A Randomized Study to Evaluate Efficacy and Toxicity Profile of Paclitaxel-carboplatin as Neo-adjuvant Chemotherapy in Locally Advanced Supraglottic and Hypopharyngeal Primaries

This study was conducted in locally advanced supraglottic and hypopharyngeal squamous cell carcinoma patients to ascertain the efficacy and toxicity profile of a two drug combination neo adjuvant chemotherapy (NACT) schedule containing Taxane and Platinum; prior to definitive concurrent chemo-radiotherapy (Def CCRT); sixty patients with stage III, IVA and IVB locally advanced squamous cell cancers of larynx and hypopharynx were randomised to two arms. Thirty patients in study group were treated with NACT with Paclitaxel (175 mg/m2) and Carboplatin (AUC 5-7) for 3, 3 weekly cycles; followed by CCRT in the patients who showed at-least a partial response (PR). These patients were compared with the 30 patients of control group who received upfront CCRT. More patients in Study arm developed grade 3 dysphagia (p = 0.001) and mucositis (p = 0.003). Renal, hematogenous and skin toxicities were identical in two arms. At 3 months post treatment complete response (CR) at primary site was 83.3% and 66.6% (p = 0.245) in study and control arms respectively. At 6 months post treatment; 20 patients (66.6%) in the study group and 17 patients (56.6%) in the control group continued to be in clinic-radiological CR (p = 0.20). NACT with Paclitaxel and Carboplatin is tolerated with manageable toxicities in patients with LAHNSCC (Locally advanced head and neck squamous cell carcinoma), with increased Grade 3 dysphagia and mucositis as compared to patients getting upfront CCRT. A longer follow-up period with a larger sample size is required to further evaluate any statistically significant benefit of adding NACT prior to CCRT.

Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study

Post treatment voice quality is an important consideration in choosing the management option for laryngeal cancer. We assessed voice quality after radiotherapy in patients of early squamous cell carcinoma of glottis comprehensively using Videolaryngostroboscopy (VLS), Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scores and Voice Handicap Index (VHI)-10. Fifty four consenting patients of early squamous cell carcinoma of glottis (Tis, T1 and T2) awaiting definitive radiotherapy were recruited consecutively. Voice was evaluated by VLS, GRBAS scores and VHI-10 before radiotherapy as well as 3 months and 12 months after radiotherapy. There were 52 males and 2 females in the study. Hoarseness of voice was the commonest presenting symptom. Mean duration of symptoms was 2.45 months (± 0.80), ranging from 1 to 4 months. 35 (64.82%) were T1 while 19 (35.18%) were T2 lesions. They received 60-70 Gy of radiotherapy in 28-35 fractions. There was only one recurrence on follow up for 12 months. On VLS at 12 months post-RT the periodicity, phase symmetry, mucosal waves and amplitude were normal in 74.07%, 70.37%, 56.67% and 78.7% cases respectively. Complete glottic closure was obtained in 72.22%. The voice was 'acceptable' (Grade 1 or 2 on VLS parameters) in more than 90% cases. Mean total GRBAS score was 3.39 (± 2.67). Mean total VHI-10 was 6.7 (± 1.75). All indices were significantly better than pre RT levels. Good quality of voice can be expected after radiotherapy for early glottic cancer in majority of patients.

Carcinoma Penis Manifesting as Upfront Supraclavicular Lymph Node Metastases Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography Scan: Report of an Extremely Rare and Aggressive Case

Carcinoma penis is a rare malignancy accounting 0.5 to 1% cases in the developed countries with a slightly higher incidence in the developing nations. Slow locoregional progression is characteristic of penile carcinoma and distant metastases are very uncommon. We hereby report a case of highly aggressive squamous cell penile carcinoma in a 46-year-old male with fulminant upfront distant dissemination to left supraclavicular lymph nodes without involving the inguinal and pelvic nodes detected by whole-body ¹⁸ F-fluorodeoxyglucose positron emission tomography scan. The scan also detected lytic destructive lesion involving the pelvic and adjacent bones with infiltration of skeletal muscles. He was treated with palliative radiotherapy to the weight-bearing sites followed by systemic chemotherapy. A thorough review of literature reveals that our case may be one of the rarest cases ever reported in world literature where an asymptomatic penile carcinoma presents with upfront supraclavicular lymph node metastasis bypassing the inguinal, pelvic, and retroperitoneal lymph node chains.

Carcinoma penis manifesting as upfront supraclavicular lymph node metastases detected by 18F-fluorodeoxyglucose positron emission tomography scan: Report of an extremely rare and aggressive case

Carcinoma penis is a rare malignancy accounting 0.5%-1% of cases in the developed countries with a slightly higher incidence in the developing nations. Slow locoregional progression is characteristic of penile carcinoma (PC) and distant metastases are very uncommon. We hereby report a case of highly aggressive squamous cell PC in a 46-year-old male with fulminant upfront distant dissemination to left supraclavicular lymph nodes (LNs) without involving the inguinal and pelvic nodes detected by whole-body ¹⁸F-fluorodeoxyglucose positron-emission tomography scan. The scan also detected lytic destructive lesion involving the pelvic and adjacent bones with infiltration of skeletal muscles. He was treated with palliative radiotherapy to the wight-bearing sites followed by systemic chemotherapy. A thorough review of literature reveals that our case may be one of the rarest cases ever reported in world literature where an asymptomatic PC presents with upfront supraclavicular LN metastasis bypassing the inguinal, pelvic, and retroperitoneal LN chains.

Toxicity Profile of Double-agent Adjuvant Chemotherapy after Concurrent Chemoradiation and Brachytherapy in Locally Advanced Cervical Cancer: Comparison with Standard Chemoradiation Protocol

Introduction: Carcinoma cervix is the most common gynecological malignancy in India and a major cause of cancer mortality and morbidity in the females despite Concurrent chemoradiotherapy (CCRT). Attempts are on to improved overall survival by addition of adjuvant chemotherapy (ACT) to CCRT. Aim: The aim of this study is to establish toxicity profile of double-agent ACT after CCRT and ICRT in locally advanced cervical cancer (LACC) and to compare it with standard chemoradiation protocol. Materials and Methods: Patients were randomized into two arms: in conventional arm (Arm 1, n = 23), patients received a standard protocol of weekly injection cisplatin 40 mg/m2 concurrently with pelvic external beam radiotherapy (5040cGy/28 fractions) followed by ICRT (03 fractions of 7 Gy each). In interventional arm (Arm 2, n = 24), patients received CCRT/ICRT protocol; and were further offered ACT with three cycles of consolidation chemotherapy using injection paclitaxel and injection carboplatin every 3 weeks after CCRT and ICRT. Results: The incidence of anemia was 14/23 (50% Grade 1) in Arm 1 and 12/24 in Arm 2 (17% Grade 1, rest higher grade). In Arm 2, 37% of patients had ≥Grade 2 neuropathy and 16% of patients had Grade 1 alopecia, whereas nil incidence was reported in Arm 1 (P = 0.005 and 0.04, respectively). Grade 3 neutropenia was observed in 4/23 (17%) patients of Arm 1 and 8/24 patients (33%) of Arm 2. None of the patients in Arm 1 required indoor supportive care while 4/24 patients (17%) were managed as an indoor patient. Among late toxicities, in Arm 2, the incidence of Grade 2 and Grade 3 anemia was 42%, whereas in Arm 1, its incidence was 22%. In Arm 1, no patient exhibited features of neuropathy, whereas, in Arm 2, 12/24 (50%) of the patients had neuropathy (P value for these two late events was <0.05 statistically significant). No therapy-induced mortality was noted. Conclusion: Exhibition of ACT with injection Paclitaxel and injection carboplatin in locally advanced carcinoma cervix is a technically viable option with manageable toxicity.

A case series of unusual presentations of Burkitt's lymphoma

Context

Burkitt's lymphoma (BL) is one of the fastest growing malignancies. It is the most common subtype of Non-Hodgkin's lymphoma in childhood. It has three major subtypes - endemic, sporadic, and immunodeficiency-associated types.

Aims

This study aims to study the clinicomorphologic features of this disease entity and to find optimal imaging technique for such cases.

Setting and Design

A retrospective observational study in a tertiary care center of academic and research potential.

Subjects and Methods

We are presenting three unusual cases of sporadic type of BL who presented initially as localized right iliac fossa mass mimicking as acute appendicitis. Initially, localized presentation progressed to diffuse abdominal mass lesions causing intestinal obstruction.

Results

These cases had emphasized the importance of accurate diagnosis by the ultrasonography (USG) or computed tomography (CT) scan for early diagnosis so as to manage such cases simply by early appropriate medical treatment.

Conclusion

In this article, we will discuss the clinical and imaging features of BL with the role of USG, CT scan and positron emission tomography/CT in the abdominopelvic imaging of pediatric patients.

Tolerance of Chemoradiation in Advanced Head and Neck Cancers: Comparison Between Inpatients and Outpatients

Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value-0.6 (Yate's corrected); P value-0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value-0.2 (Yate's corrected) P value-0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.

Comparison of Efficacy of Positron Emission Tomography/Computed Tomography with Contrast-Enhanced Computed Tomography in Pretreatment Evaluation of Head and Neck Cancers: An Institutional Experience

Introduction: Head and neck squamous cell carcinomas (SCCs) constitute 5.4% of all cancers worldwide, and 23% of all cancers in males and 6% of all cancers in females diagnosed in India. Lots of ambiguity exists in primary, nodal, and metastatic workup of these patients, especially in developing countries. Aim: The study was designed to compare the accuracy of whole-body positron emission tomography/computed tomography (WBPET/CT) scan with contrast-enhanced CT (CECT) face and neck as pretreatment evaluation for staging workup and management decision and to confirm the nodal findings on imaging with fine-needle aspiration cytology (FNAC). Design: It was a single-institute, prospective, observational, interventional study over a 2-year period. All cases of SCC of upper aerodigestive tract who were scheduled for definitive treatment concurrent chemoradiotherapy or radiotherapy were evaluated with routine investigations followed by imaging in the form of CECT face and neck and 18F-fluorodeoxyglucose (FDG) WBPET/CT. Results: In the 40 enrolled patients, all underwent CECT face and neck and WBPET/CT. During initial workup, biopsy was taken from primary site and FNAC was done from neck nodes for diagnosis and for staging. In 40 patients, CECT neck showed nodal metastasis in 39 patients; however, FNAC came positive in 38 cases. PET/CT showed nodal metastasis in 38 patients; however, FNAC came positive in 38 cases. Any node with Standardized uptake value (SUV) >2.5 was taken as suspicious lesion and FNAC was done. Sensitivity of CECT and PET/CT was 97.36% and 100%, respectively, while the specificity was 0% and 100%, respectively. Positive predictive value calculated for CECT and WBPET was 94.87% and 100%, respectively, while the negative predictive value for CECT and WBPET was 0% and 100%, respectively. Conclusion: In head and neck SCC, FDG-PET/CT is more accurate than CECT in staging of the neck.

To evaluate immunoreactivity of cyclooxygenase-2 in cases of endometrial carcinoma and correlate it with expression of p53 and vascular endothelial growth factor

Context

Increased levels of prostaglandins have been detected in cancers of several anatomic sites, including those of endometrium. Several studies have shown that cyclooxygenase-2 (COX-2) expression is aberrantly increased in various human epithelial cancers, and cellular up-regulation of COX-2 may be a common mechanism in epithelial carcinogenesis.

Aims

To examine the expressions of COX-2, p53 and vascular endothelial growth factor (VEGF) in endometrial cancer and their relationships with clinicopathologic characteristics.

Setting and Design

A retrospective observational study in a tertiary care center of academic and research potential.

Subjects and Methods

Sections from fifty cases of endometrial carcinoma were stained imunohistochemically with COX-2, p53, and VEGF. The expressions of COX-2, p53, and VEGF in endometrial cancer were examined.

Results

COX-2 was positive 19 cases (38%) of endometrial carcinoma. The COX-2 immunopositivity was 50%, 28%, and 41% in Grade 1, Grade 2, and Grade 3; and 27%, 46%, 67%, and 100% cases of Stage I, II, III, IV, respectively. p53 was positive in 24 cases (48%); 0%, 33%, and 67% in Grade 1, Grade 2, and Grade 3; and 27%, 77%, 83%, and 100% cases of Stage I, II, III, IV, respectively. VEGF was positive in 21 cases (42%); of which 0%, 33%, and 67% cases were in Grade 1, Grade 2, and Grade 3; and 17%, 77%, 83%, and 100% cases were in Stage I, II, III, IV, respectively.

Conclusion

The expression of COX-2 increase with stage of the endometrial tumor and with the expression of p53 and VEGF in the endometrial carcinomas. COX-2 inhibitors may have role in the prevention of endometrial carcinomas in high-risk cases and in preventing recurrences after treatment.

Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy

Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: "radiation fibrosis," "radiation fibrosis syndrome," and "radiation-induced fibrosis." We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.

Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center

Background:

Palliative radiotherapy (PRT) plays a significant role in the palliation of symptoms in patients with cancer and constitutes nearly 50% of the workload in different settings.

Aims:

The aim is to study patient-, disease-, and treatment-related characteristics in locoregionally advanced and metastatic malignancies meriting palliative management.

Setting and Design:

This was a retrospective observational study in a tertiary care government institute with academic and research potential.

Methodology:

The electronic medical records, medical documents, and radiotherapy (RT) treatment charts were retrieved and studied.

Observations:

A total of 460 patients were included in the study over 2 years, forming 30% of the total number of patients treated during the study period. Three hundred and ninety-six patients received PRT to the metastatic sites, while 64 patients received extremely hypofractionated PRT to the primary for symptomatic relief. Totally 442 patients showed good symptomatic response to PRT. One hundred and thirty-eight patients underwent re-irradiation. Lung was the most common primary site seen in 155 cases. The most common indication for PRT was palliation of pain from painful metastases as seen in 240 cases, and the next common indication was palliative whole-brain RT for brain metastases as seen in 159 cases.

Conclusion:

PRT forms an integral and important aspect of palliative care to the vast number of patients harboring metastatic disease that warrants some form of treatment for symptomatic relief. Short course of PRT in outdoor setting is a preferred mode of treatment to improve the quality of life of these distressed patients.

To study the efficacy of thallium-201 as tumor seeking agent and to study its role in therapeutic response

BACKGROUND

Tumour seeking characteristics of TL-201 have been underutilized. The study was undertaken to evaluate the role of TL-201 scintigraphy in tumour imaging.

METHODS

A total of 50 cases were studied over a period of 18 months (13 lymphomas, 11 breast carcinoma, 10 lung cancer, 6 of soft tissue sarcoma, 2 bone tumours and 4 cases each of thyroid and brain tumours). Thallium-201 chloride was injected IV in the dose range of 3-5 mCi. Imaging was done using Siemen's ECAM dual headed gamma camera. Mean tumour to background ratio (T/B ratio) was calculated for all the positive cases. Descriptive statistical analysis was carried out.

RESULTS

Findings revealed a sensitivity of 94.12%, specificity 87.5%, PPV 94.12%, NPV 87.50% and accuracy of 92% for TL-201 tumour imaging. The mean T/B ratio for the true positive cases at 10 min and at 3 h was 1.81 and 1.99 respectively, the difference being 0.18 (P value <0.001). Amongst them, the mean T/B ratios for low-grade tumours were 1.45 ± 0.32 at 10 min and 1.63 ± 0.38 after 3 h with difference of 0.176 (P < 0.001). For the high-grade tumours the ratios were 2.08 ± 0.35 and 2.26 ± 0.41 respectively with a difference of 0.186 (P < 0.001).

CONCLUSION

Thallium-201 scintigraphy is a useful tumour imaging modality in cases of thyroid, breast, brain, lung, soft tissue and bone tumours and lymphomas. A T/B ratio of 1.63 ± 0.38 in 3 h-delayed imaging is suggestive of low-grade tumours. For high-grade tumours a ratio of 2.26 ± 0.41 should be considered significant.

Clinical Profile of Pediatric Oncology Patients Treated by External Beam Radiotherapy: An Institutional Experience

Introduction:

Pediatric tumors are a heterogeneous group of malignant conditions requiring multimodal treatment, and management of such cases is at time challenging. We present the clinical profile of pediatric cancer patients who received radiation, either alone or as adjuvant to surgery and chemotherapy; in prophylactic, radical or palliative clinical setting.

Aim:

This study was envisaged to review our experience of pediatric oncology cases, their clinical and morphological profile, dosage schedule of radiotherapy, and the therapy induced complications.

Settings and Design:

This was a retrospective, observational study carried out in an apex tertiary care cancer institute of government set-up in a developing country.

Materials and Methods:

The treatment charts and clinical summary of patients who had received radiation over the last 5 years period were retrieved and perused. Various clinical and pathological parameters were studied and inferences drawn.

Results:

A total of 50 patients got radiation over 5 year study-period, including 37 male and 13 female patients. The commonest age group of presentation was 8-12 years followed by 13-16 years. The mean age of presentation was 9.3 years. The most common diagnosis was hematological malignancies followed by CNS tumors with 21 and 13 patients respectively. Overall the most common indication of RT was in adjuvant setting after surgery as the definitive management, where 24 patients were irradiated; and the next common indication was prophylactic cranial irradiation in 14 patients of childhood leukemias. 10 patients tolerated treatment with Grade 1 site-specific or systemic toxicities while 7 patients developed Grade 2 and more systemic toxicities. 9 patients received craniospinal irradiation, common indications being medulloblastoma and Atypical teratoma rhabdoid tumor (ATRT). 3 patients received concurrent chemotherapy with weekly Inj Vincristine. 17 patients required sedation or short general anaesthesia for radiation planning and execution.

Conclusion:

External beam Radiotherapy constitutes an important component of management of pediatric cancers. One should be judicious in Radiotherapy planning, execution and monitoring acute and delayed toxicities.

Fertility preservation in young patients with cancer

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

Comparison of sequential chemoradiation with radiation alone in the treatment of advanced head and neck cancers

OBJECTIVES

To compare locoregional control with alternating chemo radiation and radiation alone in patients with locally advanced head and neck carcinoma.

STUDY DESIGN

A prospective randomized study.

SETTING

Tertiary academic referral center.

PATIENTS

50 patients of biopsy proven locally-advanced carcinoma of head and neck.

INTERVENTION

25 patients were kept in Group I or study group (i.e. alternating chemo-radiation) and 25 patients in Group II or control group (i.e. radiation alone). In the study group, patients were given 3 cycles of chemotherapy (Cisplatin 20 mg/m([2]) and Inj. 5-FU 200mg/m([2]) from day 1-5 of each week) during weeks 1,5 and 9 alternated with radiation dose of 10Gy/week was given during weeks 2,3,4 and 6,7,8. In the control group, patients were given a total dose of 60Gy in 6 weeks.

OUTCOME MEASURES

The response rate at the primary site and nodal site was better in study group as compared to control group.

RESULTS

On comparing the response at the primary and nodal site together, 72% (18/25) patients of group I and 44% (11/25) patients of group II showed CR. PR was seen in 28% (7/25) and 36% (9/25) patients in group I and II respectively. No response was seen in 5/25 (20%) of patients in Group II.

CONCLUSION

Our study has revealed that alternating/ sequential chemoradiation is a promising and feasible approach for patients in advanced head and neck cancer.

Radiotherapy: Basic Concepts and Recent Advances

Radiation therapy (RT) is a clinical modality dealing with the use of ionizing radiations to treat malignant neoplasias (and occasionally benign diseases). Since its inception, the goal of RT has been to cure cancer locally without excessive side effects. The most important factors affecting the results of RT are the tumor type, its location and regional extent, the anatomic area of involvement and the geometric accuracy with which a calculated radiation dose is delivered. Although higher doses of radiation can produce better tumor control, the dosage which can be given is limited by the possibility of normal tissue damage. Approximately 60-65% of all cancer patients require RT as the sole treatment modality and / or in combination with surgery or chemotherapeutic drugs. There is a huge gap between demand and supply of radiotherapy facilities and infrastructure. Most of the oncocentres are located in urban areas in private sector and are beyond the reach of the common man.

Comparison of simulator-CT versus simulator fluoroscopy versus surface marking based radiation treatment planning: A prospective study by three-dimensional evaluation

BACKGROUND AND PURPOSE

Field placement for Radiation Treatment Planning can be done based on the surface markings or simulator fluoroscopy or simulator with CT facilities. A prospective study was carried out to compare these three techniques of radiation treatment planning to quantitatively find out the difference in normal tissue dosages and target volume coverage in the three groups after three-dimensional evaluation.

PATIENTS AND METHODS

The CT scans of 30 patients in the treatment position, taken on a Shimadzu SCT-3000 TF scanner at 1cm intervals, were transferred to Theraplan-500 three-dimensional radiation treatment planning computer. The normal tissues and target volumes (GTV and CTV) were outlined on all the CT slices as per (ICRU) Report no. 50. Three types of radiation treatment planning was done sequentially: Plan I-based on the surface markings alone, Plan II-based on simulator-fluoroscopy, and Plan III-based on Simulator-CT.

RESULTS

The mean dose to 95% of the clinical target volume (D95) was increased by 4.4 and 6.4% by Plans II and III as compared with Plan I. The mean dose to 3/3rd (D(3/3)) to all the critical organs was decreased by 6.6 and 8.4% by Plans II and III as compared to Plan I. The mean time, in simulator room, for field placement for Plans I-III was 6.2, 14.6 and 44 min, respectively.

CONCLUSIONS

Thus for adequate coverage of target volumes and sparing normal tissues, Simulator-CT based radiation treatment planning is the best method of radiation treatment planning though it is more time consuming.