Early Clinical Outcomes in Patients of Carcinoma Cervix Treated With Volumetric Modulated Arc Therapy.

Objective Carcinoma cervix is one of the major cancers affecting Indian women. Concurrent chemo-radiotherapy is the standard of care in the treatment of carcinoma cervix. We aimed to study the outcomes and toxicity profile of volumetric modulated arc therapy (VMAT), an advanced modality of radiation delivery when used to treat patients with carcinoma cervix. Materials and methods Patients of carcinoma cervix belonging to FIGO (The International Federation of Gynecology and Obstetrics) stages IB2- IVA were recruited into the study. The patients were treated with VMAT to an EBRT (External Beam Radiation Therapy) dose of 50.4Gy in 28 fractions, which was followed by a brachytherapy schedule of 8Gy for each fraction to point A for three fractions. Toxicities were monitored weekly during the course of treatment and thereafter at every follow-up visit. A response assessment CECT (Contrast Enhanced Computed Tomography) scan was done three months after treatment and the response was recorded using RECIST (Response Evaluation Criteria In Solid Tumors) criteria. Results Sixty-four patients were available for analysis and most of the patients belonged to stage IIB (50.3%) followed by stage IIIB (28.5%). The complete response rate was 90.6% at three months and at a median follow-up of 12 months, the overall survival was 100% and disease-free survival was 89.1%. An analysis of clinically significant toxicities (grade 2 or worse) showed that diarrhea was the most common (20.3%) followed by proctitis (14%) and anemia (9.3%). Conclusion The results of the study established that volumetric modulated arc therapy is an acceptable modality of treatment of carcinoma cervix with an attractive toxicity profile. However, longer follow-ups will provide valuable information regarding the long-term disease control and late toxicities of the treatment.

Lymphoma and Differentiated Thyroid Cancer: A Case Series.

Occurrences of lymphoma and differentiated thyroid cancer are rare. Usually, involvement of the thyroid gland is seen as a part of extranodal involvement or as a part of radiation-induced malignant transformation in previously treated lymphoma patients. The incidence of synchronous hematological malignancy with differentiated thyroid cancer is 7%. The synchronous occurrence of differentiated thyroid cancer and lymphoma poses a significant diagnostic and treatment dilemma. Here we report a case series of four patients with lymphoma and differentiated thyroid cancer. All four patients had lymphoma treated first followed by definitive management of thyroid malignancy.

Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies - a prospective observational study.

BACKGROUND: Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies. The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied. MATERIALS AND METHODS: 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m2. RESULTS: Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = -0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5-41 Hz) with significant increase in roughness of voice post treatment (p = 0.01). CONCLUSION: There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.

Borderline ovarian mucinous tumor with anaplastic carcinomatous mural nodule: A case report.

Malignant mural nodules in borderline ovarian tumors are rare. Among them, anaplastic mural nodules are infrequent and only limited case reports are available. Here we report a patient diagnosed as borderline ovarian mucinous tumor with an anaplastic carcinomatous mural nodule. She underwent comprehensive staging laparotomy and six cycles of adjuvant chemotherapy with paclitaxel - carboplatin and has no evidence of disease progression at eight months of follow up. This tumor has an aggressive behaviour and patients with stage ≥1C have inferior survival.

Topical Betamethasone Valerate As a Prophylactic Agent to Prevent Acute Radiation Dermatitis in Head and Neck Malignancies: A Randomized, Open-Label, Phase 3 Trial.

PURPOSE: We assessed the role of topical betamethasone as a prophylactic agent in patients receiving radiation for head and neck malignancies. METHODS AND MATERIALS: This randomized, open-label, phase 3 trial was completed at a single research institute. Patients receiving curative radiation for head and neck cancer were randomized into 2 groups of 75 patients each by computer-generated permuted block random assignment. Patients in the test arm applied 0.1% topical betamethasone valerate cream once a day, after radiation. Patients in the control arm received best supportive care. The Radiation Therapy Oncology Group acute toxicity grading scale was used to assess radiation dermatitis after every fifth fraction until completion and at 2 weeks after treatment. Primary outcome in both arms was the proportion of patients who developed grade 2 and 3 acute skin reaction. The trial is registered at the Central Trial Registry of India (CTRI/2017/04/008298). RESULTS: Between April 15, 2017, and October 30, 2018,150 patients were randomized into the study, with 75 patients in each arm. Fourteen patients in the test arm and 15 patients in the control arm did not complete the intended treatment. Per the intention-to-treat analysis, 25 of 75 patients (33.3%) and 38 of 75 patients (50.7%) developed grade 2 or greater radiation dermatitis in the test and control arms, respectively (absolute difference, 17.4%; 95% confidence interval, 4%-30%; P = .032). Fifteen of 75 patients (20%) developed grade 3 reactions in the test arm compared with 18 of 75 patients (24%) in the control arm (absolute difference, 4%; 95% confidence interval, 7%-15%; P = .554). CONCLUSION: Although prophylactic use of betamethasone significantly reduced the composite outcome of the proportion of patients developing grade 2 and grade 3 radiation dermatitis, it did not reduce the proportion of patients developing the clinically significant outcome of grade 3 radiation dermatitis.

Assessment of acute toxicities and early local recurrences in post mastectomy breast cancer patients by accelerated hypofractionated radiotherapy; a single arm clinical trial.

PURPOSE: Hypofractionated post mastectomy radiotherapy (PMRT) is commonly given using conventional radiotherapy technique. Volumetric modulated arc therapy (VMAT) and Intensity modulated radiation therapy (IMRT) are better sparing heart and lungs. This study was conducted to assess the toxicity profile and dosimetry outcomes of patients receiving PMRT using IMRT or VMAT. METHODS: 67 biopsy-proven patients with carcinoma of the breast who had undergone modified radical mastectomy (MRM) were included in the study. They were treated using VMAT or IMRT to a dose of 42.56 Gy in 16 fractions. Acute and late toxicities were graded using RTOG toxicity grading scale. Toxicities and recurrences were summarized as proportions with 95% confidence intervals. Spearman's correlation was used to find association between the dose received by the organs at risk (OARs) and the grade of toxicities. RESULTS: The mean age of the study population was 48±9.5 years. The incidence of acute grade 2 and above radiation dermatitis and pneumonitis were 11.9% and 7.5 % respectively. The incidence of acute esophagitis was 46.3%. With a median follow up of 9 months there were no significant late toxicities. There was only one local recurrence and three progressed to distant metastases but without local recurrence. Twenty-four patients were treated by IMRT, 43 patients were treated by VMAT. Dosimetrically VMAT and IMRT were comparable in planning target volume (PTV) coverage and OAR doses, but VMAT had less number of monitor units and shorter treatment time.

Non-Invasive Tool for Coronary Artery Diagnosis Using Signal Characteristic Analysis (CADSCAN®) and Iso-Surface Optimal Membrane-Adherent Compliant (ISOMAC®) Sensors.

MedScanSonics Inc. (MS2)'s CADSCAN®and acoustic ISOMAC®sensors combine state-of-the-art non-invasive acoustic sensing and proprietary Wavelet Transform algorithms with fast DSP core hardware to quickly detect and locate coronary arterial stenoses with near-pinpoint accuracy in real-time.