Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group.

The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.

Problems in reporting doses and volumes during multiple high-dose-rate intracavitary brachytherapy for carcinoma cervix as per ICRU Report 38: a comparative study using flexible and rigid applicators.

OBJECTIVE: The objective was to evaluate the extent of geometric and positional variations of two different applicators during multiple high-dose-rate (HDR) intracavitary brachytherapy (ICBT) in carcinoma cervix and its implication on reporting as per International Commission on Radiation Units and Measurement (ICRU) Report 38. METHODS: Fifty patients, following teletherapy, were randomly allocated to two groups of 25 each. They received a dose of 6 Gy to point A during each of the three HDR ICBT applications by either a flexible Ralstron or a rigid geometry Rotterdam applicator. The various applicator components related to its geometry and their Cartesian coordinates were evaluated from orthogonal films. The doses to ICRU bladder, rectal, pelvic, lymphatic trapezoid points, and dimensions of 6-Gy ICRU height, width, thickness, and volume were estimated for each application. RESULTS: Significant variation was observed with the three HDR ICBT applications for each group, for all components and for both applicators, although it was relatively more with the flexible Ralstron applicator. The average shift in each of the coordinates of os, uterine tip, and ovoids was around 10 mm for both groups. These resulted in significant variations in all the ICRU Report 38 reporting parameters for three insertions in any given patient and across 25 patients of both groups. CONCLUSIONS: Multiple HDR ICBT applications led to significant variation in the applicator geometry and its positions in pelvis, irrespective of the applicator rigidity. This results in uncertainties in reporting as per ICRU Report 38 guidelines, and thus calls for its revision.

Total reference air kerma: to what extent can it predict intracavitary volume enclosed by isodose surfaces during multiple high-dose rate brachytherapy?

BACKGROUND: The International Commission on Radiation Units and Measurements (ICRU) report 38 recommends reporting of total reference air kerma (TRAK) and reference ICRU isodose volumes during intracavitary brachytherapy (ICBT) in cancer of the cervix. The present study attempts to estimate the volumes enclosed by isodose surfaces from TRAK and evaluate its utility to represent doses to organs of interest. MATERIAL AND METHODS: Volumes encompassed by isodose surfaces of 3 Gy, 6 Gy, 9 Gy, and 12 Gy were obtained for 90 high-dose rate (HDR) ICBT procedures. These were used to derive a relation between isodose volumes, TRAK/dose (K/D), and rectal and bladder doses. RESULTS: Actual volumes (V) encompassed by isodose surfaces were reflected as a quadratic function of K/D (r(2)=0.998) and the expression, V=-23.09+1295.99(K/D)+5661.65(K/D)(2) gave the best estimates for various volumes. No correlation was observed between TRAK and bladder (r(2)=0.086) or rectal doses (r(2)=0.082). CONCLUSIONS: Estimates of volumes encompassed by different dose levels from TRAK could be derived with reasonable certainty. However, TRAK fails to correlate with rectal and bladder doses.

Anaphylaxis to cisplatin following nine previous uncomplicated cycles.

Anaphylaxis to cisplatin is an infrequent life-threatening complication which may occur even in patients who have received prior treatment with cisplatin. We report here a patient with carcinoma of the cervix with recurrent abdominal and thoracic disease who was previously treated with concurrent cisplatin and radiation for local control of pelvic disease. After nine previous uncomplicated cycles she developed severe anaphylaxis to cisplatin. The anaphylactic reaction was managed successfully with corticosteroids, nebulization with beta(2) agonists, and isotonic fluid support. With the extensive use of platinum-based chemotherapy regimens, either alone or in combination with radiation therapy in the management of gynecological malignancies, this uncommon complication should be kept in mind for early detection and successful management.