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Background: The inherent property of brachytherapy is its steep dose gradient and parametrium, near the pelvic wall, which gets little contribution in dose from brachytherapy. As parametria are the common sites for treatment failure, parametrial boost (PMB) may increase the disease control in case of locally advanced cervical carcinomas after 45–50 Gy of external-beam radiotherapy (EBRT) to the whole pelvis. Aims and Objectives: This study aimed to find whether a satisfactory control of the parametrial disease can be achieved with acceptable toxicity. Materials and Methods: Between December 2014 and December 2017, 92 patients were treated by concomitant chemoradiation with whole pelvic EBRT of 50 Gy in 25 fractions and weekly Cisplatin (40 mg/m2) followed by brachytherapy. Out of 89 patients, 46 patients were given an additional PMB of 10 Gy in five fractions and 46 were given no boost. Results: The local control of the disease in terms of CR or PR was comparable in the two arms (i.e., with or without PMB), with P=0.542. The central recurrences between the two arms were also comparable, 13.9% without PMB, and 9.76% with PMB, P=0.726. When parametrial recurrence is concerned, there were four parametrial recurrences (11.11%) in the arm without boost, in comparison to no parametrial recurrence (0%) in the boost arm, and this was statistically significant (P=0.044). Conclusion: In locally advanced carcinoma cervix patients, in terms of parametrial recurrence, this study showed a significant clinical benefit of an additional external beam PMB.

Background: The use of combined modality therapy including surgery, chemotherapy, and radiotherapy increases five survival rates in stage IIA and stage IIIB disease to 80% and 45%, respectively. Neoadjuvant chemotherapy (NACT) eradicates micro metastasis present in the body and also improves resectability. Aims and Objectives: The main aim of this study was to determine the locoregional recurrence and distant recurrence rates and thereby define clinical and pathological predictive factors for recurrence. Materials and Methods: This was a single institutional prospective study carried out in the Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata. From January 2017 to December 2019, according to inclusion and exclusions criteria, a total of 1183 histologically and/or cytologically proven breast carcinoma patients were included in this prospective study. Results: Breast conservative surgery was done in 16.5% of patients and the rest of the patients underwent modified radical mastectomy. Seven patients had undergone toilet mastectomy with the specimen. From the pathological review of the surgical specimens, 15.0% of patients achieved pathological complete response, while 19.4% of patients had clinical complete response. A total of 150 patients out of 1183 patients (12.67%) had disease recurrence. Conclusion: Local treatments, either surgery alone and/or RT alone, are inadequate therapies for locally advanced breast cancer patients, and multidisciplinary treatment should be used, to reach better management. Inoperable locally advanced breast carcinoma can be converted into operable by NACT.

Background: Sequential chemoradiotherapy and concurrent chemoradiotherapy are two treatment options for locally advanced non-small cell lung cancer (NSCLC). Still there is limited data regarding which is the better treatment option. Aims and Objectives: This study is to compare the response rate and toxicity pattern between induction (neoadjuvant) chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locally advanced NSCLC patients. Materials and Methods: A total of 48 Stage III NSCLC patients were selected for the study and were randomized into two arms with a 1:1 ratio. Patients of ARM-1 received concurrent chemoradiotherapy alone of a total dose of 66Gy/33# over 6 and ⅟2 weeks with paclitaxel (50 mg/m2) and carboplatin (Area under curve [AUC] 2) once every week. The study arm (ARM-2) received two cycles of induction chemotherapy with paclitaxel (175 mg/m2) and carboplatin (AUC 6) every 3 weeks and concurrent chemoradiotherapy (same CRT as on ARM-1). Results: In our study, overall response rate (Complete response+Partial response) in Arm 1 and Arm 2 was 62% and 71%, respectively. The treatment was very tolerated in our study. A mean follow-up of 12 months by Kaplan–Meier survival analysis showed a statistically non-significant difference in disease-free survival in both arms. Progression-free survival was numerically superior in the induction chemotherapy arm but the difference was statistically non-significant. Acute hematological toxicity was numerically more in the concurrent chemoradiotherapy arm, but statistically not significant. Acute lung toxicity, acute pharynx, and esophagus toxicity were numerically more in the induction chemotherapy arm but statistically non-significant. Conclusion: There was no significant difference between induction chemotherapy followed by concurrent chemoradiotherapy and concurrent chemoradiotherapy alone in the present study population.

Background: Marjolin’s ulcer (MU) reflects the malignant transformation of scar tissue or chronic inflammatory skin lesions. Due to the low incidence, only a few case reports and case series were reported in the literature to date. Aims and Objectives: In our retrospective analysis, we report our experience regarding MU over the past 16 years with a significant range of latent period, histology, and as well as underlying skin conditions, from Kolkata, India. Materials and Methods: This was a single institutional retrospective study carried out in the department of radiotherapy at the tertiary cancer, Kolkata. We focus mainly on data pertaining to the type of injury, the time gap between the initial injury and development of MU, histology, clinical stage, and treatment received, along with demographic details. Results: A total of 39 patients with histopathologically proved MUs were included according to the inclusion and exclusion criteria. The median age of patients at the time of development of MU was 52 years and with a range of 32–71 years. Out of 39 patients who participated in this study, 29 were male (74%) and ten were female (26%), 31 patients have localized disease (80%) and eight patients have metastatic disease (20%). The most common histology is squamous cell carcinoma and the least common histology was spindle cell sarcoma. The majority of the patients were treated with curative intention and a small proportion of patients were offered palliative therapy. Conclusion: Ulcers refractory to basic wound care, chronic in nature, and recent change of character of long-standing scar or wound, diagnosis of MU should be ruled out by biopsy. The management of MU should be supervised by a multidisciplinary tumor board and in the areas of epidemiology and treatment, more research is needed.

Giant cell tumor (GCT) of the bone also known as osteoclastoma typically arises from the meta-epiphyseal region of the long bone and comprises 5% of all bone tumors and 20% of benign bone tumors. Understanding pathogenesis is the key to successful systemic therapy with denosumab, a RANK-ligand inhibitor. In this context, we report seven GCT bone-treated denosumab and radiotherapy cases with a diverse clinical presentation from our institute, NRS Medical College, and Hospital Kolkata.

Background: Health-related quality of life (HRQoL) is defined as a specific subset of QoL, assessing symptoms, psychological aspects, and function. It is very important for healthcare professionals to recognize the issue-related to the QoL of head and neck cancer patients. Aims and Objectives: This study intended to measure different domains of QoL in head and neck cancer patients before and at the time of radiotherapy (RT) treatment completion, 3 and 6 months after treatment completion, and to discover the relationship between the type of treatment and QoL. Materials and Methods: An assessment of pre- and post-RT QoL of sixty head and neck cancer patients was done at our RT department, using the European Organization for Research and treatment of cancer QoL questionnaire head and neck cancer module (EORTC QLQ H&N 35). Results: Statistically significant differences were observed compared to baseline (P < 0.001) at the completion of radiotherapy in pain, swallowing, speech, cough, dry mouth, mouth opening, and senses scale and at 3.6 months of follow-up, while the HNSS (sticky saliva) scale showed statistically insignificant result at Zero (0) months (at the time of completion of radiation). Conclusion: The results of our study showed that QoL in head and neck carcinoma patients is affected in various functional and symptoms-related domains and their overall health and QoL perceived were not very satisfactory. These post-treatment-related complications were not preventable and should be talked about with the patients before starting RT.

Objectives: The importance and relevance of double primary are increasing with time as the increasing use of advanced diagnostic investigation and an increasing number of cancer survivors lead to an increase in double primary malignancy. Methods: We have collected data retrospectively from our own departmental patient’s record section from January 2011 to December 2021. All the details such as histopathology of both the malignancy, site of primary and secondary cancer, the time gap between the two cancer, clinical stage, and treatment received, along with demographic details have been recorded. Patients are divided into two categories either synchronous or metachronous when a second tumor develops either simultaneously or within 6 months of the diagnosis of the first tumor or 6 months after the diagnosis of the primary malignancy, respectively. Results: The total number of registered cases in one decade at our institute was 25,638 and among them were 41 double primary cases (0.16%). Twenty-two cases were metachronous (59%) and 19 cases (41%) were synchronous double primary. The most common site of double primary site was the head and neck region (38 %) followed by the lung, and esophagus (13% each), and the least common site was the colon (

Objectives: In areas of etiology and prevention of cancer research, Vitamin D3 is currently one of the most promising agents. By virtue of anti-inflammatory, immunomodulatory, antiangiogenic, and proapoptotic effects, Vitamin D3 may inhibit carcinogenesis, cancer cell proliferation, and tumor progression. We wanted to study the prevalence of Vitamin D3 deficiency among cancer patients and whether there is any correlation between this Vitamin D3 level with response to the treatment of cancer and survival. Methods: Between, January 2014 and December 2017, 199 patients, who completed treatment at our radiotherapy department, were included in this study. In a non-fasting state, a venous blood sample was obtained during the follow-up period, and the serum level of Vitamin D3 was determined by chemiluminescence immunoassay method. Results: A higher prevalence of suboptimal D3 concentration was seen in patients with stable or progressive disease (PD) than in those patients cured, this was statistically significant. The complete response versus partial response and PD p-values are 0.0001 and 0.0008, respectively. Overall survival (OS) difference between D3 sufficiency and insufficiency is not statistically significant (p-0.4422). However, OS difference between D3 sufficiency and deficiency is statistically significant (p-0.0001). Similarly, the OS difference between D3 insufficiency and deficiency is statistically significant (p-0.0001). Conclusions: Vitamin D3 level is significantly associated with response and there is also a positive correlation with OS. Statistically significant (p-0.0001) OS difference between D3 insufficiency and deficiency is present. Statistically significant higher prevalence of suboptimal D3 concentration was seen in patients with stable or PD than in those patients cured.

Objectives: The benefit of concurrent chemoradiation is often not achievable due to poor tolerance due to increased toxicity, which is a common problem in our setting, where a significant portion of carcinoma cervix patients presents at an elderly age, with medical comorbidities, and with poor performance status. In addition, many patients refuse chemotherapy. Accelerated radiation therapy remains one of the possible alternatives there. Hence, we would like to perform a prospective study to compare treatment results between Pure Accelerated Radiation versus Concomitant Chemoradiation in Locally Advanced Squamous Cell Carcinoma of Cervix. Methods: After the initial investigative work, a total of 62 histologically confirmed squamous cell carcinoma of cervix locally advanced stage (FIGO-stage IB2 to IVA.) with ECOG performance status 0–2 patients were randomized into two arms: Arm A (Study arm, n=30) – Patients received Six fractions per week of External Beam Radiotherapy without chemotherapy and Arm B (Control arm, n=32) patients received concurrent chemoradiation with Five fractions per week of radiation with Weekly Injection of Cisplatin at the dose of 40 mg/m2. Results: Overall response rates between the two arms were similar and statistically not significant (p=0.352). All acute late toxicities are similar in both arms except acute renal toxicity which is more in the control arm and the difference is statistically significant (p=0.005). Conclusions: In developing countries like India with limited treatment facilities, pure accelerated RT with brachytherapy, without concurrent chemotherapy, may be a good option and it can be viewed as an equally effective option for the elderly patients, the patients who refuse, those who have contraindications for chemotherapy, or have comorbidities. Further, multicenter, controlled, and Phase III trials will be needed to prove the benefit of the shortening overall treatment time and compare the efficacy with chemoradiation.

Objectives: This study intended to explore the outcome, and toxicities of neoadjuvant chemotherapy in addition to standard treatment concomitant chemoradiation in locally advanced cervix cancer. Methods: Sixty-two (n=62) locally advanced cervical carcinoma patients were randomized into two arms: The controlled arm (30 patients) received concomitant chemoradiation with external beam radiation therapy of 50 Gy to the whole pelvis and Inj. Cisplatin (40 mg/m2/week) alone and the study arm (32 patients) received three cycles, neoadjuvant chemotherapy with Inj. Paclitaxel (175 mg/m2), and Inj. Cisplatin (75 mg/m2) at 3 weekly intervals, followed by concomitant chemoradiation with external beam radiation therapy (EBRT) of 50 Gy to whole pelvis and Inj. Cisplatin (40 mg/m2/week). Responses to treatment, toxicities, disease-free survival, and progression-free survival (PFS) were analyzed in both arms. Results: Among the total of 62 patients, 30 were in the concomitant chemoradiation alone arm and 32 were in neoadjuvant chemotherapy followed by the concomitant chemoradiation arm. The median follow-up period was about 13 months. The tumor response in the form of complete or partial responses was equivalent in the two arms. The disease-free survival and the PFS were also comparable in both arms. The acute and the late toxicities were also comparable in the two arms. Conclusions: This study showed that neoadjuvant chemotherapy with paclitaxel and cisplatin before definitive concomitant cisplatin-based chemoradiation can be used as an alternative in the management of locally advanced carcinoma of the cervix.

Objectives: In our study, radiation of a higher dose per fraction (2.75 Gy/fraction, total dose of 55 Gy/20 fractions/4 weeks) with concomitant chemotherapy was compared with conventional chemoradiation (2 Gy/fraction, a total dose of 66 Gy/33 fractions/6 and half weeks, with concomitant chemotherapy), in patients of locally advanced squamous cell carcinomas of head and neck in terms of efficacy and toxicities. Methods: A total of 75 patients registered at the Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, were allotted in two arms chronologically in a 1:1 ratio. Arm A – Patients received hypofractionated radiotherapy, 55 Gy/20 fractions in 4 weeks with concomitant weekly cisplatin (40 mg/m2). Arm B – Patients received conventional radiotherapy, 66 Gy/33 fractions in 6½ weeks with concomitant weekly cisplatin (40 mg/m2). Results: Both in terms of efficacy and toxicities, the hypofractionation arm was comparable to the conventional arm, and no statistically significant difference was present between the arms. For the study arm, complete response was 56.6%, partial response was 36.6%, and for control arm, complete response 50% and partial response 37.5% (p=0.750). In terms of acute toxicities and late dysphagia, both the arms were almost similar. Conclusion: The hypofractionated regimen was associated with tolerable acute and late toxicities and satisfactory local control. Considering the patient load, the overall treatment time, and the cost of hospital stay, this hypofractionated regimen is a good treatment option in our low-resource setup.

Objectives: Medullary breast carcinoma is a very rare subtype of invasive ductal carcinoma breast which accounts for about 1–7% of all breast carcinoma. The natural history of this uncommon histological subtype is unknown because of the lack of adequate reported data in the literature and the rare variety of this tumor. In our retrospective analysis, we have tried to identify demographic clinicopathological features and treatment outcomes of this rare subtype. Methods: Between January 2012 and December 2017, total of 1271 breast carcinoma cases were identified, and clinic pathological, demographic profile, and treatment received were recorded from the medical records file. American joint committee on Cancer tumor, node, and metastasis system was used for staging. Results: Out of 1271 breast carcinomas, 19 histologically confirmed medullary carcinoma cases were identified and constitute about 1.5% of the total case. About 78% of patients were with Stage II and Stage III disease at the time of diagnosis. Eleven patients were initially treated with MRM followed by adjuvant chemotherapy and radiotherapy. Eight patients received neoadjuvant chemotherapy followed by surgery and radiotherapy. In addition to cytotoxic chemotherapy, two patients received trastuzumab also. None of the patients received hormone therapy as all the patients were hormone receptor-negative. Conclusions: Out of all invasive carcinoma, approximately 1.5% of cases were medullary carcinoma. About 90% of cases were triple-negative. Triple-negative breast cancer is usually associated with poor outcomes but medullary carcinoma despite being triple-negative, patients with medullary carcinoma have a good chance of long-term survival.

Background: In adults most common intracranial malignant lesion is brain metastasis, far outnumbering primary brain tumor. The most common primary site is lung cancer (18–64%), followed by breast (25–21%), malignant melanoma (4–16%), and colorectal cancer (2–12%). It is hypothesized that the incidence of brain metastasis might be increasing, as a result of increasing survival from recent advance in cancer treatment, more frequent brain screening for specific primary malignancy that known to have a higher prediction for brain metastasis and greater availability and use of magnetic resonance imaging (MRI) of brain. In clinical oncology, understanding brain metastasis is important, because it has profound effect on length of survival, quality of life, and in one-third to one-half of affected patients, they represent the direct cause of death despite current improvement in therapeutic approach. Epidemiological data of brain metastasis are lacking in India. Objectives: Aims of our retrospective analysis are to study epidemiology and pattern of care of brain metastasis over last one decade in Nil Ratan Sircar Medical College and Hospital, Kolkata. Materials and Methods: Between 2006 and December 2017, a total of 710 patients of brain metastasis treated in our department with palliative intent were analyzed retrospectively. New-onset neurological symptoms in a known case of cancer we always presumed that, symptoms were due to brain metastasis until proven otherwise. Hence, all patients presenting with acute neurological signs and symptoms underwent through clinical examination, contrast-enhanced (CE) computed tomography brain, and/or CEMRI of brain. Epidemiology, pattern of care, and outcome in the form of overall survival (OS) and disease-free survival were determined. Results: Fifty-seven percent patients were male. The median age was 62 years at the time of diagnosis. Lung carcinoma was most common primary site seen in 52% patients, followed by carcinoma breast second most common primary site, seen in 32% patients. Headache (73%) and motor weakness were most common presenting symptoms. Supratentorial location most common site, out of which parietal region is most common. The only small number of patients was offered best supportive care alone whereas majority of the patients were considered fit for palliative therapy. Treatment consisted of metastasectomy when possible and palliative whole-brain radiotherapy (WBRT) alone or followed by systemic therapy. Optimal supportive care in addition to chemotherapy or radiotherapy is given to all patients. A total of 254 patients were given blood product, erythropoietin, granulocyte-colony-stimulating factor following chemotherapy. Hospitalization required in 71% patients and tumor-related problem was most common cause (46%). Remaining patients were hospitalized for delivery WBRT or CCT. The median OS is 9 months. Patients with younger age and breast primary associated with better prognosis than lung primary. Conclusions: We can conclude that carcinoma lung in male and carcinoma breast in females was most common cause of brain metastasis. Because advance in palliative therapy, outcome of patients with brain metastasis has improved, and patients with brain metastasis benefit from palliative radiotherapy and chemotherapy and this treatment could be delivered easily on outpatients basis.

This paper presents the electron beam misalignment study with respect to cathode position and cathode magnetic field of 42 GHz, 200 kW gyrotron. The performance of gyrotron is affected with the misalignment of cathode position. The simulation results confirm the tolerance of cathode misalignment with respect to the design parameters such as the transverse-to-axial velocity ratio, the maximum transverse velocity spread, etc.

Background: The primary goal of treatment in oncology is cure but efforts should be made to preserve quality of life. The gold standard for treatment of muscle-invasive bladder cancer is radical cystectomy. However, radical cystectomy cannot be performed without risk of complications and often the outcome for the patient is a mediocre quality of life as the patient has to live with an artificial bladder or ileal conduit. Even after radical cystectomy, 40–50% of patients will succumb to distant metastases within 5 years. As in the case of several other malignancies, increasing efforts have been made over the last few decades to adopt organ sparing treatment. Bladder-sparing monotherapies lead to disappointing results, local disease control may be maximized using a trimodal approach based on complete transurethral tumor resection of bladder (TURB), followed by concurrent chemoradiotherapy and cisplatin-based systemic chemotherapy. Objectives: The aim of our study is feasibility of concurrent cisplatin with radiation in bladder preservation in our hospital. Materials and Methods: Thirty-two previously untreated patients of histologically proven transitional cell carcinoma of urinary bladder received concurrent chemoradiation (60 Gy) with cisplatin. All patients received concurrent chemotherapy with cisplatin infusion in a dose of 20 mg/m2/day on consecutive 5 days from Day 1 to Day 5 in 1st and 5th week of radiotherapy. Detailed clinical examination along with cystoscopy, TURB along with biopsy, and computed tomography scan of abdomen pelvis were done before treatment and to assess response toxicity, and disease-free survival (DFS) during follow-up period. Results: Median follows up period was 36 months. Local disease control was seen in 71% patients. Five years DFS is 58%. Five years overall survival is 64%. Conclusions: Concurrent chemoradiation in carcinoma of urinary bladder is feasible in our hospital and results in good local control, survival with acceptable toxicity.

Background: Worldwide, leading cause of cancer mortality is lung cancer. Approximately 63,000/year new lung cancer cases reported in India. Around 80–85% of patients of lung cancer is non-small cell histology (non-small cell lung cancer) and over >90% of patients presented locally advanced and metastatic disease. Hence, in these patients, population curative treatment approach with radiotherapy (RT) and chemotherapy in most of the time is non-viable option yielding short survival and relatively poor prognosis. In majority of such cases, the only aim of treatment remains palliative, the main aim is to improve quality of life. Although there are other medical management of symptoms palliation, radiation therapy is the cheapest option, quite effective, time efficient, and well tolerated in providing relief from symptoms. The rate of palliation of symptoms is quite high for chest pain and hemoptysis at 60–80%, whereas cough and dyspnea are improved in only 50–70%. For intrathoracic disease with obstructive symptoms, 30 Gy/10# over 2 weeks are generally recommended. Patients with poor performance status, advanced age, and associated comorbidity at the time of diagnosis, for which daily RT over 2–3 weeks is logistically difficult, 1–2 fractions have been utilized with good results. There are multiple randomized trials showed that both short and long RT course were equally effective for symptoms control. Aims and Objectives: The aims of our study are to compare the outcome, symptom control and assess toxicity profile in locally advanced lung cancer patient with 17 Gy/2 fractions (8.5 Gy/fraction, × 2 fractions) only on Saturdays over 2 weeks versus 30 Gy/10 fractions (3 Gy/fraction) over 2 weeks and to compare quality of life. Materials and Methods: This study was a single-institutional, prospective, open-labeled, randomized controlled study. Eligible patients were age ≥18 years with histopathologically proven lung carcinoma which was inoperable Stage III or IV disease and too locally advanced to curative concurrent chemoradiation, pulmonary symptoms attributable to the primary tumor, Eastern Cooperative Oncology Group (ECOG) performance status ≤3, and adequate hematologic (hemoglobin >10 g/dl; absolute neutrophil count >1500; platelet count >100,000/ml; and hepatic and renal function calculated creatinine >60 ml/min). Patients with bleeding diathesis, emphysematous bullae, poor respiratory function or reserve, pregnancy, and ECOG performance status >3 were excluded from the study. Results: Age, stage, histopathology, and pre-treatment symptoms score between two groups were comparable and statistically not significant. Pain in chest due to lung cancer was decreased in both arms due to treatment (at treatment completion Arm A = 47.62 and Arm B = 38.09). However, at the 2nd follow-up, difference between two arms was statistically significant where Arm A = 27.78 and Arm B = 15.00; P = 0.005. Global health status of patients in this study was improved in both arms due to treatment. Physical functioning emotional functioning, role functioning, global health status, cognitive functioning, and social functioning were improved in both arms due to treatment and kept improving during follow-up, but difference between two arms was not significance. Conclusions: Although overall symptom palliation, toxicity profile, and quality of life parameters are almost equal in both arms, patients with short expected survival, 8.5 Gy × 2 fractions would be preferable, limiting the number of hospital visit to a minimum. On the other hand, 3 Gy × 10 fractions schedule can be chosen for those patients with longer expected survival and better ECOG status, due to prolong duration of palliative response.

Background: Lung cancer is the most common cancer and leading cause cancer-related death in worldwide and also in India. Around 42% of these patients have adenocarcinoma. Most of these patients presented in locally advanced stage or metastatic disease. There is no significant difference in effectiveness among different chemotherapy regimens with median survival of 8 months only. Hence, additional treatment option including newer monoclonal antibodies is needed to improve tumor control and survival. Vascular endothelial growth factor (VEGF) is critical determinant of tumor angiogenesis, a process that is necessary component of tumor growth, invasion, and metastasis. Bevacizumab (Bev), a humanized monoclonal antibody (IgG1) targeting VEGF, effective in colorectal cancer, renal cell carcinoma, glioblastoma multiforme, and non-small cell lung cancer and approved for clinical use since 2004. Objectives: The aim of our study is feasibility of the combination of Bev with paclitaxel and carboplatin in locally advanced (Stage IIIB) metastatic adenocarcinoma of lung in our institute, N.R.S. Medical College and Hospital, Kolkata. Materials and Methods: Between February 2015 and December 2018, ninety-eight previously untreated patients with locally advanced metastatic (Stages IIIB and IV) adenocarcinoma of lung treated with Bev with paclitaxel and carboplatin. Paclitaxel at a dose of 175 mg/m2, carboplatin at an AUC 6 mg/ml/min, and Bev at a dose of 15 mg/kg given on the 1st day of chemotherapy. Chemotherapy administered every 3 weeks up to 6 cycles with maintenance Bev until disease progression or unacceptable toxicity whichever is earlier. Patients ECOG 2 or more, brain metastasis, squamous cell histology, and hemoptysis were not included in the study. Results: The Median overall survival (OS), progression free survival (PFS) were 9.4 and 5.2 months, respectively. Anemia (19%) and neutropenia (16 %) are most common toxicity. Conclusion: Bev with paclitaxel and carboplatin in selected patients with adenocarcinoma of lung is safe and confers survival benefit with acceptable toxicity.

Background: In India, the majority of the head and neck squamous cell carcinoma (SCC) of head and neck (60–80%) presented in locally or locoregionally advanced stage but non-metastatic disease as compared to 40% in developed nations. Uncontrolled local and/or locoregional disease causes most fatalities and predominant failure pattern is local and/or locoregional. Concurrent chemoradiation (CRT) is now standard of care. However, regarding either the optimal scheduling of chemotherapy regimen or radiotherapy (RT) dose fractionation scheme, no consensus exists. Paclitaxel is also active agents against squamous cell carcinoma of head and neck. Weekly paclitaxel appeared to be equivalent to weekly cisplatin with concurrent radiation in the treatment of locally advanced SCC of head and neck cancer (HNC). Concurrent chemoradiotherapy with paclitaxel in locally advanced head and neck malignancy is recommended in NCCN Guideline. Objectives: The aim of our study is feasibility and efficacy of CRT with paclitaxel for the treatment locally advanced HNC in our institute, Nil Ratan Sircar Medical College and Hospital, Kolkata. Material and Methods: Between January 2014 and December 2018 ninety eight (98) previously untreated patients with locally advanced histologically confirmed carcinoma oral cavity, oropharynx, and hypopharynx treated with CRT. Chemotherapy consisted of paclitaxel at a dose 40 mg/m2 over 1 h given once weekly from 1st week of RT, up to 4–6 cycles. RT consisted of 66 Gy/33#/61/2 weeks, 2 Gy/fraction, delivered by two parallel opposed lateral face and neck and low anterior neck portal, in cobalt 60 machines. Toxicity was graded using Common Terminology Criteria for Adverse Events v3. To assess response to therapy contrast-enhanced computed tomography (CECT) head and neck and/or magnetic resonance imaging head and neck; CECT chest or whole-body fluorodeoxyglucose and positron emission tomography computed tomography scan were done. Results: Overall complete response (CR) rate seen in 68% and partial response seen in 32% patients. Two-year disease-free survival, progression free survival, and overall survival were 59%, 72% and 85%, respectively. Grade II acute skin reaction seen in 45% patients and Grade III acute skin reaction seen in 55% patients. Similarly, Grades II and III mucosal reaction is seen in 48% and 52% patients. All patients experience Grade II dysphagia and managed conservatively. Conclusions: CRT with paclitaxel in locally advanced HNC is safe and confers high CR rate with acceptable toxicity. However, more randomized study with large number of patients is needed to come to conclusions regarding its efficacy.

Background: Breast cancer is a major public health problem for women throughout the world. According to GLOBOCAN 2012, India along with the United States and China is responsible for almost one-third of global breast cancer burden. There has been 11.54% increase in incidence and 13.82% increase in mortality due to breast cancer in India from 2008 to 2012. According to GLOBOCAN 2018, for both sexes, breast cancer second most common cancer after lung cancer accounting for 11.6% of total cases. Most of the cases diagnosis at an advanced stage because of inadequate screening, lack of appropriate medical facilities thereby increasing breast cancer mortality. It is the second most common malignancy among Indian women accounting for 7% of global burden of breast cancer. Incidence of breast carcinoma varied in the different regions of the world with lowest incidence in Africa, Asia and highest incidence in North America and Europe. This geographic variability is not only to environmental factors but also to lifestyle. There is a paucity of epidemiological data regarding carcinoma of breast. Objectives: The aims of our study were to evaluate the prevalence and epidemiology of breast cancer in our institution, N.R.S. Medical College Kolkata. Materials and Methods: We have analyzed 4172 newly diagnosed breast carcinoma cases, registered at N.R.S. Medical College and Hospital, Kolkata, West Bengal, India, over one decade, in between January 2008 and December 2017 retrospectively. A total of 4172 cases confirmed by pathological examination were included for analysis. Demographic and clinicopathological profile and management offered to the breast cancer patients were recorded from the medical records file. The staging was performed using American Joint Committee on Cancer tumor, node, and metastasis classification staging system. Results: In our study, about 63% of the patients came from urban areas and 37% from rural areas. The mean age at diagnosis was 52 ± 9.5 years, with a range from 26 to 82 years. The age at menarche in this study ranged from 10 to 16 years, mean being 12 ± 1.5 years. Age at the time of first pregnancy ranged from 19 to 32 years, with the mean age being 22 ± 6.2 years. Family history of breast carcinoma in first and second degree relatives was found in 92 (2.2%) patients in this study. Approximately 5% (216) patients were nulliparous. About 63% of the patients were postmenopausal while 36% were premenopausal. Common presenting symptoms include breast lump (100%) and axillary swelling (33%). Histologically, 99.5% cases were infiltrating ductal carcinoma, and it was most common histology. Most patients were diagnosed with Grade II tumors (45%) followed by Grades I and III, and approximately 75% of the patients were in Stages II and III and 10% patients in Stage IV. The most common site of metastasis was lung (33%), bone (26%), liver (23%), and brain (14%). Conclusions: The majority of the breast carcinoma patients presented with Stages II and III disease, approximately 99% cases were infiltrating ductal carcinoma, not otherwise specified and were mainly Grade II followed by Grade III disease. The prevalence of estrogen receptor, progesterone receptor hormone receptor status and Her2/neu status in the population needs further investigation in the future. The government needs to urgently strengthen and augment the existing facilities including screening, which is inadequate at present to handle the current breast cancer load in India.

Background: Worldwide, an estimated 572,034 esophageal cancer cases and 508,585 deaths occurred in 2018 and it accounts for approximately 3.2% of all malignancy. Because esophagus has no serosal covering with extensive, longitudinal connecting system of lymphatic plexus, direct invasion to contiguous structures and lymph node metastasis occurs early. Unresectable or metastatic disease at the time of diagnosis is seen in approximately 80% of patients, with cure rate 87% of patients. Conclusion: In patients with locally advanced carcinoma of esophagus and poor performance status who are unable to tolerate radical concurrent chemoradiation, combination of EBRT plus ILBT produces good local control, DFS, and durable relief of dysphagia with acceptable toxicity.

Primary intestinal lymphomas comprise of a wide variety of histological subtypes with varied presentation. The objective of this study was to determine the presentation, histological type, treatment, and outcome of patients of primary intestinal lymphoma. A retrospective analysis of 27 patients of primary intestinal lymphoma treated at our institute from 2004 to 2010 was carried out. Patients were staged according to Musshoff’s modification of Ann Arbor classification. The median age was 51 years (range, 7–76 years). Abdominal pain was the most common presenting symptom followed by mass abdomen, loss of appetite, constipation, and vomiting. The most common site of disease presentation was ileocecal region and jejunum. Diffuse large B cell lymphoma was the predominant histological type observed in 55.6 %. Eighteen patients underwent surgery with or without chemotherapy. Chemotherapy, either alone or with radiotherapy, was given to nine patients. The median follow-up was 48.3 months (range 5–94 months). The 5-year overall survival (OS) and event-free survival were 53.5 and 53 %, respectively. The 5-year OS for patients who underwent both surgery and chemotherapy was 79.5 % and for those without surgery was 13.9 %, respectively. Primary intestinal lymphomas are heterogenous diseases. Patients who underwent surgery had better survival and outcome than those without surgery. Chemotherapy is necessary for improving the survival of these patients. Optimal management is still uncertain due to the rarity of this disease.

Aims: We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival. Materials and Methods: From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide). Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis. Results: The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively ( P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (

Background: Thymomas are the most common tumors of the mediastinum. They have varied presentation ranging from asymptomatic incidental mediastinal masses to locally extensive tumor with compressive symptoms and distant metastases. The authors present our institute's experience in combined modality management of thymomas. Materials and Methods: We retrospectively reviewed 36 patients of thymoma treated in our institute from January 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy (RT) and chemotherapy (CCT) were noted. Statistical analysis was done with regard to progression free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results: A total of 17 patients had associated Myasthenia gravis and 3 patients had associated Cushing syndrome. Masaoka Stage 4a was the most common stage (13 patients) followed by stage 3 (10 patients), stage 2 (9 patients) and stage 1 (4 patients). Twenty seven patients underwent primary surgery, out of which 20 received adjuvant RT and five received both RT and CCT. Of nine non-surgical cases, four received only palliative RT whereas 5 received systemic CCT followed by local mediastinal RT. Overall, 23 patients had complete response while 13 had partial response. 1 patient had local recurrence. Three year PFS was 60% and 3 year OS was 83%. Conclusions: Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant mediastinal radiation, which helps in significant loco-regional control. Systemic CCT benefits in inoperable, advanced and high-risk tumors. Risk-adapted and multimodality approach is the need of the hour to achieve good control rates while minimizing treatment related toxicity.

Aim: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. There is limited published data on GIST from the Indian subcontinent. This 5-year retrospective analysis of 49 patients treated for GIST reports clinical and pathological features and survival outcome by risk stratification. Methods: We reviewed 49 cases of GIST from January 2004 to December 2008. Imatinib was administered after surgery in patients with either high-risk, residual or metastatic disease and at onset of recurrence or metastatic disease in patients with intermediate risk. Results: The mean age was 50 years (range, 17–80 years). Patients with localized tumor were classified as low (n = 2), intermediate (n = 4) and high risk (n = 32), based on the primary tumor and mitotic index. At a median follow up of 21 months, 2-year and 3-year recurrence or progression-free survival rates were 61 and 39%, respectively, for all patients. The median recurrence-free survival rate in the intermediate-risk and high-risk groups were 7 and 49 months, respectively. The median progression-free survival in the residual (n = 4) and metastatic disease group (n = 7) was 10 and 29 months, respectively. Conclusion: This study demonstrates the role of imatinib in adjuvant and therapeutic settings. Responses have been durable and most patients tolerate the drug well at clinically effective doses. In view of high recurrence rates in the intermediate-risk group in our study, it would be better to keep these patients on strict follow up to detect recurrence at the earliest opportunity.

Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

This paper presents a three-dimensional (3-D) simulation of a triode-type magnetron injection gun (MIG) for a 42-GHz 200-kW gyrotron with a transverse-to-axial velocity ratio of the electron beam at 1.22 and a maximum transverse-velocity spread of 3.2%. The operating mode of the gyrotron is TE_03, and it is operated in the fundamental harmonic. The MIG has been designed by using some tradeoff equations and the 3-D particle-tracing code (computer simulation technology). The simulated results have been validated with the results obtained using the 3-D code OPERA Vector Fields and the two-dimensional trajectory codes EGUN and TRAK.

A helix slow-wave structure (SWS) for a high e-ciency Ku-band 140W space TWT has been designed. Cold circuit parameters of helix SWS like propagation constant and on axis interaction impedance were determined using 3-D electromagnetic fleld simulators ANSOFT-HFSS and CST-MWS and validated with the experimental results. In-house developed large-signal code SUNRAY- 1D was used to design the complete helix SWS in 2-section with sever and taper to achieve desired output power, gain, e-ciency, and other linearity parameters such as phase shift, AM/PM factor, I/M components. Simulated RF performance of the Ku-band 140W helix TWT was validated with the experimental results. A close agreement between the simulated and experimental results has been found.

The emergence of low temperature glassy phase in widely known itinerant ferromagnet SrRuO3 is remotely understood. In order to understand this aspect, we have undertaken a detailed temperature dependent (5–250 K) neutron diffraction study. We observe a freezing of the octahedral tilt near the ferromagnetic transition and an unusual deviation in the octahedral tilt near the onset of low temperature spin glass like phase. A reduction of the ordered magnetic moment and a decline in the total integrated magnetic intensity is observed around the temperature where the glassy behaviour starts to appear. The magnetotransport study also reveals the possibility for an additional magnetic ordering by demonstrating a peak in magnetoresistance at the low temperature side as well. The neutron diffraction study presented here provides useful information to understand the observed unusual low temperature magnetic phenomena in SrRuO3.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. There is limited published data on GIST from the Indian subcontinent. This 5-year retrospective analysis of 49 patients treated for GIST reports clinical and pathological features and survival outcome by risk stratification.We reviewed 49 cases of GIST from January 2004 to December 2008. Imatinib was administered after surgery in patients with either high-risk, residual or metastatic disease and at onset of recurrence or metastatic disease in patients with intermediate risk.The mean age was 50 years (range, 17-80 years). Patients with localized tumor were classified as low (n = 2), intermediate (n = 4) and high risk (n = 32), based on the primary tumor and mitotic index. At a median follow up of 21 months, 2-year and 3-year recurrence or progression-free survival rates were 61 and 39%, respectively, for all patients. The median recurrence-free survival rate in the intermediate-risk and high-risk groups were 7 and 49 months, respectively. The median progression-free survival in the residual (n = 4) and metastatic disease group (n = 7) was 10 and 29 months, respectively.This study demonstrates the role of imatinib in adjuvant and therapeutic settings. Responses have been durable and most patients tolerate the drug well at clinically effective doses. In view of high recurrence rates in the intermediate-risk group in our study, it would be better to keep these patients on strict follow up to detect recurrence at the earliest opportunity.

Priapism is a pathologic condition of penile erection characterized as prolonged and devoid of sexual stimulation or excitement [1]. Penile metastasis is rare cause of priapism and only limited number of cases reported. In a largest case series of penile metastasis by Alcides Chaux et al. [2] only two cases reported from gastrointestinal tract (sigmoid colon). We report a case of a painful penile metastasis from dissemination of carcinoma caecum.

We intended to assess the clinicopathological features and treatment outcome in patients of uterine sarcoma. A retrospective review of medical records of patients of uterine sarcoma (2002–2007) was conducted. Overall survival (OS) was analyzed by Kaplan–Meier method. Forty-two patients met the study criterion [15 carcinosarcoma, 12 endometrial stromal sarcoma, 11 leiomyosarcoma, 3 undifferentiated endometrial sarcoma (UES), and 1 mixed sarcoma]. Median age and performance status were 52 years and ECOG 0, respectively. All patients underwent primary surgery out of which 66.7 % was total abdominal hysterectomy and bilateral salpingo-oophorectomy. FIGO (2009) stage was I, II, III, IV and unknown in 66.7, 7.1, 14.3, 9.5, and 2.4 % of the patients. Eight patients were kept on follow-up only. Adjuvant radiation, chemoradiation, and chemotherapy were offered in 8, 9, and 3 patients, respectively. Pelvic radiation: 46 Gray/23 fractions/4.5 weeks and vincristine, adriamycin, cyclophosphamide (VAC) regimen were most commonly used. Overall clinical complete response (CR), stable disease (SD), and progressive disease (PD) were, respectively, 59.5, 2.4, and 26.2 % (response not evaluable in 12 %). In the evaluable patients (N = 33), median OS was noted to be 7.67 months (mean 30.19 months). 1- and 2-year actuarial survival were 45.45 and 36.36 %. Stratified by histology, median survival in patients with carcinosarcoma, endometrial stromal sarcoma, leiomyosarcoma, and UES were, respectively, 6.57, 18.7, 6.8, and 9.38 months. On univariate analysis, response to therapy (p = 0.0003), disease stage (p = 0.00001), tumor size (p = 0.02), and performance status (p = 0.03) were significant predictors of OS. Disease stage (p = 0.005) and response to therapy (p = 0.01) retained significance on multivariate analysis. Median OS of only 6.57, 6.8, and 9.38 months, respectively, in patients with carcinosarcoma, leiomyosarcoma, and UES in our series reflect the aggressive clinical course and poor prognosis of these rare neoplasms, which mandate intensive multimodality therapy. Even in low-grade endometrial stromal sarcoma, median survival of 18.7 months in our series is far from satisfying. However, small series, poor treatment compliance and socio-economic constraints in the Indian scenario are limiting factors in the result analysis.

Involvement of the ovary by malignant lymphoma is well known as a late manifestation of disseminated disease. However, primary ovarian lymphoma (POL) is rare, accounting for 0.5 % of all non-Hodgkin’s lymphoma and 1.5 % of all ovarian neoplasms [1]. We present a case of ovarian non-Hodgkin’s lymphoma, manifesting like an advanced ovarian cancer, which was managed by surgery and chemotherapy (Fig. 1). Fig. 1 CECT scan showing ovarian mass—axial section Case Report A 45-year-old premenopausal woman (gravida 1, para 1) presented with history of pain in right side of lower abdomen, dull aching in character for 4 months which increased in severity progressively. It was associated with feeling of heaviness in lower abdomen for 2 months. She had no other systemic complains. She had normal and regular menstrual cycles with one live issue 17 years before. No other significant co-morbidities were present (Fig. 2). On examination, she had a large abdominopelvic mass present which was firm to hard in consistency and arose from the adnexal region. CECT abdomen and pelvis showed a heterogeneous mass in lower abdomen with minimal ascites. CA-125 level was 85.93 (Fig. 3). Chest X-ray and thyroid profile was normal. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intraoperatively, there was a 20 × 15 cm size irregular mass, firm in consistency which was seen arising from right ovary. Final histopathology reported it as non-Hodgkin lymphoma (NHL) of right ovary. Morphologically, it was classified as diffuse large cell B-cell lymphoma (DLBCL). On immunohistochemistry, CD 20 and LCA were positive, while CK, PLAP, and CD 3 were negative. With the histopathological diagnosis of right ovarian NHL, the patient underwent further staging evaluation (Fig. 4). No systemic lymphadenopathy was found. CECT neck, chest, abdomen, and pelvis were normal except for post-hysterectomy status. Bone marrow aspiration and biopsy did not showed infiltration. CA-125 was 9.4 postoperatively. Patient was staged as Ann Arbor Stage IE and was started on systemic chemotherapy with R-CHOP regimen comprising rituximab, cyclophosphamide, vincristine, and prednisolone in standard doses. Patient has received 6th cycle in February 2011 and is on regular follow-up with no clinical and radiological evidences of disease. Fig. 2 CECT scan showing ovarian mass—coronal section Fig. 3 CECT scan showing ovarian mass—sagittal section Fig. 4 Microphotograph showing diffuse sheets of large atypical lymphoid cells (hematoxylin and eosin stain) Discussion Malignant lymphoma is revealed by an ovarian mass in

Introduction: Primary central nervous system lymphoma (PCNSL) is relatively uncommon malignancy with potentially aggressive behavior. The standard management of PCNSL is high-dose methotrexate (HD-MTX) based chemotherapy and whole brain radiotherapy (WBRT). This treatment is associated with toxicity and requires in-patient admission with intensive monitoring. An alternative approach with WBRT followed by systemic chemotherapy with standard cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) regimen can be used in community settings in a cohort of patients who cannot receive the standard treatment due to logistic reasons. Materials and Methods: We retrospectively reviewed the patients of PCNSL treated in our institute from January 2004 to May 2010. A total of 39 patients of PCNSL were treated. All patients received WBRT followed by systemic chemotherapy with standard CHOP regimen. Survival analysis was done with Kaplan-Meier method using Statistical Package for Statistical Analysis (SPSS version 15). Prognostic factor influencing survival was evaluated using Cox regression analysis. Toxicity and overall treatment compliance analysis was also evaluated. Results: Overall compliance to RT and chemotherapy was excellent, 37 (94.9%) patients completed planned treatment within the stipulated time period. Grades II-III skin toxicity was seen in three patients and Grade II hematological toxicity was seen in two patients. At 1 month after completion of planned treatment, 15 patients had no symptoms and 20 patients had significant improvement while four patients deteriorated clinically while radiological imaging showed complete response, partial response, progression of disease in 22, 12 and 5 patients respectively. Mean overall survival (OS) was 36.34 months and median OS was 20.0 months with 3-year actuarial OS of 38%. Age of 50-year was a significant (P < 0.05) prognostic factor for survival. Conclusions: The standard of care in management of PCNSL is HD-MTX based chemotherapy. However, considering poor compliance and tolerability to treatment in low resource countries in routine clinical setting, WBRT followed by systemic chemotherapy with standard CHOP regimen for treatment of PCNSL demonstrate reasonably good outcome. This regimen is quite economic as well as simple to implement.

Thymoma is a tumor of thymus and is a rare anterior mediastinal tumor. Locally advanced thymoma with superior vena cava obstruction (SVCO) is an uncommon presentation. We here present a case of locally advanced case of thymoma with SVCO, which was managed with radiotherapy (RT) and chemotherapy (CCT). The patient had radiological complete response and is disease free for eight years.

Subcutaneous metastasis from carcinoma larynx is a rare presentation and to the phalynx is the rarest. We herein describe a case report of carcinoma supraglottic larynx, which is involving all five distal phalanges of left hand with simultaneous metastases to lung and liver. Acrometastasis is an unusual presentation, which might mimic an infectious or inflammatory pathology. The brief report highlights the importance of clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship.