Background and Purpose The ability of Low dose radiotherapy (LDRT) to control the unprecedented cytokine release associated with COVID-19 pathogenesis has been an area of widespread research since the COVID pandemic. It has not been studied adequately whether the anti-inflammatory effect of LDRT provides additional benefit when used concurrently with steroids amongst other standard pharmacologic therapy. Material and Methods 51 RT-PCR positive COVID-19 patients were recruited between November 2020 and July 2021. 34 patients were allotted to receive 0.5Gy single session LDRT along with standard pharmacologic therapy while 17 patients received standard pharmacologic therapy alone. All had SpO2<94% on room air, respiratory frequency > 24/min and SpO2/FiO2 (SF) ratio between >89 but <357. All patients underwent a baseline CT scan. They were followed up for 28 days during when serial SF ratio, blood biomarkers (CRP, Serum ferritin, IL-6), Absolute lymphocyte count (ALC), repeat CT scan were performed at pre-defined time points. Results LDRT showed a statistically significant early improvement in oxygenation, an early time to clinical recovery, early hospital discharge and better radiological resolution compared to control group. There was no statistically significant difference between the two groups with respect to ALC or blood biomarkers at any of the measured time points. The 28-day mortality rate did not show statistically significant difference between the two groups. Conclusion LDRT can be considered for selected oxygen-dependent moderate to severe COVID-19 patients for rapid relief of respiratory distress. It can be safely combined with standard pharmacologic treatment in such patients for added clinical benefit.

Background and Purpose The main cause of death in COVID-19 pneumonia is acute respiratory distress syndrome which is preceded by massive cytokine release. Low-dose radiation therapy (LDRT) has anti-inflammatory and immunomodulatory effects that can interfere with the inflammatory cascade, reducing the severity of associated cytokine release. Material & Methods 25 patients with RT-PCR proven COVID-19 disease were enrolled between November 2020 and May 2021. All patients had SpO2 < 94% on room air, respiratory frequency > 24/min and SpO2/FiO2 ratio (SF ratio) of >89 but < 357. Patients were treated according to standard COVID-19 management guidelines along with single fraction LDRT of 0.5Gy to bilateral whole lungs within 10 days of symptom onset and 5 days of hospital admission. Results LDRT was well tolerated by all patients. There was a statistically significant improvement in oxygenation as given by the SF ratio between pre-RT and day 2 (p<0.05), day 3 (p<0.001) and day 7 (p<0.001) post RT. Demand for supplemental oxygen showed statistically significant reduction between pre-RT and day 2 (p<0.05), day 3 (p<0.001), day 7 (p<0.001) post RT. 88% patients attained clinical recovery within 10 days post LDRT and median time to hospital discharge from day of LDRT was 6 days. Three patients deteriorated and died. Conclusion As per our initial experience, LDRT appears to be a promising modality of treatment with rapid relief of respiratory distress in selected patients with moderate to severe COVID-19 pneumonia. This translates to early clinical recovery and hospital discharge in the selected patient group.

Abstract:We report a case of 60 year old male with nasopharyngeal squamous cell carcinoma T2N3aMo treated with concurrent chemo-radiation 66Gy in 30 fractions with concurrent weekly carboplatin. On 1 year follow up, the patient had residual left level Ⅱnode, for which 6 cycles of Paclitaxel, cisplatin and 5-Fluorouracil (TPF) was given. Following one year disease free interval, the cancer recurred on same left level II region, for which left Modified Radical Neck Dissection was done. Post-operative re-irradiation 60 Gy in 30 fractions was given in view of extracapsular extension. After a disease free interval of 8 months, recurrence was found in nasopharynx and contralateral right level III nodal region. In our case, re-irradiation without chemotherapy has not improved disease free interval. Therefore, systemic chemotherapy along with re-irradiation should be considered for isolated nodal recurrence with extracapsular extension. (Fig. 1A). Concurrent chemoradiation with

Purpose: To compare plans of 3DCRT, IMRT and VMAT (RapidArc) and evaluate them in different dosimetric aspects along with dose to organs at risk with each technique to determine the best treatment technique for Extended field RT in cervical cancer patients Material & Methods: We evaluated External Beam radiotherapy plans of 10 patients of FIGO 2018 stage rIIIC2 who received Extended Field Radiotherapy (EFRT) to primary site along with regional nodes-bilateral external, internal iliac lymph nodes, presacral and para-aortic lymph nodes. The dose prescribed for all patients was 50.4Gy/28 fractions at 180cGy/fraction. Few patients had received gross nodal boost following this, but for better comparison only the initial phase of 50.4Gy/28 fractions was considered. All patients were planned with 3DCRT, IMRT and RapidArc. We evaluated and compared these plans dosimetrically in terms of Homogeneity Index, Conformity Index, Target Volume Coverage, Gradient Index, Unified Dosimetry Index, Integral dose, Monitor units and Doses to Organs at risk such as Anorectum, Bladder, Bowel Bag, Bilateral Femoral Heads, Bilateral Kidneys and Bone Marrow. Results: Intensity modulated techniques RapidArc and IMRT significantly spared critical organs compared to 3DCRT. Between RapidArc and IMRT, the critical organ sparing was comparable, but RapidArc had better target coverage, lesser MU and lesser treatment time. All techniques had acceptable HI, CI, GI, UDI and whole body Integral dose. Conclusion: Intensity modulated techniques should be the standard for EFRT in cervical cancer. Both RapidArc and IMRT are acceptable techniques of treatment delivery although the former may be preferred if and when available.

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