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The aim of this study was to evaluate the breast dose heterogeneity in CT-based radiotherapy treatment planning and to correlate with breast parameters. Also, the number of slices required for treatment planning in breast cancer by tangential field technique has been assessed by comparing the treatment plans according to International Commission on Radiation Units and Measurement (ICRU) 50 guidelines (1993) for single-slice, three-slice, and multi-slice (3D) planning. Sixty women who underwent isocentric tangential field breast radiotherapy were included in this study. The plans were optimized and analyzed with dose volume histograms. Sixty-three percent of the single-slice plans and 26.7% of the three-slice plans showed poor dose homogeneity as compared to the 3D plans. Dose inhomogeneity correlated better with breast volume (r² = 0.43) than the chest wall separation (r² = 0.37) and breast area product (r² = 0.36). Similarly, breast volume correlated better with breast area product (r² = 0.80) than with chest wall separation (r² = 0.56). Breast volume can be approximated to breast area product from the relation, breast volume = [(breast area product x 8.85) - 120.05]. The results of this study showed that most of the cases require 3D planning for breast cancer. It also showed that patients with large breast are prone to have more dose inhomogeneity with standard tangential field radiotherapy. In centers where 3D planning is not possible due to lack of facilities or workload, three slices-based planning can be performed to approximate the dosimetric advantage of 3D planning. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm). A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%). One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1 .5 cm (0.75-4.0 cm). A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%). One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. . Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size. [ABSTRACT FROM AUTHOR]

Discusses the use of irradiation with high dose brachytherapy to treat breast cancer in women. Global prevalence of breast cancer; Advantages and disadvantages of breast conservation therapy; Benefits from whole breast radiotherapy; Overview of studies about the use of partial breast brachytherapy.

Xenobiotic metabolic enzymes CYP1A1 and GSTM1 are known to increase the risk of head and neck cancer. However, their role in the development of oral potentially malignant disorders (OPMDs) in the Indian population is uncertain. This study aimed to investigate the CYP1A1 and GSTM1 gene polymorphism in the urban population of the state of Delhi as well as to investigate the risk of disease progression. Genotype analysis via polymerase chain reaction was conducted in 1169 cases and 1046 controls with regard to GSTM1 and CYP1A1 (ile-val) genes. The oral lesions were biopsied for histopathological diagnosis. Follow-up of the subjects was done at 6-month intervals and the status of the lesions was recorded as static, progressed, or regressed. Descriptive analysis was done with a p-value ≤ 0.05 and odds ratio with a 95% confidence interval being considered for a measure of association. Subjects who consumed both tobacco and alcohol and developed OPMD lesions were 8.2 times more likely to harbour CYP1A1 Val/Val genotype (p = 0.047; OR = 8.224; 95% CI = 1.024–66.037). The highest progression rate and lowest regression rate were found for the CYP1A1 Val/Val genotype in our sample. The CYP1A1 Val/Val genotype may be associated with an increased risk of development of OPMDs amongst consumers of both tobacco and alcohol. Real-time activity-based sensing of isoforms of the CYP1A1 enzyme in living systems is needed to validate the same. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of radiotherapy for cancer treatment in India. Topics discussed include the installation of the multi-leaf collimator designed by the Bhabha Atomic Research Centre at the Advanced Centre for Treatment, Research and Education in Cancer, under the Tata Memorial Center, the 44 Bhabhatron?II cobalt?60 (Co?60) teletherapy machines named after Indian nuclear scientist, Homi J. Bhabha and the intensity modulated radiotherapy.

The author reflects on the role of molecular markers for the cure of head and neck cancers. He states that the scope of these markers have widened in diagnosis, tailoring treatment and predicting response to cancer therapy. He further believes that molecular markers have brought a new avenue of research including work on epigenetic modification and on stem cell markers.

An interview with doctor G. K. Rath is presented. When asked about the burden of tobacco-related cancers, Rath points to the hazards it may cause to internal and external organs, particularly on the associated risks in breast cancer among postmenopausal women. Rath believes that the most important measure to prevent the abuse of tobacco is through health education. For Rath, the establishment of radiation oncology centers in India can be promoted through Public Private Partnership (PPP).

The author reflects on technological developments in radiation oncology in India. The intensity modulated radiotherapy (IMRT) can be an effective tool to reduce radiation treatment morbidity. The image guided radiotherapy (IGRT) keeps track of organ motion and has the ability to deliver accurate treatment. The combination of radiofrequency ablation and brachytherapy is being explored as an aid to residual diseases after conventional treatment. He mentions the need to improve physician training.

The author reflects on the importance of retrospective data in oncology. He states that clinical decision making in oncology depends greatly on the quality of retrospective data from clinical trials and discusses the factors that can improve the quality of retrospective data including patient follow-ups, collaborative data collection and preservation by research institutions and long-term data preservation. Finally, he emphasizes the need for the practice of evidence-based medicine.

A response by G. K. Rath to a letter to the editor about their article "Radiofrequency ablation in liver metastasis" in the previous issue is presented.

Comments on the effects of waiting times on radiation dose fractionation schedules. Tendency to shorten palliative treatments as compared to curative; Palliation for a longer period for brain metastasis; Employment of shortened dose fraction schedules on both curative and palliative patients.

INTRODUCTION: The administration of neoadjuvant chemotherapy (NACT) prior to local therapy is advantageous for women with locally advanced breast cancer (LABC), since it can render inoperable tumors resectable and can increase rates of breast conservative surgeries. MATERIALS AND METHODS: We retrospectively analyzed LABC patients who received NACT from January 2000 to December 2007. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety-one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological complete remission (pCR) was defined as no evidence of malignancy in both breast and axilla. RESULTS: Median age of the whole cohort was 45 years (range 25-68 years). Premenopausal were 42% and estrogen receptor + 49.5%. Most (90%) were T4 tumors and 70% were Stage IIIB. Median numbers of preoperative cycles were six and three in the D and A group respectively. Overall clinical response rates for breast primary were 74.3% and 53.7% (CR 28.6% vs. 16.7%, P=0.58) while for axilla ORR were 75.7% vs. 54.8% (51.4% vs. 40.4% CR, P=0.77) respectively for D and A. Corresponding pCR rates were 19% vs. 13% respectively. There was no significant difference in disease-free (three-year 56.84% vs. 61.16%, P=0.80) and overall survival (three-year 70% vs. 78.5%, P=0.86) between the two groups. CONCLUSIONS: Although pCR rates were higher with docetaxel-based NACT, it did not translate into superior disease-free survival / overall survival compared to anthracycline-based chemotherapies. [ABSTRACT FROM AUTHOR]

Aim: Glioblastoma (GBM) is one of the most aggressive neoplasms of the central nervous system with dismal survival. In recent years, different variants of GBM have been described in the literature. GBM with areas of neuroectodermal differentiation (GBM-PNET) is a relatively new entity in GBM. Presence of the neuroectodermal component increases the propensity of systemic dissemination as with other intracranial primitive neuroectodermal tumors (PNET). The optimal treatment for these patients remains a controversy, with authors reporting local radiotherapy to craniospinal irradiation and chemotherapy. We intend to analyze the pattern of care for GBM with neuroectodermal component.Materials and Methods: We retrieved data of four patients with GBM-PNET treated in our institute; data were also retrieved from published series to derive treatment and outcome results.Results: In this series, we report the outcome of a series of four patients of GBM-PNET treated with adjuvant radiotherapy and temozolomide. All but one patient underwent gross total resection of the tumor. Adjuvant hypofractionated radiation with concurrent and adjuvant temozolomide was used in all cases. The median follow-up was 12.9 months in the present series. One patient experienced local recurrence 18 months after the treatment. A review of published literature on GBM-PNET was done; studies with details of patient outcome were used for an independent analysis. Twenty-three patients were identified, and the pooled analysis revealed a median progression free and overall survival of 10 and 25, months respectively. Extent of surgery, local radiation vs. craniospinal irradiation, and age at presentation had no impact on the survival.Conclusion: GBM PNET is a new entity with only few cases reported so far. Clinical behavior and treatment outcome of these tumors are not different from conventional GBM. However, these patients are at higher risk of CSF dissemination. Hence, an individualized treatment approach is best suited. [ABSTRACT FROM AUTHOR]

Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract and are the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines or recommendations for the management of HNCs, these may not be appropriate for Indian scenarios. In an effort to discuss current practices, latest developments and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical and radiation oncologists and dentists) was formed. A review of literature from medical databases was conducted to provide the best possible evidence base, which was reviewed by experts during a consensus group meeting (January, 2019) to provide recommendations. [ABSTRACT FROM AUTHOR]

Background: The present systematic review and meta-analysis critically assessed the impact of neoadjuvant chemotherapy (NACT) in comparison to ACT in breast cancer patients in terms of oncological and functional outcomes. Methods: Randomized controlled trials comparing NACT with ACT in breast cancer patients were identified through Medline and Cochrane Register of Controlled Trials on January 21, 2016. Cochrane risk of bias assessment tool was used to assess the risk of bias. Meta-analysis was performed using fixed-effects or random-effects method depending on heterogeneity (I2). Grading of the evidences was also done. Subgroup meta-analysis on the basis of total preoperative chemotherapy or sandwich chemotherapy was also performed. Results: The present meta-analysis shows increased breast-conserving surgery (BCS) rate (n = 9, risk ratio [95% confidence interval (CI)] = 1.19 [1.03-1.37]) with NACT. Further, NACT was found equally effective regarding overall survival (n = 15, hazard ratio [HR] [95% CI] = 0.98 [0.89-1.08]), disease-free survival (DFS) (n = 14, HR [95% CI] = 1.01 [0.86-1.18]), and distant metastasis (n = 13, HR [95% CI] = 0.97 [0.82-1.16]). Although locoregional recurrence (LRR) rate was noted to be significantly higher in NACT group (n = 15, HR [95% CI] = 1.23 [1.06-1.43]), its significance disappeared (n = 13, HR [95% CI] = 1.17 [0.98-1.40]) by excluding the trials where surgery was not provided for patients with complete tumor response. After excluding such trials, preoperative NACT was associated with increased BCS with similar LRR in ACT group. Discussion: NACT has no major impact on breast cancer survival. However, it is associated with increased BCS rates. NACT downgrades tumor size facilitating more BCSs without increasing LRR. The evidences were graded for all outcomes as high except DFS and BCS as moderate. [ABSTRACT FROM AUTHOR]

Background/purpose: Anaplastic ganglioglioma (AGG) is a rare tumor with both glial and neuronal component accounting for less than 1% of all CNS tumors with limited information about the optimum treatment and outcome of these tumors.Method and materials: We did a thorough search of the PubMed with the following MesH terms: “Ganglioglioma; Anaplastic ganglioglioma; Ganglioglioma AND treatment; and Anaplastic ganglioglioma AND survival” to find all possible publications related to AGG to perform an individual patient data analysis and derive the survival outcome and optimum treatment of these tumors.Results: A total of 56 articles were retrieved pertaining to AGG with 88 patients. However, a total of 40 publications found eligible with 69 patients for individual patient data analysis. Median age for the entire cohort was 16 years (range 0.2-77 years). Surgical details were available for 64 patients. A gross total or near total resection was reported in 21 cases (32.8%), subtotal resection or debulking was reported in 25 cases (39.1%). Surgical details were available for 64 patients. A gross total or near total resection was reported in 21 cases (32.8%), and subtotal resection or debulking was reported in 25 cases (39.1%). Median overall survival (OS) was 29 months [95% CI 15.8-42.2 months] with 2- and 5-year OS 61 and 39.4% respectively.Conclusion: AGG is associated with a dismal. Pediatric age and a gross total resection of tumor confer a better progression-free survival and OS. Hence, surgery should remain the cornerstone of therapy. However, because of modest survival, there is enough opportunity to improve survival with addition of adjuvant radiation and chemotherapy. A whole genome sequencing and molecular characterization would help to derive the best treatment option. [ABSTRACT FROM AUTHOR]

The article focuses on the use of human papillomavirus vaccine for preventing cancer cervix in India. Topics discussed include improving public health in the country; analysis of immunogenicity, adverse effects and cost-effectiveness of the vaccine; and World Health Organization's recommendations on the same.

Tumor cells were immunopositive for chromogranin (diffuse), focally for synaptophysin, and showed faint immunoreactivity for cytokeratin while negative for epithelial membrane antigen (EMA), glial fibrillary acidic protein, and neurofilament. 9 Although PTPR is a rare tumor, it is being recognized more commonly nowadays due to the awareness of neuropathologists and should be considered in the differential diagnoses of tumors of the pineal region. Histopathologically, PTPR is characterized by an epithelial-like growth pattern in which the vessels are covered with multiple layers of tumor cells forming perivascular pseudorosettes, similar to our case. [Extracted from the article]

Context and Aim: The prognosis of primary gliosarcoma (PGS) remains dismal with current treatment modalities. We analyzed the outcome of PGS patients treated with concurrent and adjuvant temozolomide (TMZ).Settings and Design: Retrospective single institutional analysis.Materials and Methods: We retrospectively evaluated 27 patients of PGS treated with radiotherapy (RT) and TMZ during 2007-2012.Statistical Analysis Used: Overall survival (OS) was estimated by the use of Kaplan Meier method and toxicities were evaluate using common terminology criteria for adverse events version 2.0 (National Cancer Institute, USA).Results: Median age at presentation and Karnofsky performance status was 45 years and 90 respectively and male: female ratio was 20:7. Patients received adjuvant RT to a total dose of 60 Gy at 2 Gy/fraction. All patients except 5 received adjuvant TMZ to a median number of 6 cycles. Grade 2 and 3 hematological toxicity was seen in 8% and 4% of patients respectively during concurrent RT. During adjuvant chemotherapy, 13.6% had Grade 3 thrombocytopenia and 9.5% had Grade 3 neutropenia. Median OS was 16.7 months (1 year and 2 year actuarial OS was 70.8% and 32.6% respectively). Adjuvant TMZ was associated with a better survival (median survival 21.21 vs. 11.93 months; P = 0.0046) on univariate analysis and also on multivariate analysis (hazard ratio 1.82, 95% confidence interval: 1.503-25.58; P = 0.012).Conclusions: The results of our study, largest series of patients with PGS treated with concurrent and adjuvant TMZ shows an impressive survival with acceptable toxicity. We suggest TMZ be included in the "standard of care" for this tumor. [ABSTRACT FROM AUTHOR]

Background and Objective: Neurocytoma (NC) is a rare benign neuronal tumor. A complete excision remains curative for most of these tumors, but atypical histology and extra-ventricular location often necessitates adjuvant therapy. We intended to explore the clinico-pathological features and treatment outcome in patients of NC in our institute.Materials and Methods: Medical records were reviewed and data collected on NC over a 6-year period (2006-2012) from the departmental archives. Disease free survival (DFS) was analyzed by Kaplan-Meier method.Results: A total of 18 patients met the study criteria. Fourteen patients had intra-ventricular neurocytoma (IVNC), right lateral ventricle being the most common site of origin. Gross total resection and near total resection were achieved in eight cases each whereas tumor decompression and biopsy could be done in two cases. On post-operative histopathological examination, eight patients were found to have atypical NC while 10 patients had typical NC. All patients underwent adjuvant radiation. The median dose of post-operative radiation was 56 Gy. All patients were alive at their final follow-up. One patient had both clinical and radiological evidence of local relapse. In the evaluable patients (n = 18), after a median follow-up of 35 months the DFS rate at 2 years and 3 years are 100% and 83% respectively.Conclusion: Use of adjuvant radiation to a total dose of 56 Gy enhances the local control and achieves superior survival in patients of NC. Use of 3D conformal planning techniques may help us to achieve better therapeutic ratio in patients with NC. [ABSTRACT FROM AUTHOR]

Background:Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.Methods:Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.Results:The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.Conclusion:Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients. [ABSTRACT FROM PUBLISHER]

Background: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast-conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx).Materials and Methods: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student's t-test was used for comparative analysis of the means.Results: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14-3.48). The mean Dmean of LAD for L-EBC and R-EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77-1.60). The mean-Dmax of LCx for patients with L-EBC (2.9 Gy; range: 1.2-4.35 Gy) was statistically higher than that for R-EBC (1.3 Gy; range: 0.7-3.2 Gy) (P = 0.045). The mean-Dmean of LCx for L-EBC (2.1 Gy; range: 0.6-3.6 Gy) was also significantly higher than that of L-EBC (0.9 Gy; range: 0.7-2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m-Dmax and m-Dmean of LCx).Conclusion: This pilot dosimetric study confirms the assumption that patients with left-sided EBC are at higher risk of developing long-term cardiac morbidity when treated with PORT due to increased dose to LAD. [ABSTRACT FROM AUTHOR]

Medical electron linear accelerators with the capability of generating unflat photon (flattening filter-free, FFF) beams are also available commercially for clinical applications in radiotherapy. However, the beam characteristics evaluation criteria and parameters are not yet available for such photon beams. Atomic Energy Regulatory Board (AERB) of India constituted a Task Group comprising experts from regulatory agency, advisory body/research and technical institutions, and clinical radiotherapy centers in the country to evolve and recommend the acceptance criteria for the flattening filter-free (FFF) photon beams. The Task Group thoroughly reviewed the literature and inputs of the manufactures/suppliers of the FFF linac and recommended a set of dosimetry parameters for evaluating the characteristics of the unflat photon beam. The recommendations included the evaluation of quality index, degree of unflatness, difference in percentage surface dose between flat and unflat photon beams, percentage depth dose at 10 cm depth, off-axis-ratios and radiation beam penumbra. The recommended parameters were evaluated for FFF photon beams generated by three different models of the linac, and it was observed that recommended evaluation methods are simple and easy to be implemented with the existing dosimetry and quality assurance infrastructure of the linac facilities of the radiotherapy departments. Recommendations were also made for periodic quality control check of the unflat photon beams and constancy evaluation in the beam characteristics. [ABSTRACT FROM AUTHOR]

BACKGROUND: Malignant tumors of the trachea are rare. A multimodality treatment approach is often necessary. Outcomes of radical non-surgical approaches are sparse. Radiation combined with sequential or concurrent chemotherapy is an important treatment option. MATERIALS AND METHODS: We present an analysis of outcomes using modern radiotherapy and chemotherapy for tracheal tumors. RESULTS: Radiation dose escalation using modern techniques is of benefit for these tumors. The results with chemotherapy are encouraging. CONCLUSIONS: Radiation plays a distinct role and should be a part of treatment for these tumors. The role of chemotherapy needs to be studied further. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: Extracorporeal irradiation (ECI) is relatively a rare method used in the management of malignant bone tumors (MBT). It consists of en-bloc removal of the tumor bearing bone segment, removal of the tumor from the bone, irradiation, and re-implantation back in the body. We report our preliminary experience of using ECI for management of MBT. MATERIALS AND METHODS: From year 2009 to 2010, 14 patients with primary MBT were enrolled into this study. The eligibility criteria included histopathological proof of malignancy, no evidence of distant metastases, and suitability for limb preservation therapy. Surgery was performed about 4 weeks after completion of neoadjuvant chemotherapy. The affected bone segment was resected, irradiated extracorporeally with a dose of 50 Gy and reimplanted. Local control, complications and short-term survival were studied. Functional outcome was assessed by Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were 10 males and four females with median age of 14 years. Histopthologically, nine patients had osteosarcoma (OS) and five had Ewing's sarcoma family of tumors (ESFT). Distribution of primary site was as follows: Femur eight patients, tibia five patients and humerus one patient. At a median follow-up was 22 months, three patients (two OS, one ESFT) had local recurrence. Two patients (14%) developed wound infection in the perioperative period. The 2 year local recurrence free survival was 73% and mean MSTS score was 88. CONCLUSION: Results of our study suggest that ECI is technically feasible in the management of MBT and provides decent local control and short-term survival rates. [ABSTRACT FROM AUTHOR]

Conventional total skin electron irradiation (TSEI) for mycosis fungoides (MF) causes radiation toxicity, requiring treatment interruptions that prolong the treatment period, making patient compliance poor. We evaluated an alternate daily treatment schedule of TSEI, using a high dose rate (HDR) to minimize radiation toxicity and shorten the treatment duration. Four patients (aged 45–73 years with MF duration of 7–22 months) were treated by TSEI using HDR. The treatment was given on 5 days/week for 2 weeks followed by treatment on alternate days to deliver a total dose of 36 Gy. All the patients completed treatment in 10 weeks and had complete remission. Radiation toxicity was much less common with this schedule, requiring no treatment interruption. All the patients were until in remission after 60–84 months of follow-up. This schedule of TSEI treatment caused minimal radiation toxicity and allowed completion of treatment over a shorter period, giving good clinical remission and prolonged disease-free survival. [ABSTRACT FROM AUTHOR]

The global cancer burden has shown a distinct shift in the last two decades and its financial impact can be large, even among patients living in high resource countries, with comprehensive health insurance policies. It is hard to imagine its impact on patients of developing countries where insurance policies exist infrequently and often cost becomes the greatest barrier in availing cancer treatment. It is recognized that these costs include the direct cost of disease treatment and care, indirect costs accrued by the patient and the family, and economic losses to the society as a whole. Economic cost analysis or cost-effectiveness analysis has emerged as a basic tool in the evaluation of health-care practices. To date, these cost data have been collected only sporadically, even in the most developed countries, and there is a great need for incorporating economic cost assessment practices in developing countries, so that patients and their families can access the care adequately. The current review has been done using pubmed and medline search with keywords like cancer, cost-analysis, cost-effectiveness, economic burden, medical cost, etc. [ABSTRACT FROM AUTHOR]

Brain metastases constitute one of the most common distant metastases of cancer and are increasingly being detected with better diagnostic tools. The standard of care for solitary brain metastases with the primary disease under control is surgery followed by radiotherapy. Radiotherapy is also the primary modality for the treatment of multiple brain metastases, and improves both the quality of life and survival of patient. Unfortunately, more than half of these treated patients eventually progress leading to a therapeutic dilemma. Another course of radiotherapy is a viable but underutilized option. Reirradiation resolves distressing symptoms and has shown to improve survival with minimal late neurotoxicity. Reirradiation has conventionally been done with whole brain radiotherapy, but now studies with stereotactic radiosurgery have also shown promising results. In this review, we focus on reirradiation as a treatment modality in such patients. We performed a literature search in MEDLINE (www.pubmed.org) with key words brain metastases, reirradiation, whole brain radiotherapy, stereotactic radiosurgery, interstial brachytherapy, and brain. The search was limited to the English literature and human subjects. [ABSTRACT FROM AUTHOR]

Background: Brainstem gliomas are highly heterogeneous tumors both in their clinical manifestation and in their pathology. Despite significant advances in the surgery for brainstem gliomas many aspects of this pathology are still unclear Objective: To evaluate the clinical, radiological and surgical outcome of 40 focal 'intrinsic' brainstem gliomas and propose a surgical strategy-oriented classification. Materials and Methods: A total of 40 focal 'intrinsic' ("expanding variety") tumors have been operated over a period of 8.5-years (January 1998-June 2007). Our criteria included patients with (1) well-defined gadolinium enhancing tumor; (2) relatively long duration of symptoms (> six months) and (3) good neurological functional status and independent for all activities of daily living. The cutoff size of 2 cm was not rigidly adhered to. Results: The 'intrinsic' brainstem tumors were classified into three types: Expanding, diffuse infiltrative and pure ventral varieties. Only patients with expanding variety of brainstem gliomas were subjected to surgery, mean age 19.2 years (range 4-55 years) and male to female ration mean: 3:2). The tumor location included pons (n=19), midbrain (n=13) and medulla (n=8). Surgical approaches included midline suboccipital (n=28), retromastoid (n=7), subtemporal (n=3) and supracerebellar-infratentorial (n=2). Thirty-two cases with 'diffuse infiltrative' and 'pure ventral' variety were given radiotherapy only. Histology pathology revealed pilocytic variety (n=10), Grade II (n=17) and Grade III (n=13). There was one death in the surgical series (due to aspiration). Complications included meningitis (n=2), wound infection (n=1), chest infection (n=5) and transient mutism (n=1). Follow-up ranged from 3-68 months. Overall, 36 improved /remained same and three worsened in their clinical status at the time of discharge. Conclusion: The surgical management of intrinsic brainstem tumors presents a surgical challenge; radical excision yielded a good outcome in the majority of cases. The authors propose a classification system for 'intrinsic' brainstem tumors for defining surgical strategy. [ABSTRACT FROM AUTHOR]

This study is aimed to evaluate the impact of static and dynamic intensity modulated radiotherapy (IMRT) delivery techniques planned with Eclipse TPS on the integral dose to the healthy normal tissue surrounding the tumor-bearing area and to the volume receiving doses <5 Gy in patients with carcinoma nasopharynx treated with Simultaneous Integrated Boost IMRT (SIB-IMRT). Ten patients with carcinoma nasopharynx were chosen for this dosimetric study. IMRT plans were generated with 6X using dynamic multileaf collimator (DMLC) and static multileaf collimator (SMLC) with 5, 10 and 15 intensity levels (L). Integral dose, volume receiving 5 Gy, number of monitor units (MU) is compared against DMLC. The mean difference in the MU delivered per fraction between 5, 10 and 15 L SMLC and DMLC was -13.25% (P < 0.001, with paired t test), -11.82% (P < 0.001) and -10.81% (P < 0.001), respectively. The mean difference in the integral dose with 5, 10 and 15 L compared to DMLC was -2.96% (P < 0.001), -2.67% (P = 0.016) and -0.39% (P = 0.430), respectively. However, the difference in low-dose volume (V5Gy) was statistically insignificant with mean difference of 0.60% (P = 0.23), 1.18% (P = 0.017) and 1.70% (P = 0.078), respectively for 5, 10 and 15 L compared to DMLC. Our results show that while choosing the IMRT delivery technique using conventional MLC the concerns about integral dose and volume receiving very low doses such as 5 Gy can be ignored. [ABSTRACT FROM AUTHOR]

Aim: The main objective of this study was to analyze the radiobiological effect of different treatment strategies on high-risk prostate adenocarcinoma. Materials and Methods: Ten cases of high-risk prostate adenocarcinoma were selected for this dosimetric study. Four different treatment strategies used for treating prostate cancer were compared. Conventional four-field box technique covering prostate and nodal volumes followed by three-field conformal boost (3D + 3DCRT), four-field box technique followed by intensity-modulated radiotherapy (IMRT) boost (3D + IMRT), IMRT followed by IMRT boost (IMRT + IMRT), and simultaneous integrated boost IMRT (SIBIMRT) were compared in terms of tumor control probability (TCP) and normal tissue complication probability (NTCP). The dose prescription except for SIBIMRT was 45 Gy in 25 fractions for the prostate and nodal volumes in the initial phase and 27 Gy in 15 fractions for the prostate in the boost phase. For SIBIMRT, equivalent doses were calculated using biologically equivalent dose assuming the α/β ratio of 1.5 Gy with a dose prescription of 60.75 Gy for the gross tumor volume (GTV) and 45 Gy for the clinical target volume in 25 fractions. IMRT plans were made with 15-MV equispaced seven coplanar fields. NTCP was calculated using the Lyman-Kutcher-Burman (LKB) model. Results: An NTCP of 10.7 ± 0.99%, 8.36 ± 0.66%, 6.72 ± 0.85%, and 1.45 ± 0.11% for the bladder and 14.9 ± 0.99%, 14.04 ± 0.66%, 11.38 ± 0.85%, 5.12 ± 0.11% for the rectum was seen with 3D + 3DCRT, 3D + IMRT, IMRT + IMRT, and SIBIMRT respectively. Conclusions: SIBIMRT had the least NTCP over all other strategies with a reduced treatment time (3 weeks less). It should be the technique of choice for dose escalation in prostate carcinoma. [ABSTRACT FROM AUTHOR]

Background: In upper abdominal malignancies (UAM), due to the presence of multiple inhomogeneous tissues, a wedge-based conformal treatment planning results in high-dose regions inside the target volume. Aim: This study was designed to explore the feasibility of using a field-in-field (FIF) technique in different UAM and its efficacy in reducing the high-dose regions. Materials and Methods: Twelve patients of UAM (which included malignancies of the gastroesophageal junction, stomach, gall bladder, and pancreas) were selected for this study. Computed tomography (CT) scans were performed and three-dimensional conformal wedge plans were generated for all the cases. The same plan was copied with the wedges removed and a FIF plan was generated. The two plans were compared for mean, maximum, and median doses; dose received by 2% (D2) and 98% (D98) of the target volume; volume receiving >107% (V > 107%) and <95% (V < 95%) of the prescribed dose; conformality index (CI); and total monitor units. The doses to critical structures such as liver, kidneys, and spinal cord were also compared. Statistical Analysis: Statistical analysis was performed with SPSS, version 10.0. Results: For all the cases, the FIF technique was better than wedge-based planning in terms of maximum dose, D2, V > 107%, and CI; there was a statistically significant reduction in monitor units. With regard to doses to critical structures, there was marginal dose reduction for the kidneys and spinal cord with FIF as compared to wedge-based planning. Conclusion: The FIF technique can be employed for UAM in place of wedge-based conformal treatment plans. [ABSTRACT FROM AUTHOR]

Abstract: Oral cancer is among the most common cancers in India. Tobacco, its primary risk factor, is widely consumed across the country, in both smoked and smokeless forms. The current study assessed the prevalence of tobacco use and associated oral lesions in a section of the New Delhi population. Population-based cross-sectional survey was used. House visits in urban Delhi within 15 km radius of a tertiary care teaching hospital were conducted. The basic demographic details, tobacco and alcohol history (on a standardized questionnaire) were elicited from 71,022 individuals, followed by an oral examination (inspection and digital palpation) for detecting oral potentially malignant disorders (OPMDs) and oral cancer. Ever tobacco users comprised 22.2% while 16.1% of individuals were current tobacco users; tobacco use was higher among men than women. Bidi was the most commonly used smoked tobacco product (both genders). Regarding smokeless tobacco, gutkha and khaini use was common among men, while the majority of women consumed betel quid with tobacco. Alcohol use was found in 4% of individuals. OPMDs were detected in 3.4% of individuals. Tobacco abuse is very common in our urban community. Community-based oral health education and oral checkup by trained health care workers should be carried out to reduce the burden of tobacco use and ill effects of tobacco. [ABSTRACT FROM AUTHOR]

Aims: Radiotherapy forms an integral part of breast-conserving treatment in early-stage breast cancer. Subcutaneous fibrosis of the treated breast is an important late effect in whole-breast irradiation. The aim of this study was to compare the normal tissue complication probability (NTCP) for radiation-induced fibrosis in treated breast using accelerated partial-breast irradiation (APBI) vs conventional treatment.Materials and Methods: Ten postoperative early-stage breast cancer patients (T1N0M0) were included in this dosimetric analysis. APBI treatment was planned using conformal radiotherapy technique and conventional treatment plans included two tangential portals. All the APBI treatment plans were made with five non-coplanar beams with 6 MV photons. The prescription dose was 38 Gy in 10 fractions for the APBI treatments and 50 Gy in 25 fractions, followed by a boost dose of 16 Gy in 8 fractions, for the conventional treatments. We used Lyman's relative-seriality model and the breast fibrosis NTCP model fitting parameters for the study.Results: The equivalent uniform dose (EUD) was 30.09 Gy and 50.79 Gy in APBI and conventional treatment, respectively. The mean NTCP values for ipsilateral breast fibrosis in APBI and conventional treatment were 0.51 and 25.66%, respectively. Using the paired t-test, a statistically significant difference was seen in the breast fibrosis NTCP values for APBI vs conventional treatment (P < 0.001).Conclusions: APBI reduces the ipsilateral breast fibrosis compared to conventional whole-breast treatment in early-stage breast cancer. [ABSTRACT FROM AUTHOR]

Aims: Radiotherapy forms an integral part of breast-conserving treatment in early-stage breast cancer. Subcutaneous fibrosis of the treated breast is an important late effect in whole-breast irradiation. The aim of this study was to compare the normal tissue complication probability (NTCP) for radiation-induced fibrosis in treated breast using accelerated partial-breast irradiation (APBI) vs conventional treatment. Materials and Methods: Ten postoperative early-stage breast cancer patients (T1N0M0) were included in this dosimetric analysis. APBI treatment was planned using conformal radiotherapy technique and conventional treatment plans included two tangential portals. All the APBI treatment plans were made with five non-coplanar beams with 6 MV photons. The prescription dose was 38 Gy in 10 fractions for the APBI treatments and 50 Gy in 25 fractions, followed by a boost dose of 16 Gy in 8 fractions, for the conventional treatments. We used Lyman's relative-seriality model and the breast fibrosis NTCP model fitting parameters for the study. Results: The equivalent uniform dose (EUD) was 30.09 Gy and 50.79 Gy in APBI and conventional treatment, respectively. The mean NTCP values for ipsilateral breast fibrosis in APBI and conventional treatment were 0.51 and 25.66%, respectively. Using the paired t-test, a statistically significant difference was seen in the breast fibrosis NTCP values for APBI vs conventional treatment (P<0.001). Conclusions: APBI reduces the ipsilateral breast fibrosis compared to conventional whole-breast treatment in early-stage breast cancer. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to evaluate the applicability of World Health Organization (WHO), Southwest Oncology Group (SWOG) and Response Evaluation Criteria in Solid Tumours (RECIST) guidelines when evaluating the response of cytotoxic agents in solid tumours. Patients with a solid tumour who were planned for standard chemotherapy, were aged more than 18 years and had an anticipated life expectancy of at least 12 weeks were included in the study. Patients received chemotherapy using standard protocols and were required to have a pre-treatment evaluation of tumour burden on CT. Subsequent response assessment was performed every two cycles. Each patient was evaluated by all three criteria (WHO, SWOG and RECIST) to check the applicability of a specific criterion during routine clinical practice. In total, 80 patients were included in the study. Out of these, the response criteria displayed discordance in 17 (21%) patients. Of these 17 patients, RECIST criteria were not applicable for 6 patients owing to the small lesion size. The present study shows that a particular guideline may be useful in establishing uniformity of evaluation in a desired study population but may not be the best for that population during routine clinical practice. It also indicates that each of the guidelines has its own applicability and that no guideline can outweigh the other during routine clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment.Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment.Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm). A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%). One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease.Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size. [ABSTRACT FROM AUTHOR]

A 55-year-old man with tracheal adenocarcinoma presented with difficulty in breathing and cough with blood-tinged expectoration. As the patient refused surgery, he was treated with definitive radiotherapy to the neck and superior mediastinum to a total dose of 50 Gy (initially 40 Gy by AP/PA portals followed by 10 Gy with a three-field technique). He showed significant symptomatic relief to radiotherapy and defaulted from further treatment. He remained asymptomatic for 7 years, following which he developed sternal metastases and a local tumour recurrence. This case illustrates that long-term clinical remission can be achieved by radiotherapy alone in this rare histological subtype of tracheal carcinoma. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to compare the two standard treatment approaches in muscle invasive carcinoma of urinary bladder--radical cystectomy and chemo radiation.Materials and Methods: Transitional cell carcinoma (TCC) of bladder of stages, T2 to T4, N0/N1/N2 and M0 were included in the study. Patients were allotted to two arms of the study. Arm A consisted of radical cystectomy. Adjuvant CMV chemotherapy was given for T3/T4 or Node positive disease only. Arm B received 2 cycles of neoadjuvant CMV chemo therapy followed by concurrent chemo radiation.Results: Forty-four patients were recruited into the study. Thirty patients in the surgical arm and 13 patients in the chemo radiation arm. The actuarial two-year survival rate in surgical arm is 56% while in chemo radiation arm it is 54%. There was no statistically significant difference in disease-free survival also between the two groups.Conclusion: Chemo radiation yielded equivalent survival results with radical cystectomy. So it is worth giving preference to chemo radiation that will give a better quality of life for the patient. [ABSTRACT FROM AUTHOR]