Purpose: Gall bladder cancer (GBC) is one of the commonest and deadliest cancers of Northern and Eastern India. The absence of a population-based cancer registry in Uttar Pradesh and Bihar has resulted in a lack of statistical information even though data from several hospital-based registries suggests that incidence rates of GBC may be one of the highest in the world. We present the four-year data on GBC from our tertiary-level multispeciality hospital. Materials & Methods: This is a retrospective and analytical study. All patients of histopathologically proven GBC over four years were included and geographic, demographic and clinical data was collected and presented. Follow up, where available, was used to assess survival at 12 months and factors affecting it. Results: A total of 245 patients with GBC were diagnosed during the study period of which more than two-thirds were women. The majority of cases at our hospital were from the state of Uttar Pradesh with the highest number coming from the Eastern districts closer to the river Ganga and its tributaries. 26.5% of cases were early stage and surgically resectable, 19.6% were locally advanced and unresectable while 53.9% were metastatic at presentation. Age, stage and radical surgery as treatment had a significant association with survival at 12 months. Conclusion: GBC has an extremely high incidence in the Northern plains of India. There is a high suspicion of its association with increasing pollution of the major rivers of the region. Early detection is crucial as definitive surgery is the only curative option with any significant improvement of survival.

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Background: The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine. Materials and Methods: A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings. Results: The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min. Conclusions: The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a “safety culture,” with voluntary error-reporting and a willingness to learn from such errors.

Background: Intraoperative fluid strategy may affect the graft viability in head-and-neck surgeries with free flap reconstruction (HNS-FFR). Studies to guide regarding association of intraoperative fluid with metabolic parameters during such surgeries are infrequent. Aim: This study aimed to compare plasmalyte (PL) and normal saline (NS) (0.9%) in terms of acid–base balance and electrolytes in the peri-operative period along with graft viability during above-mentioned surgeries. Settings and Design: Prospective, observational cohort study was conducted in patients, 18–65 years, undergoing HNS-FFR at a tertiary care center. Materials and Methods: The cohort was categorized into two groups based on the intraoperative fluid used, i.e., PL (Group A) and NS (Group B) group. The primary objective was to compare arterial blood gas parameters at seven time points till the 3rd postoperative day. We studied the effect on graft viability and length of hospital stay. Statistical Analysis Used: The independent t-tests, Chi-square, or Fisher's exact test were used to evaluate the categorical variables with a repeated measures analysis of variance for inter-group comparison with P < 0.05 as significant. Results: Seventy-one (36 in Group A and 35 in Group B) patients were included in the study with comparable baseline characteristics. Group A had a better acid–base status, especially after the conclusion of vascular anastomosis (pH 7.37 ± 0.06 vs. 7.33 ± 0.04, P = 0.014) and in the postoperative period (pH 7.35 ± 0.07 vs. 7.31 ± 0.05, P = 0.013). No statistically significant difference was observed in outcome parameters between the groups. Conclusions: PL may be preferred over NS due to better metabolic milieu during HNS-FFR surgery.

Introduction: Radiation-induced malignancies are a rare phenomenon. Post-radiation sarcoma accounts for 0·5–5·5% of all sarcomas. Adjuvant radiotherapy (RT) after surgery plays a significant role in the treatment of breast cancer. Sarcomas of the breast, chest wall, sternum, axilla or supraclavicular region have been reported as a rare complication of RT for breast cancer. Osteosarcoma (OS) of the sternal bone is a rarely reported entity. OS of the sternum secondary to therapeutic ionising radiation is an even rarer diagnosis, and no such cases have been reported in India as per our literature search. Here we report such a case of post-radiation sarcoma after breast cancer treatment—OS presenting in the sternum and both the second ribs in a young lady. Findings: Our patient developed a sarcoma within a previously irradiated field. The latent period was 7·5 years. She initially suffered from a breast carcinoma for which she underwent radical surgery in the form of modified radical mastectomy. She also received 50 Gy RT dose to the chest wall and axilla. She subsequently developed an OS of chest wall in the high-dose region of RT. Another key factor is the high possibility of familial/hereditary cancer inheritance syndrome like Li-Fraumeni in our patient. Though she was never tested for p53 mutations, her young age at first diagnosis (26 years), extremely strong positive family history and spectra of cancers affecting her first-degree blood relatives (brain tumours, leukaemia) strongly hint at the possibility of such a cancer syndrome. Retrospectively, the question certainly arises, given her young age and family history, whether this patient was a right candidate for RT even once as compared to the fact that she received radiation twice.