Background: One of the most prevalent head-and-neck tumors in Southeast Asia is nasopharyngeal carcinoma (NPC). Each year, NPC causes 84,400 new cases and 51,600 fatalities worldwide. Intensity-modulated radiation therapy (IMRT), which has good local control and few side effects on healthy tissue, is being used to treat NPC. Aims and Objectives: Our study aims to assess the feasibility of cochlear sparing using volumetric-modulated arc therapy/IMRT technique. Materials and Methods: Radiotherapy plans of 20 patients diagnosed with NPC who received curative concurrent chemoradiation (Weekly Cisplatin dose of 40 mg/m2) with RT dose of 66 −70 Gy at 1.8–2 Gy/# to a total of 33–35# delivered using True beam LINAC between the year 2020 and 2022 were analyzed retrospectively. Results: Cochlea sparing reoptimization led to a considerable reduction in radiation dose for both cochleae as compared to the original treatment plans. The median D mean and D max for the left and right cochlea was found to be decreased. The difference in planning target volume (PTV)-D mean between the original and reoptimized plans was negligible. After reoptimization, the median PTV CI remained unchanged. The sparing of the left and right parotids and brain stem was not improved by reoptimization. A similar event was noted for the spinal cord, where the change from the median D max was not statistically significant. Conclusion: Our investigation showed that a much-increased cochlea sparing is possible in the majority of patients while maintaining PTV dosage coverage and the other organs at risk. Clinical trials in the future, both retrospective and prospective, should examine the effects of this optimization.

BACKGROUND The treatment of metastatic breast cancer depends on the individual patient and receptor status and general condition of the patient. Even with newer systemic and locoregional treatment, metastatic breast cancer cannot be cured completely at present. In few patients with good prognostic factor, these treatment modalities increase the progression-free survival which in turn may significantly affect the overall survival. Many patients with metastases may live several years with modern locoregional treatment and systemic chemotherapy. The aim of the treatment of metastatic breast cancer should be towards increasing the symptom-free survival and quality of life. At the same time the side effects of the treatment should be minimised. The objective of the study is to evaluate the role of locoregional treatment such as local radiotherapy and surgery in the management of patients with metastatic breast cancer. MATERIALS AND METHODS This is a retrospective observational study. One hundred and Ninety-five patients with metastatic breast cancer between the years 2003 to 2008 were taken for this retrospective ongoing study. Among these, seventy-five patients did not receive locoregional treatment, and the remaining one hundred and twenty patients received locoregional treatment to the primary. Locoregional treatment included radiotherapy and surgery. RESULTS Patient's survival was analysed at the end of 1 year, 3 years, 5 years, and at the end of 10 years. It was found that, in patients receiving concurrent chemoirradiation, survival rates at the end of 1, 3, 5 and 10 years were 89%, 58%, 46% and 42% respectively. Similarly, in patients receiving concurrent chemoirradiation followed by surgery, survival was 97%, 80%, 71% and 70% respectively. Further, survival for chemotherapy was 60%, 5%, 2% and 0% respectively. Again, for the arm including only radiotherapy, survival was around 67%, 33%, 33% and 33% respectively. Those patients who receive only hormonal therapy had 50%, 13%, 13% and 13% overall survival at the end of 1, 3, 5 and 10 years. CONCLUSION The data reported in this retrospective study confirmed that chemoirradiation improved overall survival and symptomatic local control, demonstrated in locoregionally treated patients with metastatic breast cancer.