International Journal of Cancer Therapy and Oncology
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Role of preoperative 18-FDG- PET/CT in early-stage breast cancer upstaging and modification of treatment
Get PDFPurpose: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.Methods: A total of 72 consecutive patients (age: range 24-78 years, mean 51 years), with newly diagnosed operable breast cancer (Infiltrating Ductal carcinoma: Lobular carcinoma: Others - 49:15:8) with tumor size 10-65 mm were examined preoperatively. All patients underwent conventional assessment imaging modalities like mammography, breast/axillary ultrasound and PET/CT.Results: PET/CT identified a primary tumor in all but two patients. PET/CT solely detected unsuspected distant metastases (bones, lung, brain etc) in 9 patients and new primary cancers (endometrium and lung) in another two patients, as well as 11 cases of extra-axillary lymph node involvement. In 6 patients, extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 9% (6/70) and ultimately a modification of planned treatment in 12% (9/70) of patients. PET/CT evaluation led 5 patients of stage II A to stage IV, 3 patients of stage II B to stage IV and 1 patient to Stage IIIB which further modified treatment plan from an adjuvant to a metastatic approach.Conclusion: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative 18F fluorodeoxyglucose PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer
Anticancer role of antidiabetic drug Metformin in ovarian cancer cells
Get PDFPurpose: Epithelial ovarian cancer is the most common ovarian cancer and has life threatening implications. Despite the progress in surgical and therapeutic strategies, resistance to chemotherapy is still a major concern. Chemotherapeutic agents cause cytotoxicity, primarily by the induction of apoptosis. The status of p53 is a key factor in determining the efficacy of apoptotic signaling. p53 is the most commonly mutated tumor suppressor gene in ovarian cancer. Metformin (an antidiabetic drug) has shown putative effects in many solid tumors. Hence we aimed to study the role of metformin in p53 mutated cancer cells.Methods: SKOV3 and OAW42 ovarian cancer cell line were used. The cancer cells were treated with metformin. MTT, Flow cytometry and Western blotting were used to characterize the effects of the different treatments.Results: Metformin treatment leads to cell cycle arrest in the G0/G1, S and G2/M phase of the cell cycle in SKOV3 and OAW42 respectively. Moreover, there was upregulation of Bax and downregulation of Bcl-2 protein and increased apoptosis in SKOV3 and OAW42 ovarian cancer cells.Conclusion: These findings support the potential of metformin to be used as chemoadjuvant and reflects its ability to sensitize cancer cells to apoptosis independent of p53 status
Can neck irradiation be an alternative to neck dissection in early stage carcinoma oral tongue operated for primary alone? Experience from a single institute
Get PDFPurpose: To study pattern of failure, locoregional control rates (LCR) and disease free survival (DFS) in post-operative patients of carcinoma oral tongue, and to study the impact of nodal dissection on DFS in stage I and II patients.Methods: 102 patients of carcinoma oral tongue treated between January 2009 and December 2013 were analyzed. All patients were operated for primary disease, but neck dissection was done in 78 (76.5%) patients only. However, radiation to primary site along with neck region was received by all patients. Pattern of failure, LCR and DFS were estimated.Results: At median follow up of 12 months, 10.8% patients failed locally, 10.8% in nodal region, 2.9% both at local and nodal site, and 5.9% patients failed distally. 2 year LCR and DFS was 71.2%, 90.9%, 79.5%, 0% and 55.2%, 64.4%, 57.8%, 0% in stage I, II, III, IV respectively. 2 year DFS in stage I patients, who underwent nodal dissection and post-operative radiation (14 patients) was 64.3% and in whom only neck irradiation was done (15 patients), it was 45.8%, however difference was not significant (p = 0.5). But in stage II patients, 33 patients who underwent nodal dissection and post-operative radiation, 2 year DFS was 85.4% and it was 21.4% in 7 patients who underwent neck radiation only, and difference showed trend towards significance (p = 0.05). 2 or more positive lymph nodes post dissection was the only poor prognostic factor that correlated with DFS (p = 0.02)Conclusion: While in stage I, neck irradiation alone can be a possible alternative to neck dissection and post-operative radiation; for stage II, neck dissection is mandatory
Estimation of local confidence limit for 6 MV photon beam IMRT system using AAPM TG 119 test protocol
Get PDFPurpose: The aim of this study was to estimate local confidence limit for 6 MV photon beam based intensity modulated radiation therapy (IMRT) using TG119 test protocol.Methods: The American Association of Physicists in Medicine (AAPM) Task Group 119 (TG119) prescribed a protocol to evaluate overall accuracy of IMRT system rather than independent uncertainty in dose calculation, dose delivery and measurement system. Two preliminary and five clinical test cases were created based on dose prescriptions and planning objectives given by TG119 report. Verification plans were created in a planning slab phantom, 2D Matrix dosimetry system (I’MatriXX) with multicube phantom and aS-1000 electronic portal imaging device (EPID). Radiation absorbed doses to high dose points in the planning target volume (PTV) region and low dose points in avoidance structures were measured using CC13 ionization chamber having sensitive volume of 0.13 cm3. The measured and planned doses were normalized with respect to their prescription doses and intercompared. The gamma analysis was carried out for both I’MatriXX and EPID, adopting the acceptance criteria of 3% DD (dose difference) and 3 mm DTA (distance to agreement) with 10% threshold dose.Results: For the point dose measurements with ion chamber, the average dose difference ratio in high dose low gradient PTV region was -0.0133 ± 0.012 corresponding to a confidence limit of 0.037. The average dose difference in low dose region (avoidance structure) was -0.00004 ± 0.010 corresponding to a confidence limit of 0.021. The average percentage of points passing the gamma criteria of 3% DD and 3 mm DTA for composite planar dose distribution measured by I’MatriXX was 99.47 ± 0.43 which corresponds to a confidence limit of 1.38 (i.e. 98.62% passing). Similarly, the average percentage of points passing the gamma criteria of 3% DD and 3 mm DTA for per-field dose distribution measured by EPID was 98.00 ± 2.49 which corresponds to a confidence limit of 6.87.Conclusion: Our results were well within action level given by AAPM TG119 report through multi-institutional study providing us adequate confidence in delivering IMRT treatment
Multifocal, recurrent malignant chondroid syringoma with visceral metastases: A case report and literature review
Get PDFWe present the unusual case of malignant chondroid syringoma (MCS) in a 64-year-old male with recurrent nodular skin lesions and visceral metastases. The patient underwent repeated excisions, with eventual development of widespread nodules and multiple pulmonary and hepatic nodules. Systemic chemotherapy was planned. MCS is a very rare skin adnexal tumor of the sweat glands with only around 50 cases reported worldwide. To the authors’ knowledge, this is the first reported case of MCS with a multifocal presentation and mucosal involvement
A study of X-ray volume imaging system in image guided radiotherapy with variable gantry rotations
Get PDFPurpose: The main purpose of this work is to investigate the optimal usage of X-ray volume imaging (XVI) system in image-guided radiotherapy with different gantry rotations in order to reduce scanning volume.Methods: A total of 60 scans of 16 individual patients with breast and head and neck cancer were used in this study. Full and partial gantry rotations were performed at the same time with same setup on the couch using XVI system by changing the preset information. The reference and localization images were matched with this system. The set up errors were evaluated with XVI software.Results: Variation in translational errors with full and half gantry rotations in breast cases were <2 mm in 86.6% of measurements. Similarly, variations between full and partial gantry rotations in head and neck cases were <1 mm in 95.5% of measurements. Results showed almost similar translational and rotational shifts in both full and partial gantry rotations in the majority of the cases.Conclusion: Based on selected cases in this study, partial rotation of the gantry for acquiring 3D cone beam computerized tomography (CBCT) is very useful option in reducing scanning volume and total treatment time in IGRT. However, the use of partial rotation of the gantry depends on patient thickness and area to be reconstructed to track anatomical changes near to the target
Estimation of linear quadratic (LQ) model parameter alpha/beta (α/β) and biologically effective dose (BED) for acute normal tissue reactions in head and neck malignancies
Get PDFPurpose: Linear-Quadratic (LQ) model has been widely used for describing radiobiological effectiveness of various fractionation schedules on tumour as well as normal tissues. This study estimates α/β for acute normal tissue reactions using Fe-plot method.Methods: 50 cases of locally advanced head and neck squamous cell carcinoma (stage III and IV) treated with external beam radiotherapy were included in this study. Patients were randomly distributed into Hyper-fractionation (HF) arm (1.2 Gy/fraction, twice daily, 6 hours apart) and conventional fractionation (CF) arm (2 Gy/fraction, once daily) with 25 cases in each arm. α/β and BED were calculated for acute normal tissue reactions using Fe-plot method.Results: In our study, the estimated values of α/β for RTOG (Radiation Therapy Oncology Group) grade 1, 2 and 3 skin reactions were 11.2 Gy, 10.1 Gy and 9 Gy respectively. Estimated values of α/β for RTOG grade 1, 2 and 3 mucosal reactions were 9.7 Gy, 8.0 Gy and 9.1 Gy respectively. For Hyper-fractionation arm, calculated BED values for grade 1, 2 and 3 skin reactions were 54.45 Gy11.239, 66.90 Gy10.114 and 73.43Gy9.001 respectively and for grade 1, 2 and 3 mucosal reactions were 33.5 Gy9.797, 57.8 Gy8.011 and 70.8 Gy9.106 respectively. For conventional fractionation arm, calculated BED values for grade 1, 2 and 3 skin reactions were 54.09 Gy11.239, 66.88 Gy10.114 and 73.33 Gy9.001 respectively and for grade 1, 2 and 3 mucosal reactions were 33.52 Gy9.797, 57.68 Gy8.011 and 70.73 Gy9.106 respectively.Conclusion: LQ model and the concept of BED provide an excellent tool to compare different fractionation schedules in radiotherapy. The estimated values of α/β for acute reacting normal tissues are in good agreement with the available literature
A case report of long term bevacizumab treatment in multiresistant ovarian cancer
Get PDFTreatment of multiresistant ovarian cancer is palliative and patients have needs for less toxic treatment. Anti-angiogenic treatments have a less toxic profile, and bevacizumab has shown improvement of progression free survival (PFS) in front-line trials. Bevacizumab is generally introduced in combination with chemotherapy; however this case report will describe the use of single-agent bevacizumab for more than five years (102 cycles) in a patient with relapse of advanced ovarian cancer
Quality assurance for dynamic tumor tracking using the Vero4DRT system
Get PDFPurpose: We perform quality assurance (QA) for indirect dynamic tumor tracking (DTT) using four-dimensional radiation therapy (the Vero4DRT™ system).Methods: A single photon beam was set with a 40 × 40 mm2 field size at a gantry angle of zero degrees and a low monitor unit setting of 200. Doses were measured using a 0.016 cm3 ionization chamber inserted in a phantom under stationary, DTT, and non-DTT conditions for sinusoidal (peak-to-peak) amplitude [A] and breathing period [T] (20 mm, 2 s; 20 mm, 4 s; and 40 mm, 4 s). The stationary condition was measured for comparison. Dose profiles were measured using Gafchromic EBT3 films in the phantom under the same conditions.Results: For chamber measurement, the relative doses were as follows: 0.99 with non-DTT and 1.00 with DTT at A = 20 mm and T = 2 s; 0.99 with non-DTT and 1.00 with DTT at A = 20 mm and T = 4 s; and 0.84 with non-DTT and 1.00 with DTT at A = 40 mm and T = 4 s. For film measurement, the spatial distances between the 90% dose of the dose profiles were as follows: 6.53 mm for non-DTT and 0.40 mm for DTT at A = 20 mm and T = 2 s; 6.33 mm for non-DTT and 0.15 mm for DTT at A = 20 mm and T = 4 s; and 10.61 mm for non-DTT and 0.17 mm with DTT at A = 40 mm and T = 4 s.Conclusion: Our results showed high dosimetric and geometric accuracy for DTT using four-dimensional modeling and marked reduction of the blurring effects on dose distribution. We recommend the use of a QA procedure for DTT performed using the Vero4DRT™ system
Comprehensive assessment of xerostomia in patients receiving radiation for head and neck cancer
Get PDFPurpose: Xerostomia is a well known complication of radiation for head and neck cancer. It causes significant impairment of Quality Of Life (QOL).Comprehensive assessment is possible with the help of scintigraphy, Dose-volume histogram (DVH) parameters as well as QOL questionnaire.Methods: Thirty patients of head and neck cancer undergoing radiation were assessed for xerostomia. Scintigraphic assessment of parotid gland function was done before and at six weeks after radiation. QOL questionnaire was administered before, during, and at six weeks after radiation as well as at two years of follow up. Dose received by parotids were correlated with scintigraphic and QOL outcomes.Results: Mean parotid gland volume and dose received were 24.9 cc and 45.3 Gy respectively. Mean Salivary Excretion Factor (SEF) decreased from 54.1 to 12 at six weeks after radiation. QOL scores worsened from first week (mean value: 2.37) of radiotherapy (RT) to fourth week (mean value: 15.50, p < 0.0000) , remained same till completion of RT (mean value: 17.57, p = 0.1063) and at six weeks after radiation (mean value:16.10, p = 0.2519 ). There was a significant decrease in QOL scores between post RT six weeks versus two years follow up (p < 0.0000). Mean parotid dose and QOL scores correlated at six weeks (p < 0.0000), whereas no correlation was found between SEF and QOL.Conclusion: Comprehensive assessment of parotid gland function with Scintigraphy, QOL questionnaire and its correlation with dose volume parameters is helpful in quantifying xerostomia. Even though radiation induced xerostomia persisted for a long time after radiation, it did not translate to decreased QOL