A thyroid nodule is characterized as a discrete lesion, distinguishable from the adjacent thyroid parenchyma, and is frequently encountered in clinical settings. Currently, the terminology "nodular disease of the thyroid" is advised for use in both clinical and pathological classifications due to its expansiveness. Individuals with longstanding multinodular goitres are at risk for cystic degeneration, haemorrhaging, and dystrophic calcification. The main aim of this report is to assess the potential risk of cancer, mitigate the chances of obstructive symptoms and formulate a strategy for a secure and efficient surgical procedure. This paper presents a case involving a 68-year-old female patient who reported an anterior neck mass persisting for 35 years. Clinical assessments, imaging studies, and pathological examinations indicated extensive calcification within a giant nodular thyroid disease, which exerted pressure on the colloid goitre, reducing it to a thin peripheral layer without atypical features. The distinct contribution of this case is the emphasis on the uncommon nature of this presentation, and the associated diagnostic uncertainty, despite the presence of extensive macrocalcification, which still raises concerns about malignancy and necessitates thorough examination. Additionally, it underscores the notable surgical difficulties posed by the density, size, and potential adherence of the calcified tissue to adjacent structures. Key clinical insights reveal that imaging plays a vital role in surgical planning, that the prevention or alleviation of symptoms is an important outcome and that histopathological analysis remains the gold standard for diagnosis. The occurrence of extensive calcification in such a condition is uncommon. Effective collaboration among clinicians, radiologists, and pathologists is essential for accurate diagnosis and informed decision-making regarding thyroid nodular disease. Early diagnosis and intervention for nodular thyroid conditions are advocated, as advancing lesions may lead to compressive complications.
Intestinal obstruction is a significant medical condition marked by an impediment in the bowel’s capacity to eliminate waste. This condition is characterized by a blockage that hinders digestion and the regular expulsion of waste, which can be attributed to either functional or mechanical factors. A malignant bowel obstruction is frequently observed as a complication in advanced cancer cases, particularly those affecting the digestive tract. A 59 year old male presented with a one-month history characterized by infrequent bowel movements, abdominal distension and pain. Following a comprehensive clinical and imaging studies, a diagnosis of intestinal obstruction was established. The presence of a colonic tumour located in the proximal segment of the ascending colon and caecum, accompanied by a significantly dilated caecum displaying an incompetent ileo-caecal valve and a distended ileum, constituted the indication for a right hemicolectomy. The postoperative course was unremarkable. Ultimately, histopathological analysis confirmed a definitive diagnosis of colon adenocarcinoma. Colonic cancer situated in the proximal ascending colon and the adjacent caecum is uncommon and may manifest as an intestinal obstruction. In appropriate circumstances, right hemicolectomy is considered the preferred therapeutic approach. Early detection and intervention which can be enhanced through targeted screening, are advisable to avert the complications associated with advanced colonic tumours.
Introduction: This study investigates the molecular and biophysical changes in Tumor-Associated Macrophage (TAM)-derived exosomes (TAME) compared to exosomes from non-tumor microenvironment (TE) macrophages (MO-E). TAMs are immune cells infiltrating tumors that promote cancer progression. Materials and Methods: Characterizing the cargo of TAME via Next Generation RNA Sequencing protein microarray analysis and studying their morphological and nanomechanical properties using Atomic Force Microscopy (AFM). Results: Key Findings regarding Morphology showed TAME are significantly smaller (~50.6 nm) than MO-E (~64.8 nm). TAME exhibit higher Young's modulus (~15.5 MPa) indicating increased stiffness. Surface roughness ot TAME Is slightly higher (~3.64 nm) than MO-E (~3.51 nm). RNA sequencing revealed differential expression of genes involved in drug metabolism, cell cycle regulation, survival pathways, and immune modulation. Pathways such as NF-KB, PI3K/Akt, IL-13 signaling, and metabolic reprogramming are influenced by TAME cargo. Proteomics studies showed several Top upregulated proteins include ORP150 (promotes VEGF secretion), CSRP1, C1qB, DNER, PEPD, with roles in tumor growth and metastasis. Downregulated proteins include tumor suppressors like GOLPH2 and VNN1. These protein profiles suggest TAME carry oncoproteins that support tumor proliferation, invasion, and immune evasion. Conclusion: This study demonstrates that TAM-derived exosomes are morphologically distinct and carry molecular cargo that modulates key cancer-related pathways, highlighting their potential as biomarkers and therapeutic targets. The significance lies in understanding TAME's role in cancer progression, which could lead to novel diagnostic biomarkers and therapeutic targets, especially considering current limitations in cancer diagnosis accuracy.
Development of colorectal cancer (CRC) is a slow process, where a benign polyp progresses into a malignant stage over a long period of time. The patient may be asymptomatic during this period, thus delayed diagnosis has become a prime obstacle in managing CRC. Improved routine screening for early detection and prognosis will aid in better management of CRCs reducing mortality rates. Diagnosis of CRCs is primarily based on the invasive colonoscopy and tissue biopsy and fecal occult blood test with alongside evaluation of carcinoembryonic antigen (CEA) levels in blood for prognosis and recurrence. However, CEA as a standalone biomarker for CRCs, fail due to its non-specificity, low sensitivity and high false-positivity highlighting the importance of identification of new biomarkers for CRCs. In the recent past inflammatory cytokines emerged as key drivers of CRC pathogenesis, particularly as determinants of disease progression. The pleiotropic cytokine, interleukin-6 (IL-6) has been identified as activating oncogenic gene transcription in the colorectal epithelial cells leading to the pathogenesis of CRCs. By activating STAT3 signaling pathway, IL-6 promotes initiation, growth and metastasis of the colorectal cancer cell clone. In this review, we present the prospect of IL-6 in CRCs, describing the emerging evidence for IL-6 as a potential biomarker, the drawbacks of IL-6 and future directions for IL-6 as a diagnostic and prognostic marker for CRC. The original articles were extracted from the PubMed using the key words: "IL-6/interleukin 6 levels in colorectal cancer/ IL-6/ interleukin 6 concentrations in colorectal cancer/ IL-6 expression/ serum interleukin 6/ IL-6 in colorectal cancer". Full text articles published in English in last 25 years (from 2000 to July 2025) were included and the research carried out in animal models and in vitro, reviews, case reports, meta-analyses, editorials and non-relevant articles (post –surgery/treatment, studies on IL-6 in overlapping cancers/conditions etc.) were excluded. Though IL-6 stands as a potential marker for CRCs with markedly elevated levels, heterogeneity of patient populations with inadequacy of data for defining and distinguishing clinical sub groups, control groups and methodologies have become a barrier for its progression from bench to bed side. Hence, prospective research need to be focused on obtaining data on IL-6 using standardized methodologies to determine stage-specific and population specific cut-off values in well-defined CRC sub groups.
Cancer heterogeneity, including both intertumoral and intratumoral heterogeneity (ITH), represents a major challenge in cancer diagnosis, prognosis, and therapeutic response. ITH arises through genetic, epigenetic, and microenvironmental alterations that drive phenotypic diversity and contribute to metastasis, therapy resistance, and disease recurrence. Conventional bulk tumor analyses often fail to detect rare but clinically significant subclonal populations, highlighting the need for higher-resolution analytical approaches. This review summarizes current methodologies for ITH analysis, including single-cell omics, spatial transcriptomics, molecular imaging, mass cytometry, and integrative radiomics. Spatial techniques preserve tissue architecture and cellular localization, whereas single-cell approaches provide detailed characterization of genomic, transcriptomic, and proteomic variability among individual tumor cells. In addition, multimodal strategies integrating imaging, molecular profiling, and computational analysis offer improved insight into the dynamic interactions between tumor subpopulations and their microenvironment. We further discuss major technical and analytical limitations associated with current ITH methodologies, including amplification bias, dissociation-induced transcriptional artifacts, loss of spatial information, reproducibility challenges, and difficulties in integrating multi-modal datasets. Emerging artificial intelligence and machine learning approaches may help address some of these limitations through automated image analysis, multimodal data integration, and predictive modeling, although issues related to interpretability, standardization, and external validation remain significant barriers to clinical translation. Overall, comprehensive characterization of ITH through multi-region and multi-omics approaches may improve precision oncology by enabling more accurate identification of aggressive, treatment-resistant, and metastatic tumor subpopulations. Continued advances in spatially resolved and single-cell technologies, together with robust computational frameworks, are expected to enhance the understanding of tumor evolution and support the development of more adaptive therapeutic strategies.
This study evaluated the antiproliferative effects of cisplatin, dihydroartemisinin, metformin and taro extract on MDA-MB-231 triple-negative breast cancer (TNBC) cell lines. Cisplatin at half maximal inhibitory concentration, IC50 (20 μM) induced ~45% cell death (p < 0.001 vs control), while metformin (MET), dihydroartemisinin (DHA), and taro extract (TE) alone showed minimal cell death. Combination treatments (Cis + MET, Cis + DHA, and Cis + TE) significantly increased cytotoxicity to ~60% cell death on average (p < 0.01 vs cisplatin alone), with Cis + TE producing the greatest effect (~90%). The triple metabolic combination without cisplatin caused less than10% cell death (p < 0.001 vs cisplatin-containing groups), probably supporting a cisplatin-dependent cell death.
Lung cancer persists as the leading cause of cancer-related mortality globally, largely due to late detection, genomic complexity, and limited durability of existing therapeutic interventions. The integration of CRISPR/Cas9 gene-editing systems with biomarker-driven therapeutic strategies represents a transformative advance in precision oncology. Biomarkers—including genetic mutations, epigenetic alterations, protein signatures, and circulating analytes—enable early detection, patient stratification, and dynamic monitoring of therapeutic response. CRISPR/Cas9 offers a unique opportunity to directly reprogram these biomarkers or the pathways regulating them, enhancing tumor immunogenicity, reversing immune evasion mechanisms, and strengthening anti-tumor immune responses. Preclinical models demonstrate that CRISPR-mediated biomarker editing can restore antigen presentation, augment T-cell cytotoxicity, sensitize resistant tumors to immunotherapy, and improve tumor regression. Early clinical trials further validate the feasibility and safety of CRISPR-engineered immune cells in patients. However, major challenges persist, including off-target editing, inefficient delivery to solid tumors, tumor microenvironment–mediated suppression, and ethical considerations linked to genome manipulation. Rapid advancements in editing fidelity, lipid nanoparticle systems, viral vectors, engineered vesicles, high-throughput biomarker discovery, and artificial intelligence–assisted CRISPR design are expected to accelerate clinical translation. This review synthesizes the current landscape, mechanistic underpinnings, emerging applications, and future directions of CRISPR/Cas9-enabled biomarker engineering for lung cancer immunotherapy, positioning this technology as a cornerstone of next-generation personalized oncology.
Background: Endometrial cancer (EC) is the most common malignancy of uterus in the Western World. The literature shows a varied association between biopsy versus hysterectomy specimen findings. The objective of the study is to describe the concordance and discordance between endometrial biopsy vs hysterectomy specimens for the detection and grading of EC. Methods: This is a retrospective cross-sectional analytical study. Data were reviewed from 2018 to 2021 from the departmental archive. Results: The mean±SD of age was 55.4±9.6 years. The most common clinical feature was postmenopausal bleeding (45.4%). The overall concordance for diagnosis of EC was 59.1% between biopsy and hysterectomy. The highest concordance found for endometrioid carcinoma-NOS was 67.6%. Concordance for overall grading of endometrial cancer was 52.3%, and it was maximum for G1 (78.6%). The strength of association was mild to moderate (C= 0.379 to 0.592) between biopsy vs hysterectomy was significant with the Chi2 test. A biopsy had sensitivity, specificity, positive predictive value, and negative predictive value of 67.6%, 57.1%, 89.3%, and 25%, respectively, compared to hysterectomy for diagnosis of EC. Cohen’s Kappa test showed agreement between biopsy and hysterectomy was significant and moderate for the diagnosis EC (59.1%, k=0.1101) and for grading of EC (overall grading-52.2%, k=0.2925, architectural grading- 45.5% k=0.1156, nuclear grading 40.9%, k=0.1746). Conclusion: Concordance/agreement between endometrial biopsy and hysterectomy was moderate for the diagnosis and grading of EC. The accuracy of biopsy is moderate in diagnosis of EC. We recommend endometrial biopsy as a minimally invasive surgical and cost-effective approach in resource-poor countries.
Objectives: Cancer care is changing rapidly, with many countries embracing organ-specific specialization to offer more focused and effective treatment. In India, however, most surgeons continue to practice in a more generalized way, and we still do not fully understand how they feel about shifting toward subspecialized care. This question becomes especially important in breast cancer—the most common cancer among Indian women—where dedicated expertise can make a real difference in early detection, treatment quality, and patient survival. This study aims to explore how Indian surgeons view breast organ-specific practice, their willingness to adopt it, and the challenges they foresee. Methods: Cross sectional study conducted in July 2024 in 100 surgeons of India using a self-administered google form questionnaire. Responses were evaluated and assessed. Results: Out of 100 responses, 45% were from private/corporate setting, 39% from government institutes. 30.6% were from west, 27.6% from east, 22.4% from south and 19.4% from north zone. 55% were from surgical oncology, 36.4% were from general surgery. As per the study, breast (31%) and gastro-intestinal surgery (29%) were the subspeciality of choice. 47.5% agreed that they would be interested in breast specific surgery practice if proper training was available. 30.9% considered this to be less stressful with fewer complications. Majority (48%) thought that lack of patient awareness about breast cancer specific surgeon was the biggest disadvantage of organ specific practice. 22% considered it to be technically undemanding. 51% and 27.1% suggested that a dedicated and recognized training is required and organ specific practices are required at hospitals/institutions respectively. Notably, female surgeons were more likely to choose breast surgery compared to males (50% vs. 20%), a difference that was statistically significant (p = 0.015; 95% Confidence Interval (CI): 1.50–12.25) Conclusion: Breast organ specific oncosurgery practice is still uncommon in India. More dedicated training programs are required along with adequate employment opportunities to fill the lacunae in promoting the same.
Background: Human papillomavirus (HPV) is a major etiological agent in cervical cancer and is increasingly recognized as a driver of other anogenital and head and neck squamous cell carcinomas (HNSCCs). The oncogenic potential of HPV is primarily mediated by high-risk genotypes such as HPV16, HPV18, HPV31, and HPV45, whose E6 and E7 oncoproteins disrupt p53 and retinoblastoma pathways. While the burden of HPV-associated cervical cancer is well documented, data on the prevalence and genotype distribution of HPV in oral, oropharyngeal, vulvar, and vaginal cancers in India remain limited. Objective: To identify the disease burden and determine the prevalence and genotype distribution of high-risk HPV (16, 18, 31, 45) in biopsy-proven squamous cell carcinomas of the cervix, oral cavity, oropharynx, vulva, and vagina. Methods: We conducted a retrospective analysis of 131 patients with squamous cell carcinomas diagnosed between September 2022 and August 2024 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India. PCR-based HPV detection was employed to determine the presence of high-risk HPV types 16, 18, 31, and 45 targeting the E6/E7 regions of high-risk HPV. Clinical and pathological data, including tumor stage and demographic variables, were analyzed. Results: Overall HPV prevalence was 90.1%. Site-specific positivity was highest in cervical cancers (95.8%) and vulvovaginal cancers (100%), followed by oral (84.2%) and oropharyngeal (66.7%) cancers. HPV16 and HPV31 were the dominant genotypes across all tumor sites, whereas HPV18 and HPV45 were detected at lower frequencies. Cervical cancer cases predominantly presented in advanced stages (FIGO IIB–IIIB), while vulvovaginal cancers were diagnosed at earlier stages. Conclusion: HPV infection, particularly with HPV16/31, is highly prevalent in multiple anogenital and head and neck squamous cell carcinomas in this Indian cohort. These findings reinforce the importance of HPV vaccination programs, highlight the need for comprehensive HPV screening strategies, and suggest that P16 immunohistochemistry (IHC) should be integrated with PCR-based detection to establish oncogenic causality.
Background: Malignant mesenchymal tumours originating from peripheral nerves or nerve sheath cells are classified as malignant peripheral nerve sheath tumours (MPNSTs), previously referred to as neurofibrosarcoma. Most cases of these lesions occur in patients diagnosed with neurofibromatosis type 1, while some instances may be linked to previous radiation exposure, and others arise sporadically. Case report: This report presents a 53-year-old male patient who experienced swelling in the scrotal area over the past 18 months. Clinical assessment and histopathological examination revealed a diagnosis of a perineal MPNST. Conclusion: Perineal MPNST is infrequent, presenting distinct diagnostic challenges and should therefore be considered in the differential diagnosis of perineal masses. The diagnosis was based solely on histological examination, lacking confirmation through immunohistochemical methods, which constitutes a limitation. Surgical resection yielded positive outcomes, as there were no signs of recurrence observed three months post-surgery with a longer follow-up period deemed necessary.
Background: Breast cancer is the most common malignancy in women worldwide, with 2.3 million new cases and 6,70,000 deaths reported in 2022 (Globocan). Metastatic breast cancer affects up to 30% of patients, with brain metastases occurring in approximately 25%, especially among Human epidermal growth factor receptor 2 (HER2) positive subtypes. Leptomeningeal disease (LMD), the dissemination of tumor cells to the leptomeninges and cerebrospinal fluid (CSF), is an uncommon but devastating complication. Diagnosing LMD is often challenging due to nonspecific symptoms and overlapping imaging features with infectious or inflammatory conditions. CSF cytology remains the gold standard, though newer diagnostic techniques such as CSF-based circulating tumor DNA (ctDNA) are emerging. Case Presentation: We report a previously treated case of a 42-year-old premenopausal woman with HER2-positive, estrogen and progesterone receptor-negative, metastatic breast cancer, who presented with acute onset of altered sensorium, fever, and irritability. Magnetic Resonance Imaging (MRI) brain showed multiple enhancing lesions in the cerebral hemispheres, cerebellum, midbrain, and thalami, with surrounding edema. MR spectroscopy demonstrated reduced choline and elevated lipid-lactate peaks, initially suggesting an infective etiology, however, CSF cytology revealed malignant cells, with immunohistochemistry positive for GATA3 and PanCK, confirming leptomeningeal metastases of breast origin. She was planned for whole brain radiotherapy (WBRT) and intrathecal methotrexate. Conclusion: This case highlights the diagnostic challenges of LMD in HER2-positive breast cancer. Radiological and spectroscopy findings may mimic infectious processes, especially in tuberculosis-endemic regions. In ambiguous cases, reliance on CSF cytology is crucial, and adjunctive molecular diagnostics like ctDNA may further enhance diagnostic yield. Leptomeningeal metastasis, though underdiagnosed, has significant therapeutic implications. Newer HER2-directed intrathecal therapies, advanced radiotherapy techniques such as craniospinal irradiation with helical tomotherapy or proton therapy, and evolving strategies for CSF drug delivery offer promising avenues for treatment. A high index of suspicion and early CSF evaluation can lead to timely diagnosis and potentially improved survival outcomes in this difficult to treat subset.
Immune evasion is a hallmark of cancer development and poses an important impediment to the effectiveness of immune checkpoint inhibitors (ICIs). Cancer cells take advantage of heterogeneous intrinsic and extrinsic pathways to circumvent immune detection, such as metabolic remodeling (e.g., increased glycolysis, activation of IDO1), genomic mutation (e.g., JAK/STAT, β-catenin), and epigenetic suppression of immune-regulatory genes. Concurrently, TME promotes immune suppression through Tregs, MDSCs, TAMs, and fibroblast-mediated extracellular matrix remodeling. Hypoxia and cytokine dysregulation also undermine antigen presentation and T-cell functionality. These immunoevasion strategies form the foundation of both native (innate) and adaptive resistance to ICIs, while recent evidence places emphasis on microbiota composition being able to modify therapeutic response. The PD-1/PD-L1 pathway remains the focus of ICI therapy, but PD-L1 expression is limited by spatial, temporal, and technical heterogeneity. Beyond PD-L1, integrated biomarker approaches including tumor mutational burden (TMB), microsatellite instability (MSI), IFN-γ gene signatures, and circulating tumor DNA (ctDNA) have arisen to further inform patient stratification. Emerging therapeutic technologies—e.g., dual checkpoint blockade, engineered cytokines, personalized neoantigen vaccines, and adoptive T cell therapy (CAR-T, TCR-T)—are designed to overcome resistance and maximize clinical efficacy. Integration of multi-omics and AI-based models provides additional precision in the tailoring of immunotherapy. This review integrates existing knowledge of immune escape and resistance, highlighting dynamic biomarker development and combinatorial approaches for next-generation personalized cancer immunotherapy.
Variable bladder filling during radiotherapy for carcinoma cervix significantly affects the position of target volumes to be treated. This directly impacts the precision with which advanced radiotherapy plans are delivered using specific margins to target volumes. The aim is to study mean bladder volumes and mean range of bladder motion in all three dimensions in patients of carcinoma cervix treated with Image guided radiation therapy (IGRT), and compare them to the baseline planning Computed tomography (CT) scans. For this, a total number of 25 patients/ 150 CT scans, i.e. 25 planning scan and 125 CBCT (cone-beam CT) were analyzed. The bladder volumes and bladder wall dimension were analyzed using offline views of CBCT imaging, conducted weekly for cervix cancer patients, thus adding considerable understanding to the bladder wall motions. The mean bladder volume for all 25 patients was 263.41 cc with standard deviation of 110.174 cc. When mean CBCT bladder volumes of each patient were compared to their respective planning CT bladder volumes, P was found to be insignificant (p=0.25), showing consistent bladder filling or reproducibility during treatment. The mean ± standard deviation of bladder’s transverse, anteroposterior and supero-inferior dimension was 9.55 ± 0.923 cm; 6.92 ± 2.387 cm and 7.22 ± 0.967 cm. The mean supero-inferior bladder diameter had significant variation from that of the planning CT (7.84 ± 2.749 cm vs 6.92 ± 2.387) with p = 0.018. This study shows that more liberal margins should be considered in supero-inferior dimensions and considerable lesser margins could be given on the lateral sides, as there is less displacement in transverse diameter.
We report the case of a woman in her 20s who developed osteosarcoma in the right iliac bone with germline variants in the TP53 gene (TP53: c.220Y＞C). She was referred to a university hospital and imaging studies and biopsy led to a diagnosis of Li-Fraumeni syndrome. After she underwent proton-beam therapy combined with chemotherapy along with weekly hyperthermia, she had been referred to our institution for easier access since 20XX+6. She noticed ipsilateral gluteal pain and swelling in 20XX+8. Imaging and histopathology were consistent with recurrence of the pre-existing osteosarcoma. The palliative interventions enabled her to stay at home; however, her pain consequently exacerbated in 20XX+9. She was admitted emergently, and she died after several days.
A giant multilobulated breast mass is a rare and significant presentation of fibroadenoma characterized by their considerable size, exceeding 5cm and their rapid progression, which frequently results in notable breast distortion. It can cause symptoms such as stretching of the skin with multiple dilated veins, nipple changes and even ulceration that may mimic malignancy. Presented is a case involving a 33-year-old woman with a giant multilobulated breast mass of 6 years duration noticed during lactation. Clinical, imaging and histological evaluation revealed a definitive diagnosis of a giant fibroadenoma. She was offered surgical enucleation with satisfactory outcome. Giant fibroadenoma is rare and may be noticed during lactation simulating malignancy. Hormonal changes during pregnancy and lactation can stimulate the growth of fibroadenoma.Timely histopathological validation through immunohistochemistry is crucial to prevent the unnecessary treatment of benign lesions that resemble malignant condition. Surgical intervention with enucleation is the treatment choice for this benign disease and timely surgical intervention is recommended for the avoidance of complications that may be associated with late presentation of giant lesions.
Background: Breast cancer (BC) burden has increased drastically and has been ranked 2nd worldwide and most common in India, with an incidence of 13.5% of all newly diagnosed cancers. Surgery is the main modality of treatment. The aim of adjuvant radiation therapy is to reduce local recurrence and improve survival. In breast radiotherapy, the proximity of the target to sensitive structures together with the uncertainty introduced by respiratory movement, make this treatment one of the most studied to increase its effectiveness. Various techniques like 3DCRT (Three-Dimensional Conformal Radiation Therapy), IMRT (Intensity Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc Therapy) are used in RT (Radiation Therapy). Although 3DCRT lowers radiation exposure to normal tissues, it can result in suboptimal dosing of the tumor volume. Conversely, IMRT and VMAT achieve better tumor dose coverage but pose greater challenges in protecting organs at risk (OARs). Objectives: This retrospective study aims to highlight the Dosimetric study of OARS, and compare Dosimetric values of different RT Techniques in patients receiving left-sided breast irradiation. Methods: A total of 142 left breast carcinoma patients receiving either whole-breast irradiation or chest wall irradiation were enrolled in this study. The Dosimetric parameters of the heart, left lung and right breast were evaluated and compared, and possible correlations were studied. Results: Of the 142 patients assessed, 62 patients were stage III, 93 patients underwent post-mastectomy radiotherapy and 49 patients with Whole Breast Radiotherapy (WBRT). Majority of patients were treated by 3DCRT technique. Patients were planned for the 50 Gy in 25 fractions (n-72) and 40 Gy in 15 fractions (n-70) radiation dose regimens. Heart mean dose in 3DCRT, IMRT and VMAT is 6, 7.8 and 7.1Gy respectively (p-0.002).On comparing V20 (Volume of lung receiving 20Gy) of ipsilateral (I/L) Lung with 3DCRT, IMRT and VMAT (p-0.998) is 24.8%, 27.5 % and 22.5% respectively. Contralateral (C/L) breast mean dose in 3DCRT was 0.8Gy whereas 5.3Gy and 4Gy respectively in IMRT and VMAT which was statistically significant (p-0.05) Conclusion: Significant correlations for dosimetric parameters were registered between the OARs and RT Techniques. Our results suggest that heart mean dose and C/L breast dose is minimal in 3DCRT compared to IMRT and VMAT techniques.
Background: Pituitary adenomas often require radiotherapy (RT) for residual or recurrent disease, but optimal techniques balancing tumour control and toxicity remain debated. This prospective study compares outcomes between conventional and stereotactic RT approaches. Methods: From 2014 to 2022, 22 patients with pituitary adenomas treated with RT were retrospectively enrolled (10 conventional RT [3DCRT/IMRT/VMAT], 12 stereotactic [SRS/fSRT]). All the patients disease, treatment and follow-up details were analyzed from the medical records. Primary endpoint was 3-year local control, secondary endpoints included toxicity (CTCAE v5.0) and endocrine function assessment. Results: Stereotactic RT demonstrated superior 3-year local control (91.7% vs 80%, p=0.03) with lower hypopituitarism rates (33.3% vs 60%, p=0.02). All recurrences occurred in Knosp grade 3-4 tumours. Conventional RT was associated with higher pituitary doses (>45 Gy, OR 3.2, p=0.03 for hypopituitarism). No grade ≥3 toxicities occurred in either group. Visual complications were rare (8.3% stereotactic vs 20% conventional, p=0.39). Conclusion: Stereotactic radiotherapy provides significantly better tumour control and endocrine preservation compared to conventional techniques for pituitary adenomas, particularly for non-invasive tumours. Dose constraints are critical for minimizing toxicity.
Background: With the wide application of lung cancer screening, the detection rate of multiple pulmonary nodules (MPNs) has increased annually. However, the optimal therapeutic strategy for MPNs has not achieved a consensus. This study aims to report a novel hybrid technique for the treatment of MPNs. Methods: A total of 8 patients received CT-guided lung microwave ablation combined with video-assisted thoracic surgery from March 2020 to March 2023. Three-dimensional reconstruction was conducted to distinguish the precise localization, predict the resection extent, and conduct the optimal operation procedure for each lung nodule. The clinicopathological characteristics as well as surgical complications and short-term outcomes were recorded. Results: 8 patients with a total of 18 nodules were treated by our hybrid technique. Two patients had a FEV1％ Pred lower than 90％. The nodules treated by surgery were confirmed as malignant by pathological results with a median size of 9mm.The median size of the nodules treated by ablation was 6mm. The median ablation power used for the nodules was 45 W (range, 40–50W). The ablation time was 5min. The median distance between nodules to pleura was 31mm (range 19-56mm). This hybrid technique did not increase the rate of complication and prolonged hospital stay. During the short term of follow-up, no recurrence occurred in the patients. Conclusions: We present our experience of percutaneous lung ablation combined with video-assisted thoracic surgery guided by three-dimensional reconstruction in the treatment of multiple pulmonary nodules. This technique provides a minimally invasive and personalized therapy for patients with MPNs.
Introduction: Lung cancer is the most commonly occurring cancer worldwide accounting for 12.4% of total new cases and also the leading cause of cancer deaths (18.7%). In India, Lung cancer accounts for 5.8% of new cases and 8.2% of cancer deaths. Chemotherapy and Radiation therapy plays a major role in treatment especially in inoperable cases. In this study we evaluated the factors which could affect the Overall Survival (OS) and Disease -Free Survival (DFS) in patients with Lung carcinoma treated by Sequential Chemoradiation (CTRT) and Concurrent CTRT. Materials and Method: A retrospective review was carried out on 38 patients with Lung carcinoma who were treated with either Concurrent or Sequential CTRT at our institute. Various factors like age, gender, habits, disease laterality, histology, group stage, treatment received and radiation dose were evaluated. Results were analysed using IBM SPSS Statistics version 25 and Kaplan-Meier curves. Results: Median age of patients was 65 years. The majority were men (89.4 %) and smokers (57.8%). Adenocarcinoma (63.2%) was the most common histological type followed by Squamous cell (18.4%) and Small cell carcinoma (18.4%). Majority were left-sided tumors (52.6%). Most common stage was IIIA (44.7%) followed by IIIB (39.5%). Most of the patients were treated with Sequential CTRT (78.9%) and the rest with Concurrent CTRT (21.1%). The mean radiation dose used was 61.82Gy (Range: 45Gy-66Gy). The 2-year OS and DFS in all patients was 21% and 18.4% respectively and the 5-year OS and DFS was 13.1% and 10.5% respectively. OS and DFS was better in patients diagnosed at young age (36-45 years), females, non-smokers, Adenocarcinoma histology, left-sidedtumors, stage IIIA and treated with Sequential CTRT but was not statistically significant except for Stage IIIA (p=0.007) and left-sidedtumors (p=0.029) which had significantly better OS and DFS respectively. Conclusion: Young age, females, non-smokers, left-sided tumors, Adenocarcinoma histology are favorable prognostic factors for OS and DFS in Lung cancer patients. Left-sided tumors also had a better statistically significant DFS.
