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   Table of Contents - Current issue
January-March 2022
Volume 13 | Issue 1
Page Nos. 1-38

Online since Thursday, March 31, 2022

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The effect of prophylactic cranial irradiation on brain 18F-fluorodeoxyglucose uptake in small cell lung cancer in the metabolic imaging era p. 1
Sibel Goksel, Sema Yilmaz Rakici
Introduction: Prophylactic cranial irradiation (PCI) increases survival in patients with small-cell lung cancer. Although the underlying pathophysiology is not fully understood, it has been associated with posttreatment neurocognitive impairment. Our study aims to show the brain's glucose metabolism change after PCI with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Materials and Methods: A total of 17 patients who underwent PET/CT before and after PCI were evaluated retrospectively. 18F-FDG PET images of the brain before and after PCI were compared visually and semi-quantitatively using MI-Neurology Software. The brain was automatically segmented into eleven regions by this software. The mean standard uptake values (SUVmean) of all brain regions were measured within the automatically drawn region of interest area, and standard uptake value ratio (SUVR) values were found for each region by taking the brainstem SUVmean value as a reference. SUVR values were calculated from PET/CT scannings taken before and after PCI for each patient. The P < 0.05 value was considered statistically significant in comparisons. Results: We found a significant decrease in 18F-FDG uptake and glucose metabolism of the brain after PCI when compared with PET/CT before PCI in all brain regions identified according to the Combined-AAL atlas (all P < 0.001). Similarly, a significant decrease was found in brain 18F-FDG uptake on PET/CT taken after PCI in the brainstem used to calculate SUVR (P = 0.039). Conclusion: 18F-FDG PET/CT neuroimaging may be a new metabolic imaging technique for diagnosing radiation-induced cognitive impairment in the metabolic imaging era.
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Esophageal carcinoma: An epidemiological analysis and study of the time trends over the last 20 years from a single center in India p. 8
Shahida Nasreen, Shaiba Hussain, Asifa Andleeb, Arshad Manzoor, Kaneez Fatima, Mushtaq Ahmad Sofi
Aims: Esophageal carcinoma is a common gastrointestinal malignancy. The aim of the study was to evaluate the time trends over 20 years and observe how they differ from the West. Materials and Methods: The study was conducted at SKIMS Regional Cancer Centre in Radiation Oncology Department. This was a retrospective study. Retrospective analysis was carried out from records available at the Regional Cancer Center from 1993 to 2013. The case records of 2090 patients with histological proven squamous and adenocarcinoma (AC) of the esophagus were studied in terms of age, sex, risk factors, and mode of presentation. Results: Data of 2190 patients with esophageal cancer were retrieved. Out of 2190 patients, group A included 1060 and group B had 1130 patients. The mean age at presentation was 59 years in both groups. Five hundred and thirty-eight (56.4%) were male and 477 (43.6%) were females in group A, whereas in group B, 615 were male and 515 were female. Most of the patients presented with dysphagia 2139 (97.67%). In group A, 1030 (97.16%) presented with dysphagia, whereas 1090 (96.46%) presented with dysphagia in group B. Most of the patients had lesion in middle 3rd of esophagus, 849 (80%) in group A whereas 903 (79.9%) in group B. Squamous cell carcinoma (SCC) was the most common histology in both groups, 1010 (95.2%) in group A whereas 1060 (93.8%) in group B. Most common appearance was proliferative (37.7% in group A and 37.6% in group B). Most of the patients were salt tea takers in both groups (98.11% in group A and 97.34% in group B). Conclusion: Our study suggests that esophageal cancer occurs a decade earlier in India. It affects males more than females. SCC is still the most common histological subtype and is way ahead of AC. The mid esophagus is still the most common site. There is no evidence of an increase in the rate of lower esophageal malignancy in our study as opposed to western literature.
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Evaluation of dose–Volume-based image-guided high-dose-rate brachytherapy in carcinoma uterine cervix: A prospective study p. 12
Nancy Lal, Suresh Yadav, Veenita Yogi, Om Prakash Singh, Hameed Uzzafar Ghori, Megha Choudhary, Rishika Saxena, Sachet Saxena
Background: In recent few decades, the evolution in imaging technology, especially computed tomography (CT) and magnetic resonance imaging, results in widespread availability and its use in high-dose-rate (HDR) intracavitary brachytherapy (ICBT) applications. Aim: The present study was aimed to analyze the cumulative dose–volume histogram of the tumor and organs at risk (OARs) in three-dimensional (3D) CT image-based brachytherapy planning and clinical outcomes of the treated patients. Materials and Methods: This prospective observational study included 40 patients with carcinoma cervix. After external beam radiotherapy (EBRT), a dose of 6 Gy per fraction of HDR ICBT in four fractions with a total dose to point “A” approximately 80–85 Gy was given. For planning, the tumor volumes (high-risk clinical target volume [HR-CTV]) and volume of OARs (bladder, rectum, and sigmoid colon) were contoured on each CT slice. The dose–volume parameters, i.e., minimum dose received to 90% and 100% by HR-CTV volume (D90 and D100) for target and the maximum dose received by minimum volume of 2CC (D2CC) for OARs, were calculated and assessed for clinical response in patients. Results: The mean D2CC dose was 18.24 ± 0.93 Gy, 16.44 ± 1.11 Gy, and 16.37 ± 0.67 Gy for bladder, rectum, and sigmoid colon, respectively. The combined (EBRT and HDR ICBT) mean equieffective dose in 2 Gy per fraction (EQD2) dose for bladder was 76.71 ± 2.05 Gy, for rectum was 72.82 ± 2.58 Gy, and for sigmoid colon was 72.71 ± 1.41 Gy, and its comparison with baseline values showing P < 0.01 for bladder, rectum, and sigmoid colon was considered statistically significant. The mean EQD2 dose of HR-CTV D90 was 151 ± 27.3 Gy. Patients who had received HR-CTV D90 of >90 Gy compared with <90 Gy had exceptionally better local control and complete response. Conclusion: The present study suggested that CT is a favorable modality for treatment planning in cervical cancer with limited resources setup in terms of improved tumor coverage, lesser toxicity, confirmation of applicator placement, and accounting dose to OARs.
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Clinicoepidemiological profile of adenoid cystic carcinoma: Experience from a tertiary care oncology center in Kashmir, India p. 19
Mushtaq Ahmad Sofi, Mohmad Hussain Mir, Kaneez Fatima, Asifa Andleeb, Farhana Siraj, Nazir Ahmad Dar
Background: Adenoid cystic carcinoma (ACC) is a relatively rare tumor mostly involving head and neck region of the body. Due to lack of high-quality evidence, optimal treatment is still controversial and continues to evolve over time. Aim and Objectives: To analyze the clinicoepidemiological profile of ACC in Kashmir. Materials and Methods: Data of 30 patients, who were treated in the Regional Cancer Center at She-i-Kashmir Institute of Medical Sciences (Deemed University, Srinagar) between January 2015 and December 2019, were reviewed with respect to their demographic and clinical profile. Results: The study included 30 patients with ACC. The mean age at presentation was 55 ± 12.15 years. There were 10 (33.3%) males and 20 (66.6%) females. Among salivary gland ACC s, sublingual gland (06/30, 20%) was the most common site followed by parotid gland (05/30, 16.7%). Nonhead and neck primary ACC cases were reported from lung (6.7%) and breast (6.7%). Majority of the patients presented in stage-III (43.3). Only 5 patients presented with distant metastasis. All patients were subjected to surgery. Adjuvant radiotherapy was given in 18 patients (60%). Three patients received all three modalities (surgery, radiotherapy, and chemotherapy). The overall one year survival was 96%. However, the mean & median survivals reported were 24 & 18 months respectively. Surgery with negative surgical margin is the first choice of treatment for the patients with ACC. Our findings show that the prognosis of patients with ACC in our center is comparable to other parts of country. Conclusion: ACC has locally aggressive behavior. Adjuvant radiotherapy improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.
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Low-grade gliomas: A single-institute experience p. 23
Shahida Nasreen, Arshad Manzoor Najmi, Asifa Andleeb, Kaneez Fatima, Mushtaq A Sofi, Saquib Zaffar Banday
Introduction: Low-grade gliomas (LGG) are relatively rare tumors. They comprise 5% of all brain tumors and 15% of all gliomas. As per WHO classification diffuse infiltrating LGG s fall under Grade II tumors. Although these tumors are slow growing but eventually they progress to high-grade gliomas, so these patients should be treated aggressively. Materials and Methods: From January 2012 to January 2017, clinical information of patients, who had LGG, was collected retrospectively from patient registries at the radiation oncology department of our institute. Results: A total of 25 patients were analyzed. Out of the entire cohort, 64% were males, and 36% were females. The most common presenting symptom in our patients was seizures and blurring of vision (44% each). Cerebrum was the mos common site of lesion in 19 out of 25 (76.0%) cases, and among those 19 cases, frontal lobe was involved in 12 cases (63.1%). Craniotomy with tumor decompression was performed in all patients. Gross total excision was possible in only 2 (8%) out of 25 patients, whereas the remaining 23 (92%) patients underwent subtotal or near total excision only. These 23 patients received concurrent chemoradiation by cobalt-60 unit to a dose of 60 Gy with weekly temozolomide. 18 out of 23 (78.2%) patients received adjuvant six cycles temozolomidein view of residual disease after concurrent chemoradiotherapy. At the last follow-up, all the 25 patients were alive, 20 patients had no disease on contrast-enhanced magnetic resonance imaging, while five patients had stable disease. Conclusion: We conclude that LGG is a disease of young adults with seizures as most common presenting symptom. If treated with multidisciplinary treatment these patients have the long disease and disability-free survival. Neurocognitive dysfunction is low in our study group, but it needs longer follow-up.
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Cervical sarcomatoid carcinoma – A rare case report p. 28
Monik Patel, Isha Shah, Aastha Shah, U Suryanarayana
Sarcomatoid carcinoma is a very rare morphologic entity of the female genital tract and even more rare in the cervix. Sarcomatoid carcinoma is a rare form of cancer in which the cells exhibit properties characteristic of both epithelial and mesenchymal tumors and looks like a mixture of carcinoma and sarcoma. It differs from squamous cell carcinomas of the cervix in terms of having a poorer prognosis and a short disease-free survival. The tumor is usually diagnosed at an advanced stage of presentation and is characterized by early recurrence following treatment. Surgery or radiotherapy remains the mainstay of treatment. A rare case of sarcomatoid carcinoma of the cervix in a 42-year-old female patient is reported here. The patient was examined, and biopsy from the polypoidal mass of the cervix was performed. Immunohistochemistry examination was done which favored the diagnosis as sarcomatoid carcinoma of the cervix with positivity for vimentin and P63 markers and diffuse staining of actin and negativity for CK7, CEA, ER, desmin, HMB45, MYOD1, EMA, CD10, and CK5/6. The patient was clinically defined as having International Federation of Gynecology and Obstetrics stage IIIB disease. The patient was treated by radiotherapy with a palliative approach according to clinical disease. The pathologic diagnosis of sarcomatoid carcinoma is based on histologic and immunohistochemical findings. As this entity of cervical cancer is very rare, it is difficult to draw a firm decision on disease behavior, diagnostic methods, best treatment option, and outcome. Reporting such cases might help oncologists to understand this entity of cervical cancer.
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Volumetric modulated arc technique radiotherapy in synchronous locally advanced rectal and very high-risk prostate cancer p. 32
Sujata Sarkar, Ritesh Sharma, Roopesh Reddy Yotham, Dipti Kalita
Synchronous rectal and prostate cancer is difficult to manage due to old age, complexity of pelvic anatomy, and high morbidity associated with surgery. There is very limited literature available on detailed nonsurgical management. Even achieving high-dose radiotherapy (>70 Gy) for prostate is challenging due to the proximity of rectum, which itself is a target. Few literatures focus on neoadjuvant radiation, but it causes high morbidity following surgery. Other literatures focus on conventional 2 phase radiation, which either is neoadjuvant followed by surgery or causes high toxicity. With the advancement in radiotherapy techniques, volumetric modulated arc technique (VMAT) promises treatment without prostatectomy, with sphincter preservation, and minimal morbidity. Here, we are presenting a case on synchronous locally advanced rectal and very high-risk prostate cancer, treated with radical VMAT technique. Due to the radical dose given in 4 phases, the patient need not undergo surgery, achieved complete response with no symptoms following 6 months of treatment.
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Small cell carcinoma base of tongue p. 36
Isha Shah, U Suryanarayana, Aastha Shah, Dinesh Anand, Monik Patel
Neuroendocrine small cell carcinomas (SCCs) are most commonly seen in the lung, and they rarely may arise in the extra pulmonary sites. Small cell neuroendocrine carcinoma of the tongue is an extremely rare entity with only seven cases reported in literature till date. Herein, we present a case of a 59-year-old male with a limited-stage small cell neuroendocrine carcinoma of the base of the tongue. We discuss clinical, pathological, radiological findings, and management of SCC of the base of tongue. Histopathological examination using immunohistochemistry, clinical features, and radiologic findings are all important for the correct diagnosis of extrapulmonary SCCs. As no standard therapeutic regimen exists, it is important to be aware of and to know how to deal with such rare cases.
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