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   2007| January-March  | Volume 3 | Issue 1  
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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.
  30,045 895 6
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.
  21,461 742 12
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.
  18,426 935 12
Dosimetric and qualitative analysis of kinetic properties of millennium 80 multileaf collimator system for dynamic intensity modulated radiotherapy treatments
Anup K Bhardwaj, TS Kehwar, SK Chakarvarti, AS Oinam, SC Sharma
January-March 2007, 3(1):23-28
DOI:10.4103/0973-1482.31967  PMID:17998715
The aim of this paper is to analyze the positional accuracy, kinetic properties of the dynamic multileaf collimator (MLC) and dosimetric evaluation of fractional dose delivery for the intensity modulated radiotherapy (IMRT) for step and shoot and sliding window (dynamic) techniques of Varian multileaf collimator millennium 80. Various quality assurance tests such as accuracy in leaf positioning and speed, stability of dynamic MLC output, inter and intra leaf transmission, dosimetric leaf separation and multiple carriage field verification were performed. Evaluation of standard field patterns as pyramid, peaks, wedge, chair, garden fence test, picket fence test and sweeping gap output was done. Patient dose quality assurance procedure consists of an absolute dose measurement for all fields at 5 cm depth on solid water phantom using 0.6cc water proof ion chamber and relative dose verification using Kodak EDR-2 films for all treatment fields along transverse and coronal direction using IMRT phantom. The relative dose verification was performed using Omni Pro IMRT film verification software. The tests performed showed acceptable results for commissioning the millennium 80 MLC and Clinac DHX for dynamic and step and shoot IMRT treatments.
  9,804 893 6
Radiation dose to contra lateral breast during treatment of breast malignancy by radiotherapy
Arun Chougule
January-March 2007, 3(1):8-11
DOI:10.4103/0973-1482.31964  PMID:17998712
Aims: External beam radiotherapy is being used regularly to treat the breast malignancy postoperatively. The contribution of collimator leakage and scatter radiation dose to contralateral breast is of concern because of high radio sensitivity of breast tissue for carcinogenesis. This becomes more important when the treated cancer breast patient is younger than 45 years and therefore the contralateral breast must be treated as organ at risk. Quantification of contralateral dose during primary breast irradiation is helpful to estimate the risk of radiation induced secondary breast malignancy. Materials and Methods: In present study contralateral breast dose was measured in 30 cancer breast patients undergoing external beam therapy by Co-60 teletherapy machine. Postoperative radiotherapy was delivered by medial and lateral tangential fields on alternate days in addition to supraclavicle field daily with 200 cGy/F to a total dose of 5000 cGy in 25 fractions. CaSO4: Dy themoluminescence dosimeter discs were employed for these measurements. Three TLD discs were put on the surface of skin of contra lateral breast, one at the level of nipple and two at 3 cms away from nipple on both side along the midline for each field. At the end treatment of each filed, TLD discs were removed and measured for dose after 24h on Thelmador - 6000 TLD reader. Results: The dose at the contra lateral breast nipple was to be 152.5 to 254.75 cGy for total primary breast dose of 5000 cGy in 25 equal fractions which amounted to 3.05-6.05% of total dose to diseased breast. Further it was observed that the maximum contribution of contralateral breast dose was due to medical tangential half blocked field. Conclusion: CaSO4; Dy thermoluminescence dosimetry is quite easy, accurate and convenient method to measure the contra lateral breast dose.
  9,504 716 7
Embryonal rhabdomyosarcoma of the biliary tree mimicking a choledochal cyst
Bhushan Nemade, Kaustav Talapatra, Tanuja Shet, Shripad Banavali, Mary Ann Muckaden, Siddhartha Laskar
January-March 2007, 3(1):40-42
DOI:10.4103/0973-1482.31971  PMID:17998719
Embryonal rhabdomyosarcoma (ERMS) of biliary tree is a rare type of mesenchymal neoplasm diagnosed at surgery or by preoperative liver biopsy. We present a one year eight months old child who mimicked a choledochal cyst and was eventually treated with surgery, chemotherapy with IRS IV protocol and adjuvant postoperative radiotherapy to surgical bed with 6 MV photons to a dose of 5040cGy in 28 fractions.
  8,597 533 5
Serous papillary adenocarcinoma of the rete testis: Unusual ultrasonography and pathological findings
Wilmosh Mermershtain, Neta Vardi, Irina Gusakova, Josef Klein
January-March 2007, 3(1):37-39
DOI:10.4103/0973-1482.31970  PMID:17998718
We report a case of serous papillary adenocarcinoma of the rete testis in a 22-year-old man. Adenocarcinoma of the rete testis is highly resistant to radiotherapy and any known chemotherapeutic regimen. We recommend radical orchiectomy At last follow up, the patient was well, without any evidence of recurrence, ten years after surgery.
  7,177 419 3
Factors influencing the development of ulcers and strictures in carcinoma of the esophagus treated with radiotherapy with or without concurrent chemotherapy
Rohini Khurana, Kislay Dimri, Punita Lal, Neeraj Rastogi, K Joseph, Maria Das, Shaleen Kumar
January-March 2007, 3(1):2-7
DOI:10.4103/0973-1482.31963  PMID:17998711
Purpose: To ascertain factors that could influence the development of ulcers and strictures in the definitive management of squamous cell carcinoma (SCC) of esophagus treated with external beam radiotherapy (EBRT), high-dose-rate (HDR) intralumenal radiotherapy (ILRT) with or without concurrent weekly cisplatin (CDDP @ 35 mg/m2) chemotherapy (CT). Materials and Methods: Between 1990-2005, 244 patients with inoperable SCC of esophagus were identified from our database and grouped into one of the following: those receiving at least 60Gy EBRT (Gp E, n=44); EBRT followed by HDR-ILRT (Gp E+I, n=98); at least 50Gy EBRT with CT (Gp E+C, n=68); EBRT+HDR-ILRT + CT (Gp E+I+C, n=34). Ulcers (discovered on endoscopy) and strictures evident on a barium swallow (which needed dilatations) were scored as treatment induced, if the biopsy was negative. Factors likely to influence their outcome were analyzed. Results: The groups were matched for all patient and disease characteristics except pretreatment hemoglobin and Karnofsky performance score (KPS), which were lower in Gp E. The incidence of ulcers was 7%, 8%, 6% and 21% ( P =0.08) while that of strictures was 14%, 9%, 21% and 41% ( P =0.00) for the groups E, E+I, E+C and E+I+C respectively. On univariate analysis, patients with better KPS ( P =0.03), treated with narrow applicators (6 mm vs. 10 mm, P =0.00), received CT ( P =0.00) or assigned to Gp E+I+C ( P =0.00) were more likely to develop strictures, with a trend for development of ulcers in Gp. E+I+C ( P =0.08). Logistic regression retained only Gp E+I+C for development of ulcers (OR 10.36, 95% CI 1.2-89.1, P =0.03) and strictures (OR 4.2, 95% CI 1.4-12.6, P =0.00). Conclusion: Treatment intensification as in Gp E+I+C results in about a three-fold increase in treatment induced late morbidity which can adversely impact on swallowing function and therefore emphasizes the need for optimisation of HDR-ILRT when used in a CT+RT protocol.
  6,958 556 7
Dedifferentiated chondrosarcoma of the maxilla
Anusheel Munshi, Surinder Kumar Atri, Kailash Chander Pandey, MC Sharma
January-March 2007, 3(1):53-55
DOI:10.4103/0973-1482.31975  PMID:17998723
A 20-year-old male reported with right-sided facial swelling, epistaxis and right sided proptosis of two months duration. Computerized tomography scan of the face revealed a mass in the right maxillary sinus. The patient underwent surgery and the postoperative histopathology was suggestive of dedifferentiated chondrosarcoma. The present report discusses this rare presentation and the issues in its management.
  6,471 479 5
Need for epidemiological evidence from the developing world to know the cancer-related risk factors
Agnihotram V Ramanakumar
January-March 2007, 3(1):29-33
DOI:10.4103/0973-1482.31968  PMID:17998716
The existing evidence on cancer etiology has mostly come from epidemiological studies conducted in the developed world. Now there is an urgent need to gather information on cancer risks in developing countries. Due to recent economic, demographic and health transitions, cancers are on the rise in many developing countries. Future epidemiological studies in these countries should address changing diet, level of physical activity, various environmental and occupational exposures, smoking habits and infections, relative to cancers. In many low resource settings western and conventional lifestyles can be found side by side. Therefore, epidemiological studies in such societies should determine the wide varieties of potentially dangerous exposures, examine changing patterns of related factors and should study other contributing variables as well. Apart from the advantages of such research, there are some challenges. For example, incomplete cancer and death registration, lack of documentation, only partial computerization of medical records, cultural barriers and other technical difficulties can present problems. Some strategies to meet these challenges will be discussed in this paper. There is an immediate need for more detailed epidemiological studies before these developing societies are transformed.
  6,285 585 7
Age related macular degeneration: A study of patients managed with radiotherapy
Anusheel Munshi, Rajiv Sarin, Ajay Dudhani, Ketayun A Dinshaw
January-March 2007, 3(1):12-16
DOI:10.4103/0973-1482.31965  PMID:17998713
Introduction: Age-related macular degeneration (ARMD) is the leading cause of blindness in the west. Radiotherapy affects the evolution of exudative macular degeneration directly by its effect on the endothelium and inflammation modulation. We conducted a retrospective study to evaluate the improvement in visual acuity and healing of sub retinal neovascular membrane (SRNV) following fractionated radiotherapy. Materials and Methods: 47 patients (58 eyes) of ARMD were retrospectively analyzed. One of the following radiotherapy fractionation schedules was employed in all the patients in this study. a) 15 Gy /5 fractions/1 week (five patients) b) 20 Gy/5 fractions/1 week (19 patients) c) 22.5Gy/5 fractions/1 week (21 patients) d) 25 Gy/5 fractions/1 week (two patients). VA and funduscopy was taken at each follow-up for objective improvement and to assess the healing of SRNV. Results: The median follow-up was 7.23 months. The mean improvement in the VA in the entire group was of 0.44 line. (Median 1, SD 1.04). Overall 75% of the eyes showed either steady vision or an improvement in subjective vision analysis. The deterioration free survival was significantly better in the group that had a relatively short duration of symptoms ( P =0.01). Scarring at presentation was a significant adverse factor for improvement in vision after radiotherapy ( P = 0.001). Conclusions: In patients of ARMD treated with radiotherapy, the initial duration of symptoms and scarring of eyes at presentation were significant prognostic variables for improvement in VA after radiotherapy.
  5,603 472 3
Malignant astrocytoma following radiotherapy for craniopharyngioma
G Menon, S Nair, BJ Rajesh, BRM Rao, VV Radhakrishnan
January-March 2007, 3(1):50-52
DOI:10.4103/0973-1482.31974  PMID:17998722
Radiation induced gliomas are uncommon. Occurrence of glioma following radiotherapy for craniopharyngiomas is extremely uncommon and only eight case reports have been so far published. We present our experience with one similar case of temporal gliomas occurring twelve years following radiotherapy for a sub totally excised craniopharyngioma. Although the exact mechanism of gliomas formation is unclear, their occurrence following conventional radiotherapy is a distinct possibility and signifies a poor prognosis.
  5,526 427 6
Implications of p53 over-expression in the outcome with radiation in head and neck cancers
P Lal, L Pal, S Kumar, K Dimri, A Tiwari, N Rastogi, S Singh, NR Datta
January-March 2007, 3(1):17-22
DOI:10.4103/0973-1482.31966  PMID:17998714
Background: Abnormalities in the p53 tumor suppressor gene and in the expression of its protein are commonly seen in several tumors. The prognostic implication of these p53 abnormalities was studied in 55 patients with advanced head and neck cancers. Purpose: To identify p53 as a prognostic factor in assessment of response and survival outcome to radiotherapy in head and neck malignancies. Materials and Methods: This prospective study was carried out from April 1998 to December 1999. Fifty five patients with proven squamous cell carcinoma of the head and neck region were treated by radiotherapy (RT) (n=34) with or without chemotherapy (CT) (n=21). A dose of 70Gy/35#/7 weeks was given with or without concurrent administration of weekly cisplatin (35 mg/m2). Paraffin sections obtained at the time of diagnosis, were examined immunohistochemically for p53 overexpression with monoclonal antibody DO-7 (DAKO). The scoring of p53 positive cells was carried out by a trained pathologist. Selected areas of p53 positive cells were viewed under high power field for quantitative assessment of the p53 over expression. A minimum of 1000 cells were counted and the labeling index (LI) was calculated in terms of percentage of p53 positive cells over the total number of cells counted. A 10% nuclear reactivity exhibiting chromogen positivity cutoff point was established. Observations: The data was analyzed as of January 2006. Median follow-up of all the patients was eight months (1-95 months). The median age of this study group was 58 years and of the 55 patients, 48 were males. Positive expression of p53 gene protein was documented by immunohistochemistry in 24 (44%) patients. Over expression of p53 was not associated with T or N stage, site of disease, radiation response or survival outcomes ( P =0.143). Stage was the only independent prognostic variable, both for the response to treatment (radiation) and survival ( P =0.01). Conclusions: Over expression of p53 protein, when detected immunohistochemically, does not predict for radiation response in these tumors.
  5,358 466 5
Undiffentiated sarcoma of the mitral valve with secondaries in brain in a girl of 22 years
G Sudarshan, Mohana Vamsy, S Sudha Murthy, V Sudhakar Kumar
January-March 2007, 3(1):47-49
DOI:10.4103/0973-1482.31973  PMID:17998721
During a mitral valve replacement surgery in a girl of 22 years of age, it was accidentally discovered that the valve was destroyed due to a tumor and the histopathology and immunohistochemistry findings have proved it to be undifferentiated sarcoma. She was advised by the surgeon to go for chemotherapy. There was a delay of three months from the side of the patient to reach us and during that interval she has developed secondaries in the brain. This case is being presented here for its rarity.
  4,909 300 3
Tribute to Professor P. K. Mohanta (1961 - 2006)
Kishore Singh
January-March 2007, 3(1):67-67
  3,631 221 -
Myth of finger printing and patents!
Nagraj G Huilgol
January-March 2007, 3(1):1-1
DOI:10.4103/0973-1482.31962  PMID:17998710
  3,252 397 -
Filgrastim (r-methug-CSF) in practice: Second edition
Nagraj G Huilgol
January-March 2007, 3(1):68-68
  2,998 240 -