Definitive chemo-radiotherapy in cervical oesophageal cancer: a comprehensive review of literature.

Background and Objectives: Despite decades of experience with definitive chemo-radiotherapy (CRT) in cervical oesophageal cancer (CEC), the loco-regional control and survival outcomes are dismal. This review evaluated the outcomes of various treatment strategies being commonly utilized. Materials and methods: A literature review was conducted to identify relevant articles on CEC published from years 2000-2023 addressing the predefined key questions. These questions focussed on the comparative outcomes of various primary treatment approaches (surgery, CRT, or trimodality treatment) and the radiation dose schedules, volumes, and techniques. Results: CRT is the standard approach for treatment for CEC so far. The potential role of surgery and trimodality approach in settings of evolving surgical approaches needs to be validated. The high dose schedules that are preferentially practiced in CEC have not shown any benefit in improving the disease outcomes over the standard dose schedule of 50.4 Gy. The target volume delineation practice of elective nodal irradiation (ENI) does not have a proven benefit over the involved field irradiation (IFI). The limited evidence on radiation techniques suggests that intensity-modulated radiotherapy/volumetric-modulated arc therapy (IMRT/VMAT) techniques can improve toxicity profile over three-dimensional conformal radiotherapy (3DCRT), but no advantage proven in disease outcomes so far. Conclusion: This review will guide clinicians in decision-making for the management of this relatively rare entity and the directions for future research in these areas. Future large-scale multicentre prospective studies are needed for validating and standardizing our current practices and exploring potential options to improve the outcomes.

Distinct demographic profile and molecular markers of primary CNS tumor in 1873 adolescent and young adult patient population.

INTRODUCTION: We present detailed demographic profile, tumor types, and their molecular markers in adolescent and young adult (AYA) patients of age group between 15 and 39 years with primary central nervous system (PCNS) tumors, and compare with pediatric and adult patient populations. METHODOLOGY: Demographic- and disease-related information of 1873 PCNS tumor patients of age 15-39 years registered between 1 January 2011 and 31 December 2015 at our institution was analyzed with respect to their demographics and tumor subtypes. Various molecular markers for glial tumors and subgroup classification of medulloblastoma were evaluated for AYA, pediatric, and older adult patient populations. RESULTS: AYA constituted 27% of all PCNS. Median age was 29 years. Glial tumors (62.36%) comprised the largest tumor type with astrocytoma (38.55%) being the most common histology. Glioblastoma (51.52%) was the commonest astrocytic tumor with 74.67% of them being isocitrate dehydrogenase 1 (IDH1) negative and 41.38% with O (6)-methylguanine DNA methyltransferase (MGMT) promoter methylated. Diffuse astrocytoma and glioblastoma showed significantly higher IDH1 positivity and loss of alpha-thalassemia/mental retardation syndrome X-linked (ATRX) for AYAs as compared to pediatric and adult patient populations (p < 0.0001). Medulloblastoma (73.8%) was the most commonly diagnosed embryonal tumor, with sonic hedgehog (SHH) being the commonest molecular subtype (48%). Younger patients among AYA population presents with pediatric type of tumor spectrum, while older ones present with more aggressive tumor subtypes. CONCLUSION: This is among the few studies reporting spectrum of PCNS tumor in AYA population with distinct tumor subtypes and molecular profiles. AYA patient populations may need special attention with appropriately designed clinical trials.

Assessment of usage, reuse and disposal of thermoplastic masks among radiotherapy technologists in India: A nationwide perspective.

Purpose: Radiotherapy (RT) relies on devices like thermoplastic masks (TMs), that are made up of specialized thermoplastic polymers, and used as an immobilization tool. The study aims to assess the practice of usage and reuse of TMs among radiation therapy technologists (RTTs) in India and explore their awareness of environmental impact during disposal. Materials and Methods: A cross-sectional survey was conducted among RTTs working in different healthcare settings. A structured questionnaire designed by a team of RTTs and radiation oncologists was used to collect responses. Questionnaire encompassed data pertaining to demographics, existing patient load, daily utilisation and reuse practice of TMs, preferred method of disposal and awareness of RTTs regarding environmental consequences associated with TM disposal. Results: A total of 430 RTTs participated in the study, with a median age of 31 years and a median professional experience of 8 years. Among the participants, 213 (49.6 %) reported daily TM utilization in more than 50 patients. TM reuse was reported by 350 (81.1 %) RTTs, with 257 (60 %) reusing TMs in both curative and palliative treatments. Reuse of TMs was observed more commonly in RTTs working in government facilities (81.2 %).Regarding disposal preferences, 381 (88.6%) participants preferred discarding used TMs in biomedical waste and 64.8% of these ultimately ended up as discarded scrap. Awareness regarding adverse environmental impact associated with TM disposal was reported by 320 (74.4%) participant RTTs. Conclusion: The study highlights the prevalent practice of reuse of TMs, especially in curative treatments, government-run facilities and busy treatment settings. Additionally, it emphasises the imperative for enhanced bio-medical waste management practices to facilitate more effective handling and disposal of used TMs.

"Superhero" concept to avoid anesthesia for daily radiation treatment in childhood cancer.

Advancements in therapeutic interventions have led to significant improvement in the overall management of childhood cancer. Radiotherapy forms an important component of their treatment. Modern radiotherapy technique where an optimal therapeutic ratio can be obtained demands proper and adequate immobilization of the child. This can be technically challenging sometimes, particularly when the child is noncompliant. To address this hurdle, we have used this concept of "Superhero," where we have decorated and painted the thermoplastic masks that often used in the head and neck and cranial irradiation. We have received adequate compliance for this method, and the need for anesthesia was slackened.

Nationwide Study to Assess the Psychosocial, Financial, and Professional Impact of COVID-19 Pandemic on Radiation Therapy Technologists.

PURPOSE: Radiation therapy technologists (RTTs), being the frontline health care workers, are vulnerable to COVID-19 disease and subsequent detrimental consequences of the pandemic. Hence, the study was undertaken for the comprehensive assessment of adverse effects of COVID-19 pandemic on RTTs. MATERIALS AND METHODS: This cross-sectional, survey-based study was carried out among RTTs working in various cancer centers across India. Assessment was carried out by using a questionnaire comprising the demographic profile and a structured instrument to quantify psychological, social, financial, and professional impact of COVID-19 pandemic. Responses were collected between February 1, 2021, and April 31, 2021. RESULTS: Of 302 responders, more than two third of the RTTs were concerned for getting COVID-19 disease either outside the hospital (n = 210, 69.5%) or from patients or attendants (n = 220, 72.8%). More than one third of RTTs were very much concerned for increased financial burden of COVID-19 pandemic (n = 94, 34.1%), and one third (n = 92, 30.5%) were very much concerned for newly imposed restrictions. RTTs working in a private setup (P = .000), living in a tier 1 city (P = .028), and lacking the coverage of COVID-19 disease in health insurance (P = .010) faced a significantly higher financial burden. RTTs living in tier 1 city (P = .023) and those who were in profession for > 5 years (P = .013) had significantly higher concern for ensuring proper sanitization of the professional environment. More than half (n = 171, 56.6%) were interested in taking COVID-19 vaccine. CONCLUSION: COVID-19 pandemic adversely affected psychosocial, financial, and professional well-being of RTTs even after subsidizing the initial wave, and a timely intervention is warranted for their well-being and to sustain oncologic facilities.

Distinct patterns of occurrence, common associations, and survival of patients with second primary maligancies: A 5-year single institute experience with review of literature.

BACKGROUND: Multiple primary malignancy (MPM) is defined as occurrence of two or more synchronous or metachronous primary malignancies. With the rise in cancer burden and meticulous screening of index primary malignancy (IPM) during treatment, increased incidence of second primary malignancy (SPM) is expected. This study was undertaken with an attempt to analyze the incidence, commonest associations, management strategies, and clinical outcomes of MPM. MATERIALS AND METHODS: This is an observational retrospective study carried out in a single institute with patients registered between 1st January 2015 and 31st August 2019. The International Association of Cancer Registries and International Agency for Research on Cancer (IACR/IARC) definition was used for identification of IPM and SPM. Synchronous SPM was defined as malignancy occurring within 6 months from the diagnosis of IPM. RESULTS: Out of 16,461 registered patients during the study interval, 44 (0.26%) cases were found to have MPM. A total of 31 (70.5%) cases were women and 13 (29.5%) cases were men. Median age at presentation of IPM was 48 years and of SPM was 56 years, with median duration between two primaries being 38 months. Seven patients (15.9%) had synchronous malignancies. Gynecological tumors were the most common site of IPM presentation (n = 14, 31.8%) followed by breast (n = 09, 20.5%) and head and neck tumors (n = 07, 15.9%), respectively. The most common SPM was gynecological tumors (n = 12, 27.3%) followed by gastrointestinal malignancies (n = 10, 23.3%). Curative treatment was offered to 88% of patients with IPM and 70% patients with SPM. At a median follow-up of 365 days, 21 (47.72%) patients were disease free, six (13.6%) died of disease and nine (20.5%) were lost to follow-up. CONCLUSION: The study emphasizes the importance of detecting SPM as a result of improved diagnostic and screening procedures. Clinicians should be aware of it and offer multidisciplinary management.

Multinational Study to Assess Stress Levels Among the Health Care Workers of Radiation Oncology Community at the Outset of the COVID-19 Pandemic.

PURPOSE: To evaluate stress levels among the health care workers (HCWs) of the radiation oncology community in Asian countries. METHODS: HCWs of the radiation oncology departments from 29 tertiary cancer care centers of Bangladesh, India, Indonesia and Nepal were studied from May 2020 to July 2020. A total of 758 eligible HCWs were identified. The 7-Item Generalized Anxiety Disorder, 9-Item Patient Health Questionnaire, and 22-Item Impact of Events Scale-Revised were used for assessing anxiety, depression, and post-traumatic stress disorder. Univariate and multivariate analysis was done to identify the causative factors affecting mental health. RESULTS: A total of 758 participants from 794 HCWs were analyzed. The median age was 31 years (IQR, 27-28). The incidence of moderate to severe levels of anxiety, depression, and stress was 34.8%, 31.2%, and 18.2%, respectively. Severe personal concerns were noticed by 60.9% of the staff. On multivariate analysis, the presence of commonly reported symptoms of COVID-19 during the previous 2 weeks, contact history (harzard ratio [HR], 2.04; CI, 1.15 to 3.63), and compliance with precautionary measures (HR, 1.69; CI, 1.19 to 2.45) for COVID-19 significantly predicted for increasing anxiety (HR, 2.67; CI, 1.93 to 3.70), depression (HR, 3.38; CI 2.36 to 4.84), and stress (HR, 2.89; CI, 1.88 to 4.43) (P < .001). A significant regional variation was also noticed for anxiety, stress, and personal concerns. CONCLUSION: This survey conducted during the COVID-19 pandemic revealed that a significant proportion of HCWs in the radiation oncology community experiences moderate to severe levels of anxiety, depression, and stress. This trend is alarming and it is important to identify and intervene at the right time to improve the mental health of HCWs to avoid any long-term impacts.

Management of Isolated Locoregional Recurrences in Breast Cancer: A Review of Local and Systemic Modalities.

Locoregional recurrence (LRR) after adequate treatment of primary breast cancer poses a therapeutic challenge. Advances in the management of breast cancer have led to significant improvements in survival. With this advantage, it is observed that the incidence of LRR has relatively decreased. Systemic involvement should be ruled out in patients presenting with locoregionally recurrent disease, as isolated LRR requires a treatment with curative intent. Salvage mastectomy following ipsilateral breast tumor recurrence is a time-tested treatment option and widely accepted. Second-time breast conservation surgery with or without radiotherapy is an emerging alternative. Following a second breast conservation, partial breast irradiation has been seen to improve local control. Five-year overall survival with second breast conservation and radiotherapy is in the range of 76% to 100% with acceptable toxicities. Isolated chest wall recurrences after mastectomy are difficult to manage. Multimodality treatment has been adopted to treat chest wall recurrences, following which the 5-year overall survival was observed to be in the range of 45% to 60%. Use of hyperthermia and photodynamic therapy in combination with conventional treatment options has been associated with better clinical outcomes. Systemic therapy, in the form of chemotherapy and/or hormonal therapy in addition to adequate locoregional treatment, has shown to improve survival. Multimodality treatment for isolated regional recurrences has been associated with better outcomes, and the 5-year survival rates are around 50%. All patients with LRR should be evaluated by a multi-disciplinary tumor board to individualize treatment based on the expected risk-benefit ratio of retreatment.