Introduction: Lung is a major organ at risk during Post Mastectomy RadioTherapy (PMRT), because of the risk of Radiation Pneumonitis (RP). In countries like India 2D RT is widely used due to limited access to advanced technologies. We estimated the lung dose volumetrically in breast cancer patients treated with 2D tangential techniques, the incidence of acute RP and its association with lung dose. Methodology: Retrospective study of patients who underwent PMRT was done. The images with structure sets of cases planned using 2D technique were transferred to TPS and 3 D plans were generated. CLD, MLD, LL were measured from the 2D plan in the CT simulator. LDmean and V20 were measured from from DVH, in the TPS. Correlation between V20 and LDmean was done with CLD, MLD and LL. The incidence of radiation pneumonitis and its association with lung dose also was studied. Result: Total 50 patients were analyzed of which 3 patients had radiation pneumonitis. The mean CLD was 2.28 cm ± 0.54cm, MLD was 2.32 ± 0.6cm and LL was 12.52 ±2cm. V20 for two fields (MT+LT) was 17.04 ± 5.6 Gy and for three field (MT,LT and SCF) was 28.75 ± 8.6 Gy. Positive correlation was found between for V20 & LDmean and CLD, MLD & LL (p<0.05) 6% of patients developed Radiation pneumonitis but did not have association with V20 or MLD. Conclusion: Radiation pneumonitis is major concern after chest wall irradiation and the incidence is expected to be high with conventional technique where the volume is not accurately measured. It is still an option in countries like India with resource constraints by planning cautiously with the indicators of irradiated lung, like CLD and MLD within limits thus minimizing the incidence of radiation induced lung injury.  

Background: Chemoradiation plays an important role in cervical cancer treatment but dose to organs at risk (OAR) is the limitation while escalating dose to target. With conformal techniques dose escalation is made possible without increase in toxicities. Though node positive cervical cancers have poorer prognosis delivering higher dose to the involved nodes have shown benefit. We aim to determine the patterns of failure in node positive cervical cancer patients treated with chemoradiation and to determine the grade III and IV toxicities associated with it.Methods and Materials: In this retrospective study node positive cervical cancer patients treated with conformal radiotherapy were analysed. 45 Gy -50.4 Gy was given to the pelvis and 55 Gy to positive nodes with sequential or simultaneous integrated boost (SIB) in 25 -28 fractions with weekly cisplatin 40mg/m2 followed by brachy therapy. Extended fields were used to treat patients with positive para aortic lymph nodes. Treatment toxicities were recorded as per CTCAE version 4.3. Results: Of the 62 patients 87.1% had squamous cell carcinoma and majority were in stage II (38.7%). At a median follow up of 33 months two (3.2%) patients had local recurrence, eight (12.9 %) had distant failure and one (1.6%) had loco regional recurrence. Lung was the most common site of metastasis followed by the supraclavicular region. The 3 year overall and disease free survival were 91.4 % and 77.2 % respectively. Stage of the disease (p=0.001) and residue at the end of therapy (p-0.010) showed significant association with DFS but not with OS. 21 (33%) had Grade III –IV toxicities, nine (13%) having acute toxicities and 12 (19.4%) had late toxicities. Conclusion: Though node positive cervical cancers have poor prognosis our study showed that aggressive management improves the outcome without increase in toxicities.

Context: Osteogenic Sarcoma (OGS) is the fifth most common malignancy among adolescents aged 15–19. With multimodality therapy, the long-term survival has improved from 16% in the prechemotherapy era to around 70% in the postchemotherapy era. Aim: This study aims to determine the clinical profile and survival of children with OGS being treated with limb-salvage surgery (LSS). Subjects and Methods: This is a retrospective analysis of all cases of OGS (age ≤ 19) who underwent LSS at our center between June 2009 and February 2017. Baseline characteristics were noted and multivariate analysis was performed for various variables to identify predictors of survival. Results: Among 44 cases studied majority were boys ( n = 27). Ninety-three percentage ( n = 41) were adolescents. Stage 2 disease was 75% and Stage 3 disease was 25%. The estimated 3-year overall survival (OS) was 69% (95% confidence interval [CI] 55–86) and the estimated 3-year event-free survival (EFS) was 55% (95% CI = 41–74). OS was significantly improved in patients with >90% necrosis postneoadjuvant chemotherapy (NACT) when compared with <90% necrosis (3-year OS = 88% vs. 51%, P = 0.01) and in patients who received ≤4 cycles NACT versus >4 cycles (78% vs. 60%, P = 0.04). EFS was significantly better in patients without lung metastasis at presentation (61% vs. 29%, P = 0.04), Stage 2 disease (59% vs. 38%, P = 0.04) and >90% necrosis in the tumor post-NACT (69% vs. 35%, P = 0.02). Conclusion: Significant response to NACT predicted improved OS and EFS in children with OGS treated with LSS.