To compare the acute toxicity and early treatment response in locally advanced head-and-neck cancer patients treated with accelerated fractionated radiotherapy with concurrent chemotherapy (AFCRT) versus conventional fractionation chemoradiation. Forty patients were randomized into two treatment arms. The prescribed dose to the high-risk planning target volume (PTV-HR) was 66–70 Gy at 2 Gy per fraction, 6 days a week. The intermediate-risk PTV (PTV-IR) received 59.4–63 Gy at 1.8 Gy per fraction, 6 days a week, and the low-risk PTV (PTV-LR) received 54–56 Gy at 1.69 Gy per fraction, 6 days a week for 33–35 fractions, respectively. In the control arm, the PTV-HR received 66–70 Gy at 2 Gy per fraction 5 days a week, the PTV-IR received 59.4–63 Gy at 1.8 Gy per fraction, 5 days a week, and the PTV-LR received 54–56 Gy at 1.69 Gy per fraction, 5 days a week for 33–35 fractions, respectively. Both arms received concurrent weekly chemotherapy at 40 mg/m2. Toxicity was assessed per Radiation Therapy Oncology Group (RTOG) toxicity Common Terminology Criteria for Adverse Events (CTCAE) ver. 5 weekly during radiotherapy, 6 weeks posttreatment, and at 3 months. Response to treatment was assessed at 6 weeks and 3 months using the Response Evaluation Criteria in Solid Tumors 1.1 criteria. All the patients in both study groups completed their treatment. The average number of chemotherapy cycles administered in both groups was five. The total amount of chemotherapy received in both groups was similar (P = 0.249). After 3 months of follow-up, 14 (70%) patients in the study group and 13 (65%) patients in the control group showed a complete response in the local and regional areas (P = 0.898). Progressive disease was observed in 1 (5%) patient in the study group and 4 (20%) patients in the control group (P = 0.573). Severe (grade 3 or higher) acute side effects were similar in both groups. Late side effects observed between 3 and 6 months after treatment were also comparable. Interestingly, there was a significantly higher incidence of weight loss (>10%) in the control group (P = 0.020). AFCRT was safe and feasible. The study arm had higher overall response rates with comparable toxicity with conventional chemoradiation. The findings suggest that AFCRT is a promising treatment option.

ABSTRACT:Giant basal cell carcinomas (GBCCs) represent only 0.5-1% of all basal carcinomas and are known to occur and behave differently than other basal cell carcinomas. We report a 93-year-old gentleman with GBCC of the back of superficial spreading histological type who we treated with radical radiotherapy with excellent local control. Nonaggressive histological subtypes of GBCC particularly the superficial type can be well managed with radiotherapy, especially in the elderly, and should be adequately utilized in carefully selected patients.

A bstract Trismus, a reduction in mouth opening (MO), is frequently observed in head and neck cancer (HNC) patients. Defined by an inter-incisal distance of less than 35 mm, trismus significantly impacts the quality of life. This case study examines a 36-year-old female with left buccal mucosa carcinoma, presenting with an MO of 28 mm, measured via a digital Vernier caliper. A tailored physiotherapy protocol was implemented, involving warm-up exercises and stretching with a Heister jaw opener, executed twice daily for 4 weeks. The posttreatment assessment showed a notable MO increase to 42 mm. This case illustrates the benefits of exercise therapy for trismus in HNC, suggesting its utility as a noninvasive treatment option.

A bstract Background: Squamous cell carcinoma (SCC) in the retromolar trigone of the oral cavity is an aggressive form of cancer, often leading to dysphagia as a result of radiotherapy (RT). This case report examines the efficacy of a combined physiotherapy protocol in treating RT-associated dysphagia. Case Presentation: A 43-year-old male diagnosed with SCC, displaying significant difficulty swallowing post-RT, was subjected to a 4-week physiotherapy treatment. The protocol incorporated swallowing exercises, such as lip protrusion/retraction, tongue retraction, and maneuvers including the Mendelsohn maneuver and effortful swallow, complemented by neuromuscular electrical stimulation (NMES) at the submandibular area. Outcomes: Posttreatment assessment revealed notable improvement in the patient’s swallowing capability, with increased scores on the Functional Oral Intake Scale (FOIS) and MD Anderson Dysphagia Inventory. Conclusion: The application of swallowing exercises combined with NMES may offer a promising approach to ameliorate dysphagia symptoms in patients post-RT for SCC. Further research is warranted to validate these findings and optimize treatment protocols.

Background: Head-and-neck cancers (HNCs) originate at multiple subsites with varying epidemiology and clinical profiles across India. Objectives: This study aimed to explore the demographic and clinico-epidemiologic profiles of patients with HNC at our institution. Materials and Methods: This retrospective observational study was conducted on the case records of all patients with HNC who were registered between January 2018 and December 2020 at the Department of Radiation Oncology of Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, a comprehensive cancer center in rural Northern Haryana, India. Results: We enrolled 516 patients in the study. The mean age was 56 years (standard deviation (SD) 12.6), and the male-to-female ratio was 8.6:1. Smoking was reported by 413 (80%) patients, and smokeless tobacco use was reported by only 74 (14.3%) patients. Oropharyngeal cancer (178, 34.5%) was the most common site observed, and the base of tongue (112, 21.7%) was the most common subsite; oral cavity cancer was the second most common primary site, noted in 140 (27.1%) patients. This was contrary to global and national data, wherein oral cavity cancers are the most common. Most patients (226, 43.8%) presented with locally advanced disease, that is, Stage IVA. Conclusion: Oropharyngeal cancers are found in higher proportion when compared to oral cavity cancers in this belt of Northern Haryana and Northwestern Uttar Pradesh, owing perhaps to a higher level of smoking than tobacco chewing.

Introduction: The international standard for post-operative radiotherapy for breast cancer delivers hypofractionated radiotherapy. However, many centers in India still follow the longer conventional schedule probably because of paucity of large prospective trials in Indian patients on the same and apprehension regarding tolerance of high dose per fraction in the said population. We aimed to test the feasibility of hypofractionation in our setting and compared the toxicities and the quality of life in patients receiving conventional and hypofractionated radiotherapy. Materials and methods: Eighty histopathologically proven women of non-metastatic carcinoma breast who underwent modified radical mastectomy were assigned to receive 50 Gray/25 fractions/five weeks or 40 Gray/15 fractions/three weeks. Patients were assessed for the following toxicities - radiation dermatitis, radiation pneumonitis, dysphagia, skin fibrosis, lymphedema, shoulder stiffness, and brachial plexopathy, during radiation and at treatment completion and then at first, third, and sixth-month follow-up. Health-related quality of life was assessed using the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) and breast cancer-specific quality of life questionnaire (QLQ-BR23) at treatment completion and then at first, third, and sixth-month follow-up. Results and conclusion: We had a mean follow-up of 12.78 months. All the assessed toxicities and quality of life scores were comparable between the two arms at all time points of evaluation (p>0.05); 40 Gray in 15 fractions over three weeks is feasible and as safe as the five-week schedule with comparable quality of life. Hypofractionation can be practiced as a routine for post-mastectomy breast cancer patients as this shorter radiotherapy schedule is convenient and cheaper for the patients with no compromise on normal tissue toxicity or quality of life.

Solitary bone metastasis in endometrial cancer is very rare. We report a young 29-year-old nulliparous female of endometrial cancer who developed solitary humerus metastasis after 8 months of primary treatment of surgery and adjuvant radiotherapy and chemotherapy. She was treated with local radiotherapy and combination chemotherapy and bisphosphonates. At 6 months follow-up the patient is doing well and is asymptomatic. Even though rare, keeping a high index of suspicion and sincere evaluation in patients on follow-up presenting with bone pains can detect early recurrences. Timely start of multimodality treatment helps relieve symptoms and improves quality of life.

Pancreatic adenocarcinoma is the seventh largest cause of death from cancer with a death rate of 3.8%. The 5-year survival rate is only 5%. We report A case 28 year old male presented with a 3 week history of pain in upper part of abdomen and dyspepsia of similar duration. After 2 cycles of palliative chemotherapy he presented with diminution of vision in right eye and watering of eye. USG showed retinal detachment with vitreous hemorrhage in the right eye and left eye was normal. On fundoscopy choroidal metastasis was detected as an accidental finding in the right eye. Though Ca Pancreas usually presents in as locally advanced or metastatic disease choroidal metastasis are extremely rare. Despite disappearance of ocular metastasis he had a progressive disease and died of intraparenchymal hemorrhage. Reports of pancreatic cancer with metastasis to the choroid and optic nerve have been rare. There were few reports that demonstrated the significance of a choroidal lesion as the initial clinical sign of pancreatic cancer. This aggressive behavior of the lesion may be an important feature to determine the origin of the tumor. Cancer of the tail of the pancreas is often not detected in the early stages before metastasizing.

The telephone in the oncology ward rang: the casualty nurse on the other side said that a patient with cancer was bleeding profusely from the oral cavity. I hurried to the patient; a middle-aged woman who was producing huge clots and frank blood from the mouth. The resident in otolaryngology was explaining to the patient that he was going to pack her mouth so that the bleeding could stop. There were intravenous drips on fast flow in both hands. There were two teenagers, a boy and a girl, who looked stressed but were listening to and observing intently whatever was being said and done around them. They were probably her children.