Background Multicentric glioblastoma (MCG) is a rare and aggressive form of brain parenchymal malignancy, with limited evidence guiding its optimal management. A trimodality treatment approach-comprising surgery, radiotherapy, and chemotherapy-appears to offer better clinical outcomes compared with partial treatment or supportive care alone. Objectives This study aimed to shed light on possible treatment strategies in patients with MCG and their clinical outcomes. Materials and Methods This is a retrospective case series of five patients diagnosed with MCG at our institution between January 2019 and December 2023. Patients were identified through a review of the institutional medical records department. Inclusion criteria were (1) histopathologically confirmed glioblastoma multiforme as per WHO classification, (2) radiological evidence of two or more spatially separate enhancing lesions in different brain regions with no connecting T2/FLAIR hyperintense signal, indicating absence of white matter tract dissemination or parenchymal continuity, consistent with MCG as per criteria, and (3) availability of complete clinical, radiological, and treatment data. All patients underwent pretreatment MRI with contrast, which was independently reviewed by two neuroradiologists. Surgical and oncological management decisions were made in multidisciplinary tumor board meetings. Molecular profiling, including methylguanine methyltransferase (MGMT) promoter methylation status and IDH1/IDH2 mutation status, was performed where available. Data collected included demographics, presenting symptoms, tumor locations, imaging findings, extent of surgical resection, adjuvant therapy, progression-free survival, and overall survival. Results Three patients underwent surgery, one underwent surgical biopsy, and one adult, being the exception-did not undergo any surgical intervention/biopsy. Three adults, except one adult and the pediatric patient, received radiation. All except one adult received temozolomide. The remaining adult patient who did not receive any treatment modality was a case of recurrent glioblastoma with multicentric disease, in a previously known case of solitary glioblastoma treated radically. This patient was kept on best supportive care. All the patients expired. Survival ranged from 3 to 14 months. The longest survivor (14 months) was an adult patient who underwent surgical resection followed by hypofractionated whole brain radiotherapy (30 Gy/10 fractions) and completed six cycles of adjuvant temozolomide. Patients receiving surgery followed by adjuvant therapy survived 11 to 14 months, whereas those receiving limited or no treatment had shorter survival (3-6 months). Conclusion Although outcomes remain poor, patients receiving multimodal therapy appeared to have longer survival, although interpretation is limited by small sample size. Larger studies are required to validate these findings.

Uterine cancer is one of the most common gynecological malignancies globally, with increasing incidence in developing countries. This study evaluates epidemiology, clinical and surgico-pathological characteristics, treatment patterns, and survival outcomes in patients with uterine cancer from a tertiary care center in India. This ambispective observational study included 111 patients diagnosed with uterine cancer who had undergone primary treatment between January 2018 and December 2024. Data on demographic parameters, clinical presentation, imaging, histopathology, treatment modalities, and survival were analyzed using SPSS v25. Kaplan-Meier analysis was used to estimate overall survival (OS) and progression-free survival (PFS). The median age was 57 years, with the majority being postmenopausal (83.78

TPS243 Background: Postoperative radiotherapy (PORT) improves locoregional control in oral cavity squamous cell carcinoma (OCSCC) with adverse pathological features. However, irradiation of elective regional lymphatics contributes substantially to dysphagia and long-term toxicity. In adequately dissected pN0–pN1 necks, the oncologic benefit of regional nodal irradiation remains uncertain. ELIMINATE evaluates whether omission of regional PORT maintains regional control while reducing treatment-related morbidity. Methods: ELIMINATE is an open-label, multicenter, randomized phase II/III non-inferiority trial enrolling 396 patients with resected pT1–4 OCSCC and pathological pN0–pN1 disease after adequate neck dissection (≥12 nodes in at least one hemi-neck). Eligible patients have high-risk features (positive/close margin ≤5 mm, lymphovascular invasion, perineural invasion, or pT3–4 disease) and Karnofsky performance status ≥70. Patients are randomized 1:1, stratified by T stage (T1–2 vs T3–4), nodal status (pN0 vs pN1), and margin status (free vs involved), to: Arm A (standard): IMRT to primary tumor bed and regional lymphatics (60–66 Gy in 30–33 fractions) ± weekly cisplatin (40 mg/m²) for margin-positive disease.Arm B (experimental): IMRT or brachytherapy to the primary tumor bed alone, omitting elective nodal irradiation. The primary endpoint is 2-year regional control. Secondary endpoints include locoregional control, disease-free survival, overall survival, acute toxicity (RTOG), late toxicity (LENT-SOMA), swallowing function (MDADI), and quality of life (EORTC QLQ-C30 and H&N35).The trial is powered (80%, one-sided α=0.05) to test non-inferiority with a 5% absolute margin, assuming 2-year regional control of 85% with standard PORT versus 80% with omission, allowing 10% attrition (n=396). Accrual is ongoing across participating tertiary centers. Treatment compliance, dosimetric data, toxicity, and oncologic outcomes will be reported at analysis. ELIMINATE is the first adequately powered randomized study evaluating omission of elective nodal irradiation in both pN0 and pN1 OCSCC following adequate dissection. If non-inferiority is demonstrated, this strategy may safely reduce radiation volumes, decrease swallowing morbidity, and redefine postoperative standards in selected patients. Clinical trial information: CTRI/2022/02/040311 .

PURPOSE:To report the primary analysis of a multicenter, phase III randomized trial of adjuvant radiotherapy (RT) after chemotherapy and radical cystectomy (RC) in patients with high-risk muscle-invasive bladder cancer (MIBC). METHODS:Patients with nonmetastatic urothelial MIBC at high risk after RC (any one of: T3-4, N1-3, margin positive, ≤10 nodes dissected) were randomly assigned 1:1 to adjuvant RT or observation (Obs), stratified by nodal involvement (yes/no) and chemotherapy (neoadjuvant/adjuvant/none). Stoma-sparing IG-IMRT 50.4Gy in 28 fractions was prescribed to the cystectomy bed and pelvic nodes. The primary end point was 2-year locoregional recurrence-free survival (LRFS), and the secondary end points were disease-free survival (DFS), bladder cancer-specific survival (BCSS), and overall survival (OS). RESULTS:From June 2016 to May 2024, 153 patients were randomly assigned (Obs = 76, RT = 77), with 62% and 41% of patients having pT3-T4 and pN+ stages, respectively. Over 90% of the patients received systemic chemotherapy (71% neoadjuvant and 20% adjuvant), and none received immunotherapy. After a median follow-up of 47 months, the 2-year LRFS was significantly higher with adjuvant RT versus observation (87.1% v 76.0%, hazard ratio [HR], 0.43 [95% CI, 0.20 to 0.96], P = .04). The DFS was 71.6% versus 58.7% (HR, 0.62 [95% CI, 0.36 to 1.05]), BCSS was 79.6% versus 65.0% (HR, 0.59 [95% CI, 0.33 to 1.10]), and OS was 70.4% versus 57.4% (HR, 0.78 [95% CI, 0.49 to 1.26]) for RT and Obs, respectively. CONCLUSION:Adjuvant pelvic IMRT after radical cystectomy and perioperative chemotherapy suggests an improvement in locoregional control in patients with high risk urothelial MIBC with no additional severe toxicity.

PURPOSEMuscle-invasive bladder carcinoma (MIBC) poses major treatment challenges in low- and middle-income countries because of logistical and socioeconomic barriers limiting neoadjuvant chemotherapy (NAC) delivery. While dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) improves pathologic response and survival over gemcitabine-cisplatin, its multiday schedule reduces practicality. Accelerated MVAC (AMVAC), a single-day outpatient regimen, may offer a feasible alternative. This study evaluated the feasibility and safety of AMVAC in Indian patients with MIBC.METHODSWe conducted a single-arm feasibility study at the All India Institute of Medical Sciences, Rishikesh, India, between December 2021 and November 2024. Adults with stage II-III MIBC and cisplatin eligibility received 3-4 cycles of single-day AMVAC with pegfilgrastim support before radical cystectomy. Feasibility was defined as completion of ≥3 or 4 cycles within protocol-specified timeframes. Toxicities were graded using CTCAE v5.0, and outcomes were analyzed descriptively.RESULTSSixty patients were enrolled (mean age 55.2 ± 11.2 years; 90% male); 55 received neoadjuvant, and five adjuvant therapy. The mean number of chemotherapy cycles delivered was 3.87 ± 0.85. Feasibility outcomes were favorable, with 91.6% completing three and 76.6% completing four cycles within protocol timelines. Dose reductions for grade ≥3 toxicities were required in 13 patients (21.7%), whereas four patients discontinued treatment because of reduced creatinine clearance. Grade 3 adverse events occurred in 38.3%, most commonly anemia (16.7%), fatigue, and mucositis (13.3% each). Among neoadjuvant recipients undergoing cystectomy (n = 40), pathologic complete response (PCR) was achieved in 32.5% and pathologic downstaging was achieved in 55%.CONCLUSIONSingle-day AMVAC is a feasible and tolerable NAC regimen in a resource-constrained setting, with encouraging PCR and manageable toxicity.

Malnutrition is frequent in head and neck cancer patients and may worsen during chemoradiotherapy due to treatment-related toxicities. Early identification of nutritional risk is crucial to enhance treatment tolerance and outcomes. This study aimed to evaluate nutritional status of head and neck cancer patients using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric parameters and to assess their association with acute toxicity and treatment response. This prospective observational study included 78 patients with locally advanced head and neck cancer treated with radical chemoradiotherapy. Baseline nutritional assessment included anthropometric parameters, biochemical markers, PG-SGA, and Nutritional Risk Index (NRI). Nutritional reassessment was done at treatment completion. Acute toxicities were graded using CTCAE v5.0 and treatment response was evaluated at 12 weeks using RECIST 1.1 criteria. The median age was 57 years and 91

Radiotherapy along with chemotherapy is the gold standard treatment in locally advanced Ca Cervix, delivered via 3DCRT or newer techniques like IMRT. Although a superior target conformation and normal tissue sparing can be achieved with IMRT, geographical misses and temporal changes in the volumes of the surrounding organs might lead to unpredictable dosimetric changes. These may alter the therapeutic outcomes with reduced local control and increased toxicities. An evaluation of such variations is paramount to modify our treatment strategies in the future. This prospective study was conducted between January 2021 and August 2022. Locally advanced carcinoma cervix patients were included and planned with IMRT. Kv-CBCTs were taken thrice weekly during the treatment with a strict bladder and rectal protocol. Targets and OARs were contoured on the CBCT. Volumes and doses were calculated in a bias plan. Thirty-nine patients were enrolled in this study with 408 CBCT scans taken. Analysis showed that the bladder V35Gy

The treatment of primary neuroendocrine neoplasms (NENs) of the female genital tract is difficult since they are rare, aggressive, have a high recurrence rate, and have poor prognosis. As no established guidelines exist, diagnosing and treating them can be extremely difficult for clinicians. This case study explains the role of histopathology and immunohistochemistry in diagnosing a rare neuroendocrine carcinoma of the left adnexa. Investigating novel therapeutic approaches that can enhance the clinical result for such uncommon cases is imperative.

Pain management during brachytherapy application for cervical malignancy has evolved over the years; the choice of procedure varies worldwide due to each available option's unique features and limitations. In this study, we explore the benefits and limitations of the paracervical block and assess its value in the contemporary setting. This retrospective study included patients of carcinoma cervix who underwent intracavitary brachytherapy (ICBT) from April 2021 to August 2022 at our institute. The primary objective being assessment of pain (using Numerical Rating Scale (NRS)) during ICBT of carcinoma cervix done under paracervical block. Secondary objectives were determining the difference in procedure time between ICBT done under paracervical block and spinal anaesthesia, difference in doses to organs at risk (OARs) and estimating patient preference for paracervical block for the next sitting of intracavitary brachytherapy. One hundred and forty-nine intracavitary brachytherapy insertions in 53 patients were analysed. During the tandem insertion into the uterus, none had severe pain (NRS ≥ 7), while only 11.4

INTRODUCTION:Surgery is the primary course of treatment for most patients with oral cavity tumors; however, adjuvant radiation is advised to increase the likelihood of locoregional cancer control in the presence of adverse risk factors such as pathological tumor (T3/T4) stage, nodal metastases, perineural invasion, lymphovascular invasion, and positive margins. In the present study, the outcome was assessed after post-operative radiotherapy along with factors associated with recurrence in patients with oral cavity squamous cell carcinoma. MATERIAL AND METHODS:This retrospective study included postoperative oral cavity squamous cell carcinoma (OCSCC) patients treated with adjuvant radiotherapy. Patient characteristics, factors associated with failure, and overall survival were analyzed. RESULTS:196 patients of OCSCC were analyzed. Age <40 years, tumors (>4 cm), presence of bone invasion, Depth of invasion >10 mm, positive or close surgical, extranodal extension positive had a higher risk of recurrence in oral cavity cancer. Also, a significant association was seen between pathological nodal stage (P < 0.001). The median overall survival was 20.2 months (13.8-32.9). There was a statistically significant association between stage, concurrent chemotherapy, and overall survival (P < 0.05). CONCLUSION:The present study identified that advanced stages, >10 mm depth of invasion, presence of perineural invasion, the worst pattern of invasion of 5, bone invasion, younger age, and node-positive OCSCC were poor prognostic factors. In early-stage oral cavity cancers, the decision to administer postoperative radiation should be judged by pathological adverse risk factors.

AIMS:Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard treatment for locally advanced head and neck cancer (LAHNC); however, it also results in substantial treatment-related toxicities. Oxaliplatin has similar radiosensitisation mechanisms to cisplatin and, if found to have equivalent efficacy in LAHNCs, has the potential to replace cisplatin in CCRT protocols. MATERIALS AND METHODS:This prospective trial compared weekly oxaliplatin 50 mg/m2 to weekly cisplatin 40mg/m2 in CCRT protocols for the treatment of non-nasopharyngeal LAHNCs. The primary endpoint was to compare the toxicity profile; secondary endpoints were compliance, locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). RESULTS:Between January 2019 and June 2020, we randomly assigned 70 LAHNC patients, 35 in each arm, to receive radical CCRT. At a median follow-up of 18 months (range: 3-72), acute toxicities of grade 3 or higher occurred in 31% of patients in the oxaliplatin arm and 77% of patients in the cisplatin arm (P = 0.007). The estimated 3-year LRC, DFS, and OS in the oxaliplatin and cisplatin arms were 32.3% vs 35.9%, 28.7% vs 35.9% and 35.1% vs 37.3%, respectively, while the 5-year LRC, DFS, and OS were 32.3% vs 32.4%, 28.7% vs 28.8%, and 31.2% vs 30.5%, respectively. The absolute differences observed were not statistically significant. CONCLUSION:The CCRT with oxaliplatin in non-nasopharyngeal LAHNC exhibits a better toxicity profile and appears comparable to cisplatin in terms of disease control. It may be worthwhile exploring this approach in a larger trial to gather LRC and survival data. CLINICAL TRIALS REGISTRY INDIA:CTRI/2019/01/017198.

OBJECTIVE:This study aims to compare the dosimetric differences in radiotherapy plans generated by coplanar volumetric-modulated arc therapy (cVMAT) and noncoplanar volumetric-modulated arc therapy (NcVMAT) for high-grade gliomas. MATERIAL AND METHODS:This is a single-institutional, prospective, observational study conducted during a period of one year from December 2018 to October 2019. A total of 15 consecutive patients with high-grade gliomas who planned to receive postoperative radiotherapy were included in the study. Plans were generated using both cVMAT and NcVMAT for each patient. The plans were evaluated per the International Commission on Radiation Units and Measurements (ICRU) Report 83 criteria. A dosimetric comparison of each plan was made in terms of target coverage and dose to organs at risk (OARs). RESULTS:On analyzing the results, the two techniques resulted in comparable maximum, mean, and minimum planning target volume (PTV) doses. There were statistically insignificant numerical differences observed in the conformity index (CI) and heterogeneity index (HI). Maximum optic chiasma and ipsilateral cochlea doses were statistically lower in the NcVMAT plan compared to the cVMAT plan (p-value = 0.002). The NcVMAT plans had insignificant differences in monitor units (MU) per fraction. CONCLUSION:This study highlights equal PTV coverage, homogeneity, and conformity indices between cVMAT and NcVMAT plans. A better dosimetric profile of the optic chiasma, cochlea, and equal MU per fraction favors the NcVMAT technique for treating high-grade gliomas.

Introduction:High-grade gliomas (HGGs) have dismal prognosis even with multimodality treatment entailing surgery, radiotherapy, and chemotherapy. Hence, assessment of improvement in quality of life (QOL) for evaluating treatment is critical. Target delineation for radiotherapy in HGG is often done according to the European Organization for Research and Treatment of Cancer (EORTC) and Radiotherapy and Oncology Group (RTOG) contouring guidelines, which differs on exclusion and inclusion of peritumoral edema believed to harbor malignant cells; the guidelines have not been prospectively compared for probable difference in QOL, considering the probable difference in treated volume. Objective:This article compares QOL in HGG patients receiving postoperative radiotherapy using target volume delineation based on the RTOG or EORTC guidelines. Materials and Methods:In this single-center, prospective randomized exploratory study, postoperative HGG patients were randomized to either receive radiotherapy according to the EORTC guidelines of target delineation (60 Gy/30 fractions to tumor bed and residual tumor) or the RTOG guidelines (46 Gy/23fractions to tumor bed, residual tumor, and peritumoral edema with 14 Gy/7 fraction boost to the tumor bed and residual tumor) with concurrent temozolomide (TMZ) followed by 6 months of adjuvant TMZ. The aim and primary endpoint of the study was to assess and compare QOL between the arms. Descriptive statistics were used to convey demographic data, proportions for categorical variables, and mean, median, range, and standard deviation for continuous variables. Effect size was assessed using partial eta squared test where values of 0.01, 0.06, and 0.14 signify small, medium, and large effect size, respectively. Repeated measures analysis of variance test was used for comparison of means and assessment of QOL between the EORTC and RTOG groups at 6 months. Absolute volume of planning target volume (PTV) receiving 46 and 60 Gy were described, PTV 46/60 was also described in terms of % of whole brain volume. Results:Eighteen patients underwent randomization (9 in EORTC and RTOG group each). Statistically significant improvement was noted in the overall posttreatment values in the physical well-being (PWB) domain ( p  = 0.007). Conclusion:This is the first study to compare the EORTC and RTOG delineation techniques in terms of QOL. No significant differences in QOL were noted between the two arms. Significant improvement was noted posttreatment in PWB of overall patients.

Extramammary Paget’s disease is a rare skin malignancy that presents as a primary lesion or can be an extension of an underlying adenocarcinoma. Primary extramammary Paget’s disease (EMPD) typically affects areas rich in apocrine sweat glands, such as perineum (vulva in this case). Localised form is surgically excised. However, extensive or metastatic form is treated with chemotherapy/radiotherapy or a combination of both. Data regarding treatment of extensive EMPD are limited.

BACKGROUND:Chemoradiation in head and neck carcinoma (HNC) shows significant anatomical resulting in erroneous dose deposition in the target or the organ at risk (OAR). Adaptive radiotherapy (ART) can overcome this. Timing of significant target and OAR changes with dosimetric impact; thus, most suitable time and frequency of ART is unclear.METHODS:This dosimetric study used prospective weekly non-contrast CT scans in 12 HNC patients (78 scans). OARs and TVs were manually contoured after registration with simulation scan. Dose overlay done on each scan without reoptimization. Dosimetric and volumetric variations assessed.RESULTS:Commonest site was oropharynx. Gross Tumor Volume (GTV) reduced from 47.5 ± 19.2 to 17.8 ± 10.7 cc. Nodal GTV reduced from 15.7 ± 18.8 to 4.7 ± 7.1 cc. Parotid showed mean volume loss of 35%. T stage moderately correlated with GTV regression.CONCLUSION:Maximum GTV changes occurred after 3 weeks. Best time to do single fixed interval ART would be by the end of 3 weeks.

Intensity-modulated radiation therapy (IMRT) has brought about interest in adaptive radiotherapy (ART) due to its benefit of accurately prescribing doses to tumors and sparing normal critical organs. Critical dosimetric errors and geometrical misses can occur due to anatomical changes during radiotherapy. In the present study, five patients with head and neck malignancies undergoing radiation therapy were assessed for changes in primary gross tumor volume (GTVp), nodal gross tumor volume (GTVn), and clinical target volume-high risk (CTV-HR) using weekly megavoltage-cone beam computed tomography (MV-CBCT) scans. All patients had a reduction in GTV and lateral neck diameter (LND). There were reductions in tumor volumes leading to re-planning in the 20th fraction. Daily CBCT can guide the decision on the need for adaptation in patients with tumor volume reduction and with volumes going outside the body.

Intracranial extraskeletal mesenchymal chondrosarcoma, which is characterized by undifferentiated mesenchymal cells in the presence of occasional pockets of mature hyaline cartilage, is rare in our clinical practice and commonly seen in young adults. In the pediatric population, only a few cases have been reported. In this article, we describe a case of primary recurrent intracranial mesenchymal chondrosarcoma in an 11-year-old boy well treated by surgery, radiation, and chemotherapy. We also reviewed all previously published reports on pediatric patients on the basis of their manifestations and management.

Abstract Background: In modern radiotherapy era of Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), boost of locally advanced head and neck cancer (LAHNC) can be delivered as a sequential or simultaneous integrated boost. Whether they differ in improving locoregional control or toxicity is largely unknown. In the current study, we prospectively compared two types of IMRT for non-nasopharyngeal LAHNC: sequential intensity-modulated radiation therapy (SEQ-IMRT) and simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT). Materials and Methods: Random assignment placed 66 patients with LAHNC into one of two treatment groups: SEQ-IMRT or SIB-IMRT. Patients in the SEQ-IMRT arm received a total radiotherapy (RT) dose of 70 Gy in 35 fractions over seven weeks, and the SIB-IMRT arm received 66 Gy in 30 fractions over six weeks. Concurrent weekly cisplatin 40 mg/m2 chemotherapy was given to all. Acute toxicity was evaluated in each patient once a week, and follow-up was done every three months to assess response. Results: SIB-IMRT showed a higher grade 3 or more dysphagia (45.5 percent vs. 24.2 percent, p 0.001) and higher nasogastric tube dependency. The rest of the acute toxicity profiles of both treatment arms did not show any significant difference. After a long-term follow-up of 4 years, both research arms exhibited identical progression-free (p = 0.717) and overall survival (p = 0.978) rates. Conclusion: Reduced overall treatment time and convenience in RT planning are significant advantages of SIB, especially in high-volume centers. Anticipation of higher grades of dysphagia and management of the same is necessary.