Hyperfractionation in advanced carcinoma of the uterine cervix: a preliminary report.

Experience with twice-a-day radiation therapy program for carcinoma of the uterine cervix (FIGO Stages IIB, IIIA & IIIB) is presented. The program consists of delivering 120 cGy per fraction, two fractions a day with 6 hours between fractions. A total of 6000 cGy was delivered in 50 fractions over 5 weeks. A control group was given conventional fractionation 5000 cGy in 25 fractions, 200 cGy per fraction over 5 weeks. This feasibility study enrolled 30 patients, 15 in each group. Normal tissue reactions in skin, mucosa and bowel were recorded. The acute normal tissue reactions were enhanced in the hyperfractionation group. This was significant with regard to the bowel complications. The tumor control rate did not show any significant difference between the two groups. A short follow-up period has revealed complete healing of all acute normal tissue reactions. This study shows that further dose escalation is feasible and a study with large sample size and longer follow-up is required to reach definite conclusions.

Development of collimator insert for linac based stereotactic irradiation.

The aim of this study is to develop collimator inserts of various sizes which are either not commercially available or are expensive to import. The dosimetry parameters such as tissue maximum ratio (TMR), off-axis ratio (OAR) and output factor of the developed collimator insert are compared with that of the commercial collimator insert (Radionics). In order to check the suitability of the collimator insert developed locally for clinical use and to standardize the method of development, a collimator insert of 15 mm identical to the one supplied by Radionics is developed with low-melting alloy (Cerrobend). Moreover for the clinical use of the developed collimator insert, certain acceptance tests are performed which include a collimator concentricity test, beam size check and radiation leakage test. The dose verification is carried out with a thermoluminescent dosimeter (7LiF rods) and an FBX chemical dosimeter in a human-head-shaped Perspex phantom filled with water. The variation between the calculated and measured dose is found to be within +2.4% for 7LiF rods and -2.0% for the FBX chemical dosimeter thus ensuring the suitability of the developed collimator insert for clinical use. This has encouraged us to standardize the method adapted to develop the collimator insert and to develop collimator inserts of different field sizes.

Metastases to the hand from carcinoma of the lower alveolus.

A case of carcinoma of the lower alveolus metastasizing to the phalanges of the hand is reported. The possible mechanism of such metastases, the clinical and radiological features and the role of fine needle aspiration cytology are discussed.

Effects of radiation on hearing in patients with malignancies of head and neck.

Patients with normal hearing at the start of radiation were tested for hearing during (30 GY) and at the end of radiation therapy (45-60 GY) in order to determine if there was any alteration in their pure tone hearing thresholds. A significant increase in the hearing threshold was found at high frequencies at the end of therapy. At the end of the course of radiation, clinical findings suggestive of middle ear changes due to radiation were seen in 33% of the ears. Patients whose ears are included in the field of radiation may have to be forewarned to expect a loss in their acuity of hearing, especially those whose professional life may depend on it.

Pneumothorax preceding pulmonary blastoma in a child.

Serial plain radiographic, ultrasound and CT findings of an unusual case of pulmonary blastoma are described with a review of the literature.

Epstein-Barr virus-associated Burkitt's lymphoma in India.

We studied two cases of Burkitt's lymphoma (BL) recently seen at out institution for association with the Epstein-Barr (EB) virus. Biopsies from both patients fulfilled the established criteria for the diagnosis of BL. One case had clinical features resembling those of EB virus-associated BL, and showed a pattern of elevated titres of antibodies to EB viral antigens indicative of virus association. The second case had several clinical features resembling those of non-virus-associated BL, and did not show the diagnostic serologic pattern. This report documents for the first time the association of EB virus with BL in India, and indicates that the virus-associated and non-virus-associated forms of BL may coexist in this country.