Antioxidant and antimutagenic activities of bark extract of Terminalia arjuna

Objective:The alcoholic extract of stem bark of Terminalia arjuna（ALTA） was screened for antioxidant and antimutagenic（anticlastogenic） activity.Methods:Antioxidant property was determined by l,l,Diphynyl,2-Picryl hydrazyl（DPPH） assay,super oxide radical scavenging activity,lipid peroxidation assay and total polyphenolic content was determined by Folin-Ciocalteau’s reagent.Antimutagenic activity was evaluated using micronucleus test in mice. Results:The ALTA has shown potent antioxidant activity with EC50 of 2.491±0.160,50.110±0.150 & 71.000±0.250 in DPPH assay,superoxide radical scavenging activity and lipid peroxidation assay, which is comparable with ascorbic acid with EC50 of 2.471±0.140,40.500±0.390 and 63.000±0.360 respectively.In micronucleus test,ALTA（100 & 200 mg/kg,p.o.） showed significant reduction in percentage of micronucleus in both polychromatic erythrocytes（PCE） and normochromatie erythrocytes（NCE） and also shown significant reduction in P/N ratio.Conclusions:These results suggested that ALTA possess significant antioxidant and antimutagenic activity.

Dysphagia Associated Organ Sparing Radiotherapy:Defining the Limits of Tolerance for Late Toxicity

Background:Dysphagia after radiotherapy in head and neck malignancies can severely impact a patient’s physical,social and psychological quality of life.Aspiration remains the major cause of non-disease related mortality in treated patients.The purpose of this study was to analyze the dosimetric correlates in a selective Asian subset of patients who are most eligible for Dysphagia aspiration related structure(DARS)sparing.Materials and Methods:Thirty patients with Oral or Oropharyngeal malignancies treated from March 2014 to September 2017 were analyzed for dosimetric parameters to DARS.A dosimetric and volumetric evaluation of dose parameters to the dysphagia and Aspiration associated normal structures were analyzed.The National cancer institute Common toxicity criteria for adverse events Version-3 was used to grade late dysphagia.Subjective evaluation of dysphagia was done with University of Washington Head and Neck related quality of life Questionnaire.Dosimetric comparison between IMRT and 3DCRT technique was done and correlated to toxicity.Results:Greater than Grade 2 dysphagia was observed in 10 patients(33%).In the 3DCRT cohort Grade 3&4 toxicity was higher,50%vs.25%.A threshold Mean dose of 63 Gy was identified as a significant parameter above which observed Gr 3/4 toxicity was 33%(P value=0.028).The maximum dose to the base of tongue(BOT)and Superior constrictor(SC)were dosimetric parameters which achieved significance(P value=0.013&0.005).There was no difference in the dose delivered to DARS between 3DCRT and IMRT.However,the patient reported Dysphagia scores were higher for pain(P=0.0014)in the 3DCRT cohort and can be attributed to a higher percentage of patients exceeding Parotid tolerance(70%vs.40%).The impact of Gr 3/4 toxicity on all aspects of quality of life parameters were significantly impaired with maximum compromise on late chewing,swallowing and general perception of well-being(P value=0.001).Conclusion:This suggests that a threshold mean dose(MD)of 63 Gy to the constrictors is statistically correlated to significant Gr 3/4 late toxicity.The high doses to the BOT and SC independently contribute to late toxicity.IMRT is more efficient in reducing severe late toxicity with a better patient reported quality of life parameters and should be the preferred treatment of choice.

Target Delineation in High-grade Glioma Do CTV Margins Make a Difference? ESTRO ACROP versus RTOG Guidelines a Comparative Dosimetric Study

Background and purpose:There exist two major consensus guidelines for target delineation in glioblastoma(GBM).Namely the established radiation therapy oncology group(RTOG)and the recently redefined European society for radiation oncology(EORTC)-advisory committee on radiation oncology practice(ACROP),clinical studies evaluating the pattern of recurrence with relation to the CTV margins have as of date not evidenced statistically significant difference in relation to the two guidelines.However,considering the standardization of concurrent chemo-radiation with Temozolomide nearly 20%off patients can be expected to survive 2years or beyond.Quality of life issues will play a higher role in defining the better protocol.In the current study,we have dosimetrically compared these guidelines in both perspectives.Material and methods:Thirty patients of GBM who had been planned for conformal radiotherapy during Jan 2017 to Feb 2019 were considered.Each patient dataset contoured with ESTRO-ACROP guidelines to create PLAN A and RTOG guidelines to create PLAN B.Both plans were compared to evaluate the volumetric difference in terms of PTV and the relative proximity to critical normal structures.Results:The median volume of brain irradiated to high doses(60Gy)was significantly greater in PLAN B,566cc vs 398 cc(P<0.0002).The organs at risk were better spared with PLAN A in terms of encroachment of high dose PTV volume.This achieved significance for Brainstem(P<0.01),Chiasma(P<0.04)and hippocampus(P<0.016).We were able to identify patients with PTV volume>400cc and with tumor in Parietal or Temporal regions wouldn’t benefit from PLAN A.Conclusion:The use of target delineation based on a single step plan,excluding expanded edema(ESTRO-ACROP)could potentially reduce high dose target volumes and significantly spare brainstem,optic-chiasma,and hippocampus.Patients with tumor volume<400 cc and frontal lesions are most likely to benefit.