Susovan Banerjee

Clinical outcomes of adaptive radiotherapy in head and neck cancers

OBJECTIVE The present study evaluated the efficacy and toxicity of adaptive radiotherapy (RT) among patients with head and neck cancer. METHODS 36 patients eligible for radical RT underwent RT planning scans and were planned for 54-Gy dose to both high-risk and low-risk target volumes in Phase I. All patients underwent a second (adaptive) scan during the fifth week of RT. Phase II plans for 16 Gy to high-risk planning target volume were developed on these mid-treatment scans. The primary end point was local response. Disease-free survival (DFS), overall survival (OS) and treatment-related morbidity were secondary end points. RESULTS Median reductions in gross primary and nodal disease volumes on mid-treatment scans were 34% and 43.2%, respectively. 16 patients experienced grade 3 acute mucositis. No patient had grade 3 or above haematologic toxicity. Four patients developed local recurrences, all within the RT field. Median DFS and OS were 17.5 and 23.5 months, respectively. CONCLUSION Adaptation to changes in the anatomic and tumour volume or shape may help tilt the balance towards more efficient dose delivery as well as better normal tissue sparing. ADVANCES IN KNOWLEDGE This study supports the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control and adds to the existing body of literature.

Simple diagrammatic approach to delineate duodenum on a radiotherapy planning CT scan

In recent years, there has been increasing application of intensity-modulated radiotherapy and stereotactic body radiotherapy for the treatment of abdominal malignancies (stomach, pancreas, liver, spinal metastases). This warrants accurate delineation of organs at risk, especially the duodenum. The tortuous and curvy anatomy of duodenum often indistinguishable from adjoining organs is a practical challenge. Radiation Therapy Oncology Group (RTOG) has already published upper abdominal normal structure contouring guidelines to ease the delineation process. This pictorial essay following the RTOG guideline elaborates the step-by-step identification of the different parts of duodenum in relation to the adjoining important structures.

Use of a dedicated day care unit in a modern radiation oncology facility -- a short audit

Our radiotherapy department specializes in all types of conformal therapy including stereotactic body radiotherapy, stereotactic radiosurgery and brachytherapy including interstitial and prostate seed implant. The department also includes a dedicated four-bed day care unit attached to the integrated brachytherapy suite. It is managed by a resident doctor, along with four staff nurses under the supervision of a radiation oncologist. We performed an audit of our day care unit to gain insight into its utilization and needs.

Early stage squamous cell carcinoma of the tonsil presenting with multiple organ metastases including skin and brain after successful local treatment

Early stage carcinoma of the tonsil is curable, and the incidence of systemic metastasis is very low and central nervous system involvement is very rare. A patient diagnosed with early stage tonsillar carcinoma treated with chemoradiation was followed by brachytherapy boost. One and half years after completion of treatment, the patient presented with disseminated metastasis to the skin, lung, liver, bone, and brain. He had all favorable prognostic parameters except being a young adult.

INTRAMUSCULAR 15(S)15 METHYL PGF2α IN THE TREATMENT OF MISSED ABORTION

Intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) was used for induction of labour in cases of missed abortion and intra‐uterine fetal death. The patients received premedication to control the gastrointestinal side effects. Prostin 15M was given at a dose of 250 µg every three hours and escalated whenever required. The trial was interrupted in two out of 83 patients. Altogether 75 patients (92.6%) expelled the fetus with the treatment. The mean induction abortion interval was 14.7 hours. The primigravidae had a longer (18.2 hrs) interval than the multigravidae (13.8 hrs). The mean number of episodes of vomiting was 2.9 and of diarrhoea 3.5 per patient and treatment.

RANDOMIZED COMPARISON BETWEEN TWO‐HOURLY AND THREE‐HOURLY INTRAMUSCULAR TREATMENT WITH 15(S)15 METHYL PGF2α FOR TERMINATION OF SECOND TRIMESTER PREGNANCY

In a multicentre trial, intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Up‐john) was tried at 2‐hourly and 3‐hourly intervals for induction of second trimester abortion. The time schedule was assigned randomly. Eighty‐eight patients for 2‐hourly schedule and 89 patients for 3‐hourly schedule were recruited. Of 2‐hourly 83% and of 3‐hourly schedule 88.8% of the patients aborted with the treatment. The induction abortion interval was 15.9 hours in 2‐hourly and 17.2 hours in 3‐hourly schedule. The dose of Prostin 15M was 2.2 mg and 1.7 mg respectively. The incidence of incomplete abortion was 21.9% in 2‐hourly and 27.8% in the 3‐hourly. The incidence of vomiting was less in the 3‐hourly schedule, however, there was no difference in the incidence of diarrhoea.