COVID-19 pandemic: Radiotherapy precautions and preparedness

The novel coronavirus (COVID-19) pandemic has disrupted healthcare delivery across the globe. Cancer patients are at a higher risk of acquiring this infection due to their immunosuppressed state. Timely care of patients while ensuring safety of healthcare workers is need of the hour. We list few precautionary measures that can be taken at all radiotherapy centres, during the pandemic to curb and combat the spread of this disease.

Prognostic value of response assessment fluorodeoxyglucose positron emission tomography-computed tomography scan in radically treated squamous cell carcinoma of head and neck: Long-term results of a prospective study

Objective: The objective of this study is to evaluate the diagnostic and prognostic ability of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) scan in patients with squamous cell carcinoma of the head and neck treated with chemoradiotherapy or radiotherapy only. Materials and Methods: Fifty-nine patients with HNSCC planned for radical nonsurgical treatment were randomized to receive either three-dimensional conformal radiotherapy or intensity-modulated radiation therapy. In addition to routine clinical examination and staging investigations, patients had a FDG PET-CT scan at baseline and on the first follow-up for response assessment. No evidence of clinicopathological disease for at least 6 months after the completion of treatment was considered confirmation of complete response. The presence or absence of disease during the follow-up period was used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET-CT for the primary site and node. Results: At a median follow-up of 52.5 months, 55.6% of patients were alive and disease free. Response assessment PET-CT was done at a median of 9 weeks (range: 5–18 weeks). PET-CT assessment of the primary had sensitivity, specificity, PPV, and NPV of 81.8%, 93%, 75%, and 95.2%, respectively; the corresponding figures at the node were 44.4%, 95.6%, 66.7%, and 89.6%. The median baseline maximum standardized uptake value (SUVmax) at primary and node was 14.9 and 8.1, respectively. When PET-CT was done after 10 weeks, no false-positive or false-negative findings were seen. Patients with negative PET at the first follow-up had a significantly better progression-free and overall survival. Conclusions: Disease evaluation using PET-CT has an overall accuracy of 80%. High baseline SUVmax correlates with worse clinical outcomes. Negative PET-CT at the first follow-up is a predictor for survival.

Frozen section is not cost beneficial for the assessment of margins in oral cancer

BACKGROUND: Routine use of frozen section (FS) is a costly procedure and sparsely available in resource poor countries. A proper cost benefit analysis may help to reduce its routine use and would empower surgeons to perform oral cancer surgeries without having FS facility. FS is performed to identify microscopic spread beyond gross disease that cannot be assessed clinically. OBJECTIVE: Our primary aim was to determine the cost benefit analysis of FS in the assessment of margins in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Retrospective study of prospectively collected data of 1311 consecutive patients who were operated between January 2012 and October 2013. The gross and microscopic margin status of each patient was extracted from the patient's chart. The cost estimates were performed to calculate the financial burden of FS as well as expenses incurred on adjuvant treatment resulting from inadequate margins. RESULT: Microscopic spread changed the gross margin status in 5.2% (65/1237) patients. Of this entire cohort of 1237 patients, FS helped 29 (2.3%) patients to achieve tumor free margin, and it changed the adjuvant treatment plan in 9 (0.7%) patients. The cost of FS for each patient was INR 11052. The cost-benefit ratio of FS was 12:1. Gross examination alone could have identified majority of the inadequate margins. CONCLUSION: Frozen section for assessment of margin status bears poor cost-benefit ratio. Meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.

Chest wall metastasis from hepatocellular carcinoma in the absence of a primary: An unusual presentation.

Metastatic hepatocellular carcinoma (HCC) has an aggressive course with a very poor outcome. The common hematogenous metastatic sites are the lungs, bones, and adrenal glands. The chest wall is an extremely rare site of metastasis from HCC. We report a rare presentation in a gentleman, where the chest wall metastasis kept progressing in spite of treatment, without any evidence of a detectable primary.

Prevalence of psychiatric disorder in asymptomatic or minimally symptomatic cancer patients on treatment.

BACKGROUND: Cancer not only affects organ systems physically but can also affect the mind as a psychiatric disorder. Appropriate treatment can be clinically efficacious and cost-effective. With this background, a study was conducted in a regional cancer center to assess the prevalence of psychiatric disorder amongst cancer patients and correlate it with socio-demographic parameters. MATERIALS AND METHODS: Asymptomatic or minimally symptomatic cancer patients on active anticancer treatment, fulfilling inclusion criteria, were served psychiatric assessment questionnaire. The demographic and the medical data were obtained from subjects and their medical records. Correlation of prevalence of psychiatric disorder with socio-demographic parameters was done using the Chi-square test. RESULTS: Thirty-eight patients returned the questionnaire duly filled. Of them, 24 (63%) had some psychiatric disorder. All these 24 patients were suffering from depression--15 (63%) from major depression and 9 (37%) from minor depression. Only 6 (25%) patients had anxiety disorder. The prevalence of psychiatric disorder in patients aware of the diagnosis and prognosis was 58 and 55% respectively. This was significantly higher as compared to the patients who were not aware of their diagnosis and prognosis (P-value 0.019 and 0.05 respectively). CONCLUSION: High prevalence of psychiatric disorder, especially depression, amongst the cancer patients--particularly in those who were aware of the diagnosis and prognosis. A majority of these disorders are eminently treatable. Routine psychiatric evaluation of all cancer patients is a matter of debate that needs to be addressed in larger prospective surveys.

Isolated prostatic metastasis from primary sigmoid colon carcinoma.

Metastasis to the prostate is extremely uncommon. We report a 38-year-old man with sigmoid colon carcinoma, treated with surgery and adjuvant chemotherapy, who developed isolated metastasis to the prostate four years after initial treatment. He was treated with chemoradiation and remains disease-free three years after detection of metastasis.