Renal cell carcinoma presenting with oral tongue metastasis: a rare case presentation.

Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. The occurrence of renal carcinoma metastasis to the head and neck region is extremely rare. Here we present one such case where the tongue metastasis was the initial presenting feature of disease.

Small bowel toxicity in pelvic radiotherapy for postoperative gynecological cancer: comparison between conformal radiotherapy and intensity modulated radiotherapy.

AIMS: To compare the dosimetric advantages of pelvic intensity modulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3D CRT) in small bowel dose reduction and dosimetrically correlate the clinical benefit, if any. METHODS: This retrospective study included 60 patients with gynecological cancers treated postoperatively with radiotherapy to the whole pelvis. Radiation Therapy Oncology Group (RTOG) contouring guidelines were used for contouring the pelvic nodal stations. All plans were generated using Plato Sunrise treatment planning system. The RTOG acute morbidity scoring criteria were used to define acute small bowel toxicity in our patients. Treatment was delivered using the Elekta Precise system. Patients were followed up twice weekly while on treatment. Statistical analyses (Spearman's rho and Kruskal-Wallis test) were performed using SPSS software (vers. 15). RESULTS: In all, 65% were postoperative endometrium carcinoma and 35% were postoperative cervix carcinoma patients; 34 patients were treated with IMRT and 26 patients underwent 3D CRT. In all, 28 patients experienced ≥ grade 2 small bowel toxicity (eight in the IMRT group). IMRT was able to significantly reduce the dose to bowel for doses above 30 Gy. Small bowel toxicity showed no correlation with doses below 30 Gy. The volume of the small bowel receiving more than 35 Gy of radiation was a significant predictor of the need for medication to control diarrhea during radiotherapy. CONCLUSION: Use of IMRT resulted in lower doses to the small bowel, resulting in lesser toxicity, and translated to the better tolerability of pelvic radiotherapy.

'Proptosis'--may be the only presenting feature of small cell lung cancer: a case report.

Orbital metastasis from solid tumours is an uncommon entity and lung, breast and nasopharyngeal cancers are the common sites causing such a metastasis. Proptosis as the only presenting feature without any symptom suggesting lung as the primary site is very rare. Here is a report of a patient who presented with proptosis as the only complaint and subsequent investigations proved it to be due to small cell lung cancer metastasis and without metastatic spread to any other site.

Comparison of efficacy of letrozole and clomiphene citrate in ovulation induction in Indian women with polycystic ovarian syndrome.

OBJECTIVES: The objective of this study was to compare the efficacy of letrozole versus clomiphene citrate as an ovulation induction drug in polycystic ovarian syndrome (PCOS) patients of Indian origin. METHOD: One hundred and forty seven infertile PCOS patients were randomly given letrozole (2.5 mg) (n = 69) or clomiphene (100 mg) (n = 78) from day 3 to day 7 of menstrual cycle, followed-up with transvaginal serial folliculometry from day 9. 10,000 IU of human chorionic gonadotropin (hCG) was administered when at least 1 ovarian follicle was ≥ 18 mm in size. RESULTS: The pertinent results of the study are as follows: on the day of hCG injection, mean E2 level was significantly higher in the clomphene citrate group (817 ± 286.70 pg/ml) in comparison with letrozole group (444.03 ± 85.42 pg/ml). Mean endometrial development was 8.72 ± 1.41 mm in the letrozole and 8.78 ± 1.16 mm in the clomiphene group (P = 0.004). CONCLUSION: Letrozole has beneficial effect on endometrium, thereby potentially increasing pregnancy rates after successful ovulation induction in women with PCOS.

Patterns of cancer occurrence in different regions of West Bengal--a hospital based study.

The incidence of cancer has been rising steadily in the third world countries including India. The patterns of cancer incidence reflect the racial, cultural and pharmacogenomic diversity within populations and nowhere is this diversity more striking than in the Indian subcontinent. This article shows the diversity in patterns of incidence of major cancers across three medical college hospitals in the state of West Bengal in India. All the data were collected from the period between 2001 and 2005. The results show a striking variation of incidence of major cancers in the urban, semi-urban and rural parts of the same state. Indeed the differences of the patterns are explainable by the cultural and socioeconomic differences within the populations from which the study samples are drawn. This constitutes the largest single hospital based data collected from this part of the world till date and will help in re-evaluation of cancer control programmes promulgated by the health authorities of the region.

The effect of honey on mucositis induced by chemoradiation in head and neck cancer.

The aim of this study was to evaluate the effect of pure natural honey on radiation-induced mucositis. Fifty-five patients diagnosed with head and neck cancer requiring radiation to the oropharyngeal mucosal area were divided into two groups (study arm-28 and control arm-27) to receive either chemoradiation or chemoradiation plus topical application of honey. Patients were treated using a telecobalt machine at 2 Gy per day, five times a week up to a total dose of 66 Gy. in the study arm, patients were advised to take 20 ml of honey 15 minutes before, 15 minutes after and similar amount at bed time. Patients were evaluated every week for the development of radiation mucositis using the WHO grading system. There was significant reduction in the symptomatic grades 3 and 4 mucositis in honey-treated patients compared to controls ie, 18% versus 41% for grade 3 and 4% versus 22% for grade 4 mucositis. Seventy-one per cent of patients treated with topical honey showed no change or a positive gain in body weight. In the control group also 22% had no weight loss, though none showed weight gain. Furthermore, it didn't affect blood sugar level when initial fasting blood sugar level was < 150 mg%. Honey is a cheap, simple, easily available and effective agent in reducing radiation-induced mucositis. Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis, which warrants further multicentric randomised trials to validate the findings.

Optimized point dose measurement for monitor unit verification in intensity modulated radiation therapy using 6 MV photons by three different methodologies with different detector-phantom combinations: A comparative study.

The study was aimed to compare accuracy of monitor unit verification in intensity modulated radiation therapy (IMRT) using 6 MV photons by three different methodologies with different detector phantom combinations. Sixty patients were randomly chosen. Zero degree couch and gantry angle plans were generated in a plastic universal IMRT verification phantom and 30×30×30 cc water phantom and measured using 0.125 cc and 0.6 cc chambers, respectively. Actual gantry and couch angle plans were also measured in water phantom using 0.6 cc chamber. A suitable point of measurement was chosen from the beam profile for each field. When the zero-degree gantry, couch angle plans and actual gantry, couch angle plans were measured by 0.6 cc chamber in water phantom, the percentage mean difference (MD) was 1.35%, 2.94 % and Standard Deviation (SD) was 2.99%, 5.22%, respectively. The plastic phantom measurements with 0.125 cc chamber Semiflex ionisation chamber (SIC) showed an MD=4.21% and SD=2.73 %, but when corrected for chamber-medium response, they showed an improvement, with MD=3.38 % and SD=2.59 %. It was found that measurements with water phantom and 0.6cc chamber at gantry angle zero degree showed better conformity than other measurements of medium-detector combinations. Correction in plastic phantom measurement improved the result only marginally, and actual gantry angle measurement in a flat- water phantom showed higher deviation.

Plesiotherapy for non-melanoma skin cancer: innovating to overcome!

BACKGROUND: The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset of patients. AIMS: The application of radiotherapy is subject to availability of proper equipment, non-availability of which precludes appropriate radiotherapy in most centers in third world countries. MATERIALS AND METHODS: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. METHODS: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. RESULTS: In this paper we present successful management of a cohort of non-melanoma skin cancer patients with plesiotherapy using stepping source(192) Ir HDR source. CONCLUSIONS: Plesiothrapy is an effective mode of therapy for non-melanoma skin cancer.

Intestinal mantle cell lymphoma recurring at laparotomy scar region.

Mantle cell lymphoma (MCL) is a moderately aggressive variety of non-Hodgkins lymphoma. Extranodal presentation of MCL is well known, the intestine being a common site. The incidence of colorectal involvement is relatively rare. Moreover, the recurrence of the disease at laparotomy scar site is even more rare. We report an unusual case of incision line recurrence in a case of colonic MCL occuring three years after initial treatment.

Neo-adjuvant chemotherapy with cisplatin and short infusional 5-FU in advanced head and neck malignancies.

BACKGROUND: Combination of radical surgery and radiotherapy is the standard management of head and neck malignancies. But due to considerable morbidity of surgery and associated cosmetic and functional deficiencies, often aggravated by adjuvant radiotherapy, many patients prefer only radiotherapy with its' decreased chance of survival. Proper surgical facilities are also not accessible to most of our patients. Neo-adjuvant chemotherapy and loco-regional management by surgery and / or radiotherapy have emerged as a viable alternative. AIMS: The purpose of this study is to find out the survival outcome as well as toxicity profile of Neo-adjuvant chemotherapy with cisplatin and short infusional (3 hours) 5-FU followed by radiotherapy in advanced head and neck malignancies. MATERIALS AND METHODS: From June 2002 to December 2003, seventy four patients with advanced head and neck malignancies were planned to be treated with Cisplatin (50 mg / sq. meter) on Days 1 and 2 and 5 - FU (600 mg / sq. meter) on Days 1, 2 and 3 by 3 hour infusion on Day care basis. On completion of four cycles of chemotherapy at 21 days interval, all patients were destined to receive 6000 cGy of radiotherapy to the loco - regional site. RESULTS: At one year follow up on completion of therapy, 57% patients were alive and 31% patients were disease free. These 31% patients enjoyed a good quality of life in terms of cosmetic and functional deficits. Toxicities were moderate and easily manageable. CONCLUSION: The study indicated that neo-adjuvant chemotherapy with Cisplatin and short infusional 5 - FU may be delivered on day care basis and results are comparable with Cisplatin and 96 hours continuous infusional 5 - FU. Thus avoiding the continuous infusional 5 - FU, 7 to 10 days in-patient hospitalization during each cycle may be avoided which is a constrain in developing countries like us.