Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation

PURPOSE: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. MATERIALS AND METHODS: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. RESULTS: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). CONCLUSIONS: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.

Left ventricular non-compaction with multiple ventricular septal defects

Left ventricular non?compaction [LVNC] is a congenital cardiomyopathy characterized by deep ventricular trabeculations thought to be due to an arrest of myocardial morphogenesis. Integration of various cardiac imaging modalities such as echocardiography, cardiac computed tomography and cardiac magnetic resonance imaging help in the diagnosis of this rare clinical entity. We describe a child with rare variant of LVNC with predominant involvement of interventricular septum resulting in multiple ventricular septal defects

Palliative hypofractionated radiotherapy in locally advanced head and neck cancer with fixed neck nodes

The locally advanced head and neck cancer with fixed nodes are incurable and has a short survival. This study aims to evaluate the symptom relief, disease response and acute toxicity after palliative hypofractionated radiotherapy. Between December 2010 to June 2011, previously untreated 50 patients who had histopathologically proved of head and neck squamous cell carcinoma with fixed node of stage IV, Eastern Cooperative Oncology Group [ECOG] performance status 2-3 were offered palliative radiotherapy [20 Gy/5Fr/5 Days]. Patients were evaluated at 15[th] and 30[th] day after completion of treatment for disease response [WHO], palliation of symptoms using symptomatic response grading and acute toxicities [Radiation Therapy Oncology Group, RTOG]. The most common presenting complaint was pain followed by dysphagia. Majority of patients [60-70%] had appreciable relief in their presenting symptom. In our study, we observed Partial Response [PR] in majority of patients [92%]; no patient had progressive or stable disease. None of the patients experienced radiation toxicities that required hospital admission. Almost all patients showed grade one and two acute skin and mucosal toxicities one month after completion of treatment. Advanced head and neck cancer with fixed neck node should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in great proportion of patients.