Shubhangi Barsing, Anand Parab, Anuradha Singh, G. Pemmaraju
Aims: Craniospinal irradiation (CSI) is a challenging task on halcyon due to its field size constraint (28 cm × 28 cm). CSI was planned by volumetric modulated arc therapy (VMAT) technique on Halcyon (6MV) linac with no junction shift with multiple arcs and numerous isocenter depending on the length of the patients. Methods and Materials: Planning CSI was achieved on Eclipse treatment planning system version 15.6 with anisotropic analytical algorithm and was optimized using autofeathering technique. Positioning accuracy was ensured by obtaining daily kvCBCT before radiation which ensured accurate field placement and avoidance of junctional errors. Pretreatment portal dosimetry was done to ensure the dose distribution calculated by the treatment planning system matches the dose delivered to the patient. Results: All VMAT CSI plans produced outstanding planning target volume (PTV) coverage with V95% >98% and gave acceptable doses to organ at risk in all CSI cases. Furthermore, the dose distributions were highly uniform, with homogeneity index values ≤0.1 and target conformity was equally excellent with values more than 0.95. In portal dosimetry, all of the composite images of CSI plans were evaluated, yielding good passing criteria of >98%. Conclusions: The remedy was straightforward to plan and deliver, thanks to autofeathering optimization. CSI plan was created with no junction shift which resulted in homogeneous and conformal doses to the PTV. The gamma analysis in the portal dosimetry composite image, which was utilized as a pretreatment verification, met all of the requirements and revealed a homogeneous and uniform junction dose.
{"title":"Craniospinal irradiation by volumetric modulated arc therapy technique on halcyon","authors":"Shubhangi Barsing, Anand Parab, Anuradha Singh, G. Pemmaraju","doi":"10.4103/jrcr.jrcr_2_22","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_2_22","url":null,"abstract":"Aims: Craniospinal irradiation (CSI) is a challenging task on halcyon due to its field size constraint (28 cm × 28 cm). CSI was planned by volumetric modulated arc therapy (VMAT) technique on Halcyon (6MV) linac with no junction shift with multiple arcs and numerous isocenter depending on the length of the patients. Methods and Materials: Planning CSI was achieved on Eclipse treatment planning system version 15.6 with anisotropic analytical algorithm and was optimized using autofeathering technique. Positioning accuracy was ensured by obtaining daily kvCBCT before radiation which ensured accurate field placement and avoidance of junctional errors. Pretreatment portal dosimetry was done to ensure the dose distribution calculated by the treatment planning system matches the dose delivered to the patient. Results: All VMAT CSI plans produced outstanding planning target volume (PTV) coverage with V95% >98% and gave acceptable doses to organ at risk in all CSI cases. Furthermore, the dose distributions were highly uniform, with homogeneity index values ≤0.1 and target conformity was equally excellent with values more than 0.95. In portal dosimetry, all of the composite images of CSI plans were evaluated, yielding good passing criteria of >98%. Conclusions: The remedy was straightforward to plan and deliver, thanks to autofeathering optimization. CSI plan was created with no junction shift which resulted in homogeneous and conformal doses to the PTV. The gamma analysis in the portal dosimetry composite image, which was utilized as a pretreatment verification, met all of the requirements and revealed a homogeneous and uniform junction dose.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82989158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nishana Abbas, D. Fernandes, C. Shridhar, Sandesh Rao, Amrutha Babu, S. Shankar, Sheeba Santhmayer
Context: Dose received to each pelvic group of lymph nodes, namely obturator (OB), internal iliac (II), and external iliac (EI), is less certain. This study is conducted to evaluate the dose delivered to these nodal groups so that this can be considered while planning external beam radiotherapy external beam radiation therapy (EBRT) boost in patients with gross pelvic lymph nodes. Aims: This study aimed to estimate the dose contribution to pelvic lymph nodes in three-dimensional high-dose-rate intracavitary radiotherapy (HDR-ICRT) of cervical cancer patients. Settings and Design: This was a single-arm retrospective observational study among 25 locally advanced carcinoma cervix patients treated with definitive chemoradiation. Materials and Methods: EI, II, and OB groups of lymph nodes were delineated on computed tomography data sets of selected 25 patients, and D100, D50, and D2cc to each lymph node were analyzed. The dose received by each pelvic lymph node group from all the 3 fractions of HDR-ICRT, corresponding equivalent 2 Gy dose, and percentage of brachytherapy (BT) contribution to each pelvic lymph node were calculated. Results: Mean D100 received by EI, II, and OB lymph node groups after summation across 3 fractions was 1.1 Gy, 2.34 Gy, and 3.11 Gy, respectively. Mean 2 Gy equivalent doses (D100) were 1.66 Gy, 3.41 Gy, and 4.53 Gy, respectively. Corresponding percentage of the dose received by EI, II, and OB was 4.89%, 10.43%, and 13.83% when 7.5 Gy per fraction for 3 fractions was prescribed to Point A. Conclusions: There is a significant contribution from HDR intracavitary BT to the pelvic lymph nodes in the radical treatment of cervical cancer. The dosimetric results given in this work can be used by a radiation oncologist to estimate BT doses to affected lymph nodes and integrate them into the preceding EBRT planning phase.
{"title":"Estimation of pelvic lymph node dose contribution from HDR ICBT in cervical cancer","authors":"Nishana Abbas, D. Fernandes, C. Shridhar, Sandesh Rao, Amrutha Babu, S. Shankar, Sheeba Santhmayer","doi":"10.4103/jrcr.jrcr_59_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_59_21","url":null,"abstract":"Context: Dose received to each pelvic group of lymph nodes, namely obturator (OB), internal iliac (II), and external iliac (EI), is less certain. This study is conducted to evaluate the dose delivered to these nodal groups so that this can be considered while planning external beam radiotherapy external beam radiation therapy (EBRT) boost in patients with gross pelvic lymph nodes. Aims: This study aimed to estimate the dose contribution to pelvic lymph nodes in three-dimensional high-dose-rate intracavitary radiotherapy (HDR-ICRT) of cervical cancer patients. Settings and Design: This was a single-arm retrospective observational study among 25 locally advanced carcinoma cervix patients treated with definitive chemoradiation. Materials and Methods: EI, II, and OB groups of lymph nodes were delineated on computed tomography data sets of selected 25 patients, and D100, D50, and D2cc to each lymph node were analyzed. The dose received by each pelvic lymph node group from all the 3 fractions of HDR-ICRT, corresponding equivalent 2 Gy dose, and percentage of brachytherapy (BT) contribution to each pelvic lymph node were calculated. Results: Mean D100 received by EI, II, and OB lymph node groups after summation across 3 fractions was 1.1 Gy, 2.34 Gy, and 3.11 Gy, respectively. Mean 2 Gy equivalent doses (D100) were 1.66 Gy, 3.41 Gy, and 4.53 Gy, respectively. Corresponding percentage of the dose received by EI, II, and OB was 4.89%, 10.43%, and 13.83% when 7.5 Gy per fraction for 3 fractions was prescribed to Point A. Conclusions: There is a significant contribution from HDR intracavitary BT to the pelvic lymph nodes in the radical treatment of cervical cancer. The dosimetric results given in this work can be used by a radiation oncologist to estimate BT doses to affected lymph nodes and integrate them into the preceding EBRT planning phase.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76413864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shahida Nasreen, Shaiba Hussain, Asifa Andleeb, A. Manzoor, K. Fatima, M. Sofi
Introduction: Kashmir Valley of India lies at the edge of the “Asian esophageal cancer belt.” A number of treatment modalities have been delivered to the patients of esophageal squamous cell carcinoma at our Regional Cancer Centre. We considered it worthwhile to analyze the outcome of all these modalities. Materials and Methods: In the Department of Radiation Oncology of our institute, retrospective analysis of 2090 patients was done, who were diagnosed with nonmetastatic squamous cell carcinoma of the esophagus from 1993 to 2013. Of these 2090 cases, only 1337 patients only completed the treatment. Seven hundred and fifty-three patients either did not report for treatment after registration or did not complete the treatment. These 1337 patients were reviewed in terms of dysphagia relief, local disease control, distant metastasis, and overall survival (OS) at 1 and 2 years. They were grouped into 14 different groups as per the treatment received from A to N. Results: Fourteen different treatment modalities have been used at our center from 1993 to 2013. The overall percentage of local recurrence was 14.95%, highest being in Group L (26.65) and nil in Group M. About 32.57% of patients developed distance metastasis, highest (50%) in Group J, and nil in Group M. The most common site of failure was the supraclavicular nodes (7%), followed by the bone, liver, lung, and brain. OS at 1 and 2 years was 51.86% and 20.55%, respectively. However, it could not designate any particular modality as the best for treating patients with squamous cell carcinoma of the esophagus. Conclusion: We concluded from our study that the most common failure in squamous cell carcinoma esophagus is the distant metastasis. Local recurrences are least in patients who underwent surgery. Unfortunately, we could not point out a single group from the study which could be deemed as the best treatment modality for carcinoma esophagus.
{"title":"Treatment pattern and overall survival in squamous cell carcinoma of the esophagus over two decades: A single institutional experience","authors":"Shahida Nasreen, Shaiba Hussain, Asifa Andleeb, A. Manzoor, K. Fatima, M. Sofi","doi":"10.4103/jrcr.jrcr_44_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_44_21","url":null,"abstract":"Introduction: Kashmir Valley of India lies at the edge of the “Asian esophageal cancer belt.” A number of treatment modalities have been delivered to the patients of esophageal squamous cell carcinoma at our Regional Cancer Centre. We considered it worthwhile to analyze the outcome of all these modalities. Materials and Methods: In the Department of Radiation Oncology of our institute, retrospective analysis of 2090 patients was done, who were diagnosed with nonmetastatic squamous cell carcinoma of the esophagus from 1993 to 2013. Of these 2090 cases, only 1337 patients only completed the treatment. Seven hundred and fifty-three patients either did not report for treatment after registration or did not complete the treatment. These 1337 patients were reviewed in terms of dysphagia relief, local disease control, distant metastasis, and overall survival (OS) at 1 and 2 years. They were grouped into 14 different groups as per the treatment received from A to N. Results: Fourteen different treatment modalities have been used at our center from 1993 to 2013. The overall percentage of local recurrence was 14.95%, highest being in Group L (26.65) and nil in Group M. About 32.57% of patients developed distance metastasis, highest (50%) in Group J, and nil in Group M. The most common site of failure was the supraclavicular nodes (7%), followed by the bone, liver, lung, and brain. OS at 1 and 2 years was 51.86% and 20.55%, respectively. However, it could not designate any particular modality as the best for treating patients with squamous cell carcinoma of the esophagus. Conclusion: We concluded from our study that the most common failure in squamous cell carcinoma esophagus is the distant metastasis. Local recurrences are least in patients who underwent surgery. Unfortunately, we could not point out a single group from the study which could be deemed as the best treatment modality for carcinoma esophagus.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84295460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Ozdemir, N. Okumus, B. Gursel, A. Meydan, B. Meydan, O. Yapıcı, Sema Yilmaz Rakici
Aims: We aimed to show the protective effect of carnitine and melatonin (MEL) on kidney which were applied before the radiotherapy. Materials and Methods: Seventy-two male Wistar Albino rats were divided six equal groups as Group 1 radiotherapy, Group 2 radiotherapy and MEL, Group 3 radiotherapy and carnitine, Group 4 MEL, Group 5 carnitine, and Group 6 control. Whole abdominal radiotherapy of 10 Gy was applied to the radiotherapy groups. Renal scintigraphy was performed under anesthesia on all rats after a follow-up period of 8 weeks. Histopathologic examination was performed in kidneys. Results: Group 1 showed a statistically significant deterioration of renal scintigraphy function (P < 0.05). Group 2 and Group 3 showed a better function of scintigraphical renal function and there was no significance between the control. There was no damage seen by light microscopy in Group 1, 2, 3. When evaluated histomorphological, there was a significant increase of glomerular width in Group 1 whereas Group 2 and Group 3's glomerular width decreases to the level of control group's (P < 0.00). Conclusion: As a conclusion, we consider that adding carnitine and MEL to the radiotherapy of patients who has a long-expected survival will prevent the complications due to radiotherapy.
{"title":"The effect of melatonin and carnitine on radiation nephropathy","authors":"O. Ozdemir, N. Okumus, B. Gursel, A. Meydan, B. Meydan, O. Yapıcı, Sema Yilmaz Rakici","doi":"10.4103/jrcr.jrcr_56_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_56_21","url":null,"abstract":"Aims: We aimed to show the protective effect of carnitine and melatonin (MEL) on kidney which were applied before the radiotherapy. Materials and Methods: Seventy-two male Wistar Albino rats were divided six equal groups as Group 1 radiotherapy, Group 2 radiotherapy and MEL, Group 3 radiotherapy and carnitine, Group 4 MEL, Group 5 carnitine, and Group 6 control. Whole abdominal radiotherapy of 10 Gy was applied to the radiotherapy groups. Renal scintigraphy was performed under anesthesia on all rats after a follow-up period of 8 weeks. Histopathologic examination was performed in kidneys. Results: Group 1 showed a statistically significant deterioration of renal scintigraphy function (P < 0.05). Group 2 and Group 3 showed a better function of scintigraphical renal function and there was no significance between the control. There was no damage seen by light microscopy in Group 1, 2, 3. When evaluated histomorphological, there was a significant increase of glomerular width in Group 1 whereas Group 2 and Group 3's glomerular width decreases to the level of control group's (P < 0.00). Conclusion: As a conclusion, we consider that adding carnitine and MEL to the radiotherapy of patients who has a long-expected survival will prevent the complications due to radiotherapy.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86422376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amrita Rakesh, J. Goyal, S. Soni, Abhilasha, K. Rastogi
Objective: A head-and-neck cancer (HNC) comprises one-third load of India's cancer burden. We aim to compare the target coverage and the normal tissue sparing between sequential intensity-modulated radiotherapy (IMRT) and simultaneously integrated boost (SIB)-IMRT plan for patients of locally advanced HNCs. We evaluate dosimetric parameters of two plans for a single patient and compare target coverage and conformity index (C. I.) and also assess the differences in dose received by organs at risk (OAR) by two plans. Materials and Methods: After recording the detailed history, performing a thorough clinical examination and the relevant investigations, the patients who were staged as locally advanced squamous cell carcinoma of oropharynx, hypopharynx, and supraglottic regions were chosen for the study. An informed consent was taken before enrolling them in study. Results: A total of 30 patients were enrolled in the study. Three patients were female, whereas the remaining 27 were male. Of the 30 patients 19 patients (63.34%) had oropharyngeal disease and 11 had hypopharyngeal disease (36.66%). The present study reported that 24 patients had moderately differentiated squamous cell carcinoma, two patients had well differentiated tumor, and in four patients, it was poorly differentiated carcinoma. The minimum dose, maximum dose, and the mean dose volumes of planning target volume (PTV) 1 and PTV2 which were designated as D100, Dmax and Dmean, respectively, were analyzed by both SIB and SEQ-B IMRT plans. The C. I. was derived by Radiation Therapy Oncology Group (RTOG) 90-05 (34). The C. I. for PTV1 and PTV2 by SEQ-B and SIB IMRT plans was 0.96 versus 0.95 and 0.97 versus 0.95, respectively. The mean maximum dose to brain stem was 4230.02 cGy with SEQ-B and 4305.52 cGy with SIB plan. On analyzing the mean maximum dose received by mandible, a statistically significant sparing was seen with SIB technique. Conclusion: In the present study, as no significant difference was observed in OAR sparing except mandible in both the plans. Hence, in view of the results and comparative studies, both the plans are clinically acceptable, although taking into account the tumor coverage, the sequential boost IMRT plan arm gave better results.
{"title":"A comparative study of planning and dosimetry in locally advanced head-and-neck cancer: sequential versus simultaneous integrated boost methods in intensity-modulated radiotherapy","authors":"Amrita Rakesh, J. Goyal, S. Soni, Abhilasha, K. Rastogi","doi":"10.4103/jrcr.jrcr_46_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_46_21","url":null,"abstract":"Objective: A head-and-neck cancer (HNC) comprises one-third load of India's cancer burden. We aim to compare the target coverage and the normal tissue sparing between sequential intensity-modulated radiotherapy (IMRT) and simultaneously integrated boost (SIB)-IMRT plan for patients of locally advanced HNCs. We evaluate dosimetric parameters of two plans for a single patient and compare target coverage and conformity index (C. I.) and also assess the differences in dose received by organs at risk (OAR) by two plans. Materials and Methods: After recording the detailed history, performing a thorough clinical examination and the relevant investigations, the patients who were staged as locally advanced squamous cell carcinoma of oropharynx, hypopharynx, and supraglottic regions were chosen for the study. An informed consent was taken before enrolling them in study. Results: A total of 30 patients were enrolled in the study. Three patients were female, whereas the remaining 27 were male. Of the 30 patients 19 patients (63.34%) had oropharyngeal disease and 11 had hypopharyngeal disease (36.66%). The present study reported that 24 patients had moderately differentiated squamous cell carcinoma, two patients had well differentiated tumor, and in four patients, it was poorly differentiated carcinoma. The minimum dose, maximum dose, and the mean dose volumes of planning target volume (PTV) 1 and PTV2 which were designated as D100, Dmax and Dmean, respectively, were analyzed by both SIB and SEQ-B IMRT plans. The C. I. was derived by Radiation Therapy Oncology Group (RTOG) 90-05 (34). The C. I. for PTV1 and PTV2 by SEQ-B and SIB IMRT plans was 0.96 versus 0.95 and 0.97 versus 0.95, respectively. The mean maximum dose to brain stem was 4230.02 cGy with SEQ-B and 4305.52 cGy with SIB plan. On analyzing the mean maximum dose received by mandible, a statistically significant sparing was seen with SIB technique. Conclusion: In the present study, as no significant difference was observed in OAR sparing except mandible in both the plans. Hence, in view of the results and comparative studies, both the plans are clinically acceptable, although taking into account the tumor coverage, the sequential boost IMRT plan arm gave better results.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73678327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary small-cell neuroendocrine carcinoma of the urinary bladder is a rare type of poorly differentiated and highly aggressive tumor. It accounts for <0.7% of all cancers arising from the bladder. Small-cell carcinoma of the urinary bladder is frequently found in conjunction with other histologic types such as urothelial carcinoma (transitional cell carcinoma [TCC]), squamous cell carcinoma, and adenocarcinoma. Although the tumor shares similar histological features like small-cell carcinoma originating from other sites of the body, its clinical picture is very similar to conventional TCC of the urinary bladder. Unknown etiology and pathogenesis makes its diagnosis and treatment difficult. Here, we report a case of small-cell carcinoma of the urinary bladder, its clinical presentation, pathological characteristics, behavior, management, and outcome.
{"title":"Small cell carcinoma - Urinary bladder","authors":"Isha Shah, Dhara Patel, U. Suryanarayana","doi":"10.4103/jrcr.jrcr_50_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_50_21","url":null,"abstract":"Primary small-cell neuroendocrine carcinoma of the urinary bladder is a rare type of poorly differentiated and highly aggressive tumor. It accounts for <0.7% of all cancers arising from the bladder. Small-cell carcinoma of the urinary bladder is frequently found in conjunction with other histologic types such as urothelial carcinoma (transitional cell carcinoma [TCC]), squamous cell carcinoma, and adenocarcinoma. Although the tumor shares similar histological features like small-cell carcinoma originating from other sites of the body, its clinical picture is very similar to conventional TCC of the urinary bladder. Unknown etiology and pathogenesis makes its diagnosis and treatment difficult. Here, we report a case of small-cell carcinoma of the urinary bladder, its clinical presentation, pathological characteristics, behavior, management, and outcome.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85753656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal neuroendocrine neoplasms (NENs) are uncommon type of esophageal malignancies. We describe the clinical course and molecular imaging features of the relatively rare esophageal malignancy (an aggressive poorly differentiated NEN) that was widely metastatic at the initial presentation. The patient underwent multiple cycles of chemotherapeutic regimens, employing cisplatin-etoposide and nanopaclitaxel-carboplatin and later on rechallenge with cisplatin-etoposide. There was observation of fluctuating disease course and differential characteristics of tumor lesions in terms of treatment response and recurrences with multiple cycles of chemotherapy. In view of the histopathology of high Mib-1 labeling index and dual tracer positron emission tomography-computed tomography (PET-CT) (flurodeoxyglucose [FDG] and 68Ga-DOTATATE) features, the patient was not a suitable candidate for 177Lu-DOTATATE PRRT and FDG PET-CT was the preferred imaging modality for both treatment response assessment and disease monitoring in this patient. The varying response among metastatic lesions in the same individual (with one lesion showing partial response and the other one demonstrating disease progression) was an additional noteworthy feature of the case.
{"title":"High-grade esophageal neuroendocrine neoplasm with waxing and waning disease course and differential response to chemotherapy: Dual tracer positron emission tomography-computed tomography (18F-flurodeoxyglucose and 68Ga-DOTATATE) features and disease monitoring with functional molecular imaging","authors":"Keerti Sitani, S. Basu","doi":"10.4103/jrcr.jrcr_51_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_51_21","url":null,"abstract":"Esophageal neuroendocrine neoplasms (NENs) are uncommon type of esophageal malignancies. We describe the clinical course and molecular imaging features of the relatively rare esophageal malignancy (an aggressive poorly differentiated NEN) that was widely metastatic at the initial presentation. The patient underwent multiple cycles of chemotherapeutic regimens, employing cisplatin-etoposide and nanopaclitaxel-carboplatin and later on rechallenge with cisplatin-etoposide. There was observation of fluctuating disease course and differential characteristics of tumor lesions in terms of treatment response and recurrences with multiple cycles of chemotherapy. In view of the histopathology of high Mib-1 labeling index and dual tracer positron emission tomography-computed tomography (PET-CT) (flurodeoxyglucose [FDG] and 68Ga-DOTATATE) features, the patient was not a suitable candidate for 177Lu-DOTATATE PRRT and FDG PET-CT was the preferred imaging modality for both treatment response assessment and disease monitoring in this patient. The varying response among metastatic lesions in the same individual (with one lesion showing partial response and the other one demonstrating disease progression) was an additional noteworthy feature of the case.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79919587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raghav Kesri, H. Goyal, G. Gupta, D. Bharti, Richu Sharma
Purpose: The purpose of he study was to evaluate the prevalence of epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), and ROS-1 fusions in the patients with metastatic nonsquamous nonsmall cell lung carcinoma (NSCLC) and their relation with different demographic and clinical variables. Methods: A cross-sectional study was carried out on 87 adult patients >18 years of age with a confirmed diagnosis of Stage IV metastatic NSCLC. All the patients were studied for EGFR mutations, ALK, and ROS-1 fusions. The outcome measures were the presence of EGFR, ALK, and ROS-1 fusions among the patients with NSCLC and the risk association with age, gender, smoking, and tumor differentiation. Results: Out of 87 patients, 26 (29.89%) patients tested positive for EGFR mutations, 4 (4.6%) for ALK, and a single case for ROS-1 fusion. The mean age of the patients who were EGFR positive was significantly younger than the mean age of those without EGFR mutation (56.77 ± 12.01 vs. 66.69 ± 11.34, P = 0.0004). As for the gender, females had significantly more EGFR mutations (53.85% vs. 46.15%, P = 0.013) with an odds ratio (OR) of 3.281 (1.257–8.562). Ex-smokers or nonsmokers showed an increased risk of EGFR mutation with an OR of 87.212 and 38.405 (P < 0.0001). There was no association of histology or grading with EGFR mutation. ALK and ROS-1 showed no significant association with clinical variables (P > 0.05). Conclusion: EGFR mutation is the most common occurrence in NSCLC, with other minor mutations being ALK fusion and ROS-1 rearrangements. Females, young age, and nonsmoking behavior carry a significantly higher risk of EGFR mutation, which usually confers a good prognosis.
目的:探讨表皮生长因子受体(EGFR)突变、间变性淋巴瘤激酶(ALK)和ROS-1融合在转移性非鳞状非小细胞肺癌(NSCLC)患者中的发病率及其与不同人口统计学和临床变量的关系。方法:对87例年龄>18岁且确诊为IV期转移性NSCLC的成年患者进行横断面研究。对所有患者进行EGFR突变、ALK和ROS-1融合的研究。结果指标是NSCLC患者中EGFR、ALK和ROS-1融合的存在，以及与年龄、性别、吸烟和肿瘤分化的风险关联。结果:87例患者中，26例(29.89%)EGFR突变阳性，4例(4.6%)ALK阳性，1例ROS-1融合阳性。EGFR阳性患者的平均年龄明显低于无EGFR突变患者的平均年龄(56.77±12.01∶66.69±11.34,P = 0.0004)。性别方面，女性EGFR突变显著高于男性(53.85% vs. 46.15%， P = 0.013)，优势比(OR)为3.281(1.257 ~ 8.562)。戒烟者和非吸烟者EGFR突变风险增加，or分别为87.212和38.405 (P < 0.0001)。组织学或分级与EGFR突变没有关联。ALK、ROS-1与临床指标无显著相关性(P > 0.05)。结论:EGFR突变是NSCLC中最常见的突变，ALK融合和ROS-1重排是次要突变。女性、年轻和不吸烟行为具有显著较高的EGFR突变风险，通常具有良好的预后。
{"title":"Prevalence and Clinicopathologic Risk Factors for Epidermal Growth Factor Receptor, Anaplastic Lymphoma Kinase, and ROS-1 Fusion in Metastatic Non-small Cell Lung Carcinoma","authors":"Raghav Kesri, H. Goyal, G. Gupta, D. Bharti, Richu Sharma","doi":"10.4103/jrcr.jrcr_43_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_43_21","url":null,"abstract":"Purpose: The purpose of he study was to evaluate the prevalence of epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), and ROS-1 fusions in the patients with metastatic nonsquamous nonsmall cell lung carcinoma (NSCLC) and their relation with different demographic and clinical variables. Methods: A cross-sectional study was carried out on 87 adult patients >18 years of age with a confirmed diagnosis of Stage IV metastatic NSCLC. All the patients were studied for EGFR mutations, ALK, and ROS-1 fusions. The outcome measures were the presence of EGFR, ALK, and ROS-1 fusions among the patients with NSCLC and the risk association with age, gender, smoking, and tumor differentiation. Results: Out of 87 patients, 26 (29.89%) patients tested positive for EGFR mutations, 4 (4.6%) for ALK, and a single case for ROS-1 fusion. The mean age of the patients who were EGFR positive was significantly younger than the mean age of those without EGFR mutation (56.77 ± 12.01 vs. 66.69 ± 11.34, P = 0.0004). As for the gender, females had significantly more EGFR mutations (53.85% vs. 46.15%, P = 0.013) with an odds ratio (OR) of 3.281 (1.257–8.562). Ex-smokers or nonsmokers showed an increased risk of EGFR mutation with an OR of 87.212 and 38.405 (P < 0.0001). There was no association of histology or grading with EGFR mutation. ALK and ROS-1 showed no significant association with clinical variables (P > 0.05). Conclusion: EGFR mutation is the most common occurrence in NSCLC, with other minor mutations being ALK fusion and ROS-1 rearrangements. Females, young age, and nonsmoking behavior carry a significantly higher risk of EGFR mutation, which usually confers a good prognosis.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80459412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vishnu Asokan, MeghaP Paramban, M. Tintu, T. Ajayakumar
Aim: Neoadjuvant chemotherapy in carcinoma breast results in tumour downstaging and provides the opportunity to modify treatment based on response. Pathological complete response (pCR) is considered predictive of favourable long-term outcomes. The objective was to identify clinicopathological factors associated with pCR in breast cancer and disease-free survival (DFS). Subjects and Methods: Clinicopathological details of 106 breast cancer patients receiving neoadjuvant therapy were retrospectively analyzed. The statistical analyses were performed using the Chi-square test by SPSS software (version 18.0). Pvalues were considered statistically significant when <0.05. Results: The median age of the patients was 53 years. The overall pCR rate was 23.6%. From univariate analysis, a significant rate of pCR was detected in tumours with high grade or high Ki-67 scores (P = 0.001, P = 0.019), respectively. 29 patients relapsed of which 21 were distant metastasis. On Kaplan–Meier method analysis, statistically significant factors associated with decreased DFS were high Ki 67 and lymphovascular invasion positivity. Distant metastasis occurred in 4 patients with pCR and 19 patients without pCR. The 5-year DFS rate was 84% versus 69% in patients with pCR and without pCR, respectively. Conclusion: A higher rate of pCR was obtained with neoadjuvant therapy in tumours with high grade or Ki-67. Longer DFS is achieved by obtaining pCR with ideal neoadjuvant selection.
目的:乳腺癌的新辅助化疗导致肿瘤分期降低，并提供了根据反应调整治疗的机会。病理完全缓解(pCR)被认为是预测良好的长期预后。目的是确定与乳腺癌和无病生存(DFS)的pCR相关的临床病理因素。对象与方法:回顾性分析106例接受新辅助治疗的乳腺癌患者的临床病理资料。统计学分析采用SPSS软件(18.0版)的卡方检验。当p值<0.05时认为有统计学意义。结果:患者中位年龄53岁。总pCR率为23.6%。单因素分析显示，Ki-67评分高或分级高的肿瘤中pCR的检出率显著(P = 0.001, P = 0.019)。复发29例，远处转移21例。Kaplan-Meier方法分析显示，与DFS降低相关的统计学显著因素是高Ki 67和淋巴血管侵袭阳性。有pCR的4例发生远处转移，无pCR的19例发生远处转移。pCR和非pCR患者的5年DFS率分别为84%和69%。结论:高分级或Ki-67的肿瘤采用新辅助治疗可获得较高的pCR率。通过获得理想的新辅助选择的pCR，可以获得更长的DFS。
{"title":"Clinicopathological factors predictive of pathological response and impact on disease-free survival in breast cancer: Analysis from a tertiary cancer centre in South India","authors":"Vishnu Asokan, MeghaP Paramban, M. Tintu, T. Ajayakumar","doi":"10.4103/jrcr.jrcr_54_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_54_21","url":null,"abstract":"Aim: Neoadjuvant chemotherapy in carcinoma breast results in tumour downstaging and provides the opportunity to modify treatment based on response. Pathological complete response (pCR) is considered predictive of favourable long-term outcomes. The objective was to identify clinicopathological factors associated with pCR in breast cancer and disease-free survival (DFS). Subjects and Methods: Clinicopathological details of 106 breast cancer patients receiving neoadjuvant therapy were retrospectively analyzed. The statistical analyses were performed using the Chi-square test by SPSS software (version 18.0). Pvalues were considered statistically significant when <0.05. Results: The median age of the patients was 53 years. The overall pCR rate was 23.6%. From univariate analysis, a significant rate of pCR was detected in tumours with high grade or high Ki-67 scores (P = 0.001, P = 0.019), respectively. 29 patients relapsed of which 21 were distant metastasis. On Kaplan–Meier method analysis, statistically significant factors associated with decreased DFS were high Ki 67 and lymphovascular invasion positivity. Distant metastasis occurred in 4 patients with pCR and 19 patients without pCR. The 5-year DFS rate was 84% versus 69% in patients with pCR and without pCR, respectively. Conclusion: A higher rate of pCR was obtained with neoadjuvant therapy in tumours with high grade or Ki-67. Longer DFS is achieved by obtaining pCR with ideal neoadjuvant selection.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82173061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Choudhary, R. Sharma, S. Bhaskar, M. Bhardwaj, S. Bano, Neetika Gupta
Objectives: The objective of this study was to evaluate the outcomes of intramedullary spinal cord tumor (IMSCT) and the predictive factors that affected the outcomes. We also assessed the change in the health-related quality of life (HRQOL) of the patient's postsurgery during the follow-up period. Methods: This prospective study was done on 57 patients of IMSCT for a period of 3 years. Details regarding demography, clinical symptoms, histopathology grades/types, surgery performed, and the HRQOL (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30) were noted. The outcome measures included mortality, neurological status (McCormick scale), and change in the HRQOL over a period of 6 months of follow-up. The data were entered in MS Excel and analyzed with P < 0.05 as significant. Results: Among the 57 patients, 42 (73.68%) had low-grade, 12 (21.05%) had high-grade, and 3 (5.26%) had unclassified metastatic tumors. Postoperatively, outcomes according to McCormick grade were same in 30 (52.63%) patients, worse in 15 (26.32%), and better in 12 (21.05%) patients. One patient died due to recurring seizures after metastasis. Histopathological type and surgical resection showed a significant association with McCormick grade (P < 0.05). The symptoms of paresthesia, motor weakness, and bladder/bowel involvement were significant risk factors for adverse outcomes with an odds ratio of 28.488, 6.077, and 4.035, respectively (P < 0.05). There was a significant improvement in the global quality of life of the patients after the surgery with significant improvement in emotional function, symptoms, and pain scores but a decrease in the physical functions (P < 0.05). Conclusion: The outcomes of patients with IMSCT are significantly affected by histology type, preoperative functional grade, and presenting symptoms.
{"title":"A prospective study of outcome predictors of intramedullary spinal cord tumors","authors":"A. Choudhary, R. Sharma, S. Bhaskar, M. Bhardwaj, S. Bano, Neetika Gupta","doi":"10.4103/jrcr.jrcr_49_21","DOIUrl":"https://doi.org/10.4103/jrcr.jrcr_49_21","url":null,"abstract":"Objectives: The objective of this study was to evaluate the outcomes of intramedullary spinal cord tumor (IMSCT) and the predictive factors that affected the outcomes. We also assessed the change in the health-related quality of life (HRQOL) of the patient's postsurgery during the follow-up period. Methods: This prospective study was done on 57 patients of IMSCT for a period of 3 years. Details regarding demography, clinical symptoms, histopathology grades/types, surgery performed, and the HRQOL (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30) were noted. The outcome measures included mortality, neurological status (McCormick scale), and change in the HRQOL over a period of 6 months of follow-up. The data were entered in MS Excel and analyzed with P < 0.05 as significant. Results: Among the 57 patients, 42 (73.68%) had low-grade, 12 (21.05%) had high-grade, and 3 (5.26%) had unclassified metastatic tumors. Postoperatively, outcomes according to McCormick grade were same in 30 (52.63%) patients, worse in 15 (26.32%), and better in 12 (21.05%) patients. One patient died due to recurring seizures after metastasis. Histopathological type and surgical resection showed a significant association with McCormick grade (P < 0.05). The symptoms of paresthesia, motor weakness, and bladder/bowel involvement were significant risk factors for adverse outcomes with an odds ratio of 28.488, 6.077, and 4.035, respectively (P < 0.05). There was a significant improvement in the global quality of life of the patients after the surgery with significant improvement in emotional function, symptoms, and pain scores but a decrease in the physical functions (P < 0.05). Conclusion: The outcomes of patients with IMSCT are significantly affected by histology type, preoperative functional grade, and presenting symptoms.","PeriodicalId":16923,"journal":{"name":"Journal of Radiation and Cancer Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77903740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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