ABSTRACT:Management of rectal bleeding due to various underlying malignant pathologies is a difficult situation, especially in the setting of metastatic disease. Palliative radiation is generally offered to such patients to achieve hemostasis. We report a patient diagnosed with metastatic prostate carcinoma which was infiltrating the rectal mucosa. Fifty-four year old patient, with a case of metastatic prostate carcinoma presented with rectal bleeding. On evaluation, he had a friable growth from the anal verge to 10 cm with severe bleeding. We gave intraluminal high-dose rate brachytherapy using an endoluminal vaginal/rectal cylinder applicator. A dose of 6 Gy, weekly for three weeks was delivered. High-dose-rate brachytherapy was immediately well tolerated. The bleeding stopped completely by day 4 and by day 7 patient was passing yellow stools. Intraluminal high-dose-rate brachytherapy has been proven as an effective palliative treatment in achieving hemostasis from rectal bleeding.

Aim: To estimate and compare the vaginal doses in terms of posterior inferior border of symphysis (PIBS) points such as PIBS, PIBS+2, PIBS-2, and vaginal reference length (VRL) for patients of cancer of cervix (CC) treated with intracavitary brachytherapy (ICBT) using Fletcher Williamson applicator (FW) and interstitial brachytherapy (ISBT) using Martinez Universal Perineal Interstitial Template (MUPIT).Material/methods: Treatment plans of a total of 36 consecutive CC patients, who underwent ICBT and ISBT with FW and MUPIT respectively, were retrospectively included in the study. The 3D treatment planning for all the patients had been performed on computed tomography (CT) images. The median prescription dose delivered by high dose rate brachytherapy was 6 Gy per fraction. PIBS point doses were estimated for each plan and analysed with OriginPro2024b graphing and analysis software.Results: The Mann Whitney test showed statistically significant differences in vaginal doses in terms of percentage of prescription dose (PD) between ICRT and ISBT. Spearman's rank correlation coefficient (rho) values indicated that vaginal wall dose and VRL were strongly correlated for FW applicator as compared to MUPIT applicator.Conclusion: Vaginal wall doses in terms of percentage of the PD with MUPIT applicator were found higher than with the FW applicator. Our results suggested that estimation of vaginal doses for each patient was necessary during planning phase in order to avoid the late toxicities.

PURPOSE:To evaluate the feasibility, efficacy, and safety of interstitial brachytherapy in cases of oligo-metastatic liver disease. MATERIALS AND METHOD:Four cases of liver metastases were managed over a period of 1 year in our center with close follow-up. All patients had progressive disease with histopathologially proven liver metastases and were ineligible for surgery. The procedure involved placement of brachytherapy catheters under computed tomography (CT) guidance post placement of a single 6F angiography sheath. The median size of metastasis was 2.9 cm (range 2.2-3.4 cms) in diameter, and a single fraction of radiation dose (10 to 13 Gy) was delivered. The angiography sheath and brachytherapy catheters were removed under fluoroscopic guidance post completion of the procedure with the help of an interventional radiologist. The fluoro guidance for removal of catheters was to observe any bleed. Response to treatment in terms of control of the metastases along with complications, safety, and efficacy of the procedure was observed. RESULTS:All patients underwent re-evaluation with WB-PET-CT after 1 and 6 months. In three cases, complete response with no metabolic activity was noted on WB-PET-CT scan, and in one case, there was a partial response with a decrease in the size and metabolic activity of the metastasis. No fatal complications were noted; however, acute complications like grade 1 nausea, grade 1 vomiting, pain, and local hemorrhage were noted within 1 week of the procedure. CONCLUSION:Liver interstitial brachytherapy is a feasible option in patients with maybe oligo metastatic solid tumors requiring a multi-disciplinary team effort. It is also an option for patients who are unfit for surgical excision. This is the first reported case series in India using high-dose-rate (HDR) brachytherapy techniques with an angiography sheath and flexible brachytherapy catheters.

Ferrous ammonium sulfate - Benzoic acid - Xylenol orange (FBX) solution is known for its dosimetry properties in the dose range applicable in radiation oncology. Several attempts at improving its dose sensitivity have been reported in literature. The current work explores a novel method to improve the dose response of the system in the range 0-10 Gy with the original standard composition of the solution. Value of the sensitivity of the dosimeter was found to be 7.471/Gy with excellent linearity using the developed method. This is 115 times higher than the sensitivity obtained using the conventional methods.

Purpose We present the profile of first 1,000 cases of intracranial radiosurgery (IRS) treated with Gamma Knife system at a government-funded tertiary care hospital in India. In addition to the information on the indications treated, this study provides an idea of the relevance of the Gamma Knife Radiosurgery (GKRS) for IRS in the fast-changing technological scenario. This study also shows the disease indications for which GKRS was the primary treatment preference. Materials and Methods Leksell Gamma Knife model 4C was used for GKRS. Leksell G-frame-based stereotactic localization was used for all patients. Axial magnetic resonance imaging scans were used for treatment planning with additional two-dimensional angiography images for patients treated for arteriovenus malformations (AVM). The patient population treated with GKRS at our center mainly comprised of patients referred from across the country. Results Acoustic schwannoma formed the largest group of patients (27%) followed by meningioma (21%), AVM (18%), pituitary adenoma (16%), brain metastasis (5.3%), trigeminal neuralgia (3%), cavernoma (2.4%), glomus jugulare (1.8%), craniopharyngioma (1.1%) and "others" (5%). Conclusion The case mix at our center is similar to the overall Indian case mix. However, it is different from the Asian data of 2018 but interestingly similar to the data from Middle East and Africa for 2018. Among the various categories of cranial disorders treated by us, pituitary adenoma tumors had minimum (14/161) and cavernoma tumors had maximum (24/24) proportion of cases managed with GKRS as primary treatment modality.

Introduction:Urinary bladder cancer is a major cause of morbidity and mortality worldwide. As per the data from the US cancer registry, it was diagnosed in nearly 71,000 patients and led to 14000 deaths in 2013. The Indian data in this regard are lacking with few case reports and epidemiological data only. The paucity of treatment data in this regard led us to undertake this prospective study at our radiation oncology canter. Carcinoma urinary bladder is a heterogeneous disease with variable natural history. Male preponderance and association with cigarette smoking appears to be the foremost in natural history of the disease. Our data analyzed the management of muscle-invasive medically and surgically inoperable carcinoma urinary bladder in a resource constraint setting at a tertiary care center by bladder preservation protocol (BPP). Materials and Methods:This prospective study was aimed to evaluate the treatment outcome in surgically inoperable muscle-invasive carcinoma urinary bladder in a resource constraint setting at a tertiary care center by BPP. All patients were treated with telecobalt 60 machine up to a dose of 60-66 Gy along with concurrent chemotherapy. Interim assessment was done at 40 Gy. Results:A total of nine patients were taken up for treatment with BPP. All patients were evaluated with standard evaluation protocol. All patients were followed up till any event occurred and till 6 years. Out of nine patients treated, six patients are still alive without any progression of disease and are disease free with standard evaluation on follow-up. Two patients died during the 1st year of follow-up. One patient progressed with lung and abdominal metastases 5 months after the completion of treatment and one patient was lost to follow-up. Conclusion:BPP using trimodality therapy is a suitable alternative to radical cystectomy in medically and surgically inoperable carcinoma urinary bladder. These patients should be highly compliant for regular follow-up, and acute and long-term toxicity should be evaluated in detail at each visit. BPP gives a ray of hope in such settings and should be done with caution. In our study, we treated all these patients in our resource constraint settings with good results and high survival rates. Our integrated team of radiation oncologists, medical oncologists, and urologists closely followed up these patients in order to optimize outcomes.

Objective: The objective of this study is to evaluate the surface doses for 3-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) treatment planning techniques using an inhouse designed head and neck (HN) phantom and to compare the measured surface doses with the doses calculated using the Monaco treatment planning system (TPS). Materials and Methods: An arbitrary clinical target volume was defined with 5 mm planning target volume (PTV) expansion on computed tomography images of an in house designed heterogeneous HN phantom. 3DCRT, IMRT, and VMAT plans were created using Monaco TPS for prescribed dose of 60Gy in 30 fractions to cover 95% of PTV volume. Dose measurements were performed using EBT3 Gafchromic films at 10 selected points on the surface of HN phantom, especially inside the treatment area. Percentage mean dose differences were evaluated between the TPS calculated doses and measured dose values at these identified points. Results: The average dose difference between the TPS calculated doses and film measurements were found to be varying from 11.66% to 19.73%. It was observed that TPS overestimated the surface doses in comparison to measured doses. The results also shows that Gafchromic films can be used for surface dose measurements in patients for in vivo dosimetry in areas where high skin dose is expected during radiotherapy treatment. Conclusion: The limitations of TPS should be considered while evaluating surface doses in radiotherapy plans.

Introduction: In radiotherapy treatment of head and neck (H&N) cancers, more complex quality assurance checks and patient-specific dosimetry are required to ensure accuracy in modern technology. In this paper, a new cost-effective human tissue equivalent H&N phantom was designed to serve as an economical and adaptable tool for assessment and assurance of precise radiotherapy dose delivery. Material and Methods: The phantom was designed using locally available paraffin wax and tissue-equivalent materials. Computed tomography (CT) images of the phantom were acquired using a conventional CT simulator and were registered with the images of a real patient having approximately similar physical dimensions. The geometric and attenuation properties of the structures in the phantom were studied and compared to the structures of the real patient. Results: Hounsfield unit (HU) values of different structures of the phantom were compared to the values obtained from the CT images of a real patient and were found to be in good agreement. HU values obtained for the right, and left eye, brain, larynx, and bone shell were 7(±10) HU, 6(±9), 30(±14) HU, -984(±6) HU and 873(±214) HU in phantom. Structures simulated in phantom agreed well on comparison regarding both their design and radiation properties with respect to real patient human tissues. Gamma analysis was performed for the axial dose plane at plan isocenter for both the calculated dose distribution in H&N phantom and the patient agrees for 98.79% passing rate for 3% /3mm criteria. Conclusion: The designed phantom depicts human anatomy and meets the requirements of tissue equivalence. The result shows that phantom has proved to be a cost-effective and valuable tool for accurate verification of dose distributions in regions of clinical and dosimetric interests.

Full Reference: ICRP 2022. Radiation detriment calculation methodology. ICRP Publication 152. Ann. ICRP 51 (3) Publisher: SAGE Publication, UK Pages: 103 ISBN: 9781529619003 Year: 2022 Price: UK £183.75 (Online) The International Commission on Radiological Protection’s Publication 152 (ICRP Publication 152) entitled “Radiation Detriment Calculation Methodology” was published in 2022 by SAGE Publications, UK. As described by the ICRP, this Publication is part of a thorough review launched by it on the System of Radiological Protection following ICRP Publication 103 published in 2007. Publication 152 provides a historical review of the radiation detriment calculation methodology since ICRP Publication 26 (1977) for the purpose of radiological protection. The concept of radiation detriment was introduced by the ICRP in its Publication (1973) which has been developed further by it over the last few decades. The ICRP defines radiation detriment as the excess of stochastic health effects in a group of individuals exposed to low-level radiation and their descendants compared with a nonexposed group. It is determined from sex-averaged and age-at-exposure-averaged lifetime risk estimates for a set of organs and tissues, taking into account the severity in terms of quality of life in nonlethal conditions and length of life lost. The ICRP notes that although the current scheme of radiation detriment calculation is well established, it needs to evolve to better reflect changes in population health statistics and progress in scientific understanding of radiation health effects. In this regard, update on parameters such as the reference population data and cancer severity and some improvement in cancer risk models based on the accumulation of recent epidemiological findings have been carried out. The update in this Publication should be considered an improved and corrected version of Annex A.4 of Publication 103. Radiation detriment was defined initially as the mathematical “expectation” of harm incurred in a group from radiation exposure (ICRP, 1973, 1977a). The harm in this definition was intended to encompass deleterious effects of all sorts, including the socioeconomic impact. However, only health effects were considered in practice, and hence, detriment was expressed as the expected value of the weighted number of health effects to be experienced by the group. Detriment was redefined in Publication 60 (ICRP, 1991) as a multidimensional concept that can be expressed in a variety of ways depending on the purpose. At the same time, the ICRP continued efforts to aggregate different aspects of detriment into a single quantity, and the methodology was further refined in Publication 103 (ICRP, 2007). It is currently defined as the excess of stochastic health effects in a group of individuals exposed to low-level radiation and their descendants compared with a nonexposed group. It is determined from sex-averaged and age-at-exposure-averaged lifetime risk estimates for a set of organs and tissues, taking into account the severity in terms of quality of life in nonlethal conditions and length of life lost. Publication 152 is divided into six sections comprising 103 pages, including the abstract, executive summary, references, and the annexure. Section 1 is “Introduction” which provides the background and need for bringing out the current publication. Scope and objective have been elaborated in this section, along with the structure of the Publication. Section 2 entitled “Historical Development” provides a review of the quantitative expression of radiation detriment starting from ICRP 26 (1977). It specifically describes earlier ICRP Publications dealing with the subject, namely ICRP Publications 27 (1977), 45 (1985), 60 (1991), and 103 (2007), and highlights how the calculation method has adapted to progress in scientific knowledge. It especially brings out the modifications incorporated in Publication 103 (ICRP, 2007) in terms of the adoption of a new detriment calculation methodology as compared to ICRP 60 (1991). One major change in ICRP 103 was the move to nominal risk calculation based on cancer incidence data rather than cancer mortality data. For clarification, the detriment calculated using this methodology is specifically called “radiation detriment,” and the term “detriment” means radiation detriment hereafter unless otherwise noted. Section 3 “Calculation of Radiation Detriment” is, to my mind, the most important section of this publication. It first details the computation process used in Publication 103 (ICRP, 2007) and then points out the programming errors in the calculations of the nominal risk coefficients in it. Despite a considerable increase in the nominal risk coefficients of bone marrow, breast, and ovarian cancers due to recalculations, it is shown that impact on overall nominal risk is limited (4%). Data sources, risk models, computational methods, and the rationale for the parameter values adopted are explained for each step of the process. In Publication 103, nominal risks were calculated based on cancer incidence, using the most up-to-date information at the time. Nevertheless, when adjusted for severity, the resulting detriment values were quite similar to those in Publication 60 (ICRP, 1991). It was, therefore, concluded that the approximated overall fatal risk coefficient of 5% per Sv on which international radiation safety standards were based continued to be appropriate for the purposes of radiological protection. It is demonstrated that the correction of errors does not change this conclusion. Therefore, the ICRP concluded that the miscalculations of the nominal risk coefficients and radiation detriments have no implications for operation of the System of Radiological Protection. Section 4 “Sensitivity of Radiation Detriment Calculation” presents the interesting results of a series of sensitivity analyses that examined the impact of selected parameters on radiation detriment. The aim of the analysis was to identify major sources of variation and uncertainty in the calculation of radiation detriment. The analysis found that parameters of substantial impact on radiation detriment are sex, age at exposure, dose rate effectiveness factor (DDREF), dose assumption, and lethality fraction. The parameters with the least impact are lifetime risk metric, minimum latency period, maximum attained age, and minimum QOL factor. Section 5 “Potential Evolution” discusses ways to identify the issues and possible ways to provide directions for the future evolution of radiation detriment, which could be a crucial part in the development of the Commission’s General Recommendations. Section 6 “Summary and Conclusions” summarizes the main conclusions, and includes suggestions for future improvement. It points out that radiation detriment needs to evolve depending on changes in cancer incidence and survival rates, and on advances in scientific understanding of radiation health effects. Further, it suggests that a full description of calculation steps and development of open-source software for calculating radiation detriment is necessary to improve transparency. It is also desirable to improve the way, in which radiation detriment is expressed and communicated so that nonspecialists can have a balanced perspective on the health risks of radiation, the ICRP points out. Annexure A of Publication 152 provides the updated baseline and demographic data in the form of seven tables. One aspect of Publication 152 that stands out is its comprehensibility despite dealing with a complex subject. The calculations and analyses described with graphs and tables aid in the transparency and comprehensibility of the document. The Publication can serve as a valuable and authentic resource material for medical physics practitioners and students and for all those interested in research, teaching, and practice in the area of radiological protection. The cost of the international paperback edition of the Publication is £183.75 from SAGE Publishing as found on the Internet (link: https://uk.sagepub.com/en -gb/eur/icrp-publication-152-radiation-detriment - calculation-methodology/book284987). As per the ICRP policy since 2018, all issues of Annals of the ICRP are free to access other than the current and the two most recent volumes.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue tumor with a high propensity of local recurrence after surgery. Radiotherapy as an adjuvant therapy has been shown to reduce recurrent rates of this disease. Surface mould brachytherapy is an effective and safe modality for the delivery of radiotherapy in soft tissue tumors, though its utilization and popularity have decreased in recent years. Here, we presented a case of a recurrent DFSP of the scalp who was treated with surgery followed by adjuvant surface mould brachytherapy to avoid dose inhomogeneity likely to occur in this anatomic region with external beam radiotherapy in the absence of intensity-modulated radiotherapy. The treatment was delivered successfully with minimal adverse reactions, and the patient is disease-free at 18 months post-treatment with no treatment toxicity.

Background:Accurate assessment of surface and build-up doses has a key role in radiotherapy, especially for the superficial lesions with uncertainties involved while performing measurements in the build-up region.Objective:This study aimed to assess surface and build-up doses for 6 MV photon beam from linear accelerator using parallel plate ionization chamber, EBT3 Gafchromic films, and PRIMO Monte Carlo (MC) simulation code.Material and Methods:In this experimental study, parallel plate chamber (PPC05) and EBT3 Gafchromic films were used to measure doses in a build-up region for 6 MV beam from the linear accelerator for different field sizes at various depths ranging from 0 to 2 cm from the surface with 100 cm source to surface distance (SSD) in a solid water phantom. Measured results were compared with Monte Carlo simulated results using PENELOPE-based PRIMO simulation code for the same setup conditions. Effect of gantry angle incidence and SSD were also analyzed for depth doses at the surface and build-up regions using PPC05 ion chamber and EBT3 Gafchromic films.Results:Doses measured at the surface were 14.78%, 19.87%, 25.83%, and 31.54% for field sizes of 5×5, 10×10, 15×15, and 20×20 cm2, respectively for a 6 MV photon beam with a parallel plate chamber and 14.20%, 19.14%, 25.149%, and 30.90%, respectively for EBT3 Gafchromic films. Both measurement sets were in good agreement with corresponding simulated results from the PRIMO MC simulation code; doses increase with the increase in field sizes.Conclusion:Good agreement was observed between the measured depth doses using parallel plate ionization chamber, EBT3 Gafchromic films, and the simulated depth doses using PRIMO Monte Carlo simulation code.

ABSTRACT:Various treatment modalities are available for treatment of ocular tumors, which include chemotherapy, laser, and radiotherapy (external beam radiation therapy or brachytherapy). Brachytherapy using plaque applicator is preferred over external beam radiation therapy when the tumor is well localized, as this therapy delivers radiation dose to the tumor with lower doses to normal tissues in the vicinity. However, plaque therapy is expensive and beyond the reach of many poor patients in India. The Bhabha Atomic Research Center (BARC) recently introduced an indigenous Ruthenium-106 plaque to make brachytherapy treatment available and affordable to all needy patients in India. In the present case series, we report our experience using the indigenous Ru-106 plaque for the treatment of a spectrum of ocular tumors.

The study aimed to quantify the differences in doses of OAR for multiple fractions of ICBT. The motive was to assess the reproducibility of application in subsequent sittings. This was a retrospective study of 17 patients with cervical cancer FIGO IIB-IVA stage. Patients are being treated with external beam radiotherapy (EBRT) along with concurrent chemotherapy. Each patient had undergone three intracavitary brachytherapy (ICBT) applications except two patients who had received only two applications due to comorbidity. CT images were acquired after every application to delineate the organs at risk (OAR) and target. Dosimetric parameter D2cc (dose received by 2 cc volume) reported for all three applications. The inter-fraction variation in dosimetric parameter D2cc for second and third ICBT fraction for bladder was 0.22 ± 29.72

Aim: To study 2D and 3D dosimetric values for bladder and rectum, and the influence of bladder volume on bladder dose in high dose rate (HDR) intracavitary brachytherapy (ICBT). The large patient data incorporated in this study would better represent the inherent variations in many parameters affecting dosimetry in HDR-ICBT. Material and Methods: We prospectively collected data for 103 consecutive cervical cancer patients (over 310 HDR fractions) undergoing CT-based HDR-ICBT at our centre. Correlation among bladder and rectum maximum volume doses and corresponding International Commission on Radiation Units and Measurement (ICRU) point doses were estimated and analysed. Impact of bladder volume on bladder maximum dose was assessed. Results: The ICRU point doses to bladder and rectum varied from the volumetric doses to these organs. Further, bladder volume poorly correlated with bladder maximum dose for volume variations encountered in the clinical practice at our centre. Findings: ICRU point doses to bladder and rectum are less likely to correlate with long-term toxicities to these organs. Further, in clinical practice where inter-fraction bladder volume does not vary widely there is no correlation between bladder volume and bladder dose.

Purpose: Dose received by organs at risk (OAR) in high-dose-rate (HDR) intracavitary brachytherapy (ICBT) for locally advanced cervical cancer impacts the late toxicity profile of the treatment. In the present study, we analyzed the inter-fraction variations of the minimum dose received by the most irradiated 2cc volumes (D2cc) of the OARs in ICBT. Methods and Materials: This prospective study included 40 patients with cervical cancer stage FIGO IIB-IVA treated with HDR ICBT and concomitant chemoradiotherapy with Computerized tomography (CT)- based three-dimensional planning. In addition, for 20 (of the 40) patients, the first fraction plan was superimposed on the second fraction images for studying its dosimteric impact on the OAR. The D2ccdata for the OAR was statistically analyzed for interfraction variations with Chi-square test or Fisher exact test as applicable. Paired t-test was used to compare the difference in means for the D2ccvalues between the three fractions. Results: The interfraction variations of the D2ccvalues of the OAR were statistically insignificant having P = 0.41, 0.8, and 0.20 for bladder, rectum, and sigmoid, respectively. Further, in 6 out of 20 cases, wherein first fraction plan was superimposed on second fraction images, the OAR doses exceeded the prescribed tolerance limits. Conclusion: We did not find variations in the OAR doses when each fraction was planned and treated individually. However, we found that if a single plan is used to treat subsequent fractions, OAR doses may exceed tolerance in about 30% of the cases. We believe that a larger sample size with improved compliance of bladder and bowel protocols would be needed to arrive at definitive conclusions.

The ferrous sulfate-benzoic acid–xylenol orange (FBX) dosimetry system in aqueous form has found utility in several types of applications with photon- and electron-based radiotherapy. The optical density measurements for dose estimation in the FBX were earlier performed with spectrophotometers. This chapter presents the work that involved standardization of the FBX dosimetry system in hospital conditions utilizing the "in-house" facilities such as a colorimeter in place of a costly spectrophotometer. Measurement of chemical changes brought about by ionizing radiation in a system for quantifying the radiation dose is considered as chemical dosimetry. The Fricke system is possibly the oldest and the most reliable chemical dosimeter. The FBX system can be a very versatile and cost effective dosimetry system in radiotherapy. In radiotherapy, the aim is to deliver a known radiation dose with accuracy to a target volume in a patient and spare the surrounding normal tissues, in order to eliminate the cancer cells with least side effects of radiation.

It is known that the output factors (OPFs) for external-beam radiotherapy units increase with field size due to increased scattered radiation from the collimator system. Saturation in the OPF value is generally reported beyond approximately 30 × 30 cm2. For the first time, to the best of our knowledge, we report on a drop in OPF values, although marginal, measured for a telecobalt machine beyond the 38 × 38 cm2 field size. We believe that reporting and explaining the results will lead to a better understanding of the scatter composition of the radiation from telecobalt machines. This also has the potential to impact the estimation of low dose regions in patients, in addition to being a purely scientific inquiry. We used Monte Carlo (MC) simulations to validate the measured values. The MC data showed that the decrease in OPF was due to decreased scatter from the machine head.

As the second most populous nation and one of the fastest-growing major economies, India faces many challenges, one such burning issue is the provision of cancer care. There is a huge gap in the demand and supply of health care resources in Indian oncology scenario, mainly due to steadily aging populations and also to current trends in smoking prevalence and the growing adoption of unhealthy lifestyles. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. Although incidence of cancer is low in India compared with high-income countries, mortality is high; with approximately 600,000- 700,000 deaths in 2012. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Cancer can have profound psychological, social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Currently, overall public expenditure on health care is only 1.5% of GDP. The socioeconomic, service delivery and cost and resource implications from this enormous burden require urgent attention from central and state governments, cancer communities, and public health communities to reduce their effect in a sustainable and cost-effective manner. We discuss specific barriers that must be overcome to improve prevention and early detection, enhance prompt treatment, and provide cost-effective palliative care for patients with advanced stage disease.