Utility of telemedicine in COVID-19 pandemic: our experience at a tertiary cancer center in North East India

Background: Telemedicine is a very useful tool of communication between the doctor and the patient. The aim of this study was to find out the utility of telemedicine during the lockdown period of COVID-19 pandemic in North East India.Methods: It is a cross sectional study among the cancer patients at our center on follow up or ongoing treatment and analysis of all the data acquired from telephonic conversation with our patients from 30th March, 2020 to 3rd May, 2020. Have contacted 4181 patients during this period over phone. All phone calls were done by respective department doctors.Results: From the demographic data, we get that 35.4% of patients were at good physical condition, 3.5% with poor general condition, 11.6% patients having ongoing treatment in our institute, 21.1% patients expired, 0.9% patients have nonmalignant diagnosis, 1.4% patients left the institute due to various reasons. Analyzed this data with brain storming sessions amongst the COVID-19 task force doctors and tried to find out solutions of each problem.Conclusions: Telemedicine cannot replace conventional method of in person treatment, but it proved to be a useful tool during the COVID-19 pandemic for patient follow up and treatment of cancer patients

Hypofractionated radiotherapy in post mastectomy locally advanced breast cancer: a study from a regional cancer center in North East India

Background: Adjuvant radiotherapy has increased local-regional and overall survival rates in breast cancer. Conventional fractionation delivering 50-60 Gray (Gy) over 5-6weeks is a standard approach. A shorter duration of hypofractionated treatment will be more convenient for patients and treatment providers if found safe and equally effective.Methods: Around 50 high risk breast cancer patients who underwent mastectomy were enrolled and randomized into the study arms- CF (Conventional Fractionation) Arm (50Gy/25 Fr @ 2 Gy/fraction/day 5 days a week over 5weeks) and HF (Hypo-Fractionation) arm (40.05 Gy/15 Fr @ 2.67 Gy/fraction/day 5 days a week over 3weeks). Treatment related acute and late toxicities, loco-regional recurrence; distant metastasis and survival rates were recorded for comparison.Results: Twenty-five patients were enrolled in each arm with baseline characters well matched. At median follow up of 44 months, OS was 80% in HF arm against 64% in CF arm (p-value: 0.292). HF arm also showed better DFS at 4 years of 76% compared to 64% in CF arm (p-value: 0.411). Although the difference was not significant statistically, the Hazard Ratio of 1.543 (95% CI: 0.549-4.339) for DFS and 1.801 (95% CI: 0.603-5.377) for OS indicated trends towards better outcomes in HF arm in terms of disease control and survival. Acute and late toxicities were also lesser in HF arm, though not statistically significant (all p-values >0.05).Conclusions: In post mastectomy setting, HFRT is comparable to CFRT in terms of safety and efficacy, will be more convenient for patients and care givers and hence can be a routine standard practice

Radiotherapy in Ewing’s Sarcoma Family Tumor — experience from North-East India

Introduction. The multimodality management of Ewing’s Sarcoma Family Tumors (ESFT) consists of neoadjuvant chemotherapy followed by local treatment: surgery, radiotherapy (RT) or a combination of both. The objectives of this study were to analyze disease control and overall survival in patients receiving radiotherapy as local treatment, as part of multimodality management of ESFT at our institute over a period of seven years. Material and methods. This is a retrospective single institutional study. Hospital records were searched for patients with ESFT who received radiotherapy from January, 2012 to December, 2018. Forty-nine patients were found eligible and evaluated with respect to prognostic factors, treatment-related factors and outcomes. Time to event was measured from the date of diagnosis and survival curves were estimated by Kaplan-Meier method and log-rank test for comparison. Results. Median follow up for patients was 18 months (range 3–81 months). Local failure/relapse was associated with worse survival. Five-year local control was 79.1% and overall survival 51.2% in the analyzed cohort. Local control did not differ significantly based on prognostic variables or treatment characteristics. Combined surgery and radiotherapy as local treatment along with good response to neoadjuvant chemotherapy were associated with significant improvement in overall survival (p-value < 0.05). Conclusions. Combined modality local treatment with surgery and radiotherapy along with a favorable response to neoadjuvant chemotherapy are associated with improved survival in ESFT. For unresectable tumors, radiotherapy alone remains the optimum local treatment, albeit with inferior survival outcomes

Determination of optimal clinical target volume to planning target volume margins for conformal radiotherapy planning using image guidance system in rectal cancer in prone position

Context: In advanced radiotherapy techniques such as three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), geometrical uncertainties are very crucial as they may lead to under dosing of tumor and over dosing of the nearby critical structures and hence, it is important to determine planning target volume (PTV) margins which are specific for every center. Aims: The aim of this study is to determine adequate clinical target volume (CTV) to PTV margins specific to our radiotherapy center. Settings and Design: To calculate CTV to PTV margins for rectal cancer patients in prone position using kV cone beam CBCT data sets. Materials and Methods: With the Patient immobilized in prone position using thermoplastic mask, a CT simulation was done and a comprehensive 3DCRT plan was generated. Daily kV CBCT was done to check the patient setup error. Daily setup errors were recorded and evaluated retrospectively. Results: CTV-PTV margin calculated for pelvis in the prone position was calculated using van Herk Formula and were found to be 0.5, 1.8, 0.7 cm in the lateral, longitudinal, and vertical directions, respectively. Conclusions: Image guidance is an effective method to evaluate patient setup errors. Good quality immobilization devices and stringent patient setup policies can help to reduce PTV margins further