Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR20,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR20,10increases with field size and beam energy. Surface dose Dsalso increases with field size. D98%and D2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.
Introduction To evaluate the dosimetric effect of photon energies on fixed field intensity-modulated radiotherapy (IMRT) and dual arc (DA) planning and to compare the dosimetric differences between conventional IMRT and DA radiotherapy planning. Materials and Methods IMRT and DA plans were generated for 15 patients having cervical cancer using different photon energies. IMRT and DA plans were generated using seven fields and double arcs, respectively. Dosimetric comparison was done in terms of planning target volume (PTV) coverage, sparing of organ at risk (OAR), homogeneity index (HI), conformity index (CI), and monitor units (MUs). Photo-neutron (energy ≤10MV) contribution was not considered for this study. Near region (NR) and far region (FR) were contoured to evaluate the dose deposited in nontarget area. Results No significant difference was observed ( p > 0.05) in PTV coverage for conventional IMRT and DA; however, 6 MV yielded significantly better coverage over 15 MV ( p < 0.05) for both the treatment modalities. Mean bladder dose was significantly more for conventional IMRT compared with DA. For rectal mean dose, p -value was nonsignificant for IMRT in comparison to DA, while significant difference was observed for change in photon energies for both treatment modalities respectively, except for 10 MV versus 15 MV DA plans. Significant improvements in HI (except 6 MV vs. 10 MV DA), CI (except 6 MV vs. 10 MV IMRT and DA), MUs, NR, and FR were noted. Conclusion DA generates more conformal, homogenous plans, requires less numbers of MUs, and deposits fewer doses to NR and FR regions of nontarget tissues in comparison to conventional IMRT. Although increase in photon energy for IMRT and DA plans reduces numbers of MUs and dose deposited to NR and FR regions, yet the choice for treatment of carcinoma cervix remains 6 MV due to production of photo-neutrons at higher energies.
Head and neck cancer accounts for 30% of all malignancies in India. It is the seventh most common malignancy in the world. Peri-neural invasion (PNI) is a high-risk feature in oral cavity cancer that warrants radiation treatment. The use of radiation treatment in adjuvant settings has led to better tumor control and survival outcome. Studies have shown that PNI is a result of dynamic interaction between neuron and cancer cells that includes signalling agents secreted by these cells. It has been hypothesized that radiotherapy acts by reducing tumor cell viability and through disruption of the nerve microenvironment. This review article discusses the challenges seen with PNI in head and neck cancer, its clinical outcome, how to identify high-risk groups in PNI and reduce the chances of recurrence in such patients.
ABSTRACT Laryngeal cancer typically presents at a nonmetastatic stage, and the majority of patients are treated with curative intent. Due to the functional and cosmetic morbidities associated with surgical approaches, nonsurgical modalities are increasingly favored. This update to the guidelines emphasizes a multidisciplinary approach tailored to the Indian healthcare context, enhancing treatment strategies and optimizing patient outcomes. Key recommendations include the use of concurrent chemoradiotherapy and induction chemotherapy regimens, with a focus on organ preservation whenever feasible.
Leiomyosarcoma is an uncommon malignant tumour of the pancreas. Many retroperitoneal leiomyosarcomas grow silently and are extremely large when diagnosed. We report a 45 year old lady who presented with abdominal lump and haemoptysis. Ultrasound guided biopsy of the mass revealed a pancreatic leiomyosarcoma. The patient had lung metastasis and received chemotherapy. She is alive with disease at last followup.
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