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EDITORIAL
Dreams come true
Santanu Pal
January-June 2021, 1(1):1-1
DOI:10.4103/bjoc.bjoc_01_21  
  1,570 165 -
ORIGINAL ARTICLES
Comparison of setup variations and defining a CTV-PTV margin in fractionated radiotherapy of brain tumor using Novalis Tx Orthogonal OBI (kv) versus Brain Lab ExacTrac (kv) imaging systems with brain lab mask
Hemant K Pandey, Mano Bhadauria, Ganesh Kishan Rao Jadhav, Sapna Manocha, Renuka Masodkar, Divya Piyushi, Sanjay Raut, Brijesh Goswami, Sunil Kumar Chauhan
January-June 2021, 1(1):12-18
DOI:10.4103/bjoc.bjoc_20_21  
The objective of this study is to evaluate the setup discrepancy between Brain Lab ExacTrac (kv) and Orthogonal Novalis Tx (kv) imaging systems and to obtain an optimal CTV-PTV margin. We recruited 35 consecutive brain tumor patients, immobilized with non-invasive thermoplastic BrainLab mask, between August 2016 and August 2017. The position verification done by ExacTrac, Infrared Positioning System was followed by a set of images by OBI at 0° and 90° position. The images were autofused and compared with DRR generated by TPS. The extent of translational and rotational shift was then applied and documented. The translational inter-fractional setup error (mean ± SD) in X-axis detected by OBI and ET was 0.002 ± 0.227 and −0.042 ± 0.084, respectively. In Y-axis, the error detected was −0.01 ± 0.176 and 0.075 ± 0.079, respectively, whereas in Z-axis the error with OBI and ET was 0.329 ± 0.521 and 0.051 ± 0.091, respectively. The P-value of inter-fractional errors in X, Y, and Z axes was 0.294, 0.013, and 0.004, which is statistically significant in Y- and Z-axes. Rotational inter-fractional setup errors (mean ± SD) for OBI and ET were −0.101 ± 0.257 and −0.076 ± 0.102, respectively. The rotational setup errors detected by ET in pitch and roll dimension are −0.003 ± 0.084 and −0.085 ± 0.073, respectively. The data obtained were put in Van Herk’s formula (PTV margin = 2.5 ∑ + 0.74 σ), and CTV-PTV margin was calculated. CTV-PTV margin for ET was 2.70, 2.72, and 2.94 mm and 3.38o, 2.84o, and 2.51o in lateral, longitudinal, vertical and pitch, roll, yaw dimension, respectively. The CTV-PTV margin for OBI was 7.40, 6.20, and 5.30 mm and 7.27o in lateral, longitudinal, vertical, and yaw dimension, respectively. Daily setup verifications that use the Brain LAB Exac Trac 6D image-guided system are very useful for brain tumor treatment; nevertheless, OBI kv imaging can be used for FRT of brain tumor with extended margin.
  1,567 124 -
INVITED EDITORIALS
Hippocampal avoidance prophylactic cranial irradiation in small cell lung cancer: Ready for prime time?
Tejpal Gupta
January-June 2021, 1(1):2-5
DOI:10.4103/bjoc.bjoc_37_21  
  1,521 128 -
ORIGINAL ARTICLES
Demographic profile and clinicopathological patterns of colorectal cancer in subhimalayan North India
Nitin Gupta, Shalini Verma, Muninder Negi, Soma Devi
January-June 2021, 1(1):19-25
DOI:10.4103/bjoc.bjoc_18_21  
Background: Despite colorectal carcinoma being one of the common cancers with an increasing incidence over the past few decades, there are only a few studies that have assessed its demographic, clinical, and pathological profile in the north Indian population. Objective: To assess the demographic and clinicopathological patterns of colorectal cancer (CRC) among patients in the subhimalayan region of North IndiaMaterials and Methods: This retrospective cross-sectional study analyzed the data of 244 patients with CRC who were referred to a state-owned medical college in Himachal Pradesh, India, between January 2016 and April 2020. Demographic, clinical, and pathological information was extracted from patient record files. Results: The mean age of patients in the study was 51.2 years, with an age range from 19 to 81 years. Approximately 48% of the patients were aged between 40 and 60 years, 15% were younger than 40 years, 56% of the patients were male, and 44% of the patients were female. Rectal bleeding (~46%), change in bowel habits (~41%), and abdominal pain (39%) were the common clinical symptoms. Overall, 73% of the patients were diagnosed at a mean duration of five months after the onset of their symptoms, and approximately 36% of the patients were in stage II and 48% were in stage III at the time of diagnosis. Colon carcinoma accounted for 76% of the patients, 17% had rectal carcinoma, 5% had carcinoma of recto-sigmoid, and 2% of the patients were diagnosed with ano-rectal carcinoma. Histopathologically ~ 81% patients had adenocarinoma, 14% had mucous carcinoma, 3% had signet ring carcinoma, and 2% had NET. Conclusions: In the subhimalayan region in North India, CRC has a higher male gender predominance, with a substantial number of patients younger than 40 years. Most of the cases are diagnosed after a mean duration of five months of the symptoms. Colon carcinomas are more common than rectal carcinomas, with left-sided colon carcinomas being more common than right-sided colon carcinomas. The majority of tumors are adenocarcinomas, whereas mucinous carcinomas are less common and signet ring carcinomas are rare. A greater number of patients with right-sided colon carcinomas have a higher stage and a more aggressive tumor grade at the time of diagnosis. The study also shows that there is a need to be more vigilant for colorectal carcinoma in patients with lower GIT symptoms and it lays emphasis on a colorectal screening program in such patients, to enable early detection of this tumor.
  1,409 128 -
INVITED EDITORIALS
Oligometastatic nasopharyngeal cancer: Intent and approach?
Sarbani Ghosh Laskar, Anuj Kumar, Shwetabh Sinha
January-June 2021, 1(1):6-7
DOI:10.4103/bjoc.bjoc_28_21  
  1,351 124 -
ORIGINAL ARTICLES
Dosimetric feasibility and clinical outcome of image-guided interstitial brachytherapy using two different fractionation schedule in carcinoma cervix
Abhishek Basu, Bidyut Mandal, Janmenjoy Mondal, Debjit Ghosh, Ipsita Chakraborty
January-June 2021, 1(1):26-33
DOI:10.4103/bjoc.bjoc_16_21  
Methods and Material: Overall, 60 patients were accrued between 2014 and 2017 and treated with ISBT by using Syed–Neblett Template by iridium 192 with Gamma Med plus HDR after the loader unit. They were allotted in two arms (n = 30) and received nine Gy ×2# and 7 Gy ×3 # respectively. All patients received 50Gy/25# whole pelvis EBRT by Theratron 780C. Coverage Index (CI), dose homogeneity index (DHI), overdose index (OI), dose non-uniformity ratio (DNR), D90Target, and 2cc EQD2 of OARs were calculated and correlated with toxicity, locoregional control, and survival. Statistical Analysis Used: Unpaired t-test and chi-square test were used to compare numerical and categorical variables, using IBM SPSS, V23. PFS and OS were calculated by using Kaplan–Meier analysis, and a log-rank test was used for comparison. A p-value ≤ 0.05 was considered significant. Results: Mean EQD2 for bladder (77.33 vs. 80.24 Gy) and rectum (69.12 vs. 69.87) along with D90 (9.12Gy vs. 7.20Gy) were comparable. With a median follow-up period of 38 months, three-year local control rate was 56.6% vs. 46.60% (P = 0.72) and three-year OS was also similar, 83% vs. 80% (p=.8). Dosimetric parameters and toxicity profile between two groups were comparable. Conclusions: 9Gy ×2 # is a reasonably good alternative for treating the locally advanced carcinoma cervix.
  1,358 111 -
Prognostic value of baseline white blood cell count and neutrophil–lymphocyte ratio in carcinoma cervix
Amani Bhogadi, Rohith Singareddy, Harjot Kaur Bajwa, Alluri Krishnam Raju
January-June 2021, 1(1):8-11
DOI:10.4103/bjoc.bjoc_10_21  
Aims: To evaluate the impact of baseline white blood cell (WBC) count and neutrophil–lymphocyte ratio (NLR) in carcinoma cervix patients treated with definitive chemoradiotherapy. Settings and Design: Retrospective cohort study, original research article in Department of Radiation Oncology, Basavatarakam Indo American Cancer hospital. Materials and Methods: Patients of squamous cell carcinoma cervix treated with radical chemoradiotherapy from January 2017 to August 2017 were included in the analysis. All patients had baseline blood counts, local imaging, and metastatic workup at diagnosis. Patients received external beam radiotherapy to a total dose of 50 Gy in 25 fractions along with weekly cisplatin (40 mg/m2) and brachytherapy (21 Gy in 3 fractions). Baseline WBC counts and baseline NLR were correlated with outcomes using chi square test and receiver operating characteristic curves. Statistical analysis used: The patients were divided into two groups based on high-baseline WBC count and normal-baseline WBC count. Baseline WBC counts and baseline NLR were correlated with patterns of recurrence using chi square test. The sensitivity and specificity of prognostic factors for recurrence were computed using ROC curves. Results: The NLR cut-off value of 3.47 had high sensitivity and specificity for predicting recurrence in these patients. Majority of the recurrences in patients having high WBC count and high NLR were distant recurrences. Conclusions: A high-baseline WBC count and high NLR resulted in higher rates of recurrence and inferior survival in carcinoma cervix patients in our study. These biomarkers can be used as predictors of outcomes in carcinoma cervix.
  1,356 96 -
LETTER TO THE EDITOR
COVID-19 vaccine hesitancy in oncology patients
Ingris Marie Valero Sardina, Milind Kumar, Roshan Joseph
January-June 2021, 1(1):34-38
DOI:10.4103/bjoc.bjoc_26_21  
  1,354 93 -
CASE REPORTS
Atypical herpes zoster reactivation in an elderly gentleman with advanced oral cancer
Divya Kukreja, Deep Chakrabarti, Abigail Veravolu Resu, Mranalini Verma, Madan Lal Brahma Bhatt
January-June 2021, 1(1):47-48
DOI:10.4103/bjoc.bjoc_15_21  
Background: Varicella-zoster virus (VZV) causes varicella in children and reactivation zoster in adults. A 79-year-old gentleman with an old history of varicella infection receiving methotrexate for advanced tongue cancer presented with multiple vesiculo-papular lesions in axillae and chest wall. The lesions were multidermatomal in distribution, painless, indurated, and nontender. A Tzanck smear confirmed the diagnosis of herpes zoster. His lesions resolved on antiviral therapy. Dermatologic side effects of methotrexate are otherwise rare and occur in 1%–10% of patients. Nevertheless, advanced cancer or cancer chemotherapy may cause immunosuppression leading to reactivation of VZV in some patients.
  1,282 87 -
Langerhans cell histiocytosis of solitary inguinal mass: Diagnosis and treatment of an unusual case with complete response
Sujata Sarkar, Maitrayee Saha, Tamohan Chaudhuri, Shravasti Roy
January-June 2021, 1(1):43-46
DOI:10.4103/bjoc.bjoc_24_21  
Langerhans cell histiocytosis (LCH) is a “histiocytic” disorder with a spectrum of presentations often with different names having confined a bone, overlying skin, and local lymph nodes or having multiorgan involvement. It is characterized by clonal proliferation of Langerhans cells, which have typical grooved nuclei and tennis racquet-shaped Birbeck’s granules. It is more common in children below 10 years. It is more common in men with M:F is 2:1. Bone is the most common site of involvement. Among lymph nodes, cervical chain is most commonly involved and inguinal lymphatic chain involvement is rarely seen. Diagnosis requires histopathological confirmation. Histopathology shows proliferation of dendritic cells expressing high levels of Langerin, a lectin required for the formation of Birbeck granules. It is positive for CD1a, Langerin, S100, CD68, and vimentin. Here, we are reporting a case of LCH of solitary inguinal mass, localized to unilateral pubic bone, overlying skin and inguinal nodes, in a 35-year-old man. Our aim is to discuss about the investigations leading to diagnosis of this rare entity, LCH; its treatment with surgery and adjuvant radiotherapy, which led to complete response and patient is disease free even after 4 years of treatment.
  1,210 88 -
Intracranial extraskeletal mesenchymal chondrosarcoma: A case report
Megha P Paramban, Vishnu Asokan, Apoorva Vijayan, Prasanth C Chandran
January-June 2021, 1(1):39-42
DOI:10.4103/bjoc.bjoc_19_21  
Background: Mesenchymal chondrosarcoma (MCS) is a rare and aggressive malignant tumor, a subtype of chondrosarcoma assumed to arise from remnants of the embryonic cartilage or metaplasia of meningeal fibroblasts. Intracranial extraskeletal MCSs are rare tumors, accounting for <0.16% of intracranial tumors. They usually occur in the age group of 20–30 years and are commonly found in the frontoparietal region arising from the falx and surrounding dura. Case Description: A 17-year-old girl presented with weakness of the right lower limb. Magnetic resonance imaging showed a large lobulated extra-axial mass lesion in the left parasagittal frontal region. She underwent a left frontoparietal craniotomy and excision of the tumor. She received adjuvant radiotherapy 60Gy/30 fractions. Conclusion: Intracranial MCSs are rare malignant tumors with a poor prognosis. The prognosis depends upon surgical resection and postoperative radiotherapy.
  1,142 91 -
ORIGINAL ARTICLES
Pattern of failure among HNSCC: An institution-based study
Afsana Shah, Dinesh Kumar, Govind Preet Singh, Pragya Shukla
July-December 2021, 1(2):58-65
DOI:10.4103/bjoc.bjoc_1_21  
Aim: This retrospective study was conducted to evaluate the pattern of recurrence in head and neck squamous cell carcinoma (HNSCC) patients who received a definitive chemo-radiotherapy. Materials and Methods: In this retrospective study, the data of 308 head and neck patients from January 2015 to March 2015 were analyzed. Only patients who received definitive chemo-radiotherapy were included in the study. The pattern of recurrence was stratified based on age, gender, site involved, histopathological differentiation, stage, habitual risk factors, and treatments received. Results: The mean age of the patients was 51.6 years. No association in the pattern of recurrence based on age, gender, or histopathologic differentiation was found. Patients with habitual risk factors (smoking, tobacco chewing, and alcohol) showed the poorest response to chemo-radiotherapy and unresolved residual disease. Among the primary sites involved, oral cavity patients showed the poorest response with maximum cases of residual disease. In addition, patients with advanced stage remained with residual disease and have a maximum recurrence, and the difference was statistically significant. All the patients who received neoadjuvant chemo-radiation (NACT-RT) as compared to chemo-radiation (CT-RT) had residual disease. According to the pattern of recurrence, the local recurrence was the most common followed by regional and then local and regional, but the distance recurrence was the lowest. Conclusion: Of the patients who have received definitive chemo-radiotherapy, more than half of HNSCC had residual disease. Of the patients with no residual disease, about half of them had recurrence at follow-up. However, no association in the pattern of recurrence was found based on gender or histopathologic differentiation. Patients who have multiple habitual risk factors showed the worst outcome as compared to the patients who have a single habitual risk factor. Patients with multiple habitual risk factors have maximum cases of residual disease and maximum cases of recurrence. Among the habitual risk factors, tobacco chewing was the worst habitual risk factor for refractory residual disease and recurrence. Based on the sites, the patients with carcinoma of the oral cavity showed the worst outcome in terms of residual disease, which is followed by hypopharynx, oropharynx, and then larynx carcinoma, but the rate of recurrence does not depend on the site involved. Advanced-stage patients had a poor response and with maximum cases of recurrence. A combination of chemotherapy with radiation showed better results as compared to the radiation alone in terms of response and recurrence. As to the site of recurrence, the local recurrence was the most common, followed by regional and then distance recurrence. This study indicated that HNSCC is locally aggressive, and local failures are the most common.
  514 67 -
EDITORIALS
Bengal’s journey in oncology: Back to the future
Tejpal Gupta, Abhishek Chatterjee, Jai Prakash Agarwal
July-December 2021, 1(2):49-50
DOI:10.4103/bjoc.bjoc_5_22  
  394 70 -
ORIGINAL ARTICLES
Pattern of Practices of Oncologists of Bangladesh in the COVID-19 Era
Arman Reza Chowdhury, Parvin Akhter Banu, Md Arifur Rahman, Dario Trapani
0, 0(0):0-0
DOI:10.4103/bjoc.BJOC_22_21  
Purpose: The aim of this study was to investigate the impact of coronavirus disease-2019 (COVID-19) on the practice of oncology care in Bangladesh during the first pandemic surge in 2020. Materials and Methods: This was a cross-sectional survey-type study, based on a questionnaire, which was shared via email to national oncologists and enhanced by snowballing in April–May 2020. Results: A total of 48 responders joined the survey, mostly clinical and radiation oncologists practicing in specialized cancer centers of the major cities. Patients’ triage for COVID-19 was implemented in 60% of the settings surveyed, and an impact on the clinical care was unanimously reported. Delays and interruptions in cancer treatments were common, as was a reduction of patient volume treated with radiation therapy (RT). Mechanisms for priority-setting to inform clinical decisions were set by 80% of the oncologists, including changes in the treatment protocols––more commonly for palliative care interventions and regarding the RT fractionation; also, alternative therapeutic options were more commonly discussed, particularly when patients were candidate to multimodal treatments. Value-driven and choose-wisely approaches were emphasized. Telemedicine was identified as a mechanism to reduce access to hospitals, but only for selected services (e.g., follow-up) by 78%. Protecting hospitals and health workers were identified as priority interventions to shape effective COVID-19 responses. Conclusion: This survey serves as a case study of adaptations of cancer care during COVID-19 in low- and middle-income countries. Elements of priority-settings and value-driven decision-making emerged, although the long-term impact cannot be stated, at this time.
  439 15 -
Pattern of practices of oncologists of Bangladesh in the COVID-19 era
Arman Reza Chowdhury, Parvin Akhter Banu, Md. Arifur Rahman, Dario Trapani
July-December 2021, 1(2):53-57
DOI:10.4103/bjoc.bjoc_22_21  
Purpose: The aim of this study was to investigate the impact of coronavirus disease-2019 (COVID-19) on the practice of oncology care in Bangladesh during the first pandemic surge in 2020. Materials and Methods: This was a cross-sectional survey-type study, based on a questionnaire, which was shared via email to national oncologists and enhanced by snowballing in April–May 2020. Results: A total of 48 responders joined the survey, mostly clinical and radiation oncologists practicing in specialized cancer centers of the major cities. Patients’ triage for COVID-19 was implemented in 60% of the settings surveyed, and an impact on the clinical care was unanimously reported. Delays and interruptions in cancer treatments were common, as was a reduction of patient volume treated with radiation therapy (RT). Mechanisms for priority-setting to inform clinical decisions were set by 80% of the oncologists, including changes in the treatment protocols––more commonly for palliative care interventions and regarding the RT fractionation; also, alternative therapeutic options were more commonly discussed, particularly when patients were candidate to multimodal treatments. Value-driven and choose-wisely approaches were emphasized. Telemedicine was identified as a mechanism to reduce access to hospitals, but only for selected services (e.g., follow-up) by 78%. Protecting hospitals and health workers were identified as priority interventions to shape effective COVID-19 responses. Conclusion: This survey serves as a case study of adaptations of cancer care during COVID-19 in low- and middle-income countries. Elements of priority-settings and value-driven decision-making emerged, although the long-term impact cannot be stated, at this time.
  317 57 -
EDITORIALS
Toward personalized treatment for head and neck cancers: The role of SNPs
Sushmita Ghoshal, Arnab Pal
July-December 2021, 1(2):51-52
DOI:10.4103/bjoc.bjoc_8_22  
  312 60 -
ORIGINAL ARTICLES
Changing pattern of cancer incidence in India: 25-year report of the cancer registry of a large urban cancer center
Jyotirup Goswami, Samir Bhattacharya, Arnab Gupta, Rahul Roy Chowdhury, Gautam Bhattacharjee, Saradindu Ghosh
July-December 2021, 1(2):86-88
DOI:10.4103/bjoc.bjoc_6_22  
Introduction: Cancer registries are vital for understanding incidence and prevalence of cancer, as well as appropriate funding and control measures. Materials and Methods: The data of patients registered between 1996 and 2020 at a large urban cancer centre in Eastern India was used for analysis of cancer trends over time. Results: There were a total of 1,89,315 patients. The top 5 cancer sites over the most recent 5-year block (2016–2020) were lung, oral cavity, throat, stomach, and colorectum in males and breast, cervix, liver-gallbladder, oral cavity and ovary in females. There was a consistent rise in oral cavity cancers and lung cancer in males and a consistent rise in breast cancer and ovarian cancers in females. There was a consistent fall cervical cancers, which was overtaken by breast cancer in the mid-2000s as the leading cancer in women. Digestive cancers have doubled over the last 25 years, the commonest being stomach cancer and colorectal cancers. Conclusion: The data reflects India’s changing profile of cancer, with the increase of breast and ovarian cancers, as seen worldwide. Despite lack of a robust screening/vaccination programme, cervical cancer has declined. The rise in tobacco-associated cancers (lung and mouth) is a matter of concern.
  246 31 -
Unscheduled treatment breaks during radical radiotherapy for head and neck cancers: An audit from a tertiary care center
Treshita Dey, Ankita Gupta, Nagarjun Roa Ballari, Sushmita Ghoshal, Avradeep Datta
July-December 2021, 1(2):66-71
DOI:10.4103/bjoc.bjoc_5_21  
Aims: The aim of this article was to audit radical radiotherapy practice in head and neck cancer to assess unscheduled treatment breaks and their reasons thereof. Materials and Methods: Records of all patients of head and neck squamous cell carcinomas registered in the year preceding the pandemic were analyzed. A total of 287 patients treated with radical intent with doses equivalent to 66 Gy in 33 fractions were eligible for final analysis. Results: More than half (148/287) of our patients suffered from treatment breaks during their radiotherapy treatment with primary cause being treatment-related toxicities. Radiotherapy dose of 66 Gy and above (P < 0.001), primary in the oral cavity (P = 0.009), and preceding surgery and concurrent chemotherapy (P = 0.032) were found to be significantly associated with treatment breaks as well as breaks lasting for 15 days or more. Patients having a break in their treatment were also found to have a significantly low progression-free survival (25.8 vs. 12.7 months; P = 0.012). Conclusion: It is in the interest of the patients that stringent patients’ selection criteria identify the ideal candidates for treatment intensification.
  241 35 -
CASE REPORTS
Dermatofibrosarcoma protuberans of the lower extremity: A rare tumor
Deepika Raina, Nitin Gupta, Muninder Negi
July-December 2021, 1(2):95-97
DOI:10.4103/bjoc.bjoc_39_21  
Dermatofibrosarcoma protuberans (DFSP) is a rare, uncommon, low-grade sarcoma of fibroblast origin. Clinical suspicion is confirmed by biopsy, and appropriate and confirmatory immunostaining with CD34, factor XIIIa, nestin, apolipoprotein D, and cathepsin K is to be performed in all cases of suspected DFSP. Initial treatment is surgical, and every effort should be made to completely remove the tumor at the time of initial therapy. If surgery yields positive margin, then re-resection is recommended whenever possible. For patients with DFSP in whom tumors cannot attain negative margins after surgery, adjuvant radiotherapy (RT) may be considered to improve local control. Herein, we describe a rare case of DFSP in the left leg of a 50-year-old woman treated with excision and adjuvant RT.
  200 17 -
Role of palliative chemoradiation in locally advanced head and neck cancer: A case series done in a tertiary care center in Uttar Pradesh
Gulafshan Jabi, Mohsin Khan, Pavan Deepak MandigalaVenkataRamana
July-December 2021, 1(2):98-101
DOI:10.4103/bjoc.bjoc_3_22  
Background: Shorter palliative hypofractionated schedules when given concomitantly with chemotherapy, preferably cisplatin (radiosensitizer), enhance the response rate with acceptable toxicity, resulting in better compliance of the patients. Objectives: This case series retrospectively evaluated the role of concurrent chemotherapy, preferably cisplatin, with palliative radiation 30 Gy in 10 fractions in locally advanced head and neck cancers in terms of response rates, symptoms palliation, and acute toxicities. Materials and Methods: Twenty-six patients of histologically confirmed locally advanced head and neck cancers were selected and treated during the period January 2018 and December 2020. All patients (100%) completed the treatment with an average of two follow-ups. Results: The overall response rate of 73% was observed in patients treated, and interestingly, one patient had complete response. Moreover, 100% of the patients reported improvement in at least one symptom with severity reduction in pain. As defined by the Radiation Therapy Oncology Group (RTOG) criteria for toxicity assessment, Grade 2 mucositis in 61%, Grade 1 mucositis in 11%, Grade 1 skin reaction in 15% of the patients were observed. No grade III toxicity was reported. Conclusion: Concurrent chemotherapy acts as a radiosensitizer and provides a synergistic action when coupled with radiation resulting in more efficacious control of locoregional disease of locally advanced head and neck cancers with acceptable toxicities facilitating the compliance of patients.
  192 18 -
ORIGINAL ARTICLES
Volumetric changes in lumpectomy cavity during whole breast irradiation after breast conserving surgery
Abhay P Singh, Rahat Hadi, Ashish Singhal, Madhup Rastogi, Rohini Khurana, Shantanu Sapru, Ajeet Kumar Gandhi, Satyajeet Rath, Surendra P Mishra, Anoop Srivastava
July-December 2021, 1(2):89-94
DOI:10.4103/bjoc.bjoc_23_21  
Introduction: Irradiation to the conserved breast consists of whole breast radiotherapy (WBRT) followed by tumour bed boost. Seroma in the tumor bed is a commonly observed side effects after breast-preservation, which can alter the shape of breast during WBRT and also lead to tumour bed shrinkage during boost irradiation, causing larger volumes of normal tissue irradiated. The aim was to evaluate the change in the lumpectomy cavity volumes before and after WBRT. Materials and Methods: Thirty-three patients with demonstrable lumpectomy cavity after breast conservation surgery (BCS) were included in the study. CT simulation of the breast was performed twice, initially before the start of WBRT and then 2 days prior to completion of WBRT. WBRT was delivered after contouring breast and lumpectomy volumes guided by the presence of surgical clips, seroma, and other surgical changes. Change in volume of lumpectomy cavity was analysed by Students’ paired T-test. Results: The volume reduction in the lumpectomy cavity was noted in 97% of patients (32/33). The change in lumpectomy cavity volume decreased by a mean value of 34.59% (range 0 - 72%) (p < 0.0001). The mean change in breast volume was 8.44% (range, -2.44 to 10.12%) (p - 0.394). Age, weight, location of tumour, T stage, breast volume, lumpectomy cavity volume, presence of clips and pre-radiation chemotherapy were not significantly associated with volume reduction of the lumpectomy cavity. Conclusion: The results of this study have shown that a significant volume reduction of the lumpectomy cavity after WBRT.
  186 20 -
Impact of covid-19 on cancer care – A single institution experience – Government Arignar Anna Memorial Cancer Hospital & Research Institute (RCC), Kanchipuram
IM Jarfin, V Srinivasan, S Ashok Kumar
July-December 2021, 1(2):72-77
DOI:10.4103/bjoc.bjoc_6_21  
Background: COVID-19 has impacted health care all over the world. In this article, we will discuss how the pandemic has influenced daily practice and treatment protocols in cancer care in our institution, during the course of its two waves, i.e., from March to September 2020 and March to June 2021. Materials and Methods: Several measures were taken to ensure safety and treatment of cancer patients. Setting up of isolation wards, admission of all patients for treatment, increasing radiotherapy machine ‘on time’, periodic sanitation, treatment area hygiene, personal protection equipments for medical personnel were some of them. Changes were made in radiotherapy, medical oncology, surgical oncology and anaesthesia practices. Patients who became COVID positive were managed in a Covid Care Centre, outside the premises of our institution. Results: The number of patients treated and procedures done in our institution during the first wave of the pandemic in 2020 was much lower compared to the same time period in 2019. But that was not the case with the second wave in 2021. Among the health care workers who tested positive for the virus during the two waves, none required hospitalization and no deaths occurred. Conclusion: Covid-19 has definitely influenced our cancer care for a transient period during the first wave. Modifications in treatment procedures were done only for a short period before we switched back to standard department protocols. With the onset of the second wave, taking previous wave’s experiences into consideration, measures were taken to ensure safe and continuous cancer treatment delivery.
  178 26 -
Predictive factors of recurrence free survival of patients with luminal breast cancer in southern Sri Lanka
Lakmini K B Mudduwa, Harshini H Peiris, Thushari Liyanage
July-December 2021, 1(2):78-85
DOI:10.4103/bjoc.bjoc_2_22  
Purpose: To assess the predictive factors of recurrence free survival (RFS) of luminal breast cancers in Southern Sri Lanka to bridge the existing gap in published literature on luminal breast cancers in our country. Materials and Methods: This was a bidirectional; retro prospective, cohort study. All breast cancer patients who sought the services of our immunohistochemistry (IHC) laboratory from 2006 to 2015 were included. Tissue micro arrays were constructed using the archives for the IHC analysis of Ki67, CK5/6 and EGFR. Details of ER, PR and Her2 expression were extracted from the laboratory records. Clinico-pathological data were retrieved from the records available in the laboratory, Oncology clinic and from patients. Pearson chi-square test, Kaplan-Meier model, log-rank test and Cox-regression model were used with SPSS for data analysis. Results: A total of 595 luminal breast cancers were included. Majority, were between 36–60 years of age (65.5%), Nottingham grade 2 (57.4%), TNM Stage II/III (82.0%) and had T2 tumours (53.6%). Recurrences were noted in 15.9% (n = 395, local-16.9%; distant metastasis-76.9%; second cancer-6.2%). Median follow up time was 35 months. Only 443 luminal breast cancers could be subtyped (luminal A-58.7%); luminal B Her2-negative- 22.3%; luminal B Her2-positive-19.0%). Five-year RFS of the cohort was 74.1% (luminal A-83.6%; luminal B(Her2-negative)-73.9%; luminal B(Her2-positive)-55.3%; P = 0.001). Over-expression of Her2 (P = 0.018) and CK5/6 expression (P = 0.003) had an independent effect on the RFS of the cohort. Conclusion: The three subtypes of luminal breast cancers are distinct in their recurrence free survival and tumor characteristics. Over-expression of Her2 and CK5/6 expression had an independent negative effect on the RFS of the luminal breast cancer cohort.
  152 27 -