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Aim: This study aims to evaluate the long-term treatment outcome of conventional and hypofractionation radiotherapy in postmastectomy cancer breast patients. Material and Methods: A total of 140 postmastectomy breast cancer patients were included in this retrospective study, who were treated from 2012 to 2014 with chemotherapy and various fractionation radiotherapy schedules. Radiotherapy treatment records for study group-I received radiotherapy 4256 cGy in 16 fractions over 31/2 weeks, group-II patients received 4005 cGy in 15 fractions over 3 weeks, and conventional radiotherapy group-III received 5000 cGy in 25 fractions over 5 weeks. Results: The median follow-up of patients from all groups was 60 months (range 9 to 111 months). There were 39 cases with disease failure, 13 (26%) in group I (42.56 Gy), 16 (40%) in group II (40.05 Gy), and 10 (20%) in group III (50 Gy). There were 4 locoregional recurrences (LRRs), two isolated, and 11 distant failures in group I, 3 LRRs (1 isolated LRR) and 15 distant failures in group II, and only one LRR and 9 distant failures in group III. The disease-free survival (DFS) were 74%, 60%, and 80%, respectively, in groups I, II, and III (P =0.044). Conclusion: The long-term results of this study show that hypofractionation radiotherapy in postmastectomy cases is well tolerated and acute and late side effects are also comparable to conventional fractionation. In our study, locoregional and distant failure seems slightly higher with hypofractionation schedules than in other studies, highlighting the need for more studies with long-term follow-up in postmastectomy patients. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate the efficacy, feasibility, tolerability, and toxicity of concurrent chemotherapy and brachytherapy for locally advanced cervical carcinoma.Materials and Methods: Forty patients of cervical carcinoma were included in this study. The study period ranges from October 2016 to September 2019. Patients were evaluated and treated as per the protocol: external beam radiotherapy (50 Gy in 25 fractions) and concurrent weekly chemotherapy with injection (Inj.) cisplatin (30 mg/m2) followed by high-dose rate brachytherapy (3 fractions of 7 Gy each) and concurrent chemotherapy Inj. cisplatin (30 mg/m2).Results: Out of 40 patients enrolled in the study, 36 patients completed the treatment (17 Stage II and 19 Stage III). The incidence of Grade I and II skin toxicities were 78% and 10%, respectively. The incidence of genitourinary toxicities with respect to Grade I and II were 72% and 12%, respectively. There were Grade III hematological toxicities in two patients and the brachytherapy treatment was delayed for 4-6 days. The overall complete response was found in 28 (78%) patients, partial response in six (16.7%) patients, and progressive disease in two (5.6%) patients at 3 months of follow-up. On the last follow-up, 21 (58%) patients were disease-free and there was disease failure in seven patients (5 local recurrence and 2 with distant metastasis).Conclusion: Brachytherapy with the addition of concurrent chemotherapy is effective and feasible with acceptable toxicity for advanced stages of carcinoma cervix. This study upholds an interesting approach that can be regarded as feasible and tolerable for cervical cancer patients. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome.Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India.Materials and Methods: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study.Results and Conclusions: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome. [ABSTRACT FROM AUTHOR]

Objective Of the Study: To see the different age groups, gender, sites, disease stage, treatment outcome of various oral cavity sites carcinoma by combined modalities and the overall treatment duration.Materials and Methods: A total of 212 oral cavity carcinoma patients (169 males and 43 females) with complete records (from September 2009 to December 2012) were analyzed for age, sex, histopathology, associated medical illnesses, various subsites with disease stage, various treatment modalities with the duration and follow-up records for disease control as well as disease failure at local, nodal, local + nodal, and distant metastasis.Results: The most common site in oral cavity cancer was buccal mucosa 81 (38.20%). 149 (69%) patients reported were in advanced Stages III and IV of the disease. The majority of patients 149 (70.28%) were given chemotherapy + radiotherapy postoperatively (S-CRT group). The mean follow-up for all patients was 41 months (range = 21-59 months). In terms of overall disease control and metastases-free survival, the best results were (80%) for Stage I in all oral cavity sites. Irrespective of disease stage best results (59.57%) were in alveolar ridge subsite of oral cavity carcinoma.Conclusion: Challenges are still lie ahead in treating head and neck carcinoma, as in spite of using multimodality treatment approach and biological and molecular research, the overall survival percentage has not changed much. In India as oral cavity carcinoma is in increasing trend in younger individuals massive health promotion and awareness programs targeting the risk population along with financial support for those already affected are required. [ABSTRACT FROM AUTHOR]

Aims: To analyze the differences in dose distribution, with ovoid separation in various applications, by different radiotherapists in the same patient of carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary Radio therapy (ICRT). Settings: Pravara Rural Hospital and Rural Medical College. Design: Retrospective study. Materials and Methods: Retrospective analysis of six cases of carcinoma uterine cervix, randomly chosen in the period from January 2004 and December 2007. Three selected radiotherapists performed the applicator placement for ICRT on the aforementioned patients in a consistent pattern-three consecutive ICRT treatments separated by weekly intervals. Ovoid separation was categorized into three groups: <25 mm, 26-35 mm and >36 mm. Prescribed point 'A' isodose lines with maximum separation laterally in right and left parametrium and antero-posteriorly in lateral plane was calculated for all 36 isodose charts for the 18 ICRT applications. Results: In this study, there proves to be a significant difference in the ovoid separation between the applications of the different radiotherapists in the same patient with multiple fractions of HDR-ICRT. The applications done by 'A' radiotherapist resulted in an ovoid separation of <25 mm more often, 'B' radiotherapist of >36 mm while, 'C' radiotherapist fell in between the two. Discussion and Conclusion: With more ovoid separation, lateral dose to parametrium was improved; however, antero-posterior dose was not significantly affected. In order to determine the best dose distribution, as evident in the dose charts of 'C' radiotherapist, it is recommended to choose the optimum ovoid separation in accordance to the patient's anatomy. [ABSTRACT FROM AUTHOR]

Aim: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT).Materials and Methods: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival.Results: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well.Discussion and Conclusion: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis. [ABSTRACT FROM AUTHOR]

Aim: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT).Materials and Methods: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses.Results: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B.Discussion and Conclusion: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation. [ABSTRACT FROM AUTHOR]

Various addiction patterns, dietary habits, associated medical problems and socioeconomic status in gastro-intestinal malignancies: A prospective study in rural area of Maharashtra, India. Jain Vandana S., MD, Professor & Head Kawale Darshana, MBBS, Senior Resident Jain Shailendra M., MD, Professor Waghmare Chaitali, MD, Associate Professor Pemmaraju Gopal, MBBS, Senior Resident Abstract Background: Gastro intestinal (GI) malignancies (from Esophagus to anus) are increasing with advancing age, various addictions and poor dietary habits. Early detection is difficult till patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in the healthier outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems and socioeconomic status with various sites involved in GI malignancies, in a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: This prospective study is designed to know about various addiction patterns, dietary habits, associated medical problems and socioeconomic status, along with age, sex, various sites and the stage at first visit of all histopathologically proven cases of gastrointestinal malignancies reporting in the Department of Radiotherapy & Oncology for treatment. Oral cavity to cricopharyngeal carcinomas is included in head and neck malignancies. Carcinoma esophagus, carcinoma stomach, carcinoma small intestine, colorectal (colon and Rectum) and anal canal carcinomas are considered in gastrointerstitial malignancies (and for this study). Data collection was done from Feb 2016 to Dec 2016 for the period of eleven months. A detailed questionnaire was filled after taking written informed consent from the patient. Once the target of 100 patients was achieved all the data was compiled and analyzed for the study. Patients unable to provide or not willing to give desired information are excluded from the study. Results and Conclusions: In this study out of total 100 registeredcases of GI malignancy, 61 were males and 39 were females, which show male preponderance. Most of the patients belonged to lower and upper lower class (64%) as per modified B G Prasad classification. Various histopathological types recorded were Squamous cell carcinoma (35), Adenocarcinoma (60), Adenosquamous carcinoma (2), Basaloid carcinoma (2) and Gastro intestinal stromal tumor (GIST (2)). Associated medical illnesses were rarely observed (only two cases with Diabetes Mellitus and three with Hypertension) and they were on regular treatment. One patient was on anti- retroviral therapy for HIV, two were positive for HBsAg and one for VDRL. The commonest site involved was Esophagus (41) followed by Recto sigmoid, colon & caecum, stomach & anal canal (29, 14, 13 & 2 respectively). Mean age was 59.1 years. The youngest patient was 28 years and oldest was 86 years old. 45 cases were above 60 years and only five were below 30 years of age. 85% of cases were in advanced stage of disease (III & IV). Details of various addictions alone and in combinations with duration of consumption are shown in table no-1. Commonest addiction for all sites was smokeless tobacco (SLT). 81% of cases were non-vegetarian; only 16% were pure vegetarian, details of dietary habits is shown in table-2. Gastrointestinal malignancy is showing increasing trends in India. This study gives an idea about various risk factors for the increasing trends of gastro-intestinal malignancy. The present study shows that carcinoma Esophagus is the commonest & cancer recto sigmoid in second commonest GI malignancy. Mostly the cases were addicted to one or other addiction and were taking regularly nonvegetarian diet. Awareness program for harmful effects of various addictions, the importance of vegetarian diet (high fiber) and about the early symptoms of GI malignancy will help in health promotion, prevention of various malignancies & early diagnosis of disease as well as better treatment outcome. [ABSTRACT FROM AUTHOR]