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   2008| April-June  | Volume 4 | Issue 2  
    Online since August 1, 2008

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Accessory breast tissue in axilla masquerading as breast cancer recurrence
Shikha Goyal, Tarun Puri, Ruchika Gupta, Pramod K Julka, Goura K Rath
April-June 2008, 4(2):95-96
DOI:10.4103/0973-1482.42258  PMID:18688128
Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.
  37,063 702 8
Bone metastasis in hepatocellular carcinoma: Need for reappraisal of treatment
V Satya Suresh Attili, K Govind Babu, D Lokanatha, PP Bapsy, C Ramachandra, H Rajshekar
April-June 2008, 4(2):93-94
DOI:10.4103/0973-1482.42257  PMID:18688127
Bone is an uncommon site of metastasis in patients with hepatocellular carcinoma (HCC), and often overlooked. We report two cases that had isolated bone metastasis; one of them had prolonged disease-free survival. The present series, along with the literature review, reinforces the idea that HCC should be considered in the differential diagnoses in patients presenting with metastases in bone. The presence of isolated bone metastases need not necessarily indicate poor prognosis, and all such patients need to be offered chemotherapy and at least one of the bone-directed therapies (either local radiation in cases of localized disease or bisphosphonates in the presence of extensive disease) as they may have a better outcome with therapy.
  14,182 750 24
Epidural analgesia during brachytherapy for cervical cancer patients
MG Janaki, S Nirmala, Amrit R Kadam, BS Ramesh, KS Sunitha
April-June 2008, 4(2):60-63
DOI:10.4103/0973-1482.40825  PMID:18688120
Aims: To find out the efficacy of epidural analgesia in providing continuous pain relief for patients undergoing brachytherapy for cervical cancer. Settings: Teaching Hospital. Design: Retrospective Study. Materials and Methods: A total of 152 patients of cervical cancer received epidural analgesia during 18 to 21 hours of pelvic brachytherapy. Epidural top up was given using 60-100 g of buprenorphine every 08-10 hrs. Additional top up or systemic analgesics were given for breakthrough pain. Results: Majority of patients 119 out of 152 received epidural top up twice during their stay in the brachytherapy ward. Only 20 out of 152 needed additional analgesics. Conclusions: Epidural analgesia is safe and provides satisfactory pain relief during brachytherapy and makes patient's stay more comfortable.
  8,531 437 7
Pancreatic resectional surgery: An evidence-based perspective
Melroy A D'souza, Shailesh V Shrikhande
April-June 2008, 4(2):77-83
DOI:10.4103/0973-1482.42253  PMID:18688123
A diagnosis of pancreatic cancer carries a very dismal prognosis, with the 5-year survival rate being the lowest of all types of cancer. Surgical resection offers the only hope for cure in these patients. Pancreatic resectional surgery is technically demanding, and while mortality has decreased in centers of excellence, the morbidity remains significant. Numerous controversies exist regarding various aspects of complex pancreatic resections. This review attempts to address these controversies with an evidence-based perspective. We performed a literature search in MEDLINE (www.pubmed.org) with relevant key words and the corresponding MeSH terms. The search was limited to English language publications on human subjects. A manual cross-reference search of the bibliographies of relevant papers was carried out to identify publications for possible inclusion.
  7,950 429 10
Splenic infarct as a diagnostic pitfall in radiology
Sanjeev C Joshi, Ishita Pant, Aditya N Shukla, MA Anshari
April-June 2008, 4(2):99-101
DOI:10.4103/0973-1482.42262  PMID:18688130
Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA). Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.
  6,998 433 4
Primary melanoma of testis
RK Katiyar, Abhishek Singh, Deepak Kumar
April-June 2008, 4(2):97-98
DOI:10.4103/0973-1482.42260  PMID:18688129
Primary melanoma of testis is extremely rare and even the existence of such an entity is questioned. We present the case of a 60-year-old man with primary malignant melanoma in the testis. We report this case to emphasize the need for awareness of the possibility of the testis being the primary site in the patient with a melanoma and to underline the necessity of meticulous investigation of suspicious lesions of the testis in patients with or without a past history of malignant melanoma.
  6,063 695 -
Utility of blood DNA levels in diagnosis of breast cancer
R Nalini, CR Wilma Delphine Silvia, Sheila Uthappa
April-June 2008, 4(2):57-59
DOI:10.4103/0973-1482.40826  PMID:18688119
Background: Prognostic factors, including both histopathological and biochemical variables, influence the choice of modality and the course of therapy in breast cancer. The biomarkers found in biological fluids, particularly in blood, apparently hold the best promise for the development of screening assays. Aim: To find out if any correlation exists between blood DNA level and tumor stage, size and grade. Materials and Methods: This case-control study was carried out on 52 female patients in the age-group of 18-70 years. The cases comprised 25 patients with histopathologically confirmed malignant breast cancer, while 27 patients with benign breast tumors served as the control group. Statistical Analysis: We used the Student's 't' test to compare the differences between the blood DNA levels in the two groups. Pearson's test was performed to find out the correlation between blood DNA levels and the TNM stage, tumor size and grade Results: It was observed that blood DNA levels showed statistically significant correlation with the TNM stage, tumor size and grade. Conclusion: The blood DNA level can be utilized as a noninvasive marker to assess tumor aggressiveness. Thus, it can be useful as a prognostic marker and as a marker of tumor burden.
  6,025 366 1
Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports
Ashwini Budrukkar, Debnarayan Dutta, Dayanand Sharma, Premnath Yadav, Smitha Dantas, Rakesh Jalali
April-June 2008, 4(2):70-76
DOI:10.4103/0973-1482.42252  PMID:18688122
Aims and Objectives: To study the geometric uncertainties in the treatment and evaluate the adequacy of the margins employed for planning target volume (PTV) generation in the treatment of focal conformal radiotherapy (CRT) for patients with brain tumors treated with different head support systems. Materials and Methods: The study population included 11 patients with brain tumors who were to be treated with CRT. Contrast-enhanced planning CT scan (5-mm spacing and reconstructed to 2 mm) of brain were performed. Five patients were immobilized using neck support only (NR-only) and six patients had neck support with flexion (NRF), the form of immobilization being decided by the likely beam arrangements to be employed for that particular patient. The data was transferred to the planning system (CadPlan) where three-dimensional conformal radiation therapy was planned. Digitally reconstructed radiographs (DRRs) were created for the orthogonal portals with the fixed field sizes of 10 10 taken at the isocenter. Treatment verification was done using an amorphous silicon detector portal imaging device for using orthogonal portals and the DRR was used as a reference image. An image matching software was used to match the anatomical landmarks in the DRR and the portal imaging and the displacement of the portals in x, y axis and rotation were noted in the anteroposterior (AP) and lateral images. Electronic portal imaging was repeated twice weekly and an average of 8-14 images per patient was recorded. The mean deviation in all the directions was calculated for the each patient. Comparison of setup errors between the two head support systems was done. Results: A total 224 images were studied in anterior and lateral portals. The patient group with NR-only had 100 images, while the NRF group had 124 images. The mean total error in all patients, NR-only group, and NRF group was 0.33 mm, 0.24 mm, and 0.79 mm in the mediolateral (ML) direction; 1.16 mm, 0.14 mm, and 2.22 mm in the AP direction; and 0.67 mm, 0.31 mm, and 0.96 mm in the superoinferior (SI) direction, respectively. The systematic error (S) in all patients, NR-only group, and NRF group in the ML direction was 0.31 mm, 0.28 mm, and 0.78 mm; 1.29 mm, 0.1 mm, and 2.24 mm in the AP direction; and 0.75 mm, 0.52 mm, and 0.94 mm in the SI direction, respectively. Random error (s) in all patients, NR-only group, and NRF group in the ML direction was 1.25 mm, 1.04 mm, and 1.41 mm; 1.31 mm, 1.36 mm, and 1.28 mm in the AP direction; 1.38 mm, 1.37 mm, and 1.39 mm in the SI direction, respectively. In all patients, the PTV margin with Stroom's formula in the NR-only and NRF group was 1.29 mm and 2.55 mm in the ML, 1.15 mm and 5.38 mm in the AP, and 2.0 mm and 2.85 mm in the SI directions, respectively. Conclusion: A PTV margin of 5 mm appears to be adequate; further reduction to 3 mm may be considered based on our results. Errors were significantly higher in the AP direction with NRF when compared to NR-only. Differential PTV margin may therefore be considered, with more margin in the AP and less in other directions, especially with the use of flexion devices.
  5,799 504 6
Multileaf collimator transmission from the first Hi-Art II helical tomotherapy machine in India
Rajesh A Kinhikar
April-June 2008, 4(2):88-90
DOI:10.4103/0973-1482.42255  PMID:18688125
The purpose of this study was to measure the multileaf collimator (MLC) transmission from the first Hi-Art II tomotherapy machine installed at the Advanced Center for Treatment, Research, and Education in Cancer (ACTREC). The MLC transmission was measured with an A1SL ion chamber and the radiographic extended dose range (EDR2) film in virtual water slabs at 1.5-cm depth with a source-to-surface distance of 85 cm. The MLC transmission was measured for 30 s with all leaves open and for 360 s with all leaves closed. The movable jaws were set to the calibration field size of 5 40 cm at isocenter. The MLC transmission was found to be 0.3% with the ion chamber and 0.32% with the film. Thus, the MLC transmission value was found well within the manufacturer tolerance of 0.5%. MLC can safely be used for the beam modulation during intensity-modulated radiotherapy (IMRT) to deliver accurate doses to the patients.
  5,849 337 2
The relationship between the thyroid hormone (or its lack) and dysplastic hematopoiesis
SMM Magalhaes, DA Pinheiro, MD Souza, RF Pinheiro
April-June 2008, 4(2):102-103
DOI:10.4103/0973-1482.42263  PMID:18688131
  5,615 347 -
Chondroid chordoma of petrous temporal bone with extensive recurrence and pulmonary metastases
Amit Agrawal
April-June 2008, 4(2):91-92
DOI:10.4103/0973-1482.42256  PMID:18688126
Chondroid chordoma is a variant of chordoma; it may rarely involve the petrous temporal bone and has a high propensity for recurrence. Chordoma rarely metastasizes but it is, nevertheless, associated with a poor outcome. We report a rare case of chondroid chordoma with extensive recurrence and pulmonary metastases.
  5,337 342 4
The European Organization for Research and Treatment of Cancer prostate-specific quality of life module (PR-25) in Hindi and Marathi: Translation and pilot testing process
Tabassum Wadasadawala, Vedang Murthy, Umesh Mahantshetty, Reena Engineer, Shyamkishore Shrivastava, Ketayun Dinshaw
April-June 2008, 4(2):64-69
DOI:10.4103/0973-1482.42251  PMID:18688121
Background: The side effects of various treatments for prostate cancer have a measurable impact on the general as well as disease-related quality of life, which is of pivotal concern as an outcome measure. Aim: Translation and pilot testing of the European Organization for Research and Treatment of Cancer (EORTC) prostate cancer-specific module (PR-25) into Hindi and Marathi. Materials and Methods: The translation procedure described by the EORTC was adopted; this comprised two forward translations of the original English questionnaire into Hindi and Marathi each with formation of first intermediary questionnaires and two back translations of the first intermediary questionnaires into English. The first intermediary questionnaires were adapted as the second intermediary questionnaires and pilot tested in ten prostate cancer patients as no modifications were suggested by the back translators. Results: Each patient, after completing the questionnaire, was interviewed by the local project coordinator who questioned them about each item in the second intermediary questionnaire. The patients were asked whether there was any difficulty in answering, confusion while answering, or difficulty in understanding the questions; whether the questions were upsetting; and if the patients themselves would have framed the question in a different way. Based on the suggestions or interpretations of this pilot testing, the necessary changes were incorporated and the final Hindi and Marathi questionnaires were formed. Conclusion: Both the translations were submitted to the EORTC for review and have been subsequently approved for clinical studies.
  5,287 388 2
Particle therapy in clinical practice: Is there enough evidence to justify the current surge in interest?
Rakesh Jalali
April-June 2008, 4(2):54-56
DOI:10.4103/0973-1482.42250  PMID:18688118
  4,442 374 3
Does the fluence map editing in electronic tissue compensator improve dose homogeneity in bilateral field plan of head and neck patients?
Rajesh A Kinhikar
April-June 2008, 4(2):84-87
DOI:10.4103/0973-1482.42254  PMID:18688124
The purpose of this study was to evaluate the effect of fluence map editing in electronic tissue compensator (ETC) on the dose homogeneity for head and neck cancer patients. Treatment planning using 6-MV X-rays and bilateral field arrangement employing ETC was carried out on the computed tomography (CT) datasets of 20 patients with head and neck cancer. All the patients were planned in Varian Eclipse three-dimensional treatment planning system (3DTPS) with dynamic multileaf collimator (DMLC). The treatment plans, with and without fluence editing, was compared and the effect of pre-editing and post-editing the fluence maps in the treatment field was evaluated. The skin dose was measured with thermoluminescent dosimeters (TLDs) and was compared with the skin dose estimated by TPS. The mean percentage volume of the tissue receiving at least 107% of the prescription dose was 5.4 (range 1.5-10; SD 2.4). Post-editing fluence map showed that the mean percentage volume of the tissue receiving at least 107% of the prescription dose was 0.47 (range 0.1-0.9; SD 0.3). The mean skin dose measured with TLD was found to be 74% (range 71-80%) of the prescribed dose while the TPS showed the mean skin dose as 85% (range 80-90%). The TPS overestimated the skin dose by 11%. Fluence map editing thus proved to be a potential tool for improving dose homogeneity in head and neck cancer patients planned with ETC, thus reducing the hot spots in the treatment region as well. The treatment with ETC is feasible with DMLC and does not take any additional time for setup or delivery. The method used to edit the fluence maps is simple and time efficient. Manual control over a plan is essential to create the best treatment plan possible.
  4,338 264 -
Dilemmas of Plenty
Nagraj G Huilgol
April-June 2008, 4(2):53-53
DOI:10.4103/0973-1482.42249  PMID:18688117
  3,188 245 1
Management of nausea and vomiting in cancer and cancer treatment
Nagraj G Huilgol
April-June 2008, 4(2):104-104
  2,276 329 -
Palliative and end-of-life pearls
Nagraj G Huilgol
April-June 2008, 4(2):104-104
  0 0 -