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   Table of Contents - Current issue
January-June 2021
Volume 1 | Issue 1
Page Nos. 1-48

Online since Thursday, January 6, 2022

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Dreams come true p. 1
Santanu Pal
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Hippocampal avoidance prophylactic cranial irradiation in small cell lung cancer: Ready for prime time? p. 2
Tejpal Gupta
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Oligometastatic nasopharyngeal cancer: Intent and approach? p. 6
Sarbani Ghosh Laskar, Anuj Kumar, Shwetabh Sinha
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Prognostic value of baseline white blood cell count and neutrophil–lymphocyte ratio in carcinoma cervix p. 8
Amani Bhogadi, Rohith Singareddy, Harjot Kaur Bajwa, Alluri Krishnam Raju
Aims: To evaluate the impact of baseline white blood cell (WBC) count and neutrophil–lymphocyte ratio (NLR) in carcinoma cervix patients treated with definitive chemoradiotherapy. Settings and Design: Retrospective cohort study, original research article in Department of Radiation Oncology, Basavatarakam Indo American Cancer hospital. Materials and Methods: Patients of squamous cell carcinoma cervix treated with radical chemoradiotherapy from January 2017 to August 2017 were included in the analysis. All patients had baseline blood counts, local imaging, and metastatic workup at diagnosis. Patients received external beam radiotherapy to a total dose of 50 Gy in 25 fractions along with weekly cisplatin (40 mg/m2) and brachytherapy (21 Gy in 3 fractions). Baseline WBC counts and baseline NLR were correlated with outcomes using chi square test and receiver operating characteristic curves. Statistical analysis used: The patients were divided into two groups based on high-baseline WBC count and normal-baseline WBC count. Baseline WBC counts and baseline NLR were correlated with patterns of recurrence using chi square test. The sensitivity and specificity of prognostic factors for recurrence were computed using ROC curves. Results: The NLR cut-off value of 3.47 had high sensitivity and specificity for predicting recurrence in these patients. Majority of the recurrences in patients having high WBC count and high NLR were distant recurrences. Conclusions: A high-baseline WBC count and high NLR resulted in higher rates of recurrence and inferior survival in carcinoma cervix patients in our study. These biomarkers can be used as predictors of outcomes in carcinoma cervix.
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Comparison of setup variations and defining a CTV-PTV margin in fractionated radiotherapy of brain tumor using Novalis Tx Orthogonal OBI (kv) versus Brain Lab ExacTrac (kv) imaging systems with brain lab mask p. 12
Hemant K Pandey, Mano Bhadauria, Ganesh Kishan Rao Jadhav, Sapna Manocha, Renuka Masodkar, Divya Piyushi, Sanjay Raut, Brijesh Goswami, Sunil Kumar Chauhan
The objective of this study is to evaluate the setup discrepancy between Brain Lab ExacTrac (kv) and Orthogonal Novalis Tx (kv) imaging systems and to obtain an optimal CTV-PTV margin. We recruited 35 consecutive brain tumor patients, immobilized with non-invasive thermoplastic BrainLab mask, between August 2016 and August 2017. The position verification done by ExacTrac, Infrared Positioning System was followed by a set of images by OBI at 0° and 90° position. The images were autofused and compared with DRR generated by TPS. The extent of translational and rotational shift was then applied and documented. The translational inter-fractional setup error (mean ± SD) in X-axis detected by OBI and ET was 0.002 ± 0.227 and −0.042 ± 0.084, respectively. In Y-axis, the error detected was −0.01 ± 0.176 and 0.075 ± 0.079, respectively, whereas in Z-axis the error with OBI and ET was 0.329 ± 0.521 and 0.051 ± 0.091, respectively. The P-value of inter-fractional errors in X, Y, and Z axes was 0.294, 0.013, and 0.004, which is statistically significant in Y- and Z-axes. Rotational inter-fractional setup errors (mean ± SD) for OBI and ET were −0.101 ± 0.257 and −0.076 ± 0.102, respectively. The rotational setup errors detected by ET in pitch and roll dimension are −0.003 ± 0.084 and −0.085 ± 0.073, respectively. The data obtained were put in Van Herk’s formula (PTV margin = 2.5 ∑ + 0.74 σ), and CTV-PTV margin was calculated. CTV-PTV margin for ET was 2.70, 2.72, and 2.94 mm and 3.38o, 2.84o, and 2.51o in lateral, longitudinal, vertical and pitch, roll, yaw dimension, respectively. The CTV-PTV margin for OBI was 7.40, 6.20, and 5.30 mm and 7.27o in lateral, longitudinal, vertical, and yaw dimension, respectively. Daily setup verifications that use the Brain LAB Exac Trac 6D image-guided system are very useful for brain tumor treatment; nevertheless, OBI kv imaging can be used for FRT of brain tumor with extended margin.
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Demographic profile and clinicopathological patterns of colorectal cancer in subhimalayan North India p. 19
Nitin Gupta, Shalini Verma, Muninder Negi, Soma Devi
Background: Despite colorectal carcinoma being one of the common cancers with an increasing incidence over the past few decades, there are only a few studies that have assessed its demographic, clinical, and pathological profile in the north Indian population. Objective: To assess the demographic and clinicopathological patterns of colorectal cancer (CRC) among patients in the subhimalayan region of North IndiaMaterials and Methods: This retrospective cross-sectional study analyzed the data of 244 patients with CRC who were referred to a state-owned medical college in Himachal Pradesh, India, between January 2016 and April 2020. Demographic, clinical, and pathological information was extracted from patient record files. Results: The mean age of patients in the study was 51.2 years, with an age range from 19 to 81 years. Approximately 48% of the patients were aged between 40 and 60 years, 15% were younger than 40 years, 56% of the patients were male, and 44% of the patients were female. Rectal bleeding (~46%), change in bowel habits (~41%), and abdominal pain (39%) were the common clinical symptoms. Overall, 73% of the patients were diagnosed at a mean duration of five months after the onset of their symptoms, and approximately 36% of the patients were in stage II and 48% were in stage III at the time of diagnosis. Colon carcinoma accounted for 76% of the patients, 17% had rectal carcinoma, 5% had carcinoma of recto-sigmoid, and 2% of the patients were diagnosed with ano-rectal carcinoma. Histopathologically ~ 81% patients had adenocarinoma, 14% had mucous carcinoma, 3% had signet ring carcinoma, and 2% had NET. Conclusions: In the subhimalayan region in North India, CRC has a higher male gender predominance, with a substantial number of patients younger than 40 years. Most of the cases are diagnosed after a mean duration of five months of the symptoms. Colon carcinomas are more common than rectal carcinomas, with left-sided colon carcinomas being more common than right-sided colon carcinomas. The majority of tumors are adenocarcinomas, whereas mucinous carcinomas are less common and signet ring carcinomas are rare. A greater number of patients with right-sided colon carcinomas have a higher stage and a more aggressive tumor grade at the time of diagnosis. The study also shows that there is a need to be more vigilant for colorectal carcinoma in patients with lower GIT symptoms and it lays emphasis on a colorectal screening program in such patients, to enable early detection of this tumor.
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Dosimetric feasibility and clinical outcome of image-guided interstitial brachytherapy using two different fractionation schedule in carcinoma cervix p. 26
Abhishek Basu, Bidyut Mandal, Janmenjoy Mondal, Debjit Ghosh, Ipsita Chakraborty
Methods and Material: Overall, 60 patients were accrued between 2014 and 2017 and treated with ISBT by using Syed–Neblett Template by iridium 192 with Gamma Med plus HDR after the loader unit. They were allotted in two arms (n = 30) and received nine Gy ×2# and 7 Gy ×3 # respectively. All patients received 50Gy/25# whole pelvis EBRT by Theratron 780C. Coverage Index (CI), dose homogeneity index (DHI), overdose index (OI), dose non-uniformity ratio (DNR), D90Target, and 2cc EQD2 of OARs were calculated and correlated with toxicity, locoregional control, and survival. Statistical Analysis Used: Unpaired t-test and chi-square test were used to compare numerical and categorical variables, using IBM SPSS, V23. PFS and OS were calculated by using Kaplan–Meier analysis, and a log-rank test was used for comparison. A p-value ≤ 0.05 was considered significant. Results: Mean EQD2 for bladder (77.33 vs. 80.24 Gy) and rectum (69.12 vs. 69.87) along with D90 (9.12Gy vs. 7.20Gy) were comparable. With a median follow-up period of 38 months, three-year local control rate was 56.6% vs. 46.60% (P = 0.72) and three-year OS was also similar, 83% vs. 80% (p=.8). Dosimetric parameters and toxicity profile between two groups were comparable. Conclusions: 9Gy ×2 # is a reasonably good alternative for treating the locally advanced carcinoma cervix.
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COVID-19 vaccine hesitancy in oncology patients p. 34
Ingris Marie Valero Sardina, Milind Kumar, Roshan Joseph
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Intracranial extraskeletal mesenchymal chondrosarcoma: A case report p. 39
Megha P Paramban, Vishnu Asokan, Apoorva Vijayan, Prasanth C Chandran
Background: Mesenchymal chondrosarcoma (MCS) is a rare and aggressive malignant tumor, a subtype of chondrosarcoma assumed to arise from remnants of the embryonic cartilage or metaplasia of meningeal fibroblasts. Intracranial extraskeletal MCSs are rare tumors, accounting for <0.16% of intracranial tumors. They usually occur in the age group of 20–30 years and are commonly found in the frontoparietal region arising from the falx and surrounding dura. Case Description: A 17-year-old girl presented with weakness of the right lower limb. Magnetic resonance imaging showed a large lobulated extra-axial mass lesion in the left parasagittal frontal region. She underwent a left frontoparietal craniotomy and excision of the tumor. She received adjuvant radiotherapy 60Gy/30 fractions. Conclusion: Intracranial MCSs are rare malignant tumors with a poor prognosis. The prognosis depends upon surgical resection and postoperative radiotherapy.
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Langerhans cell histiocytosis of solitary inguinal mass: Diagnosis and treatment of an unusual case with complete response p. 43
Sujata Sarkar, Maitrayee Saha, Tamohan Chaudhuri, Shravasti Roy
Langerhans cell histiocytosis (LCH) is a “histiocytic” disorder with a spectrum of presentations often with different names having confined a bone, overlying skin, and local lymph nodes or having multiorgan involvement. It is characterized by clonal proliferation of Langerhans cells, which have typical grooved nuclei and tennis racquet-shaped Birbeck’s granules. It is more common in children below 10 years. It is more common in men with M:F is 2:1. Bone is the most common site of involvement. Among lymph nodes, cervical chain is most commonly involved and inguinal lymphatic chain involvement is rarely seen. Diagnosis requires histopathological confirmation. Histopathology shows proliferation of dendritic cells expressing high levels of Langerin, a lectin required for the formation of Birbeck granules. It is positive for CD1a, Langerin, S100, CD68, and vimentin. Here, we are reporting a case of LCH of solitary inguinal mass, localized to unilateral pubic bone, overlying skin and inguinal nodes, in a 35-year-old man. Our aim is to discuss about the investigations leading to diagnosis of this rare entity, LCH; its treatment with surgery and adjuvant radiotherapy, which led to complete response and patient is disease free even after 4 years of treatment.
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Atypical herpes zoster reactivation in an elderly gentleman with advanced oral cancer p. 47
Divya Kukreja, Deep Chakrabarti, Abigail Veravolu Resu, Mranalini Verma, Madan Lal Brahma Bhatt
Background: Varicella-zoster virus (VZV) causes varicella in children and reactivation zoster in adults. A 79-year-old gentleman with an old history of varicella infection receiving methotrexate for advanced tongue cancer presented with multiple vesiculo-papular lesions in axillae and chest wall. The lesions were multidermatomal in distribution, painless, indurated, and nontender. A Tzanck smear confirmed the diagnosis of herpes zoster. His lesions resolved on antiviral therapy. Dermatologic side effects of methotrexate are otherwise rare and occur in 1%–10% of patients. Nevertheless, advanced cancer or cancer chemotherapy may cause immunosuppression leading to reactivation of VZV in some patients.
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