Conclusion:Wing board can be used in a busy radiotherapy department for setting up breast patients with a margin of 1.1 cm, 0.76 cm and 0.71 cm for small breasts and 1.96 cm, 1.12 cm and 0.98 cm for large breast in the ML, AP and CC directions, respectively. The large PTV margin in the mediolateral direction in large breast can be reduced using NAL. Further research is needed to optimize positioning of large breasted women.

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Aims: There is no consensus for palliative chemotherapy regimen in metastatic gallbladder cancer. We did a retrospective study to compare the treatment outcome in patients of metastatic gallbladder cancer treated with either gemcitabine + cisplatin (regimen A) or oral capecitabine (regimen B) alone. Subjects and Methods: A total of 67 patients between January 2015 and September 15 treated with either regimen A or regimen B were retrospectively evaluated. Statistical analysis was done in June 2019. Kaplan–Meir and Log rank test were used to compare survival between two arms. Results: Out of 67 patients, 31/67 (46%) received regimen A, and 36/67 (54%) received regimen B. Male to female ratio was 1:3. About 42% patients in regimen A and 20% in regimen B required palliative stenting. Median number of chemotherapy cycles was 4 in both regimen A (range 1->6) and regimen B (range 1->6). Patients receiving 3 cycles and 6 cycles of chemotherapy in regimen A and regimen B was 68% and 31% versus 70% and 63%, respectively (P = 0.86). Response assessment as any response (complete response + partial response + disease was stable) after 3 cycles and 6 cycles was 71% and 57% (P = 0.20), 44% and 39% (P = 0.29), in regimen A and B, respectively. Median survival was 23 weeks (range 2–106 weeks) in regimen A and 15 weeks (range 4–83 weeks) in regimen B (P = 0.40). Conclusions: The present study shows gemcitabine and cisplatin has nonsignificant better survival compared to oral capecitabine. However, oral capecitabine is more convenient and easy to administer. Studies with larger sample size are needed to further establish the standard chemotherapy guidelines.

The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of health care, including the delivery of standard care to patients afflicted with cancer. Patients with cancer may be at higher risk for COVID 19 morbidity or mortality than general population. Whether one can delay cancer procedures remains an ethical issue and there is not much clarity on management in these critical situation. Currently available literature on impact of COVID-19 on gynecological cancer management was reviewed. COVID-19 poses more risks to cancer patients especially who are older and have medical co-morbidities. On the other hand, gynecological malignancies require radical surgical procedures, complex prolonged radiation techniques, and myelosuppressive chemotherapy which make these patients more susceptible for COVID-19. A virtual multidisciplinary tumour board should conducted to plan their management. To limit the hospital visit, teleconsultation should be used to advise patients for pretherapy evaluation and post therapy follow up. Surgical decision making may be categories into three categories: patients with low, intermediate, or high acuity. Assessment of the severity of disease, co-morbidites, and logistic challenges along with COVID-19 burden in their area are important variables for individualized decision making. Safety of healthcare personnel needs to be ensured at the same time. Currently available evidence is limited by small sample size and unfamiliarity with the full impact of this pandemic on cancer. However, the ongoing crisis will strain resources needed to deliver cancer care in the future.