|Year : 2016 | Volume
| Issue : 6 | Page : 81-86
|Date of Web Publication||30-Nov-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Miscellaneous. J Can Res Ther 2016;12, Suppl S2:81-6
Case report of Waldenstrom's macroglobulinemia with hyperviscosity syndrome
P. R. Aarani Devi
Department of Radiotherapy, Govt Medical College, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Introduction: Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma is a rare, indolent subtype of Non-Hodgkin Lymphoma which accounts for less than 1 to 2% of hematological malignancies. Waldenstrom's macroglobulinemia causes over production of IgM leading to hyperviscosity syndrome and clinical picture similar to that of IgM multiple myeloma, making it difficult to diagnose upfront. Case Report: We report the case of a 66 year old gentleman who was evaluated for chronic fatigue, lower limb pain and edema in various peripheral hospitals and thereafter referred to our side with suspicion of multiple myeloma. Physical examination revealed pallor, pedal edema & axillary lymphadenopathy. Blood examination showed anaemia, raised ESR & low albumin with normal renal& liver function. Peripheral smear showed normocytic normochromic anaemia. BMA and trephine showed lymphoplasmacytic cells. SPE showed hypoalbuminemia & M-spike monoclonal gammopathy. Serum immunofixation showed positive IgM band Skeletal survey was normal. Radiologically there was splenomegaly. Fundus evaluation revealed venous stasis retinopathy suggestive of hyperviscosity. With the findings of monoclonal IgM protein, lymphoplasmacytic bone marrow and features of hyperviscosity, diagnosis of Waldenstrom's macroglobulinemia was arrived at. After 4 months of treatment with Bortezomib+Dexamethasone, patient is in remission with no features of hyperviscosity syndrome. Conclusion: It is observed that the golden period after presentation and before diagnosis has an important role in the outcome of the treatment of these patients. If a clinical suspicion of these rare neoplasms is not considered, this golden period will be lost. Hence presentations of these rare neoplasms must also be kept in mind to avoid delay in appropriate diagnosis and treatment.
An unusual case report of three primary malignancies (i.e. Carcinoma breast, carcinoma esophagus & carcinoma upper alveolus) in a female patient
Ashutosh Pattanaik , Vibha Saluja, B. Paul Thaliath, R. R. Ghosh, Sonia Tiwari
Department of Radiotherapy, Kamala Nehru Memorial Hospital, Allahabad, Uttar Pradesh, India, E-mail: [email protected]
Introduction: To describe an unusual case of three primary malignancies (i.e. Carcinoma Breast, Carcinoma Esophagus (Upper 1/3 rd ), & Carcinoma Upper Alveolus) in a female patient as well as to review the management and outcome. Materials and Methods: A female patient aged 48 yrs presented with a lump in right breast in the year 1999 for which she underwent Modified Radical Mastectomy Histopathologically proved as Invasive Ductal Carcinoma (pT4N1M0) followed by Adjuvant Radiotherapy (50 Gy/25 fr/5 wks) followed by 6 courses of Adjuvant Chemotherapy with CAF regimen. Then for 5 yrs she was on hormonal therapy with Tamoxifen. She was on Regular follow up since then till 2011 when she complained of progressive dysphagia to solid food. She was diagnosed with Carcinoma Esophagus (Upper 1/3 rd ) subsequently by endoscopic biopsy which was reported as Squamous Cell Carcinoma. She received 3 cycles of Neo-adjuvant chemotherapy with Paclitaxel/Carboplatin followed by external beam radiotherapy (50 Gy/25 Fr/5 wks) with two oblique wedge fields from 28 th February 12 to 6 th April 12. She was on regular follow up thereafter. In 2014, she presented with an ulcer in left upper alveolar region for which she underwent wide local excision with Hemi-maxillectomy with flap repair. It was followed by adjuvant radiation of 60 Gy/30 Fr/6 wks. She is on regular follow up since then and the follow up has been uneventful till now and patient has good quality of life. Conclusions: This case highlights the fact that any patient with a treated primary malignancy should have a detailed evaluation during his/her follow up, for there is every chance of missing a second or third primary malignancy.
Rare skin malignancy as a result of UV exposure: A review of trichilemmal carcinoma
Rajeev Atri , Anil Kumar Dhull, Rakesh Dhankhar, Vivek Kaushal, Shivani Malik, Rajeev Sen
Department of Radiotherapy, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, E-mail: [email protected]
Objectives: Sun exposure i.e. ultraviolet light damages the fibers in the skin called elastin. There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell and squamous cell cancers are less serious types and make up 95% of all skin cancers. Melanoma, made up of abnormal skin pigment cells called melanocytes, is the most serious form of skin cancer and causes 75% of all skin cancer deaths. Here we reviewed a rare skin malignancy, trichilemmal carcinoma (TLCA) which appears as a solitary lesion on the sun-exposed skin, especially on the face, neck, scalp and hands mainly in elderly subjects, commonly between 4 th to 9 th decades of life. Materials and Methods: The sun rays contain 3-types of ultraviolet rays which damages the DNA in the skin cells: UVA, UVB and UVC. UVB is most likely to burn the skin and is the main cause of non melanoma skin cancer, The diagnosis of skin cancers are established by means of histopathological examination complemented with immunohistochemistry of the lesion. Results: TLCA is a rare cutaneous neoplasm that develops from the external root sheath of the hair follicle and their lesions are usually slightly raised, pale, tan, or reddish frequently ulcerated or with crusts. Histologically, the tumors are composed of a lobular proliferation centered on the pilar apparatus. Tumor cells have a predominately glycogen-rich, mucin-negative, pale eosinophilic cytoplasm. All tumors exhibit areas of trichilemmal-type keratinization and presents with dyskeratotic cells. IHC is usually positive for EMA & CK. Conclusion: Mainstay of treatment remains surgical excision with wide margins and removal of regional lymph nodes, which is mostly curative, however, in recurrent or metastatic cases, radiation or chemotherapy should be tried to explore the best results.
Primary thymic mucinous adenocarcinoma: A case report
M. H. Geethi , Seetha Mohandas, Thara Somanathan 1 , A. Sajeed,
S. Roshni, S. Arun Sanker, Lijeesh, C. D. Sivanandan
Departments of Radiation Oncology and 1 Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Primary thymic mucinous adenocarcinoma is an extremely rare and aggressive subtype of thymic carcinoma. The proper diagnosis is usually made by clinicopathological and radiological findings and its primarily a diagnosis of exclusion. Only nine cases of primary thymic mucinous adenocarcinoma have been documented and the available literature on the management of these malignancies is sparse. This 34 yr old male who was evaluated for breathlessness was diagnosed with an anterior mediastinal mass on imaging. He underwent posterolateral thoracotomy and excision of the mass. Histology showed moderately differentiated mucinous adenocarcinoma of thymus (CK20 +ve, CK 5/6 +ve, CK20 +ve, synaptophysin -ve, chromogranin -ve and TTF-1 -ve). Post operative imaging showed no evidence of residual disease and he received adjuvant radiotherapy of 50 Gy in 25 fractions with IMRT technique followed by 4 cycles of chemotherapy with paclitaxel and carboplatin. After 2 months he presented with bone metastasis for which he received palliative radiotherapy to the symptomatic site and was started on bisphosphonates. He presented with bilateral hypoglossal nerve palsy after 5 months and MRI Brain showed skull base metastasis - possibly the cause of hypoglossal nerve palsy with no evidence of parenchymal metastases. He received palliative radiotherapy of 20 Gy in 5 fractions to the skull base metastasis and was offered best supportive care. He expired after 3 months due to progressive disease. This report reaffirms the aggressive nature of this rare malignancy and the treatment still remains uncertain.
Computer tomography based customized surface mould high dose rate brachytherapy for non melanotic skin cancer of scalp and face - correlation of mould characteristic and dosimetric parameters on local control, acute and late toxicity and cosmetic outcome
Poulami Basu , Anis Bandyopadhyay, Kaushik Roy, Rajiv jena, Mausumi Das, Arunima Gupta, Arnab Adhikary, Upasana Mukherjee, Proloy Basu, Shyamal Kumar Sarkar
Department of Radiotherapy, Medical College Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Objective: To quantify the late effects and outcomes of a cohort of non melanoma skin cancer patients treated with customized mould HDR Brachytherapy and to find any possible correlation of mould characteristic and dosimetric parameters with the toxicity, local control and cosmetic outcome. Materials and Methods: In this Single institutional retrospective study the Clinical outcome, Dosimetric variations and toxicities are assessed in patients of Non melanoma skin cancer treated with Surface mould Brachytherapy from January 2012 to December 2015. Results: During the study period 17 patients of Non melanoma skin cancer of face, forehead or scalp were treated with customized Surface moulds either as definitive RT or as Adjuvant therapy for high risk features, to a dose 3200-4500 cGy to the PTV, delivered in twice daily fraction in total 9 to 12 fractions. Twelve cases were Squamous cell carcinoma and five were Basal cell carcinoma. The mean depth of skin treated was 3 mm. The mean mould thickness was 8 mm. The mean D90 to the PTV was 376 cGy. Nine out of 17 patients developed Grade III or Grade IV late skin toxicity. A correlation was found between the 1cc skin dose and Grade III and IV late skin toxicity. No local or distant relapses were observed after a follow up of 12 months. Cosmetic result was good in majority of patients with acceptable acute toxicity. Conclusion: Customization of mould parameters as per skin PTV may lead to reduced skin dose and better Dosimetry thus improving Clinical outcome.
Malignant acrospiroma of chest wall in a 51-year-old lady: An unusual clinical experience
B. V. Subramanian , Pranabandhu Das, Swapna Jilla, K. V. Jagannath Rao Naidu
Department of Radiotherapy, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India,
E-mail: [email protected]
Background: Malignant acrospiroma occurs very rarely and is found more commonly over face and extremities. Involvement of chest wall is of an unusual phenomenon. The prognosis for survival in malignant acrospiroma is very poor. We present a case of malignant acrospiroma of chest wall who was treated successfully at our center. Materials and Methods: A 51 year post menopausal woman presented with a painless solitary, mobile and firmly consistent nodular swelling of size 5 Χ 4 Χ 3 cm on right upper back behind the posterior axillary fold in sub cutaneous plane without axillary lymphadenopathy. Wide local excision of the mass with more than 1 cm margin was attempted. Postoperative histopathologic report favors malignant acrospiroma/carcinomatous deposits and basal resected margin positive. Immunocytochemistry for CEA was negative and CK showing moderate to intense cytoplasmic positivity suggestive of malignant acrospiroma of eccrine sweat glands. FNAC revealed malignant deposits in the axillary lymph node after default of 2 months. The patient was then undergone adjuvant radiotherapy to the chest wall and right axillary region with 60 Gy in 30 fractions. Results: The patient after repeated surgical excision and adjuvant radiotherapy to chest wall and axillary region is now completely free of disease and local recurrence even two years after treatment. Conclusion: Although radiation therapy has not been proved to be beneficial and role of any chemo-therapeutic agent is questionable, still it has been proposed to be one possible modality to treat locally and locoregionally aggressive malignant acrospiroma of chest wall with regional lymphadenopathy following aggressive surgical excision.
All white lesions in the MRI scan are not grey
Vinay Muttagi , Surendra Reddy, B. C. Sreedhara 1 , Monish 1 , Harish 2 , J. Mathangi
Departments of Radiation Oncology, 1 Radiology and 2 Nuclear Medicine, BGS Global Hospitals, Bengaluru, Karnataka, India, E-mail: [email protected]
Objectives: To present a rare case of pelvic insufficiency fracture in a carcinoma cervix patient treated with radiotherapy which was suspected to be bone metastases. Materials and Methods: A 51 year old postmenopausal female presented with bleeding per vagina was diagnosed to have carcinoma cervix stage IIb and completed external beam radiotherapy with 3D conformal technique along with 5 cycles of concurrent weekly cisplatin chemotherapy followed by brachytherapy in August 2015. Follow up evaluation at 2 months revealed complete response both by clinical examination and by radiological imaging. During regular follow up she developed mild non localizing low back pain and her follow-up MRI revealed a T2 hyper intense lesion with contrast enhancement in L5 vertebra and bilateral sacral ala suggesting a possibility of metastases. Results: Further evaluation with PET CT revealed FDG uptake (SUV max 13.1) in L5 and bilateral sacral region (SUV max 10.8). But the CT part of the PET CT revealed small sub cortical fractures with loss of trabecular pattern suggesting a differential diagnosis of insufficiency stress fractures vs. metastases of L5 and sacral ala region. This was further confirmed by CT guided biopsy of the L5 region which revealed osteoporotic changes and no malignant cells. Patient was advised bed rest and analgesics. Conclusion: A rare complication of pelvic radiation is insufficiency fractures of the pelvis. Early detection is important, because significant morbidity may result from delaying treatment. Unawareness of this complication may lead to diagnostic difficulties and unnecessary work-up.
Cutaneous toxicity of bleomycin: A brief study
Manish Ahirwar , O. P. Singh, V. Yogi, H. U. Ghori, R. S. Jamre
Department of Radiotherapy, Gandhi Medical College, Bhopal, Madhya Pradesh, India, E-mail: [email protected]
Introduction: Bleomycin is an antitumor antibiotic, its major toxicity seems to parallel its high concentration in the skin and lungs. This study aims to assess patients with germ cell tumours who developed distinctive "flagellate" pigmentation during bleomycin therapy. Materials and Methods: 16 patients having germ cell tumour presented at the department of radiotherapy GMC Bhopal between June 2014 and June 2016. All the patients were treated with BEP regime with same doses of drugs (according to BSA). Before every cycle of chemotherapy each patient was assessed for various dermatological toxicities of bleomycin. Among these patients those presenting with typical flagellate cutaneous hyperpigmentation were given appropriate management and their bleomycin was omitted till hyperpigmentation resolves. Results: Of 16 patients suffering from germ cell tumour and receiving BEP regime (including bleomycin), typical flagellate pigmentation was seen in 11 of our patients, 2 were having various other toxicities except cutaneous toxicity while 3 of the patients remained asymptomatic. Cutaneous toxicity appeared after a cumulative dose of 90 IU to 240 IU and after 4 to 8 weeks of therapy which resolved after omitting bleomycin. Conclusion: Present study suggests that various hyperpigmentary changes can occur with bleomycin therapy. "Flagellate" pigmentation is a specific reaction in the patients treated with bleomycin which occurs predominantly on the trunk and proximal extremities in upto 69% of the patients with variable course of time and dose and is not having any specific treatment and therefore proper general examination is needed after each cycle of chemotherapy.
Second primary malignant neoplasms: A clinico-pathological analysis from a sub himalayan cancer centre in India
Saurabh Bansal , Meenu Gupta, Vipul Nautiyal, Ravi Kant, Jyoti Bisth, Chinmayee Agrawal, Mushtaq Ahmad, Sunil Saini
Department of Radiotherapy, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India, E-mail: [email protected]
Objective: To analyse the presentation and trend of increase in prevalence second malignant neoplasms and to review the relevant literature. Materials and Methods: We analyzed data of patients presenting with histologically proven synchronous or metachronous double primaries over a period of 5 years (January 2011 to December 2015). Warren and Gate's criteria have been used to designate a case as multiple primary tumor. Details such as age at diagnosis, sex, synchronous or metachronous, site of index and second malignancy, stage, histopathology, treatment; date of the last follow-up and death were collected. Results: Over a period of 5 years total 35 cases of multiple primary malignancies were observed, out of which 12 were synchronous (34%) and 23 (66%) were metachronous. The median age at the diagnosis of primary malignancy was 65.5 years (range 27-84). Out of the 35 patients, 25 (71%) were males and 10 (29%) were females. The most common site of primary tumor was head and neck (11 cases) and second malignancy was gastrointestinal tract (10 cases). The time interval between appearance of primary and secondary in the metachronous group varied from 7 months to 22 years. At the time of analysis, 37% patients are disease free, 20% patients have expired due to disease progression, 17% patients are undergoing treatment, and 26% patients are lost to follow up. Conclusion: The likelihood of occurrence of second malignancy has increased and appearance of new signs and symptoms should raise a suspicion and early detection of the disease leads to appropriate management.
Correlation of the tumor board decisions with the evidence based medicine in a tertiary health care centre
P. Guru Sai Ratna Priya , M. G. Janaki
Department of Radiotherapy, Ramaiah Medical College, Bengaluru, Karnataka, India, E-mail: [email protected]
Introduction: (1) Multidisciplinary Tumor board (MDT) plays an important role in deciding an optimal therapy for cancer patients as the decisions will be based on the highest evidence based guidelines. (2) This study was conducted to analyze how far the tumor board decisions correlated with highest available evidence. Materials and Methods: (1) In our institute tumor board is conducted once a week involving radiation, medical and surgical oncologists, gynaec oncologists, oromaxillofacial surgeons, pathologists and each case is discussed and a final decision is taken. (2) From February 2016 to August 2016, 46 cases were discussed in our MDT and the decisions taken were correlated with the NCCN guidelines. Results: (1) Out of 46 cases, 22% of the cases discussed were head and neck cancers followed by carcinoma esophagus (17%). (2) Highest evidence was available for 91% of the patients and in rest of the cases, which were less common, there were no available guidelines. (3) In 85% cases tumor board decisions were coinciding with the highest possible evidence guidelines. (4) One patient of ca supraglottis, had poor GC, hence treated only with RT, instead with chemoradiation. (5) Second patient of scalp carcinoma, received adjuvant brachytherapy and the third patient of ca stomach received adjuvant chemoradiation followed by chemotherapy instead of CT-CRT-CT. Conclusion: (1) Most guidelines give the general treatment to be followed, but for best therapeutic gain other factors like host/expertise are equally important. (2) MDT is a good platform to achieve best comprehensive outcome considering all these factors.
Merkel cell carcinoma of the gluteal region: A case report
Ajay Singh Choudhary, th Rameshwaram Sharma ,
Aseem Rai Bhatnagar, Daleep Singh, R. K. Spartacus,
Neeraj Sharma, Sandeep Bhaskar, Kartick Rastogi, Kampra Gupta, Sushil Saini, Nikesh Agarwal
Department of Radiotherapy, SMS Medical College, Jaipur, Rajasthan, India, E-mail: [email protected]
Introduction: Merkel cell carcinoma is a rare, malignant tumor of skin. It is notorious for local recurrence, early involvement of regional lymph nodes and distant metastasis. Case Presentation: A 71 year old male had a painful nodular lesion in the right gluteal region since 6 months. The nodule was pink in colour, around 2 cm in diameter, rapidly enlarging in size. He was operated with Wide excision of tumour in September 2009. After 3 months, in December 2009, he presented to us with a tumour recurrence at the same site. He underwent a Total excision of the tumour with wide margin. Post op MRI of the gluteal region showed post operative scar with no residual mass and no pelvic lymphadenopathy. The histopathology report revealed population of uniform, large, round to oval cells showing vesicular formation with prominent nucleoli and mitosis 4-5/HPF. The immunohistochemical studies showed the tumour cells express Cytokeratin, Synaptophysin and Chromogranin A and are immunonegative for LCA, CD 20, CD 3, CD 56, Mic 2 and TTF 1. The diagnosis was that of Merkel Cell Carcinoma. The patient was treated by Radiotherapy with 3DCRT (53.2 Gy/19#) to post operative tumor bed and 50 Gy/25# to B/L inguinal region. At present there is no evidence of disease. Conclusion: Early detection of the tumor and comprehensive pathological evaluation with markers for diagnosis and definitive treatment is mandatory because the disease spreads rapidly and prognosis is very favourable.
Impact of psychological counselling on depression and anxiety in newly diagnosed cases of malignancy
Himanshu Mishra , Payal Thaper, Sudhi Kulshrestha,
Anju Lata Mishra, Rohini Khurana
Department of Radiotherapy, Dr. RMLIMS, Lucknow, Uttar Pradesh, India, E-mail: [email protected]
Background: Depression and Anxiety are most common psychological disorders developed by cancer patients. Study of cancer patient's psychological reactions to their diagnosis and appropriate psychological interventions besides indicated treatment might improve their quality of life and treatment outcome. Objective: To assess the effectiveness of psychological counselling in newly diagnosed cases of malignancy. Materials and Methods: Fifty Patients with histologically proven malignancy (of any site), who were referred to Radiotherapy (RT) O.P.D. were assessed for anxiety and depression by using Hospital Anxiety and Depression Scale (HADS). Patients were then subjected to multiple sessions of psychological counselling and the same patients were assessed again for these conditions using the same scale. The impact of psychological counselling was then assessed and analyzed. Results: By HADS, anxiety level was abnormal in 10% (n = 5) and borderline abnormal in 70% (n = 35) of cases before any psychological counselling. 20% (n = 10) cases had no anxiety. After counselling all absolutely abnormal i.e. 10% became borderline abnormal and 71% (n = 25) of borderline abnormal became normal. For depression, before counselling 10% (n = 5) were abnormal, 30% (n = 15) were borderline abnormal and 60% (n = 30) were normal. After counselling, 40% (n = 2) of frank abnormal became borderline abnormal and 60% (n = 3) became normal. Eighty percent (n = 12) of borderline abnormal became normal while rest 20% (n = 3) remained as such. Conclusion: Psychological counselling results in substantial reduction in malignancy induced anxiety and depression and should be incorporated in routine clinical practice besides disease oriented treatment.
Metastatic PNET treated with curative intent
Ajay Sasidharan , Nehal Khanna, Tushar Vora, Jyoti Bajpai,
Sneha Shah, Nilendu Purandare, Mukta Ramadwar,
Seema Kembhavi, Ashish Gulia, Bharat Rekhi, Shashikant Juvekar, Sajid Qureshi, Ajay Puri, Siddharth Laskar
Department of Radiotherapy, Tata Memorial Hospital, Mumbai, Maharashtra, India, E-mail: [email protected]
Objective: Evaluation of outcome of patients diagnosed with metastatic PNET, treated with curative intent. Materials and Methods: From 2010 to 2015, 17 patients diagnosed with metastatic PNET (excluding isolated lung metastases) treated with curative intent were analyzed. All patients received multiagent chemotherapy followed by definitive radiotherapy to primary and metastatic sites with curative intent. Results: Patients were between 10 - 43 yrs of age. Six were ≤18 yrs. Primary site of disease were: Skeletal 15; Extraskeletal 2. The sites of metastases were marrow (53%), skeletal (41%), lung (23%), node (6%) and soft tissue (6%). Fifteen (88%) completed the planned treatment. Two patients died due to febrile neutropenia. Complete response was present in 5 patients post induction therapy and in 11 patients post local therapy and 9 patients post maintenance therapy. After a median follow up of 8 months (Range 0-49 mths), 6 patients (35%) were alive with disease and 9 (53%) were alive without disease. Five (29%) patients had more than 12 months follow up. Conclusion: Patients with limited metastatic disease at presentation responding well to chemotherapy & radiation therapy delivered with curative intent do have satisfactory disease control. Larger cohorts of patients need to be analysed to identify a specific group of patients that merit curative treatment.
Life after treatment in cancer patients: A comparative study
G. Prema, N. V. Kalayarasi, Giridharan, Bhaskar, Madhumathi, Sanjal, Sunddaresan, Poongodi, Vijaykarthick
Department of Radiotherapy, Madras Medical Collegu, Chennai,
Tamil Nadu, India, E-mail: [email protected]
Introduction: "Life after Cancer is miserable". Very few people return to normal life while others are significantly changed by their cancer experience - adjusting to the ill effect of the disease. Aim: To develop a brief yet sensitive & comparative assessment of quality of life of cancer patients (H&N, cervix, breast) who had completed full course of treatment in our dept. of Radiotherapy, Madras Medical College and RGGH, Chennai. Materials and Methods: This Study Includes 150 patients attending on review days which includes cancer of Head and neck (50 patients), cervix (50 patients) and Breast (50 patients) of the age group 35 - 65 years who received treatment from 2011 to 2016. The study was generated by using SF36 MEDICAL SURVEY questioner module. The assessment of health, psychosocial, emotional well being were included. Results: Symptomatic improvement is seen in 4555% of patients (24) with head and neck cancer compared to 6570% patients (32) with cancer cervix and 7580% of patients (36) with cancer breast. Recurrences and Post treatment complications like Radiation induced xerostomia, trismus, opticneurits are seen in 10% of Head and Neck cancer. Resumption of routine activities of daily living and Return to job is delayed in Head and Neck cancer by 12 years. In spite of complete awareness about risk factors 510% of people still pursue adverse risk habits in Head and Neck group. Pyschosocial and family life are affected more in Head and Neck cancers. Conclusion: Head and Neck cancer survivors are absolutely effected by social stigma and economic breakdown than Cancer cervix and Cancer breast. Fear of recurrence disability, dependence, depression are the factors which Impact patient more than physical wellbeing and symptomatic improvement [Table 1]. Education about risk factor, Emotional support for the survivors and family and Rehabilitation can be powerful tool to overcome dread full effects of disease.
Adolescent malignancies: A retrospective analysis of demography, a single institution study in north India
Debashis Panda , Sailendra N. Parida, Rekha Arya, Anurita Srivastava, Savita Arora, A. K. Rathi, K. Singh
Department of Radiotherapy, Lok Nayak Hospital (MAMC),
New Delhi, India, E-mail: [email protected]
Introduction: Incidence of malignancies in young adolescent population is rising. Materials and Methods: We considered the age group 10 to 19 years. We analyzed our hospital records, collected and analyzed the data of last two years 2014 and 2015 for a demographic study. Results: Out of total 85 (N) cases with 57.6% males: 42.4% females gender distribution, 31 cases were registered in 2014 and 54 cases in 2015. Predominantly, 15-19 year olds were more affected, comprising 53 (62.4%) cases. The catchment area for the patients was analyzed in terms of within 500 km (88.2% cases), 500-1000 km (1.2% cases) and beyond 1000 km (10.6% cases). The incidence of soft tissue sarcoma is highest (32.9%), followed by osteosarcoma (14.1%), CNS tumours (10.6%), colorectal (9.4%), gyenaecological (8.2%), head & neck (8.2%). Incidence of germ cell tumour (5.9%) and lymphoma (4.7%) was less in this age group. Extremities (23.5%) are the commonest site affected followed by head & neck (22.4%), abdomen (18.8%), CNS (16.5%), gonadal (10.6%), pelvic (4.7%) and thoracic (3.5%). 45 (52.9%) cases underwent surgery out of which 37 (43.5%) cases had received neoadjuvant chemotherapy. Out of 45 cases R0 resection was possible in 28 (62.2%) cases, R1 in 5 (11.1%) cases, R2 n 10 (22.2%) cases. Out of 85 cases 23 (27.1%) cases received radiotherapy either in neoadjuvant (n = 1), radical (n = 5), adjuvant (n = 6) or palliative setting (n = 11) due to disease progression or metastasis. 29 (34.1%) patients received adjuvant chemotherapy. Lost to follow up was considerable, with 29.4% patients not reporting for treatment after registration, 33 (38.8%) patients defaulted treatment while only 27 (31.7%) patients continue to be on regular follow up at the time of analysis. Conclusion: As we observed a shift from round cell tumour variant as mentioned in literatures to sarcoma in this young adolescent age group. Lost to follow up is a considerable issue and better means of controlling the same are required. Further studies are needed in this group of patients to understand and address the specific requirements.
Neuroendocrine tumor one year review in AHRCC
Department of Radiotherapy, AHRCC, Cuttack, Odisha, India, E-mail: [email protected]
Background: Neuroendocrine tumor (NET) are extremely rare and aggresive tumor. The annual incidence of clinically significant neuroendocrine tumors is approximately 2.5-5 per 100000. Case Series: This is a presentation of Ten cases with histological, immunohistochemistry proved neuroendocrine tumors of our institution AHRCC from the time period of 2015-2016. This case series mostly done to review the incidence of Neuroendocrine tumor, Age of diagnosis, Site and Sex prevalence of Neuroendocrine tumor in our institution. This study also help to evaluate the mode of treatment given according to site of Neuroendocrine tumor and the follow up period. Out of 8 cases 3 are of neuroendocrine tumor of lung, 1 NET of Bladder, 1 of NET of ethmoidal sinus, 1 of Pancreas, 2 of Anterior superior Mediastinum, one each from cervical lymph node and gallbladder. Out of 10 cases only 2 cases are female. Age varied from twenty three years to sixty years. Conclusion: Neuroendocrine tumor are extremely rare tumor with wide range of clinical presentation according to the site of involvement that challenged in diagnosis and treatment planning. According to clinical presentation, Histopathological subtype, immunohistochemistry and radiological evaluation accurate diagnosis and classification is vital for therapeutic intervention.
Key words: Histopathology, immunohistrochemistry, neuroendocrine tumor
Double malignancy - ureteral carcinoma and breast carcinoma: A rare case
A. Preethi , N. V. Kalaiyarasi, Giridharan, Baskar, Madhumathi, Sundaresan, Sanjal, Vijaykarthik, Poongodi
Department of Radiotherapy, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, E-mail: [email protected]
Background: Ureteral cancer and breast cancer can occur individually in many patients. The occurrence of both in the same patient is a rare phenomenon. History: 52-year old postmenopausal female, a k/c/o Right Ureteral cancer-T3N0M0 (HPE-Transitional cell carcinoma), low-grade papillary type, had undergone Right nephrectomy with bladder-cyst excision on August-2014 and received 4 cycles of Inj. Gemcitabine and Inj. Cisplatin, following which she noticed a lump in the Right breast, upper-outer quadrant, clinically 4 Χ 4 cms, mobile and non-tender and axillary fullness seen. FNAC-smear +ve for malignancy. Mammogram-BIRADS-V- cT2N0M0. Right MRM was done-January-2015, pT3N0M0. HPE-Infiltrating ductal carcinoma Grade-II. 4 nodes dissected-no tumor metastasis. Posterior margins-close margins. Lymphovascular invasion +ve. IHC-Triple Negative. This was followed by 4 cycles of FAC and 4 cycles of Taxane. Now in BIRO, MMC&RGGGH for post-mastectomy radiation therapy (PMRT). Treatment: PMRT was planned in two fields-Tangential portals for flap and Single AP portal for drainage area with tracheal shield and Head of humerus shield. 50 Gy/200 cGy/25# planned and executed followed by Post-Axillary boost. Discussion: Though occurring in the same individual, both the malignancies were treated separately. Lynch-2 syndrome (HNPCC associated with other cancers) is one such syndrome which involves cancer of both upper urinary tract (ureter and kidneys) and breast. A subset of Cowdens syndrome, with germline KLLN mutation in PTEN-negative patients, causing KLLN-hypermethylation leading to cell-cycle arrest and apoptosis, may also be associated.
Effectiveness of hemostatic radiotherapy
Department of Radiotherapy, S N Medical College, Jaipur, India, E-mail: [email protected]
Radiotherapy can cause hemostasis in select cases of malignant bleeding. We present a case in which radiotherapy was used to stop bleeding from squamous cell carcinoma of skin located over right side of buttock. Dose of 25 Gy in 5 fractions was given and bleeding was controlled very well.
Pigmented villonodular synovitis of knee: A case report
Priya Sinha , Amrut Kadam, Sindhu, Karthikeyan
Department of Radiotherapy, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, E-mail: [email protected]
Introduction: Pigmented villonodular synovitis is a benign proliferative disorder of the synovium of uncertain cause. Subsequently, two forms of the disease: a localized and a diffuse joint involvement. The incidence of PVNS is 1.8 cases per 1 million people/year. PVNS occurs in between the ages of 20 and 45 yrs, but it has been found in as young as 11 yrs and as old as 70 yrs. The knee is the most commonly affected joint. The diagnosis of PVNS is confirmed by biopsy, and the treatment of choice is synovectomy. Radiotherapy can be considered in patients with local relapse and in patients with residual disease. Case Report: A 19 year old girl presented with nontraumatic pain and swelling in right knee since 1 year which was insidious in onset and gradually progressive. Pain increases on sitting in a cross legged position. Skin was stretched but without any signs of inflammation. No ligament laxity was observed. Plain radiograph was not showing any changes. M.R.I of knee joint showed effusion, low signal intensity on both T1 and T2 weighed images with diagnosis of hyperplastic synovium. Open Synovectomy was done. Supra patellar pouch was having maximum amount of hypertrophic synovium. The synovial tissue was sent for histopathological examination. HPR was suggestive of Pigmented villonodular synovitis. Patient complained of pain and swelling even after the surgery but the intensity was decreased as compared to preop condition. Post op MRI was done 1 month later which showed residual disease in the right knee. On examination there was tenderness over medial condyle of femur. The patient was treated with external beam radiotherapy with 50 Gy in 25 fractions using 1.25 Mev Co60 gamma rays. Patient was advised follow up every 3 months. Patient started walking and even doing strenous work like long time standing after 4 months. Swelling was assessed during each follow up which showed gradual decrease and the patient did not complain of any pain. Discussion: The localized form is often effectively treated with local excision. Diffuse PVNS is usually treated with total or near total synovectomy and have a much higher rate of recurrence. Although, the treatment of choice is surgical excision, complete resection may be difficult. Local control rate for surgery alone varies from 44-92%. 2 Postop radiation can improve the local control rate (more than 90%). Radiation therapy may be used as the primary treatment modality for diffuse intra-articular PVNS, but it is considered to be better option for postoperative cases with total or incomplete resection. Radiation can be administered either EBRT or through intra-articular injection of radioactive isotopes also known as radiosynoviorthesis. The optimal dose and fractionation schedule of radiation for PVNS is unclear. Some have reported using doses as low as 16 - 20 Gy, whereas others have used doses as high as 50 Gy without complication. Conclusions: Pigmented villonodular synovitis is a rare benign proliferative disorder of the joints. Incomplete synovectomy leads to higher recurrence rates (50-56%, compared with those for complete resection 7-20%). Addition of radiotherapy can minimize these recurrences with less need for repeat surgery.
A dosimetrical approch to identify the ideal location of isocenter in intensity modulated radiotherapy treatment plans
Abhijit Mandal , Anupam Kumar Asthana, Satyajit Pradhan, Uday Pratap Shahi, Sunil Chowdhury
Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, E-mail: [email protected]
Objectives: To identify an ideal location of isocenter in Intensity Modulated Radiotherapy (IMRT) treatment plans. Materials and Methods: Twenty eight (28) clinical target volumes and four (4) English capital letters (C, L, T and H) target volumes were considered in this study. Two IMRT treatment plans were generated for each target volume in ECLIPSETM Treatment Planning System (TPS), first one with isocenter automatically placed (ISOAUTO) by TPS and second with geometric center based isocenter (ISOGEOM). The geometric center of a cuboid volume, which was formed encompassing around the target volume in sagital, transverse and frontal planes, is considered as the geometric center of the target volume as well as the isocenter (ISOGEOM) of the IMRT plans. While performing the IMRT treatment plans using Beam Angle Optimization (BAO) and Dose volume Optimization, the normal tissue objectives and target volume objectives were kept similar in both the plans. The dosimetrical parameters between the two groups of plans were compared. Results: The distance between ISOGEOM and ISOAUTO ranged from 0.16 cm to 3.04 cm with a mean and median of 0.85 cm and 0.69 cm respectively. The ISOGEOM based IMRT plans exhibited statistically significant advantages in total MU reduction (100% cases, P value ≤ 0.001), total number of field reduction (66% cases, P value ≤ 0.001) and reduction of patient mean Dose (69% cases, P value ≤ 0.001) over ISOAUTO base IMRT plans. The Conformity Index (CI), Homogeneity Index (HI) and target mean dose were comparable between both group of plans. Conclusion: Significant dosimetrical advantages may be observed, when the geometric centroied of target volume is considered as isocenter of IMRT treatment plan.
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