A BSTRACT Objectives: To assess the real-world outcomes of postoperative radiotherapy (PORT) for oral cavity squamous cell carcinoma and to examine whether delay in starting PORT affects the survival. Methods: We retrospectively reviewed 47 consecutive patients who underwent curative surgery followed by PORT. Radiotherapy was delivered using standard planning procedures, with 66 Gy in 33 fractions for high-risk patients and 60 Gy in 30 fractions for low-risk patients. Time from surgery to PORT initiation was evaluated both continuously and as ≤6 weeks versus >6 weeks. Overall survival (OS) and progression-free survival (PFS) were measured from the start of radiotherapy and analyzed using the Kaplan–Meier methods and multivariable Cox regression. Results: The median interval from surgery to PORT was 6.1 weeks (range, 2.7–9.1). With a median follow-up of 19.4 months, the 2-year OS and PFS rates were 62.3% and 39.1%, respectively. Two-year OS was 77.8% in the ≤6-week group versus 49.0% in the >6-week group ( P = 0.045). Two-year PFS was 52.2% versus 26.1%, respectively ( P = 0.062). In multivariable analysis, PORT initiation >6 weeks after surgery was independently associated with worse PFS (hazard ratio 2.865, 95% confidence interval: 1.065–7.709; P = 0.037). Conclusion: In this real-world cohort, delayed initiation of PORT beyond 6 weeks after surgery was associated with inferior outcomes, including significantly worse PFS. Optimizing postoperative treatment timelines may improve the outcomes in oral cavity squamous cell carcinoma.
A BSTRACT Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially serious neurotoxic complication characterized by acute neurological symptoms and characteristic radiological findings. Although it is classically associated with hypertension, renal failure, and immunosuppressive therapy, PRES has also been reported in association with cytotoxic chemotherapy, including gemcitabine. Gemcitabine-associated PRES remains rare, particularly in normotensive patients and in the presence of concurrent central nervous system malignancy. We report the case of a 39-year-old woman with metastatic HPV-positive cervical squamous cell carcinoma who developed acute neurological deterioration after receiving gemcitabine and carboplatin. She presented with severe headache, visual disturbances, nausea, vomiting, and papilledema without sustained severe hypertension. Initial brain computed tomography was unremarkable, while subsequent magnetic resonance imaging demonstrated bilateral cortical and subcortical T2/fluid-attenuated inversion recovery hyperintensities with areas of diffusion restriction, consistent with complicated PRES. Cerebrospinal fluid analysis was unremarkable. Despite aggressive neurocritical care management and discontinuation of chemotherapy, her condition deteriorated rapidly and was complicated by cerebral edema and uncal herniation. Neurosurgical intervention was considered non-beneficial in the setting of advanced malignancy. This case highlights gemcitabine as a possible precipitating factor for PRES even in normotensive patients and underscores the diagnostic complexity when PRES coexists with advanced cancer and central nervous system involvement. Although PRES is often described as reversible, outcomes may be poor in such patients. Early recognition, prompt neuroimaging, withdrawal of the offending agent, and multidisciplinary management remain essential to optimize outcomes.
A BSTRACT Synchronous adenocarcinomas of the rectum and prostate are rare, especially in the absence of an underlying genetic predisposition. Their anatomical proximity and differing therapeutic protocols pose a sequencing dilemma, as prioritization of one malignancy may delay the optimal management of the other and increase the risk of disease progression or treatment-related toxicity. A 79-year-old male presented with frequent loose stools mixed with blood and mucus. Positron emission tomography–computed tomography demonstrated distinct fluorodeoxyglucose-avid lesions in the rectum (maximum standardized uptake value [SUV max ]: 15.6) and prostate (SUV max : 23.19). Colonoscopic biopsy confirmed moderately differentiated rectal adenocarcinoma. Serum prostate-specific antigen was elevated at 56.35 ng/mL, and prostate biopsy confirmed acinar adenocarcinoma. To address sequencing challenges, androgen deprivation therapy (ADT) was initiated for prostate cancer, followed by abdominoperineal resection with end colostomy for rectal cancer. Definitive prostate radiotherapy and adjuvant rectal radiotherapy were delivered concurrently using intensity-modulated radiotherapy (IMRT) to prevent field overlap and dosimetric errors. Adjuvant chemotherapy for rectal cancer was subsequently administered, alongside continued ADT. At 1-year follow-up, the patient remained disease-free. This case demonstrates that synchronous rectal and prostate adenocarcinomas can be effectively managed through careful diagnostic confirmation and individualized treatment sequencing. The use of modern radiation techniques, such as concurrent IMRT, allows safe and precise dose delivery to both pelvic sites, enabling timely multimodality treatment when minimizing toxicity. Early multidisciplinary planning is essential for achieving favorable outcomes in such complex clinical scenarios.
A BSTRACT Purpose: Iso-center placement is a key determinant of dosimetric accuracy and workflow efficiency in intensity-modulated radiotherapy (IMRT). While the anatomical iso-center (AIP) is conventionally used, high-volume centers increasingly consider the virtual iso-center (VIP) defined during CT simulation to streamline patient setup. This study evaluates the dosimetric impact and workflow benefits of VIP relative to AIP in IMRT planning. Materials and Methods: A retrospective planning analysis was performed for 40 IMRT patients. For each case, two plans were generated: one centered on the AIP and the other on the VIP. Dosimetric indices, including conformity index (CI), homogeneity index (HI), target coverage, organ-at-risk (OAR) doses, monitor units (MUs), and iso-center displacement were compared. Workflow efficiency was assessed by estimating setup time saved through omission of couch shifts. Results: VIP-based plans demonstrated a statistically significant increase in MUs (mean + 4.4%, P < 0.001), strongly correlated with iso-center displacement ( r = 0.82). CI, HI, and OAR doses showed no significant differences between AIP and VIP plans ( P > 0.15). The VIP approach eliminated couch shifts, reducing average setup time by approximately 4.2 min per patient, translating into the potential to treat 5–6 additional patients per month. Larger displacements (>6 cm) were associated with greater MU penalties. Conclusions: VIP planning enhances workflow efficiency without compromising target coverage or OAR sparing. However, the consistent MU increase, particularly with large displacements, supports selective use and vigilant quality assurance.
A BSTRACT Background: Acute appendicitis is one of the most common causes of emergency abdominal surgery. While appendicectomy is curative, routine histopathological evaluation remains debated. Patient management can be altered by the incidental detection of rare but clinically significant pathologies, including low-grade appendiceal mucinous neoplasms (LAMNs), neuroendocrine tumors (NETs), parasitic infestations, and granulomatous lesions. Materials and Methods: A retrospective review of 900 appendicectomy specimens was conducted over 1 year. Data on age, gender, and histopathological diagnosis were analyzed. The study aimed to analyze the histopathological spectrum of appendicectomy specimens in a tertiary care center, highlighting both common and rare findings. Results: The mean age was 26.1 ± 16.2 years, with a male predominance (63.1%). Acute appendicitis was the most frequent diagnosis (78.2%), followed by lymphoid follicular hyperplasia (12.2%) and resolving appendicitis (5.1%). Rare but clinically relevant findings included LAMN (1.7%), NETs (1.1%), and other uncommon lesions such as lymphoma, endometriosis, granulomatous inflammation, and parasitic infestations. Conclusion: Routine histopathological evaluation of appendicectomy specimens is essential, as it identifies rare but significant pathologies that may influence prognosis and management. These findings reinforce the importance of mandatory microscopic examination of all resected appendixes.
A BSTRACT Optic pathway gliomas represent a rare subset of pediatric brain tumors, frequently associated with neurofibromatosis type 1. Pilocytic astrocytoma (PA) (World Health Organization Grade I–II) is the most common histology, yet management of isolated optic nerve gliomas remains clinically challenging due to visual morbidity. We aim to present a rare case report of optic PA in a 6-year-old male who presented with progressive diminution of vision. Magnetic resonance imaging (MRI) findings were consistent with an optic chiasm region mass lesion. The patient underwent frontal craniotomy followed by a revision surgery and still had progressive diminution of vision, MRI suggestive of a large residual lesion along the optic chiasm extending to the thalamus region, so was started on adjuvant external beam radiotherapy to achieve better local control in patient and prevent progression. Posttreatment evaluation showed no change in visual status, but also no progression in optic mass lesion, and the patient remains stable at 6-week follow-up. This case highlights with a multidisciplinary discussion and treatment approach that must be taken care when treating patients. Early diagnosis and prompt intervention play a significant role in managing the cases, so that the visual status of the patient can be tried to preserve.
A BSTRACT Ewing’s sarcoma (ES) is a malignant tumor arising from the bones and soft tissues in children and young adults. However, primary intracranial ES is extremely rare, and they generally present as supratentorial or intraparenchymal tumors. There are no standard treatment guidelines for such cases, with each patient being managed on a case-by-case basis. This paper reports a case of a 15-year-old female patient who presented with a complaint of headache and vomiting. Radiology suggested an intracranial mass in the right frontoparietal region with thinning of the adjacent overlying bone. She underwent right frontal craniotomy with tumor excision, which, after histopathological examination and immunohistochemistry, showed features consistent with ES. She was managed with multiagent chemotherapy.
A BSTRACT Augmented reality (AR) and virtual reality (VR) have emerged as transformative technologies increasingly recognized in health care, particularly for precision-focused applications in radiotherapy. These immersive technologies can enhance patient care by supporting visualization, alleviating anxiety, and improving education and training throughout the radiotherapy workflow. AR and VR applications encompass professional training, patient positioning, patient education, treatment planning visualization, and workflow optimization. However, despite these opportunities, challenges such as high equipment costs, data security concerns, system integration, and compatibility issues, as well as a lack of standardized clinical guidelines, hinder routine clinical adoption. This review aims to summarize the use of AR and VR in clinical radiotherapy, highlight their opportunities and challenges, and identify future directions for effective clinical implementation.
A BSTRACT Medical imaging utilizing ionizing radiation has become indispensable in modern healthcare, with exponential growth in diagnostic procedures over recent decades contributing to increased population radiation exposure. From a preventive medicine perspective, balancing the diagnostic benefits of radiological examinations against potential long-term cancer risks represents a critical public health challenge. This narrative review examines the epidemiological evidence linking medical radiation exposure to cancer development, quantifies population-level exposure trends, and explores evidence-based strategies for radiation dose optimization and risk reduction. We synthesize data on radiation-induced cancer risks across different age groups, organ systems, and dose levels, with particular attention to vulnerable populations including children, pregnant women, and individuals requiring repeated imaging. The review addresses cumulative radiation exposure from computed tomography, fluoroscopy-guided procedures, nuclear medicine, and other diagnostic modalities. We discuss the principles of justification, optimization, and dose limitation as fundamental components of radiation protection in medical settings. Implementation strategies, including clinical decision support systems, dose tracking programs, standardized protocols, and patient communication approaches, are examined alongside comparative international regulatory frameworks. The review highlights opportunities for dose reduction without compromising diagnostic quality, and provides stakeholder-specific recommendations for preventive medicine specialists, radiologists, healthcare administrators, and policymakers.
A BSTRACT Introduction: Radiotherapy has a crucial role in treating nasopharyngeal carcinoma (NPC). The use of intensity-modulated radiation therapy/volumetric modulated arc therapy (IMRT/VMAT) technique in treating NPC has improved the outcome and reduced the toxicities. The nasopharynx is in proximity to the medial temporal lobe which may lead to a high risk of radiation injury to the hippocampus in patients with NPC. Damage to the hippocampus is known to alter learning and memory and likely to cause cognitive problems. Objectives: The objective of this study was to evaluate the incidental dose to the hippocampus in patients with NPC undergoing IMRT/VMAT. Materials and Methods: The study population comprised 21 patients with NPC treated with concurrent chemoradiation therapy to a total dose of 66–70 Gy using IMRT/VMAT technique. The right and left hippocampus were retrospectively delineated on the axial slices from the simulation computed tomography scan for each patient using the established anatomical guidelines with magnetic resonance imaging co-registration. The mean hippocampus volume, V 3 Gy , V 20 Gy , V 40 Gy , and V 60 Gy and the average mean (D mean ), minimum (D min ), and maximum (D max ) dose to the hippocampus were analyzed. Results: The mean hippocampus volume was 3.76 cm 3 . The average D mean , D min , and D max to the hippocampus were 15.677 Gy, 5.327 Gy, and 36.78 Gy, respectively. The mean V 3 Gy, V 20 Gy, V 40 Gy , and V 60 Gy were 88.64%, 33.04%, 4.81%, and 0.08%, respectively. Conclusion: The hippocampus is exposed to significant doses during the treatment of NPC by IMRT/VMAT. This warrants the need to delineate the hippocampus as an organ at risk while treating all head and neck cancers where the clinical target volumes reach the base of the skull to prevent neurocognitive decline.
A BSTRACT The era of computer science is advancing daily, and the most updated topic being discussed is artificial intelligence (AI). AI has dominated the technology due to its ability to work better, faster, smarter, and more effectively. One of the latest advancements in AI is its ability to convert the text to images. Using the textual prompts, the AI tools used the algorithm and pretrained models to generate the synthetic images that look such as real and high-resolution images. The generated images can be used in different fields for different purposes. In radiation oncology, AI-generated images can be a very helpful tool. The images generated by AI represent a promising frontier for transforming the landscape of cancer care. Advanced generative models, such as Generative Adversarial Networks and diffusion models, provide opportunities for clinical practice, education and training, simulation and treatment, and the execution of treatment. The AI-generated images can be used in radiation oncology for virtual patient modeling, generating synthetic images for dose calculation and virtual simulation, anatomical segmentation for training, and updating the machine learning algorithm. The article discusses the importance of AI-generated images and their potential use in radiation oncology and explores the challenges and future opportunities for improving cancer treatment through better integration of these images. The article also focuses on the ethical, regulatory, and practical challenges posed by the adoption of AI-generated visuals.
A BSTRACT Purpose of the Research: This study aims to compare the radiobiological effectiveness of intensity-modulated radiotherapy (IMRT) plans generated using the eclipse treatment planning system (TPS) with 6 MV X-rays from a linear accelerator (Linac) against equivalent plans developed for a Cobalt-60 (Co-60) unit in head and neck cancer patients. Materials and Methods: Twenty-five head and neck cancer patients were planned using IMRT with Eclipse TPS for 6 MV X-rays. Equivalent Co-60 plans were generated for comparison. Dose-volume histogram (DVH) data were analyzed using BIOPLAN software and Brenner’s analytical model to calculate tumor control probability (TCP) and normal tissue complication probability (NTCP) for optic nerves and spinal cord. Results: The average TCP values were significantly higher for 6 MV Linac plans (60.2%) compared to Co-60 (46.5%) using BIOPLAN ( P < 0.001). Brenner’s model showed a 76.1% increase in TCP. NTCP values were significantly lower for Linac plans for both optic nerves (0.062% vs. 0.279%) and spinal cord (0.008% vs. 0.085%) with NTCP reductions of 76.6% and 90.3%, respectively. A strong negative correlation was observed between delivered dose and NTCP values. Conclusion: IMRT plans using 6 MV Linac provide superior tumor control with significantly reduced toxicity to critical organs compared to Co-60. Radiobiological evaluation offers a more comprehensive and predictive assessment than DVH-based metrics and should be integrated into clinical practice to enhance treatment quality and patient outcomes.
A BSTRACT This systematic review aggregates data from 15 articles published between 2000 and 2025 in PubMed, Scopus, and Google Scholar to discuss environmental exposures for lung cancer risk among never-smokers in Nigeria. The main drivers are indoor radon (levels 5–50 Bq/m 3 , occasionally higher than Nigeria’s 11.1 Bq/m 3 threshold in mining populations but within World Health Organization (WHO) 100 Bq/m 3 , associated with higher lung cancer risk by alpha radiation-induced DNA damage); particulate matter (PM 2.5 at 15–40 µg/m 3 in urban settings like Lagos and Port Harcourt, with hazard ratios 1.12–1.24 for lung cancer mortality per 10 µg/m 3 increase through inflammation and oxidative stress); household air pollution from biomass combustion (responsible for 10%–15% of never-smoker cases in rural settings, driven by carcinogens like polycyclic aromatic hydrocarbons); and asbestos (predominantly occupational in construction and mining but with rare environmental evidence but established causation of chronic inflammation leading to carcinogenesis). These exposures combined account for 15%–30% of lung cancer in Nigerian never-smokers. Although concentrations are predominantly below WHO guideline levels (100 Bq/m 3 for radon, 25 µg/m 3 for PM 2.5 ), localized exceedance and synergies with other factors underscore the need for stepped-up monitoring, cleaner energy transition, and public policy to diminish Nigeria’s industrial and rural lung cancer burden.
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas that may appear as late complications of radiotherapy. Here we report the case of a 54-year-old woman with a history of breast cancer treated with mastectomy and adjuvant chemoradiotherapy at the age of 29 in 1994, who developed an MPNST 26 years later. Electromyography and magnetic resonance imaging localized a mass along the right brachial plexus. Positron emission tomography/computed tomography showed a retroclavicular fluorodeoxyglucose-avid lesion (6.1 cm × 4.0 cm; SUV ma × 10.0) and a smaller focus in the low right neck (SUV ma × 4.8). Histopathology confirmed high-grade MPNST; immunohistochemistry demonstrated S-100/CD57/CD99 positivity with a Ki-67 index of ~70%. Genomic profiling identified a somatic CDKN2A deletion without actionable variants. The patient underwent resection, adjuvant doxorubicin, radiotherapy, pazopanib, and ultimately right upper-limb disarticulation, followed by systemic therapy, achieving complete metabolic response before nodal relapse at 44 months; care then transitioned to palliation. This case highlights the potential for very long latency of radiation-associated sarcoma, the complementary value of molecular profiling even when nonactionable, and the importance of multidisciplinary, multimodality management.
A BSTRACT An aneurysmal bone cyst (ABC) is primarily a vascular tumor that causes partial vascular occlusion, leading to bony expansion. It is rare and attributes to only 1%–2% of primary bone tumors. Usually, it is found in long bones, with only 2% tumors in the head and neck region. Pain and slow-growing swelling are the most common presentations while other symptoms are attributed to pressure symptoms due to swelling. Radiologically, there are fluid–fluid interfaces and multiple cysts within ABCs. Biopsy is the mainstay of diagnosis. The only established and standard treatment is surgery. However, ABCs show a high rate of local recurrence even after complete resection. Getting a clear margin is difficult in anatomically inaccessible areas. Selective arterial embolization in large ABCs improves surgical outcome. There is a long data since the era of orthovoltage radiotherapy (RT) regarding the use of RT in ABCs for local control. Still, there is no proper RT guideline in ABC. Here, we are presenting a rare case of ABC of skull base in a 27-year-old man treated with volumetric modulated arc therapy.
A BSTRACT Primary treatment for soft tissue leiomyosarcoma (LMS) is surgical excision; however, its frequent recurrence necessitates the options such as chemotherapy, radiation, and advancements like MR-guided radiation therapy (MRgRT) improves treatment outcomes. A 59-year old postmenopausal female presented with complaints of lower abdominal pain and lower backache for the past 6 months. A positron emission tomography and computed tomography (PET CT) whole body revealed an enlarged right paracaval lymph node. Laparoscopic excision was carried out. Intraoperatively, the mass was noted in the retrocaval region, adherent and arising from the posterior wall of the inferior vena cava (IVC). Histopathological examination revealed a malignant spindle cell tumor likely LMS. While immunohistochemistry showed positive for H-caldesmon and smooth muscle actin and negative for estrogen receptor. Postoperative magnetic resonance imaging (MRI) revealed focal, irregular soft tissue along the posterior wall of the IVC. She was planned for adjuvant radiation using MRgRT, and generated plan of the day was delivered under continuous real-time MRI of the target. On 3-monthly follow-up, PET CT scan revealed complete resolution of metabolic activity and a significant decrease in the size of the lesion.
A BSTRACT Medical radiation exposure refers to ionizing radiation encountered during diagnostic imaging and therapeutic procedures. This review examines potential cardiometabolic effects, focusing on mechanisms such as oxidative stress and mitochondrial dysfunction that may link radiation exposure to hypertension and metabolic disorders. The dose ranges associated with common diagnostic modalities (e.g., chest X-ray ~0.1–0.2 mSv, abdominal computed tomography [CT] ~8–10 mSv, and whole-body CT protocols >10–20 mSv) highlight how cumulative exposure from multiple studies or procedures could approach higher levels. Epidemiological findings from observational cohorts suggest a possible, modest association between higher cumulative medical radiation exposure and cardiometabolic outcomes, with relative risks in the low-to-moderate range (generally in the vicinity of 1.1–1.5 per defined exposure increments), although estimates are heterogeneous and subject to confounding. This work emphasizes the need for educational and awareness initiatives that mitigate risks while preserving the benefits of essential diagnostic and therapeutic radiologic practices. The findings offer actionable considerations for healthcare professionals, patients, and policymakers as they navigate the balance between clinical benefits and potential cardiometabolic risks in modern medical radiation use.
Objective: This study aimed to analyze the patterns of cancer admissions among patients undergoing radiotherapy in a tertiary care hospital in Kashmir, providing insights into prevalent cancers, treatment modalities, and demographic distributions, supported by statistical associations. Materials and Methods: A retrospective observational study was conducted in the radiation oncology department of our hospital, covering the period from October 2020 to December 2021. Data regarding patient demographics, cancer sites, and radiotherapy techniques were retrieved using a structured pro forma. Descriptive statistics were used to summarize data, and Chi-square tests were performed to assess associations between gender, age group, cancer site, and radiotherapy techniques. Statistical analysis was conducted using SPSS Version 22, with P < 0.05 considered significant. Results: A total of 205 cancer patients were analyzed, with a male-to-female ratio of approximately 1.4:1. The most common cancers treated were esophageal (15%), rectal (15%), head and neck (14%), lung (13%), and brain tumors (12.8%). The majority of patients (38%) belonged to the 60–69 years age group. Volumetric modulated arc therapy (VMAT) was the most frequently employed radiotherapy technique (69%), followed by three-dimensional conformal radiation therapy (13%) and intensity-modulated radiation therapy (11%). A statistically significant association was observed between gender and cancer site (P < 0.001), as well as between cancer site and radiotherapy modality (P < 0.001), whereas no significant association was found between age group and cancer type (P = 0.3698). Conclusion: The study highlights distinct patterns of cancer incidence and radiotherapy utilization in Kashmir. Advanced radiotherapy techniques, particularly VMAT, dominate treatment approaches. Gender and cancer site were strongly associated, emphasizing the need for personalized, region-specific cancer control strategies. These findings underscore the importance of strengthening early detection programs, enhancing outpatient services, and optimizing resource allocation to improve cancer care delivery in resource-constrained settings.
Introduction: Planning target volumes (PTV) along with critical structures, like organs at risk (OAR), are defined by high-quality computed tomography (CT) imaging, which is essential for accurate radiotherapy treatment planning. CT scans provide essential tissue density data, crucial for dose calculation algorithms. However, artifacts from high-density materials and contrast agents can compromise CT imaging. Depending on CT scanner being utilized, each treatment planning system (TPS) must precisely convert Hounsfield Units to electron density. Aims and Objectives: This study aims to compare dose calculations between contrast-enhanced CT (CE-CT) images and plain CT images in cases of esophageal carcinoma using the Monaco TPS. Materials and Methods: Thirty patients having mid to lower third esophageal carcinoma, with or without the gastroesophageal junction, who required radical radiation therapy, were included. During CT simulation, plain and CE-CT images were obtained for every patient. Two contour plans were generated: one with contrast enhancement (in the heart and abdominal aorta) and another without. Dose differences were evaluated and treatment plans were developed by employing the Monaco TPS. Results: The study found dose variations of 1.58% in the PTV, 2.16% in the heart, 2.82% in the spinal cord, 2.36% in the right lung, and 3.52% in the left lung, with statistical significance, with P = 0.0056, 0.0033, 0.025, 0.029, and 0.011, respectively. Conclusion: Intravenous contrast in planning CT images significantly impacts dose calculations for the PTV and OARs. The study suggests using plain CT as the primary imaging set for delineation or adopting advanced features like Force Electron Density could be an alternative for CE-CT users. A larger clinical dataset is needed to validate these findings, and a dosimetric model to explain this phenomenon would be beneficial.
