Recurrence Developing 21 Years after Treatment of Breast Cancer

Background: Breast cancer is a very common cancer among females. In which most recurrence (around 75%) occurs within the initial 5 years after diagnosis, especially within 3 years. Recurrence after 20 years is very less reported in the last few decades. Case Information: We are presenting a case of a 67-year old female patient presented with pleural based nodules suggestive of lung metastasis followed by brain metastasis. After reviewing history we came to know that the patient was a previously treated case of breast carcinoma treated 22 years back with mastectomy. Conclusion: We report late recurrence of breast cancer occurring 21 years after mastectomy suggesting that possibility of recurrence in carcinoma breast with 21-years latency period although rare should be taken into consideration when making decisions regarding patients who may need long term follow up.

5 Years Local Recurrencce Rates Following Post- Operative 2D Radiotherapy Treatment Planning Patients – An Institutional Experience.

Introduction: In India, almost 150,000 women are diagnosed with breast cancer every year and almost half of patients expected to die of the disease. In India most of patients with breast cancer diagnosed with advanced stage of the disease. As breast cancer treatment is multimodality approach Radiation therapy has significant impact on prevention of local recurrence. So, purpose of the study is to assess 5 year rates of local recurrence following post-operative 2D Radiotherapy treatment planning. Methods and Materials: We have selected 198 patients treated for post-operative 2D Radiotherapy treatment planning from September 2009-September 2010. All patients had undergone surgery in form of mastectomy or modified radical mastectomy. None of the patients with breast conservation surgery had been selected. All patients underwent chemotherapy either Induction chemotherapy following surgery or chemotherapy after surgery. All patients had been treated with 2D conventional Radiotherapy treatment plan with tangential fields and supraclavicular and axillary fields according to histopathology report. Patients were first taken on simulator machine and planning was done with breast wedge in position and fully abducted arm of the patient. Radiotherapy treatment dose was – 45Gy/20#, 2.25Gy/#, 5 days/week, total 4 weeks of treatment. Patients were assessed for acute toxicity every week. Patients were followed every monthly for 2 years, 2 monthly for 3rd year, 4 monthly for 4th year up to 5 year. Patients were assessed for Local recurrence up to 5 years. Results: 152 (77%) patients had undergone upfront Surgery. 46 (23%) patients were diagnosed with LABC, and had undergone chemotherapy first for downstage of the disease. After a median follow up of 34 months (range: 9-67 months), out of total 198 patients, 8.6% patients developed local recurrence. In which 6.5% (10 patients out of 152) in upfront surgery group and 15.2% (7 patients out of 46) in LABC group developed local recurrence. So, total 5% (10 patients) in upfront surgery group and 3.5% (7 patients) in LABC group out of 198 total patients developed local recurrence. Conclusion: Local recurrence after treatment of breast cancer with mastectomy+radiotherapy+/-systemic therapy is associated with a significantly higher risk of distant metastasis and death. So, in this retrospective study we have shown comparable results after 2D Conventional Radiotherapy Treatment Planning for prevention of local recurrence. Approach is safe, easy, and feasible, less time consuming and in Indian scenario where patients come in advanced stage of the disease and most of the time death is due to disease itself it is quite suitable approach at our centre. Also, we use hypofractionation regimen of 45Gy/20#, which is also feasible to reduce total treatment time and it has also shown equivalent results.

Analysis of X-knife and surgery in treatment of arteriovenous malformation of brain.

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.

Plasmacytoma of scalp.

An interesting case of plasmacytoma of the scalp is described. Extramedullary plasmocytoma of scalp is rarely reported. This patient was treated with external radiotherapy dose of which was 40 Gy/20 fraction. Disease responded very well to radiotherapy.