Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 24058

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 249 - 251

The Role Of Oxidative Stress And The Effect Of Radiotherapy On The Plasma Oxidant-Antioxidant Status In Head And Neck Cancer

MALATHI M, VIJAY M, SHIVASHANKARA A R

Dept of Biochemistry, Father Muller Medical College and Hospital, Mangalore-575002; Karnataka, India.

Correspondence Address :
Dr. Malathi M., Professor of Biochemistry, Father Muller Medical
College and Hospital, Mangalore-575002; Karnataka, India.
E-mail : malathi.mala@hotmail.com
Phone : 0824 2238255, 9480229866.

Abstract

Objectives: The present study was aimed to assess the oxidantantioxidant status in head and neck cancer patients before and after radiotherapy.

Methods: The subjects comprised of patients who had visited the Oncology Department and were diagnosed of head and neck cancer. The plasma levels of malondialdehyde (MDA), the marker of lipid peroxidation, and the antioxidants, superoxide dismutase (SOD), vitamin A, vitamin C and ceruloplasmin, were assayed before and after radiotherapy, in comparison to the healthy controls.

Results: The plasma levels of MDA were higher and the levels of SOD, vitamin A, vitamin C and ceruloplasmin were lower inthe head and neck cancer patients as compared to those in the healthy controls. These parameters showed significant changes after radiotherapy, as indicated by a lower level of MDA and higher levels of SOD, vitamin A, vitamin C and ceruloplasmin in the plasma of the cancer patients after radiotherapy, as compared to the plasma levels before radiotherapy. All the results were statistically significant (P < 0.001).

Conclusions: Radiotherapy caused a reduction in the lipid peroxidation and an improvement in the antioxidant status of the head and neck cancer patients.

Keywords

Antioxidants, Head and Neck Cancer, Lipid Peroxidation, Oxidative Stress

How to cite this article :

MALATHI M, VIJAY M, SHIVASHANKARA A R. THE ROLE OF OXIDATIVE STRESS AND THE EFFECT OF RADIOTHERAPY ON THE PLASMA OXIDANT-ANTIOXIDANT STATUS IN HEAD AND NECK CANCER. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Apr 19 ]; 5:249-251. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=249-251&id=1240

Cancer is the second leading cause of death worldwide. Eleven million new cases of cancer are diagnosed every year (1). It is estimated that there are approximately 2-2.5 million cases of cancer in India at any given point of time, with around 700,000 new cases being detected every year (2). Cancers of the head and neck include cancers of the buccal cavity, the head and neck subset, the larynx, pharynx, thyroid, the salivary glands, and the nose/nasal passages. Head and neck cancers account for approximately 6 percent of all the malignancies in the United States, and over one third of all the cancers in India (3), (4). It is the sixth common cause of death in males and the seventh in females (3). India also has the dubious distinction of having the world’s highest reported incidence of head and neck neoplasia in women. The disproportionately higher prevalence of head and neck cancers with respect to other malignancies in India may be due to the use of tobacco in various forms, the consumption of alcohol and a low socioeconomic condition which is related to poor hygiene, a poor diet or infections of viral origin (4).

Free radicals are implicated in the pathogenesis of a multistage process of carcinogenesis. They are proposed to cause DNA base alterations, strand breaks, damage to the tumour suppressor genes and an enhanced expression of the proto-oncogenes [5 -8]. The burst of the reactive oxygen species (ROS) and the reactive nitrogen species (RNS) has been implicated in the development of cancer. Increased levels of lipid hydroperoxide, MDA and nitric oxide and decreased levels of the antioxidants, catalase, SOD, glutathione peroxidase, vitamin C and vitamin E, in blood and tissues, have been reported in head and neck cancer patients (9)(10)(11)(12)(13)(14)(15)
Radiotherapy is a cornerstone in the treatment of head and neck cancer. Ionic irradiation exposes all cells in the involved field to highlevels of oxidative stress, thus resulting in the formation of ROS, increasing DNA damage and ultimately leading to cell death (16). Another mechanism of the action of radiotherapy is to alter cellular homeostasis, thus modifying the signal transduction pathways and predisposing to apoptosis (16). However, there are conflicting reports on the effect of radiotherapy on oxidative stress. Some studies have reported increased oxidative stress after radiotherapy (17), (18) while others have reported decreased oxidative stress after radiotherapy in cancer patients (18), (19), (20). These studies have shown varied responses of the individual antioxidants to radiotherapy.

The present study was taken up with a view of the paucity of Indian studies on the effects of radiotherapy on the oxidant-antioxidant status in cancer and the existing lacunae in the field of oxidative stress biomarkers of cancer. We assessed MDA, the marker of lipid peroxidation, and the antioxidants, SOD, vitamin A, vitamin C and ceruloplasmin, in the blood of head and neck cancer patients, before and after radiotherapy.

Material and Methods

Source of Data: The study was carried out at the Father Muller Medical College and Hospital, Mangalore. The study protocol was approved by the Institutional Ethics Committee. The subjects comprised of fifty patients who had visited the Oncology Department and were diagnosed of head and neck cancer, based on clinical examination and histopathological studies; they ranged in ages from 30 to 80 years (Group-1A). The same patients were then followed up after they underwent a radiotherapy regimen for six weeks (Group-1B). Fifty, age- and sex-matched, apparently healthy volunteers were included as controls in the study (Group-2). Patients with cancer in regions other than the head and neck, anysystemic diseases and infections, and alcoholics, smokers and tobacco chewers without diagnosed cancer, were excluded from the study. A detailed history of the habits (smoking, alcohol abuse and tobacco chewing), chronic illness and clinical history, was collected from the subjects. Informed consent was obtained from all the participants.

Assays: Six ml. of blood was collected in an EDTA tube by taking aseptic precautions, and this was centrifuged at 3000 rpm to separate the cells and plasma. The plasma was analyzed for the levels of MDA, vitamin A, vitamin C and ceruloplasmin, and the activity of SOD. MDA, the sensitive and convenient marker of lipid peroxidation, was estimated as thiobarbituric acid-reactive substances (21). The plasma levels of vitamin A (retinol) were assayed after extraction into heptane and by then measuring the absorbance at 327 nm (22). The measurement of vitamin C (ascorbic acid) was based on the oxidation of ascorbic acid to dehydroascorbic acid, which on treating with 2,4 dinitrophenyl hydrazine in an acidic medium, formed a red coloured bishydrazone (23). The ceruloplasmin levels were estimated, based on the oxidation of p-phenylene diamine, the colour intensity of which was measured at 530 nm (24). SOD was estimated as super oxide anions are involved in the auto oxidation of pyrogallol at an alkaline pH of 8.5. SOD inhibits the auto oxidation of pyrogallol, which can be determined as an increase in its absorbance at 420nm (25).

Statistical Analysis: The results were evaluated by employing the unpaired “t” test, the paired “t” test and the Chi- square test.

Results

In a total of fifty patients with head and neck cancer, the major anatomical sites of the carcinoma were the tongue (n=13), the oropharynx (n=6) and the hypopharynx (n=4). The remaining sites with a lesser incidence were the buccal mucosa (n=3), the mandible (n=3), the cheek (n=3), the nasopharynx (n=3), the pyriform fossa (n=3), the maxilla (n=3) the vocalcord (n=3), and one each in the floor of the mouth, the supraglotis, the pharynx, the post cricoids, the retromandibular trigone and the right maxillary antrum. The results of the present study are presented in (Table/Fig 1).

* One unit of SOD is defined as the amount of enzyme required to cause 50% inhibition of pyrogallol auto-oxidation. ** Significance of difference of the value when compared to controls, P < 0.001 (Highly significant) *** Significance of difference of the value when compared to before radiotherapy, P < 0.001 (Highly significant)The plasma levels of malondialdehyde were higher and the levels of superoxide dismutase, vitamin A, vitamin C and ceruloplasmin were lower in the head and neck cancer patients (Group-1A.), as compared to those in the controls (Group-2). These parameters showed significant changes after radiotherapy, as indicated by lower levels of MDA and higher levels of SOD, vitamin A, vitamin C and ceruloplasmin in the plasma of cancer patients after radiotherapy (Group-1B), as compared to the plasma levels before radiotherapy (Group-1A). All the results were statistically significant (P < 0.001).

Discussion

The present study revealed increased lipid peroxidation and lowered levels of antioxidants in the head and neck cancer patients. The levels of MDA, the marker of lipid peroxidation, were higher almost by 4-fold in the cancer patients as compared to the controls. The levels of the antioxidants, SOD, vitamin C, vitamin A and ceruloplasmin, were decreased in the head and neck cancer patients. This suggests an increased oxidative stress being involved in the pathogenesis of head and neck cancer.

Previous studies have reported increased blood levels of lipid peroxides and MDA, and decreased blood levels of antioxidants in head and neck cancers [8-15]. Red blood cell membranes are more prone to lipid peroxidation because of their high polyunsaturated fatty acid content and their direct exposure to molecular oxygen and haemoglobin. The compensatory mechanism to counter the ROS results in reduced levels or activities of enzymatic and non-enzymatic antioxidants in blood.

Radiotherapy is the major form of treatment which is available for head and neck cancer. Studies have shown varied findings with respect to the effect of radiotherapy on the oxidant-antioxidant status. Some authors have observed increased oxidative stress after radiotherapy and have suggested that radiation-induced free radicals cause oxidative damage to biomolecules (17), (18), (26). The authors advocating increased oxidative stress in radiotherapy have shown from their studies, that supplementation with antioxidants such as alpha-tocopherol ameliorates the oxidative damage caused by radiotherapy (26). Chitra and Shyamaladevi (26) observed a significant decrease in the malondialdehyde levels and an increase in the activities of antioxidant enzymes in oral cancer patients who were supplemented with alpha-tocopherol during radiotherapy, as compared to radiation-treated oral cancer patients without alpha-tocopherol supplementation.

Studies have shown decreased lipid peroxidation and increased activities of antioxidants after radiotherapy (18), (19), (20). The findings from our study also suggest the amelioration of oxidative stress by radiotherapy, as indicated by decreased MDA levels, and increased levels of SOD, vitamin C, vitamin A and ceruloplasmin in head and neck cancer patients after radiotherapy. Kasapovic et al. (18) proposed that the response to radiotherapy involves the age-related impairment of the antioxidant capacity for the elimination of free radicals, thus causing oxidative damage to the blood cells. They suggested that the cytotoxic effects of radiation on the healthy tissues might be more pronounced during the aging process. In concordance with our study, some researchers have observed increased blood levels of SOD, catalase, glutathione reductase, ceruloplasmin and glutathione in post-radiotherapy cancer patients (18), (19), (20).

Conclusion

The involvement of oxidative stress in head and neck cancer is evident from increased lipid peroxidation and decreased levels of antioxidants in plasma. Radiotherapy caused a reduction in lipid peroxidation and an improvement in the antioxidant status of head and neck cancer patients. Though the levels of antioxidants in plasma did not reach the control values in the post-radiotherapy scenario in cancer patients, the improvement in the antioxidant capacity was of vital importance for survival and for an improved quality of life ofthe radiation-treated patients. Further studies with a larger sample size, different stages of head and neck cancer and assessment of the effect of antioxidant supplementation before and during the radiotherapy regimen, are needed.

Acknowledgement

The authors are indebted to the Director, the Administrators and the Dean and the Chief of the Medical Services, Father Muller Medical College and Hospital, Mangalore, for their support and encouragement and for providing the required infrastructure

References

1.
Park K. Park’s Text Book of Preventive and Social Medicine, 19th edition, M/s B. Bhanot; 2007: 313 – 15.
2.
National Cancer Registry Programme. Annual Report. ICMR; 2005;776.
3.
Bhattacharjee A, Chakraborty A, Purkaystha P . Prevalence of head and neck cancers in the North East -an institutional study. Indian J Otolaryngol Head Neck Surg 2006; 58 :15-19.
4.
Mehrotra R, Singh M, Gupta RK, Singh M, Kapoor AK. Trends of prevalence and pathological spectrum of head and neck cancers in North India. Indian J Cancer 2005;42:89-93
5.
Cerutti PA. Oxy-radicals and cancer. Lancet 1994; 344: 862-63.
6.
Gonalez RA. Free radicals, oxidative stress and DNA metabolism in human cancer. Cancer Invest 1999; 17: 376-77.
7.
Irshad M, Chaudhuri PS. Oxidants, antioxidants and carcinogenesis. Indian J Exp Biol 2002; 40: 1213-32.
8.
Patel BP, Rawal UM, Raval RM, Shukla SN, Patel PS. Tobacco, antioxidant enzymes, oxidative stress and genetic susceptibility in oral cancer. Am J Clin Oncol 2008; 31 : 454-59.
9.
Halliwell B. Oxidative stress and cancer: have we moved forward? Biochem J. 2007;401:1–11
10.
Rasheed MH, Beevi SS, Armugam G, Brennan PA. Enhanced lipid peroxidation and nitric oxide products with deranged antioxidant status in patients with head and neck squamous cell carcinoma. Oral Oncology 2007; 43:333-38.
11.
Sultan Beevi S S , Hassannal Rasheed AM, Geetha A. Evaluation of oxidative stress and nitric oxide levels in patients with oral cavity cancer. Jap J Clin Oncol 2004; 34 : 379-85.
12.
Manoharan S, Kolanjappan K, Suresh K, Panjamurthy K. Lipid peroxidation and antioxidant status in patients with oral squamous cell carcinoma. Indian J Med Res 2005; 122 : 529-34.
13.
Stich HF, Anders F. The involvement of reactive oxygen species in oral cancer of betelquid-tobacco chewers. Mutation Res 1989; 214 : 47-61.
14.
Nisha, Sachdeva A, Lal H. Some oxidative stress related parameters in patients with head and neck carcinoma. Indian J Clin Biochem 2008; 23:38-40.
15.
Khanna R, Thapa PB, Khanna HD, Khanna S, Khanna AK, Shukla HS. Lipid peroxidation and antioxidant enzyme status in oral carcinoma patients. Kathmandu University Medical Journal 2005; 3: 334-39.
16.
Sakhi AK, Russnes KM, Thoresen M, Bastani NE, Karlsen A, Smeland S, Blomhoff R. Pre-radiotherapy plasma carotenoids and markers of oxidative stress are associated with survival in head and neck squamous cell carcinoma patients: a prospective study. BMC Cancer 2009;9:458-62.
17.
Sabitha KE, Shyamaladevi CS. Oxidant and antioxidant activity changes in patients with oral cancer and treated with radiotherapy. Oral Oncol 1999; 35: 272-77.
18.
Kasapovic J, Pejic S, Todorovic A, Stojilkovic V, Radosevic-Jelic L, Pajovic. Antioxidant status in breast cancer patients of different ages after radiotherapy. Arch Biol Sci Belgrade 2009; 61: 23-8.
19.
Gupta A, Bhatt MLB, Misra MK. Assessment of free radical-mediated damage in head and neck squamous cell carcinoma patients and after treatment with radiotherapy. Indian J Biochem Biophys 2010; 47: 96-99.
20.
Cartmel B, Bowen D, Ross D, Johnson E, Mayne ST. A randomized trial of an intervention to increase fruit and vegetable intake in curatively treated patients with early-stage of head and neck cancer. Cancer Epidemiol Biomarkers Prev 2005; 14: 2848-54.
21.
Ohkawa H, Ohishi N, Yagi K. Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem. 1979; 95:351-58.
22.
Bessey OA, Lowry OH, Brock MJ, Lopez JA. The determination of vitamin A and carotene in small quantities of blood serum. J Biochem 1946:166-77.
23.
Omaye ST, Turnbull JD, Sauberlieh HE. Selected methods for the determination of ascorbic acid in animal cells, tissues and fluids. In Methods Enzymol 1979;62: 3-8.
24.
Sundrman FW, Nomoto S. Measurement of human serum ceruloplasmin by its p-phenylenediamine oxidase activity. Clinical Chemistry 1970; 16: 903-9.
25.
Nandi A, Chatterjee IB. Assay of superoxide dismutase in animal tissues. J Biosci 1988; 13: 305-15.
26.
Chitra S, Shyamaladevi CS. Effect of α-tocopherol on pro-oxidant and antioxidant enzyme status in radiation-treated oral squamous cell carcinoma. Indian J Med Sci 2008; 62: 141-148.

Tables and Figures
[Table / Fig - 1]
DOI and Others

JCDR/2011/1240

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com