Adjuvant hypofractionated radiation in carcinoma breast - Photon versus Electron: Comparison of treatment outcome.

BACKGROUND: Breast cancer tissue is sensitive to hypofractionation. This is an analysis of patients treated with hypofractionated protocols since 2009, at our tertiary cancer center. METHODS: Details of breast cancer patients treated with adjuvant hypofractionated external beam radiation therapy (EBRT) from January 2009 to December 2014 were retrieved and analyzed. RESULTS: One thousand seven hundred and eighty patients received adjuvant EBRT during this period. Three hundred and eight were offered hypofractionated schedule. One hundred and eighty-eight had modified radical mastectomy (MRM) and 120 had breast conservation surgery (BCS). Dose was 40 Gy in 15 fractions to chest wall/breast, and tumor bed boost of 10 Gy in 5 fractions, where indicated, using three-dimensional conformal radiotherapy (3DCRT). Electrons were used in 159 and photons in 149. Single en face electron field was used for chest wall in MRM patients, and tangential photon beams for the whole breast. Patients on follow-up were assessed for locoregional recurrence, chest wall, breast or ipsilateral upper limb edema, brachial neuralgia, local skeletal events, pulmonary and cardiac symptoms, and cosmetic results. Two developed chest wall recurrence, one each in electron and photon arms. No skeletal, cardiac, or pulmonary adverse events were recorded. About 13.6% had arm edema, which was staged according to the International Society of Lymphology lymphedema staging, as Stage I-7.8%, Stage II-3.9%, and Stage III-1.9%. Twenty-six treated with electrons had arm edema. Increased incidence of arm edema in MRM patients could be attributed to combined surgical and radiation morbidity. Five-year overall survival was 81.9%. CONCLUSION: Hypofractionation is an accepted cost-effective standard of care in adjuvant breast radiation. Single en face electron field is well tolerated, and 3DCRT planning ensures homogeneous chest wall coverage, respecting dose constraints to organs at risk.

Asymptomatic Emphysematous Pyelonephritis - Positron Emission Tomography Computerized Tomography Aided Diagnostic and Therapeutic Elucidation.

The authors report an interesting coincidental unearthing by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of a potentially serious medical condition of emphysematous pyelonephritis in a case of nasopharyngeal carcinoma. The management by conservative ureteric stenting and antibiotics was done with gratifying clinical outcome.

Great cervical venous tumoral thrombosis of melanotic medullary carcinoma thyroid: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography enabled diagnosis and radiotherapy planning.

The authors report an extremely rare occurrence of a massive tumor thrombus involving right internal and external jugular veins extending into superior vena cava from a still rarer melanotic medullary carcinoma thyroid in the postoperative follow-up. The case was managed by hypofractionated intensity modulated radiotherapy technique with gratifying results.