Chelakkot G Prameela

Radiation dose to dysphagia aspiration-related structures and its effect on swallowing: Comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy plans.

CONTEXT Radiotherapy techniques have improved over years but have also raised concerns over subsequent acute and late effects. One such complication, dysphagia, has led to much interest and optimization in treatment delivery. AIMS The aim of this study was to compare radiation dose to dysphagia aspiration related structures (DARS) in intensity modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT), and assess its relation to post-treatment swallowing status, in patients of carcinoma of the anterior two thirds of tongue. MATERIALS AND METHODS Treatment plans of patients treated with IMRT and 3DCRT, from November 2011 to December 2012, were retrieved. Swallowing structures were contoured. Dose volume histograms were generated. Constraint doses were considered based on the statistical derivations. Swallowing status was evaluated based on University of Washington Head- and Neck-related Quality-of-Life questions addressing swallowing. STATISTICAL ANALYSIS USED IBM SPSS Statistics 20 Windows (SPSS Inc., Chicago, IL, USA) was used. Mann-Whitney U-test, Spearmans rho correlation coefficient, and receiver operating curves were used. RESULTS Definitive statistical and subjective correlations were found to exist between doses of swallowing structures, especially the constrictor muscles, the base of the tongue and larynx. Probable mean dose constraints derived statistically clinically corroborates with the swallowing status of patients. IMRT had statistically significant advantage over 3DCRT, in terms of V30 (P - 0.051), V50 (P - 0.002), V60 (P - 0.002), and D80 (P - 0.023) for swallowing structures taken together. CONCLUSION Our study is probably one of the few studies predicting possible mean dose constraints for superior constrictor, the base of the tongue and larynx. Further prospective studies are required to confirm these and to improve the swallowing quality.

Leiomyosarcoma of scrotum: A rare in-field second malignancy in a previously irradiated carcinoma of prostate and review of literature

Background: Curative intent treatments for malignancies using radiation therapy while achieving longer disease-free survivals, may also lead to solid second malignancies, a dreaded late complication. Both in-field as well as out-field second malignancies are encountered and lead to diagnostic dilemma, and delay in treatment. Materials and Methods: Details of a case of rare, in-field, radiation induced leiomyosarcoma, a rare soft tissue sarcoma, in a treated case of high risk carcinoma of prostate, who presented to our tertiary care centre was retrieved and analysed. Conclusion: Increasingly sophisticated radiotherapy techniques, while providing state of the art treatment options, does increase the potential risk of radiation-induced second-malignancies. Respecting integral-dose carries priority, until further studies elucidates mechanism of tumorigenesis.

Radical radiotherapy for carcinoma of the larynx in the elderly: Functional and oncological outcomes from a tertiary cancer care center in India

INTRODUCTION It is estimated that around 10% of all head and neck cancer patients in India are aged over 70 years. Elderly patients are often subjected to palliative or inadequate treatment for head and neck cancers in spite of being candidates for curative intent therapy. In this study we evaluated our use of radical radiotherapy in carcinoma larynx for patients over seventy years of age to determine morbidity, likelihood of completing therapy, functional and oncological outcomes. MATERIALS AND METHODS 132 patients of squamous cell carcinoma of the larynx treated between 2005-2015 at Amrita Institute of Medical Sciences, Kochi who were seventy years of age or older were included. The endpoint for analysis was overall survival. Survival curves were generated using Kaplan Meier method and univariable analysis was performed using log rank test. RESULTS The median age of patients was 77 years (range 70-102). All patients (100%) completed radiotherapy with 6 (5%) requiring treatment breaks. All patients had at least minor (grade I/II) toxicities. Grade III toxicities were seen in 10 (8%) of patients. No grade IV reactions or treatment related deaths occurred. When a univariate analysis was performed for determinants of major toxicities with age range, performance status, smoking, number of co-morbidities or TNM stage, no determinants were statistically significant. 2-year disease free survival for stage I, II, III and IV was 100%, 98%, 80% and 64% respectively, and the 2-year overall survival for all four stages was 100%. CONCLUSION Patients over seventy years tolerate radical radiotherapy for treatment of laryngeal cancer. In spite of minor toxicities, all patients completed treatment and had good oncological outcomes. Patients with stage III/IV unfit for concomitant chemotherapy administration treated with radiotherapy alone had a good disease free survival. Curative intent therapy should not be withheld from elderly patients on the basis of age.

Synchronous phalangeal metastases in upper and lower limbs from primary breast malignancy: a rare case scenario with a review of the literature

Osseous metastasis from a primary breast cancer is common, and the skeletal related morbidity is high. However, solitary acral bony metastasis is rare and the diagnosis of these lesions poses a challenge to the physician. We describe a case of a patient treated with primary breast cancer who later presented with metastatic osteolytic bone lesions confined to a forefinger and toe.

Naughty knot: a case of nasogastric tube knotting.

Nasogastric intubation is a common procedure for enteral nutritional support in medical practice. Random spontaneous true knot formation in the tube is rarely encountered and is a cause of unanticipated trauma. This is a case of a true knot formation diagnosed with fluoroscopy and managed without untoward trauma.

Metastatic endometrial carcinoma in the lung: unusual timing and site

Endometrial cancer is the seventh most common gynecological malignancy. The standard of care is surgery, followed by further treatment based on the surgical and histological findings. 1 Usually, recurrences (80%) from endometrial cancer are seen within three years of hysterectomy and late recurrences are rare. The incidence of isolated lung recurrences is approximately 2.3-7%. 2,3 This is a case report of endometrial cancer with locoregional and distant recurrence.