VMAT is dosimetrically superior to the field-in-field 3DCRT for left-sided breast cancer patients owing to its comparable PTV coverage and better sparing of heart and lung.

Argon plasma coagulation is a safe, well tolerated and effective treatment option in extensive chronic radiation proctitis which is refractory to medical management.

Context:The study was designed to evaluate the effect of a hypofractionated, palliative conformal radiotherapy regimen of 5250 cGy in 15 fractions in inoperable/incurable oral cavity carcinoma.Aims:The primary objective was to assess the change in the quality of life (QOL) with respect to pain and mouth opening pre- and post-radiotherapy using standardized questionnaires. The secondary objective was to assess overall QOL using the same questionnaires and also to assess response rates, survival, compliance, early and late toxicity.Settings and Design:This was a single-arm, prospective trial. Patients with incurable oral cavity cancer referred for palliative intent radiotherapy to the Department of Radiotherapy, RCC, JIPMER were recruited into the study.Subjects and Methods:Forty-eight patients were recruited and twenty-five patients were given conformal radiotherapy to a dose of 52.5 Gy in 15 fractions. QOL was assessed using the European Organization of Research and Treatment of Cancer (EORTC) questionnaires before and 2 months after the completion of radiotherapy. The response assessment was made using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria 2 months after radiotherapy. The early and late toxicities were assessed at 2 months and 6 months after radiotherapy completion, respectively.Statistical Analysis Used:Sample size was calculated to be 53. The Wilcoxon signed-rank test was used to compare QOL scores pre- and post-radiotherapy. Median survival was assessed using the Kaplan–Meier method.Results:There was a significant improvement in the pain, mouth opening, speech, social contact, social eating, felt ill items of the EORTC QLQ-H and N35 questionnaire and role functioning, emotional functioning, social functioning, fatigue, pain, insomnia, appetite loss, financial difficulties, and Global QOL subscales of the QLQ-C30 questionnaire. 72% of the patients had grade 3 acute radiation oral mucositis and 36% had grade 3 acute radiation dermatitis. There were no significant treatment breaks due to toxicity. There were no grade 3 late toxicities observed. Overall median survival was 5.1 months. The overall response rate was 47%. The median time to treatment completion was 24 days.Conclusions:The improvement in QOL parameters suggests that the regimen of 52.5 Gy in 15 fractions is suitable for palliative intent radiotherapy in late-stage oral cavity cancer for effective palliation for short periods.

Aim: To prospectively evaluate the acute toxicity of 3D conformal radiotherapy with dose optimization in patients with carcinoma cervix. Materials and Methods: Carcinoma cervix patients stage IIB to IIIB (n = 30) treated during November 2011 to May 2013 at the institution with 3D conformal chemo-radiation were included in the study. They received weekly Cisplatin 40 mg/m 2 for a maximum of 5 cycles. They received 46 Gy/23 fractions, 5 fractions per week of external beam radiation. In these patients dose optimization was done in order to achieve a tumor maximum dose (Dmax) around 105%. Various techniques were used for dose optimization which included the use of sub fields, adjusting the weightages, using wedges and the use of mixed energies. EBRT (External Beam Radiotherapy) was followed by two fractions of high dose rate intracavitary brachytherapy of 9 Gy each. Acute RTOG toxicity was assessed weekly during EBRT and 1 week post EBRT. Results: The median age of the patients was 45 (range: 30-55 years). All the patients completed EBRT; 63.3% of the patients received all 5 cycles of chemotherapy while 26.6% of the patients received 4 cycles of chemotherapy and 10% of the patients received 3 cycles of chemotherapy. The most predominant toxicity seen was GI toxicity, diarrhea being the most common GI toxicity followed by vomiting. Neutropenia was the most common hematological toxicity. Most patients had grade 0 and grade 1 toxicity. None of the patients had grade 4 toxicity while few had grade 2 and 3 toxicity. Conclusion: * Corresponding author. S. Balachandran et al. 205 3D conformal concurrent chemo radiotherapy with Dmax around 105% reduces acute RTOG toxicity particularly grade 3 and 4 and improves patient compliance for concurrent chemo-radiotherapy.

Background: Radiation dose received by the gastric fundus (GF) in neoadjuvant chemoradiotherapy (NACRT) may influence the development of postoperative anastomotic leak (AL) in the management of resectable esophageal carcinoma (EC) by trimodality therapy. The present study aims to evaluate dose-volume parameters of the GF and their association with occurrence of AL in EC. Materials and Methods: A retrospective analysis was performed of 27 patients with EC who underwent NACRT followed by esophagectomy with cervical esophagogastric anastomosis between January 2015 and July 2018. The GF was retrospectively contoured; dose-volume parameters of the GF were recorded. Postoperative AL was identified from surgical records. Logistic regression analysis was used to identify risk factors associated with AL. Results: The mean age of the patients was 51 ± 10.5 years; 56% (15/27) had involvement of lower 1/3 esophagus, 10/27 (37%) midthoracic esophagus, and 2/27 (7%) upper thoracic esophagus; 40% (11/27) patients developed postoperative AL and 7/11 had distal and 4/11 had mid thoracic esophageal lesions. Four of five (80%) patients treated by 3-dimensional conformal radiotherapy versus 7/22 (32%) patients treated by volumetric modulated arc therapy developed AL (p = 0.12). Univariate logistic regression revealed no significant correlation between Dmean, Dmax, V20, V25, V30, V35, D50, and AL. 8/27 patients underwent ischemic preconditioning of gastric conduit, and 2/8 had AL; 19/27 did not undergo preconditioning, and 9/19 patients experienced AL (p = 0.4). Conclusion: There was no significant negative impact of the dose received by the GF in NACRT upon AL rates. Further studies with a larger sample size are required to clarify this issue.