Correlation of 3DCRT and Open Field Treatment Techniques in Advanced Head and Neck Cancer Patients Treated by Chemoradiation.

BACKGROUND: Multimodality treatment is required for the management of head and neck cancer. Functional impairment and toxicities associated with surgery and radiation accentuate the need to develop innovative therapeutic strategies in the management of these patients to improve survival and reduce toxicity. In this study, we have compared treatment effects in patients of advanced head and neck squamous cell cancer treated by open field and 3DCRT treatment planning techniques. OBJECTIVE: This study aims to evaluate open field and 3DCRT treatment planning techniques in advanced head and neck squamous cell cancer patients managed by chemoradiation in the scenario of limited resources. MATERIAL AND METHODS: In this analytical study, 40 histologically proven unresectable advanced squamous cell carcinoma patients of oropharynx and larynx were allocated in two groups to receive 70 Gy in 35 fractions in 7 weeks with concurrent cisplatinum35 mg/m2 weekly either with open-field technique or three dimensional conformal radiotherapy (3DCRT) by ElektaSynergy linear accelerator. Target volume coverage and dose received by organ at risk (OARs) were compared. Clinical outcome in terms of response and toxicities is also evaluated in this study. RESULTS: Plans with best possible coverage of the target volume were obtained. No significant difference was found in the dose received by the spinal cord; however, it was possible to prevent higher dose to brain stem with 3DCRTin node negative patients of oropharynx cancer and larynx cancer. Skin toxicities were significantly lower in 3DCRT arm. CONCLUSION: In low resource settings with increased burden of locally advanced disease, both open-field and 3DCRT treatment techniques are comparable in terms of target coverage, OARs preservation, toxicity and treatment response.

Catering the Needs of Cancer Contemporary to this Contagious Corona Catastrophe: Institution Based Changes in Cancer Management and Protection Procedures.

The COVID-19 global pandemic has drastically affected the health care facility worldwide, posing unprecedented challenges in front of the caregivers. All hospitals need adopt measures to protect patients and health professionals and to safely triage patients (according to country/regional directives) for identifying those infected with coronavirus. As very few guidelines are available for care of cancer patients during COVID times, institutes have had to make their own strategies, based on their own expertise keeping in mind local directives and their effect on available resources and routine processes to offer best possible care. In this article, we have discussed in-house protocols for modification and prioritization of radical and palliative multimodality treatment of cancer patients along with our infection control measures in accordance with national and local guidelines during COVID emergency to stay safe and health. Also, the current study aims to modify cancer treatment and care during the COVID-19 pandemic adhering and fulfilling all protective measures.

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.