Abstracts (AROI-West Bengal Annual Conference 2023) Category: Best Paper

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ABSTRACTS

Year : 2022 | Volume : 2 | Issue : 1 | Page : 31-50

Abstracts (AROI-West Bengal Annual Conference 2023) Category: Best Paper

Date of Web Publication

31-Mar-2023

Correspondence Address:

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjoc.bjoc_Abstract

How to cite this article:
. Abstracts (AROI-West Bengal Annual Conference 2023) Category: Best Paper. Bengal J Cancer 2022;2:31-50

How to cite this URL:
. Abstracts (AROI-West Bengal Annual Conference 2023) Category: Best Paper. Bengal J Cancer [serial online] 2022 [cited 2023 Jun 6];2:31-50. Available from: http://www.bengaljcancer.org/text.asp?2022/2/1/31/373317

Central Nervous System

CNS-01: Retrospective Survival Analysis of Glioma Patients Treated in Our Institution

Shruti Mishra, Sanjoy Roy, Sandip Sarkar, Kannan Maharajan; Department of Radiation Oncology, Ruby General Hospital, Kolkata, West Bengal, India

Background: Incidence of glioma in the adult population, especially high-grade glioma, is increasing in comparison to low-grade glioma. The main objective of this study was to assess overall survival analysis in glioma patients treated in our institution between 2019 and 2021.

Materials and Methods: We retrospectively collected data from 56 glioma patients who were treated with curative intent between 2019 and 2021. All the data were recorded in Microsoft Excel and survival analysis was done using Statistical Package for the Social Sciences (SPSS) version 26.0.

Results: Of those 56 patients, the incidence of glioma with mean age (48.8 years), male predominance (69.65%), and the incidence of high-grade glioma were high (66.07%). There was involvement of the right hemisphere (50%), left hemisphere involvement (41%), and midline (9%). Frontal and parietal lobe involvement was 30.35% each followed by 23.21% temporal lobe involvement. The average treated tumor volume for low-grade glioma was 336.42 cm³ and for high-grade glioma it was 422.87 cm³. Among all patients, 32.14% underwent gross total resection and 67.86% subtotal resection before radiation. The patients who received concurrent temozolamide among high-grade glioma were 62.16%. The overall mean survival was 19.6 months, and the median overall survival was 16.70 months. Among subgroups, mean survival in low-grade glioma was 31.16 months (24.28–38.05 months) and high-grade glioma was 14.13 months (10.77–17.48 months). Median survival in low-grade glioma was 23.40 months and high-grade glioma was 12.20 months (8.98–15.41 months).

Conclusions: The results of the overall survival analysis we found from our study are almost within the range of the literature. The limitation of the study was unknown isocitrate dehydrogenase status in majority of the patients (73.2%).

CNS-02: A Mono-Institutional Audit of Primary Central Nervous System Tumor Patients in a Tertiary Care Hospital of Eastern India

Justice Mazumdar, Bappaditya Chhatui, Niladri Roy, Rina Barman, Alakananda Choudhury, Aishwarya Ravi; Department of Radiotherapy, Medical College Kolkata, Kolkata, West Bengal, India

Background: Central nervous system tumors are a heterogeneous group of neoplasms having difference in prevalence according to age groups and sex. There are very few epidemiological studies about the primary central nervous system from Eastern India.

Aim: The aim of this study was to study epidemiological patterns of primary central nervous system tumors.

Material and Methods: A retrospective study was conducted in a tertiary care center of Eastern India from January 2011 to December 2022. Data regarding age, sex, histology, symptoms, imaging, location, surgery, radiotherapy, chemotherapy, recurrence if any, and salvage treatment for recurrence were collected and analyzed.

Results: We analyzed 214 cases. Age ranged from 4 years to 72 years; males (71.9%), outnumbered females (28.03%); M:F ratio was 3.85:1.5. Neuroepithelial tumors were the most common histological finding (84%). Glioblastoma multiforme was the most common subset (33.1%), followed by anaplastic astrocytoma (13%) and diffuse infiltrating astrocytoma (13%) in neuroepithelial tumors. Medulloblastoma (6.5%) was found to be the most common tumor in the pediatric age group. The most common symptom was headache (51.4%) followed by seizures (25.2%). contrast-enhanced computed tomography of brain was done in 89.71%, whereas magnetic resonance imaging of brain was done in 10.28% of patients. Frontal lobe was the most common site of involvement. Surgical procedure consisted of excision in 37.3% followed by decompression in 24.7%.

Conclusion: Our study helps to provide information regarding burden of disease in our area. Major limitation of our study is that it is institution based and may not reflect the entire population. It also reflects the need to strengthen follow-up practices.

CNS-03: CyberKnife Radiosurgery for Refractory Trigeminal Neuralgia

Himanshu Pruthi, Tejinder Kataria, Kushal Narang, Shyam S. Bisht; Department of Radiation Oncology, Medanta—The Medicity Gurgaon, Gurgaon, Haryana, India

Background: Stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) necessitates precise localization and delineation of trigeminal nerve on appropriate magnetic resonance imaging (MRI) sequences and meticulous radiosurgical planning and treatment delivery. Twenty consecutive cases of refractory trigeminal neuralgia treated at our institute with CyberKnife SRS between March 2014 and March 2022 were analyzed.

Material and Methods: Treatment involved nonisocentric delivery of 60–65 Gy to a segment of the affected trigeminal nerve, at a 3–5-mm distance from the root entry zone. Prospectively recorded pain response, adverse effects, and dosimetric data were analyzed. Efficacy of pain response and side effects of the treatment including hypoesthesia and dizziness were measured using Barrow Neurological Institute (BNI) grade.

Results: The median age was 60 years (range 32–81 years) with male:female ratio of 3:2. Neurovascular conflict was evident on MRI in 15/20 (75%) patients. Two cases had associated trigeminal schwannomas, while no definite cause was evident in three cases. The median prescribed SRS dose was 60.0 Gy (range 60–65 Gy), with the median marginal isodose being 70% (range 66%–80%). The median target length was 6.2 mm, and mean target volume was 0.11 cm³ (range 0.03–0.2 cm³). The median D_max was 87.6 Gy (range 75–95.5 Gy), and D_mean was 74 Gy (range 65.9–80.3 Gy). The median brainstem D_max attained was 15 Gy (range 11.7–17.2 Gy). The median treatment time was 58.5 min. The two patients with associated trigeminal schwannomas received SRS 60 Gy each for TN and 13 Gy and 21 Gy for the schwannoma.

Median available follow-up was 18 months (range 5–72 months). A total of 18/20 (90%) patients reported significant pain relief post-SRS. The first significant subjective pain relief was reported at a median of 30 days (range 3–150 days) post-SRS. Adequate pain control with SRS (BNI grades I–IIIb) was maintained in 18/20 (90%) at 1-year and 2-year post-SRS, and 17/20 (85%) at 3-year post-SRS, and 15/20 (75%) patients at 4-year post-SRS. Eight out of twenty (40%) patients reported one or more side effects including hypoesthesia, numbness, or dizziness on follow-up.

Conclusion: CyberKnife SRS brings about effective pain relief in most patients with refractory trigeminal neuralgia, with acceptable side effects.

Head and Neck Malignancy

HN-01: A Prospective Observational Study on Quality of Life Assessment in Dysphagia Optimized Intensity-Modulated Radiotherapy for Head and Neck Cancer Patients

Pratijyoti Ghosh, Suman Mallik, Sayan Das¹, Arijit Sen, Monidipa Mondal; Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, ¹Department of Radiation Oncology, Medica Superspeciality Hospital, Kolkata, West Bengal, India

Background: This study was done in our setting to assess the quality of life and dysphagia scores in head and neck cancer patients treated with dysphagia-optimized intensity-modulated radiotherapy (IMRT).

Materials and Methods: Thirty-six consecutive patients of head and neck cancer from February 2021 to February 2022 were included with baseline assessment of swallowing function by M.D. Anderson Dysphagia Inventory (MDADI) score and Performance Status for Head Neck Cancer (PSSHN). The Dysphagia Aspiration Related Structures (DARS) were contoured as a single structure which was then excluded from the PTV (DARS-PTV), and this was given a dosimetric constraint of ≤50-Gy mean dose. All the patients were treated in Elekta Versa HD linear accelerator. MDADI scores and PSSHN were assessed at 3, 6, and 12 months post-RT.

Results: There was a significant decline in the MDADI composite score from baseline to 3 months post-RT (P < 0.001) and a significant improvement at 6-month post-RT (P < 0.001). No significant correlation could be established between mean dose to DARS-PTV and decline in MDADI composite score at 3 months post-RT (Pearson’s correlation coefficient = 0.103). In the PSSHN_Diet domain, significant decline in the mean score at 3-month post-RT compared to the baseline (P < 0.001) was observed which subsequently recovered at 6-month post-RT (P < 0.001). No statistically significant difference was observed in the PSSHN_Eating and PSSHN_Speech domains.

Conclusion: Using dysphagia-optimized IMRT, significant improvement in swallowing function assessed by MDADI score was observed at 6-month post-RT completion compared to 3-month post-RT.

HN-02: Assessment of Swallowing Dysfunction and Neck Dysfunction in Head and Neck Cancer Patients Post-Radiotherapy/Chemo-Radiotherapy

Mounisha Vattiprolu, Koushik Chatterjee; Department of Radiotherapy, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Background: Patients with head and neck cancer (HNC) experience treatment-related complications that may interfere with health-related quality of life. Swallowing and neck disability contribute to decrements in functional status. This study was done to assess swallowing and neck dysfunction in HNC patients post-radiotherapy (RT)/chemoradiotherapy (CXRT).

Materials and Methods: The study was an observational, prospective one that included 33 patients with HNC who received either RT/CXRT. Fiberoptic endoscopic evaluation of swallowing was used to assess the swallowing function and Penetration Aspiration Scale was used to grade the dysphagia. For neck dysfunction, Neck Disability Index, a questionnaire containing 10 questions, was used.

Results: Out of the 33 patients, 17 (52%), 6 (18%), and 3 (9%) showed mild, moderate, and severe dysphagia, respectively. Twenty-seven percent of the patients showed neck dysfunction, out of which 24% had mild and 8% had moderate dysfunction. The t-value of dysphagia was 17.390 and neck dysfunction was 14.138 with a P-value of both parameters <0.001 indicating they were significant at 1% level of significance. The study has shown that the oral cavity and oropharynx were the primary site of origin with more number of cases showing neck dysfunction and swallowing dysfunction, respectively. The use of concurrent chemotherapy did not have effect on the neck function post-treatment but showed a significant increase in swallowing dysfunction.

Conclusions: This study has concluded that cancer treatment causes dysphagia, neck pain, and decreased range of neck movements in patients with HNC post-RT/CXRT leading to a decrease in the quality of life. The dose constraints of the DARS should be kept in mind during the treatment planning. Active interventions like shaker exercise and swallowing maneuvers, swallowing, and speech rehabilitation are necessary post-treatment in all head and neck carcinomas. These small measures can lead to revolutionary changes in the rehabilitation after treatment and thus increase the quality-of-life post-treatment.

HN-03: Ultra-Low-Dose Radiation with Neo-Adjuvant Chemotherapy in Locally Advanced Carcinoma of Head and Neck—A Feasibility Study

Behjet Mirza, Sabyasachi Sarkar, Sumana Maiti Das, Aloke Ghosh Dastidar, Siddhartha Basu, Susmita Biswas; IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Background: Chemotherapy alone is not curative in locally advanced cases of head and neck squamous cell carcinoma (LAHN-SCC), but it enhances the effects of RT and is routinely used as a part of a combined modality treatment in patients with stage III or IV disease. A correlation is seen between response to chemotherapy and subsequent response to radiation. The locoregional control improves and induction chemotherapy is better tolerated than maintenance therapy. Incorporation of ultra-low-dose radiation along with induction chemotherapy was done to exploit the benefits of hyper-radiosensitivity that precedes the occurrence of a relative resistance per unit dose to cell killing by radiation, called increased radioresistance.

Materials and Methods: A total of 60 patients were taken in the study, 30 in each arm. Patients in both arms received two cycles of induction chemotherapy with paclitaxel 175 mg/m² and cisplatin 85 mg/m², while those in the study arm also received 60 cGy of external beam radiotherapy twice daily, at a gap of at least 6 h, on day 1 and 2 of each chemotherapy cycle. The total irradiation dose for induction therapy in the study arm was 480 cGy. Patients in both the arms thereafter received concurrent definitive chemoradiotherapy to a total dose of 66 Gy in 33 fr along with concurrent carboplatin AUC2. Patient assessment was done after 6 weeks of treatment completion and then every month for 1 year.

Results: At median follow-up of 12.5 months, 80% versus 66.7% had complete response. The mean progression-free survival (PFS) was 11.33 months versus 9.7 months in the control arm, while the total OS was 12.1 months versus 10.67 months in the control arm.

Conclusion: Ultra-low-dose radiation with induction chemotherapy is a promising treatment modality in locally advanced carcinoma of head and neck.

HN-04: Laryngeal Dosimetric Correlation with Voice-Quality Outcomes in Nonlaryngeal Head and Neck Cancer Radiotherapy Treated with IMRT

Manishi Bhattacharya, Sanjoy Roy, Amitabh Ray, Dipanjan Majumder, Somesh Mazumdar, Bitan Pramanik, Piyali Dutta Chowdhury; Department of Radiotherapy, Ruby General Hospital, Kolkata, West Bengal, India

Background: Intensity-modulated radiotherapy (IMRT) helps with better post-radiation quality of life due to more sparing of normal tissue to 3D-CRT. Considering the postradiation voice quality of patients, our primary objective in this study was to correlate of laryngeal organ at risk dosimetry with voice-quality outcomes in nonlaryngeal head and neck squamous cell carcinoma (HNSCC).

Materials and Methods: Nonlaryngeal HNSCC requiring radiotherapy was put into IMRT. Dose prescription was set to 60–70 Gy in 30–35 fr at 2 Gy/fr over 6–7 weeks along with or without chemotherapy. Followed by voice related quality of life questionnaire was filled up by the patient him/herself, before, at interval of two weekly till the end of the radiation therapy, and at 3 months of post-radiation, follow-up and late voice-quality outcomes have been scored at follow-up 3 monthly.

Results: Voice-quality outcomes were assessed at 2 weeks of interval during radiation and the third month of post-radiation. The median value of mean laryngeal dose, D_mean: 24.73 Gy in IMRT and P-value: <0.05. Similarly, the V₄₀ has shown the most significant correlation where r = 0.9722 and P-value is <0.05, and median value of V₄₀ in the IMRT arm was 26.72%. V₄₀ has also shown a significant correlation with voice-quality assessment score at the third month of post-radiation in the IMRT technique arm, where P-value equals 0.0036 and negatively correlated which directs that voice-quality outcomes at the third month of post-radiation would be better if V₄₀ is not more than the median value 26.72% in IMRT.

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Conclusion: In nonlaryngeal HNSCC treatment, to maintain voice quality and minimize the changes, V₄₀ and mean laryngeal dose (D_mean) should be kept as low as possible, <26.72% and <43 Gy, respectively, in IMRT technique.

HN-05: A Retrospective Analysis of Locally Advanced Carcinoma Buccal Mucosa Treated with Neoadjuvant Chemotherapy Followed by Chemoradiation versus Definitive Chemoradiation Only—A Mono-Institutional Audit

Aishwarya Ravy, Bappaditya Chhatui, Niladri Roy, Alakananda Choudhury, Arnab Kumar Ghosh, Justice Mazumder, Dharma Majhi; Department of Radiation Oncology, Medical College Kolkata, Kolkata, West Bengal, India

Background: Carcinoma buccal mucosa is cancer of the lining (mucosa) of the oral cavity. In developing countries like India, it is the commonest of the oral cavity cancers owing to the extensive usage of tobacco in various forms. About 70% of cases are locally advanced at the time of presentation. We conducted this study to compare the progression-free survival in patients treated with neoadjuvant chemotherapy followed by chemoradiation versus definitive chemoradiation in locally advanced cases.

Materials and Methods: Fifty-seven patients with locally advanced carcinoma buccal mucosa were selected. Patients were divided into two arms—those receiving neoadjuvant chemotherapy followed by chemoradiation and those receiving definitive chemoradiation upfront. The treatment and follow-up data were collected from records. Statistical analysis including Kaplan–Meier plot was used for calculating disease-free survival analysis in both arms.

Results: After a median follow-up of 27 months, 33.33% (18) patients had developed disease recurrence, 8 in the neoadjuvant arm and 10 in the definitive chemoradiation only arm (P = 0.671), with 3 patients documented to have developed distant metastasis. Two-year disease-free survival was 67% and 72.4% in neoadjuvant and definitive chemoradiation arm, respectively.

Conclusion: Our study results showed that addition of neoadjuvant chemotherapy to chemoradiation was comparable to definitive chemoradiation alone in terms of locoregional recurrence and disease-free survival for the management of locally advanced carcinoma of buccal mucosa. However, further studies are required to define the benefit of the same.

HN-06: Pattern of Locoregional Recurrence in Carcinoma of Buccal Mucosa Treated with Surgery Followed by Postoperative Radiotherapy with/without Chemotherapy: A Retrospective Single Institutional Study

Anamika Mandal, Debottam Barman, Sharmistha Roy, Bithi Pal, A. R. Deb; Department of Radiation Oncology, Medical College Kolkata, Kolkata, West Bengal, India

Background: Carcinoma of buccal mucosa is associated with high incidence of locoregional recurrence, leading to treatment failures and mortality. The current study was done to evaluate the incidence, pattern of recurrence, outcomes, and risk factors predicting recurrence in well-lateralized carcinoma of buccal mucosa treated with definitive surgery and adjuvant radiotherapy to ipsilateral side with or without concurrent chemotherapy.

Materials and Methods: Patients of well-lateralized carcinoma of buccal mucosa treated with surgery and adjuvant radiotherapy with/without chemotherapy, between January 2016 and December 2021 were included in this study. Data regarding baseline patient characteristics, histopathological features, treatment, and outcomes were retrieved from hospital’s case files and records. The primary end point of the study was to determine the pattern of locoregional recurrence.

Results: Out of total 410 cases, after a median follow-up period of about 42 months, 20% of patients presented with recurrence. Majority (88%) of the patients were males. Among the recurrent cases, most patients presented with ipsilateral locoregional metastasis (70%) and only 5% had distant metastases. Contralateral neck failure was observed in 7.3% cases among recurrent patients. The median recurrence-free survival was about 10 months. Initial stage of the disease and lymph nodal status were significant factors.

Conclusion: The incidence of locoregional recurrence was observed more in the ipsilateral side. Cases of isolated contralateral neck failure were very low and mostly occurred in N3b nodal status patients.

HN-07: Comparison of Clinical Outcome and Dosimetric Parameters of Three-Dimensional Conformal Radiotherapy versus Intensity-Modulated Radiotherapy in Patients with Head and Neck Squamous Cell Carcinoma: A Prospective Two-Armed Observational Study

Sumana Samaddar, Krishnangshu B. Choudhury, Chandan Dasgupta, Shatarupa Dutta, Bidisha Naskar Ghosh, Suranjan Maitra, Debanjan Kundu, Ananya Mahalanabish; Department of Radiotherapy, R.G. Kar Medical College, Kolkata, West Bengal, India

Background: For head and neck squamous cell carcinoma, radiation planning modalities have been evolved from two-dimensional radiotherapy to three-dimensional conformal radiotherapy, and now, intensity-modulated radiotherapy technique is the mainstay of treatment. Our study is designed to compare the treatment effect of these two techniques, 3D-CRT and intensity-modulated radiotherapy (IMRT), in terms of clinical response and dosimetric parameters, in HNSCC.

Purpose: The purpose of this study was to compare the clinical response and dosimetric parameters in patients of HNSCC, receiving radical treatment with concomitant chemoradiation with either 3D-CRT or IMRT.

Materials and Methods: Eligible patients of biopsy-proven HNSCC, attending Radiotherapy Department, R.G. Kar Medical College (January–December 2021); divided into two groups—receiving chemo-radiotherapy (CTRT) with 3D-CRT technique and with IMRT technique. Comparison of the objective response was done by using RECIST version 1.1; dosimetric parameters were compared using different target volumes; toxicity assessment was done by using the common terminology criteria for adverse events v. 5.0.

Results: The overall response rate and disease control rate were found to be slightly better in IMRT arm but not statistically significant. Significantly better conformity index and homogeneity index were achieved by the IMRT arm, concluding its better target delineation, OAR sparing, and homogenous dose distribution within the target volumes. IMRT arm showed significant reduction of grade 3 oral mucositis, xerostomia and dysphagia, whereas, due to more prevalence of all grade 3 toxicities, 3D-CRT arm showed more treatment delay. In IMRT arm, doses to brainstem, spinal cord, and parotid were significantly lower.

Conclusion: By considering all the cumulative results, we found that, for HNSCC, 3D-CRT, and IMRT techniques are comparable in terms of clinical response; and, IMRT technique can be preferable than 3D-CRT, for providing better target delineation and better critical organ preservation reducing acute radiation-induced toxicities.

HN-08: Dosimetric Comparison and Exploring Possible Clinical Impacts between Three Different Radiation Planning Techniques in Nasopharyngeal Carcinoma Using Simultaneous Integrated Boost

Debajyoti Chowdhury, Abhishek Basu, Jayabrata Biswas, Rajdeep Mitra, Annesha Sen; Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India

Background: Volumetric-modulated arc therapy (VMAT) allows rapid treatment delivery than standard intensity-modulated radiotherapy (IMRT) and both allow highly conformal dose distribution. In this study plan, quality and performance of dual arc (DA)-VMAT, single arc (SA)-VMAT and nine field (9F)-IMRT were compared using a simultaneous integrated boost (SIB) technique.

Methods: Twenty patients treated in VARIAN TrueBeam by 9F-IMRT were replanned with SA-VMAT and DA-VMAT using the Eclipse treatment-planning system (TPS) with AAA simulation. Target delineation was conducted as per Radiation Therapy Oncology Protocols (RTOG0225 and 0615). A 70-Gy dose prescribed to PTV70 and 59.4-Gy to PTV59.4 in 33 fr was applied for the SIB technique. PTV coverage, homogeneity index, mean and maximum dose to the organ at risks (OARs), and treatment delivery time (min) were analyzed. Dose distributions for SA and DA plans were verified using film dosimetry using a quality assurance phantom.

Results: In our study, all the treatment modalities provided a clinically acceptable plan quality for all planning targets. No statistically significant difference was observed in PTV D₉₈, D₉₅, D₉₀, V₉₅, V₉₀. Maximum dose (D_max) to the spinal cord, brainstem, and optic nerve was lower in DA-VMAT than 9F-IMRT and SA-VMAT and statistically significant. A lower mean dose to the larynx was achieved with 9F-IMRT (P < 0.02) and DA-VMAT (P < 0.01) than with SA-VMAT. DA-VMAT achieved a higher CI of PTV70 (P < 0.01) than SA-VMAT. The average treatment delivery time was 7.23 ± 0.7 min, 3.39 ± 0.6 min, 4.3 ± 0.4 min for 9F-IMRT, SA-VMAT, and DA-VMAT, respectively (P < 0.004).

Conclusion: All planning techniques (9F-IMRT/SA-VMAT/DA-VMAT) achieved acceptable target coverage. SA-VMAT inferior in sparing OARs than DA-VMAT and 9F-IMRT, DA-VMAT spares OARs better or equal to IMRT. DA-VMAT offered a shorter delivery time than other two planning techniques without compromising the plan quality.

HN-09: A Prospective Study Analyzing Clinical and Dosimetric Outcome in Locally Advanced Head and Neck Cancer Treated with Conformal Chemoradiation with or without Induction Chemotherapy

Annesha Sen, Abhishek Basu, Bidyut Mandal, Janmenjoy Mondal, Ipsita Chakraborty; Department of Radiotherapy, Medical College Kolkata, Kolkata, West Bengal, India

Background: Squamous cell carcinoma of the head and neck represents around 10% of new cases in India annually and with similar trend worldwide. Treatment strategies for stage III and IV HNSCC differ in view of resectibility, organ preservation, and medical conditions. Induction chemotherapy followed by CTRT is widely practiced, but Indian data regarding clinical outcome in image-guided radiotherapy scenario are still not promising. In this study, we tried to evaluate the dosimetric parameters, response rate, survival, and toxicities as well.

Materials and Methods: We started our study in august 2019 with independent ethics committee approval with 42 patients in CTRT arm and 40 patients in induction chemotherapy + CTRT arm. Patients in CTRT arm received radiation (66–70 Gy) with three weekly cisplatin 80 mg/m². In the induction arm, two cycles of TPF (Taxane, Platinum, 5FU) was given followed by concomitant radiotherapy with same dose and cisplatin. All patients were treated with intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) in true-beam linear accelerator. Baseline characteristics were compared with chi-square test; dosimetric means were compared by unpaired t-test. Survival analysis was done using Kaplan–Meier test.

Results: Median age was 54 years and median follow-up time was 32 months (19–39 months). Overall response rates (CR+ PR) were 66.6% versus 72.5% (P = 0.06). Three-year OS was 64.3% versus 70% (P = 0.25). Median disease-free survival was slightly better in IC + CTRT arm, but mean OS was comparable. Mean values of clinical target volume (CTV), PTV, spine D_max, parotid were lower in induction arm (P < 0.05). Patients with induction chemotherapy experienced more hematological toxicities (P < 0.01).

Conclusion: Induction chemotherapy followed by CTRT offers better dosimetric outcomes, slightly better progression-free survival, with more hematological toxicities and no overall survival benefit.

HN-10: A Prospective Study to Assess the Progression-Free Survival and Late Toxicity on the Basis of Sarcopenia in Patients of Head and Neck Cancer Receiving Concurrent Chemoradiotherapy

Soumyadip Mitra, Litan Naha Biswas, Jibak Bhattacharya, Tanweer Shahid, Tanmoy Ghosh, Aditi Mishra, Biplab Sarkar; Department of Radiation Oncology, Apollo Multispeciality Hospital Kolkata, Kolkata, West Bengal, India

Background: Sarcopenia, which is defined as severe loss of muscle mass and muscle function, is identified as a negative prognostic factor in all oncological patients including head and neck cancer patients. This study aims to determine the impact of sarcopenia on progression-free survival (PFS) and late toxicity among head and neck squamous cell carcinoma (HNSCC) patients treated with definitive concurrent chemoradiation.

Materials and Methods: Seventy patients with locally advanced (cT3-4N0M0, T1-4N1-3M0) HNSCC were included. All patients were treated with radical radiotherapy (intensity-modulated radiotherapy [IMRT] under image guidance) dose of 66 Gy in 30 fr over 6 weeks with concurrent chemotherapy. Pretreatment sarcopenia was assessed from radiation planning CT scan using skeletal muscle mass at C3. During treatment (at the third week and at the sixth week), sarcopenia was assessed using CBCT scan. The cut-off values for sarcopenia were set at skeletal muscle index (SMI) < 32.78 cm²/m² and < 26.19 cm²/m² for males and females, respectively. The impact of sarcopenia on treatment outcome, PFS, and late toxicity was evaluated. The association between patient factors and sarcopenia was calculated in univariate and multivariate analyses.

Results: Sarcopenic patients were more likely to be elderly, female gender, and smoker. There was a positive correlation between pretreatment SMI and pretreatment BMI (P = 0.001). The incidence of sarcopenia increased significantly (P < 0.001) from pretreatment period (44.3%) to the end of the treatment (65.7%). Fifty-four patients (77.1%) achieved complete response after treatment. PFS in sarcopenic patients was 71% versus 81.2% in nonsarcopenic patients (P = 0.1) at the end of 1 year. At 12 months of follow-up, 27 (38.6%) patients reported grade I dysphagia, 30 (42.9%) patients had grade I xerostomia, and 21 (30%) patients had grade II xerostomia. The incidence of xerostomia (93.5%) and dysphagia (61.3%) were significantly higher among the sarcopenic patients than the nonsarcopenic patients (P < 0.05).

Conclusion: Sarcopenia is a relevant problem in locally advanced HNSCC patient, and it seems to be a predictor for poor treatment response along with increased late toxicity.

Thoracic

TH-01: A Prospective Study to Evaluate Tumor Response and Toxicity in Patients with Locally Advanced Inoperable Carcinoma Esophagus Following Concurrent Chemo-Radiotherapy and Intraluminal Radiotherapy

Md. Mahboob Hossain, Diptimay Das; Department of Radiation Oncology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Background: Esophageal cancer is the ninth most common cancer worldwide with an estimated 604,100 new cases in 2020 accounting for about 3.1% of all cancer. It is the sixth most common cause-related death worldwide with an estimated 544,076 death (5.5% of the total). About 80% of the cases occur in less developed countries. Its incidence rates in men are 2.5 times as high as those in women. Carcinoma esophagus is a highly malignant disease with very low cure rate. Concurrent chemoradiation is the standard of care in patients deemed unfit for surgery. Intraluminal brachytherapy (ILRT) is effective for palliation of dysphagia and is also used as a boost to external beam radiotherapy (EBRT) in curative intent.

Aims: The aim of this study is to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) followed ILBT and RT alone followed ILBT in inoperable, locally advanced esophageal carcinoma.

Materials and Methods: The present study was a two-arm prospective comparative study. This study was conducted from March 2021 to August 2022 at the Department of Radiotherapy, IPGME&R and SSKM Hospital, Kolkata, West Bengal.

Fifty patients with inoperable, locally advanced esophageal carcinoma were randomized into two arms. In Arm A, 26 patients were given concomitant CCRT consisting concomitant EBRT (45 Gy in 25 fr, 1.8 Gy/fr over 5 weeks), and chemotherapy with injection paclitaxel (60 mg/m²) and injection carboplatin AUC 2 IV weekly for 5 weeks. This was followed by ILRT 5 Gy × 2 fr 1 week apart, starting 2 weeks after completion of EBRT. In Arm B, patients received EBRT (45 Gy in 25 fr over 5 weeks) followed by ILRT 5 Gy in 2 fr 1 week apart, starting 2 weeks after completion of EBRT. The end points were tumor response, acute and late toxicities, disease-, and progression-free survival.

Results: With a median follow-up of 12 months, the overall tumor response rate (CR + PR) was 92.3% in arm A and 70.9% in arm B (P = 0.515). Acute mucous membrane toxicity 1 [13 (54.2%)] in Arm B compared to Arm A [14 (53.8%)] was statistically significant (P = 0. 0120). In addition, more number of patients had [19 (79.2%)] RTOG acute pharynx and esophagus toxicity 2 in Arm B compared to Arm A [12 (46.2%)]; it was statistically significant (P = 0. 0218).

Conclusion: This study concludes that concurrent chemoradiation in combination with ILRT is more effective than RT alone + ILRT in locally advanced carcinoma esophagus but having higher adverse effects.

TH-02: Setting Up Four-Dimensional Computerized Tomography-Based Image Guided Radiotherapy for Locally Advanced Lung Cancer in a Tertiary Care Center of Eastern India: How Much Planning Target Volume Margin Is Justified for the Sake of Dosimetric Advantage?

Shreya Manna, Animesh Saha, Aditi Mishra, Tanmoy Ghosh, Subhra Biswal, Ajay Banik; Apollo Multispeciality Hospital, Kolkata, West Bengal, India

Background: Four-dimensional computerized tomography (4D-CT)-based image-guided radiotherapy is currently standard in many developed countries for lung cancer patients undergoing curative intent radiotherapy. However, its use is limited in a few centers in India. Majority of centers use helical-free breathing CT scan-based planning with a population-based large safety margin for planning target volume (PTV). In this study, we would also evaluate the feasibility of reduced PTV margin for 4D-CT-based planning.

Materials and Methods: Forty-six locally advanced lung cancer patients decided for radical radiotherapy was planned based on 4D-CT-based contouring, generating internal target volume and adding 5-mm PTV margin (PTV_4D). We retrospectively analyzed the setup data of 890 fr of 46 patients. Using summary data, we calculated the systematic error (∑) and random error (δ) in each of the three axes, that is, mediolateral (x), craniocaudal (y), and anteroposterior (z). We also calculated the translational vector of each fraction of individual patients. PTV margin was calculated using the van Herk formula. We also evaluated the shifts >5 mm and >7 mm. Offline images of all fractions were verified at the original position to check for adequacy of tumor coverage with PTV.

Results: Majority of patients received 60 Gy in 30 fr (95.7%). Our calculated PTV margin was 0.7 cm, 1.1 cm, and 0.5 cm in X, Y, and Z axis. PTV margin calculated for translational vector was 0.4 cm. Percentage of shifts >5 mm was 8.3%, 31.4%, and 1.1% in X, Y, and Z axis. Percentage of shifts >7 mm was 3.8%, 17.7%, and 0.2% in X, Y, and Z axis. Translational vector shift >5 mm and >7 mm was 23.1% and 0.2%, respectively. Offline imaging verification revealed that 95.5% (850 fr) of the time primary tumor was within the PTV.

Conclusion: 4D-CT-based radiotherapy planning for locally advanced lung cancer with reduced PTV margin of 5 mm is feasible with adequate target coverage. However, daily online image guidance or at least a well-defined offline image guidance protocol would be recommended with such small PTV margin.

TH-03: Comparative Study to Assess the Volumetric and Dosimetric Differences of 4D-CT-Based and Helical-Free Breathing CT-Based Target Volume Delineation for Radical Radiotherapy for Lung Cancer Patients

Aditi Mishra, Animesh Saha, Suchanda Goswami, Jibak Bhattacharya, Litan N. Biswas, Shila Mitra, Tanmoy Ghosh, Prosenjit Soren; Apollo Multispeciality Hospital, Kolkata, West Bengal, India

Background: Traditionally, helical free breathing computed tomography (FBCT) is used for lung cancer radiotherapy planning with a population-based safety margin for planning target volume (PTV). 4D-CT has shown promising result in mitigating the motion management issues associated with lung cancer radiotherapy. This study aimed to compare the volumetric and dosimetric differences between 4D-CT-based versus FBCT-based planning for locally advanced lung cancer patients undergoing radical radiotherapy.

Materials and Methods: Helical FBCT and 4D-CT planning scan were acquired consecutively at the same session with the patient being in similar position. For FBCT-based planning, PTV (PTV_3D) was CTV (CTV_3D) plus 1 cm axial and 1.3 cm superior/inferior expansions. Organ at risks (OARs) was contoured following standard radiation therapy oncology group contouring guidelines. For 4D-CT-based planning, internal target volume was created based on 4D-CT assessment. PTV_4D was created with 0.5-cm isotropic expansion. All patients had two intensity-modulated radiotherapy (IMRT) plans one based on FBCT-based volume and the other based on a 4D-CT-based volume using similar geometry, gantry angles or arc, and other radiotherapy planning and optimization parameters. The FBCT-based plans were copied onto the 4D-CT volume data set and vice versa. Both plans were compared for target coverage and OAR dose. Dice similarity coefficient (DIC) was calculated to examine the overlap between PTV_3D and PTV_4D; using the following formula: DIC = 2a/(2a + b + c), where “a” is the area of overlap between 2 measures in one patient, “b” is the area identified in the first but not the second measure, and “c” is the area identified in the second but not the first.

Results: Forty-six locally advanced lung cancer patients were treated with 4D-CT-based planning with median age being 67 years and 87% being male. Majority of patients received 60 Gy in 30 fr (95.7%). PTV was significantly low with 4D-CT-based planning (mean PTV volume 509 cm³ vs. 739 cm³). OAR doses are also significantly low with 4D-CT-based planning (mean heart dose 11.6 Gy vs. 14.5 Gy, mean lung dose 13.5 Gy vs. 15.5 Gy, mean esophagus dose 19.3 Gy vs. 21.9 Gy, and spinal cord max dose 35.7 Gy vs. 37.5 Gy). Mean DIC of PTV_3D and PTV_4D was 0.8 (80%), indicating that in 20% of the patients’ volumes were not at the same anatomical position. About 43.5% patients had complete response, 43.5% had partial response, 4.35% had stable disease, and 8.7% had progressive disease at 3-month post-treatment imaging. At a median follow-up of 10 months, there is no local recurrence.

Conclusion: 4D-CT-based radiotherapy planning with reduced PTV margin can result in significant reduction in PTV compared to FBCT-based planning with population-based PTV margin. In addition, it can lead to significant reduction in OAR doses resulting in reduced treatment-related toxicity, without compromising PTV coverage.

Breast

BR-01: The Prospective Observational Study on Assessment of Cosmesis and Quality of Life in Breast Cancer Patients Treated with Extreme Hypo-Fractionated Adjuvant Radiotherapy (FAST FORWARD Protocol)

M. J. Rajeena, Suman Mallik, Monidipa Mondal, Sayan Das¹, Arijit Sen, Shantanu Bag, Papai Sarkar; Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, ¹Department of Radiation Oncology, Medica Superspeciality Hospital, Kolkata, West Bengal, India

Background: The aim of the study is to assess cosmetic outcome and quality of life at 6 months in breast cancer patients receiving adjuvant radiotherapy with an extreme hypofractionation regimen (26 Gy in 5# over 1 week followed by 10 Gy in 5# over 1 week.

Study Design: This is a prospective observational study.

Materials and Methods: Between February 2021 and March 2022, 29 consecutive patients with breast cancer who have undergone breast conservative surgery received external beam radiotherapy to a dose of 26 Gy in 5 fr to the whole breast over 1 week followed by 10 Gy in 5 fr to the tumor bed over 1 week. The cosmetic outcomes were assessed using subjective and objective methods at baseline, at the end of radiotherapy (RT), at 3 months, and at 6 months of RT. The subjective assessment was done by a single physician using the Harvard Scale. The objective assessment was done by automated BCCT.core software. The quality-of-life assessment at all four intervals of time was done using EORTC quality of life C30, BR23 breast module, and, body-image scale.

Results: The current study showed that at 6 months of RT completion, 76% showed excellent–good (EG) and 24% showed fair–poor (FP) cosmetic outcomes using the subjective method, and 64% showed EG and 36% showed FP cosmetic outcomes assessed using objective methods. There was moderate agreement between subjective and objective methods for the assessment of cosmetic outcomes at 6 months of RT (Kappa = 0.53). The quadrant-wise location of the tumor had a significant correlation with both subjective (P = 0.006) and objective cosmetic outcomes (P = 0.120). There was a trend toward a significant correlation between overall objective cosmetic assessment at 6 months and excised tumor volume (P = 0.05). The overall quality of life was improved at 6 months.

Conclusion: The study on the assessment of cosmetic outcomes in breast cancer patients treated with an extreme hypofractionation regime showed acceptable cosmesis at 6 months of RT using both subjective and objective methods. There was an improvement in the overall quality of life in our cohort of patients from baseline to the end of 6 months of RT completion.

BR-02: Breast Cancer Survey 2023—Assessment of Various Treatment Modalities and Radiotherapy Techniques in Patients with Breast Cancer

K. Vysakha, Suranjan Maitra, Debanjan Kundu, Anupama Radhakrishnan; Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India

Background: Radiation therapy in breast cancer, which is the most prevalent cancer in the world, has evolved exponentially in recent years with the implementation of increasingly conformal radiotherapy techniques and different fractionation regimens.

Materials and Methods: The survey questionnaire was sent to resident doctors and faculties working in the field of radiation oncology at various institutes. In total, standards of practice as shared by 115 doctors were evaluated. The categorical variables were summarized in frequencies and compared. Statistical analysis was done using SPSS.

Results: Among 115 medical professionals, the public and private sectors were almost equally represented. Presentation of disease according to patient profile was found to be in line with available literature. Most of the centers reported such treatment practices in early breast cancer patients that are in concordance with current international guidelines. Most centers are using immobilization techniques for adjuvant radiotherapy in CA Breast routinely. However, intravenous contrast is not used in most centers during simulation. Deep Inspiratory Breath Hold (DIBH) is the most used motion management technique. Radiation therapy oncology group (RTOG) guidelines are followed for image segmentation by the majority. Three-dimensional conformal radiotherapy (3D-CRT) is preferred to intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT). Moderate hypofractionation and conventional fractionation are the most widely used regimens. common terminology criteria for adverse events grades are most commonly used for toxicity assessment posttherapy; however, EORTC questionnaires are yet to be routinely used.

Conclusion: In most centers across India, CT-based planning is used. 3D-CRT is preferred by the majority followed by IMRT and VMAT for breast cancer treatment, along with appropriate immobilization and motion management techniques like DIBH. Ultra-hypofractionated radiotherapy regimen is yet to be favored by most.

BR-03: Deep Inspiratory Breath Hold Technique for Locoreginal Radiotherapy in Left Breast Cancer—A Dosimetric Analysis from a Case Series at a Tertiary Care Government Hospital in Eastern India

Debanjan Kundu, Suranjan Maitra, Ananya Mahalanabish, Sumana Samaddar; Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India

Background: Major coronary events and nonbreast cancer-related deaths have become a key survivorship issue even in today’s age of conformal radiotherapy (RT) for left breast carcinoma (LBC) patients treated with locoregional RT. Lacunae in literature persists regarding use and benefits of motion management techniques like Deep Inspiratory Breath Hold (DIBH) in adjuvant RT for left-sided carcinoma breast, especially in those with poorly educated, impoverished background. Our “DIDACTIC” study aims to delineate the achievable dosimetry by use of DIBH in patients with LBC, while underlining the correlation with various radiation toxicities.

Materials and Methods: From January 2021 to December 2021, 43 consecutive patients of left-sided breast cancer who received postoperative whole-breast irradiation (WBI) or post-mastectomy radiotherapy to the breast or chest wall with DIBH technique were retrospectively analyzed. Informed consent was obtained from all the patients before the study. Preradiotherapy CT simulation was done in free breathing (FB) and in DIBH for each patient. 3D-CRT planning was done for both scans. For DIBH, the protocol of the voluntary breath-holding (vDIBH) technique was followed. Prior to simulation, all patients were trained for DIBH. Breath-hold amplitude was monitored using Varian Respiratory Gating for Scanners (RGSC) system.

Results: Most of the patients were Hindu homemakers from rural areas. Target coverage of both plans on FB and DIBH was adequate and comparable in terms of Homogeneity and Conformity Indices. The use of DIBH resulted in a significant reduction of the heart, left anterior descending artery, and lung doses. This could be correlated with reduction in maximum heart depth and heart volume in field.

Conclusion: Although implementation increased treatment time and time commitment, we found that cardiac-sparing DIBH can contribute positively toward reduction of radiation doses to organ at risks (OARs). An upfront selection of the prospective beneficiaries by using a pragmatic assessment protocol could help to well organize the workload of departments with high volume of cases.

BR-04: A Prospective Interventional Study Comparing the Short-Term Cosmetic Outcome in Breast Carcinoma Patients with Tumor Depth <5 cm from the Skin Receiving Electron or Photon Boost Post Whole-Breast Irradiation after Breast Conservative Surgery

Anjali Sharma, Sanjoy Roy, Dipanjan Majumder; Department of Radiation Oncology, Ruby General Hospital, Kolkata, West Bengal, India

Background: Breast conserving surgery followed by whole-breast irradiation (WBI) + boost to the tumor bed is the gold standard in treating early-stage breast cancer. The cosmetic results are an essential end point in breast-conserving therapy. Our primary objective of this study was to compare the short-term cosmetic outcome in patients receiving whole breast radiotherapy with electron or photon boost after breast conservative surgery at 3 monthly follow-ups for 1 year. The secondary objective was to compare the acute toxicities during weekly check-ups during the treatment and late toxicities at 3 monthly follow-ups for 1 year.

Materials and Methods: Eighty cases of early-stage breast carcinoma, post-breast conservation surgery requiring WBI were randomized into photon boost and electron boost techniques. Patients underwent hypofractionated WBI (40 Gy in 15 fr at 2.67 Gy over 3 weeks) followed by a tumor bed boost of 12.5 Gy in 5 fr over 1 week using the electron or photon technique. A CT-based simulation was carried out, and most patients were planned with the “field-in-field” 3D-CRT technique for WBI and photon boost; and by marking the projection of the post-lumpectomy volume on the skin for electron boost. Acute skin toxicities using the RTOG acute radiation morbidity scoring criteria were assessed every week during the duration of radiation for 4 weeks, followed by an assessment of late skin toxicity and breast cosmesis every 3 months postradiation therapy completion till 1 year. The RTOG/EORTC late radiation morbidity scoring scheme and Harvard/NSABP/RTOG Breast Cosmesis Grading Scale were used for assessing late toxicities and breast cosmesis, respectively.

Results: Our study assesses acute toxicities weekly during the radiation and third-month postradiation. Acute skin toxicity demonstrates a little higher toxicity in the photon arm, with grade 1 skin toxicity being 77.5% and 80%, whereas only 35% and 50% in the electron boost arm at the end of 4 weeks and 3 months, respectively. But late-skin toxicity was almost comparable in two arms at the end of 6 months and 1 year. Excellent and good cosmetic scores as observed in 22.5% versus 2.5% and 30% versus 25% of electron and photon arms, respectively. Poor cosmetic score in 20% and 10% of photon and electron arm, respectively. Over time, cosmesis in the electron arm was improved significantly (P value = 0.0006).

Conclusion: Both the techniques, electron and photon, can be used for the delivery of boost to the tumor. There was slightly higher acute toxicity in photon arms, but it was acceptable. Not much difference in late skin toxicity and cosmesis was observed. But electron arm had a little better cosmetic outcome over the period of time.

BR-05: A Prospective Observational Study to Compare the Dose Received by Cardiac Structures in Postoperative Left-Sided Breast Cancer Patients Treated by Intensity-Modulated Radiotherapy versus Three Dimensional Conformal Radiotherapy

Soumita Majumdar, Dinesh Singh, Prekshi Chaudhary, Arun Goel, Rashi Agrawal, S. Balasubramanian, P. Thanasekar, D. Anbalagan; Department of Radiation Oncology, Max Superspeciality Hospital Vaishali, Ghaziabad, Uttar Pradesh, India

Background: Adjuvant external beam radiation therapy is an essential component in the treatment of postoperative left-sided breast cancer, but along with delivery of radiation dose to the target volume, it also leads to incidental irradiation of surrounding critical organs such as the heart. This may lead to acute or late cardiovascular toxicities. The purpose of this study was to generate two treatment planning modalities, namely, three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for each patient of postoperative left-sided breast cancer followed by assessment and comparison of the dose–volume–histogram parameters (e.g., V₅, V₁₀, V₂₀, V₂₅, D_mean, D_max) of cardiac structures, that is, whole heart and left anterior descending artery (LAD) between them in order to evaluate the better modality.

Methods and Materials: Thirty postoperative left-sided breast cancer patients undergoing adjuvant radiation therapy in our institute were enrolled in this study. For each patient, two treatment plans were generated, namely, IMRT and 3D-CRT. The two treatment plans were further normalized in terms of equivalent PTV (planning target volume) coverage when a dose of 40 Gy was delivered in 15 fr. DVH parameters were then assessed and compared between both techniques.

Results: In our study, mean dose to heart in terms of V_{20 Gy} (%) was significantly lower with IMRT (7.58 ± 3.63%) as compared to 3D-CRT (17.06 ± 8.08%) with P < 0.001. Mean dose to heart in terms of V_{25 Gy} (%) was also significantly lower with IMRT (4.91 ± 3.17%) as compared to 3D-CRT (15.49 ± 7.73%) with P < 0.001. Mean dose to heart (D_mean) did not vary between the two techniques (7.75 ± 1.49 Gy with IMRT as compared to 8.15 ± 3.24 Gy with 3D-CRT) with P < 0.541. Mean dose to LAD (D_mean) was significantly lower with IMRT as compared to 3D-CRT (18.01 ± 6.5 Gy with IMRT versus 25.58 ± 8.93 Gy with 3D-CRT, P < 0.001). Maximum dose to LAD (D_max) was also significantly lower with IMRT as compared to 3D-CRT (35.13 ± 6.32 Gy with IMRT versus 40.79 ± 2.35 Gy with 3D-CRT, P < 0.001).

Conclusion: IMRT led to a significant reduction in the incidental irradiation of cardiac structures, that is, whole heart and LAD as compared to 3D-CRT with equivalent PTV coverage. IMRT leads to lesser toxicity and improves compliance to therapy.

BR-06: A Prospective Comparative Study of Post-Mastectomy Adjuvant Radiotherapy by Standard Fractionation, Hypofractionation, and Ultra-Hypofractionation Schedule in Carcinoma Breast Patients

Sandip K. Karmakar, Debabrata Mitra, Santu Mondal, Amitava Manna; Department of Radiation Oncology, IPGMER AND SSKM Hospital, Kolkata, West Bengal, India

Background: Carcinoma breast is a major public health burden for women throughout the world. Radiobiologically, tumor cells in carcinoma breast react like late-responding normal tissue. In biologically effective dose concept, dose per fraction increase causes a significant increase in biologically effective dose for tumor cells. Ultra-hypofractionation has evolved as a potential adjuvant radiotherapy. In this study, conventional fractionation, hypofractionation, and ultra-hypofractionation adjuvant radiotherapy were compared as per loco-regional disease-free survival and toxicity.

Materials and Methods: A prospective, randomized, single-institutional, open-label comparative study was conducted in the Radiotherapy Department of IPGMER-SSKM Hospital, Kolkata. Patients with locally advanced carcinoma breast were included and those with radiotherapy in chest walls within preceding 5 years were excluded. Primary objective was to compare loco-regional relapse-free survival among the three arms. Secondary objective was to compare distant disease-free survival among the three arms. Randomization was done by simple randomization. Study duration was 1 year from January 2021 to January 2022.

Results: In this study, per protocol analysis was performed. Patient numbers 27 in Arm A, 29 in Arm B, and 26 in Arm C have been analyzed with 13 in Arm A, 15 in Arm B, and 12 in Arm C who suffered from clinically T4 disease and 11 in Arm A, 9 in Arm B, and 6 in Arm C had clinically N2 disease. The toxicity profile revealed that 3 in Arm A, 2 in Arm B and 2 in arm C suffered from loco-regional relapse. One patient in Arm A and Arm C suffered from distant relapse in this study period.

Conclusion: In this study, ultra-hypofractionation radiotherapy was noninferior to conventional and hypofractionation as adjuvant therapy in carcinoma breast. In India, health-care delivery system is overburdened. Ultra-hypofractionation radiotherapy with reduced visits of patients to hospital may be the standard treatment in near future.

BR-07: Relationship between Body Mass Index and Different Clinical and Pathological Characteristics of Breast Cancer Patients Observed on Presentation at a Tertiary Care Hospital

Sattama Samanta, Subrata Chatterjee, Kaustav Chatterjee; Department of Radiation Oncology, Medical College Kolkata, Kolkata, West Bengal, India

Background: Increased body mass index (BMI) is associated with increased risk of certain malignancies. The various effects of increased BMI on pathophysiology of breast cancer still remain unclear, warranting further studies. This single institutional study aims to determine the association of BMI with different demographic and clinicopathological characteristics among breast cancer patients, namely, age at diagnosis, menopausal status, tumor stage, tumor grade, hormone receptor status, and Her2neu receptor status.

Materials and Methods: One hundred and seventy-three breast cancer patients who presented at our department from August 2022 to December 2022 were included in this observational study. For each patient, BMI was calculated using the formula: BMI = weight (kg)/{height (m)}². Age at diagnosis, present menopausal status, tumor grade, tumor stage, hormone receptor status, and Her2neu receptor status were noted. Patients with BMI ≥ 25 were taken as overweight/obese and those with BMI < 25 were taken as normal/underweight. The association between BMI and above-mentioned characteristics was assessed using SPSS-Software version 23.

Results: Mean age at diagnosis was 54.48 ± 12.32 years. Mean BMI at presentation was 24.26 ± 4.31 kg/m². Mean age at diagnosis was significantly higher for patients with BMI ≥ 25 compared to those with normal/low BMI (<25) (P < 0.001). Patients with BMI ≥ 25 presented with higher grade of tumor (Grade 3) in significantly more number of cases compared to low BMI (<25) group (P = 0.002). More patients with higher BMI had postmenopausal status on presentation in comparison to patients among lower BMI group (P < 0.001). No significant association was established between BMI, stage of carcinoma, and hormone receptor/Her2neu receptor status.

Conclusion: In our study, higher BMI was associated with higher age of presentation, higher tumor grade, and more postmenopausal patients. However, no association was found between BMI and hormone receptor/Her2neu status.

BR-08: Assessment of Adverse Mental Health Outcomes in Breast Cancer Patients

Suvra Mondal, Suranjan Maitra; Department of Radiation Oncology, R.G. Kar Medical College, Kolkata, West Bengal, India

Background: Breast cancer is one of the most prevalent cancers among women. Patients having breast cancer and receiving treatment face traumatic experience due to impacts on their self-image and sexual relationships. It may lead to psychological reactions such as denial, anger, or intense fear toward their disease and treatment process. Depression and anxiety are common comorbidities in these patients.

Purpose: The purpose of this study was to assess the prevalence and associated factors of depression and anxiety among breast cancer patients in a tertiary cancer care center of Eastern India.

Materials and Methods: A cohort of 117 breast cancer patients attending oncology outpatient department was accrued. Data were collected using a structured questionnaire based on PHQ2, GAD-2, and NCCN distress thermometer scales associated with social, demographic, and clinical factors.

Results: The mean age of the cohort taken was 52.9 years. Thirty-three percent of patients had undergone mastectomy upfront. Seventy-three percent of patients had undergone mastectomy as definitive therapy. Sixty-seven percent of patients had received chemotherapy as neoadjuvant therapy. The rest of the patients had received in adjuvant form (22%) and in palliative intent (11%). More than two-thirds of the cases had received hormone therapy. Ninety-eight percent of the patients had received radiation therapy in adjuvant form. A large percentage of these patients were found to be depressed (67.5%) and anxious (78.6%). The factors those found to be associated were age, residential area, marital status, educational level, stage of the cancer religion, and symptom burden of the disease.

Conclusion: Similar to other cancer patients from other sides of the world, our cohort of patients with breast cancer are also in high risk for developing certain debilitating psychiatric disorders like anxiety and depression. Being urban resident, experiencing extended symptomologies can be predicting factors associated with depression and anxiety among these patients.

BR-09: A Prospective Observational Study to Evaluate the Relationship between Central Lung Distance and Occurrence of Pulmonary Toxicity in Post-Mastectomy Breast Cancer Patients Treated with Cobalt-60 Teletherapy

Souvik Kundu, Diptimay Das, Somenath Kundu; Department of Radiation Oncology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Background: Cancer therapy-triggered lung impairment interferes with quality of life in breast cancer patients treated with chest wall irradiation. Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. In this study, we aim to detect the relationship between central lung distance and pulmonary toxicity based on spirometry and radiological investigations in postmastectomy breast cancer patients treated with Cobalt-60 teletherapy.

Materials and Methods: In our study, we selected 30 breast cancer patients attending the Radiotherapy outpatient department of our institute who had undergone mastectomy along with neoadjuvant chemotherapy/adjuvant chemotherapy. The baseline pulmonary status of the patients was assessed with the help of HRCT thorax, spirometry (forced vital capacity and forced expiratory volume in the first second/forced vital capacity), and clinical examinations. Thereafter, all the patients underwent chest wall irradiation with the help of Bhabatron II teletherapy machine with Cobalt-60 source. Postradiation, the patients were kept on follow-up to assess their pulmonary status with the help of HRCT thorax, spirometry, and clinical examinations at 3 months and 6 months and the results were compared with baseline to determine the relationship between central lung distance and pulmonary toxicity.

Results: In this study, it was found that postradiotherapy, the early changes of radiation pneumonitis begin to appear in HRCT thorax as early as 3 months. On clinical examination, the signs and symptoms start appearing a bit late around 6-month post-radiotherapy. On the other hand, spirometry can detect only late changes of radiation pneumonitis as significant changes start appearing after 6 months to 1 year after radiotherapy. It was also established from this study that there exists a statistically significant relationship between central lung distance and V20.

Conclusion: The following points may be concluded from this study: (1) HRCT thorax plays an important role to detect early changes of radiation pneumonitis. (2) Spirometry can mainly detect late changes of pneumonitis. (3) There exists a definite relationship between central lung distance and the appearance of pulmonary toxicity in post-mastectomy CA Breast patients treated with Cobalt-60 teletherapy.

BR-10: Radiation Dose Spillage to the Low Axilla in Early Breast Cancer Patients from Tertiary Care Hospital in Eastern India

Janmenjoy Mondal, Annesha Sen, Bidyut Mandal¹, Abhishek Basu, Parna Basu; Department of Radiation Oncology, Medical College and Hospital Kolkata, Kolkata, ¹Department of Radiation Oncology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India

Background: For patients receiving locoregional radiotherapy (RT) including the breast or chest wall, the dose received by the axilla during this irradiation remains unknown.

Objective: The aim of this article is to determine the dose received by the low axilla during locoregional RT for early-stage breast cancer patients and to assess the impact of the treatment technique three-dimensional conformal RT or static and rotational IMRT (VMAT) with clinical outcome.

Materials and Methods: The study was performed in breast cancer patients treated at the department of RT between 2018 and 2022 who received normofractionated (50 Gy in 25 fr) or hypofractionated (40 Gy in 15 fr) locoregional RT (breast or chest wall and internal mammary, supraclavicular, and infraclavicular nodes) by 3D-CRT, IMRT, or VMAT technique. Patients treated with breast conserving surgery + adequate axillary clearance treated by adjuvant chemotherapy f/b RT and boost dose of 10 Gy to the tumor bed. The low axilla (level I) was delineated retrospectively, followed by 3-dimensional conformal radiation therapy, IMRT/VMAT were planned with treatment-planning system (TPS) Eclipse (version 14.5). Clinical data were extracted retrospectively from medical records. To allow comparisons, the population was divided into a normofractionated group and a hypofractionated group. The biological equivalent doses were calculated from an alpha/beta ratio of 3.1 (rounded off to 3) for the breast. Lymphedema was assessed and grading done by American Physical Therapy Association into mild, moderate, and severe. Clinical correlation assessed with the dose, though lymphedema of ipsilateral upper limb may have multifactorial association.

Statistical Analysis Used: For each technique and fractioning subgroup, we computed the studied data and their 95% confidence intervals (CI) using nonparametric Mann–Whitney, Wilcoxon tests in SPSS version 23. A P-value of ≤0.05 was considered significant.

Results: Ninety-two patients treated by RT from January 2018 to December 2022 were studied. The mean dose received by the low axilla when it was not part of the target volume was 29.6 Gy, 39.4 Gy, and 43.8 Gy by 3D-CRT, static IMRT, and VMAT, respectively, for normofractionated radiotherapy and 23.4 Gy, 29.0 Gy, and 33.9 Gy, respectively, for hypofractionated radiotherapy. With normofractionated radiotherapy, 4.6% of the axilla received 95% (V₉₅) of the prescribed dose by 3D-CRT compared to 22.5% and 31.8% by IMRT and VMAT, respectively; with hypofractionated radiotherapy, V₉₅ was 4.6%, 17.5%, and 23.1%, respectively. The clinical correlation of lymphedema is more with static IMRT than 3D-CRT or VMAT.

Conclusion: The axilla receives a non-negligible dose during locoregional RT; this dose is greater when VMAT or IMRT were used. Prospective studies must be conducted to assess the impact of this axillary dose in terms of morbidity, which currently remains unknown.

BR-11: Long-Term Clinical Outcomes of Male Breast Cancer Patients Treated with Curative Intent by Trimodality Therapy at an Academic University Hospital in North India

Bushra Khalid, Deep Chakrabarti, Arunima Ghosh, Naseem Akhtar¹, Shiv Rajan¹, Sumaira Qayoom², Kirti Srivastava, Rajeev Gupta, Anand K. Mishra³, Madan Lal Brahma Bhatt; Departments of Radiotherapy, ¹Surgical Oncology, ²Pathology, ³Endocrine Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India

Background: Male breast cancer is a rare disease accounting for less than 1% of all breast cancer cases worldwide. Most data are derived from multiple single-institution cohorts.

Materials and Methods: This retrospective cohort study included all patients of invasive male breast cancer treated with a trimodality approach via a multidisciplinary team at an academic university hospital in North India between 2012 and 2022. Records were identified from a prospectively maintained database. Clinicopathological parameters, treatment details, recurrence patterns, and survival were determined.

Results: Thirty-four patients were included. The median (interquartile range) age was 55 (44–63) years. Most patients were union for international cancer control TNM composite stage III (73%) and node-positive (79%) with Scarff–Bloom–Richardson grade II (56%). Twenty-five patients (73%) were estrogen receptor (ER) positive. Lymphovascular space invasion (LVSI) and perineural invasion were present in 65% and 32% of patients, respectively. The most common chemotherapy timing was adjuvant (53%) followed by neoadjuvant (41%), and the most commonly used regimen consisted of a triplet of 5-fluorouracil, an anthracycline (doxorubicin or epirubicin), and cyclophosphamide (5-fluorouracil, doxorubicin, cyclophosphamide or 5-fluorouracil, epirubicin, cyclophosphamide, 50%), followed by a taxane in seven patients (20%). Patients underwent surgery (4 lumpectomies, 1 wide local excision, and 29 mastectomies) and subsequent radiotherapy to a dose of 42.6 Gy in 16 fr. At a median follow-up of 72 months, six patients had died. Twelve patients had local or distant failures (four bone metastases, two lung metastases, one brain metastases, five locoregional recurrences). The 5-year disease-free survival (DFS) was 67%, and 5-year overall survival was 90%. The median DFS was 72 months, and median OS had not been reached.

Conclusion: Our reported cohort shows that most male breast cancer patients present with advanced stages, and most are node-positive with a high incidence of ER-positive disease and LVSI. Trimodality therapy in a multidisciplinary setting offers good long-term clinical outcomes.

Gastrointestinal

GI-01: A Prospective Comparative Study on Locally Advanced Rectal Carcinoma Treated with Total Neoadjuvant Therapy versus Long-Course Radiotherapy with Concomitant Chemotherapy

Firdoushi Khatun, Shyam Sharma, Srikrishna Mandal, Linkon Biswas; Department of Radiotherapy, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India

Background: In locally advanced nonmetastatic rectal carcinoma, preoperative radiotherapy followed by chemotherapy, that is, total neoadjuvant therapy is an acceptable alternative over postoperative concurrent chemoradiation to improve locoregional control postradical surgery. The two arms of our study are as follows (1) regimen of total neoadjuvant therapy, that is, preoperative short-course radiotherapy (25 Gy/5 fr/1 week) followed by chemotherapy with 6 cycles of capOx and (2) long-course chemoradiotherapy (CRT) (50.4 Gy/28 fr/5.5 weeks with concurrent capecitabine). The aim of the study is to compare the pathological response, margin negative surgery rates, and between these two approaches.

Materials and Methods: Patients with histologically proven locally advanced, nonmetastatic rectal adenocarcinoma were randomized into a study group and a control group—the study group received short-course radiotherapy (25 Gy/5 fr/1 week) followed by chemotherapy with oxaliplatin (130 mg/m²) and tab. capecitabine (825–1000 mg/m²) after an interval of 12–14 days post-short-course radiotherapy for a total of six cycles followed by surgery after 4 weeks of completion of chemotherapy and the control group received long-course radiotherapy (50.4 Gy/28 fr/5.5 weeks) with concurrent tab. capecitabine followed by surgery after 4–6 weeks of completion of radiotherapy. Histopathology reports were studied in both groups for the determination of pathological response of tumor and surgical margin status. All patients of the control group received adjuvant chemotherapy for 6 months with oxaliplatin and capecitabine but depending on the margin status and pathological response, study group patient may or may not need two cycles of oxaliplatin and capecitabine as adjuvant therapy.

Results: Overall pathological response (complete response + partial response) was 97.7% in the study arm and 87.2% in the control arm. Complete response rate was 53.3% in the study arm and 31.9% in the control arm. Margin negative surgery rates were higher in the total neoadjuvant arm than concomitant CRT (95.6% vs. 85.1%).

Conclusion: There is a significant difference between total neoadjuvant therapy and long-course concomitant CRT in terms of efficacy and the former can be used as an acceptable alternative to long-course CRT.

Genitourinary

GU-01: Interfraction Motion for Image-Guided Intensity-Modulated Pelvic Node Radiotherapy in Intermediate and High-Risk Prostate Cancer patients—Audit from Tertiary Care Hospital in Eastern India

Addway Chakraborty, Bidyut Mandal, Parna Basu, Janmenjoy Mondal, Annesha Sen, Md. Osman Gani; Department of Radiotherapy, Medical College and Hospital Kolkata, Kolkata, West Bengal, India

Background: Movement of pelvic lymph nodes is independent to the prostate. When delivering radiotherapy to prostate and pelvic lymph nodes (LNs), daily interfraction anatomical changes need to be accounted for planning target volume (PTV) margins, grown from the pelvic LN clinical target volume need to be determined, to account for this variation in position.

Objective: The aim of this article is to quantify the relative motion of the pelvic LNs, seminal vesicles (SV), and prostate and define indicative margins for image-guided radiotherapy based on bony anatomy or prostate correction strategies for a 3 degrees-of-freedom couch.

Materials and Methods: Thirty-five patients had a planning computed tomography (CT) scan and CBCT during radiation therapy. The prostate, SV, and external and internal iliac LN regions on the left and right were outlined on each CT scan. Systematic and random uncertainties were determined along with correlations between the motions of these regions. The clinical target volume to PTV margins required to take only motion into account were calculated for each guidance method. Offline verification was done on Eclipse (version 14.5).

Results: PTV margins of 0.4 cm, 0.4 cm, and 0.7 cm left–right (LR), superior–inferior (SI), and anterior–posterior (AP), respectively, were derived for the pelvic LNs when registering to the prostate. PTV margins of 0.3 cm, 0.2 cm, and 0.4 cm LR, SI, and AP, respectively, were derived for the pelvic LNs when registering to bone. There was a posterior systematic shift of the prostate during the treatment course.

Conclusions: There is differential motion of pelvic LNs to prostate in patients with node-positive prostate cancer; there is an increasing importance in the accuracy of dose delivery to the involved LN. Hence, this group of patients may benefit from personalized radiotherapy PTV margins, especially if the involved pelvic LN is within the anterior part of the clinical target volume.

GU-02: Surface Mold Brachytherapy for a Case of Penile Cancer to Preserve Sexual Function: A Case Report

Ankita Kusary, Sayan Paul, Indraneel Banerjee, Biplab Sarkar, Naziba K. Khondekar, Subhra S. Biswal, Kirubha George, Sandipan Roy Chowdhury, Prosenjit Soren; Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

Introduction: A young male aged 29 years old, newly married, came to Apollo Multispecialty Hospitals, Kolkata, with an ulcer at glans penis. The patient was seen and evaluated by uro-oncologist and was advised surgery. The patient was not ready for penectomy. Partial removal of the penile shaft would lead to loss of sexual function because the penile shaft was 2.5 cm when not erect.

Materials and Methods: The aim of the study is to retain sexual function, the cancer was excised carefully with intraoperative frozen section biopsy with a close margin to avoid significant shortening of the shaft and loss of sexual function. A customized surface mold along with 6-mm testes shield was designed by the team of radiation oncologist and medical physicist. A U-shaped open-ended hole is created in lead sheets to place the stem in upright position completely shielding the testis. A simulation CT was done with marking the area of interest for radiation with a wire. Gross and planning target volume was marked by radiation oncologist. Surface mold had six catheters with loading length of 5.5 cm and step size of 2.5 mm. Prescription dose was 21 Gy × 6 fr twice daily with at least 6 h gap. Dose to testes was evaluated using film and ion chamber measurement.

Result: Patient tolerated the treatment well with no severe reactions. Mean dose to testis is measured as 26% of the prescription dose. Maximum achievable dose reduction to testis was achieved with short stem size limiting the shielding thickness. Six-month follow-up revealed preservation of sexual activity.

Conclusion: Surface mold brachytherapy was successfully done by shielding the testes and sexual function preserved. This can be applied to treat similar cases of penile cancer where preservation of sexual function is necessary.

Gynecological Malignancy

GYN-01: Comparison of Dosimetric Parameters and Clinical Outcomes of Intensity-Modulated Radiotherapy versus Volumetric-Modulated Arc Therapy in Patients with Carcinoma Cervix: Two-Arm Prospective Comparative Study

Ananya Mahalanabish, Krishnangshu B. Choudhury, Chandan Dasgupta, Bidisha Naskar Ghosh, Suranjan Maitra, Debanjan Kundu, Sumana Samaddar; Department of Radiotherapy, R.G. Kar Medical College, Kolkata, West Bengal, India

Background: Radiotherapy (RT) plays a major role in the treatment of gynecological cancers. Worldwide cervical cancer remains the most common gynecological cancer.

Purpose: The purpose of this study was to compare dosimetric parameters and clinical outcomes of f-IMRT versus VMAT in treatment of carcinoma cervix (FIGO 2018 staging stage IB3–IVA) with definitive chemoradiation followed by brachytherapy.

Materials and Methods: This is a two-tailed, open-labeled, comparative, observational, single-institutional study. All patients with biopsy-proven cases of carcinoma cervix included. The sample size is calculated using G*Power 3.1.9.6, Germany free software, compared dosimetric parameters and clinical outcomes between VMAT and f-IMRT in radical irradiation for cervical cancer. The control arm will be patients treated with f-IMRT (Arm B).

Results: The median age of study population was 51 years. The average per fraction treatment time in f-IMRT was 260.47 ± 53.05 s against 139.69 ± 7.86 s in VMAT arm, P value 0.000. Likewise, the monitor units was significantly less in VMAT arm (mean 543.72 ±63.020) against 1365.00 ± 124.705 in f-IMRT arm, P value 0.000. There was no difference between the two arms in homogeneity index and conformity index between both arms. Response assessments using RECIST v1 criteria showed no statistically significant difference between both arms, but increased CR was in favor of VMAT arm. Among the acute adverse events, other than skin toxicities, there were no statistically significant differences between VMAT and f-IMRT arms. Both skin all-grade toxicities and toxicities more than equal to grade 3 were significantly less in VMAT arm. Even V_{45 Gy} for bowel, bladder V_{40 Gy}, and rectum mean doses were less in VMAT arm. Probably bladder and rectal adverse events which are more of late of chronic events, the impact of reduced dose in VMAT would become prominent.

Conclusions: By considering all cumulative results for cervix cancer patients, VMAT and IMRT technique are comparable in terms of dosimetric parameters and clinical response; VMAT technique can be preferable than IMRT for providing less treatment time and lesser toxicity.

GYN-02: Prospective Study Evaluating Acute Treatment-Related Toxicities of Prophylactic Extended Field Intensity-Modulated Radiation Therapy with Concurrent Weekly Cisplatin in Locally Advanced Carcinoma Cervix

Anindita Ray, Shyam Sharma, Srikrishna Mandal; Department of Radiotherapy, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India

Background: Locally advanced cervical cancer is at risk of para-aortic lymph node (PALN) metastasis and subsequent disease progression. Multiple evidence suggest prophylactic irradiation of PALNs by extended field technique improves recurrence-free survival and hence overall treatment outcome. With conventional radiotherapy, the toxicities from prophylactic extended field radiotherapy (EFRT) are of major concern. With modern conformal techniques like intensity-modulated radiation therapy (IMRT), patients tolerate prophylactic EFRT better. So, this study was aimed to assess the acute radiation-induced toxicity profile of prophylactic EFRT using IMRT.

Materials and Methods: Fifty-eight patients of locally advanced carcinoma cervix (IIB–IVA) with radiologically negative PALNs were treated with prophylactic extended field radiation technique using IMRT at a dose of 50 Gy/25#/5 weeks with concurrent weekly injection cisplatin (40 mg/m²). Those with positive pelvic lymph nodes were treated with a total dose of 55–60 Gy in 2.0–2.4-Gy daily fractions using simultaneous integrated boost-IMRT. After EBRT, all patients received intracavitary brachytherapy (21 Gy/3#/3 weeks). Data regarding the safety profile and clinical outcome were recorded.

Results: Median age of patients at diagnosis was 51 years. About 87.3% of cases were of FIGO stage III–IVA. Commonest acute toxicities were hematological and gastrointestinal. Grade 3 anemia was seen in 17 patients (29.3 %) and grade 2 in 31 patients (53.4%). Grade 3 leukopenia and neutropenia was seen in 4 patients (6.9%) and grade 2 in 32 patients (55.2%). Grade 3 acute gastrointestinal toxicity was seen in five patients (8.6%) and grade 2 in nine patients (15.5%). At a median follow-up of 12 months, 89.6% of the patients had no PALN which was higher than the patients with para-aortic recurrence (10.3%).

Conclusions: Prophylactic EF-IMRT is a feasible option for locally advanced cervical cancer patients with radiologically negative PALN and is associated with acceptable hematological and gastrointestinal toxicity and better pelvic and para-aortic nodal control.

GYN03: A Retrospective Study of the Pattern of Recurrence in Patients of Carcinoma Endometrium: A Tertiary Care Single Center Clinical Audit

Sharmistha Roy, Debottam Barman, Anamika Mandal, Bithi Pal, Asit Ranjan Deb; Department of Radiation Oncology, Medical College, Kolkata, West Bengal, India

Background: Endometrial cancer (EC) is the fourth most common gynecological malignancy affecting Indian women. It has a good prognosis especially if diagnosed in the early stage. This study aims to identify the rates and patterns of relapses in early, nonmetastatic endometrial cancer and provide an overview on this important aspect.

Materials and Methods: A retrospective study of 183 patients with early-stage cancer endometrium was carried out. The patients were divided into the ESMO–ESGO–ESTRO risk classes (low risk [LR], intermediate risk [IR], intermediate–high risk [I–HR], and high risk [HR]). The study period was from January 2016 to December 2021. The histology, rate, and patterns of recurrence were identified and analyzed during this period.

Results: The disease recurred in 23 out of the 183 patients assessed. The recurrence rate in the HR, LR, IR, and I–HR groups were 43.4%, 8.69%, 13.04%, and 34.7%, respectively. The sites of relapse were mainly loco-regional, that is, the vaginal vault (56.6%), pelvic nodes (30.3%), and para-aortic nodes (17.39%). About 8.69% cases presented with distant metastases, seen mainly in the HR group. Among the different histologies, the endometriod variety had a better prognosis.

Conclusion: It is necessary to identify the different biological factors to stratify patients at a higher risk of relapse. This could help us to build up community guidelines for improving follow-up of early EC patients and guide us in early detection of relapses.

GYN-04: A Comparative Dosimetric Analysis of Target and Organs at Risk to Evaluate the Effect of Urinary Bladder Filling during External Beam Radiotherapy of Carcinoma Cervix

Soirindhri Banerjee, Shubha De Sarkar, Souvik Paul, Suparna K. Pal, Aloke Ghosh Dastidar; Department of Radiation Oncology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Background: In the treatment of carcinoma cervix by concurrent chemoradiation (CTRT) followed by intracavitary brachytherapy, protecting the neighboring organs from radiation toxicity is challenging as the normal tissue tolerance is a major dose-limiting factor in pelvic irradiation. The volume of the urinary bladder, a controllable influencing factor, provides scope for prevention of OAR toxicities. For the lack of a recommended urinary bladder volume for cervical radiotherapy, this study compares the radiation dose received by target and organs at risk during CTRT by varying urinary bladder volume.

Materials and Methods: This is a prospective, observational study conducted from February 2021 to July 2022 where locally advanced cervical carcinoma patients were categorized into two arms, ARM0—empty bladder and ARM50—partially full bladder (500 ml fluid intake over 1 h pretreatment) and planned and treated accordingly. The following were recorded for each arm and compared using SPSSv7.51.0: D₉₈ of gross tumour volume (GTV), D₉₀ of GTV, D₉₀ of CTV, V_{45 Gy} of urinary bladder, D_Mean of urinary bladder, V_{45 Gy} of rectum, and D_Mean of rectum.

Results: In ARM0 and ARM50, the mean bladder volume was 62.08 ± 5.1531 cm³ in ARM0 and 224.92 ± 6.9862 cm³ in ARM50. The dosimetry was as follows: D₉₈ GTV (Gy) = 43.06 ± 4.7275 and 44.63 ± 2.9250 (P = 0.3614), D₉₀ GTV (Gy) = 44.89 ± 3.5721 and 46.62 ± 2.1166 (P = 0.0831), D₉₀ CTV (Gy) = 45.49 ± 4.3944 and 46.70 ± 0.9839 (P = 0.0789), V₄₅ UB (%) = 93.43 ± 11.1737 and 85.46 ± 11.2837 (P = 0.0233), D_Mean UB (Gy) = 47.11 ± 2.7043 and 48.15 ± 3.2584 (P = 0.0773), V₄₅ rectum (%) = 80.37 ± 12.8245 and 68.15 ± 14.4904 (P = 0.0051), D_Mean rectum (Gy) = 45.77 ± 3.5997 and 42.53 ± 2.9963 (P = 0.0434) for ARM0 and ARM50, respectively.

Conclusions: A urinary bladder filled up to 220–230 cm³ may be a better protocol than an evacuated bladder in terms of bladder and rectal dosimetry.

GYN-05: Pattern of Cervical Cancer among Geriatric Patients in a Tertiary Cancer Center in West Bengal (A Hospital-Based Retrospective Study)

Soumya Dey, Abhishek Basu, Rajat Bandyopadhyay, Suparna Ghosh (Ray); Department of Radiation Oncology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: Cervical cancer is a major health-related problem among female population worldwide. Its incidence among the elderly group of patients seems to be increasing. Sociodemographic along with clinical profile of patients is the first step in planning preventive and curative measures. We thus conducted a retrospective analysis of demographic and clinical profile of elderly patients suffering from cervical cancer visiting our institute.

Materials and Methods: Hospital case records of 179 elderly patients (age ≥ 60 years) suffering from cervical cancer attending radiation oncology outpatient department (OPD) of Burdwan Medical College and Hospital from January 2019 to December 2020 were retrospectively analyzed for a sociodemographic profile, symptoms, histology, and staging.

Results: The median age of the cohort was 66 years (range 60–85 years). Patients mostly belonged to the age group of 60–64 years. The majority of patients hailed from rural background of Burdwan and other adjacent districts. All the patients were multiparous. The most common presenting symptoms were discharge, bleeding from vagina, and pain in abdomen; present in 90(50.13%), 57(30%), 32(17.88%) patients, respectively. One hundred and sixty-two (90.5%) patients had advanced stage (II–IV) at the time of presentation, while the number of cases diagnosed at early stage was only 17 (9.5%). Sixty-five percent had associated comorbidities. Squamous cell carcinoma was the most common histopathology (89.94%).

Conclusion: The study brings forth the background profile of the elderly patients suffering from cervical cancer. Since the majority of patients are present in an advanced stage of disease, appropriate preventive steps and also the possibility of initiating screening measures should be sought among an elderly group of cervical cancer patients.

Miscellaneous

MISC-01: Distribution of Cancer Patients According to Time Taken from Starting Day of Symptoms to Reporting at Cancer Care Hospital

Seenu Viswanathan, Pratibha Kole, Suman Dhabal, Sourav Sau, Ghosh Suparna (Roy); Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: In India majority of the cases of cancer present to a hospital in advanced or metastatic stage. Due to advanced stage of presentation, the occurrence of morbidity and mortality is considerably high. This occurs because commonly patients report to hospital after some delay from the time of starting of the symptoms of malignancy. The purpose of this study is to find out the various factors causing this delay.

Materials and Methods: A cross-sectional study was conducted in a peripheral tertiary care cancer institution in Eastern India in the month of December 2022. Interval between starting day of symptoms to reporting at cancer care hospital and stage of disease at presentation were the chief parameters assessed in this study. Patients having histological/cytological proof of malignancy of all gender and age groups, having Eastern cooperative oncology group-performance status 0–3 were included in this study. Patient unable to remember the delay between onset of symptoms and time of presenting to hospital, with inadequate information regarding staging and refusing to provide written consent for participation were excluded. Patient satisfying inclusion and exclusion criteria were interviewed regarding study parameters. Data thus obtained were compiled and analyzed using Microsoft excel software.

Results: Total number of patients taken for this study is 183, where 8 patients could not remember the gap between symptoms and arrival to hospital. Among them, 55 (31%) were males and 120 (68.57%) were females. Location—rural (65%) and urban (34.28%). Commonest site of cancer—breast (30.3%), cervix (24.0%), lung (9.1%), larynx (5.1%), and oral cavity (4.0%). Stage at presentation—stage 1—2.28%, stage 2—34.85%, stage 3—46.28%, and stage 4—16.57%. Incidence of patients presenting with advanced stage cancer (stage 3 and 4) with delay >1 month was 64.2%, >3 months was 84.4%, and >6 months 97%, respectively.

Conclusions: Conclusion can be drawn from this study that patients having more delay presented with higher stage of cancer which was statistically significance (P = 0.000).

MISC-02: Perceptions about Cancer and Its Treatment in Patients and Their Caregivers—The PACT Study

Suman Dhabal, Abhishek Basu, Pratibha Kole, Debopriyo Halder, Suparna Ghosh (Roy); Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: There are many unproven beliefs and myths about cancer that exacerbate the challenges faced in its diagnosis and treatment. False cultural perceptions affect cancer care along the entire disease continuum: from prevention and early detection, treatment choices, and adherence rates, management of side effects such as pain and its control, to appropriate psychosocial support, rehabilitation efforts, survivorship issues, hospice, and effective end of life care. Our study aims to shed some light on the myths and perceptions prevailing among the patients and their caregivers regarding cancer and its treatment.

Materials and Methods: A cross-sectional study was done among the patients attending the Radiotherapy Department of Burdwan Medical College in January 2023. Included were patients having a definite cytological/histological proof of malignancy and their caregivers who provided written informed consent. Excluded were those who were unable to understand the question or who had psychiatric illness rendering them unsuitable for this study. Subjects were interviewed with a pretested questionnaire regarding various possible perceptions regarding cancer and its treatment. Responses thus collected were assembled to generate data which was then subjected to statistical analysis.

Results: Two hundred and thirty-five subjects were enrolled for this study. Out of them, 46.4% were patients and 54.6% were caregivers. About 57.9% were females and 42.1% were males; minimum age 15 years, maximum age 82 years, and median age 48 years. About 81.3% of subjects were from rural background. Most common diagnosis were Ca breast, Ca cervix, Head and neck cancers, and Ca lung. Fifty-two percent of the subjects believed that cancer is a result of punishment by almighty, while 15% believed that cancer is a result of sins. Ten percent believed that smoking is the only cause of lung cancer, 12.3% believed that a lump in the breast means breast cancer; 20.9% of subject believed that cancer is contagious; 27.7% and 24.3% believed that eating sweet and sour foods can make cancer worse, respectively; 31.1% believed that restriction of food is essential during treatment.

About 16.2% and 19.6% of subjects believed that needle biopsy and surgery causes cancer to spread; 18.3% believed that alternative medicines can cure cancer; 49.85% believed that cancer always causes pain; and 10.6% believed cancer is a death sentence.

Conclusion: Conclusion can be drawn from this study that there are a lot of various beliefs and myths about cancer that exacerbate the challenges faced in its diagnosis and treatment.

MISC-03: Patterns of Tobacco Use among Cancer Patients Attending a Rural Tertiary Care Center—An Observational Study—POTUCS

Pratibha Kole, Abhishek Basu, Abhay Chakrabarty, Suman Dhabal, Manu G Madhav, Suparna Ghosh (Roy), Rajat Bandyopadhyay; Department of Radiation Oncology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: Cancer patients commonly present with antecedent addiction to tobacco consumption. Tobacco consumption after cancer diagnosis is also associated with worse tolerance of treatment, higher risk of a failure and second primary tumors, and poorer quality of life. Despite the apparent impact of tobacco use on treatment outcomes, data on pattern of tobacco use are only rarely captured in clinical trials. No clear data regarding tobacco use in the Indian rural population are available. Hence, the present study has been done to assess the pattern of tobacco use among cancer patients attending a rural tertiary cancer hospital.

Aim: The aim of this study is to estimate the pattern of tobacco use among cancer patients (with respect to the clinical and demographic variables) attending a rural tertiary cancer hospital.

Materials and Methods: A survey using a self-made questionnaire was conducted over 2 years. The duration, frequency, and dose of different tobacco products used by the patients were analyzed with respect to the clinical and demographic variables. The cause of using tobacco products, and the knowledge regarding and attitude toward tobacco were also analyzed.

Results: A total of 142 cancer patients, who were more than 18 years of age, were interviewed. The mean age of patients was 55.58 years. Most of the patients were males. Most smoked beedi (83.8%). Some patients also consumed alcohol (45.8%). Out of those consuming beedi, nearly 40% of the patients consumed one packet (20 beedis) per day. Seventy-five percent of the patients began consuming tobacco at the age of 18 years or younger.

Conclusion: The diagnosis of cancer is a life-altering event, which results in higher motivation to quit the use of tobacco. Smoking cessation initiatives can reduce the risk of developing tobacco-related malignancies.

MISC-04: A Prospective Observational Study to Quantify Set-Up Errors Using Electronic Portal Imaging Device in Head and Neck, Brain and Pelvic Malignancies Being Treated by Intensity-Modulated Radiation Therapy and Its Impact on Planning Target Volume Margin for These Subsites

Tarun Selvakumar, Gautam Bhattyacharjee, Soumadip Panda; Department of Radiation Oncology, Saroj Gupta Cancer Centre and Research Institute, Kolkata, West Bengal, India

Study Design: This is a prospective observational study.

Materials and Methods: Between February 2021 and June 2022, 20 patients with head and neck malignancies, brain malignancies, and pelvis malignancies each (total of 60 patients) being treated in LINAC by IMRT technique in our center Saroj Gupta Cancer Center and Research Institute have been observed for daily setup errors determined by matching images of DRR and EPID images taken on first 3 consecutive days and then weekly once the image was taken on subsequent weeks throughout the entire course of treatment. Systematic and random errors were calculated for three subsites in three directions separately (lateral, vertical, and longitudinal directions). PTV margins were calculated by the van Herk formula and are compared with current institutional PTV margins used.

Results: The current study showed that the mean setup errors were found to be 0.03 mm, 0.08 mm, −0.35 mm in head and neck; 0.14 mm, 0.03 mm, −0.61 mm in brain; and 0.04 mm, 0.26 mm, 1.06 mm in pelvis malignancies in lateral, vertical, and longitudinal directions, respectively.

The systematic errors and random errors of head and neck malignancies were found to be 0.75 mm, 1.02 mm, and 0.94 mm, and 1.51 mm, 1.99 mm, and 2.11 mm; of brain malignancies 0.56 mm, 0.68 mm, and 1.15 mm and 1.61 mm, 1.31 mm, and 2.38 mm; and of pelvic malignancies as 1.35 mm, 1.33 mm, and 1.73 mm and 5.04 mm, 3.81 mm, and 4.55 mm in lateral, vertical, and longitudinal directions, respectively. PTV margins are determined as 2.93 mm, 3.95 mm, 3.83 mm in head and neck, 2.52 mm, 2.63 mm, 4.55 mm in the brain, 6.90 mm, 6.00 mm, 7.52 mm in pelvic malignancies in lateral, vertical, and longitudinal direction, respectively, by van Herk formula.

Conclusion: The PTV margins in head and neck, brain, and pelvic malignancies determined by the van Herk method from the setup errors obtained through our study remain well within the PTV margins being currently used in our institute and close to those similar studies published:

The setup margins were <5 mm in all three directions in head and neck cancer patients.

The setup margins were <5 mm in all three directions in brain malignancy patients.

The setup margins were <8 mm in all three directions in pelvic cancer patients.

With the help of setup error data collected from our institute and calculation of setup margins by using the van Herk formula, we can possibly come to a conclusion that judicious use of 5 mm around CTV should adequately be the treatment required for target coverage in head and neck cancer and brain malignancies and <10 mm in pelvic malignancies.

MISC-05: Unplanned Interruption of Radiation Treatment Due to COVID-19 Impact: A Retrospective Observational Study in Tertiary Care Institute

Sayan Pal, Suparna Ghosh (Ray); Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: The aim of the study was to find out the impact of the COVID-19 disease over the patient those who were taking radiation therapy in the duration from March 2020 to October 2021. The cause of unplanned interruption of the treatment was in various contexts like immunosuppression due to cancer, comorbid condition related to COVID-19 pandemic.

Materials and Methods: The study is retrospective observational study on cancer patients undergoing radiation in that duration. We collected the data of the patients those who were registered and planned for radiation treatment from the record section. The study’s primary outcome is to investigate the effect of treatment interruption in terms of sociodemographic pattern in both sexes, natures of disease in both sexes, and how many completed successfully.

Results: We have included all the eligible patients planned for radiation from March 2020 to October 2021. Among 713 patients, total treatment interruption was 173. Among them 129 patients were found COVID-19 positive by diagnosis, 77 patients had less than 2 weeks’ treatment interruptions and remaining 52 patients had more than 2 weeks’ treatment interruptions. After recovery, 47 patients resumed and completed their treatment. Remaining 44 treatment interrupted patient’s treatment resumed within 7 days, 20 patients were febrile but did not do the test in spite of advice and treatment received within 7 days after recovering from fever; 24 patient’s treatment interrupted due to other radiotherapy-related complications. Carcinoma cervix and carcinoma breast patients were found more in number.

Conclusions: COVID-19 had a detrimental impact over radiation treatment and follow-up of cancer patients. There was a longer duration of treatment interruptions in diagnostically proven COVID-19-positive patients in comparison to COVID-19-negative patients. Most of the patients were female because of they were incapable to reach institutions in the situation without male attendants.

MISC-06: Real-World Outcomes of Solitary Plasmacytomas of Bone at a Tertiary Care Academic University Hospital in North India

Deep Chakrabarti, Bushra Khalid, Sumaira Qayoom¹, Kirti Srivastava, Rajeev Gupta, Madan Lal Brahma Bhatt; Departments of Radiotherapy, ¹Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India

Background: Solitary plasmacytoma is a relatively rare localized neoplasm of plasma cells. While most of our knowledge about them is extrapolated from retrospective studies, there is a dearth of data from developing nations.

Materials and Methods: This retrospective cohort study included all patients diagnosed with biopsy-proven solitary plasmacytomas of bone (SPB) who received radiotherapy at our department between 2013 and 2022. Patient details were obtained from a prospectively maintained database. Management decisions were guided by a multidisciplinary team. Clinical outcomes were recorded and analyzed.

Results: Twenty-seven patients underwent radiotherapy in these 10 years. Epidemiological details were as follows: median (interquartile range) age was 46 (39–55) years, male:female 2.8:1. The primary tumor location was thoracic vertebra (33%), lumbar vertebra (22%), long bones (22%), and other sites (22%). The most common presenting symptom was pain (74%) followed by swelling (37%). Three patients presented with spinal cord compression. Paraprotein estimation was available in 14 patients. The most commonly altered was IgG which was elevated in five patients. One patient each had kappa and lambda chain excess. Three patients had undergone surgery. All patients received radiotherapy. The most commonly prescribed radiotherapy dose was 45 Gy in 25 fr (range 8–50 Gy). The median duration of radiotherapy was 38 days (range 1–47 days). The median follow-up duration was 47 months, with 11 events (deaths). Two patients had a local relapse. The 5-year overall survival was 51% while the 5-year multiple myeloma-free survival (MMFS) was 43%. The median overall survival was 61 months, while the median MMFS was 24 months. Twelve patients (44%) had progressed to multiple myeloma at a median time of 20 months.

Conclusion: The risk of progression of SPBs to multiple myeloma is significant and requires adjunct therapies, which are currently being investigated.

MISC-07: Successful Treatment of Keloid with Postoperative Electron Beam Therapy: A Single Institute Experience

Mani Tirthankar Das, Sayan Paul, Adhish Basu, Naziba K. Khondekar, Biplab Sarkar, Subhra S. Biswal, Sandipan Roychowdhury; Department of Radiotherapy, Apollo Multispeciality Hospital, Kolkata, West Bengal, India

Background: Keloid is a benign skin condition with high recurrence rate which is difficult to cure with only surgery or medical treatment. Postoperative electron beam therapy is an effective treatment to cure keloids and stop its recurrence.

Materials and Methods: Keloid patients were treated immediately postoperatively with electron beam. Patients were bought to linear accelerator room (NovalisTx, varian) from the operation room and the first treatment was given within 24 h of surgery. In total, three treatments were given on 3 consecutive days. Total dose given 15–18 Gy in 3 fr with bolus of appropriate thickness, the energy of electron beam was prescribed according to the depth of the target.

Result: In total, 18 patients were treated postoperatively with total 20 keloid sites: chest wall: 13, abdomen: 1, ear: 4, and arm: 2. Among these 20 keloids, 18 had symptoms of itching, discharge, pus formation, and secondary infections. The follow-up period is 8 months–20 months. Among these, for 18 patients till last follow-up, no patient had any recurrence. For patient-reported outcome, a telephonic scoring system was used ranging from 1 to 3: score 1: no improvement, not satisfied; score 2: decreased symptom but not completely cured; and score 3 being completely cured and no symptoms. We got score 3 from all our patients except one who has scored 2 because of itching in that area.

Conclusion: Adjuvant electron beam therapy within 24 h after cosmetic excision of keloid is an effective treatment of keloids.

Category: Proffered

HN-01 (Proffered): Advantage of Oral Metronomic Chemotherapy over Symptomatic Management in Locally Advanced Head and Neck Squamous Cell Carcinoma at High-Volume Center with Delayed Dates for Radiation

Ipsita Palui, Sayani Poddar, Koushik Chatterjee, Aloke Ghosh Dastidar; Department of Radiotherapy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Background: Delayed radiation dates are quite common and an unavoidable factor resulting in increased overall treatment time and poor local control. This study determines the advantage of adding oral metronomic chemotherapy till the radiation dates are given in locally advanced cases of head and neck squamous cell carcinoma (LAHN-SCC).

Materials and Methods: Sixty patients of LAHN-SCC (except nasopharynx, cancer of unknown primary) between 18 and 65 years of age, Eastern cooperative oncology group-performance status 0–2, no prior treatment, and no distant metastasis were prospectively randomized into 1:1. In the study arm, 30 patients were given the oral metronomic regimen of tab. celecoxib (200 mg) one tablet once daily along with tab. methotrexate (5 mg) twice in a week till radiation dates are given. In the control arm, patients were given symptomatic managements till radiation dates are given. Assessment of tumor response, toxicities, and quality of life measured using RECIST criteria, RTOG scale, EORTC QLQ30, respectively. Disease-free survival and overall survival were measured at 1 year. Patients were followed up until 1 year.

Results: There is a statistically significant result in preradiotherapy response (P ≤ 0.0001). Quality of life at 6-month and 12-month post-treatment also shows statistically significant value (P ≤ 0.0001). There is a comparable tumor response, toxicities (anemia, febrile neutropenia, nausea, vomiting, diarrhea, dermatitis, mucositis), overall survival and disease-free survival, and no statistical difference between the two arms (P ≥ 0.05).

Conclusion: In conclusion, the use of oral metronomic regimen of tab. celecoxib and tab. methotrexate till radiation dates are given in locally advanced carcinoma of the head and neck is an alternative option to achieve comparable tumor response with better quality of life scoring, and it does not require any additional radiation resource. This study establishes a comparable toxicity.

TH-01 (Proferred): Changes in the Lung Function Parameters before and after Chemo-Radiation in Locally Advanced NSCLC—A Prospective Observational Study

Dipankar Dolai, Aloke Ghosh Dastidar, Suparna K. Pal; Department of Radiation Oncology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Background: Nonsmall cell lung cancer is a leading cause of death globally with an estimated 1.8 million new cases occurring in 2012 which accounted for about 13% of the total cancer diagnosed. It is also the most common carcinoma in India, where approximately 63,000 new lung cancer cases are reported each year. About 80% of these patients are present in advanced stage (stage 3 and stage 4) of the disease.

Aims: The aim of the study is to study the impact of chemoradiation on respiratory health particularly on spirometry value in nonsmall cell lung cancer patients and plan necessary actions accordingly if required.

Materials and Methods: The present study was a prospective, observational, open-label, single-institutional study. This study was conducted from February 2021 to February 2022 at the Department of Radiotherapy, IPGMER and SSKM Hospital, Kolkata. In total, 62 patients were included in this study.

Result: Mean PFT after 2 weeks of CTRT forced expiratory volume in the first second/forced vital capacity was more in stable [105.7500 ± 9.8493] compared to progressive disease [91.8182 ± 19.1028] or metastatic disease [78.0000 ± 0.0000]. It was statistically significant (P < 0.0001).

Conclusion: This study demonstrates that post-CTRT spirometric value (forced expiratory volume in the first second/forced vital capacity) improved significantly in stable disease than progressive or metastatic disease from the baseline in locally advanced nonsmall cell lung cancer. Hence, we can conclude that in respect of long-term pulmonary function, CTRT is an effective modality of treatment for locally advanced nonsmall cell lung cancer.

TH-02 (Proffered): A Comparative Study Evaluating Dosimetry, Clinical Outcome, and Toxicities after Radical Chemoradiation in Esophageal Carcinoma Using Volumetric Modulated Arc Therapy versus Step and Shoot IMRT

Osman Gani, Bidyut Mandal, Parna Basu, Janmenjoy Mondal, Annesha Sen, Addway Chakroborty; Department of Radiation Oncology, Medical College & Hospital, Kolkata, West Bengal, India

Background: Esophageal cancer is the eighth most common cancer worldwide. Globally, there were an estimated 604,100 new cases of, and 544,100 deaths from, esophageal cancer in 2020 and the fourth common cause of cancer-related deaths in India. This comparative study analyzed the respective advantages and disadvantages by comparing volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) on the dose distribution, clinical outcome, and toxicities in esophageal cancer radiotherapy with weekly concurrent injection paclitaxel and carboplatin for 5 weeks in order to provide the reference for the clinical radiotherapy technology optimization of esophageal cancer.

Materials and Methods: A total of 60 cases of patients with esophageal cancer were selected and applied to the three-dimensional radiation treatment-planning system, in order to design a VMAT plan and IMRT plan under the guidance of image-guided radiotherapy. The dosimetry and position verification difference were compared between the two groups.

Results: Revealed that the target dose distribution of the VMAT plan and IMRT plan meets the requirements in clinical dosimetry for all 60 patients in this study. Under the premise of similar target coverage, the conformal index of the VMAT plan, homogeneity index, target volume, BODY-PTV radiated volume and spinal cord D_max, bilateral lung V₂₀ and heart mean dose as well as position verification and others were obviously superior to those in the IMRT plan, and the difference was statistically significant.

Conclusion: CBCT-guided VMAT is a potentially more effective and safer treatment than IMRT for esophageal carcinoma.

GYN-01(Proferred): A Prospective Comparative Study of Concurrent Chemoradiation with Injection Cisplatin versus Injection Gemcitabine and Cisplatin Chemotherapy in Locally Advanced Cervical Carcinoma

Ashmita Ghosh, Sumana M. Das; Department of Radiotherapy, IPGME&R & SSKM Hospital, Kolkata, West Bengal, India

Background: Cervical carcinoma poses to be a potential threat both to the developed and developing countries till date. Although a lot of awareness programs have encroached into the common population regarding the severity and modifiable risk factors of the disease, it still remains to be a leading cause of death due to carcinoma among the female population.

Materials and Methods: In this study, we have incorporated locally advanced cases of carcinoma cervix patients and randomized them in two separate groups. In the conventional arm, we have treated the patients with EBRT 50 Gy in 25# along with injection cisplatin as the concurrent CT followed by brachytherapy, whereas in the study arm, we have treated the patients with injection gemcitabine and cisplatin as the concurrent CT.

Results: About 53.33% patients belonged to stage IIIB foreign the injection cisplatin group. In both the groups, 83.33% and 80% of patients, respectively, present with complete response at the end of 6 weeks. In the study arm, 30% of patients pressed with acute onset anemia of grade 1 and 50% of patients presented with grade 4 toxicities. Thirty percent of patients presented with febrile neutropenia from the study arm.

Conclusions: Standard therapy poses almost similar outcomes in terms of tumor control if compared to the study arm. However, the toxicity profiles in the study arm needs more meticulous management, and if done so, it emerges as potential area for further research.

GYN-02 (Proferred): Determination of Magnitude of Late Toxicities Specially Bladder and Rectal Toxicities in Patients of Carcinoma Cervix Who Have Completed the Treatment with Concurrent Chemoradiotherapy Followed by Intracavitary Brachytherapy

Sayan Dasgupta, Sanatan Bannerjee; Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Background: Cervical cancer continues to be a major public health problem. Women with locally advanced CA cervix (stage IB2–IVA) have a higher rate of recurrence and worse survival. For them, the use of concurrent chemoradiotherapy with intracavitary brachytherapy has increased the overall and progression-free survival.

Aims and Objective: The aim of the study is to determine the magnitude of late Toxicities, especially bladder and rectal toxicities in the patients of carcinoma cervix who have completed the treatment by concurrent chemoradiotherapy followed by Brachytherapy.

Materials and Methods: The proposed study is prospective observational and hospital-based study. Patients attending the Radiotherapy Outpatient Department of Burdwan Medical College and Hospital between the period of February 2021–June 2021 with biopsy-proven malignancy of cervix in locally advanced stage are selected. A convenience sampling method is applied. Patients have received concurrent chemotherapy with cisplatin 40 mg/m² weekly at chemotherapy ward and external beam radiotherapy (50 Gy in 25 fr over 5 weeks, 2 Gy/day for 5 days in a week) to the whole pelvis followed by 3 fr of intracavitary brachytherapy by Cobalt-60 high dose rate brachytherapy, 1 fr weekly of a dose of 7 Gy each for 3 weeks, dose prescribed at point A, 7 Gy/fr.

Patients who have completed treatment with CCRT followed by brachytherapy will be considered for evaluation. Patients are followed up for 3 monthly for at third, sixth, and ninth month at Gyne-OPD and RT-OPD. They are reviewed at RT-OPD with cystoscopy and proctoscopy reports. Toxicities of the bladder and rectum will be measured by radiation therapy oncology group late radiation morbidity scoring system.

Results: Out of 60 patients studied, G1 and G2 bowel toxicity is 18%, 20%, 12%, and 5%, 11%, 12% during first, second, and third follow-ups, respectively. Only two patients had rectal bleeding and discharge during second and third follow-ups (grade 3 rectal toxicity). Only one patient developed fistula formation during the last follow-up (Grade 4 bowel toxicity). Seventy-four percent of patients show no bowel/rectal toxicities during all three follow-ups.

G1 and G2 bladder toxicity is 22%, 27%, and 20% and 5%, 11%, and 9% during the first, second, and third follow-ups, respectively. Only one patient showed grade 3 bladder toxicity presenting with severe frequency and dysuria, frequent hematuria during the third follow-up at 9 months. No grade 4 bladder toxicity is found. Seventy-six percent of patients showed no bladder toxicity during all three follow-ups.

Conclusions: It is concluded that higher grade (grade 3 or 4) bowel and bladder toxicities are very less [only 1%] among the treated patients during all three follow-ups. Most of the toxicities were G1 or G2 toxicities. Seventy-five percent to 80% of the patients had no late bowel and bladder toxicities during all three follow-ups after treatment.

GYN-03 (Proferred): Conventional Four-Field Radiotherapy versus 3D Conformal Radiotherapy Planning in Locally Advanced Carcinoma Cervix Patients: A Dosimetric Evaluation

Jagrati Yadav, Seema Gupta¹, Indra Jeet Gupta¹, Arunima Ghosh¹, Jasmeet S. Tuteja¹, Madan Lal Brahma Bhatt¹; Department of Radiation Oncology, Kalyan Singh Super Speciality Cancer Institute and Hospital, ¹Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India

Background: Carcinoma of the uterine cervix is the second most common malignancy to affect females in developing countries. With advancements in imaging, wide variations in pelvic anatomy have been observed, thus raising doubts about adequate target volume coverage by conventional external radiotherapy fields based on bony landmarks. The present study dosimetrically compared conformal and conventional radiotherapy techniques and evaluates the need for integrating computed tomography (CT)-based planning on a routinely basis in carcinoma cervix.

Materials and Methods: Patients with histologically proven, previously untreated cervical cancer FIGO 2018 stage IIB–IVA [excluding IIIC], and fit for chemoradiotherapy registered at the Department of Radiotherapy, KGMU, were included. Their ages ranged from 42 to 64 years (median 54.5 years). All patients underwent CT-based simulation after IV contrast for proper target delineation; Target volume delineation and nodal contouring were done as per standard guidelines. The 2DCRT plan was generated based on bony landmarks using the digitally reconstructed radiographs on treatment-planning system. All patients were planned for radical radiation of 50 Gy delivered in 25 fr by external beam radiotherapy. The volume of target receiving 95% of prescribed dose (PTV95) was calculated after superimposing a conventional four-field box on digitally reconstructed radiograph. The geographic difference with conventional four-field was compared with 3D-based target volume delineation. Data were analyzed using SPSS and appropriate statistical tests were applied. All patients were treated with three-dimensional conformal radiotherapy followed by high dose rate intracavitary brachytherapy of 7 Gy in 3 fr, 1 fr/week.

Results: The median V₉₅ for conventional fields marked with bony landmarks were only 87.7% as compared to 98.9% for target delineation based on CT contouring. In only 1 patient out of 42 was the whole target volume encompassed by a four-field box marked on bony landmarks. In anteroposterior view, marginal misses ranged from 0 to 6.11 cm. Mean marginal misses were maximum at the superior margin (2.58 ± 1.36 cm) and minimum at the inferior margin (0.56 ± 1.09 cm). Miss at superior margin was seen in all patients 100% (n = 50) and at inferior margins in 44%. In lateral view, marginal misses ranged from 0 to 6.1 cm. Mean marginal misses were maximum in superior margin (2.57 ± 1.39 cm) and minimum at anterior margins (0.26 ± 0.38 cm). There was no marginal miss at posterior border. No significant difference in mean dose volume parameters was observed between conventional four-field and 3D-computed tomography methods for anorectum; however, for bladder, bowel, and femur, conventional method had significantly higher dose volume as compared to that of 3D-computed tomography method. Conversely, the mean dose to the bladder and bowel was increased significantly in the standard four-field plan when compared with the conformal-based plan.

Conclusion: The findings of the present study showed inadequate target volume coverage with conventional four-field box technique compared to 3D-CRT. The routine use of CT-based planning may be beneficial for treatment with radiotherapy in carcinoma cervix for target volume coverage.

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