Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix

Background: Patients with locally advanced cervical cancer are often severely distressed with incessant vaginal bleeding, offensive discharge and pelvic pain and are in some instances are beyond curative potential. At our institution we routinely use monthly palliative pelvic radiotherapy for these patients. Methods and Material: One hundred patients treated between 2000 & 2004 were included in this analysis. Patients were treated with parallel-opposed pelvic portals with megavoltage radiation monthly up to a maximum of three fractions (10Gy/ fraction). Patients with good response after second fraction were considered for intracavitary brachytherapy delivering 30Gy to point A. Response was documented with regard to relief of bleeding, vaginal discharge and pelvic pain. The other aspects evaluated were patient compliance, disease response, toxicity and survival. Results: Sixty-eight percent had FIGO stage IIIB, 12% had stage IVA and 14% had IVB disease. Twenty patients had metastatic disease. The median symptom duration was 5 months. Majority (67%) presented with vaginal bleeding, followed by discharge (69%) and pelvic pain (48%). All patients received at least one fraction of palliative pelvic radiotherapy. Sixty-one patients received the second fraction and 33 the third. Five patients received an intracavitary application. The overall response rates in terms of control of bleeding, discharge and pain were 100%, 49% and 33% respectively. The treatment was generally well tolerated with a median survival of 7 months. Conclusions: Monthly palliative pelvic radiotherapy results in satisfactory control of symptoms in patients with locally advanced carcinoma of cervix with acceptable complications

Brain Metastases in Soft Tissue Sarcomas: Case Report and Literature Review

Background and purpose: Brain metastasis is a relatively uncommon event in the natural history of soft tissue sarcomas. The increasing use of chemotherapy may have caused a reduction in local relapses as well as distant failures leading to an improvement in survival, thereby allowing metachronous seeding of the brain, a sanctuary site. The purpose of this report is to increase awareness amongst clinicians regarding such a possibility

Interstitial brachytherapy for orbital soft tissue sarcoma: an innovative technique

Purpose: To report an innovative technique of interstitial brachytherapy developed for treatment of orbital soft tissue tumors. Material and methods : A 4-month-old child diagnosed with rhabdomyosarcoma of orbit was treated with multi­agent chemotherapy (CTh) and brachytherapy. Pre-planning computed tomography (CT) images were obtained and clinical target volume (CTV) was defined using the pre-treatment magnetic resonance imaging (MRI). Brachytherapy plan was generated for deciding optimal catheter placement. With the child under general anesthesia, catheter entry points were extrapolated and marked on the skin as determined from the pre-planning CT scan. Implantation of catheters was performed as per pre-determined catheter position and depths. Brachytherapy plan was generated and evaluated using dose volume histograms (DVH). A comparative external beam radiotherapy (EBRT) plan using RapidArc was also generated for the CTV with a 3 mm margin as the planning target volume (PTV). Results : The mean CTV dose with brachytherapy was 158% compared to 101% with RapidArc. The CTV V100 was 90% for brachytherapy vs. 95% for RapidArc. The mean dose to Lt Lens were 51% and 60%, respectively for brachytherapy and RapidArc, while the corresponding mean doses to the bony orbit were 39% and 68%, respectively. Follow-up MRI at 3 months showed complete response of the tumor. Conclusions : Interstitial brachytherapy for orbit using this innovative technique is a safe and effective modality of local treatment for appropriately selected orbital soft tissue tumors. Brachytherapy resulted in excellent disease control with significant reduction of dose to surrounding ocular structures compared to EBRT

Electron beam radiotherapy for the management of recurrent extensive ocular surface squamous neoplasia with orbital extension

Recurrent extensive ocular surface squamous neoplasia (OSSN) with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 5040 cGy radiotherapy (15eV electrons) resulting in complete disease regression. At the end of 3 years follow-up, the patient was disease free, maintained a vision of 20/25, with mild dry eye, well-managed with topical lubricants. Extensive OSSN with orbital invasion does not always need exenteration. External beam electron radiotherapy provides a noninvasive cure with organ and vision salvage and should be considered in extensive OSSN not amenable to simple excision biopsies. Long-term studies to evaluate the effect of radiation on such eyes are suggested

Brain metastases in soft tissue sarcomas: Case report and literature review

Abstract Background and purpose: Brain metastasis is a relatively uncommon event in the natural history of soft tissue sarcomas. The increasing use of chemotherapy may have caused a reduction in local relapses as well as distant failures leading to an improvement in survival, thereby allowing metachronous seeding of the brain, a sanctuary site. The purpose of this report is to increase awareness amongst clinicians regarding such a possibility. Patients and methods: A review of the departmental sarcoma database following the presentation of this index case in the clinic. Results and discussion: An adolescent male who had previously been treated with surgery and radiotherapy for a spindle cell sarcoma of the left thigh developed a space-occupying lesion in the brain within 6 months of treatment of the primary tumor. He subsequently underwent resection of the presumed solitary brain metastasis followed by whole brain radiotherapy. On radiation he was detected to have pulmonary metastases too, for which he was offered palliative chemotherapy. The patient died of brain metastasis within 4 months. A review of the departmental sarcoma database, restricted to soft tissue sarcomas purely, maintained prospectively from 2000 till date, could not identify any other such case. Conclusion: Brain metastases from soft tissue sarcomas are rare. Patients with neurological symptoms, however, should be appropriately investigated. Surgical resection of brain metastasis could be considered for solitary brain metastasis in non-eloquent areas. Palliative radiotherapy is appropriate for patients with multiple brain metastases or co-existing extra-cranial disease

Extramedullary haematopoiesis causing spinal cord compression: A rare presentation with excellent outcome

Extramedullary haematopoiesis (EMH) as a cause of spinal cord compression in patients with thalassaemia major is very rare. Treatment of EMH includes the use of radiotherapy, hypertransfusion, laminectomy and chemotherapy in the form of hydroxyurea We report a presentation of progressive paraparesis due to a sacral mass in a 7 year old child undergoing repeated blood transfusions for thalassaemia major who had a dramatic improvement in symptoms after radiotherapy. A standard recommendation regarding the radiation dose required is not available but a dose of 20Gy delivered over 10 fractions seems to be effective and well tolerated

Brief Communications - Embryonal rhabdomyosarcoma of the biliary tree mimicking a choledochal cyst

Embryonal rhabdomyosarcoma (ERMS) of biliary tree is a rare type of mesenchymal neoplasm diagnosed at surgery or by preoperative liver biopsy. We present a one year eight months old child who mimicked a choledochal cyst and was eventually treated with surgery, chemotherapy with IRS IV protocol and adjuvant postoperative radiotherapy to surgical bed with 6 MV photons to a dose of 5040cGy in 28 fractions