A Prospective Study Comparing Dosimetry between Computed Tomography (CT) based Radiation Planning and Positron Emission Computed Tomography (PET-CT) based Radiation Planning in Treatment of Non-Metastatic Non Small Cell Lung Carcinoma.

BACKGROUND: To evaluate dosimetry between CT based radiation planning and PET-CT based radiation planning. MATERIAL & METHODS: Histologically proven 40 cases of locally advanced non-small cell carcinoma of lung were accrued for the prospective study. Contrast enhanced planning CT images and PET images were acquired. Target volume delineation, organs of interest & radiation planning were performed in Eclipse V 14.5 followed by dosimetric comparison among GTV, PTV and OARs. A p-value of <0.05 was considered significant. RESULTS: The mean of GTV were 141.18 ± 119.76 cc in CT and 115.54 ± 91.02 cc in PET-CT based and the difference was statistically significant (p=0.03). The mean of CTV were 313.91 ± 180.87 cc in CT and 260.81 ± 148.83 cc in PET-CT based and the difference was statistically significant (p=0.03). The contralateral lung mean dose was statistically very significant (p<0.01) among both the 3D-CRT plans which were 8.49 Gy in CECT based planning and 9.53 Gy in PET CT based planning. The heart mean dose was also statistically significant (p=0.03) among the plans which were 17.90 Gy in CECT based planning and 17.06 Gy in PET CT based planning. Mann-Whitney U test showed the CT based PTV D90 was 58.20 Gy vs 57.58 Gy in PET CT based planning (p=0.02). PTV V95 were also comparable in both of the plans (p=0.02). CONCLUSIONS: GTV measured using PET-CT, may be greater or lesser than the CECT-based GTV. PET-CT-based contouring is more accurate for identifying tumour margins and new lymph node volumes.

Awareness of palliative care among doctors of various departments in all four teaching medical colleges in a metropolitan city in Eastern India: A survey.

OBJECTIVE: To enquire about the level of awareness regarding various important aspects of palliative medicine among doctors of various departments in four Medical Colleges in Kolkata through a questionnaire. MATERIALS AND METHODS: A questionnaire was developed by few members of Indian Association of Palliative Care. It was distributed, to a convenience sample of doctors who worked at various departments in all four teaching hospitals in Kolkata. The distribution and collection of questionnaires was carried out within four months. RESULTS: The results suggested that 85% of the doctors felt that cancer was the commonest reason for the palliative care teams to be involved. Seventy four percent of the doctors mentioned that pain control was their prime job; 53% said that they are enjoying their encounter with palliative care, so far; 77% of the doctors thought breaking bad news is necessary in further decision making process; only 22% of the doctors reported the WHO ladder of pain control sequentially, 35% of the doctors believed other forms of therapies are useful in relieving pain, 35% of the doctors thought that they gave enough importance and time for pain control; 77% said that they had heard about a hospice, among them still 61% of the doctors thought that the patients should spend last days of their life at home. Thinking of the future, 92% of the doctors think that more and more people will need palliative care in the coming days. CONCLUSION: Amongst the doctors of various departments, there is a lack of training and awareness in palliative care. Almost all the doctors are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.

Abnormalities by pulmonary regions studied with computer tomography and clinical correlation following local-regional radiotherapy for breast cancer.

BACKGROUND: Adjuvant local-regional radiotherapy (RT) is commonly recommended for breast cancer patients. Postoperative adjuvant RT for breast cancer is associated with pulmonary side effects. This study was undertaken to measure the RT-induced pulmonary radiological changes with computer tomography (CT) scan using a CT-adapted modification of the Arriagada classification system, and to correlate these changes to RT techniques, pulmonary complications, and pulmonary function. The aim of the study is to study pulmonary radiological abnormalities with CT following different RT techniques for breast cancer, and their correlation to pulmonary complications and reduction in forced vital capacity (FVC). MATERIALS AND METHODS: CT scans of the lungs were performed prior to and 4 months following RT in 53 breast cancer patients treated with local-regional RT. The radiological abnormalities were analyzed with a CT-adapted modification of a classification system originally proposed by Arriagada. The patients were monitored for RT-induced pulmonary complications. FVC was measured prior to and 6 months following RT. Statistical analysis used were that increasing CT scores were correlated with pulmonary complications (P < 0.001). The correlation between density grade (0-3, 4-9) and pulmonary complications (no complication vs slight/severe) was tested using Chi-square exact test for trend (2-sided). In addition, correlation between CT scores and FVC was done. RESULTS: Increasing CT scores were correlated with pulmonary complications (P < 0.001). The mean reduction of FVC for patients scoring 4-9 (-220 ml) was larger than for patients scoring 0-3 (-15 ml) (Spearson correlation coefficient significant at 0.01 level 2 tailed). But the mean reduction of FVC with greater volume of lung irradiated was not statistically different than lesser volume of lung irradiated (P > 0.05). CONCLUSIONS: Radiological abnormalities detected on CT images and scored with a modification of Arriagada's classification system can be used as an objective endpoint for pulmonary side effects in postmastectomy RT.

Fatigue in breast cancer patients on adjuvant treatment: course and prevalence.

INTRODUCTION: Fatigue is a major complain in breast cancer patients and survivors. Patterns and degree varies with schedule and type of the treatment. Different co-factors may aggravate fatigue. Multimodal approach is helpful in managing fatigue. AIM: To quantify prevalence, course and degree of fatigue in breast cancer patients on adjuvant treatment and effectiveness of different management approach. MATERIALS AND METHODS: One Hundred and ten post-mastectomy breast cancer patients (Stage I to Stage III) were assessed. Patients on chemotherapy were assessed one week before, day after chemotherapy and two weeks later in every cycle. Patients on External Beam Radiation Therapy (EBRT) were assessed one week before and every week during radiation. Assessment was continued on second and fourth week of follow up. Functional Assessment of Chronic Illness Therapy - Fatigue subscale (FACIT-F) was used for assessment. Significant cofactors were also searched for. RESULTS: Eighty four percent patients experienced fatigue. Fatigue was more prevalent during chemotherapy (91%) than EBRT (77%). Patients on Chemotherapy exhibit peak fatigue day after Chemotherapy and decreased level until the next cycle. Significant increase of fatigue was seen only in first cycle. Patient on EBRT had gradually increased fatigue during the course of treatment. Lower degree of fatigue was present in post treatment period. Anemia was a significant cofactor causing fatigue (P < 0.05). Blood Transfusion improved fatigue scores. CONCLUSION: Fatigue increases during chemotherapy and or EBRT. Different intervention strategies are needed to address the issue.

Primary carcinoma of jejunum--a case report.

A 73 years old male presented with features of acute intestinal obstruction. At exploratory laparotomy, a mass was felt in jejunum. The growth with adequate margin and mesenteric lymph nodes were removed. The jejunal growth was diagnosed as adenocarcinoma on histopathology, which is a rare tumour of small intestine. He was planned adjuvant chemotherapy. He is in complete remission 6 months after follow-up.

Palliation of dysphagia in advanced, metastatic or recurrent carcinoma oesophagus with high dose rate intraluminal brachytherapy--an eastern Indian experience of 35 cases.

Oesophageal cancer, a disease with high morbidity and mortality, has a relatively high incidence in eastern India, usually presenting at advanced stage. The main aim of treatment for majority of patients remains palliation of dysphagia, which can be effectively done by intraluminal brachytherapy with or without external radiotherapy. Between January 2006 to January 2010 a total of 35 patients with advanced/metastatic (24/35) or recurrent (11/35) oesophageal carcinoma were treated with intraluminal high dose rate (HDR) iridium192 source brachytherapy at Medical College Hospitals, Kolkata. Selection for palliative brachytherapy includes one or more of the following criteria: Lesion more than 5 cm long on imaging studies or upper GI endoscopy, Karnofsky performance status < or = 50%, Locoregional recurrence. Palliative external radiotherapy (20 Gy/5# or 30 Gy/10#) was given to 11 patients (31.42%) before brachytherapy. All patients treated with 2 fractions of high dose rate-intraluminal brachytherapy (HDR-ILRT) one week apart with 600 cGy per fraction at 1 cm off axis. Thirty-five patients were treated with palliative HDR-ILRT. Significant improvement in swallowing status was seen in 20 patients (57.14%) since just after treatment up to 7.5 months. However, 9 patients (25.71%) showed no improvement, and 6 patients (17.14%) showed no changes in dysphagia scoring. Only 3 patients developed ulceration and 2 developed fistula immediately after treatment and 5 patients developed stricture. Median dysphagia-free survival was 6 months. Median overall survival was 8 months. It is concluded that intraluminal brachytherapy is an effective method for palliation of dysphagia for reasonably prolonged period.

Clinicopathological study and its prognostic implication in male breast carcinoma.

The aim of the present study is to analyse the cases of male breast carcinoma as regards its incidence, family history, clinical presentation, staging, histopathological grade, hormone receptor status and to identify the prognostic significance of the above factors on the final outcome. Seventy-nine cases of male breast carcinoma were treated in the radiotherapy department of Medical College, Kolkata from 1994-2003 (10 years). The hospital data were used to analyse the epidemiological and clinicopathologic parameters as well as the treatment offered and outcome. Incidence of male breast cancer was 0.6% among all male cancer cases and 2.5% among all breast cases. The median age of presentation was 67 years. Lump in the breast was the commonest presenting feature; 90% had advanced disease at presentation. All patients were treated by mastectomy. Majority received radiotherapy (93%) and chemotherapy (81%) as well. Hormone therapy was given to 83% patients. Five-year disease-free survival was 58% for node negative patients and 47% for node positive patients Two most important prognostic factors that affect the survival were nodal status and tumour size. Male breast carcinoma is a rare disease. Median age of presentation is much higher than the female counterpart. The prognosis and survival is similar but the incidence of positive hormone receptor is much more than breast carcinoma of females. In absence of prospective randomised trial retrospective review data from various centres could provide useful guidelines regarding therapy.