Dosimetric and radiobiological comparison of IMRT, VMAT, and helical tomotherapy planning techniques in hippocampal sparing whole brain radiotherapy with simultaneous integrated boost for multiple brain metastases.

To compare treatment planning and dosimetric outcomes for hippocampal sparing whole brain radiotherapy (WBRT) with the simultaneous integrated boost (SIB) in brain metastasis (BM) patients using tumour control probability (TCP) and normal tissue complication probability (NTCP) formalism between IMRT, VMAT, and HT techniques. In this retrospective study, the treatment data of 20 BM patients who typically received whole brain radiation with SIB treatment were used. Prescription doses of 30 Gy and 36 Gy was delivered in 10 fractions for WBRT and SIB, respectively. Niemierko and LKB models were applied for calculating TCP and NTCP. All the plans were evaluated for the RTOG 0933 protocol criteria and found acceptable. Additionally, the homogeneity of the PTV boost is 0.07 ± 0.01, 0.1 ± 0.04, and 0.08 ± 0.02 for IMRT, VMAT, and HT, respectively (P < 0.05). The percentage of TCP for the PTV boost was 99.99 ± 0.003, 99.98 ± 0.004, and 99.99 ± 0.002 of IMRT, VMAT, and HT, respectively, (P < 0.005). The NTCP value of the lenses was higher with the VMAT plan as compared to IMRT and HT Plans. The hippocampal NTCP values are equal in all three planning proficiencies. The techniques like IMRT, VMAT, and HT can reduce the dose received by hippocampus to the dosimetric threshold during the delivery of WBRT with hippocampal sparing and can simultaneously boost multiple metastases. Overall, the high-quality dose distribution, TCP, and NTCP comparison between all three planning techniques show that the HT technique has better results when compared to the VMAT and IMRT techniques.

Reirradiation and re-reirradiation in head-and-neck cancers: Learnings based on a case irradiated six times.

Second primary cancers and locoregional recurrences in head and neck cancers are common. Management is challenging owing to the effects of previous treatment. Locoregional therapy, whenever feasible, offers possibility of cure. We have managed a patient who has over a period of 15 years been treated seven times. Treatment included surgical resection four times, flap reconstruction thrice, postoperative radiation thrice, radiation therapy alone thrice. Brachytherapy has been used in two instances, intraoperative brachytherapy once and surface mould application once. Patient has maintained a good quality of life during these fifteen years but suffers from xerostomia and nasogastric tube dependence at present. The management of this patient teaches us important lessons in terms of using modern surgery and advances in radiation therapy for achieving good patient benefit.

Pattern of occurrence and treatment outcome of second primary malignancies: A single center experience.

BACKGROUND: The incidence of cancer survivors is increasing, but these individuals, unfortunately, face the risk of second primary malignancies (SPMs). This increasing incidence can be credited to increased survival rates of cancer patients, environmental factors, host factors, and genetic predispositions. Hence, vigilance on the part of the patient as well as clinician for the development of new signs and symptoms is mandatory. AIMS: Retrospective analysis of the pattern of incidence and clinical outcome of patients diagnosed with SPM and to review the literature. SETTINGS AND DESIGN: A hospital-based retrospective collection of prospective data of patients diagnosed with SPM. MATERIALS AND METHODS: Thirty-six patients with histopathologically proven SPM from January 2009 to July 2015 were included in this study. Factors such as age, sex, site, stage, histology, treatment received, and outcome were recorded. STATISTICAL ANALYSIS USED: Basic statistical tools have been used for analyzing the data. RESULTS AND CONCLUSIONS: The likelihood of occurrence of second malignancy, either synchronous or metachronous, should always be kept in mind while evaluating a cancer patient. Appearance of new signs and symptoms during the initial evaluation as well as during follow-up should raise a suspicion, and both patient and oncologist should have a low threshold for further assessment. Early diagnosis and treatment will reduce morbidity and mortality and lead to better survival outcome.

Ambiguity of Whole Body PET CT Scans in Diagnosis of Co-existing Tuberculosis and Malignancy: Is Histopathological Confirmation Mandatory?

INTRODUCTION: Whole body PET CT is an important investigation tool in malignancy patients and helps in ascertaining the metabolic activity and exact stage of the disease. However, like any other investigation, false positive results do exist and certain diseases other than cancer may show increased uptake. Hence, a careful evaluation of PET CT and clinical correlation in malignancy patients is a must to accomplish the suitable treatment. METHODS: In this retrospective observational study, seven cases of cancer with concomitant tuberculosis were included. All the patients were proven malignancy patients with advanced or metastatic stage. On clinical suspicion, a tissue diagnosis was obtained which led to change in staging as well as management of the patients. RESULTS: Seven patients were having primary diagnosis of carcinoma breast, carcinoma esophagus, coepidermoid carcinoma of submandibular salivary gland, carcinoma tongue, squamous cell carcinoma skin, carcinoma cervix and carcinoma endometrium. They showed FDG uptake at distant sites leading to upstaging of disease. On histopathological examination, lymph nodal mass reported granulomatous lymphadenitis, leading to change of overall staging and management of the patients. DISCUSSION AND CONCLUSIONS: Whole Body PET CT scan may produce false positive results and upstage the disease. It should be evaluated and interpreted with caution in cases of doubtful findings and any abnormal FDG accumulation in PET CT scan at unusual locations should be evaluated carefully and confirmed histopathologically.

Primary adenocarcinoma of ureter: A rare histopathological variant.

Primary carcinoma of ureter is an uncommon malignancy. Of which, mostly are transitional cell carcinomas followed by squamous cell carcinomas and adenocarcinomas being the rarest histopathology encountered. We report a case of adenocarcinoma ureter in a middle-aged male along with its clinical scenario. A 62-year-old male, presented with complaints of lower urinary tract symptoms. Computerized tomography urogram showed a soft tissue lesion at the right ureterovesical junction. Cystoscopic biopsy reported villous adenoma. Diethylene triamine pentaacetic acid scan reported nonfunctioning right kidney. He underwent laparoscopic right nephroureterectomy, and histopathology reported adenocarcinoma of the right lower third of ureter, with positive distal and close radial margins. The patient received external beam radiation to the postoperative bed and lymph nodes, and he is disease-free till date.