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Author(s): Nayan Agarwal (corresponding author) [1]; Arun K. Rathi [1]; Seema Kapoor [2,3]; Kishore Singh [1]; Savita Arora [1]; Ankur Jindal [4]; Kumar Prabhat [5]; Himanshi Kaushik [6] INTRODUCTION Radiation [...], Background: Biodosimetry is the quantification of absorbed radiation dose using biological material obtained from an exposed individual. Radiation can cause different types of chromosomal aberrations, including stable aberrations like translocations and unstable ones like micronuclei, dicentric chromosomes (DC), acentric, and ring forms. Dicentric chromosome assay has become the "gold standard" for cytogenetic biodosimetry due to its reproducibility, specificity (low baseline rates), and sensitivity to low doses. Using existing calibration curves and models obtained from in vitro irradiation of blood, the yield of DCs can be used to estimate the average whole-body absorbed dose. Purpose: To evaluate and compare the in vivo dose-response relation of DC aberration formation in peripheral blood lymphocytes of head and neck cancer (HNC) patients undergoing radiotherapy (RT) alone, cisplatin-based chemoradiation (CCRT), accelerated fractionation RT (AFRT), and CCRT with gefitinib (GCRT). Methodology: This prospective observational and analytical study was conducted from 2018 to 2021 in the Department of Radiation Oncology and Genetic Lab of tertiary care, teaching hospital after approval from the Institutional Ethics Committee. Biodosimetric analysis was done weekly in patients undergoing RT (n = 20) versus CCRT (n = 20), CCRT (n = 12) versus AFRT (n = 12), and CCRT (n = 6) versus GCRT (n = 6). The yield of DCs was measured in blood samples taken before starting treatment, that is, day 0 and during RT on days 6, 11, and 16 in RT alone versus CCRT; on days 7 and 13 in CCRT versus AFRT; and days 6 and 11 in CCRT versus GCRT from a blood sample drawn 1-2 h after RT. Phytohemagglutinin-stimulated lymphocytes were cultured using heparinized blood in RPMI-1640 medium supplemented with fetal bovine serum. Cells were arrested at metaphase using demecolcine, harvested by centrifugation, mounted, and stained with Giemsa. Cytogenetic analysis was performed by analyzing at least 100 metaphases with well-spread chromosomes. DC aberrations and acentric fragments were identified and recorded. To standardize the findings as per the customized field for every patient, the mean DC yield per cm[sup.2] of the irradiated area was calculated and compared. Results: The mean yield of DC/cm[sup.2] in the CCRT group was greater than the RT alone group by 16.33%, 28.57%, and 18.68% on days 6, 11, and 16 of treatment, respectively. This difference between the two groups at day 6 (P = 0.001), day 11 (P < 0.001), and day 16 (P < 0.001) was found to be statistically significant. The mean yield of DC/cm[sup.2] in the CCRT group was greater than the AFRT group by 7.9% and 18.3% on days 7 and 13 of treatment, respectively. This difference at day 7 (P < 0.001) and day 13 (P < 0.001) was found to be statistically significant. The mean yield of DC/cm[sup.2] in the CCRT group was greater than the GCRT group by 22.7% and 21.8% on days 6 and 11 of treatment, respectively. The difference at day 6 (P = 0.01) was statistically significant but, on day 11 (P = 0.065) this difference was found insignificant. Conclusion: There is a dose-dependent increase in the yield of DCs in lymphocytes of HNC patients undergoing RT with subsequent fractions. Cisplatin-based chemoradiation is the superior method of treatment intensification radio-biologically proven by higher DC yield. Keywords: Biodosimetry, cytogenetics, dicentric assay, radiobiology, radiotherapy

Author(s): Savita Arora (corresponding author) [1]; Arun K. Rathi [1]; Kishore Singh [1]; Faiz A. Ansari [1] INTRODUCTION The current standard of care for high-grade gliomas (HGG) patients is maximal [...], Aim: The purpose of this study was to evaluate the efficacy and safety of preradiation temozolomide (TMZ) in high-grade gliomas. Study and Design: It is a single-center, single arm, prospective study. The study included postoperative, histopatholgically proven cases of high-grade gliomas. Materials and Methods: Nine patients of anaplastic astrocytoma (AA) and twenty patients of glioblastoma multiforme (GBM) were enrolled in the study. All patients had undergone partial or complete resection. Three weeks after surgery, patients were started on chemotherapy, consisting of two cycles of TMZ, 150 mg/m[sup.2]/day for 5 days, repeated at an interval of 4 weeks. Patients were subsequently treated with concomitant chemoradiotherapy. A dose of 60 Gy was given over thirty fractions along with TMZ, 75 mg/m[sup.2]/day. Four cycles of TMZ were given after completion of radiotherapy, in a dose and manner similar to preradiotherapy. Statistical Analysis and Result: Treatment-related toxicity was assessed using common terminology for toxicity criteria (CTCAE v4). Progression-free survival and overall survival (OS) analysis was done. Nearly 79 of patients completed the two cycles of preradiation chemotherapy. Chemotherapy was tolerated well. Median time to progression was 11 months and 8.2 months in AA and GBM patients, respectively. Median OS was 17.4 months in AA patients and 11.4 months in GBM patients. Conclusions: Most patients of postoperative high-grade gliomas tolerated two cycles of TMZ. A good safety profile of TMZ allows it to be used in frontline settings, especially in high volume centers where a delay in starting radiotherapy frequently occurs. The use of TMZ before radiotherapy is a safe and feasible approach, and further studies are required to validate this approach. Keywords: High-grade glioma, preradiation chemotherapy, temozolomide

Author(s): Shruti Agarwal [1]; Wineeta Melgandi [1]; Deepak Raj Sonkar (corresponding author) [1]; Faiz Akram Ansari [1]; Savita Arora [1]; Arun Kumar Rathi [1]; Kishore Singh [1] INTRODUCTION Endometrial cancer [...], Settings and Design: A retrospective study which analyzed the data of female patients attending a tertiary care center in National Capital Territory for the treatment of endometrial cancer. Materials and Methods: Eighty-six histopathologically confirmed cases of carcinoma endometrium were taken from January 2016 to December 2019. Detailed information was collected regarding patient&apos;s case history, sociodemographic data (age of presentation, occupation, religion, residence, and substance addiction), clinical presentation, diagnostic and therapeutic procedures, and known risk factors (age at menarche and menopause, parity, obesity, use of oral contraceptive pills, hormone replacement therapy, and comorbidities such as hypertension and diabetes). Statistical Analysis Used: After analysis, results were presented as mean ± standard deviation and frequency. Results: Eighty-six percent of the patients (n = 73) were in the age group of 40-70 years; the mean age of the patients at diagnosis of endometrial cancer was 54 years. Eighty-one percent (n = 70) of the patients were from urban areas. Sixty-seven percent of the females (n = 54) were Hindu. All the patients were housewives with nonsedentary lifestyles. Most patients (88; n = 76) presented with bleeding per vaginum. Fifty-nine percent (n = 51) had stage I disease, followed by 15 (n = 13) with stage II, 14 (n = 12) with stage III, and 12 (n = 10) with stage IV disease. Eighty-two percent (n = 72) of the patients had endometrioid carcinoma. Other less common variants were mixed Mullerian malignant tumor, squamous, adenosquamous, serous, and endometrioid stromal. Forty-four percent (n = 38), 39 (n = 34), and 16 (n = 14) of the patients had grade I, grade II, and grade III tumor, respectively. 53.5 of the cases (n = 46) had >50 myometrial invasion at the time of presentation. Eighty-two percent (n = 71) of the patients were postmenopausal. The mean age at menarche and menopause was 13 years and 47 years, respectively. Fifteen percent (n = 13) of the females were nulliparous. Forty-six percent (n = 40) of the patients were overweight. Most patients (82) had no history of addiction. Twenty-five percent (n = 22) of the patients had hypertension, and 27 (n = 23) has diabetes as comorbidity. Conclusions: The incidence of endometrium cancer is showing a steady rise in the recent past. Early age of menarche, late age of menopause, nulliparity, obesity, and diabetes mellitus are well-documented risk factors for uterine cancer. Better outcome and control of disease is possible by understanding of endometrial cancer etiology, risk factors, and its preventive measures. Thus, a robust screening program is warranted to detect the disease in early stage and for increased survival. Keywords: Cancer in Delhi, carcinoma endometrium, carcinoma uteri corpus

Author(s): Mohammad Azam (corresponding author) [1]; Animesh Agrawal [2]; Kamal Sahni [3]; Madhup Rastogi [3]; Arun Kumar Rathi [1]; S. Farzana [4] INTRODUCTION Breast cancer is the most frequently diagnosed [...], Objective: Conventional field radiotherapy based on anatomical landmarks has been the traditional treatment for breast cancer. Having proven efficacy, it is still the current standard of treatment. The Radiation Therapy Oncology Group (RTOG) has published guidelines for contouring target volumes in postmastectomy patients. The impact of this guideline in the current clinical practice is less known; hence, we have analyzed dose-volume histograms (DVHs) for these plans and compared them with the proposed treatment plans to treat RTOG-defined targets. Subjects and Methods: RTOG consensus definitions were used to contour the target volumes in 20 previously treated postmastectomy patients. The prescription was 42.4 Gy in 16 fractions. DVHs were generated from clinically designed plans that had actually been delivered to each patient. For comparing dose to target volumes, new plans were generated with the goal of covering 95 of volume to 90 of prescribed dose. Results: In RTOG contoured Group, coverage improved for the supraclavicular (V90 = 83 vs. 94.9, P < 0.05) and chest wall (V90 = 89.8 vs. 95.2, P < 0.05). Axillary nodal coverage improved for Level-1(V90 = 80.35 vs. 96.40, P < 0.05), Level-II (V90 = 85.93 vs. 97.09, P < 0.05) and Level III (V90 = 86.67 vs. 98.6, P < 0.05). The dose to the ipsilateral lung is increased (V20 = 23.87 vs. 28.73, P < 0.05). Low dose to heart is increased in left-sided cases (V5 = 14.52 vs. 16.72, P < 0.05) while same in right-sided cases. Conclusions: The study shows that radiotherapy using the RTOG consensus guidelines improves coverage to target volumes with a nonsignificant increase in normal organ dose compared to that based on anatomical landmarks. Keywords: Breast cancer, modified radical mastectomy, radiation dosimetry, radiation therapy oncology group contouring guidelines, three-dimensional conformal radiotherapy

Author(s): Tanshi Daljit (corresponding author) [1]; Wineeta Melgandi [1]; Faiz Akram Ansari [1]; Arun Kumar Rathi [1]; Kishore Singh [1] INTRODUCTION Bladder cancer is the 11[sup.th] common malignancy worldwide, whereas [...], Cutaneous manifestation of cancers is a rare occurrence, even more so for bladder cancer, with a limited number of published reports. Iatrogenic implantation has been a major cause for it. With no clear distinction pattern from other common dermatological lesions, scattered occurrence, and poor survival; no definitive strategies are present for the management of these dermal manifestations. The present article describes a case of scalp lesion consistent with metastatic urothelial carcinoma along with a review of the literature. Keywords: Bladder cancer, cutaneous metastasis, urothelioma