Choosing a career in radiation oncology in India: A survey among young radiation oncologists.

BACKGROUND: Radiation oncology in India is much debated as a career option to take up. This survey among young radiation oncologists (YROs), the first of its kind, attempts to assess the career expectations and concerns that affect most of us. MATERIALS AND METHODS: This survey was conducted using the online survey tool of SurveyMonkey in October 2018. The Association of Radiation Oncologists of India (AROI) members' database was used to send the survey link over E-mail to recipients (AROI life member after 2004). RESULTS: Out of 1685 invitees, 492 (29.19%) recipients took the survey. Most (69.14%) of the respondents were males who worked as senior residents and junior consultants and employed in private hospitals and state-level teaching institutes. Postspecialization (MD/DNB) experience was mostly <3 years (56.52%). Most of YROs worked in Tier-I city (48.9%) mostly in telecobalt-based facilities. Most of our respondents (73.01%) aspired to work in academic teaching hospital/research institute, and the primary concern was academics/research (39.88%) followed by income (23.31%). There was a similar distribution of respondents with respect to their desire to shift to medical oncology. There was marked dissatisfaction over remuneration, job openings, job security, and poor scope of career improvement. 56.50% of respondents believed that they need to move abroad to improve their quality of life. However, 76.69% of respondents still felt very passionate about their professional choice. Finally, 61.97% of professionals believed that this survey will correctly reflect the present scenario among YROs. CONCLUSIONS: The survey portrays a mixed picture as expected. Major policy changes are required to improve the infrastructure and job opportunities of this profession.

Comparative performance analysis of 2D and 3D gamma metrics for patient specific QA in VMAT using Octavius 4D with 2D-Array 1500.

INTRODUCTION: Gamma pass percentage (GPP) is the predominant metric used for Patient Specific Quality Assurance (PSQA) in radiation therapy. The dimensionality of the measurement geometry in PSQA has evolved from 2D planar to 3D planar, and presently to state-of-the-art 3D volumetric geometry. We aim to critically examine the performance of the three-dimensional gammas vis-à-vis the older gamma metrics of lower dimensionality to determine their mutual fungibility in PSQA, using clinically approved Volumetric Arc Therapy (VMAT) plans. METHODS AND MATERIALS: Gamma pass percentages derived from PSQA for VMAT plans using Octavius 4D phantom with 2D-Array 1500 and its proprietary software were recorded. 2D planar, 3D planar, and 3D volumetric gamma pass percentages were retrospectively extracted for multiple treatment plans at three sites, using three acceptance limits, and for two modes of normalization. The differences in mean pass percentages, and the pairwise correlation between geometries were calculated within limits of statistical significance. RESULTS: A significant increase in mean pass rates was observed from 2D planar to 3D planar geometries. The difference was less pronounced from 3D planar to 3D volumetric. 2D planar v/s 3D planar showed a significant degree of correlation among themselves, which was not seen against most of the 3D volumetric pass rates. CONCLUSION: The mean gamma pass rates show conclusive evidence of the benefits of shifting from 2D planar to higher dimensions measurement geometries, but the benefits of using 3D volumetric compared to 3D planar is not always unequivocal. The correlations show mixed results regarding the interdependence of pass percentages at different geometries.

Sunitinib-induced acute severe hypothyroidism in a case of metastatic gastrointestinal stromal tumor: A case report.

Thyroid abnormalities are found nearly 70% cases receiving sunitinib therapy. Mostly, patients suffer transient hypothyroidism rarely presents with overt acute symptoms requiring levothyroxine replacement. Onset is variable in published literature. We report a case of metastatic gastrointestinal stromal tumor receiving sunitinib with normal baseline thyroid function. The patient developed symptoms of acute severe hypothyroidism with high thyroid stimulating hormone level on the 4th week of therapy. The patient responded with oral levothyroxine. clinical and biochemical parameter resolved rapidly. Patient receiving sunitinib warns baseline and subsequent surveillance of thyroid function (both clinical and biochemical). This rare dreadful condition reverts promptly with thyroxine replacement.

Interstitial brachytherapy in soft tissue sarcoma: a 5 years institutional experience with Cobalt 60-based high-dose-rate brachytherapy system.

PURPOSE: Soft tissue sarcoma (STS) is rare but aggressive neoplasm. Interstitial brachytherapy (ISBT) alone or combined with external beam radiotherapy (EBRT) as post-operative treatment improves loco-regional (LRC) and distant control. MATERIAL AND METHODS: Out of twenty-nine non-metastatic STS (lower limb 64%) patients (median age 37 yrs), treated with surgery and post-operative ISBT during February 2011 - December 2016, 27 patients with > 6 months follow-up were analyzed. Spindle cell sarcoma was the commonest (24%) histology. Eleven patients (44%) received EBRT (45-50 Gy), where ISBT was used as boost (16-20 Gy). Fourteen patients (56%) received ISBT alone (4 Gy per fractio). Treatment was done with a 60 Cobalt (60Co) source high-dose-rate system. RESULTS: With a median follow-up of 20 months (17-51 months), LRC rate was 85.7% (with EBRT 90.5% and ISBT 83.2% alone). Median disease-free survival (DFS) was 39.7 ±3.9 months (32-47.2 months). Median loco-regional failure-free survival (LRRFS) was 43.8 ±3.6 months (36.8-50.9 months). Distant failure-free survival (DFFS) was 18 months (15.5-26.6 months). Overall survival was 42.4 ±3.4 months (35.7-48.1 months). Tumor grade was a significant factor for DFFS. Total radiation dose (including EBRT) has significant influence on DFS and LRRFS. 14.8% patients developed ≥ grade 2 late toxicity (skin atrophy, hypo-pigmentation, and telangiectasia). CONCLUSIONS: Combination of surgery and ISBT with/out EBRT improves local and distant control with acceptable late toxicities. 60Co-based ISBT is safe and gives a good outcome.

Rectal separation using hydroxypropyl methylcellulose in intracavitary brachytherapy of cervical cancer: an innovative approach.

PURPOSE: This study was initiated to prove feasibility of hydrogel application in recto-vaginal space in intracavitary brachytherapy (ICBT) of cervical cancer in order to reduce rectal toxicity. MATERIAL AND METHODS: In a case of stage IIB cervical cancer, after external beam radiotherapy (EBRT), we planned ICBT 7 Gy × 3 fractions. In 1st fraction (Plan 1), due to narrow separation between rectum and cervix (0.18 cm), only 5 Gy was delivered at point A (with high-risk clinical target volume [HR-CTV] D90 5.94 Gy, intermediate risk clinical target volume [IR-CTV] D90 4.54 Gy, rectum D2cc 5.72 Gy, bladder D2cc 5.52 Gy, and sigmoid colon 5.82 Gy). In 2nd fraction (Plan 2), interstitial brachytherapy (ISBT) was attempted. For the prescription of 5 Gy, we get dose levels almost similar to the 1st insertion: HR-CTV D90 (6.7 Gy), IR-CTV D90 (3.06 Gy), bladder D2cc (5.7 Gy), rectum D2cc (4.8 Gy), sigmoid colon D2cc (1.3 Gy) (separation = 0.23 cm). During 3rd fraction (Plan 3), prior doing interstitial insertion, we instilled 50 cc of hydroxypropyl methylcellulose (Viscomet®) up to the tip of recto-vaginal septum. A repeat computed tomography (CT) scan was done 4 hours after Plan 3 treatment and it was re-planned (Plan 4) to find out migration of hydrogel if any and its dosimetric impact. RESULTS: 9 Gy was delivered to point A with a separation of 1.1 cm in Plan 3 (with HR-CTV D90 16.4 Gy, IR-CTV D90 11.3 Gy, rectum D2cc 3.6 Gy, bladder D2cc 6.9 Gy, and sigmoid colon 2.2 Gy). We achieved an optimum cumulative EQD2 dose (HR-CTV D90 98.4 Gy, IR-CTV D90 76.1 Gy, rectum D2cc 67.7 Gy, bladder D2cc 73.2 Gy, and sigmoid colon 59.3 Gy). Hydrogel volume was decreased in Plan 4 without a major dosimetric changes. CONCLUSIONS: Hydrogel instillation is a useful tool for recto-vaginal separation during cervical cancer brachytherapy. It increases therapeutic ratio without any adverse event.