Superior vena cava syndrome is referred to as a constellation of symptoms and signs caused by obstruction of superior vena cava. It can occur due to both benign and malignant causes with the latter being the predominant. There is a paradigm shift in the approach to manage this condition. It is no longer considered a medical emergency and histological diagnosis is necessary before treatment. This article reviews the causes, symptoms, pathophysiology, and overall management policy which have changed over decades.

Portal dosimetry (PD) was performed for 181 fields from 14 IMRT plans of various clinical sites at gantry zero and source‐to‐detector distance (SDD) of 100 cm. PD was realized using aSi1000 electronic portal imaging device (EPID) and portal dose prediction (PDP) algorithm implemented in Eclipse treatment planning system (TPS). Agreement of PDP predicted and EPID measured photon fluence/dose distribution were evaluated using gamma (γ) index set at 3% at 3 mm distance to point agreement (DTA). Three gamma scaling parameters, maximum γfalse(γfalse)trueprefixmax, average γfalse(γfalse)avg and percentage of points with γ≤1false(γnormal%≤1false) were estimated for each field. An independent measurement was carried out using MatriXX 2D ion chamber array with detector plane at 100 cm and γtrueprefixmax,γavg and γnormal%≤1 were estimated using OmniPro IMRT analyzing software. Effect of extended SDD and gantry rotation on portal dosimetry outcome was also investigated for another 45 IMRT fields. PDP predicted and EPID measured photon fluence agrees well with overall mean values of γtrueprefixmax,γavg and γnormal%≤1 1 at 2.02, 0.24 and 99.43%, respectively. γfalse(γfalse)trueprefixmax value was lower in 15 MV compared to 6 MV IMRT plan. Independent verification using MatriXX showed comparable overall mean values of γfalse(γfalse)avg and γnormal%≤1 at 0.25 and 99.80%. However, in all plans, MatriXX showed significantly lower γmaxfalse(p<0.05false) with an overall mean value of 1.35. In portal dosimetry, compared to gamma values at 100 cm SDD, γtrueprefixmax,γavg and γnormal%≤1 values improve from a mean of 0.16, 0.03 and 0.26 at 110 cm SDD to 0.35, 0.05 and 0.29 at 140 cm SDD. PD outcome was independent of gantry rotation. In conclusion, both MatriXX 2D ion chamber array and portal dosimetry showed comparable results and can be use as an alternative to each other for relative photon fluence verification.PACS number (s): 87.55.D‐, 87.55.de, 87.55.kd,87.55.km,87.55.Qr,87.56Fc:

Human papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Spinal epidermoid cysts, whether congenital or iatrogenic, are relatively uncommon in the spinal cord. When they occur, the typical location is in the subdural, extramedullary space of the lumbo-sacral region. We describe an unusual presentation in a 3-year-old male child which mimicked astrocytoma clinicoradiologically. The child developed sudden onset of inability in walking and weakness of both lower limbs after a fall. There was a dramatic reversal of symptoms after surgery. Histopathology revealed an epidermoid cyst of the spine. On the first follow-up visit at 3 months, the child was asymptomatic.

While HIV is often associated with tuberculosis and a number of opportunistic infections, the spectrum of diseases of patients with HIV infection encompasses a number of malignancies as well. Typically, these are the AIDS-defining malignancies, though other malignancies also comprise a significant caseload. Radiotherapy plays an integral part in anti-cancer treatment and its tolerance and efficacy in HIV+ patients are therefore important. The patient's level of immunity as manifested by the CD4 count has a significant bearing on treatment outcomes. In some cases, like primary central nervous system lymphoma (PCNSL), the occurrence of the malignancy itself is tied to the patient's immunity with increased incidence in patients with CD4 counts less than 50/mm 3. The success of highly active antiretroviral therapy (HAART) has allowed administration of standard doses of radiotherapy and even chemotherapy in recent times leading to improved outcomes. In general, standard radiotherapy and concomitant chemo-radiotherapy protocols should be used wherever possible, so as not to compromise disease control. Local control and disease-specific survival rates in HIV patients are no worse than in HIV? patients, but this is only true for CD4 counts above 200/mm 3. In certain situations like cervical intraepithelial neoplasia CIN, HAART itself is associated with disease regression. The question of increased radiosensitivity in HIV patients remains unresolved in most diseases and there are sparse data with regard to non-HIV associated malignancies in these patients. Greater caution and emphasis on good supportive care and HAART would appear to be essential when treating the malignancies in HIV+ patients with standard anti-cancer regimens.