Clinical Outcomes and Dosimetric Evaluationof Interstitial Brachytherapyin Gynecological Malignancies.

BACKGROUND: In management of Carcinoma Cervix, Brachytherapy plays a crucial role. Most commonly used technique is Intracavitary Brachytherapy (ICBT). In cases where ICBT is not technically feasible or it may result in suboptimal dose distribution, Interstitial Brachytherapy (ISBT) is recommended. With this study we wanted to study the clinical outcome and dosimetric details of interstitial brachytherapy in gynecological cancers. MATERIALS & METHODS: We analysed clinicaloutcome and dosimetric details of interstitial brachytherapy (ISBT) done for gynecological malignancies in our institute during the period 1st January 2013 to 31st December 2020. RESULTS: Total of 42 interstitial brachytherapy (ISBT) details were analysed.37 patients had Carcinoma Cervix and 5 patients had Carcinoma Vagina. In the majority of the patients, ISBT dosage schedule was three fractions 7Gy each. D2cc to rectum, bladder, sigmoid and bowel were 4.88 Gy, 5.62 Gy, 3.57 Gy and 2.47 Gy respectively. Mean CTV volume was 129.89 cc. EQD2 dose to CTV combining EBRT and ISBT dose was 85.88 Gy. D90 and D100 to CTV from ISBT were 111.96% and 68.21 % of prescribed dose respectively. Grade III/IV toxicities were seen in 5 (12%) patients. Local control rates at 1year &2 years were 88% & 85.7% respectively. DFS at 1 year, 2 years and 3 years were 80.7%, 72.3% and 65.7% respectively. OS at 1year, 2 years, 4 years and 5 years were 92.5%, 65.5%, 59.5% and 42.3% respectively. CONCLUSION: 3D imagebased dosimetry with CT based planning using MUPIT implant is a feasible option for gynecological malignancies warranting interstitial brachytherapy. In view of good clinical outcomes in terms of toxicity profile, Local control, DFS and OS with acceptable GEC-ESTRO dosimetric data, we recommend routine use interstitial brachytherapy if facilities are available and in clinical situations were ISBT is indicated.

Clinical Outcomes of Head and Neck Cancer Patients Treated with Palliative Oral Metronomic Chemotherapy at a Tertiary Cancer Center in Kerala, India.

BACKGROUND: Cetuximab-based chemotherapy is the standard palliative chemotherapy in head and neck cancers, but there is a limitation due to financial and logistic reasons, and where oral metronomic chemotherapy can be a successful alternate. Oral metronomic chemotherapy (MCT) can either be with Methotrexate alone or a combination of Methotrexate and Erlotinib. The study was aimed to assess the clinical outcome of oral MCT in head and neck cancer patients. MATERIALS AND METHODS: This was a retrospective review done at a tertiary cancer centre in India. The clinical outcomes of head and neck cancers patients started on palliative oral MCT from 1st August 2016 to 31st December 2017 were analyzed. The demographic details, toxicity profiles, response to MCT, disease progression status were analyzed. Univariate analysis was done to assess the factors associated with disease progression. Kaplan Meier curve was used for estimating progression free survival (PFS). RESULTS: Of the total 104 patients, the most common primary site of head and neck cancer was oral cavity (52%). MCT scheduled with Methotrexate and Erlotinib in 80 patients. Toxicity rate was 61%, with Grade 3-4 toxicity in 21%. Response rate was 56% and clinically meaningful response rate was 69%. Disease progression was observed in 55% patients. Median PFS rate was 134 Days. Oral MCT was permanently stopped in 73%, the most common reason being disease progression. DISCUSSION: Patients who underwent palliative oral MCT had a median PFS of 134 days which is considered as promising treatment method. Results confirmed more than 50% response rate with lower Grade 3-4 toxicities. CONCLUSION: Palliative oral MCT either with Methotrexate and Erlotinib or Methotrexate alone will be a feasible treatment option in patients with head and neck cancers treated with palliative intent.

Late toxicities among laryngopharyngeal cancers patients treated with different schedules of concurrent chemoradiation at a rural tertiary cancer care center.

BACKGROUND: Concurrent chemoradiation is the treatment of choice for laryngeal-pharyngeal cancers. Apart from survival organ preservation remains major aims of the treatment. Advanced radiation techniques like VMAT have shown to reduce morbidity. The purpose of our study is to assess the late toxicities in patients treated with concurrent chemoradiation and its association with dose to organs at risk. AIMS: Assessment of late toxicities following concurrent chemoradiation in patients with laryngopharyngeal cancers. MATERIALS AND METHODS: Retrospective study at a tertiary cancer centre on patients with laryngeal and pharyngeal cancers treated with concurrent chemoradiation with VMAT upto a total dose of 69.3 -70 Gy in 33-35 fractions and concurrent chemotherapy with Cisplatin was done. Severe late toxicities and its association with demographic and clinical parameters and dose to OAR were studied. Data was analysed using EpiData analysis v2.2.2.182. RESULTS: Of the 93 patients studied majority were males above 55 years. Oropharynx was the commonest site (58%) with T3 and N2 in majority. Late dysphagia and odynophagia was seen in 18(21%) and 23(27%) patients respectively. 16 (17%) had tube dependence and nine (9.6%) had aspiration pneumonia. D60, V50 and V60 along with site, node positivity and weight loss were found to be significantly associated with severe late toxicity. CONCLUSION: Oropharyngeal cancers, node positivity and weight loss were found to have significant grade III and above toxicities including tube dependency. Dose to larynx showed association with severe late toxicities, though dose to constrictors could not.

Clinicopathological Spectrum of Anaplastic Carcinoma of Thyroid - 5 Year Experience from a Tertiary Cancer Centre.

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal solid tumors known to affect humans. Although ATC accounts for only 1% to 5% of all thyroid tumors, it portends a dismal prognosis with a median survival of 4 to 12 months from the time of diagnosis. In this retrospective review we aim to study the clinical, cytological and histopathological features and management of ATC cases reported in our institution. MATERIALS AND METHODS: Twenty-two patients with ATC were identified from institutional database between January 2012 and December 2016. Clinicopathologic data and survival data was obtained from the medical records. Fine needle aspiration cytology (FNAC) slides and histological slides were reassessed for the predominant morphologic findings. RESULTS: Of the 22 patients, 8 were male and 14 were female. The median age at presentation was 70 years (range 50-85 years) with a median survival of 3 months. A history of pre-existing thyroid disease was present in 32% of the patients. Distant metastases were seen in 41% of patients. FNAC findings noted were pleomorphic vesicular nuclei, multinucleated giant cells, necrotic background, atypical squamoid cells, spindle cells and atypical mitosis. Majority of the patients (59%) received palliative radiotherapy as treatment.14% underwent total thyroidectomy and remaining 27% received best supportive care. CONCLUSION: ATC remains a highly lethal disease with limited survival .FNAC can serve as a reliable tool in the early diagnosis. With several drugs in clinical trial, the therapeutic scenario of ATC might improve in future.