ABSTRACT
Covid19 has become a major public health problem in India and the rest of the world. The dramatic rise in the incidence of COVID 19 cases has severely challenged our healthcare system and forced us to work with limited infrastructure, resources, and workforce. However, even in this time of adversity, we as oncologists cannot neglect the seriousness of cancer care and the utmost attention it requires for the timely management of our patients. Hence, the Association of Radiation Oncologists of India has come up with an advisory for radiation therapy keeping in mind such aspects.
ABSTRACT
Purpose: High Dose Rate (HDR) remote afterloading brachytherapy machine and advanced treatment planning system have made it possible to make variations in individual dwell times across a catheter according to tumour density and for sparing normal structures. New inverse planning technique such as Inverse Planning Simulated Annealing (IPSA) has also been introduced. But very few institutions are venturing towards volume based IPSA optimised intracavitary brachytherapy. This study focuses on dwell time deviation constraint (DTDC) feature of IPSA based optimization which restricts the large variation of dwell time across the catheter. Methods and Material: For this retrospective study we have generated IPSA optimised intracavitary brachytherapy plans for 20 cancer cervix applications. The initial DTDC value of each IPSA plan was kept 0.0. Later on gradual increment was made in DTDC values in step of 0.2. Plan modulation index (M) defined by Ryan L. Smith et al was used for characterising the variation of dwell time modulation with respect to gradual increase in DTDC parameter. Results: Plan modulation index gradually decreases with increasing value of DTDC from 0.0 to 1.0. There was the 83% decrease in M value from IPSA of DTDC 0.0 to fully constrained IPSA of DTDC1.0. There is reduction of 8.26% and 6.95% for D2cc values of rectum and bladder respectively for DTDC 1.0 compared to DTDC 0.0. Conclusions: One of the benefits of applying DTDC constrained in IPSA plan is that, it removes local hot spots. It's another advantage is the reduction in rectum and bladder dose.
ABSTRACT
Background: Colorectal cancer is rare in younger age group. Most cases occur in the second decade of life and are clinically aggressive. The prognosis of these patients is generally poor. This is a retrospective study in which data of Indian patients was compared to standard literature. Methods: Data on 32 young patients with colorectal cancer between ages of 10-25 years treated between January 2000 and December 2006 was reviewed. Clinical presentation, natural history and response to therapy were evaluated. Results: Studied cases comprised 9.9% of the total number of colorectal cancer patients. The median age of presentation was 21.5 years. Four-fifths of the cases presented in late stage. Nodal involvement was seen in 38% cases and metastatic disease in 12% cases. The rectum was the most commonly involved site. A majority of the patients presented with pain (81%), altered bowel habits (72%) and bleeding per rectum (78%). Surgery was done in 16 cases; radiotherapy in 16 patients; while chemotherapy was used in 19 cases. Responses at completion of treatment were seen in 28% cases; while 1 year post treatment only 12% cases were alive and only 6% at 2 years. Conclusions: Colorectal cancer in younger age is rare and a high level of suspicion is necessary to diagnose it at an early and curable stage. Rectal bleeding therefore should not be ignored but evaluated further with at least a digital rectal examination and a sigmoidoscopy. Failure to do so results in late presentation with consequent dismal survival rates.
ABSTRACT
Epithelial-myoepithelial carcinoma is a rare tumor which makes up about 0.2% of epithelial neoplasms of the salivary glands; parotid gland being the most common primary site of origin. The tumor may also very rarely originate in minor salivary glands of the base of the tongue. Due to rarity of its occurrence, histogenesis and clear cut therapeutic guidelines are not defined. The present report describes the case of a 48 year old male who was diagnosed to have a tubular variant of epithelial-myoepithelial carcinoma of the base of tongue, Stage T3 N0 M0 (Stage group III). The patient was treated with neoadjuvant chemotherapy followed by radical radiotherapy (Rt) and is alive with no evidence of disease 14 months following end of treatment.