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Year : 2018  |  Volume : 14  |  Issue : 11  |  Page : 928-936


Date of Web Publication29-Nov-2018

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How to cite this article:
. Miscellaneous. J Can Res Ther 2018;14, Suppl S4:928-36

How to cite this URL:
. Miscellaneous. J Can Res Ther [serial online] 2018 [cited 2019 Nov 19];14:928-36. Available from: http://www.cancerjournal.net/text.asp?2018/14/11/928/246379

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Pattern of occurrence of dual malignancies: Our institute experience

Debanjan Sikdar, Manoj Gupta, Rajesh Pasricha, Deepa Joseph, Sweety Gupta

Department of Radiaition Oncology, AIIMS, Rishikesh, Uttarakhand, India

Aims and Objectives: Single institute based study of incidence and pattern of occurrence of synchronous and metachronous dual primary malignancies. Materials and Methods: Retrospective analysis of the patient data was done at the Department of Radiation oncology at AIIMS Rishikesh from January 2018 to August 2018. Total 1550 new registered cases till August 2018 were reviewed and patients with dual / second primary malignancies were identified. 20 patients with dual primary malignancy were identified Their pattern of occurrence, clinical presentation and treatment were evaluated. Results: Out of 20 patients Male to female ratio was 3:1. In primary index malignancies head and neck were 5(25%) followed by lung and genitourinary malignancies each 3(15%). 2 patients(10%) were of hematolymphoid malignancy. Head and neck, breast, lung and GI were reported to be the common site of second primary malignancy accounting for 4 (20%) of each cases. Head and neck to aero digestive tract second primary was seen in 5(25%) of patients, also breast as second primary in index breast malignancy was seen in 2 (10%) patients. Conclusion: Second primary malignancy is a known entity in todays practice with the incidence going as high as 17 % on longer follow ups. In a known case of malignancy the possibility of a second primary tumor must always be kept in mind. This warrants a strong clinical suspicion and a complete thorough/meticulous workup in all the patients registered with any malignancy irrespective of the site and stage of the index malignancy before labelling the new disease as metastatic.

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Role of radiotherapy in the treatment of pigmented villonodular synovitis

Sai Madhuri Chennareddy, Pidatala Premkumar, Kalluri Subrahmaniyam, M. Vidya, A. Kiran Kumar, N. Madhavi, L. Yugandhar Sarma

Aims/Objectives: The aim of this study is to evaluate the effectiveness and long-term outcome of patients with diffuse pigmented villonodular synovitis (PVNS) treated with combined surgery and radiotherapy. Background: Pigmented Villonodular Synovitis (PVNS) is a rare proliferative disorder of the synovium affecting any joint but frequently found in the knee. PVNS occurs in two forms: focal lesions, usually called tenosynovial giant cell tumor (TGCT), and a diffuse form. Both are morphologically and biologically similar, but diffuse PVNS is clinically aggressive and has the tendency for local recurrence but not metastatic potential. The primary treatment is surgical removal but complete resection may be difficult due to the diffuse nature of the disease with relapse rates for surgery alone ranging from 8% to 56% depending on the resection status. External beam radiation is used as adjuvant treatment to prevent local recurrence and improve local control. There are only few publications that deal with total dose of radiotherapy for treatment of diffuse PVNS (20 to 50 Gy). Since PVNS is still a benign disorder, the use of even low-moderate dose radiotherapy should be considered with caution. Materials and Methods: Two patients diagnosed with diffuse PVNS in the knee by clinical and magnetic resonance imaging were treated with open synovectomy. In view of residual disease, both of them received adjuvant post-operative external beam radiation therapy using three dimensional conformal radiotherapy (3DCRT) technique. PTV includes whole synovial space and residual lesion plus 5mm margin. Dose prescribed was 3,600cGy in 18 fractions @ 200cGy/F over 3 weeks with 6MV photon beam. These patients were followed at regular intervals using clinical assessment, plain x-ray and magnetic resonance imaging. Results: First patient was followed up for 3 years and second one for 6 months, neither evidence of disease recurrence nor progression of bone or articular destruction was noted. No complications were noted after postoperative external beam radiotherapy. Conclusions: A combination of total or subtotal synovectomy with adjuvant post-operative external beam radiation therapy for diffuse PVNS with incomplete resection is a reliable treatment method, with good results in regard to the incidence of local recurrence and functional outcome.

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Prevalence of depression and anxiety among cancer patients in small town in India: Single Centre study

Anu Tiwari, D. K. Mondal, Zehra Fatima, R. K. Agarwal

Royal Cancer Institute and Research Centre, Kanpur, Uttar Pradesh, India

Background: Depression and anxiety in cancer patients is a common comorbidity, therefore can deteriorate ones' Quality of Life. HADS is a reliable instrument used to asses these psychological issues. To assess the predominance of depression and anxiety, this research was conducted. Methods: From 2011 patients who are coming for regular follow-up and they were screened and found that there were no metastasis or reoccurrence among them. 181 patients were screened in a single institution with the advanced disease in Kanpur, India. Patients scheduled to undergo treatment for advanced stage of malignancy of any site, age<18, had stamina for interview, Hindi or English speaking, qualified interviewer administered the interview with the help of HADS. The questionnaire had 4 pointer scale for 14 items, which were further divided in Depression and Anxiety scale. Score between 0-7 were clinical normal, 8-10 were mild and 11-21 were clinical anxious and depressed. Results: Among 181 patients, 60% needed psychological and/or psycho-pharmacological intervention as they were highly depressed, the patients which were 40%. While on Anxiety Scale 82% were either highly /mildly anxious, thus only 18% were normal. 28% of the female had depression and 38% had anxiety. On the other hand, 28% of male had depression and 51% had anxiety. Conclusion: The research showed that most of the patients needed psychological and/or psycho-pharmacological intervention. Despite the completion of the treatment most of the patients experienced maladjustment or sub-clinical psychological issues.

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Radiotherapy treatment plan delivering more than 60Gy in locally advanced carcinoma vulva

Blossom Chacko1, Susan Mathews1, V. S. Shaiju2

1Department of Radiation Oncology,2 Division of Radiation Physics, Regional Cancer Centre Trivandrum, Trivandrum, Kerala, India

Vulvar carcinoma accounts for less than 5% of gynecological malignancies. Concurrent Chemoradiation is an alternative to radical surgery in locally advanced vulvar Carcinoma. With the commonly used radiation technique, it is often impossible to deliver 60Gy to the vulval region because of grade 3-4 skin reactions. We report how a cumulative dose of >60Gy equivalent could be delivered without exceeding the skin tolerance in locally advanced Vulvar Carcinoma. A 75 year old lady, presented with vulval growth and groin swellings of 2 months duration. On examination 4 x 3.5cm proliferative lesion was seen replacing the clitoris, involving both labia. The lesion was seen reaching urethral meatus without bone fixity along with bilateral inguinal lymphadenopathy - 5x3 cm nodal mass on left and two on right side 3x2cm and 2x2cm. Punch biopsy from the lesion revealed moderately differentiated squamous cell carcinoma. CT scan showed an enhancing lesion 6.7 x 2.1cm in vulva with bilateral bulky inguinal lymph nodes and right external iliac nodal mass 4.3 x 1.7cm. As the surgeon has not considered radical surgery, she was referred for Radical Concurrent Chemoradiation. Treatment Plan CT Simulation was done with patient in supine position, thighs were kept maximally abducted with custom made separator between the knees. CT images (5mm slice thickness) were transferred to Eclipse V13.7 planning system. The target volumes include Vulval Primary- Gross tumour volume(GTV), Clinical target volume(CTV), Planning target volume(PTV). Inguinal lymph nodes- GTV, CTV. Pelvic Lymph nodes- GTV, CTV. Dose Prescription 60Gy in 25 fractions with the planning goals- 60Gy to GTV Primary, 55Gy to GTV lymph nodes, 50Gy to CTV LN (EI & Inguinal) and 45 Gy to upper pelvic lymph nodes. Planning Steps: (1) AP-PA fields. Anterior from L4-5 level covering bilateral inguinal regions. Posterior from L4-5 level but till the level of acetabular roof. Dose- 45Gy in 25 Fractions prescribed to mid pelvis with 15MV photons. (2) The dose already received at the depth of inguinal nodes from AP-PA fields was recorded. Additional dose needed for 50-55Gy was then delivered through an anterior field, the upper limit matched onto the lower limit of the 45Gy posterior field. 25Gy in 25 fractions delivered as an integrated boost of 100cGy per fraction daily to the external iliac and inguinal lymph nodes. (3) Finally the dose deficit at primary GTV was calculated (7.5Gy) and was delivered in 25 fractions using small AP-PA fields; predominantly through posterior field (0.3:1). This helped in reducing the excessive dose to anterior subcutaneous tissue. The treatment was delivered over 5 weeks without interruption. She received 4 doses of concurrent weekly Cisplatin. She had patchy grade 3 skin toxicity towards the end of treatment which subsided with topical steroids and antibiotics. She achieved complete remission both nodal and local sites and continues to be disease free 2 years after treatment with acceptable morbidity (edema and subcutaneous fibrosis over mons pubis).

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An essay on social media footprint by radiation oncology societies

Biplab Sarkar, Anusheel Munshi, T. Ganesh, A. Manikandan, B. K. Mohanti

Manipal Hospitals, Dwarka, New Delhi, India

Aim: This study was design to access the social media footprint of the radiation oncologist and radiation oncologist societies. Materials and Methods: A period of 5 months (28.01.2018-28.06.2018) was arbitrarily chosen for evaluation of social media (Facebook and tweeter) presence by two primer radiation oncology community ASTRO and ESTRO. Results: ASTRO appeared 82 times in FB in the said time frame with total likes and share of 1841 and 645 respectively; average like/post and share /post were 22.5 and 7.8 respectively. Out of these 81 posts 24 posts (29.6%) attributes to one of its journals. ASTRO tweeted 450 times in the said period of time; with a mean re-tweet/hit and like/hit is 6.6 and 11.6 respectively. Out of this 450 tweets only 13 (2.9%) tweets which include a hash tag of Red Journal (# RedJournal), Advances in Radiation oncology (#AdvancedRO) and Practical Radiation Oncology (#PRO) either in combination or independently. Nevertheless none of these 13 tweets contain any scientific information except one about the new issue alert. Although Red Journal having an independent tweeter handle which was used only six times in the specified time window which is 1.3% to that of ASTRO tweets. The FB and tweeter posts of ASTRO were leaded by the ROI (Radiation Oncology Institute) and #ASTROadvocacy respectively. ESTRO tweeted 234 times, out of which 12 posts were scientific, with 3 post each for Green journal, ctRO, TipsRO, and two posts for PhiRO. ESTRO appeared 166 times in FB out of which 21 posts were scientific. Green journal, ctRO, Phiro and TipsRO were 4, 6, 6 and 4 times respectively. Average likes and share per FB post is 25.2 and 5.9 respectively. Among all the posts from ESTRO, Green journal FB posts shows highest average like of 157/post and share of 77/post. Nevertheless annual meetings like ASTRO16 (2016) created more than 4400 tweets were exchanged and generated 13 million views over the Internet, which was an increase of 270% from the Society's previous Annual Meeting. Similarly ESTRO 37Th has generated 8819 tweets from 1505 participants (average tweet/hr-22 and average tweet/perticipents-6) creating 20.4 million views. Conclusion: Radiation oncology societies are and their scientific attributes are very feebly present in the social media. Comparing individual to society social media hits and less number of journal related or scientific posts (2.9% - ≈10%) compared to other non-scientific posts; it's evident that the societies, are reluctant on providing sufficient scientific information in social media. Social media should be effectively utilised by the scientific community, especially for those subject which having a mass appeal like cancer having two prominent reasons. First communicating general information about cancer to the society by the cancer society and second, propagating scientific information to the professionals by the journals, which is presently seriously overlooked. Only large number of temporally congested tweets during annual meeting may not sufficient to yield a proper scientific information being propagated to the information seeker and netizens.

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A comparative study of efficacy and adverse effects of oral morphine and transdermal buprenorphine for management of cancer related pain

Rina Barman, Rajat Bandyopadhyay, Sourav Sau, Premnath Dutta, Biswamit Bhattacharya, Pradip Kumar Maiti

Aims/Objective: Primary Aim: To compare the efficacy in relieving cancer related pain in two groups: Oral morphine group (Group A) and Transdermal Buprenorphine Group (Group B). Secondary Aim: To compare the incidence of constipation, nausea, vomiting, somnolence and respiratory depression between two groups. Methods: A prospective observational study was conducted from January, 2018 to August, 2018 at Department of Radiotherapy, Burdwan Medical College & Hospital, West Bengal, among patients having inoperable, locally recurrent or metastatic carcinoma of different sites. We have excluded patients aged below 18 years, unable to or not willing to give consent, having known severe cardiac, renal and respiratory co-morbidities and patients having contraindication for using Morphine or Buprenorphine. Consecutive patients with cancer related pain meeting inclusion criteria were included in two intervention groups alternately. Group A consisting of 30 patients, were given tablet Morphine sulphate (60 mg/ day in divided doses) and Group B consisting of 30 patients, were given Buprenorphine transdermal patch (20 mcg/hour applied over non-hair bearing area of body which was changed weekly) and continued throughout the period of follow up who achieved pain relief score satisfactorily. Patients in both the groups were assessed for pain relief and side effects at 2 weeks and 1 month. Efficacy in relieving pain was measured using visual analogue score (VAS) chart and constipation was defined according to Rome III criteria. Statistical analysis was done using SPSS software (version: 20; Chicago, USA). Results: Both the groups were similar in age (mean, Group A: 47.17±9.77 years and Group B: 46.7±10.35 years; p=0.86) sex (Male: Female, Group A- 18:12 and Group B- 19:11; p=0.79) distribution and pre-treatment VAS score (mean, Group A: 8.47±1.31 and Group B: 8.87±1.11, p=0.21). Majority of patients were having carcinoma of breast, lung, rectum, cervix or oropharyngeal carcinoma. There was no significant difference in mean VAS score at 2 weeks (Group A: 3.3±2.63 and Group B: 4.13±2.78, p=0.24) and at 1 month (Group A: 2.87±2.92 and Group B: 4.17±2.99, p=0.09). Similarly incidence of constipation (Group A: 86.7% vs Group B: 70.0%, p=0.21), nausea (Group A: 60% vs Group B: 50%, p=0.44), vomiting (Group A: 36.4% vs Group B: 20%, p=0.15) and somnolence (Group A: 16.7% vs Group B: 6.7%, p=0.42) during follow-up were not statistically significant. No patient from either group developed respiratory depression. Conclusion: Both oral Morphine sulphate and Buprenorphine transdermal patch have comparable efficacy in controlling cancer related pain with similar incidence in adverse effects with current study doses. Although it was not statistically significant, but oral Morphine group had lower mean VAS score than Buprenorphine transdermal patch group.

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Need of regulatory algorithms for digital platforms and artificial intelligence in oncology

Anil Kumar Dhull, Vivek Kaushal

Aims/Objectives: Cancer is a common disease, with over 100 different types of cancer and their treatment protocols are contingent on a number of factors like age, type, stage, genetic make-up etc. In any case, a cancer diagnosis is scary and stressful, and receiving treatment can also be a challenging, arduous and oftentimes painful experience. As with many other areas of healthcare, digital platforms and artificial intelligence are beginning to alter the way we manage our personal medical care and the field of oncology is no exception. Materials and Methods: Medical errors have become an accepted and unfortunate part of medical care, but clinicians may greatly underestimate how much they contribute to the problem. The average clinician is making a lot of mistakes and in a recent analysis, surprisingly, 99% clinicians fall into this category and only 1% of practicing clinicians are the “master diagnosticians,” Diagnostic errors are the largest cause of lawsuits. The field of oncology is marked by experimental treatments, burgeoning research and exciting clinical therapeutic trials. The technology field has also been busy doing its part to make diagnosing and treating cancer easier by introducing different apps which aren't just for gamers. We explored different top users medical apps for oncologists. Results: There are high number of users of these apps on Android and iOS platforms which includes 5 million for Medscape, 1 million for Epocrates, 1 million for PubMed, 0.5 million for UpToDate, 0.5 million for QxMD, 0.5 million for Mendeley, 0.1 million for PEPID, 0.1 million for Micromedex, 50 thousand for Doximity, 50 thousand for NCCN, 10 thousand for ESMO, 10 thousand for Browzine, 10 thousand for John Hopkins ABX Guidelines, 5 thousand for ASCO etc. These latest applications can keep tech savvy doctors on top of the latest symptoms, diagnosis, and treatment procedures. So oncologists were among the first practitioners to embrace mobile technologies and realize the benefits of incorporating these tools into day to day practice. Some of these tools employ artificial intelligence (AI), which are techniques that enable computers to mimic human behavior, or they use machine learning, a subset of AI that uses statistical methods to enable machines to improve as they solve more problems. The US (FDA) has also approved some AI-based tools for the use of clinicians. Conclusions: As the digital health market continues its rapid expansion, it needs proper regulations, close scrutiny, rigorous testing, and validation, especially when used in diagnosis and treatment. The algorithms on which the technologies are based must undergo thorough peer review and the data ought to be made available in the public domain. Additionally, digital oncology reporting guidelines with effectiveness should be created by robust randomized controlled trials with solid evidence and without any commercial traps. As we enter this new world of digital era, we must not allow ourselves to be dazzled by the exciting technologies suddenly and their role in health care needs careful consideration. This field needs close scrutiny to ensure approved treatment guidelines and above all, does not compromise patient safety.

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Electron beam treatment in management of keloids: A single institute experience

Nivedita Sarkar, Karthik S. Rishi, Prashanta Kesari1, Muddappa Pathikonda, G. V. Giri, Prakash Ramachandra, B. S. Srinath1

Departments of Radiation Oncology and1 Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka, India

Aims/Objectives: Keloids cause cosmetic disfigurement and functional impairment in the region where it develops and can be painful. Treatment of keloid is done when it is symptomatic and causes cosmetic disfigurement. Often the management includes repeated steroidal injections or surgical excision. We present the results of our experience by treating keloidwith post operative electrons. Materials and Methods: All patients with keloid presenting at Sri Shankara Cancer Hospital and Research Centre between May 2014 and May 2018 were included. A total of 24 keloids followingintralesional excision treated with electron beam radiation were analyzed. Post-op radiation was initiated within 24hours of excision in all cases. All patients were planned on 2D electrons with either 4MeV or 6MeV electron energy to a total dose of 20Gy in 5fractions to the post operative scar. Patients were followed up, post treatment, once every 3months. Results: 24keloids treated with electron beam were analyzed. Of the different sites, majority were in the ear and sternum. The median age was 28 years (range 17-65) Majority of patients had previous history of having received multiple treatments in the form of surgery or steroid injections. 19 sites were treated with 4MeV electrons and the remaining with 6MeV electrons. With a median follow-up of 22.5 months, only one patient had local recurrence i.e. nearly 96% (23/24) of the sites had local control and the patients were symptom free. Conclusions: Keloids treated with immediate post operativeradiation by electrons have excellent local control and provides excellent symptom relief.
Table 1

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Preoperative radiation therapy in retroperitoneal sarcoma: A single institution experience

B. Rajkrishna, Kaalindi Singh, Sunitha Susan Varghese, S. Patricia, B. Rajesh, B. Selvamani

Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India

Aim: To evaluate treatment outcomes for patients receiving preoperative radiation therapy in retroperitoneal sarcoma. Materials and Methods: A retrospective review of 8 patients with retroperitoneal sarcoma treated at our centre from 2014 to 2018. All had histological confirmation of diagnosis and all were discussed in multidisciplinary tumor board meeting before the initiation of preoperative radiation therapy. All were treated by conformal radiation therapy. We present the demographic details, radiotherapy details, toxicity profile and surgical outcomes of patients receiving preoperative radiotherapy. Results: The mean age of the study cohort was 51 years (26-72 years). One half of them had T4 disease. The mean tumour size was 14.74cm with predominant histology being Liposarcoma. Recurrent well differentiated and dedifferentiated liposarcomas were equal in numbers. The mean GTV and PTV volumes were 1930.78cc and 3842.4cc respectively. Mean dose was 45.45 Gy and the mean target volume coverage (D95) was 96.8%. All the OAR doses were within tolerance limits. Two patients developed acute RTOG grade 2 and 3 gastrointestinal toxicity while on treatment. Seven patients underwent surgery and mean interval of surgery from completion of radiation therapy was 8.24 weeks. Two patients had R0 resection, 3 had R1 resection and 2 had R2 resection. One patient had progression after 18 months: 2 had progression after 2 months and 2 progressed after 1 month. Among the 5 patients who progressed, 4 patients had local progression and one patient with Leiomyosarcoma had distant failure after 1 month of surgery. Conclusion: Compartment resection is required to achieve R0 resection. Higher dose of radiation therapy (50.4 Gy) should be considered to the areas which can have high chances of positive margin. Neoadjuvant chemotherapy prior to preoperative radiation therapy for histologies other than Liposarcoma should be studied in future trials to see if it reduces the incidence of distant failures.

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Non-HIV related Kaposi sarcoma: A case series

S. Kundavai, P. S. Sridhar, K. Roopesh, G. H. Abhilash, P. Anuradha, M. Praveenkumar, M. Anusha, Ajaikumar

Aim: To report a case series on non HIV related Kaposi sarcoma in general population. Introduction: Kaposi sarcoma is the disease of the endothelial lining of blood vessels, commonly appearing over the feet, legs or face. Caused by Human Herpes virus-8 (HHV8) infection. Male to female ratio is 3:1. There are 4 variants of Kaposi sarcoma, classical type, endemic type, HIV related and iatrogenic variant. Amercian cancer society has added a fifth variant of Kaposi sarcoma being non HIV associated type. The general treatment comprises of surgical excision and adjuvant chemotherapy with Pegylated Liposomal Doxorubicin with or without radiation to the local site (selected cases). Case Discussion: Case 1: A 75 year old African man had complaints of plaque like lesion in the left leg in 2017. It was surgically excised and histopathology confirmed it to be Kaposi sarcoma. Serology was negative for HIV. Patient was then given 6 cycles of pegylated liposomal doxorubicin, completed 6th cycle in july 2017. Presently patient is on follow up and is free of disease till date. Case 2: 40 years old African male, had complaints of small multiple skin lesions on left ankle since 8 months. He was evaluated with skin biopsy which showed morphological features of a vasoformative lesion consistent with nodular stage Kaposi Sarcoma. Serology was negative for HIV. He underwent Excision Biopsy Post op HPE revealed Kaposi Sarcoma, so he was given adjuvant radiation with electrons to a dose of 30 Gy in 10 fractions in july 2017. Patient is presently on follow up and free of disease till date. Case 3: 36 year old African male presented with edema of right leg for 3 months. Biopsy of one of the skin nodules over the right leg revealed Kaposi sarcoma with HHV8 and CD 31 positive. Serology was negative for HIV. Patient has been started on pegylated liposomal doxorubicin. Planned to assess the patient after 3 cycles for radiation and further cycles of chemotherapy. Conclusion: Kaposi sarcoma is relatively very rare in incidence in comparison to its HIV related counterparts. Even though there are no standard guidelines for treatment in non- HIV related Kaposi sarcoma, the prognosis is good since it is a localized disease.

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Impact of hematological toxicities in treatment response and clinical decision making by a cross sectional study of hematologic toxicities in patients undergoing concurrent chemo-radiotherapy

S. N. JagadeshKumar, N. V. Kalaiyarasi, R. Giridharan, C. Sundaresan, Sanjal Kumar, P. R. Vijey Karthik, N. Poonkodi, Senthil Kumar

Department of Radiotherapy, BIRO, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Aim: To analysis the impact of hematologic toxicities in patients undergoing concurrent chemo-radiotherapy with a key look on treatment response and clinical decision making. Methods: This is a cross sectional study conducted in the Radiotherapy ward of Department of Radiation Oncology, BIRO, Madras medical college. Study period was March –May 2018. The study was to analyze the hematologic toxicities during the course of concurrent chemoradiotherapy for solid malignancies. Baseline Investigations was done and repeated every week during treatment. Results: Majority of the patients had a baseline normal range of the blood counts before the start of treatment. During the course of treatment, many patients had leucopenia followed by anemia and thrombocytopenia. This was analysed with treatment response and protocols and it affected it to a significant way. Decision making was modified for every clinical event. Conclusion: Burden of cancer is increasing day by day in a economically developing country like India. Already the prevalence of anemia and its importance in many conditions like pregnancy have been elucidated and given importance in our healthcare setup. When coming to cancer, in many patients it leads to a interruption in the course of treatment, frequent decision making events and affecting treatment response. Thus the importance of drop in blood counts is elucidated in this study.

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Preoperative RT versus postoperative RT in soft tissue sarcomas

C. Saranya, Kalaiyarasi

Aim: To assess the 5 year survival in soft tissue sarcomas treated with either pre-op RT or post-op rt. to assess the wound complications in the pre-op RT & post-op RT group as a secondary assessment. Materials and Methods: This is a retrospective study conducted in our college between january 2009-2013. records of 40 patients of soft tissue sarcomastreated with curative intent were analysed. 17 patients were treated with pre-op RT,23 patients were treated with post-op RT.age groups of the patients ranged from 16- 60 years. all the tumors were localised to extremities. Results: Eligible patients in both groups were analysed. in pre-op group out of 17 patients who underwent pre-op RT 5 patients presented with poor wound healing(29%). in post-op RT group out 23 patients 3 of them presented with wound complications(13%). in the pre-op RT group 13 patients out of the 17 patients are alive (76%), while 17 patients out of 23 patients in the post OPRT group are alive(73%). Conclusion: This review of soft tissue sarcomas study showed that 5 year survival was slightly better with pre-op RT than post op RT, whereas the wound complications were found to be higher with pre-op RT than post op rt. tumor size & grade of the tumor also played a vital role in the outcome.

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Low dose radiotherapy for symptomatic pulmonary extramedullary hematopoiesis in a case of primary myelofibrosis

Naveen Reddy Gajjala, Siva Sankar Kotne, E. Prahalad, K. V. L. Anusha, P. B. Anand Rao, Chandra Sekhar Darsi, Abhinav Vasireddy

Background: Myelofibrosis with Extramedullary heamatopoiesis, is one of the myeloproliferative syndromes thought to be caused by a clonal proliferation of pleuripotent hematopoietic stem cells. In Myelofibrosis, the bone marrow typically becomes extensively fibrotic, and Extramedullary hematopoiesis (EMH) involves almost any organ/site in the body, most commonly liver, spleen and lymph nodes. It has been infrequently reported in the chest. Case Report: A 51 year old female patient came to our hospital with the diagnosis of Primary myelofibrosis with EMH. Patient had complaints of progressive dyspnoea at rest. Complete history and General examination of the patient was done. Complete blood picture revealed Thrombocytopenia. CT Chest showed bilateral lung masses. Patient was under treatment with Lenolidamide and Prednisolone. She was planned to give low dose fractionated radiotherapy to bilateral lung masses and delivered to a total dose of 180cGY in 12 fractions [15cGY per fraction]. Results: Patient tollerated Radiotherapy well. General condition of the patient was improved and had symptomatic relief after giving low Dose Fractionated RT to bilateral lung masses. Conclusion: Low dose fractionated radiotherapy to lung masses is efficacious in Palliation of symptomatic pulmonary EMH in a case of Primary Myelofibrosis.

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Prognostic evaluation of patients with metastatic spinal tumors treated with palliative radiotherapy using modified Tokuhashi's score

Aiman Mohammed, Monica Irukulla, S. Fayaz Ahmed, Deepthi Valiyaveettil

Introduction: The spine is the most common location for bone metastases. Symptomatic spinal metastasis (SM) afflicts up to 10% of cancer patients. Spinal involvement occurs in up to 40% of patients with cancer during progression of the disease. Tokuhashi's scoring has been used as a pre-surgical tool for prediction of survival in these patients. It evaluates prognostic factors like performance status, number of extra-spinal bone metastasis, metastasis to visceral organs, site of primary and neurological status of the patient. To our knowledge, only limited studies are available to use this scoring system to determine survival outcomes in patients with spinal metastases undergoing palliative radiotherapy. Aim: The purpose of our study was to determine the patient characteristics and usefulness of modified Tokuhashi's score in determining survival in patients with metastatic spinal tumors undergoing radiotherapy. Methods: This is a retrospective study of patients who underwent radiotherapy for spinal metastases from January 2013 to December 2017. Data was collected from the patient records. Overall survival was calculated from the date of diagnosis of spinal metastasis to the date of death or the last follow-up. Statistical analysis was done using EXCEL and SPSS v.20 software. Results: 69 patients with spinal metastasis from solid tumors were included in the study. The male to female ratio was 1.3:1. Median age at diagnosis of spinal metastases was 50 years (range -20 to 73). The most common site of primary cancer was lung (n=26) followed by breast (n=13). The most common region of spinal metastasis was thoracic spine (41%). Spinal metastasis in more than one site was detected in 20 patients (28.9%). 35 patients (50.7 %) developed spinal metastases during the progression of primary and 34 patients (49.2%) had spinal metastasis at presentation. 55% patients had epidural soft tissue component and 68.4 % of these patients had spinal cord compression. 64.2% patients had extra-spinal skeletal metastases and 42.8 % had visceral metastases at presentation. 16% patients were treated with 8 Gy in single fraction, 35% patients received 20 Gy in 10 fractions and 49% patients received 30 Gy in 10 fractions. The median survival was 7 months. The modified Tokuhashi's score ranged from 0 to 13 and the mean score was 6. In our study, 46 belonged to the poor prognostic group (modified Tokuhashi's score 0-8) with a median survival of 4.8 months; 20 belonged to the moderate prognostic group (modified Tokuhashi's score 9-11) with a median survival of 13.5 months and 3 patients belonged to good prognostic group (modified Tokuhashi's score >12) with a median survival of 28 months. There was a statistical significance in the difference in survival in 3 prognostic groups. On univariate analysis, presence of epidural soft tissue component, cord compression and the site of metastases did not affect the survival. Conclusion: Our study confirms the usefulness of modified Tokuhashi's score in determining the survival outcomes in patients with metastatic spinal tumors.

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A comparative prospective study of paclitaxel induced acute pain syndrome, single agent paclitaxel compared to combination of paclitaxel and carboplatin

Abdul Waheed Dar, Sanaullah Kuchay

Objectives: To describe the incidence and characteristics of Paclitaxel induced acute pain syndrome. To assess the change in pain (i.e., P-APS) related to paclitaxel alone or combination of carboplatin. Methods: The Study was a prospective one in which we included the eligible patients scheduled to receive paclitaxel weekly or 3 weekly; alone or in combination with another chemotherapeutic agent Carboplatin. Details regarding acute Pain were collected and evaluated. Results: Majority of patient who developed P-APS, received combination of chemotherapy as compared to patients who received paclitaxel alone. Majority of patients (59.2%) developed onset of PAPS on day 2nd either received paclitaxel alone or combination of chemotherapy, however majority of patients received combination of chemotherapy remained symptomatic for more than 4days. The P-APS was measurement on the basis of scoring provided by LANSS pain scale, majority of patients had pain score of less than 12. As far as nature of pain was concerned, we found that the commonest complaints were pinpricking (37%) and dull (18.6%) rather than burning (14%), numbness (7%). Majority of patient experienced pain in the knees (37%) followed by in lower limbs (22.2%), hand (20%), feet(11%), and 5% in ankle. Conclusion: The incidence and characteristics of pain is related to paclitaxel dose. Subsequent cycles of paclitaxel are having no effect on intensity of pain syndrome. Duration of pain increased by combination of Paclitaxel and carboplatin. Addition of carboplatin contributed chronicity of pain.

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Role of short course radiotherapy in metastatic spinal cord compression-comparative study

P. R. Harish Kumar, N. V. Kalaiyarasi

Madras Medical College, Chennai, Tamil Nadu, India

Aim: To compare the overall response with short course radiation regime with standard regime for metastatic spinal cord compression. Study Design: Results: Primary end point was 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Secondary end point was motor function at 6 months. Conclusion: Motor function response and ambulatory rates were not significantly different from both arms. Further follow-up is needed to confirm if ambulatory rates vary in both arms with course of time. Majority of patients presenting with cord compression have a limited survival and hence a shorter radiation regimen can be used in them.
Table 1

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Table 2

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Table 3

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Malignancy and its effects on different aspects of life of reproductive women: A retrospective study

Sumitavo Ghosh, Kakali Choudhury, Partha Dasgupta, Chandan Dasgupta

Department of Radiotherapy, R.G. Kar Medical College & Hospital, Kolkata, West Bengal, India

Malignancy and reproduction are two strikingly opposite entities in human life. While reproduction means giving birth to a new life, malignancy points towards untimely death, sometimes associated with excruciating pain and utter despair. Malignancy may be detrimental for a female of reproductive age group in multiple aspects, be it physiologically, psychologically, or socially. Objective: The objective of this study was to have an idea about the epidemiological features and treatment outcome of malignancy in women of child bearing age group, which includes females of 15 to 45 years of age. Methods: A retrospective, single institution based study was performed in the Department of Radiotherapy, R.G. Kar Medical College & Hospital, which is a tertiary care hospital situated in Eastern India. The study population included female patients in the age group of 15-45 years attending our Out Patients Department (OPD), from 1st January 2013 to 31st December, 2017. They were analyzed on the basis of epidemiology, disease diagnosis and treatment outcome. Results: the study yielded that approximately 68% of the female patients attending our OPD in the study period belonged to the reproductive age group. Commonest malignancies were of breast followed by cervix. Socio-economic status, parity, nutrition, and mode of diagnosis were also taken into consideration using different scales. Psychological effect of the disease and treatment was also measured using proper scale. Treatment approach were mostly curative with multimodality therapy. However, survival was not always encouraging due to aggressive biology of cancer in this age group. Conclusion: From the study, it could be inferred that the occurrence of malignancy in reproductive age group women is by no means an insignificant one and further studies are needed for proper awareness.

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Analytical report on a prognostic index to estimate Survival for patients with brain metastases

T. Rethinesh Kumar, N. V. Kalaiyarasi, R. Giridharan, Sundereson, Sanjal Kumar, Poonkodi, Vijey Karthick, Senthil Kumaran

Department of Radiation Oncology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Introduction: Brain metastasis is very common, with an annual incidence of approximately 170,000 to 200,000. The rising incidence of brain metastasis is most likely from a combination of increasing survival from recent advances in systemic therapy and a greater availability and use of imaging techniques. Objective: To analysis and report a Prognostic Index, based on the prognostic factors which influence the survival of the patients with brain metastases from various primary tumors. Materials and Methods: A retrospective analysis of data from 347 patients presented to our department with brain metastases of various primary tumour from 2013 to 2017, who were all treated with Palliative Whole Brain RT of 30Gy/3Gy/10#/2weeks and chemotherapy for primary, were collected and significant prognostic factors such as Age, Karnofsky performance score (KPS), Number of brain metastases and Presence of extra -cranial metastases were used to define the prognostic index to estimate the survival of the patients. Each prognostic factor was given a score of 0 to 1. Survival time was measured(in months) from the time of first presentation for brain metastases to death or last follow up. Results: The retrospective analysis of 347 patients with brain metastases shows 211(60.8%) lung, 54(15.6%) breast, 38(11%) unknown primary, 12(3.5%) kidney, 11(3%) thyroid and 21(6.1%) from other primary sites. The average overall survival is 9.9 mths (range,1 to 28). The average survival for Prognostic Score 0-1 is 14.2 mths (range,5- 28), Score 2 is 12.25mths (range,3- 27), Score 3 is 4.6mths (range,2- 13) and Score 4 is 2mths (range,1- 3). Among these, Poor KPS acts as a major individual prognostic factor affecting survival(6.2 Vs 16mths). Conclusion: The Prognostic Index of 0 correlates with the best prognosis, whereas a prognostic Index of 4 correlates with the worst prognosis. In summary, these indices provide a quick and user-friendly tool to estimate survival for patients with brain metastases.
Table 1

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Profile of patient presenting with extracranial germ cell tumor at a tertiary care center

Pritanjali Singh, Dharmendra Singh

Aims and Objective: The objective of the study was to evaluate the demographic characteristics of the patients presenting with GCT in Department of Radiotherapy, AIIMS, Patna. Materials and Methods: Retrospective analysis of data was done for the patients presented in Department of Radiotherapy AIIMS, Patna from 2014 June to June 2018 with histopathologically confirmed extracranial cases of GCT. The study focused on clinical presentation, age, tumor size, histological subtypes, tumor markers treatment details and disease free survival. Results: There were 41 patients with complete available data which included 23 (56%) female & 18 (44%) male. All females had (56%) had ovarian GCT while all males (44%) had testicular GCT. None of the cases were extragonadal GCT. The age patients were in the range of 3 to 61 years with a median age of 24 years. Most commonly affected age group was 11 to 30 years. The mean age of female population presented with malignant GCT was 21 years and for male patients was 26 years. Most commonly patients overall presented with abdominal pain, scrotal mass. Size of tumors ranges from 3 to 19.8 cm with an average size of 7.5 cm. 16 (70%) cases of ovarian GCT was unilateral & 7(30%) cases were bilateral. 18 (100%) of testicular GCT were unilateral. 70.73% patients presented with raised AFP, 63.41% patients presented with raised βHCG, 53.65% patients presented with raised AFP & βHCG both, raised LDH was noted in 70.73% patients. 92.68% cases were consisted of malignant GCT while 9.75% cases were benign GCT. 19 (82.06%) of ovarian GCT were treated with upfront surgery while 14 (78 %) of testicular tumors were treated with upfront surgery. 14 (61%) of ovarian GCT had undergone unilateral salpingoophorectomy & 10 (56%) of testicular tumors had undergone high inguinal orchidectomy, 4 (22%) were undergone orchidectomy only while 4 (22%) of testicular tumors offered biopsy only. 3 (13%) of ovarian germ cell tumours had lung metastasis whereas 3 (17%) of patients of testicular germ cell tumours presented with lung metastases. Most common chemotherapy regimen given to patients were BEP regimen followed by EP. Average number of cycles were 4 (range 3-6) cycle. Cycles were interrupted in 5 patients due to neutropenia. One patient developed deep vein thrombosis during treatment. Lung bath was given to one patient in view of lung metastasis. Salvage TIP regimen due to recurrence given in 2 patients. Conclusion: Majority of patients presenting were malignant germ cell tumors. Females GCT were more common than male. Surgery and chemotherapy provide a good outcome in these patients.

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Skeletal metastasis: An AHRCC experience

Abani Kanta Nanda, Bijayalaxmi Sahoo, Papuji Meher, Lucy Pattanayak, Sanjukta Padhi, Niharika Panda, Dipti Rani Samanta, Surendra Nath Senapati

Introduction: Bone is one of the common site of metastases and typically indicates a short-term prognosis in cancer patients. Skeletal metastasis is much more common than primary bone tumors, especially in adults. Here is a study on skeletal metastasis on 182 patients to highlight the epidemiological profile in patients of metastasis in eastern India. Aim: To study the epidemiological profile of skeletal metastases. Materials and Methods: A retrospective study was performed taking 182 patients who were treated with radiation for bone metastasis between January 2017 to December 2017. Data were extracted from the bed head tickets and radiation records of the patients in department of Radiation Oncology, Acharya Harihar Regional cancer centre, Cuttack. All the relevant parameters were put in MS Office Excel sheet and analysis was done. Results: Out of 182 patients of skeletal metastasis, 51% of patients were male and 49% of patients were female. Majority (45%) of the patients were in 5th and 6th decade of life. Regarding the site of primary, the commonest primary cancer was breast (29%), followed by lung (16%), prostate (11%), GIT (11%) and sarcoma (7%); unknown primary cancer was 8%. 85% of all the patients had axial skeleton involvement. Both axial and appendicular skeleton involvement was 10% and exclusively appendicular skeleton involvement was less i.e., 4%. Majority of patients in our institute was treated with dose 30Gy in 10# i.e. about 78% of the patients followed by 20Gy in 5# i.e., about 18% of patients. A few number of cases i.e.4% were also treated with 8Gy in 1#. Response to treatment was better with 30Gy in 10# as with this dose fractionation schedule symptomatic control was better. At the time of presentation most patients had more than one site of skeletal involvement i.e. 68% of patients and only single site of skeletal metastasis were 32% of the patients. The interval between completion of treatment and development of bony metastasis was about 2 years. Conclusion: Breast in female and prostate in male were the most common primary diseases contributing skeletal metastases. Most patients had more than one sites of bony involvement at the time of presentation. Predominantly axial skeleton was involved but both axial and appendicular skeleton involvement were also seen in a good number of cases. Only appendicular skeleton involvement was very less. Majority of bone metastasis was with middle age group patients.

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Chasing the oligomets

Nitin Abraham, Jayaprakash Madhavan, T. K. Padmanabhan, P. G. Jayaprakash, Grace Shirley, V. Arun, T. V. Sandeep, S. Sajeev, Swapna Cyriac

KIMS Cancer Center, Thiruvananthapuram, Kerala, India

Introduction: Colorectal cancers are the 3rd leading cause of cancer in the world. Liver is the most common site of metastasis in colorectal cancer, but rectal cancers have increased propensity for lung metastasis as compared to colon cancer.SBRT for lung oligometastases is safe and effective, with local control rates of about 80%. SBRT represents an alternative and competitive option in patients with lung oligometastatic disease who refuse surgical treatment or unsuitable for surgery. Case Report: This 75 year old gentleman presented to us in November 2011 with bleeding per rectum and loss of weight.CT abdomen showed a lesion in the wall of the rectum, predominently in right anterolateral region, with involvement of serosa and adjacent mesentry. No nodes. Stage 2. He received neoadjuvant chemoRT 50.4 Gy in 28 # along with concurrent Xeloda, completed on 5 January 2012. He underwent anterior resection in February 2012.HPR showed complete pathologic response. Adjuvant chemotherapy CAPEOX -6 cycles were given, completed on August 2012. On March 2013, developed a solitary peripheral right upper lobe lung metastasis of size 2.3x2 cm. He was advised surgery, but was not willing for it. He underwent SBRT 40 Gy in 8# to the lung mets. He was on regular follow up. In April 2018, he developed a solitary brain metastasis in right parietal lobe and received SRT 24 Gy in 2 #. A CT chest taken on 19 April 2018, showed an increase in the size of previously irradiated lung lesion and a new lung nodule in pasterior segment of right upper lobe. Chemotherapy with 6 cycles of CAPEOX regimen was given, completed on September 2018. A reassessment scan was taken on 25 September 2018.CT head showed good resolution of the lesion and CT chest showed decrease in the size of lung lesion and upper lobe nodule. Results: By the use of SBRT to the lung mets from rectal cancer, we got a progression free survival of 5 years. Conclusion: Good survival and local control can be achieved with SBRT for Lung Metastasis.

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Trends in brachytherapy practices across India

D. Savitha Mary, Karthik S. Rishi

Aims: To assess patterns of brachytherapy practices across India. Materials and Methods: Methodology: A 24-point questionnaire was sent to registered members of AROI and IBS. Results and Discussion: The total number of respondents was 225. 92% replied that they had brachytherapy facility in the centre they were working at. Considering that majority of the respondents(82%) were from teaching institutes, it holds a good promise that the graduating young radiation oncologists would be exposed to basic knowledge and skills in brachytherapy. Among the centres which have brachytherapy, HDR dose rate system is used by majority(99.5%) and Ir 192 is used by nearly 90%. 88% follow image based brachytherapy. Since the last two decades, a paradigm shift has been seen in image-based brachytherapy globally. This can be attributed to advances in research and studies and lowering of costs of logistics of the radiological infrastructure. Among those who had brachytherapy facility, for gynaecological malignancies, 100% would perform intracavitary treatments, however only 89% respondents had access to intravaginal brachytherapy and 62% would perform interstitial brachytherapy. In our country, which confronts largely stage III and above cervical cancers, there could be a probability of increasing tumor control with perhaps interstitial applicators, which has to be looked into. 56% centres did more than six applications per week. This shows that there is concentration of case load for brachytherapy treatments in nearly half the centres. This highlights the need to identify these centres and measures to de-congest in terms of personnel and infrastructure. The logistics of travel and accommodation add to the expense of treatment to the patient. In 3.9% of centres which did not have brachytherapy facility, the patient woud be treated with EBRT boost. 91% do CT-based and 22% MRI-based planning for gynaecological brachytherapy applications. This shows there has been a trend towards MRI-based planning. Regarding planning and treatment practices, 93% prescribe to a dose of 5-8 Gy per application for gynaecological cancers. 98% aim for an EQD2 of 80-90Gy. A majority (71%) prescribe to point A; 57% follow GEC-ESTRO guidelines and 9% to ICRU 60Gy isodose. The dose to Organs at Risk are evaluated by varied parameters- ICRU points by 25%, DVH analysis by 35%, combined 40%. This shows that the guidelines that are published and what we practice clinically are not necessarily are the same. Brachytherapy is being performed by only 31% respondents for non-gynaecological malignancies. Intraluminal brachytherapy done by 77%, Breast brachytherapy performed by 52% and brachytherapy for Head and neck sites were being done by 67% of the centres. Only 15% of the respondents perform prostate brachytherapy. Conclusion: This survey shows promising future for brachytherapy practices in India with scope for improvement in terms of infrastructure and expertise. Surveys should be done on a regular basis and discussed in forums to assess the changing trends in brachytherapy practices. Such information may be helpful in identifying gaps between suggested guidelines and actual clinical practices.

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Association between acute hematological toxicities and bone marrow dosimetric parameters in cervical cancer patients undergoing concurrent chemoradiation: A comparison between three dimensional conformal radiotherapy and intensity modulated radiotherapy

E. A. Ashitha, G. Bindu, T. Ajayakumar

Aims and Objectives: Acute hematological toxicities are an important cause of morbidity in patients receiving concurrent chemoradiation to pelvis in ca cervix. Our objectives were to find out the incidence of acute hematological toxicities in patients undergoing concurrent chemotherapy and three dimensional conformal radiotherapy(3DCRT) or intensity modulated radiotherapy(IMRT) and to evaluate the role of IMRT in reducing dose to bone marrow and hence its impact on reducing acute hematological toxicities. Materials and Methods: Between January 2016 & July 2017,47 patients with FIGO stage IB2 to IIIB ca cervix were randomized to receive 45 to 50.4 Gy in 25 to 28 fractions, delivered via either 3DCRT or IMRT with concurrent weekly cisplatin 40mg/m2. Pelvic & lumbosacral marrow were delineated as organ at risk. In the IMRT arm, constraint was given to reduce dose to bone marrow as per the RTOG 0418 protocol; BM V40≤37%. Acute toxicities were monitored weekly during RT and were graded according to RTOG acute toxicity grading system. Results: Of the 47 patients,25 patients received 3DCRT & 22 patients IMRT. Median age of patients in IMRT & 3DCRT arm were 54 & 52 years respectively. Among 3DCRT treated patients 1 was IB2 (4%),17 were IIB (68%),2 were IIIA (8%) and 5 were IIIB (20%). Among the IMRT treated patients,4 were IIA (18.2 %), 10 were IIB (45.5 %),1 was IIIA (4.5 %) and 7 were IIIB (31.8%). Patients in the IMRT arm experienced significantly fewer grade ≥2 hematological toxicities-28 % vs 72% in 3DCRT(P=0.03) and there was significant reduction in V20,30,40 pelvic marrow(P <0.001) & V10,20,30,40 Lumbosacral marrow(P=0.01). Significant reduction in grade 2 or more hematological toxicities were found when V20 pelvic marrow<86%, V30<57%, V40<29% & V40 Lumbo sacral marrow <50.9%(P=0.03). Conclusion: IMRT reduced the volume of bone marrow getting irradiated to higher doses and the incidence and severity of acute hematologic toxicities in cervical cancer patients undergoing concurrent chemoradiation.

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Patterns of lung cancer incidence by histological type and stage of detection and mortality of lung cancer in Tripura (2014-2016)

Biswajit Debbarma

Background: Lung cancer is the most common cancer diagnosed worldwide. It is also the foremost contributor to cancer-related mortality, resulting in 1.38 million cancer deaths per year worldwide. According to the GLOBOCAN 2012 report, the estimated incidence of lung cancer in India was 70,275 in all ages and both sexes. The crude incidence rate per 100,000 was 5.6, the age-standardized rate per 100,000 (world), i.e. ASR (W) was 6.9, and the cumulative risk was 0.85. The death toll due to lung cancer is projected to rise to ten million by 2030 with 7 out of 10 deaths in the developing world. Aims: To know the age of incidence, stage of detection, Treatment received and Mortality. Methods: Date are collected from 2014-2016 (HBCR) in regional cancer center, Agartala, Tripura. Results: Among 539 patients enrolled, 423 were male and 116 were female within age group of 60 to 64 years in males and 50-54 years in females. Adenocarcinoma was most common histological type in both male (47.52%) and Female (51.72%), others include Small cell, Large cell, Mucuepidermoid Tumour adenosquamous, Carcinoma Mesothelioma, signatring cell Carcinoma, Hemorrgic Sarcoma. Most patients were diagnosed in advance stage III and IV. Chemotherapy was the most common mode of treatment in 68.56% male and 61.24% Female. Other modality of treatment include combined Radiotherapy & Chemotherapy. Number of Lung Cancer death were 206 in males (out of 539) and 58 in females (out of 116 patients). Mortality incident ratio was 2.05% in males and 2% in females. Discussion and Conclusion: Patients are in the median age group were diagnosed mostly in advance stage. Histologically adenocarcinoma followed by Squamous cell carcinoma were most common. Highest incidence of death occur in the age group of 60-64 years in male and 65 – 69 and 70-74 in females. Both the gender mortality incidence ratio was equal.

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Clinico-pathological features and outcomes of adreno-cortical carcinoma: A single institution experience

Lekha M. Nair, K. M. Jagathnath Krishna, Aswin Kumar, Susan Mathews, John Joseph, Francis V. James

Background and Objectives: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with aggressive behaviour. Most of our knowledge about this rare tumor is based on retrospective case series. This study aimed at analysing the clinico-pathological features and outcomes of patients treated at a tertiary cancer centre in India.Materials and Methods: We retrospectively reviewed the data of patients with adrenocortical carcinoma registered from 1st January 2006 to 31st December 2015. Results: Thirty seven patients were included in the study, 20 males and 17 females. Median age was 49 (18-78). Hormonal overproduction was noticed in 27% of patients. Median tumor size was 10cm (2-22). Seventeen patients had metastatic disease and 20 patients were non metastatic at diagnosis. Median follow up was 22 months and median overall survival (OS) was 23.46 months. OS at 2 years and 5 years were 46.1% and 21% respectively. The median Disease Free Survival (DFS) was 20 months. DFS at 2 years and 5 years were 45% and 24% respectively. Age, sex, tumor size, hormonal overproduction, tumor laterality and stage of the disease did not influence survival. But advanced stage was associated with higher risk for recurrence. (p=0.03). Conclusion: ACC is a rare endocrine malignancy with very poor survival rates. Rate of recurrence is high even after complete surgery. Systemic treatment options are limited. Newer agents are needed to improve outcome.

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Dosimetric comparison of the two breath hold techniques (deep expiratory breath hold vs. deep inspiratory breath hold) for stereotactic body radiotherapy of pancreatic cancer

A. Anup, R. Engineer, S. Chopra, A. Dheera1, K. Ravikant1

Departments of Radiation Oncology and1 Medical Physics, Tata Memorial Centre, Mumbai, Maharashtra, India

Majority (80%) of the patients were more comfortable in the inspiratory breath hold (range of DIBH being 40-45 secs and for DEBH being 20-25 secs). DEBH resulted in decreased dose to liver where only 3.3% received a dose of 12 Gy as compared to DIBH where 7.3% received the same dose. Also, volume of duodenum receiving 15 Gy was significantly reduced in DEBH to 52% as compared to 64% in DIBH. A similar proportionate decrease was present on evaluation of lower dosage volumes for stomach where 15 Gy was received by 10% in DEBH in comparison to 14.8% in DIBH. Conclusion: DEBH appears to be advantageous over DIBH for patients being treated with SBRT for pancreatic cancer in terms of reduced volumetric dosage to the liver, duodenum & stomach after giving due consideration to patient's comfort and ability.
Table 1: Organ at risk dose comparison of both techniques

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Dosimetric comparison between a volumetric modulated arc therapy, tomotherapy (helical tomotherapy) and intensity modulated proton therapy for a case of sacral chordoma

Raees Tonse, Srinivas Chilikuri, Dayananda Shamurailatpam1, Kartikeswar Patro1, M. P. Noufal1, Rakesh Jalali

Departments of Radiation Oncology and1 Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India

Aims/Objectives: To compare the dosimetric results of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) and intensity modulated proton therapy (IMPT) in the treatment of sacral chordoma. Materials and Methods: Plans were generated for a case of sacral chordoma using VMAT, HT and IMPT. The dose prescription was 76 Gy in 38 fractions to the PTV. The PTV coverage was aimed to receive 95% prescription to 95% of volume of PTV and the CTV to receive 99% prescription to 99% of volume of CTV. Integral dose and organs at risk (OAR) dosimetric indexes were also compared between all the plans. Results: IMPT was significantly better than both VMAT and HT in all target volume dose parameters. Rectal constraints were V75 < 5%, V70 < 10%, V60 < 25%, V40 < 40% and 1 cc to receive < 105% of prescription dose and bladder constraints were V75 < 10%, V70 < 20%, V60 < 30% and V40 < 50%. There were no significant differences in target volume dose coverage or dose conformity between the VMAT and HT plans The use of posterior-oblique beams for the IMPT plan was found to be the best plan with minimal dose to normal tissues. Conclusions: IMPT led to significantly better tumor target dose coverage and conformity than compared with VMAT and HT. Modern pencil beam proton techniques significantly reduce the integral dose and dose to the OARs.


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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