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Brain metastases from breast cancer:Management approach
Tabassum Wadasadawala, Sudeep Gupta, Vaishali Bagul, Namrata Patil
July-September 2007, 3(3):157-165
DOI:10.4103/0973-1482.37409  PMID:18079579
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.
  72,910 2,251 21
"Nano": The new nemesis of cancer
Shantesh Hede, Nagraj Huilgol
October-December 2006, 2(4):186-195
DOI:10.4103/0973-1482.29829  PMID:17998702
Materials at nano dimensions exhibit totally different properties compared to their bulk and atomic states. This feature has been harnessed by scientists from various disciplines, to develop functional nanomaterials for cancer diagnosis and therapeutics. The success stories range from delivering chemotherapeutic molecules in nano-sized formulations to functional nanomaterials, which deliver thermal and radiotherapy at specific targeted sites. This brief review summarizes the recent developments of various nanotechnologies in cancer therapy and diagnostics, both from the research sector and the upcoming products in pipeline on its route to commercialization. Supportive engineering innovations and frontiers in nanomolecular research, with a potential to revolutionize cancer therapy, have been discussed in brief.
  48,766 2,764 25
Malignant pilar tumor of the scalp: A case report and review of literature
Manish Siddha, Ashwini Budrukkar, Tanuja Shet, Mandar Deshpande, Ayan Basu, Nikhilesh Patil, Rajendra Bhalavat
October-December 2007, 3(4):240-243
DOI:10.4103/0973-1482.39001  PMID:18270401
Pilar tumor is a rare neoplasm arising from the external root sheath of the hair follicle and is most commonly observed on the scalp. These tumors are largely benign, often cystic, and are characterized by trichilemmal keratinization. Wide local excision has been the standard treatment. Recent reports have described a rare malignant variant with an aggressive clinical course and a propensity for nodal and distant metastases which, therefore, merits aggressive treatment. In this report, we present a case of malignant pilar tumor of the scalp with multiple nodal metastases at presentation. Diagnostic and therapeutic considerations, in the form of adjuvant radiotherapy, are subsequently discussed.
  44,861 743 10
Hyperthermia today: Electric energy, a new opportunity in cancer treatment
Giammaria Fiorentini, Andras Szasz
April-June 2006, 2(2):41-46
DOI:10.4103/0973-1482.25848  PMID:17998673
Hyperthermia is an ancient, but nowadays rapidly developing treatment method in tumor-therapy. Its new paradigm applied in the electro-hyperthermia (oncothermia), which provides energy by means of electric-field and produces non-equilibrium thermal situation in the tissue. The temperature gradients formed in stationer conditions, destroy the membrane of the malignant cells and selectively eliminate the cancer tissue. The characteristic control parameter is the absorbed energy-dose, which is partly used to make the distortions, partly to increase the temperature of the target. This type of technique could be applied for some tumor sites, including brain, soft tissues, liver and abdominal masses, pancreatic cancer, head and neck tumors as well.
  31,629 1,433 19
Numb chin syndrome as a manifestation of metastatic squamous cell carcinoma of esophagus
H Narendra, Satadru Ray
January-March 2009, 5(1):49-51
DOI:10.4103/0973-1482.48771  PMID:19293491
Numb chin syndrome (NCS) is a sensory neuropathy presenting with numbness of the chin in the distribution of the mental nerve and the branches of the mandibular division of the trigeminal nerve. Though it can be caused by a benign process, NCS should be regarded as being due to malignancy until proven otherwise. Among the malignancies that cause NCS the most common are breast cancer, prostate cancer, and lymphoreticular malignancy. In squamous cell carcinoma (SCC) of the esophagus, spread to the mandible is a rare and often late event. An often overlooked clinical sign in mandibular metastases is hypoesthesia or paresthesia over the peripheral distribution of the inferior alveolar nerve/mental nerve; this sign has been referred to in the literature as NCS or numb lip syndrome or mental nerve neuropathy. Rarely, this may be the first presentation of a disseminated malignancy. Prognosis is usually poor. The discovery of this symptom should alert the clinician to the possibility of disseminated disease. In this article we report a rare case of metastatic SCC of the esophagus in a 40-year-old male patient who presented with NCS. We also review the mechanism, causes, and evaluation of NCS.
  29,571 679 8
Management of locally advanced breast cancer: Evolution and current practice
Ashish Rustogi, Ashwini Budrukkar, Ketayun Dinshaw, Rakesh Jalali
January-March 2005, 1(1):21-30
DOI:10.4103/0973-1482.16086  PMID:17998621
Locally advanced breast cancer (LABC) accounts for a sizeable number (30-60%) of breast cancer cases and is a common clinical scenario in developing countries. The treatment of LABC has evolved from single modality treatment, consisting of radical mutilating surgery or higher doses of radiotherapy in inoperable disease to multimodality management, which along with the above two included systemic therapy. Neoadjuvant chemotherapy (NACT) has made a tremendous impact on the management of LABC. NACT was initiated to institute systemic therapy upfront at the earliest in this group of patients with a high risk of micrometastasis burden. While NACT did not yield a survival advantage, it has however made breast conservation possible in selected group of cases. Large number of studies and many randomised trials have been done in women with LABC in order to improve the therapeutic decisions and also the local control and survival. With this background we have reviewed various treatment options in patients with LABC which should possibly help in guiding the clinicians for optimal management of LABC.
  25,244 2,293 32
Bone metastasis from ovarian cancer
Anu Tiwari, Narendra Kumar, Ranjeet Bajpai, Punita Lal
January-March 2007, 3(1):34-36
DOI:10.4103/0973-1482.31969  PMID:17998717
We report a case of epithelial ovarian cancer, which presented with lumbar vertebral metastasis soon after treatment, as a part of distant spread. This patient was then treated by palliative radiotherapy and put on second line chemotherapy i.e., Topotecan. She responded to treatment well.
  26,618 821 6
Accessory breast tissue in axilla masquerading as breast cancer recurrence
Shikha Goyal, Tarun Puri, Ruchika Gupta, Pramod K Julka, Goura K Rath
April-June 2008, 4(2):95-96
DOI:10.4103/0973-1482.42258  PMID:18688128
Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.
  24,467 603 6
Advantages of multiple algorithm support in treatment planning system for external beam dose calculations
January-March 2005, 1(1):12-20
DOI:10.4103/0973-1482.16085  PMID:17998620
The complexity of interactions and the nature of the approximations made in the formulation of the algorithm require that the user be familiar with the limitations of various models. As computer power keeps growing, calculation algorithms are tending more towards physically based models. The nature and quantity of the data required varies according to the model which may be either measurement based models or physical based models. Multiple dose calculation algorithm support found in XiO Treatment Planning System can be used to advantage when choice is to be made between speed and accuracy. Thus XiO allows end users generate plans accurately and quickly to optimize the delivery of radiation therapy.
  22,533 1,164 7
Targeting energy metabolism in brain cancer through calorie restriction and the ketogenic diet
B Thomas N Seyfried, Michael Kiebish, Jeremy Marsh, Purna Mukherjee
September 2009, 5(9):7-15
DOI:10.4103/0973-1482.55134  PMID:20009300
Malignant brain tumors are a significant health problem in children and adults and are largely unmanageable. As a metabolic disorder involving the dysregulation of glycolysis and respiration (the Warburg effect), malignant brain cancer can be managed through changes in metabolic environment. In contrast to malignant brain tumors that are mostly dependent on glycolysis for energy, normal neurons and glia readily transition to ketone bodies (β-hydroxybutyrate) for energy in vivo when glucose levels are reduced. The transition from glucose to ketone bodies as a major energy source is an evolutionary conserved adaptation to food deprivation that permits the survival of normal cells during extreme shifts in nutritional environment. Only those cells with a flexible genome, honed through millions of years of environmental forcing and variability selection, can transition from one energy state to another. We propose a different approach to brain cancer management that exploits the metabolic flexibility of normal cells at the expense of the genetically defective and less metabolically flexible tumor cells. This approach to brain cancer management is supported from recent studies in orthotopic mouse brain tumor models and in human pediatric astrocytoma treated with calorie restriction and the ketogenic diet. Issues of implementation and use protocols are discussed.
  21,200 2,009 21
Dose concept of oncological hyperthermia: Heat-equation considering the cell destruction
A Szasz, Gy. Vincze
October-December 2006, 2(4):171-181
DOI:10.4103/0973-1482.29827  PMID:17998700
We shall assume, of course, that the objective of hyperthermia is to destroy the malignant cells. Destruction definitely needs energy. Description and quality assurance of hyperthermia use the Pennes heat equation to describe the processes. However the energy balance of the Pennes-equation does not contain the hyperthermic cell-destruction energy, which is a mandatory factor of the process. We propose a generalization of the Pennes-equation, inducing the entire energy balance. The new paradigm could be a theoretical basis of the till now empirical dose-construction for oncological hyperthermia. The cell destruction is a non-equilibrium thermodynamical process, described by the equations of chemical reactions. The dynamic behavior (time dependence) has to be considered in this approach. We are going to define also a dose concept that can be objectively compared with other oncological methods. We show how such empirical dose as CEM43oC could be based theoretically as well.
  21,065 826 16
The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: A randomized control trial
PD Madan Kumar, PS Sequeira, Kamalaksha Shenoy, Jayaram Shetty
January-March 2008, 4(1):3-8
DOI:10.4103/0973-1482.39597  PMID:18417894
Aims: The present study was done to assess the effect of three alcohol-free mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies. Materials and Methods: Eighty patients with head and neck malignancies, scheduled to undergo curative radiotherapy, were randomly assigned to receive one of the three alcohol-free test mouthwashes (0.12% chlorhexidine, 1% povidone-iodine, or salt/soda) or a control. The patients were instructed to rinse with 10 ml of the mouthwash, twice a day, for a period of 6 weeks. Mucositis was assessed at baseline and at weekly intervals during radiation therapy, using the World Health Organization criteria for grading of mucositis. The baseline demography of the four groups was matched for age, sex, stage of cancer, and whether the patient had cancer of oral or extraoral regions. A post hoc test for repeated measures was used to find the difference of mean mucositis scores between the groups at various week intervals. Results: Among the 76 patients who completed the study, patients in the povidone-iodine group had significantly lower mucositis scores when compared to the control group from the first week of radiotherapy. Their scores were also significantly lower when compared to the salt/soda and chlorhexidine groups from the fourth and fifth week, respectively, after radiotherapy. Conclusions: This study demonstrates that use of alcohol-free povidone-iodine mouthwash can reduce the severity and delay the onset of oral mucositis due to antineoplastic radiotherapy.
  19,282 2,079 10
Hyperthermia, a modality in the wings
A Szasz
January-March 2007, 3(1):56-66
DOI:10.4103/0973-1482.31976  PMID:17998724
Hyperthermia is a heat-treatment. It is widely used in various medical fields and has a well-recognized effect in oncology. Its effect is achieved by overheating of the targeted tissues. It is an ancient treatment and a promising physical approach with lack of acceptance by the serious medical use. To accept the method we need strong proofs and stable, reproducible treatment quality, but we are limited by biological, physical/technical and physiological problems. However, the main point - I believe - is the incorrect characterization and unrealistic expectations from this capable method. The temperature concept of the quality assurance guidelines has to be replaced by the heat-dose sensitive characterization, pointing the essence of the hyperthermia method.
  20,528 726 12
Human papilloma virus and oral infections: An update
KL Kumaraswamy, M Vidhya
April-June 2011, 7(2):120-127
Human papilloma virus (HPV) is one of the most common virus groups affecting the skin and mucosal areas of the body in the world today. It is also a known fact that HPV causes many lesions in the oral cavity. The most common conditions induced by oral HPV infection are usually benign-like oral papillomas, oral condylomas, and focal epithelial hyperplasia. Oral HPV infection has been found to be associated with some cases of oropharyngeal cancer, but it is not the main risk factor for this kind of cancer. HPV is been proved to be the causative agent in causation of cervical cancers without doubt, but its role as a etiologic agent in causing oral cancers needs to be evaluated and studied more to come into any conclusion. We have used review papers, case reports, cohort studies, case control studies, and various internet sources published from 1960 to 2011 to prepare this review of literature.
  17,603 2,429 20
A prospective study of pharyngocutaneous fistulas following total laryngectomy
SS Qureshi, P Chaturvedi, PS Pai, DA Chaukar, MS Deshpande, KA Pathak, AK D'cruz
January-March 2005, 1(1):51-56
DOI:10.4103/0973-1482.16092  PMID:17998627
Pharyngocutaneous (PC) fistula is a common complication following laryngectomy. It leads to increased morbidity, delay in adjuvant treatment, prolonged hospitalization and an increase in treatment costs. Although a number of factors that result in PC fistula have been described, there is still no agreement on the most significant factors. We undertook a prospective study to critically analyze PC fistula and its association with various tumors, patient and treatment related factors. This was a prospective study that included 143 patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx and pyriform sinus. Use of pectoralis major myocutaneous flap to reconstruct the neopharynx, primary disease in pyriform and extensive soft tissue infiltration were significantly associated with PC fistula. Prior treatment (radiotherapy and chemotherapy), type of closure (T closure, Y closure and vertical closure), Layers of closure (full thickness interrupted, submucosal interrupted, submucosal continuous) type of suture material (silk, vicryl ), age, sex, stage, preoperative tracheostomy, cut margin status, pre/postoperative hemoglobin and experience of surgeons did not relate significantly.
  18,899 1,016 30
Vitamin D and cancer
Minu M Ali, V Vaidya
October-December 2007, 3(4):225-230
DOI:10.4103/0973-1482.38998  PMID:18270398
Vitamin D, a fat-soluble prohormone is synthesized in response to sunlight. Experimental evidence suggests that vitamin D may reduce the risk of cancer through regulation of cellular proliferation and differentiation as well as inhibition of angiogenesis. These anticancer properties have been attributed primarily to 1,25-dihydroxyvitamin D [1,25(OH) 2 D] (calcitriol), the hormonal form of vitamin D. Extensive research has shown that cells, including cancer cells, express specific receptors (VDR) for 1,25-dihydroxyvitamin D. When bound to the VDR, 1,25-dihydroxyvitamin D regulates >60 genes that exert prodifferentiating, antiproliferative and antimetastatic effects on cells, including effects on cell cycle. The amount of exposure to the sun has been found to correlate inversely with cancer mortality and survival in numerous epidemiological studies. An inverse relationship between solar ultraviolet-B (UV-B) exposure and non-skin cancer mortality has long been reported. Several ecological studies suggest that sunlight may protect against prostate, colon, rectal, female breast and ovarian cancer, all diseases that contribute to a substantially higher proportion of cancer mortality in the western industrialized world. Some analytical studies also suggest a protective association between circulating vitamin D in blood, which is largely derived from sunlight, or dietary vitamin D. Paricalcitol (calcitriol analogue) is as effective as 1,25-dihydroxyvitamin D in transactivating the prostatic VDR and in inhibiting the growth of prostate cancer cell lines and primary cultures of prostate cancer cells in vitro. Promising preclinical evaluations of calcitriol and analogues have appeared in prostate cancer animal models.
  15,796 3,640 38
Mucosal melanoma of nasal cavity and paranasal sinus
Raghav Dwivedi, Ravi Dwivedi, Rehan Kazi, Sumit Kumar, Satya P Agarwal
October-December 2008, 4(4):200-202
DOI:10.4103/0973-1482.44293  PMID:19052396
Mucosal melanoma of the nasal cavity and paranasal sinuses is seldom encountered in routine ENT practice. These tumors have poor prognosis owing to higher rates of locoregional recurrence and distant metastasis. Various treatment modalities have been employed over time but the ideal treatment approach still remains an open issue. This article presents some commonly accepted guidelines in treating these rare mucosal neoplasms.
  17,990 726 6
Analytical approach to estimate normal tissue complication probability using best fit of normal tissue tolerance doses into the NTCP equation of the linear quadratic model.
TS Kehwar
July-September 2005, 1(3):168-179
DOI:10.4103/0973-1482.19597  PMID:17998649
Aims and Objectives: Aims and objectives of this study are to get the best fit of the normal tissue tolerance doses to the NTCP model of the linear quadratic model. Methods and Materials: To compute the NTCP, the modified form of the Poisson cell kill model of NTCP, based on linear-quadratic model, is used. The model has been applied to compute the parameters of the NTCP model using clinical tolerance doses of various normal tissues / organs extracted from published reports of various authors. The normal tissue tolerance doses are calculated for partial volumes of the organs using the values of above-said parameters for published data on normal tissue tolerance doses. In this article, a graphical representation of the computed NTCP for bladder, brain, heart and rectum is presented. Results and Conclusion: A fairly good correspondence is found between the curves of 2 sets of data for brain, heart and rectum. Hence the model may, therefore, be used to interpolate clinical data to provide an estimate of NTCP for these organs for any altered fractionated treatment schedule.
  17,286 1,398 41
Oral cancer: Premalignant conditions and screening - an update
Deepa R Nair, Ritesh Pruthy, Uday Pawar, Pankaj Chaturvedi
January 2012, 8(6):57-66
Oral cancers form a significant portion of the cancer burden seen in our country. Typically, they tend to be preceded by a premalignant state for a long time. This article discusses the various types of premalignant disorders commonly seen in daily practice. Also, it is important to screen patients for these conditions so as to detect malignant changes early. Previously, the screening of patients for oral cancer and precancerous lesions has relied mainly on conventional oral examination. Nowadays, many newer techniques are available to potentially assist in the screening of healthy patients for evidence of oral cancer. This article attempts to review the current literature for screening methods and adjuncts such as toluidine blue, brush cytology, tissue chemiluminescence and autofluorescence.
  16,549 1,597 3
Myelodysplastic syndrome and pancytopenia responding to treatment of hyperthyroidism: Peripheral blood and bone marrow analysis before and after antihormonal treatment
Riad Akoum, Saade Michel, Tabbara Wafic, Brihi Emile, Masri Marwan, Habib Khaled, Abadjian Gerard
January-March 2007, 3(1):43-46
DOI:10.4103/0973-1482.31972  PMID:17998720
Hematological disorders, especially single lineage abnormalities, have been described in hyperthyroidism. Pancytopenia has been reported, without myelodysplastic syndrome or megaloblastic anemia. We studied the peripheral blood smear and the bone marrow aspiration and biopsy of a 65-year-old lady, who presented with pancytopenia and thyrotoxicosis due to multinodular goiter. She denied ingesting any toxic medication. At diagnosis: WBC: 2500 /ul, platelets count: 58.000/ul, hemoglobin level: 6.5 g/dl. The bone marrow was moderately hyper cellular with moderate myelofibrosis and arrested hematopoiesis. The TSH level was: 0.02 mIU/l (N: 0.25-4), the fT3: 18 pmol/l (N: 4-10), the routine serum immunologic tests were negative. After treatment with single agent neomercazole (carbimazole), complete recovery of the blood cell counts was obtained within one month. The bone marrow aspiration, performed three months after starting therapy, showed normal hematopoiesis. The thyroid function tests returned to normal and no autoimmune reaction was detected on routine serum testing. Persistent response was observed six months later under medical treatment. The patient has refused surgical treatment. Reversible myelodysplastic syndrome may also be part of the changes in blood picture of patients with hyperthyroidism, probably due to direct toxic mechanism.
  17,011 908 12
Isolated non-Hodgkin's lymphoma of the pancreas: Case report and review of literature
Ayan Basu, Nikhilesh Patil, Pranshu Mohindra, Bhooshan Zade, Sumeet Gujral, Mary Ann Muckaden, Siddhartha Laskar
October-December 2007, 3(4):236-239
DOI:10.4103/0973-1482.39000  PMID:18270400
Background: Isolated primary pancreatic lymphoma (PPL) is a rare extra-lymphatic non-Hodgkin's lymphoma comprising less than 1% of all extra-lymphatic lymphomas. It is seen in people of advanced age and there is a slight male preponderance. It is difficult to diagnose; the vague presenting symptoms and nonspecific laboratory/radiological findings make it difficult to differentiate the condition from pancreatic adenocarcinoma. Histopathological examination is of paramount importance to conclusively establish the diagnosis since the treatment involves lymphoma protocols, and prognosis and survival in PPL are considerably superior to that in adenocarcinoma pancreas. Case Report: We report a case of isolated PPL diagnosed after Tru-Cut biopsy and immunohistochemistry after a thorough staging workup. Result: The patient was treated with multi-agent combination chemotherapy followed by radiotherapy. Discussion: A review of literature was done using a Medline search to determine the incidence and prevalence of isolated PPL and to note the diagnosis and management of previously reported cases. Conclusion: An exceedingly rare entity, isolated PPLs need to be differentiated from pancreatic adenocarcinomas by histopathological evaluation since management is on the lines of other extralymphatic lymphomas and prognosis is significantly better.
  16,442 684 8
Advanced research on anti-tumor effects of amygdalin
Zuoqing Song, Xiaohong Xu
August 2014, 10(5):3-7
DOI:10.4103/0973-1482.139743  PMID:25207888
Malignant tumors are the major disease that cause serious damage to human health, and have been listed as the premier diseases which seriously threatened human health by World Health Organization (WHO). In recent years the development of antitumor drugs has been gradually transformed from cytotoxic drugs to improving the selectivity of drugs, overcoming multidrug resistance, development of new targeted drugs and low toxicity with high specificity drugs. Amygdalin is a natural product that owns antitumor activity, less side effects, widely sourced and relatively low priced. All these features make the amygdalin a promising antitumor drugs, if combined with conditional chemotherapy drugs, which can produce synergistic effect. In this paper, we summarized the pharmacological activity, toxicity and antitumor activity of amygdalin, mainly focused on the advanced research of amygdalin on its antitumor effects in recent years, providing new insights for the development of new anticancer drugs, new targets searching and natural antitumor mechanism investigations.
  15,808 1,243 -
Butterfly glioma of the corpus callosum
Amit Agrawal
January-March 2009, 5(1):43-45
DOI:10.4103/0973-1482.48769  PMID:19293489
The prognosis of glioblastoma multiforme (GBM) is poor even with aggressive first-line therapy, which includes surgery, radiation therapy, and adjuvant chemotherapy. Although the ideal course of treatment for elderly patients with newly diagnosed GBM is still undecided and requires further studies, the new chemotherapeutic agents administered with or without concomitant radiation therapy have shown promising results. However, in our setting, where resources are limited and newer treatment options are expensive, it is often difficult to deliver the best care to the patient.
  15,829 798 9
Detection of breast cancer by mammogram image segmentation
HS Sheshadri, A Kandaswamy
October-December 2005, 1(4):232-234
DOI:10.4103/0973-1482.19599  PMID:17998660
An important approach for describing a region is to quantify its structure content. In this paper the use of functions for computing texture based on statistical measures is pescribed.MPM ( Maximizer of the posterior margins) algorithm is employed.The segmentation based on texture feature would classify the breast tissue under various categories. The algorithm evaluates the region properties of the mammogram image and thereby would classify the image into important segments.Images from mini-MIAS data base (Mammogram Image Analysis Society database(UK)) have been considered to conduct our experiments. The segmentation thus obtained is comparatively better than the other normal methods .The validation of the work has been done by visual inspection of the segmented image by an expert radiologist.This is our basic step for developing a computer aided detection (CAD)system for early detection of breast cancer.
  15,417 1,075 1
Three dimensional conformal radiation therapy in prostate adenocarcinoma: Survival and rectal toxicity
V Kannan, VK Sathiyanarayanan, S Sagde, Vivek Anand, Sachin Almel, Asha Kapadia, V Srinivas
January-March 2005, 1(1):34-37
DOI:10.4103/0973-1482.16088  PMID:17998623
Technological advances in radiation beam planning and linear accelerator based radiation delivery have led to the development of three dimensional conformal radiation therapy (3D-CRT). The 3D-CRT clinical treatment in our hospital was started in September 1998 and till December 2002, 51 patients with M0 stage prostate carcinoma were treated. Treatment method consisted of pelvis and leg immobilization, planning CT scan, marking of planning target volume and organs at risk and 3D beam plan using multileaf collimated beam shaping through beam's eye view display. Network controlled 3D conformal radiation therapy was delivered with portal image verification. The median 3D-CRT dose was 72 Gy. Of the 51 patients, 35 were followed-up till December 2002 (minimum follow-up 2 years) in whom 32 were disease free and 3 had progressive disease. Eleven patients died, 8 of progressive disease, one due to second malignancy and two of intercurrent illness. Five patients were lost for follow up during 0 - 29 months period, after 3D-CRT. The acute rectal reaction (RTOG criteria) in 51 patients was grade 0 in 4, grade I in 31 and grade II in 16. None had greater than grade II rectal toxicity. The late rectal toxicity in 49 patients who had a minimum 6 months follow-up was grade 0 in 41, grade I in 3 and grade II in 5. Our experience suggests that a dose of 72 Gy by 3D-CRT can be safely delivered to the prostate and gastrointestinal tolerance during treatment and follow-up period was excellent.
  15,707 626 3