Purpose The entire world is currently facing a devastating crisis due to growing coronavirus pandemic, which was declared as a public health emergency by the World Health Organization on March 11, 2020. Management of cancer patients at this time is an overwhelming task. This study highlights our experience in the management of patients of gynecological malignancies over a period of 2 months during the COVID-19 pandemic. Methods Patients of confirmed gynecological malignancies who visited our outpatient clinic and those who received radiotherapy/chemotherapy in March and April 2020 were included for analysis. Guidelines issued by the National Institute of Health and Care Excellence, National Health Service, MD Anderson Cancer Centre and those by young oncologists in Italy were followed with minor modifications while managing the logistics and health worker safety. Results A total of 160 patients were treated in our department during this time period. In total, 44.4% of patients on treatment had associated comorbidities that imposed an additional risk. One hundred twenty-three patients continued treatment with their initial plan of radiotherapy or chemotherapy. New patients were prioritized based on the severity of clinical symptoms and whether the expected outcome would significantly affect their survival and quality of life. Patients were monitored for the development of treatment-related toxicities and COVID-19-related symptoms. Conclusions All oncology personnel need to identify the correct balance between risks and benefit and then proceed with further management. Thus, it is essential to cautiously select patients for treatment, minimizing the risk of exposure but adequately addressing the underlying disease.

No abstract

Background: Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. In this audit, we tried to retrospectively analyse the dosimetric difference, if any, in patients who underwent ICBT at our centre, under either GA in OT or PS in day care. Results: Thirty five patients were analysed 16/35 (45.71%) patients underwent HDR-ICBT under GA while 19/35 (54.28%) patients under PS. In both groups, a statistically significant difference was observed between the dose received by 0.1 cc as well as 2 cc of rectum (p < 0.05), while the bladder and sigmoid colon had comparable dosages. Conclusion: Though our dosimetric analysis highlighted better rectal sparing in patients undergoing HDR-ICBT under GA when compared to patients under PS, PS can still be considered an effective alternative, especially in centres dealing with significant patient load. Further studies are required for firm conclusion.

PURPOSE To evaluate the clinical outcomes in patients with cervical cancer with limited residual disease at brachytherapy (BT) treated with point-based dose prescription. METHODS Patients with locally advanced squamous cell carcinoma of the cervix treated with computed tomography (CT)-based intracavitary BT were considered for analysis. Patients with good response to external beam radiotherapy and limited residual disease suitable for intracavitary BT alone were included. Postapplication CT scans were performed before each fraction and individual plans were made for each session. The dose per fraction was 9Gy high dose rate, prescribed to point-A. Two sessions were planned, 1 week apart. The organs at risk were contoured, and cumulative dose-volume histograms were computed. Local control, pelvic control, disease-free survival, and overall survival were evaluated and late toxicities were documented. RESULTS Four hundred ninety patients were included. Overall, 79.8% had International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB disease and 20.2% had stage III to IVA disease. Median dose at point A (EQD210Gy) was 74.4 Gy (interquartile range [IQR] 72.3-74.5 Gy) and median D2cc (EQD23Gy) for bladder, rectum, and sigmoid were 82.5 Gy (IQR, 65.5-90.8 Gy), 66.5 Gy (IQR, 60.7-75.7 Gy), and 54.1 Gy (IQR, 50.5-77.3 Gy), respectively. At a median follow-up of 62 (IQR, 33-87) months, the 5-year local and pelvic control rates were 90.1% and 88.3%, respectively. The 5-year disease-free survival was 80% and overall survival was 88%. Rates of grade 3-4 bladder and rectosigmoid toxicities were 6.93% and 4.08%, respectively. CONCLUSION In patients with limited residual disease at BT, point-based dose prescription with CT planning results in good local control and acceptable toxicity. In a resource-constrained setting, patients may be triaged to receive point-based BT or magnetic resonance imaging–guided adaptive BT depending on the extent of residual disease.

Background and purpose: Adjuvant Chemoradiotherapy is the standard of care for postoperative gastric cancers with high risk features. The purpose of the current study is to do a dosimetric analysis in the postoperative setting by using 3-Dimensional Conformal Radiotherapy (3D-CRT) to a total dose of 45 Gy in 25 fractions over 5 weeks. A subsequent comparison with the 3D-CRT and IMRT of other published data is presented.Materials and Methods: Sixty postoperative patients who underwent radiation with 3D-CRT technique were included in this analysis. All patients received concurrent 5-Flurouracil or Capecitabine chemotherapy along with radiation. Radiation plans were analysed in terms of PTV coverage, conformity index (CI), homogeneity index (HI), organs at risk (OARs) and dose volume histogram (DVH) parameters. Results: DVH statistics for PTV: Dmean was 45.2±0.8 Gy, D98 was 42.9 ±1 Gy, D95 was 43.4±0.8 Gy, and D2 was 47.7±1.1 Gy. Mean CI for all plans was 1.23±0.43 and HI was 1.09±0.03. DVH parameters for OARs: right kidney, Dmean = 11.9±5.1 Gy, V18 was 21.5±13.8%, V15 was 27.2±14.9% and left kidney, Dmean was 17.7±5.8 Gy, V18 was 33.5±13.8%, V15 was 43.2±15.5%. Dmean for liver was 27.7±6.4 Gy and V20 was 69.2±15.8%. D195cc for the bowel bag was 36.3±10.8 Gy. Conclusion: The results of this study and subsequent comparison with existing literature suggests that 3D-CRT provides adequate homogenous target volume dose coverage and OAR protection, comparable to IMRT. More than the radiotherapy technique, it was the anastomotic site and the tumor location that determined the OAR doses.