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   2008| October-December  | Volume 4 | Issue 4  
    Online since December 1, 2008

 
 
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CASE REPORTS
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.
  19,280 752 6
REVIEW ARTICLES
Current status and future prospects in prosthetic voice rehabilitation following laryngectomy
Prashant V Pawar, Suhail I Sayed, Rehan Kazi, Mohan V Jagade
October-December 2008, 4(4):186-191
DOI:10.4103/0973-1482.44289  PMID:19052392
Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma around the world despite advances in conservative laryngeal surgery and radiotherapy. However, it has profound effects on respiration and deglutition, in addition to the most disabling effect-the loss of verbal communication. Successful voice restoration can be attained with any of three speech options, namely esophageal speech, electrolarynx, and tracheoesophageal (TO) speech using an artificial valve. Although, no single method is considered the best for every patient, the tracheoesophageal puncture has become the preferred method in the past decade. Several types of voice prostheses have been produced since the first prosthesis was introduced in 1980 by Blom and Singer. However, eventually all prostheses are confronted by the same problem, i.e., the development of a biofilm, leading to deterioration and ultimately to dysfunction of the prostheses, necessitating replacement. This article attempts to sum up the historical background as well as the current state of surgical voice rehabilitation following laryngectomy; we review the recent major advances as well as the future prospects. Data was collected by conducting a computer-aided search of the MEDLINE and PubMed databases, supplemented by hand searches of key journals. Over 50 articles published in the last three decades on the topic have been reviewed, out of which about 20 were found to be of relevance for this article.
  9,777 992 20
CASE REPORTS
Primary lymphoma of the ovary
Tijani Elharroudi, Nabil Ismaili, Hassan Errihani, Abdelouahed Jalil
October-December 2008, 4(4):195-196
DOI:10.4103/0973-1482.44291  PMID:19052394
Involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. We report a case of primary ovarian non-Hodgkin's lymphoma with bilateral involvement which was managed by surgery and chemotherapy. A 29-year-old woman was admitted with signs and symptoms suggestive of an ovarian cancer. Computed tomography revealed an abdominal tumor measuring 20 cm in diameter, without enlarged lymph nodes. The diagnosis of malignant lymphoma was established after bilateral adnexectomy and histological study of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient has been advised 8 cycles of standard CHOP regimen and is presently on treatment. She has now been without disease for 7 months after the surgery. According to previous reports the treatment principles and prognosis of primary ovarian lymphoma is the same as that of other nodal lymphomas.
  7,181 648 9
REVIEW ARTICLES
Development of an electronic radiation oncology patient information management system
Abhijit Mandal, Anupam Kumar Asthana, Lalit Mohan Aggarwal
October-December 2008, 4(4):178-185
DOI:10.4103/0973-1482.43342  PMID:19052391
The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information.
  6,423 414 2
CASE REPORTS
Unilateral solitary choroid metastasis from breast cancer: Rewarding results of external radiotherapy
S Nirmala, Malavika Krishnaswamy, MG Janaki, Kirthi S Kaushik
October-December 2008, 4(4):206-208
DOI:10.4103/0973-1482.44295  PMID:19052398
Intraocular metastatic tumor is the commonest intraocular malignancy in adults, with uveal tract the commonest site. In nearly 85% of cases the choroid is the afflicted site due to its vascularity. Breast and lung are the common primaries. In breast primaries, this could be the first metastatic disease. This condition should always be kept in mind in patients with visual symptoms. Fundus examination, ultrasonography and CT/MRI of the orbit help in diagnosis. Early recognition and timely treatment can save the visual function thus imparting good quality of life to the patient. External beam radiotherapy is a good local form of treatment. Hormone therapy in hormone receptor positive tumors can have additional benefits. Here we report a case of unilateral solitary choroid metastasis in a case of breast cancer treated with external beam radiotherapy.
  5,234 452 4
ORIGINAL ARTICLES
Infusion chemotherapy with cisplatinum and fluorouracil in the treatment of locally-advanced and metastatic gallbladder cancer
SS Chatni, RS Sainani, SA Mehta, KM Mohandas
October-December 2008, 4(4):151-155
DOI:10.4103/0973-1482.43341  PMID:19052386
Background: Gallbladder cancer (GBC) has a poor prognosis. Chemotherapy is traditionally considered to be ineffective. The goal of the current study was to evaluate the efficacy of infusional 5-fluorouracil (5-FU) and cisplatinum (CDDP) in patients with inoperable GBC. Materials and Methods: A total of 65 patients with inoperable GBC received palliative chemotherapy with CDDP and 5-FU. All the patients had clinically measurable disease as well as adequate bone marrow, hepatic, and renal function. Response was assessed after three cycles of chemotherapy. Results: A total of 19 patients had locally advanced unresectable cancer and 46 patients had metastatic cancer. There were 39 females and 26 males, with a median age of 50 years. A total of 212 chemotherapy cycles were administered to the patients. Response evaluation after three cycles of chemotherapy revealed complete response in five patients [7.69%; 95% confidence interval (95% CI): 2.87-16.22], partial response in 17 patients (26.15%; 95% CI: 16.57-37.81), stabilization of disease in 9 patients (13.85%; 95% CI: 6.96-23.88), and progression in 21 patients (32.30%; 95% CI: 21.80-44.35). At 6 months 44.6% patients were alive and 18.5% patients were alive at 12 months. The median overall survival was 5.7 months and the median time to disease progression was 3.1 months. This chemotherapy combination was well tolerated. There were no chemotherapy-related deaths. Conclusions: Infusion chemotherapy with CDDP and 5-FU appears to have a fair amount of activity in patients of inoperable GBC, with acceptable toxicity. Tumor shrinkage following treatment with this regimen enabled surgical resection in two patients. We believe that this promising combination must be tested against gemcitabine-based combinations in patients with inoperable GBC.
  4,700 489 9
A dose verification method for high-dose-rate brachytherapy treatment plans
Rajesh Kumar, SD Sharma, C Vijaykumar, Sudesh Deshpande, PK Sharma, S Vandana, A Philomena, Ravi H Chilkulwar
October-December 2008, 4(4):173-177
DOI:10.4103/0973-1482.44288  PMID:19052390
Aim: To evolve a fast dose verification method for high-dose-rate (HDR) brachytherapy treatment plans and to demonstrate its applicability in different clinical cases. Materials and Methods: We developed a software tool in VC++ for the Varisource HDR unit for HDR dosimetry plan verification using TG-43 parameters. HDR treatment dosimetry of a number clinical cases using Varisource was verified by comparison with the treatment planning system (TPS). Results: A number of different types of clinical cases treated by Varisource were evaluated. TPS calculated dose values and verification code calculated dose values were found to agree to within 3% for most of the dose calculation points. Conclusions: We have validated with clinical cases a fast and independent dose verification method of the dosimetry at selected points for HDR brachytherapy treatments plan using TG-43 parameters. This can be used for the verification of the TPS calculated dose at various points. The code is written to work with Varisource, but it can conceivably be modified for other sources also by using the fitted constant of the respective source.
  4,702 458 9
CASE REPORTS
Lymphoma of frontotemporal region with massive bone destruction and intracranial and intraorbital extension
Amit Agrawal, Arvind Sinha
October-December 2008, 4(4):203-205
DOI:10.4103/0973-1482.44294  PMID:19052397
Primary non-Hodgkin's lymphoma with unilateral proptosis and diffuse involvement of the cra¬nial vault and brain parenchyma is extremely rare. A 50-year-old woman developed a progressively increasing proptosis of her right eye, associated with a subcutaneous mass over the right frontotemporal region over the last 5 months. CT scan showed a high-density contrast-enhancing lesion with wide involvement of the cranium and intracranial and intraorbital extension. We performed a wedge biopsy for further analysis. Histological examination revealed that the tumor was non-Hodgkin's lymphoma. There was no evidence of systemic involvement. The patient received radiotherapy and was doing well at 18 months' follow-up. Primary malignant lymphoma involving the orbit and cranial vault is a rare malignancy, and treatment remains to be defined.
  4,318 346 2
INVITED EDITORIAL
Intensity-modulated radiation therapy for head and neck cancer in India: A promise waiting to be delivered
AK Anand
October-December 2008, 4(4):148-150
DOI:10.4103/0973-1482.44283  PMID:19052385
  4,029 563 -
ORIGINAL ARTICLES
Gliosarcoma: An audit from a single institution in India of 24 post-irradiated cases over 15 years
Piyush Kumar, Shalini Singh, Pavan Kumar, Narendra Krishnani, Niloy R Datta
October-December 2008, 4(4):164-168
DOI:10.4103/0973-1482.44286  PMID:19052388
Background: Gliosarcomas (GS) are biphasic brain tumors composed of glioblastoma multiforme (GBM) and sarcomatous component. Therapeutic approaches include maximum surgical decompression with postoperative radiotherapy. Outcomes in gliosarcoma are poor despite multimodality management. Aims: To analyze the outcome in patients of GS treated in our institute over a period of 15 years and compare it with GBM treated during the same period. Settings and Design: Clinical records of the post-irradiated GS patients and GBM patients seen between 1990 and 2004 were retrieved. Materials and Methods: Demographic and treatment variables were evaluated for their influence on overall survival (OS). The survival outcomes of GBM and GS treated during the same period were also compared. Statistical Analysis: Univariate analysis was carried out using the Kaplan-Meier method and tested using log-rank test for significance. Results: During these 15 years, 24 evaluable GS patients were treated as compared to 251 evaluable patients of GBM. There was a slight male preponderance in GS (14 males vs.10 females) with a median age of 50 years. All patients underwent surgery followed by post-operative radiotherapy (median dose of 60 Gy). None of the patient or treatment related factors were found to be significantly influencing their OS. Median OS in GS was 7.3 months compared to 7.5 months in GBM patients (P = 0.790). Conclusions: The OS appears to be similar for GS and GBM. None of the demographic variables appeared to prognosticate the survivals of GS.
  4,061 376 7
Analysis of X-knife and surgery in treatment of arteriovenous malformation of brain
Pooja Nandwani Patel, Rakesh K Vyas, Devang C Bhavsar, UK Suryanarayan, Satish Pelagade, Dipak Patel
October-December 2008, 4(4):169-172
DOI:10.4103/0973-1482.44287  PMID:19052389
Background: The goal of treatment in arteriovenous malformation (AVM) is total obliteration of the AVM, restoration of normal cerebral function, and preservation of life and neurological function. Aim: To analyze the results of X-knife and surgery for AVM of the brain. The endpoints for success or failure were as follows: success was defined as angiographic obliteration and failure as residual lesion, requiring retreatment, or death due to hemorrhage from the AVM. Materials and Methods: From May 2002 to May 2007, 54 patients were enrolled for this study. Grade I AVM was seen in 9%, grade II in 43%, grade III in 26%, grade IV in 9%, and grade V in 13%. Thirty-eight patients were treated by microsurgical resection out of which Grade I was seen in 5 patients, Grade II was seen in 17 patients, Grade III was seen in 9 patients and Grade V was seen in 7 patients. Rest of the sixteen patients were treated by linear accelerator radiosurgery out of which Grade II was seen in 6 patients, Grade III was seen in 5 patients and Grade IV was seen in 5 patients. The follow up was in range of 3-63 months. In follow up, digital subtraction angiography/ magnetic resonance angiography (DSA/MRA) was performed 3 months after surgery and 1 year and 2 years after stereotactic radiosurgery (SRS). Results: Among the patients treated with X-knife, 12/16 (75%) had proven angiographic obliteration. Complications were seen in 4/16 (25%) patients. Among the patients treated with microsurgical resection, 23/38 (61%) had proven angiographic obliteration. Complications (both intraoperative and postoperative) were seen in 19/38 (50%) patients. Conclusions: Sixty-one percent of patients were candidates for surgical resection. X-knife is a good modality of treatment for a low-grade AVM situated in eloquent areas of the brain and also for high-grade AVMs, when the surgical risk and morbidity is high.
  3,877 329 3
Modeling correlation indices between bladder and Foley's catheter balloon dose with CT-based planning using limited CT slices in intracavitary brachytherapy for carcinoma of cervix
Arun S Oinam, Jayant Sastri Goda, Sidharth Dubey, Anup Bhardwaj, Firuza D Patel
October-December 2008, 4(4):156-163
DOI:10.4103/0973-1482.44285  PMID:19052387
Purpose: To derive and validate an index to correlate the bladder dose with the catheter balloon dose using limited computed tomography (CT) slices. Materials and Methods: Applicator geometry reconstructed from orthogonal radiographs were back-projected on CT images of the same patients for anatomy-based dosimetric evaluation. The correlation indices derived using power function of the catheter balloon dose and the bladder volume dose were validated in 31 patients with cervical cancer. Results: There was significant correlation between International Commission on Radiation Units (ICRU)-38 balloon reference dose (Dr) and the dose received by 25% bladder volume (D 25 ) (P < 0.0001). Significant correlation was also found between the reference dose of mid-balloon point (D rm ) and the dose to D 25 (P < 0.0001). Average percentage difference [100 x (observed index - expected index) / expected index] of observed value of I' 25 (index for the dose to D25 bladder with respect to mid-balloon reference point) from that of expected value was 0.52%, when the index was modeled with reference dose alone. Similarly the average percentage difference for I'10cc (index for the dose to 10 cc volume of bladder with respect to mid balloon point) was 0.84%. When this index was modeled with absolute bladder volume and reference dose, standard deviation of the percentage difference between observed and expected index for D rm reduced by approximately 2% when compared to D r . Conclusion: For clinical applications, correlation index modeled with reference dose and volume predicts dose to absolute volume of bladder. Correlation index modeled with reference dose gives a good estimate of dose to relative bladder volume. From our study, we found D rm to be a better indicator of bladder dose than D r .
  3,635 323 -
EDITORIAL
Obama for a change
Nagraj G Huilgol
October-December 2008, 4(4):147-147
DOI:10.4103/0973-1482.44282  PMID:19052384
  3,333 314 -
BRIEF COMMUNICATION
Need for a paradigm for application of outcome measure (QOL scales) in head and neck cancer patients in India
Suhail I Sayed, Rehan A Kazi
October-December 2008, 4(4):192-194
DOI:10.4103/0973-1482.44290  PMID:19052393
Quality of life (QOL) is a multidimensional construct that minimally includes broadly defined assessments of the physical, psychological, and social domains of functioning. However, measuring this QOL is complicated by the fact that there are many different validated questionnaires available. In India, with people now wanting self-directed care and greater autonomy, we must direct increased efforts towards QOL and its assessment. We propose the Assessment, Translation & Validation, Application and Audit method to increase the use of QOL scales in our country.
  3,164 298 4
CASE REPORTS
Airway obstruction due to giant non-parathyroid hormone-producing parathyroid adenoma
Elina Kiverniti, Rehan Kazi, Peter Rhys-Evans, Robert Nippah
October-December 2008, 4(4):197-199
DOI:10.4103/0973-1482.44292  PMID:19052395
We present a case of a 39-year-old female patient with acute stridor due to a large tumor located at the level of the upper third of her thoracic esophagus. Parathyroid gland tumors are unusual in the differential diagnosis of mediastinal tumors. This tumor was removed via a thoracocervical approach, which offers multiple advantages when used for tumors in this location. The eventual diagnosis on histology was parathyroid adenoma. The patient had no clinical evidence of metabolic abnormalities and her pre- and postoperative calcium and postoperative parathyroid hormone (PTH) levels were within normal limits. This case poses the interesting question of whether identification of elevated PTH levels is an absolute prerequisite for diagnosing parathyroid adenomas. It is an example of a difficult diagnostic and therapeutic problem.
  3,106 224 1