Objective: The objective of the present study is to see the feasibility, tolerability and superiority of concomitant boost technique (CBT) over conventional radiotherapy (RT) in advanced head and neck carcinoma. In CBT, a second daily treatment is given at a gap of 4-6 hrs to the small field, which includes only the primary lesion and the adjacent clinically palpable lymph nodes. The main advantage of CBT is that there is very minimal enhancement in acute reactions as compared to other accelerated fractionation regimens and another advantage is that it shortens the total treatment duration from seven weeks to five weeks. The boost dose can be delivered either in the beginning, in the end or throughout the treatment. In this study, the boost dose was given at the beginning. Materials and Methods: This study included a total of 80 patients with advanced (TNM stage III and IV) carcinomas of oral cavity and oropharynx registered in the Department of Radiotherapy, KGMC, Lucknow between Jan 1999 and Feb 2000. All patients eligible for the study were divided into two groups. Group I received radiotherapy in the form of CBT and Group II received conventional RT. A total of 70 Gys were delivered to both groups, with compensators and head fixing devices. All patients were assessed weekly and were called after one month of completion of treatment to see the response. Results: Out of 40 patients, in Group I, 30 patients (75%) and in Group II, 24 patients (60%) had complete response (CR) and the rest of the patients had partial response except for one patient in Group II who had no response (NR). Acute reactions were slightly higher in Group I and were easily managed by IVF support. The median duration of follow up was 14 months (range 6-18 months). Out of those showing CR, four patients in Group I and seven patients in Group II have shown recurrence till now at a median duration of eight months and six months respectively. There was no difference in late reactions in both groups. Conclusion: To conclude, CBT is easily tolerated by patients, with slight enhancement in acute reactions and so far has given much better results as compared to conventional RT alone.

Objective: To assess the role of CT in the diagnosis of descending necrotizing mediastinitis (DNM). Materials and Methods: Fifteen patients were examined with CT of the neck and chest to evaluate the extension of infection in the mediastinum and to help in planning a surgical approach. Results: In every patient, the CT scan confirmed the diagnosis of DNM displaying cervical abscess or cellulitis with emphysema associated with diffuse mediastinitis or mediastinal collections such as empyema thoracis, pneumomediastinum or pericardial effusion. Conclusion: Early CT diagnosis of DNM helps us in deciding the appropriate early surgical approach, whereby the mortality rate could be considerably lowered