BACKGROUND Brachytherapy is an important therapeutic strategy for the treatment of locally advanced gynaecologic (GYN) cancers despite evolution of different newer radiotherapy techniques like high-dose-rate and image-guided BT. Despite being used in the management of advanced gynaecological cancer, currently there is a scarcity of studies and data on interstitial BT in Indian context. This is a retrospective analysis on 71 patients with locally advanced gynaecological malignancies treated in the period of 2010 to 2016 to assess the local tumour control, survival, and complications with the template (Syed-Neblett) guided interstitial technique. MATERIALS AND METHODS The patients with a median age of 51 years treated from July 2010 to May 2016 were retrospectively reviewed. This study included previously unirradiated 71 patients with advance stage of gynaecological malignancies, not suitable for intracavitary brachytherapy due to distorted anatomy or extensive disease stage. Histologically all patients had squamous cell carcinoma (cervix= 56, vault= 9, vagina= 6) and treated by whole pelvis external beam radiation therapy (EBRT) up to a total dose of 50 Gy in 25 fractions. These patients were further treated by high-dose-rate interstitial brachytherapy using Syed-Neblett dedicated vaginal plastic template. During treatment all these patients were re-optimised and a dose of 15-21 Gy was delivered in 3 fractions with a minimum gap of 6 hours between fractions using Varisource iX HDR unit. RESULTS Out of 71 patients 5 were lost to followup during study period and they were excluded from the final analysis. The average followup duration ranged between 6-71 months and median followup was 20 months. This study included parameters like local disease control, acute/late complications and distant metastasis. Out of 66 patients, local disease control was seen in 54 (81.81%) patients, whereas local recurrence was observed in 12 patients (18.18%). Distant metastasis developed in 10 patients, 8 were locally controlled and 2 had local recurrence. Late complications seen were cystitis and proctitis in 23/66 (34%-RTOG Gr II) and vaginal stenosis in 61/66 (92%). CONCLUSION By using Syed-Neblett template in locally advanced gynaecologic malignancies, a high dose of radiation-sparing adjacent vital organs with homogenous dose distribution could be achieved. The observed improved local control, survival and decreased operative and radiation associated morbidity without compromising the therapeutic efficacy was better than EBRT alone.

Adenoid cystic carcinoma (ACC) of the breast is very rare, accounting for only 0.1% of all breast carcinomas. Their rarity has made them difficult to study systematically with the most published series consisting of few cases or case reports; although, this existing evidence does suggest a good prognosis. ACC usually affects women, more in the sixth decade of life. However, our case has an exceptionally early onset of cancer at 16 years, the youngest ever reported in literature. Good local control can be obtained with lumpectomy and radiation or simple mastectomy for nearly all tumors. A routine axillary lymph node dissection is not recommended. We gave adjuvant radiotherapy to this patient in view of close margins and presence of lymphovascular emboli. She tolerated well with minimal side effects. Chemotherapy and hormonal therapy have no established benefit.