Three-week hypofractionated radiotherapy in early glottic cancer-a single institution retrospective study.

Background: Radiotherapy is a standard treatment option for early glottic carcinoma (stage I and II) with a fraction size of 2-2.2 Gy over 5-7 weeks. This study evaluates the outcome and prognostic factors of a 3-week hypofractionated treatment in early glottic malignancy. Materials and Methods: The case records of 329 eligible patients with stage I and II glottic carcinoma recorded at the institution from 2003 to 2008 were retrospectively analysed. All patients were treated in a Cobalt-60 machine to a dose of 52.5 Gy in 15 fractions (3.5 Gy/fraction) over 3 weeks. Results: Eighty-three percent had stage I disease. The local control rate at 5 years was 91.9%. On univariate analysis, stage I and II patients without subglottic extension had better local control. Disease extension to the subglottis fared poorly on multivariate analysis. After salvage treatment, the 5-year disease-free survival rate was 96.1% and the functional larynx preservation rate was 94.9% for stage I and 83.9% for stage II. The rate of severe complications was 2.1%. Conclusion: Comparable results with low morbidity are achievable with a 3-week hypofractionation in early glottic cancers and it offers better patient convenience. Highlights: In early glottic cancer, hypofractionated radiation provides excellent local control.Subglottic extension is a poor prognostic factor.5-year disease-free survival rate of 96.1%.5-year functional larynx preservation rate of 94.9%.Severe complication rate of 2.1%.

Treatment of Primary in Metastatic Prostate Cancer: What Is the Standard of Care?

Until recently, men with metastatic prostate cancer were commenced on androgen deprivation therapy at diagnosis, followed by sequential lines of treatment with the development of castration resistance. However, the results of recent clinical trials, which revealed that the addition of radiotherapy to the prostate to a dose of 55 to 60 Gy in 20 fractions over 4 weeks in patients with low-volume metastatic hormone-sensitive prostate cancer, in addition to androgen deprivation therapy and another systemic treatment option, either docetaxel, abiraterone, enzalutamide, or apalutamide, has led to a paradigm change in the management of this disease.

Sarcopenia in cancer: Risking more than muscle loss.

Sarcopenia is characterised by progressive and extensive skeletal muscle degeneration and is associated with functional decline. Sarcopenia has primary and secondary aetiology, arising as a result of the ageing process or through chronic cytokine-mediated inflammation (associated with health conditions including cancer), respectively. Diagnosis of sarcopenia is dependent upon detection of reduced skeletal muscle strength, mass and performance. A combination of non-radiological and radiological methods can be used to assess each of these in turn to accurately diagnose sarcopenia. Sarcopenia is known to adversely affect outcomes of patients with various forms of cancer. Early identification of sarcopenia is imperative in improving patient care and overall prognosis. Various interventions, such as resistance exercise, nutritional support, and amino acid and vitamin supplementation have shown promise in the management of sarcopenia. However, further insight into novel interventions and indeed, assessment of the benefits of management of sarcopenia in terms of survival, are required to better support cancer patients.

The impact of patient positioning and use of belly board on small bowel toxicity in patients receiving pelvic radiotherapy for gynecological malignancies.

AIM: To determine the efficacy of belly board device in patients receiving postoperative radiation for gynecological malignancies in terms of setup error and acute small bowel toxicity. MATERIALS AND METHODS: Patients requiring postoperative radiation for gynecological malignancies were prospectively randomized to either treatment with supine position (supine arm) or prone position using belly board (prone arm). Each patient underwent computed tomography simulation in the assigned treatment position, and a three-dimensional conformal radiation was planned. Weekly two to three treatment sessions were verified using portal imaging and setup errors were noted. All patients were reviewed weekly to assess for symptoms and toxicity using a structured format. The systematic and random errors were calculated along the three axes. RESULTS: Twenty-four patients were randomized and 22 patients were available for the final analysis. The systematic error in supine arm versus prone arm was 3.9 versus 3.5 mm, 2.1 versus 4.8 mm and 3.1 versus 3.1 mm along lateral, antero-posterior (AP) and cranio-caudal (CC) direction. The random error in supine arm versus prone arm was 5 versus 3.9 mm, 2.9 mm versus 4.4 mm and 4.3 versus 3.4 mm along lateral, AP and CC direction. The calculated planning target volume margin for supine arm was 1.3, 0.7, and 1.0 cm and margin for prone arm was 1.1, 1.5, and 1.0 cm along lateral, AP, and CC direction, respectively. One patient in supine arm developed Grade 3 toxicity. CONCLUSION: The systematic error and random error is more along AP direction for prone position. The acute small bowel toxicity was less using belly board.

Setup uncertainties and PTV margins at different anatomical levels in intensity modulated radiotherapy for nasopharyngeal cancer.

AIM: To determine the systematic error (∑), random error (σ) and derive PTV margin at different levels of the target volumes in Nasopharyngeal Cancer (NPC). MATERIALS AND METHODS: A retrospective offline review was done for patients who underwent IMRT for NPC from June 2015 to May 2016 at our institution. Alternate day kV images were matched with digitally reconstructed radiographs to know the setup errors. All radiographs were matched at three levels - the clivus, third cervical (C3) and sixth cervical (C6) vertebra. The shifts in positions along the vertical, longitudinal and lateral axes were noted and the ∑ and σ at three levels were calculated. PTV margins were derived using van Herk's formula. RESULTS: Twenty patients and 300 pairs of orthogonal portal films were reviewed. The ∑ for the clivus, C3 and C6 along vertical, longitudinal and lateral directions were 1.6 vs. 1.8 vs. 2 mm; 1.2 vs. 1.4 vs. 1.4 mm and 0.9 vs. 1.6 and 2.3 mm, respectively. Similarly, the random errors were 1.1 vs. 1.4 vs. 1.8 mm; 1.1 vs. 1.2 vs. 1.2 mm and 1.2 vs. 1.3 vs. 1.6 mm. The PTV margin at the clivus was 4.4 mm along the vertical, 4 mm along the longitudinal direction and 3.2 m in the lateral direction. At the C3 level, it was 5.5 mm in the vertical, 5 mm in the lateral direction and 4.4 mm in the longitudinal direction. At the C6 level, it was 6.4 mm in the vertical, 6.9 mm in the lateral direction and 4.4 mm in the longitudinal direction. CONCLUSION: A differential margin along different levels of target may be necessary to adequately cover the target.