Context:Metastatic bone disease is a commonly encountered problem in oncology practice. The most useful and cost effective treatment is radiotherapy (RT). Different fractionation schedule of RT can be used to treat such condition.Aims:Assessment of pain response in patients with vertebral bone metastasis after treating them with various radiation fractionations and to compare the toxicity profile in the treatment arms.Settings and Design:A prospective randomized study was designed to include total 64 patients from July 2010 to May 2011. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to vertebra were selected for the study. Patients were randomized to two arms receiving multiple fraction of RT with 30 Gy in 10 fractions and 8 Gy in single fraction RT, respectively.Materials and Methods:Patients with age >75 years, Karnofsky Performance Status (KPS) <40, features of cord compression were excluded from study. Initial pain response was assessed using Visual Analogue Scale (VAS) and compared using the same scale at weekly interval up to 1 month after treatment completion.Results:Arm A comprised of 33 patients while 31 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Eleven patients were lost to follow-up. Initial pain scores were 7.23 ± 0.765 and 7.51 ± 0.55 in arm A and arm B, respectively. Pain scores reduced significantly in both the arms after 1 month (4.39 ± 1.82 in arm A; 5.25 ± 2.39 in arm B). Time of initiation of pain response was earlier in arm A (P = 0.0281), statistically significant. Mild G-I toxicity was noted in both the arms but differences in two arms were not statistically significant (P = 0.49), no interruption of treatment was required because of side effects.Conclusions:Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

Background:Carcinoma cervix is one of the two most common cancers of Indian women with very high morbidity and mortality burden. Although India probably is the leading country in numbers patients of cervix treated radically with combination of teletherapy and brachytherapy (BT), there is presumed diversity of practice across the country due to the inequality of available infrastructure, absence of uniform the training of the radiation oncologists, and absence of any national guidelines. The present survey was conducted to determine current practice patterns in management of locally advanced carcinoma cervix with regard to gynecologic high-dose-rate among the radiation oncologist across the country.Methodology:A 25-item survey was undertaken to study the standard management pattern of Stage IIB–IIIB cervical cancer with special emphasis on the BT practice patterns among various young radiation oncologist working across the country. The survey was undertaken in person in the form of interview questionnaire among the younger members of association of radiation oncologist of India during two national conferences, along with telephonic interview of other members as obtained from the national directory.Results:About 57 young radiation oncologists from 57 centers across the country were surveyed. 25 of them represented private nonacademic centers, 24 represented government academic centers, the rest were from private academic, nongovernmental organization (NGO) run and other centers. The most common teletherapy dose prescribed was 46 Gy/23# for Stage II, and50 Gy/25 # for Stage III disease. HDR after loader with 192Ir is the most common machine (82.6%) in use and computed tomography scan is the most commonly (30/57) used imaging for planning. The most common intracavitary dose pattern for all stages was 7 Gy × 3 fractions (30/57s) and 9 Gy × 2 (12/57) fractions. Although in most centers, computed tomography-based delineation of organs at risk is done routinely; however, target volume delineation and dose prescription/optimization for the same is routinely done in handful of centers (5/57). The mean planned dose to Point A for combined external-beam radiation and BT (EQD210) was about 77.5 Gy for Stage IIIB and 72.6 Gy for Stage II disease.Conclusion:Although fractionation patterns may vary, the overall mean dose administered for cervical cancer is similar across the country, which is slightly lower than the recommended doses as per stage by various international guidelines.

background: Brachytherapy for carcinoma cervix has moved from point a based planning to optimization of dose based on hr-cTV. Guidelines have been published by Gec esTrO on hr-cTV delineation based on clinical gynecological examination and Mr sequences. These have given significant clinical results in terms of local control. however, many centers around the country and worldwide still use cT based planning, which restricts hr-cTV delineation, as disease and cervix can rarely be differentiated on a planning cT. Various studies have been done to develop cT based contouring guidelines from the available data, but enough evidence is not available on the clinical outcome when treatment is optimized to hr-cTV contoured on cT images. The purpose of this study is to find out the relation between local control and dosimetry of hr-cTV as delineated on cT images.Materials and methods: patients of locally advanced carcinoma cervix treated radically with eBrT of 50 Gy in 25# and at least 4 cycles of concurrent weekly cisplatin having a complete or partial response to eBrT were taken for study. all patients had completed cT based Intracavitary brachytherapy to 21 Gy in 3# of 7 Gy per # with dose prescription at point a and optimizing dose to reduce bladder and rectal toxicity. Follow up data on locoregional recurrence was obtained. hr-cTV delineation was done retrospectively on the treatment plan following guidelines by Viswanathan et al. eQD2 doses for eBrT+BT were calculated for point a and hr-cTV D90. The dosimetric data to hr-cTV and to point a were then compared with patients with locoregional control and with local recurrence. results: 48 patients were taken, all had squamous cell carcinoma. The median age was 48 years. 33.33% were stage IIa, the rest were stage IIB. Median follow-up was 30 months with 25% developing recurrence of the disease. hr-cTV D90 eQD2 dose was significantly higher in patients with locoregionally controlled disease than in patients with local recurrence (83.97 Gy 10 vs. 77.96 Gy 10 , p = 0.002). patients with hr-cTV D90 eQD2 dose greater than or equal to 79.75 Gy 10 had better locoregional control than patients receiving dose less than 79.75 Gy 10 (p = 0.015). Kaplan Meier plot for pFs showed significantly improved pFs for patients receiving hr-cTV D90 dose of at least 79.75 Gy 10 (log-rank p-value = 0.007). Three year progression free survival was 87.1% in patients receiving hr-cTV D90 dose of at least 79.75 Gy 10 . conclusion: cT based hr -cTV volume delineation with the help of pre brachytherapy clinical diagrams and MrI imaging may be feasible in a select subgroup of patients with complete or near-complete response to external beam radiation.

Purpose: Radiation for superficial tumours of the head and neck region can be given either by brachytherapy or electrons. Brachytherapy (BT), due to rapid dose fall-off and minor setup errors, should be superior to external beam radiotherapy (EBRT) for treatment of lesions in difficult locations such as the nose and earlobe. The present study is a dosimetric comparison of computed tomography (CT)-based mould brachytherapy treatment plans with 3D conformal electron beam therapy in the treatment of non-melanoma skin cancers (NMSC). Material and methods: From December 2017 to November 2018 10 patients with NMSC of the head and neck region (forehead, nose, cheek) who underwent adjuvant radiation with HDR brachytherapy (BT) with a surface mould individual applicator were enrolled for analysis. We evaluated dose coverage by minimal dose to 90% of planning target volume (PTV, D 90), volumes of PTV receiving 90-150% of prescribed dose (PD) (VPTV 90-150), conformal index for 90% and 100% of PD (COIN 90 , COIN 100), dose homogeneity index (DHI), dose nonuniformity ratio (DNR), and exposure of organs at risk (OARs) (eyes, lens, underlying bone and skin). Prospectively, we created CT-based treatment plans for electron beam therapy. We compared conformity (COIN 90 , COIN 100), dose coverage of PTV (D 90 , VPTV 90 , VPTV 100), volumes of body receiving 10-90% of PD (V 10-V 90), doses to OARs (D 0.1cc and D 2cc) of BT and electron plans. Results: We obtained mean BT-DHI 0.81, BT-DNR 0.608, Electron-DHI 1.25. We observed no significant differences in VPTV 90,100 and D 90 between BT and electron beam. Mean BT-VPTV 125,150 were significantly higher than Electron-VPTV 100,125. COIN 90 was superior for BT plans. Conclusions: CT-based surface mould brachytherapy results in better conformity of superficial lesions on small, irregular surfaces such as the nose and inner canthus than electrons with a slightly higher skin dose.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue tumor commonly occurring in the trunk or extremities, lesser than 5% being located on the scalp. Surgery is the mainstay of management of this locally infiltrative cutaneous soft tissue sarcoma, with a high probability of recurrence if margin remains positive or inadequate. Adjuvant radiotherapy to a dose of 40–60 Gy decreases this chance of recurrence considerably. Radiotherapy is generally delivered by interstitial HDR brachytherapy, opposed photon or electron beam. We report a case of a 24 year old female, presenting with a small, painless nodule over right frontal area of scalp, diagnosed as DFSP post surgery with close margin that was treated with adjuvant radiation customized HDR surface mould brachytherapy with good local control and cosmesis.