Comparison of sequential versus simultaneous integrated boost of volumetric modulated arc therapy in treatment of oropharyngeal carcinoma.

OBJECTIVE: Volumetric modulated arc therapy (VMAT) is a useful treatment technique that can reduce treatment time while producing improved dose distribution to target structures. The main aim of the study is to evaluate the outcome of oropharyngeal cancer patients treated with VMAT, sequential (SEQ) versus simultaneous integrated boost (SIB) technique in terms of survival and failures and to assess late radiation toxicities with their dosimetric parameters. MATERIAL AND METHODS: Total 54 patients of histologically proved oropharyngeal cancer patients treated by definitive radiotherapy using VMAT technique in January 2019 to December 2020 were followed up and evaluated in terms of survival, patterns of failure and late radiation toxicities by RTOG toxicity criteria. RESULTS: After a median follow up of 12 months, overall survival (OS) and disease free survival (DFS) were 64.8% and 48.1% respectively. In terms of patterns of failure, 44.4% showed local recurrence, 7.4% as regional relapse and 3.7% showed distant metastasis. While comparing sequential versus SIB, no significant difference was found in OS (64.9% vs. 59.8%, p = 0.689), DFS (52.8% vs. 35.3%, p = 0.266), local control (LC) (58.3% vs. 47.1%, p = 0.437) and regional control (RC) (94.3% vs. 88.2%, p = 0.151) respectively. Among late radiation toxicities, the most common were xerostomia (42.2% for SEQ and 24.2% for SIB group), dysphagia (33.3% for SEQ and 15.1% for SIB group) and hoarseness of voice (15.1% for SEQ and 12.1% for SIB group). CONCLUSION: SIB technique proved better than SEQ technique in terms of pattern of failure or late toxicity, but no significant difference can be reported.

Challenges Faced by Cancer Patients in Receiving Health Services During the COVID-19 Pandemic in a Tertiary Care Hospital in Rajasthan.

BACKGROUND: Amidst the COVID-19 pandemic, cancer patients may have faced difficulty accessing health care. This study explored the challenges experienced by cancer patients in availing of healthcare during the pandemic, as well as the vaccination status and prevalence of COVID-19 infection among cancer patients in the year 2021. METHOD: A cross-sectional study was conducted in a tertiary care hospital in Jodhpur, Rajasthan, to interview 150 patients from the oncology department using convenience sampling. Face-to-face interviews lasted for 20-30 minutes. The first segment of the pretested semi-structured questionnaire was directed at obtaining the patient's socio-demographic characteristics, while the second segment focused on the problems that patients encountered during the pandemic in receiving cancer care. The data were analyzed using Statistical Packages for Social Sciences (SPSS) software (IBM Corp., Armonk, NY). RESULTS: Several constraints, such as a lack of transportation services, difficulty in availing outpatient department (OPD) and teleconsultation services, long waiting times, and deferred surgeries and therapies, have hampered cancer care. COVID-19 mitigation measures further imposed additional stress and financial burden on cancer patients. Moreover, there was low vaccination coverage among cancer patients, which increases their probability of acquiring an infection. CONCLUSION: Policy reforms must prioritize cancer care in India to maintain a continuum of care by ensuring medication, teleconsultation, uninterrupted treatment, and complete vaccination to decrease the risk of COVID-19 infection and facilitate patient compliance with the healthcare delivery system.

A rare case of benign metastasizing leiomyoma at vertebrae.

ABSTRACT: Benign metastasizing leiomyoma (BML) is a rare disease that usually occurs in women of reproductive age, with a history of uterine leiomyoma treated with hysterectomy. This may present as lesions in lungs, lymph nodes, bones, brain, mediastinum, and soft tissues. However, the most commonly affected site is the lung. Here is a case report of a patient who presented with BML at vertebral body with distant metastasis to lungs, brain, and bones. A 37-year-old female, with no known comorbidities, presented with pain in the upper back, urinary and bowel incontinence, and weakness in the bilateral lower limbs. Radiological, multiple metastases were present at D2 and D9 vertebral bodies, multiple nodular lesions were present in the lungs, and solitary lesion was found in the right frontal lobe of the brain. Histology proved it to be of myoepithelial origin with low Ki-67 index. The treatment in this case was based on hormone production suppression and radiotherapy, with no signs of progression at follow-up.

Adjuvant Irradiation in Carcinoma Breast Patients: Comparison of 3DCRT and Semi-automated Complex VMAT Hypofractionated Plans.

OBJECTIVE: Adjuvant radiotherapy is required for most post MRM breast cancer patients. Aim of treatment is to target radiation to region of interest while sparing Organs at Risk (OARs). Attempts are being made to decrease dose to OARs without compromising target coverage by evolving radiation techniques. In this study, a comparison of traditional 3DCRT plans is done with semi-automated complex VMAT plans for dose received by OARs namely Contralateral Breast (CLB), Ipsilateral lung (I/LL), and Contralateral Lung (C/LL). MATERIALS AND METHODS: It was planned for 30 post MRM breast cancer patients for chest wall, ipsilateral axilla and supraclavicular lymph node. The PTV dose was 42.5 Gy in 16 fractions, 2.66 Gy/fraction, 5 days a week. For each patient traditional 3DCRT and semi-automated complex VMAT plans (conventional + tangential VMAT plans) were prepared and evaluated by radiation oncologists. RESULTS: Dose evaluation of CLB shows higher Dmax for 3DCRT plans, while, Dmean was lower for the 3DCRT plan. Difference between D2 was not significant. V2.5 was significantly less in 3DCRT, while, difference between V5 and V10 were not significant. For C/LL Dmean, V2.5, V5, and V10 were higher for the VMAT plan. For I/LL Dmean, V5 and V10 were higher, while V20 and V30 were lower for VMAT plans. DISCUSSION AND CONCLUSION: The VMAT technique described here is a useful treatment option available for difficult planning situations. OARs stated above had a mixed result showing VMAT plans to be inferior at lower dose metrics, while, superior at higher dose metrics.

Reduction of Dose to the Contralateral Breast by Superflab Use in Radiation Therapy for Mammary Carcinomas

Background: Radiation therapy is an integral part of multimodality treatment for locally advanced carcinoma of breast. Radiation doses to nearby critical normal structures like heart, lungs, and contralateral breast (CLB increases risk of second malignancies. In this study, we measured doses to the CLB and studied effects of a 1 cm thickness superflap. Materials and Methods: Fifty post-mastectomy carcinoma breast patients were included in the study.Radiation therapy of 50 Gy was planned in 25 fractions, 5 days a week, using the Eclipse Treatment Planning System version 8.9.15, with a pencil beam convolution algorithm and 6 MV photon beam. Plans were transferred to a linear accelerator (Varian 2300 CD) for execution of treatment. Twenty-four CaSO4 thermoluminescent dosimeter discs (TLDs) were used for dose measurement over the CLB. The dose was measured for each patient without a superflab for ten fractions and with for another ten fractions for subsequent comparison. Results: Mean doses/fractions received by the CLB with and without a superflab? were 3.78 ± 1.29 cGy and 7.82 ± 2.62 cGy, respectively, with total dosees of 94.69 ± 32.43 cGy (1.89% of prescribed dose) and 191.14 ± 65.62 cGy (3.82% of prescribed dose). The average reduction in mean dose with a 1 cm thick superflab was 46.57 ± 17.18%, in the range of 20 to 80% and statistically significant (p < 0.001). Conclusion: Superflab? is an effective method for dose reduction to CLB. It is an easy, convenient and low time consuming method. Elucidation of any role in reduction of 2nd malignancies in CLB now needs large studies with long follow-up.