Conformal electron beam radiotherapy using custom-made step bolus for postmastectomy chest wall irradiation: An institutional experience

Background: Postmastectomy radiation (PMRT) to the chest wall using electron beam treatment with uniform bolus was practiced at our institution. The planning target volume (PTV) included the chest wall and the internal mammary nodes (IMN) along with supraclavicular nodal regions. The varying thickness of the postmastectomy chest wall and the varying position of the IMN resulted in dose inhomogeneity in the PTV. In addition, there was the risk of increased lung and cardiac doses. In this prospective study, we report the making of a custom-made bolus using dental wax called “step bolus.” Materials and Methods: From March 2010 to January 2011, 167 patients received PMRT. As conformal photon plans were not acceptable in 48 patients, they were treated with single energy electrons and custom-made bolus. Results: Addition of the step bolus improved dose distribution to the PTV reduced the mean lung dose %, the mean heart dose % and lung dose (D10, D20, D30, D50, and D70). Forty-seven patients had Grade 2, and one patient had Grade 3 skin toxicity. Acute symptomatic radiation pneumonitis was observed in one patient. At 5 years, 29 patients were alive with a median follow-up of 32 months and no local recurrences were observed. One patient died of myocardial infarction unrelated to treatment, one patient did not come for follow-up, 22 patients had systemic metastases, and 24 patients were disease free. Conclusion: A custom-made step bolus using dental wax can be used for tissue compensation in electron beam therapy with resulting good local disease control and acceptable toxicity.

Neoadjuvant concurrent chemoradiation in male breast cancer: Experience from a tertiary cancer center

BACKGROUND: Male breast cancers (MBC) account for 1% of all breast cancers. Neoadjuvant concurrent chemoradiation (CTRT) is not the standard of care for treating breast cancer. However, in our center, it has been routinely used in patients with locally advanced breast cancer to downsize the tumor and make it amenable to surgery. AIM: This study was conducted to examine the clinical and pathological profile and outcomes of patients with MBC treated at our institute with neoadjuvant CTRT. SETTINGS AND DESIGN: The study was conducted at a tertiary cancer center and was retrospective in nature. MATERIALS AND METHODS: All MBC patients treated with neoadjuvant CTRT at our center between 2001 and 2016 were enrolled in the study. Data were retrospectively extracted from the patients' case records. STATISTICAL ANALYSIS: Kaplan–Meier method was used for survival analysis and the outcome variables were compared using the log-rank test. RESULTS: Thirty-one MBC patients who received neoadjuvant CTRT were analyzed in this study. The median age of the patients was 53 years. Stage IIB disease was observed in 8/31 (26%) patients, stage III in 20/31 (64%), and stage IV in 3/31 (10%) patients. There was no grade 3 or 4 toxicity due to CTRT. Surgery was performed in 29/31 (94%) patients and none of the patients had a pathological complete response. The median duration of follow-up was 95.3 months. The 8-year event-free survival and overall survival for stage IIB, III, and IV were 75%, 50%, and 0% and 87.5%, 69%, and 0%, respectively. CONCLUSION: This is the first study to report on the use of neoadjuvant CTRT in MBC. Prospective evidence from phase-3 randomized controlled trials on the safety and efficacy of CTRT in breast cancer is required before its routine use can be recommended.

Cytogenetic investigation in chronic myeloid leukemia: study from an Indian population.

Chronic myeloid leukemia (CML) is a malignant neoplasm of hematopoietic cells characterized by abnormal proliferation of myeloid precursors, decreased rates of self destruction and an arrest in cellular differentiation. The bone marrow and peripheral blood accumulates all forms of mature and immature granulocytes, primarily blast cells. It is the most common type of leukemia seen in India, accounting for 30% of all leukemias. Cytogenetic analysis plays a vital and important role in the diagnosis of CML patients. The present study consists of cytogenetic evaluation of 175 CML cases from the Indian population with ages ranging from 6-86 years (mean of 42.8). The study population included 115 males (65.72%) and 60 females (34.28%) with a Male: Female ratio 1.9:1. Out of the 175 cases, 164 (93.7%) were successfully karyotyped while culture failure was observed for 11 (6.3%). Among the 164 reported cases, 53 (32.3%) showed a normal karyotype while within the 111 (67.7%) abnormal cases, 96 cases (86.5%) showed the presence of Philadelphia (Ph') chromosome with standard translocation t(9;22); Ph'+ve along with secondary aberrations was detected in 9 (8.1%) cases. Variants of Ph' chromosome were detected in only one case (0.9%). Ph'-ve CML with other chromosomal aberrations were detected in 5 (4.5%) cases, including +8, del 20q, del 11q and marker chromosome. Furthermore, we believe that availability of more advanced molecular techniques can be used as a supportive tool in CML diagnosis even though it cannot fully replace cytogenetics, which remains the backbone for laboratory investigation of the disease.