I had been thinking about following points of discussion:
1) Altered Fractionation is not feasible in India for one major reason- logistics. Although, I'd love to dedicate a single machine solely for this purpose.
2) There is a compelling rationale for combining bioreductive drugs with Radiation most suitably Tirapazamine which undergoes activation under hypoxic conditions and whereby it is lethal at the same time. Unfortunately, the recently concluded Phase III trial with the same drug and XRT in head and neck failed to show any conclusive benefit. (http://www.ncbi.nlm.nih.gov/pubmed/20479425). I don't have access to full length article in JCO so would not be able to comment on it's merits or demerits.
3) Is there ANY case for combining the two drugs- Nimorazole and Tirapazamine since both of them have DIFFERENT mechanisms of action? I am not aware of any such thought process though.
4) Since hypoxia is a known marker for aggressiveness of tumor including it's metastatic potential, should the future trials incorporate "metastasis free survival" as one of the end points (although I am not sure how would it really impact another metric of "overall survival").
5) Chemoradiation is a fancy concept, in my opinion, but unfortunately, as mentioned above, it is the "standard" that needs to be addressed before it can be claimed that Nimo/Tira combination or alone with altered fractionation is definitely superior in terms of improving survival.
@ Santam Sir. I have been experimenting with my new toy having Android. It's awesome concept; brilliant execution. That has been keeping me away from here :-( but not for long!
