Brachytherapy (BT) for locally advanced cervical cancer is vital for optimal outcomes. There is heterogeneity in brachytherapy treatment practice for cervical cancer across India. In an attempt to standardize various processes involved in cervical cancer brachytherapy, the expert members of the Indian Brachytherapy Society (IBS) developed a document related to radiation therapy treatment of cervical cancer with special emphasis on brachytherapy. The guidelines are based on high quality clinical evidence, expert opinion and consensus wherever evidence was lacking. The document provides a guide for external beam radiation and details of all the processes involved in high-dose-rate (HDR) brachytherapy including patient selection, preparation, principles and technique of BT applications, target and normal tissue definition, dose prescriptions, BT planning, reporting parameters, common complications of BT and their management, scope for research, etc. In summary, we present here practical tips and tricks, recording and reporting of cervical cancer brachytherapy, which can be implemented in various clinical environments and forms the basis of this report.
Rhinosporidiosis is a chronic inflammatory disease common in India and Sri Lanka. Its manifestations are mostly nasal, though extranasal ones in head and neck region are not rare. Occasionally these presentations lead to diagnostic dilemma. Here we present some cases with its associated confusions if any. In this study thirty five patients were included. Extranasal manifestations were noted in nine cases. Two patients attended with laryngopharyngeal and one with lacrimal sac presentation-subsequent nasal endoscopic examination revealed presence of nasal masses, too. Other six cases presented with polypoidal mass hanging from nasopharynx into oropharynx. One of them was confused with nasopharyngeal angiofibroma. Two laryngopharyngeal masses were removed successfully with rigid laryngoscope followed by cauterisation of the base. The solitary lacrimal sac mass was excised by external approach combined with nasal endoscope guided excision of nasal mass. The other six cases with nasopharyngeal attachment were subjected to nasal endoscope guided removal. In all these cases, the base of the lesions was cauterised. The experience about the various manifestations and diagnostic problems is discussed here.
Objectives: Retinoblastoma is the most common intraocular malignancy afflicting children worldwide. Even though there are enough data about the epidemiology of retinoblastoma in western population, there are only few reports from developing countries like India. In this retrospective study, we aimed to describe the epidemiological patterns, survival characteristics and prognostic factors of retinoblastoma. Materials and Methods: From medical records, we retrospectively analyzed the data of 68 children diagnosed in our hospital between January 2013 and December 2017 as having retinoblastoma. Data on sex, religion, laterality, age at diagnosis, presenting signs, family history, lag time for treatment, cause of such lag time and spread of tumor, treatment mode, and survival time were collected. Results: The median age of onset was 22 ± 19.73 months (range 2-92 months).The median patient age of onset of the unilateral cases was 23 ± 20.6 months, and that of the bilateral cases was 21 ±16.2 months. The median overall survival was 28.1±2.2 months. For unilateral cases, it was 30.1±2.5 months and for bilateral cases it was 19.7±2.9 months. The overall progression free survival (PFS) was 22.2±2.3 months. For unilateral cases, it was 24.18±2.7 months and for bilateral cases it was 13.9±2.9 months. 4 cases of familial retinoblastoma were reported. Among the 13 bilateral cases, 3 were found to have pinealoblastoma too. On Cox regression analysis, age of onset below 36 months, diagnostic delay of less than 5 months and delay of treatment initiation (after diagnosis) less than 2 months were found to have significant effect on OS. The former two were found to have significant effect on PFS but not the latter (p<0.05 and HR>1). Conclusions: Almost 81% of patients presented at an advanced stage of the disease, the reason being accounted by diagnostic and therapeutic delay by virtue of a number of causes, the major one being eluded by apparently nonviolent yet ineffective alternative medicine practices. In spite of following the institutional protocols which are at par to the international guidelines, analysis shows much poorer survival in this study compared to those of developed countries. The cause might be such late presentation of the cases in already advanced stages of the disease.
Introduction:To investigate the effect of different hypo fractionated thoracic radiotherapy schedules in relation to thoracic pain relief, overall survival and post radiotherapy HRQOL in metastatic NSCLC.Material and methods:Stage IV NSCLC and had intra-thoracic symptoms, included in the study. Patients were randomly assigned to three treatments arms. (i) 17 Gy in 2 fractions in one week (ii) 20 Gy in five fractions in one week. (iii) 30 Gy in 10 fractions in two weeks. BPI module was used to assess pain score before and after the thoracic radiotherapy. Functional assessment of cancer therapy-G (FACT-G) used to investigate changes in HRQOL. Clinicians’ assessment of symptom improvement were recorded at 2nd, 6th and 12th weeks after completion of TRT.Results:Pain relief, HRQOL and OS were equivalent in all the three arms. The median OS were 6 months, 5 months, 6 months in arm A, B and arm C, respectively.Conclusion:Protracted palliative thoracic radiotherapy renders no added advantage of relief of symptoms, HRQOL and overall survival compared to short course palliative TRT in metastatic NSCLC.
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