A BSTRACT Struma ovarii (SO) is a rare monodermal ovarian teratoma predominantly composed of thyroid tissue and is usually benign in nature. Functional SO associated with thyrotoxicosis is uncommon, and its coexistence with previously treated papillary thyroid carcinoma may create considerable diagnostic uncertainty due to overlapping clinical, biochemical, and radiological findings. We report the case of a 60-year-old woman with a history of papillary thyroid carcinoma, classical variant, who had undergone total thyroidectomy 2 years earlier. She presented with symptoms of hyperthyroidism and markedly elevated thyroglobulin levels (1560 ng/mL) despite being off levothyroxine therapy. Imaging studies revealed a right ovarian mass suggestive of SO. The patient subsequently underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination confirmed benign SO. Following surgery, her thyroglobulin levels decreased to 104 ng/mL, and thyroid function normalized after initiation of levothyroxine therapy. She later received low-dose radioiodine ablation at 1.1 GBq. On follow-up, the patient remained clinically and biochemically stable. Benign SO should be considered in postthyrodiectomy patients presenting with unexplained hyperthyroidism and elevated thyroglobulin levels. Early recognition is important to avoid misdiagnosis of metastatic papillary thyroid carcinoma and to guide appropriate surgical and endocrinological management.
A BSTRACT Background: Elderly patients with head and neck squamous cell carcinoma (HNSCC) often cannot tolerate prolonged conventional radiotherapy and are under-represented in trials. As the meta-analysis of chemotherapy in head and neck cancer meta-analysis shows the benefit of concurrent chemotherapy diminishes with age, radiotherapy alone is the appropriate backbone. We evaluated the feasibility of hypofractionated simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) delivering 60 Gy in 25 fractions over 5 weeks in chemotherapy-ineligible elderly HNSCC patients. Materials and Methods: Patients aged ≥70 years with locally advanced HNSCC, Eastern Cooperative Oncology Group 0–2, unfit for or declining concurrent chemotherapy received SIB-IMRT (60, 56, and 50 Gy in 25 fractions to high-, intermediate- and low-risk planning target volumes). The primary endpoint was feasibility (≥90% of planned dose within 35 days; Grade 4 acute toxicity <25%). Acute toxicity was graded by the RTOG criteria and response by RECIST v1.1. Late toxicity is not reported here. Results: Ten patients were enrolled (median age – 74.8 years; 8 male), all with stage III/IVA disease. All completed the planned dose; 9 (90%) within 35 days. Grade 3 mucositis and dermatitis each occurred in two patients (20%); no Grade 4 toxicity occurred. Six (60%) required temporary enteral nutrition, none permanent. At 4–6 weeks, 6 patients (60%) achieved a complete and 4 (40%) a partial response. Conclusion: Hypofractionated SIB-IMRT (60 Gy in 25 fractions) is feasible and acceptably tolerated in the short term in this population. These findings are hypothesis-generating: follow-up is insufficient to establish durable locoregional control or late toxicity, and a larger study with geriatric assessment and long-term follow-up is required.
A BSTRACT Background: The rapid expansion of diagnostic imaging infrastructure globally has resulted in substantial increases in population exposure to medical ionizing radiation, with computed tomography (CT) accounting for the majority of collective dose. Saudi Arabia has undergone accelerated diagnostic imaging growth under Saudi Vision 2030, yet national trend data on CT utilization, population dose, and associated cancer risk remain limited. This study characterized trends in diagnostic CT utilization, estimated population-level effective dose, and quantified associated lifetime attributable cancer risk in Saudi Arabia between 2013 and 2022. Materials and Methods: This retrospective cross-sectional study analyzed the secondary data from Saudi Ministry of Health facility statistics, WHO Global Health Observatory imaging infrastructure data, and published dosimetry studies. Annual CT examination volumes were estimated from scanner density and utilization rate data. Effective dose per examination was derived from published diagnostic reference levels. Collective and per-capita effective doses were calculated. Lifetime attributable risk of radiation-induced cancer was estimated using the Linear No-Threshold model with risk coefficients from the Biological Effects of Ionizing Radiation VII report. Data were analyzed by imaging modality, body region, sex, and age group. Results: Estimated national CT examination volume increased from approximately 1.2 million in 2013 to 3.1 million in 2022, representing a 158.3% increase. CT scanner density grew from 9.4 to 21.6 units per million population. Per-capita annual effective dose from CT increased from 0.48 to 1.14 mSv. Abdominopelvic CT contributed the highest collective dose (38.2% of total). Chest CT volume increased fourfold between 2019 and 2021 driven by coronavirus disease 2019 diagnostic utilization. Estimated lifetime attributable cancer risk from annual CT exposure reached 1 in 1430 by 2022. Pediatric CT examinations accounted for 8.3% of total volume with disproportionate dose contribution. Conclusions: Medical ionizing radiation exposure from diagnostic CT in Saudi Arabia has more than doubled over the past decade, with estimated cancer risk approaching levels warranting systematic population-level radiation protection measures. Enforcing justification and optimization principles, establishing national diagnostic reference levels, and implementing pediatric dose reduction protocols are urgent preventive priorities.
A BSTRACT Background: This study aimed to determine the toxicity profile of cancer drugs in the Indian population and to evaluate their usage patterns among Indian patients. Materials and Methods: A prospective and observational study was conducted in the department of medicine from April 2023 to March 2024. Patients aged ≥18 years with cancer receiving immunotherapy or biological therapy were enrolled, excluding pregnant/postpartum women and those with central nervous system-related causes of weakness. A total of 152 patients were included based on the sample size estimation. Demographic, clinical, laboratory, and imaging evaluations were performed. Adverse events (AEs) were graded using the Common Terminology Criteria for Adverse Events v5.0. Statistical analysis was performed using Fisher’s exact test, with P < 0.05 considered statistically significant. Results: The mean age was 45.76 ± 12.6 years; 117 (76.97%) were males. Breast cancer (16.45%) was the most frequent diagnosis. Drugs administered included atezolizumab (20.39%), pembrolizumab (17.11%), and nivolumab (14.47%). Most AEs were mild to moderate. Cardiac events (atrial fibrillation/flutter) were mainly Grade III–IV, occurring more often with bevacizumab ( P < 0.0001). Endocrine AEs (hypothyroidism and hypopituitarism) were frequent with atezolizumab, nivolumab, ipilimumab, and avelumab (100% each, P < 0.0001). Respiratory toxicities (acute respiratory distress syndrome and allergic rhinitis) were severe with pembrolizumab, atezolizumab, and ipilimumab (>80%, P < 0.0001). Gastrointestinal AEs occurred in nearly all patients on bevacizumab, ipilimumab, and avelumab ( P = 0.004). Conclusion: Immunotherapies and biologicals produced diverse AEs, predominantly Grade I–II, but clinically significant respiratory and neurological toxicities occasionally progressed to Grade IV–V. Vigilant monitoring and individualized management are essential.
A BSTRACT Background: Patients with locally advanced head and neck squamous cell carcinoma (LAHNC) who are considered unsuitable for definitive therapy are commonly managed with palliative intent. However, a subset of patients may demonstrate significant tumor regression following short-course palliative radiotherapy (Pal RT), allowing subsequent radical treatment. This study aimed to evaluate the rate of radical conversion following initial Pal RT using 30 Gy in 10 fractions in patients with initially incurable LAHNC. Materials and Methods: This prospective, longitudinal, single-arm cohort study was conducted in a tertiary care teaching hospital in West Bengal, India, between June 2023 and May 2024. Sixty patients with histopathologically confirmed LAHNC deemed unsuitable for radical therapy because of poor performance status, comorbidities, or extensive disease burden were enrolled. All patients received Pal RT to a dose of 30 Gy in 10 fractions over 2 weeks. Treatment response was assessed 2 weeks after completion of Pal RT using RECIST version 1.1 criteria. Patients achieving complete or partial response (PR) underwent radical radiotherapy (Rad RT) to a cumulative dose of 70 Gy. Symptom relief, treatment-related toxicities, and overall survival were analyzed. Results: PR following Pal RT was observed in 43 patients (71.7%), while stable disease and progressive disease were noted in 23.3% and 5% of patients, respectively. No complete response (CR) was observed after Pal RT. All patients achieving PR subsequently underwent radical conversion. Following Rad RT, CR was achieved in 48.8% of patients and PR in 41.9%, with no cases of progressive disease. Significant symptom palliation was observed, particularly for bleeding (92.3%), pain (70.2%), and dysphagia (60%). No treatment-related mortality occurred. Acute toxicities following Pal RT were predominantly Grade 1 dermatitis and mucositis, while expected Grade 2–3 toxicities were observed after radical treatment. Median overall survival was 8 months in the Pal RT-only group, whereas median survival was not reached in the Rad RT group. Kaplan–Meier analysis demonstrated significantly improved survival among patients undergoing radical conversion (log-rank P < 0.001). Conclusion: Hypofractionated Pal RT with 30 Gy in 10 fractions is an effective and feasible strategy for patients with initially incurable LAHNC. In addition to providing meaningful symptom palliation, this response-adaptive approach identifies favorable responders who may benefit from subsequent radical treatment, resulting in improved survival outcomes.
