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Introduction: Radiation therapy to left breast cancer patients results in significant exposure to heart resulting in long-term cardiac morbidity. This exposure can be reduced by performing deep inspiratory breath-hold (DIBH) technique, however, patient selection criteria or predictive parameters are not routinely used which can identify patients who will have significant benefit with this technique. This study intends to find and use these predictive parameters measured on free-breathing (FB) simulation scan which can help to select such patients so as to develop our institutional protocol. Methods: A total of 35 patients of left breast cancer postsurgery were recruited in the study. All patients underwent 2--3 sessions of DIBH coaching followed by planning computed tomography scan in both FB phase and DIBH phase. Various anatomical parameters such as cardiac contact distance parasagittal (CCDps), CCD axial, heart--chest distance (HCD), and D were measured on FB scan and were correlated with a mean heart dose achieved in DIBH scan. Results: Dose to normal structures, namely heart and lung, was drastically reduced for DIBH scan over FB scan. V5, V10, and V20 of heart also followed a similar reduction. The mean dose to heart in FB scan was 5.34 Gy, while in DIBH scan, it was 2.79 Gy which was statistically significant. Among all the parameters measured, CCDps and D had a statistically significant positive correlation with the mean heart dose in DIBH phase while HCD had a negative correlation which was statistically significant. Conclusion: Cardiac parameters on FB scan such as CCDps, HCD, and D predict the patients with usual cardiac risk who will benefit most with DIBH techniques setting an arbitrarily cutoff value. [ABSTRACT FROM AUTHOR]

Cancer is considered to be an age related disease because the incidence of most types of cancers increases with age rising more rapidly beginning in midlife. Adolescents and young adults are a distinct population, which is not a usual age for diagnosis of tumors that are usually found in older adults. Tumors in this group of patients tend to be different from tumors found in children or older adults. The treatment of such patients is challenging as they are at a higher risk of developing long-term side effects. In this case series, we report 3 cases of adult cancers that presented at an unusually younger age highlighting the fact that there is a recent shift in paradigm in terms of age of presentation of cancer. We present 3 cases namely, supraglottic larynx squamous cell carcinoma in a 21-year-old female, adenocarcinoma of the rectum in a 22-year-old male, and adenocarcinoma of the stomach and gastro-esophageal junction in a 25-year-old male. With this case series we want to highlight this recent change in the age presentation of adult cancers and this could foreshadow the future trend of the disease. [ABSTRACT FROM AUTHOR]