Long term palliation of a metastatic primary gliosarcoma with stereotactic body radiotherapy

Primary gliosarcoma (PGS) is rare and is known for extra cranial metastases. The overall outcome is dismal and hence the focus is on providing the best quality of life. This report describes a seventy-year-old lady who at presentation had metastatic primary gliosarcoma with intractable cough. Her lung lesion was treated with stereotactic body radiotherapy (SBRT) to a dose of 10 Gy per fraction for three consecutive days. She was free of cough till her death at eighteen months after treatment. This is probably the first reported case of excellent long-term quality of life in a patient of metastatic primary gliosarcoma

Comprehensive assessment of xerostomia in patients receiving radiation for head and neck cancer

Purpose: Xerostomia is a well known complication of radiation for head and neck cancer. It causes significant impairment of Quality Of Life (QOL).Comprehensive assessment is possible with the help of scintigraphy, Dose-volume histogram (DVH) parameters as well as QOL questionnaire.Methods: Thirty patients of head and neck cancer undergoing radiation were assessed for xerostomia. Scintigraphic assessment of parotid gland function was done before and at six weeks after radiation. QOL questionnaire was administered before, during, and at six weeks after radiation as well as at two years of follow up. Dose received by parotids were correlated with scintigraphic and QOL outcomes.Results: Mean parotid gland volume and dose received were 24.9 cc and 45.3 Gy respectively. Mean Salivary Excretion Factor (SEF) decreased from 54.1 to 12 at six weeks after radiation. QOL scores worsened from first week (mean value: 2.37) of radiotherapy (RT) to fourth week (mean value: 15.50, p < 0.0000) , remained same till completion of RT (mean value: 17.57, p = 0.1063) and at six weeks after radiation (mean value:16.10, p = 0.2519 ). There was a significant decrease in QOL scores between post RT six weeks versus two years follow up (p < 0.0000). Mean parotid dose and QOL scores correlated at six weeks (p < 0.0000), whereas no correlation was found between SEF and QOL.Conclusion: Comprehensive assessment of parotid gland function with Scintigraphy, QOL questionnaire and its correlation with dose volume parameters is helpful in quantifying xerostomia. Even though radiation induced xerostomia persisted for a long time after radiation, it did not translate to decreased QOL

Equivalent dose in 2 Gy (EQD2) to pelvic lymph nodes using volume based prescription for three brachytherapy applicators — a dosimetric retrospective analysis

BACKGROUND: Pelvic lymph node (PLN) metastasis has been included in the FIGO staging, so there is a need to determine the dose contribution from brachytherapy to ascertain the total delivered dose to the pelvic lymph nodes in cervical cancer. The aim of the study was to calculate the equivalent dose in 2 Gy (EQD2) of the pelvic lymph nodes (PLNs) based on volume prescription using three applicators. Materials and methods: Forty-one patients who had undergone external beam radiotherapy followed by brachytherapy using tandem ovoids (TO), tandem ring (TR) and TO + free hand interstitial needles (TO + FH) applicators were taken for this study. 26 Gy in 4 fractions was prescribed to HRCTV. The external iliac node (ELN), internal iliac node (ILN) and obturator (OBT) were contoured and the median EQD2 of the lymph nodes was calculated. RESULTS: The median bilateral EQD2 values of ELN were 1.55 Gy (TR), 1.75 Gy (TO), 1.9 Gy (TO + FH), of ILN these were 2.57 Gy (TR), 3.27 Gy (TO), 3.04 Gy (TO + FH), and of OBT these were 3.69 Gy (TR), 4.46 Gy (TO), 4.69 Gy (TO + FH), respectively. The total median EQD2 values of TR, TO and TO + FH were 52.71 Gy, 53.03 Gy, and 53.88–62.73 Gy, respectively. CONCLUSION: Our study calculated the median EQD2 to the pelvic lymph nodes using three types of applicators in brachytherapy. This could serve as reference to decide on the EBRT boost dose while treating patients with enlarged pelvic lymph nodes

Primary cerebello-pontine angle melanoma: a case report

Intra-cranial melanomas are commonly metastatic from primary melanoma elsewhere in the body. The primary occurrence of a melanoma in the brain parenchyma is rare. We report a case of 38 year aged woman who presented with deviation of left eye and headache. On imaging, a space occupying lesion was found in the left Cerebello-pontine angle and a preoperative diagnosis of meningioma was made. She underwent left retro-mastoid sub-occipital craniectomy and excision of a black vascular tumor. Histopathological examination revealed a melanoma which was confirmed with Immunohistochemical assay. Search for dermal, mucous and ocular lesions were negative. She received adjuvant radiation to the post- operative tumor bed to 5400cGy in 30 fractions using Intensity Modulated Radiation Therapy technique along with concurrent Temozolomide. She tolerated the treatment well and is symptom free 12 months after treatment. Primary Melanomas are rare lesions of the Cerebello-pontine angle and its radiological features, evaluation and management have been discussed.-------------------Cite this article as: Ponni A, Jagannatha A, Gururajachar J, Harjani R, Koushik K, Subramanian N, Sowmya R, Varma R. Primary cerebello-pontine angle melanoma: a case report. Int J Cancer Ther Oncol 2014; 2(3):020315. DOI: 10.14319/ijcto.0203.1

Epworth Sleepiness Scale- a novel tool to assess somnolence syndrome in patients receiving radiotherapy to the brain

Purpose: Radiation to brain causes early, early-delayed, and delayed side effects. There is paucity of literature regarding early-delayed effects like somnolence syndrome. Existing studies use general symptom assessment and visual analog scales. Epworth Sleepiness Scale (ESS) is a time tested tool to assess daytime sleepiness in various conditions. In this study, the ESS has been used to determine the occurrence of somnolence in patients receiving cranial radiotherapy for primary and metastatic brain tumors. Thus the ESS has been used in a novel setting in our study. The ESS is a simple to administer questionnaire and may be useful in grading the severity of somnolence. To our knowledge, this is the second study to determine post radiation somnolence using ESS. Methods: This prospective study was conducted in 23 patients with primary and metastatic brain tumor. Patient demographics and tumor type and grade was noted. Those with Karnofsky Performance Scale (KPS) less than 70 and with pre-existing sleep disorders were excluded. Radiotherapy regimen included palliative whole brain radiation for brain metastases and conformal adjuvant radiotherapy for primary brain tumors as per standard guidelines. All subjects included were administered ESS at baseline and weekly thereafter during and for 6 weeks after radiation. Results: All 23 patients (median age 50 years) completed the planned questionnaires until 6 weeks post radiation. Twenty (87%) patients had primary brain tumors whereas three (13%) patients had metastatic lesions in brain. Of the 23 patients, 14 patients (60.86%) had abnormal or increased daytime sleepiness; of which 3 had ESS scores greater than 16. Conclusion: Somnolence was noted in 60.86% of the patients, which is in accordance with existing literature. Epworth sleepiness scale is an effective tool to detect and quantify somnolence, However, it does not consider other symptoms of somnolence syndrome and hence should be combined with visual analog scale to get complete information

Long term palliation of a metastatic primary gliosarcoma with stereotactic body radiotherapy

Primary gliosarcoma (PGS) is rare and is known for extra cranial metastases. The overall outcome is dismal and hence the focus is on providing the best quality of life. This report describes a seventy-year-old lady who at presentation had metastatic primary gliosarcoma with intractable cough. Her lung lesion was treated with stereotactic body radiotherapy (SBRT) to a dose of 10 Gy per fraction for three consecutive days. She was free of cough till her death at eighteen months after treatment. This is probably the first reported case of excellent long-term quality of life in a patient of metastatic primary gliosarcoma

Predicting toxicity for head and neck cancer patients undergoing radiation therapy: an independent and external validation of MDASI-HN based nomogram

AimWe conducted a study to validate the MDASI-HN based nomogram, which is used to predict the acute toxicities in head and neck cancer patients undergoing radiation therapy with or without chemotherapy.BackgroundTolerance to radiation varies from patient to patient and also depends on various other factors like tumor volume, dose of radiation, chemotherapy. Predicting the toxicities allow us to identify potential candidates who are likely to have a higher toxicity and, in addition, evaluates the nomogram when done on an independent group of patients.Materials and MethodsSixty biopsy confirmed head and neck cancer patients undergoing radiation were the subjects of the study. The patients completed patient reported outcome instrument (PRO) MDASI-HN questionnaire at the beginning and at the fifth week of radiation. The baseline score obtained was used to obtain the predicted score using nomogram. The nomogram was also externally validated as per the TRIPOD guidelines.ResultsThe mean baseline, predicted and score at the fifth week were 27.28±11.04, 73.33±15.51 and 82.62±17.67, respectively, for all sub-sites. A positive, significant correlation (

Comprehensive assessment of Somnolence Syndrome in patients undergoing radiation to the brain

AimThe aim of this prospective study was to assess Somnolence Syndrome (SS) in patients undergoing radiation to the brain.BackgroundSS is one of the sequelae of radiation to the brain, which is observed within three months of radiation. This is a self-limiting condition and a failure to diagnose leads to unnecessary investigations. This study was undertaken to objectively and subjectively analyze the occurrence, clinical presentation and severity of SS.Materials and methodsThirty-three patients receiving radiation to the brain were included in the study. Visual Analog Scale (VAS) was used for subjective assessment and the Littman Somnolence Syndrome (LSS) scale was used for objective assessment of SS. Sleep Latency Test (SLT) was used to quantify SS.ResultsVAS scores showed an initial fall until week 3, followed by a plateau and a sudden increase after week 10. LSS scale at week 11 and 12 showed that 13 patients (43.3%) had grade 2, 5 (16.7%) had grade 3; and 2 (6.7%) had grade 4 SS. SLT revealed a shift of predominant sleep pattern from NREM 1 to NREM 2 at 6 weeks after radiation with a p value of 0.0412.ConclusionsAn insight into SS, its features, frequency of occurrence and self limiting nature can prevent anxiety and unwarranted investigations in the immediate post radiation period

Compliance with bladder protocol during concurrent chemoradiation for cancer of the cervix and its impact on enteritis: A prospective observational study

AimThis prospective study aims to assess the compliance with bladder protocol and the correlation with enteritis during pelvic radiation.BackgroundBladder protocol is routinely used for patients undergoing pelvic radiation to reduce radiation enteritis. It is very difficult to maintain constant volume especially in the last two weeks due to radiation enteritis and cystitis.Materials and methodsHistologically proven 35 cervical cancer patients treated with concurrent chemoradiation in a tertiary care center were the subjects of this prospective study. Following CT simulation and after every fraction, patients were asked to void urine in a calibrated urine container and the volume was documented. Patients were assessed for the highest grade of radiation enteritis weekly as per common toxicity criteria. The mean voided urine volume was correlated with the radiation enteritis.ResultsThe mean urine volume at planning CT scan was 295.85[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]300[[ce:hsp sp="0.25"/]]ml (SD) with a range of 75–650. At the end of treatment, it was reduced to 233.14[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]250[[ce:hsp sp="0.25"/]]ml (range 50–400[[ce:hsp sp="0.25"/]]ml), a reduction by 21% (p[[ce:hsp sp="0.25"/]

Comprehensive assessment of xerostomia in patients receiving radiation for head and neck cancer

Purpose: Xerostomia is a well known complication of radiation for head and neck cancer. It causes significant impairment of Quality Of Life (QOL).Comprehensive assessment is possible with the help of scintigraphy, Dose-volume histogram (DVH) parameters as well as QOL questionnaire.Methods: Thirty patients of head and neck cancer undergoing radiation were assessed for xerostomia. Scintigraphic assessment of parotid gland function was done before and at six weeks after radiation. QOL questionnaire was administered before, during, and at six weeks after radiation as well as at two years of follow up. Dose received by parotids were correlated with scintigraphic and QOL outcomes.Results: Mean parotid gland volume and dose received were 24.9 cc and 45.3 Gy respectively. Mean Salivary Excretion Factor (SEF) decreased from 54.1 to 12 at six weeks after radiation. QOL scores worsened from first week (mean value: 2.37) of radiotherapy (RT) to fourth week (mean value: 15.50, p &lt; 0.0000) , remained same till completion of RT (mean value: 17.57, p = 0.1063) and at six weeks after radiation (mean value:16.10, p = 0.2519 ). There was a significant decrease in QOL scores between post RT six weeks versus two years follow up (p &lt; 0.0000). Mean parotid dose and QOL scores correlated at six weeks (p &lt; 0.0000), whereas no correlation was found between SEF and QOL.Conclusion: Comprehensive assessment of parotid gland function with Scintigraphy, QOL questionnaire and its correlation with dose volume parameters is helpful in quantifying xerostomia. Even though radiation induced xerostomia persisted for a long time after radiation, it did not translate to decreased QOL.</p