Journal of Cancer and Allied Specialties
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HYPOFRACTIONATED RADIOTHERAPY IN GLIOBLASTOMA MULTIFORME
Full text linkPurpose: The purpose of this study was to assess the outcomes in glioblastoma patients treated with hypofractionated radiotherapy.Materials and Methods: We reviewed all glioblastoma patients treated at our specialist cancer centre over 7 and a 1⁄2 years using hypofractionated radiotherapy (HRT) postoperatively. The HRT regimen was 48 Gy given at 3 Gy/ fractions in 16 fractions. We calculated overall survival using time to event analyses. Results: A total of 62 patients were identi ed of whom 44 (71%) were male. The median age of these patients was 50 years (range: 20–71 years). Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 47 (76%) and 1 in 15 (24%) patients. 7 (11%) of the patients underwent gross total resection, 52 (83%) had subtotal resection and 3 (5%) had a biopsy only. Response assessment on magnetic resonance imaging at 3-month post-HRT showed that 14 (22%) patients had regression, 21 (34%) were stable and 22 (35%) had a progressive primary tumour. 5 (8%) patients were lost to follow up. With a median follow-up of 7.8 months, the median overall survival was 9 months. Patients with ECOG-0 showed a median survival of 7 months as compared to 6 months for those with ECOG-1. Patients with stable or partial response showed a median overall survival of 8 months in comparison to 6 months for those with progressive disease. There were no signi cant differences in median survival based on the extent of surgery. A Cox multivariate model con rmed signi cant correlation of age and response to radiotherapy with survival. Conclusion: HRT consisting of 48 Gy in 3 weeks can be used for selected glioblastoma patients to reduce the overall treatment time of conventional radiotherapy by 35–40% without apparent increased toxicity or decrement in survival in a low resource environment. Key words: Chemoradiation, glioblastoma, hypofractionated radiotherapy, survival
COMPARISON OF ARGON PLASMA COAGULATION AND FORMALIN INSTILLATION IN THE TREATMENT OF RADIATION INDUCED HAEMORRHAGIC PROCTOCOLITIS
Full text linkBackground: Radiotherapy is routinely used in the treatment of pelvic malignancies and about 2–5% of these patients develop radiation-induced proctitis or proctocolitis. This complication of radiotherapy is treated in different ways. Two of these treatments, argon plasma coagulation (APC) and formalin instillation, have both been reported as to be successful modalities, but data comparing them are scarce. We conducted this study to compare these two treatment options. Methods: We reviewed the charts of patients who had radiation-induced proctocolitis and who were treated endoscopically at our tertiary care cancer centre with either APC or formalin instillation. Outcomes of the two treatments were compared in terms of bleeding control after the first session of treatment, the number of sessions required and the nal response to therapy. Results: Out of a total of 26 patients presenting with haemorrhagic radiation proctocolitis, 11 were treated with APC and 15 with formalin instillation. Success after the rst session was 53% in the formalin instillation group compared to 18% in the APC-treated group. On repeated sessions, the final response to both treatment modalities was comparable. Conclusion: Efficacy of APC and formalin instillation in the treatment of haemorrhagic radiation proctocolitis is comparable although formalin showed a better outcome after the first session. Key words: Argon plasma coagulation, formalin instillation, proctitis, radiation-induced colitis
SPECT/CT: EXTRATHYROIDAL UPTAKE ON TECHNETIUM [Tc99m] PERTECHNETATE THYROID SCINTIGRAPHY
No full textRADIOLOGICAL AND PATHOLOGICAL CORRELATION OF LUNG NODULES IN A BACKGROUND OF METASTATIC DISEASE
Full text linkBackground: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (<1 cm) lung nodules. The determination of the underlying malignant or benign nature of a lung nodule poses a great diagnostic challenge and depends on a number of factors, including the radiographic appearance of nodule, the presence of non-pulmonary metastases, characteristics of growth and histological criteria. Methods: The medical records of 89 patients admitted to our specialist cancer centre between 2008 and 2013 were reviewed. Patients of all age groups and tumour category were included in the study. Clinical data of these patients were collected and the following parameters were analysed: Radiographic diagnosis, location, size, laterality and number of nodules and histological impression. The radiological findings were then correlated with histopathological findings. The nodules were sub-classified into groups on the basis of size (A = 0–0.5 cm; B = 0.5–0.9 cm; C = 1.0–1.5 cm and D = >1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P < 0.05.Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%).Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastase