opacity was graded according to the Lens Opacity Classification System III (LOCS III). Results: Cataract was present in 1094 of the rural and 649 subjects in the urban population. Monotype subtype cataracts were found in 32% and 25% in rural and urban population and 12.68% and 18.6% were mixed cataracts in the rural and urban groups. In baseline characteristics history of diabetes, alcohol intake and presence of age-related macular degeneration were the risk factors in urban group. On multivariate analysis, the only significant risk factors for any cataract in subjects ≥60 years were increasing age in both rural [odds ratio (OR), 1.07] and urban (OR, 1.08) population, and HbA1c (OR, 1.14) in rural population. Overweight (OR, 0.6) was found to be a protective factor, and lower social economic status (OR, 1.52) a risk factor for cataract in urban population. A significant urban–rural difference was found in the prevalence of cataract and its subtypes (P ≤ 0.05). Conclusion: We found the risk factors for any cataract in older age group to be increasing age and HbA1c in rural group. Age and lower social economic status were found to be the risk factors in urban arm. A statistically significant difference was found on comparison of the prevalence of cataract and its subtypes between the rural and urban population.

Accuracy of the refractive prediction determined by intraocular lens power calculation formulas in high myopia Dong Zhou, Zhuo Sun, Guohua Deng Indian Journal of Ophthalmology 2019 67(4):484-489 Purpose: Our study was conducted to evaluate and compare the accuracy of the refractive prediction determined by the calculation formulas for different intraocular lens (IOL) powers for high myopia. Methods: This study reviewed 217 eyes from 135 patients who had received cataract aspiration treatment and IOL implantation. The refractive mean numerical error (MNE) and mean absolute error (MAE) of the IOL power calculation formulas (SRK/T, Haigis, Holladay, Hoffer Q, and Barrett Universal II) were examined and compared. The MNE and MAE at different axial lengths (AL) were compared, and the percentage of every refractive error absolute value for each formula was calculated at ±0.25D, ±0.50D, ±1.00D, and ±2.00D. Results: In all, 98 patients were recruited into this study and 98 eyes of them were analyzed. We found that Barrett Universal II formula had the lowest MNE and MAE, SRK/T and Haigis formulas arrived at similar MNE and MAE, and the MNE and MAE calculated by Holladay and Hoffer Q formula were the highest. Barrett Universal II formulas have the lowest MAE among different AL patients, whereas it reached the highest percentage of refractive error absolute value within 0.5D in this study. The MAE of each formula is positively correlated with AL. Conclusion: Barrett Universal II formula rendered the lowest predictive error compared with SRK/T, Haigis, Holladay, and Hoffer Q formulas. Thus, Barrett Universal II formula may be regarded as a more reliable formula for high myopia.

Long-term outcomes of cataract surgery in children with uveitis Sonam Yangzes, Natasha Gautam Seth, Ramandeep Singh, Parul Chawla Gupta, Jitender Jinagal, Surinder Singh Pandav, Vishali Gupta, Amod Gupta, Jagat Ram Indian Journal of Ophthalmology 2019 67(4):490-495 Purpose: To evaluate the long-term outcomes of cataract surgery in children with uveitis. Methods: Retrospective, noncomparative review of medical records of children (≤16 years) with uveitic cataract who had undergone cataract surgery between January 2001 and December 2014 at a tertiary care center was done. The main outcome measures were visual acuity and postoperative complications. Results: We recruited 37 children (58 eyes) who were diagnosed with uveitic cataract and underwent cataract surgery. The etiology of uveitis included juvenile idiopathic arthritis (n = 19), presumed intraocular tuberculosis (n = 8), idiopathic (n = 4), Behçet's disease (n = 2), Vogt–Koyanagi–Harada syndrome (n = 2), human leukocyte antigen B-27 associated uveitis (n = 1), and toxocariasis (n = 1). Phacoemulsification with intraocular lens (IOL) implantation was performed in 17 patients (27 eyes; 46.55%), while 20 patients (31 eyes; 53.44%) were left aphakic after pars plan lensectomy and vitrectomy. At an average follow-up of 3.69 ± 7.2 (SD) years, all cases had significant improvement in corrected distance visual acuity post cataract extraction; visual acuity of 20/40 or more was achieved in 32 eyes (55.17%). The most common complication was capsular opacification (37.93%). Incidence of secondary procedures as well as glaucoma was not statistically different in patients undergoing IOL implantation from those who were aphakic. Conclusion: Even though number of secondary procedures was more in pseudophakic group, meticulous choice of surgical technique and adequate immunosuppression lead to a modest gain of visual acuity in children undergoing IOL implantation in uveitis. However, scrupulous case selection and aggressive control of pre- and postoperative intraocular inflammation are the key factors in the postoperative success of these patients.

Rural Medicine

The joy of the bread aisle Peter Hutten-Czapski Canadian Journal of Rural Medicine 2019 24(2):31-31

Les joies du rayon du pain Peter Hutten-Czapski Canadian Journal of Rural Medicine 2019 24(2):32-32

Family physicians as generalists Margaret Tromp Canadian Journal of Rural Medicine 2019 24(2):33-34

Médecins de famille à titre de généralistes Margaret Tromp Canadian Journal of Rural Medicine 2019 24(2):35-36

Physician attendance during interhospital patient transfer in Ontario: 2005–2015 David Wonnacott, Eliot Frymire, Shahriar Khan, Michael E Green Canadian Journal of Rural Medicine 2019 24(2):37-43 Introduction: Interhospital transfer of patients may be attended by a variety of healthcare providers, including physicians. The role of physicians in ambulance transfer in Ontario is not well studied. This study aims to describe the cohort of physicians providing intra-ambulance patient care in Ontario from 2005 to 2015. Secondary outcomes of interest were geographical characteristics of physician-attended transfers and patient characteristics. Methods: OHIP billing data were used to find all instances of physician-attended air or land ambulance transfer from 2005 to 2015. These data were matched to physician data from the Corporate Providers Database and the Institute for Clinical Evaluative Sciences Physicians Database to describe the physicians providing intra-ambulance care. Patient and geographical data came from the National Ambulatory Care Reporting System and Registered Persons Database to describe the rurality of physician-attended transfers and patient characteristics. Results: There were 916–1216 physician-attended transfers performed by 508–639 unique physicians in any given year. Physicians were mostly family physicians without anaesthesia or emergency medicine training (58%), with CCFP-EM physicians accounting for 17% and family medicine anaesthetists 10%. Thirty-eight per cent of physicians providing intra-ambulance care practised in rural settings. Seventy-three per cent of physician-attended land transfers originated in suburban, rural or remote hospitals. Conclusions: Physician-attended ambulance transfer in Ontario is largely provided by family physicians in suburban to remote settings. This may have implications for the education of resident physicians in this unique skill set. Further research is needed into current education practices in intra-ambulance care.

Improving patient preparedness for the operating room: A quality improvement study in Winchester District Memorial Hospital – A rural hospital in Ontario Mohamed Gazarin, Emily Mulligan, Michelle Davey, Karen Lydiatt, Catherine O'Neill, Kirsti Weekes Canadian Journal of Rural Medicine 2019 24(2):44-51 Introduction: Full completion of the pre-operative checklist is important for proper preparation of patients before they enter the operating room (OR), thus increasing OR efficiency. It is also critical for patient safety and successful outcomes. According to various literature, full completion of pre-operative checklists varies widely between institutions and occurs anywhere between 21% and 92% of cases.[1],[2] Our pre-project audits revealed a suboptimal patient preparedness for the Winchester District Memorial Hospital (WDMH) OR, since only 25% of cases arriving at the OR had their pre-operative checklist completed in its entirety, with no omissions. Methods: WDMH performed a 12-month long quality improvement (QI) study to improve patient preparedness for the OR. Multiple QI initiatives were used to induce behavioural change by incorporating process mapping, enabling communication, adjusting the pre-operative checklist based on qualitative staff feedback and implementing a staff education plan. Interventions also included two post-implementation audits. Results: Remarkably, completion of the pre-operative checklist increased from 25% to 67% and finally to 94%. Furthermore, the previous chart's presence and completion of pre-operative orders improved from 87% to 100% and from 82% to 99%, respectively. Another significantly important secondary outcome was improvement in interdepartmental relationships and collaboration. With better communication and checklist completion rates, there came increased patient preparedness and improved efficiency. Conclusions: Multiple significant improvements and many additional minor improvements strongly suggest that the approaches were used were effective at improving patient preparedness.

Getting a Grip on Arthritis Online: Responses of rural/remote primary care providers to a web-based continuing medical education programme Sydney C Lineker, Lisa J Fleet, Mary J Bell, Raquel Sweezie, Vernon Curran, Gordon Brock, Elizabeth M Badley Canadian Journal of Rural Medicine 2019 24(2):52-60 Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue. Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score. Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis. Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice.

Laparoscopic cholecystectomy for ultrasound normal gallbladders: Should we forego hepatobiliary iminodiacetic acid scans? Judith Roger, Thomas Heeley, Wendy Graham, Anna Walsh Canadian Journal of Rural Medicine 2019 24(2):61-64 Introduction: Hepatobiliary iminodiacetic acid (HIDA)-radionuclear scans are used to diagnose biliary dyskinesia, the treatment for which is a laparoscopic cholecystectomy (LC). However, the predictive value of the HIDA scan for LC candidacy is debated. Case: A physical, ultrasound, and blood test for a 53-year-old woman with biliary dyskinesia-like symptoms were normal, contradicting a textbook history. A HIDA-scan was ordered but the results suggested she was not eligible for a LC. The patient insisted on receiving the procedure and gave informed consent to undergo an elective LC. Results: Six-weeks post-surgery, the patient's symptoms had ceased besides one short episode of abdominal pain. Conclusion: A LC relieved the patient's symptoms, suggesting that negative HIDA-scans can mislead correct decisions to perform a LC. Surgeons who receive inconclusive HIDA scan results should consult their patients, and when necessary and agreed-upon, take an informed risk together in an attempt to improve the patient's quality of life.

The occasional nasal foreign body Hashim Kareemi, Jeffrey Gustafson, Sarah M Giles Canadian Journal of Rural Medicine 2019 24(2):65-68

Cancer Research and Therapeutics

Filamentous bacteriophage: A prospective platform for targeting drugs in phage-mediated cancer therapy Pankaj Garg Journal of Cancer Research and Therapeutics 2019 15(8):1-10 A new modality of targeting therapeutic drugs based on the use of bacteriophage (virus), as an emerging tool for specific targeting and for vaccine development, has been an area of interest for genetic and cancer research. The approach is based on genetic manipulation and modification in the chemical structure of a filamentous bacteriophage that facilitates its application not only for in vivo imaging but also for therapeutic purpose, as a gene delivery vehicle, as drug carriers, and also as an immunomodulatory agent. Filamentous bacteriophage on account of its high surface holding ability with adaptable genetic engineering properties can effectively be used in loading of chemical and genetic drugs specifically on to the targeted lesion location. Moreover, the specific peptides/proteins exhibited on the phage surface can be applied directly as self-navigating drug delivery nanovehicles. The present review article has been framed with an objective to summarize the importance of bacteriophage in phage cancer therapy and to understand the possible future prospective of this approach in developing new tools for biotechnological and genetic research, especially in phage -mediated cancer therapy. Importantly, the peptides or proteins emerging from the surface of a nano carrier will make the expense of such peptides economically more effective as compared to other immunological tools, and this seems to be a potential approach for developing a new nanodrug carrier platform.

Magnetic resonance imaging radiomic feature analysis of radiation-induced femoral head changes in prostate cancer radiotherapy Hamid Abdollahi, Seied Rabi Mahdavi, Isaac Shiri, Bahram Mofid, Mohsen Bakhshandeh, Kazem Rahmani Journal of Cancer Research and Therapeutics 2019 15(8):11-19 Background and Purpose: As a feasible approach, radiotherapy has a great role in prostate cancer (Pca) management. However, Pca patients have an increased risk of femoral head damages including fractures after radiotherapy. The mechanisms of these complications are unknown and time of manifestations is too long; however, they may be predicted by early imaging. The main purpose of this study was to assess the early changes in femoral heads in Pca patients treated with intensity-modulated radiation therapy (IMRT) using multiparametric magnetic resonance imaging (mpMRI) radiomic feature analysis. Materials and Methods: Thirty Pca patients treated with IMRT were included in the study. All patients underwent two mpMRI pre- and postradiotherapy. Thirty-four robust radiomic features were extracted from T1, T2, and apparent diffusion coefficient (ADC) obtained from diffusion-weighted images. Wilcoxon signed-rank test was performed to assess the significance of the change in the mean T1, T2, and ADC radiomic features postradiotherapy relative to preradiotherapy values. The percentage change values were normalized based on the natural logarithm base ten. Features were also ranked based on their median changes. Results: Sixty femoral heads were analyzed. All radiomic features have undergone changes. Significant postradiotherapy radiomic feature changes were observed in 20 and 5 T1- and T2-weighted radiomic features, respectively (P < 0.05). ADC features did not vary significantly postradiotherapy. The mean radiation dose received by femoral heads was 40 Gy. No fractures were observed within the follow-up time. Different features were found as high ranked among T1, T2, and ADC images. Conclusion: Early structural change analysis using radiomic features may contribute to predict postradiotherapy fracture in Pca patients. These features can be identified as being potentially important imaging biomarkers for predicting radiotherapy-induced femoral changes.

Adjuvant radiotherapy after surgical resection for adrenocortical carcinoma: A systematic review of observational studies and meta-analysis Gustavo Arruda Viani, Bruno Silveira Viana Journal of Cancer Research and Therapeutics 2019 15(8):20-26 Purpose: Historically, the role of adjuvant radiotherapy (RT) for patients with adrenocortical carcinoma (ACC) has been controversial. The objective of this research is to review systematically the literature evaluating the role of adjuvant RT in patients with ACC undergone a surgical resection. Materials and Methods: The electronic databases were searched for articles published until July 2017 without language restriction: Lilacs, Medline, Embase, and the Cochrane. Two reviewers independently appraised the eligibility criteria and extracted data. When possible, a fixed-effect meta-analysis was done. The systematic review (SR) followed all the criteria of the MOOSE guideline. Results: Overall, 382 citations were identified. After the screening of titles and abstracts, 12 articles (eight case series [48 patients] and 4 cohort studies [136 patients]) were included in the final analysis. For the local recurrence, the pooled relative risk (RR) was RR = 0.46 (95% confidence interval: 0.28–0.75), in favor of adjuvant RT when compared with surgery alone. Concerning overall mortality and disease recurrence, no significant difference between adjuvant RT and surgery was detected, RR = 0.77 (CI 95% 0.49–1.22, P = 0.27), and RR = 0.95 (IC 95% 0.74–1.24, P = 0.67). In all cohort studies, the acute toxicities were graduated as mild and self-limited with nausea and fatigue being the most common symptoms. Only one case (1/50) of impairment of kidney function was detected as late toxicity in these studies. Conclusions: This SR and meta-analysis indicate that adjuvant RT dramatically reduces the local recurrence of ACC after surgery. Moreover, the treatment has a low acute and late toxicity, resulting in a high therapeutic index. Further, prospective studies are needed to confirm or refute the role of RT on survival and disease recurrence.

Single institution experience treating adrenal metastases with stereotactic body radiation therapy Mira Mahendra Shah, Derek Isrow, Muhammad M Fareed, Ning Wen, Samuel Ryu, Munther Ajlouni, Farzan Siddiqui Journal of Cancer Research and Therapeutics 2019 15(8):27-32 Objective: The objective of the study is to present our experience of treating adrenal metastases using stereotactic body radiation therapy (SBRT). Materials and Methods: We retrospectively reviewed patients with adrenal metastases treated using SBRT from 2001 to 2014. Response Evaluation Criteria in Solid Tumors v1.1 was used. Maximum tumor response was defined as the greatest percentage tumor reduction noted on two or more post-SBRT CT scans. Results: We identified 44 patients (median age 61.3 years, range: 25.8–85), with 54 adrenal metastases; primary diagnoses include non-small cell lung cancer (28 patients and 38 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (6 patients), and other (9 patients). Treatment was delivered in single (16 lesions, median dose 18 Gy [14–18]) or multiple fractions (38 lesions, median dose 30 Gy [16–40]). Median planning target volume was 49.65cc (3.21–984.54). Median response at first post-SBRT follow-up (median 1.65 months (m) (0.33–5.37), n = 46 lesions) was 10.8% with 91.3% local control. Median maximum tumor response was 31.8% (n = 32 lesions) at median follow-up of 5.4 m (0.9–44.8) with 96.6% local control. The response was comparable regardless of tumor histology or treatment fractionation. No patients experienced Grade 3/4 acute toxicities. One patient with a history of naproxen use required suturing with omental patch placement for perforated pyloric ulcer 14 m post-SBRT (18 Gy in single fraction) to the right adrenal metastasis; this region received <5 Gy. Ten patients treated for pain with available follow-up obtained relief. Conclusions: SBRT is a safe and efficacious treatment for adrenal metastases, demonstrating local tumor control. Further study of the impact on survival and quality of life is warranted.

Comparison of biological-based and dose volume-based intensity-modulated radiotherapy plans generated using the same treatment planning system K Senthilkumar, KJ Maria Das Journal of Cancer Research and Therapeutics 2019 15(8):33-38 Purpose: Nowadays, most of the radiotherapy (RT) treatment planning systems (TPSs) uses dose or dose-volume (DV)-based cost functions for Intensity modulated radiation therapy (IMRT) fluence optimization. Recently, some of the TPSs incorporated biological-based cost function for IMRT optimization. Most of the previous studies compared IMRT plans optimized using biological-based and DV-based cost functions in two different TPSs. Hence, the purpose of the study is to compare equivalent uniform dose (EUD)-based and DV-based IMRT plans generated using the same TPS. Materials and Methods: Twenty patients with prostate cancer were retrospectively selected for this study. For each patient, two IMRT plans were generated using EUD-based cost function (EUD_TP) and DV-based cost (DV_Treatment Plan (TP)), respectively. The generated IMRT plans were evaluated using both physical and biological dose evaluation indices. Results: Biological-based plans ended up with a highly inhomogeneous target dose when compared to DV-based plans. For serial organs, Dnear-max or D2%(Gy) of EUD-based plans showed significant difference with DV-based plans (P = 0.003). For both rectum and bladder, there was a significant difference in mean dose and D30%(Gy) dose between EUD-based plans and DV-based plans. Conclusion: In this study, we decoupled the influence of optimization parameters from the potential use of EUD-based cost functions on plan quality by generating both plans in the same TPS.

Role of serum prostate-specific antigen as predictor for bone metastases in newly diagnosed prostate cancer OP Singh, Veenita Yogi, Pallavi Redhu, HU Ghori, Ananya Pareek, Nancy Lal Journal of Cancer Research and Therapeutics 2019 15(8):39-41 Introduction: Prostate cancer is most frequently diagnosed cancer of men and bone is the most common site of metastasis. There is a lack of consensus for the selection criteria for bone scan in low-risk patients. Western guidelines do not recommend use of bone scan in asymptomatic patients and in low prostate-specific antigen (PSA) values. We try to correlate the PSA value with bone metastases through bone scan in the Indian population. Materials and Methods: A total of 68 histologically newly diagnosed prostate cancer subjected to bone scan were retrospectively analyzed. The patients were stratified into four groups according to their PSA level: The first group of patients had PSA level ranging from 0 to 10 ng/ml (n = 4), the second group had PSA level ranging from 10.1 to 20 ng/ml (n = 13), the third group had PSA levels 20.1–100 ng/ml (n = 23), and the fourth group has PSA >100 (n = 28). Results: The incidence of osseous metastases proven by bone scan was found to be zero (0 out of 4) for PSA level 0–10 ng/ml; 38.46% (5 out of 13) for PSA level 10.1–20, 60.87% (14 out of 23) for PSA level 20.1–100 ng/ml, and 100% for PSA >100 (P < 0.005) (95% confidence interval 1.01–1.1). For cut-off value of PSA ≤10 ng/ml, sensitivity and specificity were 100% and 19.05%, respectively, with positive predictive value of 73.44%. Conclusion: The correlation between PSA value and presence of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The screening bone scan at initial diagnosis should be included for all patients with PSA >10 ng/ml in Indian setting.

Effect of Au-197 nanoparticles along with Sm-153 radiopharmaceutical in prostate cancer from simulation method Akbar Abbasi, Fahreddin Sadikoglu, Mostafa Hassanzadeh Journal of Cancer Research and Therapeutics 2019 15(8):42-46 Aims: Based on recent studies, it was indicated that gold (Au-197) nanoparticles could be safely prescribed and used to enhance the absorbed dose during radiation therapy. Subjects and Methods: We evaluated the samarium-153 (Sm-153) radiopharmaceutical and Au-197 and Sm-153 radiopharmaceutical absorbed dose rate by means of the Monte Carlo technique in prostate cancer. Results: The results show that absorbed dose rate in entire prostate volume due to 20 mCi of Sm-153 radiopharmaceutical is 27.339 μGy/s, 48.837 μGy/s, and 76.176 μGy/s for γ-interaction, β¯ particle interaction, and γ+β¯ interaction, respectively. The results in the exterior of the prostate for β¯ interaction, β¯ particle interaction, and γ+β¯ interaction were 20.971 μGy/s, 1.110 μGy/s, and 22.081 μGy/s, respectively. Conclusions: The calculation results for Au-197 and Sm-153 radiopharmaceutical show that the absorbed dose rate in entire prostate volume 3% was increased and undesirable dose value in exterior of prostate 7% was decreased.

The effect of metabolic syndrome on prostate cancer final pathology Selahattin Caliskan, Selçuk Kaba, Emrah Özsoy, Muzaffer Oğuz Keleş, Orhan Koca, Mehmet Akyüz, Muhammet Ihsan Karaman Journal of Cancer Research and Therapeutics 2019 15(8):47-50 Aim of Study: Metabolic syndrome (MetS) is an abnormality that increases the risk of cardiovascular disease and diabetes. In the recent years, studies showed that MetS is associated with increased risk of incidence, aggressiveness, and mortality of prostate cancer (PCa). We examined the influence of MetS at final pathology in Turkish patients with PCa. Materials and Methods: MetS was defined according to the American Heart Association, National Heart, Lung, Blood Institute, and International Diabetes Federation and requires any three of five components. The patients without and with MetS were in Group 1 and 2, respectively. Data were compared with independent sample t-test and Chi-squared test. Results: There were 117 patients in the study. The patients' age was between 51 and 77 years with a median of 64.87 ± 5.65 and 62.29 ± 5.57, and prostate-specific antigen (PSA) level of the patients was 8.19 ± 5.35 and 8.68 ± 2.22 ng/ml in Group 1 and 2. Of these patients; Group 1 and 2 had 86 and 31 patients. High-grade PCa (Gleason >7) and advanced PCa (T3, T4) at final pathology were reported in 44.18–18.60% and 38.70–32.25% in Group 1 and 2. Conclusion: The patients with MetS are diagnosed significantly younger and had higher PSA levels than the other patients. Advanced disease of PCa is seen much more in patients with MetS.

Modified U-Shaped ileal neobladder designed for facilitating neobladder-urethral anastomosis in extracorporeal reconstruction after robotic-assisted radical cystectomy Su-Wei Hu, Chia-Chang Wu, Kuan-Chou Chen, Chen-Hsun Ho Journal of Cancer Research and Therapeutics 2019 15(8):51-55 Background/Objective: To report the initial experience and the early outcomes of a modified U-shaped ileal neobladder, which was developed to facilitate the neobladder-urethral anastomosis by minimizing the anastomotic tension. Patients and Methods: Between June 2015 and December 2016, two male and two female patients (median age: 65.5 years, range: 43–72 years) underwent the modified U-shaped ileal neobladder after robotic-assisted radical cystectomy (RARC). The most mobile and dependent ileal segment was first selected intracorporeally as the site for later neobladder-urethral anastomosis. The neobladder was formed extracorporeally, and the previously selected ileal segment formed the most dependent portion of the neobladder. The neobladder-urethral anastomosis was completed after robotic redocking. Results: The median follow-up was 8 months (3–21 months). The median operative time, console time, and extracorporeal reconstruction time were 620 min (534–674 min), 372 min (314–420 min), and 151 min (128–215 min), respectively. In all patients, the neobladder-urethral anastomosis was completed intracorporeally with minimal tension. The median hospital time after the surgery was 14.5 days (14–19 days). Postoperatively, the median peak flow rate and void volume were 10 ml/s (4–35 ml/s) and 258 ml (88–775 ml). The median postvoid residual was 20 ml (10–53 ml). At daytime, two were completely continent; the other two reported mild (1–2 pads) and moderate (>2 pads) incontinence at the postoperative 3 and 4 months, respectively. Three reported nocturnal enuresis. Conclusions: Our initial experience demonstrated that the modified U-shaped neobladder designed for minimizing the anastomotic tension is safe and feasible with its satisfactory functional outcomes.

A prospective study to compare the measured glomerular filtration rate compared to estimated glomerular filtration rate in patients undergoing definitive chemoradiation, with platinum agents for various malignancies A.H Rudresh, Vikas Asati, K.C Lakshmaiah, D Lokanatha, Suresh Babu, L.K Rajeev, K.N Lokesh, Govind Babu Journal of Cancer Research and Therapeutics 2019 15(8):56-59 Context: Renal function assessment is of paramount importance before using the platinum agents especially cisplatin. Glomerular filtration rate (GFR) estimation by diethyl-triamine-penta-acetic acid (DTPA) scan (measured GFR [mGFR]) is considered gold standard. Aims: The aim of this study is to know if we can replace the mGFR with the GFR estimation with Cockcroft–Gault formula (eGFR) in patients undergoing chemoradiation. Settings and Design: This is a prospective, descriptive study. Subjects and Methods: Patients who are planned for definitive chemoradiation will be eligible for the study. Renal function will be measured DTPA scan and Cockcroft–Gault (CG) formula. Subgroup analysis based on the weight, age, and sex will be done. Statistical Analysis Used: Demographic and renal function parameters were analyzed using summary measures. To test the significance of the difference between mGFR and cGFR, a paired t-test will be used; to look for an association between various estimates of renal function, the Pearson's correlation coefficient will be calculated using a two-tailed test. Results: Median mGFR of patients was 82.7 (range: 65–125 ml/min, standard deviation [SD] =14.0 ml/min) while the median eGFR as per the CG formula was 83.9 ml/min (range: 37–137 ml/min, SD = 24.4 ml/min). The median mGFR was only 1.2 ml/min lesser when measures by the CG formula with no significance difference between them (P = 0.66, 95% confidence interval: −4.5–6.3). Conclusions: We concluded that in resource-limited setting eGFR using CG formula can replace mGFR, especially in patients with age <60 years. Although weight did not showed a significant difference by two methods, a study with large sample is needed to confirm the result.