A comparative study in left-sided breast cancer treated with moderate deep inspiratory breath hold versus free breathing.

BACKGROUND: The moderate deep inspiratory breath hold (mDIBH) is a modality famed for cardiac sparing. Prospective studies based on this are few from the eastern part of the world and India. We intend to compare the dosimetry between mDIBH and free-breathing (FB) plans. METHODS: Thirty-two locally advanced left breast cancer patients were taken up for the study. All patients received a dose of 50 Gy in 25 fractions to the chest wall/intact breast, followed by a 10-Gy boost to the lumpectomy cavity in the case of breast conservation surgery. All the patients were treated in mDIBH using active breath coordinator (ABC). The data from the two dose volume histograms were compared regarding plan quality and the doses received by the organs at risk. Paired t-test was used for data analysis. RESULTS: The dose received by the heart in terms of V5, V10, and V30 (4.55% vs 8.39%) and mean dose (4.73 Gy vs 6.74 Gy) were statistically significant in the ABC group than that in the FB group (all p-values < 0.001). Also, the dose received by the LADA in terms of V30 (19.32% vs 24.87%) and mean dose (32.99 Gy vs 46.65 Gy) were significantly less in the ABC group. The mean treatment time for the ABC group was 20 min, while that for the free-breathing group was 10 min. CONCLUSIONS: Incorporating ABC-mDIBH for left-sided breast cancer radiotherapy significantly reduces the doses received by the heart, LADA, and left and right lung, with no compromise in plan quality but with an increase in treatment time.

Cutaneous Metastasis in a Treated Case of Cervical Cancer With Extraordinary Response to Chemotherapy: A Case Report of a Rare Event and Review of the Literature.

Cervical cancer usually metastasizes to the lung, liver, bone, and brain. Metastasis to the skin from cervical cancer is relatively uncommon. The management options are systemic therapy, palliative radiotherapy, or best supportive care. Here, we report the case of a female patient with cervical cancer, stage IIB, who received radical treatment with radiotherapy and chemotherapy and later presented with disseminated skin nodules. She was treated with combination chemotherapy (nano-dispersible paclitaxel and carboplatin), bevacizumab, and a bone-stabilizing agent (zoledronic acid). There was a complete metabolic response to the therapy. There was also a dramatic improvement in the general condition of the patient. Skin metastasis in cervical cancer often presents as non-tender skin nodules. A biopsy is mandatory to establish the diagnosis. There are no specific guidelines about management. The intention of management is palliative. The combination of chemotherapy and bevacizumab produces substantial clinical improvement.

High-Dose-Rate Intracavitary Brachytherapy Under Conscious Sedation a Viable Practical Alternative to Spinal Anaesthesia in Carcinoma Cervix: A Retrospective Study in a Tertiary Care Centre in Eastern India.

Introduction Intracavitary brachytherapy (ICBT) is an integral component in the management of locally advanced cervical cancer. Spinal anaesthesia is the preferred mode of pain management during brachytherapy procedures. In high volume, resource constraint settings, it is difficult to provide spinal anaesthesia to all patients. This study attempts dosimetric comparison of high-dose-rate ICBT with spinal anaesthesia to that under conscious sedation to find out whether brachytherapy under conscious sedation is comparable with spinal anaesthesia. Methods Retrospective data of total of 56 cervical cancer patients who received ICBT after completion of external beam radiotherapy (EBRT) were collected. Among these 56 patients, 28 patients received brachytherapy under spinal anaesthesia (SA group) and the rest under conscious sedation (CS group). Brachytherapy dose was 7 Gray per fraction weekly for three weeks. Thus, 84 brachytherapy plans of each group were analysed with respect to doses received by points A, B, P and Organs at Risk. Results The mean doses received by points A, B and P were comparable in SA and CS groups (p-value >0.05). Similarly, the mean doses received by Organs at Risk (rectum, urinary bladder, and sigmoid colon) were also comparable in both the groups (p-value>0.05). Conclusion ICBT under CS is dosimetrically non-inferior to SA, which makes it an alternative option.

Evaluation of Clinicopathological and Prognostic Factors of Male Breast Cancer: A Single-Centre Experience.

Male breast cancer (MBC) is a rare malignancy with an overall incidence of less than 1%. The epidemiological data of MBC is very limited owing to its rarity, particularly data from India. Hence, it is important to study different aspects of this rare malignancy. This paper reports a single-center experience from India that evaluated the clinicopathological behavior of MBC, their management, and outcomes. This was a retrospective review, which included 18 patients managed between 2013 to 2021. Seventeen out of the 18 patients were aged ≥50 years; the median age was 60 years. Left sides were affected more than right (left: 11, right: seven), and the most commonly affected quadrant was central (n=15/17, 88.2%). The most common (n=14) surgery was modified radical mastectomy (MRM), and the invasive ductal carcinoma was the most common (n=14) histological finding. Most cases were estrogen-receptor (ER) and progesterone-receptor-positive (n=15/18, 83.3%). The present study, though with a small sample size, adds valuable information to the literature about this rare occurrence in men.

Prospective evaluation of the setup errors and its impact on safety margin for cervical cancer pelvic conformal radiotherapy.

AIM: The primary objective was to assess set-up errors (SE) and secondary objective was to determine optimal safety margin (SM). BACKGROUND: To evaluate the SE and its impact on the SM utilizing electronic portal imaging (EPI) for pelvic conformal radiotherapy. MATERIAL AND METHODS: 20 cervical cancer patients were enrolled in this prospective study. Supine position with ankle and knee rest was used during CT simulation. The contouring was done using consensus guideline for intact uterus. 50 Gy in 25 fractions were delivered at the isocenter with ≥95% PTV coverage. Two orthogonal (Anterior and Lateral) digitally reconstructed radiograph (DRR) was constructed as a reference image. The pair of orthogonal [Anterior-Posterior and Right Lateral] single exposure EPIs during radiation was taken. The reference DRR and EPIs were compared for shifts, and SE was calculated in the X-axis, Y-axis, and Z-axis directions. RESULTS: 320 images (40 DRRs and 280 EPIs) were assessed. The systematic error in the Z-axis (AP EPI), X-axis (AP EPI), and Y-axis (Lat EPI) ranged from -12.0 to 11.8 mm, -10.3 to 7.5 mm, and -8.50 to 9.70 mm, while the random error ranged from 1.60 to 6.15 mm, 0.59 to 4.93 mm, and 1.02 to -4.35 mm. The SM computed were 7.07, 6.36, and 7.79 mm in the Y-axis, X-axis, and Z-axis by Van Herk's equation, and 6.0, 5.51, and 6.74 mm by Stroom's equation. CONCLUSION: The computed SE helps defining SM, and it may differ between institutions. In our study, the calculated SM was approximately 8 mm in the Z-axis, 7 mm in X and Y axis for pelvic conformal radiotherapy.

Prospective evaluation of XRCC-1 Arg194Trp polymorphism as bio-predictor for clinical outcome in locally advanced laryngeal cancer undergoing cisplatin-based chemoradiation.

BACKGROUND: To determine X-ray repair cross-complementing 1 gene (XRCC-1) Arg194Trp polymorphism as bio-predictor for clinical outcome in advanced laryngeal squamous cell carcinoma undergoing cisplatin-based chemoradiation (CRT). METHODS: A total of 150 patients were enrolled in this prospective study. XRCC-1 Arg194Trp genotyping categorized patients as wild (C/C) and polymorphic (C/T or T/T). The primary endpoint was to assess acute radiation-induced toxicity (ARIT). RESULTS: A significant correlation of skin (P- .04) and oral mucosal ARIT (P- .01) was noticed in the XRCC-1 polymorphic variant. A higher treatment response was noted in the polymorphic variant, and it shows a trend toward significance (P- .08). With 33 months of median follow-up, 2-year progression-free survival (PFS) and overall survival (OS) of wild vs polymorphic variant were 34.6% vs 46.9% (P- .066) and 50.6% vs 62.2% (P- .12). CONCLUSION: XRCC-1 polymorphic variants have significantly higher grade of >2 ARIT and may have improved trend for treatment response and PFS.

Could excision repair cross-complementing group-1 mRNA expression from peripheral blood lymphocytes predict locoregional failure with cisplatin chemoradiation for locally advanced laryngeal cancer?

AIM: The association of excision repair cross-complementing 1 mRNA (ERCC-1 mRNA) expression with the outcome has been reported with immunohistochemistry (IHC) using tumor tissue in head and neck cancer. We evaluated ERCC-1 mRNA expression by reverse transcription polymerase chain reaction (RT-PCR) from peripheral blood lymphocytes (PBLs) as bio-predictor of locoregional failure (LRF) to chemoradiation (CRT) for locally advanced laryngeal squamous cell cancer (LALSCC). METHODS: A total of 107 male patients with LALSCC were enrolled in this prospective study. ERCC-1 mRNA expression by PBLs was determined by RT-PCR. Definitive CRT was delivered with 35 mg/m2 weekly cisplatin. Response Evaluation Criteria in Solid Tumor 1.1 (RECIST 1.1) were used in evaluating treatment response. The primary objective was to assess LRF. The influence of patient characteristics, treatment response, weekly cisplatin cycles, ERCC mRNA expression was determined for LRF, progression-free survival (PFS) and overall survival (OS). RESULTS: A total of 98 patients completed definitive CRT. The median value of 2-ΔΔCT ERCC-1 mRNA expression was 3.9; based on which it was categorized as low and high. Correlation of ERCC-1 expression with treatment response was insignificant (P- .38). With a median follow-up of 33 months; 2-year LRF, PFS, and OS was 63.3%, 34.7% and 79.4%. The 2-year LRF, PFS and OS for low versus high expression were 53.1% versus 73.5% (P-value = 0.036), 44.9% versus 24.4% (P-value = 0.047) and 81.6% versus 77.2% (P-value = 0.33), respectively. In multivariate analysis, ERCC-1 expression, T-stage, N-stage and tumor subsite are predictive factors for LRF; T-stage and nodal recurrence for OS; stage and treatment response for PFS. CONCLUSION: LALSCC patient with ERCC-1 mRNA low expression was associated with lower LRF rate, and improved PFS.