Brain metastases are a significant cause of morbidity and mortality in patients with breast cancer. HER-2 positivity is an increasingly recognized risk factor for the development of brain metastases. Although considerable progress has been made in the treatment of this complication, supportive measures like steroids, anti-seizure medication and whole-brain radiation remain the cornerstones of management in the majority of patients. The current review discusses the above and other issues like surgical excision, stereotactic radiotherapy, adjuvant radiation, radiosensitization and chemotherapy. A brief discussion of the recent evidence for the use of 'HER-1/ HER-2'-targeted therapy is also present.

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Background: Abdominal irradiation, as a part of treatment, is often ignored in the management of refractory non-Hodgkin's lymphoma (NHL). Objective: To evaluate the efficacy and the toxicity of this approach after failure of chemotherapy. Materials and Methods: 27 patients with intraabdominal lymphoma underwent salvage irradiation between 1982 and 2001. All patients were treated with a Cobalt-60 machine. The total dose administered to the abdomen was 18-20 Gy at the rate of 1.5-1.8 Gy per daily fraction, followed by a boost to gross disease up to 20 Gy. All patients had previously been heavily pretreated with chemotherapy. Fourteen patients, nine with follicular and five with diffuse lymphomas, had primary refractory tumors that had never achieved remission. Thirteen patients, six with follicular and seven with aggressive tumors, had refractory relapsed tumors after achieving one or more complete remissions. Results: The response rate was 77%. The median follow-up was 53 months. The 5-year and 10-year survival rates were 25 and 17%, respectively. The in-field and out-of-field recurrence rates were 22 and 33%, respectively. Survival rates were significantly better for patients with refractory relapse compared to those with primary refractory lymphoma (P <0.01). There was no significant difference in terms of response, recurrence, or survival rates between follicular and aggressive types. Out-of-field recurrence occurred more frequently in initial stage III and IV disease. Toxic deaths occurred in three patients (11%). Conclusion: Salvage radiotherapy for refractory abdominal NHL is a feasible alternative for both follicular and diffuse subtypes and may provide significant palliation and prolongation of survival. It is less effective in patients with primary refractory NHL than in those with refractory relapsed NHL.

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The incidence of 5-fluorouracil (5-FU)-related cardiotoxicity seems to be dosage and schedule dependent. Although various other cardiac events have been reported in literature, a series of patients having transient asymptomatic bradycardia has not been reported in the literature as yet. We report such a series of patients who had transient asymptomatic bradycardia after being treated with continuous infusion 5-FU. We plan to do a Holter study during the period of bradycardia in subsequent patients and this may throw more light on the issue.

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The relationship and coincidence of breast cancer with thyroid disorders is a subject of extensive debate and controversy. Many studies have shown that thyroid diseases are common among women with breast cancer. We present a case of concomitant malignancy of breast and thyroid with review of literature on the association of breast with thyroid neoplasm. The potential association and plausible mechanisms of breast carcinoma development after or before the thyroid carcinoma should be evaluated in larger cohorts of patients.

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Aims and Objective: We searched for the clinically relevant suggestions, recommendations and findings amongst the papers on Psycho-oncology. The term clinically relevant for us meant 'practical and implemental modes of intervention that contribute but would not affect or interfere with the normal functioning of the present system and treatment modality of the patients.' Our intention was to use the available information for the benefit of our patients. We also searched for the data that would prove the significance of these methods. In most parts of the world it is not possible to involve a psychologist at every level of cancer care. Based on the findings, we intend to carry out our own project for the psychosocial intervention in cancer patients and make suggestions that could be adopted even by those who have little or no experience in psychology. Conclusion: The field of psycho oncology is a relatively new and evolving subspecialty of oncology and psychology at the same time. Current data and papers, which would make simple and implemental modes of intervention at psychosocial level, are limited. There is a dire necessity of solid data and list of suggestions to the specialists, non-specialists and to those who take care of the cancer patients, to enhance the care they provide to the cancer patients.

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Purpose: To estimate the transit dose from motorized wedge (MW) treatment in Equinox-80 telecobalt machine. Materials and Methods: Two plans were generated in Eclipse treatment planning system with universal wedge (UW) and MW each for 10x10 cm ² . The transit dose was measured with 0.6 cc cylindrical ion chamber and thermoluminescent dosimeters (TLD) chips at a depth of 5 cm with source to axis distance (SAD) 80 cm. Results: The measured dose with ion chamber was in well agreement with the calculated dose from Eclipse within ± 2%. The planned dose was 100 cGy while the measured absorbed dose with ion chamber for 15º, 30º, 45º and 60º MW treatment was found to be 100.94, 101.04, 100.72 and 99.33 cGy respectively. For 15º, 30º, 45º and 60º UW treatment, the measured absorbed dose was 99.33, 97.67, 97.77 and 99.57 cGy respectively. Similarly the measured absorbed dose with TLD was within ± 3% with the planned dose for universal wedge (UW) and MW. From the experimental measurements, it was found that there was no significant contribution of transit dose during MW treatment. Conclusion: The actual measurements carried out with ion chamber in Equinox-80 machine for UW and MW revealed no variation between the doses delivered. The doses were comparable for both UW and MW treatments. The results from TLD measurements additionally confirmed no variation between the doses delivered with UW and MW. It was also demonstrated that the observed excess or less transit dose with MW does not have any significant clinical impact. This assured the safe dose delivery with MW.

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The occurrence of a second malignancy in a patient with a known malignant tumour is not uncommon. Synchronous primary malignancies are still unusual We are presenting two cases treated successfully at our centre. Case report 1-A 70 year old female presented to us with lump in right breast for two years and bleeding per vaginum for two years.Histopathology of cervix showed squamous cell carcinoma (large cell non keratinizing) and clinical stage was IIIB. HPE mastectomy specimen showed infiltrating duct carcinoma and stage II. Patient was treated with external beam radiotherapy for carcinoma cervix and breast simultaneously and chemotherapy as required. Patient is on regular follow up and clinically no evidence of disease. Case Report 2 -A 40 year old female presented with mild headache off and on for one year, projectile vomiting for three months and right side facial swelling for three months. HPE brain tissue showed astrocytoma grade II and HPE parotid tumour showed low grade muco-epidermoid carcinoma. Patient was treated with surgery first then radiotherapy. Patient is in regular follow up,having no complain,clinically no neurological dysfunction and no evidence of disease at right parotid and neck region. Thus it was concluded that patients responded well to treatment. Treatment strategies in case of synchronous double malignancy depend on treating the malignancy that is more advanced first or sometimes both could be treated simultaneously. In our case we concluded that synchronous double malignancy may be treated successfully. Both sites should be treated fully as if they were occurring separately considering toxicities.

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We conducted a study wherein serum total glutathione-s-transferase levels were measured in patients (n = 27) with various stages of biopsy proven oral cancer (squamous cell carcinoma) and age and sex matched healthy human volunteers (n=10). In all patients with oral cancer, serum total glutathione-s-transferase was measured before the onset of treatment. There was a significant increase in serum total glutathione-s-transferse levels in patients with stage IV oral cancer as compared to stage II (P = 0.001) and stage III (P = 0.002) oral cancer. This shows that alterations in serum total Glutathione-s-transferase levels may have a role in cancer progression.

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Background: In patients with small-volume disseminated disease of germ cell tumors, cure can be achieved with four cycles of bleomycin, etoposide, and cisplatin (BEP). However, around 20% of these cases are not curable. Strategies to improve cure rates have shown that none of the currently available modalities were superior to the others. Among the most used ones, BEP and VIP (etoposide, cisplatin, and ifosfamide) have been the most studied. However, there are no reports comparing the two, except for a few in abstract forms from southern India. Therefore, we did a treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs VIP) that are used in poor-prognosis metastatic germ cell tumors. Materials and Methods: All male patients with germ cell tumors, diagnosed as having poor risk by IGCCCG, between January 2002 and December 2004 were included in the study. Clinical, laboratory, and other data were recorded. The patients were stratified into two categories on the basis of the type of chemotherapeutic regimen they received. Results: In all, 46 patients were analyzed, with a median follow up of 26.6 months. The baseline characteristics (age, stage, PS, histology, and serum markers) were not different in the two treatment arms. There is no significant difference in the outcome with either of the chemotherapeutic modalities. VIP is less cost effective and more toxic compared to BEP. Conclusion: In view of the greater toxicity and cost of therapy, as well as lack of either overall or disease free survival advantage, VIP is not a preferred option for patients with high-risk germ cell tumors in the Indian setting and it is still advisable to treat patients with BEP.

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