Respiratory gated simultaneous integrated boost-intensity modulated radiotherapy [SIB-IMRT] after breast conservative surgery for carcinoma of the breast: the Salmaniya medical complex experience

To present our clinical experience using SIB-IMRT Technique for Intact Breast cancer. A retrospective review of 45 cases of Stage I-IV breast cancer patients treated with SIB-IMRT with respiratory gating after conservative treatments from 35th November 2008 to 16th February 2010. The most common fractionation was 1.8 Gy to Ipsilateral Breast tissue and 2.2 Gy to the lumpectomy cavity giving whole breast dose as 50.4 Gy and Lumpectomy cavity dose as 50.4 Gy and Lumpectomy cavity dose as 61.6 Gy over 28 fractions concomitantly. Respiaratory gating was done and CT-images were taken in inspiration breath hold position. A total of 45 patients with breast cancer- stage [17.7%], II [71%], II [8.9%], IV [2.2%] were treated with SIB-IMRT with respiratory gated radiotherapy. Out of 45 patients, 24 are of left sided breast cancer and 21 are of right sided breast cancer patients. The median, Dose maximum [D-max] in SIB-IMRT is 106.2% of prescribed lumpectomy site dose. The median isodose line prescribed to PTV-2 is 100%. The Conformity index [CI] is 0.9688 [median value] and Homogeneity index [HII] 1.06 [median]. The median ipsilateral lung, mean dose is 21.66 Gy and V-20 is 37.4%. For left sided cases the median value of mean heart dose, V-30 and V-40 are 22.98 Gy, 23.45% and 9.45% respectively. Acute skin toxicity was of Grade-I in 2.2%, Grade-II in 64.4%, Grade-III in 31.1%, and Grade-IV in 2.2%. The global Breast cosmoses were seen excellent in majority [93%] of case at median follow up of 8 months duration. Breast SIB-IMRT Technique is feasible and comparable with other treatment techniques with reduced treatment duration by six fractions. At median follow up of 8 months the skin toxicity and cosmoses are excellent in high percentage of cases

Acute respiratory distress syndrome in poor prognostic germ cell tumor with multiple lung metastases: a case report

We report a case which is unique as this patient was diagnosed pathologically as adenocarcinoma of the endometrium but clinically progressed as germ cell tumor. This was evident by progressive and rapid raised tumor markers [BHCG and LDH] with the development of multiple bilateral lung metastases. She was treated by administrating low doses of systemic combination chemotherapy as per the literature. Unfortunately, she developed acute respiratory distress syndrome as the complication of treatment and died due to it