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Solitary extramedullary plasmacytoma is a rare entity. The diagnosis is established by clinical evaluation, detailed radiological workup and histopathology with immunohistochemistry markers. There is no clear standard of care for a solitary laryngeal plasmacytoma. A case of solitary laryngeal plasmacytoma is being reported here with the rationale for the chosen treatment modality.

Purpose Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. Materials and methods One hundred sixteen cases of post-operative buccal mucosa cancers-pT3 or more, node positive, close margins (1-5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm-treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60-66 Gy (44 Gy in the first phase and a coned down boost of 16-22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. Results Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). Conclusion Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.

India and the rest of the world are experiencing an outbreak of the COVID- 19 virus. WHO has declared 2019 novel coronavirus disease (COVID19), a public health emergency of international concern. (1) Palliative treatment compromises a major portion of radiation treatments in cancer. (2) Metastatic or palliation treatment presents a unique challenge in resource-limited settings as ours and early treatment to alleviate their symptoms and disease is the need of the hour to prevent further morbidity and mortality. These patients are usually more cachexic with low immunity and more prone to infection of COVID-19 than the normal population, here their treatment has to be expedited and their visits to the hospital to be minimized to prevent infection with COVID. (3) We reviewed the best evidence and recommended best practices for the treatment of common oncologic emergencies with more emphasis on balancing the risk of infection with the COVID-19 virus and the potential morbidity of delaying treatment. In COVID -19 Era pandemic, the use of hypofractionated radiation therapy for palliative patients for oncologic emergencies achieves intended functional outcomes without compromising care

Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamous cell cancer. There is paucity of literature regarding control rates in these cases. We intend to report the outcomes in terms of administered treatment and control rates. 28 patients of oral cavity verrucous carcinomas treated at our institute from March 2014 to December 2018 were reviewed retrospectively. Demographic profile, histopathological features and clinical outcomes were analyzed. Statistical analysis was performed with SPSS for Mac (version 23.0). Median age was 54 years (range 31-75) with M:F ratio of 25:3. Buccal mucosa was the most common site. All patients underwent surgical resection except one. Of these, 24 had neck dissection; 12 had supra-omohyoid neck dissection, eleven had modified neck dissection and one patient underwent radical neck dissection. Three patients had their histology upgraded to squamous cell carcinomas in the post-operative histopathology. The post-operative staging was as follows: 21% stage I and 35% stage II. One patient opted for non-surgical approach and received radical concurrent chemoradiotherapy. Median follow up was 12 months (range 6-36). Two patients had local failures and one had a regional failure. No distant metastasis was found. There was one death. 14-Months survival rate was 92%. Estimated 18 month loco-regional control rate was 92%. Curative surgical resection remains the cornerstone for VC of oral cavity. Any change of histopathology post-operatively to squamous cell carcinoma is a poor prognostic sign and needs appropriate adjuvant treatment.

Introduction Concurrent chemoradiotherapy (CTRT) remains one of the treatment options in patients with muscle invasive bladder cancer (MIBC) unwilling/unsuitable for radical surgery. We evaluated the role of volumetric modulated arc therapy (VMAT) in MIBC patients treated with definitive CTRT. Material and methods 25 patients of histologically proven transitional cell MIBC (T2-T4a, N0, M0) unwilling/unsuitable for radical surgery (after maximal transurethral resection of bladder tumour) were recruited in this prospective study. Primary clinical target volume (CTV) consisted of the gross tumour and whole bladder. Primary planning target volume (PTV) and nodal PTV were prescribed 60 Gy and 54 Gy (both in 30 fractions). Concurrent chemotherapy was cisplatin (40 mg/m2) weekly. Acute toxicities were assessed as per Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Survival estimates were done from the date of registration using the Kaplan-Meier method. Results Median age was 70 years (37-80 years). Median overall treatment time was 45 days (44-51). Median number of chemotherapy cycles was 5 (range 3-6). 5 (20%) and 4 (16%) patients respectively suffered from acute grade ≥ 2 gastrointestinal and grade ≥ 2 genitourinary toxicities during treatment. One patient each had grade 3 anaemia and neutropenia. At a median follow-up of 34 months (10-45 months), 3-year progression-free survival and overall survival were 65.6% and 81.2% respectively. 3-year distant metastasis-free survival was 90.5%. Bladder preservation rate at 3 years was 68%. Conclusions Definitive CTRT with VMAT is well tolerated in patients with MIBC unsuitable for surgery and yields decent survival and bladder preservation outcome.

Background Various studies have shown a clinical benefit of pelvic IMRT but included a significant number of patients with intact cervix and uterus. Therefore we proposed a prospective study to evaluate the toxicity, feasibility, and tolerance of IMRT in post-operative patients with carcinoma cervix and endometrium. Methods and Material: This was a prospective, single-arm study, conducted from August 2015 to October 2018 including a total of 30 patients (23 cervical and 7 endometrial cancer) who had undergone a total hysterectomy and required adjuvant pelvic irradiation. These patients were treated with pelvic IMRT using a dose of 45-50.4 Gray (Gy) at 1.8-2 Gy per fraction given as 5 fractions per week with/without concurrent chemotherapy (using injection cisplatin 35–40 mg/m2 per week) as per indications. Acute toxicities were recorded at weekly intervals during the treatment followed by the assessment of late toxicities at the time of each follow-up visits using RTOG radiation morbidity criteria. Results Maximum on treatment skin, lower gastrointestinal (LGI), genitourinary (GU), and hematological toxicities were grade 1, 2, 2, and 2, occurring in 38%, 31%, 14%, and 3.4% of the cases, respectively. No late skin and GU toxicities were observed. Maximum late LGI toxicity was grade 1, occurring in 6.67% of the cases. Five (out of 30) patients developed treatment failures (2 distant and 3 local). At a median follow-up of 35 months, the 3 year progression free survival (PFS) and overall survival (OS) were 83.3% (all stages included). Conclusion Considering acute and late adverse events in the form of skin, LGI, GU, and hematological toxicities, IMRT is well tolerated and has an acceptable toxicity profile even in the setting of an aggressive tri-modality approach.

Myxoid chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin, characterised by the presence of chondroid and myxoid matrix. These are traditionally radio resistant tumours, so wide surgical resection remains the mainstay of treatment. However, radiotherapy is generally advised for high-grade lesions with poor prognostic factors with adjuvant chemotherapy. The treatment decisions are primarily guided by the histological grade, extent of surgical resection, and site of the neoplasm. A case of a 28-year-old male who presented with recurrent painful swelling in the mandibular region is discussed here. To date, very few cases of Extraskeletal Myxoid Chondrosarcoma (EMC) occurring in the mandible region have been reported. So, due to the paucity of available literature, controversies still exist regarding effective treatment approaches in newly diagnosed and recurrent cases. This case reports the clinical presentation, histopathology, radiological characteristics, immune profile, and treatment modalities used in EMC with a comprehensive and relevant review of the literature.

Distant metastasis from Head and Neck Squamous Cell Carcinomas (HNSCC) is uncommon, Cavernous Sinus (CS) metastasis being very rare. Infrequent presentation and misdiagnosis makes it a difficult entity to identify and treat. Hereby, Authors present a rare case of 47 year old male of CS metastasis from postoperative carcinoma of buccal mucosa. The patient was a histopathologically proven case of poorly differentiated Squamous Cell Carcinoma (SCC) of left buccal mucosa for which he underwent definitive surgery. During adjuvant Radiotherapy (RT) he developed severe headache, diplopia and ptosis. 18Fluorodeoxy-Glucose-Positron Emission Tomography-Computed Tomography (18FDG PET-CT) revealed an FDG avid lesion in left CS suggestive of CS metastasis. In view of local recurrence and CS metastasis palliative RT was given. Patient responded well to palliative RT but succumbed to the disease within months. CS metastasis has poor prognosis with limited treatment options which include palliative RT, either External Beam Radiotherapy (EBRT) or radiosurgery to CS. Chemotherapy for disseminated disease has limited benefits due to lesser penetration of the blood brain barrier.

Objectives We compared the prostate motion variability and toxicities between patients treated with gold marker registration based IG-IMRT (IG-IMRT-M) and bony landmark registration based IG-IMRT (IG-IMRT-B). Methods T1c-T3b (node negative), intermediate and high risk (non-metastatic) adenocarcinoma of prostate, age ≥18 years, Karnofsky Performance Status of ≥70 were included in this retrospective study. The prostate motion variability, acute and late radiation toxicities between the two treatment arms (IG-IMRT-M versus IG-IMRT-B) were compared. Results Total of 35 patients (17 for IG-IMRT-M and 18 for IG-IMRT-B) were treated with a median radiotherapy dose of 76 Gray. The prostate variability observed with and without markers in millimeter was 4.1 ± 2.3 vs 3.7 ± 2.1 [Antero-Posterior (A-P); p = 0.001], 2.3 ± 1.5 vs 2.1 ± 1.2 [Superior-Inferior (S-I); p = 0.095] and 1.1 ± 1.7 vs 0.4 ± 1.4 [Left-Right (L-R); p = 0.003]. There was higher acute toxicity in IG-IMRT-B arm compared to IG-IMRT-M arm in terms of grade ≥2 diarrhea [50% vs 11% OR = 7.5 (1.3–42.7); p = 0.02] and grade ≥2 proctitis [38% vs 5.8%, OR = 10.1 (1.09–94.1); p = 0.04]. At a median follow up of 36 months, the late genitourinary toxicities grade ≥2 [27% vs 0%; p = 0.04] were higher in the IG-IMRT-B arm compared to IG-IMRT-M arm. Conclusions IG-IMRT-M detects higher prostate motion variability as compared to IG-IMRT-B, inferring a significant prostate motion inside fixed pelvic bony cavity. The addition of marker based image guidance results in higher precision of prostate localization and lesser acute and late toxicities.

Background: The standard of care in high grade glioma (HGG) is maximal safe surgical resection followed by adjuvant radiotherapy (RT) with/without chemotherapy. For anaplastic gliomas, studies have shown use of procarbazine, lomustine, vincristine (PCV) improves overall survival (OS) and progression free survival (PFS). Currently, there is substantial evidence that molecular markers strongly predict prognosis and response to treatment. Methods: Between January 2016 to January 2018, 42 patients were accrued and followed up till April 2019. The primary end points were to correlate molecular markers with response to therapy in terms of OS and PFS in HGG. The secondary end point was to evaluate frequency of 1p/19q codeletion, IDH 1 mutation, ATRX deletion and p53 in HGG patients. Results: The median age was 46 years (range 18-67) with M:F ratio 30:12. The frequency of IDH1 mutation,1p/19q codeletion, p53 mutation and ATRX mutation were 42.8%, 16.6%, 42.8% and 14.2% respectively. All the seven patients with 1p/19q codeletion had IDH1 mutation. Median follow up was 22 months. The 20-months PFS for different mutations were as follows; IDH1-mutated vs wild type: 53.6% vs 29.8%; p-0.035, 1p/19q codeleted vs non-codeleted: 85.7% vs 62.3%; p-0.011, p53 wild type vs mutated 32.1% vs 35.6%; p-0.035 and ATRX lost vs retained: 55.6% vs 53.3%; p- 0.369. The 20-months OS for IDH1 mutated vs wild type: 82.4% vs 30.6%; p-0.014, 1p/19q codeleted vs non-codeleted: 85.7% vs 65.8%; p-0.104, p53 wild-type vs mutated 45.5% vs 73.9%; p-0.036 and ATRX lost vs retained: 100% vs 60.3%; p-0.087. Conclusion: Codeletion of 1p/19q with IDH1 mutation in HGG is associated with a significantly favourable PFS. However, larger studies with longer follow up are required to evaluate OS and PFS in all the molecular subgroups.

Introduction: Image Guided Intensity-Modulated Radiotherapy (IG-IMRT) with marker based prostate localisation could potentially reduce the Planning Target Volume (PTV), thus reducing radiation toxicity. Aim: We retrospectively evaluated the influence of PTV reduction on radiation induced toxicity and biochemical control. Materials and Methods: This study was a single institution retrospective evaluation. Patients with histopathologically proven adenocarcinoma of prostate, age 18-80 years, Karnofsky performance status ≥70, T1c-T3bN0M0 and treated with definitive Radiotherapy (RT) were considered in the study. Patients were treated with two different approaches. The HRPTV in the PTV_7 arm was obtained by giving a 7 mm uniform PTV expansion of High-risk Clinical Target Volume (HR-CTV), except posterior margin (6 mm). While the HRPTV in the PTV_5 arm was formed by a 5 mm isotropic expansion. IG-IMRT was delivered in 2 phases with a total dose of 78 Gray in 39 fractions. Acute toxicities were graded weekly as per common terminology criteria for adverse events and late toxicities by the radiation therapy oncology group late morbidity criteria. Biochemical failure was defined by phoenix guideline. Results: Fifty patients (25 each arm) were evaluated with a median age of 68 years. At a median follow-up of 37 months (range 11-76), Grade 1, 2 and 3 overall late (3-year) Genitourinary (GU) toxicities were 68%, 24% and 8%, Gastrointestinal (GI) toxicities were 72%, 18% and 10%, respectively. The PTV_7 group had significantly higher Grade ≥3 chronic GI toxicities (10% vs. 0%, p=0.05), compared to PTV_5 group. However, there was non-significant difference in Grade ≥3 chronic GU toxicities (6% vs. 2%, p=0.6). Acute proctitis was significantly higher (48% vs. 16%, p=0.03) in the PTV_7 arm. The 3-year biochemical progression free survival rates were similar in both arms {89.5% (PTV_5) vs. 85.9% (PTV_7), p=0.47}. Conclusion: PTV reduction can be safely used with dose escalated radiotherapy while using marker based IG-IMRT. This may result in the reduction of chronic GI toxicity without compromising biochemical control.

Middle ear and external ear malignancies are rare. There is lack of consensus in managing such cases. Surgery followed by radiotherapy is the best option for advanced cancers, while radiotherapy alone in radical doses is sufficient for early disease. There is also dearth of literature in management of recurrence or metastasis. We present the case of a 25-year-old boy who had recurrence following surgery and radiotherapy for middle ear Squamous Cell Carcinoma (SCC). He was started on gefitinib and showed remarkable improvement in symptoms within two months of the treatment.

Purpose We evaluated the correlation of the x-ray repair cross complementing gene 1 (XRCC1) Arg194Trp polymorphism with clinical outcomes in head and neck squamous cell carcinoma (HNSCC) patients treated with concurrent chemoradiation therapy (CCRT). Methods and Materials In this prospective cohort study, we included 101 patients with HNSCC (oral cavity, pharynx, and larynx) who were aged ≥ 18 years, had stage III to IVB disease, had a Karnofsky Performance Status ≥ 80, and were deemed fit for CCRT. DNA extraction was done through polymerase chain reaction, and the genotypes of XRCC1 polymorphism were detected using designed restriction fragment length polymorphism. The genetic polymorphisms were classified into wild and polymorphic variants (Arg194Trp CT and TT). Radiation therapy was delivered with conventional parallel opposed lateral and low anterior neck fields with concurrent weekly cisplatin, 35 mg/m2. Acute toxicity was graded per Radiation Therapy Oncology Group criteria, and treatment response was assessed per World Health Organization criteria. Overall survival and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Results Of the patients, 62 had the wild type and 39 had polymorphic variants. Patients with polymorphic variants had higher rates of grade > 2 oral mucositis, with 35.8% versus 16.0% (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.13-7.46; P = .023); dermatitis, with 30.7% versus 8.0% (OR, 5.076; 95% CI, 1.62-15.8; P = .003); and laryngeal toxicity, with 25.6% versus 6.4% (OR, 5; 95% CI, 1.44-17.54; P = .006). Complete response rates in polymorphic versus wild variants were 76.9% versus 56.0% (P = .209). At a median follow-up of 21 months, the 2-year PFS and overall survival rates for patients with polymorphic versus wild variants were 57.0% versus 42.2% (P = .077) and 73.0% versus 55.5% (P = .143), respectively. Conclusions Polymorphic variant XRCC1 HNSCC patients treated with CCRT have significantly increased acute radiation morbidities and may have a trend toward better PFS in comparison with the wild variant.

BACKGROUND Brain metastasis has been reported in 25-40 % of cancers and is associated with fairly dismal outcome with a mean survival period of 6-9 months as reported in various case series. In management of brain metastasis, there is extensive published experience of Stereotactic Radiosurgery (SRS)/ Fractionated Stereotactic Radiosurgery (FSR) with control rates equal to or higher than those for surgery for single/oligo metastasis. The term FSR refers to stereotactically guided delivery of highly conformal radiation to a defined target volume in multiple fractions (4-5), typically using non-invasive positioning.

Background: Patients of head-and-neck cancer (HANC) undergoing chemoradiotherapy (CRT) are at high risk of malnutrition due to acute effects of radiotherapy (RT). This study was intended to assess weight loss and change in body mass index (BMI) during CRT with active diet counseling and nutritional supplementation. Aims and Objective: The primary end point was to assess loss of weight and BMI during treatment. The secondary end point is assessment of compliance to stipulated treatment time, frequency of nasogastric tube feeding, intravenous support, and duration of hospital admission. Materials and Methods: This was a prospective observational study performed in Radiation Oncology department of a tertiary care center. Consecutive patients of HANC requiring definitive or adjuvant RT (±chemotherapy) were included. Nutritional status assessment and diet counseling were done before start of RT, and further weekly assessment of body weight and BMI was done. Results: Between December 2017 and December 2018, 128 patients were included in this study. Sitewise distribution were oral cavity, oropharynx, hypopharynx, and larynx in 69, 33, 9, and 17 patients, respectively. Weight loss and BMI comparison were done at the start and end of RT (mean weight: 53.86 kg; 95% confidence interval [CI]: ± 1.71, mean BMI: 21.52; 95% CI: ± 0.95 [at the start of RT] and mean weight: 48.30 kg; 95% CI: ± 1.58, mean BMI: 19.18; 95% CI: ± 0.88 [at the end of RT]).There was a significant reduction in weight (P

We present a case of a middle-aged woman with adenocarcinoma of the lung and metastatic brain lesions. In view of her poor general condition and poor compliance to first-line chemotherapy, the patient was kept on tablet erlotinib after whole brain radiotherapy. This novel treatment resulted in a dramatic response with radiological regression in both the primary lung lesion and metastatic intracranial lesions translating in unexpected and ongoing 24-month survival.

Carcinosarcoma (CS) of the uterus is rare and accounts for 1–2% of all uterine malignancies, occur commonly in postmenopausal women. These are highly aggressive tumors with poor prognosis and often present at advanced stage. Tamoxifen (TAM) has been known to increase the incidence of endometrial carcinoma from 1 to 2 cases per 1000 women/year and of uterine sarcoma from 0.04 to 0.17 cases per 1000 women/year. TAM has weakly estrogenic properties that can produce endometrial cell proliferation and, consequently, TAM use increases the risk of endometrial cancer by approximately two- to three-fold. Currently, no consensus is present regarding the management of Uterine CS. However, surgery plays an important role in the management along with chemotherapy (CT) and radiotherapy as an adjuvant. We report a case of a woman who developed malignant mixed mullerian tumor of uterus after taking TAM for 6 years as adjuvant hormonal therapy for breast carcinoma.