Reproducibility of tangential breast fields using online electronic portal images

BackgroundTreatment verification and reproducibility plays a major role in radiotherapy to achieve better tumour control. Small uncertainties in daily repositioning of the patients and internal organ motion can lead to discrepancies between the planned and delivered radiation treatments. A factor that influences dose homogeneity and treatment volume is the accuracy of treatment setup. Small deviations in positioning the patient with regard to the beam setup could have a relatively significant impact on the treatment volume and it is imperative to control the setup error during radiotherapy. This study focuses on the importance of inter- and intra-fraction error in tangential breast radiotherapy with an electronic portal imaging device.AimTo study the variation in treatment setup due to intra-fraction and inter-fraction during tangential field breast irradiation.Materials/MethodsTwelve patients of carcinoma breast were selected for this study and CT based planning was performed with simple tangential fields. The patients were treated on a 6MV linear accelerator equipped with an electronic portal imaging device (EPID). Portal images were acquired for both medial and lateral tangential fields for 10 fractions and intra- and inter-fraction studies were performed for all the patients. Parameters such as central lung distance (CLD), central beam edge to skin distance (CBESD), central irradiated width (CIW) and cranio-caudal distances (CCD) were measured on the acquired portal image.ResultsThe average systematic differences observed for CLD, CBESD, CCD and CIW were 1.2mm, 2.8mm, 2.07mm and 3.30mm. For intra-fraction motion, the observed standard deviations for CLD, CBESD and CCD were 0.7mm, 0.73mm, and 1.36mm. Similarly the CLD, CBESD, CIW and CCD were analyzed for inter-fraction variation.ConclusionsThe online portal imaging device is an important tool for ensuring the proper delivery of planned dose. Our results suggest that intra-fraction motion of the breast has less impact on the treatment volume. Regular treatment verification between treatment fractions will help in reducing the normal tissue toxicity and ensures proper dose delivery to the tumour volume

Mesenteric gastrointestinal stromal tumour presenting as intracranial space occupying lesion

BACKGROUND: Gastrointestinal stromal tumours (GIST) usually present with non-specific gastrointestinal symptoms such as abdominal mass, pain, anorexia and bowel obstruction. METHODS: We report a case of a 42 year old male who presented with a solitary intracranial space occupying lesion which was established as a metastasis from a mesenteric tumour. RESULTS: The patient was initially treated as a metastatic sarcoma, but a lack of response to chemotherapy prompted testing for CD117 which returned positive. A diagnosis of mesenteric GIST presenting as solitary brain metastasis was made, and the patient was treated with imatinib. CONCLUSION: We recommend that all sarcomas with either an intraabdominal or unknown origin be routinely tested for CD117 to rule out GIST

Altered fractionation radiotherapy in head and neck squamous cell carcinoma

AbstractIntroductionFractionation plays a pivotal role in determining the effectiveness of radiation and follows the principle of 4 “R” of radiobiology. The various altered fractionation schedules used are hyper-fractionation, accelerated fractionation, and hypo fractionation.MethodsWe reviewed the landmark articles published in the peer reviewed journals to summarize the beneficial role of altered fractionation in the treatment of head and neck carcinoma.ResultsHyper-fractionation definitely gives very good overall survival benefit for locally advanced head and neck patient’s equivalent to survival benefit to that of concurrent chemoradiotherapy. Adding concomitant chemotherapy to altered fractionation is a logical approach to improve survival in locally advanced head and neck cancer patients, but it may be at a cost of higher toxicity. Mild hypo fractionation may be beneficial in early laryngeal cancers and may help in achieving better local control.ConclusionAltered fractionation is a very important treatment schema and requires the reinforcement of its use

The review of the patterns of presentation and various prognostic factors in male breast cancer patients

This study was aimed to analyze the patterns of presentation, various prognostic factors and therapeutic modalities for the management of breast cancer in male patients. Thirty cases of male breast cancer were treated with radiotherapy at our department between 1983 and 1997. All the patients were treated with radiotherapy besides surgery (26) and chemotherapy (12). Radical mastectomy was performed in 18 patients, while 6 patients were treated with modified radical mastectomy and 2 patients with simple mastectomy. The post operative radiotherapy was applied at the dose of 50 Gy in 25 fractions over a period of five weeks. The chemotherapy was administered in an adjuvant setting. All the patients were received hormonal therapy. Four patients were lost to follow up. The follow up period ranged from 10-92 months with a median of 38 months. The disease-free survival at 2 and 5 years were 87.7% and 54.67%, respectively. One patient recurred locally, whereas 5 patients had distant metastasis. The age, lymph node status at presentation and presence of distant metastasis were the important prognostic factors. At present, the trend is to treat male breast cancer patients like those of females stage per stage. More randomized studies are required for optimizing therapeutic approach. (Med J Indones 2001; 10: 84-7) Keywords: male breast cancer, radiotherapy, chemotherapy, surger

Accessory breast tissue in axilla masquerading as breast cancer recurrence

Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen

Accessory breast tissue in axilla masquerading as breast cancer recurrence

Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen

Rhabdoid Variant of Lung Cancer: Clinicopathological Details of a Case and a Review of Literature

Primary rhabdoid tumor of lung is a rare histological and clinical entity. Lung tumors with rhabdoid features have been included as variants of large-cell carcinoma in the 1999 World Health Organization (WHO) classification of lung tumors. A large-cell carcinoma with a rhabdoid phenotype (LCCRP) is unusual, with only 38 cases reported till date. We report the clinical details of one such case that was treated with pneumonectomy and adjuvant chemotherapy. We also present a review of the literature. To identify relevant articles, we searched PubMed, Ovid, and IngentaConnect databases using the key words \u2032rhabdoid,\u2032 \u2032lung cancer,\u2032 and \u2032primary rhabdoid tumor of lung.\u203

Lycopene in treatment of high-grade gliomas: A pilot study

Background : The therapeutic benefit of lycopene is well established for carcinoma prostate in various clinical trials and has been proposed for other malignancies including high-grade gliomas. Setting and Design : Randomized placebo control study in the Department of Radiation Oncology of a teaching hospital. Materials and Methods : Fifty patients with high-grade gliomas were treated with surgery followed by adjuvant radiotherapy and concomitant paclitaxel. Patients were randomized to receive either oral lycopene (Group A) 8 mg daily with radiotherapy or placebo (Group B). Pre-and post-radiotherapy plasma lycopene levels were measured using high-precision liquid chromatography. McDonald′s criteria were used for response assessment. Magnetic resonance imaging (MRI) of brain and Single Photon Emission Computed Tomograph (SPECT) were done three-monthly for two visits and six-monthly thereafter. Primary endpoint was response at six months post radiotherapy. Statistical Analysis Used : The data was analyzed using SPSS Software v10.0 (SPSS corporation Chicago IL) by applying Student′s t-test, ANOVA F test, Chi-square test and Karl Pearson Correlation Coefficient. Results : Median age was 38 years. The commonest histology was glioblastoma multiforme (n = 32). Pre- and post-treatment plasma lycopene levels in the patients in Gropu A were 152 ng/ml and 316 ng/ml and in the patients in Group B were 93 ng/ml and 98 ng/ml (P = 0.009). There was non-significant differences in favor of lycopene between Group A and Group B with higher overall response at six months (P = 0.100), response at last follow-up (P = 0.171) and time to progression (40.83 vs. 26.74 weeks, P = 0.089)., The follow-up duration was significantly higher for Group A than Group B (66.29 vs. 38.71 weeks, P = 0.05). Conclusions : Addition of nutrition supplements such as lycopene may have potential therapeutic benefit in the adjuvant management of high-grade gliomas