A prospective observational study to analyse the influence of bladder and rectal volume changes on prostate radiotherapy using IMRT.

AIM: To analyse the interfractional bladder and rectal volume changes and the influence on prostate position. BACKGROUND: Interfractional displacement of prostate due to variation in bladder and rectal volume is usual. It is only rational to study the bladder and rectal volume changes and their effects on prostate position during intensity modulated radiotherapy of prostate cancer. MATERIALS AND METHODS: A prospective study was conducted on twenty patients with localized prostate cancer during the first phase of radiotherapy, where 50 gray in 25 fractions was delivered by the IMRT technique with daily cone beam computed tomography Bladder and rectum volumes were delineated on CBCT images and their volumes were noted. Prostate position was noted on each set of CBCT images with respect to specific reference points defined on the ileum and coccyx, and daily prostate displacement was noted. RESULTS: Mean setup errors in vertical, longitudinal and lateral directions were noted as 1.49, 0.498 and 0.17 cm, respectively. Mean change in bladder and rectal volumes in daily CBCT images with respect to that on the first day CT images was noted as 101.94 and 10.22, respectively. Mean lateral and vertical displacement in prostate position was noted as 0.53 and 0.49 cm respectively. No considerable changes in dosimetric parameters were observed because of bladder and rectal volume changes. CONCLUSIONS: Daily CBCT should be done for accurate treatment delivery by the IMRT technique for prostate radiotherapy as prostate shifts physiologically with changes in rectal and bladder volumes.

Incidence of second primary malignant neoplasm in Malwa region of central India.

BACKGROUND: Advancement in diagnostic and therapeutic modalities lead to increased cancer survivors who have 20% higher risk of developing second primary malignancy (SPM). AIM: To look for the incidence, epidemiological factors, treatment-related factors, and common risk factors responsible for the development of the SPM in Malwa region. MATERIALS AND METHODS: Records of 7709 patients who visited the Department of Oncology between May 2008 and August 2015 were analyzed and looked for the presence of SPM based on Warren and Gates criteria for head and neck and International Agency for Research on Cancer definition for other sites. Data pertaining age at diagnosis of each tumor, gender, site, histology, the duration between primary and secondary tumors, treatment received for each malignancy, smoking and drinking habits, and metastasis sites were recorded. RESULTS: Of 7709 patients, 56 developed SPM (11 synchronous and 45 metachronous) with an overall incidence of 0.726%. For metachronous SPM, the interval of 10-312 months was observed, with a mean time of 103.32 months (standard deviation 65.9 months). About 71.42% patients with SPM belonged to fifth, sixth, and seventh age decade. The median age of diagnosis for the second primary neoplasm was 57 years (range: 34-85 years). Maximum SPM were observed among head and neck tumors (33.93%) followed by breast (26.78%). The most common sites for SPM are head and neck (32.14%) followed by digestive system (19.64%). Breast as the first or the second location was seen associated with almost all systems. For the treatment of first primary, six received surgery, three received chemotherapy (CT), one received radiotherapy (RT) alone, and rest 46 patients received combined modality. For the treatment of SPM, 37 patients received combined modality, ten received CT, three with RT, and two with surgery while four patients received no treatment. Thirty-two patients had habits of tobacco, smoking and alcohol intake with twenty patients continued these after treatment for the first primary neoplasm. CONCLUSIONS: Patients with breast and head and neck cancer have a higher risk of developing SPM. The possibility of SPM should be considered and excluded during pretreatment evaluation and during follow-up of treated cancer patients.

Dosimetric analysis of Co-60 source based high dose rate (HDR) brachytherapy: A case series of ten patients with carcinoma of the uterine cervix.

AIM: To analyse the dosimetric parameters of Co-60 based high dose rate (HDR) brachytherapy plans for patients of carcinoma uterine cervix. BACKGROUND: Co-60 high dose rate (HDR) brachytherapy unit has been introduced in past few years and is gaining importance owing to its long half life, economical benefits and comparable clinical outcome compared to Ir-192 HDR brachytherapy. MATERIALS AND METHODS: A study was conducted on ten patients with locally advanced carcinoma of the uterine cervix (Ca Cx). Computed tomography (CT) images were taken after three channel applicator insertions. The planning for 7 Gray per fraction (7 Gy/#) was done for Co-60 HDR brachytherapy unit following the American Brachytherapy Society (ABS) guidelines. All the patients were treated with 3# with one week interval between fractions. RESULTS: The mean dose to high risk clinical target volumes (HRCTV) for D90 (dose to 90% volume) was found to be 102.05% (Standard Deviation (SD): 3.07). The mean D2cc (dose to 2 cubic centimeter volume) of the bladder, rectum and sigmoid were found to be 15.9 Gy (SD: 0.58), 11.5 Gy (SD: 0.91) and 4.1 Gy (SD: 1.52), respectively. CONCLUSION: The target coverage and doses to organs at risk (OARs) were achieved as per the ABS guidelines. Hence, it can be concluded that the Co-60 HDR brachytherapy unit is a good choice especially for the centers with a small number of brachytherapy procedures as no frequent source replacement is required like in an Ir-192 HDR unit.

Unusual Metastasis from Carcinoma Cervix.

INTRODUCTION: Although the incidence of cancer cervix has reduced in India during the last two decades, still most of the patients presenting in tertiary care centers are in advanced stages. MATERIAL AND METHODS: At this center, we see 6% of cancer cervix cases every year, and most of these cases are in stage III and IVa. All these patients have squamous cell carcinoma and were treated with a combination of external and intracavitary radiotherapy along with concurrent cisplatin given once weekly. Eighty-nine point nine % patients had achieved a complete response. RESULTS: Local recurrence was seen in 17.9% at a median duration of 10.5 months, and 8.17% developed distant metastasis involving lung, liver, bone, and supraclavicular lymph nodes. Three patients developed metastasis at unusual sites involving breast, paraspinal muscles, and duodenum which are very rarely involved. These patients were treated with chemotherapy using carboplatin and Paclitaxel combination but succumbed within 8-10 months of development of metastasis. CONCLUSION: The cause of involvement of these unusual sites is not clear, but it may be hematological spread, and we want to share these reports such that these sites are seen during follow-up of patients of cancer cervix.

Radiation-induced Vulvar Angiokeratoma Along with Other Late Radiation Toxicities after Carcinoma Cervix: A Rare Case Report.

Angiokeratoma including vulvar angiokeratoma is a very rare complication of radiation. Exact incidence is still unknown, we report a case that developed radiation-induced angiokeratoma of skin in the vulvar region along with other late radiation sequelae in the form of bone fracture, new bone formation, bone marrow widening, muscle hypertrophy, and subcutaneous fibrosis, 18 years after radiotherapy to the pelvic region for the treatment of carcinoma cervix. All these late radiation sequel are rare to be seen in a single patient, and none of the case reports could be found in the world literature.